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REMARKS BY: DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: National Conference on African Americans and AIDS DATE: February 25, 1999
I've had the privilege of knowing Phill for many years. He has what George Bernard Shaw once called the Life Force. That's the spirit that makes all things seem new again for everyone he touches. Last week I was thinking about someone else with the Life Force.
Time magazine asked if I had any suggestions for their Person of the Century. Now there are some questions I have to think long and hard about. But when it came to giving Time magazine a name, I didn't have to think at all. I simply said: Nelson Mandela.
President Mandela is one of those rare people who, when the hammer of oppression strikes, the hammer cracks. He never cracked. I mention President Mandela because as he closes out his remarkable political career, the one thing he's been talking about a lot lately is another kind of oppression: AIDS.
Our nation does not face the magnitude of the HIV/AIDS catastrophe that now confronts Africa. Nevertheless, as I'll discuss shortly, the burden of HIV/AIDS falls unequally on the African American community.
President Mandela's warning that "silence fuels this epidemic" reminds us that shame, rumor, misunderstanding - and, yes, silence, still shroud HIV/AIDS in our country, including the African American community. That is why this conference is so important. You have not been silent. But many of you have been left to wage this fight against HIV/AIDS quietly and alone. All that changes today.
Medical historians will someday write that this was the place - and black history month was the time - when African American doctors, nurses, health professionals and advocates, and their sisters and brothers in other countries, came to the forefront of the battle against HIV and AIDS. Now you are united. Now you speak with one voice. Now you act with one purpose. So let me congratulate each of you for making history today.
During the next two days, you'll be joining some of our nation's leading experts in discussing the causes, prevention, care and treatment of HIV in the African American community. You'll be hearing from a number of my colleagues: Dr. Eric Goosby, Dr. Earl Fox and Dr. Joe O'Neill.
But I want to talk with you as a partner - and I hope as a sister. Because this is a battle none of us - government, practitioner or individual human being - can win alone. We must work together. Our success depends on it. And so do the lives and futures of thousands of African Americans.
I'm not going to throw a lot of numbers at you. But there are at least two numbers that can't be ignored. African Americans make up 13 percent of our nation's population. They also make up 45 percent of all new AIDS cases. Compared with other racial and ethnic groups, African Americans have the highest rates of HIV infection, the highest AIDS mortality rate, and the highest number of productive years lost.
These trends come on top of the disproportionate rates of cancer, heart disease, and stroke suffered by African Americans. So as you know better than anyone, HIV/AIDS has come like an ill wind pushing what was already a crisis in African American life expectancy even closer to the brink. A recent study by Dr. David Kindig and his colleagues at the University of Wisconsin Medical School notes that HIV is now one of the leading contributors to the gap in life expectancy between African Americans and whites.
If you're an African American male, you're almost 8 times more likely to have AIDS than a white male. And if you're an African American woman you're almost 20 times - let me repeat that - 20 times more likely to have AIDS than a white woman standing next to you. In fact AIDS - a preventable disease - is now the second leading cause of death for African American women in their most productive years of life, and the leading cause for African American men the same age.
But there is another side - a more hopeful side - to this troubling picture. We're no longer in the early days of this disease when our understanding of HIV was negligible - and our ability to fight AIDS was non-existent. Today, because of the skill and caring of African American doctors, nurses, advocates and all other medical professionals, the idea of people living with AIDS is neither a slogan nor a dream.
Working together, we've cut the overall death rate from AIDS almost in half in just one year - knocking AIDS out of the top ten causes of death for the first time since the late 1980s. Perinatal transmission of AIDS is down almost three-quarters. Combination drug therapies are not only extending life - they're allowing people with AIDS to return to work - and to the lives - they led and loved. We've nearly tripled funding for the Ryan White Care Act. This year we will spend nearly 8 billion dollars on HIV/AIDS.
But we're not just focusing on treating and preventing AIDS. We want to wipe this disease off the face of the earth. That's why two years ago, the President issued a national call to arms to find a vaccine for AIDS within ten years. You know how important these steps are. All of them are bringing us closer to the day when we can join hands and celebrate the end of this dreaded disease.
But none of this progress means anything if AIDS simply passes from being a crisis for our nation to a crisis sitting in the lap of the African American community. I believe that is morally unacceptable.
So let me be clear: Victory measured by any standard other than the total elimination of AIDS is no victory at all. We must eliminate HIV/AIDS. That's why last year, President Clinton specifically called for the elimination of racial health disparities in six critical areas - including HIV/AIDS. This commitment to closing the gap in health between whites and minorities comes on top of our all out assault on HIV/AIDS in the African American community.
That assault has been guided by three basic principles: Be comprehensive. Be inclusive. And, most important, be unwavering until victory.
Let me talk briefly about all three.
Principle One: Have a comprehensive strategy.
We've learned from some of you that the only way to beat HIV/AIDS in the African American community is to attack this disease from every direction. That's exactly what we must do - and do together. Put out good prevention messages that are funded nationally - but designed locally.
Together - expand research that takes into account the needs of people living in urban communities.
Together - fund faith-based services.
Together - train health professionals at historically black colleges and universities.
Together - leave no stone unturned in the fight to prevent and treat HIV/AIDS.
The fact is, we're teaming up with advocates, scientists, health professionals, social organizations, business and labor leaders, and people living with HIV/AIDS to beat this disease. Forty percent of the participants in AIDS clinical trials are now African American. We're helping low income African Americans without private insurance or Medicaid purchase the lifesaving drugs they need.
