HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE February 24, 1994 3:00 p.m. MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Irene Nicholia Rep. Tom Brice MEMBERS ABSENT Rep. Bettye Davis COMMITTEE CALENDAR Alaska Native Health Board. *HB 336: "An Act relating to violations of laws by juveniles." PASSED OUT OF COMMITTEE *HB 320: "An Act relating to public school health personal safety education." HEARD AND HELD (* First public hearing.) WITNESS REGISTER ANNE WALKER, Executive Director Alaska Native Health Board 1345 Rudakof Cir., Ste. 206 Anchorage, Alaska 99508 Phone: (907) 337-0023 Position Statement: Presented an overview for the Alaska Native Health Board ANDY JIMMIE, Member Alaska Native Health Board 1345 Rudakof Cir., Ste. 206 Anchorage, Alaska 99508 Phone: (907) 337-0023 Position Statement: Participant of overview for the Alaska Native Health Board JOSEPH DEXTER, Member Alaska Native Health Board P.O. Box 916 Nome, Alaska 99762 Phone: (907) 443-3311 Position Statement: Participant of overview for the Alaska Native Health Board LINCOLN BEAN, Secretary Alaska Native Health Board 1345 Rudakof Cir., Ste. 206. Anchorage, Alaska 99508 Phone: (907) 337-0023 Position Statement: Participant of overview for the Alaska Native Health Board ROBERT CLARK, Member Alaska Native Health Board 1345 Rudakof Cir., Ste. 206 Anchorage, Alaska 99508 Phone: (907) 337-0023 Position Statement: Answered questions regarding the Alaska Native Health Board LANNEA LEE, Representative Close-Up P.O. Box 9822 Ketchikan, Alaska 99901 Phone: (907) 247-2410 Position Statement: Testified in support of HB 336 DONNA SCHULTZ, Associate Coordinator Division of Family and Youth Services Department of Health and Social Services P.O. Box 110630 Juneau, Alaska 99801-110630 Phone: (907) 465-3191 Position Statement: Answered questions on Title 4 funding DEBORAH ERICKSON, Chief of Community Health Division of Public Health Department of Health and Social Services P.O. Box 110610 Juneau, Alaska 99811-0610 Phone: (907) 465-3090 Position Statement: Testified in support of CSHB 320 CHERYL KILGORE, Public Health Specialist Division of Epidemiology Department of Health and Social Services 1919 Lathrop St. # 23 Fairbanks, Alaska 99701 Phone: (907) 451-2940 Position Statement: Answered questions on the CS for HB 320 (spoke via teleconference) HELEN MEHRKENS, Health Promotion Specialist Division of Education Program Support Department of Education 801 W. 10th St. Juneau, Alaska 99801 Phone: (907) 465-8730 Position Statement: Answered questions on the CS for HB 320 (spoke via teleconference) ETTA LARSEN, Peer Educator P.O. Box 207 King Cove, Alaska 99612 Phone: (907) 497-2263 Position Statement: Testified in support of the CS for HB 320 RITA DESOUZA, Executive Director Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 MICHAEL PIERCE, Administrative Assistant Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 BRYCE MORRISON, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 DANIELLE KUAANA, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 DELISA CULPEPPER, Representative Alaska Health Education Consortium P.O. Box 196650 Anchorage, Alaska 99519 Phone: (907) 343-6960 Position Statement: Testified on the CS for HB 320 (spoke via teleconference) ALYSON CAMPBELL, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 ZEFFREY THROWELL, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 LORRI WILSON, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 ALEXIS ROBERTS, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 JANELLE BILLINGSLEA, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 MICHAEL COLE, Peer Educator Alaskans Living with HIV 174 S. Franklin St. # 208 Juneau, Alaska 99801 Phone: (907) 463-5688 Position Statement: Testified in support of the CS for HB 320 VINCE BARRY, Director Division of Education Support Program Department of Education 801 W. 10th St., Ste. 200 Juneau, Alaska 99801-1894 Phone: (907) 465-8689 Position Statement: Testified on the CS for HB 320 DEBORAH SMITH, Executive Director Alaska Mental Health Board 431 N. Franklin Juneau, Alaska 99801 Phone: (907) 465-3071 Position Statement: Testified in support of the CS for HB 320 KATHY FARIS, President Alaska School Nurses Association 701 E. Bogard Wasilla, Alaska 99654 Phone: (907) 376-5341 Position Statement: Testified in support of the CS for HB 320 ROCKY PLOTNICK, HIV Education Specialist Division of Education Program Support Department of Education 801 W. 10th St., Ste. 200 Juneau, Alaska 99801-1894 Phone: (907) 465-2843 Position Statement: Answered questions pertaining to AIDS MARVIN FARIS, Health Educator Palmer High School C/O Palmer High School P.O. Box 1688 Palmer, Alaska 99645-1688 Phone: (907) 745-3241 Position Statement: Testified in support of the CS for HB 320 PREVIOUS ACTION BILL: HB 336 SHORT TITLE: MINORS COMMITTING CRIMES W/ GUNS & KNIVES SPONSOR(S): REPRESENTATIVE(S) BUNDE,Olberg JRN-DATE JRN-PG ACTION 01/03/94 2015 (H) PREFILE RELEASED 01/10/94 2015 (H) READ THE FIRST TIME/REFERRAL(S) 01/10/94 2015 (H) HES, JUDICIARY, FINANCE 02/24/94 (H) HES AT 03:00 PM CAPITOL 106 BILL: HB 320 SHORT TITLE: PUBLIC SCHOOL HEALTH AND SAFETY EDUCATION SPONSOR(S): REPRESENTATIVE(S) TOOHEY,Hudson,Brice,Bunde, Finkelstein,Nordlund,Olberg,Porter,Sitton,B.Davis JRN-DATE JRN-PG ACTION 01/03/94 2011 (H) PREFILE RELEASED 01/10/94 2011 (H) READ THE FIRST TIME/REFERRAL(S) 01/10/94 2011 (H) HES, FINANCE 01/21/94 2127 (H) COSPONSOR(S): BRICE, BUNDE, FINKELSTEIN 01/21/94 2127 (H) COSPONSOR(S): NORDLUND, OLBERG, PORTER 01/21/94 2127 (H) COSPONSOR(S): SITTON 02/09/94 2328 (H) COSPONSOR(S): B. DAVIS 02/24/94 (H) HES AT 03:00 PM CAPITOL 106 ACTION NARRATIVE TAPE 94-28, SIDE A Number 000 CHAIR TOOHEY called the meeting to order at 3:07 p.m., noted members present and announced the calendar. She introduced Anne Walker of the Alaska Native Health Board (ANHB). ANNE WALKER, Executive Director, Alaska Native Health Board (ANHB), presented an overview for the committee. She said the board represents 93,000 Alaskan Natives on health care issues. She said there are six rural hospitals and 170 village clinics. She indicated that a legislative priority list was provided for the committee members. She said several board members were present to further explain the legislative priorities. Number 108 ANDY JIMMIE, Member, Alaska Native Health Board, stated that the ANHB presently supports HB 451, HB 332, and the CS for HB 320. He also said the board supports the increase in state tobacco taxes, but recommends that the tax be increased to $1.00 per pack of cigarettes and he felt smokeless tobacco should be taxed the same. He said the board supports loan forgiveness for health professionals (SB 235). REP. BUNDE asked what the tax would be on smokeless tobacco. MR. JIMMIE asserted that the tax should be the same for both tobacco products. MS. WALKER interjected and said if the price is high enough for cigarettes and smokeless tobacco, it would be more difficult for youths to access. REP. BUNDE questioned whether the price ever deters a person who is addicted, especially adults. MS. WALKER said studies in Canada and Norway indicated a decrease in the use of tobacco resulting from a considerable price increase. She said the focus of the tax is to not only deter children from using tobacco, but also to deter them from starting. Number 280 REP. BUNDE said preschoolers are using tobacco and questioned if $5.00 for a can of tobacco was deterrent enough for parents who share their chewing tobacco. MS. WALKER replied by saying she had seen an older youth purchase a can of chewing tobacco and proceeded to share it with younger children. She felt it would be a disincentive for adults, also, as they would be less likely to share their tobacco when it is such an expensive commodity. Number 312 REP. BUNDE maintained that his questions were not intended to discourage the concept of a tobacco tax. MS. WALKER said the goal is to emphasize health promotion and disease prevention. Number 334 JOSEPH DEXTER, Member, Alaska Native Health Board, addressed the issues of water and sewer sanitation facilities and also village clinic renovation and construction. He asserted that the ANHB considers the construction and rehabilitation of water and sanitation systems the highest priority. He maintained that it would remain the top priority until all villages have an adequate and safe water and sewer system. He referred to the Rural Alaska Sanitation Coalition and said the ANHB would be co-sponsoring a sanitation summit meeting with Alaska State Rural Development, March 14-18, 1994. He urged the attendance of the legislature. He stated that over 100 communities in rural Alaska still use honey buckets to dispose of human waste. He also commented that a village may have a water and sewer system, but may have to use outhouses and honey buckets also. He asserted that until the problems are addressed, rural Alaska will continue to face sanitation related diseases; i.e., hepatitis A and meningitis. MR. DEXTER stated that 170 clinics are utilized by Native corporations for the health aid system. He said not all the clinics have water and sewer. He urged that $500,000 be appropriated for the next two years to address that issue. He felt that funding for clinics is not equally distributed throughout the state. Number 543 LINCOLN BEAN, Secretary, Alaska Native Health Board, addressed the concerns of health program operations. He stated that home and community-based services would reduce the need for institutional services and would result in "dramatic" savings for the state. He urged the legislature to provide the medical assistance funding for the enhancement of these services, and also to support SB 249 and HB 377 for assisted living services. Mr. Bean maintained that health promotion and disease prevention initiatives hold the greatest promise for long-term reduction of mortality, illness, and injury for Alaskans. He said the aforementioned legislation would provide a strong foundation for long-term health status improvement and medical cost containment. MR. BEAN further commented that it is essential to continue efforts to resolve the Mental Health Lands Trust so that sustained state funding would remain available. He indicated that dependency on the Alaska Psychiatric Institute (API) would be reduced by allowing rural hospitals to provide inpatient psychiatric services without financial risk. He stated that the ANHB endorses HB 341, which would allow and enhance reimbursement for physician's assistant services. He explained that Southeast Alaska Regional Health Corporation (SEARHC) had been successful in establishing the first program for training physician's assistants in conjunction with the University of Washington. He urged that the legislature provide the financial support necessary to maintain that effort. He continued on to say that the University of Alaska Anchorage has been successful in securing support for beginning a Masters in Social Work degree program in Anchorage. The ANHB endorses approval by the legislature of $260,000 for the program's implementation. Number 673 REP. G. DAVIS said the physician's assistant program is a positive factor in regards to health care. MR. BEAN said it