Remarks on “Creating an AIDS-Free Generation” by Hillary Clinton

Remarks on “Creating an AIDS-Free Generation”

Hillary Rodham Clinton
Secretary of State
National Institutes of Health’s Masur Auditorium
November 8, 2011
(source with video)

Thank you. Thank you very much. Thank you. And it is, for me, a distinct personal pleasure to be back here at NIH, a set of institutions that I admire so much and which are so critically important not only to our own country and to the future of science here but indeed around the world.
I want to begin by thanking Francis Collins for his leadership and for the work that he has done. I well remember those times talking about your research and the extraordinary excitement around it, Francis.

And I want to thank Tony for his kind words but also his leadership. It’s not easy to follow one of the top 20 federal employees of all time. (Laughter.) But I think Government Executive Magazine got it just right – a richly deserved recognition.

As I came in, I saw some other friends: Dr. Harold Varmus, with whom I’ve had the privilege to work both when he was here at NIH and then in New York; Dr. Nora Volkow and her work which is so important; and Dr. John Gallin as well.

But for me, this is a special treat because here in this room are some of America’s best scientists and most passionate advocates, true global health heroes and heroines, in an institution that is on the front lines of the fight against HIV/AIDS.

I want to recognize some special people who are here today: Ambassador Eric Goosby, our Global AIDS Coordinator, and his predecessor, Mark Dybul; Lois Quam, the executive director of our Global Health Initiative; Dr. Tom Frieden from the Centers for Disease Control and Prevention; UNAIDS Executive Director Michel Sidibe; and others who are part of this Administration’s global health efforts and the multilateral organizations with which we work.

I also want to acknowledge two people who could not be with us: first, USAID Administrator Dr. Raj Shah, who has had such a positive impact on our health and development work; and, second, I am delighted to announce our new special envoy. We love special envoys at the State Department. (Laughter.) Our new Special Envoy for Global AIDS Awareness: Ellen DeGeneres. (Applause.) And Ellen is going to bring not only her sharp wit and her big heart, but her impressive TV audience and more than 8 million followers on Twitter, to raise awareness and support for this effort. I know we can look forward to many contributions from Ellen and her loyal fans across the globe.

Now, many of you know because you were there: The fight against AIDS began three decades ago in June 1981. American scientists reported the first evidence of a mysterious new disease. It was killing young men by leaving them vulnerable to rare forms of pneumonia, cancer, and other health problems. Now, at first, doctors knew virtually nothing about this disease. Today, all those years later, we know a great deal.

We know, of course, about its horrific impact. AIDS has killed 30 million people around the world, and 34 million are living with HIV today. In Sub-Saharan Africa—where 60 percent of the people with HIV are women and girls—it left a generation of children to grow up without mothers and fathers or teachers. In some communities, the only growth industry was the funeral business.

Thirty years later, we also know a great deal about the virus itself. We understand how it is spread, how it constantly mutates in the body, how it hides from the immune system. And we have turned this knowledge to our advantage—developing ingenious ways to prevent its transmission and dozens of drugs that keep millions of people alive. Now, AIDS is still an incurable disease, but it no longer has to be a death sentence.

Finally, after 30 years, we know a great deal about ourselves. The worst plague of our lifetime brought out the best in humanity. Around the world, governments, businesses, faith communities, activists, individuals from every walk of life have come together, giving their time, their money—along with their heads and hearts—to fight AIDS.

Although the past 30 years have been a remarkable journey, we still have a long, hard road ahead of us. But today, thanks both to new knowledge and to new ways of applying it, we have the chance to give countless lives and futures to millions of people who are alive today, but equally, if not profoundly more importantly, to an entire generation yet to be born.

Today, I would like to talk with you about how we arrived at this historic moment and what the world now can and must do to defeat AIDS.

From its earliest days, the fight against HIV/AIDS has been a global effort. But in the story of this fight, America’s name comes up time and again. In the past few weeks, I’ve spoken about various aspects of American leadership, from creating economic opportunity to preserving peace and standing up for democracy and freedom. Well, our efforts in global health are another strong pillar in our leadership. Our efforts advance our national interests. They help make other countries more stable and the United States more secure. And they are an expression of our values—of who we are as a people. And they generate enormous goodwill.

At a time when people are raising questions about America’s role in the world, our leadership in global health reminds them who we are and what we do, that we are the nation that has done more than any other country in history to save the lives of millions of people beyond our borders.

Our efforts must begin with the American public: from people living with the disease, to researchers in academic medical centers; to individual donors, businesses, and foundations; and philanthropies – two of my favorite ones, the Clinton Foundation – (laughter) – which helped make treatment more affordable by supporting innovative ways to manufacture and purchase drugs; the Bill & Melinda Gates Foundation, which has underwritten breakthrough research.

But let’s remind ourselves no institution in the world has done more than the United States Government. (Applause.) We have produced a track record of excellence in science. Researchers right here at the NIH conducted pivotal research that identified HIV and proved that it did cause AIDS. The first drug to treat AIDS was supported by the United States. Today we are making major investments in the search for a vaccine; for tools like microbicides, which give women the power to protect themselves; and other lifesaving innovations.

Alongside our research and development work, the United States has led a global effort to bring these advances to bear in saving lives. When my husband was president, he appointed America’s first AIDS czar and more than tripled U.S. investments in preventing and treating AIDS worldwide. And in 2003, President Bush, with strong bipartisan support from Congress, made the momentous decision to launch the President’s Emergency Plan for AIDS Relief, or PEPFAR.

At that time, only 50,000 people in Sub-Saharan Africa were receiving the antiretroviral drugs that would keep them alive. Now, more than 5 million do, along with more than a million people in other regions of the world, and the vast majority receive drugs financed by either PEPFAR or the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which the United States helped create.

And PEPFAR is having an impact far beyond AIDS. It has expanded on the World Health Organization’s efforts to treat and prevent tuberculosis, which is the leading cause of death among people with AIDS. PEPFAR has also helped build new facilities throughout our partner countries that see patients not just for HIV/AIDS, but for malaria, for immunizations, and much more. To staff these clinics, we have helped train a new cadre of professional health workers who are making their countries more self-sufficient. In some countries, the same trucks that deliver AIDS medicine now also deliver bed nets to prevent malaria.

For all these reasons, PEPFAR is one of the strong platforms upon which the Obama Administration is building our Global Health Initiative, which supports one-stop clinics offering an array of health services while driving down costs, driving up impact, and saving more lives. I say all of this because I want the American people to understand the irreplaceable role the United States has played in the fight against HIV/AIDS. It is their tax dollars, our tax dollars, that have made this possible, and we need to keep going.

To be sure, we have done it in an ever-expanding partnership with other governments, multilateral institutions, implementing organizations, the private sector, civil society groups, especially those led by people living with the virus. But the world could not have come this far without us, and it will not defeat AIDS without us.

What’s more, our efforts have helped set the stage for a historic opportunity, one that the world has today: to change the course of this pandemic and usher in an AIDS-free generation.

Now, by an AIDS-free generation, I mean one where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.

Now, HIV may be with us well into the future. But the disease that it causes need not be. This is, I admit, an ambitious goal, and I recognize I am not the first person to envision it. But creating an AIDS-free generation has never been a policy priority for the United States Government until today, because this goal would have been unimaginable just a few years ago. Yet today, it is possible because of scientific advances largely funded by the United States and new practices put in place by this Administration and our many partners. Now while the finish line is not yet in sight, we know we can get there, because now we know the route we need to take. It requires all of us to put a variety of scientifically proven prevention tools to work in concert with each other. Just as doctors talk about combination treatment – prescribing more than one drug at a time – we all must step up our use of combination prevention.

America’s combination prevention strategy focuses on a set of interventions that have been proven most effective – ending mother-to-child transmission, expanding voluntary medical male circumcision, and scaling up treatment for people living with HIV/AIDS. Now of course, interventions like these can’t be successful in isolation. They work best when combined with condoms, counseling and testing, and other effective prevention interventions. And they rely on strong systems and personnel, including trained community health workers. They depend on institutional and social changes like ending stigma; reducing discrimination against women and girls; stopping gender-based violence and exploitation, which continue to put women and girls at higher risk of HIV infection; and repealing laws that make people criminals simply because of their sexual orientation.

Even as we recognize all these crucial elements, today I want to focus on the three key interventions that can make it possible to achieve an AIDS-free generation. First, preventing mother-to-child transmission. Today, one in seven new infections occurs when a mother passes the virus to her child. We can get that number to zero. I keep saying zero; my speechwriter keeps saying “Virtually zero.” (Laughter, applause.) And we can save mother’s lives too.

In June, I visited the Buguruni Health Center in Tanzania, and there I met a woman living with HIV who had recently given birth to a baby boy. She had been coming to the clinic throughout her pregnancy for medication and information because she desperately wanted her boy to get a healthy start in life, and most especially, she wanted him to be born HIV-free. When we met, she had just received the best news she could have hoped for. Her son did not have the virus. And thanks to the treatment she was getting there, she would live to see him grow up.

This is what American leadership and shared responsibility can accomplish for all mothers and children. The world already has the necessary tools and knowledge. Last year alone, PEPFAR helped prevent 114,000 babies from being born with HIV. Now, we have a way forward too. PEPFAR and UNAIDS have brought together key partners to launch a global plan for eliminating new infections among children by 2015. And we continue to integrate prevention and treatment efforts with broader health programs, which not only prevents HIV infections, but also keeps children healthy and helps mothers give birth safely.

In addition to preventing mother-to-child transmission, an effective combination prevention strategy has to include voluntary medical male circumcision. In the past few years, research has proven that this low-cost procedure reduces the risk of female-to-male transmission by more than 60 percent, and that the benefit is life-long.

Since 2007, some 1,000,000 men around the world have been circumcised for HIV prevention. Three fourths of these procedures have been funded by PEPFAR. In Kenya and Tanzania alone, during special campaigns, clinicians perform more than 35,000 circumcisions a month.

In the fight against AIDS, the ideal intervention is one that prevents people from being infected in the first place, and the two methods I’ve described – mother-to-child transmission, voluntary medical male circumcision – are the most cost-effective interventions we have, and we are scaling them up. But even once people do become HIV-positive, we can still make it far less likely that they will transmit the virus to others by treating them with the antiretroviral drugs. So this is the third element of combination prevention that I want to mention.

Thanks to U.S. Government-funded research published just a few months ago, we now know that if you treat a person living with HIV effectively, you reduce the risk of transmission to a partner by 96 percent.

Of course, not everyone takes the medication exactly as directed, and so some people may not get the maximum level of protection. But even so, this new finding will have a profound impact on the fight against AIDS.

For years, some have feared that scaling up treatment would detract from prevention efforts. Now we know beyond a doubt if we take a comprehensive view of our approach to the pandemic, treatment doesn’t take away from prevention. It adds to prevention. So let’s end the old debate over treatment versus prevention and embrace treatment as prevention.

There’s no question that scaling up treatment is expensive. But thanks to lower costs of drugs, bulk purchasing, and simple changes like shipping medication by ground instead of air, we and our partners are reducing the cost of treatment. In 2004, the cost to PEPFAR for providing ARVs and services to one patient averaged nearly $1,100 a year. Today, it’s $335 and falling. Continuing to drive down these costs is a challenge for all of us, from donors and developing countries to institutions like the Global Fund.

Treating HIV-positive people before they become ill also has indirect economic benefits. It allows them to work, to support their families, contribute to their communities. It averts social costs, such as caring for orphans whose parents die of AIDS-related illnesses. A study published just last month weighed the costs and benefits and found that – I quote – “the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.” In other words, treating people will not only save lives, it will generate considerable economic returns as well.

Now, some people have concerns about treatment as prevention. They argue that many people transmit the virus to others shortly after they have acquired it themselves, but before they have begun treatment. That is a legitimate concern, and we are studying ways to identify people sooner after transmission and help them avoid spreading the virus further. But to make a big dent in this pandemic, we don’t need to be able to identify and treat everyone as soon as they are HIV-positive. In places where the pandemic is well established, as it is in most of Sub-Saharan African countries, most transmissions come not from people who are newly infected, but from people with longstanding HIV infections who need treatment now or soon will. We already have the tests we need to identify these people. If they receive and maintain their treatment, their health will improve dramatically, and they will be far less likely to transmit the virus to their partners.

Now let me be clear: None of the interventions I’ve described can create an AIDS-free generation by itself. But used in combination with each other and with other powerful prevention methods, they do present an extraordinary opportunity. Right now, more people are becoming infected every year than are starting treatment. We can reverse this trend. Mathematical models show that scaling up combination prevention to realistic levels in high-prevalence countries would drive down the worldwide rate of new infections by at least 40 to 60 percent. That’s on top of the 25 percent drop we’ve already seen in the past decade.

As the world scales up the most effective prevention methods, the number of new infections will go down, and it will be possible to treat more people than are becoming infected each year. And so, instead of falling behind year after year, we will, for the first time, get ahead of the pandemic. We will be on the path to an AIDS-free generation. That is the real power of combination prevention.

But success is not inevitable, nor will it be easy. Coverage levels for many of these interventions are unacceptably low. And we know from experience that to scale them up, we have to be able to deliver them not just in hospitals, but in clinics located in communities of every size and shape. If we’re going to make the most of this moment, there are steps we must take together.

First, we need to let science guide our efforts. Success depends on deploying our tools based on the best available evidence. Now, I know that occasionally it feels in and around Washington that there are some who wish us to live in an evidence-free zone. (Laughter.) But it’s imperative – (applause) – that we stand up for evidence and for science. Facts are stubborn things, and we need to keep putting them out there, even though they might, in the short term, be dismissed. Eventually, we will prevail.

Through PEPFAR and across the government, the United States is using scientifically proven results to inform our policy, which leads to real change for programs on the ground and maximizes the impact of our investments. For example, we need more research to identify the most effective ways to combine these interventions in different contexts. We know HIV is a complex pandemic that varies from country to country, district to district, from urban areas to rural. It’s the same in our own country. Combination prevention needs to reflect this complexity. Which combinations are most effective in areas where the virus is concentrated in especially vulnerable populations? What about places where it is more widespread in the general population?

We’re already working to answer these questions. We recently granted more than $50 million to three of the world’s leading academic institutions to develop rigorous studies that test what works in various settings. Today, I’m pleased to announce that we’re stepping up our efforts. The United States, through PEPFAR, will commit an additional $60 million to rapidly scale up combination prevention in parts of four countries in Sub-Saharan Africa and to rigorously measure the impact.

The results will have implications for every country where we work and for our partners as well. They will help ensure that we are translating the science into services that deliver the most impact and will allow us to take bigger steps together in our march toward an AIDS-free generation. I want to challenge other donors to join us in this effort. Go out and find partner countries that will work with you to test the most effective combinations of tools. Scale up support for treating as many people as possible. Measure the impact and share the results, so we can all learn from each other.

The second step is to put more emphasis on country ownership of HIV/AIDS programs. This is a priority for the United States. We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners – including governments, NGOs, and faith-based organizations – need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.

Country ownership also means that more partner countries need to share more responsibility for funding the fight against HIV/AIDS within their borders. Some countries have allowed money from outside donors to displace their own investments in health programs; well, if PEPFAR or the Global Fund or another donor is going to be giving us money for health, we can just take that money out of health and build some more roads. That has to change and we have to demand that it change. More countries need to follow the lead of South Africa, Nigeria, Senegal, Rwanda, Zambia, and others that are committing larger shares of their own budgets to HIV/AIDS.

Finally, we’re calling on other donor nations to do their part, including by supporting and strengthening the Global Fund. Consider just one example of what the Global Fund has already done. In 2004, virtually none of the people in Malawi who were eligible to receive treatment actually received it. As of last year, with significant help from the Global Fund, nearly half did.

This kind of progress deserves our support. The United States is the largest individual contributor to the Fund, and the Obama Administration has made our country’s first multiyear pledge to it. Some donors are, unfortunately, considering reducing their contributions. Some emerging powers and nations that are rich in natural resources can afford to give, but choose not to. To sit on the sidelines now would be devastating. It would cost lives, and we would miss out on this unprecedented opportunity. When so many people are suffering, and we have the means to help them, we have an obligation to do what we can.

And for its part, the Global Fund has its own responsibilities to meet. The United States has supported reforms at the Fund to ensure that its resources are reaching those in need and that they are focused on cost-effective, evidence-based solutions. The Fund is conducting a number of audits and investigations that have surfaced reports of fraud and corruption. It is the Fund’s responsibility to root out these abuses and end them as quickly as possible.

But let’s remember, uncovering problems is exactly what transparency is supposed to do. It means the process is working. So let’s not put the Global Fund into some kind of catch-22. Go be transparent, go be accountable, and when you find problems, we’re going to take money away from you. Now, from day one, the United States Congress has insisted that our contributions to the Global Fund support accountable programs that produce measurable outcomes. And it’s been my experience that the American people are happy to support lifesaving programs if they know they really work. And this is how we show them.

The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now. And that is something we’ve never been able to say without qualification before. Imagine what the world will look like when we succeed. Imagine AIDS wards that once were stretched far beyond their capacity becoming outpatient clinics caring for people with a manageable condition, children who might have been orphaned and then trafficked or recruited as child soldiers instead growing up with the hope of a better future, communities where despair once reigned filled instead with optimism, countries that can make the most of every single person’s God-given potential. That is the world that has always been at the core of American belief, and we have worked toward it in our own history. It’s the world I think we all would like to live in. An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.

Much of what we do will depend upon the people in this room and the hundreds and thousands like you – the researchers and scientists, the public health docs and nurses and other personnel, the community health workers, the funders and donors, the government officials, the business leaders, philanthropies, and faith communities that have all joined together in this quite remarkable way to combat this disease.

So I end where I started. We’ve made a lot of progress together in the last 30 years. It hasn’t been easy. It hasn’t been without controversy. But it has been steady, and we have stayed the course as a nation. In these difficult budget times, we have to remember that investing in our future is the smartest investment we can make. And generations of American policymakers and taxpayers have supported the NIH, medical research, scientific work, not because we thought everything was going to produce an immediate result but because we believe that through these investments, human progress would steadily, steadily continue.

Let’s not stop now. Let’s keep focused on the future. And one of those futures that I hope we can be part of achieving is an AIDS-free generation. Thank you all very much. (Applause.)

Why We Fight

by Vito Russo of ACT UP
ACT UP “9 Days of Protest” Demonstration
Albany, NY,
May 9, 1988
Also delivered at the ACT UP Demonstration at the Department of Health and Human Services, Washington D.C. October 10, 1988
(source, includes video)

VITO RUSSO: A friend of mine in New York City has a half-fare transit card, which means that you get on buses and subways for half price. And the other day, when he showed his card to the token attendant, the attendant asked what his disability was and he said, I have AIDS. And the attendant said, no you don’t, if you had AIDS, you’d be home dying. And so, I wanted to speak out today as a person with AIDS who is not dying.

You know, for the last three years, since I was diagnosed, my family thinks two things about my situation. One, they think I’m going to die, and two, they think that my government is doing absolutely everything in their power to stop that. And they’re wrong, on both counts.

So, if I’m dying from anything, I’m dying from homophobia. If I’m dying from anything, I’m dying from racism. If I’m dying from anything, it’s from indifference and red tape, because these are the things that are preventing an end to this crisis. If I’m dying from anything, I’m dying from Jesse Helms. If I’m dying from anything, I’m dying from the President of the United States. And, especially, if I’m dying from anything, I’m dying from the sensationalism of newspapers and magazines and television shows, which are interested in me, as a human interest story — only as long as I’m willing to be a helpless victim, but not if I’m fighting for my life.

If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS for anybody to give a shit. You know, living with AIDS in this country is like living in the twilight zone. Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them. They’re walking the streets as though we weren’t living through some sort of nightmare. And only you can hear the screams of the people who are dying and their cries for help. No one else seems to be noticing.

And it’s worse than a war, because during a war people are united in a shared experience. This war has not united us, it’s divided us. It’s separated those of us with AIDS and those of us who fight for people with AIDS from the rest of the population.

Two and a half years ago, I picked up Life Magazine, and I read an editorial which said, “it’s time to pay attention, because this disease is now beginning to strike the rest of us.” It was as if I wasn’t the one holding the magazine in my hand. And since then, nothing has changed to alter the perception that AIDS is not happening to the real people in this country.

It’s not happening to us in the United States, it’s happening to them — to the disposable populations of fags and junkies who deserve what they get. The media tells them that they don’t have to care, because the people who really matter are not in danger. Twice, three times, four times — The New York Times has published editorials saying, don’t panic yet, over AIDS — it still hasn’t entered the general population, and until it does, we don’t have to give a shit.

And the days, and the months, and the years pass by, and they don’t spend those days and nights and months and years trying to figure out how to get hold of the latest experimental drug, and which dose to take it at, and in what combination with other drugs, and from what source? And, how are you going to pay for it? And where are you going to get it? Because it isn’t happening to them, so they don’t give a shit.

And they don’t sit in television studios, surrounded by technicians who are wearing rubber gloves, who won’t put a microphone on you, because it isn’t happening to them, so they don’t give a shit. And they don’t have their houses burned down by bigots and morons. They watch it on the news and they have dinner and they go to bed, because it isn’t happening to them, and they don’t give a shit.

And they don’t spend their waking hours going from hospital room to hospital room, and watching the people that they love die slowly — of neglect and bigotry, because it isn’t happening to them and they don’t have to give a shit. They haven’t been to two funerals a week for the last three or four or five years — so they don’t give a shit, because it’s not happening to them.

And we read on the front page of The New York Times last Saturday that Anthony Fauci now says that all sorts of promising drugs for treatment haven’t even been tested in the last two years because he can’t afford to hire the people to test them. We’re supposed to be grateful that this story has appeared in the newspaper after two years. Nobody wonders why some reporter didn’t dig up that story and print it 18 months ago, before Fauci got dragged before a Congressional hearing .

How many people are dead in the last two years, who might be alive today, if those drugs had been tested more quickly? Reporters all over the country are busy printing government press releases. They don’t give a shit, it isn’t happening to them — meaning that it isn’t happening to people like them — the real people, the world-famous general public we all keep hearing about.

Legionnaire’s Disease was happening to them because it hit people who looked like them, who sounded like them, who were the same color as them. And that fucking story about a couple of dozen people hit the front page of every newspaper and magazine in this country, and it stayed there until that mystery got solved.

All I read in the newspapers tells me that the mainstream, white heterosexual population is not at risk for this disease. All the newspapers I read tell me that IV drug users and homosexuals still account for the overwhelming majority of cases, and a majority of those people at risk.

And can somebody please tell me why every single penny allocated for education and prevention gets spent on ad campaigns that are directed almost exclusively to white, heterosexual teenagers — who they keep telling us are not at risk!

Can somebody tell me why the only television movie ever produced by a major network in this country, about the impact of this disease, is not about the impact of this disease on the man who has AIDS, but of the impact of AIDS on his white, straight, nuclear family? Why, for eight years, every newspaper and magazine in this country has done cover stories on AIDS only when the threat of heterosexual transmission is raised?

Why, for eight years, every single educational film designed for use in high schools has eliminated any gay positive material, before being approved by the Board of Education? Why, for eight years, every single public information pamphlet and videotape distributed by establishment sources has ignored specific homosexual content?

