[Congressional Record (Bound Edition), Volume 145 (1999), Part 16]
[House]
[Pages 23777-23780]
[From the U.S. Government Publishing Office, www.gpo.gov]



                              {time}  2045

 THE IMPORTANCE OF INCREASING FUNDING FOR HIV-AIDS RESEARCH, TREATMENT 
                 AND PREVENTION IN MINORITY COMMUNITIES

  The SPEAKER pro tempore (Mr. Pease). Under the Speaker's announced 
policy of January 6, 1999, the gentlewoman from the Virgin Islands 
(Mrs. Christensen) is recognized for 30 minutes as the designee of the 
minority leader.
  Mrs. CHRISTENSEN. Mr. Speaker, I have often said on previous 
occasions when I have come to the floor that one of the greatest 
challenges facing this Nation is closing the gap in health care between 
our white population and our communities of color. It is this that the 
Congressional Black Caucus and the Health Brain Trust would address 
through its HIV state of emergency because, you see, HIV-AIDS, although 
it is very important to the welfare of our communities, is only the tip 
of the iceberg.
  The underlying problem is really the two-tiered health care delivery 
system that does not address the barriers to health but exists for 
African Americans, Hispanics, Asian/Pacific Islanders, Native 
Americans, and Native Hawaiians and Alaskans. Although the White House 
and the Department have been listening and have begun to respond to the 
call of the caucus to action, Mr. Speaker, we still have a long way to 
go, primarily because this body, the Congress, has not become fully 
engaged in the process.
  That is why we are here this evening, my colleagues and I, to raise 
the level of awareness to the disparities in health care, to provide 
information on the breadth of the gaps and to enlist our colleagues' 
assistance and support for our efforts to have health care and 
community development dollars be applied to this very grave problem 
which threatens the promise of this Nation in the next century.
  Mr. Speaker, I am joined here by several of my colleagues, and I 
would like to begin by yielding to the gentlewoman from the 17th 
Congressional District of Florida (Mrs. Meek).
  Mrs. MEEK of Florida. I thank my colleague, and I am pleased to join 
with the gentlewoman from the Virgin Islands. She has nobly shown in 
her endeavor as chairlady of the Congressional Black Caucus' Health 
Task Force that she has the unique ability to mobilize and to organize 
and push us forward into the new millennium. It is a time for such 
leadership, as the gentlewoman from the Virgin Islands has shown us, 
and I am thankful for her leadership. She is calling us here today to 
push very strongly for the full funding of the Congressional Black 
Caucus' emergency public health initiative on HIV-AIDS for the fiscal 
year 2000.
  Mr. Speaker, we cannot talk enough about this initiative; it is so 
needed. If we do not take care of the health care needs of the 
minorities, the health care needs of the majority will certainly be 
under strain, as it already is. The $349 million the Congressional 
Black Caucus has requested is targeted proportionately to African 
Americans, Hispanics, Latinos, Asian/Pacific Islanders and Native 
American communities based on epidemiological data released by the 
Center of Disease Control. So the CBC is trying its very best to target 
the funds where the real need is.
  Mr. Speaker, these dollars will build upon the success of the 156 
million requested for HIV-AIDS prevention in minority communities in 
fiscal year 1999. We thank the Congress for that allocation, but it is 
not enough. Although welcome, it is not nearly enough to combat the 
devastating effects of the AIDS epidemic in our community. African 
Americans and other minorities continue to suffer dramatically higher 
rates of disease and death, long-term rates of illnesses from treatable 
diseases than other segments of the general population; again, I quote, 
putting the money where the real need is so that it will overcome the 
disparities in our health system.
  Our Nation spends over $7 billion for HIV treatment and prevention 
and control; but listen to this, Mr. Speaker: but only $156 million is 
specifically targeted to minority communities. I repeat that. We spend 
over $7 billion in this country for HIV treatment and prevention and 
control, but only $156 million is specifically targeted to minority 
communities which now account for more than 48 percent of those 
infected by the disease. That is a mere 2 percent of impact. Surely 
steps must be taken and effective measures must be put into place to 
ensure that resources follow the trend of the disease across all 
segments of the U.S. population.
  That is why my colleague, the gentlewoman from the Virgin Islands, 
called this special order. Man's inhumanity to man is based on the 
color of one's skin is untrue. Man's inhumanity to man is not based on 
the color of one's skin, and any kind of treatment in this country 
cannot ignore the fact that we are all in this situation together. A 
minimum of $349 million should be appropriated in fiscal year 2000 to 
address this health emergency in communities of color. This is a health 
emergency.
  I want to thank the rest of my colleagues here, but I want to end by 
saying, we cannot continue to suffer these dramatic increases and this 
higher rate of mortality from death and disease and long-term rates of 
illnesses from diseases that are treatable. These diseases are 
treatable, and we cannot continue this disfunction different from other 
segments of the population. As

