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Senator HARKIN. Thank you very much, Dr. Judd. This subcommittee, and this Senator in particular, has been very supportive. The National Institute of Mental Health, last year, we increased by $101 million, $398 million to $491 million, almost a 30percent increase.

Dr. JUDD. Yes; for which we were very grateful, Mr. Chairman.

Senator HARKIN. You wound up pretty good. We wound up with $458 million. We had to come down from that, we had to compromise with the House on that, so we have a record of strong support. We want to continue that strong support as much as the budget will allow us to take advantage of the increased focus the decade will bring, and to make sure that we fulfill those objectives that were set out during this decade. So by the year 2000, we will have made some giant strides toward unlocking some of the secrets that we know are there.

Dr. JUDD. Exactly,

Senator HARKIN. We need the research done. We are getting closer all the time to unlocking some of those doors, and now is not the time to back off.

Dr. JUDD. Wonderful. Senator HARKIN. Thank you, Dr. Judd. Dr. JUDD. Delighted to hear that. Thank you very much, Mr. Chairman,

STATEMENT OF DANIEL T. BROSS, EXECUTIVE DIRECTOR, AIDS AC.

TION COUNCIL Senator HARKIN. Our next witness is Daniel T. Bross, executive director of the AIDS Action Council.

Mr. Bross, welcome to the subcommittee. And your statement will be made a part of the record in its entirety. Please summarize it.

Mr. BROSS. Thank you, Mr. Chairman, Senator Gorton, members of the subcommittee staff.

I am Dan Bross, executive director of the AIDS Action Council. The council represents more than 500 community-based AIDS service organizations at the front lines of the AIDS epidemic. I want to thank you for the opportunity to testify this morning, and to convey the AIDS community's appreciation for your leadership, and particularly your efforts last year in providing funding for the Ryan White CARE Act.

Unfortunately, once again this year, AIDS Action must come before you again with an urgent appeal for increased AIDS funding. Ten years after the reports of a strange new illness, AIDS has killed more than 100,000 Americans. There will be 60,000 newly diagnosed cases of AIDS this year alone. Every single day, 125 people die of AIDS, and 110 more become infected with HIV.

As someone who has worked for the last 5 years at the community-base level, I can tell you that the suffering out there is real, it is terrible, and it is getting worse. AIDS Action Council convenes the Coalition of National Organizations responding to AIDS, representing more than 150 national groups, actively fighting the virus.

In the coalition's expert judgment, it would take $3 billion in 1992, or $1 billion above the President's request to adequately address the epidemic. I am happy to submit a copy of our appropriations recommendations for 1992 for the record. We make this request recognizing the constraints imposed by the Budget Enforcement Act, but as a Nation we must recognize the threat that AIDS poses to our national security, and respond just as resourcefully as we have to perceived threats abroad.

Today I want to focus on the most neglected aspect of our Nation's response to the epidemic: care for men, women, and children with HIV. This year, AIDS Action Council's top priority is full funding of the Ryan White CARE Act. The statistics I cited earlier are a brutal reality for AIDS service organizations, all of which handle overwhelming caseloads to make up for the lack of services in their communities. Yet even for community-based groups, service cuts may be the harbinger of the future. Caseloads in the 16 cities under title I of the CARE Act have increased 20 percent in the last year. With 5-percent inflation, and with two additional cities now eligible, title I funding will need to be increased by 30 percent, just to meet the same fraction of need addressed last year.

The funding provided in title I is making a difference in those cities, but without significant increase in services, we will have to lag—we will not be keeping up in the increase in caseloads. The same can be said for State services funded by title II of the act. Between the level of funding proposed by the President and the expiration of overlapping funding cycles, there will be an actual decline in the level of care States can provide.

As you know, title III's early intervention programs were not funded last year. We do not know how many people have developed AIDS as a result. However, we do know that some 600,000 HIV infected Americans now need early intervention care. Sadly, only a tiny number are receiving it.

Together the CARE Act's three titles comprise a comprehensive response to the care needs of people with HIV. Full funding of these programs at more than $500 million above the President's request would represent a dramatic and unprecedented increase in funding. But please, remember that the care for people with HIV has been neglected by the Federal Government for 10 years. Consequently, the epidemic continues to devastate our Nation's health care delivery system.

PREPARED STATEMENT

Mr. Chairman, literally hundreds of thousands of Americans with HIV and their families are looking with hope to this committee. Please do not disappoint them.

Thank you.

[The statement follows:]

STATEMENT OF DANIEL T. BROSS Good morning Mr. Chairman, my name is Dan Bross. I am executive director of the AIDS Action Council. The Council represents the 500-plus community based AIDS organizations who are at the frontlines of the nation's fight against AIDS.

