News Update:

Wednesday, July 16: Congresses passes the reauthorization of PEPFAR. $48 billion is authorized for global HIV/AIDS, Malaria, and TB, and the house is adopting the senate version of the bill.

What is PEPFAR?

In 2003, President George W. Bush dedicated $15 billion over 5 years to fight global HIV/AIDS. This is the largest amount ever donated to by any single country for this cause. The President's Emergency Plan for AIDS Relief (PEPFAR) enjoys wide bipartisan support on Capitol Hill and President Bush justly regards it as one of his brightest achievements. The focus of the PEPFAR program is to prevent the spread of HIV/AIDS, treat those with HIV/AIDS, and care for those individuals affected by this epidemic. As of March 31st, 2008, PEPFAR funding has supported treatment for 1.73 million men, women and children, the majority of which are located in sub-Saharan Africa, Asia and the Caribbean (www.pepfar.gov). It is estimated that before President Bush had announced his plans for PEPFAR, only about 50,000 were receiving treatment for HIV/AIDS in sub-Saharan Africa (www.pepfar.gov).

PEPFAR Achievements:

• Supported HIV testing and counseling for more than 33 million people
  
• Provided care for more than 6.6 million (including more than 2.7 million orphans and other children infected with and affected by HIV)
  
• Provided antiretroviral drugs to nearly 1.4 million infected patients in its target countries. Millions of pregnant women have prevented an estimated 157,000 babies from being born with the HIV virus
  
• Created 33,000 service outlets, trained 100,000 medical personnel, and reached 57 million people with prevention messages last year alone

Who are the current players in PEPFAR legislation?

President Bush requested a re-authorization of the bill for $30 billion over the next five years.

Sen. Tom Coburn (R-Oklahoma) and six other Republicans (DeMint-SC, Sessions-AL, Chambliss-GA, Vitter-LA, Bunning-KY, Burr-NC) were holding up Senate vote because he/they wanted more money to go towards treatment. Originally, the senators requested that the legislation mandate that 55 percent of PEPFAR's funding be dedicated to treatment and drugs. They cited their objection to the reauthorization bill's funding of so-called "mission creep" - a host of international development efforts such as gender empowerment and poverty alleviation programs, education and agricultural assistance — as reasons for holding up the bill. However, Coburn recently compromised and agreed to at least half of U.S. bilateral aid going to medical care, but care is defined expansively. He has dropped his objections to moving the bill.

Sen. Jim DeMint (R-South Carolina) continues to block the unanimous consent to let the bill proceed because he thinks the re-authorization bill, $50 billion over five years, "spends far too much money" (demint.senate.gov). It is indeed an expansion over the $15 billion spent thus far, and over the $30 billion that Mr. Bush requested when originally seeking to re-authorize PEPFAR. But part of the increase is attributable to the addition of $13 billion to fight malaria and tuberculosis.

Majority Leader Harry M. Reid (D-Nevada) has been trying to get the Senate to debate a limited number of amendments and vote on PEPFAR before July recess. This is not going to happen.

Sen. Jeff Sessions (R-Alabama) blocked Reid's attempt to bring the bill to a vote on June 26th.

Key Issues being debated:

$50 Billion - The original PEPFAR allowed for $15 billion to be disbursed over 5 years, and President Bush requested this amount be increased to $30 billion when seeking to re-authorize PEPFAR. In February 2008, the House and White House both agreed to up the figure to $50 billion, which prompted praise from UNAIDS, the United Nations' program in Geneva, Switzerland, who claimed the generous contribution, "sends a strong signal that the United States is committed to maintaining its leadership role in the global response to AIDS" (www.washingtonpost.com). However, members of the Senate currently opposing the bill believe that it is too costly and are fighting for a reduction in the price tag.

Abstinence and Prevention - The reauthorized bill requires PEPFAR's chief to provide "balanced funding" for prevention and to ensure that abstinence and faithfulness teachings "are implemented and funded in a meaningful and equitable way." If a country spends less than 50 percent of its funding for sexual-transmission prevention on the promotion of abstinence and faithfulness, the program must justify that decision to Congress (www.washingtonpost.com). However, there is a large following that believe those on the ground providing assistance and aid to PEPFAR recipients, know better how to spend the money and allocate funds. Although "abstinence" was broadened to include "be faithful" messages -- two-thirds of what is known as the ABC strategy (C stands for "condom use"), many studies show that Abstinence-only education alone is not effective. Being required to spend money on such programs, some argue, may not be the best way to prevent the spread of HIV/AIDS. Language in the new bill should empasize the use of evidence-based prevention strategies rather than requiring a minimum dollar figure to be used on specifc abstinence programs.

