    [Public Papers of the Presidents of the United States: William J. Clinton (1995, Book II)]
    [December 6, 1995]
    [Pages 1845-1851]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks to the White House Conference on HIV and AIDS
    December 6, 1995

        The President. First of all, thank you, Sean, and thank you, Eileen.
    Thank you, Patsy Fleming and Secretary Shalala, Secretary Cisneros.
    Thank you, Dr. Scott Hitt, and all the members of the President's
    advisory council. I think most of them were actually sitting in the
    overflow room so the rest of you can be here. But I thank them--
    [Laughter]. We heard them. Let's give them a hand; maybe they can hear
    us. [Applause] Thank you. I thank Dr. Varmus, Dr. Kessler, all the
    others here who are involved in the dramatic effort that they are making
    in the fight against AIDS. Most of all, I thank all of you for coming
    and for giving us a chance to have this first-ever White House
    Conference on HIV and AIDS.
        So much has been said by the speakers who have spoken before, and so
    much is still to be said by the panelists and perhaps by some of you in
    the audience, but I'm going to do what I can to shorten my remarks
    because I want to spend most of my time listening to you and focusing on
    where we go from here. But there are a few things that I would like to
    say.
        First of all, this is a disease, and we have never before had a
    disease we could not conquer. We can conquer this. I believe that--in my
    lifetime, we've eliminated smallpox from the planet and polio from our
    hemisphere. We

    [[Page 1846]]

    can do better, and we can do better until we prevail.
        The threat of AIDS, just the very threat of it, has changed the
    lives of millions of people. And you heard from the talk about
    prevention, about which I want to say more in moment, it needs to change
    the lives of millions of more Americans. It has taken too many friends
    and loved ones from every one of us in this room. For millions of people
    it has shaken their very faith in the future.
        But it's also inspired a remarkable community spirit. One of the
    people on this program today, Demetri Moshoyannis, who is right behind
    me, grew up in a typical American--I think he's still there--
    [Laughter]--grew up in typical American suburb in a typical American
    community. He attended college, became politically active. With a quick
    mind and an active spirit, he was clearly a rising star. After
    graduating, he joined the Corporation for National Service to help us
    start AmeriCorps.
        While he was working for AmeriCorps, he found out he was HIV-
    positive at the ripe old age of 23. He took the news as a challenge, to
    use his communications skills, his organizational skills, and his
    leadership skills to educate and support his peers and help them escape
    the threat. He represents the combination of heartbreak and hope that
    makes this epidemic so unique. I am grateful to him, grateful to Sean,
    grateful to Eileen, grateful to every one of you who also represents
    that remarkable combination. We have to be worthy of your continuing
    courage.
        Twelve days ago, the Centers for Disease Control reported that our
    Nation reached another sad milestone in the AIDS epidemic: A half
    million Americans have now been diagnosed with AIDS, and more than
    300,000 have died. On this very day, and on every day from this day
    forward until we do something to change it, 120 more Americans will lose
    their lives, another 160 people will be diagnosed with the disease,
    nearly 140 will become infected with HIV.
        That's why this meeting is important. It gives us an opportunity to
    say to America what the facts are, to rally our troops, to search our
    minds and hearts, to leave here with more weapons than we came to make
    progress in this battle.
        Our common goal must ultimately be a cure, a cure for all those who
    are living with HIV and a vaccine to protect all the rest of us from the
    virus. A cure and a vaccine, that must be our first and top priority.
        When I ran for President, I said that I would do everything I could
    to pull together the necessary resources and to organize them and to
    exercise real direction toward this goal. At a time of dramatic spending
    cuts, as Secretary Shalala said, we have nonetheless increased overall
    AIDS funding by about 40 percent. If my budget passes--and on this item,
    it actually might pass this year--we'll have a 26 percent increase in
    research. For the first time since the beginning of the epidemic, there
    is now one person in charge of the Nation's entire NIH AIDS research
    program, Dr. William Paul. And though more budget cuts are coming, we
    have got to protect the research budget and the Office of AIDS Research.
    I will oppose any effort to undermine the research effort or the Office
    of AIDS Research.
        I want all our fellow Americans to know that this investment in
    science has paid tremendous dividends. Today people with AIDS live twice
    as long as they did just 10 years ago, especially those who seek early
    treatment. AIDS-related conditions that used to mean a quick and often
    very painful death for people living with HIV can now be treated and
    even prevented.
        Since this administration began, I also want to compliment Dr.
    Kessler and the FDA. In record time they are now approving new classes
    of AIDS drugs that will help to restore the damaged immune systems of
    people with HIV. Indeed, there was a study released last week which says
    that the United States is now approving drugs faster than any European
    nation. And a drug company executive was recently quoted as saying that
    we are now 2 years ahead of Europe in the approval of AIDS drugs. Thank
    you; bring on more. This is a good direction.
        Again, we have a lot to look forward to. Combination drug therapies
    are showing great promise as a means for controlling the virus in the
    human body. And just last year, we found that the use of drug therapy
    could actually block HIV transmission from mother to child. Our
    scientists tell me it's within our grasp to virtually eliminate
    pediatric AIDS by the end of the decade by offering all pregnant women
    HIV counseling and testing and guaranteeing that they have access to the
    treatment they need to protect their unborn children. We can give a
    generation of Americans the freedom of being born without HIV. We can do
    it, and we will.

