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Federal Document Clearing House
Congressional Testimony
March 21, 2000, Tuesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 6054 words
HEADLINE:
TESTIMONY March 21, 2000 JAVIER G SALAZAR MANAGER NATIONAL MINORITY AIDS COUNCIL
HOUSE APPROPRIATIONS LABOR, HEALTH AND HUMAN SERVICES, AND
EDUCATION LABOR HHS APPROPRIATIONS
BODY:
March 21,
2000 Statement of Javier G. Salazar Federal Affairs Manager My name is Javier G.
Salazar and I am the Federal Affairs Manager for the National Minority AIDS
Council (NMAQ in Washington, DC. On behalf of NMAC, I thank you for the
opportunity to testify on the impact of HIV/AIDS on communities of color and how
the pressing needs these communities are experiencing can be met in part,
through the Fiscal Year (FY) 2001 Labor, Health and Human Services, Education
and Related Agencies Appropriations bill. NMAC is the only national organization
dedicated to shaping sound, national HIV/AIDS health and social policies that
are responsive to the needs of the diverse communities of color. NMAC is also
committed to developing leadership and capacity within those communities to
address the challenges of the epidemic. The organization represents over 600
minority community-based organizations throughout the United States (U.S.) and
the territories that provide HIV prevention, treatment, and care services. NMAC
would also like to thank Chairman Porter and the rest of the committee for the
extraordinary leadership that has been shown in the past. We are relying on this
leadership as we confront the new challenges before us in the fight against
H1V/AIDS in the 21't century. This leadership has allowed our nation to make
tremendous advances against this dreaded disease and has brought hope to many
people living with HIV/AIDS. Unfortunately, for the vast majority of individuals
living in highly impacted communities that NMAC represents, this hope has yet to
become fully realized. Disparities in health among ethnic and racial minorities
and subpopulations persist. Ethnic and racial minority groups continue to lag
behind the White population, experiencing substantial disparities in health
outcomes on many significant indicators. The disparities in health experienced
by ethnic and racial minority groups are particularly evident in the case of
HIV/AIDS in the U.S. While ethnic and racial minority groups in the U.S. make up
24% of the U.S. population, they represent 67% of new AIDS cases. New and
powerful drug therapies have led to dramatic drops in AIDS deaths since 1996,
but death rates for ethnic and racial minorities continue to lag behind. While
AIDS deaths dropped generally by 45% between 1996 and 1997, deaths for Latinos
dropped by 44%, African American deaths only dropped by 38%, but deaths for
Whites dropped by 54%. African Americans In the African American community
alone, the impact of the HIV/AIDS epidemic in the U.S. has been devastating.
African Americans represent 12% of the total U.S. population, but they account
for 37% of the cumulative AIDS cases and 45% of the new AIDS cases reported in
1998. The Centers for Disease Control and Prevention (CDC) currently estimates
that 240,000 to 325,000 African Americans are living with HIV. Approximately I
in 50 African American men and 1 in 160 African American women have HI-V.
Latinos Latinos are the second most highly impacted ethnic and racial minority
group. In 1998, a total of 48,266 new AIDS cases were reported in the U.S.
Latinos accounted for 9,650 or 20% of these new AIDS cases yet accounted for
only 13% of the total population. The Harvard School of Public Health projects
that by the year 2005 the number of new AIDS cases among Latinos will surpass
that of Whites. Unabated, these trends portend disaster for the Latino
population in this new century. Asian and Pacific Islanders Asian & Pacific
Islanders (A&PIs) are experiencing significant increases in persons living
with AIDS when compared to Whites over time. The estimated number of A&PIs
living with AIDS has increased by over 108%, from 1,010 in 1992 to 2,100 in 1997
compared to an increase of 58% among Whites in the same period. The proportion
of cases among A&PIs appears to be low relative to the total U.S.
population, however it is important to note that only a small number of states
collect or report HIV/AIDS surveillance data by AP&I national
origin/ethnicity and several do not report any data on A&PIs separately. As
with the Latino community, many factors may serve to deter individuals from
learning their HIV status and account for underreporting of HIV/AIDS among
A&PIs such as social stigma, fear of jeopardizing their residency status,
and lack of access to health care. Native Americans The AIDS epidemic among
Native Americans -- American Indians and Alaska Natives - continues to grow.
