[Congressional Record Volume 149, Number 17 (Thursday, January 30, 2003)]
[Senate]
[Pages S1793-S1796]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                HIV/AIDS

  Mr. FRIST. Mr. President, for a few moments before closing tonight--
and we have had a very productive day and we will make the more formal 
announcements in about 15 minutes or so--I take a few moments 
addressing an issue that means a lot to me, personally, and to take a 
moment to reflect upon an announcement that the President made at the 
State of the Union two nights ago.
  It has to do with a little virus, called HIV/AIDS virus, and the 
devastation it has wrought on individuals, most importantly, but also 
communities and villages and counties and States and countries and 
continents and, indeed, the whole world.
  Once a year I have a wonderful opportunity to travel to Africa as 
part of a medical mission team. I travel not as a Senator, but I have 
the opportunity to travel as a physician. Last January, on one of these 
medical mission trips, I treated patients in villages and in clinics 
and a number of countries in Africa, including the Sudan, Uganda, 
Tanzania, and Kenya. Many of the patients I dealt with were infected 
with HIV/AIDS virus. This little tiny virus, a microorganism, causes 
this disease we all know as AIDS.
  I think back to a number of patients. In Arusha, in the slums, 
conditions are crowded, but as you walk through these very crowded 
slums, the people there are very proud. While there, I visited with a 
young woman by the name of Tabu. She lived in a small--by small I mean 
one room, probably 8 feet by 8 feet--stick-framed mud hut. I remember 
walking in there, as my eyes adjusted, and seeing a very beautiful 
woman, 28 years old, sitting on the edge of the bed--a human smile. And 
on the walls behind her, to keep moisture out, were newspapers 
plastered on the walls. Again, things neat and clean, but a very small 
hut which was her home--a woman with a broad smile who was obviously 
sick, and very sick, meaning she would die in the next week to 2 weeks.

  She lived in this, her home, with her 11-year-old daughter, Adija, 
whom I also met, although her other children

