Presidential Advisory Council on HIV/AIDS

Eighteenth Meeting of the Full Council

July 19-20, 2001

The Hubert H. Humphrey Building

Room 800

Washington, DC

## **MINUTES**

**Council Members Present:**

Ronald V. Dellums, Chair

Terje Anderson

Regina Aragon

Ignatius Bau, J.D.

Judith A. Billings, J.D.

Charles W. Blackwell

Stephen L. Boswell, M.D.

Stuart C. Burden

Philip P. Burgess, R.Ph.

Lynne M. Cooper, D.Min.

Joseph A. Cristina

Debra Fraser-Howze

Cynthia Gomez, Ph.D.

Bob Hattoy

Jack C. Jackson, Jr.

Ronald S. Johnson

Caya B. Lewis, M.P.H.

Miguel Milanes, M.P.A.

Brent Tucker Minor

Helen M. Miramontes, M.S.N., R.N., FAAN

Ernesto Ortiz Parra, M.D., M.P.H.

John A. Perez

Michael Rankin, M.D., M.P.H.

Todd Summers

Greg Smiley, M.P.H., Designated

Federal Official, HHS

**Invited Participants:**

Chris Bates, Deputy Director, HHS

Office of HIV/AIDS Policy

Scott Evertz, Director, White House

Office of National AIDS Policy

Terrell Halaska, Deputy Chief of Staff,

Office of the Secretary, HHS

Ernest Hopkins, CAEAR Coalition

Bertil Lindblad, Senior Liaison Officer,

The Joint United Nations Programme

on HIV/AIDS

### July 19, 2001

#### Morning Session

# Welcome

Mr. Smiley called the meeting to order at 9:20 a.m. Mr. Dellums welcomed
everyone. He said that it was important to have a last meeting and for
everyone to be here in order to reemphasize the importance of AIDS and
the recommendations of the Council, to communicate with the Bush
Administration and offer help, and for the Administration to thank the
Council.

# Update on Interim Activities

Mr. Smiley thanked the Council members for coming on short notice. He
also thanked those members who couldn't attend the meeting for their
service. Mr. Smiley announced that the Presidential Advisory Council on
HIV/AIDS (PACHA) Web site is up and running
([www.pacha.gov](http://www.pacha.gov/)) and discussed some details
about the reception for the Council members at the Old Executive Office
Building.

# Office of National AIDS Policy (ONAP) Update

Following an introduction by Mr. Dellums, Scott Evertz thanked the
Council for the opportunity to be here and for its leadership and
service.

According to Mr. Evertz, the announcement of the continuance of Council
on HIV/AIDS will occur on Friday, July 20. The Administration plans to
recharter the Council instead of issuing a new Executive Order. Mr.
Evertz hoped that those Council members with unexpired terms would stay
and said that the Council has done good work.

Regarding the Office of National AIDS Policy (ONAP), the Deputy Director
is on board and is working on the global health fund project. Mr. Evertz
said that they were off to a good start on the international front.

On Monday, July 23, ONAP will get a new detailee from the Department of
Health and Human Services (DHHS). Mr. Evertz was pleased with the spirit
of cooperation from the Clinton Administration staff. He mentioned that
at the UN meeting a nongovernment organization (NGO) from San Francisco
was allowed to participate in the roundtable because of the
input/intervention of the White House. The document coming out of that
meeting calls for aggressive AIDS work.

Mr. Summers asked a question about the appropriations request from the
Administration and HHS Secretary Thompson's comments on June 5. What is
the Administration's position on addressing the unmet needs for care,
prevention, and access to drugs? What further actions are planned
regarding the Ryan White program? Mr. Evertz replied that the Cabinet
Task Force will create a subcommittee to deal with budget issues. The
AIDS Drug Assistance Program (ADAP) program works, and its
recommendations will be taken into consideration. The AIDS service
community's concerns will not be ignored.

Mr. Burden stated that he hopes for a \$200 million down payment en
route to what will become an annual payment. Mr. Evertz said that he
doesn't know what will occur. The payment will be a percentage as
opposed to a dollar amount. The United States wants to be the largest
donor to international funding.

A council member asked about the G8 meeting---will President Bush raise
any issues regarding AIDS? Mr. Evertz replied that President Bush will
talk with our partners about their participation in the global fund. The
recommended amount of \$7 to \$10 billion needs to be spent on AIDS. Mr.
Evertz said that the Council should not look at the total amount going
to the fund. Others will participate outside of the fund.

