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health services to underserved populations, and supporting AIDS HIV programs.

HRSA will continue to administer the health professions and nursing revolving loan funds which will make available approximately $86 million for loans to about 32,500 students. The budget also includes $185 million in loan guarantee authority for the HEAL program to begin a phase-down.

In addition, the FY 1991 request continues funding for Exceptional Financial Need scholarships, Excellence in Minority Health, and the Disadvantaged Assistance programs which were included in President Bush's amended budget.

National Practitioner Data Bank

The President's FY 1991 Budget proposes to enhance the collection of user fees to cover the full cost of operations of the National Practitioner Data Bank. User fees collected in 1991 will fund the remaining cost of the first phase of the contract and to begin to implement Section V of P.L. 100-93, which will add other health professions to the databank. A primary objective for FY 1991 is to develop a system to monitor and assess compliance with the reporting requirements of the law and to report instances of noncompliance to the Secretary and to the Office of the Inspector General for field investigations.

Organ Transplantation

We believe that the allocation of organs for transplantation is more fair and equitable since the establishment of the national Organ Procurement and Transplantation Network. For example, the number of organs procured but not transplanted has decreased markedly. Also, fewer organs are being shipped overseas and, as a result, more u.s. residents, nation-wide, are receiving transplants. The 1991 budget request includes $3 million to continue support of the Network as well as the Scientific Registry used to track the scientific and clinical status of organ recipients. In additions, the request includes funds to continue support of the agency's Organ Transplantation staff.

Rural Health

The budget request includes $4 million for the office of Rural Health Policy to fund a total of seven Rural Health Policy/Research Centers. These centers will provide an information base and a policy research capability on a wide range of rural health concerns including access to care, financing systems, alternative delivery systems, and occupational health issues. The request provides funding for a national rural health information center and to staff the National Advisory Committee on Rural Health. Funding to provide technical assistance for hospitals in fiscal trouble is also included. AIDS

HRSA AIDS/HIV activities continue to be an important part of the battle to control this dreaded disease. In 1991, HRSA is asking for a total of $73 million for AIDS projects. The funds will be used as follows:

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$19.4 million to continue 7-11 of the HIV health service
grants in communities with a high incidence of AIDS;
$14.8 million to carry on the pediatric service
demonstration projects started in 1988;
$21 million to expand the Education and Training Centers
set up to instruct health care and related providers in
the care, treatment, and support of AIDS sufferers;
continued emphasis for curriculum development on AIDS in
our nation's health professions and nure

nurse training
institutions;
$13.3 million to continue the program to provide care in
community health centers for persons with AIDS/HIV
infection, with the goal of helping to relieve the
increasing burden on inpatient and long term care public
facilities while improving efforts to mainstream the
care for this population into the general health care
system; and
$4.1 for AIDS facilities renovation grants to support
construction/renovation projects in nonacute
intermediate and long-term care facilities.

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Vaccine Injury Compensation Program

The National Childhood Vaccine Injury Act of 1986 established a program to provide compensation for vaccine-related injury or death. HRSA maintains the fiscal records of the claims trust fund and provides medical advice to the court. The 1991 HRSA budget estimates obligations of $222 million for claim payments and other costs to be disbursed from the Vaccine Compensation Trust Fund.

Conclusion

In conclusion I can assure the members that we at HRSA see the coming year as one with many opportunities and numerous challenges, and we are looking forward to working with you in moving the public health agenda forward.

Mr. Chairman and members of the Committee, my associates and I will be pleased to address any questions you may have on the specifics of this budget request.

BIOGRAPHY OF DR. ROBERT HARMON

Present
Position:

Administrator and Assistant Surgeon General
Health Resources and Services Administration
U.S. Public Health Service
Department of Health and Human Services

Previous
Positions:

Director, Missouri Dept. of Health, Jefferson
City, MO. January 1986-January 1990.
clinical Professor, Dept. of family and Community
Medicine. University of Missouri/Columbia School
of Medicine. July 1986-January 1990.

Birthplace and Date:

Barnsdall, Oklahoma, March 20, 194.1

Education:

B.A. 1962-66, Washington University, St. Louis,

MO
M.D. 1966-70, Washington University School of

Medicine, St. Louis, MO
M.P.H. - 1975-77, School of Hygiene and Public

Health, Johns Hopkins University,
Baltimore, MD

Post Graduate
Training:

Internship and residency internal medicine,

University of Colorado Medical Center,

Denver, CO. 1970-73.
Certificate, Program for Senior Executives in

State and Local Government, Harvard
University, John F. Kennedy School of
Governnent. July, 1988.

Professional
Experience:

Medical officer in PSRO program, Division of Peer

Review, Bureau of Quality Assurance, Health
Services Administration, U.S. Public Health
Service, Department of HEW, Rockville, MD.
Aug 1974-Jan. 1975.