costs less to have a physician's assistant at a clinic. REP. G. DAVIS also mentioned that he appreciated the point Mr. Bean had made that those trained in Alaska are more likely to stay in Alaska. Number 708 REP. BRICE asked how the cooperation is between the University of Washington (UW) and the University of Alaska Anchorage (UAA) in regards to the physician's assistant program. MS. WALKER interjected that the rapport was very good. She mentioned that there are 12 students from Alaska participating in the program at UW. She also said the program was trying to be worked into the Alaska university system rather than having to send participants out of state. Number 741 CHAIR TOOHEY thanked all those who addressed the committee. REP. NICHOLIA asked, "How is the program working with the village behavior of health aides?" MS. WALKER replied that it is working very well. She said the concept of involving the community in identifying the problems of behavioral health has been successful. She said 62 community-based behavioral health specialists were certified. The health aides work with the communities to identify high risk families, their problems, and the solutions to those problems. Number 770 ROBERT CLARK, Member, Alaska Native Health Board, stated that the community aides are working their way up to becoming physician's assistants. MS. WALKER said having health aides in the rural communities decreases the need for sending people to API. Number 831 CHAIR TOOHEY brought HB 336 to the table. HB 336 - MINORS COMMITTING CRIMES WITH GUNS AND KNIVES REP. CON BUNDE, Prime Sponsor of HB 336, indicated there was a committee substitute (CS) for the bill. REP. G. DAVIS made a motion to adopt the CS for HB 336. CHAIR TOOHEY, hearing no objections, declared the CS for HB 336 was so moved. Number 848 REP. BUNDE spoke to the CS. He stated that the legislation addresses crimes perpetrated by young people, specifically youths in the local school districts. He said there is a difficult situation between police departments and school districts in that they are unable to communicate with each other regarding the acts or the threat of violent juveniles. He also said the situation exists between school districts. He explained a scenario where a youth is suspended for having a gun on school campus and is expelled from school. He maintained that the youth could enroll in another school district, and that the first school district cannot legally communicate with the second district regarding the youth's criminal behavior. REP. BUNDE said his intention is to have the names of youths who have been convicted of violent crimes known throughout the community, so the community can protect themselves. He felt, with that information known, the community can counsel their children accordingly. He also felt that by making the names known, it would encourage parents to be more responsible. REP. BUNDE said the focus of the CS is contained in page 4 of the proposal. He said the provision states that if an individual is thirteen years of age or older and in the possession of a knife or firearm, and has threatened or used the weapon, the privacy law that protects the privacy of juveniles would not be applicable, and the youth's name would be available to the press. School districts could communicate with one another, and the police could inform school districts of any arrests made on violent youths. Number 934 CHAIR TOOHEY clarified and asked if the youth must be convicted of the violent crime before the name can be divulged. REP. BUNDE said yes; they are innocent until proven guilty. Number 940 REP. KOTT asked again if the police, community, or school district would not be notified unless the youth is convicted. REP. BUNDE said yes. REP. KOTT was uncomfortable with the idea of a "problem child," who might be arrested and released back into the community, into the school district, and into a classroom setting. REP. BUNDE said the youth is not a problem child until convicted. He said the youth would be charged, "much like you or I", and would be innocent until proven guilty. REP. KOTT felt that most parents would want to be notified if a child in the school that their children attends had been arrested for a violent crime. Number 977 CHAIR TOOHEY interjected that it would not be legal to divulge the information without a conviction, but she agreed with Rep. Kott's sentiment. REP. KOTT indicated the similarity between SB 54 and HB 336 in regard to disclosure of records. REP. BUNDE stated that SB 54 deals with murder and HB 336 focuses on the threat or act of a violent crime. REP. KOTT said, "it also includes other crimes... in disclosing the names of juveniles." REP. BUNDE said "If you recall, I had a companion bill and if it's still similar... it's murder or Class A felonies. These things (offenses) are not Class A felonies." Number 007 REP. VEZEY asked Rep. Bunde to clarify the relationship between the right to privacy and juvenile disclosure laws. He asked why Rep. Bunde kept referring to the rights of privacy. REP. BUNDE stated he was using a more generic term of privacy, indicating that the current statute does not allow the disclosure of information. He said the term privacy was used to help in describing the problem being experienced between the police department and the Anchorage school district. He said he was not referring to the constitutional right to privacy. Number 040 REP. VEZEY said the bill was an improvement over the existing law, but he felt that juveniles should not be protected at any level. REP. BUNDE asserted that previous legislation had decided that some