Mr. WAXMAN. Dr. Boufford, as I understand your testimony, your costs are $800 per day, and the average reimbursement is $500. Even when you get reimbursement you lose $300 a day for each patient, and you have a large number of patients who get nothing whatsoever.

Dr. BOUFFORD. New York City is paying for that through the city tax levy.

Mr. WAXMAN. Mr. Lennon, you said 30 percent of your patients don't qualify for any financial assistance, and most of the AIDS patients are in that group.

Why are so many of your patients not covered by Medicaid?

Mr. LENNON. By Medicaid, because most are undocumented illegal aliens that work in the vegetable farms and sugarcane area in south Florida.

Mr. WAXMAN. Are there any special financial assistance grants, either from the State or the Federal Government, to help you with costs that you are bearing?

Mr. LENNON. No, sir.

Mr. WAXMAN. Who pays for the cost for those patients?

Mr. LENNON. We tax the residents of our hospital district ad valorem taxes to pay for this, and that is right now paying about 35 percent of our total hospital costs.

Mr. WAXMAN. Thank you very much.

Mr. Madigan.

Mr. MADIGAN. Mr. Gamble, did I understand you to say that there are presently 135,000 carriers of the virus in Los Angeles County?

Mr. GAMBLE. That is a projected estimate based on the studies, the experience to date, yes.

Mr. MADIGAN. How many of those are in the so-called high risk group? Do you have an estimate of that?

Mr. GAMBLE. Well, it is 73 percent, is what is calculated nationwide to be the high risk individuals. So that is how that figure is developed from the number of people in the community from the high risk groups, and then 73 percent represents what we expect that group to be from.

Mr. MADIGAN. So, 27 percent would be the estimate of those who were not in a high risk group?

Mr. GAMBLE. Right.

Mr. MADIGAN. Let me ask you this question: Would you first agree that perhaps the best way to alleviate this growing problem would be a better job of public education as to how the disease is spread?

Mr. GAMBLE. I would, because that is the only way of preventing its spread at this time. However, we must simultaneously provide for the taking care of those for which it is already too late; and for those 135,000 people, it is already too late.

Mr. MADIGAN. Sure. I have no argument with that.

Let me ask you pointedly, are you satisfied with the public education information so far available and the manner in which it is being made available?

Mr. GAMBLE. I am satisfied that the attention finally is beginning to be paid to it, I think just as of this summer. That should have been started earlier.

I believe the resources, to the best of my knowledge, are now being applied in that direction. But we are way behind on it and a great deal has to be done.

Mr. MADIGAN. Concerning the question of noncommunication through casual contact, I understood as of about 11⁄2 or two weeks ago that two workers in a hospital had acquired AIDS as a result of attending to the needs of AIDS patients.

Are you familiar with that story?

Mr. GAMBLE. Yes; probably from the same source.

I am not familiar with those two particular individuals, but as I understand it was not from casual contact, casual contact in being in the room or treating somebody, but these cases stem from such things as an accidental stick from the needle that has been used on an AIDS patient.

Mr. MADIGAN. I see.

Mr. DANNEMEYER. Thank you, Mr. Chairman.

I would like to ask Mr. Gamble, and the other members of the panel as well-CDC has estimated that today we have between a half million and a million persons with the AIDS virus in their blood. Do you have any reason not to accept that level of involvement by people today?

Mr. GAMBLE. No; I have no reason not to accept that.

Mr. DANNEMEYER. And they further estimate that between 25,000 and 250,000 of those in that group with the AIDS virus will have AIDS within 5 years.

Do you think that is a reasonable estimate?

Mr. GAMBLE. Was that

Mr. DANNEMEYER. Of that group today, between a half million and a million that have the virus in their blood, in the next 5 years, of that group between 25,000 and 250,000 will have AIDS. Do you have any reason to disbelieve that?

Mr. GAMBLE. That sounds on the high side, from what I have heard from the CDC. I believe another witness is from the CDC and is coming up, and may be better qualified to answer that.

But approximately 10 percent is the figure that they have used so far as those

Mr. DANNEMEYER. Of those with the AIDS virus, 10 percent will come down with AIDS?

