In April 1992, a tuxedoed Bob Rafsky, eloquent spokesperson for ACT UP/New York, interrupted a black-tie fundraiser for Bill Clinton’s Presidential campaign. “I’m dying of AIDS, and you’re dying of ambition,” shouted Rafsky, earning him -- and his demand for detailed commitments to fight AIDS -- major media coverage. This and many other protests along the campaign trail played a key role in Clinton’s pre-election promise of “loud, clear and consistent” leadership in the AIDS fight, backed by specific action pledges.

Three and a half years and one fired Surgeon General after Rafsky’s death early in Clinton’s term, how’s the chief executive doing? POZ has repeatedly documented this Administration’s overall lack of AIDS leadership and specific failures on a range of issues: Refusing to lift the ban on needle exchange funding; blocking research on medicinal marijuana; and complete inaction on the White House AIDS office’s own proposals to support youth with or at risk for HIV -- to name but a few.

Last December’s White House Conference on AIDS featured a grand display (carefully avoiding prime-time) of sympathetic Presidential rhetoric and pledges to stand firm against Republican monstrosities. Demonstrating outside, demanding action rather than words, was a community coalition that included POZ, the National Association of PWAs, PWA Coalition/New York, Housing Works and several ACT UP chapters. The group brought a list of 50 specific steps, representing a consensus well beyond the 10 organizations that penned them, that Clinton could take to fight AIDS (POZ No. 12, p. 31). As POZ wrote then, “By using the powers of veto and executive order, each action could be taken with a stroke of the President’s pen.” Several were neglected proposals from Bush’s AIDS Commission. Bowing to Republican Congressional control, the coalition did not even mention the many important AIDS-related bills -- such as the AIDS Cure Act, a way to redeem Clinton’s 1992 promise of a “Manhattan Project” for a cure -- that he could have worked to pass, as he had when it served his campaign contributors, as the corporate-favored North American Free TradeAgreement.The coalition’s recommendations were sent to the Presidential Advisory Council on HIV/AIDS. Council Chair Scott Hitt, a longtime AIDS physician and Clinton fundraiser, acknowledged at the time that our “Fifty for the Future” list included many constructive ideas. Indeed, 20 (marked by asterisks) were included, partially or fully, in the Council’s own recommendations.

By July, even this Council -- filled with loyal Democrats -- was forced to conclude in a “progress report” that “when compared with what truly needs to be done, this administration’s efforts are still insufficient.” It particularly cited a federal prevention policy that is “underdeveloped, lacks focus and is overly timid.” It also castigated what it called “officially sanctioned HIV-related discrimination” by the military, State Department and Foreign Service, which retain mandatory testing policies.

Now we have carefully reviewed the Administration’s performance on the coalition’s 50 proposed actions. Our findings, simplified in report-card form below (see box for grading criteria), paint a disturbing picture.

Promises to veto harmful Republican amendments have evaporated when the measures were passed as riders to other bills -- as witness welfare restrictions that will throw many PWAs off Medicaid, mandatory HIV testing of pregnant women and revocation of strong budget authority for the Office of AIDS Research (OAR). And even before the welfare bill was amended, Clinton’s own proposals -- time limits and funding cuts -- (now law) were bound to produce more HIV-positive homeless people and, inevitably, more deaths.

Meanwhile, the OAR’s much-vaunted blue-ribbon evaluation report -- endorsed by the Administration -- took some small steps forward on research policy proposals (only beginning to be implemented), but refused to address key issues of inappropriate drug company power and underresearched populations and treatments. Overall, Clinton’s appointees have made a few recommended AIDS policy changes (often in response to activist pressure), but most items are simply stalled or, in some cases, opposed by an Administration unwilling to invest any political capital in defending the human rights of communities demonized by the right wing.

So for all the President’s silver-tongued oratory about AIDS, we must give Bill Clinton an overall grade of “D+” on his actions.

