On the eve of AIDS Walk Wisconsin,
Scott Evertz talks about what it is like to be
President Bush’s point man on AIDS
Exclusive Interview By Mike Fitzpatrick of Wisconsin In Step
President George W. Bush’s nomination of Wisconsin’s Scott Evertz to head
the White House Office on National AIDS Policy last April generated a storm
of protest, mostly from the Religious right, who were appalled that a
Republican would nominate an openly gay man to such a visible position.
However, some contend that once the dust settled, Evertz became invisible as
well. Wisconsin IN Step recently had the opportunity to spend an hour with
Evertz and asked him about that lack of visibility, and a wide range of other
HIV-related issues from barebacking and Internet sex to needle exchange and
Wisconsin’s unique AIDS service delivery system.
Wisconsin IN Step: This interview will appear one week before AIDS Walk Wisconsin. Since there are actually two AIDS Walks this year — one in Milwaukee and one in Madison — I asked the executive directors of the AIDS Resource Center and AIDS Network to submit questions for this interview. Also in preparation for the interview I spoke with some front line workers and reviewed the most recent stories coming out of the HIV/AIDS field. So I think I have everyone’s agenda present and accounted for. My first question for you is how have the first four months been?
Scott Evertz: They’ve been good. The first couple of months were really
hectic. I had to get used to all the various groups and people who have an
interest in this issue. They sorta pounced on the office the second I got here.
I don’t mean that in a negative way. If they’d just waited a little while but as
soon as I got in the office they just all called like at once. It’s calmed down,
relatively speaking since then. I’m enjoying the position now a lot more than
I did at the beginning.
Is part of the reason that they pounced is because they have very strong concerns or worries that the Bush administration is not going to be supportive of the HIV/AIDS epidemic in this country or worldwide?
I think there was a certain skepticism. I don’t know if that is what accounted
for the “pouncing.” It was more likely that they wanted to be among the first
to have contact with the office because, as you know, persistence toward a
goal pays off and many of these are well trained Washington lobbyists. I do
acknowledge that the skepticism does exist.
So it’s more getting their network rebuilt because you’re the
new face on the block and they need to try to get in good with the new boy in town?
Yeah that’s it — but they’ve all been pretty respectful.
Well, not everyone. Look at the early response of the far right — and the far left for that matter. Was there any point during the first four months where you might have felt that you had a bullseye on your back or some other part of your body?
At the beginning, I suppose. You referred to some people on the Right. It’s
no secret that there were some people calling for my resignation — even
before I got here. But that has quieted down to actually silence. In fact some
of those who chastised the President for the appointment are sorta feeling
IN Step: Is part of the reason that they have been silent because you have been silent? In the current issue of POZ magazine, POZ writes “We attempted to ask the White House Office of National AIDS Policy director Scott Evertz himself about his views. But after many requests for an interview, the White
House press office refused saying ‘Evertz wouldn’t be doing any media for at least a couple of months.’ The Bushies are no doubt keeping him under wraps until they can drum the party line into his head.”
Yeah, I saw that. I don’t know when POZ was making contact with our press office but this interview is certainly proof I’m not being kept under wraps. In response to the latter comment about the party line being drummed into me: that’s not true. Any conversations on this issue are me embracing the officials in the White House and not the other way around. The implication is there that someone is telling me what to say and that is simply not true.
But I do get the impression that the White House office is going to operate differently than it did under the last “AIDS czar.” Is that a fair statement?
I don’t know. I’m not sure exactly how it operated under the previous AIDS
czar. I’ve spent a little bit of time with Sandy Thurman but I would be hard
pressed to answer that. I can tell you this: That we need to do a better job in
general — when I say we I’m talking about the entire administration — in
talking about what we’re doing. One of the abilities of the Clinton
administration was to get a lot of coverage on the work the administration
was doing. If there is, in fact, any sort of liberal bias in the press, that means
that we just have to work that much harder — rather than complaining about
a liberal bias in the press. But if we didn’t get (coverage) in the early months
of the administration, I do think we’re getting that now.
