Copyright 1999 Federal News Service, Inc.
Federal News Service
APRIL 20, 1999, TUESDAY
SECTION: IN THE NEWS
LENGTH:
2304 words
HEADLINE: PREPARED TESTIMONY BY
ERNEST
C. HOPKINS
DIRECTOR OF FEDERAL AFFAIRS
THE SAN FRANCISCO AIDS FOUNDATION
BEFORE THE HOUSE APPROPRIATIONS SUBCOMMITTEE
LABOR,
HEALTH AND HUMAN SERVICES AND EDUCATION SUBCOMMITTEE
BODY:
Good afternoon Mr. Chairman and members
of the Committee. My name is Ernest Hopkins and I am the Director of Federal
Affairs for the San Francisco AIDS Foundation. I come before you today to
request the Committee's support for important increases in Fiscal Year (FY) 2000
funding for Federal HIV/ADS-related programs administered by the U.S. Department
of Health and Human Services.
The San Francisco AIDS Foundation was
established in 1983 as a private, community-based response to what was then an
emerging public health emergency. AIDS Foundation staff can recall the desperate
days prior to Federal funding for ADS programs, when public health departments
in major cities were staggering under the weight of increasing caseloads of
young, desperately ill individuals presenting at hospital emergency rooms with
obscure, but deadly symptoms. Today, the AIDS Foundation provides direct
services to approximately 3,000 persons living with ADS or disabling HIV
disease, and reaches another 145,000 through our prevention campaigns, treatment
publications, toll free information hotline, public policy and community
outreach efforts.
The San Francisco ADS Foundation's clients reflect the
fact that, increasingly, the HIV epidemic is affecting disenfranchised
individuals with multiple problems in addition to HIV disease, including
homelessness, substance abuse and mental health issues. Fortyseven percent of
our clients are people of color, 84% are male and the majority of clients have
monthly incomes under $750. Fifty- eight percent of the Foundation's clients are
gay and bisexual men; however, over time we are serving an increasing number of
heterosexuals.In October 1998, the Centers for Disease Control and Prevention
(CDC) reported a 47 % decline in AIDS-related deaths between 1996 and 1997, and
a corresponding 12% increase in the number of people living with AIDS. During
this same time period, new HIV infections have remained steady at about 40,000
per year. As a result, local communities such as San Francisco will continue to
experience steadily increasing demand for HIV-related medical and supportive
services. We see this same phenomenon occurring at my own agency already. Fully
800 of the approximately 3,000 people the AIDS Foundation will serve this year
are new to the agency.
The Federal response to AIDS has literally prevented
the collapse of local public health systems, and has enabled hundreds of
thousands of low-income, uninsured individuals living with HIV/ADS to receive
high- quality health care and supportive services. These Federal resources have
also helped to leverage millions of dollars in state, local and private funding
for HIV/ADS programs.
The San Francisco ADS Foundation fully supports the FY
2000 HIV/ADS appropriations recommendations of the National Organizations
Responding to AIDS (NORA). In my testimony today, I would like to highlight
several programs and initiatives that play a particularly important role in the
City and County of San Francisco's response to the epidemic.
Ryan White
Comprehensive AIDS Resources Emergency (CARE) Act Programs
The San Francisco
AIDS Foundation requests that the Committee provides $625.2 million overall, or
a $120 million increase for Title I of the Ryan White CARE Act in FY 2000. This
funding for Title I is required to maintain access to medical care, treatment
and supportive services for those individuals already in care, and to ensure
access to care for those who will enter care for the first time.
In response
to recent HIV treatment developments, the number of individuals seeking medical
care and treatment, as well as the cost of care, has grown substantially in
recent years. A 1998 study by the Cities Advocating Emergency ADS Relief (CAEAR)
Coalition reported an average increase of 43.5 percent in the number of new
HIV/ADS clients entering CARE-funded systems between 1995 and 1997. In FY 2000,
the number of new clients seeking care is expected to increase by 20 percent.
