2007:  The Year in Review

I N T R O D U C T I O N

2007 came in with a flurry of Ryan White Care Act implementation activity and went out with the excitement of the upcoming 2008 Presidential elections. Throughout the year AIDS Action has been monitoring the Health Resources and Services Administration’s (HRSA) implementation of the Ryan White Treatment and Modernization Act of 2006. The Ryan White Reauthorization became law in the final moments of the 109^th Congress in 2006 and has meant funding and programmatic changes for many states and jurisdictions.

AIDS Action continued the year with tireless advocacy for increased appropriations in the domestic and global HIV/AIDS portfolio, first for the Fiscal Year (FY) 2007 Joint Resolution and then for FY 2008. Advocacy efforts were met with some increases for HIV/AIDS programs in the final FY 2007 and FY 2008 budget, but the politically charged appropriations process ended with figures too low to meet the true need for HIV/AIDS care, treatment, prevention, and research.    

Legislation moved quickly through the House of Representatives, which would be the first comprehensive strategy for addressing HIV/AIDS within federal prisons. AIDS Action was heavily involved with Representative Maxine Waters’ “Stop AIDS in Prison Act of 2007,” which would require federal prisons to educate inmates on HIV/AIDS prevention, offer opt-out HIV testing upon entry and release, and treat HIV positive inmates. The bill passed the House of Representatives with large bipartisan support and the HIV/AIDS community is anxiously awaiting Senate action in the upcoming legislative session.  

Work to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR) also began in 2007; the legislation expires on September 30, 2008. AIDS Action has joined global HIV/AIDS advocates in pushing for timely reauthorization and recommending necessary improvements for the program. The House and the Senate have both held reauthorization hearings. A reauthorization bill is expected to be introduced early in 2008, met with prompt legislative action.

The year concluded with a monumental victory for HIV/AIDS advocates, as Congress overturned the ban restricting Washington, DC from using local money to fund syringe exchange programs. AIDS Action was instrumental in this historical decision which has charged the HIV/AIDS community with hope and momentum for overturning the Federal ban on funding syringe exchange programs nationwide. 

As we look towards 2008, all eyes are on the Presidential Elections. AIDS activists have poised HIV/AIDS to be a major issue in the upcoming 2008 Presidential Election. AIDS Action and partner organizations have launched an intense campaign calling for a National AIDS Strategy to end the AIDS epidemic in America. By the end of December all Democratic candidates and one Republican candidate committed to creating a National AIDS Strategy if elected into office and most have come forth with thoughtful HIV/AIDS platforms. You can compare all candidate plans at www.nationalaidsstrategy.org.

2008 will also bring the release of new HIV incidence numbers from the Centers for Disease Control and Prevention (CDC) in early 2008. The highly anticipated data is speculated to show a large increase and demonstrate an urgent need for increased commitment to HIV prevention in the United States.   

Below is a summary of important HIV/AIDS developments throughout 2007. AIDS Action looks forward to continuing our advocacy work with all of our members and partners throughout the coming year.

J A N U A R Y

Ø  House Introduces the Medicare Prescription Drug Price Negotiation Act

As the Democrats took control of Congress on January 4^th, House Democrats promised an aggressive agenda for the first 100 legislative hours under Speaker Nancy Pelosi (D-CA).  House Democrats laid out several high priority issues for the first 100 hours including: lobbying reform, minimum wage, social security, college loans, energy, and health care. 

HR-4, the Medicare Prescription Drug Price Negotiation Act of 2007, was introduced in the House on January 5. As part of the House Democrats 100 hour agenda, the act was passed on January 12th. The act requires the Secretary of HHS to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged to prescription drug plan sponsors for covered Part D drugs for those enrolled in a prescription drug plan.  The goal of the bill is to achieve lower drug prices for Medicare beneficiaries. The negotiations would take effect for drug price plans beginning January 1, 2008. This legislation is of particular interest to the HIV community as many HIV positive individuals receive access to HIV prescription medications through the Medicare Part D program. The bill does not authorize the HHS Secretary to make changes to the rules regarding formularies or restrict access to covered Part D drugs under prescription drug plans.

Ø  President Bush Makes No Mention of Domestic HIV/AIDS in State of the Union

President Bush gave the State of The Union Address on Tuesday, January 23, 2007.  In his address he did not mention the domestic HIV epidemic. The only mentions to HIV/AIDS were the following sentences on the international pandemic:

“We must continue to fight HIV/AIDS, especially on the continent of Africa -- and because you funded our Emergency Plan for AIDS Relief, the number of people receiving life-saving drugs has grown from 50,000 to more than 800,000 in 3 short years.  I ask you to continue funding our efforts to fight HIV/AIDS.  I ask you to provide $1.2 billion over 5 years so we can combat malaria in 15 African countries.  I ask that you fund the Millennium Challenge Account, so that American aid reaches the people who need it, in nations where democracy is on the rise and corruption is in retreat.  And let us continue to support the expanded trade and debt relief that are the best hope for lifting lives and eliminating poverty.”

To read AIDS Action’s Press Release on the Presidential State of the Union, please visit:http://www.aidsaction.org/communications/press-releases/012307.htm.

F E B R U A R Y

Ø  President Releases FY 2008 Budget

On Monday February 5, 2007 the President released his $2.9 trillion Fiscal Year (FY) 2008 Budget Request. The release of the President’s budget request kicks off the budget process each year.  In his budget request, which is prepared in consultation with the agency heads and the Office of Management and Budget, the president lays out his priorities for federal programs and fiscal policy. His budget provides Members of Congress with a suggestion of how to set spending limits for FY 2008.  Congress then sets spending limits through a budget resolution that guides the appropriations process for the upcoming Fiscal Year, and is usually passed each spring.

