[Congressional Record Volume 141, Number 122 (Wednesday, July 26, 1995)]
[Senate]
[Pages S10715-S10728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  RYAN WHITE CARE REAUTHORIZATION ACT

  The Senate continued with the consideration of the bill.


                           Amendment No. 1855

(Purpose: To limit amounts appropriated under title XXVI of the Public 
 Health Service Act to the level of such appropriations in fiscal year 
                                 1995)

  Mr. HELMS. Mr. President, I send an amendment to the desk and ask it 
be stated.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from North Carolina [Mr. Helms] proposes an 
     amendment numbered 1855.
       At the appropriate place, insert the following:
       Sec. . Notwithstanding any provisions of this Act, there is 
     authorized to be appropriated for each of the fiscal years 
     1996 through 2000, amounts that do not exceed the amounts 
     appropriated under this Act in fiscal year 1995.

  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Mr. President, as the clerk has indicated, and I say the 
amendment as read speaks for itself, this amendment proposes to freeze 
Federal funding authorizations for the years 1996 through 2000 at an 
amount not exceeding the fiscal year 1995 funding for HIV-AIDS. The 
amount appropriated for fiscal year 1995 totals $633 million of the 
taxpayers' money.
  I consider this amendment is essential--imperative, as a matter of 
fact, to close a vast loophole in the pending bill. As currently 
written, the Ryan White Reauthorization Act authorizes funding for the 
Ryan White programs:

       At such sums as may be necessary in each of the fiscal 
     years 1996, 1997, 1998, 1999, 2000.

  As I said earlier, some of the proponents say, ``This does not mean 
anything. It still has to go through the authorization and 
appropriations process,'' which is true. But it has a psychological 
effect, when it has been written into the Ryan White authorization bill 
that the appropriations will be ``such sums as may be necessary.''
  So, as I said earlier, if it does not mean anything let us take it 
out. Because whenever I see vague, open-ended funding language such as 
this, I can understand why the Federal debt is approaching $5 trillion. 
It stands at about $4.9 trillion now.
  Congress should never write a blank check for any purpose. The least 
we can do for the American taxpayers is to specify the amount of 
Federal funding, with no obfuscation, no vagueness, no whatever.
  Taxpayers will be interested to know that the total estimated outlays 
under the current act are $3.68 billion. That is $3,680,000,000 over a 
5-year period. So we are not talking about chickenfeed. We are talking 
about real money; real money that can run up the debt, the Federal 
debt, that will be on the backs of the young people of this country for 
generations.
  This $3.68 billion does not include NIH funding or the many other 
Federal programs dealing with HIV-AIDS.
  Federal funding for AIDS research and prevention within the Public 
Health Service has increased from $200,000 in 1981--$200,000 in 1981--
to $2,700,000,000 in 1995.
  When all the other Federal funds spent on HIV-AIDS are included, the 
total is about $7.1 billion for fiscal year 1995.
  We have an arrangement in the process, I will say parenthetically, 
that I will present each of my amendments.
  Have we obtained the yeas and nays on the amendment set aside?
  The PRESIDING OFFICER. The yeas and nays have not been requested on 
the amendments set aside.
  Mr. HELMS. Mr. President, I ask for the yeas and nays on that 
amendment.
  The PRESIDING OFFICER. It is not appropriate to ask for the yeas and 
nays on an amendment which is not before the body. The Senator can ask 
unanimous consent.
  Mr. HELMS. I ask, for the purpose of obtaining the yeas and nays, 
that these two amendments be considered the pending business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELMS. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. HELMS. Mr. President, I send an unprinted amendment to the desk 
and ask it be stated.
  The PRESIDING OFFICER. There is an amendment pending.
  Mr. HELMS. I ask unanimous consent that it be laid aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 1856

  (Purpose: To ensure that Federal employees will not be required to 
            attend or participate in AIDS training programs)

  Mr. HELMS. I withdraw that amendment and send another amendment to 
the desk.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from North Carolina [Mr. Helms] proposes an 
     amendment numbered 1856.

  Mr. HELMS. Mr. President, I ask unanimous consent that reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the appropriate place, insert the following new section:

     SEC.   . OPTIONAL PARTICIPATION OF FEDERAL EMPLOYEES IN AIDS 
                   TRAINING PROGRAMS.

       (a) In General.--Notwithstanding any other provisions of 
     law, a Federal employee may not be required to attend or 
     participate in an AIDS or HIV training program if such 
     employee refuses to consent to such attendance or 
     participation. An employer may not retaliate in any manner 
     against such an employee because of the refusal of such 
     employee to consent to such attendance or participation.
       (b) Definition.--As used in subsection (a), the term 
     ``Federal employee'' has the same meaning given the term 
     ``employee'' in section 2105 of title 5, United States Code, 
     and such term shall include members of the armed forces.

  Mr. HELMS. Mr. President, the pending amendment was made essential 
because of a directive issued by President Clinton on September 30, 
1993, in which he ordered all heads of executive departments and 
agencies to develop and 

[[Page S10716]]
fully implement a comprehensive HIV/AIDS workplace policy and employee 
education prevention program. The White House staff made it mandatory 
for every Federal employee--an unreasonable requirement on its face, 
and particularly so considering the nature of these so-called education 
programs.
  For the record, the White House Office of National AIDS Policy issued 
mandatory ``guidelines'' stating:

       HIV/AIDS workplace training is mandatory for every Federal 
     employee . . . (and) the duration of the training session 
     should be not less than 2 hours, although 3 hours is the 
     recommended length . . .

  Mr. President, it may be useful to examine one agency's training 
program. The Department of Agriculture's AIDS program--which employees 
are compelled to attend--counsels Federal employees on the proper ways 
to engage in oral and anal sex and other similarly inappropriate 
subject matters.
  This is an editorial judgment on my part. I consider it outrageous--
not just inappropriate, outrageous. I took it up with the Agriculture 
Department, and we are having a go at that.
  This is an arrogant and nauseating abuse of power by the homosexuals 
in the Federal bureaucracy. Most Federal employees resent it.
  We have had scores of Federal employees to protest to us and ask us 
to do something about it.
  For example, let me to read from a letter I received from a USDA 
employee in North Carolina after the employee attended one of these so-
called training classes:

       This week we were required to attend a mandatory HIV/AIDS 
     training session which is apparently required by the 
     President of all Federal employees. This results in millions 
     of dollars in lost man-hours and consequently wages. We also 
     were required to take a pre- and post-class test . . . Since 
     we are mostly biological scientists we learned essentially 
     nothing.

  The employee continued:

       Some of the material is not appropriate for the workplace 
     (e.g. how to have safe oral sex, page 28), and it does not 
     seem too necessary for government time and money.

  That is an understatement by the employee.
  Mr. President, I also have at hand a copy of a directive issued by 
the Foreign Agriculture Service which states:

       To comply with this Presidential mandate, the Foreign 
     Agriculture service is presenting the attached MANDATORY HIV/
     AIDS training sessions.
       Please attend the session scheduled as indicated or arrange 
     to switch session with a coworker.
       Supervisors are responsible for disseminating this 
     information to there (sic) . . .

  They misspelled the word ``there,''   t-h-e-r-e. They 
meant t-h-e-i-r. They will learn how to spell that word next week.

     employees and for certifying that all employees under their 
     supervision attend a session of the mandated training . . . 
     THIS IS MANDATORY TRAINING FOR ALL FEDERAL EMPLOYEES . . . 
     ATTENDANCE WILL BE TAKEN. . .

  You see the intimidation there.
  Mr. President, so that there may be no confusion in the mind of any 
Federal employee, my pending amendment simply stipulates that hereafter 
all HIV/AIDS training programs will be made optional for Federal 
employees.
  To put it another way, nobody shall be compelled to attend a program 
that describes how to participate in oral and anal sex.
  In addition, my amendment forbids that any Federal department or 
agency can take retaliatory actions against any Federal employee who 
chooses not to attend such classes. It makes no sense to say to an 
employee ``this class is optional, but we'll be taking attendance and 
your absence will be noted,'' because the employee will be 
understandably intimidated.
  By the way, Mr. President, there are many who may be wondering why we 
are spending the taxpayers' money on these programs at all. I am one of 
them. There are today about 3 million Federal employees. It does not 
take a rocket scientist to do the arithmetic on how much this mandatory 
program is costing the American taxpayers. Even if the class costs only 
$1 per employee--and the actual cost is much more than that--even at $1 
per hour, the American taxpayers are being soaked for $3 million for 
this HIV/AIDS training.
  Mr. President, at issue in this amendment is whether all Federal 
employees are to continue to be forced to attend these programs.
  At the risk of being repetitious, I do not see any point in forcing 
Federal employees to attend a session where the subject is the kind of 
sex conducted by homosexuals.
  Like AIDS education in the public schools, Federal AIDS training 
programs are nothing but thinly-veiled attempts to restructure the 
values and attitudes of Americans in favor of homosexual lifestyles.
  So the question is obvious. Since when does a free and democratic 
society mandate that its civil servants attend such classes to learn 
about--let us use the word--sodomy? The bottom line is that the Federal 
Government has no business requiring its employees to sit through 
embarrassing and sometimes disgusting classes on HIV/AIDS.
  Mr. President, I have several insertions for the Record that I want 
included.
  Mr. President, I ask unanimous consent that the following documents 
be printed in the Record:
  First, President Clinton's Guidelines for the Federal Workplace HIV/
AIDS Education Initiative ``Aids At Work,'' April 7, 1994,
  Second, a letter from a North Carolina Federal employee who works for 
the USDA,
  Third, the Foreign Agriculture Service's ``Mandatory HIV/AIDS 
Training'' memo dated January 1, 1995, and
  Fourth, a March 29, 1995, Washington Times article entitled, 
``Mandatory Federal AIDS Classes Cited as Promoting Gay Agenda''.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Guidelines for the Federal Workplace HIV/AIDS Education Initiative 
                            ``AIDS at Work''


                               I. purpose

       On September 30, 1993, President Clinton signed a directive 
     (Directive) instructing all Federal departments and agencies 
     to provide comprehensive HIV/AIDS in the workplace training 
     for their employees. The Directive mandates that all initial 
     training be either carried out or scheduled by World AIDS 
     Day, December 1, 1994. In addition to providing HIV/AIDS 
     prevention information, all federal employees must receive 
     information on workplace policies and procedures related to 
     persons living with HIV and other chronic illnesses. Human 
     resources staff is required to review workplace policies and 
     procedures to ensure that the federal workplace encourages 
     people with any chronic illness, including those living with 
     HIV/AIDS, to continue productive employment as long as their 
     health permits.
       The President has committed his Administration to a leading 
     role in the fight to end the HIV/AIDS epidemic. Until there 
     is a cure, educating people on assessing their own risk and 
     taking appropriate steps to protect themselves from infection 
     with HIV is the best way to stop the epidemic. As the 
     epidemic matures and medical advances proceed, more and more 
     people living with HIV/AIDS will be in the workforce. Since 
     HIV cannot normally be transmitted in a workplace setting, 
     people living with HIV/AIDS should be encouraged to continue 
     working so long as their health allows them to be productive 
     employees. The Federal Workplace HIV/AIDS Education 
     Initiative (FWAEI) will serve as a model for all businesses 
     on how to provide employees the information they need to 
     prevent infection with HIV and the type of personnel policies 
     and procedures which encourage people with any chronic 
     illness, including HIV/AIDS, to continue productive work for 
     as long as their health permits.


                             II. background

       Based upon comprehensive research and evaluation of many 
     private-sector workplace programs, the Centers for Disease 
     Control and Prevention (CDC), Business Responds to AIDS, and 
     the National Leadership Coalition on AIDS recommend that the 
     following five components be included in any comprehensive 
     HIV/AIDS workplace education program: Policy/Procedures; 
     Training of Supervisors and Managers;
      Employee Education; Family Education; and Community Service/
     Volunteerism.
       The Office of National AIDS Policy (ONAP) has produced the 
     following guidelines for all Federal departments and agencies 
     to assist in the development of comprehensive HIV/AIDS in the 
     workplace programs. In order to succeed, the development and 
     implementation of a training program must take into account 
     the particular needs of each department or agency. The 
     guidelines that follow are minimum requirements and are not 
     intended to preclude any additional training that a 
     particular department or agency determines is appropriate for 
     its own employees. These guidelines will assist departments 
     and agencies in creating developmentally appropriate, 
     technically accurate, training programs whose success can be 
     measured.
                          ii. target audience

       HIV/AIDS workplace training is mandatory for every Federal 
     employee. The initial training must be conducted or scheduled 
     by World AIDS Day, December 1, 1994. The Directive does not 
     require that contractors receive training. Departments or 
     agencies may 

[[Page S10717]]
     require that contractors receive training, particularly in those 
     locations where they share the same workplace as Federal 
     employees. Contractors should not be trained with Federal 
     staff.
       Managers and supervisors should receive more in-depth 
     training that includes dealing with issues of 
     confidentiality, how to approach any necessary counseling and 
     referrals, and how to help a chronically ill employee 
     continue working and remain productive.
                            iii. class size

       Class size is critical to the successful implementation of 
     the Federal Workplace AIDS Education Initiative. Employees 
     need to have their questions answered, and large classes 
     prevent employees from getting the response time they need. 
     Class size should be limited, optimally to 30, but never more 
     than 50, participants.


