[Congressional Record (Bound Edition), Volume 147 (2001), Part 7]
[Senate]
[Pages 9860-9862]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           THE HIV/AIDS VIRUS

  Mr. FRIST. Mr. President, I rise to speak on the 20-year anniversary 
of a truly remarkable event which, at the time, no one in the world 
would have envisioned its impact--its impact on people throughout the 
United States and on people throughout the world--indeed, its impact on 
impact. No one could have foreseen an impact which, from a public 
health perspective, has resulted in the single worst public health 
crisis since the bubonic plague ravaged Europe more than 600 years ago.
  That event occurring 20 years ago today was the publication of a 
brief description of the first five cases of a disease that could not 
be explained. The five people mentioned happened to have been infected 
with a virus that had never previously been described, and which at the 
time had no name. The five people had been infected with what was later 
called the HIV virus, and they died of complications associated with 
AIDS.
  It was a case study. It was published by the CDC. At the time I was a 
third year surgical resident at the Massachusetts General Hospital in 
Boston. I remember very vaguely 20 years ago those first case reports 
being talked about. And it was vague. It was obscure. Nobody had any 
idea because that virus had never been described in the history of 
mankind. Nobody had ever before talked about a virus with such power to 
destroy--to destroy cells, to destroy cellular function, to destroy 
life itself: the HIV/AIDS virus.
  During my surgical residency, I was involved in operating every day. 
At the time, we had no earthly idea that this virus would infect much 
of our blood supply. No one knew that it would ultimately be 
transformed, 5 or 6 years later, into what became known as ``universal 
precautions,'' where, for the first time, we began to treat all blood 
in the operating room as potentially infected or potentially toxic. We 
started to wear double gloves. We started to wear a mask when we 
operated. We took these precautions to protect ourselves--not our 
patients This all occurred within a few years after these initial five 
cases were described. It changed the practice of medicine.
  I had the opportunity earlier today to meet a wonderful person, a 
person whom I had previously only heard about. Her name is Denise 
Stokes. She has a wonderful voice and a wonderful story. The story was 
told to me and many others today.
  Denise was infected with the HIV virus at the age of 13. Shortly 
after her infection was identified, she became active in the struggle 
against the virus. She described her many experiences in an intensive 
care unit. She described what it was like not to have access to 
available drugs. She talked about watching, in the depth of her 
illness, as policymakers talked about AIDS on television. She wondered 
whether at any point they would be able to respond to what has become 
the largest, most significant public health challenge in our lifetimes, 
in the last century--perhaps in the history of the world.
  She talked about saying a silent prayer that hopefully there would be 
a cure someday. She talked about her hopes that someday she, by sharing 
her experiences, could become a catalyst for ultimately discovering a 
cure for HIV/AIDS.
  Denise helped to put a face on heterosexual HIV infection in the 
1980s. She was instrumental in gaining access to African-American 
churches in the early 1990s. As I said, she was infected when she was 
13 years old. She is now 31. She talks to college students, community 
groups, and professional organizations sharing her story, a story that 
is powerful, a story that puts a face on HIV/AIDS.
  No one 20 years ago, or even 15 years ago, would have ever guessed 
that this disease would become the single worst public health crisis in 
over 700 years.
  People ask: What do we think about this virus now 20 years later? The 
Kaiser Family Foundation, in a very recent survey, showed two things 
about Americans' thinking: No. 1, they see AIDS is the most urgent 
international health issue; and, No. 2, after cancer, Americans view 
HIV/AIDS is the most urgent health issue here at home.
  And the American public is right on target. We have learned a great 
deal about this disease over the last 20 years. We know how to prevent 
it. We have fairly effective drugs and treatment therapies today for 
treating HIV and AIDS-related infections. They work in most cases if 
they are available and if they are taken properly.
  Over the last 20 years--remember, this virus was not around 21 years 
ago--AIDS has become a very effective killer. About 8,000 people will 
die somewhere in the world today from this virus, this single little 
virus that 21 years ago, to the best of our knowledge, had killed no 
one.
