Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. Speaker, will the gentleman yield?

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, the purpose of this motion to instruct is to bring the House in line with the Senate's vote on this very issue, and we are going to hear a broad debate this evening about the pros and cons of postcontraception, but that is not what I think this debate is. I think the debate is whether or not parents ought to be made or allowed to be involved in significant decisions of their children, and what we are doing now in 180 schools in this country is excepting out parents from a decision that they need to know about, excepting out parents and the child's physician from a medical decision that is being made for that individual. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, I offer a motion to instruct conferees on the bill (H.R. 4577) making appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2001, and for other purposes.

Mr. COBURN. Mr. Speaker, may I inquire of the Chair, who has the right to close on this debate?

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, in spite of what the Members of this body might think, the intention of this motion to instruct was not to create havoc in the process as we attempt to go home. I want to describe my medical practice to all of my colleagues for a minute so they have a perspective. I just heard the ``white, middle- class'' statement; and I think it is very important. Most of my patients are minorities. Most of them only have one parent. And let me tell my colleagues, every one of those parents want to know what is going on with their kids in school. And the assumption, the racial implication that if they happen to be a single mom and they have a child that gets in trouble that they do not want to know as much as everybody else is absurd and wrong and implies an absolute lack of knowledge about what is going on in this country with that valuable segment of our population. So I want to set that aside. The other thing is I want to tell my colleagues a story, one of the reasons I offered this amendment. I was in a town hall meeting in the southeast portion of my district. A 38-year-old father came in, and I have never seen anybody so mad in my life. I was the object of his rage, because his 12-year-old daughter had just shown him what she had been given at a clinic, 12 years old, no knowledge. She was given Preven. In case she needed it at some future time, she was given a bag of condoms. She was given noxonol nine. And she was given oral contraceptives. No exam, no instruction sheet on how to use them, but she was given them. Mr. Speaker, what the father was mad about is that somebody would dare be able to invade on the rights of his child and her health care without him knowing about it. And in front of 50 people, he stood there balling, to say what has happened to our country that parents are last? We heard about local control. What about parent control? What about putting the parents back in charge? We cannot take an aspirin at a school without a permission slip. If their child has an antibiotic, they have to have permission to give that child his antibiotic at the school. We are so wrong-headed and so out of sync in terms of the priorities for our children in this country it is not a wonder that we are having difficulty with these issues. The third point I want to make: we have had title X clinics for 25 years in this country. We have been teaching safe sex for 25 years. We are the highest nation in the world in sexually transmitted diseases. Nobody comes close to us. We will have 15 million new cases of sexually transmitted disease this year of which 9 million are incurable, 9 million in which the methods that we teach at our title X safe-sex clinics will not protect our children from. But we are going to dig our heads in the sand, and we are going to ignore it. The number one cause of cervical cancer is one of them. We now know that one of those is involved with prostate cancer, the number two cancer with men. But we are going to ignore that. We are going to keep doing the same thing. We are going to dumb down to the level of the lowest possible explanation and rationalize that that is the way to treat our children. It is not good enough. No wonder our kids are failing. We are not expecting enough of them. We are looking the wrong direction. There is no reason for a parent never to be involved unless incest is involved. And then, in every State in this country, it is a law that they have to notify the authorities. Otherwise they go to jail if they do not notify the authorities. This has nothing to do with school-based clinics. This has everything to do with parents, re-empowering parents. The final point that I would make that my colleagues consider is that every one of us has told a lie; and when we finally get past that lie and tell the truth, every one of us feels good about it. When we confess that lie, there is a great feeling. It is liberating. We have told the truth, that burden we are carrying. When we enable our children to be deceptive, we lessen their potential for the future. We should not be involved in that. We should be enabling them to reconcile with their parents, not become deceptive partners in alienating the children from their parents. For goodness sakes, let us really think about children. I know we are going to have the debate on abortion and pro-life; but as we solve this problem, let us empower parents to do the right thing, let us encourage the positive and discourage the negative, let us go for reconciliation between children and parents.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. As somebody who has delivered 3,500 babies and who has cared for every complication of pregnancy, I want to clear up the medical facts. A pregnancy, regardless of when Planned Parenthood says it occurs, occurs when a sperm and an egg unite. Because of where it is located, they have arbitrarily picked to say that is not a pregnancy is the biggest misstatement that I have heard. Number two is we are talking about high dose oral contraceptives. We are not talking about a small dose. The reason that we have many dosages of pills today is because the risks associated with the high doses were so great that they caused major complications for women. Now, to do morning after pills, we are reverting back to levels of hormones that we have not seen in 20 years in this country in single doses. That raises significant complications for these young women. The final thing that I would say is if this fails to work, which 25 percent of the time it fails to prevent the pregnancy, there is a concept known as limb reduction deficits, and if we look that up, what we find is babies born without hands, without fingers, without ears, without toes, and without their limbs. That is one of the causative factors from high-dose oral contraceptives at the formative stage of an early fetus. So medically, what was just stated is inaccurate. Mr. Speaker, I yield 3\1/2\ minutes to the gentleman from South Carolina (Mr. DeMint).