Why is every bus and subway ad I read and every advertisement and every billboard I see in this country specifically not directed at gay men? Don’t believe the lie that the gay community has done its job and done it well and educated its people. The gay community and IV drug users are not all politicized people living in New York and San Francisco. Members of minority populations, including so called sophisticated gay men are abysmally ignorant about AIDS.

If it is true that gay men and IV drug users are the populations at risk for this disease, then we have a right to demand that education and prevention be targeted specifically to these people. And it is not happening. We are being allowed to die, while low risk populations are being panicked — not educated, panicked — into believing that we deserve to die.

Why are we here together today? We’re here because it is happening to us, and we do give a shit. And if there were more of us AIDS wouldn’t be what it is at this moment in history. It’s more than just a disease, which ignorant people have turned into an excuse to exercise the bigotry they have always felt.

It is more than a horror story, exploited by the tabloids. AIDS is really a test of us, as a people. When future generations ask what we did in this crisis, we’re going to have to tell them that we were out here today. And we have to leave the legacy to those generations of people who will come after us.

Someday, the AIDS crisis will be over. Remember that. And when that day comes — when that day has come and gone, there’ll be people alive on this earth — gay people and straight people, men and women, black and white, who will hear the story that once there was a terrible disease in this country and all over the world, and that a brave group of people stood up and fought and, in some cases, gave their lives, so that other people might live and be free.

So, I’m proud to be with my friends today and the people I love, because I think you’re all heroes, and I’m glad to be part of this fight. But, to borrow a phrase from Michael Callen’s song: all we have is love right now, what we don’t have is time.

In a lot of ways, AIDS activists are like those doctors out there — they’re so busy putting out fires and taking care of people on respirators, that they don’t have the time to take care of all the sick people. We’re so busy putting out fires right now, that we don’t have the time to talk to each other and strategize and plan for the next wave, and the next day, and next month and the next week and the next year.

And, we’re going to have to find the time to do that in the next few months. And, we have to commit ourselves to doing that. And then, after we kick the shit out of this disease, we’re all going to be alive to kick the shit out of this system, so that this never happens again.


We Are not Crumbs; We Must Not Accept Crumbs

by Larry Kramer
Remarks on the occasion of the 20th Anniversary of ACT UP
NY Lesbian and Gay Community Center
March 13, 9007

Rodger McFarlane, Eric Sawyer, Jim Eigo, Peter Staley, Troy Masters, Mark Harrington, David Webster, Jeremy Waldron, and Hannah Arendt contributed to the following remarks.

One day AIDS came along. It happened fast. Almost every man I was friendly with died. Eric still talks about his first boyfriend, 180 pounds, 28 years old, former college athlete, who became a 119 pound bag of bones covered in purple splotches in months. Many of us will always have memories like this that we can never escape.

Out of this came ACT UP. We grew to have chapters and affinity groups and spin-offs and affiliations all over the world. Hundreds of men and women once met weekly in New York City alone. Every single treatment against HIV is out there because of activists who forced these drugs out of the system, out of the labs, out of the pharmaceutical companies, out of the government, into the world. It is an achievement unlike any other in the history of the world. All gay men and women must let ourselves feel colossally proud of such an achievement. Hundreds of millions of people will be healthier because of us. Would that they could be grateful to us for saving their lives.

So many people have forgotten, or never knew what it was like. We must never let anyone forget that no one, and I mean no one, wanted to help dying faggots. Sen. Edward Kennedy described it in 2006 as “the appalling indifference to the suffering of so many.” Ronald Reagan had made it very clear that he was “irrevocably opposed” to anything to do with homosexuality. It would be seven years into his reign before he even said the word “AIDS” out loud, by which time almost every gay man in the entire world who’d had sex with another man had been exposed to the virus. During this entire time his government issued not one single health warning, not one single word of caution. Who cares if a faggot dies. I believe that Ronald Reagan is responsible for more deaths than Adolf Hitler. This is not hyperbole. This is fact.

These are just a few of the things ACT UP did to make the world pay attention: We invaded the offices of drug companies and scientific laboratories and chained ourselves to the desks of those in charge. We chained ourselves to the trucks trying to deliver a drug company’s products. We liberally poured buckets of fake blood in public places. We closed the tunnels and bridges of New York and San Francisco. Our Catholic kids stormed St. Patrick’s at Sunday Mass and spit out Cardinal O’Connor’s host. We tossed the ashes from dead bodies from their urns on to the White House lawn. We draped a gigantic condom over Jesse Helms’ house. We infiltrated the floor of the New York Stock Exchange for the first time in its history so we could confetti the place with flyers urging the brokers to “SELL WELLCOME.” We boarded ourselves up inside Burroughs-Wellcome, (now named GlaxoSmithKline), which owns AZT, in Research Triangle so they had to blast us out. We had regular demonstrations, Die-Ins we called them, at the Food and Drug Administration and the National Institutes of Health, at City Halls, at the White House, in the halls of Congress, at government buildings everywhere, starting with our first demonstration on Wall Street, where crowds of us lay flat on the ground with our arms crossed over our chests or holding cardboard tombstones until the cops had to cart us away by the vans-full. We had massive demonstrations at the FDA and the NIH. There was no important meeting anywhere that we did not invade, interrupt, and infiltrate. We threatened Bristol-Myers that if they did not distribute it immediately we would manufacture it ourselves and distribute a promising drug some San Francisco activists had stolen from its Canadian factory and had duplicated. (The drug, now known as Videx, was released. Ironically Videx was discovered at Yale, where I went to school and with whom I am still engaged in annoyingly delicious activist battles to shape them up; they too are a stubborn lot.) We utterly destroyed a Hoffmann-LaRoche luncheon when they delayed a decent drug’s release. And always, we went after the New York Times for their shockingly, tragically, inept reporting of this plague. We plastered this city with tens of thousands of stickers reading, “Gina Kolata of the New York Times is the worst AIDS reporter in America.” We picketed the Fifth Avenue home of the publisher of the Times, one Arthur Sulzberger. We picketed everywhere. You name a gross impediment and we picketed there, from our historic 24-hour round the clock for seven days and nights picket of Sloan Kettering to another hateful murderer, our closeted mayor, Edward I. Koch. 3000 of us picketed that monster at City Hall. And, always we protested against our ignoble presidents: Reagan. We actually booed him at a huge AmFAR benefit in Washington. He was not amused. And Bush. 2500 of us actually tracked him down at his vacation home in Kennebunkport, Maine, which did not know what had hit it. And Clinton. I cannot tell you what a disappointment he was for us. He was such a bullshitter, as I fear his wife to be. And Bush again. The newest and most evil emperor in the fullest most repellant plumage. We can no longer summon those kinds of numbers to go after him.
A lot of us got arrested a lot of times. A lot of us. A lot of us. We kept our lawyer members busy. It actually was a wonderful feeling being locked up behind bars in cells with the brothers and sisters you have fought with side by side for what you fervently believe is right.

Slowly we were noticed and even more slowly we were listened to.

Along this journey some of our members taught themselves so much about our illness and the science of it and the politics of it and the bureaucracy of it that we soon knew more than anyone else did. We got ourselves into meetings with drug company scientists who could not believe our people weren’t doctors. I took a group to a meeting with Dr. Anthony Fauci, whom I had called our chief murderer in publications across the land. Dr. Fauci was and still is the government’s chief AIDS person, the Director of Infectious Diseases at NIH. We were able to show him how inferior all his plans and ideas under consideration were compared to the ones that we had figured out in minute detail. We told him what they should be doing and were not doing. We showed him how he and all his staff of doctors and scientists and researchers and statisticians did not understand this patient population and that we did. By then we had located our own doctors and scientists and researchers and statisticians to talk to, some of them even joining us. When our ideas were tried, they worked. We were consistently right. Our “chief murderer” Dr. Fauci became our hero when he opened the doors at NIH and let us in, an historic moment and an historic gesture. Soon we were on the very committees we had picketed, and soon we were making the most important decisions for treating our own bodies. We redesigned the whole system of clinical trials that is in use to this day for every major illness. And of course, we got those drugs out. And the FDA approval for a new drug that once took an average of 7-12 years can now be had in less than one. ACT UP did all this. My children—you must forgive me for coming to think of them as that—most of whom are dead. You must have some idea what it is like when your children die. Most of them did not live to enjoy the benefits of their courage. They were courageous because they knew they might die. They could and were willing to fight because they felt they soon would die and there was nothing to lose, and maybe everything to gain.
And of course funeral after funeral after funeral. We made funerals into an art form, too, just as our demonstrations, our street theater, our graphics, many of which are now in museums and art galleries, were all art forms as well. God, we were so creative as we were dying.

It is important to celebrate. But it is hard to do so when so many of us aren’t here. At least that is the way for me. I know we are twenty years old. It seems impossible to me that it has been so many years. I remember much of it as if it were yesterday. It is difficult to celebrate when one has such potent, painful tragic memories. We held so many of each other in our arms. One never forgets love like that. Make no mistake, AIDS was and is a terrible tragedy that need not have escalated into a worldwide plague. There were 41 cases when I started. There are some 75 million now. It takes a lot of help from a lot of enemies to rack up a tally like that.

Rodger McFarlane made this list of ACT UP’s achievements: accelerated approval of investigational new drugs; expanded compassionate use of experimental drugs and new applications of existing drugs; mathematical alternatives to the deadly double-blind-placebo-controlled studies of old; rigorous statistical methods for community-based research models; accelerated and expanded research in basic immunology, virology, and pharmacology; public exposure of and procedural remedies to sweetheart practices between the NIH and FDA on one hand and pharmaceutical companies on the other (now, with our own decline, unfortunately out of control again); institutionalized consumer oversight and political scrutiny of FDA approvals for all drug classes and for vast NIH appropriations for research in every disease; state drug assistance programs; and vastly expanded consumer oversight of insurance and Medicare and Medicaid reimbursement formularies. Each of these reforms profoundly benefits the health and survival of hundreds of millions of people far, far beyond AIDS and will do so for generations to come.

To this I might add that out of ACT UP came Needle Exchange and Housing Works and AID for AIDS and The AIDS Treatment Data Network and the Global AIDS Action Committee and HealthGAP and TAG, too, the Treatment Action Group.

Perhaps you did not know we did all this. As we know, historians do not include gay anything in their histories. Gays are never included in the history of anything.

Dr. Fauci now tells the world that modern medicine can be divided into two periods. Before us and after us. “ACT UP put medicine back in the hands of the patients, which is where it belongs,” he said to the New Yorker.

How could a population of gay people, call us the survivors, or the descendents, of those who did all this, be so relatively useless now? Maybe useless is too harsh. Ineffectual. Invisible. No, useless is not too harsh. Oh let us just call ourselves underutilized. As long as I live I will never figure this out.

Then, we only had the present. We were freed of the responsibility of thinking of the future. So we were able to act up. Now we only have our future. Imagine thinking that way. Those who had no future now only have a future. That includes not only everyone in this room but gay people everywhere. We are back to worrying about what “they” think about us. It seems we are not so free, most of us, to act up now. Our fear had been turned into energy. We were able to cry out fuck you fuck you fuck you. Troy Masters, the publisher of LGNY, wrote to me: ACT UP recognized evil and confronted it loudly.

Yes, we confronted evil. For a while.

We don’t say fuck you, fuck you, fuck you anymore. At least so anyone can hear.

Well the evil things that made me angry then still make me angry now. I keep asking around, doesn’t anything make you angry, too? Doesn’t anything make anyone angry? Or are we back in 1981, surrounded and suffocated by people as uninterested in saving their lives as so many of us were in 1981. I made a speech and wrote a little book called The Tragedy of Today’s Gays about all this. That was about two years ago. Lots of applause. Lots of thanks. No action.

There was a Danish study a few weeks ago. The life expectancy after infection by HIV is now thirty-five years. Thirty five years. Can you imagine that? That is because of ACT UP. A bunch of kids who learned how to launch street actions and release a propaganda machine and manipulate media masterfully, and use naked coercion, occasional litigations, and adept behind-the-scenes maneuverings that led to sweeping institutional changes with vast ramifications. We drove the creation of hundreds of AIDS service organizations across the country, leveraging hundreds of millions of dollars a year and fielding tens of thousands of volunteers, all the while amassing a huge body of clinical expertise and moral authority unprecedented among any group of patients and advocates in medical history.

We did all this. And we got all those drugs. The NIH didn’t get all those drugs. The FDA didn’t get all those drugs. We got all those drugs. And we rammed them down their fucking throats until they approved them and released them.

It was very useful, old ACT UP.

It is no longer useful. The old ACT UP is no longer useful enough. There are not enough of us. Few people go to meetings. Our chapters have evaporated. Our voice has dimmed in its volume and its luster. Our protests are no longer heard.

We must be heard! We must be.

We are not crumbs! We should not accept crumbs! We must not accept crumbs! There is not one single candidate running for public office anywhere that deserves our support. Not one. Every day they vote against us in increasingly brutal fashion. I will not vote for a one of them and neither should you. To vote for any one of them, to lend any one of them your support, is to collude with them in their utter disdain for us. And we must let every single one of them know that we will not support them. Perhaps it will win them more votes, that faggots won’t support them, but at least we will have our self-respect. And, I predict, the respect of many others who have long wondered why we allow ourselves to be treated so brutally year after year after year, as they take away our manhood, our womanhood, our personhood. There is not one single one of them, candidate or major public figure, that, given half a chance, would not sell us down the river. We have seen this time after time, from Bill Clinton with his Don’t Ask Don’t Tell and his full support of the hideous Defense of Marriage Act (talk about selling us down the river), to Hillary with her unacceptable waffling on all our positions. The woman does not know how to make simple declarative statements that involve definite details. (Read David Mixner on Hillary and Bill. It’s scary. Go to his site: To Ann Coulter calling people faggots and queers and getting away with it. As Andrew Sullivan responded to her: “The emasculation of men in minority groups is an ancient trope of the vilest bigotry!” To this very morning’s statement to the world by the chairman of the Joint Chiefs of Staff, Marine Gen. Peter Pace, that he believes the 65,000 lesbian and gay troops fighting right this very minute for our country are immoral. That our country’s top soldier can say something like this out loud and get away with it is disgusting.

If I am going after Hillary and Bill Clinton it is because I think she just might win, or should I say they might win. Two for the price of one will prove irresistible. Thus it is important to go after the Clintons now, while it still might be possible to negotiate their acceptance and support of our concerns, nay our demands, instead of climbing on their bandwagon that is akin to a juggernaut smashing all in their way as David Mixner describes. Too many gay and lesbians and our organizations are giving her fundraisers and kissing her ass too unreservedly and way way too early. As for Bill, yes, he is at last doing great work for AIDS in Africa but it sure would be nice if we had his generics in America for all those who fall through the cracks of the Ryan White Drug Assistance Program. Have you noticed how fashionable it is for foundations and the two Bills, Gates and Clinton, to do AIDS good deeds in Africa and obviously much too unfashionable to do them in America? I don’t like this woman, but I could, if she wasn’t cockteasing us just like her husband did.

We are not crumbs! We must not accept crumbs!

The CDC says some 300,000 men who had sex with men have died during the past 20 years. If I knew at last 500 of them, I know this CDC figure is a lie. Just as I know the CDC figure of gay people as only several percentage points of the population is a lie, instead of the at least some 20% of the population that the Williams Institute at UCLA Law School calculates it is possible to maintain. Who says that intentional genocide of “us” by “them” isn’t going on? They don’t want us here. When are we going to face up to this?

We are discriminated against at every turn. As we prepare to die the older among us will be taxed beyond belief. That prevents us leaving our estates to our lovers or to gay charities. God forbid the latter should happen, that gays with any money should endow gay organizations with all their gay riches. Do you think I am being too elitist in this concern? Well, you are using this gay and lesbian community center now. How do you think it supports itself? Taxation without representation is what led to our Revolutionary War. Well, way over two hundred years later gay people still have no equality. Gays are equal to nothing good or acceptable in this country. It is criminal how they treat us. We get further and further from progress and equality with each passing year. George Bush will leave a legacy of hate that will take who knows how many eons to cleanse away. He has packed every court in the land with a conservative judge who serves for life. He has staffed every single government job from high to low with a conservative inhabitant who, under the laws of Civil Service, cannot be removed. So even with the most tolerant of new Presidents we will be unable to break free from this yoke of hate for as long as most of us will live. Congresspersons now call judges to pressure them, which is illegal, and if the President doesn’t like a judge’s record, he fires them, which is also illegal. The Supreme Court is not going to give us our equality in any foreseeable future, and it is from the Supreme Court that it must come. They are the law of this land that will not make us equal. If that is not hate, if what I am talking about does not represent hate, I do not know what hate is. We are crumbs to them, if even that.

This is not just about gay marriage. Political candidates only talk about gay marriage, making nicey-nice maybes. But they are not talking about gay equality. And we are not demanding that they talk about the kind of equality I am talking about, marriage or no marriage. Gay marriage is a useful red herring for them to pretend they are talking about gays when they are not. For some reason our movement has confined its feeble demands to marriage. Well, my lover and I don’t want to get married just yet but we sure want to be equal.

I wish I could make all gay people everywhere accept this one fact I know to be an undisputed truth. We are hated. Haven’t enough of us died for all of us to believe this? Some seventy million cases of HIV were all brewed in a cauldron of hate.

Mark Harrington said to me last week that one of the great things about ACT UP was that it made us proud to be gay. Our activism came out of love. Our activism came out of our love for each other as we tried to take care of each other, and to keep each other alive.

No one is looking out for us anymore the way ACT UP looked out for us once upon a time.

ACT UP is not saving us now. This is not meant as finger-pointing or blame. It just is. No one goes to meetings and our chapters all over the globe have almost disappeared. And we must recognize this, I beg of you.

I don’t want to start another organization. And yet I know we must start another organization. Or at the very least administer major shock therapy to this one.

And I know that if we do go down a new road, we must do it right and just accept this fact that the old ACT UP we knew is no longer useful enough to the needs that we have now and move on to reparative therapy.

I also know that any organization that we start now must be an army. You have resisted this word in the past. Perhaps now that the man in charge of America’s army is calling you immoral you won’t resist it army anymore. We must field an organized army with elected leaders and a chain of command. It must be a gay army with gay leaders fighting for gay people under a gay flag, in gay battle formations against our common enemies, uncontaminated by any fear of offending or by any sense that this might not be the time to say what we really need to say. We must cease our never-ending docile cooperation with a status quo that never changes in its relationship to us. We are cutting our own throats raising money for Hillary or Obama or Kerry or, God forbid, Giuliani, or anyone until they come out in full support of all the things I am talking about, not just some tepid maybe-maybes about second-class partnership pieces of worthless paper. Immigration. Taxation without representation. Safety. Why aren’t they all supporting Hate Crimes bills that include us? Twenty-thousand Christian youths now make an annual pilgrimage to San Francisco to pray for gay souls. I am sorry but this is not free speech. This is another version of hate. If any organization sent 20,000 Christian youths to pray for Jewish souls they would lose their tax-exempt status, or they would have before George Bush. Do we protest? It is very wearying to witness our carrying on so passively year after year, particularly now that all of us—and I mean all of us—have been given the gift of staying alive. I know that young gays don’t think this way, but many of us died to give you this gift of staying alive. You are alive because of us. I wish you would see this. And we all owe it to the dead as well as to ourselves to continue a fight that we have stopped fighting.

We do not seem to realize that the more we become visible, the more that more and more of us come out of the closet, the more vulnerable we become to the more and more increasingly visible hate against us. In other words, the more they see us, the more they hate us. The more new gays they see, the more new ways they find to hate us. We do not seem to realize that the more we urge each other to come out—which indeed we must never stop doing—the more we must protect ourselves for and from our exits from our closet on to the stage of the world that hates us more and more. I don’t think we realize this and we must. We must.

Why do I think we need the word “army”? Because it connotes strength and discipline, which we desperately need to convey. Because it scares people, and God knows nobody is all that scared of us. Which they were for a while. The drug companies were afraid of us. The NIH and FDA were afraid of us. Closeted everybodies were afraid of us. No more. Our days of being democratic to a flaw at those endless meetings must cease. It has been a painful lesson to learn but democracy does not protect us. Unity does. United commitment to confront our many foes.

We never consider the establishment of a gay army, just as in the approach of the Holocaust the Jews did not consider one, even though urged, no begged, no implored to do so by their great philosopher, Hannah Arendt, who had the tragic misfortune to see what was coming and to not have her warnings heeded or even believed. Why only last week Mr. Obama implored his people, albeit with a certain timidity: “Put on your marching shoes! Go do some politics! Change this country!” If all the blacks in this country did all that, he would not only win but they would have the power they never have.

What we refuse to see is what is going on around us, believing it is happening to others but not believing that it can happen to us: the use and defense of torture, concentrations of prisoners regarded as threats to America in camps where they languish indefinitely beyond the reach of law; hidden “duplicate” governments existing under the auspices of the homeland security state, shadowing the constitutional government but secret and free of legal constraint.” (Waldron). You don’t think any of this can happen to you. I do. You don’t think that any of those “political” prisoners shipped off to camps are gay? You’re wrong. Much of the Episcopalian church is now aligning itself with Nigeria. Homosexuality is a punishable crime in Nigeria, in Ghana, in Iran, in Saudi Arabia, in a hundred different countires, as is any activism on behalf of it. Punishable means prison. Punishable means death. The Nigerian head archbishop of the Episcopalian church believes we should be put in prison. Episcopalians! Whoever thought we’d have to worry about Episcopalians. Well, whoever thought we’d have to worry about Wyoming. Matthew Shepard was murdered in Wyoming.

When will we acknowledge that we are constantly being lied to? We must have fiercely observant eyes. We must understand and confront the unprecedented, with “attentive facing up to, and resistance of, reality—whatever that might be.”(Arendt) Intelligent people—and gays are certainly that—have proved more than once that we are less capable of judging for ourselves than almost any other social group. When a conservative columnist can get away with calling presidential candidates “a faggot” and “a queer,” without any serious reprisals, than why can’t we see that we are in trouble? When the New York Times does not run an obituary on quite possibly the most famous lesbian in modern times, Barbara Gittings, than we are in trouble. When I can’t get US News and World Report to publish a letter about an insidiously homophobic cover story they wrote on Jamestown, we’re in trouble. When our country’s top military officer can call us immoral, we’re in trouble.

No, ACT UP is not saving us now. No one is saving us now.

We all think we have straight friends. We think if we have straight friends then everything is OK. But these friends are not protesting with us. They aren’t fighting with us. They enjoy the freedoms they have with their marriages and all their fringe benefits. Yes, they like us but are they going to sacrifice any of their freedoms to get us ours? Of course not. And what’s more we should not expect them to. Even though it sure would be nice; we’ve fought for them and theirs often enough.

The old ACT UP model served us well but it is time to take the next step. I am not saying that there are not more fights to be had for AIDS. There are and we must continue to fight them. Infections are up again. Prevention efforts are not good enough. It is still illegal for HIV foreigners to enter America. But these issues no longer appear to excite sufficient participation. Few people come to meetings and our chapters have disappeared. Many of us have tried to figure out what happened to us and why we ceased to be what we were. We all have thoughts about what happened but as I said I think its time to stop trying to figure it out and just move on. Expanding our demands will hopefully not silence our past concerns but invite increased numbers to meld these newer concerns I am talking about into a stronger, total mix.

