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Sunday, May 25, 2003

Roland Foster Memo: 21 November 2002

Deborah Parham, Ph.D., RN
HIV/AIDS Bureau
Health Resources and Services Administration
Department of Health & Human Services

Dear Dr. Parham,
The Subcommittee recognizes your efforts-- and the efforts of your staff-- on behalf of AIDS patients around the country and thank you for your commitment.

As you know, funding and support for the Ryan White CARE Act, that provides hope to thousands of Americans with HIV, has long enjoyed bi-partisan Congressional support. In Fiscal Year 2002, Congress appropriated approximately $2 billion for CARE Act programs. This amount is more than double the funding provided for the CARE Act only 5 years ago.

Yet despite this significant increase and support, states across the nation are reporting financial shortfalls in AIDS Drug Assistance Programs
(ADAPs). Just this week, for example, Wyoming announced that it was set to run out of federal funds to provide primary health care and medicine to AIDS patients. Eleven other states and Guam also have ADAPs with waiting lists, client expenditure caps and/or drug access restrictions. And six additional states and the U.S. Virgin Islands are expected to have waiting lists and access restrictions in early 2003.

It is a cruel dilemma to deny those diagnosed with this devastating disease life sustaining medication, especially when significant amounts of
federal funds are being provided to care for their medical needs.

The Subcommittee recognizes that existing funding distribution formulas and other constraints pose difficulties in your efforts to guarantee treatment to all those who are eligible. We would be interested in learning at the appropriate time what revisions to existing law Congress can make to adequately correct these as part of the re-authorization of the CARE Act. In the meantime, the Subcommittee believes all existing avenues must be explored and exhausted to ensure that those living with HIV/AIDS who are eligible for ADAP are provided life-sustaining medication.

One obvious solution is redirecting Title I supplemental funding to states with ADAP shortfalls and requiring as a priority for EMAs that Title I funds be used to supplement ADAP shortfalls first and provide additional covered services only after that priority has been met. Title I areas with "roll over" funds should be examined for amassing limited resources that are much needed in other areas to care for the needs of real people who lack medicine.

Could you comment on the likelihood of this approach? Please also provide other solutions you may be exploring to meet the needs of ADAP
eligible patients not receiving care.

Because of the significant amount of funds being spent to care for Americans with HIV/AIDS as part of the CARE Act and the alarming number of patients who are being shut out from the ADAP program despite these funds, the Subcommittee is interested learning how much each Title I EMA is spending on each of the following listed categories of AIDS services:

"Healthcare Services":
1. Ambulatory/Outpatient Medical Care (Primary & Specialty Care)
2. Local Title I Drug Assistance or Medications Program
3. State Title II AIDS Drug Assistance Program Contribution
4. Dental Care
5. Health Insurance Continuation
6. Home Health Care
7. Hospice Services (In-home & Residential)
8. Inpatient Personnel Costs
9. Mental Health Therapy/Counseling Services
10. Nutritional Services
11. Rehabilitation Care
12. Substance Abuse Treatment/Counseling
13. Treatment Adherence/Compliance

"Case Management":
14. Case Management

"Support Services"
15. Adoption/Foster Care Assistance/Permanency Planning
16. Buddy/Companion Services
17. Client Advocacy
18. Counseling (Other)
19. Day/Respite Care
20. Direct Emergency Financial Assistance
21. Food Bank/Home Delivered Meals/Nutritional Supplements
22. Health Education/Risk Reduction
23. Housing Assistance
24. Housing Related Services
25. Outreach/Referral to Primary Care & Related Services
26. Transportation
27. Other Support Services: Attach service name with definition

"Other Planning Council Priorities"
28. Planning Council Support
29. Capacity-Building Initiatives
30. Program/Services Evaluation
31. Other Program Support, e.g. Needs Assessment

Grantee Administration
32. Grantee administration

Thank you for your attention to this request. The Subcommittee appreciates your dedication, leadership and commitment to meeting the
needs of those living with and affected by HIV/AIDS. Please do not hesitate to contact me if you have any questions.

Sincerely,
Roland Foster
Professional Staff Member
Subcommittee on Criminal Justice, Drug Policy and Human Resources
Committee on Government Reform
U.S. House of Representatives

Wednesday, May 07, 2003

Margo Marshak Memo to Dabney House Students: 1 April 2003 (?)

Dear Members of Dabney House,

Thank you for your letter of March 11, 2003. I am pleased that you wrote because serious issues confront us as a result of the actions of members of Ricketts House. I am grateful that you acknowledged that some reaction was necessary, and sorry that you believe I overstepped several boundaries in how I chose to deal with the situation.