                         iv. length of training

       The duration of the training session should be not less 
     than 2 hours, although 3 hours is the recommended length to 
     allow ample time for questions and discussion. Allowing for 
     breaks will give staff an opportunity to digest the 
     information presented. Additional time may be required for 
     supervisor and manager training.


                    v. records/evaluation instrument

       Of the most difficult tasks you will encounter is the 
     documentation of how the Directive is being implemented and 
     whether it has an impact on the knowledge, attitudes, beliefs 
     and
      behavior of the employees. To accomplish this, accurate 
     records of training sessions, including: the names of 
     participants; the date of the training session; and the 
     total number of employees trained, are essential. All 
     individuals receiving training should have an appropriate 
     ``official training form'' sent to their personnel files, 
     and/or the attendance information should be entered into 
     their training records database. Keeping a monthly list of 
     class sizes and participants will expedite the formulation 
     of the regular quarterly reports.
       Ideally, your instructor should ask each participant to 
     complete pre- and post-training knowledge assessments. These 
     assessments will indicate whether participants increased 
     their understanding of HIV/AIDS in these training session. An 
     increased understanding of the pathology of HIV/AIDS does not 
     necessarily indicate a concomitant change in the behavior of 
     participants.
       To determine the effectiveness of the training session it 
     is important to gauge the quality of instruction. An 
     instructor/class evaluation should be administered at the end 
     of each training session. These assessments should be no more 
     than one page and ask participants to grade the class 
     comment, the instructor's ability, the quality of questions 
     and discussion, and whether the training session was 
     worthwhile. Evaluation instruments used during your training 
     should not be referred to as ``tests.'' If the evaluation 
     instruments indicate that the training session was not well 
     received, you should consider appropriate remedies including 
     altering course content or securing a different instructor.
                              vi. content

       The following topics are suggested for class content. The 
     percentages attached to these topics are intended as guidance 
     for the development of individual sessions. Discussion and 
     questions at each department or agency will vary depending on 
     the group addressed. Because discussion and questions are 
     important, and there are always time constraints, an 
     instructor must be flexible in practice.
       30% Prevention Education (The discussion must include how 
     HIV is transmitted and how to prevent transmission, including 
     both abstinence and safer sexual practices. Note: It is 
     especially important to provide sufficient time for questions 
     and answers in this part of the training and no question is 
     too dumb.)
       30% Workplace Issues Discussion/Education (Includes a 
     discussion of why this training and associated workplace 
     policies are important, why support services are necessary, 
     and data related to employees needs.)
       30% Policy Discussion/Education (Includes a discussion of 
     federal and legal protections as well as the policies of your 
     department or agency.)
       10% Resources and Closing Questions and Answers.


                            VII. INSTRUCTORS

       The instructor is key to a successful HIV/AIDS education 
     program. Instructors (Federal or non-Federal) should be 
     trained comprehensively in HIV/AIDS issues and have 
     experience with HIV/AIDS training. Instructor certification 
     is not necessary unless required by your organization. 
     (Certification may not always guarantee quality instruction 
     for your HIV/AIDS education program.) You may want to rely on 
     your department or agency's contractor policies in 
     determining who will be the most suitable instructor. In many 
     cases, members of non-governmental community based 
     organizations have a wide range of experience in HIV 
     prevention that may be helpful for all or part of a training 
     session. It is also important to note that more than one 
     instructor may be needed to present the full range of 
     information necessary. The instructor should be experienced 
     enough to tailor the session to the audience (i.e., the type 
     of questions and concerns voiced by lawyers, support 
     personnel, analysts, economists, etc. could be quite 
     different).
       A Federal employee, knowledgeable about all human resources 
     related policy issues, should present the department or 
     agency policies and procedures regarding HIV/AIDS and other 
     life-threatening chronic illnesses. Policies and procedures 
     regarding Federal employees and managers must not be 
     presented by private-sector contractors or non-Federal 
     employees.
       If your agency uses a contractor for the HIV/AIDS 
     presentations, be sure they follow these recommended 
     guidelines. Ask the contractor for information regarding the 
     teaching history and the educational experience of the 
     instructor. Include in your contract language that permits 
     the replacement of an instructor with whom you are 
     displeased.
       Before training Federal employees or contractors, all 
     instructors may want to read at least two texts from the 
     ``Suggested Reading'' section of these guidelines, preferably 
     AIDS in the Workplace. The Guide to Living with HIV, or 
     Managing AIDS in the Workplace.


                           VIII. METHODOLOGY

       The training must be tailored to the needs of each 
     department or agency. The primary goals of the educational 
     component shall be: (1) increasing employee's knowledge on 
     issues of HIV transmission; (2) increasing awareness of HIV/
     AIDS in the workplace issues and available relevant 
     resources; (3) creating positive attitudes about working 
     alongside people living with HIV/AIDS; and, (4) encouraging 
     the participation in activities, both at work and in the 
     community, that will stop the HIV/AIDS epidemic.
       Effective HIV/AIDS prevention methodology for people at 
     high risk for HIV infection (i.e., anyone engaging in 
     unprotected sex with more than one partner or people sharing 
     dirty needles), requires targeted, continuous, linguistically 
     specific and culturally based information. It is impractical 
     to divide up a workplace based on risk factors. The training 
     sessions should provide sufficient information for employees 
     to assess their own risk for HIV infection. Resource 
     information provided as part of the training session must 
     provide the employees with locations where they may obtain 
     more targeted interventions if they perceive themselves to be 
     at high risk for HIV infection.
       If, for expediency in implementing the Directive, you must 
     place all members of the same department or office together, 
     the training must be relevant to all those present. Staff 
     must be made aware that some of the issues discussed will be 
     related to sexual practices and injecting drug use. Although 
     departments and agencies are encouraged to be linguistically 
     specific in covering the issues, the training sessions should 
     not present material patently offensive to an average 
     employee. If participants find the material offensive, it is 
     often counterproductive to the goal of encouraging an 
     accurate self-assessment of risk for HIV infection.
       Classes should be interactive and allow time for 
     individuals to ask questions and to process the information 
     presented. Employees must receive materials on workplace and 
     community resources available to address any concerns raised 
     by the training session.


                        ix. video presentations

       Video presentations should not represent more than 30 to 35 
     minutes of the total class time. A video presentation alone 
     is insufficient. A discussion and question period is 
     essential for some people to adequately assess their personal 
     risk factors. Presentations may use videos to provide a 
     standardized source of information for all individuals, but a 
     video must not be the sole source of information. Individuals 
     representing policy, personnel, or employee assistance 
     programs should always be an integral part of the HIV/AIDS 
     educational program and their presentations should not be 
     substituted with video.


            x. general objectives for all employee training

       Based upon the time allocated for the class, prioritize 
     class content using the following objectives:

                          Knowledge objectives

       Participants should be able to:
       1. Define HIV.
       2. Define AIDS.
       3. Know how HIV & AIDS are related.
       4. Understand the disease process.
       5. Know how HIV is transmitted:
       a. Primary risk factors (i.e., exchange of bodily fluids 
     from a person living with HIV to someone who is not)
       b. Secondary risk factors (e.g., how the use of drugs or 
     alcohol may impair judgement about HIV risk, importance of 
     self esteem)
       6. Know how HIV is not transmitted.
       7. Understand relevant universal precautions for 
     application in the workplace.
       8. Know how to assess their personal level of risk for HIV 
     infection.
       9. Describe HIV antibody testing and encourage those that 
     perceive themselves at high risk to ascertain their HIV 
     status.
       10. Understand the rights of employees with a chronic 
     illness, including HIV/AIDS.
       11. Understand basic applications of laws, regulations or 
     policies such as disability, health and leave benefits, the 
     Federal Rehabilitation Act of 1973, the Americans with 
     Disabilities Act of 1990, and the Family and Medical Leave 
     Act, as these apply to people living with HIV/AIDS in the 
     workplace.
       12. Know agency expectations, specifically policies and 
     procedures which address co-worker responses to employees who 
     are chronically ill, including those who are living or 
     perceived to be living with HIV/AIDS.
     
[[Page S10718]]

       13. Identify what are discriminatory behaviors/actions in 
     the workplace.
       14. Understand workplace behaviors or actions that are 
     valued in terms of maximum productivity and optimum work 
     environment.
       15. Understand the importance of teaching young people how 
     to protect themselves from HIV infection, and how to talk 
     about HIV with children and adolescents.

                         Attitudinal objectives

       Ideally, participants will indicate they:
       1. View persons living or perceived to be living with HIV/
     AIDS no differently than persons with other life-threatening 
     illnesses.
       2. Feel more comfortable working with employees who are 
     chronically ill, including those who are living or perceived 
     to be living with HIV/AIDS.
       3. Are more supportive of reasonable accommodations for 
     employees who are chronically ill, including those living or 
     perceived to be living with HIV/AIDS.
       4. Feel less judgmental toward persons who are chronically 
     ill, including those living with or perceived to be living 
     with HIV/AIDS (with respect to the presumed or known 
     behaviors that resulted in their infection).
       5. Experience little or no fear of interacting with 
     employees who are chronically ill, including those living or 
     perceived to be living with HIV/AIDS.
                         Behavioral objectives

       Participants should be able to:
       1. Assess their own levels of risk for HIV infection.
       2. Adopt behaviors that eliminate transmission risks.
       3. Provide support for chronically ill employees including 
     those who are living with HIV/AIDS.
       4. Express willingness to participate in work assignment 
     adjustments necessary to provide ``reasonable accommodation'' 
     for chronically ill employees, including those living with 
     HIV/AIDS.
       5. Share HIV prevention information with others.
       6. Apply information about the Federal Rehabilitation Act 
     of 1973, Americans With Disabilities Act of 1990, Equal 
     Employment Opportunity, Family and Medical Leave Act, as well 
     as leave disability and health benefits information.


                 xi. objectives for managerial training

                         Behavioral objectives

       Managers should be able to:
       1. Apply policies and procedures for managing employees who 
     are chronically ill, including those living or perceived to 
     be living with HIV/AIDS.
       2. Manage employee disclosures assuring that 
     confidentiality is maintained. This is critical for staff who 
     may want to disclose they are living with HIV/AIDS and for 
     other staff that may want to voice concerns about working 
     with someone living with HIV/AIDS.
       3. Appropriately provide any necessary reasonable 
     accommodation in collaboration with Human Resources personnel 
     and the employee.
       4. Manage the performance of employees who are chronically 
     ill, including those living or perceived to be living with 
     HIV/AIDS.
       5. Discuss concerns with Human Resources or employee 
     assistance personnel during the employee disclosure, 
     accommodation, or referral process.
       6. Manage sensitive documents reporting an employee's HIV 
     or health status.


                         xii. policy statements

       As indicated above, the Presidential Directive requires all 
     departments and agencies to review their personnel policies 
     to ensure that they provide adequate protections for 
     employees with a chronic illness, including those living with 
     HIV/AIDS, while ensuring a comfortable and safe work 
     environment. To accomplish this we suggest the following:
       Review the Office of Personnel Management (OPM), Federal 
     Personnel Manual Letter (FPM) 792-21 (March 1988) and 
     Attachment of FPM Letter 792-21 (April 24, 1991), ``Acquired 
     Immune Deficiency Syndrome (AIDS) in the Workplace.'' 
     Applying the basic guidance from the FPM letter, establish or 
     revise your own organizational policies. OPM is in the 
     process of establishing a repository for all the policies 
     from the various departments and agencies. Upon completion of 
     your organization's policy statement, please send a copy to: 
     Chief, Employee Health Services Branch, U.S. Office of 
     Personnel Management, 1900 E Street, NW, Room 7412, 
     Washington, DC 20415. If you have questions concerning the 
     FPM letter or applicable policies, you may call the office at 
     (202) 606-1269.
       Each training participant should receive specific written 
     policy information, as well as information outlining 
     procedures for the disclosure process, counseling, disability 
     and health insurance benefits. Distribution of a policy 
     statement is not enough; each employee should receive a 
     document that contains the names, locations and telephone 
     numbers of the individuals associated with the administration 
     of the following.
       1. Equal Opportunity Employment.
       2. Interpretation of the Federal Rehabilitation Act of 
     1973.
       3. Interpretation of the Americans with Disabilities Act of 
     1990 (where applicable).
       4. Health and disability retirement benefits information, 
     Employee Assistance Programs and Counseling.
       5. Family and Medical Leave Act.
       6. State and local government interpretations.
       7. Local union representatives (where applicable).
       8. Occupational Safety and Health Administration (OSHA) 
     guidelines, especially those related to possible occupational 
     exposure to HIV.


          xiii. general policies for supervisors and managers

       Each department or agency should develop policies and 
     procedures for employees with serious illnesses, including 
     those living with HIV/AIDS, that are flexible enough to 
     accommodate individual circumstances. In some situations it 
     will be necessary to negotiate with the employee an 
     appropriate workplace accommodation. This process should 
     always include a designated representative from the Human 
     Resources Department or the Employee Assistance Program (and 
     may include a union representative).
       Each department or agency must consult with their General 
     Counsel in developing specific policies and procedures for 
     employees with serious illnesses, including those living with 
     HIV/AIDS. The following guidelines should be considered in 
     developing those policies and procedures. A department or 
     agency may develop policies that are more specific than those 
     addressed here.
                       Privacy and confidentially

       An employee's health condition is personal and 
     confidential. Employees have understandable concerns over 
     confidentiality and privacy about medical documentation and 
     other information related to an HIV/AIDS diagnoses that is 
     submitted for purposes of an employment decision.
       Precautions must always be taken to protect information 
     regarding an employee's health condition. It is inappropriate 
     to report disclosures to other upper-level supervisors unless 
     there is a documented ``need to know.'' (These cases are 
     minimal and should be confirmed with your Human Resource 
     Department.) Employees living with HIV/AIDS or other life-
     threatening illnesses are entitled to full coverage under the 
     Federal Rehabilitation Act of 1973, the Americans With 
     Disabilities Act of 1990, sick leave, Family and Medical 
     Leave Act, leave bank programs, disability benefits, and 
     equal employment opportunity. Should questions arise 
     concerning such matters, contact your Human Resources 
     Department.
       Some employees work in occupations that may put them at 
     greater risk of HIV infection (e.g., medical facilities, 
     laboratories, security personnel who might come in contact 
     with blood, etc.). These employees should attend a training 
     session with special emphasis on the use of universal 
     precautions where there might be exposure to blood-borne 
     pathogens. These guidelines can be obtained from OSHA.