It does seem that that this administration seems much less media-driven. There seems to be a much more low-key approach to government which some people would suggest is a sense of people working, doing their job and answering questions when asked rather than a constant stroking of the media in a sense of “look at me, look at me, look at me.”
Right. I’ll give you an example. When we were in Atlanta for the CDC’s
HIV prevention conference, we spent an entire afternoon in Atlanta’s central
city visiting programs that are serving injection drug users as well as people
who are infected with HIV and AIDS. It is literally the worst neighborhood
in the entire state of Georgia from a drug and crime perspective. We really
didn’t develop a press strategy around it. We decided it was more important
to reach out to these groups to let them know that care about what they’re
doing, want to see what they’re doing and want to learn from what they’re
doing. We just neglected the press on this one. If folks from the Clinton
administration were to go on a similar mission, they would have thought to
drag the press in tow to show them what they were doing. However, we
accomplished a great deal — but no one knew that we did.
Newsday reporter Laurie Garrett noticed. She did quite a report in mid-August. One thing she reported was that conference attendees jumped on the fact that administration has doubled the funding for abstinence-only (prevention) programs. Do you want to respond to that — I think you got kind of “gotcha-ed,”
as they say with a statistical trick.
The trick is referencing “doubling” when in fact the spending on abstinence-only programs is very little to begin with. As you well know, it pales in comparison to the number of dollars committed to “more traditional” HIV prevention programs. We’re talking close to 700 million dollars specifically for prevention.
And how much of that is actually for abstinence-only programs? Was that doubling one million? Two million? Ten million?
It is higher than that — I don’t know the exact figure. It’s higher than one
million, two million. But like I said it pales in comparison to the other funding — and that funding isn’t being cut. So funding the abstinence-only programs is not going to have a detrimental effect on funding of safer sex programs, the “more traditional” HIV prevention efforts.
As someone who has been dealing with HIV disease as first a volunteer and
a long time worker, is that I have a less strict view of the abstinence-only
issue. I see that there may be certain situations where abstinence only might
be the thing to do in certain circumstances. However, I don’t think it should
be the only thing that should be presented. Do you feel similarly?
Yeah, I certainly think that it (abstinence-only prevention programs) would
be the ideal for certain populations — I’m think of teenagers for example. No
parent really wants their child to engage in sex before they’re ready. On the
other hand, as I mentioned earlier, we did other off site visits in Atlanta. The
folks that we met with are utterly convinced that an abstinence-only message
would not be effective, or would be entirely appropriate. We’re going to
continue to listen to people like that. I don’t mean to suggest that the central
city is different than the upper middle class predominantly white suburbs
when it comes to dealing with teen risk.
But the “condom message” is not necessarily an effective message either. There is recent evidence of the failure of the “traditional prevention message.” The Los Angeles Times reported in late August that the city health department has
reported 85 new cases of syphilis so far this year. All are gay men and 58% of them are people who are HIV+. Isn’t the traditional message being missed here? Not only are we seeing the failure of the safer sex messages but also we’re seeing HIV+ people actively and knowingly transmitting disease.
You know it’s no secret that for years we treated HIV differently than many
other communicable diseases. As you well know there is a school of thought
that says that I — if I were HIV+ — wouldn’t bear any responsibility for
informing my sexual partners. That is kinda crazy. If nothing else it flies in
the face of the Golden Rule — “do unto others.” Yet, in the interest of extreme political correctness, and an effort to deal with the various communities, we’ve gone to extremes in being careful how we talk about responsible sexual behavior around HIV/AIDS, particularly among those who are infected.
Another thing that’s happened is that we now have a whole new way to facilitate anonymous, casual sex through the use of the Internet. You know you can go to barebacking sites on the Internet right now and find people interested in having
unprotected sex and openly admit that they are HIV+ and don’t mind topping you. It appears to be an actual movement to go out and play unsafe. Do you think there is a reason for this?
I have no — uh, I don’t know why this.. I have heard some theorize that people are just tired of safe sex. But as you point out, there appears to be almost a pro-active promotion of something which is not in the interest of public health.
For the young people currently out there, this is a 20 year old epidemic. They’ve grown up not knowing of anything but AIDS. Is there an “AIDS familiarity” that we are going to have to break through?
