THE WHITE HOUSE
Office of the Press Secretary
REMARKS BY THE PRESIDENT AT THE WHITE HOUSE CONFERENCE ON HIV AND AIDS
The Cash Room Treasury Building
1:10 P.M. EST
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 -- we heard them; let's give them a hand, maybe they can hear us. (Applause.)
I thank Dr. Varmus, Dr. Kessler, all the others here who are involved in 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. (Applause.) I believe that -- in my lifetime, we've eliminated small pox from the planet and polio from our hemisphere. We 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 a 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 a 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. (Applause.)
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. (Applause.)
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 two years ahead of Europe in the approval of AIDS drugs. Thank you, bring on more. This is a good direction. (Applause.)
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. (Applause.)
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 energy -- 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 inner-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 -- (applause).
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 is 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 three 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 provides health care for nearly half of the 190,000, 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 spinibifida, 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 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. (Applause.)
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. (Applause.) 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 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 two 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. (Applause.)
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 1980s. 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 problem, because one group of our children think that they are at no risk because nothing can ever happen to them -- they're bulletproof; another group believes 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 of the problems we talk about here in Washington give way to opportunities in the lives of people.
But we see with this -- with this problem, whether there is an atmosphere of opportunity or an atmosphere of hopelessness, too many teenagers are ignoring the responsibilities they have to protect themselves. We have to find better ways, and maybe more help from different people, to get inside their minds, to shake their spirits, to make them know 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 in 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. (Applause.)
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 Douglas 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 conscious of the nation must be roused. That's what you came here to do.
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 -- (applause) --.
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 hour glass. 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 1830s 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. (Applause.)
Q Mr. President, we will now begin the roundtable discussion with reports from each of the workshops. I'd like to begin with Dr. Renslow Sherer. He will report to you from the primary care and benefits workshop.
Dr. Sherer is a dedicated clinician and researcher who is head of the AIDS program at Chicago's Cook County Hospital.
Q Mr. President, let me add my voice to thank you for being the first President in 14 years to convene such a conference. I have four messages for you from the primary health care group, and that's for you and the Advisory Council and for the nation. And I'm really echoing many of the comments that you've just made.
Mr. President, we've made great progress in HIV care since the epidemic began. We have therapies now, as you mentioned, combination therapies that can improve the length of an individual's life and the quality of their life. We've learned a great deal in the management of HIV and established systems of care, much of which is through the benefits of the Ryan White CARE Act. In future, we need to build on the experience and expertise of those caregivers around the country who have worked for so hard for so long.
But in order to do that, we're concerned about the fact that our care system is seriously threatened by the potential for Medicaid cuts that are being debated right now. We urgently need you and the nation to support full funding for Medicaid and for the Ryan White CARE Act without mandatory testing requirements. Included in that need is the availability for all who need it for lifesaving drugs. Today, in several states -- in New York state and Kansas -- people who have had access to life-saving drugs may not now be able to receive them because of funds having expired through Title II of the CARE Act and through other means for the availability of those drugs.
Third, we need to improve access into our health care system for all who need it. In Chicago where I work, we think there are 34,0000 with HIV, but only 10,000 of those are identified, know they're infected and are in care. We must improve our ability to reach out and provide HIV counseling and testing for those who need it, in a voluntary fashion so they can engage and come into care.
Some of the new improvements in HIV care in the last year require us to once again renew efforts to train health care providers -- physicians, nurses and other health care providers -- because there's additional complexity now. And that training needs to take place in medical schools and nursing schools, and also through the AIDS education and training centers, for which funding has been threatened. Full funding of that will guarantee that we continue to be flexible and to respond to the increased training needs.
In addition, we need to ensure oversight of the quality of care. We've learned how to do HIV care well, but that's not consistently transmitted throughout our health care system. On the contrary, there are still centers, individual physicians and providers, who know little or nothing about HIV care. We urgently need to engage them and train them, as well as to ensure that when we're expanding access to care, it's to providers with knowledge and experience, so people gain from the benefits that we've made in the last 10 years.
It's very important that we pursue the most cost effective strategies that we can, but that's not the same thing as limiting costs. We're very concerned that our health care system allow for the optimal management of people with HIV. To quote one of our members, "to manage care only in terms of short-term cost considerations, it's not only bad medicine, it's inhumane and it's unethical." It is also not necessarily the most cost effective in the long run.