Making budget comparisons are complicated since the President’s FY 2008 Budget based its comparisons on the FY 2007 continuing resolution (FY 2006); not the Joint Resolution for FY 2007 which includes several increases for domestic programs. Therefore, increases that appear in the President’s budget are minimal or actual cuts and decreases are greater than the President’s budget shows. Overall, the President’s budget included an increase of $95.1 million above FY 2006 levels for Ryan White programs, but an increase of only $20.1 over the FY 2007 joint resolution, including an increase of $25 million for the AIDS Drug Assistance Program (ADAP). The President’s budget requested an increase of $93 million for HIV Prevention at the Centers for Disease Control and Prevention, all for HIV testing and the Early diagnosis Grant Program. The budget proposed a $28 million increase ($141 million total) for abstinence-only funding and a $14 million increase for the Housing Opportunities for People with AIDS (HOPWA) program.  To read AIDS Action’s press release on the budget, visit:  http://www.aidsaction.org/communications/press-releases/020507.htm.

Ø  Fiscal Year 2007 Joint Resolution Becomes Law

The Fiscal Year (FY) 2007 Appropriations Joint Resolution, H. J. Res. 20, was released by the Chairman of the House Appropriations Committee, Representative David Obey (D-WI), on January 29th. This $463.5 billion spending resolution passed the House with bi-partisan support on Wednesday, January 31 by a vote of 286-149.  The process in the House did not allow for amendments. The Senate Passed the Fiscal Year (FY 07) joint resolution, H.J. Res. 20, on Wednesday, February 14^th, 2007 by a vote of 81-15. 

The FY 2007 continuing resolution, unlike a standard CR, is not a clear flat funding at FY 2006 appropriation levels. The bill includes increased spending over the FY 2006 level for a number of health programs including the Ryan White CARE Act, The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), Community Health Centers, and Global HIV/AIDS programs. The Ryan White CARE Act received a $75.8 million increase, explicitly for Part B (Title II). The National Institutes of Health were given an increase of $619.5 million. The Centers for Disease Control and Prevention received a $100 million overall increase to prepare for and respond to an outbreak of pandemic influenza and other emerging infectious diseases. The resolution blocked CDC funding for the Early Grant Diagnosis Program in FY 2007. The bill contained a $1.3 billion increase for Global HIV/AIDS, tuberculosis, and malaria programs, bringing the total for the President’s Emergency Plan for AIDS Relief (PEPFAR) to 4.5 billion.

M A R C H

Ø  Microbicide Development Act of 2007 Introduced

On March 8th, International Women’s Day, The Microbicide Development Act of 2007 was introduced in both the House of Representatives (H.R. 1420) and the Senate (S. 823).The bill was introduced with bi-partisan support in both the House and the Senate. Senator Barack Obama (D-IL) introduced the bill in the Senate and Rep. Jan Schakowsky (D-IL) introduced the bill in the House of Representatives. 

The Microbicide Development Act would establish a dedicated microbicide research and development branch at the National Institutes of Health and strengthen microbicide activity at the U.S. Agency for International Development and the Centers for Disease Control.  Regarded as one of the most promising new technologies to address the HIV/AIDS pandemic, microbicides are a class of products, topically applied gels and creams, currently under development that women and men could use to prevent transmission of HIV and other infections. Currently, the bill has 18 co-sponsors in the Senate and 74 co-sponsors in the House.

Ø  ETHA Introduced in the Senate

On March 13th Senator Gordon Smith (R-OR) introduced the Early Treatment for HIV Act (ETHA), S.860 with large bi-partisan support.  Senator Hillary Clinton (D-NY) is the lead co-sponsor of the bill. 

ETHA would give states the flexibility to extend Medicaid coverage to low income individuals that are HIV positive. Bringing Medicaid eligibility rules in line with federal government guidelines on the standard of care for treating HIV.  Under current law you must be disabled with full blown AIDS to be eligible for Medicaid benefits.  The bill would also provide enhanced Federal matching of Medicaid funding to states that choose to extend Medicaid coverage for HIV care. ETHA is modeled after the successful Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCA), which allows states to provide early access to Medicaid to women with breast cancer.

Ø  REAL Act Introduced in House and Senate

On March 22nd, Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA) introduced the Responsible Education About Life Act (REAL), S. 972 and H.R. 1653. The REAL Act would create the FIRST federal funding stream for comprehensive sexual education.

This historic piece of legislation would provide a dedicated federal funding stream for comprehensive sexuality education that is medically accurate and age appropriate that includes information about both abstinence and contraception. Comprehensive sexual education has been found to be effective in delaying the onset of sexual intercourse, reducing the number of sexual partners, increasing contraception and condom use among young people, and reducing sexually transmitted diseases. To date, Congress has spent over $1.4 billion dollars on abstinence-only programs.  There is no evidenced based research that abstinence-only education delays initiation of sex or reduces the spread of sexually transmitted disease.

Ø  PATHWAY Act Introduced in the House

On March 28^th Representatives Barbara Lee (D-CA) and Chris Shays (R-CT) introduced H.R.1713, the Protection Against Transmission of HIV for Women and Youth Act (PATHWAY).  They introduced the bill with large bipartisan support and 56 original co-sponsors.  The PATHWAY Act was first introduced in 2006 (109^th Congress).

The bill finds that an estimated 38.5 million people are currently living with HIV/AIDS throughout the world and that in Sub-Saharan Africa women make up sixty percent of those infected. The PATHWAY Act would require the President, along with the Office of the Global AIDS Coordinator, to establish a comprehensive and integrated global HIV prevention strategy to address the specific vulnerabilities of women and girls.  The bill would remove restrictions in global HIV/AIDS prevention policies; specifically the earmark in the President’s Emergency Plan for AIDS Relief (PEPFAR) that requires 33% of HIV prevention funding to be used exclusively for abstinence-only programs. The PATHWAY Act would require the administration to address the social and cultural factors that contribute to women’s vulnerability to HIV infection by increasing access to female condoms, reducing the incidence of cross generational sex and early or childhood marriage, reducing violence against women, and expanding educational opportunities for women and girls.

A P R I L

Ø  Mathematica Releases Report on Abstinence-Only Programs

On April 13^th, Mathematica Policy Research Inc, publicly released a report entitled, “Impacts of Four Title V, Section 510 Abstinence Education Programs,” conducted on behalf of the U.S. Department of Health and Human Services (HHS). Mathematica submitted this report, which documents a federally supported evaluation of abstinence-only-until-marriage programs funded under the 1996 federal welfare reform law, to HHS.

