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March 2004 Acting Director of U.S. AIDS Policy Speaks to NORA On Monday, March, 8, the National Organizations Responding to AIDS (NORA), for which AIDS Action serves as convener, held its monthly meeting. The featured guest speaker of the meeting was Christopher Bates, the Acting Director of the Office of National AIDS Policy (ONAP) at the Department of Health and Human Services (DHHS). He gave his perspective of the state of federal HIV policy and funding and then fielded questions from attending NORA members. According to Mr. Bates, his perspective can best be described as realistic but cautiously optimistic. He opened by commenting on the “interesting times” in which we are living and characterized these times by discussing the limited resources we are facing as a country. “Many of our dollars are leaving the U.S. to address priorities abroad and we all [as advocates] ace fierce competition for the funding that remains.” We have witnessed this reality most recently with the issuance of the Ryan White CARE Act Title I awards, he pointed out. Title I grants pay for HIV care and treatment in 51 eligible metropolitan areas (EMAs), or those areas with a population of at least 500,000 that reported 2,000 or more AIDS cases during the previous five years. Many EMAs were award grants that were lower than what they had received the previous year. The funding decreases overall amounted to more than $4 million. The HHS official went on to discuss his concentration on the reauthorization of the Ryan White CARE Act in 2005. Although he is focused on it, he has been met with several disappointments which make that focus difficult. First, HHS was disappointed in the outcome of the Institute of Medicine (IOM) report—commissioned by the Health Resources and Services Administration (HRSA) and released late last year—which investigated the formulas for grant awards issued through the CARE Act. The report concluded that basing award formulas on HIV reporting rather than cumulative AIDS case reporting would not make a significant difference in funding distribution. Mr. Bates also made it clear that the community (i.e., national organizations and community activists) is of vital importance to the reauthorization process. In fact, he said that he has been waiting to hear from the community on some concrete proposals for reauthorization but he has not yet heard from a unified community voice which, he cautioned, makes it more difficult for him to help the community achieve its goals. Mr. Bates also opined that even great opportunities in the response to HIV can bring with them great challenges. Illustrating his point, he cited the unrolling of the Center for Disease Control and Prevention’s (CDC) Advancing HIV Prevention (AHP) Initiative, which is concentrating HIV prevention efforts in a few strategic areas: integrating HIV testing into all primary medical care; prevention programs directed at HIV positive persons and HIV negative persons who are at high risk for HIV; aggressive voluntary HIV testing for all pregnant women; and the increased use of the rapid HIV test. These tactics are expected to identify more HIV positive persons than ever before (as well as prevent new infections from occurring). But while it is expected that the number of people who will need such services will increase, federal funding levels are decreasing. Mr. Bates acknowledged that the HIV community is going to have to do more with less. On a more positive note, however, he claimed that these challenges can be translated into powerful messages to deliver to Congress when advocating for increased federal spending on HIV programs. Indeed, he even reminded meeting attendees that there is still time to push for budget increases for fiscal year (FY) 2005, and we have a lot of “ammunition” for effective arguments for such increases. Mr. Bates concluded his prepared comments by affirming his dedication to the domestic HIV epidemic. He reminded everyone that, to see the devastation caused by HIV, you don’t have to travel to another country; you can simply travel to some parts of Washington, DC to see the grave impact of HIV on communities. During the question-and-answer period with NORA members, Mr. Bates, prompted by questions, raised several significant points.
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