ACT UP requires a new model to do this. A new model that will allow for different kinds of actions, tactics and issues, not just HIV. I am not asking you if you even want another organization. I am hoping that you are smart enough to realize—eureka!—that the great deeds we once accomplished which changed history can be accomplished again. For we are still facing the same danger, our extermination, and from the same enemy, our own country, our own country’s “democratic process.” Day after day our country declares that we are not equal to anything at all. All the lives we saved are nothing but crumbs if we still aren’t free. And we still aren’t free. Gay people still aren’t free.

Go to Queens, go to Jamaica, go to Iran, go to Wyoming, we still aren’t free. How many places in this country, in this world, can we walk down a street holding a beloved’s hand? I went to my nephew’s wedding in Jamaica twenty years ago. They are out for blood against gay men in Jamaica now. They do it to you the minute you get off the plane. There are men with iron crowbars waiting to maim you at the airport. Does our government protest? Of course not. Who cares if a faggot dies. They are actually beheading gays in Iran. This is progress? The European Parliament which in the past had played a key role in advancing gay rights worldwide, is about to be taken over by conservative delegates that will strengthen their neo-fascist bloc, which will actually call for capital punishment for homosexuals. You don’t think that any of this can’t happen here? I do. Our country’s top soldier said so this morning. We are immoral. The Mayor of Moscow calls us dirt. Polish leaders call us scum. Ann Coulter calls us sissies. General Pace calls us immoral. Who cares if a faggot dies. A gay person murdered in Iraq or Libya or Nigeria or Jamaica or Ghana or Saudi Arabia is the same as a gay person murdered here. Why do I harp so on gay murders in foreign countries. Because gay murders in Iran have a way of becoming gay hate in Paris and London and Chicago and in the highest rank of US Army. Particularly when our own government ignores all attacks against us anywhere. Who cares of a faggot dies. It is all one world now. The disposal of gay people is an equal opportunity employer and hate is a disease that spreads real fast. I repeat: a gay kid murdered anywhere is a gay kid murdered here.

Yes, we have many things to worry about now besides HIV.

You can get married now in New Jersey but New York judges handed down some of the most bigoted “legal” hate outside of Iran, where as I have just said they are now actually decapitating gay men. They are stringing up gay boys and putting masks over their heads and hanging them as Saddam Hussein was hanged. For being gay. Does our government protest? Does any government protest? Of course not. Who cares if a faggot dies. Do you have friends in love with partners forbidden from entering America? To be separated by force from the one you love is one of the saddest things I can think of. What kind of police state do we live in? This is not right. This is wrong. It does not happen for straight lovers. It can only happen to gays who live in a country where we are hated. How many years do we have to endure being treated like this? If countries like Australia and New Zealand recognize relationship residencies for mixed nationalities, why can’t we? There was not one single demonstration against those New York judges, or indeed against any judges who are such dictators of our lives, where they work and live and sleep each night. They cannot be allowed to continue to hate us so legally. America cannot be allowed to continue to hate us so actively. It is not right. It is wrong. Don’t right and wrong mean anything anymore? Why are we not specifically included in Hate Crimes laws in many states? How many Matthew Shepherds must there be before we are specifically included in Hate Crime laws in every state?

We have right on our side and we must make everyone know it. If ACT UP is to stand for anything, let it stand for our Army Corps to Unleash Power.

Think about it. Think about all of this. Please.

We are the only people in America that it is socially acceptable to hate and discriminate against. Indeed so much hate of us exists that it is legally acceptable to pass constitutional amendments to hate us even more. This is democracy? This is how our courts and laws protect us? These are the equal rights for all that America’s Bill of Rights proclaims for all?

The biggest enemy we must fight continues to be our own government. How dare we stop? We cannot stop. We are not crumbs and we must not accept crumbs and we must stop acting like crumbs.

ACT UP is the most successful grass roots organization that ever lived. Period. There never was, never has been one more successful that has achieved as much as we. We did it before. We can do it again. But to be successful, activism must be practiced every day. By a lot of people. It made us proud once. It united us.

I constantly hear in my ears the refrain: “an army of lovers cannot lose.” Then why are we losing so? We must trust each other to an extent we never have, enough to allow the appointment of leaders and a chain of command to stay on top of things and keep some sort of order so that we not only don’t self destruct as we seem to have more or less done, but also, this time, as we did not do before, institutionalize ourselves for longevity.

I am very aware that as I spin this out I am creating reams of unanswered questions. Well, we didn’t know when we first met in this very room twenty years ago what we wanted ACT UP to become. But we figured it out. Bit by bit and piece by piece we put it together. We have a lot to thrash out and codify in a more private fashion. Armies shouldn’t show all their cards to the world. Many parts of the old ACT UP will still serve us: the choices of a variety of issues to obsess us in the detail that we became famous for; the use of affinity groups that develop their own forms of guerilla warfare. Our call for Health Care for All must still be sought. I have a personal bug up my ass that gay history is not taught in the schools. Abraham Lincoln and George Washington were gay. It may be up to activists to ram this truth down the throats of America because gay historians are too timid to. Timidity is so boring, don’t you agree?

Much of what I am calling for involves laws, changing them, getting them. We need to cobble together an omnibus gay rights bill and then hold every politician’s feet to this fire until he or she supports it. We’d find out fast enough who are friends aren’t. TAG and AmFAR once cobbled together a bunch of research priorities into a bill that they got through congress.

How about this: Jim Eigo wrote me: “a full generation after AIDS emerged as a recognizable disease, having sex still poses the same risk for HIV infection or reinfection. Having a sexual encounter with another person—a central, meaningful activity in most people’s lives—has been shadowed by fear, by the prospect of a long-term disease and by a whole new reason for guilt for more than a quarter of a century now. How have we allowed this unnatural state of affairs to persist for so long? Where are the 21st century tools for preventing the sexual transmission of HIV: cheap, effective, and utterly unobtrusive. Lovers deserve nothing less. Instead of sinking time, effort, and money into excavating the fossils of its ancient achievement, ACT UP might consider marking its birthday by mounting a fresh drive to remind government and industry that people have a right to sex without fear, without being forced to make a choice between pleasure and health. It’s an issue that might actually speak across the divides of generation, race, gender and sero-status. And it might regain for the organization some measure of the relevance it once had for the grassroots activists that gave of themselves as if their lives depended on it, because they really did.” Jim is calling for nothing less than the reclamation of our sex lives. What an utterly fantastic notion, or shall I now say goal? Why even raising this issue will find us hated even more. I am so ready for another organized fight.

Are you beginning to see how all this that I am talking about can be streamed into one new ACT UP army?

I have asked Eric to convey the main difference of what is available to us now that we did not have to work with in the past:

“In the age of the internet we can do much of what we did in our meetings and on the streets, on the world wide web.

“The information technology available today could help end the need for those endless meetings.

“Creating a blog could, in fact, incorporate even more voices and varieties of opinions and ideas than any meeting ever could.

“Where ACT UP once had chapters in many cities, we could now involve thousands more via simple list-serves and blogs. We can draw in students and schools and colleges all over the world. It is the young we have to get to once again.

“Creating a blog would allow for expression and refinement of ideas and policies, like a Queer Justice League for denouncing our enemies.

“A well organized website could function as an electronic clearing house for sharing information, for posting problems, for demanding solutions, for developing and communicating action plans.

“List-serves and a website could coordinate grassroots organizing and mobilize phone, e-mail and physical zaps or actions. They could also be used to spotlight homophobic actions, articles, movies and tv, and laws.

“Why aren’t we fighting fire with fire? Where is our radical gay left think tank? We need our own “700 Club” and our own talk radio show. Developing such gay content programming for the LOGO or Here Networks or for streaming on-line is completely possible today. Why are all the shows our community is producing about fashion, decorating or just another gay soap?”

Why even Time Magazine is now stating as a fact that websites drive the agendas of political parties.

I know that even without these tools we reordered an entire world’s approach to a disease that would have killed us all. Surely with these tools and with all our creativity we can start to take control of our destinies again.

With these tools, and with a renewed commitment to love and support and to fight to save each other, with a renewed commitment to the anger that saved us once before, with the belief that anger, along with love, are the two most healthy and powerful emotions we are good at, I believe that we could have such a historical success again.

May I conclude these thoughts, these remarks toward the definition of a new ACT UP that will hopefully begin to be discussed forthwith, with this cry from my heart:

Farewell ACT UP.

Long live ACT UP.

Thank you.

Interview With Chris Bull of the Advocate

by Bill Clinton
Air Force One
En route to: Luncheon for the DNC Gay/Lesbian Leadership Council
September 27, 2000

Hate Crimes Legislation

Mr. Bull. Thank you for agreeing to this interview. I thought we’d jump ahead in the questions a little bit, because I noticed this morning at the press briefing you talked about the hate crimes legislation and opposition to including sexual orientation in it.

There was the front page of the Washington Post today, a man walks into a gay bar in Virginia and starts shooting. With all the evidence about this particular aspect of hate crimes, why is there still so much opposition in Congress?

The President. First, let’s talk about the good news here. There’s 57 votes for it in the Senate, and about 240 votes for it in the House. Virtually all the Democrats, but four or five of them, are for it. And we’ve got 41 Republicans on a motion to instruct the conferees to leave it in the defense bill. So there’s no question that we now have a majority for it.

How would it not be included in? The leadership of the Congress and the leadership of the Republican Party is still well to the right of the country on this issue. Same thing in Texas, you know, they could have had a hate crimes bill after James Byrd was killed, if Governor Bush had just lifted a finger for it. But he was unwilling to take on the rightwing in his own party, and so it died.

And it’s the same thing in Washington. If the leaders of the House and the Senate can be persuaded to instruct their conferees to follow the will of the majority, it will prevail. If it doesn’t prevail, it’s because the leadership of the Congress and the leadership of the Republicans is still to the right of the country on the issue.

Matthew Shepard

Mr. Bull. As you may remember, the murder of Matthew Shepard, the student in Wyoming—-

The President. I remember it vividly.

Mr. Bull. —-really changed the way Americans see hate crimes against gay people. What was your initial reaction to that murder?

The President. Well, I think it was particularly horrifying and heartbreaking because he was so young and so small and the way they killed him was so graphic. But it did galvanize the country. You know, the American people are fundamentally decent. But like human beings everywhere, since the dawn of time, they’re afraid of something that’s profoundly different from the life they know and the experiences they’ve had.

Usually, the way civilization progresses is something happens that forces people to see things in a different way, in a more human way. And that’s what Matthew Shepard’s death did. I think the fact that his parents, who are obviously not leftwing activists, just mainstream, hardworking Americans, became advocates for the hate crimes legislation and the fact that that police commissioner there, O’Malley, was so eloquent in saying that the experience of dealing with Matthew’s death and dealing with his family and his friends had changed his life, as well as his attitudes.

I think those three people deserve an enormous amount of credit for the way the country has moved.

Mr. Bull. With the depth of the problem that you’ve just described, people’s psychological response to difference, is hate crimes legislation really the best way to deal with the problem? Does it really get at the roots of it?

The President. Well, I think it’s just one piece of it. I think it’s really important to pass ENDA, and there are big majorities for ENDA in the country, too. And it hasn’t passed for the same reason.

The other thing I think that’s important–and ENDA would really feed into this–is that we just need people, all the American people, to have the opportunity to interact on a human level, in the workplace, in social settings, with gays and lesbians and know that they’re interacting with them. Personal contact, it may sound old-fashioned and naive–it’s not a substitute for laws–but it will change attitudes.

I’ll never forget in the administration’s early debate over gays in the military, there was a national poll published which showed that Americans, who knew a gay person and knew they knew a gay person, were 2-1 in favor of changing the policy. So if you believe that most people have goodness in them and will, other things being equal, treat their fellow human beings in a decent and fair way, then you have to overcome ignorance and fear. And it takes time, and it takes contact.

President’s Background on Gay Rights

Mr. Bull. One of the things for which your administration will be remembered is, early on, you talked a lot about gay people in a way that Americans hadn’t heard from that level of government, which is in terms of tolerance, inclusiveness, a place at the table, having no one to waste. How did you come across that approach to including gay people in, sort of, the rhetoric of the civil rights movement?

The President. Personal contact. In 1977, when I was attorney general, there was an attempt to make–we had just adopted a new criminal code, and the criminal code had gotten rid of all the status offenses, including homosexuality. I imagine those old laws are still on the books in some States.

And one of our legislators went home, and he lived in a very conservative district, and he was roundly abused by the religious right at the time. And that’s just when they were getting up and going there, in the midseventies. So he came back and introduced a bill, essentially, to make homosexuality a crime again but turning it from a status offense into an act. And I tried to kill it then. It just struck me as wrong.

And I remember, it was the first thing that sort of, I don’t know, brought me to the attention of some of the gay community in my home State. It was never a big issue. And I failed. I thought I had it done, and I failed. Literally in the last 30 minutes of the last day of the legislative session, they voted it out. And we knew we had to kill it in committee because the legislators would be afraid to vote against it back then.

I knew from the time I was a boy growing up that I knew people who were gay, even though they didn’t talk about it. So I always felt that. And then when I started running for President and people who were active in the gay rights cause started to talk to me–starting with David Mixner, who had been a friend of mine for, by then, way over 20 years–I just decided that it was one thing I was going to try to make a difference in. And I started actively seeking out members of the gay community. Marty Rouse helped me a lot in New York, took me to a big meeting there I never will forget.

I know it seems sort of–it probably seems strange to everybody. I was running on a New Democratic platform. I was a Governor of a southern State, and on issues like fiscal responsibility and some foreign policy issues I was, I suppose, to the right of where most activist Democrats were. But it just struck me as a human rights issue from the beginning, and a personal issue.

Future of Gay Rights

Mr. Bull. Having set that tone in the White House, is there–how do we maintain it after you’re in office? How do we make sure it doesn’t go back to pitting groups against one another?

The President. Well, first of all, I think that it will never be quite the same. I think we have to give–you can’t give me too much credit and give the gay community too little, or give the American people too little credit. I mean, I don’t think it will ever be fashionable for people in national life to demonize gays again.

But I think the extent to which we continue to progress will depend entirely on who’s elected. Al Gore is for the hate crimes legislation and the “Employment and Non-Discrimination Act” and has been at least as open, if not more open, than me in pursuing this cause. This is something that he really, really feels strongly about.

And I don’t believe Governor Bush is a bad person, with a bad heart. I think he basically has a good heart. But I think that–you know, he passed on the hate crimes bill in Texas, and I don’t think he’ll be for the “Employment and Non-Discrimination Act.” And if he wins and he keeps his majority in Congress, I just don’t think we’ll get very far legislatively. And there won’t be nearly as many appointments, and I don’t think the approach to AIDS, both at home and abroad, will be nearly as aggressive.

Legislative Agenda/Gays in the Military

Mr. Bull. With all your success in setting a different tone on the gay rights debate, the legislative and policy related areas have been more challenging. How do you think–I mean, what needs to be done to actually make concrete legislative gains in terms of the military policy, et cetera?

The President. Well, I think two things. I think, first of all, on the concrete legislative gains, I think the most important thing is to change the composition of Congress. It doesn’t have to change a lot–you know, 10 or 12 seats in the House, even if the Democrats didn’t win a majority in the Senate–if we picked up three or four seats, so that it was effectively a split, I think it would change the landscape dramatically.

So I think if you had a President who was committed and some changes in the Congress, even modest changes, I think it would make a huge difference on the legislative front.

On the gays in the military issue, I think it’s important to remember—-

Mr. Bull. That was a case I’m sure a lot of Democrats who opposed an initiative—-

The President. Oh, we got killed. I think a lot of people forget– and I don’t want to be too defensive about this–but a lot of people forget that I did not accept General Powell’s proposed compromise until the Senate had voted 68-32 in a resolution against my position. The House, we knew there were over 300 votes against us, so we knew they had a veto-proof majority. But we thought we might be able to sustain a veto of an attempt to ratify the old policy, until the Senate voted 68-32 against it. So that meant they had a veto-proof majority in both Houses.

So my guess is that what the next move should be is to try to get the Congress to restore to the military and the executive branch discretion to make this decision and then to try to explore–because I think there have been some changes in attitudes to the military, too– whether there is–you know, what kind of steps could be taken from there.

I don’t think that the Congress would be willing to legislatively reverse it and adopt the policy that I favor. But they might be willing to give the policy back to the executive branch and to the military on the condition that the President pledge to kind of work through this thing with the military. And I do believe there has been some progress there. There’s still a lot of resistance, too, as you know, but I think there has been some progress.

Mr. Bull. You were pilloried on both sides of that issue in ’93.

The President. The worst of all worlds, everybody was mad at me.

Mr. Bull. Because you had your friend David Mixner–was protesting. And you said at the time that you had spilt a lot of blood on the issue. What did you mean by that?

The President. Well, just that. I mean, I cared a lot about it. I thought I was right. I didn’t agree to compromise until I was beat. One of the things I learned the first 2 years is that–I don’t think it was apparent to 90 percent of the people in the gay community who cared about this that we were beat. That is, I don’t think that we made enough of the Senate vote, and maybe what I should have done, if I just was concerned about my own standing and clarity, is just let them pass it and veto it. Then they’d override the veto. We’d be back where we were.

But the way they implemented the changes that we announced in the first few years were just about as bad as it was before. Now, it’s gotten a little better now. Bill Cohen has gotten on it and changed a lot of the training. There is no question that as a practical matter, even though it’s unsatisfying as a matter of principle, that if the policy as I announced it or implemented it, it would be better than the policy before. But for years there was a lot of resistance to that.

I think it is going to get better now if the next Secretary of Defense hews to the line that Secretary Cohen has set out.

Gay Community Leadership

Mr. Bull. The gay rights movement I think eventually came to see that it, itself, had failed to provide you a certain amount of political cover to create the conditions in America in which people supported such a change. You’ve experienced gay rights leaders for a long time now. How do you think it could become a more effective, mainstream political force in the long run?

The President. Well, first of all, I don’t think that they failed any more than I did. Look, I fight a lot of fights I don’t win. The NRA beats me more than I beat them in Congress. The insurance companies beat me on health care, and so far, they’re beating us on the Patients’ Bill of Rights. The drug companies, so far, are beating us on adding a Medicare drug benefit.

So it shouldn’t be surprising or, I would argue, discouraging that the first time you come out of the box on some of these issues you don’t win. America has always been, like all societies, a place where organized, entrenched interests initially have more power than even popular causes that are not equally well organized, particularly when the issue may not be a voting issue yet with the American people.

There are lots of issues where a majority, maybe even two-thirds, agree with me, and I still can’t pass it in Congress because to the people who are against it, it’s a voting issue or a contribution issue, and to people who are for it, it isn’t.

Now, I think the gay community has come a long way just since I’ve been here, both in terms of the sophistication of it’s arguments and the quality of its organization and its active participation in the political process, including contributing to campaigns of the people you agree with and believe in. So I think all that is to the good.

But I still say, I think the most important thing–I was just looking over the people that are going to be at this lunch that we’re going to and what they do for a living. They have normal jobs in big companies that are important, and they’re in a position to exercise influence over people with whom they work. The thing I think is important is to try to get more non-gay supporters of these issues who see it as civil rights issues and see it as a voting issue, an important political priority. And I think that it’s going that way.

Same-Sex Marriage

Mr. Bull. In ’96–I think I actually had the year wrong–you signed the Defense of Marriage Act. Do you think Americans–and, politically, that was a hard issue for everyone in Congress, as well as you. Do you think Americans will ever come to the point where they can find same-sex marriage acceptable?

The President. I don’t know the answer to that. But again, I think that under the law, gay couples who have manifested a genuine commitment should have all the legal options that others do, whether it’s how they leave their estates or cover their partners with health insurance on the job or such simple things as the right to visit hospital beds during family visiting hours, you know, the whole panoply of things.

And then I think that when people come to respect that, and people will put their own words to whatever the relationship is and it will– the main thing is that we recognize the integrity of commitments and the right citizens have to leave their property and take care of the health of people they love and all the things that people do.

Also, I think one of the things that may impact this debate in the future is the parallel debate that’s going on in some places still over adoptions, because you see more and more gay couples adopting kids. Very often, they’re children who wouldn’t be taken by other people or who haven’t been. And I think that’s going to have an impact on people.

I’ve always felt that all those anti-adoption laws were wrong. I think that the present law is the right–the historical, almost common law standard in America, although it’s in statute now and our country is–these decisions should be made based on what’s best for the child. I think that responsible childrearing is the most important work of any society. And insofar as people see it being done by gay couples, I think that will add to a bill’s support for fair treatment.

Mr. Bull. Have your own views on same-sex marriage, itself–not on civil union or domestic partnership legislation–changed since ’96?

The President. My views were and are that people who have a relationship ought to be able to call it whatever they want. And insofar as it’s sanctified by a religious ceremony, that’s up to the churches involved. And I always thought that.

I think what happened in the Congress was that a lot of people who didn’t want to be anti-gay didn’t feel that they should be saying that as a matter of law, without regard to what various churches or religions or others thought, that the United States policy was that all unions that call themselves marriages are, as a matter of law, marriages. I don’t think we’re there yet.

But I think that what we ought to do is to get the legal rights straightened out and let time take it’s course, and we’ll see what happens.

Gay Support

Mr. Bull. Just two or three more questions. With your political troubles with the GOP and the House, polls showed that gays and lesbians, along with African-Americans, were among your staunchest supporters. They really rallied to your cause and thought it was very, by and large–you know, there are certainly gay Republicans who would disagree–felt that you were being treated unfairly, your private life being used against you.

How do you feel about that support that you got from—-

The President. First of all, I was honored to have it. And secondly, I think that partly it came out of the same wellspring of experience that prompted so many African-Americans to stick with me. They’ve been there. The people who’ve been targeted, who’ve been publicly humiliated and abused, I think, identified with what was going on, because they knew, the whole world, if anybody had been paying attention, knew by then that the whole Whitewater thing was a fraud–it never amounted to anything, which has now been acknowledged–that the civil lawsuit against me was also totally unmeritorious, as even the judge said.

So they knew that basically the whole thing was just a vehicle to try to find some last, desperate way to undermine the result of two elections and what I was trying to do for the America people and the fact that I tried to be a President for people who had been left out, left behind, ignored, and kicked, as well as for the vast majority of the American people that just needed somebody to do the right things in Washington.

So I think that there were a lot of people that knew what it was like to take a bullet, and they saw it for what it was.

Religious Right

Mr. Bull. Gays and lesbians are often the target of really unrelenting attacks from the right wing, especially religious conservatives like Falwell and Robertson. They’ve sometimes turned their focus on you, as well. Does that enhance your empathy for the plight that gays and lesbians sometimes experience?