From December 1996 to December 1998, cumulative HI-V infection cases increased
by 33% to 632, and the AIDS cases increased by 24% to 1,940. It is likely that
the number of AIDS and HIV cases among Native Americans is higher than what has
been reported to the CDC due to misclassification of the ethnicity of Native
Americans by health workers and officials as White, Hispanic or Asian. The
Minority AIDS Initiative is Critically Needed Clearly, the disproportionate
impact that the HIV/AIDS epidemic is having on ethnic and racial minorities and
subpopulations is more evident today than ever before. These populations are
also overburdened by poverty and are plagued with the social ills of racism,
discrimination, homelessness, substance abuse, inadequate education,
joblessness, and a lack of adequate access to health care. All of these factors
contribute to the persistent challenges that these communities face in combating
HIV/AIDS. The Minority AIDS Initiative is a vital component of the nation's
efforts to respond to the HIV/AIDS crisis in highly impacted ethnic, racial and
other minority communities. This Initiative is grounded in the recognition that
the fight against HIV/A11DS in highly impacted communities of color can no
longer be "business as usual". By implementing this Initiative in response to
the community's call for an emergency response, Congress and the federal
government have acknowledged that dramatically different strategies and
interventions are needed to successfully attack HIV/AIDS in these communities.
NMAC strongly believes that the diverse ethnic and racial minority groups
throughout this nation must be supported and equipped to develop and sustain a
community- based response to the unique and evolving epidemics within their
communities. The overall goal of the Minority AIDS Initiative must be to address
the needs of African Americans, Latinos, Asian & Pacific Islanders, Native
Hawaiians, and Native Americans in highly impacted communities by building and
supporting the capacity of ethnic and racial minority community based
organizations and institutions and providers to deliver culturally competent and
appropriate HIV-related prevention, health care, and support services. The
initiative must also seek to expand existing culturally competent behavioral
research, conducted by minority principal investigators and to fund new research
initiatives to develop and evaluate cultural competent intervention strategies
directed towards eliminating the HIV-related health disparities experienced by
ethnic/racial minority populations. Finally, the Minority AIDS initiative must
serve to refocus and increase the responsiveness of traditional HIV/AIDS related
ftinding streams to meet the needs of minority communities. Only by refocusing
our efforts and by directly empowering communities through funding and
infrastructure development can they ultimately reap many of the benefits that
the nation has seen. The Minority AIDS Initiative is by no means the answer.
Much remains to be done to effectively meet the growing crisis of HIV/AIDS in
our communities. The Minority AIDS Initiative is the first step to ensuring that
all of the nations HIV/AIDS efforts are brought to bear on the areas that
require them most. To meet these goals successfully, NMAC supports doubling
funding for the Minority AIDS Initiative in fiscal year 2001. In fiscal year
2000 the initiative was funded at $250.8 million. In fiscal year 2001. NMAC
proposes that the initiative be funded at $500 million. The Administration
provided only $274.3 million for the initiative in its FY 2001 budget request to
Congress. We respectfully request that Congress once again show leadership and
appropriate the funding necessary to empower ethnic and racial minority
populations and subpopulations to successfully combat the epidemic. NMAC
Recommendations for the Minority AIDS Initiative NMAC strongly encourages the
committee to direct that all funding allocations be targeted based on the most
recent and complete estimated living AIDS cases among the different ethnic and
racial minorities. In addition, funding must serve to build capacity and
infrastructure within these very communities to provide and fill gaps in
critically needed HIV/AIDS services. This includes providing primary HIV
prevention, increasing access to HIV related health and support services, and
ensuring continuity of care for minority populations and subpopulations
including minority women, youth, gay men, substance users, homeless,
incarcerated and recently released individuals. In allocating the funds under
the various programs outlined below, we urge the committee to ensure that
consideration is given to the Commonwealth of Puerto Rico, the U.S. Virgin
Islands, and other territories. The Ryan White CARE Act at the
Health Resources and Services Administration (HRSA) The overall goal of the
activities funded under HRSA must be to close the existing disparities in health
outcomes experienced by ethnic and racial minorities and women of color fixing
with HIV/AIDS. To achieve 100% access and 0% disparities, all Ryan White
CARE Act activities, administered through HRSA, must target funding to
ethnic and racial minority community based organizations and institutions, to
enhance and build minority organizational and provider capacity to deliver
critical services. NMAC supports allocating funding within the Ryan
White CARE Act as follows: Title I. Supplemental funding should be
allocated to eligible metropolitan areas to support ethnic and racial minority
community based organizations and institutions. These funds must be used to
develop and expand HIV-related health and support service capacity in
communities of color, treatment education and services to increase adherence to
appropriate HIV drug therapy regimens, support services to assist children
orphaned by AIDS, and peer education to individuals living with HIV/AIDS.