I want to thank you for the opportunity to testify this morning and to underscore the AIDS community's appreciation for your leadership in the fight against AIDS, Once again, however, AIDS Action Council comes before you with an urgent appeal for increased funding for our nation's AIDS programs.

As you know, AIDS Action Council convenes the coalition of National Organiza. tions Responding to AIDS, which represents over 150 national groups concerned about a comprehensive federal response to AIDS. In our professional judgment, it would take $3 billion in funding in 1992, or $1 billion above the President's request, to begin to address the range of challenges posed by this epidemic. I am happy to submit a copy of our alternative budget proposal for the record.

We make this funding recommendation fully cognizant of the limitations imposed by the Budget Enforcement Act and our national commitment to reducing the desicit. But surely we as a nation can recognize the threat that AIDS poses to our national security and respond just as resourcefully as we have to perceived threats in the international arena.

In its tenth year, the AIDS crisis is no less dramatic than before. Indeed in many respects its demands on our nation's health care system are far more pressing than ever. Already, over 100,000 Americans have died of AIDS; the CDC estimates that there will be 60,000 newly diagnosed cases of AIDS this year alone; every day, approximately 125 people die of AIDS-related causes, 165 people are diagnosed with full-blown AIDS, and 110 people become infected with HIV.

As someone who both represents and has worked for community-based AIDS organizations, I can tell you that the suffering out there is real; it is terrible; and it is getting worse.

There is so much our nation must do to properly contain this epidemic:
-Our nation still lacks a comprehensive strategy for and commitment to edu.

cation and other prevention programs needed to stem the spread of HIV infec.
tion. What programs we have are chronically underfunded. There is a cruel
irony in the fact that the President's budget request contains only a one percent
increase in funding for prevention programs while it acknowledges that spend.
ing for Medicare and Medicaid will rise by 29 percent. We have neglected pre-
vention, and now we are paying for that neglect in the cost of care.
-Our nation's research efforts have made dramatic gains in our understanding
of HIV disease. But research efforts are being crippled by underfunding and
understaffing. A recent study conducted by the Institute of Medicine at the re-
quest of the NIH concluded that the AIDS research effort would benefit from

a 25 percent increase in funding. We fully support that recommendation. --And because of the close connection between injection and other drug use and

the transmission of HIV, it is critical that our nation's capacity to treat and prevent substance abuse be increased—and that HIV-related services be integrated

into those programs. But in the limited time I have today, I want to focus on the most neglected aspect of our nation's response to the AIDS epidemic: the care needs of people with HIV infection. In this fiscal year, AIDS Action Council's highest priority is to fulfill the promise of the Ryan White CARE Act and move toward full funding of the desperately needed programs created by CARE. The jump start given these programs last year must be more than matched this year, if we are to begin containing the burden posed by this epidemic on our nation's health care system.

The statistics I cited earlier are an every day reality for the AIDS service organizations throughout the country. They must cope with burgeoning caseloads and the disproportionate impact HIV is having on local health care delivery systems. Just last year the country's largest AIDS service provider, in New York, was forced to limit its services for the very first time.

Service cuts may be the harbinger of the future. The caseload in the 16 cities funded under the emergency assistance portion of the CARE Act has increased 20 percent in the last year. Allowing 5 percent for inflation, Title I funding would need to increase by 25 percent just to meet the same fraction of the need addressed in the 1991 appropriation. The funding already provided in Title I is making a dramatic difference in those 16 communities. But without significant increases, these communities will continue to fall behind in their battle to keep up with the growing caseload.

The same can be said for the funding provided the states in Title II of the CARE Act. With the expiration of overlapping funding cycles in 1992, level funding will mean an actual decline in the level of care-related services states can provide. On top of a growing caseload, this will result in tragedy for thousands.

As you know, Title III of the CARE Act, which provides for early intervention services, was not funded last year. It is hard to know how many people have devel. oped AIDS as a result. But we do know that some 600,000 HIV-infected Americans now need early intervention services—care that can delay or prevent their developing AIDS. Only a very small number are getting it. Indeed, the need for these serv. ices is 80 great that many of the Title I cities have set aside resources to provide such care because Title III was not funded.

Short of dramatic changes in our nation's entitlement programs, the three titles of the CARE Act, taken together, comprise a comprehensive Federal response to the care needs of people with ÅIV infection. We understand that asking for full funding of these programs—at more than $500 million above the President's budget request—would represent a dramatic, and unprecedented, increase in funding. But we must remember that care is an area that has been neglected by the Federal government until last year. We must make up for lost time. That $500 million should have been spent over the past ten years; it must be spent now.

