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There's more to public health than pandemic preparedness. On an international scale, for example, there's HIV/AIDS, tuberculosis and malaria (being concerned about one thing doesn't mean ignoring the others). So, here's an interesting story.

President Bush’s program to fight HIV/AIDS is considered by Republicans and Democrats alike to be one of the unvarnished foreign policy successes of his presidency.

So why has broad bipartisan legislation seeking to more than triple the program’s funding to $50 billion caused such a rancorous fight?

Ask Sen. Tom Coburn, M.D.

Why indeed?

Now, let's give some background. The Senate bill in question is S. 2731: Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 and it's equivalent in the House is H.R. 5501: Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The House bill passed with 100% of Dems and 60% of Republicans supporting it. The Senate bill is considered "in committee" and not yet brought to a vote. That's because Tom Coburn and six other GOP Senators have blocked it from being voted on, or even discussed.

What the bill does is reauthorize the President's Emergency Plan for AIDS Relief (also known as PEPFAR), "a five-year, $15 billion American Government initiative to combat the global HIV/AIDS epidemic." That is the one foreign policy initiative that this administration has bipartisan backing on.

As Avenging Angel diaried on Friday

As Politico detailed, Coburn and a group of six other socially conservative GOP Senators have placed a hold on the reauthorization of one of President Bush's few popular initiatives, the Emergency Plan for AIDS Relief (PEPFAR).  Enjoying broad bipartisan in Congress, the Senate has proposed boosting funding to $50 billion over five years.  But the Senate bill would do away with the previous requirements "that 55 percent of the HIV/AIDS appropriation be spent on treatment and drugs and that about 30 percent of prevention funds be allocated to abstinence education."

In other words, the legislation would:

  • Authorize $50 billion to combat HIV/AIDS, malaria and tuberculosis during the next five years.
  • Provide treatment for at least three million AIDS patients.
  • Prevent 12 million new HIV infections.
  • Provide care for five million AIDS orphans.
  • Train and support 140,000 new health professionals.
  • Authorize $4 billion for the treatment and prevention of tuberculosis.
  • Authorize $5 billion to fight malaria.  
Now, what could possibly be wrong with that? It's that "abstinence education" thing. Politico spells it out quite clearly:

The Oklahoma Republican, along with six other social conservatives, has put a hold on the bill in the Senate, unless a provision is added to direct most of the spending toward treatment for HIV/AIDS rather than toward prevention and other priorities. Otherwise, Coburn said, "the vast majority of the money is going to get consumed by those wanting to help people with HIV, rather than [by] people with HIV."

Coburn argues that treatment of HIV/AIDS-affected individuals usually drops their viral load to the point where they will not infect other people, and thus, it’s "the No. 1 prevention protocol we have."

But many other Republicans and Democrats, as well as outside public health experts and AIDS charities, dispute Coburn’s math. With the program, called the President’s Emergency Plan for AIDS Relief, set to expire in September, they are very concerned.

"Most experts agree that treatment is only one small part of the prevention agenda," said Denis Nash, director of monitoring, evaluation and research at the International Center for AIDS Care and Treatment Programs at Columbia University.

Nash, whose work includes studying the efficacy of PEPFAR programs, said that while anti-retroviral medication does considerably reduce the viral load, fewer than 10 percent of the 33 million people infected with HIV are receiving treatment.

"The prevention effect of treatment is not likely to be anywhere near the magnitude of prevention through prevention," including safe-sex education and condom distribution, said Mead Over, senior fellow at the Center for Global Development.

It's that "safe-sex education and condom distribution thing" that has the conservative Republicans all screwed up. See, the conservatives don't like condom use, even though it has proven effectiveness. They like abstinence, even though it's incomplete by itself, and has been remarkably controversial when applied to PEPFAR. So, they gin up objections that have no grounding in science. Here's Lancet on the topic:

"Many more lives will be saved if condom use is heavily promoted alongside messages to abstain and be faithful."*

* "HIV prevention policy needs an urgent cure", The Lancet 367(9518), 15-21 April 2006

And that's where Tom Coburn comes in. He and his buddies are so far out on this they even have Republicans like Michael Gerson upset.

How much do seven members of the U.S. Senate weigh?

Eyeing them -- Tom Coburn, Jim DeMint, Jeff Sessions, Saxby Chambliss, David Vitter, Jim Bunning, Richard Burr -- I'd guess they probably come in at about 1,300 pounds. These are the Republicans who have signed a hold letter, preventing action on the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR).

Now, how much do 3 million HIV-AIDS-infected people -- the treatment goal of a reauthorized PEPFAR -- weigh? This is a more difficult calculation. Adults with advanced forms of the disease can weigh about 60 pounds. Children with AIDS are like shadows falling on a scale. Maintaining weight becomes difficult with vomiting and diarrhea, with tuberculosis and fungal infections, with cancers such as Kaposi's sarcoma and lymphoma.

Coburn's response:

Part of Gerson's moral outrage is focused on my controversial stance that AIDS treatment dollars be spent on treatment. I want to preserve PEPFAR's original formula that sends at least 55 percent of all dollars to AIDS treatment so widows and orphans and actual patients, not program officers and consultants, will be the primary beneficiaries of the program.

It's not just Gerson that's ticked, it's also Richard Luger and 13 other Republicans who think this bill needs to get passed. There's are other consequences of not reauthorizing PEPFAR in a timely manner, including losing the ability to convince other nations in the G8 to cooperate and be generous with their own funding. More importantly, there are people who will die for lack of prevention and treatment.

What's scary about Coburn is not just how wrong he is (see the comments above from Denis Nash and Mead Over; they are public health experts, which Coburn is decidedly not), and how far out of the mainstream he is, it's that he's John McCain's chief medical adviser and functions as a medical adviser for Republicans (like Bill Frist on the Terri Schiavo debacle, Coburn is way over his head on this but Republicans turn to him anyway). John McCain in particular relies on Coburn to tell him what to do about medical issues (this reference is about condoms and AIDS):

Q: "But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we’re not going to distribute them,’ knowing that?"

  Mr. McCain: (Twelve-second pause) "Get me Coburn’s thing, ask Weaver to get me Coburn’s paper that he just gave me in the last couple of days. I’ve never gotten into these issues before."

and despite having a year to read "Coburn's thing", on this issue said:

"I'll be glad to assist.  I'm sorry to tell you I'm not that familiar with the process of this legislation.

making Coburn's position – right or wrong –  all the more influential.

Be that as it may, the issue on the table is reauthorizing PEPFAR and saving lives, millions of them. The Senate needs to do what's needed to get this bill to a vote (it will pass overwhelmingly, just like in the House where it passed 308-116).

This is a story we will continue to follow.  And if you want to do something about it now, you can sign this petition. While we get to vote in November for people that understand public health and science, some things can't wait until November.

Update [2008-6-15 15:39:18 by DemFromCT]: For clarification, Coburn's main stated objection is removal of fixed allocation for funding treatment (55%) in favor of local flexibility. The Institute of Medicine has recommended against fixed allocation because it does not support sustainability. My own suspicions of conservative objections remain, but the public battle will be over the allocations provision.

Update [2008-6-16 0:20:15 by DemFromCT]: More on condoms.

The seven conservative Republicans are critical of the program's higher spending level and prevention programs that include condom promotion

Originally posted to Daily Kos on Sun Jun 15, 2008 at 09:49 AM PDT.

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Comment Preferences

  •  Why are they so afraid of a condom (9+ / 0-)

    My lord, Some days I wish their fathers (of the GOP idiots) had used one

    "The woman's life is misery; for God's sake, people, at least give her a few good songs". NYT review of The Color Purple

    by arogue7 on Sun Jun 15, 2008 at 09:52:45 AM PDT

    •  It's a religion thing (3+ / 0-)
      Recommended by:
      MikeTheLiberal, arogue7, earicicle

      Be fruitful and multiply.

      I don't recall "Thou Shalt not use a Durex"
      in the 10 commandments.

      Saying the Iraq "Surge" worked is like saying Thelma & Louise had a flying car.

      by JML9999 on Sun Jun 15, 2008 at 09:55:55 AM PDT

      [ Parent ]

    •  Because!!! Condoms lead to sex! (2+ / 0-)
      Recommended by:
      AggieDemocrat, hypekiller

      And sex leads to dancing!

      And dancing mens Obama wins!

    •  because they aren't interested in disease (3+ / 0-)

      prevention, they are interested in sex prevention.

      "Well, yeah, the Constitution is worth it if you can succeed." -Nancy Pelosi, 6/29/07.

      by nailbender on Sun Jun 15, 2008 at 10:50:31 AM PDT

      [ Parent ]

      •  To be fair, (1+ / 0-)
        Recommended by:
        Jay C

        and, as precursor, I'm not a medical expert (but I'll play one anyway), the Maasai that I interacted with in Tanzania and Kenya couldn't use condoms because of the way they circumcise.  This is especially a problem because of the peoples' migratory nature and tradition of communal wives.  Thus, leaving education and lifestyle change as the only preventative measures to combat the disease.  

        In the end, I'll agree that the six Senators are misguided.  But I'll be a 100 times more pissed if the bill dies in committee.  Abstinence has a place in the fight against HIV/AIDS.  So the US Government over concentrates their effort on this method -- NGOs can concentrate on other methods.  Just as long as the program gets funded. . . Give the Senators what the want.

        •  abstinence has its place (1+ / 0-)
          Recommended by:
          terjeanderson

          certainly.  but when promoting abstinence to the exclusion of healthy or healthier ways to have sex, the focus becomes dangerous.

          coburn's concern here is NOT the reallocation of resources to anything in particular, it is the reallocation of resources AWAY from a specific something, and that is prevention.

          his legacy in the house speaks to this.

          his inappropriate and medically unsound counsel to senator mCcain about condoms equally highlights his bias.

          at one point while in the house, coburn wanted to defund the aids drug assistance program and use that money to fund a post-exposure prophylaxis program in the hospitals for the victims of sexual assault.

          _________________________________

          "it's not my stop but the view is better."

          -9.75 (economic), -7.18 (social)

          by dadanation on Sun Jun 15, 2008 at 11:13:43 AM PDT

          [ Parent ]

          •  Yeah, (0+ / 0-)

            It's a chilling line of thought.  We're actually giving  Coburn the benefit of the doubt in some respects: His stance could be based purely on donations from the pharma industry and not on religious ideals.  Terrifying and evil.

            All I'm saying is that this program needs to be funded.  And if it takes gutting it's condom provisions, so be it.  It's still a step in the right direction, and NGOs can correct for the overbalance by the US Gov by over-focusing their efforts on protection.

