WHAT IS THE U.S. ROLE IN COMBATING THE GLOBAL HIV/AIDS EPIDEMIC?

THURSDAY, JULY 22, 1999

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON CRIMINAL JUSTICE, DRUG POLICY,
AND HUMAN RESOURCES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC. The subcommittee met, pursuant to notice, at 11:30 a.m., in room 2154, Rayburn House Office Building, Hon. John L. Mica (chairman of the subcommittee) presiding.

Present: Representatives Mica, Gilman, Mink, Cummings, and Kucinich.

Also present: Representatives Lantos, Norton, Schakowsky, and Sanders.

Staff present: Sharon Pinkerton, deputy staff director; Steven Dillingham and Mason Alinger, professional staff members; Cherri Branson, minority counsel; and Jean Gosa, minority staff assistant.

Mr. MICA. Good morning, I would like to call this meeting of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources to order.

Today's hearing is entitled, What Is the U.S. Role in Combating the Global HIV/AIDS Epidemic?

We will start this morning's hearing, as usual, with opening statements. I will give my opening statement, present a brief video, and then yield to members on our panel. We will then hear from our first panel of witnesses.

We will be joined shortly by our ranking member, but we would like to proceed, because we have a full schedule today.

Today, this subcommittee will address an issue that is unequalled in both its complexity and its urgency. That is, the global HIV/AIDS epidemic, and the role of the United States in combating this terrible affliction. This growing problem is both a trade issue, a health issue, and most certainly a humanitarian issue that we cannot ignore.

Our subcommittee was recently reconstituted and vested with oversight of health and trade issues. We are committed to understanding both the nature and magnitude of this epidemic, and also to ensure the proper role of the U.S. Government in combating this disease.

Recently, we held a hearing on another terrible infectious disease, hepatitis B, and the importance of vaccines and properly designated vaccination policies in combating infections and meeting the health concerns of our citizens.

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Today and in the future, this subcommittee will perform its oversight responsibility, examining health-related programs and practices that are both promising and also that will save lives.

As we will hear today, the AIDS epidemic is global and horrific. It continues to spread across the globe unabated. We will learn that no area of the world has been harder hit than the continent of Africa, particularly sub-Saharan Africa, where two-thirds of the world's infected population resides.

Other continents and regions are also at risk today. Witnesses will tell us firsthand of the devastating impact of the epidemic in Africa, including economic, health, and humanitarian sequences. They will reveal some of the terrible consequences to themselves and their loved ones.

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We will also hear about recent developments in vaccine research and its hopefully not-so-distant potential for preventing the spread and transmission of HIV/AIDS. Recent studies show that women are now being infected at a greater rate than men. I am encouraged by recent press accounts that new, more affordable drug is being developed which may significantly reduce the incidence of AIDS transmission from an infected mother to her unborn child.

But a question still remains: What are we going to do to make certain these new drugs are available to developing countries that need them? Tragically, there are nearly 600,000 African babies newly infected each year; 9 out of every 10 infants infected with HIV at birth or through breast-feeding live in sub-Saharan Africa. This hearing will also focus on the critical and complicated issues of drug treatment for HIV and AIDS. How can we treat such a large and growing population? The World Health Organization and affiliated organizations recently announced that AIDS kills more people worldwide than any other infectious disease. Imagine, in less than two decades, AIDS has become the leading killer out of all known infectious diseases.

As you can see in the chart we have prepared, and I think it is right over here, more than 33.4 million adults and children are estimated to be infected with HIV/AIDS. This disease has already killed 14 million people. Of those, approximately 12 million, almost all are African.

Today, more than 22.5 million Africans are living with HIV/ AIDS. Reportedly, 95 percent of Africans with AIDS have not been tested, and 90 percent are unaware that they even have the disease. The tragedy resulting from this killer disease in Africa is almost inconceivable.

Zambia, for instance, has one of Africa's largest orphan populations. In 1990, it was home to approximately 20,000 orphans. By next year, the number is estimated to reach a staggering 500,000. Zimbabwe, a nation of 12 million citizens, reports 600,000 orphans, most being supported by grandparents or other relatives. Uganda, with a population of 20 million people, 10 percent of whom are now HIV-positive, also reports 600,000 children having lost at least one parent, and about a quarter of a million children having already lost both parents.

Today, we will hear testimony from a mother in an African nation, Malawi, where 20 percent of the population is HIV-positive, and life expectancy has dropped to below 40 years of age.

These numbers are devastating, and the personal tragedies unimaginable. AIDS now infects 6 million people annually around the world, and the number continues to climb. This Nation, which leads the world in science and technology, as well as world trade, must address two important issues: What are we doing about this global epidemic, and what should we do about it? Part of that is linked to our trade policy, and part of that is also linked to our health policy.

