$19.4 million to continue 7-11 of the HIV health service $21 million to expand the Education and Training Centers $13.3 million to continue the program to provide care in $4.1 for AIDS facilities renovation grants to support Vaccine Injury Compensation Program The National Childhood Vaccine Injury Act of 1986 established a program to provide compensation for vaccine-related injury or death. HRSA maintains the fiscal records of the claims trust fund and provides medical advice to the court. The 1991 HRSA budget estimates obligations of $222 million for claim payments and other costs to be disbursed from the Vaccine Compensation Trust Fund. Conclusion In conclusion I can assure the members that we at HRSA see the coming year as one with many opportunities and numerous challenges, and we are looking forward to working with you in moving the public health agenda forward. Mr. Chairman and members of the Committee, my associates and I will be pleased to address any questions you may have on the specifics of this budget request. Present BIOGRAPHY OF DR. ROBERT HARMON Previous Birthplace and Date: Education: Administrator and Assistant Surgeon General Department of Health and Human Services Director, Missouri Dept. of Health, Jefferson Barnsdall, Oklahoma, March 20, 1941 B.A. 1962-66, Washington University, St. Louis, MO M.D. 1966-70, Washington University School of M.P.H. 1975-77, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD Post Graduate Professional Specialty Certification: Internship and residency internal medicine, Certificate, Program for Senior Executives in University, John F. Kennedy School of Medical officer in PSRO program, Division of Peer Director, MEDEX Northwest Division and Assistant August 1977-November 1980. Deputy Director of Public Health, Maricopa County December 1980-November 1982. Director of Public Health and Health Officer, Adjunct Associate Professor, Dept. of Family and General Preventive Medicine, 1979. Organizations and Memberships: Association of State and Territorial Health Officials; Executive Committee, 1987-1990. National Association of County Health Officials; President, July 1983-Dec. 1985. Physicians National Housestaff Association; President, 1974-76. HIV/AIDS Senator HARKIN. Thank you very much. Thank you all very much for very succinct and to the point statements. I just have a few questions that I will ask initially, and then we will go down the order in which Senators appeared. Dr. Mason, the administration's request was $1.695 billion for AIDS in fiscal year 1991. That is about a 7-percent increase over last year; $66 million is for CDC, $67 million for National Institutes of Health. Several other small increases are offset by a $40 million cut in the Health Resources and Services Administration. So could you just basically give us an update on AIDS? What are the projections for new cases? What progress has been made in treating it? Why have you dropped funding for AZT, when all the new reports come out showing how effective AZT can be in the early stages? And what is the focus of the increase in AIDS funds in the various agencies under your control? Just sort of paint us a picture of what is happening. Dr. MASON. I would be delighted to do that, Mr. Chairman. And if I might refer you to several charts that I prepared, and there are handouts at each one of the desks. The first chart shows the magnitude of the current problem, and I emphasize that the estimated number of infected individuals in the United States is approximately 1 million. The range is 0.8 million to 1.3 million, and this is an estimate based upon studies that are Senator REID. Excuse me. We cannot hear. We cannot hear or see. Could you move that a little closer. Senator HARKIN. Pull your mike in a little bit, Dr. Mason. Senator REID. Maybe so Senator Adams could see this, could you move that over here? [Pause.] Dr. MASON. I hope you can see that now. The last time I was told people could not hear me I spoke louder and said, is that better? And someone in front said: It is louder, but it is no better. [Laughter.] We will try to carry on. Approximately 1 million cases, this is an estimate. So there is an interval there of 0.8 million to 1.3 million based on current estimates. As you know, the Public Health Service has recently revised their estimate downward. We probably were too high 2 or 3 years ago and, as better data becomes available, we are getting it better in line with what is really happening out there. Senator HARKIN. That is one of my questions. I will interrupt you right here if you do not mind. Dr. MASON. That would be fine. Senator HARKIN. There has been a reduction in that estimate. You say the only reason for that is just better data has come in? Dr. MASON. Better data. Probably with data that was available when the first estimates were made-that was 3 years ago-where we said there was one to 11⁄2 million infected, we were probably high. It is interesting at that time that various people were estimating as many as 40 million people were infected and CDC came in and said it is only 1 to 12 million, and there was a lot of criticism that they were too low. But even CDC at that time was higher than what we now feel. So there has been a slow increase in the number of infected over the last 3 years, and we are not able to measure directly how fast that is, but obviously as a nation it is not spreading like wildfire. However, among certain risk groups, particularly IV drug abusers and their heterosexual partners, we still estimate that we have rapid spread of this disease. The cumulative number of cases reported through December 31, 1989, is almost 118,000. You can see that during 1989, 35,000 cases were reported, which represents a 9-percent increase over 1988. There were 640 pediatric cases reported in 1989, and almost 60 percent of the pediatric cases reported are born to mothers who are using intravenous drugs or who are sexual partners of intravenous drug users. I would like to mention that, in the context of the distribution of these cases that you see on the chart, that a disproportion of those cases are in our minority population: 27 percent among our black population, 15 percent among our Hispanic population, and that is approximately double their ratio in the total population. We are delighted to report that during 1989, the number of cases associated with blood transfusions fell 12 percent among adults and 39 percent among children. At present, with our careful education of donors, testing and voluntary exclusion, convincing those who are at high risk not to give blood for transfusions, we are beginning to see a significant difference in the number of transfusion-associated AIDS cases. The next chart, please. REPORTED AIDS CASES BY YEAR OF REPORT It shows the reported AIDS cases by year of report. And you notice the progression of both total cases as well as in the small inset, the pediatric cases. You notice that there appears to be somewhat of a leveling off in 1989 compared with the rate of increase in previous years. We want to caution you not to jump to any conclusions that the disease is in fact slowing down to that extent. We are not totally sure why that slowdown occurred in 1989, but there could be, first of all, reporting delays. We know that one large city and a State reported numerous cases right after the end of the year and they will be reported in 1990. So you get artifacts in reporting. We know that behavior change has occurred, particularly in the white homosexual population, and that started a number of years ago, and this is undoubtedly having some effect in the occurrence of new cases. Finally, the use of these new drugs that have been developed by biomedical research and rapidly licensed by FDA is also beginning to have an impact, particularly when these are used as an early intervention before symptoms develop. So these people who are infected are slowed down in the progression of their disease, and so the disease is not reported as AIDS. We think all three of those items are responsible for the trend that is apparent there. Next chart, please. 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Year • Projections include inflation by 18% in recognition of underreporting to CDC. Beginning in 1989 an upper and lower range is displayed. Estimates are based on February 1990 projections. This again shows what has happened and gives you projections through the year 1993. It is important to emphasize that, since the average incubation period of this disease from onset of infection to |