The President. Yes, although I always—-

Mr. Bull. I mean, has it surprised you, the—-

The President. —-my empathy level was pretty high. Does it surprise me that they hated me as much as they did? A little bit. But I think there are two things. First of all, for all their railing against entitlements on behalf of poor people, a lot of those people have a sense of entitlement to cultural superiority and political power. And they don’t think anybody that’s not part of their crowd has a right to cultural legitimacy or political power. And before ’92, I think most of them thought no Democrat would ever win again. They thought they had this little proven formula, you know, to sort of portray us as enemies of ordinary Americans–to use a phrase that Newt Gingrich used against me and my wife. I think that was part of it.

And I think the other thing is, I think that one of the reasons they disliked me especially is that they see me as an apostate because I’m a southern white male Protestant, and southern white male Protestants have been the backbone of their political and social power, because we tend to be more politically and socially conservative.

So I think those are the two things that prompted it. Maybe they just don’t like me. You know that old joke about the guy that falls off the mountain? He said, “God, why me?” And He said, “Son, there’s just something about you I don’t like.” [Laughter] So maybe that’s it. I don’t know. [Laughter]

Boy Scouts

Mr. Bull. Boy Scouts of America, the Supreme Court decision upholding the Scouts’ right to determine their own membership criteria and exclude gay Scouts. Members of Congress have asked you to resign your honorary position. Would you be willing to do that?

The President. Let me ask you a fact question, first. The Girl Scouts have a different policy, don’t they?

Mr. Bull. Yes, they have no policy.

The President. Well, I can tell you that my present inclination is that I shouldn’t do it, because I think the Scouts do a world of good and because I think they can be persuaded to change. I think the policy is wrong, and I’ve made it quite clear that I think their policy is wrong. And they certainly know where I stand on it. I believe they’ll change, and I think we should keep working on them.

But I don’t know that it wouldn’t do more harm than good, especially now, at the end of my tenure, for me just to do what would be a symbolic act of resignation. I also really appreciate a lot of the good they’ve done, especially with inner-city kids and poor kids, and I don’t think we should negate the good they’ve done or we try to change what’s wrong.

I think they’re afraid. And I think there are all these, sort of, preconceptions–that I think are totally wrong–that gay adults are more likely to abuse children than straight adults. And if you look at the evidence every year in cases of child abuse that have a sexual component, there’s just no evidence to support that. But I think there’s a fear factor there.

Mr. Bull. But aren’t those kids that you’re talking about, that are being helped by the Scouts, being taught that they can mistreat gay kids, gay kids are second class?

The President. If I thought they were doing that–you know, one of the things that bothered me about the military situation is I thought there was an affirmative, anti-gay bias in the military. And there still is in some places. But as I said, I’m convinced Secretary Cohen is making an aggressive effort to deal with that now. If I thought they were, that would have some impact on me. I don’t–if that’s going on, I don’t know about it. It may, but nobody—-

Mr. Bull. Just the policy of exclusion would imply—-

The President. —-nobody has ever given me information about that. I think it’s much more a function of their buying into the presumption that, particularly, gay Scout leaders would be more likely to have some sort of improper influence on the kids, rather than being inherently anti-gay.


Mr. Bull. Can I just throw in one question, because we haven’t addressed AIDS?

The President. Sure. Yes, do that.

Mr. Bull. We probably should get that in; I’m sorry. Because of the advances of AIDS treatment and the decline in death rates, it’s hard to maintain the sense of urgency about ending this disease. You’ve worked on it a lot during your two administrations. How can we maintain that sense of urgency to conquer it?

The President. The first thing I think we have to do is to keep in mind, keep the public in mind that there are 40,000 new cases every year, and that more than half of them affect children and young people under 25. That’s a lot.

The second thing I would say is, I do believe there is overwhelming bipartisan consensus in the Congress and in the country to continue looking for a cure and to continue investing in that.

And thirdly, there is overwhelming bipartisan consensus to continue, I think, the very large funding levels that we’ve achieved in CARE. So I think we’re in reasonably good shape on that.

The next big step that I think will keep a sense of urgency is to really internationalize the struggle, to recognize America’s responsibility to deal with the global AIDS crisis and to understand that the relationship between AIDS at home and AIDS abroad is quite a close one, especially with borders being as open as they are now, a lot of immigrants coming here every year, and our responsibilities and the rest of the world and our hopes for the rest of the world–particularly in our outreach to Africa, to the Indian subcontinent, and increasingly to the states of the former Soviet Union, where the AIDS rates are growing very rapidly–our ability to do what we’re trying to do in those areas will turn, in no small part, on our ability to work with them, to help them reverse the epidemic.

You’re going to have African countries–I’ve had an unprecedented outreach to Africa, and we just passed this big trade bill with Africa, and we’re trying to get debt relief for the poorest African countries that are being well run. But there are countries over there that last year had very high growth rates, that within 10 years to 15 years will have more people in their sixties than in their thirties in those countries because of the AIDS epidemic. Their economies, their societies are very likely to become largely dysfunctional, along with their political systems, unless we can do something to turn the AIDS epidemic.

I think we can keep more edge on the fight against AIDS at home if we marry it more closely to the fight against AIDS around the world.

Mr. Bull. Thank you very much, Mr. President.

The President. I enjoyed the visit.

Mr. Bull. I appreciate it very much.

The President. Thanks.

Note: The interview began at 12:47 p.m. aboard Air Force One en route from Andrews Air Force Base, MD, to Dallas, TX, and the transcript was released by the Office of the Press Secretary on October 23. In his remarks, the President referred to Republican Presidential candidate Gov. George W. Bush; Dennis and Judy Shepard, parents of murder victim Matthew Shepard; Commander David O’Malley, Laramie, WY, Police Department, who investigated Shepard’s murder; gay activist and author David Mixner; and Marty Rouse, assistant to the Secretary of Health and Human Services. A tape was not available for verification of the content of this interview

For Obama, Gays & PWAs = Shit

by Larry Kramer
ACT UP/HealthGap Demonstration Against Obama
St. Regis Hotel, New York, NY
May 13, 2010
(source, via)

Obama is not my president. Obama is not your president. Obama does not like AIDS. Obama does not like gays. Now what are we going to do about it? Because we continue to sit on the sidelines while our world is denied us, yes, our world, which is as much our world as anyone else’s, is denied us. Our rights are denied us. Our love is denied us. We are even denied the right to fight for our country. How long must we be denied all of this before we truly rise up in united anger!

Why is it always so hard for us to fight back? This man does not like us. When someone does not like you, you fight back. This Obama who is not my president and not your president obviously does not like us. It is not a secret. Day after day and week after week and month after month he tells us he does not like us. He tells us! He does not keep this a secret. His government does not like us. His chief of staff does not like us. His Attorney General does not like us. His Department of Justice does not like us. His Generals do not like us. His Department of Health and Human Services does not like us. This is not a new situation for us.

President after President have treated us so badly. Ronald Reagan. George Bush the first. Bill Clinton. George Bush the second. Barack Obama. They have all treated us like… shit. Like little pieces of shit that they can step on with their heels and grind into the ground. Obama is treating us just like that. Like little pieces of shit he can grind into the dirt with his heel to make us go away. I wish you could see that. I wish you could see what he is doing to us for for what it is. He is manipulating us into invisibility. He HAS manipulated us into invisibility. Our people in Washington live in a never-never cloud cuckoo-land, thinking that this man likes us, not responding as, little by little, he take bits and pieces of us away. That is how they control us. Can’t you see that? Why can’t our people in Washington see that? They give them a dinner as they take away another right.

How long are we going to allow ourselves to be treated with such disdain, to be cast way in such an unwanted and disposable and ignoble fashion?

We forget what miracles we once were able to accomplish. Every single treatment for HIV/AIDS is out there because of us. If they are out there because of us, why can’t all the people waiting for Ryan White meds get them? Why can’t over 90% of the rest of the world get them? We did not fight for them just for ourselves. So many dead young men fought as activists for those drugs to save the world and this Obama will not let them save the world. Little by little he takes away our Ryan White drugs in America and our PEPFAR drugs for the rest of the world and our AIDS organizations and clinics everywhere so he can grind even more people with his heel into the earth like little helpless smelly pieces of shit. Yes, this man, like all his rotten hateful predecessors treats us like shit.

I am so tired of being treated like shit.

I wish you could realize that my words and my language and my vocabulary are not too strong. They are not strong enough!

I beg of us all. Re-assemble! Re-unite! Fight back once more with the passion and honor and truth and unity and brotherhood as we once did. We once accomplished miracles. Why do we not recall our glorious fights and build anew upon them? They treat us like shit because we let them treat us like shit. When will we get that into our heads and hearts and fight back?

How effective and fierce and unstoppable we can be when we take action together. The only reason we got those drugs is because of direct action, mobilization, fighting back. That is the reality of what we have been able to accomplish. We are alive, for those of us who are still alive, because we saved ourselves! When we fought back rudely and together, we were able to achieve miraculous victories. I take these victories, as do many of you, every morning with my breakfast.

This Obama president made a commitment to ensure that America does its fair share to fight AIDS, in Africa, in America, and around the world. He has broken that promise. He, like Clinton, has lied to us. He does not like us, this president, as the other presidents did not like us. We are not a part of their American People. He does not want us to get married, he does not want us to fight for our country, he does not want to end the plague of AIDS.

We must have the presence of mind and the force of character to insist that he and his society are wrong and we are right.

Do you need to know any more than this? This is all you need to know. And that once upon a time we accomplished miracles.

Can we do it again? Oh, please, can we do it again?

1,112 and Counting

by Larry Kramer
first published in the New York Native, Issue 59, March 14-27, 1983

If this article doesn’t scare the shit out of you, we’re in real trouble. If this article doesn’t rouse you to anger, fury, rage, and action, gay men may have no future on this earth. Our continued existence depends on just how angry you can get.

I am writing this as Larry Kramer, and I am speaking for myself, and my views are not to be attributed to Gay Men’s Health Crisis.

I repeat: Our continued existence as gay men upon the face of this earth is at stake. Unless we fight for our lives, we shall die. In all the history of homosexuality we have never before been so close to death and extinction. Many of us are dying or already dead.

Before I tell you what we must do, let me tell you what is happening to us.

There are now 1,112 cases of serious Acquired Immune Deficiency Syndrome. When we first became worried, there were only 41. In only twenty-eight days, from January 13th to February 9th [1983], there were 164 new cases – and 73 more dead. The total death tally is now 418. Twenty percent of all cases were registered this January alone. There have been 195 dead in New York City from among 526 victims. Of all serious AIDS cases, 47.3 percent are in the New York metropolitan area.

These are the serious cases of AIDS, which means Kaposi’s sarcoma, Pneumocystis carinii pneumonia, and other deadly infections. These numbers do not include the thousands of us walking around with what is also being called AIDS: various forms of swollen lymph glands and fatigues that doctors don’t know what to label or what they might portend.

The rise in these numbers is terrifying. Whatever is spreading is now spreading faster as more and more people come down with AIDS.

And, for the first time in this epidemic, leading doctors and researchers are finally admitting they don’t know what’s going on. I find this terrifying too – as terrifying as the alarming rise in numbers. For the first time, doctors are saying out loud and up front, “I don’t know.”

For two years they weren’t talking like this. For two years we’ve heard a different theory every few weeks. We grasped at the straws of possible cause: promiscuity, poppers, back rooms, the baths, rimming, fisting, anal intercourse, urine, semen, shit, saliva, sweat, blood, blacks, a single virus, a new virus, repeated exposure to a virus, amoebas carrying a virus, drugs, Haiti, voodoo, Flagyl, constant bouts of amebiasis, hepatitis A and B, syphilis, gonorrhea.

I have talked with the leading doctors treating us. One said to me, “If I knew in 1981 what I know now, I would never have become involved with this disease.” Another said, “The thing that upsets me the most in all of this is that at any given moment one of my patients is in the hospital and something is going on with him that I don’t understand. And it’s destroying me because there’s some craziness going on in him that’s destroying him.” A third said to me, “I’m very depressed. A doctor’s job is to make patients well. And I can’t. Too many of my patients die.”

After almost two years of an epidemic, there still are no answers. After almost two years of an epidemic, the cause of AIDS remains unknown. After almost two years of an epidemic, there is no cure.

Hospitals are now so filled with AIDS patients that there is often a waiting period of up to a month before admission, no matter how sick you are. And, once in, patients are now more and more being treated like lepers as hospital staffs become increasingly worried that AIDS is infectious.

Suicides are now being reported of men who would rather die than face such medical uncertainty, such uncertain therapies, such hospital treatment, and the appalling statistic that 86 percent of all serious AIDS cases die after three years’ time.

If all of this had been happening to any other community for two long years, there would have been, long ago, such an outcry from that community and all its members that the government of this city and this country would not know what had hit them.

Why isn’t every gay man in this city so scared shitless that he is screaming for action? Does every gay man in New York want to die?

Let’s talk about a few things specifically.

· Let’s talk about which gay men get AIDS.
No matter what you’ve heard, there is no single profile for all AIDS victims. There are drug users and non-drug users. There are the truly promiscuous and the almost monogamous. There are reported cases of single-contact infection.

All it seems to take is the one wrong fuck. That’s not promiscuity – that’s bad luck.

· Let’s talk about AIDS happening in straight people.
We have been hearing from the beginning of this epidemic that it was only a question of time before the straight community came down with AIDS, and that when that happened AIDS would suddenly be high on all agendas for funding and research and then we would finally be looked after and all would then be well.

I myself thought, when AIDS occurred in the first baby, that would be the breakthrough point. It was. For one day the media paid an enormous amount of attention. And that was it, kids.

There have been no confirmed cases of AIDS in straight, white, non-intravenous-drug-using, middle-class Americans. The only confirmed straights struck down by AIDS are members of groups just as disenfranchised as gay men: intravenous drug users, Haitians, eleven hemophiliacs (up from eight), black and Hispanic babies, and wives or partners of IV drug users and bisexual men.

If there have been – and there may have been – any cases in straight, white, non-intravenous-drug-using, middle-class Americans, the Centers for Disease Control isn’t telling anyone about them. When pressed, the CDC says there are “a number of cases that don’t fall into any of the other categories.” The CDC says it’s impossible to fully investigate most of these “other category” cases; most of them are dead. The CDC also tends not to believe living, white, middle-class male victims when they say they’re straight, or female victims when they say their husbands are straight and don’t take drugs.

Why isn’t AIDS happening to more straights? Maybe it’s because gay men don’t have sex with them.

Of all serious AIDS cases, 72.4 percent are in gay and bisexual men.

· Let’s talk about “surveillance.”
The Centers for Disease Control is charged by our government to fully monitor all epidemics and unusual diseases.

To learn something from an epidemic, you have to keep records and statistics. Statistics come from interviewing victims and getting as much information from them as you can. Before they die. To get the best information, you have to ask the right questions.

There have been so many AIDS victims that the CDC is no longer able to get to them fast enough. It has given up. (The CDC also had been using a questionnaire that was fairly insensitive to the lives of gay men, and thus the data collected from its early study of us have been disputed by gay epidemiologists. The National Institutes of Health is also fielding a very naive questionnaire.)

Important, vital case histories are now being lost because of this cessation of CDC interviewing. This is a woeful waste with as terrifying implications for us as the alarming rise in case numbers and doctors finally admitting they don’t know what’s going on. As each man dies, as one or both sets of men who had interacted with each other come down with AIDS, yet more information that might reveal patterns of transmissibility is not :being monitored and collected and studied. We are being denied perhaps the easiest and fastest research tool available at this moment.

It will require at least $200,000 to prepare a new questionnaire to study the next important question that must be answered: How is AIDS being transmitted? (In which bodily fluids, by which sexual behaviors, in what social environments?)

For months the CDC has been asked to begin such preparations for continued surveillance. The CDC is stretched to its limits and is dreadfully underfunded for what it’s being asked, in all areas, to do.

· Let’s talk about various forms of treatment.
It is very difficult for a patient to find out which hospital to go to or which doctor to go to or which mode of treatment to attempt.

Hospitals and doctors are reluctant to reveal how well they’re doing with each type of treatment. They may, if you press them, give you a general idea. Most will not show you their precise numbers of how many patients are doing well on what and how many failed to respond adequately.

Because of the ludicrous requirements of the medical journals, doctors are prohibited from revealing publicly the specific data they are gathering from their treatments of our bodies. Doctors and hospitals need money for research, and this money (from the National Institutes of Health, from cancer research funding organizations, from rich patrons) comes based on the performance of their work (i.e., their tabulations of their results of their treatment of our bodies); this performance is written up as “papers” that must be submitted to and accepted by such “distinguished” medical publications as the New England Journal of Medicine. Most of these “distinguished” publications, however, will not publish anything that has been spoken of, leaked, announced, or intimated publicly in advance. Even after acceptance, the doctors must hold their tongues until the article is actually published. Dr. Bijan Safai of Sloan-Kettering has been waiting over six months for the New England Journal, which has accepted his interferon study, to publish it. Until that happens, he is only permitted to speak in the most general terms of how interferon is or is not working.

Priorities in this area appear to be peculiarly out of kilter at this moment of life or death.

· Let’s talk about hospitals.
Everybody’s full up, fellows. No room in the inn.

Part of this is simply overcrowding. Part of this is cruel.

Sloan-Kettering still enforces a regulation from pre-AIDS days that only one dermatology patient per week can be admitted to that hospital. (Kaposi’s sarcoma falls under dermatology at Sloan-Kettering.) But Sloan-Kettering is also the second-largest treatment center for AIDS patients in New York. You can be near death and still not get into Sloan-Kettering.

Additionally, Sloan-Kettering (and the Food and Drug Administration) requires patients to receive their initial shots of interferon while they are hospitalized. A lot of men want to try interferon at Sloan-Kettering before they try chemotherapy elsewhere.

It’s not hard to see why there’s such a waiting list to get into Sloan-Kettering.

Most hospital staffs are still so badly educated about AIDS that they don’t know much about it, except that they’ve heard it’s infectious. (There still have been no cases in hospital staff or among the very doctors who have been treating AIDS victims for two years.) Hence, as I said earlier, AIDS patients are often treated like lepers.

For various reasons, I would not like to be a patient at the Veterans Administration Hospital on East 24th Street or at New York Hospital. (Incidents involving AIDS patients at these two hospitals have been reported in news stories in the Native.)

I believe it falls to this city’s Department of Health, under Commissioner David Sencer, and the Health and Hospitals Corporation, under Commissioner Stanley Brezenoff, to educate this city, its citizens, and its hospital workers about all areas of a public health emergency. Well, they have done an appalling job of educating our citizens, our hospital workers, and even, in some instances, our doctors. Almost everything this city knows about AIDS has come to it, in one way or another, through Gay Men’s Health Crisis. And that includes television programs, magazine articles, radio commercials, newsletters, health-recommendation brochures, open forums, and sending speakers everywhere, including – when asked – into hospitals. If three out of four AIDS cases were occurring in straights instead of in gay men, you can bet all hospitals and their staffs would know what was happening. And it would be this city’s Health Department and Health and Hospitals Corporation that would be telling them.

· Let’s talk about what gay tax dollars are buying for gay men.

Now we’re arriving at the truly scandalous. For over a year and a half the National Institutes of Health has been “reviewing” which from among some $55 million worth of grant applications for AIDS research money it will eventually fund.

It’s not even a question of NIH having to ask Congress for money. It’s already there. Waiting. NIH has almost $8 million already appropriated that it has yet to release into usefulness.

There is no question that if this epidemic was happening to the straight, white, non-intravenous-drug-using middle class, it that money would have been put into use almost two years ago, when the first alarming signs of this epidemic were noticed by Dr. Alvin Friedman-Kien and Dr. Linda Laubenstein at New York University Hospital.

During the first two weeks of the Tylenol scare, the United States Government spent $10 million to find out what was happening.

Every hospital in New York that’s involved in AIDS research has used up every bit of the money it could find for researching AIDS while waiting for NIH grants to come through. These hospitals have been working on AIDS for up to two years and are now desperate for replenishing funds. Important studies that began last year, such as Dr. Michael Lange’s at St. Luke’s-Roosevelt, are now going under for lack of money. Important leads that were and are developing cannot be pursued. (For instance, few hospitals can afford plasmapheresis machines, and few patients can afford this experimental treatment either, since few insurance policies will cover the $16,600 bill.) New York University Hospital, the largest treatment center for AIDS patients in the world, has had its grant application pending at NIH for a year and a half. Even if the application is successful, the earliest time that NYU could receive any money would be late summer.

The NIH would probably reply that it’s foolish just to throw money away, that that hasn’t worked before. And, NIH would say, if nobody knows what’s happening, what’s to study?

Any good administrator with half a brain could survey the entire AIDS mess and come up with twenty leads that merit further investigation. I could do so myself. In any research, in any investigation, you have to start somewhere. You can’t just not start anywhere at all.

But then, AIDS is happening mostly to gay men, isn’t it?

All of this is indeed ironic. For within AIDS, as most researchers have been trying to convey to the NIH, perhaps may reside the answer to the question of what it is that causes cancer itself. If straights had more brains, or were less bigoted against gays, they would see that, as with hepatitis B, gay men are again doing their suffering for them, revealing this disease to them. They can use us as guinea pigs to discover the cure for AIDS before it hits them, which most medical authorities are still convinced will be happening shortly in increasing numbers.

(As if it had not been malevolent enough, the NIH is now, for unspecified reasons, also turning away AIDS patients from its hospital in Bethesda, Maryland. The hospital, which had been treating anyone and everyone with AIDS free of charge, now will only take AIDS patients if they fit into their current investigating protocol. Whatever that is. The NIH publishes “papers,” too.)

Gay men pay taxes just like everyone else. NIH money should be paying for our research just like everyone else’s. We desperately need something from our government to save our lives, and we’re not getting it.

· Let’s talk about health insurance and welfare problems.
Many of the ways of treating AIDS are experimental, and many health insurance policies do not cover most of them. Blue Cross is particularly bad about accepting anything unusual.

Many serious victims of AIDS have been unable to qualify for welfare or disability or social security benefits. There are increasing numbers of men unable to work and unable to claim welfare because AIDS is not on the list of qualifying disability illnesses. (Immune deficiency is an acceptable determining factor for welfare among children, but not adults. Figure that one out.) There are also increasing numbers of men unable to pay their rent, men thrown out on the street with nowhere to live and no money to live with, and men who have been asked by roommates to leave because of their illnesses. And men with serious AIDS are being fired from certain jobs.

The horror stories in this area, of those suddenly found destitute, of those facing this illness with insufficient insurance, continue to mount. (One man who’d had no success on other therapies was forced to beg from his friends the $16,600 he needed to try, as a last resort, plasmapheresis.)

· Finally, let’s talk about our mayor, Ed Koch.
Our mayor, Ed Koch, appears to have chosen, for whatever reason, not to allow himself to be perceived by the non-gay world as visibly helping us in this emergency. Repeated requests to meet with him have been denied us. Repeated attempts to have him make a very necessary public announcement about this crisis and public health emergency have been refused by his staff. I sometimes think he doesn’t know what’s going on. I sometimes think that, like some king who has been so long on his throne he’s lost touch with his people, Koch is so protected and isolated by his staff that he is unaware of what fear and pain we’re in. No human being could otherwise continue to be so useless to his suffering constituents. When I was allowed a few moments with him at a party for outgoing Cultural Affairs Commissioner (and Gay Men’s Health Crisis Advisory Board member) Henry Geldzahler, I could tell from his responses that mayor Koch had not been well briefed on AIDS or what is happening in his city. When I started to fill him in, I was pulled away by an aide, who said, “Your time is up.”