[[Page 23778]]

we prepare now our wonderful Nation to enter the new millennium, this 
negative health status must not continue, must not continue, and we 
cannot continue to ignore it.
  Man's inhumanity to man, I spoke of before, but we must cease because 
of the color of one's skin. These diseases, they are no respecter of 
persons. So we must spend the amount of money it takes to be sure it is 
treated. The Secretary of Health and Human Services must begin to 
implement the recommendations stemming from the Institution of 
Medicine's body of cancer studies in communities of color.
  The Office of Minority Health must be funded. $5 million or more must 
be appropriated for demonstration projects to ensure that minority 
seniors understand how to navigate the complicated health system. 
Clearly, Mr. Speaker, clearly my colleagues in the Congress, the time 
has come for us to act. Epidemiological data is there. All we need is a 
thrust by this Congress to free the proportion of African Americans who 
suffer now in the United States three times in proportion to African 
Americans in the population.
  Of the 48,266 AIDS cases reported in 1998, African Americans 
accounted for a very high and alarming statistic. Forty-five percent of 
the total cases, 40 percent of the cases in men, 62 percent of the 
cases in women, 62 percent of the cases in children. So the Americans 
reported with AIDS through December 1998, 30 percent were black and 18 
percent were Hispanic Latino.
  Mr. Speaker and to the Congress, the time to act is now.
  Mrs. CHRISTENSEN. Mr. Speaker, I want to thank the gentlewoman from 
Florida (Mrs. Meek) for her work both in her home State and in the 
Nation, not only HIV-AIDS, but other important issues of health care 
for African Americans and other people of color and also for doing the 
annual legislative conference of the caucus reminding us that AIDS 
knows no age barriers and that seniors are also affected by this dread 
disease.
  Mr. Speaker, I yield to the gentleman from the Seventh Congressional 
District of Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. Mr. Speaker, I rise today to commend my 
colleague from the Virgin Islands for, first of all, organizing this 
important special order to discuss the importance of increasing funding 
for HIV-AIDS research, treatment and prevention in minority 
communities. Her performance has been stellar as she has led the 
Congressional Black Caucus Brain Trust and as she continues to lead us 
towards finding a way to make sure that there is equity in health care 
services and treatment for all of America.
  I have joined with my colleagues in the Congressional Black Caucus in 
urging a minimum of $349 million in HIV-AIDS to address the pending 
health crisis in communities of color. Today we are experiencing vast 
economic prosperity. These are said to be the best of economic times 
since the 1970's. Unfortunately, as our prosperity has increased, so 
too have our disparities in health care.
  It is, to quote a phrase from Dickens, the best of times and the 
worst of times. Economic prosperity is up, but so too is the number of 
uninsured in America, rising from 43 million to a total of 44 million 
today. In communities of color we see vast disparities and gaps in 
health care. African Americans represent 13 percent of the population 
but account for 49 percent of AIDS deaths and 48 percent of AIDS cases 
in 1998. One in 50 African American men and one in 160 African American 
women are infected with HIV. In 1997, 45 percent of the AIDS cases 
diagnosed that year were among African Americans as compared to 33 
percent among whites. AIDS is the leading cause of death for all United 
States males between the ages of 25 and 44 and for African American 
males between the ages of 15 and 44.
  These are valuable years not only in the lives of these individuals 
but for all of America. When we do not act to provide for research, 
treatment, education and prevention strategies, America loses. America 
loses young, vibrant taxpayers. America loses great minds and workers. 
If we do not address this epidemic, it can have dramatic consequences 
on our economy and our ability to compete globally.
  While deaths from HIV-AIDS diseases have been reduced over the last 3 
years due to advances in drug therapies, we have not seen a dramatic 
reduction in communities of color. The Centers For Disease Control 
reported that the AIDS death rate dropped 30 percent for whites, the 
majority of whom had access to new drug therapies, but found only 10 
percent for African Americans and 16 percent for all Hispanics. It is 
no doubt that the $156 million provided by the Congress last year has 
assisted in our efforts; however, more resources are needed.
  In Chicago we have witnessed a rise in the number of HIV cases. For 
example, reported cases of HIV-AIDS among African Americans in Chicago 
increased from 46 percent in 1990 to 68 percent in 1997. AIDS is the 
major cause of death for African American men in Chicago ages 15 to 24, 
the second leading cause of death for Chicago's African American men 
ages 5 to 34, and the third leading cause of death for African 
Americans in Chicago males aged 35 to 44.
  In addition, the proportion of AIDS cases in Chicago occurring among 
women tripled from 7 percent in 1998 to 22 percent in 1997. African 
American women represent about 39 percent of the Chicago's women, and 
they account for almost 70 percent of the cumulative AIDS cases among 
women in that city.
  This is truly an emergency, and it warrants the attention and 
resources of the Federal Government. As we head into the new 
millennium, it is essential that we increase not only aid but also 
education and information. It is essential that we provide resources so 
that people can understand transmission and be educated which becomes a 
real factor in reducing the advent and onset of this terrible illness.
  Mrs. CHRISTENSEN. Mr. Speaker, I want to thank the gentleman from 
Illinois for his support on the Health Brain Trust of the Congressional 
Black Caucus and for his work especially with the community health 
centers across this Nation. As my colleagues know, Mr. Speaker, 
community health centers are where most of the people of color, the 
communities that we are talking about this evening, receive their care; 
and I want to thank the gentleman from Illinois (Mr. Davis) for his 
hard work and seeing that these health centers are adequately funded to 
provide those services.
  Next, Mr. Speaker, I yield to my colleague from the 37th District of 
California (Ms. Millender-McDonald).