Ms. Aragon thought that the caution on how to look at the fund was good.
The ongoing programs must also continue. The Council supports the U.S.
contribution of \$1 billion annually. This Council is concerned that the
minority HIV/AIDS issue has not been funded. Mr. Evertz stated that the
Administration doesn't know how it will fund the minority AIDS issue and
that he will be a strong advocate within the Administration on this
issue.

Mr. Johnson asked a question on intellectual property rights. How is the
Cabinet Task Force addressing global access to treatment? Mr. Evertz
responded that the Cabinet Task Force will create subcommittees and
funnel the activities of PACHA into the subcommittees and the Task
Force. Everyone in the Administration will be included in the process
but the Task Force will have the ultimate say. He said that dialogue is
needed as opposed to yelling at the Administration.

Mr. Summers mentioned the CDC reports of AIDS among youth. The Surgeon
General's report *(The Surgeon General's Call to Action to Promote
Sexual Health and Responsible Sexual Behavior)* was not supported by the
Administration. What will the Administration do? Mr. Evertz replied that
good public health science will be relied upon. He stated that the
Administration's response to Dr. Satcher's report was influenced by
political considerations.

Mr. Minor praised the fact of the continuation of Council. He felt that
strides are being made in bipartisanship but was concerned with the
response to the Surgeon General's report. Truth should be a bipartisan
issue. What is the next step for the report? Mr. Evertz said that he has
read the report. The Administration will use some of the data from the
report that is valuable. Good public health science will direct their
efforts. Secretary Thompson's speech before the Kaiser Foundation was
brave, Mr. Evertz felt.

Ms. Fraser-Howze praised Mr. Evertz's remarks about people of color. She
continued that the minority AIDS initiative is bipartisan. Senator Arlen
Spector's support was important. What can the Council do to help on the
domestic side, especially on the minority AIDS issue? PACHA is working
with all communities of color. What more will the Administration do? Mr.
Evertz advised the Council to be fierce advocates for programs that
work. The White House will hear the Council's concerns. ADAP is
especially vocal. Don't assume that the Administration won't listen, he
said. Don't stop using the White House the way it was done in the
Clinton Administration. The numbers are staggering and they present more
challenges, not fewer.

Mr. Milanes cited problems in the Caribbean and Latin America and urged
a renewed interest in the places that are often ignored. Mr. Evertz said
that in New York, Secretary Thompson led a field trip to Flatbush and
will lead a delegation to the Caribbean.

Dr. Cooper wants a refreshing openness to learn about new issues. ADAP
funding needs to be understood by the President. Locals are panicking
about the fragile infrastructure related to medicine, homelessness, and
death. Mr. Evertz replied that a meeting with people from the states may
be possible.

Mr. Dellums stated that Secretary General Kofi Annan of the UN wants to
fund \$7 to \$20 billion annually. If the United States gives \$1
billion to the fund, others will follow at a 2 to 1 ratio. The money
will be leveraged. The private sector needs to match the U.S. funds.
That doesn't preclude other contributions from other governments.

End-of-the-road strategies will require money for many issues. From \$7
to \$10 billion is required for the greatest human health threat---AIDS.
In Latin America and Haiti already significant numbers will increase
dramatically. Mr. Dellums continued by advocating that regular order
should be suspended. Affordability should be taken out of the equation.
The drug companies should accept the difference between cost and zero.
The debate goes on while people die. Life in the United States is not
more valuable than life anywhere else. Mr. Evertz responded that he
didn't disagree. He agrees on the drug issue. The human family is a
concept, and we're not there yet.

Mr. Dellums stated that he was pleased that the White House will embrace
citizen involvement and continuation of the Council. He added that the
Secretary may visit the Council today but he is involved in a hearing on
Capitol Hill. A representative from the Office of Management and Budget
(OMB) will not speak, despite what is indicated on the agenda. Instead,
the next presentation will be in the Minority HIV/AIDS Initiative.

**[Minority HIV/AIDS Initiative]{.underline}---**Chris Bates, Deputy
Director, HHS Office of HIV/AIDS Policy

The CDC and Jackson handouts were circulated. Mr. Bates conveyed
greetings from Dr. Gustee \[spelling?\] and Dr. Cargill.

There are two campaigns: the Leadership Campaign on AIDS, which has
brought everyone to the table, and the crisis response team. Council
support has made a difference. It wants to reach out to Native Americans
and Asian and Pacific Islanders.