Finally, Mr. President, the definition of primary care really includes much of what you'll hear following and what you've included in your remarks. In order to provide care at Cook County Hospital for someone with chemical dependency, we need to be able to address their chemical dependency with drug treatment in order to encourage their continuation in primary care. We need prevention urgently, both secondary and primary prevention.
We agree with you that discrimination is a serious impediment to the ability of people to receive care and needs vigorous leadership from the White House and from all the governor's mansions of our country. Our patients need housing and need mental health care and drug treatment, and we have to think broadly. Those items will be covered by the remainder of the speakers.
In addition, primary care research in health outcomes and in clinical -- new therapies is a critical component of HIV primary care.
Again, I thank you for convening this conference and for the leadership that you've already shown. Maybe it's our most important message of all, to continue to listen to people with HIV, to affected communities, to their care providers and their loved ones, and to work with all of us to be here for the cure.
Thank you again. (Applause.)
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. (Applause.)
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 10,000 and 34,000? 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 testing; 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?
Q 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. (Applause.)
THE PRESIDENT: So how do you do it?
Q Mr. President, let me pick the single example of pregnant women. At Cook County Hospital, we have a program with our Ob-Gyn physicians in community health centers to engage pregnant women and women at risk of HIV in voluntary HIV counseling and testing. We have an exceptional compliance, well over 90 percent, with those efforts. You could not improve, and should not improve -- you can't force or use coercion in this kind of a public health problem. The first principle of public health is to engage the support and cooperation of the people.
There are many other creative strategies to reach people at risk. I think that Eileen and Sean have spoken to them, and I know you'll hear about more today.
MS. FLEMING: Mr. President, Phill Wilson was in the services workshop. He is the public policy director at AIDS Project Los Angeles, and an eloquent spokesperson on behalf of people living with HIV.
MR. WILSON: Good afternoon. As Patsy said, I'm a person living with AIDS. Tragically, I'm not alone. We are not alone. We are part of the American family. We're not a special interest group. We are men and women; we're old and young; we're gay and straight. We live in urban, suburban, rural communities. We are Americans. And we want an end to this epidemic.
With the advances that have been made especially over the last year in basic science and some therapeutic research, we have the potential for hope. I believe you know something about hope. But that hope is at peril for a number of reasons. One of those reasons is the lack of leadership. We need you to continue and to step up your leadership. You and the Congress have made a commitment to balance the federal budget by a date certain. We need you to make a commitment to end this epidemic by a date certain. (Applause.)
The American people need to hear their President say, I'm committed to setting America on a course to end this epidemic in seven to 10 years. At the very time when there's hope and promise for therapy, we are engaged in a dialogue to dismantle the very mechanisms that the majority of people living with HIV and AIDS use to access that care. Treatment without access is no treatment at all.
The health delivery system of America is crumbling before our very eyes. Medicaid must be protected. It must be protected as an entitlement program. We must maintain the standards of care, and we must support the drug assistance programs.
As was said earlier, we must resist efforts for mandatory testing. And I'll answer your question: One of the ways to close the gap is by telling people that there's something that they can do. That message hasn't gotten out there. The second thing we need to do is to tell them that they have access to that treatment. If you're poor in America, you don't have access to that treatment. If you're poor in America, you don't know that there are things that you can do. Consequently, there's no motivation for you to get tested.
Yes, in all of our agencies around the country we have waiting lists because we don't have the proper resources to, in fact, test the people who want to be tested. We must invest in a comprehensive, coordinated continuum of targeted care that begins with access to voluntary anonymous testing for every American, and includes primary medical, home health, and hospice care.
You have established research and the Ryan White CARE Act as investment programs. We would urge to include in those programs housing and prevention. We are engaged in a war, and in a war you must make sure that all your fronts are covered.
As was mentioned earlier, we've recently sent American soldiers to Bosnia. I know we all pray every night that every man and woman there will come home. Every day I feel like I am in a war, a war that I will never come home from. I imagine there are people around you who say that what we ask for is politically impossible. James Baldwin admonished us in The Fire Next Time that in our time, as in every time, the impossible is the least that we can demand. I believe, Mr. President, if you lead, America will follow. (Applause.)