children are capable of rehabilitation, and that making their offenses known publicly would impede the rehabilitation process by brandishing them as a criminal. Number 067 CHAIR TOOHEY asked if the bill should be held over and if a subcommittee should be formed, or should it be passed on to the Judiciary Committee. REP. BUNDE said, "I don't think your Co-Chair is anxious to do that." REP. VEZEY said his comments spoke to the legislation in a general way, but he would support the bill as he felt it was a definite improvement to existing law. Number 096 CHAIR TOOHEY asked for further testimony. Number 100 LANNEA LEE, Representative, Close-Up, testified in support of HB 336. She explained to the committee that the members of Close-up conducted a "mock trial" that passed legislation on HB 336. To enable the passage, they substituted the word firearm with deadly weapon. She said deadly weapon would include a knife, an axe, a club, metal knuckles, or an explosive. She felt that the majority of crimes are committed with something other than a firearm. She associated herself with the intentions of Rep. Bunde to have the juveniles' names made public. She felt the publicity would decrease criminal offenses. She further stated that a youth is in the same state of mind that an adult is in when committing a violent crime. Number 165 CHAIR TOOHEY said she would like to close public testimony and urged those who did not testify to follow the legislation to the Judiciary Committee. REP. NICHOLIA asked, if the bill was passed, could the federal government cut all Title 4 funds if there is too much information disclosed on minors? Number 200 DONNA SCHULTZ, Associate Coordinator, Division of Family and Youth Services, Department of Health and Social Services (DHSS), replied that she was unsure if there would be an impact on Title 4 funding, and said she would find out as soon as possible. She said there are other instances where federal funding could be cut due to records and information disclosure. TAPE 94-28, SIDE B Number 000 REP. NICHOLIA referred to Lannea Lee and clarified that HB 336 addresses violent crimes with the threat of death, not murder. CHAIR TOOHEY asked the pleasure of the committee. REP. G. DAVIS made a motion to pass the CS for HB 336 with fiscal note to the next committee of referral with individual recommendations. Number 245 REP. NICHOLIA said the body of the bill has changed from the original bill and asked if there would be a relative change in the fiscal note. REP. BUNDE said no. REP. BRICE indicated that there have been concerns that the Department of Health and Social Services may have federal funding problems that won't be reflected in the fiscal note. CHAIR TOOHEY said the issue could be addressed by the Finance or Judiciary Committee if that would be acceptable to Rep. Brice. REP. NICHOLIA said that was acceptable and recommended sending a note to the next committee of referral. Number 288 CHAIR TOOHEY, hearing no objections, stated that the CS for HB 336 was so moved. (Note: Rep. Bunde assumed the position of Chair for the remainder of the meeting.) Number 315 CHAIR BUNDE brought HB 320 to the table and announced that there would be testimony heard via teleconference and from Juneau as well. HB 320 - PUBLIC SCHOOL HEALTH AND SAFETY EDUCATION Number 327 REP. CYNTHIA TOOHEY, Prime Sponsor oh HB 320, stated that she wanted to propose a committee substitute (CS) for HB 320. REP. VEZEY made a motion to adopt the CS for HB 320. CHAIR BUNDE, hearing no objections, said the CS for HB 320 was so moved. Number 353 REP. TOOHEY said she has become increasingly concerned and alarmed about the health of Alaska's youth. She proceeded to list statistics that indicate that as compared to youths nationwide, rates of abuse of addictive substances and problems with public health are far greater for Alaskan youths. She said 70% of Alaskan students in grades 10 through 12 reported using alcohol at some time; and %62 of youths have tried cigarettes compared to 38% nationally. As much as 25% of all deaths in Alaska are drug related. She indicated an increasing rate of suicide among Natives and white youths under 18 years of age. Alaska has the second highest pregnancy rate for 15-19 year old youths, and the mean age of first intercourse for males is 13.2 and for females it is 14.0. REP. TOOHEY further stated that 204 Alaskans have been confirmed as having AIDS, and 489 Alaskans have been diagnosed HIV positive. She maintained that 25% of those with AIDS contracted it in their teens. Teens and women are the fastest growing group of individuals who are contracting AIDS. Rep. Toohey asserted that if healthier lifestyles are not promoted for Alaskan youths, health care costs will continue to escalate. She compared the situation to that of Africa, where all that is left of some villages are children who themselves are infected with HIV/AIDS. She stated that the CS for HB 320 would expand the list of recommended topics to be taught and would establish health education curriculum advisory committees at the district level to advise the district school boards about the health curriculum at their schools. She said the bill would mandate the teaching of age appropriate HIV/AIDS with an emphasis on appropriate behavior. For parents who do not want their children to participate in the program, there is an opt-out section. Number 514 CHAIR BUNDE noted that there were approximately 20 people who wanted to testify and asked that individual testimony be limited to two to three minutes. CHAIR BUNDE asked if the fiscal note was relative to the CS for HB 320. REP. TOOHEY