RYAN WHITE CARE REAUTHORIZATION ACT; Congressional Record Vol. 141, No. 122
(Senate - July 26, 1995)

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[Pages S10701-S10709]
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                  RYAN WHITE CARE REAUTHORIZATION ACT

  The Senate continued with the consideration of the bill.
  Mrs. BOXER. Mr. President, thank you so much. I rise in support, very 
strong support, of the Ryan White CARE Act. I want to thank my friend 
and colleague from Massachusetts for giving me just a short period of 
time to make a few remarks.
  I hope I will not have to rush back to the floor to defend against 
harmful amendments and mean-spirited amendments that attempt to drive a 
wedge between Members.
  The way I view life, we are all God's children, and when we are sick, 
we should help each other. That is what this bill is all about.
  I also want to thank the Senator from Kansas, the chairman of the 
committee, for moving this legislation to where it is today. It 
certainly means a lot to many people across this great country that we 
are responding to the AIDS epidemic.
  Indeed, it is an epidemic. An estimated 150,000 people infected with 
HIV are living in California. That is a huge number of people, Mr. 
President, who are looking to Members for help. We cannot solve every 
problem for every person. We know that. But the Ryan White CARE Act is 
the basis for having matching dollars flow into our communities, to 
help those who need it most. The Ryan White CARE Act provides funding 
for health care and supportive services for people living with AIDS.
  Title I of the act talks about the cities that are under great stress 
and great duress because of this epidemic. In California, we have seven 
title I cities: San Francisco, Los Angeles, Oakland, Anaheim in Orange 
County, Riverside/San Bernardino, San Diego, and Santa Rosa/Petaluma. 
Two more cities, San Jose and Sacramento, unfortunately, are expected 
to qualify for funding next year. I say ``unfortunately'' because it 
means that the devastation of AIDS continues to spread to new cities--
not only in my State of California, Mr. President, but across this 
great Nation.
  Through this act, we provide funding for statewide programs that 
reimburse patients for the cost of medicine. They provide insurance 
coverage and health and supportive services. And, title III(B) supports 
community-based health care clinics that are so important to outpatient 
services.
  Title IV, Mr. President, supports pediatric, adolescent, and family 
HIV care programs.
  Mr. President, at this point I want to mention a name of a woman who 
died who had dedicated her life to making sure that we paid attention 
to pediatric AIDS. That is Elizabeth Glaser, one of the greatest people 
I have ever met in my entire life. I feel blessed that somehow I 
crossed her path in my life.
  This is a woman who saw tragedy, who got the HIV virus through a 
transfusion, and unknowingly--because it was so early in the epidemic--
passed it on to two children. Her husband, Michael, who has taken up 
the cause, has lost so much love from his life, but yet he remains 
dedicated to making sure we find a cure for AIDS, and that we prevent 
the AIDS virus being transmitted from the pregnant woman to her child.
  We are seeing some breakthroughs, Mr. President, in this regard. The 
early use of AZT seems to work in many, many cases so that the children 
do not get HIV and they are born healthy.
  It is very important that we continue the Ryan White CARE Act and all 
the titles in the Ryan White Act. We know the Ryan White CARE Act is 
cost effective. The lifetime cost of treating a person with AIDS is 
over $100,000, with an average yearly cost of $38,000. People say, why 
do we spend money in the Federal Government? In this case and in other 
cases we could point to, we really save money in the end, because this 
act works to keep people out of the hospital where the care is the most 
expensive. It allows individuals to continue on with productive lives 
in their communities.
  One California study found that individuals receiving managed 
outpatient care services spent 8 less days in the hospital, saving 
$22,000 per person, or a total of $13 million in health care costs per 
year.
  Mr. President, I hope that my colleagues on the committee are aware 
of this program supported by the Ryan White CARE Act. Senator Feinstein 
mentioned it in her wonderful opening remarks today. There is a program 
that operates in California called Project Open Hand. Saturday, I went 
to visit the program. I was really moved to see the kind of community 
spirit that this program promotes. We talk about saving money. This 
program feeds people with HIV and AIDS who need that kind of help, 
people who may be too tired or too sick to cook healthful meals for 
themselves.
  It is interesting to note that there are huge donations to Project 
Open Hand, and an enormous number of volunteers. When we look over the 
budget, 18 percent of the budget comes from Ryan White funds, but all 
of rest of it flows into the program in a 5-to-1 ratio. The Ryan White 
money brings in a match of almost 5 to 1 to Project Open Hand, which 
serves more than 1,000 people every day. It is extraordinary to see the 
way it is done.
  I watched them prepare the meals there. They have different diets for 
different people. Some have to be no salt, some low salt--and it is all 
done in a way that is so efficient. So many volunteers give of 
themselves.
  Mr. President, even with Ryan White funds, title I cities have 
tremendous unmet needs. For example, in California, 62 percent of those 
in need of HIV primary care do not receive those services in Los 
Angeles; 73 percent of people with HIV in Orange County cannot get case 
management services; 45,000 publicly-funded home health care visits are 
needed for people with AIDS and HIV in Alameda County and there are no 
funds to help people with their transportation costs. They have no way 
to get to outpatient clinics.
  Mr. President, 40 percent of HIV infected individuals in Riverside 
and San Bernardino County--which we call the inland empire in 
California, that is inland from the coast--40 percent of those HIV-
infected individuals there are receiving services through the Ryan 
White CARE Act because they have no health insurance whatsoever.
  In San Diego, we have at least 900 additional people with AIDS in its 
system who were diagnosed and reported elsewhere. In other words, they 
came from Mexico and other areas to get treatment in San Diego, so 
there is a terrible problem there.
  An estimated 1,000 people with HIV are homeless in San Francisco.
  So, in conclusion, to my friends whom I thank so very much for 
bringing this bill forward, this bill is crucial. It is crucial to 
people with HIV 

[[Page S10702]]
and AIDS. And I want to point out something that is often lost. The 
groups today that are most at risk are heterosexual women and our young 
people. So, if there is an attempt on this Senate floor to ghettoize 
this disease, I will be back to speak out. Again, we are all God's 
children. We must help each other. We are all Americans. We are in this 
together. We must confront AIDS forcefully and directly, provide the 
necessary funding that will be matched by States and localities, and a 
very generous private sector.
  So I am very pleased to be here in support of this bill.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, we had many of the opening statements 
on Friday and are prepared to move forward with amendments now. The 
Senator from North Carolina [Mr. Helms] has suggested I go ahead with 
an amendment.


                           Amendment No. 1852

 (Purpose: To provide for the adoption by States of the CDC guidelines 
                          for pregnant women)

  Mrs. KASSEBAUM. Mr. President, I send an amendment to the desk and 
ask for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Kansas, [Mrs. Kassebaum], for herself and 
     Mr. Kennedy proposes an amendment numbered 1852.

  Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the appropriate place, insert the following new section:

     SEC.   . CDC GUIDELINES FOR PREGNANT WOMEN.