    [[Page 1847]]

        I think all of us know we have to do more. And you may have ideas
    for us. In the end--I want to emphasize this over and over again,
    whenever we have these conferences, it's important for the President to
    speak, but it's also important for the President and the administration
    to hear. And you don't learn much when you're talking. So I want to urge
    you all here during this meeting today and afterward in following up, we
    are combing the country and the world for the best ideas about what to
    do next.
        To move the search for a cure forward and to accelerate the pace, I
    have asked the Vice President to convene a meeting of scientists and
    leaders of the pharmaceutical industry to identify all the ways in which
    we might accelerate the development of vaccines, therapeutics, and
    microbicides that can protect people from HIV and the infections it
    causes. There are no guarantees in science, of course, but the
    collective will of government and industry can overcome huge obstacles
    as we have seen just in the last few years.
        Second, let me say I am very pleased that the decision that was made
    at the NIH to put Dr. Paul in charge of coordinating the AIDS research
    of the NIH, for the first to have it all reconciled, coordinated, and
    directed, has worked out very well. But we need to extend this effort
    Government-wide. That's why I have asked Patsy Fleming to coordinate an
    inter-departmental working group that will be chaired by Dr. Paul to
    develop a coordinated plan for HIV and AIDS research all across every
    single Department of our Government, including developing a coordinated
    research budget. And I want a report in the next 90 days. That is the
    next important step to move forward.
        We can't afford any unnecessary delays or missed opportunities. And
    I'm convinced that these two steps will help us to avoid those.
        In addition to the work in research, we have to continue to do what
    we can to assure that those who are living with HIV and AIDS get the
    support and the care they need. And I want to talk about this in some
    detail.
        For people with AIDS, the current debate over how to balance the
    Federal budget is far more than a question of political rhetoric. It is
    a matter of survival, primarily because of Medicaid. Even if we are
    successful, and I believe we will be, in reauthorizing the Ryan White
    CARE Act, at higher levels of funding--and as you heard the Secretary
    say, we've increased funding by, I believe, 108 percent in the last 3
    years--that is less than 20 percent of the total money spent to care for
    people with HIV and AIDS.
        Medicaid is the lifeline of support. It provides health care for
    nearly half of the 190,000 Americans living with AIDS, including 90
    percent of the children. It provides access to doctors, to hospitals, to
    drugs, to home care, the things that allow people to live their lives
    more fully. It pays for the drugs that keep HIV under control for longer
    and longer periods of time. And it pays for drugs that prevent the
    infections that often end the lives of those with AIDS. Medicaid pays
    for the care that allows families to stay together.
        Yet today, Medicaid, a program that parenthetically also is eligible
    to cover one in five American children--that's how many--22 percent of
    our children are living in such difficult circumstances that they are
    eligible for Medicaid. And one of the things about the congressional
    budget that I objected to so strongly is that it slashes spending on
    Medicaid by over $160 billion and turns it into a block grant, thus
    eliminating a 30-year national commitment we have made to the poor,
    especially to poor children, which I might say has given us the lowest
    infant mortality rate in our history. It is the one thing we have done
    that has helped us to drive down infant mortality among poor people who
    otherwise never see doctors. It has given elderly people, millions of
    them, a dignified life in nursing home or getting home care. And it has
    helped people with disabilities, not just people with HIV and AIDS but
    millions and millions of families on limited incomes with children born
    with cerebral palsy, children born with spina bifida, families that
    could never afford to buy a decent wheelchair for their children, much
    less send them to camp in the summertime or have them in an appropriate
    living setting. And it is the lifeline for people with HIV and AIDS.
        I say again, the Ryan White health care act is important. I'm proud
    of the fact that we have doubled the funding. I am fighting for more
    funding this year. I am proud of the fact that it enjoys some bipartisan
    support in the Congress. I am proud of the fact that when there was an
    attempt in the Senate to eviscerate it and turn it into a political
    football, the Senate almost unanimously turned it back. But be not

