We have also worked closely with a number of States and communities on epidemiologic research to answer some of the fundamental questions of concern.

During fiscal year 1985, CDC has expanded AIDS surveillance, epidemiologic studies, and laboratory investigations and has initiated major health education and risk reduction activity. Our total appropriation in fiscal year 1985 for these activities, which I will discuss in more detail below, has been $33.2 million.

National surveillance of AIDS has been maintained and upgraded through mathematical modeling of current and future trends. The completeness of case reporting is being verified in several States and cities and patients surviving over 3 years are being epidemiologically characterized.

Cooperative agreements are providing financial and technical assistance to 23 State and major city health departments for active AIDS surveillance.

Current epidemiologic studies include investigation of blood donors in transfusion acquired AIDS cases, study of families of hemophiliacs and other AIDS victims, intensive investigation of patients outside the usual high-risk groups, studies of transmission in Central Africa, and studies of health care workers who have had inadvertent needle-stick injuries.

One of these studies is following a cohort of 7,000 homosexual men in San Francisco to determine the incidence, risk factors, and natural history of AIDS disease and infection. We are performing a number of studies to determine risk factors and determine spread in homosexual or bisexual men. Laboratory support for these studies have also been provided, included characterization of the immune response to HTLV-III/ LAV infection. We have determined the susceptibility of the virus to various disinfectants and are actively searching for an animal model of HTLV-III/LAV infection.

In anticipation of FDA's licensure of a serologic test for antibodies to HTLV-III in March, CDC conducted 44 1-day seminars in 34 cities on antibody testing for this virus during February 1985. These seminars brought information about the test and its interpretations to over 7,500 health workers.

CDC followed these seminars by spending $10.4 million to help implement alternate site testing in the States. These sites were intended to help protect the Nation's blood supply by providing an alternative to blood banks and plasma centers for those persons wishing to know if they had been infected by HTLV-III. We also assisted health officials in producing a guide on management of alternative site testing. At present, HTLV-III antibody testing is available in 518 alternative sites in 52 States and territories. This initiative has served its mission to help protect the Nation's blood supply.

We also have been operating a national hotline which answers more than 700 calls daily from the general public on AIDS and makes appropriate referrals for further information. We are about to award $1.2

million in cooperative agreements to demonstrate the impact of current health education and risk reduction methods and to test innovative approaches to prevent the spread of AIDS.

CDC continued a cooperative agreement with the U.S. Conference of Mayors to help fund grassroots AIDS health education and risk reduction efforts of 19 community based organizations.

We also funded a study of the nature, scope, and evaluability of AIDS health education and risk reduction efforts conducted to date in nine large cities.

The President's fiscal year 1986 budget request asks for $45.6 million for AIDS activities at CDC. This request includes an amendment for $26.925 million. With these funds, CDC will continue and expand many critical activities initiated in fiscal year 1985, in accordance with the Public Health Service's plan for the prevention and control of AIDS. That plan calls for continuing to clarify the epidemiology and natural history of the HTLV-III infection and AIDS, continuing to implement national and community risk reduction and information programs as early prevention measures, designing and evaluating improved prevention and control measures, and designing and promoting prevention and control programs that grow in effectiveness through incorporation of new intervention tools, such as vaccine and antivirals, as they become available.

Particular attention will be paid in fiscal year 1986 to the role of heterosexual transmission and other aspects.

Approximately $2.4 million will be used in fiscal year 1986 to expand our surveillance activities. We will attempt to define the magnitude and trend of infection and disease in several special groups and geographic areas. Laboratory proficiency for HTLV-III testing in States and local laboratories will be examined. CDC also plans to use $3.825 million to expand epidemiologic studies to determine the role of specific sexual practices and other potential risks or protective factors influencing heterosexual transmission; compare frequency of sexual transmission from female to male with that from male to female; document the prevalence of infection in prostitutes and correlate these findings with history of IV drug usage and other factors; to continue to evaluate the risk of spread in day care centers and hospitals and study the spread of the virus among households in Zaire to clarify risk factors for transmission among spouses, siblings, parents, and children living in households of infected persons. Results from these studies are expected within the next 1 to 3 years.

