AIDS Research Budget Threatened

By Laura Thomas
Funds for AIDS research are in danger of being reduced to levels
that would seriously impede progress towards effective treatments.
President Bush recently released his proposed budget for 1993, including
figures for AIDS research. The President requested $873 million dollars
for AIDS Research Programs at the National Institutes of Health (NIH).
This is a 3.5% increase over last year's $841 million dollars. However,
the current rate of inflation for biomedical research is 5%, the cost of
treating people with HIV is increasing by about 20% annually, and the
number of people with HIV will go up by an estimated 30% in the next
year. Given those figures, the President is grossly underfunding
research on AIDS treatments. Prevention and care are also being
threatened with cuts and underfunding.
Funding for the NIH pays for all government funded clinical trials
of HIV treatments, including both the AIDS Clinical Trials Group (ACTG)
and the Community Programs for Clinical Research on AIDS (CPCRA) trial
systems at the National Institute for Allergies and Infectious Disease
(NIAID). It also funds basic laboratory research, some natural history
and epidemiological studies, and grants to encourage researchers to work
on HIV.
The budget for the NIH, unlike the budget for other Federal
agencies, is not earmarked for specific funding areas. Thus, advocates
have difficulty knowing exactly how much the NIH is planning to spend on
AIDS. It is particularly difficult to find out how much will go into
specific areas, such as the ACTG system, natural history studies in
women, or AIDS-related cancer research. We can look back at previous
years' spending to have a rough idea of where the money will go if
priorities stay the same, but there is little that advocates can do to
know whether or not particular projects will be adequately funded.
One solution to this problem, which has been raised by several
people, is to create a Federal AIDS Institute, along the lines of the
National Cancer Institute. This would centralize HIV-related research
into one place, enabling advocates and people with HIV to push for
adequate funding for it and to have more oversight on the priorities for
those funds. It might also encourage researchers from different fields
to collaborate. A weakness of this plan is that the institute would be
vulnerable to politically-motivated cuts. Another problem is that since
the manifestations of HIV disease are so complex it may make more sense
to encourage each of the components of the NIH to do research in their
HIV-related area of expertise, with the National Cancer Institute
investigating HIV-related cancers, for example,and the National Eye
Institute researching CMV retinitis and other eye infections.
Money within the NIH is traditionally not earmarked, so that
scientists rather than politicians can decide what the "scientifically
justified" priorities are. However, the funds are still very vulnerable
to political pressure. For example, last year funds were dramatically
shifted away from adult clinical trials into pediatric trials, even in
regions where there are very few pediatric cases. In New Orleans, the
adult AIDS Clinical Trials Unit at Tulane was defunded under
recompetition, and the funds were moved to Tulane's pediatric research
branch. There is no question that, along with all other AIDS research,
pediatric HIV research was desperately underfunded and that more money
is needed. But however much "innocent" children with AIDS are a safer
political choice than adults, it is robbing Peter to pay Paul to give
money for research on children while taking it away from research that
could help their mothers.
Dr. Thomas Merigan from Stanford University's clinical trials unit
testified to Congress last week that AIDS researchers are worried and
frustrated by the cuts in their budgets for adult research to fund
pediatric research. He said "The funding for pediatric AIDS...is nearly
equivalent to that for the adult ACTGs. It is important to
recognize...the needs in pediatrics are very important. However, there
are 20 times more infected adults than children....the funding of adult
units should be increased to at least two if not three times that of the
pediatric units in order to allow an adequate effort to be made
nationally."
Congress is currently having preliminary discussions on the AIDS
budget. Rep. Henry Waxman (Democrat, California) held hearings on the
AIDS research budget before the House Health and the Environment
Subcommittee on February 24, 1992 in Washington, DC. Speakers included
Dr. Anthony Fauci, NIH Associate Director for AIDS Research, and Martin
Delaney of Project Inform, as well as Dr. Merigan. Fauci estimated that
his agency would need an additional $100-200 million more to fund all
the scientifically justified basic and clinical research. He said
projects that would have to be cut under the proposed budget include
vaccine research, clinical trials networks, natural history studies and
training new researchers. Martin Delaney testified that according to
figures from the NIAID budget office "the actual amount spent on
clinical AIDS research through NIAID is less than $130 million
annually." This includes funds spent on the ACTG and CPCRA systems,
NIAID's intramural research, and pediatric AIDS research, and is a far
cry from the $4 billion that President Bush has claimed is being spent
on HIV-related research. Delaney listed several areas of HIV research
that have been particularly neglected, including immune-based therapies,
surrogate markers of disease progression, combined treatments for
opportunistic infections, and studies in special population groups.
What You Can Do
Congress needs to continue to hear from people who are concerned
about the US AIDS research budget. Other sections of the AIDS budget,
including prevention and education programs and the Ryan White/CARE
bill, which provides emergency assistance to the states and to the
cities hardest hit by AIDS, are also in danger of being cut or
underfunded. All of these services are essential to winning the fight
against AIDS, and we cannot afford to let Congress fund any of them at
the expense of another. The AIDS budget must be increased across the
board if there is going to be any substantial progress towards ending
the epidemic. Readers who are concerned about the amount of money being
allocated to AIDS can write or call their Representative and their
Senators. Some of the most influential people to reach are those
serving on the Sub-committee on Labor, Health and Human Services,
Education and Related Agencies of the Appropriations Committees in both
houses, listed below. Individuals who do not live in their districts
are also encouraged to write these committee members concerning the NIH
budget, as well as their own Representative and Senators.
Letters to House members should be addressed: The Honorable....,
House of Representatives, Washington, DC, 20515. Letters to Senators
should be addressed: The Honorable..., US Senate, Washington, DC,
20510. The House will be deciding on the budget in March or early
April, and the Senate in April or early May.
For more information on lobbying, readers may want to contact the
Human Rights Campaign Fund, 1012 14th Street, NW, Suite 607, Washington,
D. C., 20005, phone 202/628-4160. They are in the process of putting
together an information packet on the NIH 1993 AIDS budget -- including
a list of other important members of Congress not included below.
House of Representatives, Committee on Appropriations, Subcommittee
on Labor, Health and Human Services, Education and Related Agencies:
Joseph D. Early, D., Worcester, MA
Steny H. Hoyer, D., Prince George's Co., MD
Robert Mrazek, D., Huntington, NY
William H. Natcher, D., Bowling Green, KY
David Obey, D., Wausau, WI
John Edward Porter, R., Deerfield, IL
Carl Pursell, R., Ann Arbor, MI
Edward Roybal (D., Los Angeles, CA
Neal Smith, D., Des Moines, IA
Louis Stokes, D., Cleveland, OH
Vin Weber, R., Willmar, MN
C. W. Bill Young, R., St. Petersburg, FL

Senate, Committee on Appropriations, Subcommittee on Labor, Health
and Human Services, Education and Related Agencies:

Brock Adams, D., Washington
Dale Bumpers, D., Arkansas
Quentin Burdick, D., North Dakota
Robert C. Byrd, D., West Virginia
Thad Cochran, R., Mississippi
Slade Gorton, R., Washington
Phil Gramm, R., Texas
Tom Harkin, D., Iowa
Mark Hatfield, R., Oregon
Ernest Hollings, D., South Carolina
Daniel Inouye, D., Hawaii
Harry Reid, D., Nevada
Warren Rudman, R., New Hampshire
Arlen Specter, R., Pennsylvania
Ted Stevens, R., Alaska