by HRSA Administrator Elizabeth M. Duke
August 23, 2004
Washington, D.C.
It is just wonderful to be here this morning and to see all of you here. I know that this is a very big commitment of time and energy and travel for many of you, and we deeply appreciate your willingness to come to really plan this meeting with us and to be, really, the faculties of over 200 workshops. And it was wonderful to come through the lobby and see so many faces that I’ve seen before. It is a real recognition of what you have accomplished over these last several years. When I look around here and see the commitment, the passion, the energy that you bring to the meeting, I feel ever so blessed to be part of this community, and I thank you so very, very much.
You know, it’s a world of great ideas, and you have to find those ideas and bring them together, because ideas sort of stuck in a box somewhere aren’t going to do us much good. It’s the idea of getting your best thoughts out and bringing them to bear, not only in your worlds, but also in the worlds of your colleagues. It’s with a great deal of pleasure that I work with the HIV/AIDS Bureau, which is an energetic, idea-filled agency, which really subscribes to my view of life – that is: heresy is the name of the game. Because asking the crazy question, asking the question everybody is thinking but nobody wants to put on the table, that’s what we do for a living. I’m very proud of the bureau, and I want to thank Deborah and her leadership team for doing a great job.
I want to give you a little update on some of the things we’ve been doing. Really, when I say it’s an update on what we’ve been doing, it’s an update on what we’ve been doing in the big sense of the word “we.” Later today we’ll be releasing the most recent report on the CARE Act, and it has a wonderful statement in it. It says “AIDS incidents and mortality have fallen among uninsured people because CARE Act-funded providers are very good at reaching populations historically underserved by the larger healthcare system.” What a compliment to you, for you. The report is called The AIDS Epidemic and the Ryan White CARE Act – Past Successes, Future Challenges. It will be available on our Web site. Notice that it does give a lot of credit for those past successes. I think in life, you always have to step back and see how far we’ve come, because we have come a long way. And then you take another step back and say -- we’ve got a long way to go. But we know how to do it, and that’s the important thing.
We know how to make progress, and we’re doing it. If you think about what we’ve accomplished, think about the people we serve. In 2002, which is our most recent data, we know that our clients, many of them were below the federal poverty level. Over half of them are below the federal poverty level, and one in ten had private insurance, but under those circumstances, you still were able to provide not just care, but the best treatment available in America. You should be very proud of that accomplishment of quality. We’ve been providing great care in primary settings for a population that would not have care without us. That translates into neighbors helping neighbors, and that’s what this program is about. It’s neighbors helping neighbors, other neighbors learn, and that’s what this meeting is about.
We also know that there are a lot of challenges. I mentioned the word challenges. One of the challenges is the high cost of pharmaceuticals, and one of the things that we’d like to remind you is that another part of HRSA actually can be helpful. Many of you are already registered with the 340B program, which will provide pharmaceuticals at 30 percent off of wholesale drug costs. If you’re not involved with that program, we have a lot of folks here who would be happy to tell you about the benefits of the program. They would be delighted to help you sign up with our Office of Pharmacy Affairs, and you can do that on their Web site. It’s a great program. It’s one of the little-known wonders of what we’ve been able to do. And I always have to tell people this story, because everyone assumes that a program as big as the 340B program must include many federal staff, you know, bureaucrats running around. If I told you that that program is staffed by six people, it would tell you about the real dedication of those six people to their mission. Please get to know them; they’re good people, and they can be very, very helpful to you.
Steve mentioned the President’s Initiative for Health Centers, so I thought I’d give you a little update on that as well. We now have over 3,700 health center sites, and we’re serving well over 13 million people in our primary care network. In those health centers, we’re providing HIV testing and counseling. Over 90 percent of our health centers have counseling and testing in-house, and over 99 percent provide those services either in-house, or by referral. So the increases in the health center network under the President’s Health Center Initiative are a tremendously valuable asset to what we’re doing here together.