Clearly, younger people have not experienced what you and I have experienced. I would have to say that young people in cities that weren’t significantly impacted - and even older people (in such cities) — don’t have a memory of what it was like. I have visions of the Castro in the ’80s — but I didn’t live there, so I wasn’t as affected as people who watched so many get so very sick before their eyes. Young people — no matter where they are — did not witness the devastation this disease has caused. They don’t have the
fear of having KS lesions all over themselves or even dying because they’ve
convinced themselves that a “cure” has been found with the new drugs.
Speaking of that “cure,” less than 10% of the entire world’s infected population have access to those drugs. In late August, Brazil said that it was going to create a compulsory license so that local manufacturers could produce Viracept and not have to pay the copyright fees to the American drug company that developed it. One of the reasons Brazil appears to have acted this way is because the Bush administration — or should I say the United States government ceased filing complaints with the World Trade Organization about Brazil’s plan. Is the Bush
administration signaling something to the drug manufacturers about the extremely high costs of these drugs?
I would suggest that signaling is maybe the wrong characterization here, but
the Bush administration is certainly looking for a compromise which would
protect intellectual property and compensations while recognizing that we
have a humanitarian responsibility to provide greater access to these drugs. I
think there’s a huge misconception that the Bush administration may be
approaching the trade issue, if you will, differently than was the Clinton
administration. In fact, the folks at USDR (United States Trade
Representatives) office think that the Clinton administration was more
strident (about copyright issues) than is the Bush administration. I don’t
think we’re signaling anything but I do think you’re seeing administration of
a philosophy that many are surprised at.
The reason I brought up the high price of drugs was recent stock market tips in conservative papers such as the Washington Times suggest that one of the “best bets” in the soft financial market is stock in the drug manufacturers, noting
that 5 billion dollars of the current 100 billion dollar drug market is devoted to patented HIV medications and that HIV meds, with that market share increasing 7% annually to 13 billion dollars by 2005. The kind of money being made here on
the back of a worldwide pandemic certainly gives some folks pause. Do you see an ethical problem here?
Yeah, although I could certainly take that argument to the extreme. I think of
people who are working in the AIDS service organization industry. Many of
them are earning good and very decent salaries that enable them to buy nice
homes and to travel. I don’t have a problem with that but one can certainly
make the argument that they would not have the opportunity to do such
things if it were not for the epidemic. The same way, perhaps that the
pharmaceutical companies will make profits as a result of the epidemic. There
are a lot of people in a lot of organizations and companies that are benefiting
— we all know that. Where do you say this is unethical? We could certainly
come up with examples if you force me to give you one.
Well, can you give me an example? Can I twist your arm just a little?
Well, there are major cities in states that may be facing problems with their
ADAP (AIDS drug reimbursement) programs — meaning a shortfall in funding. In the major cities of those states, some directors are earning twice the per capita income of others in those cities. I’m not saying that this is unethical, but it is certainly something that causes us pause.
Well part of the problem is that AIDS organizations have progressed from being grassroots organizations to being institutions. POZ magazine devoted a cover story earlier this year to “AIDS Incorporated.” As the article pointed out, more
money is being diverted from direct care to the maintenance of institutions.
Yes. Yes. And the abuses are probably — in fact I know — are the exception
to the rule. But your point about the ethics of the drug industry making money brings up a larger issue of anyone making money or living a comfortable lifestyle on the illness of others. I certainly wouldn’t quarrel with someone making money to feed their family while they work for an AIDS organization — there’s certainly nothing wrong with that. I certainly don’t want to see people earning poverty wages. But, as you point out, there are ethical issues surrounding profiting, if you will.
And some low income people in this country do not have access to those medications due to eligibility limits on ADAP programs and their inability to obtain affordable health insurance. Is buried deep in your last comment some move to revise the other “third rail” of American politics, the fee-for-service health care
(laughs) I’m not gonna touch that one! Get real!
Let’s move to a different set of questions. I asked Wisconsin’s two top people in the AIDS service field — Doug Nelson of the AIDS Resource Center of Wisconsin and Bob Power of AIDS Network — to share with me the questions they’d ask you if they had the opportunity to sit down with you. Are you
comfortable answering their questions?