       (a) Requirement.--Notwithstanding any other provision of 
     law, a State described in subsection (b) shall, not later 
     than 1 year after the date of enactment of this Act, certify 
     to the Secretary of Health and Human Services that such State 
     has in effect regulations to adopt the guidelines issued by 
     the Centers for Disease Control and Prevention concerning 
     recommendations for immuno- deficiency virus counseling and 
     voluntary testing for pregnant women.
       (b) Application of Section.--A State described in this 
     subsection is a State that has--
       (1) an HIV seroprevalance among child bearing women during 
     the period beginning on January 1, 1991 and ending on 
     December 31, 1992, of .25 or greater as determined by the 
     Centers for Disease Control and Prevention; or
       (2) an estimated number of births to HIV positive women in 
     1993 of 175 or greater as determined by the Centers for 
     Disease Control and Prevention using 1992 natality 
     statistics.
       (c) Noncompliance.--If a State does not provide the 
     certification required under subsection (a) within the 1 year 
     period described in such subsection, such State shall not be 
     eligible to receive assistance for HIV counseling and testing 
     under the Public Health Service Act (42 U.S.C. 201 et seq.) 
     until such certification is provided.
       (d) Additional Funds Regarding Women and Infants.--
       (1) In general.--If a State described in subsection (b) 
     provides the certification required in subsection (a) and is 
     receiving funds under part B of title XXVI of the Public 
     Health Service Act for a fiscal year, the Secretary of Health 
     and Human Services may (from the amounts available pursuant 
     to paragraph (3)) make a grant to the State for the fiscal 
     year for the following purposes:
       (A) Making available to pregnant women appropriate 
     counseling on HIV disease.
       (B) Making available outreach efforts to pregnant women at 
     high risk of HIV who are not currently receiving prenatal 
     care.
       (C) Making available to such women testing for such 
     disease.
       (D) Offsetting other State costs associated with the 
     implementation of the requirement of subsection (a).
       (2) Evaluation by institute of medicine.--
       (A) In general.--The Secretary of Health and Human Services 
     shall request the Institute of Medicine of the National 
     Academy of Sciences to enter into a contract with the 
     Secretary for the purpose of conducting an evaluation of the 
     extent to which grants under paragraph (1) have been 
     effective in preventing the perinatal transmission of the 
     human immunodeficiency virus.
       (B) Alternative contract.--If the Institute referred to in 
     subparagraph (A) declines to conduct the evaluation under 
     such subparagraph, the Secretary of Health and Human Services 
     shall carry out such subparagraph through another public or 
     nonprofit private entity.
       (C) Date certain for report.--The Secretary of Health and 
     Human Services shall ensure that, not later than after 2 
     years after the date of the enactment of this Act, the 
     evaluation required in this paragraph is completed and a 
     report describing the findings made as a result of the 
     evaluation is submitted to the Congress.
       (3) Funding.--For the purpose of carrying out this 
     subsection, there are authorized to be appropriated 
     $10,000,000 for each of the fiscal years 1996 through 2000. 
     Amounts made available under section 2677 for carrying out 
     this part are not available for carrying out this subsection.

  Mrs. KASSEBAUM. Mr. President, I rise to offer this amendment on 
behalf of myself and Senator Kennedy, the ranking member of the Labor 
and Human Resources Committee. This amendment is aimed at preventing 
the prenatal transmission of HIV from mothers to newborn infants. 
Because new research findings show that when pregnant women with HIV 
take AZT--which is a treatment that shows positive results for those 
who have contacted the AIDS virus--it can protect their infants if 
taken at the right time. I believe we should make testing and treatment 
available to all who could benefit from this approach. Our amendment 
would begin to meet this objective.
  As many of my colleagues know, the Centers for Disease Control and 
Prevention recently released guidelines for voluntary HIV counseling 
and testing of pregnant women. These guidelines call for health 
providers to offer HIV testing to all women.
  The CDC guidelines were developed after recent research showed that 
HIV transmission to newborns from infected mothers could be 
dramatically reduced. If pregnant women with HIV take AZT during 
pregnancy, they can decrease the transmission rate to their newborns 
from 25 to 8 percent--this is a dramatic reduction.
  In response to these findings, and from a desire to protect the 
health of newborns, the amendment we offer would require States with 
the greatest number of HIV-infected newborns to implement the CDC 
guidelines. Under this proposal, 11 States plus the District of 
Columbia, which account for 80 percent of all newborn HIV cases, would 
qualify to receive grants from the Public Health Service to help offset 
some of the costs of testing and treatment.
  I offer this amendment as an alternative to a proposal which is being 
advanced in the House of Representatives, by Congressman Coburn of 
Oklahoma. To address this problem, the Coburn amendment would test 
newborn infants for HIV. I believe this is the wrong approach. It seems 
to me that it is most important that we test the mother at a time in 
the process in which we could potentially intervene. The Coburn 
amendment would allow for voluntary testing of the mother but would 
mandate testing of those babies whose mother had failed to be tested 
during her pregnancy. I regret that, under the Coburn amendment, it 
seems to me, that testing of newborns would not prevent HIV 
transmission. This why I think it is important to start the process at 
an earlier period of time, rather than after the birth of the newborn 
infant.
  As many of my colleagues know, I would actually prefer mandatory 
testing of all mothers during pregnancy for HIV. I support such an 
approach because I believe it would be the most effective way to 
prevent HIV transmission to newborns. However, I am not advancing a 
mandatory testing approach at this time because of the concerns that 
have been raised by many. These include increased Federal Medicaid 
expenditures, unfunded State mandates, and a decrease in pregnant women 
seeking prenatal care.
  For all of those reasons I decided it was best to not make it 
mandatory, but to follow the CDC guidelines in the 11 States where 80 
percent of the cases have, in the past, occurred. I believe this 
amendment, which will provide funding to States to implement the 
voluntary CDC HIV counseling and testing guidelines, and is an 
effective way to protect our Nation's newborn infants. As such, I urge 
colleagues' support for this measure.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I rise in strong support of the amendment 
put forward by the Senator from Kansas. It represents a responsible 
approach to an important issue. I am pleased we are taking action on it 
at the outset of this debate. The CARE Act is about providing health 
care and 