said the original fiscal note was approximately $500,000 and felt it was not economically feasible. She said the new proposal indicates a fiscal note for approximately $38,000. CHAIR BUNDE indicated that the fiscal note for the CS was in the bill packets. Number 572 DEBORAH ERICKSON, Chief of Community Health, Division of Public Health, Department of Health and Social Services, testified in Juneau in support of the CS for HB 320. She emphasized that behavior and lifestyle account for the large percentage of death and injury among youths, and that behaviors established during childhood are related to leading causes of major health problems and death later on in life. She said approximately 26% of Alaskans diagnosed with AIDS are age 22 to 29 and probably contracted the HIV virus in adolescence. She said of those Alaskans diagnosed with AIDS, 85% of those cases are a direct result of unsafe sex and I.V. drug use. She stated that comprehensive health education is an effective way of changing behaviors and attitudes. She said the DOE is supportive of the concept of comprehensive health education, but she would have to defer to the DOE to make a position statement. Number 647 REP. G. DAVIS asked what degree of AIDS education was being taught throughout the various school districts. MS. ERICKSON deferred to Cheryl Kilgore on teleconference. Number 652 CHERYL KILGORE, Public Health Specialist, Division of Epidemiology, Department of Health and Social Services, spoke via teleconference from Fairbanks. She deferred to Helen Mehrkens. HELEN MEHRKENS, Health Promotion Specialist, Division of Education Program Support, Department of Education, testified via teleconference from Anchorage. She stated that the data pertaining to AIDS education in schools was not particularly accurate. She indicated a study was soon to be underway that would answer the question. Number 677 CHAIR BUNDE acknowledged that Anchorage, Fairbanks, Kodiak, and Sitka were on teleconference. REP. NICHOLIA asked Ms. Erickson if she supported the CS for HB 320. MS. ERICKSON stated that DHSS is supportive of the concept and the DOE is the lead agency for the administration in terms of voicing the administration's position on the legislation. REP. NICHOLIA asked if DHSS had a position on the proposal. MS. ERICKSON said the DOE is responsible for submitting the position paper for Governor Hickel's administration. REP. TOOHEY explained that the reason the DHSS is mute on the point is because the department is not comfortable with the mandate. Number 723 REP. G. DAVIS said if a mandate is in statute, DHSS would have no choice but to abide. CHAIR BUNDE noted that Ms. Erickson stated that 85% of all the AIDS cases in Alaska are "self-inflicted or is preventable." MS. ERICKSON agreed and said it was more directly related to personal behaviors. CHAIR BUNDE clarified and said it was personal responsibility. REP. TOOHEY clarified and said woman do not get tested for HIV because they are often the innocent victim, pointing out that there may have only been a single encounter with an HIV infected partner. She said it would be ten years before the women are identified within the population as having AIDS. CHAIR BUNDE explained that he should have said "preventable." Number 753 MS. WALKER, Executive Director, Alaska Native Health Board, testified in Juneau in support of the CS for HB 320. She stressed that there should be emphasis on the prevention of adolescent health problems and the promotion of healthy lifestyles. She asserted that there needs to be a change in the method in which health care is promoted and delivered. She felt that no one sector could accomplish the task alone. She urged the collaboration of families, health providers, legislators, public agencies, and schools. She felt the CS for HB 320 was a great beginning and said the ANHB supported it and the companion bill, SB 314. She said there should be a strong and direct link between health and safety programs and schools. She related to the committee that by the age of 16 more than 50% of Alaskan youths have had sex and that three Alaskan teenagers per day give birth. She said health promotion and disease prevention would decrease the budget and change the way the state spends money. Number 842 CHAIR BUNDE asked for further testimony. Number 845 ETTA LARSEN, Peer Educator, King Cove, Alaska, testified in Juneau in support of the CS for HB 320. She said she attended a youth symposium last year for AIDS prevention that was sponsored by the ANHB. She said 30 youths from around the state were trained as peer educators to teach about HIV/AIDS within their communities. She felt the training worked well and that she has helped youths to understand the critical importance of prevention and health care. CHAIR BUNDE asked for further testimony. Number 887 RITA DESOUZA, Executive Director, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. She referred to Rep. Toohey's statement that there are 489 people in the state with HIV, and noted that less than 10% of the population of Alaska has been tested. She suggested to Chair Bunde that perhaps the phrase "self-inflicted" is an inappropriate choice of words, as she felt the real problem is that young people do not perceive themselves at risk. She stated in 1992 a 43% increase was reported in Alaska Natives for the HIV/AIDS virus. She addressed the mandate specified in the CS for HB 320. She asserted that the state mandates the use of seatbelts and the prohibition of drinking and driving to avoid harm and death to Alaskans. She said some people choose to balk when it comes to mandating a