Until a vaccine and/or therapy for AIDS is developed, the only prevention program available is health education/risk reduction. The budget amendment includes $20.7 million to reduce transmission through education which is aimed at encouraging high-risk individuals to change related aspects of their behavior.

CDC plans to spend $5.4 million to assist States in building a core capacity directed toward the prevention of AIDS and the transmission of the infection. When new scientific findings and health education/risk

reduction approaches are developed, the States would then have the systems in place to rapidly disseminate the new prevention strategy.

In addition, 15 of the highest morbidity areas will receive approximately $7.8 million to intensify their prevention efforts and implement evaluation mechanisms to monitor their effectiveness.

To determine the most effective health education/risk reduction programs and techniques, demonstration and evaluation projects will be funded for approximately $4.2 million in three or four States and cities to support intensive projects for prevention of AIDS and HTLV-III/ LAV infection. The evaluation of the effectiveness of the educational programs will be accomplished through surveys to document changes in the understanding of the AIDS risk factors and to evaluate changes in risk-associated behavior and infection rates resulting from program efforts.

Trends will also be monitored in other illnesses which are sensitive indicators of behavior change in high-risk populations. Information gained from these demonstrations will be shared promptly with all States to increase the cost effectiveness of their ongoing activities.

To stimulate new approaches to community health education/risk reduction programs, we also will award about $2 million to encourage unique and innovative approaches to prevent and/or control transmission. Approximately 10 projects would be supported in the community organizations, public health departments, and other organizations.

Finally, included in the requested amendment is $1.265 million for technical assistance to States to help them improve program effectiveness and reduce costs. This assistance will include national strategy planning, refinement of risk reduction guidelines; development of demonstration and evaluation projects; development of uniform evaluation guidelines and instruments; expanded support of the hotline and provision of training to health department and community personnel.

It is clear that AIDS continues to be the Nation's highest public health priority. In the absence of an effective treatment or vaccine, we intend to do all we can in the areas of surveillance, epidemiology, and health education in order to reduce the transmission of this virus.

This concludes my statement, Mr. Chairman. At the appropriate time, I will be glad to help answer any questions you have.

Senator WEICKER. The next witness is Dr. Donald Macdonald, Administrator of the Alcohol, Drug Abuse, and Mental Health Administration.

STATEMENT OF DR. DONALD MACDONALD

Dr. MACDONALD. I am pleased to be here today to discuss the role of the Alcohol, Drug Abuse, and Mental Health Administration in the Department's efforts with AIDS. ADAMHA is vitally involved with PHS efforts to prevent and control AIDS. As Dr. Mason has indicated, although the major risk groups for AIDS are homosexual and bisexual men, approximately 17 percent of all AIDS patients are intravenous drug users. In addition, another 8 percent are both IV drug users or gay

or bisexual men. Psychosocial consequences are common for both the AIDS patient as well as for those with known HTLV-III infection, the causative agent for AIDS. More than 50 percent of AIDS patients develop dementia and/or psychosis during the course of their illness and one in five of these demonstrate neurocognitive and behavioral change before the diagnosis of AIDS is confirmed. These clinical observations are presumed secondary to a direct viral infection of the brain with HTLV-III virus.

As part of the PHS effort to prevent and control AIDS, ADAMHA will focus activities in three areas: one, epidemiologic investigations; two, prevention and control recommendations; and three, risk reduction programs. We will collaborate with NIH and CDC in efforts to monitor the incidence of AIDS, to establish the diagnostic criteria for AIDS, and to maintain surveillance of AIDS-related complex, ARC. We are also preparing AIDS information relevant to the psychosocial aspects of AIDS and the drug use aspects of AIDS.

