Pact Would Give Global AIDS Fight Triple the Money

By David Brown
Washington Post Staff Writer
Thursday, February 28, 2008

House leaders from both parties and the White House yesterday reached agreement on a bill that would more than triple funding for the Bush administration's global AIDS program, already the largest foreign aid initiative aimed at fighting a single disease in U.S. history.

In a compromise reached late Tuesday night, the bill loosens the requirement for abstinence messages in AIDS-prevention strategies, a source of criticism of the program since it was unveiled by President Bush in 2003.

The bill authorizes $50 billion over five years to prevent infection, treat people already ill from the human immunodeficiency virus (HIV), and care for children orphaned by the epidemic. The program, known as the President's Emergency Program for AIDS Relief (PEPFAR), provided $15 billion over its first five years.

"This historic agreement will save millions of lives," said Paul Zeitz, a physician who heads the Global AIDS Alliance, a vocal critic of some original PEPFAR provisions. "With bipartisan support, Congress is beginning to fix aspects of the AIDS program that were clearly not working."

Many observers consider PEPFAR the Bush administration's most successful foreign policy initiative. Its acronym is now widely known in sub-Saharan Africa, where the targets of the program's assistance include national ministries of health and village-level church groups.

The original PEPFAR law required that one-third of prevention dollars be used to promote abstinence, setting off a rhetorical war between the program's State Department leaders and much of the rest of the AIDS community. The new bill appears to signal a truce.

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.

PEPFAR's overseers in the State Department said that in practice, they have been more lenient than the original law's language suggested. They say the requirement of one-third funding for abstinence promotion applies only to programs aimed at preventing sexual transmission of the virus, not all prevention efforts. Other prevention activities include treating pregnant women with antiviral drugs so they will not infect their newborns; efforts to make the blood supply safer; and providing clean syringes for medical use.

Furthermore, they say, "abstinence" was broadened to include "be faithful" messages -- two-thirds of what is known as the ABC strategy. (The C stands for "condom use.")

A requirement that every organization receiving PEPFAR money adopt a specific policy against "prostitution and human trafficking" -- which many activist groups also find rankling -- remains in the new bill.

The renewed PEPFAR would be broader than the original.

About $9 billion would go to fight tuberculosis and malaria, which often simultaneously infect AIDS patients in Africa. That sum would underwrite purchase of food supplements for AIDS patients, an underappreciated component of medical treatment of the disease. It would finance "microcredit" loans to women widowed by the disease or ostracized because of their infection.

The bill would permit AIDS testing and treatment at sites that provide family planning, although no PEPFAR money could 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 Tuesday night.

The legislation's goals include, by 2013, preventing 12 million new infections; providing antiretroviral treatment for 3 million people (including 450,000 children); medical and nonmedical care for 12 million (including 5 million orphans); and training at least 140,000 new health-care workers.

The bill is expected to go to the House floor within two weeks. The Senate Foreign Relations Committee is at work on its own bipartisan proposal "consistent with the way this committee operates," said a senior aide, who requested anonymity because he is not an authorized spokesman.

"This bill is not perfect, but no compromise ever is," said Howard L. Berman (D-Calif.), who became acting chairman of the House Foreign Affairs Committee upon the death this month of Tom Lantos (D-Calif.). The measure is named in honor of Lantos and the late Henry J. Hyde (R-Ill.), who as committee chairman in 2003 helped push the original bill to passage.

Numerous Republicans spoke in support of the bill, although a few said they did not have enough time to review the amended version, which was delivered to the committee room warm off the photocopying machine. About a half-dozen said "no" in the voice vote, which passed.

"I have been here 20 years, and this is the most insane thing I have ever witnessed," Rep. Dana Rohrabacher (R-Calif.) said. He added that "we have people at home who need to be taken care of," citing veterans and families that cannot afford health insurance.

Praise came from as far away as UNAIDS, the United Nations' program in Geneva, which said the vote "sends a strong signal that the United States is committed to maintaining its leadership role in the global response to AIDS."

"We are actually very pleased that the president has agreed to $50 billion," said Jennifer Flynn, a director of Health GAP, an organization frequently critical of the administration's AIDS efforts.

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