Aids “Action Plan”
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JIM LEHRER: The new White House AIDS strategy is first tonight. President Clinton signed on to a six-point plan today, and his point person is here to explain it. She’s Patricia Fleming, the President’s national AIDS policy director. Welcome, Ms. Fleming.
Let’s go through these major goals, first of all, to find a cure for AIDS. How close is that, and what is the strategy designed to do about it?
PATRICIA FLEMING: Well, the strategy has six goals which are overarching and rather general. They set out what the President would like to do in his second administration. The goals are, first of all, to conduct research leading to a cure, a vaccine, and better treatments. The second goal is prevention, to reduce the number of infections until there are none in whatever length of time that takes but as quickly as possible. The third is access to high quality treatment for all of those who need it. The fourth is to try to do something about discrimination against people with HIV and AIDS. The fifth is to continue our leadership in the international area in a fight against the global pandemic of HIV and AIDS. And sixth is to translate the results of research into better prevention and medications for people living with HIV and AIDS, and to prevent infection.
JIM LEHRER: All right. Specifically, what is the strategy designed to do in terms of finding a cure?
PATRICIA FLEMING: Well, it proposes to, for example–let me give you an example in the area of vaccines. One of the things that it does is underneath the overarching goals that I just outlined are specific opportunities for progress, such things as, for example, the vaccine initiative that was announced last week. David Baltimore, the Nobel Laureate from MIT, is going to have a new task force to consolidate and expand the research on a vaccine to prevent HIV infection. Another example would be our desire and intention to target women, injection drug users, and youth, which are new prevention programs.
JIM LEHRER: But in terms of–just so we understand where we are, from your perspective and from the general AIDS community’s perspective, how close are we to finding a cure?
PATRICIA FLEMING: How close are we to finding a cure? That’s very, very hard to say. Right now, we have drugs that are successful in treating HIV infection and in many cases getting people out of bed and going back to work. It’s really remarkable. But we have a lot of unanswered questions related to those drugs. We don’t know when to begin treatment, in what combination, and how long it will be successful.
JIM LEHRER: Does this strategy–
PATRICIA FLEMING: That’s not a cure.
JIM LEHRER: Sure. Does this strategy lay out some specifics as to how all the work that’s being done now to try to find a cure will be more effectively done, or–
PATRICIA FLEMING: That’s not the purpose.
JIM LEHRER: That’s not the purpose. Okay.
PATRICIA FLEMING: No. The strategy is a blueprint. It’s what the President wants to do during his second term and specifically during the coming year. It does not give direction to the scientists who are looking for a cure.
JIM LEHRER: Or a vaccine.
PATRICIA FLEMING: Or a vaccine. What it does is it sets up mechanisms to help move that effort along farther and more quickly.
JIM LEHRER: There have been several AIDS organizations that have issued statements today about this strategy and make that very point, that the weakness here is that it is not specific, that it’s going to be another report, very general, that’s going to be put on a shelf, and it’s going to just gather dust. Is this going to be any different than any other of those reports?
PATRICIA FLEMING: Well, first of all, it’s not a report. It’s an action plan. It has steps. It has opportunities for progress. It lays out what the President intends to accomplish. It’s the first time the President of the United States has ever gotten behind a plan to achieve the goals that he has laid out. Now it’s going to be impossible to say by which date we will have a cure or a vaccine. We don’t know that. It depends on the science. What it does is it pushes the science ahead farther and faster.
JIM LEHRER: Do you think this really will push the science?
PATRICIA FLEMING: Yes. I do. There’s no question.
JIM LEHRER: How will it push the scientists to find a cure quicker, or to find a vaccine quicker?
PATRICIA FLEMING: The departments and agencies that have responsibility for the programs dealing with HIV and AIDS in every area, research, prevention, care, and so on, have marching orders from the President. This is what he intends to accomplish in his administration.
JIM LEHRER: And are there going to be follow-ups to make sure that his strategy is implemented–
PATRICIA FLEMING: Yes.
JIM LEHRER: –in specific ways?
