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Federal Document Clearing House
Congressional Testimony
July 25, 2000, Tuesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 3920 words
COMMITTEE:
HOUSE COMMERCE
SUBCOMMITTEE:
TELECOMMUNICATIONS, TRADE AND CONSUMER PROTECTION
HEADLINE: TESTIMONY HIGH DEFINITION-TELEVISION
TESTIMONY-BY: TOM LIBERTI , CHIEF, BUREAU OF HIV/AIDS
AFFILIATION: FLORIDA DEPARTMENT OF HEALTH
BODY:
July 27, 2000 Prepared Statement of Mr. Tom
Liberti Chief, Bureau of HlV/AlDS Florida Department of Health Summary of
Testimony Florida strongly supports the Ryan White Reauthorization. Following
are six major areas of support: Transitioning to the use of HIV cases as the
basis for funding allocations We strongly support this transition to promote
more effective targeting and distribution of CARE resources. The use of CARE Act
Title 11 funding for early intervention activities The use of CARE Act Title 11
funding for early intervention activities will strengthen Florida's efforts to
fight the spread of this terrible disease. The voluntary expansion of partner
counseling and referral activities Partner counseling and referral activities
are effective interventions for reaching individuals who are at high risk of HIV
infection and are unaware of their risk. Streamlining the administration of the
CARE Act Presently, the annual CARE Act application process is overly burdensome
for state and local health departments, Title I planning councils and the
federal agency that administers Ryan White. Grants for activities to reduce
perinatal transmission We support the authorization of additional funds to
further reduce perinatal transmission, but recommend separate funding for these
grants. New competitive component of Title If We strongly support this new
competitive component for Title 11 which allows states that need additional
resources to address critical service shortages in rural and underserved areas.
Good Morning, Mr. Chairman and distinguished Members of the House Subcommittee
on Health and Environment. My name is Tom Liberti. I am Chief of the Florida
Department of Health Bureau of HIV/AIDS. The Bureau of HIV/AIDS administers all
HIV/AIDS prevention, early intervention, patient care and surveillance
activities in the state. I am pleased to have the opportunity to speak to you
today regarding HIV/AIDS in Florida, the importance of the Ryan White CARE Act
in helping us provide comprehensive and compassionate services to persons living
with HIV/AIDS and the Coburn-Waxman reauthorization legislation, HR 4807. 1
would also like to take this opportunity, on behalf of the citizens of Florida,
to thank each of you for your leadership in addressing HIV/AIDS prevention and
patient care. I would like to begin my testimony by providing a brief overview
of the HIV epidemic in our state and the enormous impact of the Ryan White CARE
Act in our state. I then have six major points I would like to cover in support
of the Ryan White Reauthorization. Overview of the epidemic in Florida Florida
has been hit very hard by the AIDS epidemic. HIV infections have penetrated
nearly every metropolitan and rural community in our state. Although Florida has
only 5.5 percent of the U.S. population, we have 10.2 percent of the 724,656
cumulative AIDS cases reported in the U.S. through 1999. Florida's population of
more than 15 million people is racially and ethnically diverse: 73 percent are
white, 13 percent are black, 12 percent are Hispanic and 1 percent are
Asian/Pacific Islander and less than I percent are American Indian. Minority
populations in Florida, particularly blacks, have been disproportionately
affected by HIV/AIDS, and the numbers of HIV/AIDS cases in their ranks have been
increasing at an alarming rate. Of the 78,000 reported AIDS cases, 46 percent
are among blacks, 39 percent are whites and 15 percent are Hispanics. Males
account for 78 percent of the reported AIDS cases and females account for 22
percent. In the attachment, you will see additional information regarding
HIV/A1DS demographics in Florida. The importance of the Ryan White CARE Act The
Ryan White CARE Act has made an enormous difference in the lives of Florida's
men, women and children who are infected and affected with HIV/AIDS. The Ryan
White CARE Act has enabled us to make a broad range of health care and support
services available through community systems of care to increasing numbers of
people with HIV/AIDS. For many living with HIV/AIDS, these systems are their
only source of care and treatment. In 2000, $16,568,647 of Florida's $84 million
Ryan White Title 11 award will be allocated to 14 HIV consortia throughout the
state. These consortia provide basic, primary patient care and support services
to eligible persons living with HIV disease in their respective areas. Florida
has worked hard to provide a continuum of care for all residents infected with
HIV and to provide equal access to the standard of HIV care. We have taken a
leadership role in promoting the coordination of Title I (patient care funding
to cities), Title 11 (patient care funding to states), Title III (funding for
early intervention service and planning), Title IV (funding for pediatric and
family programs) and Part F programs (Special Projects of National Significance,
dental reimbursement and AIDS Education and Training Centers). The state is
committed to coordinating and planning programs that ensure that all persons
living with HIV disease in Florida have access to basic care and support needs.