Malaria and Tuberculosis (TB)- Although the original PEPFAR bill allowed for great successes in combatting HIV/AIDS in developing nations, many are still dying everyday from malaria and TB. The new bill if passed would dedicate about $9 billion would go to fight tuberculosis ($4 billion) and malaria ($5 billion), which often simultaneously infect AIDS patients in Africa. TB is the leading cause of death among people living with HIV/AIDS (PLWHA) and one of the most common opportunistic infections they experience (www.pepfar.gov). The prevalence of HIV infection among patients in TB clinical settings is high, up to 80 percent in some countries (www.pepfar.gov). Funding to reduce the incidence of deaths from malaria would support the growth programs to increase the use of insecticide treated bed nets, use indoor residual spraying (IRS), and procurement of highly effective artemisinin-based (anti-malarial) combination therapies (ACTs) (www.fightingmalaria.gov).

Family Planning- The new bill will permit AIDS testing and treatment at sites that provide family planning, although no PEPFAR money can be used for contraception or abortion. An earlier version would have allowed the money to be used for reproductive health, but that was removed during negotiations in February before the bill passed through the House. The House version addresses integration of family planning and HIV services, but uses language that may restrict PEPFAR funding only to groups in compliance with the global gag rule, which restricts clinics that perform abortions from receiving PEPFAR funds. However, integration of family planning services and HIV services is not discussed in the Senate version of the new bill. Groups such as Physicians for Human Rights (PHR) are calling for the integration of family planning and HIV services in the final PEPFAR reauthorization legislation (physiciansforhumanrights.org).

Heath Care Workers- The legislation's goals include, by 2013, also include training 140,000 new health care workers that would serve those areas currently lacking these resources the most. However, the current language in the new bill is vague and does not specify that health care workers will be educated in topics other than HIV and how these workers will be retained to create a sustainable health care system. Additionally, no specific language in the bill addresses the safety and well-being of health-care workers themselves while treating those affected by this epidemic. Health care worker safety is important to stress because without it, it is difficult to maintain a capable workforce and attract additional workers into the field.

Travel Ban - For nearly 20 years the US has banned HIV positive foreigners from entering the country for the purposes of tourism (www.globalhealth.org). Hopeful visitors are able to obtain (usually with great difficulty) a waiver to enter the country for humanitarian or other specified purposes. Individuals with a waiver will have their HIV status permanently stamped into their passports, violating their privacy in the name of public security. The US is one of only 14 countries that has legally imposed a ban on HIV-positive individuals. The other countries include Armenia, Brunei, Saudi Arabia, Russia, and Iraq. China recently lifted their travel ban hoping to make a good impression to the rest of the world in light of the the upcoming Olympics to be held in Beijing this summer. Allowing the travel ban to continue has made US appear close minded to rest of the world, especially by its fellow developed nations, the majority of whom have no policies restricting the entry of individuals with HIV into their countries. The United States' conservative policy on the entry of HIV-infected individuals also makes it unlikely that the US will ever host the annual International AIDS Conference, which is happening in Meixco City, Mexico this year. Language in the new PEPFAR bill reflects the removal of this travel ban, however, there are concerns that the ban may not be removed if from law if maintaining it enables other controversial aspects of the new bill to be added or approved.

The "Anti-Prostitution Loyalty Oath" - In 2003, Congress passed the United States Leadership against HIV/AIDS, Turberculosis, and Malaria Act (Global AIDS Act) and the Trafficking Victims Protection Reauthorization Act (TVPRA). The “anti-prostitution loyalty oath” was also introduced in 2003 by conservative anti-choice legislator, Rep. Chris Smith (R-NJ) and is applied to all U.S. government funding for international HIV/AIDS programs (www.pathfind.org/site/PageServer). The U.S. Global AIDS Act bars the use of federal funds to “promote, support, or advocate the legalization or practice of prostitution (www.genderhealth.org).” The “prostitution loyalty oath” requires that U.S. and foreign non-governmental organizations receiving any U.S. HIV/AIDS funding adopt a policy "explicitly opposing prostitution and sex trafficking" throughout their programs (www.genderhealth.org). This means that any organizations receiving funding from the U.S. for HIV/AIDS relief may not be involved in work with women who are or have been involved in commercial sex work/sex trafficking.