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In the United States the early governmental response to the AIDS crisis is considered by many people to have been deplorable. Despite quick action on the part of the Centers for Disease Control (CDC) to determine the causes and modes of transmission of AIDS, its investigations were crippled by underfunding and inadequate staffing. The National Institutes of Health (NIH) moved at what many considered a maddeningly slow pace in opening up the grant process for funding AIDS research, and most early federal funding was forced on the Department of Health and Human Services by congressional appropriations bills. The Reagan administration was silent on the question of AIDS; Reagan did not give a speech on AIDS until 1987, six years after the CDC began work on tracking and controlling the epidemic and after more than twenty thousand Americans had died of the disease.

Although federal funding increased dramatically, it was often too little too late. Moreover, AIDS prevention and education programs were hampered by guidelines written by and resistance from right-wing members of Congress and the administration. Many public health officials had argued for the importance of large-scale HIV testing, but when the federal government began to move toward the articulation of a national prevention policy, discussions often were stymied by right-wing insistence on mandatory testing coupled with a refusal to agree to anonymous testing or guarantee nondiscrimination toward those who tested positive. Moreover, the administration was deeply resistant to AIDS prevention programs that provided education on safe sex. Believing that such programs advocated promiscuity and homosexual behaviors, the Reagan administration advocated prevention programs that emphasized abstinence and moral behavior.

In 1987 Congress passed legislation banning federal funding for educational materials that indirectly or directly promoted homosexual activity. As late as 1988 most federal AIDS policy came from Congress, which continued to push through ever-larger spending bills and challenge the lack of direction provided by the nation's health agencies.

The 1990s saw increased federal involvement in and funding of the AIDS crisis, including the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act, which provided federal funds for organizations providing community-based treatment. Steps were taken to prevent discrimination against HIV-positive individuals, and a federal court struck down the 1988 restrictions on AIDS educational materials. In 1993 the Clinton administration established the White House Office of National AIDS Policy, which was designed to provide federal leadership and guidance in the national response to AIDS, and in 1999 it established the LIFE (Leadership and Investment in Fighting an Epidemic) initiative to address the global AIDS epidemic. Funding for AIDS research, treatment, and education--both nationally and globally--increased throughout the 1990s, and by 2000 both Congress and the Clinton administration had earmarked significant funding for the HIV response and had created a number of agencies and commissions to help develop and implement future AIDS policies.

In 2003 President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion plan to fight AIDS globally. Although Bush was credited for making AIDS a significant part of his foreign policy, his administration was criticized for endorsing abstinence-only prevention programs. One third of PEPFAR funding was reserved for agencies promoting abstinence programs. In 2004 new CDC regulations, which had to be followed by any organization receiving federal money for HIV prevention programs, required that educational materials include information on the lack of effectiveness of condom use and prohibit sexually suggestive content; in 1993 the CDC had issued a statement with the NIH and the U.S. Food and Drug Administration (FDA) declaring that condom use was highly effective in curtailing HIV transmission.

After 2000 the United Nations and the World Health Organization took the lead in organizing global treatment and prevention programs. Such undertakings, however, were underfunded and often fell short of their goals.

References:

Arno, Peter S., and Karyn L. Feiden. 1992. Against the Odds: The Story of AIDS Drug Development, Politics, and Profits. New York: HarperCollins.

Farber, Celia. 2006. Serious Adverse Events: An Uncensored History of AIDS. Hoboken, NJ: Melville House.

Shilts, Randy. 1988. And the Band Played On: Politics, People, and the AIDS Epidemic. New York: Penguin.

Treichler, Paula A. 1999. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham, NC: Duke University Press.

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