Remarks as prepared; not a transcript

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

"The Health State of the City of New Orleans" Conference
Dillard University, New Orleans, Louisiana

Thursday, November 13, 2003

"HIV/AIDS Prevention, Research, and Treatment: New Strategies and Investments"

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Thank you, Dr. Stephens. [Kevin Stephens, M.D., Director of City of New Orleans Department of Health]

Itís an honor to be here with you today. Itís especially wonderful to have this opportunity to address the students. Many of them have worked hard their entire lives, always striving toward higher education. I applaud that focus and determination.

Background

When I meet people for the first time, they seem to assume that I always planned to be Surgeon General. Nothing could be further from the truth. I am actually a high-school dropout. My career progression has been anything but a straight line to the Surgeon Generalís office.

I have been a Special Forces medic, a registered nurse, a paramedic, a trauma surgeon, a law enforcement officer, a professor, and a public health system CEO. Iíve also been a poor Latino street kid who had difficulty accessing care. I was what is now called a health care disparity. Iíve also had the experience as a child of being hungry and homeless.

I grew up in New York City, the oldest of four kids. My parents were good people, but they struggled with serious and eventually fatal substance abuse problems. We were poor, and the first time I can remember being homeless was when I was 6 years old.

My abuelita always made sure that we had a place to sleep, and a lot of the time that place was on the floor of her little apartment in the projects. There were times that more than a dozen family members were living in that one-bedroom apartment.

Abuelita was the matriarch of our family. She weighed about 90 pounds soaking wet, but was the toughest person Iíve ever known. The mother of 27 children, she came to New York seeking a better life for them and her grandchildren. I disappointed her terribly when I dropped out of high school. My brothers, sister, and I all dropped out, as did most of the kids we knew. In our Ďhood, high school graduation was a reportable event.

So I ran the streets, doing odd jobs. Until a man from the neighborhood, an Army Green Beret, told me that I needed to go back to school. I told him that I couldnít ó at age 17, I was just too old. So he said that I needed to talk with the Army recruiter.

I decided that I wanted to join the Special Forces. But to join Special Forces, you had to have a high school diploma.

That was my first barrier. And really my first academic success was getting my Army
GED. I became a Special Forces medic and weapons specialist. In Vietnam, I took care of my 12-man Special Forces A-Team, and they took care of me.

I thought that I would make the Army a career, but the older guys told me that if I wanted to be a doctor, I should go for it. So I went home to New York, where I was incredibly lucky to enroll at Bronx Community College, which had an open enrollment program for Vietnam vets.

I did well there, and starting making up for having failed at school during the first half of my life. I went from BCC to the University of California at San Francisco for college and medical school.

I loved school, finishing medical school in three years, and at the top of my class, because I never took time off ó I just wanted everything they could throw at me.

By then, I had been an Army medic, a lifeguard, a paramedic, and a registered nurse. These were all jobs I did to support myself and my family, and they all taught me something about taking care of different populations.

San Francisco

But nothing could have prepared me for the early- to mid-1980s in San Francisco. I did my internship and residency at San Francisco General Hospital. I often did shifts and traded shifts with my friend and colleague Julie Gerberding, who many of you now know as the Director of the Centers for Disease Control and Prevention.

As a surgeon I started seeing a lot of patients with unexplained bowel obstructions who also had other serious symptoms, like dermatological problems. Many of these patients were young men. We couldnít figure out what was wrong with them. Although we didnít know it at the time, San Francisco General was at the heart of the beginning of Americaís AIDS epidemic.

HIV/AIDS

More than 20 years later, AIDS is still a devastating disease. Itís a global epidemic that keeps making even deeper inroads into human security.

AIDS kills the young and middle-aged. It delivers death to people in the prime of life. It kills in Americaís cities and rural heartlands. It acts slowly, and its victims suffer greatly.

Few of us have escaped having a friend or family member ravaged by the disease. And HIV/AIDS disproportionately affects African Americans and Hispanic Americans in our nation, just as it affects our brothers and sisters in Africa, Latin America, and the Caribbean.

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. 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 disproportionate numbers.

  • More than 42 million people are living with HIV worldwide.
  • 5 million were newly infected in 2002.
  • Africa has been the hardest hit. 3 million African children are infected by HIV.
    3 million. And the disease has left 11 million orphans, more children than live in the entire states of Louisiana, Texas, and California combined.
  • Louisiana

    And here in Louisiana, it is African Americans who continue to be disproportionately impacted by HIV/AIDS. In 1999, 75% of newly detected HIV/AIDS cases were among African Americans, although African Americans comprise 32% of the Louisiana population. (1.)

