United States Congress (Washington, DC)
Chris Smith
2 April 2008
document
Washington, DC — US Rep. Chris Smith (R-NJ), Senior Member of the House Foreign Affairs Committee and Ranking Member of the Subcommittee on Africa and Global Health today gave excerpts of the following remarks during House floor debate of HR 5501 the “Tom Lantos and Henry Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008:
Excerpts of Statement by Rep. Chris Smith (R-NJ)
Floor Debate of HR 5501 “Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008”
April 2, 2008
Mr. Speaker, I rise in strong support of the “Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008”—an admittedly long, but appropriate title for a bill that is long on substance, meaningful intervention, tangible compassion, and relief.
Aptly named for two of the giants of this institution who shepherded President George W. Bush’s PEPFAR initiative through the Congress in 2003, H.R. 5501 will literally mean the difference between life and death to millions, especially in sub-Saharan Africa.
The Bill before us today is consensus legislation, a delicate balance that if kept intact—and only if kept intact—will be signed into law. So I want to thank Chairman Berman and Ranking Member Ros-Lehtinen and the other Members and staff for helping to forge today’s “PEPFAR Consensus.” I want to specifically thank Sheri Rickert, Mary Noonan, Autumn Fredericks, Yleem Poblete, Peter Yeo, Pearl Alice Marsh, and David Abramowitz.
As Members know, close to 70% of the estimated 33 million people with HIV live in Sub-Saharan Africa. Of the 2.5 million children afflicted with this dreaded disease, 90% live in Africa as well.
When combined with opportunistic infections like Tuberculosis—the number one killer of individuals with HIV—and Malaria alone kills 1 million each year, again mostly in Africa—the HIVAIDS pandemic compares among humanity’s worst. Former Chairman Hyde frequently compared the sickness to the bubonic plague—the Black Death—an epidemic that claimed the lives of over 25 million people in Europe during the mid-1300’s.
I know some Members are likely to wince at the cost—$50 billion over five years for PEPFAR, the Global Fund, Tuberculosis, and Malaria—but that sum of money will likely prevent 12 million new HIV infections worldwide, and support treatment for 3 million people including an estimated 450,000 children. That sum of money will also provide care to 12 million individuals with HIV/AIDS including 5 million orphans and vulnerable children and will help train and deploy at least 140,000 new health care professionals and workers for HIV/AIDS prevention, treatment, and care.
On the prevention side, the legislation requires that the Global AIDS Coordinator provide balanced funding for sexual transmission prevention including abstinence, delay of sexual debut, monogamy, fidelity and partner reduction. If less than 50% of sexual transmission prevention monies are spent on the Abstinence and the Be faithful parts of the ABC model, the Coordinator must provide a written justification. (Currently the Coordinator exercises waiver authority in this regard without notifying Congress so this language ensures greater taxpayer transparency and accountability.)
Five years after PEPFAR first began, the efficacy and importance of promoting abstinence and be faithful initiatives have been demonstrated. The evidence is compelling.
According to joint comments by the U.S. Department of State, USAID, and HHS on PEPFAR “Congressional directives have helped focus U.S. Government (USG) prevention strategies to be evidence-based. Because of the data, ABC is now recognized as the most effective strategy to prevent HIV in generalized epidemics…. The legislation’s emphasis on AB activities has been an important factor in the fundamental and needed shift in USG prevention strategy from a primarily C approach prior to PEPFAR to the balanced ABC strategy. The Emergency Plan developed a more holistic and equitable strategy, one that reflects the growing body of data that validate ABC behavior change.”
So thanks Mr. Pitts for writing the AB earmark into the original law.
It goes on to say; “ABC-Abstinence, Be Faithful and Correct and Consistent Condom Use – is the most effective, evidence-based approach to sexual transmission of HIV infection. Recent data from Zimbabwe and Kenya…mirrors the earlier success of Uganda’s ABC approach to preventing HIV. These three countries with generalized epidemics…have demonstrated reductions in HIV prevalence, and in each country the data point to significant AB behavior change and modest but important changes to C. Where sexual behaviors have changed, as evidenced by increased primary and secondary abstinence, fidelity, and condom use, HIV prevalence has declined.
In Zimbabwe, Science reported in February 2006 that among men aged 17 to 29 years in eastern Zimbabwe, HIV prevalence fell by 23% from 1998 to 2003. Even more impressively, the prevalence among women aged 15 to 24 dropped by a remarkable 49%.
In Kenya, the Ministry of Health estimates that HIV prevalence dropped from approximately 10% in 1998 to approximately 7% in 2003.”
This past September, in 2007, the Foreign Affairs Committee heard from Dr. Norman Hearst who said; “the key to sustainability must be prevention. We cannot treat our way out of this epidemic… Most PEPFAR priority countries have generalized epidemics.”
He went on to say: “Five years ago, I was commissioned by UNAIDS to conduct a technical review of how well condoms have worked for AIDS prevention in the developing world. My associates and I collected mountains of data, and here’s what we found…. we then looked for evidence of public health impact for condoms in generalized epidemics. To our surprise, we couldn’t find any. No generalized HIV epidemic has ever been rolled back by a prevention strategy primarily based on condoms. Instead, the few successes in turning around generalized HIV epidemics, such as Uganda, were achieved not through condoms but by getting people to change their sexual behavior.”
“These are not just our conclusions. A recent consensus statement in The Lancet was endorsed by 150 AIDS experts, including Nobel laureates, the president of Uganda, and officials of most international AIDS organizations… [it said] the priority for adults should be B (limiting one’s partners). The priority for young people should be A (not starting sexual activity too soon….” “This contrasted with other funders that often officially endorse ABC but in practice continue to put their money into the same old strategies that have been unsuccessful in Africa for the past 15 years….”
Dr. Hearst concluded by saying, “Decisions are often made by expatriates and westernized locals trained in rich countries who have internalized prevention models from concentrated epidemics.” And, “In most countries with generalized epidemics, the rich have higher HIV infection rates than the poor….Anything that dilutes the focus of AIDS prevention in Africa from changing sexual behavior may do more harm than good.”
An article published in the New York Times, June 13th, by Helen Epstein, pointed out “that many efforts aimed at stopping the spread of HIV have had disappointing results. Epstein said that ignoring the need to promote fidelity in sexual relations ‘may well have undermined efforts to fight the epidemic.’ She wrote: ‘Government planning documents, United Nations agency reports, AIDS awareness campaigns and AIDS education curriculums are strangely silent on the subject.’”
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