  Its impact has been tremendous. Consider the research field--speaking 
as a physician and medical scientist, I can say that in 1981 we had no 
drugs to treat this virus. About 6 years later, we had six or seven 
drugs. Now, we have about 65 drugs to treat this virus. In spite of 
that, as I said, it is killing about 8,000 people a day.
  One thing that gives us some hope is the great boldness, the genius 
of our research industry--both the public sector through NIH and the 
private sector through the pharmaceutical companies --where there are 
today over 100 drugs in the pipeline to combat HIV/AIDS.
  Our successes have been many. We have reduced the incidence of 
mother-to-child transmission thanks to counseling, voluntary testing, 
and AZT for pregnant women. New HIV infections have declined sharply. 
The Ryan White CARE Act, which originated in the

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Congress, supports care for over 100,000 people who otherwise would not 
be able to afford therapy. The drugs have doubled their life 
expectancies. That's a tremendous success. It has cut in half the 
average length of stay for HIV-related hospitalizations.
  This body, I am proud to say, has responded to the changing face of 
HIV/AIDS, in the communities where it appears. For example, last year 
Congress expanded the reach of the Ryan White CARE Act to include a 
wider range of communities. We created supplemental grants for emerging 
metropolitan communities that previously had not been affected and in 
the past did not qualify for such funding.
  The expansion in the program will benefit such places as Nashville, 
TN, where the Comprehensive Care Center, led by Dr. Steve Raffanti, has 
served more than 3,000 patients over the last 6 years, and is currently 
following almost 1,900 patients, 40 percent of whom fall below the 
poverty level.
  How? The Congress first authorized the Ryan White CARE Act ten years 
ago and we reauthorized it five years ago and then again last year.
  Congress has also responded with increased funding. Ryan White 
funding is now at a level of $1.8 billion a year. That is not double 
what it was when we started, or tripled, or quadrupled. It is 7 times 
what we initially put into the funding of the Ryan White Care Act.
  But there is so much more to be done. There are 500,000 to 600,000 
Americans living with the HIV infection and another 320,000 people with 
AIDS. We have reduced the number of new infections from 150,000 a year 
down to 40,000 a year. That is tremendous progress, but it is not 
acceptable. 40,000 new infections per year is one new infection every 
13 minutes, 24 hours a day, 365 days a year.
  Our loved ones are at risk. Even worse, there are some new danger 
signs on the horizon. The progress and the advances that have been made 
appear to have created an element of complacency. Surveys indicate 
today that 80 percent of our young people do not believe they are at 
risk for HIV infection. Such ignorance and complacency breeds 
incaution, less prevention, and, ultimately, more infections.
  Last week, the CDC featured a report which cited a frightening 
increase in HIV incidence for young African-American gay and bisexual 
males. In Tennessee, the number of HIV/AIDS infections increased by a 
startling 35 percent over the 2-year period of 1998 to the year 2000. 
We simply cannot allow this increase in the number of infections. We 
cannot allow a new wave of infections in our country. All of this is a 
call to arms, a call to arms for all of us as citizens of our 
communities, as Americans, and as citizens of the world.
  As we were talking this morning, Denise talked about initially 
withdrawing within herself as the virus infected her at age thirteen. 
As she grew older, she started to reach out--first, to her community; 
later, to policy makers.
  Denise should be an example for all of us. We have a moral obligation 
to reach out within our communities and beyond, to the United States of 
America and beyond. We need to reach out to the entire world. Indeed, 
as troubling as the trends are in this country, they pale beside the 
staggering disaster of HIV/AIDS in the developing world, especially in 
sub-Saharan Africa.
  The historical enemies of human beings--and we all know what they 
are: war, famine, natural disasters, persecution--today are dwarfed by 
the global epidemic of HIV/AIDS. The crisis is one of public health. 
The crisis is one of developmental economies. The crisis is one of 
humanitarian outreach.
  The global statistics of HIV/AIDS are chilling. I just mentioned that 
an American is infected with HIV/AIDS every 13 minutes. During that 
same 13 minutes, 72 people will die of HIV/AIDS somewhere in the world. 