              General practices for discussing disclosures
       Generally, when employees disclose any life-threatening 
     illness, including HIV/AIDS, a supervisor should not 
     immediately initiate any sudden changes in the employee's 
     working environment. Be sensitive to the possible 
     contribution of anxiety over this condition to work behavior. 
     Any part of the disclosure process should include discussions 
     with the employee, the first-line supervisor, and a 
     representative from the Human Resources Department or the 
     Employee Assistance Program (and may include the employee's 
     union representative.)

                  Making ``Reasonable'' accommodations

       The purpose behind reasonable accommodations is to provide 
     alternatives for employees living with disabilities, in this 
     case HIV/AIDS, to continue productive work as long as 
     possible. Reasonable accommodations provide a work 
     environment where individuals living with disabilities can 
     maximize their productivity and continue to be part of the 
     workforce. The implementation of reasonable accommodations 
     usually has a positive impact on all staff, as it 
     communicates the willingness of managers to care for the 
     individual needs of employees.
       What reasonable accommodates does not mean is that 
     employees with disabilities, including those living with HIV/
     AIDS, are held to significantly different performance 
     standards than employees without disabilities in similar 
     positions. It also does not mean new jobs must be created to 
     accommodate any employee living with a disability.
       When look at an individual employee's condition, consider 
     changes in work assignments like job restructuring, 
     reassignment, liberal leaves or flexible schedules for 
     employees living with HIV/AIDS in the same manner as for 
     other employees whose medical conditions affect their ability 
     to perform safely and reliably. In so doing, observe 
     established policies governing qualification, internal 
     placement, transfers and other staffing requirements. 
     Alternate work scheduling is often the least expensive and 
     simplest accommodation.

                    Addressing co-workers' concerns

       Be sensitive and responsive to co-workers' concerns, and 
     emphasize the need for education. Be clear that mistreatment, 
     harassment, malicious gossip, or hurtful actions in the 
     workplace will not be tolerated. Through educational efforts 
     and private discussions, teach employees that no medical 
     basis exists for refusing to work with a fellow employee, or 
     clients of a department or agency, living with HIV/AIDS.


                       xiv. training suggestions

       The following recommendations are made by the Office of 
     National AIDS Policy to assure quality in this initiative. By 
     following 

[[Page S10719]]
     these suggestions you can reduce training obstacles, ensure quality 
     standards, and expedite the educational process.
       1. Upon reviewing these guidelines, examine your 
     organizational structure, the composition of your workforce 
     and any logistical considerations that impact on training. By 
     looking at other training programs offered by our department 
     or agency, you may determine the most appropriate method for 
     conducting HIV/AIDS workplace training for your staff.
       2. To achieve consistency, coordinate the training at every 
     level throughout the organization. Request initial input from 
     department heads who can ensure the plan is carried out 
     consistently. Develop a network of HIV/AIDS coordinators 
     throughout your organization. Share the educational plan with 
     them, develop a strategy and schedule the sessions. Also, you 
     may want to include union representatives in your network of 
     coordinators.
       3. Establish a local-area network (LAN) bulletin board for 
     questions and answers concerning HIV/AIDS issues, employee 
     benefits, leave programs, interpretation of the Family and 
     Medical Leave Act, policies affecting the terminally ill, 
     etc. Keep entries into the system confidential.
       4. Collect questions anonymously and publish answers in 
     employee newsletters. If your own organization does not have 
     a newsletter, perhaps your union does.
       5. If your organization employs someone living with HIV/
     AIDS, and he/she feels comfortable talking to a group, you 
     may invite the employee to a question and answer
      session or to make brief presentations, especially for World 
     AIDS Day, December 1. These presentations, if included in 
     the training, should not exceed 20 minutes.
       6. For workplaces where the risk of occupational exposure 
     to HIV may be greater (i.e., occupations in which employees 
     routinely, or are likely in some circumstances, to come in 
     contact with blood or blood products), a special training 
     session on ``Bloodborne Pathogens/Universal Precautions'' in 
     addition to the general HIV/AIDS training session may be 
     appropriate. Be sure to inform the class of the exact date, 
     time and location. Detailed, or specific questions about 
     bloodborne pathogens and universal precautions can be 
     answered in the Bloodborne Pathogens session.
       7. Keep the education and policy modules together and offer 
     them as one session, including a discussion of workplace 
     policies and procedures. (Managers and Supervisors may need 
     more details from the policy representative.)
       8. When asked hypothetical questions that demand complex 
     explanation, maintain credibility and try to negotiate the 
     discussion back to the facts and objectives. Politely refer 
     ``highly improbable'' questions to designated Human Resource 
     or employee assistance personnel. You may want to visually 
     tract the questions (using a flipchart etc.), ensuring that 
     each question is addressed by the end of the session. 
     However, if too many questions are deferred, the instructor 
     may lose credibility. A skilled, experienced instructor will 
     strive to provide the necessary balance.
       9. Conduct pilot sessions to validate your training 
     sessions and ask for input from unions, human resources, 
     training and employee assistance departments. Optimally, 
     retain the same effective instructors throughout your 
     agency's or organization's program.
       10. Before conducting the pilot sessions, take time with 
     the instructor to discuss the employees who will be attending 
     the sessions. (Are they analysts, lawyers, accountants, 
     support staff?) The instructors will not need great detail, 
     but a little background information will make the instructor 
     more at ease and ``set the stage'' for successful training.
       11. Work with your training departments and ensure that 
     basic components of the HIV/AIDS training, especially policy, 
     are incorporated in required managerial training and new 
     employee orientation. If you do not have a new employee 
     orientation program, maintain accurate records and provide 
     future HIV/AIDS training sessions as needed. Remember this 
     initiative is ongoing and HIV/AIDS workplace education must 
     become a part of all employee's ongoing training.
       12. As an option, offer some weekend or evening sessions to 
     include family members, friends of employees, and other 
     members of the community who interact with your department or 
     agency.
       13. During the training, provide supplemental information 
     regarding discussions of HIV/AIDS with children and teens. 
     The theme for World AIDS Day, December 1, 1994, will be 
     ``AIDS and the Family.'' You may want to offer seminars or 
     workshops emphasizing ``AIDS and the Family'' throughout the 
     year, or during the week of December 1, 1994.
       14. Provide additional information to all employees to 
     enhance and reinforce understanding about the nature and 
     transmissions of HIV/AIDS. Use news bulletin, personnel 
     management directives, meetings, guest experts. Q&A sessions, 
     films and video newsletters, union publications, fact sheets, 
     pamphlets.


                          xv quarterly reports

       Each department and independent agency is required to send 
     quarterly reports to the Office of National AIDS Policy. 
     These reports are compiled and sent directly to the 
     President. Accurate record keeping will expedite the report 
     writing process. The FWAEI Quarterly Report should include:
       1. The number of staff trained during the quarter, 
     including number of classes and average class size.
       2. The total number of staff trained since inception of the 
     initiative (September 30, 1993).
       3. The percentage of the total staff of the department or 
     agency that (2) represents.
       4. Any difficulty faced in implementing the HIV/AIDS 
     education program (logistical problem, unclear 
     communications, personnel resistance).
       5. Progress made in updating and revising departmental non-
     discrimination policies.
       6. Future plans and milestones in implementing the HIV/AIDS 
     initiative within your department or agency. (How many 
     employees are scheduled during the next quarter, and foreseen 
     barriers to full implementation.)
       7. List private-sector and non-profit organizations who 
     have visited with you about their training programs.
       8. Other activities you plan or have scheduled to re-
     emphasize AIDS Awareness, especially for World AIDS Day, 
     December 1, 1994. Include any press articles about your 
     implementation of the Federal Workplace AIDS Education 
     Initiative.
       9. For the last report of the year, your future plans 
     section must include what will be your plans for conducting 
     training for the following calendar year. This shall include 
     how many people you estimate to be trained per quarter for 
     the following year.
       Due dates for future reports are June 15, September 15, 
     December 15. All reports should be faxed or mailed to the 
     Federal Workplace AIDS Education Coordinator. Mailing 
     information follows.

                 Office of National AIDS Policy contact

       For information about these guidelines, contact the Federal 
     Workplace HIV/AIDS Education Coordinator, Executive Office of 
     the President, Office of National AIDS Policy, 750 17th 
     Street, Suite 1060, Washington, DC 20503, telephone (202) 
     690-5560 or FAX (202) 690-7560.

                          Interagency meetings

       Each month the Office of National AIDS Policy Conducts a 
     meeting to discuss questions, as well as to present materials 
     that have been developed by organizations for the FWAEI. The 
     meeting is open to Federal and non-Federal employees. Meeting 
     notices are normally faxed and not confirmed by a mailing. 
     Please be sure that your contact name, address, telephone 
     number and fax number are correct with the Office of National 
     AIDS Policy. (See Office of National AIDS Policy Contact.)


                             xvi. resources

       The Office of National AIDS Policy, the Department of 
     Energy, the Office of Personnel Management, and other Federal 
     agencies have collaborated with the Department of Health and 
     Human Services' employee assistance program to develop 
     training packages which comply with these guidelines. 
     Supervisor training materials are nearly completed and your 
     agency FWAEI contact will be notified when these training 
     packages are available.
       Materials should include resources and information provided 
     by local community based organizations who work with HIV/AIDS 
     related issues. The CDC National AIDS Clearinghouse can help 
     you find information (800) 458-5231. The Centers for Disease 
     Control and Prevention's National AIDS Hotline number, 1-800-
     342-AIDS, must be included in all resource information. 
     Throughout the training, this number should be clearly posted 
     in the room.
                        xvii. suggested readings

                              Periodicals

       ``A Case of AIDS'' by Richard S. Tedlow and Michele S. 
     Marram, Harvard Business Review, November-December 1991, 
     pages 14-25.
       ``AIDS Education Is a Necessary High-risk Activity,'' by 
     Jonathan A. Segal, HRMagazine, February 1991, pages 82-85.
       ``AIDS Policy & Law,'' a bi-weekly newsletter of Buraff 
     Publications, 1350 Connecticut Avenue, N.W., Suite 1000, 
     Washington, DC, 20036, (202) 862-0926.
       ``Financial Realities of AIDS in the Workplace,'' by Vaughn 
     Alliton, HRMagazine, February 1992, pages 78-81.
       ``Human Immunodeficiency Virus/Acquired Immunodeficiency 
     Syndrome Training from a Union Perspective,'' by Elaine 
     Askari, MPH, and John Mehring, B.A. American Journal of 
     Industrial Medicine, 22:711-720 (1992).
       ``AIDS Reference Guide,'' published by Atlantic Information 
     Services, 1050 17th Street N.W., Suite 480, Washington, DC 
     20036, (202) 775-9008.
       ``Removing the Mystery from AIDS Education,'' by Anne E. 
     Jordheim, Ed.D., R.N., Management Review, February, 1990, 
     page 20.
       ``Why AIDS Policy Must Be a Special Policy,'' by Ron 
     Stodghill II, Russell Mitchell, and Karen Thurston, and 
     Christina Del Valle, Business Week, February 1, 1993, pages 
     53-54.