Report card by Mark Hannay

F 1.*Veto legislation that inadequately funds or eliminates federal entitlements to Medicaid
B * Medicare
F or welfare
F 2. * Veto legislation coercing pregnant women or newborns to be tested for HIV
D 3. Direct the Centers for Disease Control and Prevention (CDC) to state opposition to mandatory HIV testing of any population or forced AZT use during pregnancy
C 4. * Direct the Health Care Finance Administration (HCFA) to establish AIDS care standards for approval of state Medicaid managed care waivers
C 5. * Direct HCFA to mandate Medicaid coverage of HIV-related off-label drugs and alternative treatments which are clearly useful
C 6. * Direct HCFA to mandate Medicaid coverage of HIV counseling and testing
A 7. * Direct the Health and Human Services (HHS) Department to use the Americans with Disabilities Act to regulate Medicaid managed care waiver applications
D 8. Allow federal inmates to apply for post-release Medicaid coverage
C 9. * Order the Bureau of Prisons to practice HIV standards of care defined by the National Institutes of Health (NIH)
F 10.* Order the Food and Drug Administration (FDA) to stop harassing AIDS buyers’ clubs and requiring individual prescriptions to accompany drug imports
A 11. Order FDA to approve acupuncture needles to facilitate insurance reimbursements
D 12. Direct the Federal Emergency Management Agency to declare D.C. an AIDS disaster area
B 13. Order the Environmental Protection Agency, the Department of Agriculture and HHS to develop guidelines to monitor and test drinking water for cryptosporidium
B 14.* Veto funding cuts for the Housing Opportunities for People With AIDS program at the Housing and Urban Development (HUD) Department
D 15.* Grant the National HIV/AIDS Office of Housing at HUD the authority to require local AIDS housing efforts as a condition for federal funding
C 16. Direct all HUD employees to recognize HIV eligibility for McKinney Act (housing) programs and ensure that local governments allocate mandated funds to AIDS housing
D 17. Order a percentage of AIDS housing dollars set aside for former prisoners and PWAs with drug use or mental illness
C 18. Direct HUD to develop full range of appropriate housing models for PWAs
C 19. Direct HUD to develop medical safety and tenants’ rights standards for all AIDS housing
F 20.* Veto any bill that weakens the budget authority of the NIH Office of AIDS Research (OAR) or fails to set fixed funding levels
F 21. Direct OAR to preserve the community-based AIDS clinical trials network and maintain the budget for all HIV trials
D 22.* Direct OAR to increase the percentage of clinical trials of under-researched treatments in community use
C 23.* Order FDA to require all drug trials to perform gender-specific analysis and halt trials that exclude women of child-bearing potential
D 24. Order NIH to remove barriers to participation by low-income, rural and incarcerated PWAs in clinical trials, on review panels or at conferences
D 25. Direct OAR to hold a conference on pathogenesis theories and to fund large studies of long-term survivors and non-progressors
D 26. Direct NIH to do natural history studies of underresearched populations and confer about priorities with diverse community representatives
D 27. Order NIH to adopt their drafted policy on conflict-of-interest disclosure for members of peer-review committees
F 28. Direct NIH to reinstitute “reasonable pricing” clauses for federally-researched drugs
F 29. Stop blocking the proposed UCSF clinical trial comparing marijuana to Marinol for HIV-related pain, wasting and nausea
C 30. Support the proposed China-UCSF agreement for joint AIDS treatment research
D 31. Direct NIH to to formulate a standard of care for nutritional and dietary treatment of PWAs
B 32.* Direct the Immigration and Naturalization Service (INS) to assume hardship in deportation proceedings for immigrant PWAs
B 33.* Direct INS to recognize PWAs as a protected asylum category
C 34. Order liberal granting of INS waivers of HIV restrictions in family categories
C 35. Direct INS to implement an AIDS training program for staff
F 36. Direct INS to exempt all immigrants with disabilities from new Medicaid and welfare legislation restricting immigrants’ eligibility
F 37. Order CDC and the Department of Education to link federal funding to implementing explicit HIV education programs (including condom distribution)
F 38.* Order that CDC certify the usefulness of needle-exchange programs to remove existing restrictions on using federal funds for such programs
B 39. Direct CDC to summarize the evidence that state syringe-prescription laws promote HIV transmission
D 40. Remove non-legislated content restrictions on federally-funded HIV prevention programs
A 41.* Direct CDC to meet community groups’ requests for technical assistance for HIV prevention
C 42. Reallocate CDC prevention dollars to target under-reached groups, such as prisoners, substance users and gay youth
C 43.* Direct NIH to prioritize development of new drug-abuse treatments (especially for crack addiction)
F 44. Reallocate federal drug-treatment dollars to improve programs for prisoners
D 45. Direct the AIDS Treatment Information Service to include information on nutrition and alternative treatments
C 46.* Speak out against HIV-related discrimination and prejudice based on race, ethnicity or sexual orientation
F 47. Appoint a surgeon general committed to frank AIDS prevention education, needle exchange and a high profile on AIDS issues
D 48. Encourage national media to accurately report on HIV-related diseases
D 49. Direct the 46 federal agencies with arrest power to set guidelines for handling PWAs, and urge state and local authorities to adopt these guidelines
D 50. Commit to international leadership on AIDS, including implementing actions required by the Paris AIDS Summit declaration signed by the U.S., and offer to share data on federally-developed treatments and trial methodology with all countries

*Included, partially or fully, in recommendations of Presidential Advisory Council on HIV/AIDS

Includes actions taken as of August 12,1996