                              {time}  2100

  Ms. MILLENDER-McDONALD. Mr. Speaker, let me first thank the 
gentlewoman from the Virgin Islands (Mrs. Christensen) for her 
steadfast commitment and leadership to this very critical, but 
important, issue in the African American community, the Latino 
community, the Asian community, and all communities of color. She has 
not only shown leadership in this area, but in all areas on health 
issues as they relate to people of color. She has brought about an 
inclusion, and that is evident, of the 39 African American Members of 
Congress who have joined forces with her in this fight to raise the 
issue of funding in our community.
  African Americans and other minorities continue to suffer a 
drastically higher rate of death and disease and longer term rates of 
illnesses from treatable diseases than other segments of the U.S. 
population. As our Nation prepares to enter the new millennium, this 
negative health status must not continue to be ignored.
  As the Nation spends over $7 billion for HIV-AIDS treatment, 
prevention and control, only $156 million is targeted to address HIV-
AIDS in communities of color, a mere 2 percent. Surely steps must be 
taken and effective measures put in place to ensure that resources 
follow the trend of the disease across all segments of this population. 
We are asking for a minimum of $349 million to appropriate in fiscal 
year 2000 to address this health emergency in communities of color.
  Mr. Speaker, I started an AIDS walk in the Southern California area 
because of the devastation of this disease, both domestically, and, 
now, internationally, in Africa, Brazil, Asia and Latin America.

[[Page 23779]]