We've created HIV/AIDS treatment guidelines - that are regularly updated - and you can download from the Web to help you treat your patients using the most up-to-date information.
We're working to break the link between substance abuse and AIDS - by funding comprehensive substance abuse treatment programs at the local level - and specifically targeted to African Americans.
Our Office on Women's Health and our Office of HIV/AIDS Policy are meeting with each other - and with grassroots women's organizations - to come up with specific strategies for fighting HIV/AIDS in African American women.
When I talk about a comprehensive approach to fighting AIDS - I don't just mean programs. I mean leaders too. I'm extremely proud of the team we've put together - starting with Dr. David Satcher, our new Surgeon General. Dr. Satcher has made fighting HIV in the African American community a central part of his life's work. He understands what this disease is doing to minority communities - and frankly to Africa from where he just returned. Dr. Satcher has both the skill and the moral authority to lead us toward an end to this epidemic.
Another member of our team is Dr. Margaret Hamburg. Dr. Hamburg was formally Commissioner of Health in New York City. Today, her many duties include making sure that the President's goal - and your goal - of eliminating health disparities is met.
And with me this morning is Dr. Marsha Martin - my special advisor on HIV/AIDS and homelessness. When Marsha talks, I listen.
Principle Two: Be inclusive when decisions are made.
We don't want to impose programs and ideas on the African American community. We want to listen, learn, and fight as a team.
So, our strategy is not top down. It's bottom up. It's about helping you fund your projects. Implement your ideas. Support your prevention and treatment programs. That's the strategy we built on as we've worked with the Congressional Black Caucus. The Caucus is very concerned that African American are not benefiting equally from the available treatment and good prevention strategies that have brought down the mortality rate - and rate of new infections - for other communities. Frankly, they have a point.
One recent study concluded that among HIV infected adults living with an advanced stage of the disease - a disproportionate number are male, African American and poor. We also know that African Americans are less likely to be tested for HIV; have less access to the newest treatment regimens; and have experienced a less sharp decline in death rates following the introduction of new anti-retroviral therapies.
So last October, the President teamed up with the CBC and announced an additional 156 million dollars to enhance the federal response to HIV/AIDS in racial and ethnic minority communities. These funds will support leaders on the front line. Leaders like you. And their purpose is to build on progress already made by hundreds of community based organizations in the African American community - where the real work of fighting AIDS is taking place. I should add, we're asking for even more funds next year to address disparities in HIV/AIDS. A full 171 million dollars.
We also have Crisis Response Teams that are targeting minority communities with a high concentration of HIV. The teams will only come in at the request of political and health leaders at the community level - and will include experts trained to meet the specific needs of each community. Finally, our Office of Minority Health, works closely with African American communities across the United States - as a resource for information and referral, and as a vehicle for receiving policy guidance from advocates and health professionals.
Principle Three: Be absolutely unwavering in our determination to bring this epidemic to an end.
Churchill said it best: Never, never give up.
That's the attitude you have about HIV/AIDS. My colleagues in the Administration and I share it every waking minute. Still, I'm not here to tell you we can win this battle today, this month or even this year. But I am here to tell you: Together, we will win, and we won't quit until we do.
With your strong voices - and help from Congress - we've increased funding for AIDS-related programs by more than 90 percent since 1993. Our budget request for next year is close to 4.5 billion dollars, including an additional 100 million dollars for Ryan White, money that will boost the areas most important to the African American community. That means prevention. Encouraging people to know their status. Early intervention. Access to quality care. And purchasing drugs that fight HIV.
But, again, this fight is not just about programs or money. It's about heart. And it's about character.
I can tell you, the President, the Vice President and the First Lady have all spoken passionately and eloquently about how we cannot turn a blind eye to what HIV/AIDS is doing to African Americans. The fact is, at the end of our lives, we will all be judged by our commitment to ending this terrible epidemic.
We absolutely must not fail.
I've come full circle, because as I said at the beginning of my remarks, the way to make sure we don't fail is to continue to work as partners. You are the leaders of this battle. We know that - and we need you to stay involved.
For that reason, I urge you to learn as much as you can about identifying, preventing and treating HIV/AIDS in the African American community. Download our treatment guidelines. You can find them at www.hivatis.org. Encourage your patients to get tested and know their HIV status. That includes pregnant women. Ask questions - and be on the look out for risky behaviors that can lead to HIV infection.
Work with your local communities - in schools, civic organizations, businesses and homes. Also work with our Health Resources and Services Administration. We can help you with referrals; finding community based services; and funding. Use your skills, training and knowledge of the African American community to first close the gap in who gets AIDS, and then to close the door on AIDS.
After seeing the AIDS Quilt, a student in Virginia Beach recently wrote this about AIDS: "I lost my uncle to this disease a few years ago. It frightens me to think that some people could have been spared for this disease if only they had been educated."
Another student, this one from Wellsville, Missouri wrote: "I don't think the kids at my school actually realize how many people have died from AIDS, and how many die each year. Everybody thinks it can't happen to them - but it can." That's the real reason we're here today.
To teach. To prevent. To stop the fear. To make sure it doesn't happen to anyone anymore.
This conference - and your leadership - will bring that day, if not within sight, certainly within reach.
Thank you.