Another Presidential Initiative that affects HRSA is the President’s recent announcement of
$20 million to help people with ADAP medications.
This is a very important effort.
The president took a look at the rating list in ten states and was concerned.
The question that we got was, what can we do now?
And the answer was to put together a program, which the President announced about a month and a half ago, to deliver $20 million to patients in 10 states. Those are the states that had waiting lists in June.
We’re in the process of sorting out the actual mechanisms to get the medicines to those patients and, once that mechanism is in place, we hope we’ll be able to target a $35 million increase in ADAP that was included in the 2005 budget that we proposed to Congress to areas that are experiencing a waiting list. The ADAP program has increased tremendously.
It is now at $784 million, and that will purchase drugs for over 100,000 patients a month.
That’s up from 94,000 just this year. When we look at the challenge of reauthorization, we will be facing an opportunity to target these resources to those who need them most.
We want to provide more retroviral drugs.
We want to have more funding for doctor visits and lab tests.
We want to make sure that the reauthorization will allow people to get the services they need most, the best in quality, the most modern, the most beneficial.
When we look at areas of particular focus and targeting, one of the areas that we’ve identified is the U.S./Mexico border.
When you look at that 2,200-mile border, you find that if that area were a state of this union, across the board, it would have the worst health statistics in the nation.
And that is a disgrace. So we have targeted all of HRSA’s resources to improvements along the border. One of the ways we’ve pushed this initiative a big step forward is by doing immunizations.
We’re also going to be doing health education, testing and screening, and meeting with the people who need us most in that area.
And this is not a one time effort, but rather, we see this as an opportunity for revving up the engines of care and taking off to provide much better care in that area of our country.
So please be involved in that activity.
We would be so pleased to have you involved.
One way of looking at our work in the border area and the work we’re doing with the government of
Mexico is as another important part of our international involvement.
You know one of the things that you all have done very well is to pioneer great care, and now, you’re getting recognition for that, because people are looking at what you’ve done, and they want to know how to do it.
As a result, the President and Congress have given us authority to operate internationally and to bring the benefits of what you’ve discovered, to those others in the world who can benefit.
And that’s through President Bush’s Emergency Plan for AIDS Relief. I always have to stop on that one, because it’s got a title so long, and we just call it PEPFAR. But this is an important fight.
This is a five-year commitment. This is $15 billion, with a B.
It’s the largest commitment ever made by a single nation for an international health initiative.
Through PEPFAR, the
U.S. will devote $5 billion to our ongoing bilateral programs with over a hundred countries. We’ll increase our pledge to the Global Fund to fight AIDS, tuberculosis and malaria.
That, you know, is chaired by our Secretary, Tommy Thompson.
We’ll increase that by over a billion dollars over five years. And in 15 of the most impacted countries, 12 of them in Africa,
America will commit $9 billion to provide treatment, prevention and social services to millions of people who would not have those services, would not have that care had you not pioneered what we’ll be taking more broadly to the world. It is a tremendous compliment to you that this international effort is undergoing such an expansion, and so I thank you for that, and the world thanks you. That’s right. You should applaud yourselves. It is a huge success, and it is one that we all need to recognize.
Tomorrow, Steve mentioned that there is an awards luncheon, and I am thrilled by the opportunity to recognize eight of your colleagues for their excellence and their leadership. But I always see awards ceremonies in groups like this as a way of complimenting everyone here. Here are eight leaders who are symbolic of the excellence which is characterized by every program in this room. And so tomorrow at that luncheon give hugs and kisses and lots of applause to your colleagues who have won those awards, but at the same time give yourself a pat on the back, and accept the real thanks, the gratitude of this nation, and actually now, the gratitude of this world. Because of you, this world is a better place. Because of you, people live better lives. Because of you, some people are living lives. So thank you. Thank you from the bottom of my heart from this agency, this government, from this world for everything that you do. Thank you so very, very much. Thank you.
