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Clinton, Shalala, Fleming Host Gathering of AIDS Advocates, Care Givers and People Living with HIV at Day-Long Conference

Election Year Sleight of Hand?

On December 6, 1995, the White House held a one-day conference on HIV and AIDS. TAG Policy Director Gregg Gonsalves was one of the three hundred or so invited guests, and one of nine individuals selected to participate in a discussion with President Clinton at the meeting. He prepared this report from the gathering.

Early in November, an envelope from 1600 Pennsylvania Avenue was delivered with an invitation to attend the upcoming White House Conference on HIV in December. The meeting would be the first time since the epidemic began that an American President brought people living with the disease, those working on the front-lines–whether in care, prevention or research, and all the relevant senior federal officials, to the White House to discuss our country’s response to AIDS.

Activists had called on three Presidents of the United States to confront the AIDS crisis and take a leadership role in the fight against the disease. Near the close of his first term in office, Bill Clinton took the first step and sat down to listen to what those working in AIDS said needed to be done to bring us closer to an end to the epidemic.

The first White House Conference on HIV was an important and historic event for several reasons. First, we are in the midst of a war by Congressional Republicans about the safety net of services that provide health care, housing, food and other necessities to the poor, the elderly, the very young, and the sick and that are heavily relied upon by people with HIV. An unambiguous Congressional decision has been made that a national checkbook balanced in seven years is worth sacrificing the lives and well-being of our nation’s most vulnerable citizens. The White House Conference on HIV was an important platform which allowed Americans to see the faces of those who will be affected deeply by the Republican budget cuts and to hear their stories. The Conference also allowed the President of the United States to go on record once again against the most heinous of the Republican proposals.

Second, the Conference was an important exercise in contrast. Despite the caterwauling of ACT UP/New York members outside the conference, the Clinton Administration has had a better record on AIDS than the two Presidential Administrations before it. The White House Conference on HIV allowed the AIDS community to praise the Clinton Administration’s modest efforts on the disease, while pushing and demanding that it go further. In an election year, the Conference also stood as a reminder that we are likely to fare better with a Democrat in the White House than with a Republican Chief Executive–and a Republican Congress in tow.

The meeting began with nine concurrent workshops on the following topics: biomedical research on therapeutics (drug development + clinical research); biomedical research to prevent HIV infection (vaccines + microbicides); prevention–research and practice; substance abuse–research and treatment; housing; primary care and benefits; services; international issues, and; discrimination. The workshop participants were charged to develop a list of priorities in each of the aforementioned areas for the afternoon session of the conference, where one person from each of the workshops would report back to the President on the morning’s deliberations.

I was charged with reporting back to the President from the workshop on biomedical research to prevent HIV infection. I was daunted by the task of distilling two hours of discussions on vaccines and microbicides by eminent scientists, leading public health officials and industry and community representatives into only a few minutes of remarks to the President. Shortly before 1PM, all the conference participants made their way through the Secret Service gauntlet and into the Cash Room of the Treasury Building and took their seats. The nine individuals chosen to report back to the President on the morning’s sessions took seats at a U-shaped table at the head of the room.

First there were words of greetings by Secretary Shalala and AIDS Czar Fleming. Patsy Fleming, who for years worked for the late New York Congressman Ted Weiss (Weiss had pushed for and sponsored early Congressional hearings on AIDS), remarked on the central difference she felt between the Clinton Administration and those preceding it. She said when she was working in Congress she felt she was on the outside, fighting the Reagan and Bush Administrations’ complacency towards the epidemic and hostility towards people with HIV, and now she felt as if she was fighting the epidemic with the support of the President and the rest of the Executive Branch. Whatever the weaknesses in the Clinton AIDS record, many in the room couldn’t help but feel at least the change of heart in the White House.

The President then took the podium for a long speech on AIDS. The speech began with a recitation of the facts of the epidemic, the hundreds of thousands of Americans infected, the hundreds of thousands dead. Finally, a President was telling the facts to the nation after years of citizens trying to get a succession of indifferent Presidents to simply listen. Mr. Clinton began talking about the accomplishments of his Administration. First on his list was his increase in funding for AIDS research at the National Institutes of Health and the establishment of a new and stronger NIH Office of AIDS Research as a command center for research on HIV infection. Then Mr. Clinton made a commitment that TAG has been pushing for for over a year: he publicly vowed to protect the AIDS research budget and the Office of AIDS Research from its opponents in Congress. Clearly, TAG’s efforts had paid off.

The President went on to praise the Food and Drug Administration for its rapid approval of AIDS drugs, commenting that we are two years ahead of Europe in bestowing marketing approval on new drugs for AIDS. He also announced the formation of a new task force led by Vice-President Albert Gore to bring together scientists and leaders of pharmaceutical and biotech companies to discuss ways of accelerating the development of new drugs, a vaccine, and microbicides against HIV.

The President then turned to something dear to his heart: a discussion of the Congressional plans to hack away at Medicaid. Mr. Clinton reminded those at the meeting that Ryan White funds account for only 20% of the monies spent on care for people with AIDS. Medicaid “provides health care for nearly half of the 190,000 Americans living with AIDS, including 90% of the children,” said the President. Congressional plans to cut Medicaid by $160 billion and to turn it into a block grant ending a 30 year commitment to our nation’s most vulnerable people would be “a stake in the heart of our efforts to guarantee dignity to the people with AIDS in this country,” he continued. Mr. Clinton continued to talk about the ramifications of the drive to rashly balance the budget in 7 years. He spoke about housing and prevention programs. He spoke about discrimination and was probably the first U.S. President to speak out against homophobia on national television.

After the speech, the President took his seat at the table, sandwiched between Patsy Fleming and me. One by one, each of the nine “reporters” presented Mr. Clinton with a synopsis of the morning’s deliberations in their subject area. When it was my turn, I turned towards the President and began my remarks by stressing the importance of a vaccine against HIV in stopping the AIDS epidemic, especially in the developing world. I then told him that the great minds assembled in the morning believed the development of a vaccine and topical microbicides was possible. In order to achieve this goal, I told Mr. Clinton, we have to increase public investment in biomedical research and development. I then attacked the Congress calling them “mad book-keepers” holding both the HIV-seronegative and the HIV-seropositive hostage to their zealotry. The President laughed.

I then informed the President that vaccine developers were bailing out of AIDS and that there needed to be intervention on the highest levels of his Administration to bring them back to the table. I then praised his decision to have Vice-President Al Gore form a task force on this very issue. Finally, I made a pitch for doubling the NIH budget and for investing America in a cure for AIDS, cancer, Alzheimer’s disease and other illnesses. The meeting then broke up and we went to a reception where we listened to remarks from the First Lady Hillary Clinton, who despite her troubles in Washington, was greeted by the meeting’s participants with boisterous applause. She spoke eloquently about putting a face on the cuts in programs Republicans in Congress would like to make simply a matter of numbers on a balance sheet. When the day was over, David Barr and Mike Isbell of Gay Men’s Health Crisis, Eileen Mitzman of Mother’s Voices and I headed for the airport, back to New York, back to the trenches, back to work, back to the epidemic.

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