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President's AIDS `Strategy' Offers Call to Arms, Few New Weapons

By Rick Weiss
Washington Post Staff Writer
Tuesday, December 17, 1996; Page A04

President Clinton plans to unveil the first "national strategy" for fighting AIDS today, a 40-page prescription that calls for sustained research funding and better coordination of anti-AIDS programs but offers no dramatic proposals that would redefine the federal government's approach to the epidemic.

The document, applauded by some as a long-awaited rallying cry for AIDS research but derided by others as a rehashing of well-worn ideas, was prepared by the president's Office of National AIDS Policy and will be released today at a White House ceremony that will not include any public remarks by the president.

Notably, the report defers action on one of the more controversial issues relating to the disease: the current ban on federal funding of needle-exchange programs for drug users. Instead, the report recommends waiting for the results of a Health and Human Services report on that topic, due in February.

The strategy report highlights six areas worthy of enhanced federal support in coming years, including development of new drugs and a preventive vaccine, reduction of new cases through unspecified "prevention efforts," access to patient services and protection against discrimination for people infected with HIV, the virus that causes AIDS.

"None of us can afford to sit by and watch this epidemic continue to take our neighbors, friends and loved ones from us," Clinton wrote in a letter accompanying the report. "HIV/AIDS affects us all, and we must wage this battle together until we can proclaim victory."

The report explicitly sidesteps the issue of how to organize such a crusade, however, noting that implementation of a plan to achieve the report's goals will be the responsibility of the Presidential Advisory Council on HIV and AIDS, the federal Interdepartmental Task Force on HIV and AIDS, the private sector and others.

AIDS researchers said that although there were no surprises among the report's stated ambitions, they were gratified to see long-standing scientific and public health goals getting Clinton's imprimatur.

"The news is not the goals themselves but the president's commitment to them," said Nobel laureate David Baltimore, a professor of molecular biology and immunology at the Massachusetts Institute of Technology, who was recruited to lead the nation's effort to develop an AIDS vaccine.

But to others, Clinton's call to arms sounded too familiar.

"We've had this before," said Peter Staley, founder of Treatment Action Group, a New York-based AIDS research advocacy group. "Every year it seems we have a report from an advisory committee on AIDS. The problem is the politicians let them gather dust. While Clinton has certainly been far more active than his Republican predecessors, as far as instituting policies that will actually help, he's been wanting."

AIDS has killed more than 343,000 in this country since it took root here more than 10 years ago and is now the leading cause of death among Americans aged 25 to 44 years old. In March, an independent report commissioned by the National Institutes of Health criticized aspects of the nation's AIDS research effort as fragmented, wasteful and lacking direction.

The NIH analysis was the most recent of several AIDS-related reports that have been published by government and quasi-governmental agencies over the years, but the new National AIDS Strategy defines itself as the first "to provide a national focus and direction for the U.S. government's response to HIV and AIDS."

The report details ongoing research efforts and progress to date but is vague about what changes, if any, are recommended for the future, highlighting instead various "opportunities for progress." In many instances, rather than spelling out specifics, the report uses phrases such as "maintaining its commitment" and "continue to exhibit strong leadership on this issue." It also calls for "sustained" and "adequate" funding of research.

Privately, some officials lamented the report's liberal use of inspirational quotes from some of Clinton's previous statements about AIDS, and the amount of space dedicated to past accomplishments, which they said gave the report a politicized tone. Activists were less subtle in their criticism.

"This report is remarkable not for what's in it but for what's not in it," said Wayne Turner, of ACT UP Washington, an advocacy group that obtained a copy of the report on Sunday and distributed it to news organizations, including The Washington Post.

"There's no bold new initiatives like needle exchange, an AIDS czar with real power, or the Manhattan Project to find a cure," Turner said in a statement. "You can't fight the war on AIDS with paper soldiers."

An estimated 26 percent of new AIDS cases in 1995 were due to infections acquired through intravenous drug use, up from 17 percent in 1985, according to federal Centers for Disease Control and Prevention in Atlanta. Studies have suggested that the spread of HIV through drug use could be reduced by giving drug addicts clean needles in exchange for used needles. But Congress has banned use of federal money for needle-exchange programs because of fears they could encourage drug use.

An administration spokesman, speaking on condition of anonymity, said the new report was unprecedented for its clear endorsement of a strong federal stand against AIDS.

"It says from the president of the United States to all of the agencies that work on AIDS, `This is important to me, this is a priority to me.' It says that the president of the United States is determined to move forward on this and accomplish real progress."

Since 1987, AIDS has risen from being the 15th most common cause of death among all Americans to the eighth. The CDC estimates that about 50,000 Americans become newly infected with HIV each year, and that between 650,000 and 900,000 Americans are living with HIV.

© Copyright 1996 The Washington Post Company

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