[[Page S10703]]
hope to people living with HIV disease. It is about making the promise 
of advances in biomedical research a reality in the lives of our fellow 
Americans in need.
  Research has demonstrated we can reduce the transmission of HIV from 
mother to child by providing HIV positive pregnant women with AZT, 
during the second or third trimesters of pregnancy and during delivery. 
In so doing, we can save young lives and help keep families together.
  In response to this important discovery, public health officials and 
maternal and child health care providers have worked closely with the 
Centers for Disease Control to design guidelines for standards of 
medical practice that will help to maximize the impact of this 
discovery. Earlier this month, the CDC issued guidelines recommending 
that all pregnant women receive counseling about the benefits of 
seeking HIV testing, and that such testing be made available on a 
voluntary basis.
  Where this is currently being done, more than 95 percent of the women 
have sought voluntary HIV testing. I think that is really the heart of 
this whole amendment that Senator Kassebaum has talked about.
  We have a nationwide problem. The amendment is focused in the areas 
where there is the greatest need, and has been encouraged by voluntary 
counseling. And where we get the voluntary testing and where we have 
the appropriate kind of counseling consistent with the CDC guidelines, 
you get 95, even higher percentage. Dr. Koop, who has been working in 
this area, talks about areas and communities that are up to 98 percent, 
which is what, obviously, we are interested in doing. If effectively 
implemented, the guidelines will make a tremendous difference.
  So the amendment offered by the Senator from Kansas will ensure that 
these guidelines are implemented in those States with the most 
significant problems. We know that more than 80 percent of the cases of 
pediatric AIDS occur in 11 States, including my own State of 
Massachusetts. The amendment will ensure action by these States. It 
authorizes funds to assist them with that action.
  This approach is supported by the Academy of Pediatrics, the American 
Medical Association, the March of Dimes, the Governors, the State 
Health Officers, the State AIDS Directors, the Pediatric AIDS 
Foundation, and a host of other public health and social service 
organizations.
  We talked with Dr. Koop yesterday, who strongly supported this action 
as the most responsible means of moving toward this important issue.
  So, Mr. President, I urge the Senate to accept it. I think what we 
have found out in the whole battle on AIDS is where we work toward 
encouragement and work with consultation and counseling, we get a very 
positive response. That is what this particular measure does. If we 
were to come back in a more compulsive situation which has been 
recommended by others, what has happened--and the data reflect this--is 
that there is less of a desire and willingness to move ahead and get 
the test.
  This I think makes sense from a public health point of view. It makes 
particular sense with regard to the children. And it makes sense from a 
scarce-resource point of view.
  So I commend the Senator for this amendment and urge its adoption. I 
think it is a very, very important one. It is the a result of research 
that has been going on at the Centers for Disease Control.
  We have 7,000 infants that are born each year that are HIV. Three-
quarters of those will be free and on their own within about a year or 
a year and a half. But, as the Senator's amendment points out, with the 
addition of AZT treatment, that number comes down to only about 8 
percent.
  So the way that the Senator has proposed I think maximizes the 
opportunities to help and assist the infants, and also will get them 
the most positive response and do it in a way which is financially most 
responsible.
  I commend her for this approach and urge our colleagues to accept 
this amendment.
  The PRESIDING OFFICER. Is there further debate on the amendment?
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. I thank the Chair.
  Mr. President, I do not know how anybody can oppose this. I certainly 
support it. I think that we should expedite the consideration of this 
bill by letting all amendments possible be approved on voice vote, and 
not get into any high-jinks about second degree. I am not going to 
second-degree anybody's amendment. We can save a lot of time if we do 
not get involved in that, and can get this Ryan White bill behind us.
  I certainly approve of this amendment. I urge its adoption.
  Mr. HATCH. Mr. President, I rise in support of the Kassebaum-Kennedy 
amendment to S. 641 which essentially adopts the guidelines of the U.S. 
Public Health Service [PHS] which require counseling and voluntary 
testing of pregnant women who are at risk for HIV infection.
  The PHS has issued guidelines in the following areas: Information for 
both infected and uninfected pregnant women which will help improve 
their health and that of their infants; laboratory considerations 
involved in HIV testing of these populations; and necessary follow-up 
services for HIV-infected women, their infants and other family 
members.
  The guidelines released this month by the PHS are an excellent model. 
They recommend that health care providers ensure that all pregnant 
women are counseled and encouraged to be tested for HIV infection. This 
will allow women to know their infection status, which can both help 
them maintain their own health and reduce the risk for perinatal HIV 
transmission.
  The guidelines also emphasize that HIV testing should be voluntary. 
Health care providers should counsel and offer HIV testing to women as 
early in pregnancy as possible so that informed and timely therapeutic 
and reproductive decisions can be made.
  The issue of mandatory testing is one I have studied in great detail. 
I understand the reasons why requiring mandatory testing of pregnant 
women or newborns may seem like a good idea. However, I have concluded, 
that such a mandate, while well-intentioned, often has the opposite 
effect of turning those women who are most likely to be infected with 
the HIV virus away from the system.
  The issue boils down to access and trust; mandatory testing 
accomplishes neither.
  My reasoning is as follows:
  The idea of mandatory testing creates a great deal of apprehension 
and fear in precisely those women whom we would want to test.
  Some women fear that if there were mandated testing, it may not be 
accompanied by necessary informed consent.
  Others fear they may not be informed of the results of their HIV 
status.
  We unfortunately have a tragic precedent for this with the infamous 
Tuskegee experiments; African-American men in the South were tested for 
syphilis and were not treated if found to be positive for the disease. 
The fact that they were uninformed about the testing and not treated, 
continues to tarnish the reputation of the public health establishment.
  For many, especially the poor who utilize the public health system, 
there is often very little trust of a system which is not responsive to 
their health care needs, poorly staffed, over-crowded and ill-equipped 
to provide the necessary services.
  Mandating treatment for all pregnant women independent of their risk 
factors for HIV significantly increases the rate of false positive 
results.
  In other words, due to the sensitivity and specificity of testing for 
HIV, indiscriminate mandatory testing increases the likelihood that 
women who are falsely positive will be treated.
  And, as I understand it, while AZT is a potentially life saving 
medication which has helped literally thousands of people, it is not 
without significant side-effects and morbidity. We should not be 
subjecting individuals who may not be HIV positive to unnecessary 
treatment.
  Mandating testing without providing the treatment merely sets up the 
largely false expectation that services will be provided.
  This would be a cruel hoax for those individuals who may test 
positive and not have the access to appropriate medical services. 

[[Page S10704]]

