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“We know there is hope. It seems to me we have a moral obligation to act on what we know and proceed toward early intervention.”

—Then-Rep. Barbara Boxer (D-CA)

Enactment

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The Drumbeat for Early Intervention

Then-Representative Barbara Boxer (D-CA), calling for the Federal Government to ramp up its commitment to providing care to people in need, said, “We invested millions. We know there is hope. It seems to me we have a moral obligation to act on what we know and proceed toward early intervention.”5

In his testimony, Mervyn Silverman of the American Foundation for AIDS Research stressed the critical need for early intervention services. “The importance of early medical intervention has dramatically increased the number of Americans urgently in need of HIV-related care—up to 1 million Americans are in imminent risk of developing very serious and costly AIDS-related illnesses unless this early intervention is available to slow the progression of their HIV infection. Early intervention is but a cruel myth if the treatments are available and people cannot afford them. Medicaid funding for early intervention is essential.”5

The drumbeat for early intervention echoed throughout both hearings, as did the call for emergency relief to urban areas hardest hit by AIDS. It was, according to the witnesses, time to respond to AIDS like other natural disasters.

Chart: Aids Cases and Deaths
View the data
AIDS Cases and AIDS Deaths for All Age Groups, 1981-1990
Year AIDS Cases AIDS Deaths
1981 314 134
1982 1,113 448
1983 3,001 1,476
1984 6,049 3,382
1985 11,359 6,734
1986 18,494 11,626
1987 27,558 15,573
1988 33,590 19,882
1989 38,154 25,978
1990 38,280 27,311
Source: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. January 1992:17. Table 12.

“Epicenters of this disease must be considered natural disaster areas and be eligible for the type of emergency funding we would afford a drought in Kansas, a flood in Texas, . . . an earthquake in San Francisco.”

—Pat Christen

HIV/AIDS Viewed as “Natural Disaster”

“Epicenters of this disease must be considered natural disaster areas and be eligible for the type of emergency funding we would afford a drought in Kansas, a flood in Texas, . . . an earthquake in San Francisco,” said Pat Christen, executive director of the San Francisco AIDS Foundation. “AIDS should be considered no less a natural disaster than any of these other tragedies . . . In the same way that we spread the cost of the drought, flood or earthquake over the whole population to assist those regions hardest hit by such anticipated disasters, we must also spread the cost of AIDS over the entire nation.”5

The inadequacy of the health care safety net and the need for more Federal support to expand the availability of HIV treatment were not new stories. Indeed, Congress had acted on HIV/AIDS care in a more limited way 2 years earlier with several provisions in the wide-ranging Health Omnibus Programs Extension (HOPE) of 1988. In addition to provisions on HIV research and prevention, the legislation included grants for home- and community-based health services, subacute care demonstration projects, and anonymous counseling and testing programs. These programs were limited, and funding was only authorized for 2 or 3 years. As Stephen Bennet, CEO of AIDS Project Los Angeles, testified at the field hearings, “Our home health care agency is funded with pilot project money. It is all over next year; it is all over . . . All of the money is capricious money, fragile money. There is no ongoing streams [sic] of funding to provide services for people.”5

And so, in the spring of 1990, as the AIDS advocacy community was gearing up to build a broad consensus for action, leaders on AIDS issues in the House and Senate prepared to introduce major legislation that would provide that funding stream. The first iterations of the Senate (S. 2240) and House (H.R. 4470) bills—introduced in early March and April, respectively—included disaster relief for hard-hit urban areas, but the two bills also had significant differences.

The House Takes Aim at Early Intervention and Medicaid

The House bill, known as the AIDS Prevention Act of 1990, had as its centerpiece two provisions aimed specifically at getting more people tested for HIV and helping those in all stages of HIV disease get access to early intervention in hopes of slowing disease progression. One provision would have sent funds to the Centers for Disease Control and Prevention to provide State grants for HIV counseling, testing, and treatment. The other was aimed specifically at giving states the option of providing Medicaid to people with HIV.

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