                                 Books

       The AIDS Benefits Handbook by Thomas P. McCormack published 
     in 1990 by Yale University.
       AIDS Handbook by Brenda S. Faison, M.P.D. and edited by 
     Laila Moustafa, Ph.D., published in 1991 by Designbase 
     Publishing, P.O. Box 3601, Durham, North Carolina, 27702-
     3601.
       AIDS in the Workplace, Legal Questions and Practical 
     Answers, by William F. Banta, 

[[Page S10720]]
     published in 1993 by Lexinghouse Books, 866 Third Avenue, New York, NY 
     10022.
       Getting the Word Out, A Practical Guide to AIDS Materials 
     Development by Ana Consuelo Mariella, 1990 by Network 
     Publications, P.O. Box 18830, Santa Cruz, CA, 95061-1830.
       The Guide to Living with HIV Infection by John G. Bartlett, 
     M.D. and Ann K. Finkbeiner, published in 1993 by The Johns 
     Hopkins University Press, 2715 North Charles Street, 
     Baltimore, Maryland 21218-431.
       Managing AIDS in the Workplace, by Sam B. Puckett, L.L.B., 
     M.B.A. and Alan R. Emery, Ph.D., published in 1988 by 
     Addison-Wesley Publishing Company, Reading MA.
       Preventing AIDS, A Guide to Effective Education for the 
     Prevention of HIV Infection, American Public Health 
     Association, 1015 Fifteenth Street, NW, Suite 300, 
     Washington, DC 20005 (202) 789-5600.
       Training Educators in HIV Prevention, An Inservice Manual 
     by Janet L. Collins, Ph.D. and Patti O. Britton, 1990 by 
     Network Publications, P.O. Box 1830, Santa Cruz, CA 95061-
     1830.
       We Are All Living With AIDS, How You Can Set Policies and 
     Guidelines for the Workplace, by Earl C. Pike, published in 
     1993 by Deaconess Press (a service of Fairview Riverside 
     Medical Center, a division of Fairview Hospital and 
     Healthcare Services), 2450 Riverside Avenue South, 
     Minneapolis, MN 55454.
       100 Questions and Answers About AIDS by Michael Thomas 
     Ford, published in 1993 by New Discovery Books, MacMillian 
     Publishing Company, 866 Third Street, New York, NY 10022.
                               Message #1

       Subject: Mandatory HIV/AIDS training.
       Author: Stec at FAS07.
       Date: 01/31/95 02:27 p.m.
       On September 30, 1993, President Clinton mandated Federal 
     HIV/AIDS education for all Federal employees. To comply with 
     this Presidential mandate, the Foreign Agricultural Service 
     is presenting the attached mandatory HIV/AIDS training 
     sessions.
       Please attend the session scheduled as indicated or arrange 
     to switch session with a coworker.
       Supervisors are responsible for disseminating this 
     information to their employees and for certifying that all 
     employees under their supervision attend a session of the 
     mandate training.
       Please contact Charlotte Stec, 720-1596, if you have any 
     questions regarding this training.

                               Message #2

       Subject: PL 480 status of PA report.
       Author: Rivera JA at FAS15.
       Date: 01/31/95 03:13 p.m.
       The monthly Public Law 480 ``Status of PA'' report is now 
     available on the ``u'' drive. To access it, go to ``pl480'' 
     from the Windows' File Manager, since this is a Lotus file, 
     and click on ``title1''. This report shows Public Law 480, 
     Title I agreements signed, purchase authorizations issued, 
     and sales registered. For information, please call Jose 
     Rivera at 720-6286.
                                                                    ____



                            Training Program

       Please attend the session scheduled as follows in 
     accordance with your last name. This is mandatory training 
     for all Federal employees. If you cannot attend your 
     scheduled session, please arrange to switch sessions with a 
     coworker.
       Attendance will be taken. All participants should bring a 
     pencil or pen with them.
       A Sign Language Interpreter will be provided for the 
     afternoon session of February 7th only. Employees requiring 
     special accommodations should contact Charlotte Stec.

           Date, Time, Location, Last Name, Begins in Letters

       February 7, Tuesday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, A-BE, BI-CI.
       February 8, Wednesday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, CL-DI, DO-GA.
       February 9, Thursday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, GE-HAN, HAR-HO.
       February 14, Tuesday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, HU-KI, KL-MA.
       February 16, Thursday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, MC-M, N-PL.
       February 17, Friday 8:30-11:30 a.m., 12:30--3:30 p.m., 
     Jefferson Auditorium, PO-RO, RU-SL.
       February 24, Friday 8:30-11:30 a.m., 12:30-3:30 p.m., 
     Jefferson Auditorium, SM-TI, TO-WES.
       February 28, Tuesday 8:30-11:30 a.m., Jefferson Auditorium, 
     WET-Z.
       (For further information or questions, contact Charlotte 
     Stec, HIV/AIDS Coordinator, on 720-1596 or FAX 720-2016.)
                                                                    ____

               [From the Washington Times, Mar. 27, 1995]

      Mandatory Federal AID Classes Cited as Promoting Gay Agenda


                 training addresses religion as barrier

                         (By Rowan Scarborough)

       The Clinton administration's guidelines for mandatory AIDS 
     training of all federal employees call for the ``breaking 
     down of audience resistance'' to the program's teachings if 
     that resistance is based on ``religious beliefs.''
       The training manuals portray people opposed to condom 
     distribution in schools as ``partisans.'' They tell trainers 
     to use the words ``sex partners'' instead of ``husband and 
     wife'' and ``injecting drug user'' instead of ``addict.''
       Would-be trainers have to discuss their views on 
     ``homosexuality for my child'' as part of the selection 
     process.
       A federal worker who underwent training this month said she 
     was offended when the instructor, a private contractor, began 
     talking about her grandmother's likely sex practices.
       ``I was shocked and upset when the instructor personalized 
     anal sex for each person in the room by saying our 
     grandmothers probably practiced birth control by 
     participating in anal sex,'' said the worker, who described 
     the three-hour session on the condition that she not be 
     identified.
       ``I was highly offended,'' she said, ``I have a very godly 
     grandmother, and I just broke down and cried. I guess they're 
     trying to say homosexuals do it that way and so did your 
     grandmother.''
       The guidelines are in documents from the departments of 
     Energy, Health and Human Services, and Agriculture. Other 
     departments are believed to use similar guidelines, which are 
     coordinated and approved by the White House.
       Aimed at the 2.1 million federal employees, the ``Federal 
     Workplace AIDS Education Initiative'' was authorized last 
     year by Mr. Clinton, whose campaign received political and 
     financial support from the homosexual community.
       Administration rules for AIDS instruction tell trainers:
       To avoid certain terms, such as ``husband and wife,'' 
     ``homosexual men,'' ``promiscuous,'' ``sexual preference'' 
     and ``addict.''
       To deflect ``homophobic comments'' during a training 
     session by saying, ``There is some division of opinion on 
     that point.''
       To watch out for troublemakers among the pupils. A federal 
     worker who takes an ``intransigent point of view'' on condom 
     distribution in schools or needle distribution is pegged as a 
     ``partisan.'' A ``heckler'' is someone who ``expresses 
     disbelief, disgust or scoffs at content and processes.'' A 
     ``moralist'' believes that ``people who are HIV-infected 
     through sex or drug use deserve what they get.''
       To suggest that a person use his own drug-injection 
     equipment or try ``disinfecting with bleach'' to avoid 
     getting the human immuno-deficiency virus, which causes AIDS.
       The Department of Energy's AIDS program is titled, 
     ``Walkin' the Talk'' and includes a discussion of ``serial 
     monogamy,'' which it defines as an ``exclusive sexual 
     relationship with one individual at a time.''
       ``Practicing serial monogamy and therefore having several 
     sexual partners, even over an extended period of times, may 
     place one at risk for HIV infections unless he or she 
     practices safer sex,'' the program says.
       One of the training manuals included a scoring system 
     titled ``Values About HIV/AIDS-Related Issues.'' It was used 
     to select AIDS instructors.
       Candidates were asked to rate their opinion on several 
     topics, including ``sex without love,'' ``sex outside of a 
     committed relationship,'' ``homosexuality for my child,'' 
     ``stiff sentences for injection-drug users who share needles 
     and other drug-injection paraphernalia,'' and ``laws to 
     protect homosexuals from discrimination in housing, jobs and 
     public accommodations.''
       Jim Woodall, a vice president of the conservative group 
     Concerned Women for America, said President Clinton should 
     ``cease and desist'' the training. He said the goals could be 
     achieved by giving employees a Centers for Disease Control 
     and Prevention brochure on AIDS prevention.
       ``We have been suspecting for a long time that AIDS 
     education is being used as a facade to promote the homosexual 
     lifestyle,'' Mr. Woodall said. ``AIDS education used in 
     public schools and college campuses has now invaded our 
     government, where the president is mandating federal 
     employees to sit down for four hours for this type of 
     education. It's a fraud.''
       Mr. Woodall's 600,000-member organization is compiling 
     information on the program.
       ``I do not have any problem with gays relating to gays when 
     talking about sex,'' he said. ``The issue is, the U.S. 
     government is promoting that agenda using taxpayer dollars.''
       Richard Sorian, White House spokesman on AIDS policy, 
     disagreed with the group's characterization of the program. 
     ``The effort has been a very successful effort to supply 
     people with information that allows them to protect 
     themselves and protect their family,'' he said.
       He said Concerned Women for America is misinterpreting some 
     of the training material. For example, he said, the section 
     on ``breaking down audience resistance'' based on religion is 
     an effort to have workers air those concerns so they can be 
     discussed.
       ``They are not trying to change someone's religious beliefs 
     at all,'' Mr. Sorian said. ``What they are talking about is 
     beginning the instruction with any concerns they have or 
     religious belief that might make them uncomfortable with the 
     discussion so they can be comfortable in the discussion.''
       Mr. Sorian said such words as ``addict'' are avoided for a 
     good reason: ``If you say drug addicts are susceptible to 
     HIV, but they don't consider themselves an addict, then they 
     don't recognize themselves as an addict.''
       He said he has received ``positive feedback'' from 
     participants who have used the 

[[Page S10721]]
     information to educate others. The program is scheduled to end this 
     week. The White House AIDS office then will know how many 
     workers were reached.
       Some federal workers have objected to the training.
       A defense Department employee said he walked out during his 
     department's session.
       ``I don't believe I should sit next to a female and be told 
     how to do intercourse, no matter how sidetracked they go,'' 
     said the employee, who requested anonymity. ``I don't want to 
     be in mixed company and talk about a lifestyle I'm not 
     involved in, that I don't approve of. I don't care to be 
     instructed by Big Brother in things I avoid.''
       A Drug Enforcement Administration worker who objected to 
     attending AIDS training was ordered to attend or be 
     disciplined for insubordination.
       Mr. Woodall said the system ``weeds out any people who have 
     a problem with the gay lifestyle.''
                                                   March 31, 1995.
     Senator Jesse Helms,
     Century Post Office Building,
     Raleigh, NC.
       Dear Senator Helms: At a time when our total federal budget 
     is under scrutiny, it seems appropriate to study all 
     expenditures. Within USDA,ARS our budgets for agricultural 
     research are particularly tight. Nevertheless, we spend a 
     tremendous amount of time in all types of training sessions. 
     This week we were required to attend a mandatory HIV/AIDS 
     training session which is apparently required by the 
     President of all Federal employees. This results in millions 
     of dollars in lost man hours and consequently wages. We also 
     were required to take a pre- and post-class test. 
     Unfortunately, at least in our agency, there is no way to 
     test out of the class time. Since we are mostly biological 
     scientists we learned essentially nothing. The enclosed 
     material was to be read prior to the class and thereby using 
     more of our valuable time. Some of this material is not 
     appropriate for the workplace (e.g. how to have safe oral 
     sex, page 28), and it does seem to be necessary for 
     government time and money.
       I hope you and other congressional members will carefully 
     consider the cost/benefits of our numerous training sessions. 
     The taxpayer's money can be better spent on research in our 
     agency than in peripheral training sessions not suited to us.
           Sincerely,
  Mr. HELMS. Mr. President, I ask for the yeas and nays on this 
amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. HELMS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. HELMS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELMS. Mr. President, I ask unanimous consent to lay aside the 
previous amendment so that I can offer another amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 1857

(Purpose: To limit amounts appropriated for AIDS or HIV activities from 
               exceeding amounts appropriated for cancer)

  Mr. HELMS. I now send an amendment to the desk and ask that it be 
stated.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from North Carolina [Mr. Helms] proposes an 
     amendment numbered 1857:
       At the appropriate place, insert the following new section:

     SEC.  . LIMITATION ON APPROPRIATIONS.

       Notwithstanding any other provision of law, the total 
     amounts appropriated for any fiscal year for AIDS and HIV 
     activities may not exceed the total amounts discretionary 
     funds appropriated for such fiscal year for activities 
     relating to cancer.

