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Congressional Testimony
March 8, 2000, Wednesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 4000 words
HEADLINE:
TESTIMONY March 08, 2000 JEFF JACOBS DIRECTOR OF GOVERNMENT AFFAIRS AIDS ACTION
HOUSE APPROPRIATIONS LABOR, HEALTH AND HUMAN SERVICES, AND
EDUCATION LABOR HHS APPROPS
BODY:
March 8, 2000
Jeff Jacobs, Director of Government Affairs AIDS Action Council Mr. Chairman and
Members of the Committee, I am Jeff Jacobs, Director of Government Affairs for
AIDS Action Council. At my side is my deputy, Julio C. Abreu. AIDS Action is the
national voice on AIDS, representing all Americans affected by HIV/AIDS. We are
here today to testify on behalf of our 3,200 community-based organizations as
well as several of our nation's local health departments. We would like to begin
our testimony today by saying thank you. This Committee is directly responsible
for the recent dramatic advances in the care, treatment, and research of HIV
disease. The progress of the past few years would not have been possible without
the funding this Committee has appropriated. Chairman Porter, Representative
Obey and distinguished members of this committee on both sides of the aisle, the
AIDS community is here today to say thank you. I wish we could also say our job
is done but unfortunately almost one million Americans are living with HIV
disease. Many if not most are poor and all will need treatment, care and
services if they are to live productive lives. Mr. Chairman, this is your last
appropriations bill and we are so thankful to have had the opportunity to work
with you over the past six years. The year 2000 will also mark our first
Appropriations Bill in the 21st Century. We're here to talk to you about the
world's deadliest infectious disease and how it affects our nation. But we are
also here to ask for your continued support for the programs that are designed
to address this epidemic. Care, treatment and research need your continued
support and we are here today to outline those very important needs. Yet, we
want to begin our recommendations by outlining the nation's need to do more to
prevent HIV infection in the first place. What could be more humane than the
prevention of HIV infection? What could be more cost efficient than the
prevention of HIV infection? This is a difficult, complex, and expensive disease
to manage. Once someone becomes infected with HIV we need to help him/her live
with this disease through expensive treatments. We also must be vigilant in our
quest to find better treatments, develop a vaccine, and continue our search for
the elusive cure through research. But what about the opportunity we have to
improve our nation's HIV prevention efforts? This year the President has
requested a $40 million increase for the HIV prevention efforts at the Centers
for Disease Control and Prevention. We are thankful for the President's request
for an increase in this important area. However, let me explain why we are also
disappointed in the Administration's request. In the year 2000, 40,000 new HIV
infections will occur in the United States. 20,000 of those infections will
occur in young people under the age of 25. Mr. Chairman, preventing HIV
infection must become a national priority. After all this is an infectious
disease that requires us to be smarter than the virus itself. In some
populations we have made progress with our prevention efforts but just when we
think we are making inroads the virus shifts into new population groups and we
are always in danger of being behind the curve. Yet, we know that HIV prevention
works. Studies show that combining a variety of intense, sustained prevention
interventions do facilitate long-term behavior change. Improving access to
devices like condoms and sterile needles promotes safer practices; building
skills and modifying community norms provides people with the capacity to
negotiate difficult social situations; and timing prevention messages early may
stem participation in risky behaviors. Prevention has helped slow the rate of
new HIV infections in the United States from over 150,000 in the late 1980s to
around 40,000 per year currently. This decline in new infection rates includes a
decrease in HIV prevalence among young white men by 50 percent between 1988 and
1993; a drop in HIV prevalence among injection drug users in New York City from
34 percent in 1990 to just over 4 percent in 1998; and a 73 percent decline in
the number of infants who acquire AIDS through mother-to-child transmission from
1992 to 1998. It is far less expensive to prevent someone from becoming infected
in the first place than to care for that person once they are infected.
Researchers estimate that the cost of lifetime treatment for HIV infection now
averages about $155,000. Estimates are that 40,000 people are infected yearly,
resulting in an annualized cost of more than $6 billion. Only 4,000 infections
must therefore be prevented annually to result in cost savings, and only 1,255
must be prevented for the investment to be cost-effective according to the CDC.