bill that will provide every young person with the knowledge to avoid becoming infected with HIV. She stated that it is the state's moral responsibility to ensure that every young person knows how to protect themselves. MS. DESOUZA stated that most of the concern is being placed on the $40,000 fiscal note. She asked what the cost would be in human suffering, death, devastation of families, and the medical costs that would be shared by all if the state does not mandate the proposed legislation. She maintained that it costs an average of $119,000 for lifetime medical costs for AIDS treatment for one individual. She said the program would pay for itself thousands of times over. She then posed the question: How many more young Alaskans will have to suffer and die before something is done? She urged immediate action. Number 992 CHAIR BUNDE said most every high school aged youth knows that unsafe sex is dangerous, but they continue to practice unsafe sex, regardless. He said he still felt it is a personal decision that causes the infection. Number 000 MICHAEL PIERCE, Administrative Assistant, Alaskans Living with HIV (ALHIV), testified in Juneau in support of the CS for HB 320. He stated that he had a letter from the President of the Alaska State Medical Association that endorses the CS for HB 320. He read an excerpt of the letter that expressed the need for preventative medicine comprehensive health care and strongly urged that emphasis be put on the education of youths in regards to HIV/AIDS. Mr. Pierce brought to the attention of the committee the Open Hearts Project that ALHIV initiated. The program will sponsor Ginny White's visit to Alaska. He said Ginny White was the mother of Ryan White, her son who contracted AIDS through a factor transfusion to treat hemophilia. Ryan died at age 19 of AIDS. He said Ms. White now travels the United States as an AIDS educator teaching parents and children about HIV/AIDS. He further stated that the project mailed cut-out hearts across the state and has received approximately 600 in return that will be used along with thousands more to decorate the Senate Finance Committee when she addresses the legislature March 24, 1994. He said the hearts would be a visual sign of support. Mr. Pierce stated that 96% of Alaskans favor HIV/AIDS education. He further stated that in 1992 a study showed that only 52% of the parents polled said their children were receiving AIDS education. Number 071 BRYCE MORRISON, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. He stated that as part of the training for being a peer educator, those being trained were introduced to a person with full blown AIDS. He said it was a very "convincing" experience. He said the gentlemen was in constant physical pain and had to take at least 16 different medications. He said he never wants to see his friends subjected to the disease. CHAIR BUNDE mentioned that, much like himself when he was young, youths think they are immortal. He asked if the message was getting through to Bryce Morrison's peers. BRYCE MORRISON replied yes. Number 096 DANIELLE KUAANA, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. She stated that teens and women are the fastest growing demographic for the contraction of AIDS. She said some of her girlfriends are at high risk because of their behavior, and that was a motivating factor for her becoming a peer educator. She does not want to see anyone suffer. CHAIR BUNDE referred to the growing abstinence movement in the U.S. He asked Danielle Kuaana if abstinence was becoming a goal of youths her age. DANIELLE KUAANA said in order for people to abstain they must be taught why and how. REP. TOOHEY stated that the proposal stresses abstinence and the teaching of skills of how to abstain. Number 129 DELISA CULPEPPER, Representative, Alaska Health Education Consortium, testified via teleconference from Anchorage on the CS for HB 320. She stated she had concerns regarding mandates for health education, but thanked Rep. Toohey for bringing the issue of adolescent health problems to everyone's attention. She expressed concerns for having a mandate for only one area and also the lack of specificity regarding age related curriculums, and who would decide the curriculum. She further questioned the amount of the fiscal note and what it supports. She felt there needed to be more specificity for the bill to be passed and implemented effectively. She said a concern was that there are many other health issues that need to be addressed in schools and hoped that the proposal would not edge out those issues. Ms. Culpepper said she supported the concepts, but felt there needed to be clearer guidelines. Number 179 REP. TOOHEY said the language was intended to be broad to allow school districts to decide what the parents, teachers, and administrators want to teach their students. She said the legislation would be mandated by the school district and that each district will come up with their own plan. CHAIR BUNDE suggested that Ms. Culpepper express her concerns in writing to Rep. Toohey. Number 201 CHAIR BUNDE asked if there was further testimony from Anchorage. There was none. TAPE 94-29, SIDE A Number 000 CHAIR BUNDE asked for further testimony. Number 010 ALYSON CAMPBELL, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. She stated that the more she attended meetings pertaining to HIV/AIDS education, the more she realized that she would not risk her life just for the pleasure of it, and she would wait to become sexually active after she marries. She felt that what she was teaching her peers was having an impact. CHAIR BUNDE stated that