1995: Politics

[Note: Each year AIDS TREATMENT NEWS publishes a list of
treatments to watch during the coming year. Our list for 1995
was not ready for this issue; it will probably appear in
issue #215.]

As of this writing (January 6), it is too early to know what
threats to AIDS research, care, and prevention will come from
the new Republican-controlled Congress. A serious but little-
noticed concern is that Congress will spend the next six
months debating and passing tax cuts, without telling people
what programs will be cut to pay for them. Then, starting
around July, programs will suddenly and hastily be cut before
the new fiscal year which begins in October. Military
programs, social security, and Medicare -- which are the most
expensive -- will be spared because they have powerful
constituencies, resulting in huge cuts elsewhere (including
Medicaid, which unlike Medicare is only for persons with
financial difficulties). Exactly where the cuts occur will
depend on the strength of political constituencies, not on
the national interest.

Under this scenario, the reauthorization of the Ryan White
CARE Act -- a major priority of AIDS organizations -- could
be relatively easy. But reauthorization is only one step in
funding; money must also be appropriated later. We will need
grassroots public support for both steps.

On AIDS prevention, another concern is that funding from the
U.S. Centers for Disease Control may be put into block grants
to states; then states with conservative administrations may
defund AIDS prevention because it is controversial. With
block grants, state bureaucrats controlled by the governor
and the legislature will make the decisions, eliminating the
community involvement which has developed in Federal
programs.

AIDS should be bipartisan, and there is talk that Washington
AIDS organizations over the years have worked mainly with a
few Democrats, and not built working relationships with other
Democrats, or with moderate Republicans, and their staffs.
(The new Congress could be helpful in some ways, such as
reducing the vast, legally-required inefficiencies in drug
development, allowing small companies to participate
effectively.)

Both parties should remember a nationwide survey, published
by the BOSTON GLOBE on June 17, 1990, page 1, which found
that one American in five personally knew someone who had
AIDS or was HIV positive; the survey questioned 1,000 adults
chosen to be representative of the U.S. population. As far as
we know, no similar survey has been done since, so we do not
have more recent data. But the percentage is probably higher
by now, because there are more cases, and also because there
is more openness about AIDS, so the illness is less likely to
be concealed.

[Incidentally, the same poll which showed that mass
organizing in AIDS is possible also showed why it is
necessary --the huge "compassion gap" depending on how people
were infected. About 88 percent strongly agreed that people
who got AIDS from a blood transfusion should be treated with
compassion. But the figure fell to about 43 percent for those
who got AIDS through a homosexual act, about 42 percent if
through IV drug use, and about 45 percent if through sex with
a drug user.]

Of these 50 million or more people who have a personal
connection with the epidemic, a relative, friend, or
acquaintance whose life is at risk, probably far fewer than
one percent have ever contacted their representatives in
Congress, or any other public officials, to let them know of
their concern. Many members of Congress -- probably most --
never hear from their constituents that AIDS is important to
them. Unless this changes, we are in serious trouble.

A central reason for the silence is that AIDS organizations,
with very few exceptions, have failed to ask the public (in
ways that make sense to those not already heavily involved)
to contact their representatives. Most AIDS "action alerts"
have been written for AIDS professionals; they take many
shared assumptions for granted, and do not explain the
rationale of the issue to the general public. Many of the
largest AIDS political organizations do not even offer
individual memberships, or any other way for non-specialists
to be involved.

Also, most people will not phone or write public officials
alone by themselves, just on the basis of a written document;
they also want to hear about the issue from other people.
AIDS organizations need to support grassroots groups
throughout the country, which could meet frequently and make
their concerns known to their representatives.

Our representatives must hear from us no matter what their
position -- even if they already seem to be committed
enemies, or committed friends. They need to know their
constituents care. And we will need to include political
communication as a regular part of our everyday lives, not
only at elections or when AIDS is in the headlines, but at
all times.

The "AIDS Coffee Klatch," described in the last issue of AIDS
TREATMENT NEWS, is one model for small, local groups. We had
to start independently, as national AIDS organizations are
not doing this work. And we had to write our own action
alerts, because most of the existing ones proved unusable.
Small citizens' groups should not need to do this.

The AIDS community is facing disaster if it does not do a
better job of grassroots organizing. It must bring together
the organizers who can do the work with those who can fund
them. And it must support local groups with policy
recommendations and action alerts which both activists and
the public can fully endorse. And it must develop a
"corporate culture" of day-in, day-out mass mobilization of
support.