Problems with the use of fire at Ricketts House date back a number of years and include an incident in which a student was severely burned. There have been repeated discussions regarding fires and safety in the Ricketts courtyard. I understand that during the last set of discussions, involving Dr. Brennen and Dr. Lorden, Ricketts House and then Vice President Brennen wer advised by the Safety Office and the Office of General Counsel that the fire pot did not comply with applicable fire code provisions. At that time, because the Pasadena Fire Department had not reviewed the site, and because Ricketts House assured Dr. Brennen and Dr. Lorden that it would only use the fire pot for approved, supervised fires, Dr. Lorden allowed its continued use. Because of prior incidents, Ricketts House was required to participate in training on safety and risk from fires. However, when the Fire Marshall inspected the site, he determined that it was unsafe and illeagal to use the fire pot and ordered that fires cease and that the fire pot be removed.

I went to Ricketts House and explained that the Pasadena Fire Department had determined that it was unsafe and illegal to have an open fire in the Ricketts House courtyard. I made it clear there could be no more open fires in the Ricketts courtyard. Despite this, on at least two subsequent occasions, members if Ricketts House attempted to have unauthorized open fires in the courtyard until they were stopped by security. I took no action towards the House, despite this repeated misconduct, in hopes that Ricketts House would take responsibility to monitor its own behaviour and control the actions of its members. In order to encourage that to happen, we worked with members of Ricketts House for its initiation and, although not all of their requests were granted, we helped by obtaining a permit for a bonfire on the athletic field.

Rather than using the permitted bonfire, members of Ricketts House built an open fire in the courtyard and, making matters much worse, chained and/or tied doors to prevent security from discovering it. If there had been any type of emergency, not only would students have been hindered from exiting, but emergency crews would have been impeded from entering. Their conduct endangered Ricketts House members' lives and the lives of other students.

Unfortunately it is clear from this history that Caltech's normal disciplinary processes have not served to prevent ongoing problems over many years surrounding the use of the Ricketts fire pot. As an officer of Caltech, I have responsibility to try to ensure the saftey of the student body. This was clearly a time when it was my duty and obligation as Vice President for Student Affairs to attempt to stop this illegal and dangerous behaviour.

You state that the estimated $5000 charge for security is a fine. It is not. Based on the House's inability to control the dangerous misconduct of its members, Ricketts House demonstrated that it could not be trusted to abide by the law, bu Institute policy, or by common sense. Because of the repeated violations, there was every reason to believe that the risk of misconduct at Apache was high. Becasue Caltech cannot allow conduct that endangers the lives of students and others, and because I wanted Apache to proceed as scheduled, I determined that oversight was necessary to assure that further misconduct would not occur. The $5000 was the estimated cost of that oversight; the actual cost that will be billed to Ricketts is $4457.40.

I made no threats. This very serious matter clearly was taken very lightly by Ricketts House. As a result, I took steps to ensure that Ricketts House understands the seriousness of their behaviour so their misconduct stops. I explained what will happen if members of Ricketts House continue to engage in dangerous misconduct so that they are on notice of the consequences of their actions. The members if Ricketts House would bear full responsibility if the House were to close.

It is my earnest hope that we can put this behind us now and work together in a common purpose to make the undergraduate experience at Caltech as good as it can be. I hope that we can move forward together in a positive fashion. I believe that all of us want to find ways to make student life at Caltech flourish, to strengthen the Honor Code, and to promote safety.

Best wishes,

Margo Marshak


Letter from Dabney House Students to Margo Marshak: 11 March 2003

Dear Vice President Marshak,

On February 14th we, the members of Dabney House, were presented with a copy of the letter that you sent to Ricketts House on February 13th. We have some concerns over the content of the letter and its implications for student life at Caltech. These concerns consist of your blatant disregard of the disciplinary routing process, specifically the CRC; the precedent set by fining a student house; and the threat of disbanding a fundamental institution of undergraduate student life at Caltech.

By making a unilateral decision regarding the actions of Ricketts House, you have bypassed several levels of the disciplinary routing process. While this may be common practice at other universities, Caltech has a unique disciplinary structure in which students sit alongside faculty and administrators in deciding what disciplinary actions should be taken. The CRC, Director of Residence Life, and Deans have always handled these types of cases in the past, and the Vice President of Student Affairs has appealed their decisions when necessary. However, by failing to allow due process to occur through these entities, you have cut the appeals process solely to President Baltimore and disrupted the system of checks and balances carefully put in place to ensure an unbiased treatment of any situation that might arise.