Mr. GAMBLE. Come down with AIDS. The problem is, that of those with the AIDS virus a large percentage are infectious; they don't know they have the virus, but they are infectious as to AIDS. Mr. DANNEMEYER. You mentioned the sensitivity, Mr. Gamble, that nurses working in hospitals have today.

Do you believe that nurses working in hospitals treating AIDS patients should, at the discretion of the nurse, be able to wear protective clothing, like gowns, masks and gloves?

Mr. GAMBLE. Yes; and I don't know of anywhere where that is not permitted.

Mr. DANNEMEYER. Well, we have been referred to a case at San Francisco General Hospital where nurses treating AIDS patients were told by the administrators at the hospital that they were not

to wear protective clothing because it impinged on the sensitivity of the AIDS victims.

Mr. GAMBLE. I believe that has been corrected, from the reports I have seen, Mr. Dannemeyer. But that is a concern. But it should not be the concern should be both for the patient that you are treating and the welfare of the employee doing that treatment. So it is a balance between those two things.

I do not believe there is any rule, certainly not in any hospital that I am aware of in southern California, where if a nurse, for her own safety, believes she should be so equipped, that she would not be permitted to be so equipped.

Mr. DANNEMEYER. I share that view.

Also, we know that AIDS can be transmitted sexually, and yet we have many instances around the country today where local health officers have not taken action to shut down bathhouses.

Do you believe that we should shut down bathhouses as to where for instance, in Los Angeles County today, we have probably 25 or 30; San Diego County, probably 30; San Francisco, another 30.

Do you believe we should be shutting down those bathhouses?

Mr. GAMBLE. I am not a public health official, Mr. Dannemeyer, and I don't think that is in the purview of—I couldn't give you an accurate answer.

Mr. DANNEMEYER. Let's change the question a little bit.
Mr. GAMBLE. OK.

Mr. DANNEMEYER. It is the policy of the State of California to shut houses of prostitution on two grounds: one, to protect the public health; second, to protect public morals.

Is there any reason why our policy on bathhouses, where we know that AIDS is being transmitted sexually, should be different than it is with respect to houses of prostitution?

Mr. GAMBLE. If it is established that those bath houses are injurious to society in the same parameters as houses of prostitution are, yes, it would be applicable. But I think those businesses have certain rights to operate, you have to prove that they are performing an illegal act, I would presume.

Mr. DANNEMEYER. There is no question that bathhouses-although they started out in our culture as a place where you get a bath-are being used for something different today.

How about persons working in the health care industry with AIDS; for instance, on the policy question, do you believe that doctors and dentists and nurses who have AIDS should be working in the health care industry treating patients?

Mr. GAMBLE. Yes; the difficulty is in whether it is as much danger to them as it might be to the other patients. During the little more than a year lifetime of somebody who has AIDS-when they have actually come down with the AIDS-they may not be as infectious as the person who is among the 1 million who have the virus but have not yet developed AIDS itself.

I don't think you can regulate just against one particular part of the society saying that they should be excluded from these jobs without including the entire 1 million people now infected with the virus. And I don't know as a society how we can cope with that many people being excluded.

Mr. DANNEMEYER. I am not talking about having the virus in their blood. I am talking about diagnosed as having AIDS.

For instance, would you like to have a dentist with AIDS working on your teeth?

Mr. GAMBLE. I believe that a dentist without AIDS should be using proper protection now just as much as a dentist with AIDS. Mr. DANNEMEYER. That is not my question.

Mr. GAMBLE. If they use the recommended protection, then the dentist with AIDS will not give me AIDS.

Mr. DANNEMEYER. Would you like to have a dentist with AIDS working on your teeth?

Mr. GAMBLE. If he took proper precautions, yes.

Mr. WAXMAN. The gentleman's time has expired.

Mr. DANNEMEYER. Mr. Chairman, I noticed that you took from 10:28 to 10:35. I have not yet consumed 7 minutes. I would respectfully request the 7 minutes that you took.

Mr. WAXMAN. The gentleman will certainly have a time on the second round.

Is he asking unanimous consent for 2 additional minutes?