  Scientific prospective clinical trials reveal that early detection of 
HIV-infected mothers and subsequent treatment with AZT reduces the 
transmission rate of HIV to the newborn by a third.
  The key to prevention and appropriate treatment is education and 
counseling of the pregnant woman.
  I think that the Kassebaum-Kennedy amendment address these issues in 
a responsible way.
  This amendment shows that the Senate is on the side of counseling and 
voluntary testing as advised by our Nation's top public health experts. 
Education and prevention remain our best weapons against this horrible 
epidemic.
  I thank Senators Kassebaum and Kennedy for developing this dialog, 
and hope this amendment is a position we can maintain in conference.
  The PRESIDING OFFICER. Is there further debate on the amendment? If 
not, the question is on agreeing to the amendment.
  The amendment (No. 1852) was agreed to.
  Mr. HELMS. Mr. President, I move to reconsider the vote by which the 
amendment was agreed to.
  Mrs. KASSEBAUM. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mrs. KASSEBAUM. Mr. President, I appreciate the comments of the 
Senator from North Carolina. I am glad to start off with such a 
positive amendment and share with him that I think it is important to 
debate these amendments, just the value of amendments as they are 
presented. I think that we both share the desire to move forward on 
this legislation. I appreciate the comments of the Senator from North 
Carolina.
  Mr. HELMS. I thank the Senator from Kansas.
  Mr. HELMS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. HELMS. Mr. President, I thank the Chair.
  Mr. President, as the Senate proceeds to the consideration of the 
proposal to reauthorize the so-called Ryan White CARE Act of 1990, 
there are so many ironies, that I feel obliged to call attention to 
some of them. Although the homosexual activists of America have created 
a virtual minefield for any Senator who dares raise a question about 
the legislative history of this proposal.
  These homosexual activists have managed to convince the news media, 
and a surprising number of Senators, that it is irrelevant to talk 
about who and what really caused the death of Ryan White--Ryan White, 
the 18-year-old hemophiliac who died of AIDS because tainted blood was 
pumped into his veins, blood that was tainted in the first place by a 
homosexual conduct somewhere generations back.
  The Centers for Disease Control was quite candid in the early 1980's 
as to when and how the AIDS disease was brought to America. The CDC may 
be somewhat politically correct now.
  In any event, I have in hand a volume which I obtained on loan from 
the Library of Congress, a book authored by Randy Shilts entitled ``And 
the Band Played On.'' Newsweek magazine described this book in 1987 as 
``compelling and often shocking, impassioned, and path breaking, the 
best book yet on AIDS.''
  The Washington Post described it as ``a monumental history.''
  Time magazine called the book ``stunning and impressively researched, 
a richly detailed narrative.''
  The Chicago Tribune described it, ``It reads like a good medical 
sleuth story. But it is not fiction. It is a painstakingly detailed 
history.''
  Mr. President, let us emphasize how virulent the AIDS virus is. A 
Canadian airline flight attendant, who knew he had AIDS and whose name 
is a matter of record, flew into the United States, and over a period 
of time--I am quoting from page 147 of Mr. Shilts' book--the Canadian 
airline flight attendant ``established sexual links between 40 patients 
in 10 cities. The role played by the flight attendant was remarkable,'' 
Mr. Shilts says. And he continues, ``At least 40 of the first 248 
homosexual men diagnosed with HIV or AIDS in the United States as of 
April 12, 1982 either had had sex with the flight attendant or had had 
sex with someone who had.''
  Mr. Shilts continued, ``The links sometimes were extended for many 
generations of sexual contacts, giving frightening insight into how 
rapidly the epidemic had spread before anybody knew about it.''
  Mr. President, I include those details to emphasize the virulence of 
HIV, AIDS, and it has been that way since the very beginning. Yet, I 
know of not one homosexual organization that has advocated abstinence 
from engaging in the incredibly offensive and revolting conduct that 
has led to the proliferation of AIDS; not to this good day has there 
been even a hint that abstinence should be followed. No. The homosexual 
activists have gone precisely in the other direction, demanding more 
and more Federal funds for research and special funding for personal 
care available to no other Americans suffering and dying of other 
diseases like cancer, heart disease, diabetes, and Alzheimer's.
  This is a unique piece of legislation. It was in 1990, and it still 
is. There has never been a bill like this for any other disease.
  The ferocity of the lobbying and the intensity of media criticism of 
anyone raising a question about all of this has caused many in Congress 
to go along with the questionable demands of the homosexual lobby.
  I myself, Mr. President, have taken the heat, but I will not be 
deterred. The Senate probably will pass this bill again, and the House 
has already passed it. And it may become law because President Clinton 
will rush and sprain his ankle grabbing a pen to sign it.
  I have intended to have my say, and I have intended to offer a number 
of amendments for the consideration of Senators to vote for or against 
as they please. But I think the Senate ought to go on record.
  Let us examine some of the support the American taxpayers are forced 
to give to a comparison of diseases. Let us start off with AIDS.
  This year, $2,700,000,000 for AIDS. That is the tab Congress has 
demanded that the American taxpayers furnish.
  That is more money than for any other disease.
  The Congressional Research Service breaks down the money like this:
  This year, $1.548 billion for research, $491 million for so-called 
prevention or education programs--and I will get into that in just a 
minute--and $664 million for treatment. And this is only for fiscal 
year 1995.
  The fiscal year 1996 request totaled a whopping $2.9 billion --$1.819 
billion for research, $526 million for prevention or education, and 
$555 million for treatment programs.
  Now, the disease AIDS ranks No. 8 in America among all of the 
diseases in terms of causing death. The No. 1 killer is heart disease 
followed by cancer, followed by stroke and lung disease, diabetes, 
Parkinson's disease, Alzheimer's, and so forth.
  But do they get money like this? No. AIDS is No. 8--No. 8--yet AIDS 
gets more Federal money than any of the other diseases. If memory 
serves me correctly, the original 1990 Ryan White bill was funded with 
money taken from a fund originally allocated for Alzheimer's disease. 
The Federal Government spends $91,000 for every patient who dies of 
AIDS. The Federal Government spends $5,000 for each American who dies 
of cancer.
  I know the advocates of this Ryan White reauthorization bill will 
claim that comparisons are odious, but there is a great big odor rising 
from the manner in which Congress is falling all over itself to do what 
the homosexual lobby is almost hysterically demanding that Congress do.
  Now, then, I am a little bit fascinated by a clause in this existing 
bill that is now the pending business, language which authorizes--and 
let me quote from the bill--``appropriations of such sums as may be 
necessary for each of the fiscal years 1996, 1997, 1998, 1999, and 
2000.''
  Supporters of the bill say, ``Oh, well, do not worry about that, 
Jesse. That does not mean anything. It still will have to go through 
the authorization and appropriations process each year.''
  Well, if that is so, Mr. President, if it does not mean anything, let 
us take out that reference to ``such sums as may be necessary.'' I will 
bet you a quarter not one of the proponents will agree to that. Of 
course, it means something. 

[[Page S10705]]

