THE WHITE HOUSE
Office of the Press Secretary
REMARKS OF THE PRESIDENT IN HIV-AIDS ADVISORY COUNCIL MEETING The Cabinet Room
5:45 P.M. EST
MS. THURMAN: Good afternoon, everybody. I want to thank you all for joining us this afternoon. Those of us who are gathered in this room today are partners in a battle that, while we've had significant successes in recent years, has no end in sight. Our victory over AIDS will require incredible resolve, persistence, and steadfast leadership.
This is a struggle which we all know has had all too few national leaders, but has always had the support of this leader. It is my distinct honor to present to you our leader, the President.
THE PRESIDENT: I want to get right to the subject of listening to all of you, but I would like to say that, as all of you know, we had a very good couple of days when we finally made the budget last year -- we've had a lot of good increases, a lot of things that I know you care so much about. But we've got a lot of work to do, especially in prevention and in the vaccine development I think we're going to -- (inaudible) -- pretty soon.
I would prefer, I think, because we've met before and I'm trying to stay familiar with your concerns -- I think we've done a good job of getting the money into the programs this time, but there's a lot more we can do -- (inaudible.) However you organized this -- (Laughter.)
DR. HITT: Okay, we want to start off by having Reverend Mother Altagracia Perez lead us in a short prayer.
REVEREND PEREZ: Thank you. Thank you, Mr. President, for this moment where we can gather our thoughts and especially bring to mind all those who today are in need of courage and strength, so if we could have a moment of silence.
Spirit of life and justice and power, we welcome you in our midst. We've been brought together by a desire to improve the quality of life for all the people that we serve and represent. We're especially conscious at this moment of the men and women, that right now, are in harm's way. Our thoughts are with them and their families, as we await their safe return.
We're also ever-mindful of those who are gathered here with us and, through us, all those who struggle daily with a virus that has no cure and is hard to live with. They are here with us; the people who called us to this work; those who have gone and who have left us their legacy of courage and perseverance.
We especially gather in a spirit of gratitude for our President. We remember all too well those dark years, when a meeting like this would have never happened. We are grateful for his life and for his leadership, and we pray that you sustain him through the power of your spirit. Give him strength and courage, and stamina, and wisdom, as he continues to lead us through this dark time.
There's still so much that we have to do. Let us especially remember our communities of color and those most vulnerable throughout the world who today, and every day, are living in a state of emergency. May each of us leave this encounter with our vision of what we can do together restored, and our strength renewed, to go forward and face the challenges that await us. In the name of the One who came with hope and brought us light, we pray. Amen.
DR. HITT: Mr. President, on behalf of the Council I want to thank you for meeting with us, especially so close to your recent high profile events regarding the Congressional Black Caucus HIV Initiative for communities of color and World AIDS Day spotlight on international crisis.
Six and a half years ago I was very honored to stand with you on the stage of the Palace Theater in Los Angeles, where you outlined your commitment and genuine care and concern for those living with HIV and a really good vision of how -- (inaudible.) In light of the efforts you made in securing unprecedented funding, for starting the Office of AIDS Research, Office of National AIDS Policy, convening the White House Conference on AIDS, establishing a goal of a vaccine -- which are all landmarks I think you can be very proud of -- I am just as honored to be with you here today.
THE PRESIDENT: Thank you.
DR. HITT: In addition, I want to thank you for the humbling honor of serving this Council of incredibly dedicated and committed individuals as its chair, and to tell you on behalf of all of us how honored we are to serve your administration.
Continuing with our task of offering advice to you, we recently adopted our priorities, which reflect the community realities, especially the urgent need for action in the racial and ethnic communities, and in the youth of our country. This epidemic has been full of changes and challenges and we're really at a crossroads in this epidemic. The media all the time tells us about how people are living longer and this is a chronic, manageable disease and less people are dying overall of AIDS.
What they often fail to mention is that curb-prevention efforts are not reaching the American public. Three hundred thousand Americans don't even know they're HIV positive. And contrary to your own stated goals, we are not decreasing the numbers of new people infected. And, in fact, in many communities the numbers are increasing.