Q Mr. President, Virginia Apuzzo was the reporter in the housing workshop. She's the former deputy executive director of the New York State Housing Department. She is a New York State Civil Service Commissioner, serves on the New York State AIDS Advisory Council, and was executive director of the National Gay Task Force at the beginning of the epidemic.
MS. APUZZO: Mr. President, we began from the premise that decent, safe and affordable housing is a basic right in America. We wish to underscore that housing is an HIV-AIDS issue.
We discovered early on that it was an AIDS and HIV issue when scores of people were put out of their homes and put out of their jobs because of discrimination vis-a-vis AIDS and HIV. So we didn't initially get into the housing business, we responded to the demand.
Housing is the foundation upon which any program of care or services must build. Without stable housing the person with HIV-AIDS cannot access any of the programs or services that you support. People who are homeless are virtually red-lined out of programs for prevention and care. It is a fact that nearly 50 percent of the persons with HIV and AIDS will be homeless or at risk for becoming homeless at some time in their life in the course of their illness.
If that happens, that person will drop out of any system of health care for their illness. And the next time that person will be seen will be in an acute care facility. The stay in that hospital for that particular patient costs an average of over $1,000 a day. If that person's health improves in the course of their hospital stay, the stay will probably be prolonged because the hospital has no place to release the person.
The cost of providing housing services in the HOPWA-funded residential facility is less than one-tenth, and some estimate as low as one-twentieth of the amount that I underscored for the hospital stay. HOPWA dollars reduce the use of emergency health care services by an estimated $40,000 per year. But HOPWA alone can't do the job. We have relied in the past, and need to continue to rely in the future, on the flexibility afforded by -- and Section 8 housing.
In the context of housing, we speak of a continuum of care, a range of housing and services that change over the course of the illness. It may be that a person at some time needs rental assistance, at another time needs transitional housing or group housing or skilled nursing care. That continuum of care has to be set up with the focus being the person and where the person is at that time of the illness in their life. We underscored that housing is a family issue. Houses support families. In some instances they help reconstitute families. And where there is no family, housing helps to create a sense of family.
We understand that you are preparing a seven-year budget plan. We need for you to consider how critical housing is in that scheme of things. And we need that to be reflected as a priority of yours.
And, finally, Mr. President, as has been said before, we've waited 14 years and watched 300,000 people die to have the opportunity that you've given us today to come before you. We would surely fail those who have passed on and those who are not here to speak for themselves if we didn't reiterate, each of us, that this struggle needs and deserves your leadership -- not for a meeting, not for a day, not for a year, but for the duration, Mr. President.
Thank you. (Applause.)
Q Mr. President, Deborah Cotton was in the research workshop. Dr. Cotton is associate professor of medicine at Harvard Medical School and a physician at Massachusetts General Hospital in Boston. She has been involved with most of the important research questions since the beginning of the epidemic.
DR. COTTON: Mr. President, on behalf of my colleagues in the biomedical workshop, I'm very pleased to be able to report real progress in the treatment of AIDS. As you said so eloquently in your opening remarks, patients are now living longer and living better lives.
Nonetheless, we all know that people are continuing to die every day and we must do more. We must do more because this is now the chief cause of death in people of their most productive years. Because, in fact, our therapies are cost effective and will reduce the burden of cost to our society in caring for those people. In addition, we know that the results that we have in AIDS are going to translate into other diseases. And, of course, because this is the right thing to do.
As you know, this is a virus which directly hits our immune system which is supposed to protect us from infection and tumors. We've had to learn a tremendous amount about how this virus works, and we've done that. This represents, really, an unprecedented achievement of American science, medicine and patient advocacy. And I think that it really is a model for moving forward with other diseases, in addition to AIDS.
We know now a lot about this virus, how it's constructed, how it's activated, where it hides. We know how it interacts with the immune system. And this has really enabled us to have a three-pronged approach against this disease. First, we're developing drugs that actually try to eradicate or control the virus itself. And, because of an unprecedented cooperation between patient advocacy groups and the FDA, we now have or will soon have six approved anti-viral drugs.