Mr. COBURN. Madam Speaker, on that I demand the yeas and nays.

Mr. COBURN. Madam Speaker, I yield back the balance of my time.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, there are 4,000 other places in the United States that they can get these pills if they want them. We do not need it in the school. It amazes me that our whole goal is to help somebody keep a lie in our school-based clinics when we use a morning-after pill. The fact is there is a lot of freedom when young women go to their parents after having made a mistake, and are encouraged to do that. Know what? If we cannot do this in the school, that is what will happen is the school nurse will encourage the young woman to talk with her mother and if she has a father and say we need to talk with them and get their permission to do this. There are 4,000 other places funded by the Federal Government where this can happen. What we are saying is this should not happen in schools. Mr. Speaker, I yield 2 minutes to the gentleman from New Jersey (Mr. Smith).

Mr. COBURN. Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Camp).

Mr. COBURN. Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Pitts).

Mr. COBURN

Mr. COBURN. Mr. Speaker, pursuant to clause 7(c) of rule XXII, I hereby announce my intention to offer a motion to instruct conferees on H.R. 4577 tomorrow. The form of the motion is as follows: I move that the managers on the part of the House on disagreeing votes of the two Houses on the bill, H.R. 4577, be instructed to recede to Section 517 of the Senate amendment to the House bill, prohibiting the use of funds to distribute postcoital emergency contraception (the morning-after pill) to minors on the premises or in the facility of any elementary or secondary school.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I ask unanimous consent to withdraw my name from H.R. 3250.

Mr. COBURN

Mr. COBURN. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Maryland (Mrs. Morella).

Mr. COBURN. Mr. Speaker, I yield 30 seconds to the gentlewoman from Texas (Ms. Jackson-Lee).

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, let me make a couple of points. The area which the gentlewoman spoke about was from the concerns of New York were with title II. We adjusted all of that funding, and she is aware that we adjusted that. The State of New York supports this bill. So let there be no question. We responded to what they recognize was a problem and fixed the title II funding distribution in the bill. The second thing, the reason we pulled the chart down was so we could put up the other one, which both show the same thing. The GAO testimony is clear. There is a disproportionate amount of money going for people in the EMA in San Francisco. I do not want to see that drop one penny. I do not believe it will. If I thought it would, I would not be sponsoring this bill. I believe the statement of the gentleman from New York (Mr. Towns) was probably the most profound of all, that we need more money. Dr. Green's testimony about more ADAP funds we authorized whatever may be consumed in this bill, and it is our job to make sure it is appropriated to make sure those people are there. So I think it is important for us to be clear. The fact is that GAO testimony says there is a marked disproportion. We are not going to fix that all. We are going to fix that a little bit, 2 percent this year, which, in direction, 2 percent this year with what has been appropriated will have no effect on the San Francisco EMA. I would hope that they would recognize that. Mr. Speaker, I reserve the balance of my time to close.