Ms. Fraser-Howze offered the same support she had made to Mr. Evertz.
She continued by saying that the minority AIDS initiative has come a
long way but this Council brought another level of credibility to the
initiative. She referred to section 5 in the Council notebook. Many
different caucuses are involved, and other communities will be called
upon to be active. Recommendations have already been submitted to
President Bush as a result of the National Black Leadership Commission
on AIDS meeting in Atlanta in June.

Ms. Aragon congratulated the National Black Leadership Commission on
AIDS. She said that coordination and collaboration has increased in the
last year. Obtaining \$540 million is the rallying cry. The
Administration's commitment should be obtained in a timely way.

Rev. Edwin Saunders, Senior Pastor, Metropolitan Interdemoninational
Church in Nashville, spoke to the Council. He said that the June meeting
in Atlanta is evidence of what can occur with the commitment of many
communities. Continued funding is crucial for continued development of
infrastructure. Declaring a state of emergency is critical. Money must
follow the trends of the disease. Grassroots initiatives are important
to developing partnerships for impact on AIDS. Rev. Saunders gave as an
example South Africa and the Satcher trip. Connections made there
resulted in paying off the land and upgrading the facility. Bureaucracy
is not required. Atlanta leadership helps to see models like this.

Symbolic significance was added to the report of the Commission---it was
done on the Morehouse campus in the Martin Luther King, Jr. chapel. Rev.
Saunders urged the Council to support the recommendations that resulted
from the Atlanta meeting. Ms. Lewis echoed her support for the Atlanta
recommendations.

Mr. Bau added notes of caution about \_\_\_\_\_\_\_ \[transcript\] and
the bureaucracy. There is a lack of infrastructure in minority
organizations. A double standard is created on evaluation activities.
The Centers for Disease Control and Prevention (CDC) requires that all
organizations request assistance, which creates bureaucratic burdens.
The devil is in the details, he said. Ms. Fraser-Howze agreed with Mr.
Bau. All of these requirements have nothing to do with legislation. It
is important for all communities to take responsibility and to move
forward.

Mr. Summers added that organizations are struggling to survive. The
Health Resources and Services Administration (HRSA) has made this a
struggle to survive. He stated that administrative oversight is needed
over the agencies. Mr. Jackson added that Native Americans are trying to
get support.

Rev. Saunders said that his congregation ended up buying the land in
South Africa. He added that \$5,000 to \$7,000 per month has a
significant impact. It is equal to the entire contribution of the South
African Government to this project. Rev. Saunders wants to share models.

Mr. Milanes asked about the faith-based initiative and its impact on
groups like Rev. Saunders'. He added that CDC already had a faith
initiative, which has been eliminated. The faith initiative must
emphasize faith versus a religious agenda. Historical response must not
be compromised.

Ms. Fraser-Howze suggested that the Council add another recommendation
to the Secretary on support for a minority HIV/AIDS initiative
(discussed in detail later).

# FY '02 Budget Update

Mr. Anderson stated that it is early in the appropriations process. He
didn't have a clear indication of the way things are going. The
Labor-HHS appropriations will not go forward until September but other
appropriations bills will. (Ms. Aragon pointed out that the National
Organizations Responding to AIDS \[NORA\] recommendations are in the
notebook with detailed information.)

Mr. Anderson said that the core level of funding---core grants---needs
to be talked about.

Mr. Burgess asked about how the shortfall with ADAP developed. Mr.
Anderson explained that every state has a different ADAP. It depends on
how generous the Medicaid program in each state is. Twelve states are in
eminent danger of crisis. Mr. Burgess asked if the solution is to go
back to the governors and legislators? Mr. Anderson replied that it's
hard for states to step up sometimes to meet the matching requirements.

Ms. Miramontes pointed out that the Secretary of the Army has a list of
programs to cut, including AIDS. Mr. Anderson hadn't heard that. Often
the military doesn't want the money.

Mr. Hattoy thought a good contact might be Matt Fong.

Mr. Boswell said that a change in treatment guidelines might lead to
less funding urgency. Mr. Anderson argued that the focus should be to
bring new people into care. There are 40,000 new infections each year in
the United States.

Mr. Summers expressed frustration that nobody from OMB had spoken to the
Council. He pointed out that Mr. Evertz's comments about ADAP being the
only strategy will exclude other Ryan White programs. Medicaid expansion
is a pressure point for domestic programs.

Ms. Aragon said that we need a comprehensive approach. It can't be just
an ADAP approach, it can't be only the minority portfolio, it can't be
just a global approach. It needs to be across-the-board.