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did not live with them in that hut because Tabu was so ill and so sick 
that she simply couldn't physically manage having the other children 
there. As she explained her story to me--again, I was the physician 
from America who came to be with her--her story was one she was a 
little bit embarrassed about because she literally had to send her 
children away because of her disability--her physical disability, due 
to this little tiny virus--to send them away to live with her mother 
who could take care of her children.
  I mentioned her smile. As my eyes adjusted, I saw that she was indeed 
wasted, thin and sick, but her eyes and her smile were full of hope. 
That smile in many ways hid the pain of that illness, the pain of 
having to send her children away. The next day, she left her hut and 
she was going to go live with her mother for the last few days of her 
life, to die in her childhood home.
  Tabu told me she was one of four sisters, all of whom had HIV/AIDS. 
All had been infected with the virus. Musuli, a sister 20 years old, 
who lived with her mom; Zbidanya, 15 years of age; and an older sister, 
Omeut, who had already died.
  Tabu died the next week. But she didn't have to. If we do our job and 
if we follow the bold leadership as spelled out by the President of the 
United States, we can cure this disease, a disease that is destroying 
nations--indeed, destroying a continent, and mercilessly and 
relentlessly spreading throughout the world--Russia and China and the 
Caribbean.
  That face of Tabu, there in Arusha, in that home, is indeed the face 
of AIDS in Africa and in nations around the world.
  The little tiny virus is not all that different from the viruses I am 
quite accustomed to treating in the population I treated before coming 
to the Senate, that can tear apart individuals, but this virus is 
different in that it is smarter. It is more cagey than other viruses. 
But it is still just a little microorganism that is wiping out these 
continents, a little tiny virus. It is ravaging families. It is causing 
mass destruction, this little tiny virus. It is ravaging societies. It 
is ravaging economies. It is ravaging countries. And, indeed, it is 
ravaging whole continents. To my mind, there is no greater challenge, 
morally or physically, facing the global health community today than 
this global health crisis.
  The other interesting thing about it is, it is new. Usually if you 
have something this devastating, you think it has a long history and 
has grown over the years and over the centuries. But it is new. When I 
was in medical school, we had never heard of an HIV virus; we had never 
heard of the disease called AIDS. I am not that old; 1981 was the first 
time in this country we were smart enough to figure out that there is 
this little HIV virus that causes AIDS--1981. That is 22 years ago.
  But since that pandemic--epidemic means a disease spreading in one 
part of the world. A pandemic is just that, it is spreading all over 
the world. That is where the ``pan'' in pandemic comes from. Since 
1981, more than 60 million people have been infected with this little 
virus that wasn't around 23 years ago. That is basically the population 
of the great State of New York times 3. Twenty-three million people 
have died from this little tiny virus. And we are losing the battle. We 
are fighting it, but it is a battle we are losing as we go forward.
  For every one person who has died since I was in medical school, say, 
since 1981 when we first discovered it in this country, for every one 
person who has died in the last 20 years, in the best of all worlds, if 
we do everything perfectly, we do everything right, for every one 
person who died in the last 20 years, two people are going to die in 
the next 20. That is in the best of all worlds.
  Why is that? Because there is no cure for this virus. People hear me 
talk on this floor a lot about vaccines, saying we need to protect the 
infrastructure and fight bioterrorism with these vaccines. We do not 
have a vaccine for this little tiny virus. So we have no cure. We have 
no vaccine to prevent it. As I said earlier, this little virus is 
smart. Whenever we have a therapy that works pretty well, the little 
virus changes itself--probably 1,000 times faster than other viruses--
so it will defy that treatment. Every time we get a treatment, it 
changes itself. It is a cagey virus.
  The virus causes AIDS. AIDS is the disease, the manifestation. Tabu, 
being wasted and thin--the virus itself is what causes it. What do we 
know about the disease itself? Whom does it hit? Put aside perceptions, 
the stigma of AIDS. Put them aside. Let me tell you about the virus. 
The virus hits young people. Eight hundred thousand children were 
infected in 2002. Young people account for 60 percent of the new HIV 
infections each year. Worldwide, 13 million people have been orphaned 
by AIDS. Most of them are, indeed, in Africa. When you are orphaned by 
AIDS; you are left without mentors; you are left without parents; you 
are left without a supportive structure; you are left without the 
support we have in other, more advantaged, countries.
  As I go to Africa on these mission trips--again, I go down as a 
physician--you have the opportunity to go walking through villages. 
Nothing really can prepare you for walking through a village and 
looking at the people in the homes. You see very old people--not very 
old, but old for the society there--people in their seventies, sixties, 
fifties. Then you see just little kids running around. What you do not 
see are people 20 years of age, to 35, to 40 years of age. It is almost 
like this whole segment of the population has been wiped out--old 
people and young people, but nobody in their productive years.
  That is what you see if you go to Nairobi and you walk through the 
Kibera slums, which go on, it seems, forever. When you walk through the 
slums, you don't see people in their most productive years.
  Entire generations are being wiped out, and kids are growing up in 
the streets with no parents and no mentors. And that all translates 
down into no hope.
  What is fascinating is that we have the power to bring them hope. 
That is why I get excited when the President thinks big. And he 
articulated that in the State of the Union speech. It is thinking big 
because we have the power to bring them hope. We must ask ourselves, 
How can we, since we have that power, not use that power?
  Most people do not realize the disease of AIDS caused by the virus is 
today a disease of predominantly women. It is just not part of what we 
historically have pictured what this disease is all about. More than 
half of all the people now infected with AIDS are women.
  With AIDS on a rampage through the villages of sub-Saharan Africa, 
life expectancy in Africa is now 47 years of age. I wouldn't be alive 
at 47 years of age.
  What is interesting is, what increment is due to this little, tiny 
virus? If the HIV virus had never appeared over the last 20 years, 
instead of living 47 years you would live 62 years--just because of 
this little virus.
  If you are born in Botswana, you are not going to live to 47 years, 
or 45, or 43, or 42, or 41. You may live to the age of 38. Average life 
expectancy, if you are born in Botswana today, is 38 years of age 
because of this single little virus wiping out people, destroying 
people, killing people in their most productive years.
  In 2005, in Zimbabwe, 20 percent of its workforce will be wiped out 
due to AIDS. Death is tragic enough. Taking this productive segment of 
society, very quickly you have to ask yourself, with that productive 
segment as parents and with the infrastructure of civil society 
disappearing, what happens to the children who are left behind? Who 
will feed the children? Who will mentor those children?
  Law enforcement is being wiped out, and teachers are being wiped out. 
Kenya has reported in recent years as many as 75 percent of the deaths 
in law enforcement, in its police force, are AIDS-related. In civil 
society the potential for disruption is obvious.
  If you look at what this little tiny virus incrementally does to the 
economy of these countries, we see we can give unlimited aid and money, 
but unless we defeat this little virus, the economies are not going to 
grow; they are going to diminish. If you look at those countries where 
the prevalent rates are about 20 percent or so--which is, in medical 
terms, significant penetration, but not unusual for Africa--the economy 
doesn't grow but drops