I’ll read them exactly as written, commentary and all, and give credit where credit is due. Bob Power’s first question is as follows: AIDS Service Organizations have spent years developing their overall HIV/AIDS expertise. AIDS Network has proven year after year for the past 16 years that we produce quality work and have played a shared role in keeping the HIV infection rate relatively low. We do not look forward to losing prevention/case management dollars to new agencies simply because they’re faith-based. If the Bush Administration is determined to bring “faith-based” agencies into the fold of HIV and AIDS, are they prepared to spend more money to keep the experts funded as well?”
The answer to is question is “no.” I don’t see diverting funds from AIDS Network or any organization to faith-based organizations. It’s not going to be a robbing of Peter to pay Paul. He’s right his agency has been doing a good job — there’s no reason to change that.
Doug Nelson’s first question deals with the recent increase in HIV infections in gay men. “The HIV infection rate in America is on the rise again among gay men, especially young gay men. With the increasing attention that is being given to the
devastation of AIDS in developing countries, what public policy strategies will you pursue to intensify the domestic response to AIDS in this country?”
Well the infection rate isn’t increasing, it’s leveled off at about 40,000. What
I think Doug is referring to is the populations that represent that 40,000 — are new populations. Because where the epidemic is presenting itself is creating challenges to reaching these new populations. In many cases in these
populations there’s greater stigma about HIV itself and the ways one can
contract HIV. From our policy standpoint, it’s our challenge to develop new
strategies and to make sure we follow the epidemic, if you will. To make sure we know where it’s going and to spend our money wisely, recognizing that it is an ever changing process.
In terms of where the epidemic is moving, it certainly seems to be moving internationally into new territory. The United States has come under some criticism from other countries that we are not doing enough for the worldwide effort. How would you respond to that criticism?
Number one, we’re doing more than any other country on the face of the
earth. Is it enough? Maybe not, but I do find it interesting that others are
criticizing the world’s largest donor to the global AIDS effort. In the
President’s announcement that we are going to contribute 200 million to 300
million to the global pot he clearly indicated that this would be just a down
payment of sorts. As we build the mechanisms to make sure that these funds
are actually getting to effective programs on the ground, as they say, we will
continue to contribute greater sums. We’re gonna continue to step up to the
plate. I would add, as a caveat to Doug’s question, we’re not going to go rob
Peter to pay Paul. There’s not going to be some sort of fighting between our
domestic and our international agendas.
Speaking of balance, Doug Nelson asked a question about Ryan White funding. “The Ryan White Care Act is the federal government’s most important investment in HIV care and treatment yet it distributes funds inequitably by giving twice as
much funds per AIDS case to large states like California or New York than Wisconsin and other midwestern states. Do you support the concept that a person with AIDS in Wisconsin deserves a comparable amount of federal support as a person with AIDS in California, and what policy changes will you pursue to achieve a more equitable Care Act?”
Yes. I support a policy which evenly distributes federal money to people in
California and people in Wisconsin. I will be working closely with organizations like AIDS Action which represent a cross section of organizations in some of the larger cities and states and organizations in smaller states like Wisconsin. And it will take the work of advocates like Doug and Mike Gifford (of ARCW) to make this happen. I’m sure you’re aware that the argument goes that some of the states which were first affected built the infrastructure at a time when the epidemic was out of control and we’ve continued to support that infrastructure.
It is also true that some of those states are still dealing with greater numbers and are limiting services. I have a number of clients who have relocated to Wisconsin and were amazed that they could obtain services simply because they were HIV+. In many places you need to have an AIDS diagnosis, or meet income eligibility limits to obtain even basic case management services. Wisconsin is one of the few states left with universal acceptance policies.
One of our goals will be to challenge states, not only because its a solid
Republican argument, to be responsive in ways like Wisconsin is because in
some cases the AIDS diagnosis rate may be due in part to a lack of response.
If we can use this office as a bully pulpit to present that challenge, we’ll do
You’ve had a chance to look at the “lay of the land” across the entire land. Most people in Wisconsin don’t realize that Wisconsin’s system of AIDS service delivery is quite different than most other states. Wisconsin has very coordinated case management and service delivery provided by two major providers. That’s simply not the case in almost every other state.