Mr. Anderson added that positive initiatives in substance abuse
treatment, community health centers, and increases at NIH will face a
difficult political dynamic, especially with the projections of the
surplus shrinking. It will be a painful process with discretionary
programs and a difficult environment.

Overview of September 2000 Report: Highlights of Key Recommendations and
Review of New Recommendations to the Administration

Ms. Aragon spoke about the proposed changes and how they evolved. Later
in the day two subcommittees---Prevention and Services---will form to
discuss six recommendations, hopefully without a lot of changes.

There are essentially three issues \[transcript\]:

1.  Minority HIV/AIDS---Council member Isbell wanted to refer to gay men
    of color

2.  

3.  

Ms. Aragon wanted to propose language for inclusion, which was agreed to
by unanimous consent.

After discussion, Mr. Dellums asked if there was a consensus that the
millennium recommendations were agreed to. The millennium
recommendations mirror the minority recommendation. He got the sense
from the group that they agreed.

Council member Levine, who was absent from this meeting, had commented
to Ms. Aragon that Recommendation 2 (Increased Appropriations for U.S.
and Global HIV/AIDS Programs in FY 2002) was too long. Ms. Aragon didn't
agree, and thought that domestic and global issues should be grouped
together.

Dr. Levine also commented on the Surgeon General's *Call to Action*. She
thought this was very important and shouldn't be buried. This
precipitated a discussion on various options on where it should be
placed by Ms. Aragon, Dr. Gomez, Ms. Lewis, Mr. Boswell, Mr. Dellums,
and Mr. Anderson. Creating a new Recommendation 6 supporting the Surgeon
General's report with an emphasis on youth was agreed to by unanimous
consent.

During the discussion two other issues emerged. Mr. Blackwell wondered
how compatible the Surgeon General's report was with the youth
recommendation. Mr. Minor thought that the report was more specific on
funding than on youth. He urged that the two concepts be separated to
not dilute either.

Mr. Anderson expressed the opinion that the upcoming issue of abstinence
versus condoms warranted a standalone recommendation. Mr. Summers asked
about the political implications on the condom issue. Mr. Burden
suggested that everyone read the Surgeon General's report. Mr. Bau
thought findings should be emphasized, not the Surgeon General's report,
because of political considerations. Mr. Dellums argued that good
science is good science, not ignoring what you don't want, and that the
science is inconclusive that using condoms will prevent sexually
transmitted diseases (STDs). Dr. Gomez felt that condoms and what they
protect for should be in the recommendation. Mr. Milanes thought
Recommendation 2.7 was sufficient. Mr. Summers and Mr. Dellums observed
that the purpose of these recommendations was to present new information
since the September 2000 recommendations.

Ms. Aragon summed up the discussion: Recommendation 1 will include
millennium recommendations and the study on gay men of color, and 6 will
focus on sex and youth.

Mr. Summers raised the issue about the continuation of the Council and
expectations for the future. He wanted the continuation to be real, for
the Council to really be used. Mr. Dellums thought that this issue
should not be in the context of the recommendations.

Dr. Gomez wanted the prevention message not to be overlooked in the
introduction. She was also worried about timing---coming to consensus
before the Secretary would meet this afternoon with the Council. Mr.
Smiley suggested shortening the lunch period to continue work on the
recommendations.

Ms. Aragon wanted process. Mr. Smiley explained the Secretary's timing
to come to this meeting. There was discussion about whether everything
could be finished and agreed to by 2:00. Many felt that care should be
taken with the concepts in the recommendations. There was agreement that
the subcommittees should discuss the recommendations and present some
revised language for the Council to consider. Mr. Boswell urged that
unanimous support was important.

Mr. Burgess and Mr. Blackwell had problems with 5.5, which discussed
abortion counseling. Ms. Lewis wanted to discuss Mr. Burgess's concern
before the full Council.

Ms. Aragon suggested that the Prevention subcommittee work on
Recommendations 4, 5, and 6, and that the Services subcommittee work on
Recommendations 1, 2, 3, and the introduction.

Earlier Mr. Perez had suggested scripting the presentation for the
discussion with the Secretary and that small groups should work out the
philosophical issues on the recommendations.

Ms. Fraser-Howze wanted to know what the Secretary had been told about
coming to this meeting. She suggested that introductions be made, and
that Mr. Dellums and the heads of the subcommittees speak about their
concerns. She wanted to make another appointment for the Council to meet
with Secretary Thompson to discuss the recommendations. She wondered,
what is the Secretary's expectation of this meeting? Mr. Smiley thought
that three speakers should offer the services of the Council to the
administration, present new recommendations, and \[transcript\]. Mr.
Dellums wanted the Secretary to appear at the meeting in order to
dignify the group. Then he suggested that the recommendations be
presented in conference call.