  Mr. HELMS. As the clerk has read, Mr. President, this amendment 
proposes that the Ryan White CARE Reauthorization Act of 1995 have this 
provision to guarantee that any and all Federal funds authorized and 
appropriated for HIV/AIDS will not exceed the total Federal funds 
authorized and appropriated for and in connection with the disease of 
cancer.
  The leading cause of death in America today is heart disease, 
followed closely by cancer. HIV/AIDS ranks ninth, No. 9--I believe, as 
a matter of fact, they lowered it to No. 8. So make that read HIV/AIDS 
ranks eighth in the number of deaths it causes. It is of interest that 
HIV/AIDS receives $2.7 billion per year in Federal funding, which 
exceeds Federal funding in connection with any other disease. Heart 
disease, for example, Mr. President, kills more than 720,000 Americans 
every year, and $805 million in Federal funds are allocated and 
appropriated for heart disease. Cancer kills 515,000 Americans, and it 
receives $2.3 billion.
  I think the arithmetic of all of this, Mr. President, speaks for 
itself. I want the Record to show that I hope a cure for HIV/AIDS is 
found tomorrow morning, and I encourage every research effort toward 
this end. However, I have to make it clear that I am appalled at what 
has become a total politicization of Federal funding for medical 
research and health services.
  The pending amendment stipulates that Congress may not authorize or 
appropriate more money for HIV/AIDS than is authorized and appropriated 
in connection with the disease cancer. More people are dying from heart 
disease and cancer and stroke and lung disease and accidents and 
pneumonia and diabetes and Alzheimer's and suicide than die from AIDS. 
Each one of these kills more people than does the disease AIDS, yet 
AIDS receives a disproportionate amount of the taxpayers' money.
  On average, the Federal Government spends about $91,000 on every 
person who dies of AIDS. The Federal Government spends about $5,000 for 
every person who dies of cancer.
  Now, I have my own ideas about priorities, but that is an issue for 
another day. And I think I am correct in my impression that Americans 
agree that this discrepancy is neither fair nor equitable.
  In a nutshell, the pending amendment will bring a measure of equity 
and fairness to the existing priorities in the area of HIV/AIDS 
funding. As long as cancer kills 18 times as many people as AIDS, and 
AIDS nonetheless receives more Federal funding, it is time I think that 
Congress established some new equitable priorities.
  Mr. President, I ask that all of my previous amendments be set aside 
enabling me to ask for the yeas and nays on this amendment.
  The PRESIDING OFFICER. The yeas and nays have been requested. Is 
there a sufficient second? There is a sufficient second.
  The yeas and nays were ordered.
  Mr. HELMS. I yield the floor.
  Mrs. KASSEBAUM. Mr. President, I am not sure if we are ready to 
propound a unanimous-consent agreement yet or not.
  Mr. HELMS. I am certainly ready to hear it.
  Mrs. KASSEBAUM. No, I guess we are not. So if I may just for a moment 
respond to several of the amendments that have been put forward by 
Senator Helms. On the amendment that talks about promotion of 
homosexual activity. I certainly have great sympathy for wanting to 
limit what the activities might be supported. I will be introducing an 
amendment which addresses that same issue but perhaps not in the same 
way as Senator Helms. I will not get into a definition of the 
amendment. Since the unanimous-consent agreement has not been put 
forward yet, I am not sure whether we should go ahead and send our 
amendments to the desk, but perhaps we will get them all out and then 
we can decide what to do.


                           Amendment No. 1858

     (Purpose: To prohibit the use of funds for certain activities)

  Mrs. KASSEBAUM. I send to the desk an amendment. I ask unanimous 
consent to set aside the amendments.
  The PRESIDING OFFICER. Without objection, the pending amendment is 
set aside. The clerk will report the amendment of the Senator from 
Kansas.
  The assistant legislative clerk read as follows.

       The Senator from Kansas [Mrs. Kassebaum] proposes an 
     amendment numbered 1858.

  Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:
       At the appropriate place, insert the following new section:

     SEC.   . PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

       Part D of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-71) as amended by section 6, is further amended 
     by adding at the end thereof the following new section:
     
[[Page S10722]]


     ``SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

       ``None of the funds authorized under this title shall be 
     used to fund AIDS programs, or to develop materials, designed 
     to promote or encourage, directly, intravenous drug use or 
     sexual activity, whether homosexual or hetero-sexual. Funds 
     authorized under this title may be used to provide medical 
     treatment and support services for individuals with HIV.''.

  Mrs. KASSEBAUM. The amendment I have sent to the desk will prohibit 
the use of the Ryan White CARE Act funds to support activities which 
promote homosexuality. This provision will assure that the funds 
allocated under this act would be used to provide treatment for 
individuals. There would be no funds to be used for promotion of 
homosexual activities. I offer this amendment because I am aware that 
some of my colleagues are concerned that the CARE activities may lead 
to increased sexual activity or to increased drug use. Specifically, 
some are concerned that needle exchange programs and prophylactic 
distribution programs may lead to increased homosexuality or drug 
abuse. Whether or not these concerns are valid, my amendment makes it 
clear that none of the funds expended under this act could be used for 
such promotion activities. Rather, this provision would assure that 
CARE Act funds would be used for treatment. In this regard, it is more 
narrow than the amendment that has been offered by Senator Helms in 
that it clearly states that the CARE Act funds are for treatment only, 
not prevention or homosexual promotion activities.
  I offer this amendment because I would like to have us fully consider 
some of the language and implications of that language, and that will 
be set aside at such time as we come to a vote on the legislation.
  Senator Helms also put forward an amendment to ensure that Federal 
employees will not be required to attend or participate in AIDS 
training programs. I would for myself think that is a very sensible 
amendment. Mr. President, it does seem to me that we should not have to 
require attendance of Federal employees for such programs. I would like 
to say, though, I do not believe that the intent was to design these 
programs to change the lifestyle of Americans. I think the intent was 
to really try to have an understanding of AIDS, what it was about, what 
type of disease it was. But I really myself strongly will support 
Senator Helms and say that in my mind it should not be a required 
attendance.
  Another amendment that Senator Helms put forward was on the funding. 
He would hold the funding levels to the same as they are in 1995. Mr. 
President, the House Appropriations Committee has appropriated $656 
million for 1996. If we take the 1995 level, that is $651 million. But 
holding it until the year 2000 when AIDS cases are increasing at 20 
percent a year seems to me to be a very difficult way for us to address 
this issue at this time. And I think it clearly should be left up to 
the appropriators. I know that the appropriators today--the Presiding 
Officer is on the Appropriations Committee--are not going to be 
frivolous in the moneys they spend. And I have a great deal of 
confidence that they will take into consideration the needs that are 
addressed that have to be met in the Ryan White CARE legislation and 
will consider wise and sensible use of those funds. So that amendment I 
would just have to oppose because I think putting that type of 
restraint until the year 2000 clearly would do a disservice to many who 
are in serious need.
  The other amendment was regarding funding equity. And I will be 
considering another amendment to address that issue because, as I 
mentioned earlier, it is of great concern. And one of the things where 
we would differ is what moneys go to research and is discretionary 
funding and what moneys come from, say, Medicare and Medicaid and the 
Social Security disability funding. That makes a big difference in the 
total amount, and I think it is important that there is an 
understanding regarding that difference. So, I will be putting forward 
another amendment on funding equity a bit later as we complete this 
debate.
  I yield the floor, Mr. President.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. I will just take a moment because the Senator from 
Kansas has outlined what I think has been a very responsible and 
thoughtful series of options for the Senate to make a judgment and a 
decision upon. They will be available to the Members as they examine 
these issues over the nighttime, and then we will have a chance to 
address them tomorrow and, hopefully, reach a final resolution. I think 
she has summarized the reasons and justifications for the positions 
which she has outlined, and I am in very substantial agreement. With 
some issues along the way we may have some difference. But I think 
there will be a series of alternatives for the Members to make a 
judgment on these matters on tomorrow and, I think, for the Members to 
make a final judgment on these questions tomorrow as well.
  What remains will be the Gregg amendment, which deals with the 
exports of various pharmaceuticals and medical devices that have not 
been approved by the FDA or, for that matter, approved by the other 21 
different countries that have regulatory agencies. He will best 
describe his amendment. This is a matter which is before the Human 
Resources Committee, and it certainly was my impression up until this 
afternoon that that would be a part of the whole FDA reorganization and 
structure. It is appropriate that it should be because we have a 
different criteria, for example, for pharmaceuticals and how the FDA 
treats those versus biotech and medical device legislation. So, I had 
thought we would be addressing that as part of our total FDA review.
  It has been the judgment of the Senator from New Hampshire to offer 
that measure, which initially, as I understand it, was a Hatch measure 
to this proposal. And we will have a chance to discuss that in the 
morning and make some judgment on that issue. And I would certainly 
invite our colleagues to pay close attention to the debate that will, 
hopefully, take place at 9:30 if we are able to work through our 
consent agreement.
  Mr. President, I have more extended remarks on some of these measures 
which I will either make this evening or include in the Record. 
Hopefully, we are at a point where we might be able to consider a 
consent agreement, and I have been here long enough to know that, if 
that is possible, it is wise to try to take advantage of the 
opportunity before it may escape.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER (Ms. Snowe). The Senator from Kansas.
  Mrs. KASSEBAUM. I ask unanimous consent that the name of the Senator 
from New Mexico, Senator Domenici, be added as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. KASSEBAUM. It is my understanding we are close to being able to 
put forward the unanimous-consent agreement. I think there still needs 
to be a couple of additional checks made.
  Mr. HELMS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. If the Senator will yield.
  It is perfectly acceptable to me, Madam President.
  It will take a unanimous consent to vary the order in which the 
amendments were presented, is that not correct?
  The PRESIDING OFFICER. That is correct.
  Mr. HELMS. Just so there will be no accidental mistake made, I ask 
unanimous consent that all amendments be voted on tomorrow morning in 
the order in which they were presented.
  The PRESIDING OFFICER. Is there any objection?
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Could the Senator state again what the request was? As I 
understood it, we were in the process of trying to work out a consent 
request to cover the disposition of the measures tomorrow.
  Mr. HELMS. If the Senator will yield. I am not suggesting anything 
that would vary the unanimous consent that I hold in my hand. I favor 
that. I simply want to be sure that all amendments are voted upon in 
the order in which they were presented.
  Mr. KENNEDY. I see the Senator from Kansas on the floor.
  
[[Page S10723]]

  Mrs. KASSEBAUM. Well, I did not present my amendment regarding 
promotional activities until you had completed presenting all of your 
amendments. I wonder in the voting if they could not follow each other, 
so that we are----
  Mr. HELMS. Is that the one where you deleted the second half of mine?
  Mrs. KASSEBAUM. Yes. Although it is changed.
  Mr. HELMS. You did not change the language in the first half?
  Mrs. KASSEBAUM. Yes. It is a different approach because it is just 
targeted to the care, but using some similar language.
  We are going to end up voting on the Senator's amendment. This says 
the same thing but does not get into a definition.
  Mr. HELMS. Madam President, I am going to have to suggest the absence 
of a quorum on this one because that is a contradiction of my 
understanding. Perhaps I can correct it. May I see a copy?
  Mrs. KASSEBAUM. The Senator has it.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. HELMS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HELMS. Madam President, I ask that it be in order for the Senator 
from North Carolina to ask for the yeas and nays on final passage on 
the Ryan White bill.
  The PRESIDING OFFICER. It is in order.
  Mr. HELMS. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. HELMS. I thank the Chair. I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mrs. KASSEBAUM. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 1859

  (Purpose: To strike provisions relating to the medicare wage index)

  Mrs. KASSEBAUM. Madam President, I send an amendment to the desk on 
behalf of Senator Graham of Florida for immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Kansas [Mrs. Kassebaum] for Mr. Graham 
     proposes an amendment numbered 1859.

  Mrs. KASSEBAUM. Madam President, I ask unanimous consent that further 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       On page 41, line 7, strike ``the product of--'' 
     and all that follows through line 15, and insert the 
     following ``an amount equal to the estimated number of living 
     cases of acquired immune deficiency syndrome in the eligible 
     area involved, as determined under subparagraph (C).''.
       On page 43, strike lines 1 through 13.
       On page 43, line 14, strike ``(E)'' and insert (D)''.
       On page 43, line 24, strike ``(F)'' and insert (E)''.
       On page 44, line 3, strike the end quotation marks and the 
     second period.
       On page 46, line 5, strike ``the product'' and all that 
     follows through line 14, and insert the following ``an amount 
     equal to the estimated number of living cases of acquired 
     immune deficiency syndrome in the eligible area involved, as 
     determined under subparagraph (D).''.
       Beginning on page 46, line 17, strike ``means the'' and all 
     that follows through line 8 on page 47, and insert the 
     following: ``means an amount equal to the sum of--
       ``(i) the estimated number of living cases of acquired 
     immune deficiency syndrome in the State or territory 
     involved, as determined under subparagraph (D); less
       ``(ii) the estimated number of living cases of acquired 
     immune deficiency syndrome in such State or territory that 
     are within an eligible area (as determined under part A).''.
       Beginning on page 48, strike line 1 and all that follows 
     through line 14 on page 49.
       On page 49, line 15, strike ``(F)'' and insert (E)''.
       On page 49, line 19, strike ``(G)'' and insert (F)''.
       On page 50, line 4, strike ``(H)'' and insert (G)''.
       On page 53, between lines 20 and 21, insert the following 
     new section:

     SEC. 7. STUDY ON ALLOTMENT FORMULA.