  In looking at it from the domestic side of things, according to the 
Centers for Disease Control, as of June 1997, 32.4 percent of all males 
age 13 and older are African Americans, and 14.8 percent are Hispanic. 
Of all females age 13 and older, 24.2 percent are Caucasians, 58.4 
percent are African Americans, and 16.4 percent are Latinos or 
Hispanics. Of all children under the age of 13 years old, 60.8 percent 
are African Americans and 19.5 percent are Hispanic.
  You can see this very devastating disease, Mr. Speaker, has impacted 
the minority women and children tremendously, with this being the 
leading cause of death among African American women ages 25 to 44, 
right in those reproductive years. We can ill afford to let this 
continue, Mr. Speaker. We must raise the awareness of this devastation 
domestically.
  With African Americans making up 13 percent of the U.S. population 
and Hispanics making up 11 percent of the U.S. population, these 
percentages signal an alarming and inhumane quandary for all Americans. 
We, the Members of Congress, are in a position to impact the lives of 
America's families struggling to lead healthy, productive lives. We can 
serve an integral role in educating parents, teens, and members of our 
communities on HIV, how it is transmitted, what treatment options exist 
for those who are living with HIV, the need to obtain HIV testing, and 
the clarification of rampant myths associated with the disease that for 
so long has been exclusively associated with homosexual white males.
  Now, HIV, as I have just read to you, is devastating domestically, 
but this disease is also devastating Africa by large numbers. 
Presently, there are nearly 23 million adults and children living with 
HIV-AIDS on that great continent. According to UNESCO, AIDS is now 
Africa's leading cause of death. Please hear me, Mr. Speaker, and those 
in the outer communities. It is the leading cause of death here 
domestically among African American women ages 25 to 44, and it is the 
leading cause of death on the continent of Africa.
  With prevalence rates reaching 25 percent of all adults in some 
countries, the epidemic is decimating the pool of skilled workers, 
managers, and professionals who make up the human capital to grow 
Africa's democracies and economies.
  While the HIV-AIDS disease continues to devastate women domestically 
and throughout Africa, and finding a cure seems far into the future, we 
cannot afford to give up. The Congressional Black Caucus will not give 
up. We are calling on all Americans of good will not to give up. We are 
calling on our African sisters and brothers not to give up.
  There are many things that we can do as world citizens to help 
address the myriad problems associated with the HIV-AIDS epidemic. 
Education programs in the workplace, schools, and churches can help 
create new attitudes toward gender and AIDS transmission. Women's 
health services that include treatment, testing and counseling, 
prevention and support services, can greatly empower women as they 
combat this disease while caring for their children.
  Mr. Speaker, we must support the cause of a comprehensive program for 
African American, Latino and Asian women and the entire minority 
population in testing, education in schools and the workplace, peer 
education, and counseling.
  Research is also essential if we are to conquer this disease. We want 
to encourage more investment in scientific research that will make 
tests for earlier detection simple and affordable, develop new 
technologies for prevention, and promote women's health rights and 
human rights vis-a-vis HIV-AIDS and related issues.
  Mr. Speaker, I am calling tonight on all of us to join forces with 
the Members of the Congressional Black Caucus, led by the gentlewoman 
from the Virgin Islands (Mrs. Christensen) to not only address this 
critical devastating disease but help us in the funding to try and find 
a cure.
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentlewoman, and I also 
want to thank you because you have been a leader on the issue of HIV/
AIDS before I got to the Congress, not only for the Nation, but what I 
understand has been called the most diverse district or one of the most 
diverse districts in the country. Having started the annual AIDS walk 
that is now being replicated across the country, I want to thank you 
for that. I thank you for joining us this evening.
  Next I would like to yield, Mr. Speaker, to my colleague the 
gentlewoman from the 18th Congressional District of Texas (Ms. Jackson-
Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentlewoman from 
the Virgin Islands (Mrs. Christensen) for her leadership, and I thank 
her for organizing this special order. I particularly am gratified for 
the opportunity to join my colleagues on a message to the American 
people of the enormity of the crisis of HIV-AIDS in the minority 
community.
  In particular let me also emphasize that, albeit we are here on the 
floor of the House and we may sound as if we are working studiously to 
secure the passage or secure the funding, I hope our tone does not in 
any way diminish the enormity of the problem and the crisis and the 
urgency.
  I would like to additionally thank the gentlewoman from the Virgin 
Islands (Mrs. Christensen) for her leadership on the Health Brain Trust 
here in the Congressional Black Caucus. Among the many issues she 
discussed, there was a great focus on HIV-AIDS, as well as many other 
health issues in the African American community. But the emphasis is 
not only the African American community, but the emphasis is also on 
the enormous, again I use that term, because they are so extensive, 
disparities in healthcare for the minority community.
  Dr. King wrote a book some years ago that said, ``If not now, then 
when?'' I would offer to say that the reason why we are here on the 
floor of the House is to ask that same question: If not now, when? How 
many more have to die? How many more statistical horror stories do we 
have to hear about HIV-AIDS before we can have the United States 
Congress consider the $349 million that is being supported by the 
Congressional Black Caucus at the leadership of the gentlewoman from 
the Virgin Islands (Mrs. Christensen) in asking for this money to help 
us in this crisis of HIV-AIDS?
  It has been noted, Mr. Speaker, but I think it is important to note 
again, 48,266 cases were reported in 1998, and, for your ears, African 
Americans accounted for 45 percent of total cases; 40 percent of cases 
in men, 62 percent of cases in women, and 62 percent of cases in 
children.
  Mr. Speaker, 62 percent of our children are HIV infected and probably 
more affected. I have worked in my community on the HIV question for a 
number of years, remembering my visit to the United States Congress in 
1990 with my mayor to support the passage of the Ryan White treatment 
legislation, when Houston, Texas, the fourth largest city in the 
Nation, was then 13th on the list in the United States of America of 
HIV cases.
  So this problem or this issue has been growing and it has been 
developing and it has, yes, been spreading. As with the crisis now in 
New York City with St. Louis encephalitis, or whatever else this virus 
may be called, HIV-AIDS does not stop at the border of any State or 
city.
  So I have seen in the City of Houston this growth mushroom. In fact, 
a few weeks ago I held a grant meeting with many of my minority HIV 
organizations. Part of the emphasis was the outreach to explain to them 
that they should be dutiful and studious in seeking grants to help 
educate our communities. What I was overwhelmed with was the enormous 
challenge, again, that these groups were facing, the numbers of cases 
that they were having, and the amount of money that they needed.
  This whole situation with women in their childbearing stages, twenty-
five to 44 being HIV infected. It is a direct link to our children 
being born with this deadly disease. In many instances, the treatment 
or the outreach would be