In addition, thousands of HIV individuals cannot get the early treatment the public health service guidelines tell them that they should get, but, rather, they have to wait until they become disabled from the disease before becoming eligible for treatment.
Out of all our recommendations to date, there are a few items we would like to discuss with you today that need your specific presidential intervention now if we are going to achieve these goals. Before we give you these few suggestions I want to emphasize to you that none of what we're recommending to you today would be possible without the tireless efforts of several people who serve you, this Council and the people living with HIV and AIDS -- especially in the White House and across administration. It's because of them that you've had so many successes -- namely your own NAP Director, Sandy Thurman -- (applause) -- who made real your vision of a White House office that leads the national response to this epidemic, along with the Deputy Director Todd Summers and the Council's Executive Director, Dan Montoya. And we appreciate the efforts very much.
The Rabbi has a few words.
RABBI EDELHEIT: Mr. President, we're honored to be with you today, especially so soon after your recent trip to the Mideast, where you courageously engaged in the making of peace, where you brought the gift of hope to the land of the Bible.
During this week of Hanukkah, on the eve of Ramadan and one week before Christmas, we are all reminded that all these religious holidays promise us light in the darkest time of the year. As your Advisory Council, we want to help you fulfill your vision to bring the light of hope to those living with HIV/AIDS.
HIV/AIDS still darkens the path to that bridge that crosses into the 21st century to which you have prophetically led us. We want to help you illumine the darkness that still covers the path to that bridge. We must warn you that there are some Americans who are in danger of being unable to cross when you lead our nation to that bridge into the 21st century.
How can we be sure that the African American who has no access to clean needles, nor the newest combination of drug therapies will get to the other side? What do we need to do to make sure that the Latino youth who is not eligible for Medicaid will have access to primary care and still be able to work that he, too, can cross the bridge with other Americans?
Here is a gift, Mr. President, from my four children. It is a dreidel -- that's right. I'm impressed. (Laughter.) It is the traditional spinning top we play -- and the four letters on it, Mr. President, stand for "a great miracle happened there." But, Mr. President, we know that there will be no one great miracle that ends HIV-AIDS. So we are here to help revive your vision of zero rate of transmission and an equitable access of care to all persons battling HIV disease.
We are here with you today, Mr. President, when a terrible political darkness has fallen over this land, because we want you to know that we will do whatever it takes to cross that bridge with you into the 21st century.
DR. HITT: As I said, we fought through a lot of recommendations and tried to come up with some specific new initiatives that we wanted to bring to your attention. And to start that off, I'm going to have Mr. Tom Henderson lead with one of the new initiatives.
MR. HENDERSON: Mr. President, when I stood, with many others during the stirring speeches of Bob Latoy (phonetic) and Elizabeth Glaser at the 1992 Democratic National Convention, I truly believed it would be my last national convention. But because of the remarkable progress we've made under your leadership in fighting this disease, I'm still here today, alive and well.
That's primarily because I'm fortunate enough to be employed and adequately insured and, therefore, able to enjoy the benefits of the new combination drug therapies. For those who must rely on Medicaid, however, for their health care, the story is often much different.
On one hand, we have new public health service standard-of-care guidelines that call for early treatment of HIV prior to disability. But on the other hand, in many cases, accessing Medicaid requires individuals to be already disabled. Instead of being able to enjoy the benefits of living longer and better lives, many are still forced to wait until they're sick and unable to work before they can even begin treatment.
Not only is that inhumane, Mr. President, it's costly as well. Access to quality medical care for those living with HIV who are incarcerated is also a major problem. In most cases, there is no preparation for connecting those individuals to medical care, once they are released back into the community.
In April of 1997, the Vice President asked HCFA to evaluate the possibility of expanding access to Medicaid for poor HIV-positive individuals, prior to becoming disabled. HCFA/HHS has concluded that can't be done in a budget-neutral manner. Now, some would suggest that the only near-term solution is to rely on the demonstration programs called for in the Jeffords/Kennedy legislation. Mr. President, we reject those conclusions. We believe there are two things that can be done now, without legislation, to solve this problem. First, OMB currently requires finding offset cost savings within Medicaid only to determine budget neutrality. Any savings generated within other federal programs can't be considered to determine budget neutrality.