Moreover, we do not believe that charging Ricketts House five thousand dollars for security was a reasonable response. Many members of Ricketts House took no part in lighting the fire or barring the gates. Specific individuals were responsible for these actions, and as such, it is unreasonable to implicate those who were completely unrelated to the incident. Furthermore, security has always been granted free of charge for interhouse parties. You operate under a double standard by charging them for security while security for other parties continues to be paid for by Residence Life. Forcing them to pay for this normally free service can only be construed as an excuse to fine Ricketts House.

Not only is a fine on Ricketts House unwarranted, but it also sets a bad precedent for future disciplinary situations. The amount of money that individual houses possess is so small a fraction of that available to Caltech that such fines serve absolutely no purpose other than to punish the house in question. Under no circumstances are punitive measures appropriate at Caltech; the spirit of the honor code strongly favors actions intended to reverse harm that has occurred and, if possible, prevent future harm. There are many alternatives that are more constructive than simply bullying houses into submission. For example, fining Ricketts House does not teach members the dangers of the actions you are trying to prevent. On the other hand, requiring members to attend a fire safety training session would both accomplish this goal and maintain the essential trust between members of our community.

Additionally, we take strong objection to your threat of ?closing Ricketts House ... and precluding bringing in another freshman class.? While this nominally affects only Ricketts House, it is an indirect assault on the house system as a whole. After one house has been disbanded, there is little to prevent the dissolution of the other houses and the subsequent destruction of the house system. The house system, which radically sets Caltech apart from other schools, enables students to tolerate the intense academic pressure that would be unbearable in its absence. In fact, many students decide to matriculate here because of the unique social atmosphere that it provides. Closing Ricketts House would not only slight the majority of current undergraduates, but would in all likelihood alienate a substantial number of alumni, not to mention the estate of Mr. Ricketts himself. Ricketts House has been a part of Caltech much longer than any current professor, student, or administrator. There is no action serious enough to warrant the dissolution of a seventy-year-old student house; for someone who has been here for less than one year to even make such a threat is utterly unjustifiable.

We fully understand the extent and severity of the situation, including the barring of the gates while the fire was burning. Furthermore, we do not condone the actions of the members of Ricketts House involved in the incident and agree that some reaction was necessary. Nevertheless, we feel that you have overstepped several boundaries in how you have chosen to deal with the situation and sincerely hope that you will take these concerns into consideration. We appreciate any feedback that you could offer us and welcome the possibility of opening a dialogue over these matters.

Sincerely,

Members of Dabney House


Margo Marshak Memo: 13 February 2003

Memorandum To: The Students of Ricketts House
From: Vice President Margo Marshak
Date: February 13, 2003

As you will recall, Tom Mannion and I met with you on the evening of January 10, 2003, to present the Pasadena Fire Department's written demand that Caltech '[d]iscontinue and remove [the] "open burning" structural vessel from student residential housing courtyard (Ricketts House).' The order also stated that '[t]he [firepot's] operational reliability, location and past practice of occupants constitutes a very hazardous condition...' During the discussion that ensued, I made it very clear that any open burning fire in the courtyard would not be permitted because it would be out of compliance with the Uniform Fire Code.

I came to your house with good will, but collectively and in many cases individually, you have betrayed my trust several times during the past month with the most serious known breach of conduct occurring this past Saturday February 8, 2003. You also have placed the safety of all members of your house at risk. Because you failed to ensure responsible communal behavior, it is now my responsibility to hold you accountable for your actions.

It has been brought to my attention that Apache is scheduled for this Saturday night. Because of your unwillingness to govern yourselves responsibly, I find it necessary to assign at least two security guards, costing approximately $5000 to be paid by Ricketts, to the house over the weekend.

From this time forward, any unauthorized fires or other violations of policy will result in immediate disciplinary measures. In case of specific individuals, this discipline could include involuntary leave from Caltech. In the case of communal wrongdoing, I will consider closing Ricketts House for your use and precluding bringing in another freshman class. This means that you could be dispersed, with no guarantee of on- or off-campus Caltech housing.

Please don't be mistaken about my resolve or my word. We have reached a point where these types of behavior cannot continue. The future of Ricketts House is in your hands. I sincerely hope that you will make wise choices.


Roland Foster Memo: 11 April 2003

The Subcommittee is concerned that research funded by the National Institute for Health's National Institute for Mental Health is being misread and manipulated and contributing to the misuse of limited federal resources intended for HIV/AIDS care and prevention.

