On March 1, the House Appropriations Subcommittee on State, Foreign Operations and Other Programs held a hearing on federal efforts to combat global HIV/AIDS and tuberculosis (TB). The hearing covered a range of issues related to funding for global HIV/AIDS programs managed by the State Department.
In her opening remarks, Chair Nita Lowey (D-NY) stated, “I am very pleased that this subcommittee was able to increase funding for HIV/AIDS, TB, and malaria programs in the FY2007 continuing resolution to $4.556 billion…This funding has had results: 822,000 people are on antiretroviral therapy, 61.5 million people have been reached through HIV prevention community outreach programs, and over 2 million orphans have received assistance. We can all be proud of these results, achieved in partnership with thousands of health care workers overseas. However, the pandemic is unyielding. UNAIDS reported in 2006 that 39.5 million people were living with HIV, with new infections on the rise. Disconcerting evidence indicated that some countries, which previously had stable or declining HIV rates, are seeing a resurgence of new cases. While our efforts are impressive, they are clearly not enough.”
While Ranking Member Frank Wolf (R-VA) voiced support for the work of the President’s Emergency Plan for AIDS Relief (PEPFAR), he focused his remarks on the issues of transparency at the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). Rep. Wolf expressed his concerns about recent allegations regarding the misuse of funds earmarked for focus countries and programs serving people living with HIV/AIDS, and the administration’s response to the reports.
Ambassador Mark Dybul, United States Global AIDS coordinator, testified that, “Of those for whom PEPFAR provided site-specific support for treatment in the focus countries, almost nine percent were children and approximately 61 percent were women.” He continued, “Prevention of mother-to-child transmission (PMTCT) is a key element of the prevention strategies of host nations, and PEPFAR is supporting their efforts. UNAIDS estimates that 12 percent of new infections globally in 2006 (530,000 infections) occurred among children, and that more than 90 percent of these were due to mother-to-child transmission…Through fiscal year 2006, PEPFAR has supported antiretroviral prophylaxis for HIV-positive women during 533,700 pregnancies, which has saved an estimated 101,500 infants from HIV infection.” Dr. Dybul continued, “When comparing results from the first year of the Emergency Plan in fiscal year 2004 to fiscal year 2006, all countries have scaled up, and most have dramatically improved availability of PMTCT services to pregnant women.”
On the issue of gender inequity, Dr. Dybul also testified, “Around the world, girls and women are contracting HIV at an alarming rate. The reasons are complex, but they are invariably tied to pervasive, powerful, and often brutal gender inequities. In many of the most heavily affected countries, women and girls are simply powerless to protect themselves against contracting HIV/AIDS. Because of this, PEPFAR places a high priority on addressing gender inequities. In fiscal year 2006, we allocated $442 million to support more than 830 HIV interventions that include a gender-related element. Each of PEPFAR’s 15 focus countries is required to include programs that include one or more of these strategies: increasing gender equity in HIV/AIDS activities and services; reducing violence and coercion; challenging negative male norms; expanding women’s legal rights and protections; and increasing women’s access to education, vocational training, and microfinancing.”
During questions, Rep. Jesse Jackson, Jr. (D-IL) expressed concern about the unintended consequences of increased funding for HIV/AIDS treatments in other countries. “What is PEPFAR doing to help and not exacerbate the shortage of health care workers? I’m concerned that we are drawing workers to HIV/AIDS treatment and from other areas where they also are desperately needed.” Dr. Dybul responded that the programs are designed to allow countries to shift resources as needed, although not every country has taken advantage of that flexibility. Dr. Dybul added that although there was not a lot of data on whether the increased HIV/AIDS funding negatively affects other health programs, there was no early indication that there had been a decrease in other health sectors.
Rep. Dave Weldon (R-FL) discussed the role faith-based organizations have played in treating people with, and families affected by, HIV/AIDS. He indicated that he was not surprised that faith-based organizations have played a significant role in treatment and family support, but that he also was concerned that the Global Fund had not moved in a similar direction. Rep. Weldon added that with cultural and capacity issues that act as barriers to HIV/AIDS treatment, more should be done to integrate faith-based organizations into the work of the Global Fund.
Rep. Betty McCollum (D-MN) used her time to raise the issue of nutritional support. Rep. McCollum stated that food support has been cited as the “greatest, most urgent need” for those suffering from HIV/AIDS and that the lack of adequate food supplies diminishes the ability to prevent and care for the disease. Although Rep. McCollum was pleased to see that Ethiopia had been successful in integrating nutritional support with HIV/AIDS treatment, she was concerned that the same had not been done in the remaining focus countries.
Rep. Barbara Lee (D-CA) stated that she believed it was a “mistake in 2003” to mandate that a third of the HIV prevention funds be earmarked for abstinence-until-marriage programs. Rep. Lee explained that she would reintroduce legislation the “Prevention Against Transmission of HIV for Women and Youth Act” to eliminate the abstinence-only set aside. “If we support ABC [Abstain, Be faithful, correct and consistent use of Condoms], then we need to support all three, not just abstinence…doing so leads to dealing with issues of gender, whether it’s female condoms, violence against women or microfinance and other forms of empowerment. The empowerment of women is integral to combating AIDS. This earmark affects women in their ability to deal with AIDS in appropriate ways.”
