[Extensions of Remarks]
[Pages E241-E242]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PREVENTING THE TRANSMISSION OF HIV

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HON. TOM LANTOS

of california

in the house of representatives

Thursday, February 26, 1998

Mr. LANTOS. Mr. Speaker, earlier this month the Subcommittee on
Health and Environment of the Commerce Committee held a hearing on
``Preventing the Transmission of the Human Immunodeficiency Virus
(HIV),'' at which a number of witnesses discussed the problems related
to this serious health issue facing our nation. The subcommittee also
considered legislation that has been introduced in the House relating
to HIV transmission. I requested the opportunity to present a statement
for inclusion in the record of the hearing, Mr. Speaker, because of the
importance of this issue to my congressional district and because of
the serious national importance of this health problem. Unfortunately,
there is considerable misunderstanding of the issue and the best way to
deal with it.
Mr. Speaker, I ask that my statement to the Subcommittee on Health
and Environment be placed in the Record, and I urge my colleagues to
give thoughtful consideration to this important issue. It is probable
that the House will be considering legislation involving the
transmission of HIV later this year, and it is important that all of us
here in this body be well informed on this issue.

Statement of Congressman Tom Lantos

Hearing of the Subcommittee on Health and Environment on Preventing the
Transmission of the Human Immunodeficiency Virus (HIV)

House Committee on Commerce

Mr. Chairman, I thank you for conducting this hearing on
HIV transmission and prevention and for this opportunity to
express my support of our country's public health efforts in
dealing with this serious epidemic.
As you know, the Center for Disease Control (CDC) reports
over 600,000 AIDS cases reported nationally since the
outbreak of the AIDS epidemic. Annually, 40,000 new HIV
infections are reported and approximately 650,000-900,000
Americans are diagnosed HIV-positive. According to the San
Francisco AIDS Foundation, California alone currently reports
over 100,000 cases which accounts for nearly 18% of all AIDS
cases in the U.S. Only New York reports a larger total number
of AIDS cases. These figures indicate precisely why the fight
against HIV transmission and infection is a top public health
priority.
Despite these overwhelming numbers associated with HIV
infection, I am greatly encouraged by the fact that
California has recently reported a 60% decline in AIDS-
related deaths in the first six months of 1997, as compared
to the first six months of 1996. And it is especially urgent
that we understand what has enabled California to
dramatically decrease its number of AIDS deaths and cases so
that we may reproduce these efforts and continue to
successfully combat the disease. Federal funding has been a
main impetus through which we have developed new drug
therapies, and we cannot underestimate the significance of
improved access to medical care and increased prevention
efforts in reducing AIDS transmission and fatalities.
Our country needs to take an intelligent approach to the
AIDS epidemic. By intelligent approach, I mean that we need
to take into account how different populations are affected
by this disease. We now know that new HIV infections in the
U.S. occurs among people between the ages of 13 and 20. Young
gay and bisexual men experience disproportionately high
numbers of AIDS cases and HIV infections. We know that the
proportion of AIDS cases has risen among women and among
several minority groups, despite declining in several other
populations. The facts are compelling, and rather than ignore
these facts, we should direct our attention to specific
populations that have been specifically affected.
Research and science are our tools; we should use them to
guide us in our federal policies. Because the scientific and
statistical findings in regards to HIV transmission indicate
significantly different proportions of HIV infection in
different population groups, I am fully supportive and a
proud cosponsor of H.R. 1219, the Comprehensive HIV
Prevention Act of 1997, introduced by my esteemed colleagues
Representative Nancy Pelosi (D-CA) and Representative
Constance Morella (R-MD). Their legislation will promote
targeted, primary prevention programs that effectively
consider the increasing challenge for high risk populations
such as people of color and women. H.R. 1219 would enhance
federal coordination and planning by giving authority and
responsibility for developing a strategic HIV prevention and
appropriations plan to the Secretary of HHS, in consultation
with an Advisory Committee. In addition, the bill will
authorize further research for investigating possible new HIV
infection sites. With its provisions for community-based
prevention programs, counseling and testing programs,
treatment and related services for rape victims, funding for
AIDS/HIV education and information dissemination, as well
as adolescent and school-based programs--the Pelosi-
Morella act is a thorough and natural extension of current
HIV prevention programs in the United States. It will
approach HIV prevention through methods that are locally
defined, community-based, and that utilize at-risk
population targeting.
In contrast, the HIV Prevention Act of 1997 (H.R. 1062) is
based upon a belief that identifying individuals who are HIV
positive, in and of itself, can prevent new infections. It is
a major setback to the progress we have been making in
implementing effective HIV prevention programs. Despite the
fact that no other disease is required to be reported by
federal mandate, and despite the fact that the CDC has not
requested that Congress create such an unprecedented mandate
for HIV, H.R. 1062 still calls for mandatory partner
notification.
Furthermore, H.R. 1062 mandates reporting of HIV infected
people to the State public health officer and the CDC. Not
only should HIV reporting remain a state responsibility, but
this mandate is a coercive measure which would discourage
people at risk for HIV from seeking treatment and testing at
a time when we are making impressive breakthroughs in new
treatments. This measure would only hurt our efforts to slow
HIV transmission, a public health concern. There is no reason
for us to isolate and differentiate HIV from other sexually
transmitted diseases, nor to stigmatize HIV infected
citizens.
The creation of a national partner notification program as
would be mandated by H.R. 1062 would also be an unnecessary
waste of resources. Furthermore, the Ryan White CARE Act
Amendments of 1996 already requires states to administer
partner/spousal notification programs as a condition of
receiving HIV care funding. The HIV Prevention Act of 1997
would prevent state and local officials from effectively
targeting their programs and making decisions to meet the
needs of their individual, unique