Mr. Summers said that he didn't want to miss the opportunity to present
ideas to Secretary Thompson on appropriations, minority issues, and NIH
talking points. There was basic agreement on this idea. Dr. Gomez
suggested that the effort should be recognized on the recommendations
presented to the Secretary. Mr. Bau wanted to hear the Secretary's
remarks and allow time for a question-and-answer period. Mr. Hattoy
suggested that there may be things to ask for, such as the budget and
NIH report.

#### Afternoon Session

**[Overview of the United Nations General Assembly Special Session on
HIV/AIDS and Update on the Global HIV/AIDS Fund]{.underline}**---Bertil
Lindblad, Senior Liaison Officer, the Joint United Nations Programme on
HIV/AIDS, New York

Mr. Lindblad gave a PowerPoint presentation and provided an update on
the UNAIDS\
co-sponsoring mechanism. He said that the special session was a turning
point that led to an unprecedented high-level political commitment to
tackle the AIDS epidemic. AIDS was recognized as a political issue and
as a development challenge.

The Declaration of Commitment on HIV/AIDS was adopted by acclamation.
Mr. Lindblad characterized the Declaration as being strong and
action-oriented, and he said that the Declaration calls for resources
commensurate with the epidemic. Among other things, the Declaration of
Commitment includes leadership; prevention of new infections; and care,
support, and treatment. It deals with HIV/AIDS and human rights; the
reduction of vulnerability; children orphaned and made vulnerable by
HIV/AIDS; and the alleviation of the social and economic impact of the
epidemic.

Mr. Lindblad said that the Declaration of Commitment is unique in that
it recognizes the driving forces of the epidemic and sets new targets.
The strong gender perspective recognizes the importance of protection of
human rights as key element, stresses importance of partnerships at all
levels, and underscores involvement of people living with HIV/AIDS.

The next steps include a letter going out from Secretary General, a
guidance note to be prepared, UNAIDS to develop indicators, follow-up
with civil society partners, and a work plan to support implementation.

The global fund is evolving for HIV/AIDS, malaria, and tuberculosis. By
mid-December recommendations for the fund will hopefully be approved.
One billion dollars has come into the fund as of now.

Mr. Summers asked where UNAIDS goes from here, with a statement from
country to country? Mr. Lindblad responded that the Declaration was a
gift to UNAIDS. All of the pieces are now in one place---the UNAIDS
secretariat co-sponsored the Declaration and the Secretary General will
have this as a backbone. A more technical version of the report is being
developed.

Mr. Burden asked about the World Bank role---will it be new or
different? Funding is imaginative through NGOs, but what is the
likelihood of funding these organizations? Mr. Lindblad said that the
White House is a co-sponsoring agency and has some of its own programs.
It was agreed to use the World Bank as fiduciary body. It's important to
have a smooth mechanism for funding NGOs. How funding will be directed
is still unclear.

Ms. Fraser-Howze asked, given the mission of Council, what does Mr.
Lindblad want to ask from PACHA? Mr. Lindblad suggested that the Council
go through the Declaration at its next meeting and place it in the
context of global and domestic issues.

Mr. Dellums said that Secretary of State Powell, President Bush, and
Secretary General Annan each have called for a global fund, as has the
Leach-Lee bill. Mr. Dellums doesn't want to end up with several global
funds with limited resources.

Mr. Lindblad suggested that Council members visit the UNAIDS Web site.

Ernest Hopkins from the CAEAR Coalition (Communities Advocating
Emergency AIDS Relief) presented the NGO perspective to the Council. He
said that groups are lobbying on Capitol Hill now for domestic issues.
Mr. Hopkins saluted members of the Council for support and their
collaboration.

A lot of work was done in advance of the UN meeting. There was a good
listserv, which Mr. Hopkins characterized as "breaking the silence."
Many NGOs were frustrated around the Declaration---they felt no sense of
collaboration. They sensed that the deal was already cut before the
meeting. In addition, there was little opportunity for NGOs to
participate. NGOs from other countries were very sophisticated about the
epidemic in their countries.

Mr. Hopkins characterized the meeting as the best of times and the worst
of times. Language in the Declaration supporting reproductive rights and
targeted populations in need of direct services was controversial. There
was a lack of support on the part of the UN. The U.S. delegation set up
a process to make themselves available to NGOs. As an American, Mr.
Hopkins said he was disappointed in the remarks of Secretary Powell in
the general session.