    And over 70% of diagnosed AIDS cases in the New Orleans area are among African Americans. [Caucasians made up 29% of the diagnosed AIDS cases] (2.)

    Today, take stock of your own work, your own expertise, your personal convictions, and decide what you can do to change these facts.

    What We Are Doing

    The Bush Administration is providing leadership globally and here at home. Weíre providing resources and scientific expertise to address the problem.

    1. The Bush Administration spent over $16 billion ó the largest amount ever ó on HIV/AIDS programs last year in response to our nationís 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.
    2. We are using taxpayer resources wisely and well ó 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. This includes early knowledge of HIV status through testing. Early knowledge is critical to controlling the spread of the HIV infection, as is access to quality patient care.
    4. The Department is working to comprehensively address the issue of HIV/AIDS prevention, care, and treatment. We are using the ABC approach as part of our response to the epidemic: 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. The A-B-C approach was developed in Uganda, where it has created a national AIDS prevention strategy.
    5. In addition, research on HIV/AIDS is critical. Many approaches to HIV prevention are being developed or refined, and the "holy grail" of HIV prevention remains the development of a safe and effective HIV vaccine. We need New Orleans to support ongoing research efforts, address misconceptions related to vaccine research, and encourage local volunteers to take part in available clinical trials.

    The bottom line is this: The United States is using a multi-pronged approach, simply unprecedented in human history, to stop the spread of this insidious disease at home and abroad.

    On the international front, Secretary Thompson is a leader is the fight against AIDS. As Chairman of the Global Fund, he has already accomplished a great deal. So far, the United States has spent or requested $1.6 billion for the Global Fund ó more than a third of the money pledged to the fund.

    The Secretary will visit Africa this month to focus on what more is needed to help the men, women, and children who are already suffering because of AIDS, and to help promote ways to prevent the spread of the disease.

    As President Bush has said ó "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, Iím proud that this Administration, under President Bush and Secretary Thompson, has done more to combat and treat AIDS than any other Administration.

    Successes

    We have seen some great successes:

  • First, prevention efforts have reduced the annual number of new HIV infections in the United States from about 150,000 per year to about 40,000 per year. (3.)
  • 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 for those in the developing world.
  • And finally, in the area of treatment, some very recent, very good news: Over the past few years, scientists have identified new targets for HIV therapy and novel drugs that block other stages of the virus replication cycle. Among them are agents that block viral genes from entering the host cell nucleus, and drugs that keep the virus from attaching to or entering the cell in the first place. In the latter category, the Food and Drug Administration recently approved a drug known as T-20 that blocks the fusion of HIV to the host cell membrane. It holds great promise for the many HIV-infected patients who harbor a strain of the HIV virus that is resistant to current therapies. (3.)
  • I enumerate these successes to you with the greatest humility. President Bush, Secretary Thompson, and I know that the real credit is due to the brilliant scientists who dedicate their lives to finding a cure for AIDS. At the top of that list is my friend Dr. Tony Fauci, Director of NIHís National Institute of Allergy and Infectious Diseases, who has dedicated his professional life to understanding, preventing, and curing HIV/AIDS. This is an exciting time in research, and weíre seeing real progress.

    The list of people who deserve our unending thanks and support also includes the thousands of other scientists, doctors, public health workers, and people living with AIDS who toil in incredibly challenging circumstances to make possible what just at the turn of the 20th century was truly beyond our most optimistic dreams.

    Charge

    I hope that it includes you, especially right here in New Orleans. We can win this fight. We can give babies born to HIV-positive mothers a chance at life. We can give our young people the ABC message that could save their lives. We can give people living with AIDS the chance at a longer, symptom-free life. The reality is that one person can make a difference, and a community that cares and joins together can do even more.

    New Orleans can and should be that community. Think big. Think outside the box. You can be a model for our nation. I want to come back here every year during my tenure as Surgeon General and learn about the successes youíve had, the work youíve done. Iím in this fight with you. Thank you.

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    References:

    1. Louisiana Health Facts: http://www.dhh.state.la.us/LaMHA/Mino_facts.htm#Mino_facts
    2. 2003 Minority Health Report: "From Disparity to Parity":
      http://www.dhh.state.la.us/LaMHA/pdf/Minority%20Health%20Report.pdf
    3. NIAID: http://www.niaid.nih.gov/director/congress/2003/fy2003budget.htm

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    Last revised: January 9, 2007