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HEALTH: Activists Hail US Senate Approval of Major AIDS Bill

Jim Lobe

WASHINGTON, Jul 17 2008 (IPS) - AIDS and global health activists are hailing Wednesday's approval by the U.S. Senate of an unprecedented five-year, 48-billion-dollar bill to fight AIDS, malaria, and tuberculosis overseas, particularly in Africa.

The bill also overturned a 21-year-old law that bans most foreign visitors who are HIV-positive from entering or gaining permanent resident in the U.S.

The bill, the subject of months-long negotiations, was passed by a convincing 80-16 vote and will likely be approved by the House of Representatives next week before President George W. Bush, who has supported the bill, signs it into law.

The dissenters consisted of right-wing Republicans who objected to the bill's cost and its relaxation of previous constraints on how the money would be spent. Their attempts to amend the bill more to their liking and reduce the funding by some 15 billion dollars were rejected by mostly two-to-one margins.

"This bill is a tremendous achievement," said Paul Zeitz, executive director of the Global AIDS Alliance (GAA), one of a number of non-governmental organisations (NGOs) that lobbied hard for the legislation.

"This bill will expand American leadership on global health and foster hope around the world," he said. "Once fully funded, it will not only help poor countries but serve America's interests as well."

At the same time, he and other activists cautioned that the bill only authorises spending the 48 billion dollars. During each of the next five years, Congress will have to actually appropriate the money in what is a separate process.

Nonetheless, the bill effectively extends and expands the five-year-old, 15-billion-dollar President's Emergency Plan for AIDS Relief (PEPFAR), the 2003 Bush initiative that, in the words of the Democratic chairman of the Senate Foreign Relations Committee, Joseph Biden, during Wednesday's debate, was "the single most significant thing the president has done." PEPFAR is due to expire Sep. 30.

Over its life, PEPFAR, which Bush launched on the eve of the U.S. invasion of Iraq, is estimated to have provided life-saving treatment for about 1.5 million AIDS victims, prevented some seven million new infections, and provided care to another 10 million people, including several million children who have lost one or both parents to AIDS.

The programme, which has focused on a dozen sub-Saharan African countries, hard-hit Caribbean nations, and Vietnam, has also provided HIV testing and counseling for some 33 million people.

Bush's 2005 President's Malaria Initiative (PMI), which is designed to reduce malaria-caused deaths by 50 percent in 15 African nations by 2009, has distributed some four million insecticide-treated bed nets and more than seven million anti-malarial treatments and financed the indoor spraying of several million homes.

The PMI will be incorporated into the new programme, which is called the Lantos-Hyde U.S. Leadership Act in honour of former chairmen of the House Foreign Affairs Committee, Democrat Tom Lantos and Republican Henry Hyde, who were strong advocates of global-health programmes. Both men died during the past year.

In anticipation of PEPFAR's expiration, Bush asked Congress earlier this year to authorise 30 billion dollars for its expansion over the next five years, but the House voted by a nearly three-to-one margin in April to increase the total to 50 billion dollars. The Senate Foreign Relations Committee approved the House version 18-3 the following month.

That bill represented a compromise between Democrats, who generally championed the huge boost in funding, and anti-abortion Republicans, who insisted on adding certain restrictions, as they repeatedly did with PEPFAR, on how the money could be spent.

Under the bill, for example, none of the funding can be provided to family planning clinics or groups that perform abortions or even lobby for relaxing anti-abortion laws in their home countries, or that decline to explicitly denounce "prostitution and human trafficking".

The bill also requires the programme's administrators to ensure that abstinence and fidelity strategies to prevent the spread of the disease – strategies that many public health experts believe are generally not nearly as effective as condom distribution – "are implemented and funded in a meaningful and equitable way." That language represented a relaxation of a PEPFAR requirement that at least one-third of prevention funds be spent on abstinence and education.

The Senate version of the bill incorporates all of the House's restrictions. It also added a requirement that more than half of the programme's bilateral AIDS-related aid – about 30 billion dollars – be earmarked for treatment and care in order to gain the backing of a key Republican senator, Tom Coburn of Oklahoma, a leader of the group of right-wing lawmakers who had threatened to filibuster the bill.

The Senate also agreed to reduce total funding from 50 billion dollars to 48 billion dollars and direct the two-billion-dollar difference to health and related programmes designed to benefit Native Americans.

Under the bill's language, the 30 billion dollars earmarked for bilateral programmes will aim to sustain the lives of three million victims of the disease, prevent 12 million HIV new infections, and care for another 12 million victims, including five million orphans.

In addition, the bill would provide 10 billion dollars – or two billion dollars a year – to the cash-strapped Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, which works in many more countries than those covered by PEPFAR and with fewer restrictions on how its funding can be spent. Because of their lack of control over the Fund, both the Bush administration and many Republicans have resisted past Democratic efforts to boost U.S. contributions to it.

About four billion dollars of the total would be spent on fighting tuberculosis, the leading cause of death among people who are infected with HIV, while five billion dollars will be earmarked for malaria. The remainder would be roughly split between AIDS research and developing capacity for indigenous health systems and personnel in target countries.

"We and our members around the world applaud the U.S. Senate for settling its internal differences and passing a strong bill," said Nils Daulaire, president of the Global Health Council, an international NGO close to the leadership of the World Health Organisation (WHO).

Still, he agreed with Zeitz and others, including the International Centre for Research on Women, who expressed regret that the bill retains restrictions on the spending provisions, particularly the bans on funding for clinics and groups that provide or promote abortion or that refuse to denounce prostitution.

At the same time, they commended lifting the ban on HIV-positive visitors entering the U.S. The ban, which could be waived in some circumstances, was a trademark issue of the longtime leader of far-right forces in the Senate, former Foreign Relations Committee chairman Jesse Helms, who retired from the Senate in 2003 and, coincidentally, died last week.

"Lifting the ban gives us hope that the U.S. government will move toward a comprehensive policy that responds to the realities of the epidemic and the science of prevention, treatment and care," said Daulaire.