[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.

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    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.