3 March 2008
analysis
Washington, DC — The House Foreign Affairs Committee last week approved a commitment of $50 billion over 5 years for spending on global AIDS and related diseases, $20 billion more than the President's original proposal.
The bill, which also includes other provisions such as funds for training of health care workers, and is expected to pass the full Congress. But health activists note that additional pressure on U.S. presidential candidates is needed to ensure other measures, such as ensuring access to essential medicines.
This AfricaFocus Bulletin includes a summary of the provisions of the compromise Global HIV/AIDS Bill passed by the House Committee, an editorial from The New York Times on the same subject, and an article on intellectual property rights policy and global health by Jamie Love. Love, who has been one of the leading experts and activists on the subject, stresses that there are hopes for new policy from U.S. presidential candidates, but none has yet supported legislation to ensure that trade agreements do not block access to essential medicines. .
For earlier AfricaFocus Bulletins on related issues, see http://www.africafocus.org/healthexp.php and
http://www.africafocus.org/country/usa-africa.php
Summary of Compromise on Global HIV/AIDS Bill
Staff, House Committee on Foreign Affairs
http://foreignaffairs.house.gov
February 27, 2008
The compromise text includes more than 95% of the language contained in the Democratic draft of the 5-year reauthorization legislation. This new legislation has the support of Foreign Affairs Acting Chairman Howard Berman, Ranking Republican Member Ileana Ros-Lehtinen, and the White House.
The legislation contains groundbreaking provisions which move the Global HIV/AIDS program beyond the "emergency" phase of implementation to "sustainability", dramatically boost HIV/AIDS programming related to women and girls, strengthen health systems in countries hard-hit by the HIV virus, authorize HIV/AIDS programs to include linkages to food and nutrition, education and health care programs, and increase U.S. contributions to the Global Fund.
The new bill funds the Global HIV/AIDS, Tuberculosis and Malaria initiative at $50 billion over 5 years, the amount provided for in the Democratic draft. The President previously had called for $30 billion over 5 years.
The compromise legislation overturns the controversial and ineffective 1/3 abstinence-only requirement that applies to global HIV/AIDS prevention funding. Instead, the Administration will be directed to promote a "balanced" prevention program in target countries, including all elements of the Abstinence, Faithfulness, and Condoms (ABC) approach towards HIV prevention. The Administration will also be required to report to Congress if behavioral change programs, such as abstinence and fidelity, do not receive 50% of the funds devoted to the prevention of sexual transmission of HIV in countries in which there is a generalized HIV epidemic (currently, 33% of all HIV prevention funds in all countries - a much larger pot of funds - must be spent on abstinence). The 50% figure triggers a report, and is not an earmark governing the expenditure of funds.
The new bill authorizes, for the first time, the expenditure of Global HIV/AIDS funding to provide HIV/AIDS testing and counseling services in family planning programs supported by the U.S.
government. This will ensure that many more women of reproductive age receive vital information related to their HIV status and HIV/AIDS education. While the compromise bill does not authorize the use of Global HIV/AIDS funding to provide contraceptive services (other than condoms and other related bulk commodities as in current law) in the context of HIV/AIDS programming, it does not prohibit such activities.
The compromise text returns to existing law related to the so-called "prostitution pledge.
The bipartisan bill contains new benchmarks for U.S.
contributions to the Global Fund, but does not contain a funding penalty if the benchmarks are unmet.
The Global AIDS Fight: Editorial
The New York Times, February 29, 2008
Congress and the White House are preparing to ramp up spending on programs to combat AIDS and related diseases around the world while removing some of the ideological blinders that have long undermined the effort to slow the spread of the AIDS virus. It will be a welcome strengthening of a foreign aid program that was already one of the shining accomplishments of the Bush administration.
The House Foreign Affairs Committee this week approved a bipartisan compromise, crafted in negotiations between House leaders and the White House, that would authorize a hefty $50 billion over the next five years to support campaigns against AIDS, tuberculosis and malaria. This represents a huge increase over the $19 billion appropriated in the first five years of the program and a significant increase over the new funding requested by President Bush. The president had originally proposed $30 billion over five years, primarily to fight AIDS, whereas the new bill would authorize perhaps $37 billion to $41 billion to the AIDS struggle.
The administration's program started small five years ago to meet a perceived emergency as the AIDS epidemic spread out of control.
It has already provided drug treatment to almost 1.5 million men, women and children and supportive care to millions of others. The focus for the next five years will be on making some of the initial gains sustainable.
In one farsighted move, money will be used to train some 144,000 new health care workers over the next five years to care for people infected with H.I.V., the virus that causes AIDS. That is at best a start on easing the severe shortage of health care workers in the developing world, which some estimates peg in the millions. Other donor nations will need to contribute to the training effort as well.
The most troublesome ideological constraint on the program - a requirement that one-third of the funds used for prevention services be spent on abstinence education - has been greatly eased.
The bill calls for a balanced prevention program that would promote abstinence until marriage and fidelity thereafter, as well as condoms. It requires countries to report if abstinence and fidelity funding falls below a certain percentage, but it sets no firm percentage that has to be met.
The House is expected to pass the bill in the near future, and the Senate is considering its own version. Although some Republicans are grumbling over the amount of money proposed, it is important that Congress appropriate the full $50 billion if possible. Even that sum would almost certainly not provide universal access to treatment for all people infected with H.I.V., a goal that the major industrialized nations claim to be pursuing.
Access to medicine in developing countries -- hoping for change
The Huffington Post
February 29, 2008
By Jamie Love
For his first seven years, Bill Clinton pursued an aggressive policy of imposing tough intellectual property rules for developng countries, most importantly in the area of new medicines, which were seen as an important U.S. export. In 1994, I began a long effort to address the flaws in this policy, working first with (Huffpo blogger) Rob Weissman, Ralph Nader, and soon a few global public health groups, like Health Action International and MSF, and local public health groups in Thailand and South Africa. In 1998, through 1999, a global campaign advocating the use of compulsory licenses on medicines was launched. By June of 1999, a small but very motivated and informed group of U.S. AIDS activists began a campaign to disrupt the Gore campaign for President, to protest Gore's direct involvement in bullying South Africa over proposed changes in its patent laws.
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