I could see our mayor relatively blameless in his shameful.secreting of himself from our need of him in this time of epidemic – except for one fact. Our mayor thinks so little of us that he has assigned as his “liaison” to the gay community a man of such appalling insensitivity to our community and its needs that I am ashamed to say he is a homosexual. His name is Herb Rickman, and for a while our mayor saw fit to have Rickman serve as liaison to the Hasidic Jewish community, too. Hasidic Jews hate gays. Figure out a mayor who would do that to you.

To continue to allow Herb Rickman to represent us in City Hall will, in my view, only bring us closer to death.

When I denounced Rickman at a recent gay Community Council meeting, I received a resounding ovation. He is almost universally hated by virtually every gay organization in New York. Why, then, have we all allowed this man to shit on us so, to refuse our phone calls, to scream at us hysterically, to slam down telephones, to threaten us, to tease us with favors that are not delivered, to keep us waiting hours for an audience, to lie to us – in short, to humiliate us so? He would not do this to black or Jewish leaders. And they would not take it from him for one minute. Why, why, why do we allow him to do it to us? And he, a homosexual!

One can only surmise that our mayor wants us treated this way.

My last attempt at communication with Herb Rickman was on January 23rd [1983], when, after several days of his not returning my phone calls, I wrote to him that the mayor continued to ignore our crisis at his peril. And I state here and now that if Mayor Ed Koch continues to remain invisible to us and to ignore us in this era of mounting death, I swear I shall do everything in my power to see that he never wins elective office again.

Rickman would tell you that the mayor is concerned, that he has established an “Inter-Departmental Task Force” – and, as a member of it, I will tell you that this Task Force is just lip service and a waste of everyone’s time. It hasn’t even met for two months. (Health Commissioner David Sencer had his gallstones out.)

On October 28th, 1982, Mayor Koch was implored to make a public announcement about our emergency. If he had done so then, and if he was only to do so now, the following would be put into action:

1. The community at large would be alerted (you would be amazed at how many people, including gay men, still don’t know enough about the AIDS danger).

2. Hospital staffs and public assistance offices would also be alerted and their education commenced.

3. The country, President Reagan, and the National Institutes of Health, as well as Congress, would be alerted, and these constitute the most important ears of all.

If the mayor doesn’t think it’s important enough to talk up AIDS, none of these people is going to, either.

The Mayor of New York has an enormous amount of power – when he wants to use it. When he wants to help his people. With the failure yet again of our civil rights bill, I’d guess our mayor doesn’t want to use his power to help us.

With his silence on AIDS, the Mayor of New York is helping to kill us.

* * *

I am sick of our electing officials who in no way represent us. I am sick of our stupidity in believing candidates who promise us everything for our support and promptly forget us and insult us after we have given them our votes. Koch is the prime example, but not the only one. Daniel Patrick Moynihan isn’t looking very good at this moment, either. Moynihan was requested by gay leaders to publicly ask Margaret Heckler at her confirmation hearing for Secretary of Health and Human Services if she could be fair to gays in view of her voting record of definite anti-gay bias. (Among other horrors, she voted to retain the sodomy law in Washington, D.C., at Jerry Falwell’s request.) Moynihan refused to ask this question, as he has refused to meet with us about AIDS, despite our repeated requests. Margaret Heckler will have important jurisdiction over the CDC, over the NIH, over the Public Health Service, over the Food and Drug Administration – indeed, over all areas of AIDS concerns. Thank you, Daniel Patrick Moynihan. I am sick of our not realizing we have enough votes to defeat these people, and I am sick of our not electing our own openly gay officials in the first place. Moynihan doesn’t even have an openly gay person on his staff, and he represents the city with the largest gay population in America.

I am sick of closeted gay doctors who won’t come out to help us fight to rectify any of what I’m writing about. Doctors – the very letters “M.D.” – have enormous clout, particularly when they fight in groups. Can you imagine what gay doctors could accomplish, banded together in a network, petitioning local and federal governments, straight colleagues, and the American Medical Association? I am sick of the passivity or nonparticipation or halfhearted protestation of all the gay medical associations (American Physicians for Human Rights, Bay Area Physicians for Human Rights, Gay Psychiatrists of New York, etc., etc.), and particularly our own New York Physicians for Human Rights, a group of 175 of our gay doctors who have, as a group, done nothing. You can count on one hand the number of our doctors who have really worked for us.

I am sick of the Advocate, one of this country’s largest gay publications, which has yet to quite acknowledge that there’s anything going on. That newspaper’s recent AIDS issue was so innocuous you’d have thought all we were going through was little worse than a rage of the latest designer flu. And their own associate editor, Brent Harris, died from AIDS. Figure that one out.

With the exception of the New York Native and a few, very few, other gay publications, the gay press has been useless. If we can’t get our own papers and magazines to tell us what’s really happening to us, and this negligence is added to the negligent non-interest of the straight press (The New York Times took a leisurely year and a half between its major pieces, and the Village Voice took a year and a half to write anything at all), how are we going to get the word around that we’re dying? Gay men in smaller towns and cities everywhere must be educated, too. Has the Times or the Advocate told you that twenty-nine cases have been reported from Paris?

I am sick of gay men who won’t support gay charities. Go give your bucks to straight charities, fellows, while we die. Gay Men’s Health Crisis is going crazy trying to accomplish everything it does – printing and distributing hundreds of thousands of educational items, taking care of several hundred AIDS victims (some of them straight) in and out of hospitals, arranging community forums and speakers all over this country, getting media attention, fighting bad hospital care, on and on and on, fighting for you and us in two thousand ways, and trying to sell 17,600 Circus tickets, too. Is the Red Cross doing this for you? Is the American Cancer Society? Your college alumni fund? The United Jewish Appeal? Catholic Charities? The United Way? The Lenox Hill Neighborhood Association, or any of the other fancy straight charities for which faggots put on black ties and dance at the Plaza? The National Gay Task Force – our only hope for national leadership, with its new and splendid leader, Virginia Apuzzo – which is spending more and more time fighting for the AIDS issue, is broke. Senior Action in a Gay Environment and Gay Men’s Health Crisis are, within a few months, going to be without office space they can afford, and thus will be out on the street. The St. Mark’s Clinic, held together by some of the few devoted gay doctors in this city who aren’t interested in becoming rich, lives in constant terror of even higher rent and eviction. This community is desperate for the services these organizations are providing for it. And these organizations are all desperate for money, which is certainly not coming from straight people or President Reagan or Mayor Koch. (If every gay man within a 250-mile radius of Manhattan isn’t in Madison Square Garden on the night of April 30th to help Gay Men’s Health Crisis make enough money to get through the next horrible year of fighting against AIDS, I shall lose all hope that we have any future whatsoever.)

I am sick of closeted gays. It’s 1983 already, guys, when are you going to come out? By 1984 you could be dead. Every gay man who is unable to come forward now and fight to save his own life is truly helping to kill the rest of us. There is only one thing that’s going to save some of us, and this is numbers and pressure and our being perceived as united and a threat. As more and more of my friends die, I have less and less sympathy for men who are afraid their mommies will find out or afraid their bosses will find out or afraid their fellow doctors or professional associates will find out. Unless we can generate, visibly, numbers, masses, we are going to die.

I am sick of everyone in this community who tells me to stop creating a panic. How many of us have to die before you get scared off your ass and into action? Aren’t 195 dead New Yorkers enough? Every straight person who is knowledgeable about the AIDS epidemic can’t understand why gay men aren’t marching on the White House. Over and over again I hear from them, “Why aren’t you guys doing anything?” Every politician I have spoken to has said to me confidentially, “You guys aren’t making enough noise. Bureaucracy only responds to pressure.”

I am sick of people who say “it’s no worse than statistics for smokers and lung cancer” or “considering how many homosexuals there are in the United States, AIDS is really statistically affecting only a very few.” That would wash if there weren’t 164 cases in twenty-eight days. That would wash if case numbers hadn’t jumped from 41 to 1,112 in eighteen months. That would wash if cases in one city – New York – hadn’t jumped to cases in fifteen countries and thirty-five states (up from thirty-four last week). That would wash if cases weren’t coming in at more than four a day nationally and over two a day locally. That would wash if the mortality rate didn’t start at 38 percent the first year of diagnosis and climb to a grotesque 86 percent after three years. Get your stupid heads out of the sand, you turkeys!

I am sick of guys who moan that giving up careless sex until this blows over is worse than death. How can they value life so little and cocks and asses so much? Come with me, guys, while I visit a few of our friends in Intensive Care at NYU. Notice the looks in their eyes, guys. They’d give up sex forever if you could promise them life.

I am sick of guys who think that all being gay means is sex in the first place. I am sick of guys who can only think with their cocks.

I am sick of “men” who say, “We’ve got to keep quiet or they will do such and such.” They usually means the straight majority, the “Moral” Majority, or similarly perceived representatives of them. Okay, you “men” – be my guests: You can march off now to the gas chambers; just get right in line.

We shall always have enemies. Nothing we can ever do will remove them. Southern newspapers and Jerry Falwell’s publications are already printing editorials proclaiming AIDS as God’s deserved punishment on homosexuals. So what? Nasty words make poor little sissy pansy wilt and die?

And I am very sick and saddened by every gay man who does not get behind this issue totally and with commitment – to fight for his life.

* * *

I don’t want to die. I can only assume you don’t want to die. Can we fight together?

For the past few weeks, about fifty community leaders and organization representatives have been meeting at Beth Simchat Torah, the gay synagogue, to prepare action. We call ourselves the AIDS Network. We come from all areas of health concern: doctors, social workers, psychologists, psychiatrists, nurses; we come from Gay Men’s Health Crisis, from the National Gay Health Education Foundation, from New York Physicians for Human Rights, the St. Mark’s Clinic, the Gay Men’s Health Project; we come from the gay synagogue, the Gay Men’s Chorus, from the Greater Gotham Business Council, SAGE, Lambda Legal Defense, Gay Fathers, the Christopher Street Festival Committee, Dignity, Integrity; we are lawyers, actors, dancers, architects, writers, citizens; we come from many component organizations of the Gay and Lesbian Community Council.

We have a leader. Indeed, for the first time our community appears to have a true leader. Her name is Virginia Apuzzo, she is head of the National Gay Task Force, and, as I have said, so far she has proved to be magnificent.

The AIDS Network has sent a letter to Mayor Koch. It “contains twelve points that are urged for his consideration and action.”

This letter to Mayor Koch also contains the following paragraph:

It must be stated at the outset that the gay community is growing increasingly aroused and concerned and angry. Should our avenues to the mayor of our city and the members of the Board of Estimate not be available, it is our feeling that the level of frustration is such that it will manifest itself in a manner heretofore not associated with this community and the gay population at large. It should be stated, too, at the outset, that as of February 25th, there were 526 cases of serious AIDS in New York’s metropolitan area and 195 deaths (and 1,112 cases nationally and 418 deaths) and it is the sad and sorry fact that most gay men in our city now have close friends and lovers who have either been stricken with or died from this disease. It is against this background that this letter is addressed. It is this issue that has, ironically, united our community in a way not heretofore thought possible.

Further, a number of AIDS Network members have been studying civil disobedience with one of the experts from Dr. Martin Luther King’s old team. We are learning how. Gay men are the strongest, toughest people I know. We are perhaps shortly to get an opportunity to show it.

I’m sick of hearing that Mayor Koch doesn’t respond to pressures and threats from the disenfranchised, that he walks away from confrontations. Maybe he does. But we have tried to make contact with him, we are dying, so what other choice but confrontation has he left us?

I hope we don’t have to conduct sit-ins or tie up traffic or get arrested. I hope our city and our country will start to do something to help start saving us. But it is time for us to be perceived for what we truly are: an angry community and a strong community, and therefore a threat. Such are the realities of politics. Nationally we are 24 million strong, which is more than there are Jews or blacks or Hispanics in this country.

I want to make a point about what happens if we don’t get angry about AIDS. There are the obvious losses, of course: Little of what I’ve written about here is likely to be rectified with the speed necessary to help the growing number of victims. But something worse will happen, and is already happening. Increasingly, we are being blamed for AIDS, for this epidemic; we are being called its perpetrators, through our blood, through our “promiscuity,” through just being the gay men so much of the rest of the world has learned to hate. We can point out until we are blue in the face that we are not the cause of AIDS but its victims, that AIDS has landed among us first, as it could have landed among them first. But other frightened populations are going to drown out these truths by playing on the worst bigoted fears of the straight world, and send the status of gays right back to the Dark Ages. Not all Jews are blamed for Meyer Lansky, Rabbis Bergman and Kahane, or for money-lending. All Chinese aren’t blamed for the recent Seattle slaughters. But all gays are blamed for John Gacy, the North American Man/Boy Love Association, and AIDS.

Enough. I am told this is one of the longest articles the Native has ever run. I hope I have not been guilty of saying ineffectively in five thousand words what I could have said in five: we must fight to live.

I am angry and frustrated almost beyond the bound my skin and bones and body and brain can encompass. My sleep is tormented by nightmares and visions of lost friends, and my days are flooded by the tears of funerals and memorial services and seeing my sick friends. How many of us must die before all of us living fight back?

I know that unless I fight with every ounce of my energy I will hate myself. I hope, I pray, I implore you to feel the same.

I am going to close by doing what Dr. Ron Grossman did at GMHC’s second Open Forum last November at Julia Richman High School. He listed the names of the patients he had lost to AIDS. Here is a list of twenty dead men I knew:

Nick Rock
Rick Wellikoff
Jack Nau
Donald Krintzman
Jerry Green
Michael Maletta
Paul Graham
Harry Blumenthal
Stephen Sperry
Brian O’Hara
Jeffrey Croland
David Jackson
Tony Rappa
Robert Christian
Ron Doud

And one more, who will be dead by the time these words appear in print.

If we don’t act immediately, then we face our approaching doom.

* * *

Volunteers Needed for Civil Disobedience

It is necessary that we have a pool of at least three thousand people who are prepared to participate in demonstrations of civil disobedience. Such demonstrations might include sit-ins or traffic tie-ups. All participants must be prepared to be arrested. I am asking every gay person and every gay organization to canvass all friends and members and make a count of the total number of people you can provide toward this pool of three thousand.

Let me know how many people you can be counted on providing. Just include the number of people; you don’t have to send actual names – you keep that list yourself. And include your own phone numbers. Start these lists now.


Remarks at the White House Conference on HIV and AIDS

by Bill Clinton
December 6, 1995
The Cash Room Treasury Building

1:10 P.M. EST

THE PRESIDENT: First of all, thank you, Sean, and thank you, Eileen. Thank you, Patsy Fleming and Secretary Shalala, Secretary Cisneros. Thank you, Dr. Scott Hitt, and all the members of the President’s Advisory Council. I think most of them were actually sitting in the overflow room so the rest of you can be here. But I thank them — we heard them; let’s give them a hand, maybe they can hear us. (Applause.)

I thank Dr. Varmus, Dr. Kessler, all the others here who are involved in dramatic effort that they are making in the fight against AIDS. Most of all, I thank all of you for coming and for giving us a chance to have this first-ever White House Conference on HIV and AIDS.

So much has been said by the speakers who have spoken before, and so much is still to be said by the panelists and perhaps by some of you in the audience, but I’m going to do what I can to shorten my remarks, because I want to spend most of my time listening to you and focusing on where we go from here. But there are a few things that I would like to say.

First of all, this is a disease, and we have never before had a disease we could not conquer. We can conquer this. (Applause.) I believe that — in my lifetime, we’ve eliminated small pox from the planet and polio from our hemisphere. We can do better, and we can do better until we prevail.

The threat of AIDS, just the very threat of it, has changed the lives of millions of people. And you heard from the talk about prevention, about which I want to say more in a moment, it needs to change the lives of millions of more Americans. It has taken too many friends and loved ones from every one of us in this room. For millions of people it has shaken their very faith in the future.

But it’s also inspired a remarkable community spirit. One of the people on this program today, Demetri Moshoyannis, who is right behind me, grew up in a typical American — I think he’s still there — (laughter) — grew up in a typical American suburb in a typical American community. He attended college, became politically active, with a quick mind and an active spirit. He was clearly a rising star. After graduating, he joined the Corporation for National Service to help us start AmeriCorps.

While he was working for AmeriCorps, he found out he was HIV positive at the ripe old age of 23. He took the news as a challenge, to use his communications skills, his organizational skills and his leadership skills to educate and support his peers and help them escape the threat. He represents the combination of heartbreak and hope that makes this epidemic so unique. I am grateful to him, grateful to Sean, grateful to Eileen, grateful to every one of you who also represents that remarkable combination. We have to be worthy of your continuing courage.

Twelve days ago, the Centers for Disease Control reported that our nation reached another sad milestone in the AIDS epidemic — a half million Americans have now been diagnosed with AIDS and more than 300,000 have died. On this very day, and on every day from this day forward until we do something to change it, 120 more Americans will lose their lives, another 160 people will be diagnosed with the disease, nearly 140 will become infected with HIV.

That’s why this meeting is important. It gives us an opportunity to say to America what the facts are, to rally our troops, to search our minds and hearts, to leave here with more weapons than we came to make progress in this battle.

Our common goal must ultimately be a cure, a cure for all those who are living with HIV, and a vaccine to protect all the rest of us from the virus. A cure and a vaccine, that must be our first and top priority. (Applause.)

When I ran for President, I said that I would do everything I could to pull together the necessary resources and to organize them, and to exercise real direction toward this goal. At a time of dramatic spending cuts, as Secretary Shalala said, we have nonetheless increased overall AIDS funding by about 40 percent. If my budget passes — and on this item, it actually might pass this year — we’ll have a 26 percent increase in research. For the first time since the beginning of the epidemic, there is now one person in charge of the nation’s entire NIH AIDS research program, Dr. William Paul. And though more budget cuts are coming, we have got to protect the research budget and the Office of AIDS Research. I will oppose any effort to undermine the research effort or the Office of AIDS Research. (Applause.)

I want all our fellow Americans to know that this investment in science has paid tremendous dividends. Today people with AIDS live twice as long as they did just 10 years ago, especially those who seek early treatment. AIDS-related conditions that used to mean a quick and often very painful death for people living with HIV can now be treated and even prevented.

Since this administration began, I also want to compliment Dr. Kessler and the FDA. In record time they are now approving new classes of AIDS drugs that will help to restore the damaged immune systems of people with HIV. Indeed, there was a study released last week which says that the United States is now approving drugs faster than any European nation. And a drug company executive was recently quoted as saying that we are now two years ahead of Europe in the approval of AIDS drugs. Thank you, bring on more. This is a good direction. (Applause.)

Again, we have a lot to look forward to. Combination drug therapies are showing great promise as a means for controlling the virus in the human body. And just last year we found that the use of drug therapy could actually block HIV transmission from mother to child. Our scientists tell me it’s within our grasp to virtually eliminate pediatric AIDS by the end of the decade by offering all pregnant women HIV counseling and testing and guaranteeing that they have access to the treatment they need to protect their unborn children. We can give a generation of Americans the freedom of being born without HIV. We can do it, and we will. (Applause.)

I think all of us know we have to do more. And you may have ideas for us. In the end — I want to emphasize this over and over again — whenever we have these conferences, it’s important for the President to speak, but it’s also important for the President and the administration to hear. And you don’t learn much when you’re talking. So I want to urge you all here during this meeting today and afterward in following up, we are combing the country and the world for the best ideas about what to do next.

To move the search for a cure forward and to accelerate the pace, I have asked the Vice President to convene a meeting of scientists and leaders of the pharmaceutical industry to identify all the ways in which we might accelerate the development of vaccines, therapeutics, and microbicides that can protect people from HIV and the infections it causes. There are no guarantees in science, of course, but the collective will of government and energy — industry — can overcome huge obstacles as we have seen just in the last few years.

Second, let me say I am very pleased that the decision that was made at the NIH to put Dr. Paul in charge of coordinating the AIDS research of the NIH, for the first to have it all reconciled, coordinated and directed, has worked out very well. But we need to extend this effort government-wide. That’s why I have asked Patsy Fleming to coordinate an inner-departmental working group that will be chaired by Dr. Paul to develop a coordinated plan for HIV and AIDS research all across every single department of our government, including developing a coordinated research budget. And I want a report in the next 90 days. That is the next important step — (applause).

We can’t afford any unnecessary delays or missed opportunities. And I’m convinced that these two steps will help us to avoid those.

In addition to the work in research, we have to continue to do what we can to assure that those who are living with HIV and AIDS get the support and the care they need. And I want to talk about this is some detail.

For people with AIDS, the current debate over how to balance the federal budget is far more than a question of political rhetoric. It is a matter of survival, primarily because of Medicaid. Even if we are successful, and I believe we will be, in reauthorizing the Ryan White CARE Act, at higher levels of funding — and as you heard the Secretary say, we’ve increased funding by, I believe, 108 percent in the last three years — that is less than 20 percent of the total money spent to care for people with HIV and AIDS.

Medicaid is the lifeline of support. It provides health care for nearly half of the 190,000 Americans living with AIDS provides health care for nearly half of the 190,000, including 90 percent of the children. It provides access to doctors, to hospitals, to drugs, to home care, the things that allow people to live their lives more fully. It pays for the drugs that keep HIV under control for longer and longer periods of time. And it pays for drugs that prevent the infections that often end the lives of those with AIDS. Medicaid pays for the care that allows families to stay together.

Yet today, Medicaid, a program that parenthetically also is eligible to cover one in five American children — that’s how many — 22 percent of our children are living in such difficult circumstances that they are eligible for Medicaid. And one of the things about the congressional budget that I objected to so strongly is that it slashes spending on Medicaid by over $160 billion and turns it into a block grant, thus eliminating a 30-year national commitment we have made to the poor, especially to poor children, which I might say has given us the lowest infant mortality rate in our history. It is the one thing we have done that has helped us to drive down infant mortality among poor people who otherwise never see doctors. It has given elderly people — millions of them — a dignified life in nursing home, or getting home care. And it has helped people with disabilities, not just people with HIV and AIDS, but millions and millions of families on limited incomes with children born with cerebral palsy, children born with spinibifida, families that could never afford to buy a decent wheelchair for their children, much less send them to camp in the summertime or have them in an appropriate living setting. And it is the lifeline for people with HIV and AIDS.

I say again, the Ryan White health Care Act is important. I’m proud of the fact that we have doubled the funding. I am fighting for more funding this year. I am proud of the fact that it enjoys some bipartisan support in the Congress. I am proud of the fact that when there was an attempt in the Senate to eviscerate it, and turn it into a political football, the Senate almost unanimously turned it back.

But be not deceived, we could double it. And if this Medicaid budget goes through, it is a stake in the heart of our efforts to guarantee dignity to the people with AIDS in this country. (Applause.) Thank you. (Applause.)

I want to say one other thing. I want to thank the Secretary of Housing and Urban Development for the work that he has done to increase opportunities in housing for people living with AIDS. (Applause.) We have taken some tremendous hits in the HUD budget, some of them we have inflicted in an attempt to get the deficit down. And there will doubtless be further reductions which will require reorganization on an unprecedented scale at the Department. But Henry Cisneros and I were together on the day before Thanksgiving at a shelter serving food, and he told me again the one thing that we must not do is to undermine the ability of the Department of Housing and Urban Development to try to provide dignified, adequate, compassionate housing opportunities for people living with AIDS.