Mr. COBURN. Mr. Speaker, reclaiming my time on that statement to say that that area, that EMA gets twice as much money per person with that than anybody else in the country. If the gentlewoman can stand and defend that while people in Oklahoma are waiting in line and not getting drugs, while people cannot get any of the care in rural areas in this country because more money is consumed in one EMA relative to all the rest, and we can stand by and watch people have to wait for somebody to die before they can get on a drug list, I will not recognize that. I will not accept that. I believe that it is an unfounded statement. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, reclaiming my time, we will have to disagree. The facts, they are very obvious. The facts are people with HIV today in this country are not and do not have the same reference to treatment and care based on the funding formula that we have. There is no recognition that we want to and there is no admission that we want anybody to get less treatment, nor will there be. The fact is that, as the gentlewoman from California very well knows, in the San Francisco EMA, they spent $55,000 of Ryan White CARE money to fund the advocacy of an election in California, an initiative balance that had nothing to do with Ryan White. So we also know many other things about EMA that I do not think we need to go into here. The facts are that, in San Jose, in the same area that the gentlewoman is, we are seeing $3,000 spent, whereas in the San Francisco EMA, it is $5,900. So I would respectfully disagree with the gentlewoman from California (Ms. Pelosi). The last point that I would make, if one has never told somebody they have HIV, if one has never been there to tell them that and then know they are not going to have access, regardless of whatever efforts one has, one cannot imagine the feeling knowing that one just put that person in a position of watching themselves die as we stand by. So I am not about to want anybody in the San Francisco EMA to have that experience because I have had to tell people that, and I doubt very few others in this body have. So I object to the fact that the gentlewoman would say that we are interested in withholding care for anybody with this disease. That is not what this debate is about. I understand that is where my colleagues want to take it. That is not what this debate is about. Mr. Speaker, I yield to the gentlewoman from California (Ms. Eshoo).

Mr. COBURN. Mr. Speaker, we have just spent 15 minutes talking about a tug of war over money, and what we should be talking about is prevention and the great things this bill does to keep the next person from getting HIV infected. When I came to Congress in 1995, one of my goals was to try to raise the level of awareness of how we can prevent this disease. This is not hard. But we have let extraneous issues get before us. There is no one on that side that I doubt their compassion for wanting to do the same thing I want to do, and that is to not ever see another person get this disease. The gentlewoman from California (Ms. Pelosi) and the gentlewoman from California (Ms. Eshoo) feel as strongly about that as I do, and I know the gentleman from California (Mr. Waxman) does. The gentleman from California has been a prince to work with. It has been one of the real pleasures of my time in Congress to have worked on this bill with him, and I will remember it and I thank him for his cooperation. But we cannot forget about what this epidemic is about. There should not be 40,000 new infections this year for this disease. Now, think about it. For every one person who gets this disease, it is a minimum of $10,000 in health care. If we prevent 1,000 from getting it, we save $10 million in health care that year, the next year, and every year. If we drop the infection rate in half in this country, we will save $5 billion in 3 years, just by dropping the infection rate. We will have more money to take care of everybody that has it, plus we will be able to spend $5 billion on cancer research for breast cancer, just by prevention. We get lost in the wrong issues. The issue is prevention. This bill goes a long way in identifying that. I will work with anybody to make sure nobody gets shortchanged when it comes to this, but we have to work together to make sure that there is no waste; that there is not exorbitant payments to groups that are not doing things to help people with HIV; that we do everything that we can to make sure the next person does not get infected. I took a lot of heat in 1995 putting a baby AIDS bill into the Ryan White. It never got funded, and what was funded was not used for babies. The State of New York had the courage to put in a baby AIDS bill, where if we did not know the status of the mother they were tested. Today, all babies who are born are tested for HIV; 98.8 percent of them are in care. We have made a tremendous difference just in the discussion of it in the State of New York. I applaud the State of New York for what they have done. Mr. Speaker, I thank again the gentleman from California (Mr. Waxman) and his staff, Paul; my staff, Roland Foster, and I look forward to the conference as we go along, because the House, I am sure, will pass this bill.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. (Mr. COBURN asked and was given permission to revise and extend his remarks.)

