On March 4, the House International Relations Committee held a hearing to examine the implementation of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25). The law authorizes $3 billion in each of FY2004 through FY2008 for HIV/AIDS, tuberculosis, and malaria prevention and treatment programs. Of that amount, up to $1 billion may be used for the Global Fund to Combat AIDS, Tuberculosis, and Malaria in FY2004. The law also requires the State Department to establish a U.S. Global AIDS Coordinator and requires the President to develop a “comprehensive, integrated, five-year strategy to combat global HIV/AIDS.” Specifically, the five-year strategy should include a particular focus on the needs of families, women, young people, and children. The five-year strategy, The President’s Emergency Plan for AIDS Relief: U.S. Five-Year Global HIV/AIDS Strategy, was submitted to Congress last week.
Chair Henry Hyde (R-IL), opened the hearing saying, “I do not seek to reopen old debates on the politics of HIV/AIDS. Instead, I seek an objective evaluation of the strategy reported to Congress to ensure it sets the United States in the right direction to fight this pandemic.” Criticizing the report, Chair Hyde said that it “is not a comprehensive, five-year global strategy on how to implement Public Law 108-25. It is, instead, a political document that articulates general principles that guide the President’s initiative to administer a program of assistance for 15 focus countries…In sum, I am disappointed with this document.”
Rep. Barbara Lee (D-CA) agreed, “I am somewhat disappointed as well.” Stating that the “most glaring fault” of the report is its “lack of a real specific focus on women,” Rep. Lee pointed out that while the document recognizes that “gender inequalities fuel the epidemic and that specific interventions must be tailored to specific populations, including women,” the details “are practically nonexistent.” She went on to say that the report failed to address efforts to reduce stigma and discrimination against women infected with HIV, and she criticized the report’s focus on the ABC [abstain, be faithful, and if necessary use a condom] prevention method. “The ABC strategy will be ineffective for many women who are at risk,” she said.
Ambassador Randall Tobias, U.S. Global AIDS Coordinator, detailed the administration’s efforts to implement the law, stating that last week he announced the first release of funds totaling $350 million. “This money will go to scale up programs that provide anti-retroviral treatment; abstinence-based prevention programs, including those targeted at youth; safe medical practices programs, including safe blood programs; and programs to provide care for orphans and vulnerable children.”
He continued, “With just this first round of funds, an additional 50,000 people living with HIV/AIDS in the 14 focus countries will begin to receive anti-retroviral treatment, which will nearly double the number of people who are currently receiving treatment in all of sub-Saharan Africa. In addition, prevention through abstinence messages will reach about 500,000 additional young people in the Plan’s 14 focus countries in Africa and the Caribbean.”
In discussing the five-year plan, Ambassador Tobias called it “comprehensive” and “integrated” and said it was built on four cornerstones: expanding integrated prevention, care, and treatment; identifying new partners; encouraging national leadership around the world; and implementing strategic information systems that will provide feedback on best practices.
“Within this framework, we will strive to coordinate and collaborate our efforts in order to respond to local needs and be consistent with host government strategies and priorities,” he said.
During the question and answer session, Rep. Lee pressed the ambassador on the question of whether condoms should be made available to the entire population as a prevention strategy. “The focus on abstinence programs fails to take into account the transmission of the disease in marriage,” she said, citing a recent New York Times article, which said that young married women are being infected at higher rates than young unmarried women. “How do you see condom distribution and education for the total population?”
“C is important in those targeted groups that are engaging in high-risk behavior, including those who choose to engage in high-risk behavior and those who are forced to engage in high-risk behavior,” responded Ambassador Tobias. However, “unless condoms are used correctly and consistently, evidence suggests that that is not a strategy that is going to work.”
Rep. Betty McCollum (D-MN) continued the questioning. “Less than one percent of the people know their status,” she said. “We have women who are going to be married,…who will be in monogamous relationships,…and they don’t know their partner’s status…Are you going to provide condoms to those women?”
“Yes,” he responded, clarifying that the scenario presented depicted a population at high-risk.
Rep. Jo Ann Davis (R-VA) stated that cervical cancer is the leading cause of cancer death among women in sub-Saharan Africa. “Eighty percent of the world’s cervical cancer deaths are in Africa, Asia, and South America, and many of those who are infected with HPV are also infected with HIV,” she said, continuing, “Because of the importance of properly addressing HPV, I wanted to bring to your attention an error within the document.” Quoting from Appendix B of the report, Rep. Davis said that the statement “…correct and consistent use of condoms can be expected to decrease (though not eliminate) the risk of transmitting HPV” was incorrect. That statement was attributed to a 2001 National Institute of Allergy and Infectious Diseases (NIAID) workshop on the scientific evidence of condom effectiveness for sexually transmitted disease prevention. “If you take a closer look at the NIAID workshop [document] cited, it actually states, ‘for HPV, the panel concluded that there was no epidemiological evidence that condom use reduced the risk of HPV infection,’” she stated, telling the ambassador that she would request a correction to the administration’s report to “reflect the available science on HPV.”