One of these is in an entirely new class and one that flows right out of our basic science research. Several appear to be extremely powerful in being able to reduce the amount of virus in the blood and restore immune function. In addition, we have new evidence that these drugs used in combination will have much greater ability to provide a very durable effect.
Many of us here were at a meeting this week where data from an important clinical trial were presented, which for the first time demonstrates that treating people before they have symptoms can extend their life. This is a truly major result.
Several people, yourself included, have commented on the fact that we are now able to dramatically reduce the transmission of HIV from mother to baby. In addition to the widespread and wonderful results that this will bring to our population -- and it has been said, it's ability to potentially stop the pediatric epidemic -- it also teaches us that antiviral drugs can prevent transmission. And we need to expand on that work to other populations.
Despite all of these advances in antiviral therapies, they certainly do not provide cure. In the meantime, we have new drugs which are just beginning to be shown to be effective in restoring immune function. This kind of research will be a value not only in AIDS, but also in cancer and many other immune deficiencies.
Perhaps most importantly to those of us who have been caring for patients for so many years, rather than sitting by and watching our patients die of devastating infections we can now effectively prevent some of the leading causes of morbidity and mortality in AIDS patients, the opportunistic infections that we all know so well. We're also beginning to see progress in treating AIDS-related cancers. And this, again, is an example of research that will spill out and spill over to other types of cancer as well.
There is now tremendous momentum because of these advances and because of very important work that now shows us that the virus is very active from the beginning of the disease. This means that we have to start to think about treating much earlier. And as several other speakers have said, this means that we have to get the message to the American people that we need to have them come into therapy early, that there are things that we can do for them. We hope that we will eventually be able to treat the disease most effectively at its very earliest stages.
To preserve this kind of momentum we believe that there are several things that are needed. First, we would like to applaud your leadership in trying to preserve funding for basic biomedical science in the United States. We would also like to applaud your support, your very strong support of both the OAR and the FDA. We would like to see this kind of support continue. We would also like to see a strengthening in coordination of our system for doing clinical trials which would pull in not only the pharmaceutical industry and academic centers, but also community-based centers.
We need help in finding ways to make these important clinical trials both achievable by people of color, women and children, and also attractive to them as places where they can receive a state-of-the-art therapy in a respectful environment.
We need to successfully translate our research. And we've talked about that in several ways. I would like to mention the real need we have to preserve and protect academic medical centers as the home for this kind of biomedical research. These are places where we can bring together basic clinical scientists and clinicians and patients as well. And we must find ways to preserve them.
Finally, Mr. President, we would like to thank publicly all of the many people who have participated in clinical research in AIDS. They are the people who have made all of this progress possible. Sadly, many of them are no longer with us, but we remember them; we honor them; and we hope sincerely that their contribution will end up producing a cure for AIDS. (Applause.)
MS. FLEMING: Mr. President, Gregg Gonsalves will report from the Biomedical Prevention Workshop. Gregg found out he is HIV positive in March of this year. He is policy director of the Treatment Action Group and one of the most knowledgeable activists working to improve our nation's research efforts.
MR. GONSALVES: I just wanted to give you some messages from our Biomedical Prevention group this morning. The economic consequences of HIV infection, the social barriers and the cost of behavioral or biomedical intervention against HIV, particularly in the developing world, make the development of an HIV vaccine and topical microbicides the world's best hope for stopping the AIDS epidemic.
This is how we will save the greatest number of lives, and also in these fiscally conscious times how we will do it in the most cost-effective manner. The cost of treatment far outweighs the cost of prevention in the long run.
The second message we wanted to get to you is that an effective vaccine and the microbicide -- we need to define terms here. We're talking about female-controlled chemical or barrier methods of preventing HIV transmission are possible. We've made enormous advances in our basic knowledge of HIV and the immune system over the past several years. And we stand at the brink of an era of great possibility. But if we're going to realize our goals we need to do several things.
First of all, we need to increase the public investment in research and development on vaccines and biomedical research, in particular. Right now, one out of 10 grants at the National Institutes of Health gets funded -- one out of 10. That means there are nine wonderful awards that don't get funded and research that does not get to be done.