Director, MEDEX Northwest Division and Assistant

Professor, Dept. of Health Services, School
of Public Health and Community Medicine;
Adjunct Assistant Professor, Dept. of
Medicine, School of Medicine; University of
Washington, Seattle, WA.
August 1977-November 1980.

Deputy Director of Public Health, Maricopa County

Dept. of Heath Services, Phoenix, AZ.

December 1980-November 1982.
Director of Public Health and Health Officer,

Maricopa County Dept. of Health Services,

Phoenix, AZ. November 1982-December 1985.
Chairman, Department of Community Medicine,

Maricopa Medical Center, Phoenix, AZ.

December 1980-December 1985.
Adjunct Associate Professor, Dept. of Family and

Community Medicine, University of Arizona
School of Medicine, Tucson, AZ. 1981-85.

General Preventive Medicine, 1979.

Specialty
Board
Certification:

Internal Medicine, 1973

Specialty
Board
Eligibility:

Organizations and Memberships:

Association of State and Territorial Health

Officials; Executive Committee, 1987-1990.
National Association of County Health Officials;

President, July 1983-Dec. 1985.
Physicians National Housestaff Association;

President, 1974-76.

HIV/AIDS

Senator HARKIN. Thank you very much.

Thank you all very much for very succinct and to the point statements. I just have a few questions that I will ask initially, and then we will go down the order in which Senators appeared.

Dr. Mason, the administration's request was $1.695 billion for AIDS in fiscal year 1991. That is about a 7-percent increase over last year; $66 million is for CDC, $67 million for National Institutes of Health. Several other small increases are offset by a $40 million cut in the Health Resources and Services Administration.

So could you just basically give us an update on AIDS? What are the projections for new cases? What progress has been made in treating it? Why have you dropped funding for AZT, when all the new reports come out showing how effective AZT can be in the early stages?

And what is the focus of the increase in AIDS funds in the various agencies under your control? Just sort of paint us a picture of what is happening.

Dr. MASON. I would be delighted to do that, Mr. Chairman. And if I might refer you to several charts that I prepared, and there are handouts at each one of the desks.

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The first chart shows the magnitude of the current problem, and I emphasize that the estimated number of infected individuals in the United States is approximately 1 million. The range is 0.8 million to 1.3 million, and this is an estimate based upon studies that are

Senator REID. Excuse me. We cannot hear. We cannot hear or see. Could you move that a little closer.

Senator HARKIN. Pull your mike in a little bit, Dr. Mason.
Dr. MASON. Thank you, Senator Reid.

Senator REID. Maybe so Senator Adams could see this, could you move that over here? [Pause.]

Dr. MASON. I hope you can see that now. The last time I was told people could not hear me I spoke louder and said, is that better? And someone in front said: It is louder, but it is no better. [Laughter.]

We will try to carry on.

Approximately 1 million cases, this is an estimate. So there is interval there of 0.8 million to 1.3 million based on current estimates. As you know, the Public Health Service has recently revised their estimate downward. We probably were too high 2 or 3 years ago and, as better data becomes available, we are getting it better in line with what is really happening out there.

Senator HARKIN. That is one of my questions. I will interrupt you right here if you do not mind.

Dr. MASON. That would be fine.

Senator HARKIN. There has been a reduction in that estimate. You say the only reason for that is just better data has come in?

Dr. MASON. Better data. Probably with data that was available when the first estimates were made-that was 3 years ago-where we said there was one to 142 million infected, we were probably high.

It is interesting at that time that various people were estimating as many as 40 million people were infected and CDC came in and

said it is only 1 to 142 million, and there was a lot of criticism that they were too low. But even CDC at that time was higher than what we now feel.

So there has been a slow increase in the number of infected over the last 3 years, and we are not able to measure directly how fast that is, but obviously as a nation it is not spreading like wildfire.

However, among certain risk groups, particularly IV drug abusers and their heterosexual partners, we still estimate that we have rapid spread of this disease. The cumulative number of cases reported through December 31, 1989, is almost 118,000.

You can see that during 1989, 35,000 cases were reported, which represents a 9-percent increase over 1988. There were 640 pediatric cases reported in 1989, and almost 60 percent of the pediatric cases reported are born to mothers who are using intravenous drugs or who are sexual partners of intravenous drug users.

I would like to mention that, in the context of the distribution of these cases that you see on the chart, that a disproportion of those cases are in our minority population: 27 percent among our black population, 15 percent among our Hispanic population, and that is approximately double their ratio in the total population.

We are delighted to report that during 1989, the number of cases associated with blood transfusions fell 12 percent among adults and 39 percent among children. At present, with our careful education of donors, testing and voluntary exclusion, convincing those who are at high risk not to give blood for transfusions, we are beginning to see a significant difference in the number of transfusion-associated AIDS cases.

The next chart, please.

REPORTED AIDS CASES BY YEAR OF REPORT

U.S., 1982 - December 31, 1989 Number of Cases 40,000

[graphic]

Pedlatric Cases

30,000

20,000

10,000

1982

1983

1984

1987

1988

1989

1985 1986

Year

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