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An Unprecedented Problem: The Clinton Administration and HIV/AIDS in the United States

“AIDS is terrifying. It inflicts tragedy on too many families. But ultimately, it is a disease; one we can defeat just as we have defeated polio, many forms of cancer and other scourges in the history of our nation.”
President Clinton, June 25, 1993

The first official reports in the U.S. of what later became known as Acquired Immunodeficiency Syndrome (AIDS) came on June 5, 1981, in the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly Report, “Pneumocystis Pneumonia-Los Angeles,” describing an unusual and severe lung infection in five young, previously-healthy gay men in Los Angeles. Soon afterwards, health officials reported outbreaks of an aggressive cancer, Kaposi’s Sarcoma, among gay men in California and New York. Both Pneumocystis carinii pneumonia and Kaposi’s Sarcoma are rare, deadly diseases associated with severely weakened or suppressed immune systems.

By 1983, the number of reported cases of AIDS in the US was doubling every six months. President Ronald Reagan appointed the first President’s Commission on the HIV Epidemic four years later in June 1987. That October, the AIDS Memorial Quilt was displayed on the National Mall for the first time, its 1,920 panels listing the names of many who had died of AIDS.

While health experts strove to determine the best ways to treat the disease and curb its spread, the societal and governmental response to the crisis was often haphazard, slow, and characterized by prejudice. Latent homophobia, racism, and xenophobia worsened the social stigma towards those with HIV/AIDS, as the majority of the affected population were members of the LGBTQ+ community, immigrants, racial minorities, and users of intravenous drugs. This discrimination also negatively affected the lives of those who had acquired HIV via blood transfusion and infants who had acquired HIV before birth.

“...this whole disease is bringing out the best and the worst in America, isn't it? I mean, it's exposing some of our prejudice in ways that are self-defeating since every family and every child is now at risk. And yet it's also showing us the courage, the self-determination, the incredible capacity of the American people to give and to love.”
President Clinton, Remarks at World AIDS Day event, December 1, 1993

The Clinton Administration

During the 1992 presidential campaign, Bill Clinton promised to make the national AIDS strategy a priority in his administration, and promised to implement an integrated, multi-faceted approach to the prevention and treatment of HIV/AIDS. At that time, the need for a broad, coordinated federal response to the growing AIDS pandemic could not be understated. In 1992, HIV/AIDS became the number one cause of death among American men between 25 and 44 years of age. By 1994, it became the leading cause of death for all Americans between the ages of 25 and 44.

Haitian Refugees

In the first days of his administration, President Clinton was faced with a choice of what to do about HIV-positive Haitian refugees seeking entry into the United States. The military dictatorship in Haiti which followed the 1991 coup-d’etat led thousands of Haitians to seek asylum in the U.S. Most were turned away. While those eligible for asylum were usually brought into the U.S. for hearings, those who were HIV-positive were instead detained at Guantanamo Bay Naval Base, in Cuba. After a district court order in early June ruled that it was unlawful for these refugees to be detained indefinitely, the Clinton administration negotiated their parole into the United States. Shortly afterwards, on June 10, 1993, President Clinton signed the National Institutes of Health Revitalization Act of 1993, which, among its many statutes, gave the Office of AIDS Research oversight of all AIDS research conducted by the National Institutes of Health and increased the inclusion of women and minorities in healthcare research. It also codified that HIV/AIDS infection would render an immigrant or other foreign national ineligible to receive a visa or to enter the United States, a ban that remained in place until 2010.

White House Office of National Aids Policy

On June 25, 1993, President Clinton appointed Kristine Gebbie to serve as the nation’s first AIDS Policy Coordinator and lead the newly created White House Office of National AIDS Policy, a unit of the Domestic Policy Council, which worked with multiple federal agencies to provide AIDS policy guidance and coordinate the federal government’s efforts against HIV/AIDS. Gebbie had previously served as a member of the President’s Commission on the HIV Epidemic under President Reagan, and as president of the AIDS Task Force of the American Society of State and Territorial Health Officers. She served as AIDS Policy Coordinator, known informally as the “AIDS Czar,” until 1994.

