Laura Bush: U.S. "taxpayer money'' fighting AIDS

by Mark Silva

First Lady Laura Bush will travel to Africa next week to highlight what American "taxpayer money'' is contributing to the global fight against AIDS, malaria and other diseases. But first the first lady traveled across town today to Howard University Hospital, where everyone seen for whatever reason is tested for HIV and those who test positive are treated – also with the help of federal tax dollars.

"AIDS is not the death sentence that it once was,'' Mrs. Bush said at Howard. Yet, people combating AIDS still confront a "stigma'' that remains for those who test positive – that's still so in the United States and "certainly'' so in Africa. With the president seeking a doubling of the U.S. commitment to the global war on AIDS in the next five years – boosting it to $30 billion -- the first lady will travel to Senegal, Mozambique, Zambia and Mali on a five-day journey next week to make both Americans and Africans more aware of the problem.

The Tribune will travel with her, as print pool reporter for her trip, and the Tribune followed her to Howard this morning, as pool as well. Read more here about today's run-up to the first lady's African tour.

The first lady's motorcade rolled from the South Lawn drive of the White House at 8:38 am EDT on a sweltering and hazy morning, with a clear sky shrouded by Code Orange haze - and we're not talking about homeland security, but Washington air quality - for the ride to Howard University Hospital. It was relatively compact, with five vehicles and two D.C. police escorts, and it obeyed traffic signals.

The motorcade paused for a red light outside the storefront Warehouse Theater on 7th Street NW, where "Son of a Bush, a comedy revue," is billed in the window.

This trip was serious, however:

At Howard, Mrs. Bush was helping to showcase a program partly financed by the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which is a reauthorization of the 1990-vintage Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which has long provided funding for the fight against AIDS. Since 2001, the White House says, the president has allocated more than 74 billion dollars for HIV and AIDS treatment and 15 billion for research on AIDS.

The motorcade arrived 8:52 am at the Ambulatory Care Center, where we were led to the fifth floor of the medical tower and the CIDMAR unit. The Center for Infectious Disease Management and Research has been open here since 2005. Dr. Celia Maxwell, who is assistant VP for health services and director of the women's health initiative at Howard, served as a tour guide through the unit

In a dimly lighted reception area, with several chairs arranged on a carpet by a counter, Maxwell gave the first lady an over-view of the program. Mrs. Bush wore a dark brown pantsuit, turquoise blouse and open-toed sandals. They stood in the carpeted waiting area, where Maxwell explained that they had a clinic here, but for these patients they felt it best to establish a patient-doctor relationship, so each of the patients who come here see the same doctor each time. "Each patient has their own doctor, which they see all the time," Maxwell told the first lady, who nodded and repeated "mm-hmm" several times and had some questions too.

"How often do they come, typically?" Mrs. Bush asked Maxwell.

"It depends," Maxwell said. Some, as often as once every two weeks.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Disease at the NIH, stood on the carpet of the waiting room with them and answered questions. The first lady asked if patients are getting anti-retroviral drugs here, and he said some are - there are federal guidelines for that, but some people fall into "the gray zone,'' Fauci replied. Doctors here help sort that out, though some people do refuse or resist it

There are close to 250 regular patients here, Maxwell told them. Some come in through the emergency room - because what Howard University Hospital has undertaken is the routine HIV testing of all who come to this hospital for whatever reason – be it the ER or for cosmetic surgery.

Nationally, Fauci told the first lady, "We have hit the wall with 40,000 new infections in the US each year. We have to push that wall down."
Mrs. Bush said she had met Dr. Maxwell at the White House on World AIDS Day. They talked about programs "funded in large part by the American taxpayer. I was so fascinated by what Dr. Maxwell had to say about this hospital being the first site… offering testing for AIDS to every single person who comes in, for whatever reason they are here'' – be it an accident or for cosmetic surgery. "The whole point of it… how important it is for everyone to have an AIDS test be a regular part of their medical test.'
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If you know you are positive, you can prevent the infection of loved ones, and seek treatment, Mrs. Bush said. "People can live positively with AIDS and lead healthy lives for a long time. AIDS is not the death sentence that it once was.''

"Avoiding testing… is a big mistake,'' she said.

They spoke of the routine testing and how shocking the results are to some people.

"Just imagine the devastation of learning that you are HIV, learning almost by accident, because you were tested when you came in for something else,'' Mrs. Bush said. Getting the care and mental health support is important, she said, "because of the whole mental health part of it, and the whole upside down, finding out your life isn't really what you thought it was.''

Fauci said: "When you find out somebody is positive, we don’t have the healthcare delivery system like we have here… Ultimately, when people examine costs, they need to balance what the big picture is against the cost of the upfront investment.'' We have seen that with AIDS drugs, "now that we have millions and millions of people on AIDS drugs, the costs go down.''

Maxwell said: "So many of our patients coming in have been seeing doctors for many years, have never been tested… about 30 percent of the preliminarily reactive are over the age of 50… we have had several in their 70s and 60s… And so, what we have found also in talking to patients is that many patients assumed that they were being tested…. I couldn’t possibly have a risk or something married for 35 years.'' some "have no risk that they know of, other than being married.'' (What a great statement, that is.)

Fauci: "That's the beauty of routinizing it.''

There are physicians who are nervous about asking about patients' sexual history, he said. "If you have a grandmother in their fifties and you ask them about their sexual history, they'll smack you.''

Fauci told the first lady: "In your travels, Mrs. Bush, someone may raise the objection… it's really not cost-effective… (but) routinizing testing is not incompatible'' with testing for target groups. "Routinizing is totally compatable'' with targeted testing.

As the meeting broke up, Mrs. Bush said to people milling about the room:

"Next week, I'm going to go to Africa and I'm going to visit a number of the programs that are funded by taxpayers… I really wanted to lead up to that trip to Africa by coming here first, to talk about what our domestic problem is… we are a lot farther along… we have almost reduced mother to child transmission, where very few babies are born with HIV… which is still a problem in Africa….

" have been to some terrific programs already in Africa and I'll see more this time, where mothers, HIV positive mothers, counsel prospective mothers,'' she said. "There is such a stigma associated with it…. I am really so happy to have this chance to be here and see this great work you are doing, congratulate you, plus get the word out nationwide how important this great program is.''

The first lady also sat for a radio interview with April Ryan of the American Urban Radio Networks, who graciously provided a tape for the pooler – with excerpts printed here:

Mrs. Bush spoke of "the stigma associated with HIV – and there still is a stigma in the United States, and certainly in Africa.'' This is a big problem, she said. "On the other hand, if you know what your status is, then you can protect a lot of people around you,'' she said. "It's something that we have to fight and something that we have to talk about.''

"I urge people to find out what their status is,'' she said. "The good news is, there is funding.''

Asked about going to Africa and what sort of mindset she finds in leaders there, she said, "It's a global issue. And AIDS – HIV – is a global problem.''

Fifteen countries are targeted by PEPFAR, the president's program to fight AIDS, mostly in sub-Saharan Africa but also Vietnam and others.

"This is not the United States coming in and doing everything,'' Mrs. Bush said. "This is the United States working with other countries,'' she said. "It's very important to admit that AIDS is a problem… (but) most of these governments know that it is a problem that they have to address.''

"The good news about AIDS is, if you go on anti-retrovirals, you can lead a healthy life,'' she said.

Asked about the trip and what the president can do to get the message out in his remaining time:

"I want the American people to know what they're doing,'' the first lady said. "This is American taxpayer money. This is what Americans are doing in Africa…. That's the point. We want the American people to know, because it's they're taxpayer money that's doing it.''