Also, current policy only allows looking at a five-year budget window. We believe those hurdles can be overcome, but only if you make the decision to include a broader look at cost savings, and a longer budget window, and then direct the Secretary of HHS, and the Director of the OMB, to modify current policy to account for any resulting savings.
Second is the issue of drug cost. Mr. President, the time to deal with crucial drug cost issues is while we're also dealing with expanding access to those drugs. The vastly increased market for HIV drugs that would result from early access makes simultaneously negotiating drug cost reductions both reasonable and possible. We believe that asking the Vice President to include such drug cost issues in his ongoing discussions with the pharmaceutical industry could offer substantial potential for progress. Breaking the current gridlock, Mr. President, surrounding these issues will require your personal intervention. With that intervention, however, providing Medicaid access to early intervention therapies can be accomplished.
THE PRESIDENT: Well, I'll see what I can do about that. You know, generally, this whole medical coverage problem is getting worse in America. It reminds me of that joke that the Republicans used to tell on us -- they told me if I voted for Barry Goldwater we'd get involved in Vietnam too much. And I did, and sure enough, it happened. (Laughter.) And they said when they attacked Hillary and me for our health care plan, they said that if people supported it, things would get worse. And sure enough, they did. (Laughter.)
We've had -- these coverage problems have gotten quite profound, and as a consequence, with fewer and fewer people getting medical coverage at work, what you've got is more and more people trying to find a way to get into Medicaid.
One of the things, for example, that I want to look at as a result of this is something we're doing with disabled people who get back into the workplace. I just started an initiative not very long ago to try and have people who have disabilities, including some people with HIV and AIDS when they get better -- if you have disabilities and you go back to work, it used to be automatically you lose your Medicaid. And now more and more people are working in small businesses where they don't have employer-based health insurance or they have small pools and they can't afford to take somebody with a preexisting conditions.
So we're trying to modify the rules so that when people are on disability, then they get off of it and they go back into the work force, they can keep their Medicaid for some period of time. And I want to go back and see exactly how we did that and what else we can do here.
Tom, I want to make sure what you said. You believe that there are savings in non-Medicaid areas that would come from keeping people off -- giving people the drugs before they get sick in the first place.
MR. HENDERSON: As you know, the process right now is for states to seek waivers. We've been working closely with a number of states who have been working on those waivers for submission at the present time. They believe there are significant savings in SSI and SSDI, in other areas, that would result --
THE PRESIDENT: -- all would be counted.
Q Yes, sir. And current rules don't allow that.
THE PRESIDENT: I've got to go back and look at that. Part of it is the way the law disaggregates money into mandatory and non-mandatory spending. I'll look at it and see if we can do something about that. I know it's very important.
I presume you still -- hello, Bob.
MR.HATTOY: Hello, Mr. President. (Laughter.) Sorry I'm late.
THE PRESIDENT: I'm glad you're here. (Laughter.)
MR. HATTOY: I'm glad you're here. (Laughter and applause.)
THE PRESIDENT: --- notwithstanding what you said, you still think we ought to pass the Kennedy-Jeffords bill. It's a good bill.
MR. HENDERSON: Absolutely. We just think that there are some things that can be done in the near-term, though, within the administration that do not require legislation, that they would move this problem forward.
THE PRESIDENT: I'll do some work on it -- what you said.
MR. ROBINSON: Mr. President, as you said in your opening statement, prevention of new infections is an area where, although we've made some progress, we still have a great deal to do. In fact, this Council, the community at large, and your administration, has struggled with the challenge of preventing new infections.
Today we want to raise two issues related to prevention with you. First, as you know, this Council supported making federal funding available for needle-exchange programs. Today, we again want to ask you for your support in this area. We've made a request of Secretary Shalala and HHS to provide us -- the Council, the Office of National AIDS Policy, and other federal agencies -- with a summary of the scientific information that supports needle-exchange programs to prevent new infections. We believe that this would be an important first step in fulfilling the administration's commitment to assisting communities that chose to use these life-saving programs.