In 1996, the federal government attached a provision to the welfare reform law establishing a federal program for abstinence-only-until-marriage programs.  This program, Section 510(b) of Title V of the Social Security Act, dedicated $50 million per year to be distributed among states that choose to participate.  States accepting the funds are required to match every four federal dollars with three state-raised dollars. Programs that receive the Title V funding are prohibited from discussing other methods of contraception, including condoms, except in the context of failure rates.

Mathematica Research, Inc. conducted a 10 year, one million dollar study, funded by the federal government, to determine the effectiveness of Title V Abstinence-Only programs. The study found no evidence that abstinence-only programs increases rates of sexual abstinence. Students who received abstinence-only instruction were just as likely to have sex as those in a control group who did not receive abstinence-only education. 56% of program students remained abstinent and 55% of control group students remained abstinent. This difference is not statistically significant.  Among teens in both groups who had sex by the end of the study period, the average age of a first sexual encounter was 14.9 years. In both groups, a majority of those who were sexually active reported having two or more partners. In both groups, one fourth reported having three or more partners. And in both groups, only 23% said they always used condoms when having sex.

Furthermore, abstinence-only program participants were less likely to know that condoms can lower the risk of sexually transmitted diseases. 21% of program participants reported that condoms never protect against HIV, compared with 17% of control group students. 23% of program students reported that condoms are never effective at preventing HPV and Herpes, compared to 15% of control group students. 

Ø  Stop AIDS in Prison Act Introduced on April 19^th

On April 19^th Representative Maxine Waters (D-CA) introduced the Stop AIDS in Prison Act, H.R 1943. The Stop AIDS in Prison Act is a comprehensive policy developed for the Federal Bureau of Prisons to provide HIV testing, treatment and prevention for inmates within federal correctional settings.  Representative Waters introduced this bill with bi-partisan support.  Co-sponsors include Representatives John Conyers (D-MI), Chairman of the House Judiciary Committee; Lamar Smith (R-TX), Ranking Member of the House Judiciary Committee; Bobby Scott (D-VA), Chairman of the Judiciary Subcommittee on Crime, Terrorism, and Homeland Security, which has jurisdiction over Federal prisons; and Randy Forbes (R-VA), Ranking Member of that subcommittee.

The goal of this bill is to stop the spread of HIV/AIDS among inmates, promote HIV/AIDS awareness and prevention among inmates, provide comprehensive medical treatment to inmates who are living with HIV/AIDS, and to reduce the risk that inmates will transmit HIV to other persons in the community following their release from prison. The bill requires federal prisons to provide voluntary HIV tests and counseling to inmates upon entry and release, HIV prevention education to all inmates, and timely, comprehensive medical treatment for all HIV positive prisoners. There are provisions in the bill to protect inmates from punishment for requesting an HIV test and to offer positive inmates access to voluntary partner notification systems. 

The bill is introduced in strategic collaboration with Representative Barbara Lee’s JUSTICE Act of 2007, H.R. 178, which would allow condom distribution in Federal prisons.

M A Y

Ø  OSI Report Calls for a National Strategy to Fight Domestic AIDS Epidemic

On May 1^st the Open Society Institute’s Public Health Program released a report calling for the United States to develop a comprehensive national plan for fighting the HIV/AIDS epidemic.  The report, “Improving Outcomes: Blueprint for a National AIDS Plan for the United States,” states that the United States should do what it asks countries that receive U.S. global AIDS support to do: develop a national plan that provides “a roadmap for concrete and equitable results.”  The report was prepared and written for the Open Society Institute (OSI) by Chris Collins.

The report notes that over the 26 years of the HIV/AIDS epidemic, several advisory bodies have issued proposals and recommendations for improving the domestic response to HIV/AIDS.  Few of these proposals and sets of recommendations have been plans of actions with clear objectives, identified responsibilities and timelines, and they did not include strategies to evaluate and refine efforts.  More pointedly, many of the recommendations were met with inaction and their worthy goals forgotten.

As its title suggests, the report gives an outline as to what an effective plan that transforms the way the U.S. addresses HIV/AIDS would look like.  It describes the characteristics of a strategic national plan, giving emphasis to evidence-based and cost-effective programming, the setting of clear priorities for action with ambitious but credible targets for improvement, on the importance of the involvement of multiple sectors, promoting innovative ideas about overcoming structural barriers to effective prevention and treatment and requiring the Secretary of the U.S. Department of Health and Human Services to report regularly on the status of progress towards meeting the plan’s targets.  The report states clearly that the primary focus of a national plan must be the prevention and treatment needs of African Americans. To read the report, please visit:    http://www.soros.org/initiatives/health/focus/phw/articles_publications/publications/improving_20070430/improving_20070501.pdf.

Ø  President Bush Announces Expanded Commitment to PEPFAR

On May 30^th President Bush made an official announcement in the White House Rose Garden calling on Congress to double current funding levels for the President’s Emergency Plan for AIDS Relief (PEPFAR) to $30 billion dollars and to reauthorize and extend PEPFAR for an additional five years as the program is set to expire in September 2008. The first authorization of PEPFAR in 2003 directed $15 billion over five years to combat HIV/AIDS, Tuberculosis, and Malaria primarily in 15 focus countries; the largest international health initiative dedicated to a specific disease. 

Bush’s announcement was met with both praise and criticism. While many international HIV/AIDS advocacy organizations, international aid organizations, and lawmakers praised Bush’s commitment to the PEPFAR program by reaffirming its continuation, they also acknowledged that an additional $30 billion dollars to the program falls far short of the true need.  Some feel that calling the additional $30 billion a doubling of the program is a misconception, as $30 billion is nearly what the US is already on track to spend over the next five years even without the President's announcement. Several advocates demand a much bolder US response than what the President proposed, by reauthorizing the program at closer to $50 billion dollars and lifting controversial restrictions on prevention funding that require 33% of prevention funds to be used for abstinence only until marriage programs and restrict funding to help commercial sex workers to truly keep pace with the needs of developing countries most heavily devastated by the HIV/AIDS epidemic.

