Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
192125721
label
[AIDS/HIV]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
192125721
contentType
document
title
[AIDS/HIV]
citationUrl
collections
Records of the White House Office of Public Liaison (Reagan Administration)
Max Green's Subject Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
192125721
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
15f3aeb0df80ba1d
ocrText
Ronald Reagan Presidential Library
Digital Library Collections
This is a PDF of a folder from our textual collections.
Collection: Green, Max: Files
Folder Title: [AIDS/HIV]
Box:03
To see more digitized collections visit:
https://www.reaganlibrary.gov/archives/digitized-textual-material
To see all Ronald Reagan Presidential Library inventories visit:
https://www.reaganlibrary.gov/archives/white-house-inventories
Contact a reference archivist at: [email protected]
Citation Guidelines: https://reaganlibrary.gov/archives/research-
support/citation-guide
National Archives Catalogue: https://catalog.archives.gov/
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
December 2, 1987
PRESS BRIEFING
BY
ADMIRAL JAMES D. WATKINS,
CHAIRMAN OF PRESIDENTIAL COMMISSION
ON AIDS
The Briefing Room
2:48 P.M. EST
MR. COOPER: This briefing is by Admiral James D.
Watkins, Chairman of the Presidential Commission on AIDS. It is for
sound and camera.
ADMIRAL WATKINS: Today, on behalf of all members of
the Presidential Commission on the Human Immuno- Deficiency Virus,
HID Epidemic, I submitted our preliminary report to the President of
the United States. The preliminary report, as many of you may know,
was passed to the Commission in the Presidential Executive Order of
24 June 1987. And in that he required this preliminary report within
90 days of the commissioners being sworn in. While we are a week
early, in terms of the end point of that 90 days, I felt it very
important that we get the report in in timely fashion so we could
move on expeditiously with the important work at hand.
You've just been passed copies of this report, and
while you haven't had a chance to look at it yet in any depth,
basically what it is is a situation report which includes a section
on where we have been, what I call the base line review, the process
for the future, where we are going, and an approach that says we are
going to identify for you, Mr. President, obstacles to progress in
prevention, care, and cure of this infectious disease.
We also point out to the President that we feel
there are certain critical issues that are of such importance, not
only to the Commission to carry out its mandate, but more
importantly, to those with AIDS and to the rest of the American
people as a whole, that we informed the President that we intended to
submit interim reports as required, but we felt in specific there
were four issues on which we had to report in February. And these
will be resolved by the Commissioners during the forthcoming December
and January hearings. The first of those hearings on prevalence will
start next week. These four critical areas are outlined in the
report and in the forwarding letter to the President as follows:
Incidence and Prevalence. This is urgenly needed for any kind of
long-term projections, which we were required to report back to the
President on, such as financial impact, the amount of health care
needed for the nation in the future and the like. The second issue
will be on patient care. And I point out in the report in some depth
the need for home health care programs and other out-of-hospital care
programs. The need is urgent, and we have to facilitate and expedite
making available the necessary facilities to handle the current load,
let alone the projected load.
Third issue of requiring some urgent attention, in our
opinion, is new drug development. There seems to be a mismatch
between what we hear from grass roots, many with AIDS and those that
care for them, and what we hear at the highest level, and looking in
the middle seeing a state change its laws regarding expeditious entry
of experimental drugs into the system to deal with this fatal disease
-- has inspired us to look at this on an urgent basis.
MORE
- 2 -
And lastly the issues that we intend to focus on in the
very near term, among the many we will have to focus on in the longer
term, will be the subject of substance abuse. Our investigations to
date have shown that inpatient and outpatient drug abuse treatment
programs are still unavailable to HIV infected individuals, and this
was borne out once again in a recent trip to Florida in which at
least in one or more counties those that are HIV infected cannot
receive help at the very clinic that is attempting to rehabilitate
them from their drug abuse practices.
And then I close out in my forwarding letter to the
President a statement that the HIV epidemic will only be controlled
by developing a national strategy that combines the best research,
health care, legal, educational, public health and financial wisdom
available. And we think that in the challenging months ahead -- the
next six months that the Commission has in it life, that we can come
to grips with these issues and provide the advice to the President
and his Cabinet, to federal, Congressional and state leadership that
will helf focus all of our efforts in an evenhanded and balanced
fashion across the nation in one of the most aggressive
public-private ventures that has ever been taken on in the country.
We think we can guide that, at least at the outset, and set some
ground rules for the future.
I believe our Commission is now on a solid footing. I
think we have our act together, and we're encouraged that we can
carry out the remainder of our charter under the Presidential order
in timely fashion.
And, with that, I'll open myself to questions.
Q sir, you indicated that you will release or send
recommendations to the President even before you finish the final or
even the interim reports. When do you expect these first
recommendations will go forward?
ADMIRAL WATKINS: In February. We must look at these
four issues in the ensuing two months. We will have extensive
hearings starting next week on prevalence, followed the following
week by I-V drug abuse. So the aggressive schedule I am talking
about sets our sights on at least two if not more hearings per month.
These will be two- and three-day hearings. They will be extensive by
the best witnesses we have in the country on these issues, and we
hope not to have to wait until 24 June to give the President our
thoughts on these. And we've staged it in a way that these issues,
we think, can be compartmented and isolated up front, and we can take
positions on those that need not wait for six months.
Q sir, to follow up, might, in terms of your
recommendations, the Commission consider the availability of syringes
for heroin abusers and the increase in drug --
ADMIRAL WATKINS: It will be the subject of considerable
discussion during the middle-December hearings on I-V drug abuse, but
which Dr. Ben Primm, one of our new arrivals, is one of the nation's
leading experts, and he will actually help me chair that particular
set of hearings. In fact, as you may know, we had the Institute of
Medicine, National Academy of Science group the other day where we
began a debate on the efficacy of clean needles and syringes, even in
a pilot demonstration program.
Q
Your report's conclusion, according to the press
release at least, said that -- referred to the need to set aside
prejudice and fear. Some conservatives in and out of the
administration say there is no evidence of discrimination in any
significant fashion against AIDS sufferers. Are they wrong about
that?
ADMIRAL WATKINS: I don't know what -- who you are
referring to. I do know that from a grassroots level, with many of
MORE
- 3 -
the individuals who are actually afflicted with the disease, that
they believe and I happen to feel that some of them have been
discriminated against without any question. We see it in the
willingness of many communities, for example, to accept home and
residency and hospice programs, so it's really there, and the degree
to which we can solve that problem as Commission members is probably
problematical, but I do think we are going to have great focus on
this particular area because when you get into the area of
discrimination or confidentiality you are probably at the root of the
apprehension and fear that is out there on the part of those that are
afflicted and those that would be willing, for example, to come
forward in the voluntary testing area.
Q
A follow-up. Is it your hope and your expectation
that this Commission will actually take a stand as opposed to just
raising lots of questions -- take a stand on such issues as mandatory
testing, federal discrimination?
ADMIRAL WATKINS: My feeling is that this Commission must
take a stand on most of those issues. Some of those issues perhaps
will. require the pros and cons when it's not very clear at the time
we complete our deliberations that we can even come down -- we may
not have all the information at our fingertips to make a decision.
But I am not going to allow us to shy away from the difficult issues.
We have committed ourselves as commissioners -- and I make this
statement to the President -- we will not shy away from these
controversial issues. How far down we get on those issues is going
to be subject to debate. My feeling is that we can get down as far
as we need to go to solve our problem as commissioners to carry out
the mandate the President has given us.
Q Admiral, are there any recommendations at all for
immediate federal action in this report, and if not, is February as
early as you will do that --
ADMIRAL WATKINS: Yes, February is as early as we can do
it.
Q
Has the White House gone along with that strategy?
ADMIRAL WATKINS: The White House has received this
paper. I'm sure that it would be premature for me to say that the
President has reviewed it. I think it's only fair for them to take a
look at it. We have never raised expectations that in the
preliminary report of an issue as complex as this that we would come
down on recommendations on some of the most controversial public
policy issues that have ever faced this nation in a few weeks. After
all, it was only eight weeks ago that we were under severe criticism
by you and many others, and in many cases, legitimately so.
So for us to come out now and pontificate on some of the
most delicate issues would be, I think, inappropriate. And I have
said that publicly many times -- that our attempt now is to get
ourself focused on a structure and an approach to this complex issue.
And if you'll read the first 22 pages of that report, you are
overwhelmed by the scope of this disease and how it's going to impact
on the nation as a whole.
Q Will the recommendations be unanimous opinions of
the Commission or will you have minority reports?
ADMIRAL WATKINS: There is no way that I believe I can
get unanimous opinions on many of these issues. They will be
majority opinions. I will certainly entertain where necessary
minority views. I think that's appropriate. After all, there's some
54 bills on Capitol Hill, none of which have passed the Congress,
because of the very issues we are talking about here today, and I
don't expect that the Commission is going to have 100 percent
consensus. I happen to be one that believes that if you have 70
percent consensus in this country, you're doing pretty well -- 80 is
MORE
- 4 -
really fine. And 51 to 49 is not unusual.
Q The Commission is going to discuss that scope in
some way. You said it covers 22 pages. What do you mean?
ADMIRAL WATKINS: Well, the scope of the I'm talking
about the scope of the charter itself is very, very broad. If you've
read the charter of the Executive Order, which is included in the
report -- and it's in your package, by the way -- it is very, very
extensive. And in the first 22 pages of our report, we've somewhat
grasped the scope of the variety of issues that are in this Executive
Order. And I think you'll see as we go through there that we have a
dedicated Commission, we know where we're going, we have the issues
surrounded, and we're focusing on those where the 200 witnesses that
we've had come before us say we need help in these areas. And that
is from grassroots to the highest level.
So my feeling is that we're cutting across every single
agency, every single community-based organization, every single
religious body that gets into the care and help of others across the
nation in all aspects. After all, we're asked to look at the
medical, ethical, legal, social and financial impact of this epidemic
on the nation. I can't give you a broader cross section of the
country when we have that kind of a mandate.
Q Will you expand on this match you talked about in
terms of new drug development?
ADMIRAL WATKINS: Well, in the recent CDC weekly AIDS
report, for example, I believe they reported some 42 -- 44 different
drugs -- experimental drugs worldwide to deal with AIDS. In this
country so far we have one drug that is licensed and designated
solely for the epidemic, as you all know, and that's AZT.
So -- and while there are many other experimental
opportunities there, the mismatch is this -- a person with AIDS --
let's say a recent visit to Florida highlighted this to me -- a
person with AIDS came up to me and said, "Because I have been unable
to apply some of the drug protocols in this country, I've gone to
Paris and received those drug protocols, including Ampligen. I am
now on Ampligen and a special protocol in Philadelphia. I have lost
my Kaposi's Sarcoma red blotches. I feel good again, and while it
may not extend my life, I am healthy, I feel good about myself, and
my feeling is that more of us need to be on such a protocol."
