NATIONAL COMMISSION ON ACQUIRED IMMUNE
DEFICIENCY SYNDROME

STATEMENT OF JUNE E. OSBORN, M.D., CHAIRMAN

ACCOMPANIED BY CARLTON LEE, LIAISON OFFICER

BUDGET REQUEST

Senator HARKIN. We will now hear from the National Commission on Acquired Immune Deficiency Syndrome.

The Commission's fiscal year 1992 request is $3 million, an increase of $72,000 over last year's level.

This Commission is charged with promoting the development or a national policy on AIDS and providing recommendations on the most effective methods to employ for controlling the spread of AIDS nationwide.

Dr. Osborn, I would like to welcome you back before the subcommittee. I want to commend you and the other Commission members on your work this past year and a half. The policy recommendations the Commission has presented on AIDS and the HIV epidemic have been invaluable to this subcommittee as we appropriate the money.

I know you share my sadness and concern over the vast amount of work that we have ahead of us in the 1990's. With over 100,000 deaths from AIDS to date, this tragic disease has taken a toll on our society and seems to be affecting younger women and infants at an alarmingly increasing rate. So, Dr. Osborn, I am looking forward to hearing your views on these issues so we can continue to map out a clear and active strategy to combat this epidemic.

So, Dr. Osborn, again welcome. Your statement will be made a part of the record. If you could summarize it, I would be most appreciative.

Dr. OSBORN. Thank you, Senator. Thank you for your welcome. I am pleased to be here.

With me is Mr. Carlton Lee, who is our liaison officer. Sadly Maureen Byrnes, who you know, could not be here because a very dear friend died of AIDS and she is at a funeral, which I am afraid will become a more frequent event for all of us in the upcoming times.

Senator HARKIN. Please give Maureen our best regards.

Dr. OSBORN. I certainly will. She sends her apologies.

As you know, the National Commission on AIDS is charged with promoting the development of a national consensus on policy concerning AIDS and of studying and making recommendations for a consistent national policy.

Allow me to take this opportunity to commend you and other Members of Congress for the passage of both the Americans with Disabilities Act and the Ryan White Comprehensive AIDS Re

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sources Emergency Act during the last session. The implementation of these acts will have far-reaching consequences for all those living with HIV disease.

Thus far, over 164,000 Americans have been diagnosed with AIDS and, as you just noted, over 102,000 of these individuals have died, close to 120 people are dying every day now, and I am sad to say probably over 150 are becoming infected every day. All of these numbers will escalate dramatically over the next several years. Nearly 1 million Americans face premature illness from HIV infection, and the minimum number of new infections each year-the minimum number-is 45,000. The more likely number is somewhere between two and five times that many. Since the interval between onset of infection with HIV and AIDS is commonly up to 10 years, each increment assures us of certain trouble into the 21st century now.

Confronted with the increasing human toll of the HIV epidemic, the Commission early in its tenure recognized the need to intensify national efforts to understand and meet the needs of people living with HIV disease and to stop the spread of HIV infection. Accordingly, the Commission in its work has endeavored to create broad public agreement on the magnitude, scope, and in particular, urgency of HIV epidemic.

The Commission has also sought to inspire leadership at all levels of both the public and private sectors to put in place effective, cooperative and nondiscriminatory systems and resources required for prevention, comprehensive care, and research efforts necessary to halt the epidemic.

We continue to fulfill our statutory mandate through public hearings, meetings, round table discussions, staff analyses, and interim reports, as well as site visits that we have made throughout the country. These forums provide a foundation for decisionmaking by providing an opportunity to consider expert testimony on the increasingly complex issues related to HIV disease, and by giving the Commission occasion to interact with and learn from care providers and persons living themselves with HIV disease in their own communities.

Since we began our work 19 months ago, we have heard from as many as 700 individuals and organizations from over 75 cities. We have issued three interim reports, an annual report, and are about to release a fourth report on HIV disease in correctional facilities. All of our earlier reports have been provided to the subcommittee and I believe are part of the record.

The activities of the Commission during the past year have reinforced our view that the Nation has far to go before we can claim victory in the war on AIDS. Based on what we have seen and heard, it is clear that the decade of the 1990's will be far worse than what we have thus far experienced. The epidemic continues to spread throughout the Nation, and our educational efforts have yet to take on the urgency needed to meet the demands of this terrible disease for which there will not be for some time a vaccine or a cure. As the caseload grows, there will be ever-increasing strains on the Nation's already faltering health care financing and delivery systems, an issue that we consider to be top priority. In fact, I should point out to you that the stresses and strains that you have

heard about in the AIDS epidemic relate to the surviving 60,000 cases of AIDS, with 10 times that many currently in need of care. At this time I would like to highlight some of our findings and recommendations of the past year.