Yes, and that certainly brings an efficiency which obviously is going to result
in a benefit to clients. You’re simply not spreading administrative dollars among many service providers. That brings efficiency which has generated many many progressive ideas in Wisconsin. One such idea is working to get people with an HIV diagnosis on medical assistance rather than waiting until they have an AIDS diagnosis. At this point the evidence is anecdotal — we can’t that it is a budget control, but it is certainly an idea that makes a lot of sense because it was talked about before Gov. Thompson left Wisconsin to become Secretary of Health and Human Services. I know he remains interested in looking at it.
Are there things in the Wisconsin model of AIDS service delivery that you’d like to see adopted nationwide?
Not necessarily anything thing policy-wide, but from a philosophical
perspective, people in Wisconsin tend to have a desire to get along — and
that’s a great value in Wisconsin. For the most part, people who are providing care in Wisconsin have realized that by getting along, people are better served. I certainly don’t see that kind of cooperation in other parts, other places around the country. I actually see fighting.
You see turf wars between different brands of “AIDS Incorporated”?
Oh, you bet!
Another of Bob Power’s questions: “Wisconsin is fortunate to have supportive government officials who have listened to the experts on the philosophies and realities of clean needle exchange programs. It is our understanding you are supportive of syringe exchange. What efforts can/will you make to, at the
very least, discontinue the ban on federal funding for these programs?”
I have indicated in a number of different go-rounds is that I view it as my job
to present substantive and conclusive data that I can gather on this issue to
those who need to make a decision to eliminate a ban — or to keep it in
place. I know there was work done in my predecessor’s office in the previous administration. As we all know, nothing happened. I would answer Bob by saying that my job is to present to those making the decision the data, and day that this office is charged with keeping people, among other things, from contracting HIV. This (needle exchange) is saving lives and the evidence is conclusive. You know, quite frankly, often times, when I was speaking about needle exchange I was speaking without having seen any of the data or seeing any of the reports, just hearing anecdotal stories and how it doesn’t increase drug use. I’m in the process of gathering the information that I need to substantiate (my support) through clinical studies.
Power’s last question serves as a good sum-up question and it doesn’t surprise me that once again he’s referring back to the former occupant of the White House. “President Clinton challenged the research community to develop an HIV vaccine in 10 years. Why haven’t we heard Dubya make any similar challenges or any basic statement on the state of AIDS in the U.S. today?”
The President has spoken on the state of AIDS, both in the United States and
internationally. He has talked about the fact that we will continue to challenge
those that are in the job of vaccine research to do so as quickly as possible.
There is no demonstrable change between the aggressiveness with which the
Clinton administration addressed the HIV/AIDS issue and we do.
So you are in effect saying that we will see the continuation of policies started by a philosophically different political opponent continue in the Bush administration?
Yeah, and I would have to add that a great number of the national HIV/AIDS
policies are also the result of a Republican Congress. It wasn’t just the Clinton administration which was at the forefront. Ryan White was historically underfunded in President Clinton’s budget. It was the Republican Congress that came to the rescue, if you will, and increased the levels of funding to those which the AIDS service community deemed acceptable.
I remember hearing those regular outcries about the funding and you have to admit that some of those numbers went up through the efforts of individual Congressmen on both sides of the aisle.
Oh sure. And you know what I find fascinating is hearing some of the personal stories of people in Congress who have friends and family members living with HIV or who have passed away. Their commitment is personal as well as one of policy. You’d be surprised — you really would. I certainly am not in a position to provide you with a list of people.
Is there anything that you’d like to share with the readers of Wisconsin IN Step that we haven’t covered?
Number one, I appreciate the opportunity to do this interview. Number two, I want to stress again that there is no difference in response between the previous administration and this one. We are committed, if not more so, to the comprehensive approach to dealing with HIV and AIDS. I guess the third thing would be to stress again that I have no muzzle on. If people don’t see me as frequently as they did my predecessor, that means that we need to do a better job on the publicity side. But the fact is that no one is telling me what to say or where to go or what to do.