That is the kind of thing I'm talking about. We don't
know what is wheat and chaff. I am not smart enough -- I'm not an
expert -- a medical expert -- but I have a team now that I've brought
aboard, and I point this out to the President -- seven good solid
medical types who have had their hands in the AIDS business for a
long time who know what they're talking about technically, and they
help advise me on a day-to-day basis -- they are full-time staff --
to help me on these kinds of issues. And I believe they even feel
that there's a streamlined approach to better balance. Those that
are crying for more involvement with experimental drugs. And they're
willing to use their own bodies in that test if they can feel better
and do better. And many of them find it immoral, for example,
knowing that it's a deadly disease and they're on that track, to
receive plate placebos in this particular case. When they know that,
at least with the AZT protocol, even for those infected there seems
to be indication of prolonged life. Not, perhaps, very long, but
some indication.
So these are the kind of things we're going to try to
deal with on that particular issue. They're very real, but to the
people that have AIDS -- and I believe it's something that we've
heard enough about that we can no longer wait on that particular
issue. And that's why we're putting it up front.
Q
Is it your sense, then, that the FDA is delaying the
MORE
- 5 -
ADMIRAL WATKINS: No, I think it'd be very premature to
say that. It -- you know, there's a lot of people involved in that
whole package. From the pharmaceutical companies that may develop
something, to the testing procedures, the NIH involvement, the FDA --
I think it would be a mistake.
This is a public-private venture, as I say, of the first
order in the nation. We don't want to start putting -- poking our
finger -- as Commissioners at this stage in our early life -- at
where fault might be. Our whole emphasis will be a positive approach
to give greater hope to the nation that we can keep this under
control, protect the public health and care for those afflicted as
well as find the cure. And I don't think we want to start poking our
fingers at anyone right now. We're saying, here are the issues that
are coming up from witnesses and we're going to take them on head on.
Q Admiral --
ADMIRAL WATKINS: Right back here.
Q
A few moments ago you said, when you read your
report, "One is overwhelmed by the scope of the disease, I think you
said, and how it will affect the nation.
ADMIRAL WATKINS: The scope of the issue, I think,
surrounding the disease -- how broad it is and what kind of issues
you get into in public policy as well as health and all of the
various aspects of dealing with it.
Q
You also you -- I think you finished your
statement by saying, "and how it will affect the nation as a whole."
ADMIRAL WATKINS: Right.
Q I wonder if you would expand on that for us now.
ADMIRAL WATKINS: Well, I think there are many in the
past -- and it's rather typical of infectious disease histories -- to
go through certain phases of disbelief, of a small community -- it's
not applicable to us -- to the final recognition that it's all of our
problem.
We went through that in drug abuse and now we know it's a
national malaise that we have to deal with. And it's directly
related to what we're doing in the AIDS business. As you know, a
recent report in New York stated that those that were in the I-V drug
abuse business were 53 percent affected in -- with the AIDS virus --
infected with the AIDS virus.
So when I say, affect the nation as a whole, we can no
longer sweep it under the rug as being focused in certain select
community areas. It's all of our problem we're going to have to
deal with it that way.
Q Can I follow that up on the scope of it? I don't
know if you're aware -- the CDC report I believe is being released
today. But what can you tell us about not only the present incidence
of AIDS, but more importantly, the projection --
ADMIRAL WATKINS: Right.
Q
-- about its penetration in the at large --
ADMIRAL WATKINS: Well, this is why our first issue is
prevalence, because it's so important for us to get that baseline.
Now, I was able to be briefed this morning by the Domestic Policy
Council representative on the content of the briefing you'll receive
this afternoon. And it's an effort by CDC to take all the data from
MORE
- 6 -
a family of surveys and begin to harden up some of the information
that was presented in 1986 on the data.
I think you'll find -- and I have not read this thing in
any detail -- I've only been briefed. But, on the surface, it
appears that no major upheavals in that data are going to be
presented. There is a spectrum -- and I don't want to take anything
away from the next briefer -- there's a spectrum that generally falls
within the one-to-1.5 million projection of HIV infected individuals
in the country that was projected last year. So I don't see any
major change in that at this point. But it also agrees, in that
report, with our report. So they are generally very mutually
supportable that prevalence information is essential to make our
projections. And they aren't there yet. And the White House has
embarked -- the President made a decision in October, to move out
expeditiously with not only the family of surveys, but a set of pilot
runs on nearly 30 cities in the nation. Followed by, over the next
couple of years, at least as recommended by the CDC, a sero
prevalence, a survey throughout the nation, when all of the things
that we are trying to deal with now can be set aside so that
volunteerism can bring forth a good, solid sero prevalence survey
that makes some sense, from which we can make the kind of budgetary
and other projections we need to deal with this disease.
or Will the Commission go out of business after you
submit the final report?
ADMIRAL WATKINS: The charter says that we are out of
commission on 24 July 1988.
Q Will you be making any recommendations to establish
a national AIDS commission?
ADMIRAL WATKINS: I think that clearly one of the topics
we must discuss is the topic raised by the American Medical
Association and the National Academy's Institute of Medicine, in
which they recommended a commission that is a little bit unlike the
commission we have. We certainly can be a contributor to a concept
of a follow-on commission. But those two bodies recommended that
there be some continuing central body for coordination of the variety
of things we see. This will be a topic that we'll be debating during
the forthcoming six months, and certainly will be one of the
recommendations we must make to the President, so that we don't leave
this with a commission report that gathers dust on the shelf, but
rather there is hopefully going to be some continuing leadership
recommendations we can make to the President to allow him to pass the
baton on to his successor in a more orderly way on this particular
issue, so we don't lose momentum and we don't have to have a new
commission to review it two years from now. Hopefully, we can do
that.
Q Admiral, considering the scope of the problem, why
do you feel confident you will be able to make recommendations as
early as February to the President?
ADMIRAL WATKINS: Well, those are only on very selected
issues. Those are four issues that I talked about. That is not on
the entire report. We cannot begin to cover the entire report. In
fact, 24 June is going to press us to the very limit. You look in
that report at the schedule of hearings alone, and remember we have
to follow the Federal Advisory Commission Act, which is a very
specific act that controls our operations. And we have to go through
federal register and all the preparations. And the openness makes it
almost difficult sometimes to have debate that we would like to have
preparatory to some of these hearings. So we have a a lot of things
we have to go through. And two hearings a month at three per
hearing, three days per hearing, is a very rigorous schedule. But I
enjoy the openness of this particular one because I believe that in
that openness, there is a mechanism to help bring some calmness to
what has been in many cases a rather chaotic and confused picture out
MORE
- 7 -
there at grass roots level. And at least we are talking now, I
think, in an orderly fashion. That there are many players in this
game and all of us have to pull together, public and private. And it
certainly is not all federal by any means, as we have seen when we
are in the field. It is going to take all of us.
Q
Admiral, you said one of the issues you will be
debating is whether or not to supply clean needles and syringes to
drug addicts. Wouldn't that be, in effect, advocating illegal acts
under the state and local laws?
ADMIRAL WATKINS: Well, yes, because you see -- but this
is a recommendation, after all, from a very prestigious organization.
And if you will read the report of the National Academy's Institute
of Medicine -- and they weren't overplaying it. They said should
there not be, we recommend that there be some kind of a test program
on that. We are raising the question in our Commission. We don't
quite understand that. Is that more important than say, enhanced
methadone clinics and rehabilitation clinics, that now have three to
six month waiting lines in New York City alone. Shouldn't we be
focused on that side of it rather than on this which has the
perception of encouragement, of carrying out an illegal practice. So
we are on your wavelength. I don't want you to think that we are --
we are just raising the issue now. But I hope that we can make a
recommendation to the President along the lines -- on all aspects of
I-V drug abuse. And to move out in a much more aggressive way
because this is going to become a much more serious issue in the
nation as a whole, as you all know, in just drug abuse, let alone
AIDS related drug abuse.
Q
Maybe you've already talked about this, but in these
areas that you are trying to move immediately on, there is no mention
of a comprehensive education campaign.
ADMIRAL WATKINS: Oh, yes, but you see that is going to
take -- I think we either have three or six days of hearings just on
education alone. This is going to take real time and work on our
part, because the education that is going on now at grass roots
level, at state level, and even some federal documents and so forth,
we are going to be looking at the efficacy of each one of those. Are
we reaching the communities or are we kidding ourselves that we are
getting to the very people who may not be able to read some of those
documents, may not even be influenced by them. How good are they?
We don't know all those things yet, so we recognize that the sole
weapon we have today is education. But we are not smart enough at
this point in time, without extensive hearings and review, to know
exactly what that process should be. It is one of the most
complicated. Because you are not just dealing with education of the
infected people or the non-infected people. You are also dealing
with education of health care providers, doctors, dentists, and all
the others who have to -- and counseling and the like, counselors and
the like, that have to bring their skills to bear on this thing.
That education is every bit as important as the education of the
American public. So all of those things have to be packaged up. In
fact, the AMA itself, in March as I understand it, is holding a
massive conference on education on AIDS to deal with their own
medical community. And I think that could well be the embryo of a
more structured and orderly national policy on education regarding
all aspects of AIDS.
Q But you could triage education issues and focus on
the group most at risk, the I-V drug use community.
ADMIRAL WATKINS: We will -- in the I-V drug abuse issue,
you are correct. We will specifically look at intervention
strategies. Because, as you know, they haven't been very successful
in almost anything we've done in drug abuse. Recidivism is very high
and many we just can't get to. So this will be a very definite piece
of the education process, but in no way can we surround education in
two months. It will be one of the most important of all of the
MORE
- 8 -
subjects we take up and will require extensive hearing. Yes?
Q Admiral, from the data you have seen now, how would
you characterize the threat that the AIDS epidemic poses to the
nation? And is there anything you can compare it to within your own
experience in another century?
ADMIRAL WATKINS: I don't have -- I am not a medical
person. So it is difficult to me to place it in perspective with
other sexually transmitted diseases, for example, such as syphilis in
the 30s. I just can't do it. There are many elements of response,
of national response to infectious disease which are similar. But
the disease itself is not. This is a fatal disease. We have -- the
latest epidemiologic report from CDC says 47,000 now are infected, 60
percent of whom have already died. The projections that were made
are now being validated to a certain extent in the incident reports.
It's a very serious disease that's going to cost the nation in 1991,
we know now, at least $16 billion to deal with, so it's a significant
disease. It's a great killer, it's one we have to worry about.
I think the heterosexual transmission is not all that
well-known at this time. We're going to be certainly worried about
that. The American people are worried about it, all the surveys say
the American people are worried about it, so I have to say certainly
from my experience, and my experience within the Navy is about all
I'm limited to in the area of infectious disease, is, this is the
most significant infectious disease certainly this nation has ever
faced.
Now, I believe that all those statements made early on on
this have not changed. They will not be changed today, as you hear
the CDC report. I think it would be very dangerous for this nation
with -- let's say that the upper limit now instead of 1.5 million is
1.4 million to say -- aha, it's receding, and therefore it's not as
big a problem. It is a significant problem, it is not going to go
away. It's here for a long time. Remember that the incubation
period is now being demonstrated as moving out from about five to
eight years. And that is even more worrysome about the long-term
impact on the nation of those infected with the virus. So it's going
to be here a long time, and it's a tough one, and right now, as you
know, Dr. Koop has said he doesn't see any vaccines coming on the
scene for five to ten years, and the cures are not in hand yet --
maybe five years away, and to some degree, we've seen a little
contribution of that with AZT, but certainly that's not the answer.
Q
Does the Commission believe it knows where AIDS came
from?
ADMIRAL WATKINS: Knows what?