There is still significant disagreement among nations about the global
fund---who should receive funds, how they should be administered, and
whether NGOs should receive funds directly. Mr. Hopkins said that a
"misunderstanding" was the amount of money to be in the fund.

Mr. Summers asked if the document gives U.S. groups background to push
for a more comprehensive plan for America. Mr. Hopkins responded that
yes, the document can be used to move forward, and Mr. Lindblad agreed.
The final draft is strong, according to Mr. Hopkins. The discussions
that took place on the floor are important. Governments had to tackle
this and discuss issues they had never before addressed, such as men
having sex with men.

Mr. Dellums stated that no one knows where AIDS will take us on this
planet. There must be a world commitment to solving AIDS. We must
conquer problems never attacked before. Ten billion dollars is a low
level when considering all of the world.

Mr. Bau commented that the United States is better at telling other
nations what to do than doing it ourselves.

Mr. Anderson pointed out that the Council hadn't talked about U.S.
immigration regulations to waive travel requirements to attend the UN
meeting. This is a violation of human rights.

Ms. Fraser-Howze asked Mr. Hopkins, knowing this Council, what would you
recommend the Council consider regarding the Declaration? Mr. Hopkins
suggested taking the document apart and identifying goals and
objectives, then comparing it with what is in place in the United
States. Expose the shortcomings.

Ms. Fraser-Howze remarked that there are dueling funds. Mr. Dellums
thought that was good question to ask Secretary Thompson. There is some
concern about the global fund having a U.S. label on it.

Ms. Billings said that even though reproductive rights aren't in the
document, it's very encouraging that the Secretary General let the chips
fall where they may by speaking out.

Mr. Anderson distributed three documents, one a CNN article that was
just obtained online. The handouts were CNN.com, "Condom Report
Questions STD Protection"; NIAID, DHHS, "Draft Workshop Summary:
Scientific Evidence on Condom Effectiveness for STD Prevention"; and
"The AIDS Community Responds. An Unscientific Review: A Politically
Motivated Report" to the "Scientific Report on Condom Effectiveness for
STD Prevention."

Revisiting the Council recommendations, Ms. Lewis commented on
Recommendation 5 (Improved Coordination and Continued Leadership in the
Global Fight Against HIV/AIDS) by asking, are we not discussing domestic
coordinated effort? Ms. Aragon explained the history of the
recommendation.

Mr. Cristina thought that the introduction needed a more comprehensive
theme. He would like Recommendation 2 to refer to the 13 million
children that are orphaned worldwide. He suggested some language.

Returning to the issue raised by Mr. Burgess, he stated that
Recommendation 5 goes into a new arena (STDs instead of AIDS). Abortion
services should also not be here. The Bush agenda is known. By raising
this issue, the entire document will be branded as off base.

Ms. Aragon thought that there was a way to address this with language.
She explained how the current language had been developed and made
stronger. The most important message is no funding restrictions. Mr.
Hattoy agrees with Ms. Aragon's new language but is concerned that any
abortion issue may preclude other education.

Mr. Perez moved that Recommendations 4 and 5 be switched and that new
language be inserted. The motion was agreed to.

Dr. Gomez mentioned the new Recommendation 6 and improving education of
sexual health through abstinence only.

Mr. Burgess wanted the first section modified. Mr. Summers thought that
Dr. Gomez and Mr. Anderson were talking about two different things. Dr.
Parra thought youth should be given more emphasis. Dr. Gomez thought it
didn't deal exclusively with youth. Ms. Lewis suggested that youth be
moved up.

# Public Comments

Kaethe Morris Hoffer, Manager of Federal Affairs, AIDS Foundation of
Chicago, thanked Mr. Burden and Mr. Burgess for their work. They are
also from Chicago. In addition, she singled out Ms. Aragon and Mr.
Anderson.

Ms. Hoffer considers the Council to be very useful and hopes that the
Administration will work with the Council.

She is distressed by the Administration's comments on AIDS. This
Administration is not interested in fighting AIDS, she said. Ms. Hoffer
supports the Council's efforts to urge the President and Secretary
Thompson to recognize the AIDS crisis in the people of color community,
how it affects young people and women, and to learn about the
inequality. She said the Council should help the Administration to fund
programs, encourage the Administration to not support abstinence-only
education, and help the Administration understand affordable health care
and housing. Given the role of bigotry, the President must fight AIDS
and not support poverty or bigotry.

