Copyright 1999 Federal News Service, Inc.
Federal News Service
APRIL 15, 1999, THURSDAY
SECTION: IN THE NEWS
LENGTH:
2987 words
HEADLINE: PREPARED TESTIMONY OF
MR.
DANIEL ZINGALE
EXECUTIVE DIRECTOR, AIDS ACTION COUNCIL
BEFORE THE
HOUSE APPROPRIATIONS COMMITTEE
SUBCOMMITTEE ON LABOR,
HEALTH AND HUMAN SERVICES, EDUCATION AND
RELATED AGENCIES
BODY:
I am Daniel Zingale, Executive Director
of AIDS Action Council, the national voice for over 3,200 community-based AIDS
service providers and the people living with HIV/AIDS they serve. AIDS Action
Council is the only national organization dedicated solely to shaping federal
AIDS policy.
AIDS Action Council is extremely grateful for the leadership
the Chairman and the Members of this Subcommittee have shown over the years
concerning funding for the HIV/AIDS programs that fall under your purview. Many
of the dramatic advances in the care, treatment, and research of HIV disease
would not have been possible without a commitment to a federal response to the
epidemic that this committee has provided over the course of the epidemic.
HIV and AIDS continue to be one of the greatest challenges the public health
community has ever confronted. In fact, our nation's Surgeon General, Dr. David
Satcher has said that HIV "is probably the worst pandemic that we've ever
seen..." and that the virus increasingly affects people of color in the U.S.
because "...it seems to lodge more in people who are poor." He goes on to
emphasize that "people who don't have access to information and resources are
disproportionately impacted."
Statistics from the Centers for Disease
Control and Prevention (CDC) indicate that the AIDS death rate fell by 42
percent between 1996-97 continuing a trend due in part to the increasing
availability of effective treatments. The federal dollars provided by this
subcommittee are responsible for saving many of these lives and we sincerely
thank the members of this committee for their role in this incredible success
story.
AIDS was once the leading cause of death for all Americans ages 25 to
44, but now has dropped to fifth on that list. Sadly, it remains the leading
cause of death for African-Americans and the second leading cause of death for
Latinos in the same age group. As you know, the epidemic now disproportionately
affects communities of color and our youth. Half of the over 40,000 new
infections annually are among individuals under the age of 25, and nearly 70% of
AIDS death rates estimated for 1997 are among people of color. Women accounted
for 22 percent of new AIDS cases in 1997, up from 7 percent in 1985. Last year,
the funding increases included in the Omnibus legislation as a result of the
Congressional Black Caucus initiative helped to address the intensifying HIV
epidemic in communities of color.
Research has provided us with increased
knowledge about the scientific aspects of HIV, including the virus's origin in
the middle of this century. And with the appointment of Dr. Gary Nabel to lead
the National Institutes of Health's Vaccine Research Center, our nation is
finally moving in the direction of developing a vaccine to curb the spread of
HIV.
However, medical, scientific, and research advances do not tell the
entire story about HIV and AIDS in America. While fewer people are dying of
AIDS, the number of new HIV infections remains, for yet another year, above the
40,000 mark. These are 40,000 individuals who will need treatment and care in
the coming years. Many of these individuals along with many of the more than
120,000 people infected from 1995-1997 are poor or will become poor and will
need to access the AIDS Drug Assistance Program (ADAP), an
important component of the Ryan White CARE Act. A number of these individuals
who have been infected with the virus in the past 4 years have yet to learn of
their infection, and have yet to apply for the programs funded by this
committee.
PREVENTION
Mr. Chairman and members of this distinguished
subcommittee, we must do more to prevent HIV infection. First, because it is
humane to protect individuals from this deadly disease and second, because this
committee will find it difficult in the coming years to find the funds to pay
for all the new individuals who will need drugs and care if they are to survive.
Last year, AIDS Action unveiled its "Virtual Vaccine," a comprehensive,
ten-point, proactive national prevention plan to reduce the number of new HIV
infections. Absent a medical cure, we have advocated the use of prevention and
education as a veritable cure for HIV. Our plan includes numerous initiatives
grounded in science such as the use of community-based interventions and small
group education sessions that have been proven to be effective in the
communities to which the epidemic has now spread. Last month, the American
Journal of Public Health reported results from a five-city study that found that
community-based prevention programs were definitively successful in reducing
unsafe behavior. AIDS Action believes that the replication of community-based
interventions that are based on science can decrease the rate of new HIV
infections. In fact, we believe it is imperative that we step up our nation's
HIV prevention effort as soon as possible.
As you know, the CDC spearheads
the federal governments prevention strategy, by funding community-based HIV
prevention efforts, and monitoring the HIV/AIDS epidemic. Absent a cure or
vaccine, prevention strategies are an effective use of the precious resources
appropriated by this committee. The CDC estimates that only 3,995 infections
must be prevented annually to result in cost savings to this committee and the
taxpayer. While we are thankful that other AIDS-related programs have received
funding increases in the latter half of this decade to save the lives of those
with HIV disease, HIV prevention funding at the CDC has not even increased at
the rate of inflation. To remedy this imbalance, AIDS Action proposes a $184.2
million increase over FY99 for the CDC's HIV prevention-related programs.