Ø  AIDS Action Opposes Nomination for Surgeon General

On May 24th President Bush nominated Dr. James Holsinger, a cardiologist from Kentucky, as his choice for Surgeon General. In the following weeks, HIV/AIDS and gay right’s organizations heavily criticized the nomination. AIDS Action was the first national organization to publicly oppose the nomination.  This opposition led to contentious Senate confirmation hearings.

Dr. Holsinger has had an extensive career in the Department of Veterans Affairs, University Kentucky Medical Center, and Kentucky’s State Department of health. However, he also has a record showing prejudice towards homosexuals.  It is this bias that puts his ability to advocate for the better health of all Americans into question.

Most disturbing to HIV/AIDS and gay rights activists was a 1991 paper prepared for the United Methodist Church by Dr. Holsinger entitled “Pathophysiology of Male Homosexuality,” Holsinger expressed his medical opinions about the abnormality and health dangers of gay and lesbian sexual practices. His record shows his support for reparative therapy to “cure” homosexuals, an approach widely discredited by mainstream medical and scientific organizations.

J U N E

Ø  Labor HHS Appropriations Moves through House Sub-Committee

On June 5th the full House Appropriations Committee formally voted on the subcommittee 302b allocations (the total amount each committee is permitted to spend) for the Fiscal Year (FY) 2008 spending bills. The committee approved an allocation of $151.1 billion for discretionary spending in the Labor-HHS-Education bill which was an increase of more than $10 billion above President Bush’s $140.9 billion request and $6.6 billion over the FY 2007 allocation of $144.5 billion. 

The Labor-HHS-Education Appropriations Subcommittee then marked up the FY 2008 appropriations bill on June 7th. Within the bill there were several increases appropriated to HIV/AIDS programs. Increases from FY 2007 to the Ryan White CARE Act were seen in Title I ($32 m), Title II base ($3m), ADAP ($41 m), and Title III ($23m). Sub-committee members appropriated an increase to domestic HIV prevention at the CDC ($63.8 m) as well as a sizable increase to abstinence-only education programs. Community Based Abstinence Education programs received a proposed increase of nearly $28 million (President Bush’s budget request), the second largest increase in the program’s history.  The National Institutes of Health (NIH) received an increase of $750 million, $200 million of which was an increase to the Global Fund, leaving an increase of $549 million for NIH research. The subcommittee did NOT fund the Early Diagnosis Grant Program.

Ø  Rep. Velázquez Introduces HIV Emergency Local Partnership Act of 2007

On June 15th Representative Nydia Velázquez (D-NY) introduced H.R. 2736, the HIV Emergency Local Partnership Act of 2007.  Original cosponsors include: Luis Fortuño (R-PR), Jose Serrano (D-NY), and Hilda Solis (D-CA). The introduction of this bill comes one week after Rep. Velázquez requested to Government Accountability Office (GAO) to investigate the state of treatment and care for HIV/AIDS patients in Puerto Rico. The bill calls for increased federal funding to address the HIV/AIDS crisis in Puerto Rico and in minority communities throughout the United States.

The bill would add an additional $50 million to the Minority AIDS Initiative (MAI) programs in the Ryan White CARE Act to provide comprehensive HIV/AIDS services to minority populations. It would establish and authorize funding for a pilot MAI grant program for collaborative efforts among community health centers to provide comprehensive HIV/AIDS services for racial and ethnic minorities. The bill would exempt people living with HIV/AIDS in U.S. territories, such as Puerto Rico, from the funding limitations in territorial Medicaid programs beginning in FY 2007.

Ø  Senate Appropriations Committee Passes Labor HHS Appropriations

On June 21st the full Senate Appropriations Committee passed the FY 2008 Labor, Health and Human Services, and Education Appropriations Bill. The Labor-HHS subcommittee marked up the bill on June 19th.  The sub committee approved the bill unanimously with no amendments.

Within the bill there were some increases appropriated to HIV/AIDS programs. Increases from FY 2007 to the Ryan White CARE Act were seen in Title II base ($5m), ADAP ($25.4 m), and Title IV ($3.2m). There was no increase to domestic HIV prevention at the CDC. Without adding additional funding, the Committee assigned $30 million to be carved out of existing HIV Prevention funding to go towards the Early Diagnosis Grant Program, to be used if and when states become eligible. The Senate Appropriations committee significantly decreased funding for abstinence-only education. Community Based Abstinence Education programs received a proposed decrease of $28.5 million. The National Institutes of Health (NIH) received an increase of $1 billion.

Ø  DC Ban on Syringe Exchange Overturned in Financial Services Bill

On June 28^th the House of Representatives passed the Financial Services appropriations bill, which contains appropriations for the District of Columbia, by a vote of 240 - 179.  In an historic vote, the bill passed the House of Representatives without the rider prohibiting the District from using local funds for syringe exchange programs for the first time since the ban was instituted in 1998.

This change is important because Washington, D.C. has one of the highest HIV/AIDS rates in the country, with an estimated 1 in 20 DC residents infected with HIV and 1 in 50 living with AIDS. Injection drug use is the second most common mode of HIV transmission among men in the District and the most common mode among women in the city. Despite demonstrated evidence that syringe exchange programs can dramatically reduce HIV transmission without increased drug use, the District’s local government has been impaired by the federal government ban on the usage of local funding to coordinate treatment and rehabilitation programs with syringe exchange programs. District Mayor Adrian Fenty has said that he will provide local funds for needle-exchange programs as soon as Congress removes the language.
 

To read AIDS Action’s Press release on the lifting of the DC ban, visit: http://www.aidsaction.org/communications/press-releases/062907.htm.

J U L Y

Ø  House Appropriations Committee and Full House Pass Labor-HHS Appropriations Bill

On July 11th the full House Appropriations Committee passed the Fiscal Year (FY) 2008 Labor-HHS-and Education Appropriations Bill. The legislation includes $151.5 billion in discretionary spending which is about $7 billion more than FY 2007 and exceeds President Bush’s budget request for Labor-HHS-Education programs by $10.6 billion, making the bill a likely veto target. However no amendments were offered in full committee to significantly reduce the bill’s overall spending.