Dr. Michael Burke, Senior Research Associate, American Institutes for
Research Prospect Center, spoke as a member of the public. He is
concerned with the faith-based initiative---it should not force a
mission statement on meetings of organizations. Regarding syphilis, the
faith community sees sex education as the enemy, not dealing with
values, including self-esteem building. On the minority health
initiative, at the grassroots, groups are not working together. There
needs to be education about all minorities. The Evertz presentation
stated that the budget surplus is disappearing. There needs to be
discussion about reproductive health--STDs, HIV/AIDS---and make
linkages. There needs to be an ecumenical approach to other
stakeholders.

The Council then broke into two subcommittees to edit and discuss
amendments to the new recommendations. Following the breakout sessions,
Ms. Aragon described the Services group's actions. Discussion followed
on different opinions as to the language that should be used. It was
suggested that Mr. Blackwell offer some revised language, which must be
finalized by Friday. Mr. Jackson pointed out his testimony before the
Congressional Black Caucus, the Congressional Hispanic Caucus, and the
Congressional Asian Pacific American Caucus (distributed earlier), which
Mr. Blackwell agreed to read.

Following a suggestion, Mr. Hattoy said that many communities have been
invisible and that group names should be included. Ms. Fraser-Howze
suggested that there be a vote on the revised new recommendations with
another discussion on the 1.3 issue. Mr. Burgess moved to accept the
changes of the Services subcommittee with the exception of 1.3. Dr.
Cooper seconded the motion and it carried.

Changes were discussed from the Prevention subcommittee. After
discussion it was decided to change "international purchase fund" to
"global fund to ensure purchase and distribution."

The motion and second to accept this committee's work were agreed to.

Mr. Dellums talked about asking for the Secretary or his designee to
meet with Council or come to the reception. A representative will be
here tomorrow.

## The Council meeting was adjourned for the day at 6:15.

### July 20, 2001

##### Morning Session

Mr. Dellums called the Council meeting to order at 9:05 a.m.

Mr. Blackwell had some proposed language for Recommendation 3.1, which
was accepted. Mr. Dellums moved that the Council adopt the six
recommendations and the introduction. The motion was agreed to by
unanimous consent.

Mr. Dellums announced that at 10:00 PACHA will meet with a designee of
Secretary Thompson. Mr. Smiley said that Ms. Halaska will come back this
morning since the Secretary can\'t be here.

Mr. Dellums asked for discussion on what to say to the designee. Mr.
Summers stated that this person is not in a policymaking position, which
won't be helpful. The embargo of the NIH study was lifted today. He
expressed frustration with Bush Administration proposals, and Mr.
Summers suggested that one possibility for discussion is appropriations.
Dr. Gomez expressed frustration with the Secretary not appearing, since
all of the Council members had to rearrange their schedules for this
meeting. She asked if there was a more radical approach to take. Mr.
Minor suggested asking what the next steps for the Surgeon General's
report will be. Ms. Aragon said that appropriations should emphasize
domestic issues as well as global issues, and the importance of care and
treatment, prevention, and research. A Council member thought that the
group should stress a comprehensive approach, and NGOs ability to apply
for funds directly and not through host governments.

Mr. Bau questioned whether Ms. Halaska is the best person to speak to.
He thought PACHA should ask her to outline the Secretary\'s vision of
the Council and its role, about access to other officials outside of
HHS, and which Council members will be rotating off. Ms. Aragon
suggested asking for the Administration's response to the Council
recommendations in writing by a certain date. Mr. Burden pointed to the
lack of an OMB representative and the Secretary\'s not coming. He
thought the Council should shift the conversation to Ms. Halaska's
priorities. Ms. Fraser-Howze said this presents opportunity to speak
about appropriations. She has never seen a meeting at this level before
with no top officials coming. She recommended that Mr. Dellums write the
letter to the Secretary expressing the disappointment of the Council
about their not appearing at the meeting.

Mr. Dellums announced that the Secretary did sign certificates of
appreciation for the Council. Discussion continued about the frustration
of the Council and the apparent lack of interest of the Administration
in PACHA. Various suggestions were made as to the next steps. The
consensus was for Mr. Dellums to lead off in speaking to Ms. Halaska
reflecting concerns, and for the others to join in if need be. The
designee, Ms. Halaska, would then speak. The floor will be open for
questions regarding the nature of the Council, concerns about
appropriations, and other issues. Dr. Gomez should talk about the
recommendations. Dr. Gomez asked for clarification on reading the
recommendations.