So I say to you, when we talk about balancing the budget, I’d like to remind you that our administration has cut the deficit nearly in half in ways that were honorable and fair and enabled us to increase our investment in things that mattered, not just the war against AIDS, but education, technology, medical research, the environment, to bring the deficit down and lift the society up. And that’s the way we ought to approach this.

I want to say more about this in a minute, but this budget debate, because it requires tough choices, will inevitably require us to define what kind of people we really are. When times are easy and you can just dole out money to everybody that shows up at the door, it’s pretty hard to tell what your values are. When times are tough, and you have say yes some places and no others, it becomes far, far clearer.

So I ask you to help us in the fight against the Medicaid cuts, to help us to preserve Secretary Cisneros’s ability to support housing opportunities.

I got the message. I heard what you said about prevention. I would point out that in the last two years we have asked for increases in our prevention budget. But I am very worried about what’s happening there because of what has already been said.

We have to set a goal. And I hope you will suggest one coming out of this conference. We have to reduce the number of new infections each and every year until there are no more new infections. And we all have to do that. (Applause.)

We know that for this to work it has to be targeted and it has to be sustained, as the gay community demonstrated in the 1980s. We know now we have to pay particular attention to young people and those who abuse drugs. There is a lot of evidence that huge numbers of our young teenagers continue to be completely heedless of the risks of their behavior.

I was pleased to see the public service announcements that Secretary Shalala released to educate young people and to urge them to take responsibility to protect themselves. I would say we ought to go further, and you need to help us. We have to educate these kids, but we also have to tell them they cannot be heedless of the consequences of their behavior.

It is not enough to know — they must act. It is in the nature — it is one of the joys of childhood that children think they will live forever. It is one of the curses of childhood in some of our meanest neighborhoods that children think they won’t live to be much beyond 25 anyway. In a perverse way, both of those attitudes are contributing to the problem, because one group of our children think that they are at no risk because nothing can ever happen to them — they’re bulletproof; another group believes that no matter what they do, they don’t have much of a future anyway. And they are bound together in a death spiral when it comes to this. This is crazy. We have got to find some way to tell them you must stop this.

We are doing what we can to make those toughest neighborhoods safer. Believe it or not, amidst all the talk here in Washington, you could hardly know it, but out there in America in almost every community, the crime rate is down, the welfare rolls are down, the food stamp rolls are down, the poverty rolls have dropped for the first time in over a decade. Why? Because if you invest in people and their future and jobs are created and people go to work and hope begins to be infused in people’s lives, all of the problems we talk about here in Washington give way to opportunities in the lives of people.

But we see with this — with this problem, whether there is an atmosphere of opportunity or an atmosphere of hopelessness, too many teenagers are ignoring the responsibilities they have to protect themselves. We have to find better ways, and maybe more help from different people, to get inside their minds, to shake their spirits, to make them know care about them and we want them to have a future. But we cannot do the one thing that only they can do, which is to control their own decisions. And we have to do more. And if you’ve got any better ideas for me, believe me, I am all ears.

I want to say, too, just a little word about the importance of trying to tie our prevention efforts with HIV and AIDS to our prevention efforts with drugs and substance abuse, because that’s the second big problem area of populations. In 1993 and again in the crime bill in 1994, we increased our federal investment in drug treatment. And I’m working to try to convince Congress to do even more. We know that the right kind of treatment programs work. We know that the right kind of prevention programs work. And we know that we can marry the two.

I’ve asked the CDC to convene a meeting of state and local people involved in both public health and drug prevention to develop an action plan that integrates HIV prevention and substance abuse prevention. And I hope that we can do that and do it now, because I think it will make a significant difference.

I have to tell you that I am very worried that what we see with the HIV rates among juveniles is now being mirrored in drug use. Last year’s statistics showed unbelievably that drug use among people 18 to 34 was going down, but casual drug use among people 12 to 17 was going up. I think it is clearly because there are too many kids out there raising themselves, thinking nobody cares about them and not thinking there’s much of a future. So we have to deal with these two things together.

And while we search for a cure, work to improve treatment, strive to prevent new cases and to protect the hard-won gains of the past, I’d also like to say just a word about the basic human rights of people living with HIV and AIDS.

AIDS-related discrimination unfortunately remains a problem that offends America’s conscious. The Americans with Disabilities Act now offers more than 40 million Americans living with physical or mental disabilities, including those living with HIV and AIDS, protection against discrimination. And the Justice Department, the Department of Health and Human Services, the Equal Employment Opportunity Commission, they have been vigorously enforcing the ADA. We’re about to launch a new effort to ensure that health care facilities provide equal access to people with HIV and AIDS.

We simply cannot let our fears outweigh our common sense or our compassion. And as Sean said, we can’t let our bigotry — to use his word, we can’t let our homophobia blind us to our obligations. (Applause.)

I say that for two reasons. One is that the fastest growing group of people with the HIV virus are not gay men. This is not a disease that fits into the homophobic world view. But the second reason is that regardless of sexual orientation or race or income or even whether a person has sadly fallen victim to drug abuse — as someone who has lived in a family with an alcoholic and with a drug abuser — every person — I say this with clear knowledge, experience and conviction — every person with HIV or AIDS is somebody’s son or daughter, somebody’s brother or sister, somebody’s parent, somebody’s grandparent.

And when we forget this, when we forget that all the people who deal with this are our fellow Americans and that most of them share our values and our hopes and our dreams and deserve dignity and decency in the treatment we give them, we forget a very great thing that makes this a special country. And we forget it at our own peril.

In one way or another nearly every person in America at one time in his or her life has been subject to some sort of scorn. Woodrow Wilson once said that you could break a person with scornful words just as surely as with sticks, and beat him. And I think that’s an important thing, too, to remember.

The American people need to know that everybody in this country and, indeed, throughout the world, is now vulnerable to this disease. We need to identify what our responsibilities are in this country, and our responsibilities to developing countries, are to deal with the problem, to search for a cure, to search for a vaccine, to deal with the treatment issues. But I’m not sure it doesn’t begin with dealing with our own hearts and minds on this. That’s where you have to come in.

Frederick Douglas said, during the great struggle against slavery, that it was not light that is needed, but fire; not the gentle shower, but thunder; the feeling of the nation must be quickened, the conscious of the nation must be roused. That’s what you came here to do.

Don’t forget this — most Americans are good people. The great burden we have as Americans is that when we have to deal with something new, too often we can’t deal with it from imagination and empathy, we have to actually experience it first. I do not want to wait until every single family has somebody die before we have a good policy — (applause) –.

So I ask you — I understand anger and frustration, but I will never understand it until someday and something happens to me and I know the sand is running out of my hour glass. So I can’t totally understand it. But I ask all of you to remember this — this is fundamentally a good country. Alexis de Tocqueville said in the 1830s that this was a great country because we are a good country. And if we ever stop being a good country, we would no longer be a great country.

So I ask you to use this moment to give America a chance to be great about this issue, give our people a chance to feel this the way you feel it, to see it the way you see it, to know it the way you know it.

When I was getting ready for the conference yesterday, I called Bob Hattoy sitting back there in the room. I said, what do you think I ought to say tomorrow? What do you think is going to happen? We were talking. And he said, I think you ought to think about all the people who waged this battle with us in 1992 who aren’t around anymore. And so we just went through them name by name.

And then right before I came over here I looked at the picture of little Ricky Ray that I keep on my desk at the White House in the Oval Office. And I remembered his family and the members that are still struggling with it.

Give the country a chance to be great about this. Shake them up. Shake me up. Push us all hard. But do it in a way that remembers this is fundamentally a good country. Every now — when we stray, we get off the track a little bit, but we’re still around for more than 200 years because most of the time when the chips are down, we do the right thing. And I am convinced that people like you can get this country, starting here in Washington, to do the right thing.

Thank you, and God bless you all. (Applause.)

Q Mr. President, we will now begin the roundtable discussion with reports from each of the workshops. I’d like to begin with Dr. Renslow Sherer. He will report to you from the primary care and benefits workshop.

Dr. Sherer is a dedicated clinician and researcher who is head of the AIDS program at Chicago’s Cook County Hospital.

Q Mr. President, let me add my voice to thank you for being the first President in 14 years to convene such a conference. I have four messages for you from the primary health care group, and that’s for you and the Advisory Council and for the nation. And I’m really echoing many of the comments that you’ve just made.

Mr. President, we’ve made great progress in HIV care since the epidemic began. We have therapies now, as you mentioned, combination therapies that can improve the length of an individual’s life and the quality of their life. We’ve learned a great deal in the management of HIV and established systems of care, much of which is through the benefits of the Ryan White CARE Act. In future, we need to build on the experience and expertise of those caregivers around the country who have worked for so hard for so long.

But in order to do that, we’re concerned about the fact that our care system is seriously threatened by the potential for Medicaid cuts that are being debated right now. We urgently need you and the nation to support full funding for Medicaid and for the Ryan White CARE Act without mandatory testing requirements. Included in that need is the availability for all who need it for lifesaving drugs. Today, in several states — in New York state and Kansas — people who have had access to life-saving drugs may not now be able to receive them because of funds having expired through Title II of the CARE Act and through other means for the availability of those drugs.

Third, we need to improve access into our health care system for all who need it. In Chicago where I work, we think there are 34,0000 with HIV, but only 10,000 of those are identified, know they’re infected and are in care. We must improve our ability to reach out and provide HIV counseling and testing for those who need it, in a voluntary fashion so they can engage and come into care.

Some of the new improvements in HIV care in the last year require us to once again renew efforts to train health care providers — physicians, nurses and other health care providers — because there’s additional complexity now. And that training needs to take place in medical schools and nursing schools, and also through the AIDS education and training centers, for which funding has been threatened. Full funding of that will guarantee that we continue to be flexible and to respond to the increased training needs.

In addition, we need to ensure oversight of the quality of care. We’ve learned how to do HIV care well, but that’s not consistently transmitted throughout our health care system. On the contrary, there are still centers, individual physicians and providers, who know little or nothing about HIV care. We urgently need to engage them and train them, as well as to ensure that when we’re expanding access to care, it’s to providers with knowledge and experience, so people gain from the benefits that we’ve made in the last 10 years.

It’s very important that we pursue the most cost effective strategies that we can, but that’s not the same thing as limiting costs. We’re very concerned that our health care system allow for the optimal management of people with HIV. To quote one of our members, “to manage care only in terms of short-term cost considerations, it’s not only bad medicine, it’s inhumane and it’s unethical.” It is also not necessarily the most cost effective in the long run.

Finally, Mr. President, the definition of primary care really includes much of what you’ll hear following and what you’ve included in your remarks. In order to provide care at Cook County Hospital for someone with chemical dependency, we need to be able to address their chemical dependency with drug treatment in order to encourage their continuation in primary care. We need prevention urgently, both secondary and primary prevention.

We agree with you that discrimination is a serious impediment to the ability of people to receive care and needs vigorous leadership from the White House and from all the governor’s mansions of our country. Our patients need housing and need mental health care and drug treatment, and we have to think broadly. Those items will be covered by the remainder of the speakers.

In addition, primary care research in health outcomes and in clinical — new therapies is a critical component of HIV primary care.

Again, I thank you for convening this conference and for the leadership that you’ve already shown. Maybe it’s our most important message of all, to continue to listen to people with HIV, to affected communities, to their care providers and their loved ones, and to work with all of us to be here for the cure.

Thank you again. (Applause.)


I want to ask one brief question, if I might. One of the difficulties that we have in dealing responsibly with this issue involves the dilemma that you just laid out when you said we ought to have voluntary testing, not mandatory testing. And the issue is most clearly represented with the whole question of pregnant women now given the advances that have been shown. I’ve studied the CDC guidelines; I think they’re — they make sense to me. I think the rest of us who don’t know the facts ought to follow people that we hire to make these judgments. You know, if there’s — it makes a lot of sense to me. (Applause.)

But you just said that there were 34,000 people that needed your services, and only 10,000 were getting them and we had to find a way to get more people to get voluntarily tested. So how do we close the gap between 10,000 and 34,000? What can we do? What can you do? What can the rest of us do? That’s what’s driving this whole mandatory testing thing. It’s not the notion that people are out there hiding, trying to avoid getting testing; it’s that there’s this huge gap and that society is being burdened by it, and so are these people. So how do we close that gap?

Q I know other speakers today will address, this but let me start. Mandatory testing not only will not address this problem, it will further drive people away and be a disincentive to their coming into care. (Applause.)

THE PRESIDENT: So how do you do it?

Q Mr. President, let me pick the single example of pregnant women. At Cook County Hospital, we have a program with our Ob-Gyn physicians in community health centers to engage pregnant women and women at risk of HIV in voluntary HIV counseling and testing. We have an exceptional compliance, well over 90 percent, with those efforts. You could not improve, and should not improve — you can’t force or use coercion in this kind of a public health problem. The first principle of public health is to engage the support and cooperation of the people.

There are many other creative strategies to reach people at risk. I think that Eileen and Sean have spoken to them, and I know you’ll hear about more today.

MS. FLEMING: Mr. President, Phill Wilson was in the services workshop. He is the public policy director at AIDS Project Los Angeles, and an eloquent spokesperson on behalf of people living with HIV.

MR. WILSON: Good afternoon. As Patsy said, I’m a person living with AIDS. Tragically, I’m not alone. We are not alone. We are part of the American family. We’re not a special interest group. We are men and women; we’re old and young; we’re gay and straight. We live in urban, suburban, rural communities. We are Americans. And we want an end to this epidemic.

With the advances that have been made especially over the last year in basic science and some therapeutic research, we have the potential for hope. I believe you know something about hope. But that hope is at peril for a number of reasons. One of those reasons is the lack of leadership. We need you to continue and to step up your leadership. You and the Congress have made a commitment to balance the federal budget by a date certain. We need you to make a commitment to end this epidemic by a date certain. (Applause.)

The American people need to hear their President say, I’m committed to setting America on a course to end this epidemic in seven to 10 years. At the very time when there’s hope and promise for therapy, we are engaged in a dialogue to dismantle the very mechanisms that the majority of people living with HIV and AIDS use to access that care. Treatment without access is no treatment at all.

The health delivery system of America is crumbling before our very eyes. Medicaid must be protected. It must be protected as an entitlement program. We must maintain the standards of care, and we must support the drug assistance programs.

As was said earlier, we must resist efforts for mandatory testing. And I’ll answer your question: One of the ways to close the gap is by telling people that there’s something that they can do. That message hasn’t gotten out there. The second thing we need to do is to tell them that they have access to that treatment. If you’re poor in America, you don’t have access to that treatment. If you’re poor in America, you don’t know that there are things that you can do. Consequently, there’s no motivation for you to get tested.

Yes, in all of our agencies around the country we have waiting lists because we don’t have the proper resources to, in fact, test the people who want to be tested. We must invest in a comprehensive, coordinated continuum of targeted care that begins with access to voluntary anonymous testing for every American, and includes primary medical, home health, and hospice care.

You have established research and the Ryan White CARE Act as investment programs. We would urge to include in those programs housing and prevention. We are engaged in a war, and in a war you must make sure that all your fronts are covered.

As was mentioned earlier, we’ve recently sent American soldiers to Bosnia. I know we all pray every night that every man and woman there will come home. Every day I feel like I am in a war, a war that I will never come home from. I imagine there are people around you who say that what we ask for is politically impossible. James Baldwin admonished us in The Fire Next Time that in our time, as in every time, the impossible is the least that we can demand. I believe, Mr. President, if you lead, America will follow. (Applause.)

Q Mr. President, Virginia Apuzzo was the reporter in the housing workshop. She’s the former deputy executive director of the New York State Housing Department. She is a New York State Civil Service Commissioner, serves on the New York State AIDS Advisory Council, and was executive director of the National Gay Task Force at the beginning of the epidemic.

MS. APUZZO: Mr. President, we began from the premise that decent, safe and affordable housing is a basic right in America. We wish to underscore that housing is an HIV-AIDS issue.

We discovered early on that it was an AIDS and HIV issue when scores of people were put out of their homes and put out of their jobs because of discrimination vis-a-vis AIDS and HIV. So we didn’t initially get into the housing business, we responded to the demand.

Housing is the foundation upon which any program of care or services must build. Without stable housing the person with HIV-AIDS cannot access any of the programs or services that you support. People who are homeless are virtually red-lined out of programs for prevention and care. It is a fact that nearly 50 percent of the persons with HIV and AIDS will be homeless or at risk for becoming homeless at some time in their life in the course of their illness.

If that happens, that person will drop out of any system of health care for their illness. And the next time that person will be seen will be in an acute care facility. The stay in that hospital for that particular patient costs an average of over $1,000 a day. If that person’s health improves in the course of their hospital stay, the stay will probably be prolonged because the hospital has no place to release the person.

The cost of providing housing services in the HOPWA-funded residential facility is less than one-tenth, and some estimate as low as one-twentieth of the amount that I underscored for the hospital stay. HOPWA dollars reduce the use of emergency health care services by an estimated $40,000 per year. But HOPWA alone can’t do the job. We have relied in the past, and need to continue to rely in the future, on the flexibility afforded by — and Section 8 housing.

In the context of housing, we speak of a continuum of care, a range of housing and services that change over the course of the illness. It may be that a person at some time needs rental assistance, at another time needs transitional housing or group housing or skilled nursing care. That continuum of care has to be set up with the focus being the person and where the person is at that time of the illness in their life. We underscored that housing is a family issue. Houses support families. In some instances they help reconstitute families. And where there is no family, housing helps to create a sense of family.

We understand that you are preparing a seven-year budget plan. We need for you to consider how critical housing is in that scheme of things. And we need that to be reflected as a priority of yours.

And, finally, Mr. President, as has been said before, we’ve waited 14 years and watched 300,000 people die to have the opportunity that you’ve given us today to come before you. We would surely fail those who have passed on and those who are not here to speak for themselves if we didn’t reiterate, each of us, that this struggle needs and deserves your leadership — not for a meeting, not for a day, not for a year, but for the duration, Mr. President.

Thank you. (Applause.)

Q Mr. President, Deborah Cotton was in the research workshop. Dr. Cotton is associate professor of medicine at Harvard Medical School and a physician at Massachusetts General Hospital in Boston. She has been involved with most of the important research questions since the beginning of the epidemic.

DR. COTTON: Mr. President, on behalf of my colleagues in the biomedical workshop, I’m very pleased to be able to report real progress in the treatment of AIDS. As you said so eloquently in your opening remarks, patients are now living longer and living better lives.

Nonetheless, we all know that people are continuing to die every day and we must do more. We must do more because this is now the chief cause of death in people of their most productive years. Because, in fact, our therapies are cost effective and will reduce the burden of cost to our society in caring for those people. In addition, we know that the results that we have in AIDS are going to translate into other diseases. And, of course, because this is the right thing to do.

As you know, this is a virus which directly hits our immune system which is supposed to protect us from infection and tumors. We’ve had to learn a tremendous amount about how this virus works, and we’ve done that. This represents, really, an unprecedented achievement of American science, medicine and patient advocacy. And I think that it really is a model for moving forward with other diseases, in addition to AIDS.

We know now a lot about this virus, how it’s constructed, how it’s activated, where it hides. We know how it interacts with the immune system. And this has really enabled us to have a three-pronged approach against this disease. First, we’re developing drugs that actually try to eradicate or control the virus itself. And, because of an unprecedented cooperation between patient advocacy groups and the FDA, we now have or will soon have six approved anti-viral drugs.

One of these is in an entirely new class and one that flows right out of our basic science research. Several appear to be extremely powerful in being able to reduce the amount of virus in the blood and restore immune function. In addition, we have new evidence that these drugs used in combination will have much greater ability to provide a very durable effect.

Many of us here were at a meeting this week where data from an important clinical trial were presented, which for the first time demonstrates that treating people before they have symptoms can extend their life. This is a truly major result.

Several people, yourself included, have commented on the fact that we are now able to dramatically reduce the transmission of HIV from mother to baby. In addition to the widespread and wonderful results that this will bring to our population — and it has been said, it’s ability to potentially stop the pediatric epidemic — it also teaches us that antiviral drugs can prevent transmission. And we need to expand on that work to other populations.

Despite all of these advances in antiviral therapies, they certainly do not provide cure. In the meantime, we have new drugs which are just beginning to be shown to be effective in restoring immune function. This kind of research will be a value not only in AIDS, but also in cancer and many other immune deficiencies.

Perhaps most importantly to those of us who have been caring for patients for so many years, rather than sitting by and watching our patients die of devastating infections we can now effectively prevent some of the leading causes of morbidity and mortality in AIDS patients, the opportunistic infections that we all know so well. We’re also beginning to see progress in treating AIDS-related cancers. And this, again, is an example of research that will spill out and spill over to other types of cancer as well.

There is now tremendous momentum because of these advances and because of very important work that now shows us that the virus is very active from the beginning of the disease. This means that we have to start to think about treating much earlier. And as several other speakers have said, this means that we have to get the message to the American people that we need to have them come into therapy early, that there are things that we can do for them. We hope that we will eventually be able to treat the disease most effectively at its very earliest stages.

To preserve this kind of momentum we believe that there are several things that are needed. First, we would like to applaud your leadership in trying to preserve funding for basic biomedical science in the United States. We would also like to applaud your support, your very strong support of both the OAR and the FDA. We would like to see this kind of support continue. We would also like to see a strengthening in coordination of our system for doing clinical trials which would pull in not only the pharmaceutical industry and academic centers, but also community-based centers.

We need help in finding ways to make these important clinical trials both achievable by people of color, women and children, and also attractive to them as places where they can receive a state-of-the-art therapy in a respectful environment.

We need to successfully translate our research. And we’ve talked about that in several ways. I would like to mention the real need we have to preserve and protect academic medical centers as the home for this kind of biomedical research. These are places where we can bring together basic clinical scientists and clinicians and patients as well. And we must find ways to preserve them.

Finally, Mr. President, we would like to thank publicly all of the many people who have participated in clinical research in AIDS. They are the people who have made all of this progress possible. Sadly, many of them are no longer with us, but we remember them; we honor them; and we hope sincerely that their contribution will end up producing a cure for AIDS. (Applause.)

MS. FLEMING: Mr. President, Gregg Gonsalves will report from the Biomedical Prevention Workshop. Gregg found out he is HIV positive in March of this year. He is policy director of the Treatment Action Group and one of the most knowledgeable activists working to improve our nation’s research efforts.

MR. GONSALVES: I just wanted to give you some messages from our Biomedical Prevention group this morning. The economic consequences of HIV infection, the social barriers and the cost of behavioral or biomedical intervention against HIV, particularly in the developing world, make the development of an HIV vaccine and topical microbicides the world’s best hope for stopping the AIDS epidemic.

This is how we will save the greatest number of lives, and also in these fiscally conscious times how we will do it in the most cost-effective manner. The cost of treatment far outweighs the cost of prevention in the long run.