Q
Where AIDS came from.
ADMIRAL WATKINS: I don't -- it's not in our charter to
find out. I think we're -- I don't know that we're going to be
really looking hard at fixing the source of that. Obviously in the
presentations we've had, we've been told a little bit about its
sources, and what it's not, and perhaps that might be of some
interest, and certainly we can pick it up. But it has not been one
of our items in focus at this point. It's not asked of us in the
charter.
Q
The commission has been criticized for not having a
PWA as one of its members. How much input will they have in helping
you draft your --
ADMIRAL WATKINS: I have a PWA in my staff who happens to
be in the hospital right now with a pneumocystis carinii pneumonia.
Q
In what capacity?
MORE
- 9 -
MR. WATKINS: He works with us. He does a lot of the
press work for us. He's a wonderful young man. I've been in contact
with him in the hospital. We may lose him, I don't know. I hope
not. We're giving him all the help we can. We're going to try to
get him on an Ampligen just because he's with us -- on Ampligen
"protocol", to give him whatever help we can for the remainder of his
life. And in fact, we're seriously considering bringing on another
individual right now to work who has some very specific skills that
can help us in the Commission work. We also have one -- a gay member
of the staff who we hire as a consultant periodically. He's given us
a great deal of help. And I think we've learned some new insights by
having this kind of closeness within the staff. So I don't think you
need everybody on the -- as a commissioner who either has AIDS or has
these other interest group feelings. I believe we have a good
Commission, we have a terrific staff, and we're balancing that staff
with the kinds of individuals that can give us the best insights.
or
Do you think there should be stronger
anti-discrimination statutes if you're asking for more testing to get
better prevalence data, or are you also asking --
MR. WATKINS: There has to be more anti-discrimination.
Statutes begin to worry me a little a little bit. We had a
presentation before the Commission by a group under consultation of
HHS that gave an incredibly important report, and it's in your
document there, which is a summary of what's going on in the States.
And I admit two years ago if you look at the body of information
coming in from the States on this subject, there were about 40 pages.
Today, there are three volumes. And it makes a difference. The
States are moving out in many ways. Perhaps some of them
disconnected it with other States, and perhaps they're focusing on
different issues. But nevertheless, they're moving out. And many of
them are getting into this anti-discrimination aspect of it in a big
way, whether you subsume it within the handicapped set of laws that
exist today, or whether you generate new ones, I'm not sure. We're
going to have an entire section on legal and ethical issues, and one
of which is going to be focused right in this area.
Q What worries you about statutes, if you didn't --
you said it worries you.
MR. WATKINS: Well, I worry about anybody writing a
simplistic law. We found out, and I pointed out to the President in
my report to him, that what -- what on the surface seems very
logical, when you get down to the human level begins to fall apart.
So, certainly flexibility has to be in there when we're dealing with
human beings, each of whom seems to have a different case history.
And so all I'm saying is, a race to statute is okay, providing we
know what we're doing. I hope that we can provide some guidance to
the President, for example, of how he might deal with
anti-discrimination statutes when they come to him, and I think we
can give him balanced perspectives on those kinds of things, and we
can read what's coming up from the states. We've had a lot of
experience, at a grassroots level. But certainly, we are going to be
sensitive to the anti-discrimination and confidentiality issues which
really right now are one of the obstacles to progress.
Q
You said you had gay people and AIDS victims on your
staff. Do you have any I-V drug abusers?
MR. WATKINS: No, I think that's rather --
Q That's a major part of the problem.
MR. WATKINS: I don't know of any I-V drug abusers right
now that would be all that useful. Now, if we have a rehabilitated
drug abuser who really is moving in expeditiously there, then I hope
Ben Primm, in his work, because he's chairman of this group, will get
an advisory panel together of these kinds of intervention strategists
MORE
- 10 -
to help us understand better the I-V drug abuser. I really don't --
I don't see a need to have every one of these kinds of individuals as
commissioners in order for us to tap the well of knowledge that's out
there. Certainly in the area of minority AIDS, we have one of the
best gentlemen in the country on our Commission, and he has been
charged by me to pull together whatever advisory staff he needs to
help in this regard, and to help advise the Commission, and I think
that that's quite adequate.
THE PRESS: Thank you.
END
3:22 P.M. EST
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
December 2, 1987
PRESS BRIEFING
BY
SECRETARY OF HEALTH AND HUMAN SERVICES
DR. OTIS BOWEN AND
DR. MASON OF THE CENTER OF DISEASE CONTROL
The Briefing Room
3:33 P.M. EST
MS. ARSHT: This briefing by Secretary of Health and
Human Services, Otis Bowen, and Dr. James Mason of the Center for
Disease Control is ON THE RECORD for sound and camera. I want to
tell you as we start, that Secretary Bowen is supposed to be back at
the Department for a 4:00 p.m. meeting.
Q
That's fine.
MS. ARSHT: And we are running a little late, so you
might want to question him first.
Q
What's happening at 4:00 p.m.?
SECRETARY BOWEN: Today we're going to provide you with a
report which is a review of the current knowledge on the spread of
the HIV infection, and we're also going to give you a summary of
plans for expansion of the HIV surveillance activities.
It represents the first step in implementing a
comprehensive national HIV surveillance program, which has been
developed in response to the President's directive to our Department,
which was: Number one, to carry out a comprehensive program to
determine the nationwide incidence of the HIV virus, and to predict
its future occurrence, and to initiate epidemiologic studies to
determine the extent to which HIV virus has penetrated the various
segments of our society.
The development of this surveillance system represents
the latest step in the federal government's efforts to halt the
spread of the AIDS epidemic caused by HIV.
Previous efforts and accomplishments would include, in
1981, soon after the syndrome -- later to be called the Acquired
Immune Deficiency Syndrome -- was recognized, the PHS, through the
Centers for Disease Control, began recording morbidity data for all
AIDS cases recorded by state and territorial health departments.
Research efforts were initiated to attempt to determine
the causes and the potential cures for AIDS. In a few short years,
we were able to show epidemiologically that AIDS was caused by an
infectious agent, and guidelines were then issues for the prevention
of AIDS through blood and blood products, and between persons, and
then in 1984 the AIDS virus itself, later to be called HIV, was shown
to be the actual cause of the disease.
In 1985, the AIDS antibody blood tests were licensed and
screening of the nation's blood supply began. In 1986, in response
to continued spread of the disease, the Public Health Service
developed and published an action plan to serve as a guide for
continued research and as a basis for an expanded information
education plan to prevent AIDS in our country.
MORE
- 2 -
In that same year, the President directed the Surgeon
General to prepare a report on AIDS that could be used to provide
information to the public and to the health community about the
disease, how it is spread, and how to prevent the infection. And, as
you know, the Surgeon General's report was issued in October of '86.
During this past year, we were rewarded by some of the --
with some of the fruits of our research efforts, with the licensure
of AZT. Our Department's information and education program moved
into an intensive phase marked by the expansion of HIV counseling and
testing and the prevention of AIDS.
Groundwork was also laid for moving into a new phase of
AIDS surveillance, which we are implementing in this fiscal year.
Our surveillance system of AIDS cases will be supplemented by a new
system to provide us continuing information about the extent of HIV
infection in the United States. In this system, we will gain
information from a family of surveys, including 30 cities across the
United States, to be conducted under the auspices of CDC. In
addition, CDC's National Center for Health Statistics will conduct
pilot studies to determine the feasibility of conducting a national
household sero-prevalent survey.
The pilots will take over a year's time, and they will
help us to determine: Number one, if we are on the right road;
number two, if not, which direction should we be headed; number
three, whether the journey should continue.
It's clear that we are dealing not with just one
epidemic, but actually a series of sub-epidemics, varying in the way
that it is affecting different parts of our population, varying
geographically across the nation. This new program can provide
information that is needed by cities, states and the federal
government in developing policy and planning future actions.
Armed with information about the number of people
infected, the prevalence of HIV infection, and information about the
progression of the HIV epidemic, which we call the incidence, then
policymakers at all levels will have the information needed to target
the distribution of prevention sources to population in greatest
need, to plan for health service needs, direct research to behavioral
change, prevention on other areas, and then evaluate the
effectiveness of the HIV prevention and control programs.
And now, Dr. Mason, Director for Centers for Disease
Control, will go over the plans for the expansion of the HIV
surveillance activities.
Dr. Mason?
DR. MASON: Thank you, Secretary Bowen. I suspect that
many of you have been sitting for quite awhile, and you'd appreciate
it if I'd be brief.
Better and more extensive information on the
sero-prevalence and sero-incidence of HIV infection in the U.S.
population is essential. As all of you know, we've had over 47,000
cases reported in the United States. But in a disease with a
terribly long incubation period, the number of reported cases does
not represent well the extent of infection among the population of
this country. with an incubation period that is at least 7.5 years,
we need to know what's going on under the water, in terms of an
iceberg of infection.
If this nation is to pursue wise policy development and
planning, we need to know how many are really infected. We need to
know the rate of spread in various risk groups and in communities
throughout the nation. We need to know patterns of occurrence.
Secretary Bowen has said that we're not dealing with just one
epidemic. National figures are just an additive set of numbers that
MORE
- 3 -
represent what's going on in 50 states and hundreds of communities
throughout the nation.
And if one thing is clear to us, that the epidemic and IV
drug abusers is not identical with the epidemic among homosexual or
bisexual men, or among heterosexuals. The epidemic that was caused
by blood clotting concentrates that were given to hemophiliacs is
different, because no longer are those clotting factors infected.
so, the shape and the dynamics of that epidemic are totally different
from IV drug abusers, where infection is still continuing to occur.
And so, we've been directed by President Reagan to get a
handle on not only national figures, but to work with state and local
health departments, so that we will know in depth what's occurring in
terms of infection. That's the only way that we really can determine
resource needs; where to target these resources geographically, or to
populations at risk; to plan for health care services that are needed
today, and that will be needed in the future; what research is still
required with regard to behavior, prevention and control, or with
regard to other aspects of the epidemic?
And finally, without the kind of information about spread
of infection, we really can't evaluate how well we're doing in
getting this epidemic under control -- whether our media campaigns,
or whether the education that's being provided in schools or
billboards or whatever's being done -- does it have an impact? Are
people changing behavior to reduce their risk? We don't know unless
we're able to look at infections.
So, the report that you've been given is a comprehensive
systems of getting the information that will be needed to improve our
policymaking and planning. We're going to start by continuing the
data that's being collected by case reporting. We're going to
continue to look at data that's being collected by the nation's blood
banks, by the military applicants, by Job Corps enterers. We're
going to continue to look at the research studies that have been done
as we followed cohorts of infected individuals.
In addition, we've been directed to begin a surveillance
system in 30 standard metropolitan statistical areas. We selected
those areas based upon 20 high-risk areas in terms of reported cases,
and 10 medium- to low-risk areas.
And in those communities, with the cooperation of
community health leaders, state health departments, we'll be
collecting information in STD clinics, in drug treatment clinics, in
family planning clinics and prenatal clinics, tuberculosis clinics,
and in sentinel hospitals. This kind of information collected over a
period of time will not only give us an understanding of patterns of
infection in terms of prevalence data, what is there today, but as
you see that over a period of time, we'll be able to measure
acquisition of new infection, whether incidence rates are declining
or increasing or staying the same. And that is actually very
important in terms of pursuing our control and prevention procedures.