Let me be very clear with you. The Congress's plan to balance the budget in seven years using drastic cuts in discretionary domestic spending will entirely cripple our search for an effective vaccine and topical microbicides for AIDS. Don't let these mad bookkeepers with simply numbers on their minds hold those infected with HIV -- (applause) -- please don't let them hold people who are uninfected with HIV and those infected with the disease hostage. AIDS programs and biomedical research need to be priority investments over the next seven years.
The National Institutes of Health will be the engine that drives vaccine development from basic research all the way to the clinical evaluation of vaccine candidates. But the government can't do it alone. Vaccine development depends upon the strong commitment from industry, and right now companies are heading out of the field. We need you to make vaccines and microbicides a national priority because they are not right now. A first step would be to ask the Vice President to call together vaccine manufacturers, scientists and governmental officials to figure out how to get them back into the game. And you've already announced that and we applaud that. It really needs to be the intervention of the Vice President on that level to make it happen.
What you could do is to reach out to your counterparts in Japan and France and all around the world and coordinate a global vaccine effort together, because it's a global epidemic and if we don't eradicate HIV everywhere, we'll never eradicate it anywhere. (Applause.)
NIH has a very small budget when you compare it to the rest of the giant agencies of the federal government, and what it is going to give to the American public against AIDs, against cancer, against Alzheimer's Disease is multifold, and the investment is worth it. And if you want to cure this epidemic, if you want to cure cancer, if you want to cure Alzheimer's Disease, you could double the NIH budget next year. But it's not going to happen.
MS. FLEMING: Thank you.
Mr. President, Demetri Moshoyannis was in the prevention workshop. You spoke about Demetri in your remarks.
MR. MOSHOYANNIS: Mr. President, we need, understand and appreciate your presidential leadership on the issue of HIV prevention. And as such, we ask that you, one, protect HIV prevention dollars in the federal budget by making it an investment priority, as the President's Council on HIV-AIDS has recommended. We need you to make a clear statement and a commitment to continued funding for HIV prevention, research and implementation. Block-granting of prevention dollars to the states is unacceptable. (Applause.)
Number two, support current prevention efforts because we know prevention works. It is currently the best and most cost-effective way to halt the spread of the disease. However, it requires that we address some key issues, issues that you already stated -- issues of human sexuality, special orientation including homophobia -- thank you for using that word -- gender, age, race and culture. We need to ensure that education is not only ongoing but honest and comprehensive. We need to be specific and sensitive to the needs of individuals and communities, especially women, communities of color, and rural communities.
Continued support for the community planning process is critical. Additionally, the needs of young people both inside and outside formal education systems are critical, especially in building self-esteem, communication and life skills -- skills I wish I had.
Number three, provide greater financial support, application and translation of behavioral research findings to the general public. As an example, longitudinal studies of high-risk behaviors and circumstantial risks will give all life-saving insight.
Finally, number four, support greater coordination and financial support from different streams of public life, including the private sector and the federal government. We have seen the responsiveness to HIV prevention from foundations, a few corporations, community-based organizations. But we need to stress the more coordinated response.
Finally, we must have access to three things: plain and simple, information, number one. In simple, honest, and nonjudgmental and nonmoralistic language, young people, people of color, women and rural community members need continued HIV education and resources. We need to understand our individual and community rights and responsibilities.
Number two, risk and harm reduction. Condoms and other innovative barriers are not the answer, but they help in the fight. Condom availability programs and needle exchanges are intervention strategies that have proven to be effective. We must support them. (Applause.)
Finally, and not the least of which is very important, programs that utilize delayed intercourse strategies must be supported.
Another finding from our group is that we need to use mass media as a tool for education in the public eye. All sectors of the public arena, including federal government, should explore the use of mass media campaigns in HIV prevention. Other countries have done this. This strategy has proven to be effective in the anti-smoking agenda, for instance. We must use all that we know about social marketing strategies to bolster our current HIV prevention efforts.
This is only the tip of the iceberg, but, hopefully, it will open up some debate and conversation at the White House. (Applause.)
MS. FLEMING: Mr. President, Ed Morse will tell you about the substance abuse workshops. He's a sociologist who does research in behavior medicine with an emphasis on substance abuse and HIV infected women. He's associated with both the Tulane and the Louisiana State University Schools of Medicine.
