[Congressional Record Volume 142, Number 116 (Thursday, August 1, 1996)]
[Extensions of Remarks]
[Pages E1446-E1447]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             INTRODUCTION OF THE HIV PREVENTION ACT OF 1996

                                 ______
                                 

                           HON. TOM A. COBURN

                              of oklahoma

                    in the house of representatives

                        Thursday, August 1, 1996

  Mr. COBURN. Mr. Speaker, it has been just 15 years since the first 
cases of AIDS were recognized. The first thousand cases had been 
reported to the CDC by February 1983. The cumulative incidence of 
reported AIDS reached 10,000 in the spring of 1985, only 2 years later. 
The cumulative number of cases reached a total of 513,486 by the end of 
1995. Of these, 319,849 were known to have died. Clearly, this is an 
epidemic of historic proportion that is continuing to grow.
  While no cure exists for AIDS, we know enough about the disease to 
prevent its spread completely. For instance, we now know that AIDS is 
caused by the human immunodeficiency virus [HIV] and is actually the 
end stage of HIV infection. We also know that the disease is 
transmitted through the exchange of body fluids and it attacks the 
body's immune system, eventually leaving the body unable to fend off 
disease.
  What we do not know is the extent of the disease. We have failed to 
employ the public health procedures which have been successful in 
curtailing other epidemics in our efforts against HIV. These include 
confidential HIV reporting and partner notification.
  We have made an effort to report cases of AIDS on a State and 
National level but not cases of HIV. We do not make it a priority to 
notify those who may have been exposed that their lives may be 
endangered.
  Put simply, the Federal Government and the public health community 
have been AWOL in the battle against HIV. Sound medical practices have 
been abandoned and replaced with political correctness. HIV has been 
treated as a civil rights' issue instead of the public health crisis 
that it is.
  Today, I am happy to introduce the HIV Prevention Act of 1996 in an 
attempt to return sound medical practices to our Nation's public health 
policy and curtail the spread of the deadly HIV epidemic.
  Recent scientific breakthroughs make prompt passage of this bill 
extremely important.
  Many of the world's top HIV scientists have suggested that it may be 
possible to eradicate the virus from the body and completely suppress 
it by using a combination of new HIV drugs. Some believe that these 
drugs may transform HIV from a terminal disease into a chronic disease 
like diabetes or heart disease. However, researchers agree that the 
success of these drugs depends upon getting treatment early.
  This bill aims at protecting the uninfected and at helping those who 
are infected to discover their status as early as possible to maximize 
the opportunities now available.
  The following is a section-by-section summary of the proposal.

                   Improved HIV Epidemic Measurement

       The HIV Prevention Act establishes a confidential national 
     HIV reporting effort.
       Currently every State reports AIDS cases, which is merely 
     the end stage HIV infection. By confidentially reporting new 
     cases of HIV, those responsible for control of the disease 
     can more accurately determine the current extent of the 
     epidemic as well as future trends, rates of progression, 
     direction of spread, possible changes in transmissibility and 
     other critical factors of disease control. Such information 
     will allow for the development of long-term strategies based 
     on reliable data.


                          PARTNER NOTIFICATION

       The HIV Prevention Act would require States to inform 
     individuals if they may have been exposed to HIV by a current 
     or past partner.
  Partner notification is the only timely way to alert those in danger 
of infection and is the standard public health procedure for curtailing 
the spread of virtually all other sexually transmitted diseases.
       Partner notification essentially requires two steps. The 
     fist is counsel all infected individuals about the importance 
     of notifying their partner or partners that they may have 
     been exposed. The second is for their doctor to forward the 
     names of any partners named by the infected person to the 
     Department of Health where specially trained public health 
     professionals complete the notification. In all cases, the 
     privacy of the infected person is, and must be, protected by 
     withholding the name of the infected person from the partner 
     being notified.

