On April 26, the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, and International Security held a hearing on federal funding for domestic HIV/AIDS programs.
Chair Tom Coburn (R-OK) stressed the importance of early diagnosis, explaining that “fear-based policies continue to serve as deterrents to testing and diagnosis and deny the benefits of those miraculous AIDS drugs that the early activists fought so hard to make available to thousands of Americans today.” He expressed his support for a New York law that requires HIV tests for every newborn and treatment for affected mothers and their infants: “The proportion of all pregnant women being aware of their HIV status at delivery has increased from 64 percent in 1997 to 95 percent in 2004. The number of HIV-infected infants in New York dropped from more than 500 a year in the early 1990s to 8 in 2003. Furthermore, more mothers and impacted infants are receiving treatment.”
Associate Administrator for the HIV/AIDS Bureau at the Health Resources and Services Administration Deborah Parham Hopson said that the HIV/AIDS epidemic has spread most rapidly in minority communities, noting that it is the leading killer of African American men between the ages of 25 and 54. She stated that “the disease is also taking an increasing toll on women in the U.S., accounting for a growing percentage of new AIDS cases, rising to 27 percent of the cases diagnosed in 2004. Women of color, particularly African American women, have been hard hit and represent the majority of new AIDS cases among women, an estimated 82 percent. The primary mode of HIV transmission is sexual contact, followed by injection drug use for women.” Dr. Hopson highlighted the success of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, including a program aimed at preventing mother-to-child transmission of the virus: “Our medical care providers reported serving 5,375 HIV-positive pregnant women in 2004. Fifty-one percent were in care during the first trimester of their pregnancy. The percentage of pregnant women receiving prenatal care rose to 76 percent by the second trimester. Eighty-one percent receive antiretroviral (AVR) treatment to prevent transmission of HIV to their child.”
Kevin Fenton, director of the National Center for HIV, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC), lauded the “dramatic” decrease in mother-to-child HIV transmission, but noted that “transmission continues to occur mostly among women who lack prenatal care or who are not offered voluntary HIV counseling and testing during pregnancy. Even though CDC recommends screening of all pregnant women, studies from a limited number of jurisdictions have shown that such screening is not yet universal. With universal screening of pregnant women in combination with prophylactic administration of antenatal antiretroviral drugs, perinatal transmission rates could be reduced to less than 2%.” He explained that new CDC guidelines “will recommend routine (or opt-out) HIV screening in health care settings. Under this approach, the patient is notified that HIV screening is routine for all patients and has the opportunity to ask questions and decline testing. HIV testing should not take place without a patient’s knowledge.”
Summarizing a report on Ryan White programs, Director of Health Care for the Government Accountability Office (GAO) Marcia Crosse stated, “All 50 states, the District of Columbia, and Puerto Rico have policies or have enacted laws regarding HIV testing of pregnant women to help reduce perinatal HIV transmission. The majority of states have adopted a policy of voluntary testing of pregnant women that is consistent with CDC’s guidelines.” Explaining that GAO contacted eight states to discuss their testing procedures, she added, “Three states routinely include HIV tests in a standard battery of prenatal testing, but a woman can refuse to be tested for HIV. In the other five states, a woman is counseled during prenatal care and must consent to an HIV test, usually in writing, before a test can be performed. Of the eight states that we contacted, three Connecticut, New Jersey, and New York collect the data needed to determine statewide perinatal transmission rates. Six of the eight states we contacted reported that the number of HIV-positive newborns declined in their state from 1997 to 2002.”
The subcommittee also heard testimony from Beth Scalco, director of HIV/AIDS programs for the Louisiana Office of Public Health. She summarized the state’s efforts to prevent mother-to-child HIV transmission and noted that there were only three reported cases in 2003: “Louisiana requires written consent for HIV testing, which has not been a deterrent in testing pregnant women who are unaware of their status. We treat each case of perinatal transmission as a sentinel event and follow up to determine where the woman fell through the cracks in the health care system. We continue to find that the lack of access to prenatal care and fear of seeking care for non-citizens and substance using women remains the primary barrier to eliminating perinatal acquired infections.” Ms. Scalco suggested that “one way to further reduce cases is to provide hospitals serving the un- and underinsured with HIV rapid tests for use in the labor and delivery setting. This would require resources for the rapid test kits as well as training for hospital staff on counseling and administration of the screening tests.”
On April 27, the House Energy and Commerce Subcommittee on Health held a hearing on the reauthorization of the Ryan White CARE Act. Several of the same witnesses testified before the subcommittee, including Dr. Fenton and Ms. Crosse. Members of the subcommittee focused their discussion and comments on concerns regarding proposed changes to the funding formulas under Titles I and II of the Ryan White CARE Act.