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I would challenge what the gentlewoman from California (Ms. Pelosi) had to say. If my colleagues can see in this chart the nominal funding per AIDS case, and the arguments that she just made do not hold water. The fact is the 13,000 people she describes, California still is getting money for them. Their funding formula in San Francisco still considers those 13,000. There is nothing in this bill as people are identified with HIV, not AIDS, San Francisco will get more money, not less money. So the argument that there will be less money attributable to recognition of HIV and what is done in the EMA in San Francisco, it holds no water. If one looks at this chart, what one sees is that San Francisco, in real dollars, based on 1999 EMA gets $5,958 per AIDS case. The next closest is $3,132 in Miami, Florida. My colleagues can see all the rest of the red there. The vast majority gets 60 percent or less than San Francisco. The goal of this bill is not to hurt San Francisco. The goal of the bill is to help those very people who do not have access at anywhere close to the level to the program, the medicines, or any other aspect of the Ryan White CARE funds. This is about fairness. This is not about fairness for a white male in Oklahoma. This is about fairness to an African American or Hispanic female in a rural area or in Baltimore who today does not get the same amount of resources directed to them that is available to somebody in San Francisco. It is not about penalizing. It is about fairness. Mr. Speaker, I gladly yield to the gentlewoman from California (Ms. Pelosi) for her question.

Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I submit for the Record a letter from the State of New York on the baby AIDS provision that they have in testing, and also the 1990 Senate Ryan White CARE Act Debate Regarding the Need for HIV Partner Notification. State of New York, Department of Health, Albany, NY, February 3, 2000. Hon. Tom A. Coburn, M.D., Member of the Congress, U.S. House of Representatives, Cannon House Office Building, Washington, DC. Dear Dr. Coburn: I have been asked to reply to your letter of December 20, 1999, to Commissioner Novello on prevention of perinatal HIV transmission. The perinatal HIV prevention program at the New York State Department of Health is a comprehensive program that seeks to address many of the steps in the chain of events leading to an HIV-infected child, as identified by the Institute of Medicine in their 1998 report, ``Reducing the Odds.'' An important initial prevention step in this chain of events is to ensure that all pregnant women are enrolled in prenatal care in the first trimester and ideally, have received preconception care. Significant program resources, including new funding from the Centers for Disease Control and Prevention (CDC) for outreach to high risk women, are directed to this purpose in New York State. In 1997, 10.6 percent of all women (according to birth certificate data) and about 10 percent of HIV positive women in New York State (based on chart reviews) received no prenatal care. The second step in preventing perinatal transmission is to ensure that all women in prenatal care receive HIV counseling and testing according to the U.S. Public Health Service guidelines. In New York State, regulations adopted in 1996 (10 NYCRR sections 98.2(c), 405.21(c), 751.5(a)) require all regulated prenatal care providers (hospitals, clinics, HMO providers) to provide HIV counseling with a clinical recommendation to test, to all prenatal care patients. Such counseling and recommended testing is the standard of medical care in New York State, even for physicians not practicing in regulated settings. The Commissioner has sent a letter to this effect to all prenatal care physicians in the State. The letter was co-signed by the State Medical Society and the State chapters of professional organizations in pediatrics, obstetrics and family practice. The Department also monitors prenatal HIV counseling and testing rates at all regulated health care providers through review of a sample of prenatal care medical records. These data are fed back to providers and technical assistance is provided to improve delivery of these services. For women who test HIV positive or are known to be HIV positive during pregnancy, the State has developed a network of specialty providers for perinatal HIV medical care. These providers ensure that each HIV positive pregnant woman has a full evaluation for combination antiretroviral therapy depending on her own health status, prescribe zidovudine (ZDV) according to the PACTG 076 regimen for prevention of perinatal transmission, and make referrals for housing, adherence counseling and other supportive services that these women may need to adhere to therapy. New York Medicaid and the State's AIDS Drug Assistance Program (ADAP) provide reimbursement for pharmaceuticals for women in need so that all women have access to preventive therapy. The Department, with the help of a panel of expert clinicians, publishes detailed clinical treatment guidelines for antiretroviral therapy and prevention of perinatal transmission, and also funds a network of clinical education providers across the state to train clinicians carrying for HIV positive patients. In the area of newborn HIV testing, Public Health Law (PHL) 2500-f, signed into law by Governor Pataki in 1996, created an exception for newborn HIV testing to the informed consent requirements for HIV counseling and testing in the HIV Confidentiality Law, PHL Article 27-F. It also directed the Commissioner to develop a comprehensive program for the testing of newborns for HIV. This program is further defined in State regulations (10 NYCRR Subpart 69-1) and has gone through two phases. During the first phase, beginning on February 1, 1997, the Department's Newborn Screening Laboratory began HIV testing of all newborn filter paper specimens submitted for metabolic screening without removing patient identifiers and returning those test results to the birth hospital for transmittal to the pediatrician of record. Prior to that time, blinded HIV newborn testing had been done for epidemiological purposes since the late 1980's, and mothers had been encouraged to receive a copy of their newborn's HIV test result since May 1996 (over 90 percent of mothers consented to receive their newborn's HIV test result in that program). Universal newborn HIV testing has resulted in the identification of all HIV-exposed births. HIV test results from the newborn testing lab are often not available until two weeks after birth. These results are not timely enough to permit administration of ZDV therapy to prevent HIV transmission, but can be used to counsel women to stop breastfeeding which may prevent some cases of transmission. Newborn testing has allowed hospital and health department staff to ensure that over 98 percent of HIV positive mothers are aware of their HIV status and have their newborns referred for early diagnosis and care of HIV infection. In less than 2 percent of cases have women not been located to receive newborn HIV test results and have their HIV-exposed newborns tested for HIV infection. The Department is in the process of reviewing all pediatric medical records up to 6 months of age for HIV-exposed infants born starting in 1997 to determine the quality of HIV care they are receiving and to document the perinatal HIV transmission rate. The second phase of the newborn HIV testing program began on August 1, 1999. It added regulatory amendments to Subpart 69-1 to require expedited HIV testing in the hospital delivery setting in cases where an HIV test result from prenatal care is not available. This addition to the newborn testing program was undertaken because of evidence that perinatal HIV transmission may be reduced by initiating ZDV therapy during labor or soon after delivery, even if ZDV was not taken during prenatal care (NEJM 1998;339:1409-1414). Hospitals now screen all women admitted for delivery for HIV test results from prenatal care. If a prenatal HIV test result is not available, the hospital must provide the woman with HIV counseling and expedited testing if she consents. If the mother does not consent to HIV testing of herself, the hospital must perform expedited testing on her newborn immediately after birth under the authority of the comprehensive newborn HIV testing law. Expedited tests must be available as soon as possible, but in no case longer than 48 hours. Provisional data from the initial months of the program show that 32 HIV positive women/ newborns were identified for the first time by expedited testing at delivery, permitting early initiation of ZDV in most cases; 12 additional positive cases could have been identified if all hospitals had fully implemented the program, and 17 false positive HIV results occurred. False positive preliminary HIV tests occur because Western blot confirmation of preliminary positive results cannot always be obtained in the 48 hour time period. The Department has encouraged the Food and Drug Administration (FDA) to approve additional rapid HIV tests in the near future to alleviate this problem. A significant benefit of the expedited testing program is that delivery hospitals are now working more closely with their prenatal care providers to ensure that HIV counseling and testing is done at the appropriate time during prenatal care and that the test results make it to the delivery hospital. Rates of participation in prenatal care in New York State are monitored by review of birth certificate data. These rates have been increasing gradually over recent years. Currently about 80-85 percent of women delivering report first or second trimester prenatal care and about 10.6 percent of women report no or unknown prenatal care. There has been no detectable change in prenatal participation trends through 1997 that might be related to the newborn testing program. Anecdotally, we have not heard of problems in this regard. The analysis is currently being updated through 1998. Prenatal care for HIV positive women is also being examined through review of prenatal charts. Limited numbers of women whose HIV status was identified by newborn testing are being interviewed to see what the impact of newborn testing has been. Ultimately, the goals of the prenatal HIV prevention program in New York are to reduce prenatal HIV transmission to the lowest possible level through; ensuring access to prenatal care for all pregnant women; ensuring counseling and testing of all women in prenatal care; ensuring that all HIV positive pregnant women are offered and adhere to ZDV therapy and are evaluated themselves for combination therapy and other care needs; ensuring that HIV test information is transferred in a timely way to the anticipated birth hospital; and, conducting expedited testing in the delivery setting for all women/newborns for whom prenatal HIV test results are not available. Newborn testing will continue to be conducted at the Department's Newborn Screening Laboratory to ensure that all HIV positive newborns are identified and referred to care. The newborn testing data also provide valuable, timely information to monitor the epidemiology of perinatal HIV and prevention efforts. Thank you for your interest in our program. Please let me know if I can provide any further information. Sincerely, Guthrie S. Birkhead, M.D., M.P.H., Director, AIDS Institute.