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2.6 percent a year because of the HIV/AIDS virus. Why? Because you wipe 
out the most productive people in that society. We see poor countries 
growing poorer because of the virus, not just financially, which is how 
we measure gross domestic product, but spiritually. The hopelessness, 
the helplessness that comes from this little virus, all of a sudden 
becomes the norm.
  What is the role of the United States of America, especially in light 
of the President's pronouncement the other night? Historically we have 
much to be proud of. I think we need to add that, because we read about 
people from other countries and people associated with the United 
States who have never stepped to the plate. I want to disabuse my 
colleagues and people who are listening. The United States has already 
done much to combat global HIV/AIDS in terms of research, and in terms 
of financial investment, both unilaterally and bilaterally. You hear 
about the Global Fund on AIDS, Tuberculosis and Malaria--an important 
fund, a new fund, that hasn't yet been proven. But it becomes sort of 
the marker in many people's minds of what we are contributing. In 
truth, it is one part of a huge battle--a lot of resources that were 
actually invested in fighting AIDS, but in terms of that Global Fund on 
AIDS, Tuberculosis and Malaria, the United States was the first donor 
under President Bush. In a second round of financing, we once again 
were the first donor to that fund. Before the President's announcement, 
we were that global fund's largest donor. We placed $500 million, more 
than any other nation. That is a quarter of all the pledges. The next 
closest country hasn't even matched half of our commitment.

  I say that because I am offended when people say the United States 
simply has not stepped to the plate.
  Just as impressive is the speed with which we have addressed this 
issue historically. We ramped up funding dramatically in both direct 
aid, bilateral aid, and global fund money.
  Total funding in 1999 was $154 million. Remember, the President two 
nights ago was talking about billions of dollars. Just 4 years ago we 
spent totally $159 million. In the last 4 years, there has been an 
eightfold increase, up to about $1.2 billion. Indeed, the United States 
is today leading--even before the President's announcement--the global 
fight against HIV/AIDS. I think we can be proud of that. But--and is 
where the President's announcement came--we can do more. I believe in 
support of what the President has said from a moral standpoint, we can 
and should and will do more.
  I mentioned we are losing the battle. Every 10 seconds somebody dies 
of the infection. But in that same 10 seconds there are two new 
infections. Remember that we have no cure. That is right now. That 
shows there is so much to be done. Each death and each new infection is 
one more tragic battle lost in the war against this killer virus.
  I think, I know, that we have a moral obligation and a human 
requirement to provide more resources to fully enter the big war to win 
the battle one person at a time. Those resources must be managed and 
monitored so they get to those people who we intend to help. The 
process must be transparent. I know that the President, because he has 
told me personally and in meetings many times, wants to invest that 
money making sure we get results; that the money is used wisely with 
focus, that it is used transparently, and that we measure the results 
we set out to achieve.
  I think also we in this body need to summon the commitment of all 
Americans to be soldiers in this war in whatever way they possibly can. 
I say that only because as elected officials, although we know it is 
the right thing to do and morally the most powerful thing to do, some 
constituents around the country ask, Why in the world are you investing 
in a disease that, yes, affects the world but is predominantly a 
continent so far away?
  One of the reasons I am carrying on this discussion tonight is 
because I think each of us has an obligation--has an opportunity but 
also an obligation--to help educate not just our colleagues and people 
in Congress but people all across America. We need to do that every day 
in speeches--every time I go back to Tennessee or my colleagues go back 
to Nevada or South Dakota or Georgia or California. We have made a lot 
of progress in the last couple of years. With the President's 
announcement in the State of the Union Address, I believe we are on the 
cusp of a truly historic leaf that I believe can turn the tide of this 
devastating disease, if we will start saving lives and also instilling 
hope.

