Like many single-issue constituency groups that worry about the fate of their programs under the new, Republican-controlled Congress, AIDS advocates are feeling vulnerable.
The GOP revolution has raised serious questions about funding and support for AIDS treatment, education and prevention programs, which have been growing because of strenuous lobbying for more than a decade.
Republicans have made it clear they will spare little in their efforts to achieve deep budget cuts and to turn many spending decisions over to the states--a philosophy likely to take a toll on all programs.
Many AIDS advocates believe they could have a tougher time than most because Congress likely perceives theirs as an unpopular constituency. Everything the Republicans will do "will be done in a cost-saving context, and public relations will not play in our favor," said Christine Lubinksi, who until recently was acting executive director of the Washington-based AIDS Action Council.
"All of these programs that are vital to us will be assaulted under broad budgetary challenges, and it will be difficult to . . . fight for them because other programs, non-AIDS programs, also will be taking hits," she said.
House Appropriations Chairman Rep. Bob Livingston (R-La.) has made it clear that no program will be exempt from scrutiny.
"Everyone who wants to save a program will have to do his or her darndest to explain why that program is necessary--and why it has to be done through the federal government," an aide to the lawmaker said.
The battle over AIDS cuts began recently with two House subcommittees voting to scale back several major programs. Under heavy lobbying pressure from AIDS advocates, some of the money was restored by the full Appropriations Committee--but their fate on the House floor remains uncertain. A vote could come this week.
One subcommittee approved cutting $23 million from the $590 million budgeted for HIV prevention programs of the Centers for Disease Control and Prevention. The panel also attempted to trim $13 million from the $633 million for the Ryan White Care Act, which provides support for direct care, clinics, drug assistance programs, counseling and other services in cities and states hit heavily by AIDS.
Another subcommittee proposed killing a $186-million housing subsidy program for people with AIDS.
The full Appropriations Committee--prodded by Rep. Nancy Pelosi (D-San Francisco)--voted to reject the Ryan White and CDC cuts, although elimination of the housing program still stands.
"We saw these subcommittee proposals as the opening gun in a mean-spirited campaign to erode critical AIDS programs, and we mounted an all-out effort to show them that life-saving AIDS programs must remain, even in tight budget times," said Mark Barnes, executive director of AIDS Action Council.
President Clinton has promised to increase spending above the current AIDS budget, which--excluding entitlements--stands at $2.86 billion. He wants to boost spending for the Ryan White program, named for a teen-age hemophiliac who died of AIDS, to $724 million in fiscal 1996, an increase of $91 million.
Paradoxically, House Speaker Newt Gingrich (R-Ga.) wrote a letter last September to Rep. Thomas J. Bliley Jr. (R-Va.), now chairman of the House Energy and Commerce Committee, supporting reauthorization of the Ryan White program.
Among the other areas of concern for AIDS groups:
* Possible capping, or "block granting," of Medicaid, where about 40% of all AIDS patients end up. The move could result in a loss of services, or a reduction in the eligibility for these services--a potentially serious problem for public hospitals dependent on that money, AIDS advocates say.
* HIV prevention programs at the CDC could be put into a block grant with all other health prevention programs and turned over to state health departments, with the states making the decision about how much of that money should be directed toward HIV-prevention programs.
* Possible new battles over the substance of prevention and education programs, such as sex education, condom distribution in the schools and needle-exchange programs.