Today Rep. Nancy Pelosi (D-SF) sent a letter to Health and Human Services Secretary Tommy Thompson expressing her concern about a recent Administration report that mischaracterizes HIV prevention programs at the San Francisco Stop AIDS Project.
The San Francisco Stop AIDS Project provides vital health information on HIV prevention through neighborhood outreach, community forums, and workshops. In November, the Office of Inspector General at the Department of Health and Human Services issued a report that makes questionable claims about the Stop AIDS Project.
Pelosi writes in the letter:
“Community-based organizations play a vital role in our public health infrastructure because they combine programmatic expertise with extensive knowledge of the target populations they serve. The federal government has a responsibility to support the difficult, and often heroic, work of these organizations.
“We all agree that federal funds must be spent appropriately and properly monitored. However, the mischaracterizations in this IG report could undermine the work of an effective organization, and inadvertently contribute to the burden of disease and death among gay and bisexual men.”
The complete text of the letter to Secretary Thompson follows:
December 13, 2001
Tommy G. Thompson
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
Dear Secretary Thompson:
Thank you for your leadership in the Department of Health and Human Services’ efforts to provide treatment and care to those living with HIV/AIDS, and to prevent new HIV infections in this country and across the globe. Your continued commitment to these vital programs is greatly appreciated. I am writing to express my strong concern about the Office of the Inspector General Report on HIV prevention programs at the San Francisco Stop AIDS Project, issued by Janet Rehnquist on November 16, 2001. I believe the report seriously mischaracterizes the work of this unique community-based organization and ask that potential punitive measures against Stop AIDS Project be set aside in favor of strengthening technical assistance from the Centers for Disease Control and Prevention to this and other HIV prevention entities to assist them in adhering to federal regulatory, administrative and programmatic requirements.
The federal government has made a commitment to work with local communities to do what is necessary to reduce the spread of this terrible disease, and save lives. That commitment includes providing education and prevention messages that young, sexually active individuals, and others at high risk for HIV infection, will understand and respond to as they make decisions about their behavior. As Scott Evertz, Director of the White House Office of AIDS Policy, stated at the Youth and HIV Prevention: New Directions conference on November 30, “It is very important that messages be targeted to the audience that they are being directed to. And in some cases, that may mean something that my 76-year old mother in a suburb of St. Louis may not want to see, but that someone living in the Castro in San Francisco has to hear.”
Evidence in San Francisco documents that the number of new HIV infections among gay and bisexual men doubled between 1997 and 2001. As the CDC will confirm, these trends have also been reported in other US cities as well as in Canada, France, the United Kingdom, Germany and Australia. AIDS still is an urgent public health crisis, and the CDC must target effective HIV prevention programs to gay and bisexual men. Stop AIDS Project is the only community-based organization in San Francisco with a specific mission to prevent HIV among gay and bisexual men. As such, its targeted services respond to these trends and are crucial in my community.
The report issued by the Office of the Inspector General makes several questionable claims about the work of Stop AIDS Project and the use of HIV prevention funds in San Francisco. Specifically, the report claims that CDC guidelines on AIDS-related materials, issued on June 15, 1992, were violated because materials used for workshops, in the opinion of the IG, directly encouraged sexual activity and were “obscene”. However, the workshop materials in question were focused on HIV prevention activities and included information about the potentially harmful effects of promiscuous sexual activity. More importantly, the Supreme Court ruled in Miller vs. California that these prohibitions are to be determined by local community standards. The report states that the Office of the Inspector General did not attend any of the workshops in question. However, representatives from the CDC have attended three workshops and did not report them to be promoting sexual activity or “obscene”.
The CDC attempted to implement a national “offensiveness” standard in the late 1980’s. However, this national standard was determined to be unconstitutional and was struck down by the U.S. District Court for the Southern District of New York on May 11, 1992 in Gay Men’s Health Crisis vs. Sullivan. Currently, grantees are required to comply with a materials review process based on local community standards. Stop AIDS Project submitted its workshop promotional materials for review prior to conducting the workshops, and was in compliance with the materials review requirements as it understood them. Today, Stop AIDS Project is working with the San Francisco Department of Public Health and the CDC to insure full compliance with the materials review process, and curriculum for all workshops are being submitted to the local review panel, as are all other printed materials.
Stop AIDS Project has received direct funding from the CDC since 1990, and has faced the same administrative challenges that many small community-based organizations confront. However, the organization has conducted annual external audits of its contracts, and there have never been any violations found in these audits. As noted above, steps have been taken to address the concerns that were raised in Ms. Rehnquist’s report.
As you know, community-based organizations play a vital role in our public health infrastructure because they combine programmatic expertise with extensive knowledge of the target populations they serve. The federal government has a responsibility to support the difficult, and often heroic, work of these organizations. Through innovative approaches that include neighborhood outreach, community forums, and workshops, Stop AIDS Project provides vital health information to gay and bisexual men in my community. For nearly twenty years, Stop AIDS Project has been an example for HIV educators nationwide, and its mission continues to be essential in responding to the HIV/AIDS epidemic in San Francisco and across the country.
We all agree that federal funds must be spent appropriately and properly monitored. However, the mischaracterizations in this IG report could undermine the work of an effective organization, and inadvertently contribute to the burden of disease and death among gay and bisexual men. Fortunately, you have the expertise within the CDC and NIH to shape a prompt and effective response to this reemerging public health crisis. Your leadership in this response can make an important difference in saving precious lives.
Thank you for your consideration of these concerns, and your commitment to the fight against HIV/AIDS. I look forward to working with you to ensure that those at risk for HIV infection receive accurate and appropriate information on HIV prevention.
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