Second, we want to recommend to you that the White House Office of National AIDS Policy be directed to undertake a bold, national media campaign to promote voluntary HIV testing. Without a cure, preventing new infections is our best strategy. This is especially true for African-Americans and other people of color, where the severe and ongoing health crisis has created a public health emergency.
One reason why stemming the tide of new infections has been so elusive is the fact that so many people don't know that they're infected. As a person who has thrived for the past 17 years, despite the fact that I'm living with HIV, I understand the importance of knowing one's -- status. It has offered me an opportunity to seek treatment for my HIV, and made me more aware of the need of protecting myself and others from infection.
Some members of Congress and others in the community have called for misguided measures, such as mandatory HIV testing, mandatory contact tracing, and mandatory partner notification -- measures that we believe will not be effective. However, like us, they are concerned that too many people living with HIV don't know it and, therefore, risk infecting others.
We believe that this campaign would demonstrate your administration's sound public health approach to this challenge. Modeled on ONDCP's national youth anti-drug media campaign, this voluntary HIV testing campaign would raise awareness about the continuing threat of HIV while lessening the stigma of HIV testing. Working with the CDC, national advertisors and other media concerns, ONAP would develop this campaign as a public/private partnership, which we believe would build on your legacy of an activist government and enhance your efforts to end racial and ethnic health disparities.
Mr. President, we hope you seriously consider undertaking this campaign of voluntary HIV testing, because we believe it is essential to our efforts of preventing infection.
THE PRESIDENT: It sounds like a good idea. I think Sandy is going to come up with a proposal of what we should do, but I think it's a good idea.
MS. THURMAN: We'll work with you and get one done.
THE PRESIDENT: And it offers the promise of sort of getting by the divisive arguments of the past and actually doing something. I like it.
MS. MIRAMONTES: Mr. President, I came here today as a mother with a son living with AIDS, to talk to you about vaccines. But before I speak to you about the vaccine issue, I want you to know that combination therapies, although valuable for many, are also failing some people -- some in this room -- as well as my son. So, therefore, I really want to stress the need for continuing research, both in vaccines and in therapeutics, is as important today as it ever was.
First, I want to thank you for what you have accomplished in moving the agenda on the AIDS vaccine issue and establishing the 10-year goal. But there are several critical issues that only you can address if your goal is to be reached. And I have two examples I want to give you.
The first one, it has been 19 months to the day since your announcement of the vaccine goal, and a director of the vaccine center at NIH has not yet been appointed. We know that even though the center is only about 10 or 15 percent of the funding, this appointment really is important to be made and should be made as soon as possible.
Secondly, a preliminary vaccine meeting was held more than six months ago and, to date, there has been no follow-up meeting. When President Kennedy announced that we were going to put a man on the moon, he appointed a person within the White House to oversee this endeavor. After hearing almost 100 hours of testimony, we recommended a coordinator be placed within your Office of National AIDS Policy, with adequate resources -- and I need to really stress that -- with adequate resources to coordinate the vaccine effort. This is not that we want to tell any one agency what they are to do, but rather to coordinate vaccine activities across all relevant federal agencies. And I think the next piece is especially important: developing true partnerships with the international community and the private industry.
We also recommended that a comprehensive plan be developed and implemented, and this hasn't happened, either. I think we all need to remember that the person most at risk, worldwide, is a young person of color, and that the most effective strategy for stopping this pandemic is an effective vaccine.
So what I'm asking you, Mr. President, if you're willing to use your position to really address these critical issues.
THE PRESIDENT: Well, let me make a couple comments. First of all, I think the vaccine director is about to be appointed -- (inaudible.)
Secondly, I do think that -- the new Director of the Office of AIDS Research has been doing quite a good job. We got about a 33 percent increase in funds for vaccine research in the last budget, so that's good. And we're going to try to -- I just had a brief meeting, before I came in here, with our folks, talking about how we can expand Sandy's -- this kind of work and kind of ride herd on this thing -- (Applause.) I think that's important. It does make a difference just to have a sort of sustained White House involvement on any kind of project to keep cutting through the resistance.