PATRICIA FLEMING: As a matter of fact, the strategy was developed by my office in conjunction with community people. I spent a lot of time traveling around the country, talking to people with HIV and AIDS, to care givers, to families, and here in Washington, to national AIDS organizations and to the presidential advisory council. So I have brought together a lot of opinions and interests and needs into this, and then in conjunction with the agencies responsible for carrying it out, we put together this strategy. Now, as I said, it’s action steps. It’s not a report to sit on a shelf. It’s a guide. It’s a blueprint. It doesn’t spell out day by day, line by line, dollar by dollar what must be done. It cannot do that and have it stick. But this is something the agencies have bought into, and the President is behind. It’s something that we have needed and has been recommended and asked for for years.
JIM LEHRER: By whom?
PATRICIA FLEMING: Well, for one thing by the commission on AIDS that was appointed by President Bush, by congressional committees that wrote reports, one of which I was part of when I worked for Ted Weiss in the House, and by the President, himself.
JIM LEHRER: Which is one of the House subcommittees on health.
PATRICIA FLEMING: Oversight of health.
JIM LEHRER: Oversight. Right.
PATRICIA FLEMING: Right.
JIM LEHRER: Another point that’s been made today after this strategy has been issued, that it doesn’t speak to the question of needle distribution to combat the spread of AIDS by drug users. Why did this report not speak to that issue?
PATRICIA FLEMING: Well, I’ll tell you what it does. It identifies injection drug users as one of the most important target populations for prevention efforts and for attention generally. And that means more access to treatment, treatment as a form of prevention of HIV infection, more–a way of getting people who do shoot drugs up to use clean needles, a stop on the importation of drugs from other countries, to control drug use in that way, as Barry McCaffrey, the AIDS czar has–I mean, the drug czar, has outlined. And then, it doesn’t close the door against needle exchange at all. In fact, it talks about needle exchange as a program that has been successful in many cities. It leaves the door open.
JIM LEHRER: But as we sit here now, the use of federal funds is banned, has been since 1992, I believe, is that right?
PATRICIA FLEMING: Yes.
JIM LEHRER: And President Clinton has indicated in the past that he was going to try to overturn that, but there’s no mention of that. That’s not part of his strategy to do that.
PATRICIA FLEMING: No, it’s not specifically part of the strategy. Congress–
JIM LEHRER: Why is that?
PATRICIA FLEMING: The Appropriations Committee in the last appropriations process asked the secretary of HHS to provide a report to the committee–to the Congress on needle exchange. It asked two questions. One is, does it reduce the number of new infections, and the second is, does it increase drug use, the needle exchange program?
JIM LEHRER: Which has been one of the criticisms of needle exchange.
PATRICIA FLEMING: That’s right. It has been. The scientists will look at all the evidence and determine whether those two criteria have been met and report back to the Congress in February. This is not something that I felt the Office of National AIDS Policy or the President ought to interfere in. This is something that is a scientific review that has to take place to respond to those two questions.
JIM LEHRER: In general terms, Ms. Fleming, this has been referred to as a new strategy on combating AIDS. What is new about it? How would you characterize the new elements to this?
PATRICIA FLEMING: Well, I tell you, though, actually, Jim, this is not totally new. A lot of the things in it are things that we have been doing that need to be continued, that need to be strengthened, that need to be put forward in a different way. What’s new about it is that it’s been all brought together in one document, and the President has given it his imprimatur. That’s the major thing that’s new about it. It’s the first time.
JIM LEHRER: In general terms, do you feel that the war against AIDS, the drive to find a cure, a vaccine, prevention, all of the things that are part of the strategy, is moving–has there been progress? Is the movement upward in this?
PATRICIA FLEMING: It is. And I’m sure that you and many of our viewers are very aware of the new drugs that have been approved in recent months. We do know that the infection rate has not dropped. It has dropped from a hundred thousand some years back, a hundred thousand a year down to about forty thousand a year now. We need to bring that lower. But we have seen some successes. For example, in pediatric AIDS, where the transmission is from mother to child, we have seen a drop in that. And one of the reasons it that we have discovered, scientists have discovered that AZT can block transmission in some cases from mother to child. The President wants that to be expanded so that there will be ultimately no more pediatric AIDS cases, no more vertical transmission from mother to child. That’s an achievable goal, and that’s part of the strategy.
JIM LEHRER: All right. Well, thank you very much.
PATRICIA FLEMING: A pleasure.