  While I am at it, let me raise a question about the provision in this 
Ryan White bill's title V which creates new education and training 
centers related to homosexuality and AIDS.
  Mr. President, this bill is silent in seven languages about teaching 
the importance of abstinence. It is not even mentioned. Abstinence, I 
say again and again and again, is the only way AIDS will ever be 
brought under control. And the activists do not even use the word or 
permit it to be used.
  There is general agreement among scientists that the biggest risk for 
contracting HIV or AIDS is the number of sexual partners homosexuals 
have. The more promiscuous a homosexual, the greater his risk of 
contracting HIV or AIDS, and, by the way, infecting innocent people 
like little Ryan White, whose name is being exploited in this 
legislation, who had nothing to do with that. He was innocent.
  Reliable surveys, Mr. President, show that many homosexuals average 
16 different sex partners every month, 182 partners per year. And my 
source for that is a document ``Hepatitis B Cohort Study of 1980,'' and 
I have it available for any Senator who wants to see it.
  Now, is it not clear, Mr. President, that AIDS is a chronic disease 
of sexually promiscuous people? And a lot of innocent people like Ryan 
White are caught up in it, unknowingly and without any misconduct on 
their part.
  Let me move on. Mr. President, you would not believe the stonewalling 
that has been going on in and by the Clinton administration to prevent 
my staff and me from obtaining statistical information about how these 
millions and billions of dollars of the taxpayers' money are to be 
spent and have been spent in the past. You call HHS--and we have the 
date and time and the name of the people we talk with--and they say 
they do not know, that there is no monitoring going on.
  Stonewalling, that is what we have. But I say this, and I say it with 
all the sincerity I possess, that before the Senate Appropriations 
Committee acts on this bill, S. 641, I hope Senators Hatfield and Byrd 
and all of the members of the Appropriations Committee will insist on 
credible documented information about who has received the Ryan White 
funds since the enactment of the 1990 version of the Ryan White CARE 
Act.
  That is all I ask. If Senator Robert C. Byrd says it is all right, 
after he has looked at the information, I will be reasonably satisfied 
because I trust Senator Byrd. We do not belong to the same party. We do 
not agree on everything. But I respect him as an honorable gentleman. I 
think the American people will be appalled by what their hard-earned 
tax dollars are supporting in fact. Nobody knows now. I am sure Nancy 
Kassebaum has no idea what is going on because I know this lady. I know 
her inclinations, and I know her character. But a lot of things are 
going on that have not been discussed or disclosed to the Congress of 
the United States let alone the American people.
  For example, I have a brochure from the Gay Men's Health Crisis.
  By the way, I hate to use the word ``gay'' in connection with sodomy. 
There is nothing gay about these people. ``Gay'' used to be a beautiful 
word. It has been corrupted, but that is another argument for another 
day.
  This Gay Men's Health Crisis organization put out a brochure 
describing various and sundry methods of homosexual sex. Now, I have 
been around the track a long time, and I have seen a lot of things in 
my lifetime, but I can just imagine how the average American would 
react if they could see what this is all about. Not once--I reiterate, 
not once--is abstinence mentioned as the way to avoid HIV infection. 
They do not want abstinence.
  Senators may be interested in an advertisement by another homosexual 
outfit, the so-called Whitman Walker Clinic in Washington. This 
advertisement says: ``If you visit a bath house remember to always use 
a latex condom. Used properly latex condoms prevent HIV, AIDS and other 
sexually transmitted diseases.''
  Now, this statement is blatently false. It is inaccurate. It is 
misleading. And yet taxpayer funds are being used to circulate this 
falsehood, giving false hope to homosexuals in their many and various 
liaisons.
  Then there is the Washington Blade, which is a homosexual newspaper 
published here in Washington, DC. They have a pink section they call 
Lights Out. The implications are obvious on that. This pink ``Lights 
Out'' section is dedicated exclusively to advertising for anonymous 
dates, sexual encounters. No names are given. You just pick this one 
that sounds good to you, and there you go. Decency prevents me from 
reading the so-called classified ads out loud on the Senate floor. 
Suffice it to say here comes the Whitman Walker Clinic again. This time 
implying, ``Just do it, but do it with a condom.'' And they know that 
is not so. They know that it is not so. The Whitman Walker Clinic, 
which receives Ryan White CARE Act money from the American taxpayers, 
who care for people with HIV or AIDS, leads homosexuals to believe that 
as long as you use a condom it is safe to have anonymous sexual 
encounters.
  Now, what kind of use of the American taxpayers' money is that? 
People say, it is hateful for Jesse to talk about this. But somebody 
needs to talk about it. Somehow the American people need to know and 
deserve to have an understanding of what is going on, not get up here 
with all of the plaintive remarks about Ryan White. Let us talk about 
what killed Ryan White. Who furnished the tainted blood? Where did it 
come from? I met the little boy one time. I was sorry for him then, and 
I am sorry that he is dead now. But it was not accidental. There was 
somebody who did not care, who furnished tainted blood.
  Now, the Gay Men's Health Crisis and the Whitman Walker Clinic are 
not the only such homosexual outfits receiving Ryan White funds 
advocating so-called safe sex. As I said earlier, I do not believe 
Senators could possibly believe the stonewalling by the Clinton 
administration to prevent us, my staff and me, from obtaining accurate, 
verifiable statistical information on precisely how these millions and 
billions of dollars have been spent and will be spent. I think it is a 
legitimate question for the legislative branch to ask the executive 
branch. But not the Clinton administration. Nobody. That is off limits. 
They have got a deal. The Senate is debating whether or not to 
reauthorize this act for appropriations of such sums as may be 
necessary, and nobody can tell me and nobody can tell the American 
people exactly where this money is going and for what it is being 
spent.
  Oh, you hear all of the wonderful stories about how these people say 
it is being spent. And I suppose some of it is being spent for good 
purposes. But Congress does not monitor this, and HHS will not let 
anybody monitor it. So it is sort of a closed shop, do you not see?
  Incidentally, speaking of the word ``care,'' I have been the butt of 
a lot of diatribes lately, like the New York Times, which put words in 
my mouth that I had not said. And these editorial writers around the 
country somewhere along the line gave up this responsibility of 
checking for themselves what the facts are and what was really said. 
They pick up a report from the New York Times, and they rush to their 
little hot typewriters or little hot microphone or camera and say, 
``Oh, you cannot talk about this. This is a hateful thing to do.''
  It is all right with me what they say. I do not care. I do not talk 
to them much anyway because they will take a snippet here and a snippet 
there and about 5 seconds here and 5 seconds there, and they will make 
the quote say what they want it to say. The first amendment does not 
require that they be honest or fair about anything.
  For the record, Mr. President, let me say that I do not hate anybody, 
but I have been accused of it in editorial after editorial. I do not 
hate homosexuals. I do not even know any homosexuals. But what I do not 
like is for the Congress of the United States to bow and scrape to 
homosexual pressure and give them Federal funds and rights and 
privileges that other Americans are denied. That is what I do not like. 
And, yes, Mr. President, I have a deep sympathy for homosexuals who are 
dying of AIDS because of their having deliberately--deliberately--
placed their lives at risk. I have deep sympathy for anybody who sticks 
a loaded pistol in his mouth and pulls the trigger. You are playing 
Russian roulette 