    [[Page 1848]]

    deceived; we could double it. And if this Medicaid budget goes through,
    it is a stake in the heart of our efforts to guarantee dignity to the
    people with AIDS in this country. [Applause] Thank you.
        I want to say one other thing. I want to thank the Secretary of
    Housing and Urban Development for the work that he has done to increase
    opportunities in housing for people living with AIDS. We have taken some
    tremendous hits in the HUD budget, some of them we have inflicted in an
    attempt to get the deficit down. And there will doubtless be further
    reductions which will require reorganization on an unprecedented scale
    at the Department. But Henry Cisneros and I were together on the day
    before Thanksgiving at a shelter serving food, and he told me again the
    one thing that we must not do is to undermine the ability of the
    Department of Housing and Urban Development to try to provide dignified,
    adequate, compassionate housing opportunities for people living with
    AIDS.
        So I say to you, when we talk about balancing the budget, I'd like
    to remind you that our administration has cut the deficit nearly in half
    in ways that were honorable and fair and enabled us to increase our
    investment in things that mattered, not just the war against AIDS but
    education, technology, medical research, the environment, to bring the
    deficit down and lift the society up. And that's the way we ought to
    approach this.
        I want to say more about this in a minute, but this budget debate,
    because it requires tough choices, will inevitably require us to define
    what kind of people we really are. When times are easy and you can just
    dole out money to everybody that shows up at the door, it's pretty hard
    to tell what your values are. When times are tough and you have to say
    yes some places and no others, it becomes far, far clearer.
        So I ask you to help us in the fight against the Medicaid cuts, to
    help us to preserve Secretary Cisneros's ability to support housing
    opportunities.
        I got the message. I heard what you said about prevention. I would
    point out that in the last 2 years we have asked for increases in our
    prevention budget. But I am very worried about what's happening there
    because of what has already been said.
        We have to set a goal. And I hope you will suggest one coming out of
    this conference. We have to reduce the number of new infections each and
    every year until there are no more new infections. And we all have to do
    that.
        We know that for this to work it has to be targeted and it has to be
    sustained, as the gay community demonstrated in the 1980's. We know now
    we have to pay particular attention to young people and those who abuse
    drugs. There is a lot of evidence that huge numbers of our young
    teenagers continue to be completely heedless of the risks of their
    behavior.
        I was pleased to see the public service announcements that Secretary
    Shalala released to educate young people and to urge them to take
    responsibility to protect themselves. I would say we ought to go
    further, and you need to help us. We have to educate these kids, but we
    also have to tell them they cannot be heedless of the consequences of
    their behavior.
        It is not enough to know; they must act. It is in the nature--it is
    one of the joys of childhood that children think they will live forever.
    It is one of the curses of childhood in some of our meanest
    neighborhoods that children think they won't live to be much beyond 25
    anyway. In a perverse way, both of those attitudes are contributing to
    the problems, because one group of our children thinks that they are at
    no risk because nothing can ever happen to them; they're bulletproof.
    Another group believed that no matter what they do, they don't have much
    of a future anyway. And they are bound together in a death spiral when
    it comes to this. This is crazy. We have got to find some way to tell
    them: You must stop this.
        We are doing what we can to make those toughest neighborhoods safer.
    Believe it or not, amidst all the talk here in Washington, you could
    hardly know it, but out there in America in almost every community, the
    crime rate is down, the welfare rolls are down, the food stamp rolls are
    down, the poverty rolls have dropped for the first time in over a
    decade. Why? Because if you invest in people and their future and jobs
    are created and people go to work and hope begins to be infused in
    people's lives, all the problems we talk about here in Washington give
    way to opportunities in the lives of people.
        But we see with this problem, whether there is an atmosphere of
    opportunity or an atmosphere of hopelessness, too many teenagers are
    ignoring the responsibility they have to protect themselves. We have to
    find better ways and

