CONTENTS Dunne, Richard, executive director, Gay Men's Health Crisis..... Fraser, David W., M.D., president, Swarthmore College, and member, Institute of Medicine, and Health Care and Public Health Panel of the National Academy of Sciences Committee on a National Strategy for Gebbie, Kristine M., R.N., M.N., administrator, health division, Oregon Department of Human Resources. Gerald, Gilberto, director of minority affairs, National AIDS Network Joseph, Stephen C., M.D., M.P.H., commissioner of health, New York City Rosenberg, Michael J., M.D., M.P.H., executive director, American Social Stroud, Florence, R.N., M.P.H., deputy director for community public health programs, San Francisco Department of Public Health.. Swales, George, M.A., director, Sunnye Sherman AIDS Education Project. Weiss, Hon. Ted, a Representative in Congress from the State of New York, and chairman, Human Resources and Intergovernmental Rela- tions Subcommittee: Opening statement Windom, Robert E., 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, Direc- tor 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..... Letters, statements, et cetera, submitted for the record by: Dowdle, Dr. Walter R., Deputy Director [AIDS], Center for Infectious Diseases, Centers for Disease Control, Department of Health and Breakdown for high incidence areas by project area Information concerning money spent for fiscal year 1987 Dunne, Richard, executive director, Gay Men's Health Crisis: Prepared Fraser, David W., M.D., president, Swarthmore College, and member, Institute of Medicine, and Health Care and Public Health Panel of the National Academy of Sciences Committee on a National Strategy for Letters, statements, et cetera, submitted for the record by-Continued Page 131-143 Swales, George, M.A., director, Sunnye Sherman AIDS Education Project: 162-172 Windom, Robert E., M.D., Assistant Secretary for Health, Department of Amount budgeted to aid community-based groups for fiscal year 1987. 92 Memorandum concerning "Housecalls" series Fiscal years 1986 and 1987 expenditures for the AIDS augmentation Money spent in fiscal year 1986 on community-based capacity build- 92 Prepared statement..... 27-46 Weiss, Hon. Ted, a Representative in Congress from the State of New York, and chairman, Human Resources and Intergovernmental Relations Subcommittee: May 15, 1986, memorandum concerning a draft initiative.......... 78-85 51-56 APPENDIXES Appendix 1.-Documents referred to in the record 193 312 THE FEDERAL RESPONSE TO THE AIDS EPIDEMIC: INFORMATION AND PUBLIC EDUCATION MONDAY, MARCH 16, 1987 HOUSE OF REPRESENTATIVES, INTERGOVERNMENTAL RELATIONS SUBCOMMITTEE OF THE COMMITTEE ON GOVERNMENT OPERATIONS, Washington, DC. The subcommittee met, pursuant to notice, at 10:03 a.m., in room 2154, Rayburn House Office Building, Hon. Ted Weiss (chairman of the subcommittee) presiding. Present: Representatives Ted Weiss, Barney Frank, and James M. Inhofe. Also present: James R. Gottlieb, staff director; Gwendolyn S. McFadden, secretary; Mary Kazmerzak, minority professional staff, Committee on Government Operations; and Linda A. Valleroy, Ph.D., congressional science fellow. OPENING STATEMENT OF CHAIRMAN WEISS Mr. WEISS. Good morning, The Human Resources and Intergovernmental Relations Subcommittee is now in session. We will be joined by other colleagues as the hearing proceeds. Since 1981, the Public Health Service has reported almost 32,000 cases of AIDS in the United States. Unknown thousands suffer from pre-AIDS conditions. Medical experts believe that up to 2 million Americans are already infected with the AIDS virus. Based on the current growth rate of the epidemic, more than 74,000 new cases will be diagnosed in the year 1991 alone. These numbers only hint at the incredible suffering being endured by those struck down by the disease and by their families and friends and loved ones. We have no vaccine to prevent the disease. Effective drugs for treatment are not yet in sight, although a few do show some promise. In light of these facts, it would be a grave mistake for the American people to relax and assume that researchers will find a cure for AIDS in the near future. Public health officials tell us that the greatest hope for stemming the AIDS epidemic is an aggressive public health education campaign, greater than the United States has ever undertaken. Last fall, the National Academy of Sciences concurred, emphasizing that "The most effective measures for significantly reducing the spread of... (AIDS) are education of the public and voluntary changes in behavior." At about the same time the Surgeon General warned when releasing his excellent report on AIDS last October, "The need (for education) is critical and the price of neglect is high." Today the subcommittee will hold its seventh public hearing on the Federal response to AIDS. In earlier hearings we have reviewed overall AIDS funding, discrimination, patient care, civil rights, testing and drug development, issues which remain extremely important. Today, we will focus on Federal efforts to devise and implement a massive public education campaign. There are many dedicated Government Public Health Service people attempting to mount an effective education campaign. But, despite their urging for months, and in some case, for years, of specific education