2003 State of the Union Address
........................................... Bush Speaks AIDS: .. [AIDS excerpt]
"... As our Nation moves troops and builds alliances to make our world safer, we must also remember our calling, as a blessed country, to make this world better. Today, on the continent of Africa, nearly 30 million people have the AIDS virus -- including three million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than four million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims -- only 50,000 -- are receiving the medicine they need.
"Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says, "We have no medicines ... many hospitals tell people, 'You've got AIDS. We can't help you. Go home and die.' "
"In an age of miraculous medicines, no person should have to hear those words. AIDS can be prevented. Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from 12,000 dollars a year to under 300 dollars a year -- which places a tremendous possibility within our grasp.
"Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many. We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief -- a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent seven million new AIDS infections ... treat at least two million people with life-extending drugs ... and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS. I ask the Congress to commit 15 billion dollars over the next five years, including nearly ten billion dollars in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.
"This Nation can lead the world in sparing innocent people from a plague of nature. And this Nation is leading the world in confronting and defeating the man-made evil of international terrorism.... "
complete State of the Union Address
PRESS AND RESPONSES:
Bush Asks for $15 Billion to Fight AIDS
By Maggie Fox, Reuters Health and Science Correspondent
WASHINGTON (Reuters) - President Bush, under fire from AIDS groups for what they call his neglect of the epidemic, asked Congress Tuesday to triple AIDS spending in Africa and Haiti to $15 billion over five years.
The announcement, made in his annual State of the Union Address, took AIDS campaigners by surprise, but they quickly both welcomed the plan and expressed skepticism about it.
"I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean," Bush said.
"This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS," Bush added.
On its Internet web site at http://www.whitehouse.gov, the White House said the plan would target Botswana, Ivory Coast, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia.
It said the plan calls for the United States to work with private groups and governments to "put in place a comprehensive plan for diagnosing, preventing and treating AIDS."
Stephen Lewis, the United Nations special envoy for HIV/AIDS in Africa, welcomed what he called "the first dramatic signal from the U.S. administration that it is now ready to confront the pandemic and to save or prolong millions of lives."
"It opens the floodgates of hope. Most importantly, it issues a challenge to every other member of the G7 to follow suit," he said in South Africa after a tour of the region.
The Physicians for Human Rights, which campaigns on a range of issues from land mines to HIV, last week urged Bush to increase global AIDS spending to $3.5 billion a year.
"This is totally unexpected," John Heffernan, a spokesman for the group, said in a telephone interview. "We applaud it. It really is an extraordinary commitment that clearly shows that the United States is serious about combating AIDS."
The Global AIDS Alliance welcomed the news but worried that the Bush administration could be competing with existing AIDS funds, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. The United States has been accused of not putting its fair share into the Fund.
"In the (White House) fact sheet it said only $1 billion of the 10 billion in new money will go to the Global Fund," said Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance. "We are very concerned that will leave the fund vastly underfunded and undermine its success."
A SLOW START?
Zeitz also said it looked like the program would start out slowly, with just $2 billion allocated for next year.
The International Association for Physicians in AIDS Care said it would closely watch what would be done with the money, if Congress approved it. "The devil is in the details," said Scott Wolfe, a spokesman for the group. But he also strongly welcomed the move, adding, "We call on other global leaders to step up and demonstrate similar commitments."
More than 36 million people are infected with the virus that causes AIDS -- 25 million in Africa alone. The United Nations predicts AIDS will kill 70 million people in the next 20 years unless rich nations step up efforts.
Bush noted this. "There are whole countries in Africa where more than one-third of the adult population carries the infection," he said. "More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims -- only 50,000 -- are receiving the medicine they need."
There is no cure for AIDS but a cocktail of expensive drugs known as anti-retrovirals can keep disease at bay. Campaigners have been angered that such drugs are available in rich nations but not to the countries hardest hit by the epidemic.
"AIDS can be prevented," Bush said. "Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year, which places a tremendous possibility within our grasp."
The new Senate majority leader, Tennessee Republican Bill Frist, nodded and smiled as Bush spoke. Frist, a medical doctor, does frequent volunteer work in Africa.
"It's unprecedented. It is huge. And of everything he said tonight, it has the capacity to save more lives in this country I would say, but also globally, than anything else said," Frist told CNN.
Activists Hail President's Call for More
Funding to Fight AIDS
By Paul Blustein
Washington Post Staff Writer
Wednesday, January 29, 2003; Page A12
President Bush's exhortation for Congress to commit $15 billion over five years to fight AIDS in Africa appears to herald a major increase in Washington's spending on the deadly epidemic. Even some of the president's toughest critics last night hailed his emphasis on providing drugs to people who have contracted the AIDS virus.
But details on how the money would be used were sketchy, and only about one-tenth of the new money would go to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a recently launched initiative that enjoys widespread support abroad and among AIDS activists in the United States.
"There are a lot of unanswered questions, but from what we can tell, this seems very, very positive," said Thomas Hart, director of government relations for the Episcopal Church, after listening to the president's remarks about AIDS in his State of the Union address. Although Hart voiced concern that the funding won't come quickly enough to address the emergency nature of the epidemic, he said, "The overall figure is very important, and talking about providing low-cost [anti-AIDS] drugs is a major, very positive shift" for the White House.