First, what actions are we now taking to combat the international spread of this disease? From all appearances, not nearly enough. The administration's AIDS czar has acknowledged that the epidemic has been met with indifference by Americans and also by their government. We cannot afford to let this indifference continue.

I am heartened to learn that some in the administration are now speaking out on the issue, even though our trade policies to date have been unclear on this matter, sometimes even contradictory. Should we, through the office of our United States Trade Representative, apply economic pressure or withhold assistance to nations such as South Africa when that nation attempts to engage in self-help to combat its national health emergency?

Can we identify better approaches to expanding HIV and AIDS prevention and treatment in developing nations, rather than imposing rigid licensing and import practices?

Is it necessary for AIDS-stricken developing nations to rely on periodic pronouncements of intentions to provide limited foreign aid from the United States? And I wrote this before, I guess, the announcement recently of $100 million, I believe, being offered by the Vice President and the administration.

Can nations in need and the pharmaceutical industry negotiate a solution that meets the growing health and humanitarian needs, while also ensuring that a reasonable profit is made to support future drug development?

These are all tough questions that this Nation and this Congress must address, as we are, in fact, the world's foremost economic power; a world leader in science, technology and trade.

The second question is what should we do about the epidemic? In answering this question, let me share with you one description of a crisis and possible response that was highlighted recently in a national television news segment. This takes several minutes, but I think it is worth our time. It is not a scientific piece, but it does show us, firsthand, the situation.

With Members' forbearance, I would like to show it.

We will play that tape.

[Videotape played.]

Mr. MICA. I would say that this news video is very short and superficial. It illustrates the tragedy of the epidemic, raises a number of questions, and also presents us with a dilemma: Does drug treatment delivery in developing countries pose significant risks of new strains of AIDS?

I hope we will learn more about this issue today, and about some of the trade and health implications mentioned. I am convinced that we cannot leave ourselves to do nothing to help these nations

and these people, and I cannot believe that there is no other recourse for us but to watch millions of people die without treatment. Here in the United States, while AIDS continues to spread, AIDS deaths have dropped recently by 47 percent, primarily due to new drug treatments that prolong lives and allow people to remain productive, and the availability within our market of these treatments. I hope that we can do much more for other nations and our trading partners who are now in need. It is clear that many developing nations cannot progress economically until solutions to this crisis are found.

In a recent survey of American citizens, almost 90 percent of those surveyed nationwide say that it is safest and cheapest to fight infectious diseases at their source, which is most often in the developing world. In fact, today, we will hear from a witness who is in our country because she cannot acquire the drug treatment in her native Africa that she needs.

The survey also found that more than 80 percent of Americans see AIDS as a bigger problem today than they did 10 years ago, despite advances in treatments. The United States plays a vital role in the global economy, and we also remain a Nation at risk. Recent data indicates that the infection rate among American women is increasing more rapidly than among males. As I said at the beginning, African Americans are six times more likely to contract HIV/AIDS than others.

These are some of the reasons that the solution to combating the global HIV/AIDS epidemic is complex and will not be achieved as quickly as we all hope. Yet I am convinced that through a better understanding of this international health crisis, we can improve our treatment and prevention efforts both domestically and internationally.

It is imperative that vaccine research proceed expeditiously. We also should assist, not hinder, developing nations and our trading partners in their efforts. I cannot fathom that we simply wait while the epidemic reaches the multiples of the 14 million AIDS casualties who have already died from this horrible disease. The millions of infected babies, orphaned children, new infections each year, and deaths that occur internationally without treatment are simply unacceptable. This crisis demands our immediate attention from this government, and more than a Band-Aid approach.

Today, it is my hope that as we learn more about the crisis, we can begin to formulate a more effective response. It confounds me that we can dedicate substantial government resources to learn whether we have problems with global warming while tens of millions are facing certain death from an immediate and growing crisis where real science can save lives.

I look forward to the testimony of our witnesses, and we have many of them today. This is a topic that has raised a great deal of interest and attention, rightfully so, because it is the greatest health threat facing the world.

I wish to thank my colleagues in Congress for sharing their ideas with the subcommittee on this topic. I also want to commend those witnesses with this disease who have the courage to discuss publicly this most sensitive and pressing health issue.

Finally, I believe that we have a moral and humanitarian responsibility to publicly air this incredible human tragedy, and our response should be done both as a Congress and as a civilized Nation. Years from now, and millions of deaths later, we must not be accused of turning our backs on this great holocaust.

[The prepared statement of Hon. John L. Mica follows:]