    [[Page 1849]]

    maybe more help from different people, to get inside their minds, to
    shake their spirits, to make them know we care about them and we want
    them to have a future. But we cannot do the one thing that only they can
    do, which is to control their own decisions. And we have to do more. And
    if you've got any better ideas for me, believe me, I am all ears.
        I want to say, too, just a little word about the importance of
    trying to tie our prevention efforts with HIV and AIDS to our prevention
    efforts with drugs and substance abuse, because that's the second big
    problem area of populations. In 1993 and again in the crime bill in
    1994, we increased our Federal investment with drug treatment. And I'm
    working to try to convince Congress to do even more. We know that the
    right kind of treatment programs work. We know that the right kind of
    prevention programs work. And we know that we can marry the two.
        I've asked the CDC to convene a meeting of State and local people
    involved in both public health and drug prevention to develop an action
    plan that integrates HIV prevention and substance abuse prevention. And
    I hope that we can do that and do it now, because I think it will make a
    significant difference.
        I have to tell you that I am very worried that what we see with the
    HIV rates among juveniles is now being mirrored in drug use. Last year's
    statistics showed unbelievably that drug use among people 18 to 34 was
    going down but casual drug use among people 12 to 17 was going up. I
    think it is clearly because there are too many kids out there raising
    themselves, thinking nobody cares about them, and not thinking there's
    much of a future. So we have to deal with these two things together.
        And while we search for a cure, work to improve treatment, strive to
    prevent new cases and to protect the hard-won gains of the past, I'd
    also like to say just a word about the basic human rights of people
    living with HIV and AIDS.
        AIDS-related discrimination unfortunately remains a problem that
    offends America's conscious. The Americans with Disabilities Act now
    offers more than 40 million Americans living with physical or mental
    disabilities, including those living with HIV and AIDS, protection
    against discrimination. And the Justice Department, the Department of
    Health and Human Services, the Equal Employment Opportunity Commission,
    they have been vigorously enforcing the ADA. We're about to launch a new
    effort to ensure that health care facilities provide equal access to
    people with HIV and AIDS.
        We simply cannot let our fears outweigh our common sense or our
    compassion. And as Sean said, we can't let our bigotry--to use his word,
    we can't let our homophobia blind us to our obligations. I say that for
    two reasons. One is that the fastest growing group of people with the
    HIV virus are not gay men. This is not a disease that fits into the
    homophobic world view. But the second reason is that regardless of
    sexual orientation or race or income or even whether a person has sadly
    fallen victim to drug abuse--as someone who has lived in a family with
    an alcoholic and with a drug abuser--every person--I say this with clear
    knowledge, experience, and conviction--every person with HIV or AIDS is
    somebody's son or daughter, somebody's brother or sister, somebody's
    parent, somebody's grandparent.
        And when we forget this, when we forget that all the people who deal
    with this are our fellow Americans and that most of them share our
    values and our hopes and our dreams and deserve dignity and decency in
    the treatment we give them, we forget a very great thing that makes this
    a special country. And we forget it at our own peril.
        In one way or another nearly every person in America at one time in
    his or her life has been subject to some sort of scorn. Woodrow Wilson
    once said that you could break a person with scornful words just as
    surely as with sticks and beat him. And I think that's an important
    thing, too, to remember.
        The American people need to know that everybody in this country and,
    indeed, throughout the world, is now vulnerable to this disease. We need
    to identify what our responsibilities are in this country and our
    responsibilities to developing countries are to deal with the problem,
    to search for a cure, to search for a vaccine, to deal with the
    treatment issues. But I'm not sure it doesn't begin with dealing with
    our own hearts and minds on this. That's where you have to come in.
        Frederick Douglass said, during the great struggle against slavery,
    that it was not light that is needed but fire; not the gentle shower but
    thunder; the feeling of the Nation must be quickened, the conscience of
    the Nation must be roused. That's what you came here to do.

    [[Page 1850]]

        Don't forget this: Most Americans are good people. The great burden
    we have as Americans is that when we have to deal with something new,
    too often we can't deal with it from imagination and empathy, we have to
    actually experience it first. I do not want to wait until every single
    family has somebody die before we have a good policy.
        So I ask you--I understand anger and frustration, but I will never
    understand it until someday and something happens to me, and I know the
    sand is running out of my hourglass. So I can't totally understand it.
    But I ask all of you to remember this: This is fundamentally a good
    country. Alexis de Tocqueville said in the 1830's that this was a great
    country because we are a good country. And if we ever stop being a good
    country, we would no longer be a great country.
        So I ask you to use this moment to give America a chance to be great
    about this issue, give our people a chance to feel this the way you feel
    it, to see it the way you see it, to know it the way you know it.
        When I was getting ready for the conference yesterday, I called Bob
    Hattoy, sitting back there in the room. I said, ``What do you think I
    ought to say tomorrow? What do you think is going to happen?'' We were
    talking, and he said, ``I think you ought to think about all the people
    who waged this battle with us in 1992 who aren't around anymore.'' And
    so we just went through them name by name. And then right before I came
    over here I looked at the picture of little Ricky Ray that I keep on my
    desk at the White House in the Oval Office, and I remembered his family
    and the members that are still struggling with it.
        Give the country a chance to be great about this. Shake them up.
    Shake me up. Push us all hard. But do it in a way that remembers this is
    fundamentally a good country. Every now--when we stray, we get off the
    track a little bit, but we're still around for more than 200 years
    because most of the time, when the chips are down, we do the right
    thing. And I am convinced that people like you can get this country,
    starting here in Washington, to do the right thing.
        Thank you, and God bless you all.