  Over the past 2 years, Senator Kerry and I, with a bipartisan group 
of Senators, have constructed and put together what I believe is a 
significant bill that addresses this little, tiny virus--this cagey 
virus that is causing this mass destruction--and which addresses the 
moral challenge this virus represents. The legislation will be 
discussed in the Foreign Relations Committee next week, led by the 
Senator from Indiana, chairman of that committee, Senator Lugar. I hope 
this bill becomes the legislative counterpart to President Bush's bold 
initiative.
  The President has pledged more resources, significantly more 
resources, a tripling in funding. He has proposed an emergency plan, 
and he has used--this may be the most significant thing--the bully 
pulpit to rally a great Nation to this noble cause. He sets the gold 
standard for humanitarian efforts for the United States but also for 
the world. I know he has personally committed to achieving results. His 
proposal, once our bill is acted upon, will prevent 7 million of these 
new infections, will provide the antiretroviral drugs for 2 million 
HIV-infected people, will care for 10 million HIV-infected individuals 
and AIDS orphans, and will provide $15 billion--$15 billion--in funding 
over the next 5 years.

  I should also add that, as a government, we cannot do it alone. Even 
single leaders cannot do it alone. Even what this body does cannot do 
it alone.
  It is truly remarkable, as I have been addressing this particular 
issue over the last 8 years, to see this new intersection, this new 
coalition of partners that heretofore just has not existed. It has not 
existed. By that I am talking about the pharmaceutical companies. At 
the end of the day, it is going to be the research of the 
pharmaceutical companies--in developing vaccines, in figuring out why 
this virus changes--that will give much of the answer. The 
pharmaceutical companies, the faith-based community--the churches, the 
spiritual community--the academies, and the universities all across 
this great Nation are coming together at this intersection, along with 
Government and along with, I should add, the private sector and 
foundations.
  I mention the foundations because we just saw an announcement last 
week by Bill Gates. It is significant, with big numbers, huge numbers 
going to global health. We have seen nothing like this in the history 
of the world. It comes from a foundation that, in truth, moves a lot 
faster than Government can move. We have been working on the HIV/AIDS 
issue for years and years and years. Bill Gates basically said: Listen, 
I see the problem. I am going to go out and do my best to lick the 
problem. Indeed, he announced this past week a remarkable $200 million 
grant to establish what is called the Grand Challenges in Global Health 
initiative. This is going to be a major new effort and a partnership 
with our NIH, our National Institutes of Health, which will accelerate 
research on the most difficult scientific barriers in global health.
  Today, only 10 percent of medical research in this country--only 10 
percent--is devoted to the diseases which account for 90 percent of the 
health burden in the world. Mr. Gates said: It doesn't make sense. For 
90 percent of the health burden in the world, we are only spending 10 
percent of our research dollars. Let's do something about it. He is in 
a position to do just that. Through his foundation, he will change just 
that.
  The Gates initiative will provide grants to support the collaborative 
efforts of the most creative and innovative scientists and researchers 
in the world. The initiative will draw attention to these urgent global 
health research needs. And it will stimulate where I think the real 
answer is going to be; that is, the public-private partnerships--the 
partnerships with the academies, with the churches, with the 
pharmaceutical companies, with the leadership, yes, of the United 
States and other of the wealthier countries, but also the leadership of 
the disadvantaged countries, the countries that are

