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The AIDS Relief Miracle

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By Michael Gerson
Wednesday, March 12, 2008

It is common practice on Capitol Hill to name bills in such a way that only a monster could oppose or veto them. So every pork-laden exercise in congressional logrolling is knighted with a title like the Infant and Maternal Health, Family Farm Survival, Environmental Safety, Stray Animal Welfare, Equity, Hope and Empowerment, Civil Rights Act of 2000-whatever.

The reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR), in contrast, was named after two recently deceased members of the House of Representatives: Tom Lantos and Henry Hyde. Lantos, a Holocaust survivor, recognized unnecessary death when he saw it. Hyde dedicated his political life to the dignity of human life. And both knew how legislative compromise could serve an honorable cause.

Five years ago, while shepherding the first AIDS bill through the House, these leaders struck an agreement: They separated AIDS relief from the partisan debate over abortion. Funding for prevention focused on a proven approach known as ABC -- practice abstinence, be faithful and use condoms. The program also helped provide AIDS treatment on a large scale for the first time.

When the emergency plan was announced, there were about 50,000 people on AIDS drugs in sub-Saharan Africa. Today there are about 1.4 million. It is perhaps the most successful foreign assistance effort since the Marshall Plan.

Earlier this year, the Lantos-Hyde compromise seemed to be unraveling. Some congressional Democrats pushed for more expansive family planning within AIDS programs -- which a number of conservatives interpreted as a push for abortion rights. Some congressional Republicans seemed primed for a culture-war battle, with the people of Africa as the main victims.

Instead, we saw a last-minute, late-night outbreak of sanity. Negotiators chose, once again, to skirt the abortion issue. Republicans kept a provision that prohibits funding for groups that support the legalization of prostitution. Democrats achieved an $11 billion increase in AIDS funding above the president's request; they also put an end to the 33 percent set-aside in PEPFAR's prevention funding for abstinence and faithfulness programs. Both sides seemed pleased with additional money to fight malaria and tuberculosis and expand medical infrastructure.

Ending the set-aside for abstinence and faithfulness programs is not a victory for the people of Africa. For many African women, the promotion of faithfulness in particular is an urgent, feminist issue -- it is often men with multiple concurrent partners who bring disease into the home. The most effective efforts to reduce HIV infection combine broad condom use with behavior change, including the delayed onset of sexual activity. So PEPFAR has devoted about 7 percent of its total budget to abstinence and faithfulness programs, and about 6 percent to the distribution of condoms -- an even-handed approach.

But the substitute language on prevention programs still requires "balanced funding" among A, B and C; it was a concession to Democrats, not a surrender. Organizations from the conservative Family Research Council to the liberal Global AIDS Alliance have issued statements generally favorable to the compromise, which is expected to pass the full House and then go to the Senate.

A few conservatives seem to be choking on the price tag -- $50 billion over five years for the whole package. It is easy to understand opposition to foreign assistance when it is wasted. But opposition is harder to justify when a program has recently helped save more than a million lives. In this case, there is little distinction between stinginess and cruelty.

A few liberal global health advocates want to revisit the abortion issue in PEPFAR on the theory that aggressive family planning is necessary to AIDS prevention. It is true that abortion prevents the transmission of AIDS -- as it prevents the transmission of cleft lip and clubfoot and bed-wetting. It is a miracle treatment -- except for the fact that the patient dies. It is always possible to "solve" the problems of poverty and disease by eliminating the poor and sick -- but it is hardly a consensus approach to development.

By resisting these ideological extremes, members of Congress can participate in something extraordinary -- a true miracle of science and conscience, and politics at its noblest. A president proposes action, good men and women in the tradition of Lantos and Hyde pass a law, and a young woman I met in South Africa, once bed-ridden from ulcerations covering her legs, exclaims, "I can dance again." A congressional vote is taken, and a woman walks, then dances -- and many more are saved.

In the end, they are the best reasons for Congress to approve the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.

michaelgerson@cfr.org


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