I think I'll stop there, and with Secretary Bowen, answer any
questions that you might have.
Q Dr. Bowen, on these new -- in the 30 cities or
metropolitan areas that you are going to do this new testing, will
this new testing in prenatal clinics, drug abuse clinics, sexually
transmitted disease clinics, be voluntary and what will be the level
of confidentiality?
SECRETARY BOWEN: I think I am going to refer the
question --
DR. MASON: This will be anonymous testing so that
confidentiality will be absolutely preserved. We are already doing
this in sentinel hospitals. And, of course, it must be done so that
confidentiality is ensured.
MORE
- 4 -
Q
What are sentinel hospitals?
Q
If somebody tests positive anonymously, do you
intend to tell them that they have it?
DR. MASON: On anonymous testing, for example, in a
hospital setting, a random sample of blood samples are provided and
no identification is given. All we get is age, sex, race and where
they live. If an individual tests positive in this kind of an
anonymous system, there is no way that we can get back to the
individual because we don't know who it was.
Q
What are the medical ethics of not informing a
person they have AIDS?
DR. MASON: These people would not have been informed if
the study hadn't been done, because the blood wasn't drawn for that
purpose. And we have carefully gone to ethicists and ethics
committees and this is felt to be perfectly consistent with obtaining
information without violating confidentiality of individuals.
Q Secretary Bowen --
SECRETARY BOWEN: I think you are also underestimating
what the physicians themselves are doing. They want to know if their
patient has AIDS, and I think if we leave this into a system of
strictly public health and doctor-patient relationships, that there
is going to be a lot more testing done than we -- any of you think
will be done, and that you have a built-in system of confidentiality.
You have a built-in system of counseling with the doctor-patient
relationship. And just because they had an anonymous test, there is
no sign that the physician may not have ordered the test himself too.
Q Dr. Mason, five weeks ago you spoke to a bunch of
reporters at a breakfast meeting. Dr. Bowen was there too. You
mentioned the thirty cities, you mentioned the sentinel hospitals.
You also said you are abandoning any at this time. At the time that
you spoke, you said you were abandoning any hope of a national
seroprevalence study in large part because so many people were
unwilling to participate. You now suggest that you're again adopting
it. And it's six years into the epidemic -- CDC basically doesn't
have good numbers on how many people are infected. What are you
doing differently now that you haven't done before? And why are you
now switching gears and readopting something you abandoned a month
ago?
DR. MASON: We haven't abandoned anything. We have been
working on the thirty sentinel cities during the last six months. My
comment that you are alluding to was a question with regard to a
national seroprevalence survey, which is a bit different than what we
are talking about. And I was asked about the probability of such a
national seroprevalence survey being done and I said the likelihood,
I felt at that point in time, was small. What we are doing on the
national seroprevalence survey, as we've moved ahead now, in the
Commerce Business Weekly, that we are going to do through
contracting, pilot studies in probably up to three communities to see
what kind of a response rate we can get in a random household survey.
We will look at each of those and if we can get the response rate
that would be required to accurately do a national seroprevalence
survey, then following the pilot studies to work through the numbers,
the response rates, how big a final sample would have to be made on a
national basis, then at that point a decision will be made whether to
do the national seroprevalence survey.
Q Dr. Bowen, given -- bearing in mind what you said
about this being a series of epidemics, what has this review, what
new picture has it painted in your mind as to what the situation with
AIDS is in the United States?
MORE
- 5 -
SECRETARY BOWEN: I don't think that it's painted any new
picture. I don't think that very much has changed, but we still have
to admit that the data that we have is not as good as we would like
it to be. I think that the statistics show that this is not a
massive wildly spreading epidemic among heterosexuals, as some people
fear, and I think that panic should be avoided in all instances. And
that is probably why we want to make as careful an offering of the
scientific information that we have available to all of you because
we do consider you partners in the education of the people. And
goodness, any questions that you have, we want to make every effort
to answer them so that we can get the good information --
Q
How many AIDS cases are there in the United States
now?
Q
What are your best estimates of the numbers of AIDS
patients out there? What are you best estimates?
SECRETARY BOWEN: Dr. Mason just went through that in
another meeting, and he did it so well I am going to ask him to do
that once more. He has the figures right on the tip of his tongue.
DR. MASON: Eighteen months ago, June, 1986, at the
Coolfont Conference of the Public Health Service, were experts from
within the Public Health Service and without the Public Health
Service were convened together. A number of projections were made.
One projection was that by 1991 there would be a total of 270,000
cases and that 154,000 individuals would have died. And in this
conference, by using an empirical model, we estimated that somewhere
between 1 million and 1.5 million Americans were infected.
As a result of the exercise that we've gone through in
producing this report, we've updated risk factors in terms of the
various high-risk groups. We've looked at the best statistical data
we could get -- 50 surveys and studies of homosexual men, 88 studies
of IV drug abusers, we've looked at hemophiliacs. And we've revised
some of the approximations that were used 18 months ago. And,
interestingly, when you make those revisions, it doesn't change the
total infected a great deal -- about the same range -- 1 million to
1.5 million infected.
In addition, we tried using exponential models to see if
we could come any closer to this, and the problem with these models
is that we don't have the data that we need. For example, we don't
know the incubation period of AIDS -- how fast infection progresses
to disease. And when one plugs this into a model, you get such a
wide range. The best estimates of range -- ranging from about
400,000 infected to about 1.7 million infected. And so even those
kind of models don't give you a more precise estimate.
So we're basically saying we'll stick with our figure of
1 million to 1.5 million infected. Now some of you are going to say,
well, does that mean that no infections have occurred in the United
States in the last 18 months because you're staying within the range.
And that's not what I intend to say at all. We probably were a bit
high a year and a half ago, and our instruments aren't accurate
enough to measure changes that have occurred within that range.
The numbers that were being bandied about in June of 1986
with regard to the number infected was somewhere between two and
three times higher than what our estimate was, and everyone thought
we were being awfully conservative. Well, it turns out, we may have
been a little high, but we certainly are within the range and we're
not going to make any change in that range until we have additional
information that will enable us to do that more accurately.
Q
Can I follow that up?
Q
Dr. Bowen, you say that the disease is not spreading
MORE
- 6 -
Q Just to follow that question up before you get onto
a new subject, can you tell me whether or not, based on what
information you now have, whether the incidence of AIDS has
stabilized in every group except the minority community in the U.S.?
DR. MASON: No, I can't say that. I think in this
multitudinous epidemics that the dynamics are such that some are
decreasing in incidence figures, particularly white homosexual males.
Most of our studies show that the incidence is down. In IV drug
abusers generally, I don't think we see that same decline in
incidence. Now IV drug abuse, inner cities, poverty, blacks,
hispanics -- it's hard to separate that mix.
Q That's still going up?
DR. MASON: But for that reason I suspect in our inner
cities and our black and hispanic groups, we're still seeing an
increase, particularly associated with IV drug abuse and the
heterosexual partners of IV drug abusers. That's one area of real
concern.
Q
Dr. Bowen, you made the statement that you don't
feel that the disease is spreading wildly among heterosexual people
and that you want to dispell a feeling of panic. Considering that
you just admitted you don't have good numbers, arent' you afraid that
that might pass along a message of false security?
SECRETARY BOWEN: No, I don't think so, simply because
the sole scientific evidence shows that AIDS is hard to get. You
have to -- the only way that you're going to get it is through the
use of shared dirty needles or through promiscuous homosexual
activities or being born of a mother who has it.
Q But heterosexual people can get it through sexual
contact, too.
SECRETARY BOWEN: I'm sorry, I didn't get it.
Q Heterosexual people can get the disease.
SECRETARY BOWEN: Yes, they can get the disease. But the
educational efforts are being effective, we think, in those
particular areas -- not as effective as we'd like, but they are being
effective and, as I said, AIDS is hard to get, and one, with just the
proper education on it and has the proper amount of fear that one
should have with the disease, is not going to get it.
Q
Would you say then that under certain groups or
populations that the disease is coming under control? Do you feel
confident in saying that? How effective are your education efforts?
Do you have any numbers?
SECRETARY BOWEN: I'm going to defer to Dr. Mason on that
question, but the statistics do not show that it is wildly spreading
and that it is preventable and that we are devoting a tremendous
amount of efforts for education and information, and that's the only
means of prevention that we have at the present time. And I'll let
Dr. Mason answer any statistics that he has on that. I don't know.
DR. MASON: Well, I would just say that over a billion
dollars is being spent at the federal level for research and for
education, information and disease control activities, and it -- we
really don't have the data sets that will enable us to precisely
measure how well we're bringing the disease under control. That's
one of the things that we talked about -- why we want to put all of
those surveys into place.
But what our data does show us, as imprecise as it is, is
that the disease is not spreading wildly through the United States
MORE
- 7 -
population, but it is spreading in those groups that continue to
participate in behaviors that transmit the virus. And there is no
change -- the IV drug abuse needle is as infectious in the United
States today as it was four or five years ago.
Q Dr. Bowen, the timetable here in the book indicates
that a national survey would be concluded in June, 1990. Isn't that
an embarrassingly long time, a. And, b, what's the price tag on this
huge survey?
SECRETARY BOWEN: It's a lot longer than we would like,
but it's been said, if you want a report bad, you may get it bad, and
we are going to stick to the timetable that will get scientifical
useful information and not information that will be harmful. We are
looking --
Q Price? What is the price tag?
SECRETARY BOWEN: Do you have a price tag on it? I don't
know.
DR. MASON: The price tag for the pilot phases of the
national seroprevalence surveys are in the range of $5 million. For
the family of surveys, the 30 standard metropolitan statistical
areas, we're talking about a range of $30 million for that kind of
information. The time -- we would like to speed that up as rapidly
as we can. But, just as Dr. Bowen has said, to get good data, you
have to go through the contracting process. The contractor has to
have time to develop a protocol. Each phase has to be phased in,
even though we can fast track some of this. And if any of you have
suggestions or know of people who have suggestions on how we can
carry out a scientifically valid survey faster than that, we'd love
to sit down and talk with you.
Q Can I follow up on that?
Q
You start it sooner. Why wasn't it started sooner
-- (laughter) -- no money? No, seriously, I'm not kidding.
DR. MASON: No, it wasn't a matter of money. The
surveillance systems were first put into place in 1981. As time has
gone on, one by one they've been put into place and improved and
expanded. We didn't even have a test until 1985. And then for a
long period of time there was concern about the validity of the test
-- false positives, false negatives.
And so, now that we've had experience with the test --
including both the ELISA and the Western Blot -- we know that when
these tests are carried in qualified, well-controlled laboratories
that the number of false positives are exceedingly low. We will get
some false negatives but we won't get a lot. And so we feel that the
state of the art of our science has now reached the point where one
can begin to do this kind of careful, seroprevalence data collection.
Q Dr. Bowen --
Q Dr. Bowen, is there anything in what you're
reporting today that decreases the need and the pressure for more
federal dollars for research or anything that the Feds are now
spending money for? Is there less need to spend money because of
what you found out and reported today?