       (a) Study.--The Secretary of Health and Human Services 
     (hereafter referred to in this section as the ``Secretary'') 
     shall enter into a contract with a public or nonprofit 
     private entity, subject to subsection (b), for the purpose of 
     conducting a study or studies concerning the statutory 
     formulas under which funds made available under part A or B 
     of title XXVI of the Public Health Service Act are allocated 
     among eligible areas (in the case of grants under part A) and 
     States and territories (in the case of grants under part B). 
     Such study or studies shall include--
       (1) an assessment of the degree to which each such formula 
     allocates funds according to the respective needs of eligible 
     areas, State, and territories;
       (2) an assessment of the validity and relevance of the 
     factors currently included in each such formula;
       (3) in the case of the formula under part A, an assessment 
     of the degree to which the formula reflects the relative 
     costs of providing services under such title XXVI within 
     eligible areas;
       (4) in the case of the formula under part B, an assessment 
     of the degree to which the formula reflects the relative 
     costs of providing services under such title XXVI within 
     eligible States and territories; and
       (5) any other information that would contribute to a 
     thorough assessment of the appropriateness of the current 
     formulas.
       (b) National Academy of Sciences.--The Secretary shall 
     request the National Academy of Sciences to enter into the 
     contract under subsection (a) to conduct the study described 
     in such subsection. If such Academy declines to conduct the 
     study, the Secretary shall carry out such subsection through 
     another public or nonprofit private entity.
       (c) Report.--The Secretary shall ensure that not later than 
     6 months after the date of enactment of this Act, the study 
     required under subsection (a) is completed and a report 
     describing the findings made as a result of such study is 
     submitted to the Committee on Commerce of the House of 
     Representatives and the Committee on Labor and Human 
     Resources of the Senate.
       (d) Consultation.--The entity preparing the report required 
     under subsection (c), shall consult with the Comptroller 
     General of the United States. The Comptroller General shall 
     review the study after its transmittal to the committees 
     described in subsection (c) and within 3 months make 
     appropriate recommendations concerning such report to such 
     committees.
       On page 53, line 21, strike ``7'' and insert ``8''.

  Mrs. KASSEBAUM. Madam President, this amendment has been agreed to by 
both sides. It addresses a problem that would exist particularly in 
Florida regarding formula. It is designed to be of assistance in 
addressing that in a way that we have all agreed we think works, to 
everyone's benefit.
  Mr. KENNEDY. Madam President, I urge the acceptance of the amendment. 
This addresses some of the special needs of the State of Florida. I 
think it is justified. I hope the amendment would be accepted.
  The PRESIDING OFFICER. The question is on agreeing to the amendment.
  The amendment (No. 1859) was agreed to.
  Mrs. KASSEBAUM. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. HATCH. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HATCH. Madam President, they are trying to put together a final 
agreement so that they can go out tonight. Until they do, let me take a 
few minutes and express myself on the Ryan White bill.
  Madam President, people are dying. People are dying and we have the 
chance today or tomorrow to enact legislation that will really make a 
difference--really make a difference in their lives, and the lives of 
their families and friends who love them.
  We have the chance to enact legislation that will help alleviate some 
of the pain and suffering of individuals who are infected with HIV.
  We have a chance to enact bipartisan legislation showing that 
Congress cares more about people--about people who are critically ill 
and need our help--than about how those people got ill.
  Madam President, in 1981, two physicians unknown to each other, on 
opposite ends of the United States, made similar observations that they 
would 

[[Page S10724]]
then publish in their respective medical journals.
  They noted that a small group of their otherwise healthy patients 
were becoming infected with organisms that would normally affect 
individuals who were for some reason immune-suppressed. In layman's 
terms--these patients had a weakened immune system.
  By the end of the following year, 1982, almost a thousand cases of 
the disease had been reported to the Centers for Disease Control. 
Congress had appropriated $8 million for research to combat this 
mysterious virus.
  Over the next few years, the number of such cases dramatically 
increased and began to spread throughout the country, as did our 
realization that the virus, now called acquired immune deficiency 
syndrome, AIDS, was not going to be eradicated overnight.
  Funding for research rose to $44 million in fiscal year 1983, $104 
million in fiscal year 1984 and by fiscal year 1990 had reached $3 
billion. By 1987, there were cases in each of our 50 States.
  As I look back, I recall how AIDS began to touch on each of our daily 
lives, as the number of cases grew, and the need for increasing 
research and service-related funding for this growing epidemic.
  We began to expand funding beyond the Department of Health and Human 
Services, to the Department of Defense, the Agency for International 
Development, and the Bureau of Prisons.
  We funded the Department of Labor, the Department of Housing and 
Urban Development and the Veterans Administration. We provided funding 
through the Federal Employees Health Benefits Program.
  Our response grew with the magnitude of the disease, as it should 
continue today.
  As I think back to the early days of AIDS, and how the growing 
numbers of infected individuals and the resultant death toll caused 
this country so much alarm and panic.
  Unfortunately, as with any unsuspected crisis, the immediate response 
from many--including members of both houses of Congress--could be 
characterized as denial, anger, and blame. Fortunately, over time, our 
compassion has grown for those infected with this insidious virus, as 
our understanding about the causes of and treatments for this 
devastating disease increased.
  As I look back, I think of the swift reaction of our health care 
community, yet how painfully clear it was that both our research and 
service delivery infrastructures lacked the capacity to address the 
growing number of cases of HIV infection.
  I talked about our growing research effort. I did not talk about the 
dedication of our scientists, and their ensuing frustration, as a 
cure--or even a vaccine--continued to elude our grasp.
  Today, they still remain outside our grasp.
  As I look back, I recall how the service delivery programs evolved--
the AIDS service demonstration projects, the home and community-based 
health services grant programs, and the AIDS drug reimbursement 
program--yet we still could not keep pace with the need for services in 
our communities.
  They came out of our Labor Committee, and we were proud to authorize 
those programs which have really served to help people. But they were 
not enough.
  Out of this great need for community-based, compassionate care was 
born the Ryan White Comprehensive AIDS Resources Emergency [CARE] Act 
of 1990, a bill I was pleased to author with my colleague from 
Massachusetts, Senator Kennedy.
  We named the bill after Ryan White, a courageous, intelligent and 
caring young man from Indiana, who worked tirelessly to educate others 
about HIV and AIDS. Ryan helped replace fear and indifference with hope 
and compassion. One of the great lessons of his life--that we should 
not discriminate against those with the HIV virus of other illness--
remains true today. His tireless efforts, indeed his legacy, is being 
carried on by his mother, Jeanne White. And I met with her a number of 
times. And I have to say she is doing a good job.
  There are so many others who have spoken out with the same spirit and 
eloquence, including Mary Fisher, founder of the Family AIDS Network, 
who is a tireless crusader against AIDS, and our much-missed friend 
Elizabeth Glaser, who established the Pediatric AIDS Foundation which 
has done so much to improve the lives of children infected with HIV.
  I can remember when she first walked into my office. I did not know a 
lot about pediatric AIDS. I knew about adult AIDS. But I did not 
realize so many children were being infected at that time. When she 
walked in and explained it to me, I have to say we decided to help her. 
Our colleagues, Senator Metzenbaum and others, helped her raise her 
first million dollars for the Pediatric AIDS Foundation at a wonderful 
dinner here in Washington, DC and she went on from there to raise 
several more million dollars in the fight against AIDS, and, of course, 
she is one of the most valued heroines in this country, as far as I am 
concerned. There have been so many unnamed others in countless 
communities across the Nation.
  Today, we have before us reauthorization of the Ryan White CARE Act.
  My message is simple: it is an important act. It must be 
reauthorized.
  The need continues.
  Let me discuss a few dramatic facts in order to highlight the 
tremendous impact of this disease and explain why this bill should be 
passed.
  The most revealing fact is that the No. 1 cause of death for males 
aged 29 to 44 is now AIDS.
  In the last decade, the proportion of cases represented by women has 
almost tripled.
  Even in my small home state of Utah, it is estimated by the 
Department of Health that there are 5,000 people infected with the HIV 
virus. To date, 1,110 have been diagnosed with full-blown AIDS, and 644 
have died.
  Indeed, our knowledge of AIDS has expanded dramatically since those 
early days.
  We now know that AIDS is not a gay disease, or a Haitian disease.
  We know that it cannot be transmitted by casual contact.
  We know that it affects man, woman and child, whatever race, whatever 
nationality.
  AIDS does not play favorites. It affects rich and poor, adults and 
children, men and women, rural communities and the inner city.
  We know much, but the fear remains.
  Madam President, things have changed since 1990. But the need for 
this legislation remains.
  The number of cases continues to increase. At the end of 1994, the 
Centers for Disease Control and Prevention had recorded 441,528 cases 
of HIV. The number continues to grow.
  The emotional and economic burden for HIV patients and their families 
is substantial, and it continues.
  The Ryan White CARE Act has made a difference and should continue to 
make a difference.
  There is so much that remains to be done.
  Since its enactment in 1990, the Ryan White AIDS Care Act has 
provided the necessary assistance to those persons and their families 
affected by the AIDS epidemic. Often, the funding provides for models 
of HIV service delivery that are considered to be some of the most 
successful health care delivery models in history.
  I am very proud of Utah's Ryan White program. Let me tell you of some 
of our accomplishments.
  Ryan White funds were used to establish a home health services 
program which provides much needed homemaker, health aide, personal 
care, and routine diagnostic testing services.
  A drug therapy program has been established that offers AZT and other 
drugs to individuals infected with HIV.
  Ryan White funds have been used to provide health and support 
services through an HIV Care Consortium, which offers vital services 
such as dental, mental health counseling, transportation, benefits 
advocacy, eye exams and glasses, legal advocacy, information and 
education, nutrition counseling, and substance abuse counseling.
  These are programs which are in place and which are working. They 
should be continued.
  I believe it is vital that we reauthorize the Ryan White Act.
  Madam President, many have noted that AIDS brings out the best and 
worst in people. Let us hope that this debate reflects the best of the 
great American traditions of reaching out to those in our community.
 
[[Page S10725]]

  I plead with my colleagues today, and I will tomorrow, let us not 
backslide on this. I wish to compliment the distinguished chairman of 
the Labor and Human Resources Committee, and the ranking member, 
Senators Kassebaum and Kennedy, for the work that they have done and 
for the courageous way that they have gone about it and for the work 
they have done on the floor here this day. I personally respect both of 
them very much, and I appreciate what they are doing in this bill.
  Our progress has been great, but we have so much more to do to wipe 
out this virus. Let us hope and pray that one day, like smallpox, the 
HIV virus will be eradicated as a public health problem, and that is 
what we are talking about, public health, for everybody. Until then, 
Ryan White programs offer the only glimmer of hope to thousands of 
Americans who are living with HIV.
  So I wish to thank my esteemed colleagues, especially our floor 
managers today, Senators Kassebaum and Kennedy and others who have 
worked so hard to move this important piece of legislation forward. I 
will work with them in any way I can to see that this legislation is 
sent to the President as quickly as possible, and I again hope that we 
can do this probably tomorrow morning.
  I thank the Chair.
  Mrs. KASSEBAUM. Madam President, I wish to express appreciation to 
the Senator from Utah. Senator Hatch, as he mentioned, was the original 
cosponsor along with Senator Kennedy of the Ryan White CARE Act in 
1990. If it had not been for the leadership he provided, I am not sure 
we would be here today debating renewal of that legislation. It was 
crucial at that time to help develop an understanding of what it was 
all about, and I think without Senator Hatch's strong and forthright 
and dedicated concern at that time, it would have been extremely 
difficult to have the public awareness and support that it has. I just 
wish to express that appreciation to the Senator from Utah.
  Mr. HATCH. If the Senator will yield, I certainly thank her for her 
kind remarks, but I feel equally disposed to congratulate her and to 
thank her for the work she is doing this year and has done in the past. 
She and Senator Kennedy have done a very good thing here. So I thank 
her very much.
  Mrs. KASSEBAUM. I would just say Senator Hatch, of course, we miss on 
the Labor Committee, where he was at one time chairman and ranking 
member, and I have big shoes to follow in that leadership on the Labor 
and Human Resources Committee.
  Mr. BYRD. Mr. President, earlier today during the debate on S. 641, 
the Ryan White CARE Reauthorization Act, the distinguished senior 
Senator from North Carolina [Mr. Helms] raised questions concerning 
where the appropriations for the Ryan White Program have been going. He 
indicated that he had been unable to receive any detailed information 
from the Clinton administration. He further stated his hope that the 
Appropriations Committee would be able to provide such information in 
connection with the fiscal year 1996 appropriations bill. I have asked 
the staff to look into this matter and get such information as is 
available as quickly as possible. For now, I have a CRS Report dated 
March 31, 1995, entitled ``Health Care Fact Sheet: Ryan White CARE Act 
Reauthorization.'' This report sets forth the programs which are 
authorized for funding under the Ryan White Comprehensive AIDS 
Resources Emergency Act of 1990 (P.L. 101-381). Under that act, this 
report states that:

       Grants are made to States, to certain metropolitan areas, 
     and to other public or private nonprofit entities both for 
     the direct delivery of treatment services and for the 
     development, organization, coordination, and operation of 
     more effective service delivery systems for individuals and 
     families with HIV disease.