The second message we wanted to get to you is that an effective vaccine and the microbicide — we need to define terms here. We’re talking about female-controlled chemical or barrier methods of preventing HIV transmission are possible. We’ve made enormous advances in our basic knowledge of HIV and the immune system over the past several years. And we stand at the brink of an era of great possibility. But if we’re going to realize our goals we need to do several things.

First of all, we need to increase the public investment in research and development on vaccines and biomedical research, in particular. Right now, one out of 10 grants at the National Institutes of Health gets funded — one out of 10. That means there are nine wonderful awards that don’t get funded and research that does not get to be done.

Let me be very clear with you. The Congress’s plan to balance the budget in seven years using drastic cuts in discretionary domestic spending will entirely cripple our search for an effective vaccine and topical microbicides for AIDS. Don’t let these mad bookkeepers with simply numbers on their minds hold those infected with HIV — (applause) — please don’t let them hold people who are uninfected with HIV and those infected with the disease hostage. AIDS programs and biomedical research need to be priority investments over the next seven years.

The National Institutes of Health will be the engine that drives vaccine development from basic research all the way to the clinical evaluation of vaccine candidates. But the government can’t do it alone. Vaccine development depends upon the strong commitment from industry, and right now companies are heading out of the field. We need you to make vaccines and microbicides a national priority because they are not right now. A first step would be to ask the Vice President to call together vaccine manufacturers, scientists and governmental officials to figure out how to get them back into the game. And you’ve already announced that and we applaud that. It really needs to be the intervention of the Vice President on that level to make it happen.

What you could do is to reach out to your counterparts in Japan and France and all around the world and coordinate a global vaccine effort together, because it’s a global epidemic and if we don’t eradicate HIV everywhere, we’ll never eradicate it anywhere. (Applause.)

NIH has a very small budget when you compare it to the rest of the giant agencies of the federal government, and what it is going to give to the American public against AIDs, against cancer, against Alzheimer’s Disease is multifold, and the investment is worth it. And if you want to cure this epidemic, if you want to cure cancer, if you want to cure Alzheimer’s Disease, you could double the NIH budget next year. But it’s not going to happen.

MS. FLEMING: Thank you.

Mr. President, Demetri Moshoyannis was in the prevention workshop. You spoke about Demetri in your remarks.


MR. MOSHOYANNIS: Mr. President, we need, understand and appreciate your presidential leadership on the issue of HIV prevention. And as such, we ask that you, one, protect HIV prevention dollars in the federal budget by making it an investment priority, as the President’s Council on HIV-AIDS has recommended. We need you to make a clear statement and a commitment to continued funding for HIV prevention, research and implementation. Block-granting of prevention dollars to the states is unacceptable. (Applause.)

Number two, support current prevention efforts because we know prevention works. It is currently the best and most cost-effective way to halt the spread of the disease. However, it requires that we address some key issues, issues that you already stated — issues of human sexuality, special orientation including homophobia — thank you for using that word — gender, age, race and culture. We need to ensure that education is not only ongoing but honest and comprehensive. We need to be specific and sensitive to the needs of individuals and communities, especially women, communities of color, and rural communities.

Continued support for the community planning process is critical. Additionally, the needs of young people both inside and outside formal education systems are critical, especially in building self-esteem, communication and life skills — skills I wish I had.

Number three, provide greater financial support, application and translation of behavioral research findings to the general public. As an example, longitudinal studies of high-risk behaviors and circumstantial risks will give all life-saving insight.

Finally, number four, support greater coordination and financial support from different streams of public life, including the private sector and the federal government. We have seen the responsiveness to HIV prevention from foundations, a few corporations, community-based organizations. But we need to stress the more coordinated response.

Finally, we must have access to three things: plain and simple, information, number one. In simple, honest, and nonjudgmental and nonmoralistic language, young people, people of color, women and rural community members need continued HIV education and resources. We need to understand our individual and community rights and responsibilities.

Number two, risk and harm reduction. Condoms and other innovative barriers are not the answer, but they help in the fight. Condom availability programs and needle exchanges are intervention strategies that have proven to be effective. We must support them. (Applause.)

Finally, and not the least of which is very important, programs that utilize delayed intercourse strategies must be supported.

Another finding from our group is that we need to use mass media as a tool for education in the public eye. All sectors of the public arena, including federal government, should explore the use of mass media campaigns in HIV prevention. Other countries have done this. This strategy has proven to be effective in the anti-smoking agenda, for instance. We must use all that we know about social marketing strategies to bolster our current HIV prevention efforts.

This is only the tip of the iceberg, but, hopefully, it will open up some debate and conversation at the White House. (Applause.)

MS. FLEMING: Mr. President, Ed Morse will tell you about the substance abuse workshops. He’s a sociologist who does research in behavior medicine with an emphasis on substance abuse and HIV infected women. He’s associated with both the Tulane and the Louisiana State University Schools of Medicine.

MR. MORSE: Mr. President, the epidemics of substance abuse and HIV in this country are overlapping and highly inter-related. The issues of substance abuse research, prevention and treatment programs must be carried out and continue to move forward in an environment which instills cooperation, exchange of information and a loss of fear, hopefully in the future, of lack of funding. Every time we turned around, funding is always a threat. Neither the researchers, nor the program director, nor the director of program are going to be able to sustain successful programs that actually aim at substance abuse and HIV if it’s a continuous threat.

I would hope that as the country considers balancing a budget, as you yourself have said today, and others here, that there are people behind the numbers. There are people who need help. The substance abuse issue has to be addressed. The society has long ago passed it to the side, but we will move nowhere with HIV and AIDS if we do not address substance abuse in this country.

The programs of research, programmatic efforts intervention and treatment are in fact cost effective and they now are cost effective means of reducing the spread of HIV. So we actually get two bangs for the buck, if, sir, if we have the confidence, if we have the goal to move forward.

Abstinence programs have been very successful and for the most part of accepted in our society. Harm reduction programs are, to say the least, probably not well accepted. And yet it is there that more than likely we will be getting people off the streets by welcoming into centers, rather than pushing them out. They’ll be welcomed into treatment rather than setting such high hurdles that no one will be able to quality. (Applause.) Bleach programs, education, housing, detox efforts, all are at the nexus.

But there is no point in beating around the bush with you. I was asked to speak honestly. We must face the issue of a needle exchange program on a national level. (Applause.) I know that your council — the advisory council on HIV and AIDS — will come to address the policy ramifications of such a needle exchange policy. Those, I’m sure, will be more eloquently spelled out by them. I only ask you — and the group that worked with — ask you to listen to them carefully as you sit with them.

The major institutions in our society, be they insurance company or religious organizations, need to know that your calling to society is not just to the man in the street, but the man on Wall Street as well. They have a responsibility. (Applause.)

The face of substance abuse has no religion, it is of all religions. The face of substance abuse has no race, it is of all races. The face of substance abuse has no social class, it is of all social classes. There are those who have been marginalized in our society beyond belief — the African American, women, persons who live off on a far island called Puerto Rico, which actually considers itself a part of the United States, and rightfully so, yet pushed aside; the Hispanic population, which by the end of this century will be probably the largest Spanish speaking country in the world, they are marginalized; and our children. We need help with substance abuse. Only you can help us move.

Approximately — today, approximately one-third of all cases of AIDS are based in substance abuse, specifically, injectable drug users. One half of all new cases are clearly directly related to substance abuse. Substance abuse is a major key to the solution to this problem. We ask of you, and our group begs of you, to listen and provide the leadership to society to accept that substance, as HIV, is a disease that we need to do research on and we need to move forward with today. And we need to move forward with it today, and past tomorrow, and next year, and the year after, until it too, with AIDS, is gone.

Thank you. (Applause.)

Q Mr. President, Mike Isbell will report from the Discrimination Workshop. He’s Associate Executive Director of the Gay Men’s Health Crisis and the former Director of the AIDS project at Lambda Legal Defense and Education Fund.

Q Mr. President, the nation’s leading health experts say that we need to fight the stigma associated with HIV because it impedes our public health efforts to bring the epidemic under control. You asked earlier why so few people have been voluntarily tested for HIV. In a climate of fear and discrimination and stigma, many people simply don’t want to learn their HIV status because they believe that nothing good is going to come of them on the other side.

Similarly, people who are infected won’t seek appropriate health care if they believe that they’ll be the victims of discrimination. We’ve made important progress since the beginning of the epidemic in fighting discrimination. We now have a federal law which you referred to, the Americans With Disabilities Act, which broadly protects against HIV-related discrimination in employment, housing and public accommodations.

But what we’ve often lacked in the epidemic, as other speakers have alluded to, particularly in the epidemic’s first decade, is the solidarity of our political leaders with people with AIDS. And it’s here where we need your help the most.

Your comments and this entire conference have been inspiring. And we are delighted to hear your inspiring words. But I would urge you to also raise awareness among corporate CEOs, among our religious leaders and among our religious leaders, and among our civic leaders throughout the country because they, too, need to hear the message that you delivered to us earlier today.

Mr. President, when a family experiences a crisis, family members pull together and seek strength and support from one another. Mr. President, there is a crisis in the American family, and that crisis is called AIDS. We need you to tell the truth about AIDS, that one out of 93 American men are infected with HIV and will, barring a significant medical development, die at an early age. For African American men, the rate is one in 33. AIDS is the leading killer of American men and women between the ages of 25 and 44.

Mr. President, the worst form of HIV discrimination is inequitable access to health care, and I would simply bring my voice and add those to the others to say that we strongly urge you to ensure the continuation of the Medicaid program and ensure that every Medicaid recipient has a private right of action to fight discriminatory health care treatment.

We are extremely aware, Mr. President, that many members of Congress wish to further stigmatize people with HIV for short-term political gain, and we urge your leadership in opposing these efforts. In particular, the Defense Authorization Bill would terminate qualified HIV positive service personnel. We need you to say no to this provision that treats people with HIV differently than any other group.

The House of Representatives would like to require that pregnant women and their newborns be tested for HIV without their informed consent. Even though we know that voluntary programs work, we urge you to oppose this measure.

Today, members of the House of Representatives are holding hearings because they apparently would rather see young people die than learn the truth about this disease. (Applause.) And we implore you, Mr. President, to oppose those who would base our public policies on fear and ignorance.

And, finally, the congressional welfare bill would withhold basic medical services to people solely on the basis of their immigration status, and we urge you to oppose that provision as well. (Applause.)

Mr. President, your AIDS Advisory Council will be giving you further recommendations in the area of discrimination, and I would request that you and your staff carefully study them.

And finally, let me say again, thank you for convening this historic meeting, and hopefully it’s the first of many to come. Thank you. (Applause.)

MS. FLEMING: Mr. President, Martina Clark is the reporter from the International Workshop. Martina Clark is with the International Community of Women Living With HIV and AIDS and the California-based World Organization, and has been a warrior in the international fight against AIDS, especially as a member of the governing board of the new U.N. program known as U.N. AIDS.

MS. CLARK: Thank you. Mr. President, we live in a global community. Most people in this country are descended from somewhere else. The faces of AIDS, both in this country and abroad, clearly reflect this diversity. We at this table who are HIV positive are but a handful of the 18 million people worldwide who are living with HIV.

As has already been mentioned, the recent difficult decision to send 20,000 Americans into Bosnia to help our global community will remain on the minds of everyone in this country until, God willing, they return safely by Christmas of 1996. And, yet, in the fight against AIDS, we’re losing the war.

Using conservative estimates from the World Health Organization, 20,000 people will become newly infected with HIV before the Redskins suit up for the football game on Sunday afternoon. Twenty thousand individuals will die of AIDS by the end of next week. Increasingly, the group most affected by this epidemic is women, both married women and single women. Every minute of every day, two women become infected with HIV. Every two minutes of every day, a woman dies of AIDS.

In many areas, more than 60 percent of all new infections are occurring in young women between the ages of 15 and 24 years old. Worldwide, this epidemic is overwhelmingly spread through heterosexual contact, and still, men and women of all sexual orientations from all cultures continue to become infected.

The epidemic affects individuals in their most productive years. It is a family issue. Who will give birth to the children? Who will care for the orphans? Who will raise the food so that countries can eat, survive and not become dependent on the United States in future years?

The United States has already taken a clear lead in this global epidemic, and this must continue. We cannot isolate the United States, as HIV has already successfully penetrated every border of every nation. Our current immigration policy will do absolutely nothing to decrease the spread of AIDS. It only increases the stigma, fear, denial and discrimination already so rampant in this pandemic. (Applause.)

We must secure the continued funding of our international development programs, such as USAID, so that we can ensure that our future generations have economic, social and political stability in the planet. We must share our advances with other nations so that all people, not just the privileged few living in the northern hemisphere, can live longer, more productive lives. The U.S. must continue its support of the new United Nations program on AIDS. And I would encourage you to take advantage of expertise and meet personally with Dr. Peter Piaf (phonetic) — the program director, to be more fully briefed on the epidemic.

The U.S. must continue to follow through on documents already signed, such as the Paris Summit, which highlight the inclusion of people living with HIV and AIDS at all policy and decision-making levels, and research on female-controlled methods of prevention, to name but a few.

In closing, Mr. President, and perhaps most importantly, the world looks to you for leadership. We must continue to bridge our work with our international partners, because the experiences shares from abroad and the research conducted with other countries will be our greatest tools in applying lessons learned to help my brothers and sisters living with HIV in this great country.

And finally, if I may, I would like to invite all of the HIV-positive people in this room who so wish to stand up and show the true diversity and reality of this epidemic. (Applause.)

MS. FLEMING: Mr. President, would you like to make a comment or ask a question of any member of the panel?

THE PRESIDENT: I think maybe we should open the floor to the audience and see if anyone else has anything they’d like to say. (Applause.) I hear talking of those behind me that I can’t see.

Q Mr. President, I want to thank you today for holding the conference. And I especially appreciate that many of us were able to meet with Cabinet secretaries or high-level administration officials. The group that I was I with, we met with Secretary Cisneros. Secretary Cisneros has a model program that I think that should be replicated throughout your administration. He meets bimonthly with AIDS housing activists and providers to find out what’s going on in the AIDS housing community. And that’s led to the creation of an AIDS housing office at HUD.

That kind of connection with this epidemic in each department can make a real difference with this disease. And I urge you to work with all your Cabinet secretaries to make that happen. (Applause.)

Q My name is Jeff Reynolds. I’m director of policy at Long Island Association of AIDS Care. Long Island leads the nation in — AIDS cases, and we’ve been yelling and screaming for years that the white picket fences don’t protect you from AIDS.

I’m wondering if you would consider adding your voice to that message and doing a prime-time address on AIDS. There is a lot of media here today, and many people — (inaudible) — on prime time, we need the heart of America to hear your voice and to let them know that AIDS is a reality. Will you do that? (Applause.)

Q Mr. President, my name is Jeffrey Morris and I am chairman of the HIV-AIDS — Organization, in Miami, Florida. In Miami, I, unfortunately, regrettably, have to announce that 17 percent of our population are over the age of 50. And with all due respect, Secretary Shalala, we do need something for this particular segment of our population because they are, indeed, very, very — in isolation.

Q Mr. President, the National Task Force on AIDS — came up with a series of recommendations, from regulating — to ensure that women of child-bearing age who are HIV positive would have access to — cases of clinical trials and that, in fact, the side effects — (inaudible.) I would please urge you, Mr. President, to ensure that these regulations are actually promulgated —

Q Mr. President, I’m a person living with AIDS and like many people, I have named my remaining — after my friends. And I’ve listened intensely today to the conference and the comments today. And it seems to me that we are sugar-coating a little bit of the problem, at least a problem to someone who is living with the disease.

Thank you, Doctor Koffman and Dr. Kessler for all that you do, but there is today on the horizon — on the horizon — the most impressive group, class of drugs to fight HIV. And the most promising of those have, of course, not yet received approval and are available. And in people’s lives, like myself, two months, three months, four months, are critical to sustaining life. And I would just like to ask you and those people who work with you to do whatever you can to see that those drugs receive the top priority of approval and we can get them out as quickly as possible.

Thank you. (Applause.)

Q Thank you. I’d like to reemphasize — HIV as an development issue. Despite your administration’s involvement and commitment to the HIV issue, I’d like to emphasize that you, as the leader in international AIDS awareness and prevention — international — $120 million. — programs under very serious threat from Congress. We really need your support. Our development programs overall and HIV — for anything at all at the international level.

MS. FLEMING: Thank you, Mr. President. (Applause.)

THE PRESIDENT: I would like to say just one thing before I go.

First of all, I have learned a lot. I even learned some things about some bills in Congress I thought I already knew all about. (Laughter.) And I would like to encourage you to make sure that through our AIDS Office or through the Advisory Council and Scott Hitt that we have an actual record of every question asked and every issue raised. I think it’s very, very important that we do a systematic follow-up on every issue raised, every question asked.

Q Mr. President, why didn’t you do a systematic follow-up on the two previous conferences on AIDS? You promised in your campaign to adopt the recommendations. Why has it taken another year for you to —

THE PRESIDENT: Didn’t you listen to what we said before about what we’ve done the last two years? (Applause.) Most of the —

Q I heard you talk about —

THE PRESIDENT: Do you want me to answer, or do you want to keep talking?

Q — I did not hear you talk about specific actions that will save lives today. And there’s a list of 50 that have been followed by a range of — that have been submitted to officials in your administration. And it has taken two years, and now —

THE PRESIDENT: First of all, that’s not accurate. We recommended a lot of those recommendations, as you know. So I think that’s a little unseemly for you to say. We had a set of recommendations we got when we got here, most of which have been implemented. I am very sorry — I am very sorry — now, wait a minute. I listened to you, now you listen to me. I listened to you. (Applause.)

I am very sorry that there is not a cure. I am very sorry that there is not a vaccine. I regret that not everything I have asked for has been approved by the Congress. In the context of what is happened in this country in the last three years, I believe we have gone a long way toward doing what we said we would do. But I will never be satisfied — and you won’t, and you shouldn’t be — until we have solved the problem. That is what this meeting is about and that’s what I am trying to do. And I think all of us should do what we can to be constructive.

Q — (inaudible) —

THE PRESIDENT: Well, that’s a matter of dispute. You have your version of the facts and I have mine, and I’ll leave it to others to make a judgment.

Q — (inaudible) —

THE PRESIDENT: Let me just say, I believe this has been a good meeting. I think most people are glad they came and I think most people believe they’re better off than they were four years ago. (Applause.)

END 2:37 P.M. EST

Remarks at the Commonwealth People’s Forum

by Stephen Lewis, Co-Director of AIDS-Free World
Tuesday, November 24, 2009
Port of Spain, Trinidad and Tobago

This is a moment of truth for the Commonwealth. The anti-homosexuality Private Member’s Bill
introduced into the parliament of Uganda, and now proceeding through the normal legislative
process, puts the Commonwealth’s legitimacy and integrity to the test.

In a fashion unmistakable in both clarity and intent, the putative legislation declares war on
homosexuality. There are deeply offensive sodomy laws and homophobic statutes on the books
of many other Commonwealth countries, particularly here in the Caribbean. But nothing is as
stark, punitive and redolent of hate as the Bill in Uganda; nothing comes close to such an
omnibus violation of the human rights of sexual minorities. For some time now, Uganda has had
offensive anti-homosexual legislation on the books, but this variant, this inflammatory redesign
makes of the law a veritable charter of malice.

What is truly staggering about all of this is that not a peep of skepticism or incredulity has come
from President Museveni. And President Museveni is chairing the Commonwealth Heads of
Government summit. In so doing, he makes a mockery of Commonwealth principles.

One must remember that the last meeting of CHOGM was held in Uganda in 2007, and issued
what is called the “Munyonyo Statement of Respect and Understanding”. It asserted that the
Commonwealth “is a body well-placed to affirm the fundamental truth that diversity is one of
humanity’s greatest strengths”. It went on to say that “accepting diversity, respecting the dignity
of all human beings, and understanding the richness of our multiple identities have always been
fundamental to the Commonwealth’s principles and approach …”. President Museveni signed
the document. How in the world does he reconcile the affirmation then with the defamation now?

It is noteworthy that much of the strongest opposition to the Bill is coming from the courageous
Lesbian, Gay, Bisexual, and Transgender activists on the ground. LGBT activism always
commands admiration, but in this instance especially so, because their very lives hang in the

The proposed legislation actually mandates the death penalty for any HIV positive gay man who
has sex with another man or any HIV-positive lesbian who has sex with another woman. But
because it’s often hard to believe the sheer malignancy of language, let me quote directly from
the Bill itself. Section 2 of the Bill is titled, “The offence of homosexuality”.

It reads as follows:
Clause “(1) A person commits the offence of homosexuality if — (a) he penetrates the anus or
mouth of another person of the same sex with his penis or any other sexual contraption; (b) he or
she uses any object or sexual contraption to penetrate or stimulate the sexual organ of a person of the same sex; (c) he or she touches another person with the intention of committing the act of

Clause “(2) A person who commits an offence under this section shall be liable on conviction to
imprisonment for life”.

Where does the death penalty enter this twisted world of sexual paranoia? Let me quote the
applicable section and sub-section. Section 3 of the Bill is titled, “Aggravated homosexuality”.
It reads in part: “A person commits the offence of aggravated homosexuality where the …
offender is a person living with HIV”. “A person who commits the offence of aggravated
homosexuality shall be liable on conviction to suffer death”. And just in case there’s any
conjecture, we have this finale: “Where a person is charged with the offence under this section,
that person shall undergo a medical examination to ascertain his or her HIV status”.

From whence do such sentiments arise? What dark corner of the soul is at work? The entire bill
confounds rationality.

In fact, the legislation has a powerfully Orwellian flavor. Section 14 has the title “Failure to
disclose the offence”. It requires everyone in the entire society to report on any evidence of
homosexuality and to do so within twenty-four hours. If it weren’t so extreme, so menacing, so
lunatic, it would be the stuff of theatrical parody. Parents, teachers, doctors, entrepreneurs,
preachers, landlords, community health workers, members of the media, civil society activists,
anyone who can identify a homosexual, gay or lesbian, or has reason to believe that
homosexuality is lurking, must report to the authorities or face a fine, or jail term of three to ten
years, or both. Can you imagine a father or a mother turning in a son or daughter? Can you
imagine a teacher ratting on a student? Can you imagine a physician who’s taken a Hippocratic
oath to tend to the sick betraying that trust because of a patient’s sexual orientation? But that’s
exactly what this law requires.

I’ve truly never seen its like before. Please forgive the harsh language, but this intended antihomosexual
statute has the taste of fascism.

And yet, that’s only the half of it. What is put at terrible risk here — beyond the threat of the
death penalty for HIV-positive homosexuals — is the entire apparatus of AIDS treatment,
prevention and care.

It’s profoundly ironic that the country that’s seen as emblematic of success in fighting the
pandemic is now contemplating such a decisive step backwards. The effect of this legislation
will inevitably be to demonize homosexuality even further, to intensify stigma, to drive gay men
and women underground, to terrify them in their everyday lives, to diminish dramatically the
prospect of counseling and testing to establish HIV status, to make it virtually impossible to
reach homosexuals with the knowledge and education and condoms that prevent the spread of

It’s equally ironic that this retreat into the dark ages of the virus comes at precisely the moment
when the world understands the overwhelming importance of dealing with high risk groups, be
they sex workers, or injecting drug users or men who have sex with men. Indeed, in Uganda
itself, as recently as last year, the Uganda AIDS Commission, in conjunction with UNAIDS,
called for a review of legal obstacles to the inclusion of most-at-risk populations, including
MSM, in the response to the pandemic. That review built logically on the introduction, by the Ministry of Health in 2008, of the “Most At Risk Populations’ Initiative” (MARPI) formulated to target specific groups, including homosexuals.