In a recent Harris poll, a two-to-one margin favored spending a higher
proportion of all health care dollars on prevention and health promotion. Over
90% considered HIV prevention "very important." The CDC has an ambitious goal to
reduce the cumulative number of new HIV infections 50% by the year 2004. The
President's request is inadequate to reach this goal. A meaningful investment of
at least $100 million is needed to stave off new infections at this scale. AIDS
Action recommends a total investment of $985 million for HIV prevention at the
CDC. An initiative on this scale will not only help to save future generations
but it will also save future limited resources. AIDS is still the leading cause
of death for African-Americans between the ages of 25-44, and is the second
leading cause of death, for Latinos in the same age group. Women accounted for
24 percent of new AIDS cases in 1998, representing a steady increase from only 7
percent in 1985. This epidemic is not over. For communities of color, the
minority AIDS initiative backed by the Congressional Black Caucus and the
Congressional Hispanic Caucus is critical for delivering services to begin to
address the vast disparities that come to light with HIV. We applaud your
efforts to direct resources to communities of color, and urge you to build on
this investment for FY2001. It is clear that your investment in HIV and AIDS
programs is reaping big dividends: -AIDS deaths are still declining, albeit at a
much slower rate than just two years ago; -Powerful new drugs have restored
health and hope to hundreds of thousands of people with the virus; and Research
is progressing on new drugs and vaccines to both treat and prevent HIV
infection. In fact, your investment in the NIH is translating into the improved
care and treatment provided by the Ryan White CARE Act. Its emphasis on early
treatment, comprehensive health services, and the provision of drugs, is
literally saving people's lives. The Ryan White CARE Act, without question,
plays the most critical role in ensuring access to appropriate care and services
for Americans living with HIV/AIDS. In fact, in recent years, Ryan White
providers have experienced between 30 to 40 percent increases in the number of
new patients. In 1998, at least 500,000 people received primary care and support
services under the Ryan White CARE Act, 60 percent of those were people of
color. Originally enacted in 1990 and reauthorized in 1996, the Ryan White
Comprehensive AIDS Resources Emergency (CARE) Act represents the federal
government's largest financial allocation specifically for HIV-related health
and support services. Each year, as the number of people with HIV-disease
increases, the need for appropriate HIV care grows. As of June 30, 1999, 711,344
cases of AIDS have been diagnosed in the United States. There are nearly one
million Americans living with HIV, 280,000 of which have AIDS. The intricate,
fragile, AIDS care infrastructure, constructed to ensure comprehensive health
care and services for people with AIDS who had nowhere else to turn, is
struggling to keep pace with new and ongoing demands. The success of the CARE
Act is based on a recognition that medications alone are not enough to
effectively fight AIDS. This coordinated and comprehensive approach makes the
CARE Act a cost-effective and efficient investment. The need for the care and
services provided by the CARE Act is great. Therefore, AIDS Action recommends an
$89 million funding increase for Title I over last year; a $45 million increase
for Title 11 (non-ADA-P); a $130 million increase for Title 11 -
ADAP; a $46 million increase for Title III; a $19 million
increase for Title IV; a $3.6 million increase for AIDS Education Training
Centers; and a $4 million increase for Dental Reimbursements. AIDS Action and
its members are appreciative of Congress' continued support of the Ryan White
CARE Act over the past decade. The result of these efforts is that thousands of
people living with HIV/AIDS have been able to lead productive lives due to the
care, treatment and services provided by the CARE Act. Throughout the United
States, the CARE Act continues to make a tremendous difference in the lives of
people living with HIV disease. The CARE Act is in large part responsible for: -
People with HIV/AIDS living longer, more productive lives. - Local control that
has assisted communities in designing care and treatment services that meet
their specific needs. -A safety net that helps to ensure better access to
appropriate care, treatment and services for all people living with HIV/AIDS.