SECRETARY BOWEN: No, I don't think there's any less
need. And the need for money may be pretty flexible simply because
you don't know which experiment is going to be the one that brings on
the vaccine or which one is going to bring on the new medications,
which will then need a -- perhaps a great deal more money to further
develop it. I don't think money is going to be the problem, simply
because this administration and everyone in Congress that I've talked
to is -- are all willing to do whatever is necessary -- financially
MORE
- 8 -
and otherwise -- to control the epidemic.
Q If I may follow up, sir -- one of the persistent
criticisms down through the years has been the reluctance to spend
money -- particularly early on. I think some people are going to
say, well, if they're lowering the estimates -- if they're saying
that the previous estimate was high, well, they're going to pull back
on some of the money. Are you saying you're not going to do that?
SECRETARY BOWEN: Well, it's not our intention to, no.
Q
Dr. Bowen --
Q
Are you lowering the estimates, in fact? Is that
what you're doing? And why do make a distinction between the spread
in some groups and the other? Isn't it just as serious a problem
among homosexuals and intervenous drug users as it is among
heterosexuals? Why does it matter that among some groups it's not
spreading? And how can you say that if you don't have the numbers?
DR. MASON: Well, I don't think any of us want to imply
in any way that we have precise data. And that's exactly why the
family of surveys and the pilot studies for the random household
survey will be done. So I don't want any of you to overread what
we're saying. And I hope you'll read the report because we've been
very, very careful and conservative in there.
The work needs to go on in all people who have -- who are
engaging in risky behavior. It doesn't matter whether they're
heterosexual, whether they're IV drug abusers, whether they're
homosexual or bisexual men. We are not saying for a moment that any
of that needs to stop.
CDC was asked to do a scientific assessment to -- based
upon data available in November, 1987. What is our best estimate of
the number of people infected? And we delivered that best estimate
to the Domestic Policy Council today. And there was no pressure or
any way -- one way or the other. They simply wanted the best
estimate of how many we felt were infected and that was the driving
force behind the number. And we don't need to relax we shouldn't
relax any of the efforts that we're carrying out to get this epidemic
out -- under control.
We're not saying that it's under control. We're saying
it's not spreading like wildfire. And we can be relieved about that,
but it means that we've got to continue all the effort that have been
going on in the past. Research, education, information, the testing
and counseling all of those things -- the right mix of those. And
information that we've provided today provides us with where we need
to target more resources. Some areas we may not be needing to spend
as much as we have been. In other words, instead of shotgun blasts
out there, the more precise we can be about in which populations it's
spreading, where it seems to be getting under control, we can do a
more intelligent job with better intelligence in getting at this
epidemic.
Q
How many --
Q
Okay, Dr. Bowen, rather than tackling the issue of
education, critics would charge that once again the administration is
talking about more testing. Could you respond to that? Are you
really where is our national education program? Why haven't we
mailed out the Surgeon General's report?
SECRETARY BOWEN: There's been over eight million copies,
I believe, of the Surgeon General's report already mailed out. Every
congressman has the opportunity to obtain as many copies as he or she
desires. And some of them have asked for as high as 250 thousand
copies to be mailed door to door. Our federal responsibilities on
MORE
- 9 -
AIDS, it seems to me, are three or four. Number one is to do the
basic research.
There is a lot of other research being done out there in
the private areas, but the basic research on the virus itself and on
the epidemiology, how it is spread and so forth. The second is to do
research on the development of drugs to kill the virus, drugs to
stimulate the body's immunity and more drugs to help cure the
opportunistic diseases that come along with AIDS. And then the big
one that we are working hard and fast on, but it has a date in the
future for completion, is the vaccine. And you have to remember, it
took 17 years to develop a vaccine for hepatitis, and here we have
only known about this virus of AIDS for two years. It took -- we
know as much about AIDS in the few years that we have known of the
disease as we knew about polio in 40 years. So I think that we've
have made tremendous progress.
Another thing the federal government needs to do is to
develop the educational and informational material and then get it
disseminated to the areas all over the country.
Q
Dr. Mason, Dr. Bowen, how do you characterize, sir,
the spread among the high risk groups. A while ago you said it is
not spreading like wildfire through the general population. How is
it spreading in the high risk groups? What is -- how do you
characterize that?
SECRETARY BOWEN: It is spreading simply because of the
high risk behavior in those groups.
Q How is it spreading, sir? Is it spreading fast,
faster or less fast than it was 18 months ago?
SECRETARY BOWEN: I think the statistics remain just
about the same. I don't think there has been any great -- and
correct me if I am wrong on this -- but the homosexual community has
listened to the educational efforts, perhaps better than those in the
IV drug use. But again, the IV drug users are the one that are the
very, very hardest to reach. And simply because if they have an
addiction and they are in need of a fix, they could care less about
AIDS at that particular time. So that is essentially the reason that
it is continuing to spread there.
Q
Dr. Bowen, you just mentioned drug development as
the responsibility of the federal government, and yet Admiral Watkins
just told us that drug development is going to be one of the four
things the Commission is going to devote -- it was a top priority,
because so many people with AIDS believe the drugs are not being
developed and the cures are not being developed. As the person who
oversees both the National Institutes of Health and Food and Drug
Administration, would you disagree with that as something the
Commission should be looking at? Do you stand by the process as it
is now?
SECRETARY BOWEN: Oh, I think the Commission has every
right to say that that is one of the main things they need to look
at. But I think it is just simply a perception, if that be the case,
that the federal government is not doing all it can to develop drugs.
They are, believe me they are.
Q Is it a good process or are there improvements to be
made in the drug approval process?
SECRETARY BOWEN: Well, we've made tremendous
improvements in the entire drug approval process, but there has been
extensive improvements in speeding up in the method by which drugs
for the treatment of AIDS will be authorized and you can just look at
the action on the AZT for that, and certainly all other drugs that
show promise of efficacy and safety for the treatment of either the
AIDS virus or the opportunistic diseases will be treated in the same
MORE
- 10 -
fashion that AZT was.
Q
Dr. Bowen, how does --
Q
Dr. Mason, how does the house-to-house survey work,
and the confidentially -- the pilot program for the house-to-house?
Obviously that's different from the hospitals --
DR. MASON: The question is about the random household
survey -- how will it work with regard to confidentiality? We will
never identify that individual. They'll be given a code number so
that they can call in to get the result of their test, but there's no
way that we could go back to identify that individual after
information is collected.
Q
They're going to go to the house and --
Dr. MASON: It will be -- as it's designed to be --
random household survey to try to be as representative of the United
States population as you possibly can. That's the only way that you
really can find out how many there are infected in the United States
of America -- is do a random survey, and of course the Gallup Poll or
one of those other polls -- they telephone 600 or so. But with AIDS,
since you're working with particular people, you're going to have to
over-sample. In so many populations, it becomes very difficult. And
then to get statistical significance, you've got to have an
appropriate number. And if a lot of the people won't respond -- for
example, those that were higher risk for AIDS didn't respond, then
you'd under count the infections and you'd come up with a very
falsely low number, and that's the last thing we want. And that's
the reason for the pilot studies -- to make sure that you can do it
accurately enough to make it worthwhile doing it.
MS. ARSHT: We'll take one last question.
Q
What cities --
Q
Dr. Bowen, Admiral Watkins, when he was here
earlier, said that he thought that AIDS was the most significant
infectious disease the nation has ever faced. Considering the
discussions we've had about numbers, do you agree with that?
SECRETARY BOWEN: Yes, I would agree with it simply
because of the things that it involves. It involves sex, it involves
reproduction, it involves drugs, it involves lifestyles, it involves
minorities and so forth, so I think that -- sure, it would have to be
considered one of the most significant diseases that has ever come
along.
Q
He didn't say, "one of the," he said, "the most." "
SECRETARY BOWEN: Okay, I'll even buy that.
THE PRESS: Thank you.
END
4:10 P.M. EST
Human Immunodeficiency Virus Infections in the United States:
A Review of Current Knowledge
James O. Mason, M.D., Dr.P.H.
Director, Centers for Disease Control
BACKGROUND
Transmission of human immunodeficiency virus (HIV) infections in the
United States can be slowed or halted by reducing or eliminating the
behaviors that place individuals at risk of acquiring HIV infection.
Over 46,000 cases of acquired immunodeficiency syndrome (AIDS) have been
reported to CDC since 1981 as part of a national surveillance program.
Although AIDS occurs as the result of HIV infection, the mean interval
from infection with HIV to the onset of AIDS exceeds seven years.
Information on the number of currently infected individuals (prevalence)
and the rate at which new HIV infections occur over time (incidence) is
vital to monitoring the progression of the HIV epidemic.
More precise and more consistently collected data on the prevalence of
HIV infection remain to be collected for individuals whose behavior
places them at increased risk and for the general population. Better and
more extensive information is essential for targeting and evaluating
control and prevention efforts at local and State level, for predicting
future health care needs, and for understanding where the HIV and AIDS
epidemic is headed. Better models which make use of the specific data
will also aid in our understanding of the spread of this virus.
Surveillance of the prevalence and incidence of HIV infection by
continually monitoring sentinel populations and expanding focused
seroprevalence surveys and studies, and developing models to help
interpret the data remains a critical element of the Nation's response to
this major public health crisis.
HIV IN THE UNITED STATES: CURRENT KNOWLEDGE
In October 1987, an epidemiological team from the CDC, with assistance
from the National Institute on Drug Abuse (NIDA)/Alcohol, Drug Abuse and
Mental Health Administration (ADAMHA) and the National Institutes of
Health (NIH), conducted an intensive review of published and unpublished
data on the extent and trends of infection with HIV in the United
States. While the various surveys and studies differ in design and
cannot be precisely compared, nevertheless a description of the
approximate patterns and trends of HIV infection is useful.
Infection in Groups at Recognized Risk. Observed prevalence of infection
remains highest in those groups which account for the vast majority of
AIDS cases.
Seroprevalence in homosexual and bisexual men in 50 surveys and studies
throughout the country ranges from under 10 percent to as high as 70
percent, with most findings falling between 20 percent and 50 percent.
In 88 surveys and studies, observed HIV prevalence varies more widely for
intravenous drug abusers, ranging from highs of 50 to 65 percent in the
New York City vicinity and Puerto Rico to rates which vary but which are
mostly below 5 percent in areas other than the East Coast.
Persons with coagulation disorders requiring clotting factor concentrates
(hemophiliacs) vary in HIV prevalence depending on type and severity of
the disorder--approximately 70 percent overall for hemophilia A and
35 percent for hemophilia B--but the prevalence rates appear uniform
throughout the country, reflecting the national distribution of the
clotting factor concentrates.
Heterosexual transmission of HIV clearly occurs. The prevalence in
regular heterosexual partners of infected persons ranges from under 10
percent to 60 percent, while in partners of those at risk but of unknown
HIV status the prevalence is lower, generally under 10 percent.
Infection in Groups Drawn from the General Population. In selected
groups of the general population--blood donors, civilian applicants for
military service, Job Corps entrants, sentinel hospital patients, and
women in settings related to fertility and childbearing--HIV infection
prevalence is generally a fraction of 1 percent, though seroprevalence
rates vary considerably and have been found to be much higher in
populations in selected inner city populations.
