AIDS Research at the NIH: A Critical Review

If AIDS activists ever leave any legacy other than their own bodies, it will be, among other things, a
movement for national health care and the democratization of research.
The pattern of Federal AIDS research funding from 1981 through 93 is:
NIH AlOS Budget by Year
(with rate of Increse from previoue year)
1982 $ 3,355,000 -
1983 21,668,000 5115%
1984 44,121,000 103%
1985 63,737,000 44%
1986 134,667,000 111%
1987 260,907,000 94%
1988 473,285,000 81%
1980 601,316,000 27%
1900 743,532,000 24%
1901 790,821,000 7.6%
1992 841,417,000 5.2%
1993 873,377,000 3.8%
After several years (in the mid 1980s) of program growth, the NIH AIDS budget is now falling relative to
inflation (a 3.8% increase for AIDS research next year, while inflation is predicted to reach 5.1%,
according to the Biomedical Research and Development Price Index computed by the Commerce
Department). From 1982 to 1989, Congress always appropriated much more for AIDS than the
Administration requested. That pattern has now been reversed. In 1991, Congress authorized $3
million Iless than the President requested for AIDS research. For several years, Congress has imposed
new demands on the NIH AIDS program without authorizing new funds with which to carry them out.
For example, in 1990 the Congress earmarked $40M for research on children with AIDS, especially for
clinical trials. Since there was no new money appropriated for this purpose, the funds came directly
from the adult AIDS Clinical Trials Group (ACTG). The result is that now, in 1992, the US Government
is spending $105.00 for research on every child with AIDS in America, compared with just $1.00 for
each adult. The Pediatric ACTG is now as large as the adult ACTG, which has been cut to make ends
meet.
When it comes to research policy, Congress is often like a bull in a china shop, dropping in to make a
mess and then storming out again. For example, also in 1991, Congress imposed new restrictions on
the right of NIH personnel to travel for work. This was ostensibly because some Congressmen feared
that junketeering NIH employees would litter the streets of Florence swilling cappucino rather than
negotiating with drug companies and attending seminars. The result of this mini-scandal was a $10 -million reduction in the overall NIH AIDS budget and severe, ongoing restrictions on NIH travel. This
makes it even more humiliating to work for the government. For the last two years, activist groups
have sent more members to the intemrnational AIDS conferences than has the NIAID Division of AIDS,
the lead agency charged with conducting Federal AIDS research. NIH can still spend other funds
sending extramural experts to Bethesda for meetings, but its own employees are virtual prisoners on
the campus.
While Congress is careless and capricious, the Administration, from the White House down to the
Secretary of Health + Human Services [HHS], has adopted an AIDS strategy of "malign neglect,"
apparently hoping the problem will solve itself. Recently, the US National Commission on AIDS, a third
of whose members were named by the President, condemned the Administration for its inadequate,
inconsistent, and heavily politicized AIDS policy.' Barring a change in administration, it would be
foolish to expect leadership from the White House or HHS on AIDS anytime soon. This creates a
conundrum; officials relatively low within the Executive Branch are delegated leadership on AIDS policy
National Commission on Acquired Immune Deficiency Syndrome. "Commission Cites Tragic Insufficiency
of Administration's AIDS Efforts." Press release, 25 June 1992.