            •  no, gutting its condom program (1+ / 0-)
              Recommended by:
              terjeanderson

              would NOT be a good thing and would in fact be exactly what coburn wants.

              your assumption is that NGOs internationally are funded and funded well-enough to offset the investment of the US.  in all of my ears of hiv work at the federal level (with and at congress, with and at the administration(s) and with and at the agencies that have hiv in their mandate) i never found that NGOs internationally were as safe and financially secure as you suggest.

              hell, the NGOs in this country are not.

              letting condom distribution and/or prevention education be dropped from the bill would be wrong.  

              coburn wants it dropped.  that per se should make the compromise unacceptable for anyone who is concerned about the global pandemic.

              _________________________________

              "it's not my stop but the view is better."

              -9.75 (economic), -7.18 (social)

              by dadanation on Sun Jun 15, 2008 at 11:59:53 AM PDT

              [ Parent ]

              •  If given the option of a dead bill (0+ / 0-)

                or a bill gutted of condom provisions which would you choose?

                I'd take the gutted and less effective bill.  It looks like the bill has become a political gambit, a tool like anit-gay legislation for Senators to show their conservative stripes for their constituencies.  

                •  what? you act as if the coburn idea is good (1+ / 0-)
                  Recommended by:
                  wilderness voice

                  the house bill passed and did not include a change in language the way that coburn would have the senate version.

                  the 14+ republicans who wrote their letter in protest of the coburn proposal do not want he provision cut.

                  why would anyone give to coburn the power to do so when it is neither a sound policy nor warranted?

                  this is not a solomon's choice, particularly not in the manner as you have presented it to me.

                  period.

                  coburn's tantrum's goal is exactly to force a compromise where none is necessary.

                  my answer to your question?
                  neither.  
                  the bill is fine without the coburn proposal and should move forward regardless of him and his 5 colleagues.

                  coburn should not be granted the satisfaction of gutting ANYTHING from that bill.

                  period.

                  and frankly, sen reid can and should move this bill and force coburn's hand.  with 14+ Rep senators on his side, i am hard-pressed to see where and how coburn has either the clout or the numbers in the senate to give him the satisfaction of allowing his moralizing and fundamentalist belief-system to hurt this program.

                  so i ask you, what is it about coburn's proposal that you find so compelling?  compelling enough for you to now have already gone down the path of "either we give him what he wants or we lose everything?"

                  he only has as much power and control over this reauthorization as he is given.  and i do not see any justification for giving him any.

                  _________________________________

                  "it's not my stop but the view is better."

                  -9.75 (economic), -7.18 (social)

                  by dadanation on Sun Jun 15, 2008 at 06:12:32 PM PDT

                  [ Parent ]

                  •  Ugh. (0+ / 0-)

                    This message isn't solely directed to you, but why is option number one in internet conversations always to question the motives of anyone who doesn't mirror your language.  It's tiring. Where do I even begin to imply that the Coburn Amendment is good?  That's creative reading to say the least -- especially since we fundamentally agree, along with everyone in this thread, about the best policy.

                    A Senator can put a hold on any bill in their committee, killing it before it comes to light for discussion or voting.  As per this thread, this appears to be the current status of the bill:

                    The Senate bill is considered "in committee" and not yet brought to a vote. That's because Tom Coburn and six other GOP Senators have blocked it from being voted on, or even discussed.

                    Thus, Senator Coburn does have the ability to block the bill.  I'm sure senior Republican leadership could threaten to take away his pork, but that doesn't look lightly.  If it comes down to flawed bill or no bill, I'm still leaning flawed bill.U

                    •  i am aware of the hold on the bill (0+ / 0-)

                      as an aside, coburn prides himself on being the senator with the lowest (read -- NO) amount pork in any bill.

                      how senate leadership deal with individual senators and their holds on bills is one thing; whether and to what extent constituents and advocates force leadership mto have the bill move to the floor is another.

                      it is especially important for advocates and constituents and activists to maintain a demand that the bill not be changed, not be altered and not be subject to the whim and caprice of coburn.  

                      to suggest at this point that a substantially gutted bill is better than no bill at all presupposes that coburn can and will have his way.

                      and in that regard, to have negotiated away the bill before it had to be negotiated away is really unwise.

                      not to mention unnecessary.

                      i have seen coburn pull this stunt before.  the more divided or compromised he knows the community to be the more adamant he is about his "policy" or "compromise," etc.

                      given the bipartisan support this bill has enjoyed, to cast this temper tantrum of coburn's as the republicans trying to force a  wedge issue for the election is really not all that fair.  on the issue of responding to international hiv (and malaria and TB) we even have jesse helms acting as a good guy.  that speaks volumes.

                      this is not intended to be cast as an election issue; it is a personal vendetta that is coburn's.

                      _________________________________

                      "it's not my stop but the view is better."

                      -9.75 (economic), -7.18 (social)

                      by dadanation on Sun Jun 15, 2008 at 11:11:06 PM PDT

                      [ Parent ]

                  •  Condoms work. Abstinence doesn"t. (1+ / 0-)
                    Recommended by:
                    dadanation
          •  First, let unmarried Congressmen be abstinent. (0+ / 0-)
        •  abstinence in addition to (0+ / 0-)

          not instead of.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 11:16:20 AM PDT

          [ Parent ]

        •  Exactly. (0+ / 0-)

          If the bill has been so successfull, why change it?  These senators, misguided though they may be, are only forcing a renewal to be a renewal, rather than the rewrite that has been snuck into play here.

          Give them the clause they want - it was there in the first place. The bill isn't being renewed without it; it's being rewritten.

      •  Republicans are immune to AIDS (0+ / 0-)

        didn't you know that?

        Anthropologists for human diversity; opposing McCain perversity

        by Denise Oliver Velez on Sun Jun 15, 2008 at 04:11:48 PM PDT

        [ Parent ]

    •  if the government won't do it. (0+ / 0-)

      we'll do it anyway. IF YOU LIVE IN SAN FRAN, there is the AIDS Walk on July 20th!

  •  You are on a roll today - (14+ / 0-)

    with two outstanding pieces back to back.

    At least on this hold we know who are the perpetrators.

    And it is important to hold up to the light of day Coburn's influence on McCain, even though I don't expect that Obama would do so, given how they have cooperated on other issues.

    Perhaps this is something worth wide distribution in various circles:

    medical

    women

    LGBT

    anyone with both a brain and a heart

    peace.

    Those who can, do. Those who can do more, TEACH! If impeachment is off the table, so is democracy

    by teacherken on Sun Jun 15, 2008 at 09:54:13 AM PDT

    •  I really like the long form essay (7+ / 0-)

      we have adopted for Sundays. Suits me.

      more diarists should do the same on Sundays like you did.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 09:57:10 AM PDT

      [ Parent ]

      •  I have a dumb question. (0+ / 0-)

        (I am man enough to ask a dumb question!)

        Are you one of the front pager folks that get "supported" or sponsored by the subscription thing?

      •  thanks for your kind words (0+ / 0-)

        my diary today was not intentional.  I planned to be working on something for tomorrow on education that is long overdue.  But when I began to read Rich it struck me that it represented a good starting point for a further exploration.  So I sat down and began to write.  

        I think your first story and mine today were quite complementary - I think it useful to offer multiple perspectives on the same topic: it enables us all to broaden and deepen our understanding.  

        Your two pieces represent a great deal more work, thought and care than my diary.  I suppose the diary was a product of subconscious reflection that came together as I read Rich.   I admire people who bring to their discussions the kinds of thoughtfulness you have shown in these two.

        Occasionally I do have something like that -  looking at the list jotter provided today for last year,I rearead the one of mine listed to realize that (a) it is one of the most coherent and effective and lucid things I have posted; (b) it is still relevant; (c) perhaps one of the roles I perform is being able to introduce people to ideas, or to restate and make more inviting and accessible things they might not otherwise encounter  I am happy when I am able to perform such a function.

        peace

        Those who can, do. Those who can do more, TEACH! If impeachment is off the table, so is democracy

        by teacherken on Sun Jun 15, 2008 at 10:08:47 AM PDT

        [ Parent ]

  •  I did a report on PEPFAR (11+ / 0-)

    about a year ago and in my research it was very clear those abstinence only requirements (one third of the total budget) was actually doing more damage in Africa and was tying the hands of health care providers.

    PEPFAR has been a limited success and any characterization of it as being a "wildly successful" achievement of the Bush administration are false and will continue to be false so long as these abstinence only requirements send this tax money down the drain and hurt the prevention efforts it's supposed to be helping.

    "People place their hand on the Bible and swear to uphold the Constitution. They don't put their hand on the Constitution and swear to uphold the Bible." --J.R.

    by michael1104 on Sun Jun 15, 2008 at 09:55:49 AM PDT

    •  Nothing the Shrubhouse has done has been (2+ / 0-)
      Recommended by:
      MikeTheLiberal, earicicle

      "wildly successful"

      Saying the Iraq "Surge" worked is like saying Thelma & Louise had a flying car.

      by JML9999 on Sun Jun 15, 2008 at 09:57:25 AM PDT

      [ Parent ]

    •  compared to what else he's done (2+ / 0-)
      Recommended by:
      MikeTheLiberal, earicicle

      I can appreciate the hyperbole.

      Compared to what it could do, you are exactly right.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 09:58:17 AM PDT

      [ Parent ]

    •  So this legislation does NOT (0+ / 0-)

      authorize funds for condom distribution (that's what I gathered)?

      If not, heh, I tend to agree: it can't POSSIBLY be "wildly successful", even "effective", and ultimately, it will create even MORE widows and orphans and infected people.

      Sounds like it's always been half-assed (if not downright "purposefully ineffective") legislation, and still is.

      •  the bill (1+ / 0-)
        Recommended by:
        dadanation

        would do away with the previous requirements "that 55 percent of the HIV/AIDS appropriation be spent on treatment and drugs and that about 30 percent of prevention funds be allocated to abstinence education."

        (35) Efforts to promote abstinence, fidelity, the correct and consistent use of condoms, the delay of sexual debut, and the reduction of concurrent sexual partners represent important elements of strategies to prevent the transmission of HIV/AIDS.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Jun 15, 2008 at 10:58:24 AM PDT

        [ Parent ]

        •  as i've said beforer (2+ / 0-)
          Recommended by:
          terjeanderson, Prognosticator

          for coburn, it s not ultimately his concern where the moneys are reallocated TO, he is just all about making sure that the funds get reallocated FROM -- and that "from" would be any type of prevention intervention.  it matters not one whit to him what the data say about condoms, healthy sexual curriculum, or for that mater community-level or structural level hiv prevention interventions, he refuses to be reality-based in this arena. he has been like this since he was in the house.

          and his stymieing of the bill NOW at this juncture is an intentional and very predictable coburn strategy.

          as the braking point looms closer on the horizon, coburn will maintain his stance.  he has after all, nothing to lose.  he is once again playing chicken with the chamber and is pretty certain that he will win.