sex may be great, but it isn't any worth dying for. Number 077 ZEFFREY THROWELL, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. He stated that the reason he was addressing the committee was because a lot of his friends are dying and they don't know it yet, because the HIV epidemic is spreading. He said the legislation was the only plan at this time that could effectively stop the spread of AIDS. He reiterated that it would cost $40,000 to educate thousands of youths for the prevention of the spread of AIDS, as opposed to the $119,000 it costs to "string along" the life of a person suffering with full blown AIDS. Number 130 LORRI WILSON, Peer Educator, Alaskans LIving with HIV, testified in Juneau in support of the CS for HB 320. She felt that her teachings are having successful results for the peers she is reaching, but the legislation should be passed so that everyone would be educated to prevent the spread of AIDS. She felt many lives will be saved. Number 163 ALEXIS ROBERTS, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. She stated that she is thirteen years old and that she has friends 13 and 14 years old that are sexually active. She said those individuals do not know the consequences of their actions. She related the expressions of regret on her friends faces when she informed them of the realities of HIV/AIDS being a sexually transmitted disease. She said if the legislation does not pass, the disease will spread faster than the education will. CHAIR BUNDE stated that the bad news is that there are 13 year old "babies" trying to make babies, and the good news is that Alexis Roberts is trying to prevent it from happening. Number 200 JANELLE BILLINGSLEA, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. She stated HIV/AIDS is a young person's disease, too. She said she couldn't describe the pain and agony that those who are infected suffer. She indicated that her teacher signed her up to take the training to be a peer educator because her teacher doesn't know enough about AIDS. She said if her teacher doesn't know enough, "then we're lost." CHAIR BUNDE referred to the high teenage pregnancy rate and asked Janelle Billingslea, if the sexual transmission of AIDS can be prevented, could there be considerable prevention of unwanted pregnancies? JANELLE BILLINGSLEA replied yes. Number 250 MICHAEL COLE, Peer Educator, Alaskans Living with HIV, testified in Juneau in support of the CS for HB 320. He stated that he had previously thought he knew a lot about AIDS until he attended the training for peer educators. He said he has been doing presentations at school and helping to educate his friends. He said his friends need the education because many are not willing to remain abstinent. He said the education is not in the schools and that the students desperately need it. He said many of his friends ask him who in the school has AIDS. He tells them that everyone in the school who is sexually active is a potential AIDS victim. CHAIR BUNDE asked if Michael Cole's friends listen to him or is it "uncool to be an educator?" MICHAEL COLE said "it's very cool" to be a peer educator. Number 345 VINCE BARRY, Director, Division of Education Program Support, Department of Education, testified in Juneau on the CS for HB 320. He stated that the legislation would require each school district to establish a health education advisory committee. He said the DOE does support the requirement for the establishment of a health education curriculum advisory committee for the districts. He said the advisory committee would ensure that the district receives the best advice from local health experts, parents, and other community members. He maintained that the DOE recognizes the importance of a structured health curriculum and agrees that students need to be instructed in HIV prevention and other important health risks. However, he expressed concerns regarding the content of the curriculum, the age appropriateness of the curriculum, and the level of emphasis on the content. He asserted that these issues would be best decided by the local school boards in consultation with parents, local health providers, and community members. He further stated that because of the aforementioned reasons, the DOE continues to oppose the imposition of state level curriculum mandates. Number 412 REP. KOTT asked Mr. Barry if he was in a position to address the fiscal note. MR. BARRY said if he's not, Helen Mehrkens could answer. REP. KOTT asked what the $38,000 under the contractual line was for. MR. BARRY answered that it was for training. He said the compliance issue is not factored into the fiscal note. REP. KOTT asked if the bill calls for the increase of at least one person in the DOE. REP. TOOHEY indicated that page 2, behind the fiscal note, would provide an explanation. Number 467 REP. KOTT said, "I see the contractual arrangement on page 2, but I'm just curious as to how the department plans on increasing one person.. .and that has been, in fact, addressed in the fiscal ramifications, but still..." MR. BARRY said the fiscal note assumes the districts would pick up all the training costs for their staff. He commented that a limited survey among seven of the largest districts estimates the total training costs to be $262,000 for K-12. He also said it would cost an additional $54,600 to send a local trainer to an academy. He asked Helen Mehrkens if the figures were correct. Number 495 HELEN MEHRKENS agreed with the numbers. MR. BARRY asked Ms. Mehrkens about the addition of one person to the DOE. MS. MEHRKENS stated that the fiscal note for the CS for HB 320 does