Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H., F.A.C.S.
United States Surgeon General
Department of Health and Human Services

Thank you, Fran. [Frances Ashe-Goins, Deputy Director of the Office on Women’s Health, Office of Public Health and Science]. Thank you all for coming today, and I want to extend a special thank you to Dr. Cristina Beato, our acting Assistant Secretary for Health, for being here today. I also want to thank the BET HIP HOP choir and Matthew O’Neill for joining in this very important observance.

Over the past year, I’ve had the privilege of serving with you here at HHS, working closely with our very dynamic leader Secretary Thompson. Today as we join together to observe the 15^th Annual World AIDS Day, we remember how AIDS has changed our lives, and our world. My own early experiences as a physician included working with patients suffering from HIV. I did my medical internship and residency from 1979 to 1985 at San Francisco’s Mission General Hospital. I often worked with my friend and colleague Julie Gerberding. Now, as Director of CDC, Dr. Gerberding is still very much involved in the fight against AIDS.

Back then, as a young surgeon, I started seeing a lot of patients with unexplained bowel obstructions, unusual cancers, and other serious symptoms. Many of these patients were young men who would soon die extraordinarily painful deaths caused by symptoms that we couldn’t trace to any logical origin. So we couldn’t explain their illness or their deaths to their families and loved ones. At best, we treated symptomatically. It was hopeless and frustrating and sad for us, and for their families. Although we didn’t know it at the time, San Francisco General was at the heart of America’s nascent AIDS epidemic.

Today, over 40 million people around the world are living with HIV/AIDS. In 2002, there were 5 million new HIV infections. We can’t just think of them as numbers… these are real people. With real pain and real families and real people who care for them.

AIDS kills our youth, our middle-aged, our seniors. Gay or straight — it impacts everyone. It delivers death to people in the prime of their life and no city or town or village can escape it.

HIV/AIDS disproportionately affects African Americans and Hispanic Americans, just as it affects our brothers and sisters in Africa, Latin America, and the Caribbean. But this has little to do with genetics. More than 99% of the genetics of everyone, everywhere are the same. But it has a lot to do with health literacy…health education. The fact is that in many minority and poor communities, people have not truly accepted that they can become infected with AIDS, that they are not immune.

From Harlem, New York, to Haarlem, South Africa, men, women, and children of color are being infected with the AIDS virus in staggering numbers. Africa has been hit the hardest. Three million African children are infected by HIV. 3 million. And the disease has left 11 million orphans, more children than live in D.C., Virginia, Maryland, and New York combined.

Earlier today I visited the Family Medical Counseling Services clinic in Anacostia. I met their amazing staff and saw their patients — men, women, and children — who are struggling every day in their personal lives with HIV and AIDS. And while we’ve made progress we know that these patients and health care professionals struggle every day with the pain of this disease.

But the news is not all grim. We have not yet found a way to defeat AIDS, but we have learned some effective ways of fighting it. Two decades ago, HIV/ AIDS was a death sentence. But today we have more people living with AIDS then at any other time. Today, there is hope for AIDS patients.

The Bush Administration is providing leadership globally and here at home.

1. Last year, the Administration spent over $16 billion — the largest amount ever — on HIV/AIDS programs in response to our nation’s crisis and the global crisis. President Bush has requested over $18 billion in domestic and international AIDS funding for fiscal year 2004. We are standing shoulder to shoulder with communities, health departments, and faith-based organizations to battle HIV/AIDS and to help the people who are infected get the care they need.
    
   The Department is committed to ensuring that the resources follow the disease. And we are placing special emphasis on delivering help to those American communities that are the hardest hit.
    
   
2. We are using taxpayer resources wisely — our programs and policies are evidence-based and reflect the highest standards of accountability in dollars spent and outcomes reached.
    
   
3. HHS supports a wide range of prevention, testing, treatment, and research strategies to fight HIV/AIDS. Early knowledge is critical to controlling the spread of the HIV infection, as is access to quality patient care. Testing and diagnosis are especially important for preventing mother-to-child transmission because we can treat HIV positive pregnant women to prevent the virus from passing to their babies.
    
   
4. We are also using the ABC approach as part of our response to the epidemic. Developed in the East African country of Uganda, where the ABC approach has meant a significant decline in HIV and AIDS, we are now taking their lead in a common-sense effort to reduce HIV transmissions here.
    
   ABC stands for Abstinence, Be Faithful, and Use Condoms. We are encouraging young people to delay sexual activity. We are reminding those who are already in relationships of the importance of faithfulness and monogamy. And we are encouraging those who engage in high-risk behavior to use condoms consistently and correctly, each and every time they have sex.
    
   
5. And research is a critical component of the HHS strategy to fight HIV. Many approaches to HIV prevention are being studied and refined, and development of a safe and effective vaccine is in the works. Vaccine candidates are a big part of our hope for the future AIDS arsenal.

The bottom line is that the United States is using a multi-pronged approach, unprecedented in human history, to stop the spread of this insidious disease at home and abroad. President Bush and Secretary Thompson are leaders in the fight against AIDS. As Chair of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Secretary Thompson has already accomplished a great deal.