[[Page 23780]]

the door or the divide that would protect that woman during her 
childbearing stages becoming susceptible to HIV-AIDS and, therefore, 
carrying it to her child. More information, more treatment, more access 
to information, more education.
  Of Americans reported with AIDS through December 1998, 37 percent 
were black and 18 percent Hispanic. In 1998, the annual AIDS incidence 
rate among African American adults in adolescence was eight times that 
of whites. African American women accounted for 70 percent of all 
reported cases of HIV infection among all women in 1998.
  Mr. Speaker, let me share with you why this may be a more difficult 
challenge than most would like to think. The difficulty of the 
challenge is to say that it is outreach, it is making sure that we 
reach individuals who are intimidated by institutions, by medical 
facilities, by hospitals, who are intimidated as to what would happen 
to them if they report they have HIV-AIDS, that they would be fired or 
not have the opportunity for seeking care because they were afraid of 
what may happen to them. Many of these women are homeless, single 
parents. Many of them are without a spouse or family situation. So the 
$349 million that we are seeking is to be able to assure the funding of 
the minority health office. It is to ensure outreach.
  I would simply say, Mr. Speaker, that we have an uphill battle, but 
the battle must be one that is joined by all of my colleagues, frankly 
confronting the crisis of HIV-AIDS and dealing with that population in 
a way that said if not now, then when?
  I believe the time is now, Mr. Speaker, to fight the fight and win 
the battle; and I am delighted, not delighted to be here tonight to 
fight this battle, because it is not a delight, but I am certainly in 
it for the fight, in order to ensure that we save more lives.
  I thank the gentlewoman for yielding me this time and joining with us 
by giving us the opportunity to participate in this special order.