This study also demonstrated that the overall cost of care grew substantially
during the same time period. This increase in the cost of care is related to
three factors: 1.) increases in the number, length and complexity of medical
visits (65 percent increase in length of each visit and a 27 percent increase in
the number of visits); 2.) new and expensive viral laboratory tests, and; 3.)
the use of pharmaceuticals not covered by the state-based AIDS Drug Assistance
Programs (ADAP).
The fifty-one Eligible Metropolitan Areas
(EMAs) funded through Title I of the CARE Act are home to 74 percent of all
reported AIDS cases in the United States; Together, an estimated 156,000 people
with HIV/ADS will be served in these epicenters in FY 2000.
Because of
increasing ADS cases, in FY 2000, up to three new communities may become
eligible for Title I funding; These emerging epicenters must be funded
adequately, and not at the expense of existing Title I areas that are also
continuing to experience growing service needs. Because of inadequate
appropriations in FY 1999, seven Title I areas actually received less funding
than in FY 1998, including the Californian communities of San Francisco/San
Mateo/Marin and Santa Rosa/Petaluma. At a time when the nation continues to see
approximately 40,000 new HIV infections annually, with many individuals
thankfully living longer due to treatment advances, funding cuts run counter to
common sense and good public health practice.
As the second decade of the
epidemic comes to a close, it is clear that the HIV/ADS epidemic is far from
over. It is also apparent that HIV medical care and treatment will continue to
be complex, expensive (albeit less expensive than inpatient hospital-based
care), and unavailable or unworkable for some. Despite the promise of new drugs,
there continues to be a significant number of individuals who cannot tolerate
their side effects, or whose bodies have become resistant to them rendering the
medications ineffective. These individuals, as well as those struggling to
continue their treatment, will need essential support services.According to the
Health Resources and Services Administration (HRSA), approximately 64 percent of
Title I clients nationally are people of color. Despite aggressive outreach to
disenfranchised communities, medical care and anti-HIV treatment utilization by
communities of color continue to lag. These continued disparities translate into
poorer health outcomes, including slower reductions in AIDS-related deaths. For
this reason, in addition to our request for an overall increase in support for
Title I, the AIDS Foundation requests that the Committee increase funding for
the Title I-specific appropriation that was approved as part of the FY 1999
Congressional Black Caucus HIV/AIDS Initiative. A significant increase in this
targeted funding would allow Title I communities to protect and expand targeted
programs in the African American community and other communities of color that
are disproportionately affected by HIV/AIDS.
The AIDS Drug
Assistance Program (ADAP)
The San Francisco AIDS Foundation
requests that the Committee provides $544 million overall, or an $83 million
increase for the AIDS Drug Assistance Program (ADAP) in FY
2000. This funding level is necessary to provide ongoing services to the 53,765
clients who utilized state ADAPs in June of 1998 and to extend
access to the estimated 500-600 new clients that will enter the program monthly
in FY 2000. The National ADAP Monitoring Project reports that,
compared to July 1997, in June 1998, ADAP programs served 22
percent more clients and the cost of treatment had grown by 37 percent due to
increases in the cost per client, the number of clients served, and the
increasing costs of combination anti-HIV drug therapies. ADAP
spending for anti-HIV drugs grew by 54 percent between July 1997 and June 1998.
Today anti-HIV drug costs represent 88 percent of ADAP
expenditures.
I want to thank the Committee for its considerable support of
ADAP in recent years. Since 1996, Congress has responded to the
critical pharmaceutical needs of people living with HIV disease through
significant increases in funding. Yet, despite these efforts, many states
continue to face shortfalls and must restrict the number of drugs covered
because of insufficient resources.
In California, Federal support for
AIDS-related drugs last year leveraged an additional $51.6 million in state
funding in FY 1998, allowing adequate access to ADAP for all
eligible Californians living with HIV/AIDS. The California ADAP
formulary provides access to all 14 anti-HIV medications approved by the Food
and Drug Administration (FDA). In addition, California's ADAP
also includes over 80 FDA approved drugs that are used to treat opportunistic
infections and symptoms associated with HIV disease. From 1997 to 1998, the
national expenditures on drugs to treat opportunistic infections and other
conditions actually decreased by 31 percent--a further indicator of the success
of early care, treatment and support services.