Mr. COBURN. Mr. Speaker, I yield myself 2\1/2\ minutes. Mr. Speaker, the AIDS Action Council, the largest AIDS organization in the United States, supports this funding formula. Let us be clear about that. Number two is Ryan White title I funds, San Francisco last year received over $35 million. At the end of the year, they had a $7 million balance in their checking account. If we take the growth in title I funds that we have seen in this Congress and the two congresses previously, we are averaging 24 to 29 percent per year increase. Take a million dollars. Under this hold harmless, at the end of 5 years that means they would have $750,000. But at a growth rate of 24 to 29 percent, what they would actually have is well over a million dollars at the end of that 5 years. So we are into the specifics of talking about a cut when there is no cut. The fact is there is extreme imbalance in the amount of funding that is going to the EMA in San Francisco versus other areas and it is recognized. This legislation is not intended to hurt San Francisco. I will have a private wager with the gentleman and gentlewomen from California that in 5 years there will be more money under this formula for each of those EMAs than there is today, including San Francisco. Because, in fact, if we increase something 25 percent per year, at the end of 5 years we will not have 200 percent, we will have about 270 percent. So even with the 25 percent cut, if that would happen, and that is just the potential. I understand my colleagues should be concerned to protect what is already coming in. The second point that I would make is that the testimony from the GAO clearly said that there is a disparity in the funding. And they clearly said that the foundational factor under which we made that funding was based on what the funding was in 1990, which was evidence of those who had HIV, had AIDS, and had died. So the base that is used for the San Francisco EMA continues to recognize in its base not people living with HIV, but people who have died from AIDS, people living with AIDS. What our formula will say is if HIV increases in San Francisco, they will get more money. As people live longer, they will get more money. And what we do is to make sure somebody who lives in South Carolina in the rural areas has the same opportunity for care and treatment as somebody in San Francisco. Mr. Speaker, I reserve the balance of my time.

Mr. COBURN. Mr. Speaker, may I inquire as to the balance of time.

Mr. COBURN. Mr. Speaker, I yield myself 2 minutes. Mr. Speaker, I also have a chart I want to show. Firstly, I thank the gentleman from New York (Mr. Towns) for his support of the bill and his fair criticism of what he sees as maybe a problem in funding disparities. However, I would tell him that the concerns of the State of New York were really of title II in this bill and not title I, and we changed that funding formula to meet the concerns of the State of New York. I also would point out, as he can see on a cost adjusted basis, that the State of New York on a basis of a per AIDS case gets approximately $1,900 less per individual in New York City than somebody in San Francisco, and the whole disparity that we are trying to address is not to harm San Francisco but is to make an equalization for those in New York City that they might have an increase in funds. The gentleman from New York (Mr. Towns) also made the statement that probably our problem is that there is just not enough money here, and I would probably tend to agree with him, that that is the base problem. The other thing that I want to correct in his statement is there are 350,000, at least 350,000 in this country today that are infected with HIV that do not know it. It is not 100,000. It is 350,000. There are another 350,000 who have HIV and do know it, and there are another 350,000 who have full-blown AIDS. The problem is, and the reason this bill has moved some direction towards prevention, is we have made no dent in the case of new HIV infections in 7 years in this country. The fact is that 40,000 this year, 40,000 next year and 40,000 last year and the 2 years before continue to get infected with this virus and that is why this bill is so important, because it redirects us to where the epidemic is, not to where it was. We still recognize where it was but we want to put the dollars where the epidemic is. Mr. Speaker, I reserve the balance of my time.