21. What linkages are there between community health centers and the AIDS Service Demonstration Grants program? In which cities are there specific tie-ins? 22. The CDC provides $153 million in grants to States for AIDS prevention, including counseling and testing services. In which States are community health centers receiving any of these funds? 23. To what extent are the programs of the STD and tuberculosis clinics funded by CDC referring HIV-infected patients to community health centers? 24. Has HRSA requested an increase in funding for community health centers in FY 1991? If so, does the Public Health Service budget include it? What percent is included? 25. What amount of funds is CDC transferring to HRSA for demonstration grants to help community health centers set up testing and counseling services? How many persons will be served? Will you request an increase in funds for this program in FY 1991? If so, how much? 26. In the FY 1990 budget, CDC requested $171 million for counseling and testing. The PHS reduced this to $86 million and OMB cut this further to $16.8 million. Did CDC request an increase for these programs for FY 1991, and if so, how much was it, and did you approve it? 27. If you recommended that testing and counseling be level funded, why did you do so when knowledge that early intervention will delay the onset of full-blown AIDS would result in an increased demand? 28. Please describe any research funded by PHS to determine the effectiveness of counseling programs now in place? 29. What are the specific site placements of National Health Service Corps (NHSC) physicians in New York and New Jersey in FY 1989? Please include their specialization, and the jurisdiction and facility to which they are assigned. 30. How many placements of NHSC physicians are you planning to make in New York and New Jersey in FY 1990? In which jurisdictions and facilities? 31. A recent survey of one homeless shelter for men in New York City found that 62 percent of the men tested were infected with HIV. This high incidence is not necessarily typical of all shelters for the homeless, however, it indicates the existence of a large AIDS problem among this population. How many persons with HIV infection is your homeless health care program currently reaching? 32. 5 How many homeless persons with HIV infection will you reach in FY 1990 and 1991? 33. What special care are homeless HIV-infected persons receiving from this program for their underlying immunodeficiencies and other infections such as tuberculosis and endocarditis? 34. 35. How many adolescents in the U.S. are HIV-infected? What is the number of homeless adolescents in America today, and of that number, how many do you estimate are HIV-infected? 36. Are homeless health care programs funded by HRSA reaching homeless youth? How many? - - 37. The Institute of Medicine/National Academy of Sciences has published two reports Confronting AIDS in 1986 and an update in 1988 and several papers on the AIDS epidemic. In these documents, the IOM/NAS has charged that the nation has suffered from "the absence of strong federal leadership" and "a lack of cohesiveness and strategic planning" in its response to the AIDS epidemic. The reports cite as an illustration of "clearly inadequate" public policy, the provision and financing of health care. What is being done differently by this Administration, as compared with the previous Administration, with regard to leadership and strategic planning to combat the AIDS epidemic? 38. What are the functions of the National AIDS Program Office (NAPO)? we 39. In response to a subcommittee request for all documents related to care for persons with HIV infection and AIDS, received only one document from NAPO. It is dated April 28, 1989, and its title is "Cost and Financing of HIV Infection." The paper contains the following sentence: "If a medication were found to be indicated for large numbers of the seropositive population it probably will result in ... increases in counseling and testing costs as well as substantial increases in long term ambulatory care." This is the only reference to early intervention we received from NAPO. And yet, the CDC, NIH, FDA and the Office of the Assistant Secretary for Health (OASH) had been working on early intervention for many months. Why wasn't NAPO aware of this interagency effort? 40. The President's budget requested $3.7 million and 28 FTEs for NAPO. What will those funds be used for, and what work products will be produced? Please submit to the subcommittee a description of all the work products produced by this office in the past two fiscal years and the plan for the coming fiscal year. 41. 6 The President's budget requested $25 million for an AIDS "contingency fund" to be administered by OASH. According to the budget justification, this is for "added flexibility in allocating resources. Please provide an explanation of this and state what the plans are for spending the $25 million. 42. Authorization for the program to provide approved AIDS drugs to persons who cannot afford to pay for them has been added to the reconciliation bill. Does the administration support this? The authorization is for $30 million for the first year. Would you consider using the $25 million in the contingency fund for this purpose? 43. The five-year national strategy for the prevention of AIDS among IV drug users, developed by the National Institute on Drug Abuse, states, "it is not enough to simply expand drug abuse treatment. Additional funding is also needed to ... incorporate HIV testing and counseling programs within treatment programs, and to provide specialized services for patients with AIDS. Minimal standards of care must be developed and enforced to assure the quality of care provided." The paper also stated, "stable long-term funding is needed" for these purposes. What has the Public Health Service done in response to this? What plans are there for stable long-term funding? 44. At the subcommittee hearing on July 28, several witnesses spoke of the need for patient care in clinical trials. This is especially important, they said, in enrolling IV drug users, women, minorities and others who may not have access to primary care on a regular basis. How many of the AIDS Clinical Trials Units now provide patient care to those enrolled in clinical trials? For those which do provide care, please describe the types of services offered. 45. What are the barriers to participation in clinical trials by IV drug users, women and minorities? 46. Two witnesses, Dr. Lawrence Brown and Dr. Donald Craven, testified at the subcommittee hearing on July 28 that compliance rates among IV drug users are no worse than those of non-users, if they are provided with adequate and appropriate support services and health care. Dr. Brown cited two studies and Dr. Craven spoke from his own experience. Are such services covered by the research grants? If not, how are you assisting the ACTUS in providing such services? 47. Community-based research groups seem to be better able to provide patient care during clinical trials than academic centers where trials are traditionally conducted. In light of this, will you increase funding for this program in FY 1990 over the $6 million level in FY 1989? How much will you request for FY 1991 and 1992? Enclosed are responses to questions submitted to Dr. James O. Mason for the record of your August 1, 1989, hearing on HIV/AIDS health care and treatment. Also enclosed is an updated table that you requested, of expenditures for HIV/AIDS compared with total health care expenditures. If we may be of further assistance in this matter, please do not hesitate to contact me. QUESTION 1: Two-thirds of the AIDS cases in the U.S. are concentrated in cities in just five States New York, New Jersey, California, Texas, and Florida. In most of these States, health care for poor and minority citizens has been inadequate prior to the advent of the AIDS epidemic. Do you think the Federal Government has a responsibility to target assistance on these States to help them cope with the financial burden of this disease? ANSWER: The Federal Government, through the AIDS-specific grant programs of the Health Resources and Services Administration (HRSA), has provided significant financial assistance to these five States and others to help them organize efficient systems of HIV care. Under the HRSA Service Demonstration Projects (SDPS), |