Kaisernetwork.org (Washington, DC)
17 July 2008
Politics and Policy
Senate Passes PEPFAR Reauthorization Legislation
[Jul 17, 2008]
The Senate on Wednesday voted 80-16 to approve legislation that would reauthorize the President's Emergency Plan for AIDS Relief at almost $50 billion over the next five years, "rejecting efforts to pare down the bill's" spending levels, the Washington Post reports (Kane, Washington Post, 7/17). The measure would replace and expand the current program, which was passed by Congress in 2003 at $15 billion and will expire at the end of September (Abrams, AP/Google.com, 7/17).
According to the Los Angeles Times, although passage of the measure had stalled in recent weeks over objections from some Republicans concerning its cost, how the money would be spent and the role of abstinence education, most Senate Republicans joined Democrats in backing the measure, which the Bush administration also supports. Sen. Richard Lugar (R-Ind.) said, "It's one of the strongest ways the U.S. has made an impact on a number of countries where our diplomacy hasn't been effective in the past," adding that one of the bill's goals is "the alleviation of extraordinary suffering on Earth" (Patel, Los Angeles Times, 7/17). Sen. Joseph Biden (D-Del.), chair of the Senate Foreign Relations Committee, praised Bush's "bold" support for AIDS funding, calling it his greatest achievement as president. "We've made tremendous strides, but our work is not nearly finished," Biden said, adding, "Two million people died last year of HIV/AIDS. Over two and a half million people died of malaria" and tuberculosis. According to the Post, Sen. Tom Coburn (R-Okla.), who is a "staunch opponent of most government spending," said PEPFAR "is by far the only true foreign policy program that's working. The dollars are actually making a difference" (Washington Post, 7/17). In a statement, Bush said, "With passage of today's bill, we are one step closer to ensuring that this excellent program continues to help those in need. I encourage the full Congress to move quickly to send me final legislation that I can sign" (Cowan, Reuters, 7/16).
Leading opponents of the measure earlier on Wednesday continued to express concern about the bill's price tag. Sen. Jim DeMint (R-S.C.), whose amendment to reduce the program's funding to $35 billion was rejected by a 32-63 vote, said, "Why, at a time when our country is in debt as far as we can see, why would we as a country create the biggest foreign aid bill in history and borrow more money, $50 billion, and send it all around the world?" (Graham-Silverman, CQ Today, 7/16). Sen. John Cornyn (R-Texas) said the funding should have been reduced to $35 billion over five years. "There should be a limit," he said, adding, "It's one thing to say you'll support it at $15 billion; it's another thing to say you'll support it at $35 billion. To me, it's entirely another thing to support it at $50 billion" (Washington Post, 7/17).
According to CQ Today, the only "sizeable change" adopted by the Senate was to trim the original $50 billion authorization to $48 billion and to include $2 billion for American Indian issues. The chamber also adopted an amendment intended to increase oversight of the Global Fund To Fight AIDS, Tuberculosis and Malaria and encourage cost-sharing and transition strategies as part of agreements with countries that receive PEPFAR aid (CQ Today, 7/16). Although some Republicans objected to a provision in the bill that would ease U.S. HIV/AIDS travel restrictions, Sen. Jeff Sessions (R-Ala.) dropped his amendment to challenge the provision (Reuters, 7/16). The Senate also defeated an amendment by Cornyn to establish a "sunset" commission to propose legislation that would abolish any global HIV/AIDS program Congress did not explicitly reauthorize. In addition, an amendment by Sen. Judd Gregg (R-N.H.) to set up an inspector general for the program, and another by Sen. Jon Kyl (R-Ariz.) that would have limited spending in the program's final year to $10 billion, also were rejected (CQ Today, 7/16).
The House version of the legislation, which would allocate $50 billion for PEPFAR, passed in April (Kaiser Daily HIV/AIDS Report, 7/16). According to Biden, there are small differences between the two versions of the legislation. The Post reports that one "key" difference between the House and Senate versions is that the House bill would permit funding for family planning programs in developing countries (Washington Post, 7/17). The House version would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services (Kaiser Daily HIV/AIDS Report, 4/3). In addition, the House version includes some spending mandates that are not in the Senate bill, including a requirement that 20% of PEPFAR funding be allocated to prevention. The Senate version includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. Both versions would overturn an existing law that requires one-third of prevention funds be spent on abstinence and fidelity programs, instead requiring a report to Congress if countries do not spend half of prevention money on such programs (CQ Today, 7/16). Biden said that he has been working with House leaders and that he is confident they can come up with a final version "within a matter of days" (AP/Google.com, 7/17).
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Science & Medicine
Gene Mutation That Protects Against Virtually Extinct Form of Malaria Makes Blacks More Susceptible to HIV, Study Says
[Jul 17, 2008]
A gene mutation that likely protected people living in sub-Saharan Africa from a form of malaria seldom found in the region now could make blacks more susceptible to HIV, according to a study published Wednesday in the journal Cell Host & Microbe, the New York Times reports. The researchers say if their results are confirmed by other research, important insights into HIV's biology could be gleaned (Wade, New York Times, 7/17). The researchers estimate that the gene mutation could account for about 11% of, or 2.7 million, HIV cases in sub-Saharan Africa (Russell, San Francisco Chronicle, 7/17).
According to the researchers, there are no immediate practical implications of the study's findings. However, the findings "in theory" could be used to develop a "susceptibility test" that can identify the mutation. In addition, HIV vaccine researchers could use the findings to tailor vaccine candidates to groups most likely to benefit from such vaccines, the Wall Street Journal reports (Naik, Wall Street Journal, 7/17).
For the study, researchers compared blood samples of 814 black U.S. military personnel who were HIV-negative with samples from 470 personnel who were HIV-positive. The researchers examined the samples for a protein known as the "Duffy antigen," which enables some malaria parasites to enter red blood cells (San Francisco Chronicle, 7/17). People with a genetic mutation that disables the Duffy antigen are protected against the Plasmodium vivax malaria parasite, a form of which was common in Africa thousands of years ago (Dunham, Reuters, 7/16).
About 90% of blacks living in Africa and 60% of U.S. blacks have a disabled Duffy antigen, according to the researchers. However, the Duffy antigen absorbs HIV, preventing the virus from entering white blood cells. Those with a disabled Duffy gene therefore are more susceptible to HIV, according to the study. The researchers found a 40% higher risk of HIV among the military personnel whose genes disabled the Duffy antigen (San Francisco Chronicle, 7/17).
In addition, the researchers found that HIV-positive people with a disabled Duffy antigen had a slower progression to AIDS and likely survived about two years longer than those without the variant (Wall Street Journal, 7/17). Although researchers are unsure why the absence of the antigen both increased susceptibility to HIV and slowed progression of the virus, it is possible that people without the antigen have lower levels of infection-fighting chemokines in their blood, which make infection more likely but limit damage to the body if infection occurs (Kaplan/Maugh, Los Angeles Times, 7/17).
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