Persons at increased risk for HIV are asked not to donate blood and
therefore prevalence and incidence rates in donor groups will
under-represent the actual rates in the population. The overall
prevalence of HIV antibody in Red Cross blood donors who have not been
previously tested averages 0.043 percent seropositive. Applicants for
military service, who under-represent persons in the principal risk
groups for HIV, have a crude HIV antibody prevalence of 0.15 percent,
which when adjusted to the age, sex, and race composition of the United
States 17 to 59 years of age population, is 0.14 percent. Job Corps
entrants, disadvantaged youths 16 to 21 years of age, thus far have a
prevalence of 0.33 percent. Patients without AIDS-like conditions thus
far tested anonymously at four sentinel hospitals have a prevalence of
0.32 percent, compared with a sex- and age-adjusted prevalence of
0.11 percent for military applicants from the same cities.
Childbearing women in Massachusetts, tested anonymously through
filter-paper blood specimens from their newborn infants, have an HIV
prevalence of 0.21 percent. This compares with 0.13 percent for female
applicants for military service from the same State. The findings from
surveys in womens' health clinics ranged from 0 percent to as high as 2.6
percent positive (other than in groups of pregnant drug users where the
prevalence reaches nearly 30 percent). The higher prevalences occurred
in areas of high AIDS case incidence in women.
- 2 -
Variation of HIV Prevalence by Geography, Age, Sex, and Race or Ethnicity.
The geographic distribution of HIV prevalence in blood donors and
applicants for military service, and to a limited extent in homosexual
men and IV drug abusers, is similar to the geographic distribution of
AIDS cases, being highest on the East and West Coasts and lowest in the
northern Midwest and mountain States. HIV prevalence, like AIDS case
incidence, is greater in urban than in rural areas. These latter areas
must be monitored closely for spread of HIV infection and targeted for
prevention efforts.
Like AIDS cases, HIV infection both in general population groups and high
risk groups is concentrated in young to early middle-aged adults, and is
consistently more common in men and in the black and Hispanic populations.
Heterosexuals. Information on the extent of HIV infection in exclusively
heterosexual, non-IV-drug using persons without known sexual exposure to
partners at increased HIV risk comes from two principal sources:
evaluation of risk factors in seropositive blood donors and applicants
for military service, and HIV surveys in heterosexuals attending sexually
transmitted disease (STD) clinics.
Limited studies of exposure risks in seropositive donors as well as in
seropositive military applicants and in active duty military personnel
suggest that approximately 85 percent of such individuals have
identifiable risks for HIV. If the risk factor data from these limited
studies are found to be consistent in more extensive national studies,
then HIV prevalence levels in persons without acknowledged or recognized
risks would be below 0.021 percent in military applicants and 0.006
percent in blood donors. However, more extensive studies on risk factors
are urgently needed, particularly in inner city areas where heterosexual
HIV transmission would be predicted to occur based upon AIDS case
surveillance data.
In limited studies of the highest-risk subgroup of heterosexuals, those
being treated for STD, when rigorously interviewed to assess risk factors
with follow-up reinterview of seropositives, the prevalence of HIV ranges
generally from 0 percent to 1.2 percent in persons without specific
identified risk factors. By contrast, homosexual men at the same clinics
range to over 50 percent positive.
HIV Infection Trends Over Time. Incidence of New Infection. Trend and
incidence information is much less available and much more difficult to
develop than prevalence data.
In the two general population groups tested over time, applicants for
military service and first-time blood donors, HIV prevalence rates have
remained stable for two years, although the prevalence in donors has
fluctuated seasonally. Increased self-deferral of persons with risk
factors or who already knew they were HIV-infected may have contributed
to this observed prevalence pattern, the apparent stability reflecting
the competing effects of self-deferral by infected persons and the
continued occurrence of new HIV infections.
- 3 -
There is evidence that new infections continue to occur in blood donors,
in military personnel, and in groups at increased risk. However, in some
groups the rate of new infection (incidence) may have declined somewhat
from the rates which prevailed in the early 1980s, since 1) declines in
incidence of new infections have been observed in eight cohorts of
homosexual men, the current principal risk group; 2) the net
seroprevalence in military applicants and donors (which rose at some time
to their current levels from zero before HIV was introduced) appears no
longer to be rising; and 3) serologic screening of blood products and
heat treatment of clotting factor concentrates have vastly reduced new
infection in transfusion recipients and hemophiliacs. However,
insufficient trend and incidence data are available to evaluate recent
patterns in and heterosexually active persons or in local geographic
areas such as the inner cities.
The HIV and AIDS epidemic is a composite of many individual, though
overlapping, sub-epidemics each with its own dynamics and time course.
While the incidence of new infection in certain subgroups may have
declined somewhat, in the absence of specific information, incidence
rates cannot be assumed to have declined in all subgroups or in all
geographic areas. It is important that trends be monitored in IV drug
abusers and in heterosexually active persons as well as in localized
areas such as inner cities. There is insufficient data to determine the
overall incidence and trends of HIV infection.
Implications for Estimates of National HIV Prevalence. In 1986, a large
group of public health and medical specialists from within and from
outside the government was convened by the PHS and developed an empirical
working estimate of 1 to 1.5 million infected Americans. This was based
on the estimated sizes of populations at risk and the estimated average
seroprevalence values for those populations. The Institute of Medicine,
National Academy of Sciences reviewed and considered this working
estimate reasonable. If the estimate is recomputed in light of more
recent HIV seroprevalence data and newer estimates for the size of
populations at risk, little net change in the estimate occurs. If the
HIV prevalence rates observed in low-risk groups, or multiples thereof,
are extrapolated to the entire population, the figures fall below 1
million. When several empirical mathematical models are tested using
AIDS surveillance data and disease progression rates from the
well-studied San Francisco cohort, the resulting estimates of total HIV
infections range from 276,000 to 1,750,000, with best estimates of
420,000 to 1,649,000. Proceedures that produce such a wide range of
results from the same data indicate that there are either insufficient
data or insufficient models or both. Hence, there is a need for improved
data and model development to assist in monitoring HIV infection in this
country.
The available data and models are consistent with the PHS estimates in
June, 1986. Since new infections have continued to occur during the past
17 months, this would imply that the upper range of the 1986 estimate
(i.e., 1,500,000) may have been somewhat high at that time. The overall
conclusion, however, is that a very large number of Americans are now
- 4 -
infected. The estimation of the total number of persons infected will
remain complex and inexact. There is no substitute for carefully
obtained incidence and prevalence data. Additional surveys and studies
are needed to determine the current extent of spread of HIV through the
population.
Human Immunodeficiency Virus Infections in the United States:
A Review of Current Knowledge
James O. Mason, M.D., Dr.P.H.
Director, Centers for Disease Control
BACKGROUND
Transmission of human immunodeficiency virus (HIV) infections in the
United States can be slowed or halted by reducing or eliminating the
behaviors that place individuals at risk of acquiring HIV infection.
Over 46,000 cases of acquired immunodeficiency syndrome (AIDS) have been
reported to CDC since 1981 as part of a national surveillance program.
Although AIDS occurs as the result of HIV infection, the mean interval
from infection with HIV to the onset of AIDS exceeds seven years.
Information on the number of currently infected individuals (prevalence)
and the rate at which new HIV infections occur over time (incidence) is
vital to monitoring the progression of the HIV epidemic.
More precise and more consistently collected data on the prevalence of
HIV infection remain to be collected for individuals whose behavior
places them at increased risk and for the general population. Better and
more extensive information is essential for targeting and evaluating
control and prevention efforts at local and State level, for predicting
future health care needs, and for understanding where the HIV and AIDS
epidemic is headed. Better models which make use of the specific data
will also aid in our understanding of the spread of this virus.
Surveillance of the prevalence and incidence of HIV infection by
continually monitoring sentinel populations and expanding focused
seroprevalence surveys and studies, and developing models to help
interpret the data remains a critical element of the Nation's response to
this major public health crisis.
HIV IN THE UNITED STATES: CURRENT KNOWLEDGE
In October 1987, an epidemiological team from the CDC, with assistance
from the National Institute on Drug Abuse (NIDA)/Alcohol, Drug Abuse and
Mental Health Administration (ADAMHA) and the National Institutes of
Health (NIH), conducted an intensive review of published and unpublished
data on the extent and trends of infection with HIV in the United
States. While the various surveys and studies differ in design and
cannot be precisely compared, nevertheless a description of the
approximate patterns and trends of HIV infection is useful.
Infection in Groups at Recognized Risk. Observed prevalence of infection
remains highest in those groups which account for the vast majority of
AIDS cases.
Seroprevalence in homosexual and bisexual men in 50 surveys and studies
throughout the country ranges from under 10 percent to as high as 70
percent, with most findings falling between 20 percent and 50 percent.
In 88 surveys and studies, observed HIV prevalence varies more widely for
intravenous drug abusers, ranging from highs of 50 to 65 percent in the
New York City vicinity and Puerto Rico to rates which vary but which are
mostly below 5 percent in areas other than the East Coast.
Persons with coagulation disorders requiring clotting factor concentrates
(hemophiliacs) vary in HIV prevalence depending on type and severity of
the disorder--approximately 70 percent overall for hemophilia A and
35 percent for hemophilia B--but the prevalence rates appear uniform
throughout the country, reflecting the national distribution of the
clotting factor concentrates.
Heterosexual transmission of HIV clearly occurs. The prevalence in
regular heterosexual partners of infected persons ranges from under 10
percent to 60 percent, while in partners of those at risk but of unknown
HIV status the prevalence is lower, generally under 10 percent.
Infection in Groups Drawn from the General Population. In selected
groups of the general population--blood donors, civilian applicants for
military service, Job Corps entrants, sentinel hospital patients, and
women in settings related to fertility and childbearing--HIV infection
prevalence is generally a fraction of 1 percent, though seroprevalence
rates vary considerably and have been found to be much higher in
populations in selected inner city populations.
Persons at increased risk for HIV are asked not to donate blood and
therefore prevalence and incidence rates in donor groups will
under-represent the actual rates in the population. The overall
prevalence of HIV antibody in Red Cross blood donors who have not been
previously tested averages 0.043 percent seropositive. Applicants for
military service, who under-represent persons in the principal risk
groups for HIV, have a crude HIV antibody prevalence of 0.15 percent,
which when adjusted to the age, sex, and race composition of the United
States 17 to 59 years of age population, is 0.14 percent. Job Corps
entrants, disadvantaged youths 16 to 21 years of age, thus far have a
prevalence of 0.33 percent. Patients without AIDS-like conditions thus
far tested anonymously at four sentinel hospitals have a prevalence of
0.32 percent, compared with a sex- and age-adjusted prevalence of
0.11 percent for military applicants from the same cities.
Childbearing women in Massachusetts, tested anonymously through
filter-paper blood specimens from their newborn infants, have an HIV
prevalence of 0.21 percent. This compares with 0.13 percent for female
applicants for military service from the same State. The findings from
surveys in womens' health clinics ranged from 0 percent to as high as 2.6
percent positive (other than in groups of pregnant drug users where the
prevalence reaches nearly 30 percent). The higher prevalences occurred
in areas of high AIDS case incidence in women.
- 2 -
Variation of HIV Prevalence by Geography, Age, Sex, and Race or Ethnicity.