MR. ROBINSON: Thank you very much.
MS. ARAGAN: Mr. President, the next issue we would like to discuss is the need for your FY 2000 budget to include meaningful and substantial increases in HIV funding. The Council is very grateful to you for your strong and public support for the record increases in funding in FY 1999. At the local level, these increases will really make a difference in the real lives of the people who are struggling to live with this disease, and those who are at risk for infection.
In particular, we want to thank you for the active role that you and your staff played in successful efforts to secure $156 million for the Congressional Black Caucus Initiative. As you know, that initiative is designed to address the severe and ongoing health crisis affecting African Americans, Latinos and other communities of color in the United States.
But as you know, Mr. President, the emergency conditions that led to the need for the CBC Initiative require a sustained and expanded federal response. As you finalize your FY 2000 budget, we ask that you use this opportunity to build upon the momentum of FY'99. Specifically, we are asking that full funding for the CBC initiative be included in your base budget. As you know, some of it was one-time funded -- and that this funding be expanded in FY 2000. It is also critical that the distribution of these new funds be expedited, to reflect the fact that this is a response to a crisis situation.
As my colleagues have discussed, we are also requesting that you propose a bold funding for a bold national testing awareness media campaign, and that access to HIV treatments be expanded both through the Ryan White CARE Act and through Medicaid.
Finally, Mr. President, we ask that your budget reflect the leadership role the U.S. must play in efforts to address the global pandemic, and my colleague, Mike Isbell, will say a little bit more about that in a minute. This Council certainly understands the political dynamics of the budget process, in which you must consider what the Congress itself will fund in setting your own numbers. But the reality is that your budget really sets the stage for all future deliberations in FY 2000. We really need your initial budget request to include these AIDS funding increases so that congressional action can build upon the strongest base possible. In short, we need you to raise the bar.
MR. ISBELL: Mr. President, six million people become infected with HIV each year around the world, half of them under the age of 25. More than 90 percent of the infections in the world happen in the developing world where there is little or no access to the drugs that have made such a big difference to people in this country.
We were extremely impressed and heartened by your use of World AIDS Day to highlight the need for American leadership in the global fight against HIV. We strongly support the $10 million program that you announced to address the needs of women and orphans of AIDS. And we would strongly support you making this one-time funding a permanent part of USAID.
Despite this initiative, Mr. President, U.S. funding for global AIDS activities has declined in real dollar terms since 1993. Just last year the administration proposed a 10 percent cut in federal support for funding for infectious disease programs throughout the world. We believe that we cannot turn the tide against HIV throughout the world without the aggressive, bold, energetic leadership of the United States. And we would strongly encourage in your next budget, Mr. President, that you're about to send to the Hill, that you include substantial increases for international AIDS programs at USAID and the CDC.
Just also to close, we'd also strongly support an improved coordination of the many federal programs that happen all across the government that have a role to play in the international AIDS efforts. Secretary Albright has announced, as you know, a plan to draft a U.S. international AIDS strategy, and we would hope that you would look to this as a first step toward making sure that all the federal agencies are reading off the same page and that they're part of the same team -- because it's an urgent problem and it requires an urgency of the entire U.S. government.
THE PRESIDENT: Well, in general, let me say I think the budget should reflect better attention both to prevention at home and to the communities of color. And I've been trying to get more money for the USAID mission and we'll put some more money in there. I think I'd like to make two points.
One is that this budget year will be more difficult than the last one because we got such big increases in everything last time and because of the global economy kind of slowing down, we don't expect the same amount of revenues to come in this time. And we have to fund all the big increases we got last time again. But we'll do the best we can.
The second thing I would like to say is I think that it would be very helpful to have all of you using your, whatever influence you have, with members of Congress in both parties to support more global efforts, because eventually all this is going to a menace to the United States. So it's not only a moral imperative, it's also very practical over the long run.