Funding should be made available to support technical assistance and training
activities by indigenous, community-based and tribal organizations to increase
the participation of minority providers and individuals living with HIV/AIDS in
planning councils and to develop and disseminate culturally and linguistically
appropriate materials, education and training on HIV/AIDS. Title III. Funding
should be allocated for planning grants, direct service grants and targeted
technical assistance and capacity building grants to ethnic and racial minority
community-based health care and service providers. Funds should also be made
available to national, regional and local organizations representing people of
color to provide technical assistance, and enhance collaborations, and linkages
designed to strengthen HIV /AIDS systems of care in highly impacted and
underserved communities of color. Funding should also be used to support
targeted planning grants designed to build the HIV primary care capacity of
indigenous minority organizations. Title IV. Funds should be allocated to
support traditional minority community-based providers of services to minority
women, children, youth and families. Part F. Funding through the AIDS Education
& Training Centers should be targeted to continue to develop and expand
minority provider education subcontracts with Historically Black Colleges and
Universities (HBCUs), Hispanic Serving Institutions (HSIs) and national ethnic
and racial minority medical and nursing associations. Funding through the
Special Programs of National Significance should be directed to support
indigenous, community-based and tribal organizations to evaluate the HIV/AIDS
services needs of, and develop models of care to address the needs of Native
Americans, Asian Americans, Native Hawaiians and Other Pacific Islanders living
with HIV/AIDS. Centers for Disease Control and Prevention (CDC) NMAC supports
allocating resources to the CDC to support activities designed to fund ethnic
and racial minority community based organizations and institutions to address
the trends of the HIV/AIDS epidemic in communities of color. NMAC supports the
use of Minority AIDS Initiative resources for the following programs and
activities: Directly Funded Minority Community Based Organization (CBO) Program.
This program must be expanded to fund grant applications from minority
organizations with a history of providing culturally competent and
linguistically appropriate services to communities of color. CDC Community
Development Program. Funds should be used to support new grants and enhance
existing grants to support needs assessments and enhance community planning
processes to integrate HIV, STD, TB, substance abuse prevention and treatment,
care and community development within communities of color. Faith-based
Prevention Programs. Funds should be used to support new faith-based prevention
programs in diverse ethnic and racial minority populations and to support and
enhance existing faith- based programs. Technical Assistance Programs. Funds
should be allocated to continue to provide technical assistance for grantees
under the Directly Funded Minority CBO program, for Faith-Based Initiative
Programs, and to develop and strengthen their capacity of existing and new
programs to provide targeted primary and secondary prevention services.
