In confronting the nation's AIDS epidemic, President Bush has tried to follow the path of least political resistance -- retreating from policies that seem likely to provoke a hostile response. But this cautious road has proved bumpy, earning him scorn rather than praise from some conservatives, medical specialists and AIDS activists.
On one hand, many AIDS groups are frustrated by the White House's refusal to promote safe sex and the use of condoms, authorize the distribution of clean needles to drug addicts and repeal a ban on immigration by AIDS victims.
On the other, self-styled conservative champions of family values criticize Mr. Bush for not requiring the reporting of AIDS infections to health authorities, the notification of sexual partners and mandatory AIDS tests for surgeons, dentists and other health care workers.
The president's search for a middle ground on AIDS is, perhaps, reflected in plans for Mary Fisher, a 44-year-old Florida woman with the virus, to address the GOP convention tonight.
Ms. Fisher, a mother of two, contracted the virus in a way acceptable even to social conservatives -- through sex with her husband.
But she represents a minority. Of the 226,281 AIDS cases reported to the federal Centers for Disease Control by June 30, 196,786 or 87 percent acquired it through homosexual contact or intravenous drug use.
Only 14,045, or 6 percent, contracted the disease through heterosexual sex.
However it is transmitted, AIDS is one of the most serious public health issues facing the United States. The U.S. Centers for Disease Control reports that by June 30 the disease had claimed the lives of 152,153 people in the United States, a disproportionate number of them young adults.
That's more than 2 1/2 times the number of Americans killed in the Vietnam war.
Mr. Bush wins general praise for supporting the Americans with Disabilities Act, which affords people with the virus some protection from discrimination.
And the president's defenders point out that there has been a steady increase in spending on AIDS research and other programs since 1988.
But AIDS groups give Mr. Bush little or none of the credit on the budget issue.
"The Congress has been responsible for the increases over the past four years, not the president," said Carisa Cunningham, a spokesman for the Washington-based AIDS Action Council.
Even the non-partisan National Commission on Aids, appointed jointly by the White House and Congress, is unhappy. Several members complained in June that it took eight months for the Department of Health and Human Services to respond to a list of recommendations for action -- including their call for a national strategy to attack the disease.
All the suggestions for new programs were rejected, said Dr. June E. Osborn, chairman of the commission. "I personally feel quite disappointed about the nature and the level of response in prevention and planning," she said in an interview this week.
A few weeks ago, former Los Angeles Laker Earvin "Magic" Johnson, who is infected with the virus, threatened to quit the commission. He was appointed by President Bush.
"Every time we ask for more funding or adequate funding, we get shot down or turned down by the president," Mr. Johnson told CNN. "Whether it's care, hospice, housing or whatever, we just can't get the funding. We have the plan, but we can't implement the plan because we don't have the funding, so it's really frustrating."
One of the president's defenders is Karen Czarnecki, deputy director of the conservative Heritage Foundation. "I think they've got a pretty good track record on aids prevention, research eduction and overall funding," she said. Maybe too good, in fact.
The federal government spends $110,280 per victim on AIDS research, education and prevention, she said. "When you compare that with the $288 per person with heart disease, $2,608 per person with someone with cancer, perhaps we are spending a little too much," she said. "You can attribute that to the very vocal stance of the AIDS lobby."
But AIDS activists said over the past four years, they have had little influence in the White House. Instead, they say, the president has repeatedly caved in to political pressures from the right.
One example: In 1991, Health and Human Services Secretary Louis W. Sullivan canceled a planned $18 million National Institutes of Health study of teen-age sexual practices after two conservative leaders on Capitol Hill, Rep. William E. Dannemeyer, R-Calif., and Sen. Jesse Helms, D-N.C., threatened to fight it.
At the urging of the National Commission on AIDS, the administration relented and permitted people infected with AIDS to visit the United States for medical treatment or to attend conferences.
But the White House also overruled the commission on a related issue, barring any immigrants infected with the virus on the theory that additional AIDS cases would further strain the nation's health care system.
Although the policy affects only a small number of people, AIDS groups view it as a humiliating slap at victims of the disease.
"The importance of the immigration issue is mostly symbolic," Ms. Cunningham said. "It indicates who's in charge of health policy. It's not the public health people, it's the political people. Too often in this administration, politics and not public health have been the concern in making AIDS policy."
Some conservatives, meanwhile, think the president has been too timid in challenging AIDS groups.
"Refusing to endorse the distribution of condoms and needles is a good thing," said Michael Schwartz, director of the Free Congress Center for Social Policy, a conservative think tank that focuses on social issues. "At least Bush hasn't done that kind of harm. On the other hand, we haven't seen the administration do much positive to halt the spread of the disease."
"We still don't have the requirement that infected persons notify spouses, that emergency workers know the status of people they come in contact with," Mr. Schwartz said.
Health officials should keep records of those with the virus and notify sexual partners, he said.
Surgeons, dentists and others who might infect their patients should be required to have AIDS tests and tell their patients the results.
"But there's no strategy," Mr. Schwartz said. "There's no strategy because this administration, like the previous administration, simply has not had the will to stand up to the ACT-UP characters."
In the eyes of some critics, the president's gravest sin has been silence. He's made only one major speech about the disease in the past four years.
"He's been virtually the same as Reagan," Ms. Cunningham said. "He has not made it an issue and he's avoided talking about it whenever he could."
Public health experts point out that there is no cure for AIDS, which as far as anyone knows is always fatal. That makes prevention all the more important.
Dr. Michael Johnson, an assistant professor of international health at the Johns Hopkins school of public health, said the administration's prevention efforts have been limited to urging abstinence. And there is precious little talk of that.
"There is the unrealistic attitude that you can tell young people to abstain and that will do it," he said. "And they haven't even made a good campaign to get that misdirected message out."
"It's a little in the vein of the naive drug abuse slogan of 'just say no,' " he said. "Having people remember the words 'Just say no,' doesn't lead to an emotional impact that's likely to change people's behavior."
Rating the Bush administration's AIDS policy
Carisa Cunningham or the Washington-based AIDS Action Council
Comment: "There was a feeling after RR that Bush had to be better. We don't feel that way anymore."
Grade: D. "That's probably because I'm too kind to give him an F."
* Michael Schwartz, director of the conservative Free Congress Center for Social Policy:
Comment: "There's no strategy because this administration like the previous administration simply has not had the will to stand up to the ACT-UP characters."
Grade: "C, maybe even a C+, mainly because he hasn't done that much destructive."
* Dr. Michael Johnson, assistant professor of international health at Johns Hopkins School of Public Health.
Comment: "They're talking about preaching abstinence to people. Even if you were to say, 'Okay, that's all you need to do,' there hasn't even been a great commitment to that."
Grade: C- or D.
* Karen Czarnecki, deputy director of the conservative Heritage Foundation.
Comment: "I think they've got a pretty good track record on AIDS prevention, research education and overall funding."
* Dr. John Bartlett, director of AIDS patients care for the Johns Hopkins Health System.
* "I don't think the president has provided particularly good leadership in this area, I don't think many politicians have."
* "Probably a C."
* Dr. June E. Osborn, chairman of the bipartisan National Commission on Aids.
Comment: "I personally feel quite disappointed about the nature and the level of response in prevention and planning."
Grade: Declined to give one.
MARY FISHER TO SPEAK
Mary Fisher, a 44-year-old mother of two who has been exposed to the AIDS virus, will address the Republican National Convention in Houston tonight at 9:10 and will urge the party faithful to support more spending on AIDS research and education.