Mr. WEISS. Thank you very much, Mr. Inhofe.

You have not heard any evidence that, in fact, this disease is transmitted by mosquitos, have you?

Dr. FRASER. No. And I think the probability of that is very small, given the concentration of virus in the blood and the amount of blood that is carried by mosquitos.

Mr. WEISS. Thank you very much. Thank you, Dr. Fraser, for appearing and sharing your knowledge with us.

Our second panel will consist of Federal agency officials, and I want to welcome all of them.

First, we have Dr. Robert E. Windom, our distinguished Assistant Secretary for Health, Department of Health and Human Services, accompanied by other Public Health Service officials, who he will introduce.

Dr. Windom, Dr. Dowdle, Dr. Noble, and the other distinguished members of the panel, as you know, we ask our witnesses to swear or affirm to the truth of their testimony. So would you all please stand to be sworn?

Do you affirm that the testimony you are about to give is the truth, the whole truth, and nothing but the truth?

Thank you. Let the record indicate that all of the witnesses have replied in the affirmative.

Dr. Windom, your entire statement will be entered into the record as submitted to us, and you can then proceed as you deem most appropriate. We would appreciate it if you could limit your oral presentation to 10 minutes, if possible.

STATEMENT OF ROBERT E. WINDOM, M.D., ASSISTANT SECRETARY FOR HEALTH, DEPARTMENT OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY DR. LOWELL HARMISON, DEPUTY ASSISTANT SECRETARY FOR HEALTH; DR. WALTER R. DOWDLE, DEPUTY DIRECTOR [AIDS], CENTER FOR INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL; DR. JUAN RAMOS, DEPUTY DIRECTOR FOR PREVENTION AND SPECIAL PROJECTS, NATIONAL INSTITUTE OF MENTAL HEALTH; DR. ROY PICKENS, DIRECTOR OF CLINICAL RESEARCH, NATIONAL INSTITUTE OF DRUG ABUSE; DR. GARY NOBLE, AIDS COORDINATOR, PUBLIC HEALTH SERVICE; DR. SAMUEL MATHENY, DIRECTOR, AIDS OFFICE, BUREAU OF RESOURCES AND DEVELOPMENT, HEALTH RESOURCES AND SERVICES ADMINISTRATION; DR. JAMES HILL, ASSISTANT TO THE DIRECTOR, NIAID; AND HARELL LITTLE, CHIEF, BUDGET BRANCH, OASH

Dr. WINDOM. Thank you, Mr. Chairman, and members of the committee. I am pleased to have this opportunity to discuss the Public Health Service's response to the Acquired Immune Deficiency Syndrome epidemic and the emphasis on education and prevention activities.

With me today are Dr. Lowell Harmison, Deputy Assistant Secretary for Health; Dr. Gary Noble, the Public Health Service AIDS Coordinator; Dr. Walt Dowdle, the Deputy Director of the Centers for Disease Control; Dr. Juan Ramos, NIMH Deputy Director for Prevention and Special Projects; Dr. Roy Pickens; Dr. Samuel

I will now summarize my testimony, Mr. Chairman.

In a few short years, AIDS has grown from a rare and unusual health problem to an epidemic of major proportions; it is expected to continue to grow. More than 31,000 cases of AIDS have been reported to date. Already 16,000 of these patients have died. It is estimated that by the end of 1991, the cumulative total of AIDS cases in the United States will reach 270,000 and result in nearly 180,000 deaths.

Statistics will show that in 1986, AIDS became one of the top 10 leading causes of potential life loss. Cases of AIDS have been reported in all 50 States, Puerto Rico, the Virgin Islands, and the trust territories.

Although the majority of cases continue to occur among homosexual and bisexual men and intravenous drug abusers, the infection is also spreading among non-IV-drug-abusing heterosexuals and from infected mothers to newborn infants. Nearly 1,200 cases of heterosexual transmission and more than 450 cases of AIDS in children have been reported.

In addition, most infected IV drug abusers are heterosexual and can spread the virus by their sexual contacts.