[[Page E242]]

populations. We cannot tolerate a reductive one-size-fits all
solution to HIV infection, a complex epidemic.
We should not simplify our efforts to prevent HIV
transmission. In fighting the epidemic of HIV, we have
learned a great deal from our colleagues in scientific
research. Because I believe that needle exchange programs
have proven to be an effective and cost-effective way of
reducing the spread of HIV, I am delighted to also be a
cosponsor of H.R. 2212, the HIV Prevention Outreach Act of
1997, introduced by Representatives Elijah Cummings and Nancy
Pelosi.
A single clean syringe costs less than 10 cents, and
treatment for one HIV-infected individual costs over
$100,000. More than half a billion dollars in health care
expenditures could be avoided through the implementation of
needle exchange programs. There is a tragic cost to not
acting and implementing needle exchange programs. The
Cummings-Pelosi bill would end the ban on federal funding of
needle exchange programs, and along with H.R. 1219, it
enables us to battle AIDS in such a way that does not ignore
the inroads we have already made into how the disease has
affected certain populations.
It is my pleasure to announce that I am not alone in my
sentiments about needle exchange. The findings of the
scientific community support my view that needle exchange is
a necessary and extremely efficient way of dealing with HIV
transmission. To date, six federally funded studies,
including a Consensus Development Conference by the National
Institutes of Health and also a study by the University of
California, San Francisco for the Centers of Disease Control
and Prevention, all demonstrate the effectiveness of needle
exchange in reducing an important risk factor for HIV
transmission. It is not a coincidence that by providing clean
needles to injection drug users who comprise nearly 50% of
newly infected HIV victims, we are slowing the spread of HIV
not only to those who will use the needles but to their
partners and their children as well.
This information has found the ears of the American public,
approximately 66% of which support needle exchange.
Distinguished and respected public health organizations such
as the American Medical Association, the American Public
Health Association, as well as public officials and legal
groups such as the United States Conference of Mayors and the
American Bar Association have all heard the facts supporting
needle exchange and are supportive of preserving the
authority of the Secretary of Health and Human Services to
determine if federal funds can be used for needle exchange
programs.
In the matter of HIV transmission and infection, we should
listen to what our scientific knowledge makes undeniable; we
need comprehensive programs such as those authorized by the
Pelosi-Morella bill, and we need to give our public health
officials the means to combat HIV through needle exchange, as
expressed through the Cummings-Pelosi bill.
I urge the Congress not to delay the use of federal funds
for needle exchange programs. Furthermore, I want to
reiterate the importance of learning from our research
investigations of HIV infection and AIDS cases. The spread of
HIV has taken a specific path that we have traced, and that
we must take steps to counteract. The word is out that needle
exchange is a successful way of addressing HIV transmission.
The word is out that we can best approach this problem by
funding research and funding programs that will allow states
to target and address the specific developments of the HIV/
AIDS epidemic. We need to lift the ban on federal funding of
needle exchange and to address the needs of children, women,
and minorities who are affected by AIDS and the HIV
infection.
Thank you again for holding this important hearing. I hope
you will be supportive of state and local officials in their
efforts to combat HIV transmission and infection.

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