The CDC needs this proposed increase to fund prevention strategies that are
scientifically proven to work and are implemented at the community level. In
particular, funding must be allocated for the CDC's minority and youth
initiatives, which are critical to the development and implementation of
effective, culturally sensitive, age-appropriate prevention strategies targeted
at those communities most at risk. For example, findings from the National
Institute of Mental Health's Multisite HIV Prevention Trial demonstrated that
well- designed, behavioral programs are effective in preventing HIV infection
and other sexually transmitted diseases in high-risk, vulnerable,
disenfranchised populations. This study, which was published in the June 19,
1998 issue of Science, is critical because it is the largest randomized,
controlled, HIV behavioral intervention study of low-income, urban
African-Americans and Latinos. In addition, HIV prevention is funded by a
process that gives state and local health departments the flexibility they need
to design targeted prevention strategies with cooperation from community based
organizations. Additional funding for the CDC will also enable important
evaluation of the agency's HIV prevention efforts to maximize their
effectiveness and efficiency. And finally, increases are needed to implement the
new CDC Partner Counseling and referral Services Guidelines which have been
revised with cooperation from health departments and community health advocates.
SUBSTANCE ABUSE TREATMENT AND SERVICES
Equally important in developing a
comprehensive HIV prevention plan is addressing issues surrounding substance
abuse treatment and services. Approximately 50 percent of new HIV cases are
directly or indirectly linked to substance abuse. Much of the disproportionate
increase in infection rates among women, communities of color, and adolescents
can be attributed to injection drug use and substance abuse generally, which in
turn contributes to unsafe sexual behavior among drug users and their sexual
partners.
The Substance Abuse Prevention and Treatment Block Grant,
administered by the Substance Abuse and Mental Health Services Administration
(SAMHSA), is the primary funding source for public substance abuse prevention
and treatment services. For fiscal year 2000, AIDS Action proposes a $300
million increase over FY 99 for the block grant to ensure that all Americans
have access to substance abuse prevention and treatment services. Substance
abuse prevention and treatment prevent disease, cost far less than HIV medical
care, and drastically reduce the human suffering associated with AIDS.
Another important aspect of controlling the spread of HIV due to injection
drug use is for this committee to permit the federal funding of syringe exchange
programs as part of a comprehensive prevention strategy. Well-designed programs
are based on science and sound public health practice that have been endorsed by
the American Medical Association and the American Public Health Association to
decrease HIV transmission rates without increasing drug use. Furthermore, needle
exchange programs are often the first link for substance abusers to seek
treatment.
CARE
Without question, the Ryan White CARE Act, administered
by Health Resources and Services Administration (HRSA), plays the most critical
role in ensuring access to appropriate care and treatment for Americans living
with HIV/AIDS. CARE Act funds are used to provide primary medical care, AIDS
drugs, viral load testing, case management and other enabling services for
thousands of individuals living with HIV/AIDS. For FY 2000, AIDS Action proposes
an overall $319.2 million increase over FY 99 for the medical, social services
and training programs in the Ryan White CARE Act. Providing high quality,
coordinated care not only makes good medical sense, but also saves money.
Findings from RAND's recent Health Care Services and Utilization Study (HCSUS)
strongly suggest that the promise of early intervention services to people
living with HIV/AIDS reduces hospitalizations, maintains quality of life, and
saves lives - the very focus of the Ryan White CARE Act itself.
While each
of the four CARE Act titles and Part F addresses a specific need, they
complement each other and play a critical role in making Ryan White the health
care and social service safety net of last resort. Increased funding for all of
the Titles of the Ryan White CARE Act is needed to ensure that the program can
continue to meet service needs and successfully support the provision of
medications to men, women and children living with HIV disease.
- For Title
I, which provides emergency formula and competitive grants to metropolitan areas
most heavily affected by the HIV/AIDS epidemic, AIDS Action proposes an increase
of $120 million in funding over FY '99.
- For Title H, which provides
formula grants to state health departments in all 50 states, the District of
Columbia, and the territories, and dedicated grants to state AIDS Drugs
Assistance Programs (ADAP) for the purchase of therapeutics to
treat HIV and HIV related disease, AIDS Action proposes an increase of $83
million in funding over FY '99. This request includes an increase of $85 million
for state formula grants and $173 million specifically to
ADAP.- For Title III, which provides competitive grants to
existing community- based clinics and public health providers serving
traditionally underserved populations, AIDS Action proposes an increase of $39.7
million in funding over FY '99.
- For Title IV, which provides competitive
grants to pediatric, adolescent and family HIV care programs, AIDS Action
proposes an increase of $15 million in funding over FY '99.
- For Part F,
which provides funding to educate and train health care providers in HIV/AIDS
care through the AIDS Education & Training Centers (AETCs), AIDS Action
proposes an increase of $5 million in funding over FY99 for the AETC program.