          _________________________________

          "it's not my stop but the view is better."

          -9.75 (economic), -7.18 (social)

          by dadanation on Sun Jun 15, 2008 at 11:21:13 AM PDT

          [ Parent ]

          •  adsf (2+ / 0-)
            Recommended by:
            dadanation, terjeanderson

            worth pointing out that the AIDS Healthcare Foundation
            issued the press release in support of a 55% amendment.. and more recently they issued this press release that stands by Coburn's position b/c treatment is so important...

            ::

            problem is that as an AIDS activist i do not co-operate with the AIDS Healthcare Foundation... probably never will, unless they stop acting out of narrow self-interest. (their timely press releases are sometimes nice; true.)

            this article deals with criticisms of AHF after they settled a lawuit with Abbott over a 400% increase in the price of a medication:

            "We don't agree with the price increase, but at the same time, with this settlement, we'll be able to treat a whole lot of people," AHF general counsel Tom Myers told Reuters. "We thought it was a good outcome."

            The key word was "we," in that AHF benefits directly, not the greater community of people living with AIDS.

            The health insurance giant Aetna filed a similar lawsuit against Abbott in May over the Norvir price increase. However, it mysteriously withdrew the lawsuit two days later. Some believe that Abbott quietly agreed to give Aetna a price break or rebate on its AIDS drugs.

            "This was a carefully orchestrated sell-out by AHF," said Thomas Gegeny, executive director of The Center for AIDS in Houston, in a statement released by the AIDS Treatment Activists Coalition (ATAC), a broad national group of individuals and organizations involved in the fight against AIDS.

            "As far as the HIV/AIDS community is concerned, the issue of Abbott's unprecedented price increase for Norvir is not settled, nor will it be settled until the price is lowered to its former value."

            "The behavior of both AHF and Abbott in this matter should come as no surprise," added ATAC member Martin Delaney, founder of Project Inform in San Francisco. "AHF has a history of bargaining for its own interests to the exclusion of those in the community as a whole."

            •  whoops ;; the 2nd & more important press release (1+ / 0-)
              Recommended by:
              dadanation
            •  i have no thing nice to say about ahf (0+ / 0-)

              imagine being on the hill when the ryan white care act is being reauthorized and have the e.d. of the aids healthcare foundation testify to congress that san francisco is serving, and i quote, dead people with its ryan white moneys.

              and then flash forward a few years and have ahf open up one of their stores here in san francisco with the proceeds to help support the aids healthcare foundation's clinic here in san francisco.

              they did not seem to mind taking money from san francisco for their own good while at the same time helping congress CUT nearly one-third of all of san francisco's ryan white care act funds.

              they are not even a non-profit entity.  they are a for-profit entity.

              the fact that they agree with coburn is of both no surprise to me and an equally compelling reason to question the value the coburn proposal.

              like you, and in agreeing with the quotation above from the director of project inform, i find them appallingly greedy and thoroughly without a scruple.

              _________________________________

              "it's not my stop but the view is better."

              -9.75 (economic), -7.18 (social)

              by dadanation on Sun Jun 15, 2008 at 05:48:44 PM PDT

              [ Parent ]

    •  thank you for this moment of clarity (1+ / 0-)
      Recommended by:
      terjeanderson

      the restrictions within the current authorization of PEPFAR are bad enough.

      but to do away with the prevention language would be to add insult to injury.

      _________________________________

      "it's not my stop but the view is better."

      -9.75 (economic), -7.18 (social)

      by dadanation on Sun Jun 15, 2008 at 11:16:47 AM PDT

      [ Parent ]

  •  Because the original program was for show.. (2+ / 0-)
    Recommended by:
    dadanation, MikeTheLiberal

    not for GO.

  •  Some days I wish I believe in hell... (6+ / 0-)
    because Coburn sure deserves to rot in it for eternity.

    Thanks for writing about 2 important issues today...both are great posts.

    •  I believe in hell. (1+ / 0-)
      Recommended by:
      dadanation

      So he will rot in eternity.

      At least, in MY reality.

      Does that make sense?

      Ironic, sardonic, sarcastic, cynical, acerbic, derisive... But I still believe in the Dream!

      by grover on Sun Jun 15, 2008 at 11:01:17 AM PDT

      [ Parent ]

      •  And (oh, good Lord, I'm thinking over here) (1+ / 0-)
        Recommended by:
        dadanation

        The Republicans are mostly good (ahem!) Christians.  THEY all believe in hell, so in THEIR realities too.

        Whew. That's enough meta-reality for me. I'm going back to bed.

        Ironic, sardonic, sarcastic, cynical, acerbic, derisive... But I still believe in the Dream!

        by grover on Sun Jun 15, 2008 at 11:03:13 AM PDT

        [ Parent ]

    •  if the hopes of two people could make it happen (2+ / 0-)
      Recommended by:
      Elise, terjeanderson

      we'd be able to crate such a place for this rotten man.

      and in his comments, you'll see how coburn drops his other coded messaage:

      so widows and orphans and actual patients, not program officers and consultants, will be the primary beneficiaries of the program.

      which is, in essence, the same stump refrain he used when he was leading the reauthorization of the ryan white care act while in the house.  

      his meme about "program officers" and "consultants" is meant to suggest waste, fraud and misspent precious US dollars.  even when the acts are laid bare, facts which speak against his coded claim of fraud and waste and mismanagement, this is not of any concern to him.

      coburn is all about ending social programs.  no two ways about it.  the PEPFAR reauthorization is a means to an end for him -- which ever and whaever vehicle he can latch on to that will alow him to move his agenda forward, he will, he has done and will always do.

      the data show what works.  data do not matter here to coburn.  his "concern" as a physician is clearly noted and clearly out of step with his oath, his title and his "alleged" interest in the program.

      this latest hijacking and ransom-holding is par for the course for him.

      _________________________________

      "it's not my stop but the view is better."

      -9.75 (economic), -7.18 (social)

      by dadanation on Sun Jun 15, 2008 at 11:31:18 AM PDT

      [ Parent ]

  •  Bush doesn't care (4+ / 0-)

    Molly Ivins' book, Bushwhacked, Life in George Bush's America lists several examples of how the White House screws up our foreign policy to repay his contributors. Here is one from page 251 (I'm hunting and pecking here so there is no link):

    In July [of 2001] Bush replaced the usual contingent from the American Medical Association and the American Public Health Association who normally represent our country at the World Health Assembly. Instead, he dispatched Jeanne Head, a professional anti-abortion activist with the National Right to Life Committee, Janice Crouse of Concerned Women for America-the outfit founded by Beverly LaHaye, wife of the apocalyptic evangelist and author Tim LaHaye-and John Klink, a former chief negotiator for the Vatican. None of them is an expert on public health. The U.N.'s World Health Organization is widely credited with doing terrific work, including wiping out smallpox and other diseases. That Bush would have sent such an eccentric delegation to an international conference is indicative of the contempt with which the administration views such efforts.

    The plural of anecdote is not data.

    by bobinson on Sun Jun 15, 2008 at 09:56:26 AM PDT

    •  W's policy: put foxes in charge of the henhouse. (1+ / 0-)
      Recommended by:
      bobinson

      He did it systematically and thoroughly, with all agencies in the government.

      Utterly evil.

      Sweet are the uses of adversity...[Find] tongues in trees, books in the running brooks, Sermons in stones, and good in everything. -Shakespeare, As You Like It

      by earicicle on Sun Jun 15, 2008 at 10:28:43 AM PDT

      [ Parent ]

    •  exactly (2+ / 0-)
      Recommended by:
      bobinson, get the red out

      ?remember what bush did when he first took office in january of 2001?  remember what he did on the anniversary of roe v wade on january 22, 2001? this:  

      On the 28th anniversary of Roe v. Wade, President Bush signed an executive order Monday banning federal funds to international family planning groups that offer abortion or abortion counseling.

      when it comes to health care, be that hiv, std, repro health, substance abuse, mental health, housing, responses to natural disasters, etc. this administration has been abumdantly clear where it stands --  with one foot firmly on the neck of those who need such services and the other foot kicking data and facts to the curb.

      coburn is lock-step with the administration on its abstinence-only and no family-planning activities regarding abortion.

      _________________________________

      "it's not my stop but the view is better."

      -9.75 (economic), -7.18 (social)

      by dadanation on Sun Jun 15, 2008 at 11:39:17 AM PDT

      [ Parent ]

  •  You have to ask?? (0+ / 0-)

    Why is AIDS Prevention Being Blocked By Republicans?

    Because they hate black people?

    "People should not be afraid of their government; governments should be afraid of their people." --V

    by MikeTheLiberal on Sun Jun 15, 2008 at 10:00:30 AM PDT

    •  No, actually, they hate all people that aren't (1+ / 0-)
      Recommended by:
      MikeTheLiberal

      subservient to their will.

      Blacks have a well-know history of rejecting subservience, so it's prudent to reject them out of hand.  /snark

      How do you tell a predator from a protector? The predator will eat you sooner rather than later.

      by hannah on Sun Jun 15, 2008 at 10:06:00 AM PDT

      [ Parent ]

  •  Oklahoma (2+ / 0-)
    Recommended by:
    paulko, earicicle

    The home of dumba$$ senators.  Its sad when the last good one was Sen Boran now President of OU and father of Dan Boren (?-OK02)

    Born in Oklahoma Raised in Ohio Escaped to Meechigan!!!

    by MI Sooner on Sun Jun 15, 2008 at 10:02:08 AM PDT

  •  Barbaric Ideology. (5+ / 0-)

    There is an undeniably evil streak in the population of all Republican sorts.

    It's clearly not  "all of them" because "most of them" are not exactly vicious fascists. They simply believe they are right when they are most likley mistaken.

    But there's a sub-group - the Tom Delay's, The Orrin Hatch's, the Haley Barbours and Trent Lotts - the ones in real power that have a particularly ugly belief system that DOES INCLUDE getting rid of lots of human beings in the near future. Some here, some there.

    Their response to Katrina in New Orleans is an awesome example.

    It's racist and it's the worst of Elitist Social Darwinism. They call it manifest destiny.