    [At this point, Dr. Renslow Sherer, director of the AIDS clinic at Cook
    County Hospital in Chicago, IL, discussed methods for improving primary
    care for HIV patients.]

        The President. Thank you.
        I want to ask one brief question, if I might. One of the
    difficulties that we have in dealing responsibly with this issue
    involves the dilemma that you just laid out when you said we ought to
    have voluntary testing, not mandatory testing. And the issue is most
    clearly represented with the whole question of pregnant women now given
    the advances that have been shown. I've studied the CDC guidelines; I
    think they're--they make sense to me. I think the rest of us who don't
    know the facts ought to follow people that we hire to make these
    judgments. You know, if there's--it makes a lot of sense to me.
        But you just said that there were 34,000 people that needed your
    services, and only 10,000 were getting them and we had to find a way to
    get more people to get voluntarily tested. So how do we close the gap
    between 10 and 34? What can we do? What can you do? What can the rest of
    us do? That's what's driving this whole mandatory testing thing. It's
    not the notion that people are out there hiding, trying to avoid getting
    tested; it's that there's this huge gap and that society is being
    burdened by it and so are these people. So how do we close that gap?
        Dr. Sherer. I know other speakers today will address this, but let
    me start. Mandatory testing not only will not address this problem, it
    will further drive people away and be a disincentive to their coming
    into care.
        The President. So how do you do it?

    [At this point, representatives reported on the various HIV/AIDS issues
    that were discussed by the nine working groups that comprised the
    conference.]

        The President. I would like to say just one thing before I go.
        First of all, I have learned a lot. I even learned some things about
    some bills in Congress I thought I already knew all about. [Laughter]
    And I would like to encourage you to make sure that through our AIDS
    office or through the advisory council and Scott Hitt that we have an
    actual record of every question asked and every issue raised. I think
    it's very, very important that we do a systematic followup on every
    issue raised, every question asked.

    [[Page 1851]]

        Q. Mr. President, why didn't you do a systematic followup on the two
    previous Presidential commissions on AIDS? You promised in your campaign
    to adopt the recommendations. Why has it taken another year for you to--
    [inaudible].
        The President. Didn't you listen to what we said before about what
    we've done the last 2 years? Most of the----
        Q. I heard you talk about--[inaudible]----
        The President. Do you want me to answer, or do you want to keep
    talking?
        Q. ----I did not hear you talk about specific actions that will save
    lives today. And there's a list of 50 that have been followed by a range
    of New York organizations that have been submitted to officials in your
    administration. And it has taken 2 years, and now----
        The President. First of all, that's not accurate. We implemented a
    lot of those recommendations, as you know. So I think that's a little
    unseemly for you to say. We had a set of recommendations we got when we
    got here, most of which have been implemented.
        I am very sorry--I am very sorry--now, wait a minute. I listened to
    you; now you listen to me. I listened to you. Look, I am very sorry that
    there is not a cure. I am very sorry that there is not a vaccine. I
    regret that not everything I have asked for has been approved by the
    Congress. In the context of what has happened in this country in the
    last 3 years, I believe we have gone a long way toward doing what we
    said we would do. But I will never be satisfied, and you won't, and you
    shouldn't be, until we have solved the problem. That is what this
    meeting is about, and that's what I am trying to do. And I think all of
    us should do what we can to be constructive.
        Q. [Inaudible]
        The President. Well, that's a matter of dispute. You have your
    version of the facts and I have mine, and I'll leave it to others to
    make a judgment.
        Q. [Inaudible]
        The President. Let me just say, I believe this has been a good
    meeting. I think most people are glad they came, and I think most people
    believe they're better off than they were 4 years ago.

    Note: The President spoke at 1:10 p.m. in the Cash Room at the Treasury
    Department. In his remarks, he referred to Sean Sasser, member, board of
    directors, AIDS Policy Center for Children, Youth & Families; Eileen
    Matzman, board member, Mothers' Voices; and Dr. Scott Hitt, Chair, and
    Bob Hattoy, member, Presidential Advisory Council on HIV/AIDS.