The research, "The Mpowerment Project: A Community-Level HIV Prevention Intervention for Young Gay Men," was conducted by the Centers for AIDS Prevention Studies (CAPS) and the Division of General Internal Medicine at the University of California, San Francisco. The grant number is MH46816 and the center grant number is MH42459.

The stated objective of this research was to examine "community level programs to prevent infection with the human immunodeficiency virus (HIV)." Yet, this study-which claims to examine the effectiveness of a program intended to prevent HIV-does not examine, report or include the HIV infection status of the participants. It is, therefore, impossible to determine if the program examined was actually effective in preventing HIV. Rather than examining the HIV status of the participants, the authors focused on the participants age, race, dating status, education level, enjoyment of 'unsafe' sex and condom usage. The authors concede "this study relied on self-reported behavior."

While self-reported behavior can sometimes be useful and interesting, it is often exaggerated and unreliable as the research subjects may give the answers to researchers that they believe they are expected to provide rather than the truth.

It seems quite peculiar that a federally funded HIV prevention study would rely entirely on self reported behaviors (that may or may not have prevented HIV) and not examine whether or not HIV was actually prevented. There would be no way of knowing whether these behaviors or the program that promoted them were effective unless the HIV status of the research participants was routinely evaluated. This, of course, was either overlooked by the researchers and those who approved the study for federal funding, or intentionally ignored.

The conclusions of this research was community-level HIV prevention programs "effectively led to HIV risk reduction" and "to reach risk-taking young gay men, HIV prevention activities must be embedded in social activities and community life." This may indeed be the case (even though the data in this study is insufficient to determine if HIV was indeed prevented by participation in these activities). These conclusions have, however, been and continue to be manipulated to rationalize the misuse of federal AIDS funding under the guise of HIV prevention. These HIV "prevention" activities include, but are not limited to, erotic writing classes, zoo trips, great sex workshops, pointers on where to have anonymous sex in public places, masturbation instructions, 'fisting' forums, and tips of how to negotiate sex with prostitutes. These programs are all being funded by the Centers for Disease Control and Prevention (CDC).

The particular group misusing federal funds for these activities is the Stop AIDS Project of San Francisco. You will note on the Stop AIDS Project's website (http://www.stopaids.org/mod.php?mod=userpage&page_id=25&menu=13 ) under "Does HIV Prevention Work?," the NIH funded study is cited to rationalize these programs:

"Community-level programs can reach large numbers of people and can therefore be cost-effective. The MPowerment Project promoted a norm of safer sex among young gay men through a variety of social, outreach and small group activities designed and run by young men themselves. They found that young men engaging in unsafe sex who were unlikely to attend workshops were more likely to be reached through outreach activities such as dances, movie nights, picnics, gay rap groups, and volleyball games."

At the same time that these HIV 'prevention' programs are being conducted in San Francisco by the Stop AIDS Project with nearly $700,000 annually provided by the CDC, HIV rates in the city are on the rise along with rates of other STDs including syphilis, gonorrhea and chlamydia. This would indicate that these programs that Stop AIDS Project claims are effective based on NIH research are not indeed effective. But then again, HIV and STD rates were never evaluated or considered when the NIH research concluded the effectiveness of HIV prevention programs.

The Subcommittee would strongly recommend that all current and future research funded or supported by NIH on HIV prevention programs considers HIV status in addition to self-reported behaviors and acquisition of other STDs. This seems to be a reasonable requirement to ensure scientific accuracy when validating the effectiveness of a program and to prevent further manipulation of research that leads to the abuse of federal AIDS funds. If research on the effectiveness of HIV prevention programs does not evaluate whether HIV infection occurred among those participating, after all, how is it possible to conclude that HIV was indeed prevented? The opposite could, in fact, be the case. It would be impossible to determine without actually collecting this vital scientific data.

In addition to this request to include more sufficient, measurable data in studies, the Subcommittee would appreciate written responses to the following:

(1) Does the NIH concur that the conclusions reached by this NIMH-funded survey support the claim that picnics, volley ball games, erotic writing classes, zoo trips, great sex workshops, pointers on where to how to have anonymous sex in public places, masturbation instructions, 'fisting' forums, and tips of how to negotiate sex with prostitutes are effective HIV prevention programs?

(2) Does the NIH believe that self reported behavior is sufficient in and of itself to conclusively prove effectiveness or does NIH believe that credible scientific studies that evaluate programs intended to prevent HIV should include rates of HIV seroconversion and STD infection of those participating in the study?