                              {time}  2115

  Mrs. CHRISTENSEN. Mr. Speaker, let me just close by thanking my 
colleagues who have joined us here this evening.
  I will say in closing that Dr. Harold Freeman, a world-renowned 
expert on cancer, told us at our spring Brain Trust that although we 
had been fighting the war on cancer, on which he is an expert, we had 
perhaps been fighting the wrong kind of war, and that the kind of war 
we need to be fighting to be successful against cancer, heart disease, 
diabetes, and HIV-AIDS, and all of the diseases that are causing the 
disparities in communities of color, needs to be more of a guerilla 
war, a hand-to-hand type of combat against these diseases within our 
neighborhoods.
  That is what we are here asking for, for the resources to be brought 
to our communities, this evening. We ask for the support of our 
colleagues for the CBC initiative, and the $349 million that will be 
needed to bring these resources to this community.
  Mr. Speaker, last month the United States Commission on Civil Rights 
issued its report entitled: ``The Health Care Challenge: Acknowledging 
Disparity, Confronting Discrimination and Ensuring Equality.''
  We in the CBC have long said that health care is the new civil rights 
battlefield, and we have approached it accordingly.
  Let me quote in part from the report. Although there was a dissenting 
view, the report states quite clearly and without dispute that equal 
access to quality health care is a civil right. And that despite the 
many initiatives, and programs implemented at the Federal, State and 
local levels, the disparities in health care for women, the poor and 
people of color will not be alleviated unless civil rights concerns are 
integrated into these initiatives and programs.
  The report cites access to health care, including preventive and 
necessary treatment as the most obvious determinant of health status, 
and cites barriers: to include health care financing, particularly the 
ability to obtain health insurance, language, cultural 
misunderstanding, lack of available services in some geographical 
areas, and in some cases lack of transportation to those services.
  Behaviors, and the need to accept individual responsibility for one's 
health has often been cited as an important determinant, but the 
investigation done by the Commission clearly shows that although 
behaviors such as smoking, diet, alcohol, and others can be correlated 
to poor health status, they only account for a modest portion of health 
disparities which exist across age, sex and race and ethnic categories.
  What is often not taken into account is the social and economic 
environment in which personal choice is limited by opportunities. I am 
referring to issues such as low income, the unavailability of 
nutritious foods, and lack of knowledge about healthy behaviors.
  So while we help those most affected to understand more about healthy 
behaviors and make the appropriate lifestyle changes, it is the work of 
this Congress to improve the educational and housing environment, and 
to bring the economic growth being experienced by most of America to 
our more rural and ethnic communities.
  What are some of the other changes that the Commission recommends be 
implemented to meet this important challenge? Not surprisingly they go 
to the heart of the congressional black caucus initiative.
  One of the disparities the Commission found is that although there is 
an effort to eliminate racial and ethnic health disparities, I quote--
there has not been any systematic effort by the steering committee at 
the Department of Health and Human Services or Office of Civil Rights 
to monitor or report on the Department's progress.
  This is precisely what the funding of the offices of minority health 
within the agencies would address. It would give these offices a line 
item budget, and build into the system a process whereby minority 
interests and expertise would be brought to bear in decision and policy 
making within the Department.
  The Commission stated in its transmittal letter to the President and 
leaders of Congress that the offices of women and minority health 
throughout HHS should take a more proactive role in the incorporation 
of these populations' health issues in HHS. Treated as peripheral, 
these offices are forced to operate under the constraints of extremely 
limited budgets. HHS must recognize the potential impact of these 
offices and increase funding accordingly.
  This we feel is critical to creating the internal changes and 
departmental culture that is necessary to effect the change which must 
be achieved in the health of people of color.
  The report cites the importance of physician diversity and cultural 
competence in the delivery of health services. It found that within the 
context of patient care it is necessary to open up medical knowledge to 
include multicultural and gender perspectives to health, health care, 
and patient-provider interaction. It further states that a major 
finding of their research is that clearly more minorities are needed as 
health care professionals.
  The current appropriations committee report indicates a reduction in 
funding below the President's request for programs that would make this 
happen. These funds need to be reinstated and I ask the House's support 
in doing so.
  The Commission also stated that their research indicated that 
minorities and women--particularly minority and poor women--have been 
excluded from clinical trials for decades.
  Again in their transmittal letter the Commission states: another 
focus of the Office of Secretary, OCR and minority health should be the 
lack of medical research by and about minorities. HHS must take the 
lead in enforcing the mandated inclusion of females and minorities in 
health related research both as participants in and recipients of 
Federal funds for research.
  The CBC, under the leadership of Jesse Jackson, Jr., is supporting 
the creation of a center of disparity health research which would 
elevate the current Office of Minority Health to center status.
  This is an important measure to achieving diversity which is 
important in both research and researchers.
  Lastly, the CBC initiative is about making resources available to our 
communities so that they themselves can be the agents of the necessary 
change and improvement in our health status.
  The Commission states that ``to be effective in reducing disparities 
and improving conditions for women and people of color, they must be 
implemented at the community level, particularly in conjunction with 
community based organizations.

                          ____________________