Mr. Chairman, literally hundreds of thousands of Americans with HIV infection and their families are looking with hope to this committee. Please don't disappoint them and send thousands to an early death.

TESTING AND COUNSELING STATUTE Senator HARKIN. Mr. Bross, thank you very much for your testimony. Again you have a sympathetic ear here. We will do everything we can. The President's request is a 3.5-percent increase. Title III, the testing and counseling statute requires at least 35 percent of funding be spent on new services. My question is should we first insure existing services are not cut.

Mr. BROSS. The President's request of a 3.5-percent increase does not even meet inflation for this year. As I cited in my testimony, we are looking at a 20-percent increase in caseloads, just in the title I cities. So I think that in order to meet the needs of the people out there, we need to maintain at least current services. And with the President's request, we are really looking at a reduction in current services.

Senator HARKIN. You are asking for about $1 billion over what the President has requested.

Mr. BROSS. That is for AIDS programs throughout the Federal Government, sir. On the CARE Act specifically, we are only asking that Congress appropriate the moneys that were authorized last year. And that is $851 million.

Senator HARKIN. I understand. Mr. Bross, we will do our best.

Mr. BROSS. I know you will, Senator. Thank you very much. STATEMENT OF DR. MATHILDE KRIM, AMERICAN FOUNDATION FOR

AIDS RESEARCH Senator HARKIN. Our next witness is Dr. Mathilde Krim, American Foundation for AIDS Research. Dr. Krim, good to see you again. And welcome to the subcommittee. Your statement will be made a part of the record in its entirety.

Dr. KRIM. Thank you, Mr. Chairman. Yes; we submitted a written statement, and because of the very short time today, I will limit my presentation to emphasizing a few important facts that I would hope you would keep in mind during the appropriations process. I will comment specifically on behalf of AmFAR, the American Foundation for AIDS Research on the research needs related to AIDS.

One of the very important facts to remember is that we are facing today only the early phases of a worldwide epidemic of a deadly viral infection. The World Health Organization has predicted that the number of cases over the next 10 years will be tenfold larger than during the past 10 years—than what we have experience over the past 10 years. And also that there will be a demographic change in the epidemic, and that by the year 2000, 30 to 40 percent of all people with AIDS will be women and children.

The second important fact is that this epidemic will not be selflimiting, it will not disappear by itself. There are good reasons for this statement, and if you are interested, I could list them later.

The third important fact is that, therefore, only biomedical research can control, ultimately, eventually, the epidemic and stop it in producing treatments for people who are already infected and a vaccine to protect the uninfected.

The fourth important fact is that HIV infection invariably leads to AIDS and we have never yet saved the life of a person with AIDS. We have made progress. We have been able to prolong survival, but we have not saved anybody yet. A lot remains to be done.

In the Federal Government, the agencies that have the heaviest responsibilities in the crucial research effort are the National Institutes of Health, the Alcohol Drug Abuse and Mental Health Administration, and the Centers for Disease Control. Progress in the war against AIDS, not only on behalf of American citizens, but on behalf of people all around the world, depends almost entirely upon new fundamental knowledge developed by or through the extramural programs of these three agencies. And they all are in need of significant additional support.

The capacity for scientific discovery is far from being fully reached at this time. For example, we found only 24 percent of all the approved grants admitted to the NIH. And for this reason, the American Foundation for AIDS Research support increase in funding for all basic biomedical research. It endorses, speaking of the work of the NIH specifically, it endorses the recommendations of a recent study conducted by the Institute of Medicine. And it particularly recommends to your attention a program of the NIH, called community program for clinical research on AIDS, or CPCRA, which is an innovative and cost-effective program that accelerates the pace at which promising experimental treatments are evaluated and made accessible to all those who need them, including women.

The CPCRA Program, I hope, will continue to receive funding, and, in fact, significantly increase support in the years ahead.

We also need much further research on addictive disorders in order to have a better understanding of these disorders so that treatment can be for rational and more cost effective treatments. It is an illusion to us for a national strategy for drug treatment on demand and education unless we have more rational and cost-effective treatments.

Finally, I would like to say that resources for these research efforts should not come from other domestic programs, nor should they be provided at the expense of medical care for those with AIDS. We just heard the extremely urgent needs in this area from the representative of the AIDS Action Council, nor should these resources come at the cost of prevention education for those at risk of AIDS.

We are well aware of the restrictions of the Budget Enforcement Act, but we know of the numbers, we know of the suffering, and we know how much the American people needs to understand why it must and how it can protect itself from AIDS.

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