Twice that number will become newly infected.
  I have had the opportunity to serve on the Foreign Relations 
Committee. In that committee, I chair the Africa subcommittee. I have 
had the opportunity to travel to Uganda, to Kenya, to the Congo, to the 
Sudan. I have had the opportunity to perform surgery in hospitals in 
the last several years where HIV infections among patients run as high 
as 50 percent. When you travel to Africa, just as Secretary Powell did 
2 weeks ago, you see that Africa is losing an entire generation. It is 
that middle generation that is being wiped out. It is that working 
generation that is being wiped out. It is the parenting generation that 
is being wiped out.
  How many orphans result? How many devastated families? How many 
impoverished villages? How many ruined economies?
  The good news is we know a lot about how to reverse the epidemic 
through a combination of political commitment--I am speaking to my 
colleagues and to the political leadership of others around the world--
of donor support--again, I am speaking to those both inside and outside 
government who are in a position to contribute--and of newly committed 
leadership in countries being devastated by the disease. Those three 
elements, in places such as Uganda, Senegal, and Thailand, have had 
remarkable successes.
  On the ground in these countries, work by community-based 
organizations, both religious and secular, has been the linchpin of 
success.
  It is very important that we not separate prevention from care and 
treatment. Science has not yet found a cure. There is no vaccine for 
HIV/AIDS. Not yet. It will be 5 years, or 7 years, or 10 years maybe 
more. I am not sure if it will even be a vaccine. It may be a highly 
effective treatment. One of the many problems of this virus is, once it 
gets into the memory system of the cells of the human body, those cells 
stay there for decades, 60 and 70 years. That's just one of the 
challenges for our research community.
  Recent action by the pharmaceutical companies to slash prices on 
antiretrovirals for poor countries has done two things. First, it sends 
the message of hope. Second, it puts a spotlight on the necessity of 
establishing an infrastructure of health care to be able to engage in 
prevention and care and treatment.
  Access to treatment and drugs for opportunistic infections such as 
tuberculosis is also critical. For all the damage that HIV/AIDS does, 
tuberculosis kills more people in Africa with AIDS than any other 
opportunistic infection.
  Creation and ongoing support of public health infrastructure, of 
health care delivery systems, including personnel training, is 
essential to effective treatment and education programs.
  What more should we do to address this challenge?
  The reason I am discussing this tonight is that 21 years ago, before 
the first case studies, we had no idea of the catastrophe of this 
pandemic which now travels across the world. I have spoken a lot about 
Africa in the last few minutes; and there is increasing public 
awareness of the magnitude of the disaster there. When I ask which 
single country in the world has more HIV/AIDS cases than any other, 
most of my colleagues and those listening would guess a country in 
Africa. That's wrong. It is believed that India now has more cases than 
any other country.
  If I ask what country in the world has the fastest growth rate in 
HIV/AIDS, again, most would guess an African country. That's also 
probably wrong. We think it's Russia. Frankly, we're not sure because 
public health information is so poor in most of these places.
  There is no debate that no region of the world is more affected than 
Africa. But guess which region is second; it's the Caribbean.
  This is truly a global challenge. The price tag for an effective 
response is staggering. Billions of dollars are going to be required. 
The United Nations estimates that $3 to $5 billion will be required in 
Africa alone. $3 to $5 billion to develop an appropriate human and 
physical infrastructure to address this challenge. Governments must 
respond. Legislatures like ours, the executive branch, and the 
governments of the world are the only ones able to commit the resources 
needed.
  New public-private partnerships that draw on our creativity must be 
developed to implement the strategies that are put forward.

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  The United States has taken real leadership on this issue. Although 
we often are criticized by other nations, we need to make it clear that 
the United States right now is contributing about half the funds that 
the entire world is currently spending internationally to fight the 
problem.
  We spend more than anyone on research and on education. We spend more 
than anyone on treatment of HIV/AIDS. We spend more than anyone to help 
the rest of the world deal with this problem. Indeed, U.S. foundations 
alone have contributed more money to attack this problem than most 
other governments.
