Like so much else with AIDS, Governor Arnold Schwarzenegger’s proposed budget cuts to AIDS programs is a matter of resources, priorities, and political will. Given limited resources, failures in priorities and political will need to be carefully considered, holding those who may have dropped the ball accountable.

A rally sponsored by the San Francisco AIDS Foundation (SFAF) was held January 13th protesting Schwarzenegger’s proposal to place 1,400 Californians onto waiting lists for medications provided under the AIDS Drug Assistance Program (ADAP). But is it just Schwarzenegger, a Republican, who dropped the ball?

Just last September, California Senators Dianne Feinstein and Barbara Boxer failed to co-sponsor Senator Charles Schumer’s (D-NY) amendment to an appropriations bill that would have added $214.8 million to the federal ADAP budget, although they subsequently voted for it. Schumer’s amendment was defeated, in part, by four democrats who voted against it — Senators Thomas Carper (D-DE); Kent Conrad (D-ND); Byron Dorgan (D-ND); and most despicably, Zell Miller (D-GA), in whose state five people reportedly died while languishing on Georgia’s ADAP waiting list — and by two senators running for president, John Edwards (D-NC) and Joe Lieberman (D-CT), who both failed to vote. These six democrats dropped their political-will ball.

The amendment was eventually ruled out of order by the Chair, claiming it would exceed discretionary limits in the Congressional Budget Resolution, which sets overall spending. Discretionary caps did not, however, prevent the Senate from passing President Bush’s $87 billion request for Iraq. The Senate could easily have suspended its rules, approved the $214.8 million needed to rescue ADAP, and still handed Bush $86.78 billion. All 100 senators failed miserably in political will.

Of the 49 Republicans voting against Schumer’s amendment, perhaps some remembered what transpired in 1996, after the ADAP Working Group convinced House Appropriations subcommittee Chairman John Porter (R-IL) to add $100 million to 1997’s federal ADAP budget. The CAEAR Coalition — a group of cities and prominent AIDS organizations, including SFAF, advocating for emergency relief to hard-hit cities — was miffed all $100 million was earmarked solely for ADAP. SFAF’s director of federal affairs, Ernest Hopkins, a CAEAR Coalition member, helped convince Congresswoman Nancy Pelosi to divert $50 million of the 1997 ADAP increase to other portions of the CARE Act, instead. The AIDS Treatment Advocacy Project and the International Association of Physicians for AIDS Care, among others, alleged the money was wrongfully diverted and would undoubtedly lead to premature deaths. Pelosi and Hopkins dropped the ball in 1996; the 49 republican senators may have remembered history all too well.

Returning to the present, the Bay Area Reporter noted on January 8 that Dana Van Gorder, SFAF’s director of state and local affairs, estimated $24 million was needed to rescue California’s ADAP program in FY 2003, and another $45 million would be needed for FY 2004, contradicting SFAF’s web site, which indicates ADAP needs only $25 million for California’s FY 2004-05 budget. But another B.A.R. story on January 15 noted Schwarzenegger proposed only a 2 percent, or $6.6 million, cut to overall HIV/AIDS funding — not $24 million, $25 million, or $45 million. Ignoring for a moment the gaping discrepancies between the various amounts, Van Gorder, sadly, did not note SFAF has already diverted $22.4 million — between grants paid and grants payable — to its African affiliate organization, Pangaea, across a two-year period ending in June 2003. Van Gorder also failed mentioning how much money SFAF has diverted to Africa for the current period ending June 2004; reasonable people wonder whether the cumulative amount sent overseas has now reached $36 million.

In order to fund the minimum of $22.4 million already diverted to Africa, SFAF cut services to its Bay Area clients — including accepting fewer clients, increasing waiting lists for services, and providing less one-on-one counseling time — and simultaneously chopped its grantmaking support to other smaller Bay Area AIDS service organizations, hypocritically turning its back on both constituencies. Between grants paid and grants payable, 53 percent of SFAF’s “program service” expenses ending in June 2003 went to Africa.

How did we get to a point where SFAF has prioritized its insatiable need to make a name for itself in Africa ahead of taking care of the health needs of San Franciscans with HIV/AIDS? Prioritizing global needs ahead of local, domestic needs seems horribly out of whack.

Van Gorder called for a “huge community outcry” at the rally to oppose Arnold’s proposed ADAP budget. But where is the “huge community outcry” over SFAF having prioritized the diversion of massive millions to Africa while ignoring the needs of its own Bay Area neighbors?

If the 23,900 Californians currently enrolled in ADAP were required to pay an annual $500 co-payment, that would raise half of the $24 million needed to rescue ADAP. SFAF could well afford making a $500 co-payment for all 23,900, at a cost of only $11.9 million, which it could have taken from the $13.6 million it sent to Africa in just the period ending June 2003, restoring the remainder to Bay Area services. Other non-profit organizations could pick up the remaining half, and there would be no need for a California ADAP waiting list. For that matter, some (although not all) ADAP clients, such as Paul Wisotzky, a former SFAF board member who is currently board chairman of Pangaea, could afford a $500 co-payment out of their own pocket.

While some argue that non-governmental organizations such as SFAF shouldn’t have to assume healthcare coverage we expect from our government, it’s a matter of priorities. The alternative, as Van Gorder suggested, is to withhold ADAP medications completely for some Californians. Before we have ADAP waiting list deaths in California, and in order to rescue ADAP domestically, these and other accountability failures in priority-setting and political will must be fairly reconsidered.

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SFAF’s Bay Area service cuts are explored in a report posted on www.thelastwatch.com.

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