There is no vaccine against AIDS and only a few drugs with very limited therapeutic potential. Complicating the picture is the fact that infected persons are capable of spreading the virus to others for years before experiencing the signs or symptoms of AIDS. At this time, information and education, which provide opportunity for individuals to eliminate or to reduce high-risk behavior, are the only means we have to prevent the spread of AIDS infection.

From the beginning, providing information has been an important part of our work. Our early efforts concentrated on the dissemination of scientific information to America's health community. Recently there have been significant changes in the direction and momentum of these efforts. Eighteen months ago, among our primary concerns were the safety of our blood supplies and the provision of alternate testing sites for people who believed they may have been exposed to the AIDS virus. Since then, safeguards have been put in place to ensure the safety of our blood supply. The alternate test sites have become a nationwide counseling and testing program, and AIDS health education and risk reduction programs are now in place across the Nation.

The report of the Public Health Service meeting in Coolfont, WV, last June and the Surgeon General's report on AIDS that was issued in October together mark the beginning of a more intense phase in our information and education efforts.

Within the Public Health Service, I have taken steps to enhance the effectiveness of our fight against AIDS. I have strengthened the position of the Public Health Service AIDS Coordinator. I have continued to rely on the Public Health Service Executive AIDS Task Force and its work by a series of subgroups, one of which focuses on information, education, and health education risk reduction. I have assigned lead agency responsibility for this activity to the CDC, and they now chair that subgroup.

CDC's Director, Dr. James Mason, has also taken steps to strengthen the management of AIDS activities. Also we initiated a Federal Coordinating Committee on AIDS Information, Education,

and Risk Reduction, which brings together Federal officials to coordinate the Federal Government's AIDS information and education efforts. I serve as Chairman of that Committee.

At my direction, the CDC is coordinating the development of the information education plan to prevent and control AIDS in the United States. This is a comprehensive Public Health Service plan for informing and educating the American people about AIDS. The plan specifies the audiences to be addressed, the basic elements of AIDS information and education, and the outline of strategies by which this education can be accomplished.

The plan draws upon the knowledge and experience the Public Health Service has gained since AIDS was first recognized, and it incorporates the contributions of many experts in the PHS agencies.

Successful implementation of this plan depends upon action and collaborative efforts among State, county, and municipal governments, professional and service organizations, the private sector, and the Federal Government.

From 1983 through 1986, the PHS spent $40 million to inform and educate the public in groups at high risk of acquiring the infection. In fiscal year 1987, we are planning to spend more than $79.5 million and in fiscal year 1988 more than $103.9 million. However, it is expected that funds appropriated by Congress in any given year for information and education will be multiplied manyfold by the efforts and resources of the public, other public agencies, and the private sector. This combined cooperative effort over the long term will have a much greater impact on changing public behavior than the efforts of the Federal Government alone.

Under the plan, our efforts are targeted to certain populations. The first is the general public.

A second is the special population of school- and college-aged youth. Schools, colleges, and family institutions provide an effective channel for appropriately instructing the young people of our Nation about AIDS before and as they reach the ages when they might practice behaviors that put them at risk of infection.

A third target population is those persons at increased risk or who are infected. Our highest priority is informing and educating those groups at increased risk of acquiring or transmitting the AIDS virus because of certain behaviors or circumstances, such as homosexual and bisexual men, IV drug abusers, hemophiliacs, female sex partners of those at risk, and prostitutes and their clients.

The fourth target population is our Nation's health workers. Members of this group have direct responsibility for patient care and for counseling AIDS patients, persons with laboratory evidence of infection, or other concerned persons. They will provide leadership in informing and educating the public.

I will highlight the activities that are being directed toward each of these populations.

Now that we have taken steps to protect our blood supply, we will be concentrating on preventing the sexual transmission of the AIDS virus and preventing the transmission of AIDS among IV drug abusers. Primary Federal responsibility for this aspect lies within the CDC. Information and education efforts to prevent the

sexual transmission of AIDS will encompass a number of major activities. This fiscal year, we are planning to conduct a national public information campaign.

In September 1986, an AIDS hotline service was expanded to a full 24 hours daily operation. We are continuing to distribute our Public Health Service public service announcements, as well as publications and materials prepared in collaboration with the American Red Cross and other organizations. To date, we have distributed about 325,000 copies of the Surgeon General's Report on AIDS.

