[Congressional Record Volume 167, Number 207 (Wednesday, December 1, 2021)]
[Senate]
[Pages S8859-S8860]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             WORLD AIDS DAY

  Mr. CARDIN. Madam President, on December 1, we mark the 33rd 
anniversary of World AIDS Day, which gives us an opportunity to pause 
and reflect on the lives lost to HIV/AIDS, how far we have come in the 
fight against this virus, and what we need to do to ensure an AIDS-free 
future.
  Since the first cases of AIDS were reported domestically in June 
1981, more than 700,000 Americans have tragically died due to AIDS-
related complications. Significant scientific advances, brought about 
by public and private partnerships, led to the development of 
antiretroviral therapies--ARTs--which have been instrumental in 
decreasing AIDS-related mortality rates by more than 80 percent since 
they peaked in 1995. Investment in U.S. disease surveillance, 
prevention, and public education has similarly led to an almost 50-
percent decline in the incidence of infection since 2010.
  We are fortunate to have premier scientific research institutes 
within my home State of Maryland working together to combat this deadly 
virus. The National Institutes of Health, the Walter Reed Army 
Institute of Research, and the Institute of Human Virology at the 
University of Maryland all lead U.S. and global research on developing 
treatments and a vaccine for HIV/AIDS. The world-class research 
institutions housed in Maryland have not only substantially led the 
scientific advancements with respect to HIV/AIDS; they have also played 
a significant role in reducing the number of new cases among 
Marylanders and affording those who contract HIV/AIDS to continue 
living full lives. Across Maryland, more than 30,000 adults or 
adolescents were living with HIV at the end of 2020.
  Though my State ranks seventh among all U.S. States and Territories 
in HIV diagnosis rates per 100,000 people, we are making great strides 
to prevent new infections. Last year, Maryland recorded fewer than 
1,000 new cases of HIV infection for the third consecutive year and a 
significant decrease over the peak of 2,612 new HIV infections among 
Marylanders in 1991. Public health initiatives the Maryland Department 
of Health implemented have been instrumental in reducing new 
infections, including programs like safe-sex education programs, condom 
distribution, access to prophylactic medication, and a statewide 
needle-exchange program for injection drug users.
  Today, approximately 1.2 million Americans are living with HIV, and 
they are able to lead healthier and safer lives due to increased access 
to care under the Patient Protection & Affordable Care Act, ACA. The 
ACA has led to increased patient protections such as the prohibitions 
on rate-setting tied to health status, the elimination of preexisting 
condition exclusions, and an end to lifetime and annual dollar limits. 
Still, there are challenges ahead. Increasing prescription drug costs 
for ART regimens and health insurance benefit designs that shift out-
of-pocket costs onto patients risk the progress we have made to end the 
HIV epidemic in the U.S.
  Although Federal financial support to Medicaid, the largest source of 
insurance coverage for people living with

