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Senate Committee Considers Africa’s HIV/AIDS Crisis

On February 14, the Senate Foreign Relations Committee held a hearing on Africa’s HIV/AIDS crisis. Presiding Chair Russ Feingold (D-WI) began the hearing by saying that the HIV/AIDS pandemic is “truly one of the most urgent foreign policy priorities that we confront today.”

Sen. Bill Frist (R-TN) noted that with the “appropriate strategy and planning,” the United States could reverse the “continuation of the most devastating…health crisis that mankind has ever seen.”

During the hearing, Dr. Eugene McCray of the Centers for Disease Control and Prevention (CDC) said that the region hardest hit by HIV/AIDS is sub-Saharan Africa, which accounts for 70 percent of all HIV/AIDS cases. Currently, the CDC is working in collaboration with the U.S. Agency for International Development (USAID), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), the Department of Defense, and the Department of Labor, on initiatives for science-based primary prevention programs and care and treatment programs.

Dr. McCray explained that most developing nations lack the necessary infrastructure to adequately address the HIV/AIDS epidemic. He emphasized that voluntary counseling and testing (VCT) is “the cornerstone for prevention and the gateway to care and treatment.” However, if there are insufficient quantities of test kits or if the kits are not delivered on time, VCT cannot be done. If information infrastructure fails, “individuals anxiously awaiting test results cannot get them,” said Dr. McCray.

The CDC offers technical assistance and funding for various prevention activities. According to Dr. McCray, the prevention of mother-to-child transmission is a priority for most developing nations and is the only “proven opportunity to use drug therapy to avert transmission from one person to another.” He explained that the CDC works to provide necessary drug therapy to pregnant and postpartum women and their newborns, and to promote replacement feeding strategies to avoid transmission via breast milk.

Dr. McCray also explained that another program sponsored by the CDC “looks at ways to effectively integrate prevention of HIV, other sexually transmitted infections, and unintended pregnancies in reproductive health care.” He added that for these prevention programs to be effective, they must be “mounted on a large scale.”

Dr. E. Anne Peterson of USAID testified that most new infections in Africa occur in individuals ages 15 to 24, 75 percent of which are in young girls and women. She noted that in sub-Saharan Africa, 55 percent of HIV/AIDS infections are occurring in women and in Kenya the increasing number of infected women has resulted in 600,000 infants becoming infected with HIV annually. She added that simple interventions to reduce mother-to-child transmission are available, but less than 5 percent of women in sub-Saharan Africa have access to these services.

When asked by Sen. Feingold what is being done to address the challenges surrounding the costs of treatment and resources, Dr. Peterson responded that USAID is working with the pharmaceutical companies on mother-to-child transmission programs. She explained that the pharmaceutical companies provide the drugs for the programs and USAID “works the protocols.”

Sen. Frist asked for further information on the role of women and young women and what the United States can do. Both Dr. McCray and Dr. Peterson agreed that “education is key” to reducing the high rates of HIV/AIDS. Dr. Peterson explained that the most effective tactics involve talking with young schoolgirls about how to handle unwanted sexual advances by older men and discussing with young boys appropriate behavior and respect towards girls and women as well as HIV/AIDS prevention. She added that the female condom would allow women a choice on how to protect themselves.

In addition to supporting the use of female condoms, USAID has supported the development and evaluation of microbicides to prevent sexual transmission of HIV/AIDS. This year, USAID will spend approximately $15 million in this area and Dr. Peterson noted one “promising” microbicide is in the final stage of clinical evaluation.

After hearing Dr. Jeffrey Sachs of the Center for International Development at Harvard University speak, Sen. Feingold commented that he had never heard such “powerful and passionate and important testimony.” Dr. Sachs said that he “continues to be alarmed” that only one or two doses of antiretroviral therapy is given to mother and child and that they are the only recipients of this type of therapy. He continued by saying that the United States must “stop winging it,” because the HIV/AIDS pandemic is not “a game of the minimum amount that can be gotten away with to say we’re doing it.”

Agreeing with Dr. Sachs, Dr. Jim Yong Kim of the Program in Infectious Disease and Social Change at the Harvard Medical School, said that “what is happening right now is that we have therapy that we can provide and we’re not providing it.” He also said that although education and condoms help, “massive infusions for treatment can accelerate prevention very rapidly.”

The final witness, Martin J. Vorster of the Mahyeno Tributary Mamelodi in South Africa described the significant role of faith-based organizations (FBOs), but added that the resources of these organizations are inadequate because the South African government does not fund religious institutions. In order to receive government funding, the FBOs would have to become non-profit organizations that fall under the Department of Welfare. This poses a problem, Mr. Vorster explained, because any non-profit organization receiving government funding cannot receive funding from any other source. Mr. Vorster stressed that more must be done to help Africa because Africans “[do] not just want a handout, but a hand up…They want to be empowered.”

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