[[Page S10706]]
either way. And homosexuals are losing and losing and losing, and they 
do not want to talk about abstinence.
  Now, homosexuals know the risk they are running with their sexual 
conduct. They go on television programs. I saw one or two on ``60 
Minutes'' the other night, 2 or 3 weeks ago. They discussed why they 
just cannot abstain and why it is so much more intimate not to try to 
protect themselves from being infected with AIDS or preventing others 
from being infected. They are not interested in abstinence. They are 
not interested. In all candor, Mr. President, when you get down to the 
guts, feathers and all, they do not give a damn.
  But the rest of us do. A lot of us are sick and tired of all the 
pretenses of injured innocence. They are not innocent. They know it. 
And that is why they are so belligerent in their demands that 
homosexuality be accepted as just another lifestyle--indeed, a 
specially protected and encouraged lifestyle. And that is not a 
reckless statement because I am about to explain what I mean. I do not 
believe they will ever sell that bill of goods to the American people.
  But back to Senator Hatfield, the distinguished chairman of the 
Senate Appropriations Committee, and Senator Robert C. Byrd, who has 
served with distinction as chairman of that committee in the past, and 
he serves now, of course, as ranking minority Member. The Department of 
Health and Human Services has declined to make any useful information 
available to my staff or me. They say they have no records of how many 
homosexual advocacy groups receive or have received Ryan White funds. 
They have no record of what they do with it. But to that I say, why? 
Why? And I think the American people are entitled to say, why? It is 
not HHS money. It is not Jesse Helms' money, and it is not Nancy 
Kassebaum's and certainly not Ted Kennedy's money, or any of his 
aides'. It is the American people's money. They have a right to know 
the full information.
  Senators Hatfield and Byrd and other members of the distinguished 
Senate Appropriations Committee might start by inquiring officially and 
formally how much Federal money was delivered to, for example, the Gay 
Men's Health Crisis Organization in New York, or right here in 
Washington, how about the homosexual outfit, the Whitman Walker Clinic? 
Surely, the Appropriations Committee is entitled to know. Surely, the 
Members of the Senate are entitled to know.
  During the past 15 years, Mr. President--and I shall conclude 
shortly--AIDS has killed 270,000 people in this country.
  Heart disease kills more than that in less than 5 months. Less than 2 
percent of the deaths last year in America were the result of AIDS.
  I go back to Ryan White. I was sorry for that young man then, and I 
am sorry for him now. He died at age 18 of AIDS, a disease that he 
almost certainly contracted from that tainted blood that had its origin 
as a result of that homosexual airline flight attendant who was the 
first documented instance of the AIDS disease being brought into North 
America from Africa.
  We will never know, of course, the precise list of individuals who 
passed the HIV virus along--in what they call the generational series 
of homosexuals--to drug users, and one or more of them contributed to 
that blood transfusion that Ryan White got.
  But you know one thing, they were involved in it and they know it, 
too, but they want to obscure that. They usually go around Ryan White 
to attract sympathy for them, undeserved sympathy. I am talking about 
the ones who have not caught it yet, but they are playing Russian 
roulette and they want the discovery to be made so it will be safe for 
them. I do not think there is ever going to be a protection of that 
nature developed by science. I find myself hoping that it will be, but 
I just do not believe it is going to happen.
  Ryan White was without blame. He was a hemophiliac who had to have a 
blood transfusion, but he did not deserve a fatal tainted blood 
transfusion.
  Ryan White was innocent, and I pass no judgment on any member of his 
family or any other family who has lost in such a way a member of their 
family. I do not have any real problem--I do not understand it--but I 
do not have any problem with Ryan White's name being exploited by the 
kind of people who have acknowledged that they either cannot or will 
not even try to restrain their impulses to prevent the further spread 
of AIDS.
  Michael Fumento, an associate of the Competitive Enterprise Institute 
in Washington, has written a book that all Senators should read, but 
probably will not. The name of the book is ``The Myth of Heterosexual 
AIDS.''
  I wish some of the people in the press gallery would read it. Mr. 
Fumento relates that he called the offices of a number of Senators to 
inquire about the fairness of devoting so much of the taxpayers' money 
to one disease at the expense of other diseases. He said he asked in 
each Senate office for a statement on the fairness of it all. And then 
he wrote:

       Wonder of wonders, I got no answer.

  He concluded this way:

       And while several Senators claim that as President they 
     would be tough enough to deal with America's foreign 
     adversaries, when it comes to AIDS activists, they go 
     crawling for the deepest foxhole.

  I am not looking for a foxhole. What I want is for the American 
people to be informed as to how this money is to be spent, where it is 
to be spent and by whom it is to be spent. Do not take the word of 
Senators who say, ``Well, we had in our State this situation,'' or 
others, ``We had our situation and it's terrible,'' and so forth and so 
on. Of course, it is terrible, but that does not address the problem. 
Let us find out how this money is being spent. That is all I have said 
at any time along the line. No foxhole for me. We will find out sooner 
or later what happened.
  Mr. President, I ask unanimous consent that an op-ed column written 
by Mr. Fumento, published on June 19 by the Washington Times, be 
printed in the Record at the conclusion of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. HELMS. Mr. President, for the guidance of the clerk, the headline 
in the article is ``Bill Oils the AIDS Squeaky Wheel.''
  Mr. President, I yield the floor.
                               Exhibit 1

               [From the Washington Times, June 19, 1995]

                    Bill Oils the AIDS Squeaky Wheel

                          (By Michael Fumento)

       Grab your wallet, folks! The Senate is about to demonstrate 
     its boundless compassion again by spending billions of your 
     dollars. But this time it won't just be unfair to taxpayers 
     but to the great majority of Americans suffering from serious 
     diseases.
       The subject of this latest act of largesse is the cynically 
     named Ryan White Act, which is up for reauthorization. With 
     58 co-sponsors, its Senate approval is virtually guaranteed, 
     though for the moment its passage is blocked by North 
     Carolina Republican Sen. Jesse Helms.
       Enacted in 1990, ostensibly to provide care for such 
     victims as Ryan White, the measure was a sham from the start. 
     Young Ryan White was a hemophiliac who won the heart of the 
     nation after he contracted AIDS. He died at age 18. But only 
     2 percent of AIDS victims in 1990 were hemophiliacs, 
     according to the federal Centers for Disease Control and 
     Prevention. Today it's 1 percent. Less than 2 percent of AIDS 
     victims are under the age of 20.
       One wonders how the bill would have fared had it been named 
     the Robert Mapplethorpe Act, after the late homosexual 
     photographer famous for such depictions as bullwhips 
     extending from people's posteriors.
       The Ryan White Act was also sold as a means of helping, as 
     National Commission on AIDS Chairwoman June Osborne put it, 
     the ``many parts of rural America [that] are about to be 
     blind-sided by the epidemic.'' Yet then, as now, cases from 
     non-metropolitan areas amounted to 5 percent of those 
     reported.
       Predictably, almost all of the money went to those places 
     that had the most AIDS cases. This means not Ryan White's 
     town of Cicero, Ind., but rather New York City, Los Angeles, 
     San Francisco and other areas that also happened to be 
     Democratic strongholds. In other words, it followed the same 
     supply lines as all the Democratic pork of that era. The 
     money went for those who make up the bulk of
      AIDS victims: homosexual men and intravenous drug abusers.
       Further, even on a per-patient level, the bill resulted in 
     allocating several times more money per victim in larger 
     cities than in less-populated areas.
       Misnaming and misrepresenting the act has paid handsomely. 
     In its first five years, spending more than doubled from $276 
     million in 1991 to $664 million for this year, for a total of 
     over $2 billion.
       This time around, the bill is sponsored by Kansas 
     Republican Sen. Nancy Kassebaum. When I called her office, 
     her aide cited--