    This is why they gutted the government, refuse to police the food system, allow dangerous pharmaceutical drugs to be sold, encourage tobacco-smoking and alcohol consumption, encourage the fast food diet that is killing america with diabetes and why the obstruct healthcare reforms.

    its how they can look at torture and call it "interrogation".

    There are some really really bad human beings in control of a lot of things and if we could replace them we could change the world.

    (But when half your own political party -  the alleged "opposition party" is dedicated to not doing a thing to them... you can sort of kiss that goodbye.)

  •  "Family values" is a euphemism (0+ / 0-)

    which means that the authority of the male is derived from the potential for paternity.  
    Homosexuals challenge that proposition by rejecting paternity as a necessary adjunct to authority--i.e. homosexuals challenge the essence of male authority.
    Ergo, homosexuals are a bad influence on society.
    AIDS kills homosexuals.  
    Ergo, why would authentic males want to stop the spread of AIDS?

    Do you follow the logic?

    That AIDS also kills heterosexuals and women and children is unfortunate.  As the protectors of male authority, we have to take the bad with the good.  /snark

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Sun Jun 15, 2008 at 10:03:47 AM PDT

  •  Fans of abstinence should be asked one question: (4+ / 0-)

    How can rape victims abstain from sex?

    Counseling abstinence is fine and dandy, but rapists don't generally respect virginity pledges...

    •  The victims of rape are obviously (3+ / 0-)

      not in tune with the necessity of males to establish their authority by actualizing their potential paternity.  If they were in tune, they would not raise an objection, but would be keen participants in this important rite.

      Same goes for women who seek intervention to terminate a pregnancy prematurely.  They, too, are participants in the effort to frustrate the actualization of potential paternity.

      How can patriotism survive if paternity is undermined?

      How do you tell a predator from a protector? The predator will eat you sooner rather than later.

      by hannah on Sun Jun 15, 2008 at 10:11:15 AM PDT

      [ Parent ]

  •  One thing I DON'T see mentioned here (3+ / 0-)
    Recommended by:
    paulko, distraught, get the red out

    is why it is that Harry Reid has ANY reason to respect the hold put on by these Christo-fascist Senators.

    -7.88, -6.72. "Wherever law ends, tyranny begins."--John Locke IMPEACH THE BASTARDS!!!

    by caseynm on Sun Jun 15, 2008 at 10:06:55 AM PDT

    •  exactly, we must call out Sen Reid (2+ / 0-)
      Recommended by:
      sardonyx, paulko

      if he respects this absurd hold (after Lugar's Dear Colleague letter from 14 Republicans), then Reid must be accused of playing politics with this issue.  I (for one) will not allow him to blame a failure of this magnitude on Republicans, when we have well over 60 votes.

    •  I'm so glad you asked (0+ / 0-)

      I display my ignorance, but how can Repiblican Senators hold up anything in committee when, I thought, the party in the majority sets the agenda of what bills get to the floor and which don't. Or, at least I thought that was how it worked.

      •  there is Senate courtesy toward holds (0+ / 0-)

        from either party. What they CAN do and what they CHOOSE to do are different.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Jun 15, 2008 at 12:20:58 PM PDT

        [ Parent ]

  •  Coburn has a legit point. Does Sex Ed = HIV? (0+ / 0-)

    Condom usage is more sex education vs. specific AIDS prevention.  It has great value but it covers unwanted pregnancy and all kinds of sexually transmitted diseases not just AIDS.

    Is using AIDS money for sex education the best use of AIDS specific money?  As Coburn notes, paying money to "educators" is money that doesn't go to help victims of AIDS.

    As the stats show, people with AIDS have a very hard time getting treatment, drugs that can make a huge difference in their lives and prevent them from spreading the disease to their children or sex partners.

    Coburn's point that at least 55% go to AIDS victims for treatment seems fair. In fact, one could argue that 100% should go to helping people with AIDS and separate funding should be sex education and condoms which is only 10% about AIDS.

    •  pssst. You're ignoring his desire to keep (4+ / 0-)
      Recommended by:
      AggieDemocrat, grover, HGM MA, earicicle

      abstinence only in there, which is a COMPLETE waste of money.

      -7.88, -6.72. "Wherever law ends, tyranny begins."--John Locke IMPEACH THE BASTARDS!!!

      by caseynm on Sun Jun 15, 2008 at 10:13:12 AM PDT

      [ Parent ]

      •  Nope. Coburn takes money out of "absintence" (0+ / 0-)

        Coburn takes the money out of the "education/prevent" aspect and requires it be spent on actual treatment of people suffering from AIDS.

        So your point is totally wrong.

        •  what the bill provides for is (1+ / 0-)
          Recommended by:
          terjeanderson

          prevention and treatment. It leaves the which and what more to local agencies than the previous iteration instead of fixing it by legislation. The new bill allows for condoms.

          The Leadership Act that created PEPFAR required the Institute of Medicine (IOM) to undertake a review of the initiative within three years of its inception. The report of this expert evaluation - published in March 2007 - contained a number of criticisms of PEPFAR policies and suggestions for improvement. To a large extent, these findings vindicated what many AIDS activists had been saying for some time:65

             * Inflexible budget allocations, including the one-third earmark for AB programmes, are harmful and should be removed.
             * More effort is needed to empower women and girls and improve their status.
             * PEPFAR should trust the WHO to prequalify drugs, and not require FDA approval, in order to increase use of generics.
             * PEPFAR must transform from an emergency response into a long-term, sustainable programme - in particular by helping to expand the health workforce.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 11:47:01 AM PDT

          [ Parent ]

          •  And Coburn is OK with prevention AND treatment. (0+ / 0-)

            His point of view, is that 55% should be on treament, money spent on people with AIDS vs. money given to people not afflicted with AIDS to run prevention programs.

            Coburn's point is entirely legit as the entire budget could get eaten by programs with none actually going to directly benefit people with AIDS.  A 55/45 split doesn't sound particularly bad.

            If it's a case of the legislation dying or going ahead as is, then it must go ahead as is but demonizing Coburn over a legit point is not helpful.

            •  you are really not understanding this (1+ / 0-)
              Recommended by:
              terjeanderson

              I don't know why. but you can't legislate what percentage goes for treatment and expect the program to be effective.

              Let's assume we take Coburn at his word (I don't, but you can - I think he just wants the program canned). This is what the high-powered review concluded (I.e that Coburn is wrong):

              In addition, the Committee recommends that Congress remove the budgetary allocations but replace them with alternative mechanisms for accountability to ensure results and to permit Country Teams the maximum flexibility to achieve the 5-year performance targets for supporting prevention of 7 million infection, providing antiretroviral therapy to 2 million people, and care for 10 million people affected by HIV/AIDS including orphans and vulnerable children.

              The figures were based on prior allocations. The concept remains: legislating percentages is a bad idea. Some places need more of this:

              A transition from its focus on emergency relief to an emphasis on long-term strategic planning and capacity building for a sustainable response.

              Addressing the long term factors that underlie the epidemics in each country including:

                 * Emphasizing and enhancing prevention with accumulation of better data to determine the most appropriate interventions needed in the countries.

              http://www.iom.edu/...

              Different strokes for different folks.

              Coburn's objections are not supported by science and peer review.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Jun 15, 2008 at 12:01:09 PM PDT

              [ Parent ]

              •  Coburns detractors are not consistent. (0+ / 0-)

                For example, you say there must not be set allocations and then note that the new program SETS ALLOCATIONS of how many will be treated.

                "providing antiretroviral therapy to 2 million people, and care for 10 million people affected by HIV/AIDS including orphans and vulnerable children."

                Why have SET ALLOCATIONS limits on how many get treated but no set allocations on how much is paid to people who don't have AIDS/HIV, who have no need for life saving medical intervention?

                "I think he just wants the program canned."

                And you are clearly wrong since Coburn voted for it last time and has clearly stated he will vote for it again if it maintains a high level for actual help for those with AIDS.

                If Coburn uses this to prevent passage of the funding, then you would be correct. If he simply requires the pre-existing guarantee of funding for direct help to people with AIDS, then you are wrong.

                •  it predicts how many are being treated (1+ / 0-)
                  Recommended by:
                  terjeanderson

                  based on funding; that's not a set allocation.

                  If Coburn uses this to prevent passage of the funding, then you would be correct. If he simply requires the pre-existing guarantee of funding for direct help to people with AIDS, then you are wrong.

                  What Coburn needs to do is release the hold and debate the issue with his peers on the floor of the Senate. If he can make a case for his POV, good for him. that's how it works.

                  Right now, he is preventing even that. he doesn't appear to accept Institute of medicine recommendations about the need for sustainability and flexibility:

                  To help support this transition from emergency relief to sustainability, the report identifies a number of opportunities for improving PEPFAR. One area of emphasis is what the global AIDS policy community refers to as "harmonization." The concept builds on country ownership and leadership of its response its HIV/AIDS epidemic. Donors are expected to commit to three principles of harmonization:

                  following the national AIDS plan; participating in the country’s national AIDS coordinating agency; and working within the country’s national AIDS monitoring
                  and evaluation framework.

                  The need for harmonization has a number of specific policy implications. The Committee found, for example, that congressional budget allocations have limited PEPFAR’s ability to tailor its activities to the local epidemic in each country and to harmonize with each country’s national plan. Therefore the report recommends that Congress replace budget allocations with other mechanisms that take into account the needs of individual countries and that allow spending to be directly linked with the efforts necessary to respond to those needs.

                  I keep highlighting this because you (and Coburn) keep ignoring it. This is one of those "give a man a fish vs teach him how to fish" things.

                  As far as his motivation, I do not trust him. But we shall see.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Sun Jun 15, 2008 at 12:31:28 PM PDT

                  [ Parent ]

                  •  It states only SET number will be treated. (1+ / 0-)
                    Recommended by:
                    goanliberal

                    and then critiques Coburn for requiring set allocation for the spending 55% for people with AIDS, 45% for AIDS prevent. That is clearly contradictory.

                    Nothing in your quote suggests it there is any variability. If even fewer will be treated, then it makes Coburn insistence on proportionality even more important as none of it might be used to actually help people with AIDS but be spent, as Coburn fears, on consultants and advisers and programs versus specifically helping people with AIDS.

                    Coburn's request for fixed allocation so that most of the money is spent on people with AIDS does not seem unreasonable. Yes we see that some disagree with that view but that is the purpose of the legislation. Perhaps other funding should be provided for the teaching the use of condoms since this is not strictly focused on AIDS but all STDS and unwanted pregnancy.

                    Bottom line is the exaggerated hyperbole attacking Coburn does not seem justified.

