The heavy hand of the Department of Health and Human Services (HHS) may be bearing down on organizations involved in AIDS prevention programs. The latest action may make continued federal funding contingent on following HHS guidance on conferences and workshops to ensure that such events do not encourage sexual activity, even if funded with private dollars. On June 13th, the director of the Centers for Disease Control and Prevention, Julie Louise Gerberding, sent letters to San Francisco-based Stop AIDS and the city of San Francisco’s Department of Public Health warning that recent "workshops with titles and/or program descriptions" appear to encourage sexual activity in violation of Section 2500 of the Public Health Act. CDC has a cooperative agreement with Stop AIDS and the San Francisco Department of Public Health to conduct AIDS prevention educational programs. The claim was made despite the fact that the promotional materials in question had been approved by a review board mandated by CDC’s guidelines that apply to AIDS grantees. The CDC letter to Stop AIDS said continued use of the materials could result in “disallowance or discontinuation of federal funding." More disturbingly, HHS now appears to be applying these standards to Stop AIDS’s non-federally funded workshops. The CDC claim was made despite the fact that a Program Review Panel approved the materials in question. In June 2002, CDC published interim final rules that require grantees to have materials approved by a review panel. (The rules were published June 15, 1992, 57 Federal Register 26742.) Stop AIDS says it is using the same standards for current materials and workshop titles and descriptions as in the past. Current guidelines and regulations governing grants and cooperative agreements do not apply to non-federal funds (except for matching funds). However, CDC has told Stop AIDS informally that the standards extend to all its programs, citing accounting principles. CDC has not provided any legal authority for this claim, and the department's “Uniform Administrative Requirements for Awards and Subawards” does not require specific procedures to separate federally funded activities from privately funded ones. Nor does it place limits on how private funds can be used. The focus on Stop AIDS is not new. On February 13, 2003, Gerberding wrote to Rep. Mark Souder (R-IN), a chair of a key oversight committee, telling him that CDC and the Inspector General of the Department of Health and Human Services each investigated past activities of the nonprofit. Each review gave Stop AIDS a clean bill of health. Gerberding was writing to Souder because he previously expressed concerns that Stop AIDS was engaging in improper behavior. At the same time as Gerberding sent the June 13 letter to Stop AIDS and the city, she sent another letter to Souder informing him that Stop AIDS has workshop titles and program descriptions "that involve, for example, advice on promoting relations with escorts and prostitutes, in my view, appear to violate Section 2500." Gerberding tells Souder that CDC is instructing Stop AIDS to "refrain from using such program titles." She also notes the CDC will notify HIV prevention program grantees about existing restrictions, and will "intensify oversight of grantee activities." Stop AIDS staff expressed shock over the CDC letter. They note that the city of San Francisco, with its own funds, supports the workshops. However, CDC has noted that it is difficult to discern between private and federal funds used by Stop AIDS and so has suggested that the private funds should carry the same restrictions as the federal funds. The National Association of People With AIDS wrote to CDC’s Gerberding objecting to the letter to Stop AIDS, saying “the chilling impact it has on community-based prevention efforts across the country is frightening and unacceptable.” The CDC's letter to Stop AIDS and expected mass mailing to all its grantees notifying them about compliance with last June’s rules has similarities to a letter HHS sent to Head Start grantees, threatening loss of funding for a grassroots lobbying effort to oppose the administration’s plan for reauthorizing Head Start. Although federal grantees can spend their non-federal funds on lobbying, the HHS letter did not make this clear. It is hoped that the letter to HIV grantees does a better job of explaining the law, and does not try to control the operation or content of privately funded activities or speech. (For background on the Head Start letter see our previous Watcher article.)