Patricia “Patsy” Fleming served as the Director of the White House Office of National AIDS Policy from mid-1994 until early 1997. Starting in early 1995, Fleming chaired an interdepartmental task force on HIV/AIDS, tasked with developing a national strategic plan outlining the objectives of the entire federal government in combating HIV/AIDS. The task force’s final report, released in December 1996, summarized the current nature of the government's response and identified opportunities for additional government efforts, providing a comprehensive summary of goals and unmet needs linked with relevant budget figures. Jeffrey Levi served alongside Fleming as the Deputy Director of the White House Office of AIDS Policy from 1995 through 1996, and was also involved with the Interdepartmental Task Force on HIV/AIDS and other AIDS policy initiatives during that time.

Presidential Advisory Council on HIV/AIDS

Presidential Advisory Council on HIV/AIDS

On June 14, 1995, President Clinton signed Executive Order 12963 establishing his Presidential Advisory Council on HIV/AIDS (PACHA) dedicated to providing recommendations to the Secretary of Health and Human Services on policies, programs and research into effective HIV/AIDS treatments and prevention, and services to people living with the disease. By the end of October 1995, over 500,000 cases of AIDs had been reported in the U.S. since the pandemic had begun, and over 300,000 of those affected had died. Progress was being made in prevention, testing and treatment of HIV, but there was no clear path to ending the pandemic. The week following World AIDS Day on December 1st, 1995, the White House hosted a series of meetings in the first White House Conference on HIV/AIDS.

Controversies

The Presidential Advisory Council on HIV/AIDS issued a Progress Report in 1996 commending the President for increasing funding for disease research and support. This same report criticized the administration for implementing mandatory HIV-testing for military service members, and for failing to lift the Reagan-era ban on federal funding for needle-exchange programs. Amid the Clinton administration’s attention to the AIDS crisis, no topic was more hotly contested than needle-exchange programs, which sought to lower instances of HIV-infection via needle-sharing among intravenous drug-users by increasing the availability of sterile needles and syringes. These programs were a key part of HIV-prevention strategies in many countries, including France, the Netherlands, Great Britain, Australia, and Canada. While opponents claimed that such programs promoted illegal drug use, research from the CDC as well as a joint panel created by the National Academy of Sciences to study the effectiveness of needle-exchange programs had shown that these programs significantly impacted the spread of HIV but did not encourage increased drug use. Health and Human Services Secretary Donna E. Shalala acknowledged these findings in 1998, but ultimately the administration upheld the ban and left the funding of needle-exchange programs in the hands of state and local governments.

Turning Points

Aids Memorial Quilt

In 1996, the number of new AIDS cases in the U.S. declined for the first time since the pandemic began. AIDS was no longer the leading cause of death for all Americans between the ages of 22 and 44, but it remained the leading cause of death for African Americans in this age group. In the summer of 1996, the on-going research initiatives on HIV infections led the U.S. Food and Drug Administration to approve the first HIV home testing kits, a viral load test to measure the amount of HIV in a person’s blood, and the first non-nucleoside reverse transcriptase inhibitor drugs. That October, the 40,000 quilt panels of the AIDS Memorial Quilt covered the entire National Mall. President Clinton and his family viewed the quilt on October 11th, the first time a sitting president visited the quilt. This was the last time the quilt would be displayed in its entirety, as it would only continue to grow.

President Clinton appointed Sandra L. Thurman as the Director of the Office of National AIDS Policy (ONAP) at the White House on April 7, 1997. Before her appointment as Director of ONAP, Thurman was a member of the Presidential Advisory Council on HIV/AIDS and of the Georgia State AIDS Task Force, the Fulton County HIV Planning Council, and the Executive Committee of Cities Advocating Emergency AIDS Relief (CAEAR). She served in this capacity until 2001. While giving the commencement address at Morgan State University on May 18, 1997, President Clinton announced the prioritization of developing an AIDS vaccine within the next decade, wanting it to be the “first great triumph” of the 21st Century.