The complexity of HIV disease has made the AETC program more important than
ever. Ever changing treatment regimens means that our nation must do more to
ensure that providers are up-to-date on the latest treatment guidelines. Part F
also provides funding for the Dental Reimbursement program for which we
recommend an increase of $1.2 million over FY99.
The intricate, fragile,
AIDS care infrastructure, constructed to ensure basic health care for people
with AIDS who had nowhere else to turn, is struggling to keep pace with new and
ongoing demands. In recent years, Ryan White providers have experienced from 30
to 40 percent increases in the number of new patients. New treatments and
reductions in AIDS death rates have contributed to the increased demand on the
AIDS Care infrastructure.
Meeting the challenge of greater health care and
service demands requires not only increased funding, but also the development of
innovative and flexible solutions. The Ryan White CARE Act, itself, was created
in this spirit. To meet the demands for new drug therapies and bolster
ADAP, many states have instituted cost effective, high- risk
insurance purchasing programs. Indeed, new data released by the National
Alliance of State and Territorial AIDS Directors and the Kaiser Family
Foundation point to the growing need to narrow gaps in access that separate
people from life saving therapies. Through these progressive programs,
individuals living with HIV can access life saving therapies and comprehensive
medical care. To maximize federal and state investments, AIDS Action recommends
that states be given the flexibility to use ADAP specific
funding to purchase high risk or other insurance policies -- that provide full
prescription benefits -- for eligible individuals.
Health Care Financing
Administration (Medicaid Demonstration Project) Despite the existence of federal
AIDS programs, such as ADAPs and the other components of the
Ryan White CARE Act, Medicaid serves as the foundation of AIDS care through its
provision of both comprehensive health care and drug therapies. While
ADAPs provide limited prescription drug coverage for some
uninsured and underinsured people with HIV and AIDS, these programs cannot (and
are not designed to) meet the need for comprehensive primary care and diagnostic
services.
Ultimately, discretionary programs such as ADAP
cannot meet the health care needs of people living with HIV/AIDS. AIDS Action
Council proposes the allocation of $100 million in the HCFA budget to support a
Medicaid demonstration project for states that choose to pursue an expansion of
Medicaid eligibility to low-income HIV positive individuals. These funds could
be utilized to pay the federal share of expanding Medicaid eligibility to this
population. This allocation would assist in providing health care services,
including prescription drugs, under the Medicaid program to about 25% of the
estimated number of low-income HIV positive individuals who meet income
requirements, but who do not currently meet disability criteria for the Medicaid
program.
Medicaid provides access to health care coverage for low income,
uninsured, disabled people. Most low-income individuals who are HIV positive but
have not been diagnosed with AIDS, however, are not eligible for Medicaid,
because they do not meet the program's disability standards or other categorical
eligibility requirements. To qualify for Medicaid, people must meet income
requirements and the disability criteria of the federal Supplemental Security
Income (SSI) program. Therefore, with the exception of some women and children,
the majority of people with HIV/AIDS must become disabled by AIDS in order to
qualify for Medicaid. Despite the fact that early clinical intervention --
including primary care, preventive services, and medication therapies -- has
been shown to improve health and delay the onset of expensive opportunistic
infections, most HIV positive individuals must wait until they are disabled by
AIDS before they can receive Medicaid.
RESEARCH
While both a cure for
HIV disease and a vaccine to prevent new infections remain elusive, AIDS
research has produced significant achievements. The productive life span of
Americans diagnosed with HIV has doubled since 1987 and may double again with
the recent advances in basic research coupled with the new drugs. But we must
remember that the new drugs are not a cure and we are still years from the
development of an effective vaccine. In order to continue to make advances in
HIV/AIDS research, funding for overall research efforts at the National
Institutes of Health must increase. For FY 2000, AIDS Action proposes a $268.6
million increase over FY '99 for the National Institutes of Health AIDS-related
biomedical and behavioral research.
NIH AIDS research is part of our
nation's larger commitment to biomedical research. AIDS research enhances and
stimulates research in other fields, with broad implications for human diseases
such as cancer, heart disease, Alzheimer's disease, and others. Twenty-five
percent of NIH AIDS research funds are used for basic science research, which
has broad implications across scientific disciplines.
This Subcommittee and
the Congress have made a bipartisan commitment to maintain a vigorous national
commitment to the flagship biomedical and behavioral research enterprise at the
NIH. However, the size and breadth of the AIDS research portfolio conducted by
all 24 NIH Institutes requires a coordinated and strategic plan to ensure that
federal resources are effectively managed to facilitate answers to the
scientific questions which hold the greatest promise. In order to accomplish we
need a strong Office of AIDS Research that has the ability to coordinate and
plan the NIH AIDS budget.
CONCLUSION
Our nation is at a crucial juncture
in the fight against AIDS. While we have made incredible progress on several
fronts, so much more remains to be done. AIDS Action Council calls upon the
federal government, in partnership with communities across the country, to
assertively ensure that the new hope touches the lives of all people affected by
HIV/AIDS. Thank you for the opportunity to testify.
END
LOAD-DATE: April 20, 1999