(3) Could NIH also provide the Subcommittee with a chart listing all NIH funded research conducted over the past 5 years as well as ongoing studies that evaluate HIV prevention, indicating whether each research project is evaluating: (a) self-reported behaviors; (b) measurable outcomes including HIV and other STD infection rates; or (c) both self-reported behaviors and measurable data including HIV and STD rates.

Thank you for your assistance with this request.

Roland Foster
Professional Staff Member
Subcommittee on Criminal Justice, Drug Policy and Human Resources
House of Representatives
B-373 Rayburn HOB
Washington, DC 20515
(202) 225-2577
(202) 225-1154


Roland Foster Memo: 13 March 2003

The Bush administration has vowed to combat sex trafficking, what it called a fast-growing "modern-day form of slavery" in which foreign women and children are lured with false pretenses into the U.S. for prostitution. President Bush issued a directive to crack down on the sex trade during an international summit hosted by the State Department and the War Against Trafficking Alliance, the first such conference on the topic in the U.S. As many as 4 million people worldwide, half of whom may be children, are victims of the sex trade. Estimates are that 50,000 to 75,000 of those children are brought into the United States each year.

The Subcommittee strongly supports President Bush's efforts and is gravely concerned about efforts at the National Institutes of Health that contradict the President's mission and instead seek to legitimize the commercial sexual exploitation of women.

One particular program the NIH is funding (with over $640,000 last year alone) in San Francisco seeks to "promote protective work environments" and "protective behaviors" for "commercial sex workers" from Asia. By so doing, the NIH is, in effect, advancing the sex trade as a legitimate form of commerce that simply needs to be made "safer."

The fact is, prostitution is not, and never will be "safe." Women and children of the sex trade are sexually exploited, molested, raped, physically and emotionally abused and exposed to life threatening sexually transmitted diseases. These STDs include HIV and HPV, which causes cervical cancer and is not prevented by condom use.

Women and children being exploited by the sex trade are victims that need liberation, not research to make their exploitation "safer." It is dehumanizing to even call these victims "commercial sex workers" as the NIH does in its abstract. Any U.S. government funding examining the sex trade should explore ways to end this barbaric, dehumanizing and illegal activity. The NIH research does just the opposite by seeking ways to make it more "protective," and therefore more acceptable. It is unacceptable under any conditions.

The behaviors being examined by the NIH are immoral and illegal, as they should be, in the United States. Knowledge of such illegal exploitation should be reported to the appropriate legal authorities for investigation and prosecution. The NIH and its collaborator on this project, are instead, providing legitimacy and financial support to the continuation of the sex trade.

This study suffers from the same dearth of scientific ethics that the U.S. Public Health Service demonstrated when it funded the notorious Tuskegee experiment in which African Americans with syphilis where observed for decades but never notified that they were infected or given treatment that was available to cure the disease. The Tuskegee experiment was dehumanizing and laden with racism. The San Francisco study examining Asian women is based upon a similar, unethical, racist, dehumanizing concept. Another similar NIH project in Miami, that received nearly $600,000 in federal funds last year, includes African-Americans and Latinas.

It is abominable that the U.S. federal government, in the name of scientific research, is funding efforts to legitimize the commercial sexual exploitation of Latinas and Asian and African American women.

U.S. Secretary of State Powell explained that under the "Trafficking Victims Protection Act of 2000," President Bush had, "directed all relevant United States agencies to combine forces to eradicate trafficking and help rehabilitate its victims." The Subcommittee assumes that this White House directive applies to NIH.

Please provide the Subcommittee with the following information:

(1) Ethical reviews, if any, that NIH conducted for the San Francisco and Miami studies.

(2) The name(s) of the NIH employee(s) who approved funding for the San Francisco and Miami studies, including the names of the individuals on the panels that reviewed the studies applications.

(3) A list of all efforts, if any, by the NIH and collaborators on these studies to notify law enforcement of illegal activities being conducted that were observed or witnessed.

(4) The ages of all of the women observed in these studies.

(5) The score given to each study by the review panels.

(6) A full listing (including funding amounts) of all NIH funded studies over the past decade involving commercially sexually exploited women, including prostitutes or "commercial sex workers."

(7) A detailed explanation by NIH outlining how these studies to create "protective" environments for "commercial sex"-costing over $1 million last year alone-- support the President's directive for all federal agencies to join together to "eradicate trafficking and help rehabilitate its victims."

Thank you for your attention to this matter.

Roland Foster
Professional Staff Member
Subcommittee on Criminal Justice, Drug Policy and Human Resources
Committee on Government Reform
U.S. House of Representatives
(202) 225-2577
(202) 225-1154


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