Global HIV Programs Approved by Committee

On April 2, the House International Relations Committee approved, 37-8, legislation (H.R. 1298) that would provide assistance for international HIV/AIDS, tuberculosis (TB), and malaria programs.

Sponsored by Rep. Henry Hyde (R-IL), H.R. 1298 would authorize the request outlined in the President’s State of the Union Address for $15 billion over the next five years to “prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS” (see The Source, 1/31/03).

H.R. 1298 also would require the Department of State to establish a Coordinator of U.S. Government Activities to Combat HIV/AIDS Globally. The coordinator would be appointed by the President and would be responsible for the oversight and coordination of all U.S. efforts to combat HIV/AIDS internationally.

The bill contains a number of congressional findings that state “women are four times more vulnerable to infection than are men and are becoming infected at increasingly high rates, in part because many societies do not provide poor women and young girls with the social, legal, and cultural protections against high risk activities that expose them to HIV/AIDS.”

Another congressional finding states that “mother-to-child transmission is largely preventable with the proper application of pharmaceuticals, therapies, and other public health interventions.” H.R. 1298 would require the President to submit an annual report on the Administration’s efforts to prevent mother-to-child transmission of HIV/AIDS.

Committee Chair Hyde noted that members “are here to build on the bipartisan work accomplished last year.” He added that H.R. 1298 is “a bill that, for the first time authorizes treatment for more than 2 million people; a bill that takes the necessary step of creating a single coordinator to ensure cohesion and unity of effort among the various agencies of the United States government that can contribute to our overall AIDS effort.”

Ranking Member Tom Lantos (D-CA) added, “Today’s mark-up is truly historic. This morning we are considering perhaps the most ambitious piece of legislation in this committee’s long history.”

The committee approved, by voice vote, a manager’s amendment that would provide $3 billion in each of FY2004 through FY2008 for HIV/AIDS, TB, and malaria programs. Of this amount, up to $1 billion could be used for the Global Fund to Combat AIDS, Tuberculosis, and Malaria in FY2004.

Under the bill, prevention, treatment, and educational activities would include:

• Programs that teach ways to avoid contracting HIV/AIDS, including “delaying sexual debut, abstinence, fidelity and monogamy, reduction of casual sexual partnering, and where appropriate, use of condoms;”
• Confidential voluntary testing and counseling;
• Programs aimed at preventing and reducing mother-to-child transmission through medications and access to infant formula and other alternatives for infant feeding;
• Programs to strengthen indigenous health care delivery systems, including clinical training for indigenous organizations and health care providers;
• Assistance to strengthen and expand hospice and palliative care programs for patients with HIV/AIDS, their families, and their primary caregivers;
• Pharmaceutical assistance for individuals infected with HIV/AIDS, including “antiretrovirals and other pharmaceuticals and therapies for the treatment of opportunistic infections, nutritional support, and other treatment modalities;”
• Education of populations that are at high risk of contracting or spreading HIV/AIDS, including “those exploited through the sex trade, victims of rape and sexual assult, individuals already infected with HIV/AIDS, and in case of occupational exposure of health care workers;” and
• Purchasing test kits, condoms and, when proven effective, microbicides.

Rep. Joseph Pitts (R-PA) offered an amendment that would have given funding priority to prevention programs that promote abstinence over those that condone condom use. Rep. Barbara Lee (D-CA) offered a secondary amendment that would also include condom use as a priority in prevention efforts. After approving the Lee amendment by a vote of 24-20, the committee approved, by voice vote, the modified Pitts amendment.

Another amendment offered by Rep. Pitts would have allowed funding for faith-based groups even if they advocate abstinence over condom use. The amendment failed, 21-23.

A number of other amendments were approved by voice vote, including:

• An amendment by Rep. Dana Rohrabacher (R-CA) that would call for 10 percent of the funds to go toward helping children whose parents have died of AIDS;
• An amendment by Rep. Sherrod Brown (D-OH) that would require more accountability by the U.S. Agency for International Development for its programs to combat TB;
• An amendment by Rep. Grace Napolitano (D-CA) that would give priority to organizations that already administer programs aimed at preventing mother-to-child transmission of HIV/AIDS;
• An amendment by Rep. Howard Berman (D-CA) that recognizes the importance of the public-private partnership, Medicines for Malaria, in developing new anti-malaria drugs;
• An amendment by Rep. Betty McCollum (D-MN) that would ensure that physician’s assistants would be eligible for participation in a pilot program that would place health care professionals in countries severely affected by HIV/AIDS, TB, and malaria; and
• An amendment by Rep. Jeff Flake (R-AZ), as modified by a secondary amendment by Rep. Lantos, that would reduce funding for the Global Fund to Combat AIDS, Tuberculosis, and Malaria in the amount equal to that given by the fund to governments on the Department of State’s terrorism list. However, non-governmental organizations in those countries would not be affected by the amendment.

Another amendment offered by Rep. Christopher Smith (R-NJ) was approved, 24-22. The Smith amendment would require that HIV/AIDS treatment and prevention organizations explicitly oppose prostitution and sex trafficking in order to receive funding. Rep. Lantos offered a secondary amendment to block the Smith amendment; however, the Lantos amendment failed by a vote of 21-22.