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Jennifer Klein's Files
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SENT BY:Xerox Telecopier 7020 ; 5- 1-96 :10:04AM ;
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Talking Points on Ryan White CARE Act
Today's New York Times story on the Ryan White CARE Act reauthorization is a
misleading and incomplete account of the bipartisan agreement that has been I ached.
Background
Approximately 7,000 HIV-positive women give birth in the U.S. each year. 1 [istorically, an
average of 25 percent of the infants born to those women are infected as well. In 1993,
researchers at the NIH found that treatment of HIV-positive pregnant women with AZT
during pregnancy and childbirth and treatment of the newborn with AZT for S X weeks can
reduce the risk of perinatal infection by 67 percent. The Public Health Servic : issued
guidelines recommending that all pregnant women be counseled on the benefit of HIV
testing and AZT treatment and that they be offered voluntary HIV antibody te: ting.
The CDC recently reported that the number of pediatric AIDS cases occurring in the U.S. in
1995 declined to 800 from a total of 900 in 1994. A separate study in North Carolina
indicates that the rate of perinatal transmission declined from 21 percent of all infants born to
HIV-positive mothers in 1993 to just 8.5 percent in 1994. Results from hospi als in major
urban centers -- Miami, Atlanta, and New York -- show similar results.
The Administration View
The President has strongly supported reauthorization of the Ryan White CARI Act, as a vital
source of medical care and support services to Americans living with HIV/AIDS. The
Administration believes that the Public Health Service guidelines are the apprc priate
approach to reducing the incidence of perinatal HIV infection. The conference agreement
appears to give those guidelines an opportunity to prove their effectiveness. V'e have already
seen evidence that they are working in communities with high rates of perinat: 1 transmission.
We also believe that these guidelines will remain the standard of care in the U.S.
The Conference Agreement
The conference agreement calls for the following:
Authorizes $10 million to assist states in implementing the Public Heal h Service
guidelines, which call for voluntary counseling and testing for all pregr ant women.
Within four months of enactment (Sept. 1996), the Centers for Disease Control and
Prevention, in consultation with the states, must develop and implemen a system for
states to gather data related to perinatal transmission of HIV to docume nt reduction in
such transmission.
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The Secretary of HHS is directed to contract with the Institute of Medi ine to evaluate
the extent to which state efforts have been effective in reducing perinat 1 transmission
of HIV and to analyze existing barriers to further progress.
Within two years of enactment (May 1998), the Secretary shall report t nese findings
to Congress along with any recommendations made by the Institute of ] Medicine.
After two years and four months (Sept. 1998), the Secretary of HHS W ill determine
whether mandatory HIV testing of all infants born in the U.S. whose n others have
not undergone prenatal HIV testing has become routine practice in the provision of
health care in the U.S. This determination will be made in consultation with states
and experts.
If the Secretary of HHS determines such mandatory testing has become routine
practice, after an additional 18 months (March 2000), a state will no lo ager receive
Title 2 Ryan White funding unless it can demonstrate one of the follow ing:
-- A 50 percent reduction in the rate of new AIDS cases resulting from perinatal
transmission, comparing the most recent data to 1993 data (a comparat le measure is
established for states with fewer than 10 cases);
-- At least 95 percent of women who have received at least two prenats 1 visits prior to
34 weeks gestation have been tested for HIV; or,
-- A program for mandatory testing of all newborns whose mothers hav e not
undergone prenatal HIV testing.
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HIV Testing of Newborns/Ryan White CARE Act Reauthorization
May 1, 1996
The NY Times reported today that House and Senate conferees have reached I greement on a
measure attached to the Ryan White CARE Act Reauthorization that would SV entually require
states to begin mandatory testing of newborns for HIV, if voluntary counseling programs
failed to adequately lower the rate of HIV infection in newborns.
The conference agreement emphasizes the voluntary approach to couns ling and
testing recommended by the Public Health Service, first and foremost, and we support
that approach.
Also, the agreement authorizes $10 million to assist states in implemen ting the Public
Health Service Guidelines and provides two and a half years for states to demonstrate
that the voluntary approach is working effectively to reduce the rate of HIV infection
in newborns.
Do you support the conference agreement?
We have not yet seen the final bill. but barring any last minute surpris IS being added
to the legislation. we are very pleased that this compromise was reache d. We believe it
is vitally important to continue this program which offers medical care to hundreds of
thousands of Americans living with HIV and AIDS. We also believe t] at voluntary
testing of newborns is the best way to reduce their HIV-infection rate and we are
pleased that this compromise will give states the opportunity to prove hat the Public
Health Service Guidelines are working.
It is possible that mandatory testing could kick-in in later years. What is your position?
We believe that the Public Health Service Guidelines and voluntary te ting are the
most effective way to reduce the number of babies born infected with HIV. We have
been encouraged by recent studies which have shown a reduction in th : rate of
infections since the developement and introduction of the Public Healt I Service
Guidelines. This legislation provides ample opportunity for states to pt ove that these
guidelines are working.
We all have the same goal: to reduce the percentage of babies born in ected with HIV.
If it is shown in coming years that our current approach has not work d, than we will
have to try another strategy. This legislation indicates what that strateg y might be
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Facts on HIV -- Public Health Service Guidelines:
Approximately 7,000 HIV-positive women give birth in the U.S. each year.
Historically, an average of 25 percent of the infants born to those wor en are infected
as well.
In 1993 researchers at the NIH found that treatment of HIV positive P 'egnant women
with AZT during pregnancy and childbirth and treatment of the newbc rn with AZT for
six weeks can reduce the risk of mother-child infection by 67 percent.
Immediately, the CDC and others began informing doctors and women about the
importance of early detection and began drafting guidelines. In Spring of 1995 the
Public Health Service issued guidelines recommending that all pregnar t women be
counseled on the benefits of HIV testing and AZT treatment and that t ley be offered
voluntary HIV antibody testing.
The Public Health Service Guidelines voluntary approach has showed 1 esults. The
CDC recently reported that the number of babies diagnosed with AIDS in the U.S.
declined from 900 in 1994 to 800 in 1995.