Surveillance. Funding should be allocated to the CDC to improve the collection,
analysis and dissemination of HIV and AIDS surveillance and other
epidemiological data regarding Native American, Asian American, Native Hawaiian
and Other Pacific Islander populations by the CDC and by state, local and
territorial health departments. National Institutes of Health (NIH) - Office of
Research on Minority Health NMAC supports the allocation of funds to expand
research to develop and strengthen science-based HIV prevention and care
interventions for highly impacted ethnic and racial minority groups. Funding
should be targeted to support new culturally competent behavioral research
projects and expand existing culturally competent behavioral research projects,
conducted by minority principal investigators, that seek to identify the factors
and interventions that promote HIV risk reduction behaviors and reduce
disparities in HIV related health outcomes. These projects should examine the
role of cultural and gender factors that affect women's risk for HIV infection,
develop interventions to reduce HIV infection through high-risk behaviors, and
develop interventions that decrease the rate of mortality in targeted minority
populations. NMAC also supports using funds to increase the number of Native
American, Asian American, Native Hawaiian and other Pacific Islander principal
investigators funded to conduct HIV behavioral research targeting the links
between sexual behaviors, substance use and HIV infection among Native
Americans, Asian Americans, Native Hawaiians and other Pacific Islanders.
Substance Abuse and Mental Health Services Administration (SAMHSA) NMAC supports
increasing funding to SAMHSA to increase activities that strengthen the capacity
in communities of color to provide substance treatment services. Minority
Initiative resources must be used to support and expand the Center for Substance
Abuse Treatment's (CSAT) targeted service expansion and capacity building to
minority, community-based substance abuse treatment. These activities should
address the special needs of underserved subpopulations including minority
women, youth, gay men, incarcerated and recently released individuals and
multiply diagnosed individuals. Funding should also be targeted to support
existing programs and expand activities under the Center for Substance Abuse
Prevention (CSAP) that strengthen integrated substance abuse and HIV/AIDS
prevention capacity in communities of color and to address the unique needs
highly impacted adolescents, out of school, homeless and runaway youth. NMAC
supports the use of funds to enhance state and county efforts to plan and
develop integrated substance abuse and HIV/AIDS treatment and prevention
services to communities of color. Funds should also be used to support existing
substance abuse treatment facilities for pregnant and postpartum women and to
expand the program through a competitive process. Office of the Secretary,
Public Health and Social Services Emergency NMAC supports funding for the Office
of the Secretary, Public Health and Social Services Emergency Fund, to support
existing and expand integrated HIV, substance abuse and mental health prevention
and care activities aimed at decreasing the HIV/AIDS related health disparities
experienced by ethnic and racial minority populations, including underserved
subpopulations of minority women, youth, gay men, incarcerated and recently
released individuals and multiply diagnosed individuals. Office of the
Secretary, Office of Minority Health (OMH) NMAC supports additional funding for
OMH to develop new and expand existing activities and programs to address the
trend of the epidemic in communities of color and subpopulations. These funds
should be allocated based on priorities identified in the previous fiscal year,
which include support for the Minority Community Coalition Demonstration Grants
program and the Bilingual/Bicultural Demonstrations Grants Program targeted to
fund H1V/A_IDS prevention activities by minority organizations. In addition,
funding must be targeted to support new H1V/AlDS prevention activities by at
least four indigenous, community- based organizations in Native American, Asian
American, Native Hawaiian and other Pacific Islander communities through the
OMH's Minority Community Coalition Demonstration Grants program and its
Bilingual/Bicultural Demonstration Grants program. Funds should be targeted to
national, regional and local minority organizations with a history of service to
communities of color to provide technical assistance and to expand the National
Minority Organization/Cooperative Agreement Program. Funds should also be
directed to expand and strengthen contracts with HBCUs and HSIs to provide
funding to minority behavioral scientists to enhance the implementation of
research-based prevention activities for disease prevention, health promotion
and HIV/AIDS in conjunction with community organizations targeting minority
populations. Conclusion NMAC strongly believes that if we are to reduce and
ultimately eliminate the tragic impact that the HIV/AIDS epidemic is having on
ethnic and racial minority populations and subpopulations, Congress must give
these communities the tools and resources they require to combat the epidemic.
Fully funding the Minority AIDS Initiative will ensure that these communities
can begin to build capacity and the service delivery infrastructure needed to
close the gaps in HIV/AIDS health outcomes and to ultimately share in the
success and hope that many in the nation have and are experiencing.
LOAD-DATE: March 30, 2000, Thursday