                    If Coburn were to kill the legislation vs. allowing it to go forward in its current form, then one could question his motives.

            •  Coburn is just a sweetheart. He is also opposed (0+ / 0-)

              to public funding of education.

    •  Are you kidding me??? (1+ / 0-)
      Recommended by:
      HGM MA

      You do realize that if you PREVENT the spread of the HIV virus, eventually the treatment budget goes to ZERO because you have no more AIDS patients?

      Condoms are highly effective and inexpensive. Paying educators is a great investment. The so-called "moral objection" to condoms is the most immoral fallacy of our times. It says: My religious belief trumps the lives of hundreds of millions of people. It condemns millions to sickness, suffering and death. All of which could be prevented with pennies worth of latex.

      I think the actions of Coburn and company sickens the God in whom they claim to believe.

      Sweet are the uses of adversity...[Find] tongues in trees, books in the running brooks, Sermons in stones, and good in everything. -Shakespeare, As You Like It

      by earicicle on Sun Jun 15, 2008 at 10:21:01 AM PDT

      [ Parent ]

      •  So let people with AIDS die and focus on prevent? (0+ / 0-)

        Of course, we haven't managed to "prevent" other sexually transmitted diseases so we will not totally prevent AIDS's either.

        Coburn is saying use this funding for treating people with AIDS who can't afford treatment.

        Condoms prevent AIDS and many other diseases.  Funding for teaching about condom use is not exclusive to AIDS while the funding for this bill is exclusive to AIDS.

        Take the condom education money out of the elementary education budget where it belong so every kid knows about condoms and STD's by the 6th grade (12 years old).

        •  this bill is not exclusive for AIDS (1+ / 0-)
          Recommended by:
          earicicle

          it includes TB and malaria. it also helps to fund and train health workers overseas.

          Building public health infrastructure is a vital part of health care.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 11:42:23 AM PDT

          [ Parent ]

        •  This bill is about FOREIGN assistance, so (0+ / 0-)

          this idea is moot, and shows you didn't read the diary:

          Take the condom education money out of the elementary education budget where it belong so every kid knows about condoms and STD's by the 6th grade (12 years old).

          Treatment and prevention must both be addressed. But the most ludicrous thing is this doctrinaire gang of Republican hypocrites holding up ALL funding for EVERYTHING (treatment & prevention of HIV/AIDS, as well as malaria and TB for God's sake!) over the issue of condoms.

          Here's an idea: if they are morally opposed to condoms, they don't have to use them. But as the diarist shows, medical evidence proves condoms save lives when it comes to HIV/AIDS. So when it comes to prescribing whether others should use condoms, this gang should STFU.

          Sweet are the uses of adversity...[Find] tongues in trees, books in the running brooks, Sermons in stones, and good in everything. -Shakespeare, As You Like It

          by earicicle on Sun Jun 15, 2008 at 11:45:59 AM PDT

          [ Parent ]

          •  the formal hold up is over the 55% rule (1+ / 0-)
            Recommended by:
            earicicle

            my suspicions are deep that it is more than that. the lack of flexibility in the program hurts it. That's pretty much everyone's conclusion except Coburn's.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Jun 15, 2008 at 12:18:42 PM PDT

            [ Parent ]

    •  here's CDC (2+ / 0-)
      Recommended by:
      dewley notid, earicicle

      Latex condoms, when used consistently and correctly, are highly effective in preventing heterosexual sexual transmission of HIV, the virus that causes AIDS. Research on the effectiveness of latex condoms in preventing heterosexual transmission is both comprehensive and conclusive. The ability of latex condoms to prevent transmission has been scientifically established in laboratory studies as well as in epidemiologic studies of uninfected persons at very high risk of infection because they were involved in sexual relationships with HIV-infected partners. The most recent meta-analysis of epidemiologic studies of condom effectiveness was published by Weller and Davis in 2004. This analysis refines and updates their previous report published in 1999. The analysis demonstrates that the consistent use of latex condoms provides a high degree of protection against heterosexual transmission of HIV. It should be noted that condom use cannot provide absolute protection against HIV. The surest way to avoid transmission of HIV is to abstain from sexual intercourse or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.

      That's why Lancet says do both. It's not really a debatable point as to whether condoms work.

      Prevention is key. As far as that goes,

      Prevention of HIV and treatment of those suffering from the disease should not be seen as mutually exclusive, but as mutually reinforcing, complementary arms of a comprehensive global AIDS strategy. The following considerations argue for the immediate scaling up of prevention and treatment: (1) moral and social implications of denying treatment to millions of people already infected; (2) the structural limits to the efficacy of prevention programs when no treatment is available; (3) the evidence of synergy between HIV prevention and treatment, and (4) treatment's role in providing political leverage for AIDS control, including stronger prevention efforts.

      This programs scales up form 15 to 50 billion and covers both. by not having fixed dictates, it frees local clinics to do more of what works, including condom use.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 10:25:25 AM PDT

      [ Parent ]

      •  A-freakin'-men. Those pesky facts... (0+ / 0-)

        always get in the way!

        Of course it was Dr. (!) Bill Frist (R-LaLaLand) who "wasn't sure" if HIV could be transmitted via saliva, wasn't it?

        And I seem to remember our good friend Tim Russert made him squirm one Sunday nailing him about this ridiculous quote.

        Sweet are the uses of adversity...[Find] tongues in trees, books in the running brooks, Sermons in stones, and good in everything. -Shakespeare, As You Like It

        by earicicle on Sun Jun 15, 2008 at 10:42:21 AM PDT

        [ Parent ]

    •  PS also, training (1+ / 0-)
      Recommended by:
      earicicle

      Train and support 140,000 new health professionals.

      Someone has to provide diagnosis, care and counseling. You don't just go to Walmart and get your drugs. So, there's no such thing as 100% treatment.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 10:29:10 AM PDT

      [ Parent ]

    •  No, his point is wong, There will never be (0+ / 0-)

      enough resources to treat everyone because the rate of new infections make it impossible to adequately provide treatment in Africa.  The only manner in which this pandemic can ever be controlled is to cut the rates of new infections by two thirds and prevention is the only way this can be accomplished.  That stats are fuzzy in determining what viral load levels make it "less likely" that transmission occurs because so many factors go into it.  What we do know is that the proper use of condoms is the best and highest prevention available in attempts to slow HIV transmission rates.  The evidence is indisputable.    

      If you tremble with indignation at every injustice then you are a comrade of mine. - Ernesto Che Guevara

      by HGM MA on Sun Jun 15, 2008 at 10:54:30 AM PDT

      [ Parent ]

      •  So don't treat poor people with AIDS? (0+ / 0-)

        Sorry but that philosophy is the same psuedo-Darwinism we hear from the right wingers all the time. We'll never eliminate illietracy so don't educate. We'll never eliminate sickness so don't provide health care.

        Coburn's point is that all the money should go to people suffering from AIDS, people who otherwise could not afford treatment.

        It's a legit point.

        •  it is not a legit point (1+ / 0-)
          Recommended by:
          terjeanderson

          for every 2 people treated, at least 2.5 more come down with it. You can't treat your way out of this or 'prevent by treating'. You have to prevent AND treat. WHO, public health experts and epidemiologists all agree on this point.

          "The prevention effect of treatment is not likely to be anywhere near the magnitude of prevention through prevention," including safe-sex education and condom distribution, said Mead Over, senior fellow at the Center for Global Development.

          Put another way, the goal of the new legislation is to treat 3 million (that's one million more than now), prevent 12 million.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 11:39:58 AM PDT

          [ Parent ]

          •  You can't treat your way out of cancer either. (0+ / 0-)

            Sorry your point is a meaningless tautology.

            Coburn is saying use at least 55% of the money for an AIDS program to help people with AIDS.

            Abandoning people with the disease in favor of preventing it in others is not a valid choice.

            Coburn is saying that the point of "Emergency Plan for AIDS Relief" is to provide relief to people with AIDS more than providing prevention.

            It's a legitimate question. What is the purpose of the funding?

            •  your concepts are wrong (1+ / 0-)
              Recommended by:
              terjeanderson

              really wrong. "An ounce of prevention is worth a pound of cure" is not a tautology.

              See note above from the institute of medicine, which has studied this extensively.

              The Leadership Act that created PEPFAR required the Institute of Medicine (IOM) to undertake a review of the initiative within three years of its inception. The report of this expert evaluation - published in March 2007 - contained a number of criticisms of PEPFAR policies and suggestions for improvement. To a large extent, these findings vindicated what many AIDS activists had been saying for some time:65

                 * Inflexible budget allocations, including the one-third earmark for AB programmes, are harmful and should be removed.
                 * More effort is needed to empower women and girls and improve their status.
                 * PEPFAR should trust the WHO to prequalify drugs, and not require FDA approval, in order to increase use of generics.
                 * PEPFAR must transform from an emergency response into a long-term, sustainable programme - in particular by helping to expand the health workforce.

              This legislation attempts exactly that. The inflexible budget allocation is harmful, and needs to be removed. According to the estimates, the number of people treated goes up, and the number prevented goes way up.

              Honestly, what part of that are you having trouble with?

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Jun 15, 2008 at 11:52:53 AM PDT

              [ Parent ]

            •  if cancer were an infectious disease (0+ / 0-)

              and threating cancer lowered its spread, then treatment would equal prevention. That's what Coburn is saying. He's wrong. The data does not support his view.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Jun 15, 2008 at 11:54:22 AM PDT

              [ Parent ]

            •  How about doing both (1+ / 0-)
              Recommended by:
              DemFromCT

              So why does it need to be a choice between treatment and prevention? How about taking a radical approach to public health and try to do both

              Should we stop all anti-smoking efforts and simply use all the money to treat lung cancer?

              I'm a person living with HIV, I've spent a lot of time working in Africa, Asia and the Caribbean. The idea that a single approach will over come this epidemic is ridiculous -- we need a multi-pronged set of efforts -- voluntary counseling and testing, prevention through behaviour change and barriers, treatment of those infected, development of effective biomedical prevention tools (vaccine, microbicide), orphan care, food sexurity, blood supply safety, research for improved treatments, and serious efforts to address the inequalities that drive the epidemic (poverty, gender roles, homophobia, xenophobia, sexual violence, racism, etc).

              No one formula will work in every country -- depending on the state of the epidemic there (very different approaches needed in countries with a 20% seroprevelance than a country with 1% seroprevelance, different needs in a country with a well developed health infrastructure vs. those without, different needs for epidemics driven by needle sharing, heterosexual spread, and male/male sexual contact. Dictating an arbitrary precentage for each country without accounting for local need is ridiculous.