So far, the United States has spent or requested $1.6 billion for the Global Fund — more than a third of the money pledged to the entire fund by all nations. Secretary Thompson is in Africa right now leading the largest-ever U.S. delegation to that continent. During their trip they are focusing on what is needed to help the people who are already suffering because of AIDS, and to help promote ways to prevent the spread of the disease.

The Secretary’s delegation includes U.S. and international health officials, members of Congress, and leaders from more than 40 faith-based organizations, private-sector groups, and charitable organizations. They will visit urban and remote areas of four hard-hit nations: Kenya, Rwanda, Uganda and Zambia. The sites supported by President Bush’s Emergency Plan for AIDS Relief and by the Global Fund.

And tonight I will depart for Uruguay, where I will represent the Department and take part in the 8^th World STI/AIDS Congress. I am proud to take our message to other nations.

As President Bush has said — "There are only two possible responses to suffering on this scale. We can turn our eyes away in resignation and despair, or we can take decisive, historic action to turn the tide against this disease and give the hope of life to millions who need our help now. The United States of America chooses the path of action and the path of hope."

As a physician, as Surgeon General, and as an American, I’m proud that this Administration, under President Bush and Secretary Thompson, has done more to combat and treat AIDS than has ever been done in the history of this nation.

We have seen some great successes:

• First, prevention efforts have reduced the annual number of new HIV infections in the United States from over 150,000 per year to about 40,000 per year. 40,000 is still too many, but the number of new infections in our nation is going in the right direction — down.
   
  
• Second, we have seen the positive impact of advances in HIV therapeutics for many people living with HIV/AIDS in the United States and other western countries, and more recently the promise these medicines offer in the developing world.
   
  
• And finally, in the area of treatment, some very recent good news: Over the past few years, scientists have identified new targets for HIV therapy and novel drugs that block stages of the virus replication cycle.
  
  The FDA recently approved a drug called T-20 that blocks the fusion of HIV to the host cell membrane. This holds true promise for many HIV-infected patients who harbor a strain of the HIV virus that is resistant to current therapies.

These are great successes, and I list them to you with the greatest humility. President Bush, Secretary Thompson, and I know that the real credit is due to the brilliant scientists and public health professionals throughout the world and particularly in the HHS family who dedicate their careers to preventing, treating, and someday curing AIDS.

As Surgeon General, I also want you to know that the Department cares about your health and well-being. We are committed to providing all of our employees with the latest information on HIV/AIDS.

Today we are offering free, confidential, rapid HIV testing for employees here in the Southwest complex, and that testing will take place throughout December. Please take advantage of this opportunity to learn your HIV status.

Thanks to Secretary Thompson’s commitment to the development and approval of the rapid HIV testing technology, this essential health information can now be provided quickly, even in non-medical settings.

There are many benefits to getting tested, including the chance for early entry into treatment. Learning your status early in the disease still doesn’t happen for many Americans, so they lose out on the benefits of early treatment — like preventing illnesses that arise from a weakened immune system.

In addition, when people know that they are HIV positive, they can help to prevent transmission of the disease. You can also find information about HIV on the Department’s World AIDS Day web site.

We can win this fight. As Secretary Thompson said before he left for Africa yesterday: "People need to know when they should be tested and should know their own HIV status. Our efforts must start with knowledge, because HIV/AIDS has no power over a well-informed person who makes safe, educated decisions regarding his or her health."

We need to improve health literacy and health knowledge both here and abroad. By working together to support culturally competent messaging we can reach communities with accurate information and abiding hope.

We need to relay the facts:

1. Anyone who might be at risk for HIV must be tested.
    
   
2. There is no cure, no vaccine. But there are drugs that can enhance the lives of people with HIV/AIDS.
    
   
3. Unfortunately there are still communities who refuse to acknowledge that HIV causes AIDS. Instead, they have bought into the myth that the treatments actually lead to death. We need to change this culture of cynicism and show them a culture of hope.
    
   
4. Drug use is dangerous on so many levels. Not only is the drug damaging to a person’s physical, psychological, and emotional well being, needle sharing continues to be a significant conduit of HIV transmissions.
    
   
5. We need to communicate to those people who insist on seeking out HIV. We know that by making simple, smart choices, anyone can greatly reduce their risk of contracting HIV.
    
   And,
    
   
6. Worldwide we need to promote the ABC message brought to us by President and Mrs. Museveni of Uganda. We know that abstinence is 100% effective in stopping the spread of disease. In many places prostitution and promiscuity have literally given legs to sexually transmitted diseases that attack entire communities.

As I said earlier, the pain of HIV and AIDS is not distinct to one community. It affects us all. I’m sure we’ve all been moved at the sight of the AIDS Memorial Quilt. Over 44,000 panels, woven together, much like our lives, showing the lives of so many of our friends and loved ones lost in this battle.

In closing, I would just like to say that I was so proud to see our President eating his Thanksgiving dinner with the troops in Iraq. Then I thought about how our missions aren’t that different. Those soldiers are working to give liberty from death’s grasp from tyranny. We’re working to give liberty from death’s grasp from disease.

We are all soldiers in an epic struggle to save lives. We all working toward the hope of a better, safer, freer tomorrow. The reality is that one person can make a difference, and a community that cares and joins together can do even more. HHS can and should be that community. Each of you is a role model, and as a Department we are the living embodiment of what people can do when they work together for the good of our nation.

Thank you.

Last Revised: April 27, 2004

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