The geographic distribution of HIV prevalence in blood donors and
applicants for military service, and to a limited extent in homosexual
men and IV drug abusers, is similar to the geographic distribution of
AIDS cases, being highest on the East and West Coasts and lowest in the
northern Midwest and mountain States. HIV prevalence, like AIDS case
incidence, is greater in urban than in rural areas. These latter areas
must be monitored closely for spread of HIV infection and targeted for
prevention efforts.
Like AIDS cases, HIV infection both in general population groups and high
risk groups is concentrated in young to early middle-aged adults, and is
consistently more common in men and in the black and Hispanic populations.
Heterosexuals. Information on the extent of HIV infection in exclusively
heterosexual, non-IV-drug using persons without known sexual exposure to
partners at increased HIV risk comes from two principal sources:
evaluation of risk factors in seropositive blood donors and applicants
for military service, and HIV surveys in heterosexuals attending sexually
transmitted disease (STD) clinics.
Limited studies of exposure risks in seropositive donors as well as in
seropositive military applicants and in active duty military personnel
suggest that approximately 85 percent of such individuals have
identifiable risks for HIV. If the risk factor data from these limited
studies are found to be consistent in more extensive national studies,
then HIV prevalence levels in persons without acknowledged or recognized
risks would be below 0.021 percent in military applicants and 0.006
percent in blood donors. However, more extensive studies on risk factors
are urgently needed, particularly in inner city areas where heterosexual
HIV transmission would be predicted to occur based upon AIDS case
surveillance data.
In limited studies of the highest-risk subgroup of heterosexuals, those
being treated for STD, when rigorously interviewed to assess risk factors
with follow-up reinterview of seropositives, the prevalence of HIV ranges
generally from 0 percent to 1.2 percent in persons without specific
identified risk factors. By contrast, homosexual men at the same clinics
range to over 50 percent positive.
HIV Infection Trends Over Time, Incidence of New Infection. Trend and
incidence information is much less available and much more difficult to
develop than prevalence data.
In the two general population groups tested over time, applicants for
military service and first-time blood donors, HIV prevalence rates have
remained stable for two years, although the prevalence in donors has
fluctuated seasonally. Increased self-deferral of persons with risk
factors or who already knew they were HIV-infected may have contributed
to this observed prevalence pattern, the apparent stability reflecting
the competing effects of self-deferral by infected persons and the
continued occurrence of new HIV infections.
- 3 -
There is evidence that new infections continue to occur in blood donors,
in military personnel, and in groups at increased risk. However, in some
groups the rate of new infection (incidence) may have declined somewhat
from the rates which prevailed in the early 1980s, since 1) declines in
incidence of new infections have been observed in eight cohorts of
homosexual men, the current principal risk group; 2) the net
seroprevalence in military applicants and donors (which rose at some time
to their current levels from zero before HIV was introduced) appears no
longer to be rising; and 3) serologic screening of blood products and
heat treatment of clotting factor concentrates have vastly reduced new
infection in transfusion recipients and hemophiliacs. However,
insufficient trend and incidence data are available to evaluate recent
patterns in and heterosexually active persons or in local geographic
areas such as the inner cities.
The HIV and AIDS epidemic is a composite of many individual, though
overlapping, sub-epidemics each with its own dynamics and time course.
While the incidence of new infection in certain subgroups may have
declined somewhat, in the absence of specific information, incidence
rates cannot be assumed to have declined in all subgroups or in all
geographic areas. It is important that trends be monitored in IV drug
abusers and in heterosexually active persons as well as in localized
areas such as inner cities. There is insufficient data to determine the
overall incidence and trends of HIV infection.
Implications for Estimates of National HIV Prevalence. In 1986, a large
group of public health and medical specialists from within and from
outside the government was convened by the PHS and developed an empirical
working estimate of 1 to 1.5 million infected Americans. This was based
on the estimated sizes of populations at risk and the estimated average
seroprevalence values for those populations. The Institute of Medicine,
National Academy of Sciences reviewed and considered this working
estimate reasonable. If the estimate is recomputed in light of more
recent HIV seroprevalence data and newer estimates for the size of
populations at risk, little net change in the estimate occurs. If the
HIV prevalence rates observed in low-risk groups, or multiples thereof,
are extrapolated to the entire population, the figures fall below 1
million. When several empirical mathematical models are tested using
AIDS surveillance data and disease progression rates from the
well-studied San Francisco cohort, the resulting estimates of total HIV
infections range from 276,000 to 1,750,000, with best estimates of
420,000 to 1,649,000. Proceedures that produce such a wide range of
results from the same data indicate that there are either insufficient
data or insufficient models or both. Hence, there is a need for improved
data and model development to assist in monitoring HIV infection in this
country.
The available data and models are consistent with the PHS estimates in
June, 1986. Since new infections have continued to occur during the past
17 months, this would imply that the upper range of the 1986 estimate
(i.e., 1,500,000) may have been somewhat high at that time. The overall
conclusion, however, is that a very large number of Americans are now
- 4 -
infected. The estimation of the total number of persons infected will
remain complex and inexact. There is no substitute for carefully
obtained incidence and prevalence data. Additional surveys and studies
are needed to determine the current extent of spread of HIV through the
population.
HUMAN IMMUNODEFICIENCY VIRUS INFECTIONS IN THE
UNITED STATES
A REVIEW OF CURRENT KNOWLEDGE AND PLANS FOR
EXPANSION OF HIV SURVEILLANCE ACTIVITIES
A Report to the Domestic Policy Council
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
CENTERS FOR DISEASE CONTROL
with support from
the Alcohol, Drug Abuse and Mental Health Administration and
the National Institutes of Health
December 2, 1987
CHRONOLOGY OF MAJOR EVENTS SINCE 1981
1981
CASES OF KAPOSI'S SARCOMA AND PNEUMOCYSTIS PNEUMONIA AMONG YOUNG
MALES FIRST REPORTED
NATIONAL SURVEILLANCE FOR AIDS BEGUN
1982
EPIDEMIOLOGIC EVIDENCE INDICATED THAT AIDS IS CAUSED BY AN
INFECTIOUS AGENT
PUBLICATION OF THE FIRST AIDS GUIDELINES FOR HEALTH-CARE AND
LABORATORY WORKERS
CASE OF AIDS REPORTED IN HEMOPHILIACS
1983
AIDS CASES ASSOCIATED WITH BLOOD TRANSFUSIONS
PHS GUIDELINES FOR PREVENTION OF AIDS IN BLOOD CENTERS AND
BETWEEN PERSONS
PHS EXECUTIVE COMMITTEE ON AIDS (LATER THE PHS EXECUTIVE TASK
FORCE) ESTABLISHED
TOLL-FREE NATIONAL AIDS HOTLINE ESTABLISHED
1984
AIDS VIRUS IDENTIFIED AS CAUSE
HEAT TREATMENT OF PRODUCTS FOR HEMOPHILIACS RECOMMENDED
1985
AIDS ANTIBODY BLOOD TESTS LICENSED
SCREENING OF THE NATION'S BLOOD SUPPLY BEGUN
FIRST INTERNATIONAL CONFERENCE ON AIDS HELD IN ATLANTA, GEORGIA
1986
PRESIDENT REAGAN DIRECTED THE SURGEON GENERAL TO ISSUE A REPORT
ON AIDS
PHS COOLFANT ACTION PLAN PUBLISHED
SURGEON GENERAL'S "REPORT ON AIDS" ISSUED
EXPERIMENTAL AIDS DRUG, AZT, APPROVED FOR USE AS INVESTIGATIONAL
NEW DRUG
PHS COUNSELING AND TESTING GUIDELINES PUBLISHED
1987
AZT (ZIDOVUDINE) LICENSED
PRESIDENT REAGAN APPROVED THE AIDS EDUCATION AND INFORMATION
PRINCIPLES
PHS AIDS INFORMATION/EDUCATION PLAN PUBLISHED
HIV COUNSELING AND TESTING IN THE PREVENTION OF AIDS
EXPANDED
PRESIDENT REAGAN CALLS FOR COMPREHENSIVE NATIONAL PROGRAM TO
DETERMINE EXTENT OF HIV INFECTION
PRESIDENT REAGAN APPOINTED THE COMMISSION ON THE HUMAN
IMMUNODEFICIENCY VIRUS EPIDEMIC
PRELIMINARY TESTING OF EXPERIMENTAL VACCINE IN HUMAN VOLUNTEERS
BEGUN IN UNITED STATES
PRESIDENT REAGAN DECLARED OCTOBER AIDS AWARENESS AND PREVENTION
MONTH
PRESIDENT REAGAN APPROVED THE FAMILY OF SURVEYS TO DETERMINE HIV
PREVALENCE AND TO CONTINUE COLLECTION OF DATA
REVIEW OF CURRENT KNOWLEDGE ABOUT HIV INFECTION PRESENTED
EXISTING SOURCES OF DATA ON AIDS CASES AND HIV
INFECTION FOR NOVEMBER 30 REPORT
National reporting of AIDS cases
HIV serologic surveys and studies in high risk and general population groups
STD clinics
Drug treatment centers
Hemophilia treatment centers
Heterosexual partners of persons at high risk
Cohorts of homosexual men
Prisons
Prostitutes
Women's health clinics
Sentinel hospitals
Blood donors
Civilian applicants for military service
Job Corps entrants
Newborn screening (Massachusetts)
Cases of AIDS in the United States
by Quarter of Report to CDC, November 2, 1987
5000
4000
Cases
3000
2000
1000
0
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
1981
1982
1983
1984
1985
1986
1987
Quarter of Report
*Reporting for the fourth quarter of 1987 is incomplete.
Incidence of AIDS Cases by State, Per Million Population
as of November 2, 1987
137
43
11
9
89
56
33
1
44
15
160MA
7
33
693
16
101 RI
43
160 CT
21
92
346 NJ
125
24
45
174 MD
49
38
103
93 DE
372
149
21
38
88
1427 DC
66
26
49
28
89
51
51
32
52
23
48
159
176
134
PR
64
278
165
123
Cases of AIDS by Age and Gender, United States
November 2, 1987
2000
1750
1500
Males
1250
(N=41,336)
1000
750
500
250
Cases
0
1000
750
Females
(N=3,421)
500
250
0
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
Age at Diagnosis
Comparison of U.S. AIDS Patients and the U.S. Population
by Race/Ethnicity, November 2, 1987
White
Hispanic
Black
Other
60.6%
79.6%
0.9%
2.5%
13.6%
6.4%
24.8%
11.5%
AIDS Patients
Population-1980 Census
(44,757)
(226,545,805)
Adult Cases of AIDS, by Transmission Category
United States, November 2, 1987
(N=44,129)
Transmission Category:
Homosexual/Bisexual Men* (73.7%)
IV Drug Users (16.4%)
Hemophiliac Coagulation Disorder (0.9%)
Heterosexual Contact (3.9%)
Transfusion Associated (2.1%)
Other/None of the Above (3.0%)
*10.2% of homosexual/bisexual men
reported having used IV drugs.
Cases of AIDS in the United States, by Quarter-Year
Projected from Cases Reported as of April 30, 1986 and
Shown with Cases Reported as of November 24, 1987
30000
25000
Projected cases
Cases reported through April 1986t
20000
Cases reported May 1986 - November 1987++
Cases
15000
68% Confidence Bounds
10000
5000
0
Pre 81
81
82
83
84
85
86
87
88
89
90
91
Year
Projected cases are by quarter of diagnosis.