  This does not mean that we are the only ones doing our part. Other 
nations, the United Nations, the World Bank, corporations, and 
philanthropies have been joining together, particularly over the past 
year.
  President George W. Bush, just 3 or 4 weeks ago, took a real 
leadership position, committing $200 million, the first country to do 
so, to a global fund to combat AIDS.
  Secretary of State Colin Powell, on his recent return from Africa, 
said:

       There is no war that is causing more death and destruction 
     . . . that is more serious . . . than the war in sub-Saharan 
     Africa against HIV/AIDS.

  I will close with seven steps we can take to engage this war:
  No. 1. United leadership. We should ask the political, religious, and 
business leaders of the world to unite in joining the international 
commitment to halt the spread of HIV/AIDS and to help those afflicted 
with the disease. They should commit both financial and human resources 
to the fight.
  No. 2. A global fund. I mentioned and commended President Bush's 
commitment to this global international fund for HIV/AIDS, 
tuberculosis, and malaria. This should not be an American fund. It 
should not even be a United Nations fund. It should be a global fund 
that represents a new way of doing business--transparent and 
responsive. Traditional donors such as European countries, Japan, and 
others, as well as the business community, foundations, and other 
institutions of civil society should all be participants in this fund.
  In the very near future, I intend to offer legislation authorizing 
U.S. contributions to this new global fund, this new way of doing 
business.
  No. 3. Swift funding. We should put nongovernmental and community-
based organizations, both religious and secular, at the forefront of 
the action on the ground by getting funds to them quickly so they can 
most effectively do their jobs reaching out. We know they have an 
enormous impact, and speed saves lives.
  No. 4. Partnerships. We should encourage and empower coalitions and 
partnerships of governments, universities, academies, research 
institutions, multilateral institutions, corporations, and the 
nongovernmental organizations to come together as partners, as 
coalitions, to help fill the gap between the available resources and 
the unmet needs of prevention, care, and treatment. Each member of the 
partnership brings a unique contribution to the battle.
  No. 5. Research. We should make absolutely certain that international 
research efforts on disease affecting poor countries--and that includes 
AIDS, malaria, and tuberculosis--are reinforced in a manner that 
assures the best scientific research in the world can lead to real 
benefits for the developing world at a cost they can afford.
  We should continue to aggressively support and encourage research 
into vaccines and treatments in both private and public institutions 
like the National Institutes of Health. The Senate has recently 
supported the doubling of funding at the NIH over 5 years. We should 
also give new financial incentives for private research. The 
pharmaceutical companies are doing tremendous research in the field of 
HIV/AIDS, but more is needed.
  There are numerous vaccines currently under investigation. Their 
success will be measured in millions of lives saved. Just think of it.
  No. 6. Prevention, care, and treatment. I already mentioned that 
prevention needs to be tied to care and treatment. I am very excited 
about new low-cost options which can link care and treatment with 
prevention over time.
  No. 7. And I will close with this--is hope. As I talked with Denise 
Stokes today, I was struck by her remarkable enthusiasm, her optimism, 
and her commitment to teaching others about this disease which changed 
her life from the age of 13.
  The most remarkable thing to me, as I listened to her and learned 
that she was just in the emergency room 2 days ago, was the simple fact 
that here she was talking to a large crowd of people with her story. 
She was sharing what was inside, reaching out broadly to people from 
all over the world, bringing her special message which can be summed up 
in one word: ``hope.''
  We should do all we can to provide comfort and care to families all 
over the world today. We should address the issue of the orphans 
created by this terribly destructive disease. We have a moral 
responsibility to give them hope.
  Yes, the challenge is before us--a moral challenge, a humanitarian 
challenge. There has never before been such a challenge in terms of 
sheer magnitude.
  As Americans, it is natural to reach out to those around us, 
domestically, to give a helping hand. Now we must join with other 
nations to extend our helping hand further to create a better world, a 
safer world, and a more fulfilling world. We do that here at home with 
boldness, genius, and creativity, along with a healthy dose of courage, 
persistence, and patience. Let us now rise to the global challenge as a 
compassionate people in a great and compassionate nation.

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