President's Budget Request for FY 2007

On Monday, February 6, 2006 the President's Fiscal Year 2007 Budget Request was released. The release of the President's budget marks the beginning of the FY2007 appropriations process. This is the process through which the Division of STD Prevention at Centers for Disease Control and Prevention (CDC) receives funds to support the 65 states, cities, and territories that provide STD programs.

Overall, CDC's FY 2007 President's Budget reflects a total proposed funding level of $8.2 billion, a decrease of $178.6 million below the FY 2006 Enacted level of $8.4 billion (a 2.1% decrease). The President's budget includes a slight but significant cut to the STD budget.

The DSTDP proposed funding level of $156,929,000 represents a decrease of $1,107,670 (.7%) from the $158,036,000 appropriated for 2006. Although DSTDP was spared the more draconian cuts (or elimination) that other programs suffered, the STD program is already significantly under funded. Continued erosion of vital public funds severely undermines the states' ability to provide needed services.

ASHA will continue to provide updates throughout the appropriations process. Please let us know if you need additional information. We hope you will join us as we advocate for increases to the STD program in the coming months.

FY 2007 President's Budget Request for HIV, STD, TB
($ in millions)

The CDC STD programs are included in the HIV, STD, TB line item in the federal budget.

Program	FY 2007 President's Budget Request	FY 2006 Final	Change from FY 2006 Final
CDC HIV/AIDS/STD and TB Prevention HIV STD TB	$1,032,969 739,579 156,929 137,423	946,577 651,118 158,036 136,461	+86,392 +88,461 -1,107 -962

President's budget on select related health programs:

• flat-funding, $283 million, for Title X family planning services.
• increase in the abstinence-only-until-marriage programs to $204 million (+$22).  The Budget also expresses support for increasing funding for abstinence-only programs to $270 million by 2009, and continuing providing $4.5 million for abstinence program evaluations each year.
• $188 million for States, Faith-based and Community organizations for a new initiative to combat the spread of HIV/AIDS, particularly within minority communities nationwide to “promote marriage and healthy family development”—$95 million will be provided through the Ryan White program for treatment and outreach, and $93 million will be through the Centers for Disease Control and Prevention for increased testing among high-risk populations.
• flat funding for the National Institutes of Health (NIH).

The budget and accompanying documents are located at: http://www.gpoaccess.gov/usbudget/fy07/browse.html.


Merck Vaccine Protects Against Key Strains of HPV

Merck's experimental HPV vaccine, Gardasil, prevented 100 percent of high-grade cervical pre-cancers and non-invasive cervical cancers resulting from HPV types 16 and 18, according to new data released on October 7. These types account for 70 percent of cervical cancers.  Gardasil is also designed to target types 6 and 11, which account for 90 percent of cases of genital warts.  The phase III trial involved more than 12,000 women aged 16 to 26 from 13 countries, including the U.S., who were followed for an average of two years after enrollment.  Merck expects to submit an application to the FDA before the end of 2005.  Cervical cancer results in approximately 290,000 deaths worldwide each year, including 3,700 in the U.S. GlaxoSmithKline (GSK) is also developing a cervical cancer vaccine called Cervarix, which it plans to submit for approval in Europe and elsewhere in 2006. GSK's vaccine Cervarix has shown to be 100% effective in preventing transmission of HPV strains 16 and 18 in earlier stage clinical trials. GSK said it plans to recommend its vaccine for girls as young as age 10, while Merck has said it plans to lobby states to require the vaccine for all 12-year-old children before they can enter school.

ASHA has been active in efforts to promote understanding, awareness, and acceptability of cervical cancer vaccines. Visit ASHA's HPV & Cervical Cancer Prevention Resource Center for more information on HPV and the vaccines in development.

HPV and Condoms

In letters to Health and Human Services Acting Principal Deputy Inspector General Dara Corrigan, Rep. Mark Souder (R-IN) and Former Representative Tom Coburn (current Chair of the Presidential Advisory Commission on HIV/AIDS) raised serious allegations about the implementation of laws related to HPV and condoms. The letters outline problems with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) implementation of provisions regarding preventing HPV infection that were passed in 2001.

The central issue is language drafted by Dr. Coburn that requires the FDA to reexamine condom labels to determine whether they are "medically accurate" regarding their effectiveness in preventing STDs, including HPV. CDC was required to conduct public education and surveillance. In his letter, Dr. Coburn charges that the CDC has subsequently issued "medically inaccurate" information about condom effectiveness and that "[t]he actions and lack of actions taken by the CDC and FDA to undermine this law are both illegal and threaten the health of millions of Americans." STD advocates have long been concerned that Dr. Coburn's stated desire to address the high prevalence of HPV was related to ongoing efforts to disparage condom effectiveness. He has accused the CDC, the medical community, and women?s health advocacy organizations of indifference to HPV because of continued support for condoms.

There is clear support for Mr. Coburn's goal of reducing the prevalence of HPV and consensus that the surest way to prevent HPV is through abstinence. However, public health advocates have been concerned that his narrow focus on condoms as an ineffective strategy to reduce HPV is misguided and could harm public health efforts to encourage condom use to prevent HIV and other STDs.

Studies have indicated that condom use is linked to lower incidence of diseases associated with HPV, such as genital warts and cervical cancer, but research regarding the value of condoms in actually preventing infection with the virus has typically given mixed, inconclusive results until very recently.

New data presented by Rachel Winer and colleagues at the meeting of the International Society for Sexually Transmitted Diseases Research (ISSTDR) in July 2005 suggests condom use may be an important tool in protecting against HPV infection.

123 female university students were followed for an average of 28 months, during which the participants kept diaries of their sexual behavior (including condom use) and were tested for HPV DNA every four months. The investigators found women reporting consistent, correct use of condoms (for every sex act) with their male partners were 70% less likely to have genital HPV detected during the study compared to those not using condoms.  

Genital HPV is the most common STD in America; an estimated 80% of sexually active individuals will contract it at some point in their lives.

Politics and Science

Politics and Science in the Bush Administration, a congressional report prepared for Representative Henry Waxman (D-CA) by the minority staff in the Special Investigations Division of the House Committee on Government Reform, raises serious concerns about the integrity of scientific research in the Administration. The report provides an account of administrative actions and policies covering more than 20 subject areas, including health and policy. In particular, the report cites scientific distortions across a broad range of policy issues, but states that most issues fall into two broad categories: those related to reproductive health and stem cells; and those related to the workplace and the environment.

For the STD community, the scientific issues related to reproductive health have been of concern. The report mentions the suppression of information and ?distortion of scientific evidence? on the effectiveness of condoms. Other sexual health related examples include: the push for an abstinence-only agenda by distorting what works in sex education programs; and the elimination of a CDC initiative "Programs That Work," a series of sexuality education programs that were found to be effective in scientific studies but did not include abstinence-only programs. The report alleges that the "Administration's interference with science has lead to misleading statements by the President, inaccurate responses to Congress, altered web sites, suppressed agency reports, erroneous international communications and the gagging of scientists."

To combat charges of partisan attacks, the report quotes leading scientists, scientific journals and agency officials serving in past Republican administrations expressing concern about the importance of maintaining the integrity of the scientific and policy making processes. The report can be downloaded from the web site of the House Committee on Government Reform at www.politicsandscience.org.