              My friends living with HIV in Africa and Asia are adamant about expanding treatment, but they also are adamant about prevention, because they know that the only way to slow this epidemic is a sane, multi-sectoral, multi-faceted effort.

              Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

              by terjeanderson on Sun Jun 15, 2008 at 12:27:42 PM PDT

              [ Parent ]

        •  What?? Its about numbers, nothing else! (0+ / 0-)

          Geez, that makes now sense.  So your solution is to just wait in a clinic hand out medications without every doing anything to end new people getting in line for those medications.  This is bullshit, you accuse me about regurgitating right wing talking points???  The correlation of lower transition rates as with detectable viral rate is suspect at best and cannot be advocated as a legitimate strategy for prevention.  Coburn and his right wing fanatics are using psudo science as a justification not to fund family planning and your falling for it.

          If you tremble with indignation at every injustice then you are a comrade of mine. - Ernesto Che Guevara

          by HGM MA on Sun Jun 15, 2008 at 11:58:23 AM PDT

          [ Parent ]

    •  Utterly fatuous. (0+ / 0-)

      When Congress mandates that 55% of funding go to AIDS "victims" for treatment, this funnels that money to BigPharma, while wasting a precious opportunity to prevent more transmission.
      Because here's the thing: Africa's virulent promiscuous macho culture guarantees the repeated indirect exposure of millions of innocent women to all of their husbands' extracurricular sexual partners. When condom use because the norm, transmission of the disease falls. When it's replaced by treatment after the fact, millions more will become HIV positive.

      Uganda is the relevant case here. They went from a health care basket case due to rampant AIDS to a highly effective AIDS prevention program based on widespread availability of condoms, facilitated by a highly successful public relations campaign that made condom use "cool". Of course once religious fundamentalists got wind of this they blew a gasket, and worked assiduously to destroy the program. Fundie allies in Uganda's government went so far as to maliciously "quaranteen" condoms in warehouses indefinitely until they could be "tested to guarantee effectiveness". Condom availability in Uganda nosedived, public reluctance to use them skyrocketed, and AIDS rates began to climb rapidly once again.

      Another victory for the forces of pig-headed righteousness.

    •  Condoms are probably the most effective way to (0+ / 0-)

      prevent aids.  It is better to prevent aids than to let someone catch it, pass it on to others, and then treat that person and whomever else he/she may have infected.

  •  sadly, i'll bet things change if one of those (0+ / 0-)

    socially conservative lawmakers turns up HIV-positive.

    "The most common form of terrorism in the U.S.A. is that carried on by bulldozers and chain saws." Edward Abbey

    by timbuck on Sun Jun 15, 2008 at 10:11:33 AM PDT

  •  Sex Control. nt (1+ / 0-)
    Recommended by:
    timbuck

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Jun 15, 2008 at 10:12:32 AM PDT

  •  Stuck in the 1980s (1+ / 0-)
    Recommended by:
    timbuck

    Republicans love AIDS because it kills only gays, Blacks, druggies and Haitians.

    If you're a Republican, the 1980s were your Eden, and that was all true, because you were an idiot.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Sun Jun 15, 2008 at 10:12:36 AM PDT

    •  Republican Congressman Stewart MacKinney (0+ / 0-)

      died of AIDS.

      So did Terry Dolan, an infamous right wing director of the National Conservative Political Action Committee.

      Roy Cohn of Joe McCarthy fame.

      Paul Gann of Proposition 13 fame.

      David Brudnoy - conservative Boston talk show host.

      Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

      by terjeanderson on Sun Jun 15, 2008 at 12:34:19 PM PDT

      [ Parent ]

  •  McCain is a tool (2+ / 0-)
    Recommended by:
    timbuck, earicicle

    Another sad example of McCain showing that he is unfit to lead!

    -----

    My Blog:

    The American Portrait

    http://americanportrait.blogspot.com/

    by RMac1721 on Sun Jun 15, 2008 at 10:14:22 AM PDT

  •  YouTube (0+ / 0-)

    And nowadays, to draw an ever broader contrast between real people and folks like Coburn, people are learning how to have safe sex on the internet.
    Folks like Coburn are in politics because the political system's failures. There's the rubber, there's the road, and there's folks like Frist and Coburn who are in outer space. Even after the Schiavo debacle these assholes still think they have open access to our bedrooms.

    Big stinky war mongering domestic spy machines suck!

    by plok on Sun Jun 15, 2008 at 10:15:31 AM PDT

  •  David Vitter (6+ / 0-)

    taking a stance on ANYTHING because of "morals" is so beyond ridiculous it's hard to know where to start.  These people have no shame whatsoever, none.

    No brains.
    No hearts.
    No shame.

    Jeepers.

    Thank you for this superb diary.  

    1-20-09 The Darkness Ends "Where cruelty exists, law does not." ~ Alberto Mora

    by noweasels on Sun Jun 15, 2008 at 10:17:57 AM PDT

  •  For many Republicans... (0+ / 0-)

    Governing the country has become a contest, not a goal.

    If the left/progressives/Democrats have an idea that might be good then it automatically must be opposed.

    Letting the other side implement a good idea would run up the score for the opposition.

    Winning is everything.

    Unusual travel suggestions are dancing lessons from God. - Kurt Vonnegut

    by BobTrips on Sun Jun 15, 2008 at 10:27:23 AM PDT

  •  When I was recently in Africa, I saw street (2+ / 0-)
    Recommended by:
    DemFromCT, distraught

    advertising for HIV?AIDS prevention with an ABC format:

    Abstinence
    Be faithful
    Condom use

    This ia a three legged stool -- without one of the legs, it will fall down.

    John McCain - Practicing the old style of politics for the past 72 years!

    by Its the Supreme Court Stupid on Sun Jun 15, 2008 at 10:35:31 AM PDT

    •  disagree a bit (1+ / 0-)
      Recommended by:
      terjeanderson

      please see this diary for a window into why i think the ABC model is full of shit. Prevention should maybe focus on the Be faithful part b/c of how concurrent sexual networks facilitate transmission throughout the population, considering the biology of HIV infection and transmission http://www.dailykos.com/...

      and there's also a need to begin scaling-up circumcision, but both of these important prevention initiatives have to be encouraged/done in culturally appropriate and non-imperialistic ways.

    •  Yes, but... (0+ / 0-)

      The way the US government has implemented  it hasn't been just about promoting abstinence and delay of sexual initiation -- it has been "abstinence only" -- lying to people (especially young people) by telling them that sexual abstinence is the only way to protect themselves, denying them lifesaving information about condoms and other prevention measures.

      Early in the Bush administration, I met with a senior AIDS policy maker who told me that when the administration talked about "ABC" they meant "Capital A, capital B, small c." That about sums it up

      Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

      by terjeanderson on Sun Jun 15, 2008 at 12:38:39 PM PDT

      [ Parent ]

  •  we need phone calls to Reid urgently (0+ / 0-)

    if this issue could be front paged in the beginning of this week, with a call to action for Kossacks to call Senator Reid's office, I think that would be tremendously helpful.  He needs to grow a backbone... we have well over 60 votes.

    i've been diaring about this issue for a few weeks and i did one yesterday on the topic as well. Thank you very much DemFrontCT for this story.

    i think it's important that we do not harshly criticize McCain here, unless he fails to "do what [he] can to unstick that bill," as he promised that he would to some 'bird-doggers' with the ONE Campaign, at a town hall on Thursday. I think it's totally appropriate that he even be applauded, if he can get us over this impasse. Of course, it may be more important to McCain that he be applauded by the faith based groups mentioned in the Politico article and by the ONE Campaign (rather than by us liberals).

    Here's the ONE Campaign person questioning McCain...

  •  Does the bill include needle exchange? (0+ / 0-)

    McCain: The best they could come up with.

    Masel4Senate 2012

    by ben masel on Sun Jun 15, 2008 at 10:37:34 AM PDT

    •  nope (0+ / 0-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 10:47:53 AM PDT

      [ Parent ]

    •  federal $$ of syringe exchange is not allowed (1+ / 0-)
      Recommended by:
      DemFromCT

      and IMO this is much more of a domestic issue b/c the PEPFAR focus countries have generalized epidemics, where injection drug use is a largely insignificant cause of transmission.

      •  Except Vietnam (1+ / 0-)
        Recommended by:
        distraught

        where the epidemic is largely IDU driven

        no US $ for needle exchange there, but a major breakthrough when they allowed treatment money to be used for substitution therapy (methadone, etc). Also, the Vietnamese government is going ahead with needle exchange with non-US $.

        There is some indication of small but growing IDU pockets in part of Tanzania, Kenya, Nigeria, and South Africa -- but the public health response has been very slow.

        Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

        by terjeanderson on Sun Jun 15, 2008 at 12:41:27 PM PDT

        [ Parent ]

  •  If the consequences weren’t so horrific (0+ / 0-)

    I would almost be laughing that one of the few positives of the Bush legacy is being undermined by the most reactionary of his own party.  Tom Coburn is no Christian.

    If you tremble with indignation at every injustice then you are a comrade of mine. - Ernesto Che Guevara

    by HGM MA on Sun Jun 15, 2008 at 10:43:59 AM PDT

  •  So Coburn wants to filibuster? (2+ / 0-)
    Recommended by:
    paulko, distraught

    What a hold means, per the Senate glossary:

    An informal practice by which a Senator informs his or her floor leader that he or she does not wish a particular bill or other measure to reach the floor for consideration. The Majority Leader need not follow the Senator's wishes, but is on notice that the opposing Senator may filibuster any motion to proceed to consider the measure.

    Come on, Harry ... call these guys' bluff.  If they want to filibuster this and make themselves look like fools on national TV, let them.

    The Repubs distort, but we will not abide.

    by Christian Dem in NC on Sun Jun 15, 2008 at 10:48:59 AM PDT

  •  McCain is not the same as George Bush (1+ / 0-)
    Recommended by:
    HGM MA

    All evidence so far shows that he'll be much worse.

    Look at these people! They suck each other! They eat each other's saliva and dirt! -- Tsonga people of southern Africa on Europeans kissing.

    by upstate NY on Sun Jun 15, 2008 at 10:54:55 AM PDT

  •  The Question Posed: Why is GOP Blocking...? (0+ / 0-)

    AIDS prevention?  Simple.  Because they think that most people who catch the disease are Democrats, and who cares about using public money to save the lives of Democrats?

  •  Still confused (1+ / 0-)
    Recommended by:
    Tuscany

    This was diaried earlier, and I'm still confused. According to Politico:

    The legislation scraps the previous requirement that 55 percent of the HIV/AIDS appropriation be spent on treatment and drugs and that about 30 percent of prevention funds be allocated to abstinence education.