activities that are needed, they have been unable to get administration approval even for an overall AIDS information plan, which has been circulating for months. In some cases, aggressive Federal activity has been stalled by bureaucratic and interdepartmental fighting, and in other cases, by controversies over the content of education materials being developed by Federal contractors. Only after this hearing was announced a few weeks ago did a number of important projects finally begin to start moving at the Department. Some of these had been stalled for months, like a proposal to hire an ad agency to begin work on a media campaign. Even with this new initiative, it will probably be another full year before the mass media campaign begins. One major stumbling block to Federal efforts is the continuing dispute over the content of school education material on AIDS. While I agree that school curriculum should be locally determined, the administration must not use this as an excuse to limit the information local school boards and parents have available to make those decisions. As the Surgeon General stated, "We can no longer afford to sidestep frank, open discussions about sexual practices.' The National Academy of Sciences was forced to conclude last fall that "The present level of AIDS-related education is woefully inadequate. It must be vastly expanded and diversified." Other countries with many fewer AIDS victims have undertaken some excellent education campaigns. These will hopefully become models for the United States. of ficials have stepped in to fill the void in Federal efforts. Some of Fortunately, many local organizations, and public and private these, like the American Red Cross, have been supported by grants from the Public Health Service, but much, much more is needed. Education, information and the practice of safe behavior are the to lessen unnecessary fear and to cease discrimination against only weapons we presently have to stop the spread of the epidemic, AIDS victims. efforts appear to have been, at best, slow and inadequate. Today, Until now, the Federal Government's information and education we will attempt to learn why, and try to make sure that everything As we proceed and other members arrive, we will afford them which can be done, is being done. the opportunity to make their opening statements. We have a number of panels scheduled. Our first witness, panel one, will be Dr. David W. Fraser, who is president of Swarthmore College, a member of the Institute of Medicine, and a member of the Health Care and Public Health Panel of the National Academy of Sciences Committee on a National Strategy for AIDS. Dr. Fraser, before we proceed, the tradition and practice of the subcommittees of the Government Operations Committee is to swear in the witnesses. Would you please raise your right hand. Do you affirm that the testimony you are about to give will be the truth, the whole truth, and nothing but the truth? Let the record indicate that the witness answered in the affirmative. Dr. Fraser, your entire statement, as prepared, will be entered into the record, without objection. STATEMENT OF DAVID W. FRASER, M.D., PRESIDENT, SWARTHMORE COLLEGE, AND MEMBER, INSTITUTE OF MEDICINE, AND HEALTH CARE AND PUBLIC HEALTH PANEL OF THE NATIONAL ACADEMY OF SCIENCES COMMITTEE ON A NATIONAL STRATEGY FOR AIDS Dr. FRASER. Next to the threat of nuclear war, AIDS is fast becoming the most important public health problem of the 20th century. That importance comes from three facts, that it is likely to kill 179,000 people in the United States alone by 1991, that it af fects especially young adults and, increasingly, children, and that, although we have no effective drugs to treat it nor vaccine to prevent it, we do know how to prevent the spread of the virus that causes it. Education is the one tool that we have for controlling the AIDS epidemic but up to now it has not been used with near the effectiveness that is called for. I shall try to lay out the case for a centrally coordinated, comprehensive educational program to halt the spread of HIV, the AIDS virus, via sexual transmission, through intravenous drug use and from mother to infant. HIV is most commonly spread by sexual intercourse, specifically anal intercourse and vaginal intercourse. People who are intent on not catching HIV have several good strategies they can follow. The surest is to remain in a monogamous relationship that has been so since 1977 or to abstain from anal or vaginal intercourse but these strategies are not practical for many people and the number for whom this advice is not helpful grows as each generation becomes sexually active. For those people, using a condom during anal or vaginal intercourse is likely to be very effective. Barring a tear in the condom the HIV is most unlikely to be transmitted through it, and other activity during lovemaking, including kissing and oral-genital intercourse, does not seem to spread the virus. For couples who become monogamous, the blood test for antibody for HIV may be very helpful in determining when it is safe to stop using a condom. If both partners are seronegative 6 months after entering into a monogamous relationship, they are on pretty solid ground to assume that condoms are no longer needed so long as they have sex only with each other. |