In addition, the agency strategy and implementation plans to prevent and to control AIDS include: preparation of educational and information materials which we are going to direct to drug abusers and to health care personnel caring for them; preparation of a monograph directed toward the health care worker addressing the psychosocial needs of AIDS patients and persons infected with HTLV-III; and research into epidemiologic and neurobehavioral aspects of AIDS. To date, ADAMHA has provided support for research on AIDS totaling $6.5 million. Utilizing these funds we have looked at the prediction or sexual behavior change in high-risk groups, performed epidemiologic studies of AIDS among IV drug users, psychoimmunologic correlates of AIDS, and studied interactions between psychoactive drugs and their outcome on viral illness. Two ADAMHA institutes are particularly concerned, the National Institute on Drug Abuse [NIDA] and the National Institute of Mental Health [NIMH], both of which have primary roles in our AIDS activities.

NIDA's current efforts are directed toward assessing the spread of HTLV-III exposure, AIDS and AIDS-related complex among the drug using population, and addressing the needs of the drug users already infected by the virus or symptomatic of AIDS. The Institute's activities have focused on three principal populations: those drug users currently infected; other drug users at high risk and concerned about the disease, and drug abuse treatment and service providers. We are concerned about developing more effective prevention measures to incorporate the increased knowledge about this disease and assist in stopping the spread of AIDS in these populations.

To accomplish these goals, NIDA intends to continue its ongoing prevention activities and information dissemination efforts.

Specifically, NIDA works in a number of areas. The first is reducing IV drug use, which is part of NIDA's principal mission, the reduction or elimination of drug use. Because of the AIDS problem among IV drug abusers, this mission becomes more important and reducing drug use will, obviously, decrease the spread of AIDS.

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Second, NIDA is attempting to clarify the epidemiology and natural history of drug users. Studies have examined samples in both high and : low prevalence areas for AIDS in the drug user population. Studies of the interaction of drugs and their abuse with human function hold great possibilities for clarifying the cofactors.

NIDA also stimulates and conducts research and development of effective prevention approaches and treatment agents. NIDA efforts center on research related to HTLV-III disease among the drug using population. In addition to the epidemiologic studies, we are looking at intervention strategies to determine their efficacy in reducing the spread of HTLV-III disease among the drug-using population.

NIDA is working with national, State, and community risk prevention and education programs to enhance prevention and control measures. We continue to develop and disseminate information aimed at reducing the incidence of HTLV-III and to disseminate information to specific high risk groups and to the general public about the relationship among drug abuse, the spread of HTLV-III, and the subsequent development of AIDS and AIDS-related complex.

NIDA designs and evaluates improved prevention and control measures. One aim is to expand our knowledge base for transfer and technical assistance activities aimed at better informing drug abuse treatment providers about methods and procedures most suited for serving drug abuse clients infected with or at risk of becoming infected with the AIDS virus.

Efforts are aimed at engaging in drug abuse treatment, and other appropriate medical programs, drug users who have AIDS or other stages of infection or who are at high risk of contracting or spreading HTLV-III. Because there are significant geographic differences in the incidence of AIDS among IV drug users, control programs recommended may vary from State to State.

The National Institute of Mental Health's [NIMH] current efforts are directed toward understanding the psychiatric, behavioral, and psychosocial aspects of AIDS. This includes identifying those psychological and behavioral factors which may negatively or positively influence the course of illness and identifying the relationship between immune function and mental health status, such as depression, anxiety, or responses to high levels of stress. Specific activities are in the area of research and support services. We are supporting investigations focused on psychiatric, biobehavioral, neuropsychologic, and psychosocial aspects of AIDS. Investigators supported by the Institute are developing neuropsychologic instruments specific to AIDS patients; identifying those factors predictive of sexual behavior change associated with the AIDS epidemic; delineating the different psychologic responses of the AIDS, ARC, and HTLV-III patients; and studying the cognitive change associated with and antecedant to the development of AIDS.

NIMH also participates in the implementation of national, State, and community risk prevention and education programs. We are continuing to develop information on the mental health consequences of AIDS di