There were no changes to the HIV portfolio from the subcommittee’s mark.  The bill shows a $63 million increase for domestic HIV prevention at the CDC over the FY 2007 Joint resolution.  However, only $18 million is new funds.  The other $45 million represents funds that were shifted from non-HIV CDC programs for the Heightened Response Initiative in African American communities.  All of the $63 million, including the Heightened Response funds, will be for HIV testing.    

After three days of debate, the House of Representatives passed the Fiscal Year (FY) 2008 Labor-Health and Human Services-Education Appropriations bill (H.R. 3043) on July 19^th, by a vote of 276 to 140. The bill would provide a total of $607 billion, including $151.7 billion in discretionary spending for labor, health, and education programs. President Bush has publicly announced that he will veto bills that exceed his budgetary requests, on the basis of spending levels. The sub and full committee version of the bill included language to adjust Title I (Part A) of the Ryan White CARE Act allocations. The inserted language ensures that Eligible Metropolitan Areas (EMAs) do not suffer total funding losses greater than 8.4% and that Transitional Grant Areas do not suffer total funding losses greater than 13.4%. This creates a “floor” that the report language refers to as a “stop loss”.  The language is retroactive for FY 2007, which means a certain level of adjustment for affected jurisdictions is possible depending on implementation.  The report language urges the Health Resources and Services Administration (HRSA) to provide additional funding to the EMAs and TGAs that lost funding in FY 2007 by using a portion of FY 2008 funding to backfill those losses. The House voted to increase funding for Title I by $32 million. It is not certain how much of this new funding would go to backfill the FY 2007 losses and how much would be used to maintain the floor in FY 2008, but it is possible that approximately $10 million per year could be used for this purpose.

Ø  Senate HELP Committee Holds Surgeon General Confirmation Hearing

On July 12th the Senate Health, Education, Labor, and Pensions (HELP) Committee held a confirmation hearing for Dr. James Holsinger, the president’s nominee for Surgeon General.  Dr. Holsinger, currently a professor at the University of Kentucky College of Public Health, was nominated by President Bush on May 24^th. AIDS Action wrote a letter of objection to the Senate HELP Committee, organized a community sign on letter in opposition and released the following press release: http://www.aidsaction.org/communications/press-releases/071207.htm.

The hearing was attended by a number of LGBT rights and HIV/AIDS organizations who oppose Dr. Holsinger’s nomination based on a history of anti-gay attitudes.  Senator Kennedy questioned both the scientific accuracy of a paper written on homosexuality in 1991 and the motivation behind it.  With at least three Senators noting Dr. Holsinger’s attitude towards the gay community, the paper was a focal point for the overarching theme of the hearing: whether or not Dr. Holsinger would put science over ideology.Under questioning, Dr. Holsinger repeated more than three times that he would resign if the conflict between the administration’s ideology and the science was surrounding an issue of overwhelming importance. 

To date, a floor vote confirmation has not been scheduled for Dr. Holsinger.

Ø  Senate Appropriations Continue Without DC Syringe Exchange Ban

Both the Senate Appropriations Financial Services Subcommittee (on July 10^th) followed by the Full SenateAppropriations Committee (on Thursday 12^th ) voted in favor of a Financial Services Appropriations bill that did not contain a rider prohibiting the District of Columbia from using its own local funds for syringe exchange programs.  In recent years the Senate voted not to include this rider as well. However, the exclusion is noteworthy because the House of Representatives voted on June 28^th not to include the rider for the first time since the DC ban was instituted in 1998.  This means that the Financial Services appropriations bill that reaches the President’s desk is almost certain to overturn the ban.  It is not known if the President will veto the bill, although the ban on the District’s local funding is not among the President’s veto threats.  The next step is for the full Senate to vote on the ban.  However, it is unlikely that the Senate will do so prior to the August recess.  District Department of Health Director Gregg A. Pane has said that as much as $1 million in local funds will become available for syringe exchange programs in the District as soon as the language is approved.

Ø  House Passes HUD Appropriations Bill, Includes HOPWA Increases

The House approved the Fiscal Year (FY) 2008 Transportation/Housing and Urban Development (T/HUD) appropriations bill on July 24^th by a vote of 268-153. The House passed the bill after two days of discussion and debate on the House floor. The bill includes a $14 million increase for the Housing Opportunities for People with AIDS (HOPWA) program, bringing HOPWA’s total funding level to $300.1 million.

Ø  House Judiciary Committee Passes the Stop AIDS in Prison Act of 2007

On July 25^th the House Judiciary Committee unanimously passed the Stop AIDS in Prison Act of 2007, H.R. 1943. The bill passed with no amendments and no statements of opposition. 

The Stop AIDS in Prison Act requires the Federal Bureau of Prisons to test all federal prison inmates for HIV upon entering prison and again prior to release, unless the inmate opts-out of taking the test. Rep. Maxine Waters’ (D-CA) legislation also would require that inmates be tested for HIV once a year and upon their request, and would call for confidential counseling for inmates before and after HIV testing.  The bill also requires HIV/AIDS prevention education for all inmates and comprehensive and timely treatment for those inmates who test positive.

A U G U S T

Ø  ETHA Introduced in the House

On August 2^nd Speaker of the House, Nancy Pelosi (D-CA) introduced the Early Treatment for HIV Act (ETHA), H.R. 3326. Representatives Ileana Ros-Lehtinen (R-FL) and Eliot Engel (D-NY) were also lead sponsors of the bill.  The bill was introduced with equal bi partisan support, with a total of 54 original co-sponsors.

The first Early Treatment for HIV Act was introduced in 1999 in the 106^th Congress, but Congress has yet to approve ETHA. Senator Gordon Smith (R-OR) with Senator Hilary Rodham Clinton (D-N) as lead cosponsor introduced ETHA in the Senate on March 13^th.      