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being subjected to the ravages of HIV/AIDS.
  I would not have said this 4 years ago, but we will defeat this 
little virus. When I close my eyes, that is what I see: this little 
virus--and all the death and destruction--but this little tiny virus, 
in part because I am a doctor. When I think of disease, I always look 
at the cause of it. But it is that little virus. We will defeat it. Let 
me repeat that: We will. It will be with the leadership of the United 
States of America. And by ``leadership,'' I am talking about this body, 
working with the President, working with the House of Representatives, 
working with the public-private partnerships. With that leadership, we 
will defeat this virus.

  But the question is--and the reason timing is important--how many 
children and women and men are going to die before we defeat the virus? 
I already told you, in the best of all worlds, for every one person who 
died in the last 20 years, two are going to die in the next 20. Even if 
we discovered a vaccine right now, that is going to happen, because the 
vaccine is for prevention.
  The real question is, Will 60 million or 80 million or 100 million 
people die? Or, again, under the leadership of the President of the 
United States, and with the legislation that we can generate in this 
body, instead of it being 100 million, can it be 20 million or 40 
million or 45 million or 50 million? Or will it grow from 100 million 
to 200 million or 300 million?
  That is the urgency. That is why we need an emergency response. And 
that is why, as a physician, as someone who, with my own hands, has had 
the opportunity to work with hundreds of HIV/AIDS patients in this 
country and in many countries in Africa, it means so much to me. I have 
seen that so directly.
  The answer is in our hands. Literally, it is in our hands. We are 
capable today of slowing this pandemic. It is going to increase in the 
near future. There is nothing we can do about that. But we can slow the 
trajectory. Indeed, in countries such as Uganda it has already 
flattened and decreased, so we know there are things we can do now to 
reverse this trajectory. But we have to choose to fight first. We need 
to make that commitment the President made 2 nights ago and fight it 
with our will, fight it with resources, fight it with energy and as 
much spirit as we can muster.
  I will close because I know it is late, and we have worked again 
aggressively over the course of the day and have made real progress, 
but I will close by simply saying, the President, I know, is committed 
in both word and deed. I think it is now time for our body, this 
legislative body, to come together to work for this legislation and 
help lead a great people and a great nation to overcome one of the 
greatest moral and public health challenges the world will face in the 
21st century.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. REID. Mr. President, if I could ask the majority leader to yield 
just for a brief second, I of course appreciate very much the majority 
leader's statement. It has even more meaning based on his being a 
physician. But having been to Africa just a few months ago for the 
second time, and to see the difference in the approximately 8 or 9 
years from the time I first went, to see the devastation by this plague 
that is sweeping this continent is stark.
  It is frightening to think that thousands of people every day in that 
continent are dying--not hundreds. They don't take weekends off. There 
are no vacations. They continue to die during those periods of time.
  I say to my distinguished Republican leader, I also appreciate 
President Bush devoting some of his time in the State of the Union 
Address to AIDS and acknowledging that there is a need to do more 
financially. I appreciate that very much.
  I do say, however, to the majority leader, that, as you know, we 
tried last year to pass the same initiative. So it is not as if we have 
been standing still. We tried to do this in the past and, frankly, we 
were held up in its passage.
  I also say that the United States, of course, is doing a lot, doing 
more than any other country, as the majority leader has indicated. But 
I believe we have an obligation to do that. I think it is good that we 
are doing it. I think we should do more.
  I also would like to support what the majority leader has said. The 
Gates Foundation is exemplary. I think it is wonderful we have a 
private sector joining to try to do something to defeat this plague. 
That is what it is.

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