[[Page E1447]]

       Notification allows for early medical treatment which can 
     prolong and improve lives. It also curtails the spread of 
     HIV, and therefore, saves lives.
       Studies confirm that only 10 percent or less of people who 
     have recently tested HIV-positive manage, by themselves, to 
     notify their partners.
       Between 50 percent and 90 percent of those who tested 
     positive cooperate voluntarily with notification. Further, 
     even higher proportions of those partners contacted- usually 
     90 percent or more- voluntarily obtain an HIV test.
       An overwhelming number of Americans believe that the rights 
     of partners of those infected with HIV should be balanced 
     against medical privacy rights held by the infected partners 
     according to a poll published in the New York Post.
       Legislation requiring spousal notification has already been 
     signed into law (Public Law 104-146). It makes perfect sense 
     to expand notification to all of those who may have been 
     exposed to HIV.
       The Centers for Disease Control and Prevention has 
     concluded that even if only one in 80 notifications results 
     in preventing a new case of HIV-infection, given the huge 
     medical and social costs of every case, notification pays for 
     itself.
       The American Medical Association (AMA) has endorsed non-
     consensual partner notification for HIV infection and CDC has 
     required states to establish procedures for partner 
     notification for AIDS.
       More than 30 states have enacted specific HIV partner 
     notification provisions as of July 1994 and several others 
     have passed laws allowing for the disclosure of HIV 
     information in response to a court order.
       It is estimated that between 630,000 to 900,000 Americans 
     are living with HIV infection and about 50,000 people became 
     infected with HIV each year. Sadly, most of those infected do 
     not know it and do not get tested until they are already sick 
     with AIDS-related disease. By this point, they have been 
     denied the medical care that can prolong their lives and 
     stave off illness and may have infected others unknowingly.
       Aggressive partner notification will also bring greater 
     safety to our nation's blood supply


                    hiv testing for sexual offenses

       The HIV Prevention Act requires that those accused of 
     sexual offenses be tested for HIV.
       Many times the victims of rape and other sexual assaults 
     also become victims of HIV.
       Because HIV is incurable, rape and molestation victims must 
     have the right to know if they have been exposed to HIV as 
     soon after exposure as possible so they can immediately begin 
     medical treatment if necessary.
       Victims can not rely solely on testing themselves for the 
     disease because there is often a lag time that can last for 
     several months between HIV exposure and infection. Therefore, 
     the only timely, logical and practical way for a victim to 
     know if they may be at risk of HIV is to learn the status of 
     their attacker.
       Most states allow for victims to find out whether their 
     attackers have HIV, but only after convicted of an assault, 
     which may take many months or even years.
       Even if the victim tests negative, knowing the status of 
     their assailant provides many victims with a sense of relief 
     and allows them to seek further medical advice and take 
     precautions if positive.


                       hiv and medical procedures

       The HIV Prevention Act protects both health care patients 
     and professionals from inadvertent exposure to HIV. It would 
     do this by encouraging medical associations to establish 
     guidelines for providers with HIV to follow in the 
     performance of any risk prone invasive medical procedure on a 
     patient and by allowing providers to test a patient for HIV 
     before performing such a procedure if the provider considers 
     such a test necessary.
       Both health care professionals and patients should be given 
     the ability to protect themselves from unwarranted HIV 
     exposure.
       A recent study of hospital nurses concluded that workplace 
     stress due to the fear of HIV contagion is high and the most 
     effective way to reduce fear is to inform staff of the HIV 
     status of patients.
       Similar proposals regarding patients and health care 
     providers passed the Senate overwhelming in 1991, but were 
     later dropped in conference.
       The public would like doctors and dentists with AIDS or HIV 
     to be legally required to inform their patients of their 
     health status according to 93% of those polled in a New York 
     Post survey.


                 irresponsible behaviors involving hiv

       The HIV Prevention Act expresses the sense of the Congress 
     that States should criminalize irresponsible behaviors by 
     those who are infected.
       Those who are infected with any disease have a 
     responsibility to prevent transmitting the disease to others. 
     Because no cure exists for HIV, those who knowingly place 
     others at risk of infection are endangering innocent lives.
       79% of Americans believe that those who knowingly infect 
     another person with HIV should face criminal charges. Half of 
     those surveyed said that people who knowingly transmit the 
     virus should be charged with murder.


                        confidentiality and hiv

       The HIV Prevention Act expresses the sense of Congress that 
     strict confidentiality must be observed at all times in 
     carrying out the provisions of this Act.

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