not include any additional personnel. Subsequently, she said, there would be no plans for providing compliance monitoring. She then indicated that federal grants could fund the training of educators for the promotion of HIV prevention in school programs. Number 521 REP. KOTT asked if the education specialist indicated on page 3 of the CS was funded by the federal government. REP. TOOHEY stated that line 18, page 3, indicates that the position of education specialist is already established in statute. CHAIR BUNDE asked for further public testimony. Number 567 DEBORAH SMITH, Executive Director, Alaska Mental Health Board, testified in Juneau in support of the CS for HB 320. She stated that the board supported the fact that mental health education is a part of the proposal, although, she said, the board would prefer suggested curriculums, not mandated curriculums. Number 578 KATHY FARIS, President, Alaska School Nurses Association, testified in Juneau in support of the CS for HB 320. She stated that many students come to her during school hours with concerns about being pregnant or having venereal diseases, but rarely do they approach her asking if they need to be tested for AIDS. She said there is a lack of concern from youth today. She suggested that any bill that helps youths with life skills is worth any amount of money. Number 605 REP. G. DAVIS asked Ms. Faris how much AIDS education is being taught in the schools. MS. FARIS said in the Mat-Su Borough there is a health curriculum with mandated personal safety and life skills that addresses AIDS and abstinence. She said at certain grade levels the teaching is minimal. She felt the issue should be addressed on a continuing basis, year to year. CHAIR BUNDE said there is AIDS education at the kindergarten level in the Anchorage school district, but it is very nonspecific. Number 656 REP. TOOHEY asked Rocky Plotnick how many schools have an AIDS education curriculum. Number 675 ROCKY PLOTNICK, HIV Education Specialist, Division of Education Program Support, Department of Education, answered questions in Juneau on the CS for HB 320. She said there is not a concrete number because there are so many different ideas of what HIV prevention/health education is. Number 760 CHAIR BUNDE said when he was 13 years old he could not be held by gunpoint to listen to a group of adults discuss sexually transmitted diseases. He also asked Ms. DeSouza to thank the students who testified. REP. G. DAVIS related that he was a tutor at one time and occasionally AIDS education was part of his work. He felt the materials he used were very good. He said there is always the possibility of teachers out there who don't care and their attitude will be reflected in how they teach an AIDS education curriculum. Number 818 CHAIR BUNDE asked Ms. Plotnick how she addresses those people who believe that AIDS education curriculums promote sexual activity. MS. PLOTNICK answered that her response is that the number one way to prevent the spread of HIV is sexual abstinence; and in fact, there is more emphasis in programs to postpone sexual involvement. She maintained that it is easier to encourage people to postpone sexual activity than to get them to stop once they are already active. Number 841 CHAIR BUNDE asserted that the earlier a person becomes sexually active, they are more likely to have multiple partners. He also said children of single parent homes tend to be sexually active at earlier ages. MS. DESOUZA said the World Health Organization has done 19 studies in six different countries, including the United States, addressing the question of whether or not teaching about HIV/AIDS education increases earlier sexual activity or increases sexual activity at all. She said none of the studies showed that there was an increase in either and that most studies showed a decrease in sexual activity as a result of education. She said it is a myth to believe that education will increase sexual activity. Number 881 MS. PLOTNICK said her education program is age appropriate and that she teaches people not to be fearful. CHAIR BUNDE asked Rep. Toohey if her legislation encourages peer counselling. REP. TOOHEY said the provision encourages students against using peer pressure negatively. Number 900 CHAIR BUNDE said obviously a 13 year old will listen to another 13 year old before listening to an adult. REP. TOOHEY added that the language is broad so the districts can decide for themselves. CHAIR BUNDE suggested that the language be more specific pertaining to peer counselling. Number 942 MARVIN FARIS, Health Educator, Palmer High School, testified in Juneau in support of the CS for HB 320. He stated that there is a concern among educators in general that they are not properly trained and therefore not capable of providing the informational services necessary. CHAIR BUNDE closed public testimony and asked the pleasure of the committee. REP. G. DAVIS said he would like more time to study the bill as he was uncomfortable with the mandate section and the lack of specifics as to how a district is going to disseminate information and the grade level appropriateness. CHAIR BUNDE suggested that a subcommittee be formed. He further suggested that Rep. Toohey include specific language in the bill regarding peer education. Chair Bunde asked for Representatives Toohey and Gary Davis to form a subcommittee and said it was his intention to bring the bill up again at the earliest convenience of the committee. He then indicated that CSHB 320 would be held over. Seeing no further business before the committee, CHAIR BUNDE ADJOURNED the meeting at 5:00 p.m.