A
Conversation
with
Robert
Fogel,
Member
of
President's
Advisory
Commission
on
AIDS
3/13/98
The Week Online spoke with Robert Fogel, partner in the law firm of Hilfman and Fogel, and a member of the President's Advisory Council on AIDS, about the upcoming meeting in Washington, and the possibility that the Council will take action to put pressure on the administration to lift the ban on the use of federal AIDS dollars for syringe exchange programs. WOL: In the wake of the Council's demand last year that Secretary Shalala make the required determination that Needle Exchange Programs (NEP's) prevent AIDS transmission without increasing drug use, and that she produce a plan for the funding of such programs -- neither of which she has done -- there seems to be some pressure for the Council to take action. What do you see as the potential outcome of this upcoming meeting in Washington? RF: Well, all of us who are fighting to have the federal ban lifted have been frustrated. And while I understand and feel the frustrations of those who are calling for us to resign immediately, it is unlikely that that will happen at this time. At our meeting last July, Ben Schatz (Executive Director of the Gay and Lesbian Medical Association, and member of the Council) brought up the fact that on the issue of discrimination against people with HIV and AIDS in certain areas, he was being stonewalled by the administration. Now, this was an issue that the President had told us that he would address. At that point, I considered the position that we had been facing regarding the needle exchange ban, and I said, "Well, if we're going to come together and sit in Atlanta, or in Washington, and do this work and make our recommendations, just to be ignored, then I move that we resign en masse. And somebody seconded it. And that was a watershed, I think, in the Council's work. Ultimately someone else asked that we withdraw the resolution, and we did. Ultimately, the story got out and it was picked up by the AP, and it did become an issue of concern within the administration. Since that time, we have seen a lot of progress on the discrimination issues, but none, of course, on needle exchange. Once you resolve to resign over an issue, it is truly an end-game strategy. There are steps, short of resigning ourselves, that might better be taken at this time. This is a life and death issue, and I, for one, am certainly aware of that. But there is a question of how to convey to the administration that this shouldn't be a political issue, and when and how we can best get that across. We are pretty determined, as a group, to see action taken by the administration, but there is, I think, a logical and strategic process to be followed. WOL: And what would those intermediate steps entail? RF: I think that it is quite possible, after meeting with the Council and speaking to administration representatives, that we would determine that it is time to call for the resignation of Secretary Shalala. It would have to be a resolution that was short and direct, to the effect that as the Secretary has failed to follow through on the stated intent of the President to do all that he can to reduce the transmission of HIV down to zero, that it is our recommendation that she step down. I'm not saying that this will necessarily happen, mind you, but proposing such a resolution is something that I'm sure will be brought up. WOL: Do you feel that the President has played politics with this issue? RF: I do feel that the issue is politically charged, no doubt, but I also see this President as someone who has not been afraid to anger people who disagree with him. I have a lot of respect for him in that to me, it seems as if he has done what he feels is right for the country. Of course, he's also a political creature, so that does have some bearing on his actions. But I think that he simply needs to be told that this is the right thing to do, why it is the right thing to do, and how to make it politically palatable. Allowing federal AIDS dollars to be used to fund NEP's does not make one "soft on drugs". In the end, I have confidence that he'll do the right thing. WOL: So then what is your assessment of why it hasn't been done to this point? RF: There are certainly people within the administration who have taken the position that it's politically unnecessary to lift the ban... that it will be used as a political issue and that if local governments want to do this then they can find the funding to do it. There are also those who are totally opposed to the idea ideologically, regardless of the politics. The other side is that there are people in the White House, including Sandra Thurman, the national AIDS Director, who are pushing very hard for the ban to be lifted. As I said, I think it's going to be a matter of presenting the what's and why's to this President. WOL: So is there a line in the sand that the council will draw? RF: Certainly. I don't want to give the impression that the Council is not committed to getting the ban lifted, because we are. My sense is that this issue is very much on the President's front burner right now. We will meet in Washington this week, and if it sounds like things are coming to a head, if we're satisfied that the question is not if but only when, then I think that we'll look at that. But that doesn't mean that we're willing to wait forever. Even now there is the possibility that a decision will be made to call for the secretary's resignation this week. Look, what we want is an answer. If the President says "no" than it's no longer the secretary's fault, right? So why call for her resignation? But the President hasn't said anything, so as of now it's still the Secretary's responsibility. At this point, she could get up on a soap box and support needle exchange, and then let the White House say no if they choose. We could go from there. Right now we are simply being put off and ignored, and that is not going to be acceptable. The Council is very serious about this issue. I think that there was a window of opportunity to get this done right after the '96 election, and that the opportunity was wasted. And if we move forward strongly this week, and come June at our next meeting nothing's been done, and we get the response that "well the congressional races are coming up -- there are political concerns," that certainly won't be acceptable. We've heard that too many times before. That kind of response will only serve to temper our willingness to accept rhetoric as fact, and I think that at that point there would be a real possibility of resignations by Council members. WOL: So you would, ultimately, resign over this issue? RF: You know, several people on the Council have said that they're not sure that needle exchange, or at least the federal ban, is an issue that they are willing to resign over. To them, I've said that it's not just a matter of needle exchange, it's about the development of a strategy, a cohesive plan on prevention. And at this point, at the federal level, that plan still doesn't exist. Needle exchange, we know, is an effective part of such a plan, and one which reaches a very vulnerable and very hard to get at population. So needle exchange has become a litmus test for something much larger. It comes down to creating a strategy, to heeding the advice of the experts you have brought in. At the White House Conference on AIDS, the president stood there and pledged to do "whatever is necessary" to get HIV transmissions to zero. We all walked out of that conference extremely happy, he said he'd do whatever it took. Well, this president has been criticized in the past for taking a "one speech" approach to problems. In other words, he gives one great speech but there's no follow through. This time, there was terrific follow through. Shalala attended a bunch of regional AIDS conferences, they seemed really engaged. But now, looking back, the follow-up was just rhetorical. Sure, there's more money now, but prevention got the smallest increase. Well, if you're not going to spend on prevention, of course your costs and spending will increase for drugs and treatment. But that doesn't constitute a substantive commitment to deal with a preventable, contagious disease like AIDS. WOL: Have you spoken, recently, to other Council members about resigning? RF: Absolutely. I think that the most persuasive perspective that I've heard from a fellow Council member about resigning at this time is that given the choice between tendering our own resignations or calling for Shalala's resignation, why should we be the ones? I mean, we're actually doing our job. At the same time, I have heard people say that it is better to remain on the inside, almost at all costs. But to me, there comes a point where having people on the inside, complaining but not acting, gives an excuse to stick with the status quo, as if there's some process that is taking place. And in the end, I'm not willing to play that part for anybody. (DRCNet's interview last October with AIDS Council member Alexander Robinson can be read online at http://www.drcnet.org/rapid/1997/10-11-1.html#interview.)
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