[[Page S10707]]
     yes--the rural AIDS bogeyman. One wonders if the good senator knows 
     that Kansas has all of 245 AIDS cases last year, just 3 
     percent of the national total. Of those, eight were children.
       In fairness, Sen Kassebaum has rewritten the act so that 
     more money will be authorized for rural areas. But with so 
     few patients there, the money must necessarily flow right 
     back through the old pork pipeline established in 1990.
       The biggest difference this time is that the estimated cost 
     will balloon from slightly more than $2 billion to $3.6 
     billion. This even though the AIDS epidemic is declining. New 
     AIDS cases are being reported at a rate well below the 80,000 
     of last year.
       Yet even if the bill weren't such a budget-buster, it would 
     be terribly wrong.
       Ryan White provides no money for medical research, so no 
     one will ever be cured of AIDS with all those billions of 
     spending. Along with some allocations for education that are 
     redundant with the $500 million
      federal AIDS education budget, the Ryan White Act simply 
     provides money for treatment, drugs, free meals, in-home 
     care and the like.
       It's nice that sick people can get such services regardless 
     of their income levels. But for anybody with any disease 
     besides AIDS the sign on the door reads, ``Go away!'' There 
     is no Gilda Radner Act for victims of ovarian cancer, no 
     Ronald Reagan Act for Alzheimer's disease patients. Some 
     elderly and indigent people with such diseases can qualify 
     for programs like Medicare and Medicaid, but then so can AIDS 
     patients.
       No, the Ryan White Act was a gift to one extremely squeaky 
     wheel. Not content with a medical research budget that dwarfs 
     that of every other disease but cancer--despite being only 
     the ninth-greatest killer of Americans--the AIDS activists 
     demanded and got privileges that persons with other diseases 
     can't even dream about.
       Quite simply, the homosexual activists want special 
     treatment because they themselves, and their friends, have an 
     extraordinary chance of contracting the disease. Somehow they 
     have translated ``Gimme! Gimme! Gimme!'' into a cry for 
     compassion. Long gone are the days when AIDS activists begged 
     merely to be treated no worse than the victims of diseases 
     not associated with behaviors society finds distasteful.
       I called the offices of both Sen. Kassebaum and the other 
     Kansas senator, Bob Dole, for a statement about the fairness 
     issue. Wonder of wonders, I got none. To a Congress always 
     eager to take money from all of us and give it to some of us 
     to buy votes, fairness is a four-letter word. And while 
     several senators claim that as president they would be tough 
     enough to deal with America's foreign adversaries, when it 
     comes to AIDS activists they go crawling for the deepest 
     foxhole.

  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER (Mr. Santorum). The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, I would like to answer, some of the 
questions that were raised by the Senator from North Carolina. I know 
how much Senator Helms genuinely cares about this issue. I would like 
start by saying that many of the 64 cosponsors of this legislation were 
cosponsors of the legislation in 1990. So they, I hope, are familiar 
with what was in the bill then and what is in the bill now.
  We have had a through hearing on this bill. A GAO report on the 
funding equities and distribution, which had been requested by Senator 
Brown of Colorado and myself was used as the basis for that hearing. 
The report had been requested because of our concern about equity of 
funding for all individuals with AIDS.
  I share with Senator Helms a concern about the fact that sometimes we 
are not able to do the type of oversight that we should, but with the 
hearing and the GAO report we were able to propose in this bill changes 
to provide equity in the distribution of funds.
  It is sad, but true, that there are many who have been victims of 
HIV. Some individuals like Ryan White contracted this disease through 
contaminated blood. Unfortunately, this illness has had a ripple effect 
with involvement of individuals from many walks of life but also the 
family members of those infected have also suffered. So we have to be 
mindful of all who have suffered. I think that this epidemic must be 
viewed in the broader sense of the epidemic and the tragedy.
  Senator Helms quoted figures related to the amount of money that has 
been expended for the major causes of deaths in this country. I lost a 
niece, several years ago to cancer. She had two small children. I 
remember through the years of her struggle with cancer discussing 
Federal Government funding levels for cancer. She questioned why there 
could not be more expended for cancer research than we were spending on 
AIDS. I spent time researching this important question in hopes of 
finding an answer. One thing that became apparent to me was that money 
that goes into research for HIV is also very valuable for other 
illnesses like cancer.
  The figures that Senator Helms gave were only for research, and I 
would like to give figures that include not only the research 
expenditures but also the moneys that come from Medicare, Medicaid, 
Social Security disability funding, and the Public Health Service 
moneys. For HIV and AIDS, it is about $5.4 billion a year; for cancer, 
about $15 billion a year; for heart disease, about $34 billion a year.
  One of the reasons that the Ryan White CARE legislation came into 
being, Mr. President, was to help provide assistance to those who were 
not eligible for Medicare; because they were not yet of age to receive 
Medicare or to receive Medicaid, because they had an income level which 
would not allow them to qualify. As we all know such medical care 
services even those that are basic can be very costly.
  That was the genesis of the Ryan White legislation. It has grown 
significantly in funding since 1990, but so have the number of AIDS 
victims.
  I suggested in 1990 that we do such sums. I do not think that this a 
good approach for defining the level of authorizations. I would propose 
an amendment, if this would be of any benefit, to say define the 
funding level for the first year which would be consistent with the 
appropriated levels reported recently by the House of Representatives. 
The House appropriation figure just recently passed is $656 million for 
1996; then such sums in the following years. At least that puts a 
benchmark which gives some consistency between the House and Senate.
  Senator Helms mentioned a new title, title V, which was is slated to 
receive a small amount of funding, $17 million, in this year's 
authorization. I would like to explain this program a bit further. 
Title V is for AIDS Education Training Centers [AETC]. This title is 
not new. It has been moved from the health professions bill to this 
legislation. It seemed appropriate to consolidate those efforts related 
to AIDS into one legislation.
  AETC's are not a new program. It has been funded for many years. 
Under this program, health providers are educated and trained in the 
best ways to treat individuals with AIDS, particularly children and 
women. Given the complications and numerous illnesses which individuals 
with AIDS often acquire, health providers benefit from this type of 
education. I believe that patients also benefit from better trained 
physicians and other providers. This explains why there is a new Title 
V, although we must remember that this is not new, but rather a program 
moved from the Health Professions program to this legislation.
  Mr. President, this is not a piece of legislation that is 
enthusiastically embraced by everyone. It raises fears. It raises 
concerns. It certainly raised emotional levels and questions of 
morality, which Senator Helms has noted.
  I think the Senator from California earlier today, Senator Feinstein, 
spoke with real eloquence, of two people she personally knew, and how 
it affects so many. Sometimes people who do not fit the pattern that 
Senator Helms has mentioned are also infected.
  AIDS touches people, not only those who are ill and/or dying, but it 
touches many others as well. That is why the Ryan White bill came into 
being--not to take his name in vain. The intention was to provide 
services that could be of help to families who are suffering--and to 
patients--who are infected with this disease.
  I yield the floor. I do not know whether there are other amendments 
to be considered.