-An effective model of service delivery that can be adapted to meet the needs of
other life threatening diseases. As the AIDS epidemic continues to grow and
expand into more disenfranchised communities, the need for CARE Act services is
even more critical to the health and well being of individuals who have to deal
with multiple barriers in accessing health care. We urge you to provide a $336
million increase for the Ryan White CARE Act for FY2001. Despite the existence
of federal AIDS programs, such as the AIDS Drug Assistance Program, Medicaid
serves as the foundation of AIDS care through its provision of both
comprehensive health care and drug therapies. However, most low-income
individuals who are HIV positive are not eligible for Medicaid, because they do
not meet the program's disability standards or other categorical eligibility
requirements. Low-income people with HIV must get sick with AIDS before they
qualify for Medicaid. Not being eligible for Medicaid neglects the need that HIV
positive individuals have for access to the new treatments and care. Early
intervention for people with HIV is now accepted as a standard, recommended by
NIH, and is cost effective. Therefore, AIDS Action proposes that this committee
allocates the funds necessary for the Health Care Financing Administration to
support a Medicaid demonstration project for states that choose to pursue an
expansion of Medicaid eligibility to low-income HIV positive individuals. While
both a cure for HIV disease and a vaccine to prevent new infections remain
elusive, AIDS research has experienced significant achievements in the last
year. The most important of these range from the discovery of the surface
proteins employed by HIV to infect cells, to the approval of two important
classes of drugs to treat HIV - the protease inhibitors and the non- nucleoside
reverse transcriptase inhibitors. These and other therapeutic advances have more
than doubled the productive life span of Americans diagnosed with HIV since
1987. The recent advances in basic research coupled with the new drugs may
easily double it again. In order to keep up this remarkable rate of progress,
our country needs to sustain support of vital health and behavioral research
conducted at the National Institutes of Health. As important, Congress must
ensure that the nation continues to receive as large as possible a return on its
investment in research. This demands that all research be conducted in the most
scientific and efficient manner possible. For AIDS research, this means it is
critical to support a consolidated budget administered by the Office for AIDS
Research. It is only by continuing to support the integrity of this funding
mechanism that the resources our nation spends on AIDS research will be
allocated to the most promising areas of medical and scientific exploration. In
addition, AIDS research has had major benefits for other scientific disciplines
and diseases. Therefore, we urge this panel to fund an increase of $323 million
for HIV/AIDS research at the NIH for FY2001. Last, but not least, we urge this
committee to increase funding for the Substance Abuse Treatment Block Grant.
Much of the disproportionate increase in HIV infection rates among women,
communities of color, and adolescents can be attributed to substance abuse.
Increased funding for substance abuse treatment is desperately needed to help
slow the spread of the virus. Despite overwhelming evidence of the link between
substance abuse and HIV/AIDS, valuable drug and alcohol abuse prevention and
treatment programs have been cut over the years. Because of this and lack of
public and private resources, substance abuse treatment is available for only I
in 4 people who need it. Additionally, there is clear scientific information
showing us how to effectively prevent and treat substance abuse, however, it is
rarely used for public health policy or by AIDS service organizations. We
recommend an increase of $400 million for the SAMHSA Block Grant. We also need
to address the linkages between injection drug use and HIV infection. A 1997 NIH
Consensus Panel concluded that needle exchange programs prevent the spread of
HIV and do not increase illegal drug use. This committee should allow federal
funds for these programs which have been endorsed by the American Medical
Association and the American Public Health Association. Your committee has also
been charged with the tremendous task of providing much needed assistance to
address the global epidemic. HIV threatens to bring down entire nations in some
regions of the world. We appreciate your funding of the LIFE initiative for
assistance to Africa last year, and recommend that we build upon that investment
for FY2001, and direct other funds to crisis hot spots. Consequently, our
success and advances in care and treatment have created a new and difficult
challenge for the 21st Century --- complacency. At the 7th Annual Conference on
Retroviruses and Opportunistic Infections last month it was reported that 31
percent of individuals in one study said that they were less concerned about
becoming HIV infected than they had been previously, and 17 percent said they
were less careful about sex or drug use because of the availability of better
HIV treatments. This complacency is unacceptable and we must do everything in
our power to reverse these dangerous attitudes. In conclusion, we urge this
Committee to continue to provide leadership by increasing funding for these
programs that save lives. Thank you for this opportunity to testify.
LOAD-DATE: March 15, 2000, Wednesday