    And Coburn wants to add in a requirement that most of the funds be spent on treatment. I don't see how this can be interpreted any way other than he's holding out for a requirement that less be spent on abstinence education.

    So how is it that very socially conservative Coburn wants less spent on abstinence education? And what is all this talk of prevention, which doesn't even seem to be part of the equation?

    •  huh (1+ / 0-)
      Recommended by:
      terjeanderson

      i'm a bit confused about your confusion :-)

      but i'm willing (and hopefull able) to clarify...

      this bill contains new language that basically means that 50% of prevention money should be allocated to abstinence and faithfulness programming in generalized epidemics, BUT countries do not have to meet this requirement if they don't want to and if the Office of the (US) Global AIDS Coordinator agrees and then submits an explanation to Congress for each country where the 50% requirement is not met... this is a bit more flexible than PEPFAR I (which required 33% spending without allowing for discretion).

      so it's possible that Coburn and company want to preserve the 55% treatment requirement b/c they think that money will be spent on other prevention programming.  (for example, the implementation of circumcision programs might be costly but the initial studies have shown it to be some 50% effective in preventing HIV infection in men)

      i think that Coburn may also realize that amongst public health circles there seems to be much more re-analysis of Uganda's supposed ABC model...meaning that it is now accepted partner reduction (i.e. concurrent sexual networks) were lessened in Uganda and that this was a much larger part of the success than abstinence... basically, without an extreme focus on A, i think some religious conservatives will think that we are going against God's will or whatever... here's a diary i did that provides a window into Uganda and the reduction in "concurrent" sexual partnerships: http://www.dailykos.com/...

    •  Coburn wants the original requirement (0+ / 0-)

      he says it's because he wants 'treatment' to be fixed at 55% but what he really wants is to deny the use of condoms. That's not always relevant overseas, but the flexibility to work on prevention as well as treatment, with a variety of prevention strategies, annoys Coburn.

      He also doesn't like the amount of money spent, and that the flexibility allows local agencies to decide what they need for themselves. And he doesn't like supporting the UN.

      Most regrettable is that if Coburn wants to truly debate the issue, he needs to loosen his hold. His hold prevents debate. So by putting a hold, he gets to sabatoge the program without telling the world exactly why.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 11:30:15 AM PDT

      [ Parent ]

      •  I think that's where I'm confused (0+ / 0-)

        what he really wants is to deny the use of condoms

        Condoms are neither treatment nor abstinence education. Yet the argument seems to be about how much to allocate to treatment vs. abstinence education.  I am not clear on how requiring the bill to direct most funding to treatment denies condoms, at least not in comparison to current funding. I could see where maybe he is trying to close the door to allocating more money to condoms, but not less, compared to the status quo.

        Also, why would Coburn be more determined to prevent the use of condoms than to support abstinence education? He isn't Catholic, is he?

        Finally, is there any evidence he wants to deny condoms? Or is that just a conclusion?

        •  my conclusion is that Coburn doesn't want the (0+ / 0-)

          bill to pass at all. You can cite what he said or you can watch what he is doing.

          my title asks why, because it's not crystal clear why.

          here is what we know: among the reasons Coburn cites as to why this bill should not pass are:

          - too much money in the bill.

          - support for doing away with fixed moneys percentages (which used to require abstinence and did not fund condoms). Coburn says it's because fixed money for treatment is good. The Institute of Medicine and everyone else says it is not, that locals should have more flexibility, and that means if they choose lessening abstinence in favor of condoms or vice versa.

          – too much support for 'infrastructure' (i.e., training health care workers), but without HCW to diagnose and treat, the program is not sustainable.

          I think Coburn has multiple reasons for opposing the bill (including his worry about how the locals will spend the money, but the main stated objection is the removal of "55% for treatment" part of the bill.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 12:16:13 PM PDT

          [ Parent ]

        •  btw (0+ / 0-)

          ask yourself why abstinence was part of the fixed funding in the first palce

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Jun 15, 2008 at 12:16:44 PM PDT

          [ Parent ]

          •  Because a whole bunch of DC politicians... (1+ / 0-)
            Recommended by:
            terjeanderson

            ...are completely out of touch with reality?

            No, not really. They are probably very much in touch with the realities of getting re-elected, and ignoring the realities of HIV and human sexuality.

            •  well, there's this (0+ / 0-)

              The seven conservative Republicans are critical of the program's higher spending level and prevention programs that include condom promotion.

              http://seattlepi.nwsource.com/...

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Jun 15, 2008 at 07:41:13 PM PDT

              [ Parent ]

              •  I hear you (0+ / 0-)

                But I'm a scientist, so I stick pretty close to the facts. And the fact that a group of Republicans criticize something that includes condom promotion doesn't lead me to the automatic conclusion that this one aspect of the program is why one of the Republicans opposes it. It's a legitimate theory, but, IMO, one not proven by the facts in evidence.

                I am also somewhat of a Coburn fan. [gasp!] I read his book, Breach of Trust: How Washington Turns Outsider Into Insiders after the 2004 election, and it was such a breath of fresh air after being saturated with partisan emotionalism for over a year.  I posted here in 2006 that I thought his description of what happened (or didn't happen) with the Republican Congress elected to fulfill the Contract With America is what would happen (or not happen) with the Democratic Congress that everyone was trying to elect to stop the war. Bingo.

                Coburn and I are diametric opposites when it comes to many social issues, but I don't care about that. I care about what politicians do, not what they "stand for." I support his efforts to promote fiscal responsibility and eliminate earmarks. I also have the courage of my convictions, so I don't back off of that just because he's going after a program that I like. (For a number of years, I worked for an organization that is a likely recipient of this very funding.) All doors swing both ways or not at all.

                Since I am not in a position to vote (or not vote) for Coburn, I have felt no obligation to follow him closely. I am just interested because I read his book, and because his general counsel was kind enough to talk with me at some length when I made an issue-related visit to the Senate awhile back, even though I am not one of Coburn's constituents. I am curious mostly about how much he seems inclined to use his office to push his social agenda, versus his main issue, which is fiscal responsibility. I don't like anyone using an elected office to push their social values onto the rest of us, even if I share those values.

                So far, it seems that he can be counted on to fall in line on conservative social issues, but that they are not his driving motivation. On this particular issue...I'm doubtful that many socially conservative Republicans care how much illicit sex people in developing countries have. It's our morals they are concerned with, not those of the unwashed masses.

                •  the 7 have varying motivations (0+ / 0-)

                  but the major issue is blocking the bill (hard fact), and the intriguing issue is why (soft). You can't always present facts about people's opinions, and when it comes to complex entities like humans, there's room for competing motivations. Also, smart politicians don't leave a quote trail.

                  The amount of money, the concept of foreign aid, the idea of unfettered prevention with condoms (compared to the previous iteration of fixed apportion of abstinence required) are all there in the mix. Put it together how you like.

                  That last cite sees it as I do, which I discovered only after writing the piece.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Mon Jun 16, 2008 at 09:37:41 AM PDT

                  [ Parent ]

                •  more... (0+ / 0-)

                  please read these comments

                  http://www.dailykos.com/...

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Mon Jun 16, 2008 at 01:53:50 PM PDT

                  [ Parent ]

      •  Of course he does. He's a wingnut. (0+ / 0-)
  •  I can dream but I would hope that (0+ / 0-)

    Brad Henry, Drew Edmonson, or Dan Boren run to remove Coburn from office in 2010. OK has to have the worst pair of Senators.

  •  Does the bill eliminate abstinence education? (0+ / 0-)

    I have no problem with distributing condoms to people who are going to have sex -- including to infected people who would like to have sex safely with their spouses.

    But...

    No condom in the world is as safe as not having sex with infected people.

    Anybody who's willing to follow that path -- is a win.

    It's even a win if they lapse here and there.
    Sure, the lapses expose them to danger, but infectious diseases are a numbers game.  More exposures mean greater risk. Fewer exposures mean lesser risk.

    At any rate -- this is a very good thing we've been doing.  Surely we can find a way to keep doing it.  People are dying who could be saved.
    Children are being orphaned and starved because people who are dying but could be saved are not around to be parents and to grow food.

    Compromise, somebody!!!  
    Save these lives.

    Free speech? Yeah, I've heard of that. Have you?

    by dinotrac on Sun Jun 15, 2008 at 11:11:37 AM PDT

  •  Oklahoma has to have the (0+ / 0-)

    worst two Senators.

  •  They understand everything just fine (0+ / 0-)

    They are primitive fundamentalist savages who think AIDS is God's punishment for sex and who don't want us to interfere with the Divine butchery--that's all.

  •  the one good thing (1+ / 0-)
    Recommended by:
    DemFromCT

    that Bush has done was establish PEPFAR.

    Through the agency I am affiliated with, there are over 100,000 men, women, and children alive today because of that program. I have met many of them - they are happy, healthy and grateful they got a second chance.  It will be certain death for them if they lose their supply of ARVs.

    Coburn is a fool. It's time to delete these nut jobs  from the political process.

    If we cannot elect this man, we don't deserve him.

    by lisastar on Sun Jun 15, 2008 at 11:23:47 AM PDT

  •  Coburn is known for controversial (0+ / 0-)

    medical positions. He also has a very controversial position on the revival of DDT (despite documented evidence that mosquitoes develop immunity to DDT over time).

    Last year Coburn went so far as to block recognition of Rachel Carson during the centennial celebration of her birth.

    From the Oklahoma Indpendent Media Center:

    May 31, 2007 - A Republican Senator who successfully prevented the US Senate from honoring the centennial of the birth of environmentalist and Silent Spring author Rachel Carson received campaign donations from a member of the board of directors of a group that sponsors pro-DDT advocacy, RAW STORY has found. William Dunn, President of Dunn Capital Management in Stuart, Florida, gave $4,000 to the campaign of Senator Tom Coburn in 2004, according to Federal Election Commission records. Dunn sits on the board of the Competitive Enterprise Institute, a group that promotes the use of DDT to fight malaria, and has sponsored a website called "Rachel Was Wrong," which condemns the environmental scientist and activist for her famous book.

    Refuge Watch -- news from America's national wildlife refuges

    by Naturegal on Sun Jun 15, 2008 at 11:28:42 AM PDT

  •  I'm confused (0+ / 0-)

    Ok, if it is so easy for the Republicans, as a minority party, to stop legislation dead in it's tracks, then why in the hell didn't the Democrats do the same thing when they were in the minority.

    This is all the more reason why we not only need a veto proof/filibuster proof majority in Congress, we also need to do something about these out of date, arcane rules that can result in the minority stopping the majority from acting.