This fiscal year, we will be establishing a National AIDS Information Clearinghouse in order to manage and handle the many publications regarding AIDS prevention and control. We plan to bring together major public and private sector organizations that are currently actively involved in the fight against AIDS and solicit their contribution to the Nation's effort to stem the epidemic.

Working at community levels, NIDA, the National Institute of Drug Abuse, is utilizing mass media and special print media to inform their special target audiences. Local communities are being encouraged to undertake public education programs. We are working with the entertainment community to encourage the industry to undertake activities to educate the public.

A national toll-free telephone has been established which directs drug abusers to treatment programs in their communities. This hotline service has been promoted in advertising which promotes treatment for intravenous drug abusers. The drug hotline is linked also to our AIDS hotline.

Schools efficiently can inform 90 to 95 percent of young people about the dangers of AIDS and how to avoid becoming infected. The 5 percent of children who do not attend school may be at even greater risk and will require special efforts through mechanisms other than schools if they are to be reached by our efforts.

In 1987, we are initiating a comprehensive school health education program. To supplement the State and local efforts, we will be working with national organizations to help schools provide effective AIDS education. To round out our program, we will be undertaking a number of other activities designed to assist State and local education agencies, such as establishing an annotated, computerized bibliography of relevant AIDS education materials, summarizing the private sector development of effective school health education materials, assessing the impact of national, State, and local efforts, and establishing a national coalition for AIDS school health education.

Prevention and control of AIDS will depend upon successfully interrupting the transmission of the virus among those persons whose behaviors or their circumstances put them or others at risk of infection. The major element of our efforts to prevent sexually transmitted AIDS is the provision of assistance to the States in conducting AIDS prevention programs, which include health education risk reduction programs and counseling and testing.

Currently, we are funding six demonstration projects designed to implement and evaluate intensive community level programs to prevent the transmission of HIV infection. Two of the projects have

program elements directed toward reaching minority populations at risk.

CDC, working with the Health Resources and Services Administration [HRSA] and the National Hemophiliac Foundation, is supporting the development and delivery of health education and risk reduction counseling programs for hemophiliacs.

We will be continuing our joint venture with the Conference of Mayors that is designed to help stimulate information and education programs at the community level. In 1987, we will be initiating pilot projects to develop and test approaches to prevent perinatal transmission of the AIDS virus.

The two major problems confronting this area of public health are (1) how to reach uninformed groups-adolescents, ethnic minorities, drug abusers, and women-with the message on risk reduction, and (2) how to surmount resistance of persons toward changing their behavior. Thus, the National Institute of Mental Health also has funded research into these areas.

Targeted AIDS community demonstrations will be awarded as demonstration research contracts that focus on specific prevention initiatives. Health workers also will be stimulated and involved to help decrease the risk of transmitting the virus to others; they also represent a major channel for providing adequate AIDS information.

NIDA's educational activities are focused on providers who come in contact with drug abusers, such as drug abuse treatment program staff, primary health providers, and social service personnel. Emphasis is placed on building State and local training capacity, developing educational and training materials, and training trainers to facilitate such capacity building.

The National Institute of Mental Health is striving to overcome a shortfall of funding for academic institutions throughout the Nation to train all types of AIDS health care providers to recognize, refer, or treat the mental health elements of this disease.

The National Institute of Dental Research is developing posters and leaflets for use in dental offices, clinics, and schools to increase awareness of the need for the use of barrier techniques for dental care providers.

In fiscal year 1987, HRSA will award grants to develop three regional AIDS Education and Training Centers to provide education and training for health care providers. HRSA is also supporting AIDS service demonstration projects in New York, San Francisco, Los Angeles, and Miami, which provide extensive information related to the prevention of further spread of the AIDS virus.

CDC has engaged in a wide variety of activities, ranging from the issuance of guidelines in the MMWR to distributing slide series in response to nearly 4,000 requests.

In conclusion, sir, I have been highlighting the work of our Public Health Service agencies, and I am proud to be associated with all these dedicated people in the Public Health Service who have committed so much personal effort to the battle to prevent AIDS.

But it must be emphasized that we are not working in isolation. We must recognize the role that the media has played in helping to