Reported cases are by quarter of report, lagged two months to account for reporting delays.
#
Reporting for the final quarter is incomplete; total includes 1,320 cases reportable only under
the revised AIDS surveillance definition.
The Clinical Spectrum of HIV Infection
"Iceberg"
CDC-Reportable AIDS
Opportunistic Diseases
and Related Conditions
Nonspecific signs and symptoms
of illness secondary to
immunodeficiency.
Immune complex disease
(e.g. thrombocytopenia)
Asymptomatic infections
Prevalence of HIV Antibody in Military Recruit Applicants
Sex-Adjusted for Population of Age 17-59 Years, by State
October 1985 - September 1987
(Percent Positive)
.04
.00
.00
.00
03
.05
.04
.01
.03
13 MA
.01
.04
.34
.04 RI
.02
.05
.11 CT
.04
.08
.30 NJ
.03
.10
.04
.33 MD
.04
.10
.07
.19 DE
14
.06
.08
.07
.96 DC
.05
.12
.03
.08
.06
.06
.05
.04
.08
.09
.04
.07
.15
.12
.10
PR
.02
.18
.11
.47
Source: Department of Defense
HIV Prevalence Among Red Cross Blood Donors,
United States, April 1985 - May 1987
0.12
0.11
First Time Donors
0.10
(N=1,514,369)
0.09
Percent Antibody Positive
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
All Donors
(N=9,671,411)
0.00
A M J J A S O N D J F M A M J J A SONDJFMAM
85
86
87
Months
Source: American Red Cross, centers with data available since April of 85
Number of Surveys/Studies
0
1
2
3
4
5
6
7
8
9
10
HIV Seroprevalence (percent)
0-4 5-9' 10-14 15 15-19' 20-24 25 25-29' 30-34 35 35-39 39' 40-44 45 45-49' 50-54 55-59 60-64 65-69 70-74
Surveys and Studies 1984 - 1987
HIV Antibody Prevalence in Homosexual and Bisexual Men
HIV Antibody Prevalence in IV Drug Users
Surveys and Studies 1984 - 1987
34
32
30
28
26
Number of Surveys/Studies
24
22
20
18
16
14
12
10
8
6
4
2
O
0-4
5-9'
10-14
15-19'
20-24
25-29'30-34
35-39'
40-44
45-49'
50-54
55-59'
60-65
65-69'
HIV Seroprevalence (percent)
RELATIVE RISKS FOR AIDS AND RELATIVE RATES OF HIV
INFECTION PREVALENCE FOR BLACKS AND HISPANICS
COMPARED TO WHITES
BLACKS COMPARED
HISPANICS COMPARED
STUDY GROUP
TO WHITES
TO WHITES
AIDS Cases¹
All AIDS cases
3 to 1
3 to 1
AIDS in heterosexuals
12 to 1
9 to 1
AIDS in heterosexual
IV drug users
20 to 1
21 to 1
AIDS in female partners
of IV drug users
23 to 1
29 to 1
AIDS in children of
IV drug users
25 to 1
17 to 1
HIV Infection²
Military applicants
7 to 1
3 to 1
Blood donors
12 to 1
3 to 1
Sentinel hospitals
3 to 1
Homosexual/bisexual men
3 to 1
IV drug users
4 to 1
3 to 1
1
Relative risks of reported AIDS cases based on 1980 U.S. Census data.
2
Relative rates of HIV seroprevalence in surveyed persons.
HIV Incidence in Cohort Studies of Homosexual Men,
Percent of Uninfected Men Becoming Infected, by Year
25
20
Percent Newly Infected
15
10
5
O
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
Year
Rates of Primary/Secondary Syphilis in Homosexual Men
Selected Sites, 1980-1987
75
15
Columbus,
12
New York City,
50
Ohio
9
New York
6
25
3
Rate per 100,000 Male Population
O
O
200
400
150
Denver,
300
San Francisco,
Colorado
California
100
200
50
100
O
O
20
10
15
Indianapolis,
8
Washington
Indiana
6
State
10
4
5
2
O
0
80
81
82
83
84
85
86
87
80
81
82
83
84
85
86
87
Year
HIV Seroprevalence (Percent Positive) in Homosexual Men (A),
71 IV Drug Users (B) and Hemophiliacs (C) in Selected Areas
50
83
79
37
73
36
49
40
41
1
28
25
28
ABC
5
1
2
A B -
NYC Area
Seattle-
Tacoma
A B -
- B c
ABC
A B -
ABC
74
Denver
Minneapolis
Madison-
Chicago
Boston
52
50
Milwaukee
19
16
ABC
A B -
Philadelphia-
San Francisco
Pittsburgh
73
35
48
25
4
A B -
ABC
Baltimore
Los Angeles
78
84
75
28
44
3
33
35
23
12
12
10
1
A B -
1
0
0
0
Long Beach
- B c
A B C
A B c
A B -
A B -
A B c
Cleveland-
Albuquerque
Kansas City-
Arkansas
Lexington-
Atlanta
St. Louis
Louisville
Dayton
Approximate averages from multiple recent studies.
SUMMARY OF OBSERVED HIV SEROPREVALENCE
IN HIGH RISK AND GENERAL POPULATIONS
POPULATION
HIV SEROPREVALENCE
High risk
Homosexual and bisexual men
20-50% (typical range)
IV drug users
2-60% (highly variable
depending on
geographic area)
Hemophiliacs
hemophilia A
70%
hemophilia B
35%
Heterosexual partners of
10-60%
HIV-infected persons
General population
Blood donors (first-time tested)
0.043%
Military applicants
0.14%
(age-, sex-, race-adjusted)
Job Corps entrants
0.33%
Sentinel hospital patients
0.32%
Childbearing women
0.21%
(Massachusetts statewide)
PUBLIC HEALTH SERVICE ESTIMATE OF HIV PREVALENCE IN
THE UNITED STATES BY POPULATION GROUP, 1986
ESTIMATED
APPROXIMATE
TOTAL
POPULATION
SIZE
SEROPREVALENCE
INFECTED
Exclusively homosexual
throughout life 1
2,500,000
15%-20%
375,000-500,000
Other homosexual contact1
2,500,000-
10%
250,000-750,000
7,500,000
Regular (at least weekly)
750,000
30%
225,000
intravenous drug abuse²
Less frequent IV drug use²
750,000
10%
75,000
(
Persons with hemophilia³
14,000
70%
10,000
Other groups (transfusion
recipients, other hetero-
sexuals, infants)
?
?
?
Total
1,000,000-1,500,000
1
Kinsey, et al: Sexual Behavior in the Human Male, Philadelphia, Sauders
Publishing Co., 1948; and U.S. Census data, 1980.
2
National Institute on Drug Abuse (personal communication), 1986.
3
National Hemophilia Foundation (personal communication), 1986.
REEVALUATED PUBLIC HEALTH SERVICE ESTIMATE OF HIV
PREVALENCE IN THE UNITED STATES BY POPULATION
GROUP, 1987
ESTIMATED
APPROXIMATE
TOTAL
POPULATION
SIZE
SEROPREVALENCE
INFECTED
Exclusively homosexual
throughout life 1
2,500,000
20-25%
500,000- 625,000
Other homosexual contact
2,500,000-
5%
125,000- 375,000
including highly infrequent¹
7,500,000
Regular (at least weekly)
900,000
25%
225,000
intravenous drug abuse²
Occasional IV drug use²
200,000
5%
10,000
Persons with Hemophilia A³
12,400
70%
8,700
Persons with Hemophilia B³
3,100
35%
1,100
Heterosexuals without specific
identified risks
142,000,000
0.021%⁴
30,000
Subtotal
900,000-1,270,000
Other groups (heterosexual
additional 5-10% of total
45,000- 127,000
partners of persons at high
number of infections
risk, heterosexuals born in
Haiti and Central Africa,
transfusion recipients,
other)
Total
945,000-1,400,000
1
Kinsey, et al: Sexual Behavior in the Human Male, Philadelphia, Sauders
Publishing Co., 1948; and U.S. Census data, 1980.
2
National Institute on Drug Abuse (personal communication), 1987; excludes
persons who have used drugs only once or twice.
3
Host Factors Div., CDC, and National Hemophilia Foundation (personal
communication), 1987.
4
See Text (VIII. A.).
PERSONS INFECTED WITH HIV AT THE END OF 1987,
UNITED STATES, ESTIMATED¹ FROM REPORTED AIDS CASES,
BY RATE OF DISEASE PROGRESSION
AND ASSUMED INFECTION CURVE
(with 95% confidence bounds in parentheses)
Rate of Disease Progression³
ASSUMED
INFECTION
SLOWEST
MOST LIKELY
FASTEST
CURVE
2
PROGRESSION
PROGRESSION RATE
PROGRESSION
Logistic
420,000°
420,000
420,000*
(403,000- 438,000)
(312,000- 528,000)
(268,000- 572,000)
Log-logistic
1,363,000
853,000
276,000
(918,000-1,809,000)
(186,000-1,519,000)
( 66,000- 511,000)
Damped-Exponential
1,750,000
1,649,000
1,468,000
(576,000-2,936,000)
(566,000-2,732,000)
(556,000-2,380,500)
*
chi-square goodness-of-fit p.>50
Notes:
1
Each of the estimates for the number infected has been increased by 20% to account for unreported
or unrecognized AIDS cases.
2
See text (VIII.C.) for discussion of limitations of each curve.
3
Data for disease progression are taken from a study of infected homosexual men in San Francisco.
The lower 95% confidence estimate (slowest progression rate) for the cumulative number of men
developing AIDS after each of 1-11 years was taken as 0%, 0%, 0%, 2%, 5%, 9%, 17%, 21%, 26%,
31%, 36%; the best estimate (most likely progression rate) was taken as 0%, 0%, 2%, 5%, 10%,
15%, 24%, 30%, 36%, 42%; and the upper estimate (fastest progression rate) was 0%, 0%, 4%, 8%,
15%, 21%, 31%, 39%, 46%, 52%, 58%. The rates for years 8-11 were not taken directly from the
San Francisco data but were extrapolated from prior years.
COMPREHENSIVE HIV SURVEILLANCE
NUMBER
TARGET
TESTED
DATE
ANNUALLY
National Household Seroprevalence Survey
Pilot Studies
Planning started
6/12/87
Completed
4/30/89
3,800*
National Household Survey
Recommendations to proceed or not
5/15/89
More than 50,000*
Completion
6/30/90
Family of Surveys
Sentinel Surveillance in 30 SMSAs*
Sentinel hospitals
Sexually transmitted disease clinics
Drug abuse clinics
Tuberculosis clinics
Childbearing women/newborns
Family planning clinics
Plan presented to Domestic Policy Council
9/16/87
All operational
5/30/88
1,600,000
Special Ongoing Studies
Childbearing women/newborns
Military applicants
Military active duty
Job Corps
Blood donors
Prisons
College students
Homosexual/bisexual cohort
National Health and Nutrition Examination Survey
National Health Interview Survey
Clinical specimens
Emergency rooms
All Studies Operational
6/30/88
7,700,000
#
One time testing only. Other surveys will be ongoing
in order to derive incidence (new infection) data.
Standard Metropolitan Statistical Area (SMSA)