ETHA would give states the flexibility to extend Medicaid coverage to low income individuals that are HIV positive.  Under current law you must be disabled by full blown AIDS to be eligible for Medicaid benefits.  The bill also provides enhanced matching of federal Medicaid funding for states that choose to extend Medicaid coverage for HIV care. ETHA is modeled after the successful Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCA) that allows states to provide early access to Medicaid to women with cancer.

Ø  House Passes the CHAMP Act

On August 1^st the House passed the Children’s Health and Medicare Protection Act of 2007 (CHAMP), H.R. 3162. The Bill would expand the State Children’s Health Insurance Program (SCHIP) by $47.4 billion dollars over five years, adding five million uninsured to the current six million covered under the program. The CHAMP Act passed 225-204 in the House on a nearly straight party line vote, and under the rule there were no amendments to the bill. To read the bill in its entirety, please visit: http://www.thomas.gov/cgi-bin/bdquery/z?d110:h.r.03162:.

There are two substantial Medicare Part D improvements in the bill which would affect people living with HIV/AIDS.  Section 221 would allow funding under the AIDS Drug Assistance Program (ADAP) and Indian Health Services to count towards True Out Of Pocket (TrOOP) costs required under Medicare Part D. TrOOP includes funding for deductibles and co-insurance as well as the difference between the amount of funding needed to make up the coverage gap between the amount of a beneficiary’s initial coverage (set at $2400) and a beneficiary’s “catastrophic coverage” which is reached when the beneficiaries have paid a total of $3850 (including all the deductibles and co-insurance costs paid in the initial $2400).  This coverage gap is often referred to as the “doughnut hole.”

Section 225 of the bill will codify the “six protected drug” classifications, including HIV antiretrovirals under Medicare Part D. Guidelines for the Centers for Medicare and Medicaid Services (CMS) currently require drug plans to cover all, or substantially all, drugs in six classes of drugs critical to treating HIV/AIDS, mental health conditions, cancer, epilepsy, and autoimmune diseases).  This provision in the CHAMP Act would codify the guidelines into law.  Healthcare organizations, including AIDS Action, have sought codification because they have been concerned that the guidelines must be reinstated by CMS every year and that the loss of these protections could be used as a bargaining point in negotiations. The ADAP and “six protected class” provisions are the top Medicare goals for AIDS Action. 

Ø  Lee Introduces HIV Nondiscrimination in Travel and Immigration Act

On August 2^nd Representative Barbara Lee (D-CA) Introduced the HIV Nondiscrimination in Travel and Immigration Act, H.R. 3337. This bill would amend the Immigration and Nationality Act by striking the language that bans HIV positive non-citizens from entering the United States or from attaining legal status. Under current immigration law and policy, prospective immigrants, foreign students, refugees and tourists can be denied admission into the United States if they are HIV positive.

Representative Lee’s bill does not completely overturn the discriminatory policy, but it returns the authority to the Secretary of Health and Human Services to determine which diseases should be included on the list of communicable diseases and the bill states, “HIV infection should not be required by law to be included on such list.”

AIDS Action fully supports this bill as in important step in overturning the discriminatory and outdated policy that has banned HIV positive non-citizens entry into the United States for over 20 years. The bill can be found at http://www.thomas.gov/cgi-bin/bdquery/z?d110:h.r.03337:.

Ø  Senator Lugar Introduces PEPFAR Reauthorization Bill

On August 2^nd Senator Richard Lugar (R-IN), introduced S.1996, “The HIV/AIDS Assistance Reauthorization Act of 2007.” This is the first piece of legislation introduced to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), which is set to expire on September 30, 2008.  Senator Lugar introduced the bill without any co-sponsors.

The bill would reauthorize the current legislation until 2013 and authorize a total of $30 billion over the life of the program (including the first five years). It would also allow for increased support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, modify the abstinence only language, and preserve the Orphans and Vulnerable Children (OVC) provisions without alteration.

The bill would strike the abstinence directive in PEPFAR that requires 33% of all prevention funding to be dedicated to abstinence only programs.  Instead it would mandate that 50% of funding directed to prevent the sexual transmission of HIV be spent on abstinence and fidelity programs.

S E P T E M B E R

Ø  Senate Passes FY 2008 Foreign Operations Appropriations Bill

The Senate passed the Fiscal Year (FY) 2008 Foreign Operations Appropriations Bill, H.R. 2764 on September 6th by a vote of 81-12. 

The $34 billion bill includes $4.5 billion for efforts to fight global HIV/AIDS. Of the $4.5 billion, $590 million is dedicated to the Global Fund to Fight AIDS, TB, and Malaria (Global Fund).  These figures vary slightly from the House passed version of the bill.  The House passed the FY 2008 Foreign Operations bill on June 22^nd. The House version included $5.08 billion for international HIV/AIDS prevention, care, and treatment and allocated $550 million to the Global Fund. 

The Senate debated and voted on several amendments Thursday afternoon before final passage of the bill.  Of particular significance to the global health expenditures in the bill, was an amendment offered by Senators Boxer (D-CA) to repeal the Mexico City Policy (The Global Gag Rule). The amendment was adopted.  The Mexico City policy which began in 1984 under President Ronald Reagan, was discontinued during the Clinton Administration, and restored during the current Bush administration.  It prohibits US aid and funding to foreign organizations that promote or provide abortion services.

It is important to note that the Mexico City policy remained in the House version of the bill, and in the final omnibus bill version of the bill.

Ø  Senate Passes T/HUD Appropriations Bill, Includes HOPWA Increases

The Senate approved the Fiscal Year (FY) 2008 Transportation/Housing and Urban Development (T/HUD) Appropriations Bill, S. 1789, on September 12^th by a vote of 88-7. The bill includes a $14 million increase for the Housing Opportunities for Persons with AIDS (HOPWA) program, bringing HOPWA’s total funding level to $300.1 million.

Ø  John Edwards Releases HIV/AIDS Platform

On September 18^th former Senator John Edwards was the first presidential candidate to publicly commit to creating a national HIV/AIDS strategy to fight the domestic epidemic. He did so in the unveiling of his plan to address HIV/AIDS both in the United States and across the globe.