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HIV, has increased through the duration of public health emergency due 
to the COVID-19 relief bills, tightening State budgets amid record 
Medicaid enrollment could hinder access to treatment or care for the 
HIV/AIDS population. Forty-two percent of adults with HIV receive 
healthcare under Medicaid.
  In the U.S., the fight against this disease also disproportionately 
affects communities of color, with Black and Latino Americans 
accounting for a disproportionate share of new HIV diagnoses and 
deaths, consisting of about 70 percent of new diagnosis despite making 
up roughly 30 percent of the U.S. population. The Biden-Harris 
administration's theme for World AIDS Day this year is ``Ending the HIV 
Epidemic: Equitable Access, Everyone's Voice,'' denoting a strong 
commitment to addressing health inequities within the epidemic. I share 
the administration's determination to address the disproportionate 
impact of the epidemic on marginalized populations like the LGBTQI+ 
community and racial and ethnic minorities.
  Internationally, the U.S. has invested more than $100 billion in the 
global HIV/AIDS response through the President's Emergency Plan for 
AIDS Relief--PEPFAR--and the Global Fund to Fight AIDS, Tuberculosis 
and Malaria, Global Fund. This investment has saved more than 20 
million lives, prevented millions of people from becoming infected, and 
achieved HIV/AIDS epidemic control in more than 50 countries. Since 
2003, PEPFAR has changed the trajectory of the HIV epidemic around the 
globe by expanding access to HIV prevention, treatment, and care 
interventions. PEPFAR is one of the most successful and cost-effective 
efforts in the history of American foreign assistance.
  Despite the progress we have made around the globe, there is still 
significant work to do. Of the 38 million people globally living with 
HIV, 12.6 million are not accessing lifesaving treatment. In 2019, 
there were 1.7 million people newly infected with HIV--more than three 
times the global target--and 690,000 people perished from this terrible 
disease. While we have made strides in combating HIV/AIDS in eastern 
and southern Africa, we have seen increases in new infections in 
Eastern Europe, central Asia, the Middle East, and Latin America.
  As with last year's commemoration, this year's World AIDS Day finds 
us continuing to battle the COVID-19 pandemic. Support through PEPFAR 
and the Global Fund has financed efforts to minimize the disruption of 
the pandemic on HIV epidemic response efforts, through services like 
telehealth and multimonth dispensing of antiretroviral therapies. The 
COVID-19 pandemic, however, continues to affect the global response to 
HIV and threatens the decades of progress we have made against this 
disease. In addition to disrupting HIV treatments and prevention 
services, downstream impacts of the pandemic have cut off vulnerable 
populations from educational and social support services, and growing 
inequalities resulting from the economic downturn are likely to lead to 
increases in HIV risk behaviors and vulnerability. The Global Fund 
reported that last year, HIV testing dropped by 22 percent and the 
percentage of HIV-positive TB patients on antiretroviral therapies 
dropped 16 percent.
  A world free from HIV requires global leadership from the United 
States, and we have stepped up to the plate by heavily investing in the 
global response to HIV. From significant contributions to the Global 
Fund to the creation of PEPFAR, U.S. global health leadership and 
international collaboration helped to turn the tide on the global 
epidemic. This is as true today as it was 33 years ago. International 
public health crises require international responses. Unlike the 
previous administration, I support President Biden's actions to 
reprioritize cooperative global health response efforts. We are only as 
strong as the weakest health system, and it is incumbent upon the U.S. 
to lead global health response efforts as we look to end the COVID-19 
pandemic and HIV/AIDS epidemic.
  One of the biggest tragedies of the HIV epidemic is that millions of 
people around the world died while waiting for treatment, and once 
treatment became available in 1987, it was out-of-reach. At about 
$8,000 a year--more than $17,000 in today's dollars--the first HIV drug 
was too expensive for populations who needed it most: low-income 
communities in the U.S. and low and middle-income countries. While 
Congress authorized $30 million in emergency funding to States to pay 
for low-income patients' treatment, global access to the drug lagged. 
For example, when we established PEPFAR in 2003, only 50,000 people in 
Africa were accessing lifesaving HIV treatment.
  We cannot make the same mistake with COVID-19. While we have made 
great strides domestically to vaccinate our population, it is equally 
important to vaccinate the rest of the world from COVID-19. The Biden 
administration has made significant strides to supply and commit future 
supplies of vaccines to low-income countries, and I implore the 
administration to continue working with vaccine manufacturers to 
expedite this effort as fast as humanly and safely possible. Equally 
important is ensuring access, when approved, to antiviral treatments. 
One potential antiviral treatment reduces the risk of hospitalization 
and death by 89 percent in high-risk adults when used in conjunction 
with ritonavir, a medication commonly used to treat HIV. The potential 
success of this antiviral treatment is a testament to the biomedical 
infrastructure of the United States, where the incredibly innovative 
treatments we developed for HIV may be effective in battling the COVID-
19 pandemic, too.
  COVID-19 does not respect borders. To protect our domestic health, we 
must ensure that our allies and low and middle-income countries around 
the world have affordable access to eventually approved COVID-19 
vaccines, diagnostics, and therapeutics. While we celebrate the 
progress we have made with respect to HIV/AIDS this World AIDS Day, we 
must recommit ourselves to continuing this fight because success is 
within our grasp.
  We have made so much progress through international partnerships. 
Donor nations; civil society; people living with HIV; faith-based 
organizations; scientific research community and academic partners such 
as Johns Hopkins University, the University of Maryland, and the Walter 
Reed Army Institute of Infectious Disease Research; the private sector; 
foundations; and implementing organizations such as Catholic Relief 
Services and Lutheran World Relief have complemented those partnerships 
tremendously. We must apply the lessons of the fight against HIV to our 
current battle against the COVID-19 pandemic so we can save more lives 
and get the global economy back on track.

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