We are also committed to avoiding duplication or overlap of services and
obtaining services and products of the highest quality at the lowest possible
cost. Through the coordination of CARE Act grantees, state and local
partnerships have been established at every level. Florida's AIDS Drug
Assistance Program (ADAP) has experienced tremendous growth
over the last few years, and we expect to serve over 12,000 HIV infected
individuals through ADAP during 2000- 2001. For the year 2000,
the Florida ADAP is being funded with a combination of Ryan
White Title 11 and state general revenue for a total of $70,000,000. At this
time, the program provides 54 drugs on the formulary. This includes access to
all antiretrovirals, all protease inhibitors, most major drugs to fight or
prevent opportunistic infections, hepatitis A and B vaccines, blood modifiers,
drugs for neuropathy, drugs for wasting, drugs for lipid-lowering and diabetes
and drugs to lessen the side-effects of HAART therapy. This program is available
in all of Florida's 67 counties through the Department of Health. The Ryan White
CARE Act is responsible for the expansion of this critical program and the
subsequent decline in HIV-related deaths in Florida. HIV/AIDS deaths peaked in
1995 with 4336 deaths and declined to 1547 in 1998. Another significant impact
of Ryan White Title 11 is the AIDS Insurance Continuation Program. In the year
2000, we will fund the AIDS Insurance Continuation Program with Ryan White Title
11 funds and general revenue funds for a total of $4,593,016. This project,
administered by the Health Council of South Florida in Miami, has been an
overwhelming success with enrollment having grown from approximately 100 clients
in 1993/94 to approximately 1500 at present. This program is a tremendous
success because it allows individuals with AIDS to continue to receive their
private health care while avoiding the tremendous public expense associated with
health care received under Medicaid or other publicly funded programs. Support
of the Ryan White Reauthorization Florida strongly supports the Ryan White
Reauthorization. The approaches articulated in the Ryan White Reauthorization
reflect many of the new dynamics of the HIV epidemic. The number of people
living with HIV disease is growing and the diversity of the epidemic is
broadening. This bill will give states the flexibility to tailor their response
to the unique needs of the changing epidemic. As you consider the CARE Act
Reauthorization, I would like to highlight the following six major areas of
support that are part of HR 4807: - Transitioning to the use of HIV cases as the
basis for funding allocations We strongly support this transition which will
promote more effective targeting and distribution of CARE resources.
Confidential name reporting of HIV infection was implemented in Florida in July
1997. Florida's confidential HIV infection reporting system has identified
16,754 newly diagnosed HIV cases through May 2000, including 158 pediatric
cases. The current estimated number of persons infected in Florida is 65,000 - I
00,000. We estimate that 65 percent of those know their status and 35 percent do
not. HIV infection reporting plays a vital role in our ability to target HIV
prevention and early intervention efforts. HIV infection reporting has allowed
the state to be "in front of the epidemic." This enables us to get those
infected with HIV into care earlier, so they can live longer, healthier lives.