His platform outlines specific objectives and goals for addressing the domestic epidemic.  In his plan, Edwards guarantees universal access to HIV treatment by 2012, promises to create a national HIV/AIDS strategy, focuses on disparities, supports the Ryan White CARE Act and HOPWA programs, pledges to base prevention efforts on science not political ideology, and calls for a strengthened HIV/AIDS research agenda.

You can read John Edwards complete HIV/AIDS platform at: http://nationalaidsstrategy.org/documents/John%20Edwards%20AIDS%20Policy.pdf.

Ø  Over 100 Organizations Call for National Strategy to End AIDS in America

AIDS Action, along with several National HIV/AIDS organizations, launched a new website, National AIDS Strategy: A Call to Action.  The website, www.nationalaidsstrategy.org, officially launched on August 21^st. It is dedicated to gathering support for a National AIDS Strategy in the United States.  Through the website, both organizations and individuals can endorse the Call to Action, which states that the next President of the United States must develop a results-oriented National AIDS Strategy, designed to improve the outcomes of our national response to the HIV/AIDS epidemic in the United States.

There are currently over 100 organizations and individuals who have endorsed the call to action.  To sign the Call to Action, learn more about the strategy, and view a list of current endorsers, go to www.nationalaidsstrategy.org. Please also share this website with friends and colleagues.Supporters issued a Press Release on September 17^th to highlight that more than 100 organizations call for a National AIDS Strategy to end the epidemic in the United States. The Press Release can be found at: http://www.nationalaidsstrategy.org/index.php?option=com_content&task=view&id=18.

Ø  House Passes Stop AIDS in Prison Act of 2007

On September 25^th the House of Representatives passed H.R. 1943, The Stop AIDS in Prison Act by a 2/3 majority voice vote.  The Stop AIDS in Prison Act would require the Federal Bureau of Prisons to develop policies and provide HIV opt-out testing upon entry into and exit from the federal prison system, along with treatment and prevention services for inmates within federal correctional settings.  Representative Maxine Waters (D-CA) introduced the bill with bi-partisan support on April 19^th and it passed the House Judiciary Committee unanimously on July 25^th.   AIDS Action supports the legislation as a way to ensure that the federal system is offering all of the prisoners HIV testing at the earliest possible moment to make sure that inmates receive early HIV treatment and care, prevention and counseling services and that people who are reentering society upon finishing their sentences are connected to HIV treatment and care.  In 2008, we look for the Senate to take action on this bill.

Ø  House Foreign Affairs Committee Holds Hearing on PEPFAR Reauthorization

On September 25^th The House Foreign Affairs Committee held a Congressional hearing on the President’s Emergency Plan for AIDS Relief (PEPFAR). This first hearing on PEPFAR Reauthorization titled, “PEPFAR Reauthorization: From Emergency to Sustainability,” was held to discuss how to move the program from one of emergency relief to long term sustainable success during the upcoming reauthorization. PEPFAR was passed into law in 2003 and will expire on September 30, 2008. 

Expert witnesses shared their experience and recommendations on how to achieve sustainability through PEPFAR Reauthorization.  The witnesses included Dr. Helene Gayle, President and CEO of CARE, USA; Dr. Nils Daulaire, President and CEO of the Global Health Council; Dr. Joia Stapleton Mukherjee, Medical Director of Partners in Health; and Dr. Norman Hearst, Professor at University of California San Francisco School of Medicine.

Ø  SCHIP Passes House and Senate, Title V Abstinence Education Extended

On September 26^th the House passed the compromised conference report to reauthorize the State Children’s Health Insurance Program (SCHIP) by a vote of 265-159. The Senate quickly followed, passing the bill on September 27^th by a vote of 67-29. Under the bill, SCHIP would be expanded by $35 billion over the next five years, to $60 billion, offset by a 61 cent increase to the Federal cigarette tax.  The program is estimated to cover an additional 4 million low income children who would otherwise be uninsured.

The bill was a “clean” reauthorization of the SCHIP, closely following the original Senate contours of the bill. The original House passed version of the bill, the CHAMP Act, included several Medicare reforms that were not included in the conference report. The House version would have allowed funding under the AIDS Drug Assistance Program (ADAP) and Indian Health Services to count towards True Out Of Pocket (TrOOP) costs required under Medicare Part D. The bill would have also codified the “six protected drug” classifications, including HIV anti-retrovirals under Medicare Part D.

O C T O B E R

Ø  House Holds Hearing on PEPFAR Reauthorization and Food Security

On October 9th the House Foreign Affairs Subcommittee on Africa and Global Health held a hearing entitled: The President’s Emergency Plan for AIDS Relief (PEPFAR): Is it fulfilling the Nutrition and Food Security Needs of People living with HIV/AIDS? The purpose of the hearing was to examine whether or not the United States government is providing adequate nutritional support as part of its global AIDS programs, and how to best address nutrition through PEPFAR Reauthorization. Representative Donald Payne (D-NJ), chairman of the subcommittee, led the hearing.  Representative Diane Watson (D-CA) was also present.

Ambassador Mark Dybul, United States Global AIDS coordinator testified first. Additional witnesses included Dr. Robert Einterz, Director and Co-founder of the Indiana-Moi partnership, Mr. Wallaligne Beriye, Ethiopian Country Director for Project Concern International, and Ms. Annemarie Reilly, Chief of staff for Catholic Relief Services.

Ø  Senate Passes FY 2008 Labor-HHS Appropriations Bill

On October 23rd the Senate passed the Fiscal Year (FY) 2008 Labor-HHS Appropriations Bill, H.R. 3043, by a vote of 75-19. Funding levels for HIV/AIDS programs remained the same as the full committee passed version of the bill. 

Ø  Senate Foreign Relations Committee Holds PEPFAR Hearing

On October 24^th The Senate Foreign Relations Committee held a hearing on the President’s Emergency Plan for AIDS Relief (PEPFAR) entitled, “The Next Phase of the Global Fight against HIV/AIDS.” Ambassador Mark Dybul, U.S. Global AIDS Coordinator gave the sole testimony.