In April of last year, the Commission issued its second interim report to Congress and the President. Key among the recommendations was a call for an establishment of a Federal interagency mechanism to coordinate a national plan for combatting the epidemic. The Commission found that a lack of clear definition of government roles at all levels has hampered our national ability to organize health care services, to recruit and train health services personnel, to provide housing for the sick, to provide effective HIV education and prevention programs, to provide coordinated, comprehensive substance abuse treatment and prevention programs, and to develop sufficient moneys to finance these efforts. All across the country there is a cry for leadership from the Federal Government and partnership between different levels of government and the private sector. There is no question that there have been creative and often heroic efforts at every level to address the HIV epidemic, but coordination of these efforts is the missing link to an effective national strategy.

The National Commission on AIDS will continue to recommend policy goals for a national plan. However, it is critical that a Federal interagency mechanism be in place soon so that those who are ultimately responsible for the implementation will have an active role in its development.

In August, the Commission issued its third interim report based on our findings concerning the HIV epidemic in rural America, in addition to issues concerning HIV in the health care work force, and the status of research initiatives. In the report the Commission called for an expansion of HIV education and outreach services in rural communities and additional resources to combat the three epidemics of HIV infection, drug addiction, and sexually transmitted diseases in rural America.

The report highlighted the need to address concerns about the limited number of enrollees in clinical trials at the National Institutes of Health, as well as the lack of demographic and geographic diversity of participants. The desperate need for more research on the management of opportunistic infections, usually the cause of death for people with HIV disease, was also stressed.

Finally, the report called for immediate actions to deal with a shortage of crisis proportions of health care providers capable and willing to care for people living with HIV disease.

Last summer we went to New York for a firsthand look at HIV disease in correctional facilities. As mentioned earlier, a report based on the powerful testimony we heard from corrections and prison health professionals from New York, but also from all around the country, as well as testimony from present and past detainees, will be issued in just a week or so by the Commission.

Last November we conducted hearings and site visits to examine the effects of the HIV epidemic on the Commonwealth of Puerto Rico, which has the second highest-San Juan has the second highest per capita rate of HIV in the country, the first being Washing

ton, DC. It was clear that the epidemic presents a number of unique challenges to the Commonwealth.

In December the Commission held meetings in Baltimore to discuss issues surrounding the financing of health care for people with HIV disease. And as mentioned earlier, we consider health care financing issues to be of the utmost importance and will devote much of our time and efforts to this matter over the coming months in coordination with other groups that are looking at those issues. We also had extensive discussions in Baltimore in December with numerous individuals from around the country about the HIV epidemic in the African-American communities.

In January of this year, the Commission held hearings on substance use in relation to HIV. Preventing the spread of the virus among intravenous and nonintravenous drug users is a formidable task. The overlapping epidemics of HIV disease and substance use present our Nation with major challenges, and we will continue to focus much of our attention on this important issue.

A few weeks ago, members of the Commission conducted site visits to various parts of the country to see the impact of the epidemic in native American communities where it has surfaced with a vengeance recently. This past week the Commission conducted hearings and site visits in Chicago that focused on the HIV epidemic in Hispanic-American communities and among the Nation's adolescent and pediatric populations.

Over the next several months, we plan to examine HIV disease among women and bisexual men, Asian-Americans, as well as other communities. We will also be spending a good deal of time examining issues of prevention and considering the health care delivery and financing needs of people living with HIV disease.

In its statutory role of advising Congress and the President, the Commission is trying to play an active role in the policy debate around issues relating to the epidemic, as well as legislative initiatives, such as the Americans with Disabilities Act and the Ryan White Comprehensive AIDS Resources Emergency Act of 1990.

As I am sure you know, the Commission has also been proactive in calling upon the administration and Congress to reassess current U.S. immigration policy as it relates to HIV disease. We are very pleased that both Congress and the administration have taken excellent steps to rectify existing policy, and we hope that the issue is favorably and durably resolved soon.

As required by law, the Commission will submit a major report to Congress and the President late this summer.

In fiscal year 1992, we plan to continue to conduct our activities through a variety of forums in Washington and around the country. As the second decade of the epidemic begins, the challenges before us are many. It is critical that the public health strategies of the 1990's designed to meet these challenges receive top priority at all levels of government and the private sector.

PREPARED STATEMENT

We will continue to fulfill our mandate with great determination and look forward to continuing our close working relationship with the Congress in the months ahead.