Racial Disparity

In 1998, though the overall number of new HIV/AIDS cases had declined two years in a row, the disease persisted as a severe and ongoing health care crisis among minority populations. AIDS remained the leading killer of African American men aged 25-44 and the second leading killer of African American women in the same age group. Though representing approximately 13% of the U.S. population, African Americans comprised more than 40 percent of all new HIV/AIDS cases in 1998, and African-American women made up 60 percent of all new female cases. Likewise, the Hispanic population represented over 20 percent of new HIV/AIDS cases and only 11 percent of the U.S. population. In October and December of 1998, President Clinton declared multiple new initiatives and funding increases to AIDS prevention, treatment, and support for affected communities. These initiatives were part of the Clinton administration’s larger Initiative to Eliminate Racial and Ethnic Disparities in Health.

The Wider Scope

Presidential Advisory Council on HIV/AIDS

The later years of the Clinton administration saw a growing focus on how the AIDS pandemic was a risk to more than just health. At the urging of Vice President Gore, on January 10th, 2000, the United Nations Security Council met to discuss the danger which HIV/AIDS posed to peace and security in African nations, the first time they had met to discuss a health issue in that context. In April, President Clinton declared the ongoing HIV/AIDS pandemic a threat to U.S. national security as well. In his last State of the Union address on January 27, 2000, President Clinton announced the launch of the Millennium Vaccine Initiative. This initiative was designed to create incentives for developing and distributing vaccines against HIV, TB, and malaria, three diseases with an on-going global impact, affecting millions of people each year. In May, President Clinton issued an Executive Order to assist developing countries in importing and producing HIV treatments. Though these efforts did increase funding, some involved in the global fight against AIDS felt disappointment in how these measures balanced developing nations’ access to affordable treatments with protections for the monetary interests of American pharmaceutical companies.

Impact

That December 1, 2000, on World AIDS Day, the White House released a report from the Office of National AIDS Policy summarizing the work the administration had done to combat the HIV/AIDS pandemic. Throughout his administration, President Clinton sought to make the HIV/AIDS pandemic a visible and effective priority, emphasizing that the disease was a threat to all people. At the same time, many felt disappointment that more wasn’t done, or felt that the administration’s strategies were ineffective. Research by the Centers for Disease Control for World AIDS Day 2000 indicated that the stigma surrounding HIV/AIDS infection had lessened over the previous decade, but misinformation about the disease still impacted the understanding of approximately 40% of the public. The devastating and on-going impact of the HIV/AIDS pandemic in the U.S. and across the world greatly influenced the trajectory of the latter decades of the twentieth century and would continue to do so well into the twenty-first.

Open Collections on the HIV/AIDS Epidemic on the Clinton Presidential Library's Digital Library

  • 2007-1550-F, Records on the Global AIDS Crisis.
    This collection focuses on the AIDS crisis in an international context, including the detainment of HIV-positive Haitian refugees at Guantanamo Bay, the US reactions to the AIDS pandemic in sub-Saharan Africa, and international cooperation. (These records have been digitized on the Clinton Digital Library.)

  • 2019-0460-F, Records Relating to AIDS Coalition to Unleash Power (ACT UP).
    This collection focuses on the AIDS Coalition to Unleash Power (ACT UP), a grassroots advocacy group founded in 1987 working to bring attention to the AIDS crisis through acts of nonviolent protest and civil disobedience. (These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.)

  • 2018-0756-F, Records of Kristine Gebbie from the National AIDS Policy Office, 1993-1994.
    This collection focuses on correspondence, meetings and events related to the work of the White House Office of National AIDS Policy. (These records have been digitized and are available on the National Archives Catalog.)