The anti-HIV medications used
in combination to create Highly Active Antiretroviral Therapy (HAART), while not
a cure, will continue to offer opportunities for improved health to many
individuals living with HIV/AIDS. Additional resources would alsoimprove access
to ADS- related medications for African Americans and women living with HIV/ADS
who continue to have lower utilization rates. For all of these important
reasons, the San Francisco ADS Foundation urges Committee support for this
request.
Congressional Black Caucus (CBC) HIV/AIDS Initiative
The San
Francisco AIDS Foundation requests that the Committee provide a minimum of $171
million for targeted emergency assistance to address the severe and ongoing
health crisis related to HIV/AIDS in the African American community and other
communities of color. I want to thank Chairman Porter, Congresswoman Pelosi and
other members of the Committee, including your former colleague Congressman
Louis Stokes, as well as members of the Congressional Black Caucus, for
approving targeted resources in FY 1999 to respond to this growing health
emergency. Our hope is that the impact of these targeted efforts will become
evident in all HHS agencies that provide HIV services.
The majority of
people living with HIV/ADS in the U.S. are people of color. Communities of color
often face additional health care and social service challenges. Therefore,
targeted initiatives, which focus resources on emerging crises, may provide the
most strategic Federal response to address these intractable and longstanding
problems. The CARE Act continues to provide an effective response to the
fragmentation that exists in the U.S. health care system overall. Although the
CARE Act cannot and should not be expected to eliminate longstanding health
disparities that exist between groups, CARE Act grantees, providers and clients
can and should' act as agents for change. Targeted CBC funding will help them do
so. The San Francisco ADS Foundation is fully committed to working with Congress
and the Administration to reduce racial disparities and improve access to
quality care for all individuals living with HIV/ADS.
HIV Prevention
Programs at the Centers for Disease Control and Prevention (CDC)
The San
Francisco AIDS Foundation requests that the Committee provide $848 million in
total funding for HIV prevention education, surveillance, and behavioral
research at the CDC. This $191 million increase over FY 1999 levels would
provide increased resources to reduce the 40,000 new HIV infections that occur
annually in the U.S. Over 85 percent of the HIV prevention funds are allocated
to state and local health departments, national and regional minority
organizations and community-based organizations to provide both primary and
secondary HIV prevention services.
I also want to urge the Committee to
support funding for qualitative research to inform the design of effective HIV
prevention programs. The ADS Foundation recently conducted such research in an
effort to better understand the complex processes involved in individuals'
decisions whether or not to engage in safer sex practices. We are now using this
research to design and evaluate two innovative prevention programs targeting gay
and bisexual men in San Francisco, one of which is the Black Brothers
Esteemprogram for African American men. In an era of increasingly complex
prevention issues, we firmly believe that the CDC must invest more in
qualitative research so that local communities can develop more effective HIV
prevention strategies.
Substance Abuse and Mental Health Services
Administration (SAMHSA)
According to CDC, the majority of new HIV infections
in the U.S. are now directly or indirectly related to drug use. Of those
diagnosed with AIDS to date, drug use is linked to more than 30 percent of adult
cases, 60 percent of cases among women and 53 percent of pediatric cases. The
San Francisco AIDS Foundation requests that the Committee provide $255 million
to the Center for Substance Abuse Treatment (CSAT) and $255 million for the
Center for Substance Abuse Prevention (CSAP).
In closing, I also want to
urge the Committee to support increased funding for HIV/AIDS research at the
National Institutes of Health, as well as $1.7 million in funding for the Office
of HIV/AIDS Policy (OHAP) at HHS. OHAP will continue to play a key role in the
development of policies and priorities regarding HIV/AIDS, including the ongoing
review of Clinical Guidelines on the Management of HIV Infection.
Thank you
for this opportunity to testify before the Committee. We know that you share the
San Francisco AIDS Foundation's mission to end the pandemic and the human
suffering caused by HIV.
END
LOAD-DATE: April
30, 1999 