The new legislation thus eviscerates existing public policy. Is no one in the political apparatus of
Uganda alert to the destructiveness of it all? I am reminded of the remarkably sensible words of
Michael Kirby, former justice of the High Court of Australia: “… the fact remains that the
current approaches, particularly in Commonwealth countries in Africa, Asia and the Caribbean,
place an impediment in the way of tackling this major epidemic. Criminalize people and you
cannot reach out to their minds and effectively influence their conduct … that message is now
one of great importance for the Commonwealth of Nations where AIDS is definitely a priority

Indeed, there’s a very real crisis of conscience in the offing. Both the Presidential HIV/AIDS
Initiative in the United States — PEPFAR as it’s known — and the Global Fund to Fight AIDS,
Tuberculosis and Malaria, have invested huge sums in Uganda to subdue the pandemic. Last year
from PEPFAR alone, the amount was $283 million, and the Global Fund has a five-year
commitment of another $250 million. But both those organizations premise their support in part
on dealing with high-risk groups. What are they to do? This is no trifling matter. Members of
Congress have already written to the Secretary of State raising the dilemma of having PEPFAR’s
work on the ground in Uganda so dramatically compromised. More, under the recent revisions to
PEPFAR, the United States must now negotiate “Partnership Framework Agreements” with
recipient countries, and part of the agreement hinges on addressing target groups, including men
who have sex with men. How in the world is that to be negotiated in the face of the antihomosexuality

Moreover, under President Obama, American policy is clearly shifting. This is a very good thing.
Under the previous administration, the United States, through PEPFAR, forced countries like
Uganda into compliance with awful policies involving, for example, sex workers and
abstinence…; the United States used money, and withheld money, to serve a right-wing agenda.
In a sense, Obama is now involved in an act of redemption.

Just last March, the US administration declared its support for a UN declaration on sexual
orientation and gender identity. The declaration is strong: it calls on all countries to
decriminalize consensual homosexual conduct, and it condemns violence, discrimination,
exclusion and stigmatization based on sexual orientation and gender identity. It also condemns
killings and executions, arbitrary arrest and deprivation of economic, social and cultural rights on
those same grounds. The declaration is seen as a great victory for LGBT human rights. It has the
support of 67 member states. I note, with consternation, that Mauritius is the only African
Commonwealth country to have signed, and I note, with profound dismay, that not a single
Commonwealth country in the Caribbean has signaled support.

President Obama, on the other hand, is firmly on record for the protection of gay and lesbian
rights, and Hilary Clinton has said “…human rights is and always will be one of the pillars of our
foreign policy. In particular, persecution and discrimination against gays and lesbians is
something we take very seriously”. Dr. Eric Goosby, who heads PEPFAR, is even more firmly
on the record: “I look forward to working with field and headquarters staff, Congress and others
in the Administration to ensure that PEPFAR effectively targets the most-at-risk and vulnerable
populations — including LGBT populations — with culturally appropriate prevention, care and
treatment interventions”.

The Government of Uganda and PEPFAR are on a collision course. President Museveni had best
wake up and smell the dollars.

I would never wish to counsel financial penalties, but it’s a real conundrum. Worse, the
employees of the non-governmental community-based organizations that receive the money
would be subject to risk of imprisonment if they continued to work with homosexuals. I was
struck by a letter written to the American Ambassador in Uganda, from a group of Foundations
that do HIV/AIDS programming in the country, asking him to “take appropriately stern action to
oppose the bill …” They were agitated and vehement in their condemnation of the Bill, noting
that it put their local and international employees and consultants at risk of criminal charges.
They felt, in fact, that the Bill has already applied a chill to human rights and civil liberties in
Uganda and is an unrelievedly nasty piece of work. They observed, somewhat sardonically, that
the Ambassador has diplomatic immunity, but their collective staff in the projects they funded
have no such protection.

And the complications abound.

The new Executive Director of UNAIDS (and ironically, a former UNICEF Representative in
Uganda who knows Museveni well) has staked a good part of his growing reputation on
deploring homophobic legislation, valiantly fighting for the human rights of the gay community
and speaking unequivocally about his revulsion at punitive anti-homosexual behavior. As a
matter of fact, Michel Sidibe is on record in a way that speaks directly to the import of the
Ugandan Bill. He is reliably reported to have said (and it certainly rings true): “It pains me that
80 countries have laws which criminalize same-sex sex, and it outrages me that seven countries
can invoke the death sentence for homosexual practice”.

Well, now it verges on eight countries, and the death sentence is directly linked with HIV positive
gay men. So what, I ask, does Michel Sidibe do now? Does he communicate that
outrage directly and publically to President Museveni? Does he enlist the intervention of the UN
Secretary-General? Does he write to the Secretary-General of the Commonwealth and ask that
Uganda be suspended in the event that the legislation passes in its present form? What counsel
does he give to the Global Fund and PEPFAR? These are not idle questions: the Executive
Director of UNAIDS is an influential figure who cannot allow his outrage to be but sound and
fury ending in capitulation.

Furthermore, what’s going on with the legislation is not simply confined to the egregious
sections that I’ve quoted. There are several additional odious sections; the erosion of human
rights has few limits. One other clause of the Bill purports to extend the arm of the state into the
bedrooms of the world. Using what is called “extraterritoriality”, the legislation decrees that any
Ugandan engaging in homosexual acts outside of Uganda is equally culpable, and will be
arrested and charged accordingly. Thus, homosexuality joins terrorism and treason in the
pantheon of extraterritorial jurisdiction to be exercised by Uganda. How this would be enforced
is not immediately apparent, and of course the clause is ridiculous, but the ridiculous has a habit
of becoming national jurisprudence if it’s driven by hatred.

The evidence of just how foolhardy and crazed the legislation is, lies in its most extreme feature:
the Bill asserts that where any of its provisions is in conflict with any international human rights
instrument that Uganda has ratified, the content of the Bill will prevail over international law.

This is palpable nonsense, and simply not possible. But it is a fascinating glimpse into the
twisted cerebral calculus that fashioned the legislation.

Naturally, the protagonists of the legislation are mounting arguments in its defense. The
arguments are unsustainable.

We are reminded that this is a Private Member’s Bill, and the Government is simply following
legislative practice in allowing it to be debated. That’s just a clever ruse. I sat in a
Commonwealth parliament for more than fifteen years, and where a Private Member’s Bill
threatens to dominate public debate and the parliamentary session, the government always makes
clear where it stands. In this instance, the defenders point out that President Museveni has not yet
spoken. He has found time, since the Bill was tabled on October 14th last, to make some
disparaging remarks about homosexuals at a recent youth event in Kampala, but it’s true that he
hasn’t yet definitively pronounced on the Bill itself. But ominously, one of his senior cabinet
ministers has: Mr. James Nsaba Buturo, Minister of Ethics and Integrity heralded the legislation
with apparent enthusiasm. InterPress News quotes him as saying “It is with joy we see that
everyone is interested in what Uganda is doing, and it is an opportunity for Uganda to provide
leadership where it matters most. So we are here to see a piece of legislation that will not only
define what the country stands for, but actually provide leadership around the world.”

He could better be called the Minister of Fear and Loathing.

I know that the views I am expressing on behalf of the organization I represent, AIDS-Free
World, will seem tough and harsh to some. But let me tell you what we feel.

We don’t think that this piece of legislation deserves a careful parsing of its clauses, invoking all
of the international human rights instruments that Uganda has endorsed, from the Universal
Declaration of Human Rights to the Covenant on Civil and Political Rights, attempting to show
where the Bill is in conflict with human rights principles. That just gives far too much credibility
to the proposed legislation. On its face, without more than a simple glance at the substance, the
Bill is revealed as an unbridled attack on the human rights of sexual minorities. There is no
overall clause worthy of retention. There are phrases here or there (like the prohibition of sex
with a minor) that any sentient human being can agree with. But the Bill cannot possibly be
salvaged. It must be expunged in total from the parliamentary record. And for those who believe
in conspiracy theories, let me say that the fundamentalist hand of the religious right in the United
States is not difficult to discern.

Nor do we think that we need treat this issue with respect. We don’t believe that we have to
‘respectfully submit’ our arguments to anyone, or seek to ‘respectfully influence’ the powersthat-
be. There are some moments in life where defining issues are indelibly joined. I remember
sitting behind my then Canadian Prime Minister, Brian Mulroney, at the Commonwealth meeting
in Vancouver in 1987. The issue was apartheid. The contest was between Margaret Thatcher and
Mulroney, and Mulroney let her have it. There was no respectful pretense. He didn’t parse the
pass laws, he didn’t invoke the clauses of international covenants, he just lacerated Prime
Minister Thatcher for defending apartheid, and he decried it for what it was: a totalitarian regime
rooted in racism and the savage decimation of human rights. It’s worth noting that he was joined
by Sir Shridath Ramphal, then the Secretary-General of the Commonwealth, who was slightly
more restrained but unmistakable of tone and purpose. That was a time when the Commonwealth
stood for something.

The analogy with apartheid is not a stretch. In 1998, the Constitutional Court of South Africa
ruled on a case involving the National Coalition for Gay and Lesbian Equality. The court held
that “the constitutional protection of dignity requires us to acknowledge the value and worth of
all individuals as members of our society.” The court then concluded with the words, “Just as
apartheid legislation rendered the lives of couples of different racial groups perpetually at risk,
the sodomy offence builds insecurity and vulnerability into the daily lives of gay men. There can
be no doubt that the existence of a law which punishes a form of sexual expression for gay men
degrades and devalues gay men in our broader society. As such it is a palpable invasion of their
dignity and a breach of the Constitution.”

It’s no accident that the recent judgment of the High Court of Delhi in India in July of this year
similarly struck down a provision of the Indian Penal Code that criminalized consensual same
sex conduct, finding that it was a violation of the right to live in privacy and dignity, which
privacy and dignity were constitutionally protected.

In other words, on every conceivable front the anti-homosexuality legislation has not a statutory
leg to stand on.

Yet President Museveni is permitting it to proceed. And at the meeting of Heads of the
Commonwealth, he will, sadly enough, find a throaty gaggle of like-minded colleagues.

It would not surprise us if the Prime Minister of Jamaica were particularly thrilled. Jamaica is, as
everyone knows, a hot-bed of homophobia, more pronounced than anywhere else in the
Caribbean. And while Jamaica would never introduce a bill akin to that of Uganda, the political
leadership in general, and the Prime Minister in particular are willing to sustain a rabidly hostile
environment for all lesbian, gay, bisexual and transgendered people. I visited Jamaica not so long
ago for the precise purpose of examining the relationship between the criminalization of
homosexuality on the one hand and HIV/AIDS on the other. The connection is indisputable. I
met with several of the sexual minority groups, and the stories of hatred and beatings and
harassment and prejudice make the blood run cold.

And so the situation becomes a breeding ground for AIDS. Let it be understood: it’s not
homosexuality that spreads AIDS; it’s the culture that brutalizes gay men and forces them
underground that spreads AIDS. The prevalence rate in the general population of Jamaica is
barely 1.5%. The prevalence rate amongst the community of MSM is over 31%. The HIVpositive
gay men become what UNAIDS calls the classic bridging population … to show that
they’re ‘real’ men and protect themselves from the wrath of society, they marry or take women
as lovers so that their acquired heterosexuality is firmly on display. And then the women get
infected. The cloistered gay sexual behavior, driven by fear and the sodomy laws, keeps them
away from testing and health care and education that would diminish HIV infection. It’s a crazy
equation. But the Prime Minister of Jamaica pays no heed. One can almost imagine President
Museveni and Prime Minister Golding cozying up together around the Commonwealth table as
they share dismissive laughter about the woes of the gay community, while simultaneously
signing the latest Commonwealth declaration on universal human rights.

The trouble is: it’s no laughing matter. Of the 53 countries in the Commonwealth, 40 have
sodomy laws. A majority of states in the Commonwealth Caribbean have a sodomy law: it’s a
sure recipe for the gradual, ineluctable spread of the virus. In a recent report on AIDS, UNAIDS
points out that whereas “ … HIV prevalence is less than 1% among the general population of most countries in the region, it may be between 5 and 20 times higher among men who have sex
with men.” In its Epidemic Update for 2009, issued just today, UNAIDS re-emphasizes the
alarming rates of transmission amongst the MSM populations in the Caribbean. By way of direct
comparison with the Caribbean, every single country in Latin America has removed punitive
legislation directed at homosexuals, making the prevention and treatment of AIDS vastly more

Africa is another throw-back. We’ve finally reached the point where the epidemiologists are
chronicling the spread of AIDS within the homosexual population of the continent. Until now,
the subject was taboo … the possibility of gayness was rejected out of hand. But UNAIDS
provides this disturbing quote: “A recent literature review of HIV infection among men who
have sex with men in Africa identified 19 surveys published through May 2009 from 13
countries, in addition to several unpublished works, highlighting the expansion of available data.
For each country, the HIV prevalence among men who have sex with men was higher than
among the adult male population.” In today’s newly-released Epidemic Update for 2009 to
which I’ve referred, UNAIDS, for the first time ever, devotes a lengthy section to the increasing
evidence of elevated transmission of the virus amongst the MSM population.

In this context, it’s positively criminal to table a parliamentary bill like that of Uganda. It’s one
thing to talk about the promotion of the ‘traditional family’ as the author of the Bill does ad
nauseam; it’s quite another thing to incite the promotion of disease and murder. Gays and
lesbians don’t challenge traditional families; their private sexual practices don’t invade the
sanctity of family life. The accusation is a vile canard. People who plead the supremacy of
family values over other human values have one of two motives: either they’re biblical
fundamentalists whose religiosity has gone haywire, or they’re so steeped in irrational fear of
different sexual orientation that human rights have no meaning.

Ultimately, the Commonwealth has a severe crisis on its hands. It may seem a fortuitous
distraction to focus on the financial downturn and climate change. To be sure, they’re both
important. But roiling just beneath the surface of calm deliberation is this immense civil
libertarian struggle. We know we’ll win the struggle. It’s just a matter of time. It always is. But
in the process, intense pain will be felt, lives will be ruined, people will die. That’s what is too
much to bear. A terrible price is always paid on the incremental road to social justice … in this
case, an entire community held to the ransom of predatory fear.

President Museveni is no fool. He’ll figure a way out before fatal damage is done to his
reputation. But if we want that to come sooner than later, the Commonwealth must put Uganda’s
anti-homosexuality law on its agenda. Someone has to raise it; perhaps Prime Minister Gordon
Brown. It should be collectively agreed that if the law passes, Uganda will be suspended from
the Commonwealth. The credibility of the Commonwealth is hanging by a spider’s thread. The
member states take it less and less seriously. Climate change will be resolved at Copenhagen
next month or Bonn or Mexico City in 2010; nothing will be resolved here at Port of Spain. The
financial crisis will be dealt with by the G8 and G20 in Canada in 2010; nothing will be resolved
here at Port of Spain. If the once-upon-a-time civilized values of the post-colonial
Commonwealth are to be restored, then the monstrous war on homosexuality is the place to start
the restoration.

Uganda makes a perfect beginning.

Remarks on the Ryan White CARE Act

by Orrin Hatch (R-UT)
July 26, 1995
Text from the Congressional Record
( source, with video)

Mr. HATCH. Madam President, they are trying to put together a final agreement so that they can go out tonight. Until they do, let me take a few minutes and express myself on the Ryan White bill.

Madam President, people are dying. People are dying and we have the chance today or tomorrow to enact legislation that will really make a difference–really make a difference in their lives, and the lives of their families and friends who love them.

We have the chance to enact legislation that will help alleviate some of the pain and suffering of individuals who are infected with HIV.

We have a chance to enact bipartisan legislation showing that Congress cares more about people–about people who are critically ill and need our help–than about how those people got ill.

Madam President, in 1981, two physicians unknown to each other, on opposite ends of the United States, made similar observations that they would then publish in their respective medical journals.

They noted that a small group of their otherwise healthy patients were becoming infected with organisms that would normally affect individuals who were for some reason immune-suppressed. In layman’s terms–these patients had a weakened immune system.

By the end of the following year, 1982, almost a thousand cases of the disease had been reported to the Centers for Disease Control. Congress had appropriated $8 million for research to combat this mysterious virus.

Over the next few years, the number of such cases dramatically increased and began to spread throughout the country, as did our realization that the virus, now called acquired immune deficiency syndrome, AIDS, was not going to be eradicated overnight.

Funding for research rose to $44 million in fiscal year 1983, $104 million in fiscal year 1984 and by fiscal year 1990 had reached $3 billion. By 1987, there were cases in each of our 50 States.

As I look back, I recall how AIDS began to touch on each of our daily lives, as the number of cases grew, and the need for increasing research and service-related funding for this growing epidemic.

We began to expand funding beyond the Department of Health and Human Services, to the Department of Defense, the Agency for International Development, and the Bureau of Prisons.

We funded the Department of Labor, the Department of Housing and Urban Development and the Veterans Administration. We provided funding through the Federal Employees Health Benefits Program.

Our response grew with the magnitude of the disease, as it should continue today.

As I think back to the early days of AIDS, and how the growing numbers of infected individuals and the resultant death toll caused this country so much alarm and panic.

Unfortunately, as with any unsuspected crisis, the immediate response from many–including members of both houses of Congress–could be characterized as denial, anger, and blame. Fortunately, over time, our compassion has grown for those infected with this insidious virus, as our understanding about the causes of and treatments for this devastating disease increased.

As I look back, I think of the swift reaction of our health care community, yet how painfully clear it was that both our research and service delivery infrastructures lacked the capacity to address the growing number of cases of HIV infection.

I talked about our growing research effort. I did not talk about the dedication of our scientists, and their ensuing frustration, as a cure–or even a vaccine–continued to elude our grasp.

Today, they still remain outside our grasp.

As I look back, I recall how the service delivery programs evolved–the AIDS service demonstration projects, the home and community-based health services grant programs, and the AIDS drug reimbursement program–yet we still could not keep pace with the need for services in our communities.

They came out of our Labor Committee, and we were proud to authorize those programs which have really served to help people. But they were not enough.

Out of this great need for community-based, compassionate care was born the Ryan White Comprehensive AIDS Resources Emergency [CARE] Act of 1990, a bill I was pleased to author with my colleague from Massachusetts, Senator Kennedy.

We named the bill after Ryan White, a courageous, intelligent and caring young man from Indiana, who worked tirelessly to educate others about HIV and AIDS. Ryan helped replace fear and indifference with hope and compassion. One of the great lessons of his life–that we should not discriminate against those with the HIV virus of other illness–remains true today. His tireless efforts, indeed his legacy, is being carried on by his mother, Jeanne White. And I met with her a number of times. And I have to say she is doing a good job.

There are so many others who have spoken out with the same spirit and eloquence, including Mary Fisher, founder of the Family AIDS Network, who is a tireless crusader against AIDS, and our much-missed friend Elizabeth Glaser, who established the Pediatric AIDS Foundation which has done so much to improve the lives of children infected with HIV.

I can remember when she first walked into my office. I did not know a lot about pediatric AIDS. I knew about adult AIDS. But I did not realize so many children were being infected at that time. When she walked in and explained it to me, I have to say we decided to help her. Our colleagues, Senator Metzenbaum and others, helped her raise her first million dollars for the Pediatric AIDS Foundation at a wonderful dinner here in Washington, DC and she went on from there to raise several more million dollars in the fight against AIDS, and, of course, she is one of the most valued heroines in this country, as far as I am concerned. There have been so many unnamed others in countless communities across the Nation.

Today, we have before us reauthorization of the Ryan White CARE Act.

My message is simple: it is an important act. It must be reauthorized.

The need continues.

Let me discuss a few dramatic facts in order to highlight the tremendous impact of this disease and explain why this bill should be passed.

The most revealing fact is that the No. 1 cause of death for males aged 29 to 44 is now AIDS.

In the last decade, the proportion of cases represented by women has almost tripled.

Even in my small home state of Utah, it is estimated by the Department of Health that there are 5,000 people infected with the HIV virus. To date, 1,110 have been diagnosed with full-blown AIDS, and 644 have died.

Indeed, our knowledge of AIDS has expanded dramatically since those early days.

We now know that AIDS is not a gay disease, or a Haitian disease.

We know that it cannot be transmitted by casual contact.

We know that it affects man, woman and child, whatever race, whatever nationality.

AIDS does not play favorites. It affects rich and poor, adults and children, men and women, rural communities and the inner city.

We know much, but the fear remains.

Madam President, things have changed since 1990. But the need for this legislation remains.

The number of cases continues to increase. At the end of 1994, the Centers for Disease Control and Prevention had recorded 441,528 cases of HIV. The number continues to grow.

The emotional and economic burden for HIV patients and their families is substantial, and it continues.

The Ryan White CARE Act has made a difference and should continue to make a difference.

There is so much that remains to be done.

Since its enactment in 1990, the Ryan White AIDS Care Act has provided the necessary assistance to those persons and their families affected by the AIDS epidemic. Often, the funding provides for models of HIV service delivery that are considered to be some of the most successful health care delivery models in history.

I am very proud of Utah’s Ryan White program. Let me tell you of some of our accomplishments.

Ryan White funds were used to establish a home health services program which provides much needed homemaker, health aide, personal care, and routine diagnostic testing services.

A drug therapy program has been established that offers AZT and other drugs to individuals infected with HIV.

Ryan White funds have been used to provide health and support services through an HIV Care Consortium, which offers vital services such as dental, mental health counseling, transportation, benefits advocacy, eye exams and glasses, legal advocacy, information and education, nutrition counseling, and substance abuse counseling.

These are programs which are in place and which are working. They should be continued.

I believe it is vital that we reauthorize the Ryan White Act.

Madam President, many have noted that AIDS brings out the best and worst in people. Let us hope that this debate reflects the best of the great American traditions of reaching out to those in our community.

I plead with my colleagues today, and I will tomorrow, let us not backslide on this. I wish to compliment the distinguished chairman of the Labor and Human Resources Committee, and the ranking member, Senators Kassebaum and Kennedy, for the work that they have done and for the courageous way that they have gone about it and for the work they have done on the floor here this day. I personally respect both of them very much, and I appreciate what they are doing in this bill.

Our progress has been great, but we have so much more to do to wipe out this virus. Let us hope and pray that one day, like smallpox, the HIV virus will be eradicated as a public health problem, and that is what we are talking about, public health, for everybody. Until then, Ryan White programs offer the only glimmer of hope to thousands of Americans who are living with HIV.

So I wish to thank my esteemed colleagues, especially our floor managers today, Senators Kassebaum and Kennedy and others who have worked so hard to move this important piece of legislation forward. I will work with them in any way I can to see that this legislation is sent to the President as quickly as possible, and I again hope that we can do this probably tomorrow morning.

I thank the Chair.

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