On February 27, the House Foreign Affairs Committee approved, by voice vote, H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The bill would authorize $50 billion through FY2013 for the President’s Emergency Plan for AIDS Relief (PEPFAR). Of that amount, the bill would authorize $2 billion annually for the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, $4 billion annually to combat tuberculosis, and $5 billion from FY2009-13 to combat malaria. PEPFAR’s current authorization (P.L. 108-25), which provided $15 billion over five years, expires at the end of FY2008. President Bush had called for $30 billion for the program during his State of the Union address.
Sponsored by Acting Chair Howard Berman (D-CA), the compromise legislation would remove the requirement that one-third of all funds spent on prevention go to abstinence-until-marriage programs part of the Abstain, Be Faithful, Correct and Consistent Use of Condoms (ABC) approach to HIV prevention. However, if a country’s HIV prevention plan dedicates less than 50 percent of funds to “behavioral change programs, including abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction,” the bill would require the U.S. Global AIDS Coordinator to report to Congress “on the justification for this decision.”
The legislation would permit PEPFAR funds to be used for HIV testing and education in family planning clinics, but not other reproductive health services. It would not explicitly authorize funds for contraception. H.R. 5501 would provide assistance to groups that provide microloans to women affected by the disease, and would “coordinate and provide linkages between HIV/AIDS prevention, treatment, and care programs with efforts to improve the economic and legal status of women and girls.” It would require a congressional report on the needs of women and youth, as well as the causes of gender disparities in HIV infection rates.
The bill also would institute a program for microbicide development and would integrate the treatment of tuberculosis and HIV. The measure would provide nutritional support for at least 180 days to those infected with HIV with a body mass index at or below 18.5 “or at the prevailing WHO [World Health Organization]-approved measurement for BMI,” as well as to the person’s household. It would add 14 Caribbean nations to the list over which the U.S. Global AIDS Coordinator has explicit statutory authority, and it would maintain the requirement that no funds “may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”
Rep. Berman said the legislation “ensures that HIV/AIDS programs are linked to, and integrated with, other relevant development programs, such as nutrition, and allows HIV/AIDS testing and counseling to be provided in the U.S. bilateral family planning program” and “provides for certain benchmarks to improve the transparency and accountability of the Global Fund, and makes sure that additional emphasis is placed on women and girls who face the scourge of HIV/AIDS.”
He continued, “This bill is not perfect, but no compromise ever is. However, this agreement between [Ranking Member Ileana] Ros-Lehtinen [R-FL], the White House, and the committee majority is in the best spirit of the great leaders of this committee who guided the 2003 act into law…Twenty million innocent men, women, and children, we must remember, have perished from HIV/AIDS 20 million. Forty million around the globe are HIV-positive. Each and every day, another 6,000 people become infected with HIV. We have a moral imperative to act, and act decisively.”
Rep. Ros-Lehtinen noted that PEPFAR provides over 1.4 million people with HIV with antiretroviral drugs, and that it has supported HIV testing and counseling for 30 million and care for nearly 6.7 million. “African government officials and non-governmental organizations have repeatedly and publicly stated their gratitude that PEPFAR has finally provided resources for prevention strategies that focus on the ABC approach and that respect local values and indigenous cultures,” she said. “The compromise requires the AIDS coordinator to provide ‘balanced funding for prevention activities for sexual transmission of HIV/AIDS,’ and to ensure that abstinence and faithfulness programs ‘are implemented and funded in a meaningful and equitable way.’”
“The agreement before us helps ensure that HIV/AIDS funding is not used to support family planning programs,” she continued. “The bipartisan agreement also maintains the existing certification requirements that any group or organization receiving PEPFAR funds have a policy explicitly opposing prostitution and sex trafficking.” The requirement, which is also in current law, will not prevent organizations from working with sex workers. The bill “also strengthens the important ‘Conscience Clause’ by ensuring that service providers are not required to ‘endorse, utilize, make a referral to, become integrated with, or otherwise participate in any program or activity to which the organization has a religious or moral objection,’” she said.
Because the compromise was reached late the night before, some committee members said they had not had time to thoroughly review the legislation, and voted against it. “The lack of process” is “troubling,” Rep. Jeff Flake (R-AZ) said. “We’re running a deficit; every dollar we spend is a dollar we borrow.” He said the increase in funding levels “deserved a hearing,” and he criticized the fact that members could not offer amendments. Rep. Berman said that the $50 billion funding level had been circulated for about a month.
Rep. Dana Rohrabacher (R-CA) criticized the increase in funding levels and the fact that the U.S. would fund health programs abroad even while there were uninsured people in America. He called the spending “generosity gone wild.” Rep. Dan Burton (R-IN) questioned the ability of countries to “absorb $50 billion” when the previous authorization was only for $15 billion. Rep. Chris Smith (R-NJ) replied that countries had been slow in ramping up PEPFAR-funded programs, but now that many had begun, they would be able to use the additional funds effectively.