HIV infection reporting has clearly shown a significant increase in HIV
infection in Florida's minority communities. While blacks comprise 13 percent of
Florida's population, they account for 60 percent of the HIV cases. As a result
of this alarming trend, numerous minority initiatives have been implemented,
including the launching of a statewide media campaign, the creation of the
Minority HIV/AIDS Task Force, the passage of legislation to improve racial and
ethnic health outcomes, and the hosting of state and national minority leaders
at an interagency health symposium and a number of leadership conferences. We
also work very closely with minority, community- based organizations to
implement culturally sensitive HIV prevention and treatment programs and with
clergy and their congregations to mobilize risk-reduction education and
supportive attitudes from within the community. - The use of CARE Act Title 11
funding for early intervention activities The use of CARE Act Title 11 funding
for early intervention activities, including activities that assist in case
finding and linkages to care, will strengthen Florida's efforts to fight the
spread of the terrible disease. Through early intervention activities, including
innovative counseling and testing, such as the use of oral fluid testing, we
will be able to identify more individuals who are HIV infected and unaware of
their status. Getting these individuals into early care and treatment is vital
to successful HIV treatment. In addition, access and the availability of health
care services represent key opportunities to prevent further HIV transmission. -
The voluntary expansion of partner counseling and referral activities Partner
counseling and referral activities are effective interventions for reaching
individuals who are at high risk of HIV infection and are unaware of their risk.
From January to December of 1999, 6,258 positive HIV tests were reported in
Florida. Of this number, 2,801 tests were assigned for notification of test
results. Of these, 1,442 requested the partner counseling and referral services
provided by the Department of Health. This intervention identified 2,784
partners and at-risk persons. From this number, 187 were identified with a new
positive HIV antibody test. - Streamlining the administration of the CARE Act We
strongly support the provision which requires the Secretary of HHS to consult
with states and Eligible Metropolitan Areas (EMAs) to develop a plan for
simplifying the application process for Title I and Title 11. Presently, the
annual CARE Act application process is overly burdensome for state and local
health departments, Title I planning councils and the federal agency that
administers Ryan White. The enormous amount of time that these entities devote
to the administrative requirements of a yearly application process direct fiscal
and human resources away from the provision of services that are the focus of
the CARE Act. - Grants for activities to reduce perinatal transmission We
strongly support the authorization of additional funds to further reduce
perinatal transmission. We recommend, however, a separate authorization for
these grants and not taking money from increases in Title 11 funds, base or
ADAP. This provision gives states the flexibility to devise
programs appropriate to their jurisdictions. In Florida, we have seen a dramatic
reduction in pediatric HIV/AIDS cases over the last few years. Since 1992, we
have experienced an overall 82 percent reduction in reported pediatric AIDS
cases. In May of 1999, an important success for Florida was reported in the
Centers for Disease Control and Prevention Morbidity (and Mortality Weekly
Report. Data from this report indicated that Florida had one of the highest
percentages of pregnant women who could recall being tested for HIV. Another
important milestone in our efforts to make a difference in the lives of
Florida's women and children was the passage in the Florida Legislature of the
Targeted Outreach to Pregnant Women Act (TOPWA). This legislation provides funds
for local prevention and outreach projects for women who are pregnant and at
risk of delivering an HIV or substance exposed newborn. These extremely
successful projects are coordinated through local health departments with
community-based providers. - New competitive component of Title 11 HR 4807 adds
a supplemental component to Title 11 which will support grants to states that
have one or more eligible communities. Eligible communities are non-EMA areas
that demonstrate severe need. We strongly support this new competitive component
for Title 11. It allows states that need additional resources to address
critical service shortages in rural and underserved areas. Since the Ryan White
CARE Act was passed in the early 90s, the CARE Act has served as the most
important program for HIV/AIDS care and treatment in our state. We would like to
thank you once again for the opportunity to provide testimony on the impact of
HIV/AIDS in Florida and to commend the members of this committee for their hard
work, support and leadership on this critical issue. I am available for
questions and comments as you work on this legislation.
LOAD-DATE: August 25, 2000, Friday
