This evening, the US Senate voted to reauthorize PEPFAR AIDS legislation (the President's Emergency Plan for AIDS Relief), despite a gauntlet of last-minute obstacles and objections ranging from a Senate Republican filibuster to amendments to drastically cut funding and PEPFAR's reach.
Senate approval is the last major obstacle to the bill's becoming law. PEPFAR reauthorization is targeted to prevent 12 million HIV infections and treat three million people over five years. The Senate version also contains a provision that would lift the infamous HIV travel ban, which generally prohibits HIV+ people from entering the United States.
Said John Bradshaw, JD, Washington Director for Physicians for Human Rights: "In passing this bill, Congress has saved countless lives in a single evening. It is difficult to exaggerate the impact that this $48 billion program will have on people suffering in Africa and around the world from AIDS, tuberculosis, and malaria. The vote also sends a message of support to many of those who suffer that the U.S. is even more committed than ever to getting them the help they need. We welcome the provisions that would bolster Africa's health work force. Without more health workers, there can no lasting progress in addressing these diseases. We applaud the removal of the HIV travel ban, which is and always has been a human rights violation and has no basis in the needs of public health."
Africa's catastrophic health worker shortage, which received little mention in the original legislation, is now a central element of the reauthorized bill passed by the Senate. PEPFAR reauthorization will support countries in developing long-term health workforce plans, will fund 140,000 new health workers, and will pay for a push for 2.3 health workers per thousand people. Many African countries currently employ far fewer health workers than that ratio would provide, crippling efforts to combat AIDS, tuberculosis and malaria.
The health worker shortage has been cited by international health organizations such as the World Health Organization and World Bank as perhaps the single biggest obstacle to implementing HIV services. Indeed, PEPFAR reauthorization provisions constitute the single biggest effort to alleviate Africa's health workforce crisis of any wealthy country.
PEPFAR, the world's largest anti-AIDS program which also now addresses malaria, tuberculosis, and nutrition, has so far treated over 1.5 million people with AIDS. The bill is seen as a cornerstone of President Bush's legacy as he leaves office, and has overall enjoyed wide bipartisan support, including from Republican Senator Richard Lugar, a co-sponsor of the bill who became an energetic proponent.
President Bush initially proposed $30 billion for the reauthorized program (the initial price tag for PEPFAR 1 was $15 billion), but grassroots support, including bold leadership from Physicians for Human Rights, eventually pushed that figure to $48 billion.
Below is a summary of PHR's positions on some of the salient provisions of the version passed this evening by the Senate:
Africa's Health Workforce Crisis: PEPFAR reauthorization will support countries in developing long-term health workforce plans, will fund 140,000 new health workers, and will help pay for a push for 2.3 doctors, nurses, and midwives per thousand people. Many African countries currently employ far fewer health workers than that ratio would provide, crippling efforts to combat AIDS, tuberculosis and malaria.
PHR is advocating for including a provision during conference that would provide health care for health workers themselves – an issue not addressed in the Senate bill, but that is included in the House version – and stronger language about safe working conditions and health workforce plans.
Injection drug use (IDU) policy—PHR welcomes the increased attention given to IDUs in the proposed legislation, which favors increased access to HIV prevention for this group.
The bill makes… "the reduction of HIV/AIDS behavioral risks a priority of all prevention efforts by …promoting voluntary counseling and testing, addiction therapy, and other prevention and treatment tools for illicit injection drug users and other substance abusers." It promotes substitution therapy for IDUs. [NOTE: An effort is underway in the House to repeal the US ban on needle exchange, including a letter to House leadership signed by 56 Members of Congress, urging the leadership to "seek immediate removal of the ban on federal funding of syringe exchange."]
In addition, there is a reporting requirement that PEPFAR must track the number of IDUs reached by PEPFAR services in each affected country, including users at risk of becoming infected with HIV. The inclusion of prevention services for users not yet HIV-positive is a breakthrough and differs from PEPFAR 1, which only targeted HIV-positive injection drug users.
Women: PHR supports the focus given in the bill to programs to combat HIV/AIDS among women. Women's unique vulnerability to HIV is explicitly discussed in the bill.
The bill provides important targets for preventing mother to child transmission and AIDS medical treatment for children.
PEPFAR five-year strategy must include a plan to address the needs of women and girls, including specific strategies, targets, and goals. The bill also mandates:
• A report on the five-year plan must be submitted annually to Congress.
• It expands monitoring and evaluation and operations research to include collection and analysis of data on gender-responsive interventions, and will develop gender indicators.
• It authorizes new IOM evaluation four years later to assess performance
• It calls for compacts with countries to include how they will address the needs of women and girls.
The integration of family planning services and HIV services, seen as critical by advocates including PHR, is not discussed in the Senate version. PHR is calling for the integration of family planning and HIV services in the final PEPFAR reauthorization legislation. Such integration is essential in order to catch women with HIV as early as possible to prevent and treat the disease.
HIV Travel Ban: PHR strongly supports the repeal of the longstanding ban preventing people with HIV from visiting the US, and calls for this language to be included in the final legislation. The Travel Ban is a violation of human rights, including the right to privacy and the right against discrimination.
PHYSICIANS FOR HUMAN RIGHTS
For 20 years, Physicians for Human Rights (PHR), based in Boston, MA,
has advanced health and dignity by protecting human rights. As a founding member of
the International Campaign to Ban Landmines, PHR shared the 1997 Nobel
Peace Prize. www.physiciansforhumanrights.org