  • 2018-0755-F, Patsy Fleming, Director of White House Office of National AIDS Policy, 1994-1997.
    This collection focuses on the development of a national strategy for HIV/AIDS. (These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.)

  • 2018-0759-F, Jeffrey Levi, Deputy Director of the White House Office of National AIDS Policy, 1995-1996.
    This collection focuses on White House AIDS policy and the national strategy for HIV/AIDS, HIV testing on newborns, the 1995 White House Conference on HIV/AIDS, the Presidential Advisory Council on HIV/AIDS meetings and discussions, the 1996 National Defense Authorization Act, and the Ryan White CARE Act Reauthorization. (These records have been digitized and are available on the Clinton Digital Library.)

  • 2018-0763-F, Records relating to Eric Goosby, Interim Director of the White House Office of National AIDS Policy, 1997.
    This collection focuses on the HIV Prevention Act of 1997, Medicaid access due to disability, treatment costs, needle exchange programs, the Presidential Advisory Council on HIV/AIDS, drug labeling, vaccine funding, and the AIDS Drug Assistance Program. (These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.)

  • 2018-0764-F, Files of Sandra Thurman, White House Office of National AIDS Policy, 1997-2001.
    This collection focuses on healthcare, racial and ethnic disparities, funding, the impact of new treatments, prevention and global intervention strategies, housing, incarcerated populations, legislative efforts, mental health and substance abuse, and the Ryan White CARE Act Program.(These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.)

  • 2012-0045-S, Emails of Sandra Thurman, Director of White House Office of National AIDS Policy, 1997-2001.
    This collection focuses on national and international AIDS/HIV policy, needle exchange programs, awareness events, and sub-Saharan Africa. (These records have been digitized and are available on the Clinton Digital Library.)

  • 2018-0758-F, Segment 1, 2018-0758-F, Segment 2, Records of Todd Summers, Deputy Director of White House Office of National AIDS Policy, 1997-2000.
    This collection focuses on HIV/AIDS policy, needle exchange programs, policy discussions, World AIDS Day, and the Presidential Advisory Council on HIV/AIDS (PACHA). (These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.)

  • 2006-0947-F, Records relating to the Export-Import Bank of the United States and an HIV/AIDS program for Africa announced in July 2000.
    This collection focuses on the Export-Import Bank’s announcement of $1 billion in guaranteed loans to Sub-Saharan African countries for the purchase of medicines and medical equipment to fight the spread of HIV/AIDS, as well as the 2000 G-8 summit in Okinawa and the Clinton administration’s efforts to obtain funding for the African debt relief. (These records have not been digitized, and are accessible only in the Clinton Library’s Research Room.) 

Works Cited

https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline A Timeline of HIV and AIDS, Federal HIV/AIDS Web Council

https://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm “Pneumocystis Pneumonia – Los Angeles,” Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control, June 5, 1981.

https://www.cdc.gov/mmwr/preview/mmwrhtml/00022174.htm “Update: Mortality Attributable to HIV Infection Among Persons Aged 25-44 Years – United States, 1991, 1992,” Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control, November 19, 1993.

https://www.oar.nih.gov/about/history Office of AIDS Research, National Institutes of Health

https://www.cdc.gov/mmwr/preview/mmwrhtml/00039622.htm “First 500,000 AIDS Cases - United States, 1995,” Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control, November 24, 1995

https://www.aidsmemorial.org/quilt-history “The History of the AIDS Memorial Quilt,” National AIDS Memorial

https://minorityhealth.hhs.gov/assets/pdf/checked/AIDS%20Initiative%20for%20Racial%20and%20Ethnic%20Minorities.pdf “The Minority AIDS Crisis: Congressional Black Caucus prompts Administration to launch $156 million HIV/AIDS Initiative for Racial and Ethnic Minorities,” By Jennifer Brooks, Closing the Gap, HIVS/AIDS, April 1999, U.S. Department of Health and Human Services