MR. MORSE: Mr. President, the epidemics of substance abuse and HIV in this country are overlapping and highly inter-related. The issues of substance abuse research, prevention and treatment programs must be carried out and continue to move forward in an environment which instills cooperation, exchange of information and a loss of fear, hopefully in the future, of lack of funding. Every time we turned around, funding is always a threat. Neither the researchers, nor the program director, nor the director of program are going to be able to sustain successful programs that actually aim at substance abuse and HIV if it's a continuous threat.
I would hope that as the country considers balancing a budget, as you yourself have said today, and others here, that there are people behind the numbers. There are people who need help. The substance abuse issue has to be addressed. The society has long ago passed it to the side, but we will move nowhere with HIV and AIDS if we do not address substance abuse in this country.
The programs of research, programmatic efforts intervention and treatment are in fact cost effective and they now are cost effective means of reducing the spread of HIV. So we actually get two bangs for the buck, if, sir, if we have the confidence, if we have the goal to move forward.
Abstinence programs have been very successful and for the most part of accepted in our society. Harm reduction programs are, to say the least, probably not well accepted. And yet it is there that more than likely we will be getting people off the streets by welcoming into centers, rather than pushing them out. They'll be welcomed into treatment rather than setting such high hurdles that no one will be able to quality. (Applause.) Bleach programs, education, housing, detox efforts, all are at the nexus.
But there is no point in beating around the bush with you. I was asked to speak honestly. We must face the issue of a needle exchange program on a national level. (Applause.) I know that your council -- the advisory council on HIV and AIDS -- will come to address the policy ramifications of such a needle exchange policy. Those, I'm sure, will be more eloquently spelled out by them. I only ask you -- and the group that worked with -- ask you to listen to them carefully as you sit with them.
The major institutions in our society, be they insurance company or religious organizations, need to know that your calling to society is not just to the man in the street, but the man on Wall Street as well. They have a responsibility. (Applause.)
The face of substance abuse has no religion, it is of all religions. The face of substance abuse has no race, it is of all races. The face of substance abuse has no social class, it is of all social classes. There are those who have been marginalized in our society beyond belief -- the African American, women, persons who live off on a far island called Puerto Rico, which actually considers itself a part of the United States, and rightfully so, yet pushed aside; the Hispanic population, which by the end of this century will be probably the largest Spanish speaking country in the world, they are marginalized; and our children. We need help with substance abuse. Only you can help us move.
Approximately -- today, approximately one-third of all cases of AIDS are based in substance abuse, specifically, injectable drug users. One half of all new cases are clearly directly related to substance abuse. Substance abuse is a major key to the solution to this problem. We ask of you, and our group begs of you, to listen and provide the leadership to society to accept that substance, as HIV, is a disease that we need to do research on and we need to move forward with today. And we need to move forward with it today, and past tomorrow, and next year, and the year after, until it too, with AIDS, is gone.
Thank you. (Applause.)
Q Mr. President, Mike Isbell will report from the Discrimination Workshop. He's Associate Executive Director of the Gay Men's Health Crisis and the former Director of the AIDS project at Lambda Legal Defense and Education Fund.
Q Mr. President, the nation's leading health experts say that we need to fight the stigma associated with HIV because it impedes our public health efforts to bring the epidemic under control. You asked earlier why so few people have been voluntarily tested for HIV. In a climate of fear and discrimination and stigma, many people simply don't want to learn their HIV status because they believe that nothing good is going to come of them on the other side.
Similarly, people who are infected won't seek appropriate health care if they believe that they'll be the victims of discrimination. We've made important progress since the beginning of the epidemic in fighting discrimination. We now have a federal law which you referred to, the Americans With Disabilities Act, which broadly protects against HIV-related discrimination in employment, housing and public accommodations.
But what we've often lacked in the epidemic, as other speakers have alluded to, particularly in the epidemic's first decade, is the solidarity of our political leaders with people with AIDS. And it's here where we need your help the most.
Your comments and this entire conference have been inspiring. And we are delighted to hear your inspiring words. But I would urge you to also raise awareness among corporate CEOs, among our religious leaders and among our religious leaders, and among our civic leaders throughout the country because they, too, need to hear the message that you delivered to us earlier today.