                           Amendment No. 1853

    (Purpose: To require spousal notification in cases in which an 
individual is diagnosed with infection with the human immunodeficiency 
                                 virus)

  Mr. HELMS. Mr. President, I have some amendments to come before the 
Senate. I do not intend to second-degree anybody else's amendment, and 
I hope we can just have up-and-down votes and get this bill out of the 
way.
  Now, Mr. President, I send an amendment to the desk and ask it be 
stated.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from North Carolina [Mr. Helms] proposes an 
     amendment numbered 1853.


[[Page S10708]]

  Mr. HELMS. Mr. President, I ask unanimous consent that further 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       At the end, add the following new section:

     SEC.  . SPOUSAL NOTIFICATION.

       (a) Prohibition on the Use of Funds.--The Secretary shall 
     not make a grant under this Act to any State or political 
     subdivision of any State, nor shall any other funds made 
     available under this Act, be obligated or expended in any 
     State unless such State takes administrative or legislative 
     action to require that a good faith effort shall be made to 
     notify a spouse of an AIDS-infected patient that such AIDS-
     infected patient is infected with the human immunodeficiency 
     virus.
       (b) Definitions.--As used in this section--
       (1) AIDS-Infected Patient.--The term ``AIDS-infected 
     patient'' means any person who has been diagnosed by a 
     physician or surgeon practicing medicine in such State to be 
     infected with the human immunodeficiency virus.
       (2) State.--The term ``State'' means a State, the District 
     of Columbia, or any territory of the United States.
       (3) Spouse.--The term ``spouse'' means a person who is or 
     at any time since December 31, 1976, has been the marriage 
     partner of a person diagnosed as an AIDS-infected patient.
       (c) Effective Date.--Subsection (a) shall take effect with 
     respect to a State on January 1 of the calendar year 
     following the first regular session of the legislative body 
     of such State that is convened following the date of 
     enactment of this section.

  Mr. HELMS. Let me sum up this amendment. I think we had two votes 
against it the last time.
  This amendment requires that States receiving Federal funds for AIDS 
education and prevention take specific legislative and/or 
administrative steps to make sure that spouses--that is, the wife or 
husband--of an individual infected with the HIV/AIDS virus, that the 
spouse be promptly notified.
  Let me say why I think we ought to vote on this again. Some years 
back, 2 or 3, I forget how long ago, there were several circumstances 
that led me to draft this amendment at that time.
  It began when I received a call from a young woman who worked on the 
House side of the Congress who said, ``Senator, my mother wants to come 
by and talk with you on a matter of confidence. She doesn't want you to 
ever use her name,'' and I shall not. They came, a lovely lady and her 
beautiful daughter. I shall never forget that visit. The meeting did 
not last long. After the usual amenities--and I had no idea what the 
lady wanted to discuss--but after the usual amenities, I seated them. 
The three of us began to discuss why she had come and what I might be 
helpful to her about.
  At that point, tears welled up if that mother's eyes as she began to 
tell the story. She took a deep breath and stated the bottom line. She 
had AIDS, she said, ``and I am dying.'' Her bisexual husband, you see, 
had infected her with the AIDS virus. He had not informed her he was 
infected, and State law in her State forbade the family doctor from 
telling her--which I consider to be outrageous.
  Now, Mr. President, we hear so much about protecting the 
confidentiality of AIDS-infected patients, yet we hear nothing about 
the fatal consequences of confidentiality laws. The homosexuals march 
in Washington, and they demand their rights, but what about the rights 
of this lovely lady and the thousands of others like her, potentially, 
who, through no fault of their own, have become infected with the 
deadly AIDS virus, or may be infected in the future?
  Do they not have rights, too? Should there not be laws to protect the 
innocent spouses, instead of those who hide behind the confidentiality 
law and, as in this case, are causing others to die?
  What a terrible tragedy. Only 12 States protect the lives of spouses 
of HIV-infected citizens, only 12 States. Eighteen States provide for 
notification of partners, but they are silent on the rights of spouses. 
What kind of fair play is that? And you know what I mean when I say 
``partner.''
  Does this not lead to the conclusion that some States may appear more 
concerned with protecting the interests of the HIV-positive spouse 
instead of the life of the unsuspecting innocent spouse?
  This amendment does not require States to initiate a spousal 
notification program. It simply says that if States want Federal money, 
which they take from the taxpayer--if States want money to combat the 
AIDS virus, the AIDS disease, those States are going to have to make a 
genuine and concerted effort to protect innocent spouses from being 
exposed to the AIDS virus.
  It is time to start treating AIDS as the public health issue that it 
is, rather than the civil rights issue that it has become. I have no 
doubt that if we take this step, it will help curb, to some extent at 
least, the spread of this lethal disease.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, maybe, as a clarification of what we 
did last year, it is my understanding that, in law, from what we had 
before, that each State is required to set up its own notification 
system. Is that correct?
  Mr. HELMS. Not to my knowledge. But even if it is, if you will 
forgive me, it will not hurt the Senate to go on record again.
  Mrs. KASSEBAUM. No, I have no problem--I was just asking the Senator 
if he knew if that was not correct that each State is required to set 
up its own?
  Mr. HELMS. My expert is sitting to my left, and sometimes to my right 
as well, and she says she does not know about that. And so, of course, 
I do not.
  Mrs. KASSEBAUM. Mr. President, I suggest the absence of a quorum for 
a minute until we look at the language and get some comparison, so 
maybe we can accept that.
  Mr. HELMS. That is fine, just so there is no attempt to second-degree 
my amendment, because then we will have protracted debate.
  Mrs. KASSEBAUM. No, I agree with the Senator. I know the effect of a 
second-degree amendment.
  Mr. HELMS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. HELMS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Thompson). Without objection, it is so 
ordered.
  Mr. HELMS. Mr. President, I ask for the yeas and nays on the pending 
amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I hope that this amendment will be 
accepted by the membership. I intend to vote for it.
  The PRESIDING OFFICER. Is there further debate on the amendment? If 
not, the question is on agreeing to the amendment. On this question, 
the yeas and nays have been ordered, and the clerk will call the roll.
  The legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Utah [Mr. Bennett], is 
necessarily absent.
  Mr. FORD. I announce that the Senator from Illinois [Mr. Simon], is 
necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
who desire to vote?
  The result was announced--yeas 98, nays 0, as follows:

                      [Rollcall Vote No. 332 Leg.]

                                YEAS--98

     Abraham
     Akaka
     Ashcroft
     Baucus
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Helms
     Hollings
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Kyl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun 

[[Page S10709]]

     Moynihan
     Murkowski
     Murray
     Nickles
     Nunn
     Packwood
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simpson
     Smith
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone

                             NOT VOTING--2

     Bennett
     Simon
       
  So the amendment (No. 1853) was agreed to.
  Mrs. KASSEBAUM. Mr. President, I move to reconsider the vote by which 
the amendment was agreed to.
  Mr. KENNEDY. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. LOTT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Mississippi.

                          ____________________