Fraser - AIDS education March 16, 1987 responsibility in that way will be essential for mounting an effective Suggestions for model program, but other elements will also be necessary. programs for education and control must be developed for use in the states, and the money must be provided for putting those model programs in place. Experienced representatives of state and local health departments, health care providers, educators and potential consumers can help greatly in advising on the content of these model programs. The use of serologic testing in conjunction with careful counselling is likely to be an important part of education especially of those in high risk groups. This will require great expansion of counselling and voluntary testing in clinics for sexually transmitted diseases, IV drug use, and obstetrics and gynecology. In all of this work, we must be very careful to protect the confidentiality of test results if these programs are to be effective in reaching those that need them. Private physicians must be mobilized to serve as counsellors and educators for all of their patients at risk of AIDS. Professional medical organizations, like the American Medical Association and the American Academy of Pediatrics, and state medical societies should be leaders in encouraging and focusing the work of private physicians to alert their patients to the danger and to help them make responsible choices. Special attention must be paid to AIDS education for young people in junior high school, high school and college, many of whom are entering periods of experimentation with sex and drugs. Frank discussion of the risk Fraser AIDS education 7 March 16, 1987 necessity. of AIDS and behaviors that do and do not transmit HIV has become an urgent CDC could, for example, develop several model curricula for use in junior high schools, allowing local school boards to select which might be most appropriate for their particular settings. By taking the initiative, however, CDC and the Federal government generally would indicate how important it is that AIDS education be universal, be frank and begin early. A broad and effective educational campaign is likely to require far more use of advertising than has occurred to date. Prime time television offers an important opportunity to reach a large portion of the U.S. population with detailed information about AIDS risk and practical preventive measures. The networks should be willing to contribute substantially to this effort as part of their public trust. Local radio spots and billboards can also be used imaginatively. AIDS education should be pursued with a sense of urgency and a level of funding that is appropriate for a life-or-death situation. Greatly expanded educational programs to effect behavioral change are necessary for high-risk groups and the public at large. The total budget for AIDS education and public health measures from governmental and private sources combined should approximate $1 billion annually by 1990. This represents per capita expenditure equal to that provided by the State of California for San Francisco in 1986. If we are to slow the spread of HIV, we must be ready to educate the entire U.S. population with the intensity that to date has been reserved for selected high risk groups. With a disease that has as long an incubation period as AIDS we cannot afford to initiate intensive and Mr. WEISS. Thank you very much, Dr. Fraser. Before we proceed with questions, let me take note of the fact that we have been joined by one of the newest members on the subcommittee and in the Congress, Mr. Inhofe from Oklahoma. We are delighted to have you with us. I understand that you have an opening statement that you would like to give. Mr. INHOFE. Yes, I do, Mr. Chairman, if I may be allowed to make a brief opening statement. I want to thank you for holding the hearing on AIDS education and prevention efforts. It is urgent that we as Members of Congress work toward stopping this dreadful killer. In my home State of Oklahoma, the number of AIDS cases has doubled each year since 1983 according to the State health officials I have personally talked to. By the end of the decade, the disease could become the No. 2 communicable disease in the State. To date, there have been 92 reported cases of AIDS and 49 deaths. Of the reported cases, 25 have occurred in Tulsa, OK, the district which I represent. Oklahoma health officials estimate that the number of AIDS cases could top 800 by 1990. Although these numbers are much lower than most other States, the spread of AIDS represents a serious threat to all communities. Today's tragic reality is that AIDS is continuing to affect more Americans because many of its victims continue to transmit the disease because they are unaware that they are carriers of the virus. AIDS is no longer confined to homosexuals and drug users but has been spread to the general population. Recent studies by the Federal Public Health Service indicate that approximately 9 percent of all new cases of AIDS involve those who contracted the disease as a result of heterosexual activities. It is my hope that today's hearing will make significant progress in preventative measures to stop the spread of AIDS. I want to thank you for giving this emphasis on it, Mr. Chairman. One of the myths that kind of spreads around is that only people on the east coast and the west coast should be concerned with this problem. In visiting with Bill Dannemeyer prior to going into session in January, I found that people out in California are very much concerned. There seems to be a fear, Mr. Chairman, for people in my part of the country to address this as being a serious problem. So as an experiment and I will share this with you, I went back in the third week in January, and held a news conference just on AIDS and the threat that it was in a very frontier spirited conservative area like Tulsa, OK, and let me assure you that it captivated their attention. I feel very strongly in my limited exposure to the knowledge on AIDS that it is the greatest life threat in the history of the world. I am very, very much concerned about it. So that comes from out in Oklahoma, and I do have a question for Dr. Fraser