AIDS Lecture 10/22/87
Statement on Pediatric AIDS
by
C. Everett Koop, MD
Surgeon General
US Public Health Service
Deputy Assistant Secretary For Health
Department of Health and Human Services
Before The
Committee on Education and Labor
Subcommittee on Select Education
US House of Representatives
October 22, 1987

This is another occasion when but one day elapsed since giving the previous lecture on
AIDS.

 

As the public may not universally know, when one appears before a House or Senate
Committee under most circumstances he or she is given five minutes to summarize for
the committee the essence of a prepared statement usually ten to fifteen pages long that is
circulated to the committee the day before and is made available to the public on the day
of the hearing. The statement which follows is, as with all the statements in the archive,
made before congressional committees, the long version not the summary.

As much as individual members of this committee might have known about AIDS in
general, it was safe to assume that their depth of knowledge on pediatric AIDS was slim;
hence some detail has been included here for their understanding and ready reference. I
began by saying that AIDS in children was first described in 1982. I made clear that the
Department of Health and Human Services had sponsored a number of local and national
meetings on pediatric AIDS to discuss the disease and set a course for dealing with its
consequences. Two things immerged from such meetings: infected infants , children and
their families were subject to discrimination and sometimes were unable to obtain basic
services. As of the time of the presentation 595 cases of AIDS in children under 13 had
been reported to the Center for Disease Control. Eighty five percent of those have been
reported just since 1985 with many believing that the numbers are still underestimated. It
was necessary to cover first the youngsters who were HIV positive because they had
hemophilia and had received either transfusions or clotting factor (blood product) before
either mode of transmission of those life saving measures was considered unsafe — that is
before 1985. Next, children affected received their infection from HIV positive mothers
either through the placenta in utero or via birth canal at the time of delivery. For 73% of
those, the mothers were either IV drug users themselves or the sexual partners of IV drug
users. 67% of all AIDS patients who were heterosexual were IV drug abusers or sex
partners of IV drug users at the time this lecture was given. 14% of children born to
infected mothers came for areas such as Central Africa and Haiti where there is a high
heterosexual transmission of AIDS.
There are serious geographic differences in AIDS distribution. 70% of the children with
perinatally acquired AIDS in the United States are from New York, New Jersey, and
Florida. This reflects the close link between babies with AIDS and mothers who are
associated with IV drug abuse.

It is interesting that even as late as 1987 when this lecture was given, I listed a risk group
as being Haitian. This was in error. We could not understand the epidemiology of the
number of patients HIV positive in Haiti. We thought Haitians were unusually
susceptible. Eventually we found that much Haitian medical care was given by doctors
who also practice voodoo along with western medicine and gave their medications by
way of needle without sterilizing the equipment between patients. It is said that most of
those doctors used the same needle over and over again without sterilization until it
became too dull to penetrate the skin. So we were having the same type of transmission
that takes place in IV drug abusers; it had nothing to do with being Haitian.

Most of the 30,000 cases of AIDS that have been reported in women are of child bearing
age and the CDC projects the number of cases of AIDS in women will exceed 20,000 in
less than 5 years. I then discussed some of the research going on at NIH at the National
Institute of Allergy and Infectious Diseases, (NIAID). I also reported that the CDC was
awarding funds for several new pediatric projects -- especially studying

rates of infection in high prevalence geographic areas. Other CDC studies include
investigation into adolescent risk and an effort to truly determine the number of infected
persons in the United States.

The Health Resource and Service Administration began the supprt of several
demonstration projects and some of these I had talked about along with those of NIH and
CDC at a previously reported appearance before a congressional committee in this
archive.

The Office of Human Development Services, (OHDS) I reported would soon publish a
coordinated discretionary grant announcement asking for a proposal to demonstrate
innovative approaches to providing child welfare service to infants and young children
with AIDS. 1.2 million dollars has been allocated to this project per year for the next 3
years.

In the Office for the Assistant Secretary for Planning and Evaluation there is being
conducted a short-term exploratory examination regarding non-medical care for AIDS

children.

Another effort in the same direction is being carried out by our regional Public Health
Service Office in New York and covers individuals in New Jersey as well.

This also seemed like a good time to report on the Surgeon General’s Workshop on
Children with HIV Infection and Their Families, which was held in Philadelphia in April
of 1987. Findings of that workshop were reported and had been disseminated widely
including recommendations from 10 work groups. I went into some detail on five of the
recommendations. These recommendations are important to speak about because they
resemble a proposal being made in HR bill 3009, which was the reason for the hearing in
question.

I also covered the training of foster care personnel, respite care, AIDS babies with special
needs, community homes, and then had the temerity to say that although we in the Public
Health Service supported all of the proposals in the bill we believed that the goals would
be accomplished by programs already underway in our department thereby making
legislation nonessential for this purpose. I also outlined our proposal for grants to carry
out much of what was contained in HR 3009, the allocations of up to 1.2 million per year
for the next three years. I did note that this was substantially a lower sum than had been
authorized at HR 3009. I closed with the hope that we could continue to work with the
members of the subcommittee on this problem and this disease.

Because of the nature of this statement before the House Subcommittee no index is
included.