Mr. President, when a family experiences a crisis, family members pull together and seek strength and support from one another. Mr. President, there is a crisis in the American family, and that crisis is called AIDS. We need you to tell the truth about AIDS, that one out of 93 American men are infected with HIV and will, barring a significant medical development, die at an early age. For African American men, the rate is one in 33. AIDS is the leading killer of American men and women between the ages of 25 and 44.
Mr. President, the worst form of HIV discrimination is inequitable access to health care, and I would simply bring my voice and add those to the others to say that we strongly urge you to ensure the continuation of the Medicaid program and ensure that every Medicaid recipient has a private right of action to fight discriminatory health care treatment.
We are extremely aware, Mr. President, that many members of Congress wish to further stigmatize people with HIV for short-term political gain, and we urge your leadership in opposing these efforts. In particular, the Defense Authorization Bill would terminate qualified HIV positive service personnel. We need you to say no to this provision that treats people with HIV differently than any other group.
The House of Representatives would like to require that pregnant women and their newborns be tested for HIV without their informed consent. Even though we know that voluntary programs work, we urge you to oppose this measure.
Today, members of the House of Representatives are holding hearings because they apparently would rather see young people die than learn the truth about this disease. (Applause.) And we implore you, Mr. President, to oppose those who would base our public policies on fear and ignorance.
And, finally, the congressional welfare bill would withhold basic medical services to people solely on the basis of their immigration status, and we urge you to oppose that provision as well. (Applause.)
Mr. President, your AIDS Advisory Council will be giving you further recommendations in the area of discrimination, and I would request that you and your staff carefully study them.
And finally, let me say again, thank you for convening this historic meeting, and hopefully it's the first of many to come. Thank you. (Applause.)
MS. FLEMING: Mr. President, Martina Clark is the reporter from the International Workshop. Martina Clark is with the International Community of Women Living With HIV and AIDS and the California-based World Organization, and has been a warrior in the international fight against AIDS, especially as a member of the governing board of the new U.N. program known as U.N. AIDS.
MS. CLARK: Thank you. Mr. President, we live in a global community. Most people in this country are descended from somewhere else. The faces of AIDS, both in this country and abroad, clearly reflect this diversity. We at this table who are HIV positive are but a handful of the 18 million people worldwide who are living with HIV.
As has already been mentioned, the recent difficult decision to send 20,000 Americans into Bosnia to help our global community will remain on the minds of everyone in this country until, God willing, they return safely by Christmas of 1996. And, yet, in the fight against AIDS, we're losing the war.
Using conservative estimates from the World Health Organization, 20,000 people will become newly infected with HIV before the Redskins suit up for the football game on Sunday afternoon. Twenty thousand individuals will die of AIDS by the end of next week. Increasingly, the group most affected by this epidemic is women, both married women and single women. Every minute of every day, two women become infected with HIV. Every two minutes of every day, a woman dies of AIDS.
In many areas, more than 60 percent of all new infections are occurring in young women between the ages of 15 and 24 years old. Worldwide, this epidemic is overwhelmingly spread through heterosexual contact, and still, men and women of all sexual orientations from all cultures continue to become infected.
The epidemic affects individuals in their most productive years. It is a family issue. Who will give birth to the children? Who will care for the orphans? Who will raise the food so that countries can eat, survive and not become dependent on the United States in future years?
The United States has already taken a clear lead in this global epidemic, and this must continue. We cannot isolate the United States, as HIV has already successfully penetrated every border of every nation. Our current immigration policy will do absolutely nothing to decrease the spread of AIDS. It only increases the stigma, fear, denial and discrimination already so rampant in this pandemic. (Applause.)
We must secure the continued funding of our international development programs, such as USAID, so that we can ensure that our future generations have economic, social and political stability in the planet. We must share our advances with other nations so that all people, not just the privileged few living in the northern hemisphere, can live longer, more productive lives. The U.S. must continue its support of the new United Nations program on AIDS. And I would encourage you to take advantage of expertise and meet personally with Dr. Peter Piaf (phonetic) -- the program director, to be more fully briefed on the epidemic.
The U.S. must continue to follow through on documents already signed, such as the Paris Summit, which highlight the inclusion of people living with HIV and AIDS at all policy and decision-making levels, and research on female-controlled methods of prevention, to name but a few.