Mr. DANNEMEYER. I am just asking for the equal time you had, Mr. Chairman.

Mr. WAXMAN. We are on a 5-minute rule.

Mr. DANNEMEYER. You didn't observe it.

My request is to have 7 minutes.

Mr. WAXMAN. The gentleman will be given 2 additional minutes. Mr. DANNEMEYER. I thank the chairman.

There is another question, that some other witnesses on the panel may like to respond to the questions I posed to Mr. Gamble. Dr. Boufford or Mr. Lennon, would you care to respond on any of those questions?

Dr. BOUFFORD. I think the issue of employees in the health care field is a very important one, and the key issue is adequate education so people understand what their risks are. We have been very pleased in New York at the cooperation of our unions and health professionals in not going to excess and really understanding when they are at risk and when they are not at risk. I think that is the important issue there.

We also have been looking at the issue of whether certain categories of health workers with AIDS should be excluded from providing care, and our general information and feeling is they should not-that they are not providing additional risks to patients. Clearly, they and their physician would have to decide whether there was additional risk to them.

Mr. DANNEMEYER. Are you familiar with the provision that I think exists today that nurses with AIDS are not permitted to work in maternity wards, because there is a certain spore emitted from one with AIDS from breathing that can cause brain defects in children?

Dr. BOUFFORD. No; I am not at all aware of that.

Mr. DANNEMEYER. If you will check into it, you will find that that is an existing practice today. Nurses with AIDS are not permitted to work in maternity wards.

Dr. BOUFFORD. That is not a practice in New York.

Mr. DANNEMEYER. Maybe it is something you could explore.

Mr. Lennon, do you have any further comments?

Mr. LENNON. Just basically a couple of things, Mr. Dannemeyer. No. 1, we do not have any bathhouses that I am aware of in Belle Glade but if we did I would urge them to be closed. Second, if I knew a dentist had AIDS, I would not go to him.

Mr. DANNEMEYER. I thank you. Thank you, Mr. Chairman.

Mr. WAXMAN. The gentleman still has more time. Mr. Scheuer. Mr. SCHEUER. Thank you, Mr. Chairman.

I congratulate you on having held this extraordinarily important and interesting hearing. I think all of us are interested in how we get from 7,000 deaths and 15,000 people with AIDS in this whole country to the million people who are carrying the germ. That is an exponential increase.

I think we are interested in learning how we stop the increase and how we contain it. Does anybody have any suggestions to us from the point of view of public health, how from the preventive health point of view can we cut this incredible geometric progression?

Mr. THOMPSON. Let me respond, Congressman. The complication with this disease is that it is a changing epidemiological event. Several things have come to light recently: You have complication with drug abuse and the breakdown of drug abuse in the system, which may make the drug abuser more susceptible to the disease, above and beyond contaminated needles; you have the problem that the disease, since it is not checked by any kind of antibody, can mutate, and become different forms of the disease; you have a lack of understanding, epidemiologically, about the period of incubation and in fact what will occur 6 to 8 years down the road.

Mr. SCHEUER. Also it is spreading in the heterosexual community. How do heterosexuals protect themselves? Right now assume it is homosexuals and intravenous drug abusers or hemophiliacs for the most part, but now we hear it is breaking into the heterosexual community of nondrug abusers, nonhemophiliacs. How do heterosexual men and women protect themselves? How should they perceive of their sexual lives and the proper means to take to protect themselves in this whole new environment, unprecedented?

Mr. THOMPSON. All of this only points out that this is a very complex disease. There is no single thing that can be done to stop it. There is no closing of certain public facilities that will immediately lead to a diminution of the disease, particularly in a city like New York, as you know, where there is a bigger proportion of drug users that are the recipients of the disease and the passers of the disease to partners and children.

It is a very complex disease, and must be tackled on a whole series of fronts, in order to▬▬

Mr. SCHEUER. Are there a few individual things that would help? For example, I have heard that if we gave away needles to intravenous drug users, and made it unnecessary for them to reuse needles that other entravenous drug users had employed who were infected with AIDS, that this would have a substantial dampening effect on the spread of AIDS. If society gave away those needles to any drug user who wanted them, would that protect the entire het