  It further states that for fiscal year 1995, $633 million has been 
appropriated for these purposes.
  Mr. President, I ask unanimous consent that the report be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 CRS Report for Congress--Health Care Fact Sheet: Ryan White CARE Act 
                            Reauthorization

       The Ryan White Comprehensive AIDS (acquired immune 
     deficiency syndrome) Resources Emergency (CARE) Act of 1990 
     (P.L. 101-381) authorized a set of Federal grant programs to 
     provide emergency assistance to localities disproportionately 
     affected by the human immunodeficiency virus (HIV) epidemic. 
     Grants are made to States, to certain metropolitan areas, and 
     to other public or private nonprofit entities both for the 
     direct delivery of treatment services and for the 
     development, organization, coordination, and operation of 
     more effective service delivery systems for individuals and 
     families with HIV disease. Total FY 1995 appropriations were 
     $633 million. CARE Act programs are currently authorized 
     through FY 1995. On Mar. 29, 1995, this Senate Committee on 
     Labor and Human Resources ordered reported S. 641, the Ryan 
     White CARE Reauthorization Act of 1995. The bill would modify 
     the CARE Act programs and extend authorizations through FY 
     2000.


                  current ryan white care act programs

       Title I of the Act provides emergency formula and 
     supplemental grants to disproportionately affected, eligible 
     metropolitan areas (EMAs). Eligible areas with more than 
     2,000 cases of AIDS, or where the cumulative per capita 
     incidence exceeds one quarter of 1% may apply for title I 
     funds. Half of each year's appropriation is distributed to 
     EMAs under a formula based on cumulative caseload and 
     incidence; the remainder is used for supplemental grants 
     awarded on the basis of applications by EMAs. Forty-two EMAs 
     received funds for FY 1995, up from 16 in FY 1991. Title I 
     funds are directed to the chief elected official 
     administering the public health agency providing outpatient 
     and ambulatory services to the greatest number of persons 
     with AIDS in the designated area. The official must establish 
     an HIV Health Services Planning Council which further sets 
     priorities for care delivery in accord with Federal 
     guidelines.
       Title II provides formula grants to States and Territories 
     for comprehensive care services including home and community-
     based care, continuity of health insurance coverage, payment 
     for pharmaceuticals and other treatments to prevent 
     deterioration of health, and other services. Grants are 
     allocated on the basis of recent AIDS caseload and State per 
     capita income. States reporting 1% or more of the national 
     AIDS caseload are required to match Federal funds ($1 State 
     for every $2 Federal in FY 1995) and must use
      50% or more of their grant toward establishing an HIV health 
     and support services consortium. The Secretary withholds 
     10% of Title II appropriations to support special projects 
     of national significance (SPNS), a grant program that 
     promotes advancements in the delivery of health care and 
     support services to the HIV population.
       Title III(b) provides early intervention categorical grants 
     to public and private nonprofit entities already providing 
     primary care services to populations at risk of HIV. Services 
     allowed under title III(b) include counseling and testing, 
     case management, outreach, medical evaluation, transmission 
     prevention, and risk reduction strategies. (Title III(a), 
     authorizing early intervention grants to States, has never 
     been funded.)
       Title IV authorizes a number of different HIV-related 
     programs, of which only one, pediatric demonstration grants, 
     had been funded. These grants foster collaboration and 
     coordination between clinical research and health care 
     providers and target HIV infected children, pregnant women, 
     and their families.
       Appropriations for FY 1995 total $633 million as follows: 
     $357 million for title I, $198 million for title II, $52 
     million for title III, and $26 million for title IV. (On 
     March 2, the full House Committee on Appropriations rejected 
     a subcommittee reported rescission of $13 million in FY 1995 
     funds.)


        S. 641, the Ryan White CARE Reauthorization Act of 1995

       As reported, S. 641 authorizes appropriations of such sums 
     as may be necessary for all titles for FY 1996 through 
     FY2000. It makes numerous changes in CARE Act programs, 
     including expansion of permissible services, stronger 
     planning and coordination requirements, and a greater 
     emphasis on services to minorities and to women and children. 
     There are also important funding changes, as follows:
       A single appropriation would be authorized for titles I and 
     II. For FY1996, 64% of funds would go to title I; a method 
     for distribution for later years would be developed by the 
     Secretary.
       Allocation formulas for titles I and II would be based on 
     estimated persons living with AIDS (rather than cumulative 
     cases) and would include a new factor reflecting area 
     variation in the costs of services. These changes would 
     redirect funds to the areas where the epidemic is growing 
     most rapidly; temporary hold-harmless provisions would 
     prevent sharp funding reductions for existing grantees. New 
     EMAs would have to have populations of at least 500,000, and 
     would be eligible on the basis of caseload alone (rather than 
     caseload or incidence).
       The special projects of national significance program would 
     be funded through a 3% withhold from each title, rather than 
     10% from title II alone.


[[Page S10726]]
                                                                            AIDS FUNDING HISTORY--SEPTEMBER 27, 1994                                                                            
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                             Fiscal    Fiscal    Fiscal                                                                             Fiscal                                      
                                              year      year      year      Fiscal      Fiscal      Fiscal      Fiscal      Fiscal      Fiscal     year 1995     House      Senate    Conference
                                              1986      1987      1988     year 1989   year 1990   year 1991   year 1992   year 1993   year 1994      req                                       
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
HRSA                                                                                                                                                                                            
    Education and Training Centers........  ........    $1,550   $11,106     $14,640     $14,549     $17,029     $16,984     $16,435     $16,435     $16,157     $16,287     $16,287     $16,287
    Pediatric AIDS........................  ........  ........     4,787       7,806      14,803      19,518      19,747      20,897  ..........  ..........  ..........  ..........  ..........
    Facilities and Renovation.............  ........  ........     6,702       3,903       4,342       4,029  ..........  ..........  ..........  ..........  ..........  ..........  ..........
    Other.................................   $15,311    10,350    14,361      29,692      74,023  ..........  ..........  ..........  ..........  ..........  ..........  ..........  ..........
    Ryan White                                                                                                                                                                                  
        Emergencuy Assistance (Title I)...  ........  ........  ........  ..........  ..........      87,831     121,663     184,757     325,500     364,500     352,500     356,500     356,500
        Comprehensive care (Title II).....  ........  ........  ........  ..........  ..........      87,831     107,704     115,288     183,897     213,897     195,897     198,897     198,147
        Early Intervention (Title III)....  ........  ........  ........  ..........  ..........      44,891      49,862      47,968      47,968      66,968      51,568      52,568      52,318
        Pediatric Programs (Title IV).....  ........  ........  ........  ..........  ..........  ..........  ..........  ..........      22,000      27,000      26,000      26,000      26,000
                                           -----------------------------------------------------------------------------------------------------------------------------------------------------
          Subtotal--Ryan White............  ........  ........  ........  ..........  ..........     220,553     279,229     348,013     579,365     672,365     625,965     633,965     632,965
                                           =====================================================================================================================================================
        AIDS Dental Services..............  ........  ........  ........  ..........  ..........  ..........  ..........  ..........       7,000       6,884       6,937       6,937       6,937
                                           -----------------------------------------------------------------------------------------------------------------------------------------------------
          Subtotal--AIDS..................    15,311    11,900    36,956      26,349      33,694     261,129     315,960     385,345     602,800     695,406     649,189     657,189     656,189
CDC.......................................    62,155   136,077   304,942     377,592     442,826     496,960     480,132     498,253     543,253     532,693     606,000     558,253     590,243
    Total NIH.............................   146,656   293,977   500,399     742,428     904,455   1,004,825   1,047,294   1,072,453   1,297,115   1,379,052   1,337,606   1,337,606   1,337,606
                                           =====================================================================================================================================================
SAMHSA                                                                                                                                                                                          
    Cntr Ment Hlth Serv...................  ........  ........  ........  ..........  ..........  ..........  ..........       2,987       6,943       5,343       6,881       5,394       6,943
    Cntr Subs Abuse.......................  ........  ........  ........  ..........  ..........  ..........  ..........      21,156      21,156       2,726      10,526      20,526      18,026
                                           -----------------------------------------------------------------------------------------------------------------------------------------------------
        Subtotal--AIDS....................  ........  ........  ........  ..........  ..........  ..........  ..........      24,143      28,099       8,069      17,407      25,920      24,969
                                           =====================================================================================================================================================
Agency for Health Care Policy and Research  ........  ........     1,000       6,831       8,474      10,252      10,135       9,624      10,624      11,917      10,557      10,624      10,591
Office of the Secretary                                                                                                                                                                         
    Health Initiatives....................  ........  ........  ........       3,416       4,010       2,149       2,075       2,073  ..........  ..........  ..........  ..........  ..........
    National AIDS Program Office..........  ........       363     3,308       3,023       3,666       3,789       2,452       2,936       2,869       2,848       2,899           0       1,750
    AIDS Contingency Fund.................  ........    30,000  ........  ..........  ..........  ..........  ..........  ..........  ..........  ..........  ..........  ..........  ..........
                                           -----------------------------------------------------------------------------------------------------------------------------------------------------
      Total...............................   224,122   472,317   846,505   1,159,639   1,397,125   1,779,104   1,858,048   1,994,827   2,484,760   2,629,985   2,623,658   2,589,592   2,621,348
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

                                                                                                                                                                                      __________
  Mr. KOHL. Mr. President, I rise as a cosponsor and enthusiastic 
supporter of S. 641, the Ryan White CARE Act reauthorization.
  The AIDS epidemic is a continuing crisis in our Nation that shows no 
sign of abating. Once a problem for only a few big urban areas, the 
crisis has increasingly impacted people in smaller cities and rural 
areas. More and more Americans are seeing friends and relatives 
stricken with HIV disease and are struggling to find adequate services 
for their loved ones.
  Mr. President, over 2,700 Wisconsinites have been diagnosed with HIV 
infection and AIDS since 1985. As of March 1995, the Centers for 
Disease Control and Prevention has reported 481,234 cases of AIDS 
nationwide. The Ryan White CARE Act has been critical for communities 
responding to the AIDS crisis by helping to establish coordinated 
health care systems. Over 300,000 people afflicted with the disease 
receive life-prolonging treatment through the act.
  This bill continues programs that help hard-hit municipal areas, 
support coordinated State efforts to combat AIDS, and provide primary 
care to special populations, including pregnant women and children. The 
Ryan White CARE Act represents the most effective type of government 
initiative; it targets State and Federal Government resources to fund 
comprehensive plans under the guidance of community leaders, medical 
professionals, affected populations, and officials at municipal, State, 
and Federal levels.
  Since the enactment of the Ryan White CARE Act, Wisconsin has 
utilized its limited allocations to reach underserved areas of the 
State while concentrating resources on hard-hit communities. Care is 
available to citizens in every part of the State, not just a few 
cities. All funding in Wisconsin is provided through a consortium of 
community-based groups. This community oriented approach has allowed 
delivery of services to AIDS patients in their home, avoiding costly 
long-term hospitalization until absolutely necessary. The result is 
compassionate care for the afflicted and considerably less Medicaid 
spending, which saves State and Federal resources.
  The Ryan White CARE Act has proven invaluable in meeting the AIDS 
crisis, but like most government programs, has room for improvement. I 
am pleased to say that this bill does not simply continue the status 
quo of the original legislation. There are substantial changes that 
better target Federal resources while meeting the current threat of HIV 
and AIDS. These consensus changes were carefully worked out with input 
from those who fight the AIDS tragedy every day.
  The bill resolves longstanding formula inequities that pitted groups 
against one another. The new formula responds to the evolving dynamics 
of the epidemic. Using General Accounting Office recommendations, 
funding would now be distributed based on those currently living with 
AIDS and the changing cost of care.
  States where AIDS is widespread, but without cities designated as 
``eligible metropolitan areas,'' have not qualified for title I 
funding. Such States, like Wisconsin, have relied on limited 
allocations of title II funding in order to reach the afflicted in both 
urban and rural areas. The revised bill changes title I and title II 
funding by including an estimation of the number of individuals 
currently living with AIDS and the costs of providing services. The new 
title II formula is adjusted so that cases are not double counted, 
which unfairly advantages some States that also have title I cities. 
Provisions are also included to prevent service disruptions due to the 
formula changes.
  We must improve our response to AIDS given the alarming growth of the 
epidemic. Few would question that AIDS is one of the leading public 
health threats facing our Nation and the world. As such, a unified 
response must be maintained. This bill contains positive changes to 
equitably distribute funding and allows communities to continue working 
together to provide the most effective treatment for AIDS victims.
  Mr. President, let us not get bogged down in extraneous issues that 
cloud the purpose of this legislation. The nature of this crisis 
demands targeted, compassionate treatment for those afflicted with a 
devastating disease. Women, children, and men of all ages and 
backgrounds are victims of HIV. Families and whole communities have 
been devastated by AIDS. They deserve our continued commitment.
  The Ryan White CARE Act received strong bipartisan support when 
originally enacted. With 63 current cosponsors of S. 641, the Senate's 
resolve to advance this important measure is clear and should remain 
undeterred.
  I urge my colleagues to support the Ryan White CARE Act and provide 
quick passage.
  Mr. SMITH. Mr. President, I am going to vote against S. 641, the so-
called Ryan White CARE Act.
  This is not going to be a popular vote, and I am sure that many will 
say that I am being unfair to AIDS victims and their families. But, I 
believe that this it is this bill that is unfair.
  Unfair to persons suffering from other diseases, and their families. 
Unfair to small States, like New Hampshire. Unfair to the taxpayers.
  First of all, let me make it clear that I take a back seat to no 
Senator in my concern for those inflicted with HIV and AIDS. I have 
always supported Federal AIDS research. But, we are already funding 
AIDS research.