when the appropriate time comes. Mr. WEISS. Thank you very much, Mr. Inhofe. Dr. Fraser, you are familiar with the Surgeon General's report on AIDS, I'm sure. Mr. WEISS. We will, incidentally, from time to time be placing the various reports and documents that we refer to in the hearing record, without objection. If any of the members or any of the witnesses have material which they would like to place in the record, please so indicate and we will try to make that effort. Are you in general agreement with the findings and recommendations contained in the report? Dr. FRASER. Yes. I think in general the U.S. Public Health Service has done a remarkable job in investigating this problem and in identifying ways to control it. I think that more has to be done than has been done. Much of the limitation of that has to do with funding, but clearly the directions are outlined by the Surgeon General. Mr. WEISS. Are there any areas of serious disagreement between the National Academy of Sciences' report and the Surgeon General's report? Dr. FRASER. I think the biggest area of contrast is in the concern of the National Academy and Institute of Medicine Committee that the education effort be greatly expanded, centrally coordinated and put forward more assertively than has been the case in the past. We recognize that many in the U.S. Public Health Service want to do that same thing but our Committee wanted to emphasize this even more strongly than the Surgeon General has because there is so much more to do. Mr. WEISS. The National Academy of Sciences' report states that "education to prevent HIV infection can be strongly expected to bear results," especially in view of the serious and fatal nature of the disease. What leads you to believe that education will help to prevent HIV infection? Dr. FRASER. I think the best evidence of that comes from the gay populations, as in San Francisco, where intense efforts have been put in place by the city, by private voluntary organizations, and by the State of California, along with help from the U.S. Public Health Service. There, there has been evidence of changes in sexual behavior, as evidenced by drops in rectal gonorrhea rates, indicating changes in sexual behavior in that population. Mr. WEISS. Until recently, relatively little money has even been requested by the Public Health Service for information/education. I wonder if this can be connected in any way to the overly optimistic predictions by the administration several years ago that soon we would have a vaccine and effective treatment measures. Is there still a belief in the administration, do you think, that one need not worry too much about AIDS because we will soon have a cure? Dr. FRASER. There may be members of the administration who believe that. The scientists with whom I talked believe that, for the next 5 or 10 years, our emphasis has to be on education because it is the only method we have to halt spread of the virus. Even the optimists think that a vaccine will be unavailable for the next 5 years. Mr. WEISS. The NAS report describing AIDS education to date states "The present level of AIDS related education is woefully inadequate." Why did the Committee come to that conclusion? Dr. FRASER. Well, for example, if we look at one of the major needs, counseling in conjunction with confidential serologic testing of high-risk groups, perhaps $40 million has been spent last year on that activity. I would estimate that the cost of a really adequate program of counseling and confidential testing of high-risk people would cost somewhere between $200 and $600 million a year. It is a major expense to train counselors. There is a high burnout rate among counselors. There is the need for very careful work between counselors and high risk people, to make sure that they understand the way this disease is spread, that they understand the mechanisms that are open to them to halt the spread of the disease and they understand what their own situation is, if they happen to be infected. Mr. WEISS. The report also states that "If behavior modification is the goal of education about AIDS, the content of the material presented must address the behavior in question in as direct a manner as possible." The Surgeon General agreed with that very conclusion. Based on your experience and the discussions of the NAS Committee, do you believe that the Federal Government can effectively support frank and open education efforts? Dr. FRASER. I think it's hard for the Federal Government to do that. I think that the Federal Government has taken some steps to put some distance between the tendency to be reserved in speech and the actual decisionmaking about what materials are used at a local level, but I certainly see a trend toward more frankness. I think we need much more frankness than we have had to date, not just talk about condoms but talk about specific sexual acts, as I did in my testimony. Mr. WEISS. Why did the Committee believe that only the Federal Government was situated "to develop and coordinate a massive campaign to implement the educational program"? Dr. FRASER. The Federal Government has been superb in my view and I think in the view of all members of the Committee in pursuing the scientific aspects, the epidemiologic aspects and the virological research that has been necessary. It is in a uniquely strong position to provide publicity about the need for education and adequate funding throughout the United States, not just in States where there is already the perception of a very high risk, like California or New York, but in States where the perception is that the risk is not so immediate. We need to have education put in place intensively now in highand low-risk areas. I do not see the central drive for that coming efficiently anywhere from any source other than the Federal Government. Mr. WEISS. The Public Health Service has been working on what they call an AIDS information/education plan for many months. Have you, or to your knowledge, any of the National Academy of Sciences' Committee members been asked to assist in the drafting or review of the Public Health Service plan? Dr. FRASER. I have not been asked and I don't know of other people who have been asked. |