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Senate Passes PEPFAR Reauthorization

On July 16, the Senate approved, 80-16, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (H.R. 5501), after substituting the text of its own bill, S. 2731, as amended. The bill was approved by the Senate Foreign Relations Committee on March 13 (see The Source, 3/14/08). The House passed a similar bill, H.R. 5501, on April 2 (see The Source, 4/4/08). The House is expected to pass the Senate version of the bill next week.

The bill would authorize $48 billion through FY2013 for the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This amount also includes $5 billion for malaria and $4 billion for tuberculosis (TB). The bill’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.

The Senate version would require that “more than half” of the bill’s bilateral assistance be used for treatment and care services, a provision added at the request of Sen. Tom Coburn (R-OK). Unlike the House-passed bill, the Senate version does not address family planning; the House measure would permit PEPFAR funds to be used for HIV testing and education in family planning clinics.

Like the House bill, the measure would continue the ten percent set-aside for orphans and vulnerable children included in the original authorization, strengthen mother-to-child transmission prevention and treatment, and authorize microbicide research and development at the National Institutes of Health, the Centers for Disease Control and Prevention, and the United States Agency for International Development, in recognition of the “need and urgency to expand the range of interventions for preventing the transmission of…(HIV), including nonvaccine prevention methods that can be controlled by women.” As in the House version, the Senate bill would remove the requirement that one-third of all funds spent on prevention go to abstinence-until-marriage programs. However, if a country’s HIV prevention plan dedicates less than 50 percent of funds for “activities promoting 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.” Both versions also 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.”

Among the amendments considered, the Senate adopted, by voice vote:

  • an amendment by Sens. John Thune (R-SD) and Byron Dorgan (D-ND) to redirect $2 billion of the authorized funds to American Indian safety and health, reducing the total authorization to $48 billion;
  • an amendment from Sen. Jeff Sessions (R-AL) to advise the public about the risks of contracting HIV from blood exposures, to investigate unexplained infections, and to promote universal precautions in health care settings; and
  • an amendment by Sen. David Vitter (R-LA) to withhold 20 percent of the funds for the Global Fund until the secretary of State certifies that the Global Fund has provided the State Department with access to financial and other data.The Senate rejected:
  • an amendment by Sen. Jim DeMint (R-SC) that would reduce the bill’s total funding authorization from $50 billion to $35 billion, 31-64;
  • an amendment by Sen. Judd Gregg (R-NH) to establish an inspector general within the Office of the Global AIDS Coordinator, 44-51; and
  • an amendment by Sen. John Cornyn (R-TX) to establish a bipartisan commission to improve oversight and eliminate wasteful government spending within the Act, 32-63.Sen. Joe Biden (D-DE), the bill’s sponsor, said, “Two million people died last year of HIV/AIDS. Over two and a half million people died of malaria and TB. That’s over 10,000 people killed per day — per day — because of these diseases. These are mothers and fathers and sisters and brothers, whole families have been devastated, whole communities have been affected. It is our moral obligation to lead this global fight against these diseases. We’ve been negotiating this legislation for many months and it is a product of bipartisan compromise and commitment to saving lives worldwide.” Sen. Biden continued, “I would also like to thank the president. His decision to launch this initiative was bold and unexpected and I believe historians may regard it as his finest hour. We will be proud to send this legislation to his desk.”

    Sen. Richard Lugar (R-IN), who cosponsored the bill with Sen. Biden, stated, “PEPFAR has provided treatment to an estimated 1.4 million men, women, and children infected with HIV/AIDS in Africa and elsewhere. Before the program began, only 50,000 people in all of sub-Saharan Africa were receiving life-saving, anti-retroviral drugs. Reauthorization of PEPFAR enables us to build upon these successes, save lives on a massive scale, and preserve the fabric of numerous fragile societies. We should understand that our investments in disease prevention programs have yielded enormous foreign policy benefits during the last five years. PEPFAR has helped to prevent instability and societal collapse in a number of at-risk countries; it has stimulated contributions from other wealthy nations to fight AIDS; it has facilitated deep partnerships with a new generation of African leaders; and it has improved attitudes toward the United States in Africa and other regions.”

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