Senator Biden, Chairman of the committee, gave opening remarks in which he guaranteed the reauthorization of PEPFAR, which expires September 30, 2008. He lauded the program as one of President Bush’s greatest accomplishments and the largest public health effort in history. He listed his top three priorities in going forward: 1. Reauthorize PEPFAR 2. Expand and improve Prevention 3. Eliminate Earmarks in the bill. He also placed an emphasis on integrating HIV/AIDS programs with larger development efforts, building health capacity in Africa, expanding efforts to address gender based violence and inequities, and improving efforts to combat TB and malaria. His opening statement can be found out:

http://biden.senate.gov/newsroom/details.cfm?id=286036&.

Following the opening statements, Ambassador Dybul offered his testimony. During his testimony he praised the original PEPFAR legislation and called for minor changes to the bill during reauthorization. He cited evidence of the program’s success stating that PEPFAR has obligated 94% of its funding to date and is close  to achieving its ambitious five-year targets of supporting treatment for two million people, preventing of seven million new infections, and caring for 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children.

Ø  President Vetoes SCHIP, House Fails to Override

On October 18^th the House of Representatives voted to override the President’s veto of H.R. 976, The Children’s Health Insurance Program Reauthorization Act of 2007. The override vote failed, 273-156, falling 13 votes short of the two-thirds majority required to override a Presidential veto.

Ø  Barack Obama Creates HIV/AIDS Platform; Commits to National Strategy

Presidential candidate Barack Obama released his HIV/AIDS platform on October 19th entitled, “Fighting HIV/AIDS Worldwide.” In this platform, he outlines his plan to combat HIV/AIDS in America as well as globally.

In his plan to combat HIV/AIDS in America, he pledges to develop and implement a national HIV/AIDS strategy in the first year of his presidency. He also vows to fix the nation’s health care system by signing universal health care legislation into law by the end of his first term.  In this plan, he commits to fighting disparities in the domestic epidemic, improving the quality of life for those living with HIV/AIDS, assuring adequate and safe housing for those living with HIV, expanding funding for research, promoting HIV Prevention, and bringing Medicaid coverage to low income HIV positive Americans through the passage of the Early Treatment for HIV Act (ETHA). He articulates his support for legislation that would lift the ban on federal funding for syringe exchange programs and his strong support of the Ryan White CARE Act.

To view Barack Obama’s plan to combat Global HIV/AIDS please visit:  http://nationalaidsstrategy.org/OBAMAFactSheetAIDS.pdf 

N O V E M B E R

Ø  FY 2008 Labor-HHS Appropriations Conference Figures Released

On November 1st House and Senate conferees officially met to negotiate a conference Fiscal Year (FY) Labor-HHS-Education Appropriations Bill. Conferees came to an agreement on the conference report, and released proposed conference figures after the meeting. The total discretionary allocation in the conference report $150.7 billion, which is $1 billion less than in the House-passed bill and $841 million more than the Senate version. It is $9.8 billion more than Bush requested.

The conference report includes a total increase to the Ryan White program of $84.3 million. This includes an increase to the AIDS Drug Assistance Program (ADAP) of $33 million. A breakdown of other Ryan White programs as well as figures for HIV prevention at the Centers for Disease Control and Prevention were not made public. The conference report includes an increase to the National Institutes of Health of $1.1 billion. The conference report also included the House's full $28 million increase for the Community Based Abstinence Education program (CBAE).

Ø  Presidential Candidates Sign Pledge for Leadership on Global AIDS and Poverty

Six democratic candidates for President signed the "Presidential Pledge for Leadership on Global AIDS." The pledge detailed the need to, "create, support and fund a comprehensive plan to address the HIV/AIDS pandemic" in the US and globally.  The plan includes a commitment of $50 billion by 2013 for the global fight against HIV/AIDS.

Endorsers include, Senator Hillary Clinton, Senator Barack Obama, Senator Joe Biden, former Senator John Edwards, Governor Bill Richardson, and Representative Dennis Kucinich. No Republican candidates have signed on to the pledge to date.

Ø  House Fails to Override Labor-HHS Appropriations Veto

On November 15^th the House failed to override the President’s veto of the FY 2008 Labor-HHS-Education Appropriations Bill by a vote of 277-144. This was two votes shy of the necessary “greater than 2/3” majority needed to override a Presidential veto in the House of Representatives.

Among the HIV portfolio increases to Labor-HHS programs in the vetoed bill were increases of $84.3 million to the Ryan White CARE Act including $32.3 million for Title I (Part A), $4 million for the Title II (Part B) Base, $33 million for the AIDS Drug Assistance Program (ADAP), $11.5 million for Title III (Part C), and $3.5 million for Title IV (Part D). The bill also would have increased HIV Prevention at the Centers for Disease Control and Prevention (CDC) by $6.2 million and the National Institutes of Health by $1.1 billion. The vetoed bill also included a $28 million increase to the Community Based Abstinence Education Program.

Failing to override the President’s veto seriously jeopardized the increases to domestic HIV/AIDS programs seen within the Labor-HHS conference bill. Prior to the vote on November 15th, Senate Majority Leader Harry Reid (D-NV) announced that Democratic leaders are working to craft on omnibus appropriations bill. This bill would split the difference between the President’s budget request for appropriations bills (excluding Defense and Military-Construction/VA) and the amounts proposed by Congress in half.

Ø  Homeland Security Proposes New Rule on the HIV Travel Ban

On November 5^th The Department of Homeland Security (DHS) Bureau of Customs and Border Protections issued a proposed rule change on the “Issuance of a Visa and Authorization for Temporary Admission into the United States for Certain Nonimmigrant Aliens Infected with HIV.” The proposed rulemaking comes over 11 months after December 1, 2006 (World AIDS Day) when the White House announced that the President would “direct the Secretary of State and the Secretary of Homeland Security to initiate a rulemaking that would propose a categorical waiver for HIV-positive people seeking to enter the United States on short-term visas.”

The proposed rule does not change the HIV Inadmissibility Clause of the Immigration and Nationality Act, which bars HIV positive immigrants already in the United States