[[Page S10727]]

  In fact, AIDS research is by far the most heavily funded area at the 
National Institutes of Health.
  Earlier this year, I was sent a table from the American Heart 
Association regarding the distribution of research dollars at the 
Department of Health and Human Services. The table tracks HHS research 
funding dollars spent per death in fiscal year 1993.
  It tracks five diseases--HIV-AIDS, diabetes, cancer, heart disease, 
and stroke. We are spending $36,763 per HIV-AIDS death, $5,421 per 
diabetes death, $3,708 per cancer death, $1,032 per heart death, and 
$731 per stroke death.
  Clearly, relative to other diseases, the Federal Government has 
demonstrated a firm commitment to funding AIDS research. In fact, the 
American Heart Association materials go on to say that HHS--

     spends 36 times more research funding per death of an AIDS 
     victim than was spent per death of a victim of heart disease. 
     Similarly, with regard to dollars spent per death, AIDS 
     funding exceeded stroke funding by 50 to 1.

  It seems that, in an effort to demonstrate our commitment to AIDS, we 
have seriously shortchanged many other devastating illnesses.
  As you can see, AIDS research is already being funded. The 
Congressional Budget Office estimates that this bill will cost $3.7 
billion over the next 6 years. So, where is this $3.7 billion going to 
go? If it is not research, what exactly is the Ryan White CARE Act?
  One of the architects of the Ryan White Program, the senior Senator 
from Massachusetts, summarized in his opening statement how Ryan White 
funds have assisted the city of Boston:

     15,000 individuals are receiving primary care, 8,000 are 
     receiving dental care, and 9,000 are receiving mental health 
     services. An additional 700 are receiving case management 
     services and nutrition supplements.

  I am very pleased to hear that so many people are being assisted in 
this way, particularly in Boston--right across the border.
  But, Mr. President, what makes someone with AIDS more entitled to 
federally funded mental health or dental services than someone with 
cancer or diabetes or Alzheimer's?
  No other disease has its own program like this.
  I am not saying that we should pit one disease against another, and 
say that they ought to all receive the same amount of funds.
  What I am saying is that we are already spending huge amounts of 
money on AIDS, without this bill.
  Would I like to see AIDS victims receive these services? Of course I 
would. I would like for everyone to receive these services.
  But, we need to face the budgetary realities. Our national debt 
recently climbed over the $4.9 trillion mark. It is rapidly reaching $5 
trillion. We can't just keep plowing full speed ahead with these sorts 
of spending programs without contemplating how we are going to pay for 
them.
  But, Mr. President, what concerns this Senator in particular is how 
my State of New Hampshire gets shortchanged in the funding formula in 
S. 641.
  The Senate Labor Committee provided me with a State-by-State 
breakdown of 1996 funds under this bill. According to the Labor 
Committee, when you combine titles I and II, my State of New Hampshire 
gets about $1,125,000.
  It is difficult to look at this number and determine whether this is 
higher or lower than what we should be getting. So, my staff 
calculated, using Census Bureau population statistics, how much each 
State gets back for every dollar it contributed for this bill. This new 
breakdown clearly shows where most of the money is going.
  New Hampshire gets only 20 cents on the dollar.
  That is, for every dollar we put in, we only got 20 cents back, while 
the State of New York gets $3.18 for every dollar they put in.
  Washington, DC, gets $7.26 for every dollar.
  I ask unanimous consent that this State-by-State breakdown be 
included in the Record at this point.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 FISCAL YEAR 1996 FUNDING BREAKDOWN FOR S. 641, THE RYAN WHITE CARE ACT 
                [By total funds and cents on the dollar]                
------------------------------------------------------------------------
                                S. 641 Funds                    Cents on
            State                    (in       Population (in     the   
                                thousands)\1\   thousands)\2\  dollar\3\
------------------------------------------------------------------------
Alabama......................          $1,350          4,1872       $.24
Alaska.......................             100             599        .12
Arizona......................           2,794           3,936        .52
Arkansas.....................             753           2,424        .23
California...................          69,290          31,211       1.64
Colorado.....................           3,581           3,566        .74
Connecticut..................           4,618           3,277       1.04
Delaware.....................             586             700        .62
D.C..........................           5,578             578       7.26
Florida......................          35,585          13,679       1.92
Georgia......................           8,626           6,917        .92
Hawaii.......................             499           1,172        .32
Idaho........................             138           1,099        .09
Illinois.....................          10,415          11,697        .66
Indiana......................           1,537           5,713        .20
Iowa.........................             333           2,814        .09
Kansas.......................             812           2,531        .24
Kentucky.....................             644           3,789        .13
Louisiana....................           4,530           4,295        .78
Maine........................             228           1,239        .14
Maryland.....................           8,577           4,965       1.27
Massachusetts................           6,956           6,012        .85
Michigan.....................           4,310           9,478        .34
Minnesota....................           1,725           4,517        .28
Mississippi..................             954           2,643        .27
Missouri.....................           4,310           5,234        .61
Montana......................             100             839        .09
Nebraska.....................             267           1,607        .12
Nevada.......................             964           1,389        .51
New Hampshire................             302           1,125        .20
New Jersey...................          19,678           7,879       1.85
New Mexico...................             479           1,616        .22
New York.....................          78,531          18,197       3.18
North Carolina...............           2,415           6,945        .26
North Dakota.................             100             635        .11
Ohio.........................           3,291          11,091        .22
Oklahoma.....................           1,051           3,231        .24
Oregon.......................           2,241           3,032        .54
Pennsylvania.................           8,501          12,048        .52
Rhode Island.................             555           1,000        .41
South Carolina...............           2,680           3,643        .54
South Dakota.................             100             715        .10
Tennessee....................           1,847           5,099        .27
Texas........................          24,096          18,031        .99
Utah.........................             428           1,860        .17
Vermont......................             104             576        .14
Virginia.....................           3,668           6,491        .42
Washington...................           4,151           5,255        .58
West Virginia................             211           1,820        .09
Wisconsin....................           1,068           5,038        .16
Wyoming......................             100             470        .16
Puerto Rico..................          13,690  ..............  .........
                              ------------------------------------------
      Totals.................         349,451         257,908       1.00
------------------------------------------------------------------------
\1\Source: Senate Labor and Human Resources Committee.                  
\2\Source: 1993 figures, U.S. Census Bureau.                            
\3\Figure obtained using the following formula: S/(P/U*T). S= FY96      
  funding (titles I & II) by state; P= state population; U= Total U.S.  
  Population; T= total funding under S. 641 (titles I & II).            

  Mr. SMITH. Mr. President, as I look at this table, it seems to me 
that my State would be better off funding its AIDS programs on its own.
  If we collected $10 in State taxes, we would have $10 to spend on 
AIDS services.
  But, under this formula, we give the Federal Government $10, and 
Uncle Sam writes us a check for $2, and then tells us how to spend it.
  I would urge my colleagues to take a look at this breakdown, and 
consider how their own State does, before supporting this bill.
  Mr. President, I have to congratulate the proponents of this 
legislation. They have done a superb job at packaging it up with a 
glitzy title, lots of cosponsors, and a masterful press campaign.
  Everyone knows the story of Ryan White, the courageous 13-year-old 
boy who fell prey to this devastating disease.
  It is a very effective technique. You name your bill after a person 
with a heroic story who is deeply admired by millions of Americans, 
like Ryan White, and people are afraid to vote against it.
  This makes for good politics, but, too often, bad policy.
  Frankly, Mr. President, if Ryan White were alive today, because he 
was from Kokomo, IN, and not a big city, he would not qualify for 
assistance under the emergency relief program--which accounts for $368 
million--nearly half of next year's funds.
  The only funds that he might qualify for would be under the ``CARE 
grant program'' (title II) which are distributed by a formula using the 
numbers of AIDS cases, rather than the size of the cities. But, 
according to CBO, the formula in this bill only allocates $205 million 
for this section--just over half the amount allocated for the big 
cities.
  So, the big cities get $368 million, the rest of the country--
including those same big cities--get to divide up the $205 million that 
is left over.
  If we are trying to help all AIDS victims, like Ryan White, why are 
most of the funds being funneled into large cities?
  Some would argue that they get more funds because they have more AIDS 
cases. That is not why they do better under this bill.
  That might be the reason that States with big cities get more money 
under title II, the $205 million CARE program. But the bulk of funds in 
this bill go to title I--$368 million.
  That section says that big cities, cities with more than 500,000 
residents, get all of the money, as long as they have more than 2,000 
cases of AIDS.
  If you have 499,000 residents, and a huge AIDS population, forget it. 
You get nothing. This has nothing to do with AIDS cases, or fairness, 
or need--only size.
  Suffice it to say that my State does not have any cities that are 
that big.

[[Page S10728]]

  Manchester has about 100,000 people.
  Nashua has about 80,000.
  Concord has about 36,000.
  So, this bill says ``tough luck for the State of New Hampshire, and 
many other States.''
  That is not to say that New Hampshire does no have an AIDS problem. 
We have the same problem that every other State has.
  I would urge my colleagues to take a look at the state-by-state 
breakdown that I put in the Record earlier and see how your own State 
does.
  But, we could have the highest incidence of AIDS in the Nation, and 
that would not matter. Under title I, it is cut and dry. Unless you 
have 500,000 residents, you don't get a nickel.
  In conclusion, Mr. President, it would be very easy for me to look 
the other way and vote for this bill. I would probably save myself a 
lot of grief and controversy.
                      Unanimous-Consent Agreement

  Mrs. KASSEBAUM. Madam President, I think we have now reached an 
agreement.
  I ask unanimous consent that the following amendments be the only 
amendments in order to S. 641, and that no second-degree amendments be 
in order to the amendments: the pending amendment is No. 1854. Then 
following, Helms amendment 1855; Helms amendment 1857, regarding 
funding equity; Helms amendment 1856, regarding training; Kassebaum 
amendment 1860, regarding funding equity; a Kassebaum amendment 
regarding promotion, 1858; a Gregg amendment regarding FDA, and a 
Kennedy amendment regarding FDA.
  Further, that all debate time be used on the above-listed amendments 
this evening with the exception of the amendment to be offered by 
Senator Gregg, and the amendment to be offered by Senator Kennedy.
  Further, that at the hour of 9:15 a.m. on Thursday, Senator Reid be 
recognized for up to 15 minutes for general debate on the bill, to be 
followed at 9:30 by Senator Gregg, to be recognized to offer his 
amendment on which there would be 1 hour to be equally divided in the 
usual form.
  I further ask that following the conclusion of the debate on the 
Gregg amendment, Senator Kennedy be recognized to offer his amendment 
regarding FDA, on which there would be 30 minutes to be equally divided 
in the usual form, and that following that debate the Senate proceed to 
vote first on the Helms amendment 1854, followed in sequence with two 
back-to-back votes on other amendments in the order in which they were 
offered, and that there be 10 minutes for explanation between each of 
the remaining votes, to be equally divided in the usual form, and that 
following the disposition of the above-listed amendments, the Senate 
proceed to third reading and final passage, all without any intervening 
action or debate.
  The PRESIDING OFFICER. Is there objection? The Chair hears none, and 
it is so ordered.
  Mrs. KASSEBAUM. Further, Madam President, I ask unanimous consent 
that any votes occurring after 12:30 p.m. as a result of this agreement 
be postponed to occur at a time to be determined by the two leaders.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. KASSEBAUM. I thank the Chair.
  Madam President, there are no further votes for this evening.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. I ask unanimous consent that further proceedings 
under the quorum call be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________