AIDS activists around the country are watching with growing alarm as Gov. George Pataki takes steps to dismantle the AIDS Institute, a state agency that has played a leading role in national and state policy on AIDS. The move is seen as part of a wider backlash against a decade of more liberal AIDS policies and funding. PNS correspondent Annette Fuentes, a former staffer at Newsweek and the Village Voice, is a freelance journalist.

NEW YORK -- New York's AIDS Institute -- for over a decade a leader in the fight against the deadly virus -- is battling for its own life. AIDS activists across the country see its fate as a bellwether for their own future in a conservative political climate increasingly hostile to AIDS activism and bent on budget cuts.

"New York has always been a major player in national discussions from Ryan White funding to prevention programs," says Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, a Washington-based lobbying group. "That voice is now being silenced."

In the year since Republican governor George Pataki swept into office, the Institute's senior staff have been fired, its director forced out and a high-profile advisory council frozen out. Next door in Connecticut, a similar scenario is being played out under another Republican governor, John Roland. There, the state AIDS Division, modeled after New York's, is also being dismantled and its functions merged into other state health department units.

But budget cutting is only one edge to the backlash. More punitive social and legal policies on AIDS are also on the rise. Under Gov. Pataki, New York is set to reverse a decade-long policy against mandatory disclosure of a newborn's HIV status. And in December, Pataki introduced a new law making AIDS tests mandatory for anyone arrested for a misdemeanor or felony -- a move long opposed by the AIDS Institute.

"One of the manifestations of the backlash is a trend toward mandatory testing -- of pregnant women, of suspects," notes Ben Carlson, community relations director at Mobilization Against AIDS in San Francisco. "There is also a rise in the stigmatization of people with HIV. The debates seem to have returned to things we thought we had resolved a long time ago."

New York's AIDS Institute was founded in 1983 as the first governmental agency at any level to aggressively combat the spread of AIDS through education, research and medical programs. Today, the Institute has a $180 million budget -- half of that federal funding -- and administers 600 contracts for everything from case management to legal services for people with AIDS.

"If not for the AIDS Institute, New York State would have been slower to recognize new trends like the orphaning of kids," says Mike Isbel, policy director of Gay Men's Health Crisis, a Manhattan-based advocacy group. "It put all these experts under one roof -- health care financing experts, public health experts. The Institute is like a Swiss clock of coordinated AIDS care."

But the Institute's relative independence and maverick reputation earned it resentment from many elected officials and health department staff. They felt AIDS was garnering too much funding and attention compared to other public health issues.

Now, says David Hansell, an advisory council member and independent health care consultant, "the AIDS Institute is being pulled back into the Department of Health and losing its ability to do many things. Fifteen years into the epidemic, the administration wants to mainstream AIDS and treat it like any other health problem."

AIDS activists worry that this official downgrading signals a normalizing of the disease. "The sense of crisis is gone," notes Dr. Mervin Silverman, executive director of the American Foundation for AIDS Research in San Francisco. "And if AIDS isn't felt as a crisis, people don't respond through their behavior, or with funding."

While Gov. Pataki has promised not to slash the Institute's budget, he is considering turning all AIDS funding into block grants to localities, with fewer regulatory strings attached. That, says Hansell, would be devastating.

"The state has set standards and it would be a disaster if those standards were abolished. The quality of response to AIDS would vary according to local officials' commitment."

For AIDS activists the final straw came when the Institute's new director announced that the AIDS Drug Assistance Program (ADAP) would no longer pay for two-thirds of the drugs now covered for uninsureed people. The ADAP program, which paid for 195 medicines, had expanded beyond the federal monies funding it. A last ditch effort to convince Pataki to continue funding ADAP through March collapsed early in January.

"New York has long had the most innovative and effective programs without a break-the-bank approach," notes Isbel of Gay Men's Health Crisis. "It would send a deeply disturbing message if New York State were to roll back our progress."