In closing, Mr. President, and perhaps most importantly, the world looks to you for leadership. We must continue to bridge our work with our international partners, because the experiences shares from abroad and the research conducted with other countries will be our greatest tools in applying lessons learned to help my brothers and sisters living with HIV in this great country.
And finally, if I may, I would like to invite all of the HIV-positive people in this room who so wish to stand up and show the true diversity and reality of this epidemic. (Applause.)
MS. FLEMING: Mr. President, would you like to make a comment or ask a question of any member of the panel?
THE PRESIDENT: I think maybe we should open the floor to the audience and see if anyone else has anything they'd like to say. (Applause.) I hear talking of those behind me that I can't see.
Q Mr. President, I want to thank you today for holding the conference. And I especially appreciate that many of us were able to meet with Cabinet secretaries or high-level administration officials. The group that I was I with, we met with Secretary Cisneros. Secretary Cisneros has a model program that I think that should be replicated throughout your administration. He meets bimonthly with AIDS housing activists and providers to find out what's going on in the AIDS housing community. And that's led to the creation of an AIDS housing office at HUD.
That kind of connection with this epidemic in each department can make a real difference with this disease. And I urge you to work with all your Cabinet secretaries to make that happen. (Applause.)
Q My name is Jeff Reynolds. I'm director of policy at Long Island Association of AIDS Care. Long Island leads the nation in -- AIDS cases, and we've been yelling and screaming for years that the white picket fences don't protect you from AIDS.
I'm wondering if you would consider adding your voice to that message and doing a prime-time address on AIDS. There is a lot of media here today, and many people -- (inaudible) -- on prime time, we need the heart of America to hear your voice and to let them know that AIDS is a reality. Will you do that? (Applause.)
Q Mr. President, my name is Jeffrey Morris and I am chairman of the HIV-AIDS -- Organization, in Miami, Florida. In Miami, I, unfortunately, regrettably, have to announce that 17 percent of our population are over the age of 50. And with all due respect, Secretary Shalala, we do need something for this particular segment of our population because they are, indeed, very, very -- in isolation.
Q Mr. President, the National Task Force on AIDS -- came up with a series of recommendations, from regulating -- to ensure that women of child-bearing age who are HIV positive would have access to -- cases of clinical trials and that, in fact, the side effects -- (inaudible.) I would please urge you, Mr. President, to ensure that these regulations are actually promulgated --
Q Mr. President, I'm a person living with AIDS and like many people, I have named my remaining -- after my friends. And I've listened intensely today to the conference and the comments today. And it seems to me that we are sugar-coating a little bit of the problem, at least a problem to someone who is living with the disease.
Thank you, Doctor Koffman and Dr. Kessler for all that you do, but there is today on the horizon -- on the horizon -- the most impressive group, class of drugs to fight HIV. And the most promising of those have, of course, not yet received approval and are available. And in people's lives, like myself, two months, three months, four months, are critical to sustaining life. And I would just like to ask you and those people who work with you to do whatever you can to see that those drugs receive the top priority of approval and we can get them out as quickly as possible.
Thank you. (Applause.)
Q Thank you. I'd like to reemphasize -- HIV as an development issue. Despite your administration's involvement and commitment to the HIV issue, I'd like to emphasize that you, as the leader in international AIDS awareness and prevention -- international -- $120 million. -- programs under very serious threat from Congress. We really need your support. Our development programs overall and HIV -- for anything at all at the international level.
MS. FLEMING: Thank you, Mr. President. (Applause.)
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 follow-up on every issue raised, every question asked.
Q Mr. President, why didn't you do a systematic follow-up on the two previous conferences on AIDS? You promised in your campaign to adopt the recommendations. Why has it taken another year for you to --
THE PRESIDENT: Didn't you listen to what we said before about what we've done the last two years? (Applause.) Most of the --
Q I heard you talk about --
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 -- that have been submitted to officials in your administration. And it has taken two years, and now --
THE PRESIDENT: First of all, that's not accurate. We recommended 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. (Applause.)
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 is happened in this country in the last three 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 four years ago. (Applause.)
END 2:37 P.M. EST