Mr. Smiley introduced Tracy Carson \[spelling\], who will work with Mr.
Evertz. He said it was a pleasure and honor to work with the Council. He
may be going to Barcelona to plan the next international AIDS
conference.

Ms. Fraser-Howze thanked Mr. Smiley for his work. Mr. Summers asked Mr.
Dellums to express the Council's appreciation for Daniel Montoya, the
former PACHA executive director. Mr. Dellums will do that.

Ms. Terrell Halaska then arrived. Mr. Dellums stressed that the comments
of the Council are not directed to the messenger and that there is
significant concern that the message sent by having no high-level
Administration officials come to this meeting is wrong. Mr. Dellums
underscored that the Council is concerned that it is laboring in
isolation. He asked Ms. Halaska to communicate these concerns to the
Administration.

Ms. Halaska responded by saying that some anger should be directed at
her for overscheduling Secretary Thompson. The Secretary sends his
regrets. She said that the door to Mr. Thompson's office is open for
Council members to meet with him individually. She continued, saying
that the first Cabinet Council will meet today. The Cabinet Secretaries
will meet on domestic and international concerns to look across
government to address issues. The international and domestic are
interwoven. Ms. Halaska pointed to the Flatbush visit as an example of
both domestic and international issues converging. She stated that there
is a need to approach the issues holistically. DHHS programs will be
examined to see how they can work more effectively. The Department will
be spending \$10.2 billion annually. The next step is governmentwide
effectiveness.

PACHA rechartering will be announced within the next week. Eight or nine
terms will not expire, and the new members will be announced soon.

Mr. Bau asked how the Secretary will view the role of the Council,
changes in operation, interaction between the Council and the White
House, and its role with the Cabinet Council Task Force.

Ms. Halaska said that it is most important for the Administration to
hear from outside Government what is going on. We need to find a way to
work on the community level to prevent, treat, and care. How can the
Federal Government support these efforts? The work of PACHA will be
funneled to the Cabinet Council Task Force and ONAP. DHHS Deputy
Secretary Allen's review will look for holes and overlap, and reach
outside of the department.

Dr. Gomez wanted to convey the work of this Council since its report was
released. She hopes the Secretary looks at the report. The Council has
reemphasized issues that have emerged in the interim. Dr. Gomez spoke
briefly about the six new recommendations. Mr. Summers said that the
Council wanted to emphasize the recommendations that need immediate
action, especially appropriations and support for increases to NIH. He
is concerned with the lack of increased funding in treatment, care,
housing, and the minority AIDS issue.

Ms. Fraser-Howze said that Ms. Halaska has an awesome task. It is the
Administration's burden to take responsibility for the issues now that
the Council recommendations are complete. Ms. Fraser-Howze gave some
statistics on communities of color being undercounted. In addition to
the trip to Flatbush, the Secretary should also look at Watts and
Bedford-Styvesant. People in the United States in communities of color
have third world health conditions. They die at outrageous rates. Ms.
Fraser-Howze urged that an emergency be declared on the issue of AIDS in
the minority population. She said that of the \$10.2 billion proposed, a
lot of the money is in Medicaid. The minority initiative is one of first
initiatives to focus on communities of color. She wants the President's
support for funding. Not enough attention is paid to international
communities in the United States. The Administration must respond with
cultural competency and it should embrace this cause.

Ms. Halaska agreed with everyone's comments. Including entitlements in
money for AIDS, it is important to look at what Medicaid has been doing.
Things can be done better---the waiver process needs improvement.
Secretary Thompson will launch a major preventive health care
initiative, although not specifically aimed at AIDS. He will reach out
to the Council on preventive health care.

Mr. Summers said that substance abuse funding is important. The Ryan
White program is concerned with issues in addition to AIDS, and it needs
more funds. Mr. Summers cautioned that there is a misperception on the
misuse of funds. The Administration needs to make a commitment to invest
in prevention. Ms. Halaska responded that it was not her intention to
criticize how money is being spent. We need to figure out how to spend
it better. Mr. Summers wants the Council to be used in this.

Following the departure of Ms. Halaska, discussion covered several
issues, including immigration restrictions. Mr. Dellums noted that he
has a meeting coming up with Deputy Secretary Allen and an August 7
meeting with Secretary of State Powell to discuss AIDS. He will bring
the Council's report to Powell's attention. This should institutionalize
the State Department relationship with Council.

Mr. Smiley thanked the Council for meeting and all who helped.

The meeting was adjourned at 11:00 a.m.