One of the things that has kind of bothered me is that in the aftermath of the Cold War we were able for several years to reduce our defense budget, and that was a good thing and everyone --and even the Pentagon wanted to do it. There reduced like by about 300,000 the number of civilian employees. And they plan for further reductions there.
But during that time, we actually needed to make a larger commitment on the diplomatic front or in the non-defense security areas, if you will. And with the exception of the special efforts we made in the former Soviet Union to dismantle and destroy nuclear weapons, basically there's been a wholesale effort to cut back on our diplomatic budget, even though, contrary to popular wisdom, the United States spends a smaller percentage of our income on international affairs than any other major country.
And one of the things that I have seen -- almost no one knows this, but it's true -- one of the things that I have -- now, to be fair, we also spend more on defense and a lot of our defense goes to protect other countries, as you see in the last couple of days. But, still, for the numbers -- are so much more modest, not only for -- if you just look at the USAID program, the health programs, the empowerment of women and children, especially young girls, initiative, the small scale microeconomic development -- all that stuff that doesn't cost much money and it has a huge impact. And especially a lot of the things we can do in public heath.
And, interestingly enough, a lot of the preventive activities that we would engage in with regard to AIDS, for example, would go quite well with other things we need to be doing out there with these large populations anyway in a lot of countries that have severe public health problems.
So we've been sitting here meeting in our -- I've been having each of the last three or four days rather long, detailed budget sessions, trying to figure out how to get more blood out of that turnip. And one of the things that I'm trying to do is to figure out how to make the case to the Congress in an effective way that the United States has enormous interest, as well as obligations, in making these kinds of investments beyond our borders.
And I think anything you can do to help that, I would appreciate it. I mean, there is this sort of general awareness in Congress that the world is becoming more interdependent. There's a much more sophisticated understanding of the economics, for example. But it's not just economics. It's the environment, it's the public health, it's all these other things where we are becoming more and more caught up with each other.
Our major military mission in the last six months, before the operation in Iran, has been to send several thousand of our uniformed personnel to Central America to help them rebuild after Hurricane Mitch. It's not only the right thing to do from a humanitarian point of view, it is in our national interest. Because if those countries don't rebuild they will become highly vulnerable to all the drug traffickers. And if they don't rebuild then all their people will have to come here. And if they can't get here legally will try to come illegally. So there's all these things that we need to begin to see our relationships beyond our borders, as more of an extension of our relationships with one another, rather than as something totally different and apart from our relations with one another.
And, anyway, I don't mean to give you a speech on that; I know you believe that. But the point I want to make is, most people who run for Congress never have to think about these things unless they have a large immigrant population within their district from a particular place. So it doesn't -- this kind of discussion we're having, because you understand the HIV/AIDS issue -- I'm preaching to the choir here. But anything you can do to sort of just sit down and walk through this with congressional delegations, or their chiefs of staff, or whoever the appropriate people are from around the country, I would really appreciate.
Because I think there is a lot of support. For example, you can always get good support in Congress, bipartisan, for a big increase in the Ryan White Act. And now, we've finally got pretty good support in Congress, this whopping increase we had to help people purchase the drugs, the medicines. But it drops off markedly when you try to talk about the connection between what we're doing here at home and beyond our borders. And I really think you could help, because this is one example of a more general challenge the country will have to face -- more every year for the next 20 years. Maybe forever, but certainly for the next 20 years.
DR. HITT: Mr. President, we really have made -- probably hundreds of recommendations in the past few years, I mean -- (Laughter.) We've tried our best to narrow down --
THE PRESIDENT: This is the most energetic -- (Laughter.)
DR. HITT: But we have narrowed down a few specific initiatives we brought to your attention today and the reason is clear, that we've talked to many administration officials and this is where we feel that there's a logjam that you can really help and get involved in, and take it to heart.
THE PRESIDENT: I will.
DR. HITT: And thank you, again, for meeting with us.
THE PRESIDENT: Thank you for the dreidel, the book, the letters. Thank you very much. (Applause.)
END 6:40 P.M. EST