  •  Bill Clinton and John Kerry are the ones who... (0+ / 0-)

    ... championed the aid and are the ones who deserve the true credit. Bush should be credited for not vetoing it.

    •  Not exactly the case (1+ / 0-)
      Recommended by:
      DemFromCT

      I despise George Bush as much as other Kossacks, but in this case he actually deserves some credit.

      George Bush did propose PEPFAR -- he announced it shortly before the invasion of Iraq, partly as a way to improve the world's view of the US as we were about to violate international law. He also did it because his evangelical friends (Franklin Graham, etc) who has missions in Africa saw the huge scale of the problem and convinced him to do something (in the meantime slicing a big pie of federal money for their work in Africa).

      In DC at the time, we were all shocked and pleasantly surprised by Bush's initiative -- it was much bigger and more ambitious than anything every proposed by the Clinton administration -- it upped the game from talking about millions to talking about billions.

      There is a lot of PEPFAR that the Congress and administration have gotten wrong in details of prevention, prostitution, needles, generic drugs, etc -- but despite all of that, it will stand in history as the one good thing that Bush did while in office.

      (And if any member of Congress deserves credit, it is Barbara Lee -- she was introducing ambitious programs to scale up our global AIDS response when no one thought it was possible).

      Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

      by terjeanderson on Sun Jun 15, 2008 at 12:52:59 PM PDT

      [ Parent ]

  •  This isn't just a Republican problem!!! (0+ / 0-)

    There are social conservatives on both sides of the isle who want to force their warped visions down our throats. Bad religion does not make good politics!!!

    Let the bill die and use it as a campaign talking point !!!

  •  Abstinence is a sham. (1+ / 0-)
    Recommended by:
    BlackGriffen

    As is the morality of the right.

    We're not dealing with a religious issue here.  We're dealing with fascists who essentially want anyone not squirming under their ideological thumb to piss off and die.

    Nonsensical, unnecessary death from AIDS is just another price of resistance.  Like unnecessary death from lack of healthcare in general, or from starvation, or from a 500 pound bomb.

    Basically, they like it when people who are different from them die.  It's more a hygiene issue than anything approaching a religious stance.

    Dude, where do I go to vote against the neocons?

  •  Why the Fuck is This Hold Honored? (0+ / 0-)

    That damned Reid didn't seem to give a flying fuck when Senator Dodd put a hold on the FISA bullshit, and did his level best to steamroll a man from his own party in some big fucking hurry to do the wrong thing. When a couple of wingnuts place a hold that could cost people their lives, however, it's stop the fucking presses.

    Reid, Rockefeller, Schumer, Hoyer, Feinstein, and of course Lieberman are all fucking tools who can't get their god damned filthy hands out of the people's business soon enough.

    •  from a practical POV (1+ / 0-)
      Recommended by:
      pistolpeteMA

      (and Kagro's the process guy to check with), any of the 7 GOP senators can object to unanimous consent to proceed with Senate business, tying up everything.

      That's why courtesy is so important.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 06:54:24 PM PDT

      [ Parent ]

  •  Isn't it more than condoms? (1+ / 0-)
    Recommended by:
    BlackGriffen

    Isn't the Aids relief tied to money for clinics that also advise women on pregnancy, abortion, etc.? Isn't this the bill that was  passed saying if clinics in third world countries even mentioned abortion that they would lose out on any money?
    I hate the praise the Administration (and some in Congress) get for Aids relief that ends up only causing more pregnancies and Aids in the long run because they can't tackle the problem without having one hand tied behind their backs.

    "In a time of universal deceit -- telling the truth is a revolutionary act."

    by MA Liberal on Sun Jun 15, 2008 at 01:14:07 PM PDT

    •  different bill (1+ / 0-)
      Recommended by:
      DemFromCT

      the abortion language (know as the "Mexico City" language) was implemented by George W Bush by executive order on his first day in office. It prevents most US family planning money from going to any organization that talks about abortion.

      Thankfully this language has not been added to the PEPFAR legislation (although grantees were required to sign a statement that they didn't support prostitution in order to get the money -- which is why it was exceptionally embarrassing when the head of USAID got found on the client list of the DC madam)

      But there is no question that the policy that restricts family planning funding deprives many in the developing world of access to services - from great organizations like Marie Stopes International - that could help prevent new infections.

      Once social change begins,it cannot be reversed. You cannot uneducate the person who has learned to read...You cannot oppress people who are not afraid anymore.

      by terjeanderson on Sun Jun 15, 2008 at 04:26:37 PM PDT

      [ Parent ]

  •  Wasn't Jim Bunning (0+ / 0-)

    an athlete?
    When he was in the locker room, did he practice abstinence with all those naked men running around? These repubs are so cheeky!

  •  $55 Billion is more than the ENTIRE NIH budget... (0+ / 0-)

    ...right?  Shouldn't we consider spending to prevent disease (and stimulate the economy) in our own country???

    •  it's not either/or (1+ / 0-)
      Recommended by:
      pistolpeteMA

      it's that and...

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Jun 15, 2008 at 09:21:17 PM PDT

      [ Parent ]

      •  Either or (0+ / 0-)

        The argument of either or is based on the assumption that there is a finite piece of pie that needs to be diveded up among these things.  This is fundamentally flawed when you look at how we are spending things right now.  A shift of the billions spent in Iraq could stimulate the economy, give more money to NIH and fund PEPFAR2.

  •  I wonder what Jesus would do... (0+ / 0-)

    I try not to speak for him, but I reckon he'd want all the prevention possible.

    What a disgrace Coburn is. Then again, he probably thinks HIV/AIDS is God's judgment for something, probably teh gays.

  •  Thanks for covering this (1+ / 0-)
    Recommended by:
    DemFromCT

    As one of the strong advocates for this legislation, I would like to thank you for this posting. The fact that these seven republicans are playing politics with peoples lives is maddening.  It pains me to say that PEPFAR1 is the best thing to come out of 8 years of George Bush. If the Senate refuses to act on this then we are going to have to rely on Bush to protect his legacy by getting this bill moving again.    

    •  if you have insight as to why the 55% provision (1+ / 0-)
      Recommended by:
      pistolpeteMA

      is so important, or other motivations for blocking it, please share.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Mon Jun 16, 2008 at 09:39:08 AM PDT

      [ Parent ]

      •  Why the 55% earmark is bad news bears (0+ / 0-)

        This is admittedly a complicated issue, so I am going to attempt to oversimplify things a bit first.  The larger situation here is that DC policy makers are making decisions in DC that should best be left to "in-country" coordinators.  With this earmark we would be "tying the hands" of implementers on the ground and telling them how best to fight the epdidemic in their country.  The reality is that the epidemic varies from country to country and some places may need a varying blend of treatment and prevention dollars.  The people on the ground fighting AIDS are the ones best suited to make these decisions, not policy makers in DC.  AIDS treatment, prevention and care programs work best when developed from the ground-up.
        In addition, thanks to negotions by the Clinton Foundation and International Patent law test cases in Brazil and Thailand, the cost of ARV treatment has gone down.  If the US would allow the same generics as the WHO and MSF approved list, US could save an additional 30% spent on treatment.  This trend is expected to continue and the cost of treatment will continue to go down.
        On a slightly tangential note, hard percentage earmarks were abondoned all togehter in this bill.  This helped us get around the har 1/3 abstinence only earmark, to a softer reporting requirement if less than 50% is spent on loosley defined "behavior change".  This will allow more money to spent on things like condom distribution and not failed abstinence only programs, country coordinators just need to report on why, ie abstinence only doesn't work.
        There is concern that if we give on the 55% treatment earmark, it leaves open possibility of inserting the VERY BAD and FAILED 1/3 abstinence prevention earmark.
        And very simply put, we cannot treat ourselves out of this epidemic, it will take blended approach of treatment and prevention.

  •  erroneous information on viral load (2+ / 0-)
    Recommended by:
    DemFromCT, pistolpeteMA

    Coburn argues that treatment of HIV/AIDS-affected individuals usually drops their viral load to the point where they will not infect other people

    WRONG!!!!!

    just because someone's viral load measure is "undetectable" it does NOT mean there is no HIV present.  it just means the lab test can't accurately quantitate BELOW a certain level.  you still have the virus that can be passed onto other people.

    if your viral load is undetectable at less than 75 copies per milliliter that means you have any number of virus copies from 1-74.  all it takes is ONE to infect someone.  this kind of misinformation is what continues to get people infected.  Coburn needs to get a clue!

    I'm a blue drop in a red bucket.

    by blue drop on Mon Jun 16, 2008 at 12:42:18 PM PDT

    •  You got that right... (1+ / 0-)
      Recommended by:
      pistolpeteMA

      I was just about to copy and past that section of the article and say the same exact thing when I saw your response. I work in an HIV clinic. My head nearly exploded when I read that part.
      The one thing we stress to EVERYone, no matter WHAT their VL load is..a low VL doesn't mean you cannot spread it. Geez..can they not get some HIV/AIDS specialists to weigh in on the FACTS??
       One other factoid..even is 2 people are both HIV +, they still need to use condoms. Why? because every virus has a different genetic make-up or "genotype". The genotype is tested to see what HIV meds are effective against someone's virus. the test also tells which meds the virus is resistive to. I realize that you probably already know all this, I'm just wanting to share it with others here who may not.

      Person A's genotype is most likely totally different than Person B's...one has to think on a cellular level. A's virus strands hook up with B's virus strands and a WHOLE NEW virus is made..potentially changing A and B's HIV genotype.

      Once the genotype is changed, their medicine regimine may or may NOT be effective anymore. You have a whole new beast and the person is back to square one..find a new HIV drug that will work against the virus. Of course, the person may not realize he/she has a newly resistant virus til it is too late and by that time, the VL has skyrocketed and their CD4 count has plummeted.

      I vaguely remember this stat from a conference I sat in on: 18% of all newly diagnosed persons have a genotype that are already resistant to all HIV meds. So while the general public may get all excited when they hear on the news that a new HIV med is on the market, they are not educated about the "resistance factor"..how many people will the new drug actually help?? How many will a new drug on the market mean nothing to because their genotype is resistant?

      The congress people  need to have a long sit down with AIDS/HIV specialists before they end up doing more harm to people than good.

  •  His way or no way. (1+ / 0-)
    Recommended by:
    Kiamichi

    Coburn is not interested in making anything to help people simple.  He caused a ruckus during the SCHIP votes for health care for our own children here.  Why would he be interested in all avenues to improve the lives of children in the rest of the world?

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