In his speech, Bush quoted a doctor in rural South Africa who said that, because of the lack of medicine, many hospitals turn away AIDS patients with the words: "We can't help you. Go home and die."
The president said, "In an age of miraculous medicines, no person should have to hear those words." He noted that anti-retroviral drugs "can extend life for many years" and have dropped dramatically in cost.
Bush said the $15 billion he was proposing to spend over five years to combat the spread of AIDS in Africa would include "nearly $10 billion in new money." If approved by Congress, that would roughly triple U.S. outlays over projected levels. The current U.S. budget for AIDS treatment and prevention programs -- domestic and foreign -- is a bit more than $1 billion annually.
But the spending would not triple immediately. Under Bush's proposal, outlays would nearly double, to $2 billion, in fiscal 2004, "and ramp up thereafter," according to a White House fact sheet. The $10 billion in new money would include about $1 billion for the Global Fund, a Geneva-based organization that provides grants to governments and nongovernmental organizations in poor countries where AIDS, tuberculosis and malaria are rampant.
The amount earmarked for the Global Fund is considerably less than the fund's executive director, Richard Feachem, has been seeking in a recent fundraising tour of wealthy nations. Feachem has urged the United States to contribute $2.5 billion to $3 billion over the next two years. So far, Washington has committed $500 million over two years.
Activists voiced disappointment that Bush appeared to be giving short shrift to the Global Fund, which Paul Davis, director of U.S. government relations for Health GAP, an AIDS activist group, called "the single most effective tool we have in this effort." But even Davis -- who noted he had recently been arrested outside the White House in an AIDS protest -- said, "Tonight, we applaud the president for acting to address the plague of AIDS in Africa, and we are particularly encouraged by his focus on getting treatment for 2 million people."
Paul Zeitz, executive director of the Global AIDS Alliance, also voiced enthusiasm, saying: "The president's announcement tonight is a tremendously encouraging sign that he is taking this issue seriously, not just on a rhetorical level, but in terms of the budget. We are especially delighted he so clearly recognized the urgent need for cost-effective AIDS treatment."
The Washington Post
Bush's plan calls for $1 billion for GFATM in new money over 5 years, or on average $200 million per year. This information is in the White House Fact Sheet, which is reproduced below.
THE WHITE HOUSE
"FACT" SHEET ......... [without responsibility for truthfulness]
"It includes $10 billion in new funds, of which $1 billion is for the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. Funding will begin with $2 billion in FY 04 and ramp up thereafter."
Combating the International HIV/AIDS Pandemic
President Bush announced the Emergency Plan for AIDS Relief, a five-year, $15 billion initiative to turn the tide in the global effort to combat the HIV/AIDS pandemic. The HIV/AIDS pandemic has killed at least 20 million of the more than 60 million people it has infected thus far, leaving 14 million orphans worldwide.
Today, on the continent of Africa, nearly 30 million people have the AIDS virus including three million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than four million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims are receiving the medicine they need.
The Presidents Emergency Plan for AIDS Relief will help the most afflicted countries in Africa and the Caribbean wage and win the war against HIV/AIDS, extending and saving lives. The following countries will be the focus of the initiative: Botswana, Cote dIvoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia.
In each of these countries, the United States will work with private groups and willing governments to put in place a comprehensive system for diagnosing, preventing and treating AIDS. Central hospitals will have laboratories, specialized doctors, and nurses to anchor the system. Satellite clinics will provide antiretroviral drugs and education on the prevention of AIDS. By truck and motorcycle, nurses and local healers will reach the farthest villages and farms to test for the disease and to deliver life-saving drugs
is intended to:
* Prevent 7 million new infections (60 percent of the projected 12 million new infections in the target countries);
* Provide antiretroviral drugs for 2 million HIV-infected people; and
* Care for 10 million HIV-infected individuals and AIDS orphans.
The $15 billion virtually triples the current U.S. commitment to fighting AIDS internationally. It includes $10 billion in new funds, of which $1 billion is for the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. Funding will begin with $2 billion in FY 04 and ramp up thereafter.
Activist responses [continuing]
The President himself made such a point of front-loading tax breaks in his speech, saying that tax breaks now means more small businesses and more jobs and a better economy. By the same token, I guess, front-loading AIDS funds now means more drug purchases (better for economy), more healthy workers, more small businesses, more jobs, better global economy. Under the President's own logic, it makes sense to front load the payments to get more drugs to more people for a better global economy.
Two notes below also sound very smart:
One way we might respond to President
Bush's announcement is to strategically misinterpret it: we could
say something like
From another person:
Please all...look closely at the PR victory, and the real nightmare of the specifics:
1: Bush said that the cost of
a year of ARV has dropped from 1200/yr (the UNAIDS accelerated
access type of negotiated prices for least developed countries)
to less than $300 dollars/yr....the only way to have that cost
for drugs is to have haart with GENERICS!!! I think we should
send out a broadside....BUSH endorses use of low cost generic
ARV to fight AIDS in Africa. The 300/yr is not doable otherwise....seems
to me he is (?inadvertently) endorsing generics, but in any case....let's
Okay. The White House AIDS Initiative push bore some fruit, and we have a lot to celebrate. For real: congrats, folks. The programmatic claims made in the speech were tremendous and wonderful.
However, before we fall all over ourselves to cheer for the president, lets take a look at the numbers:
A) we need to dissect the WH speech & fact sheet, which claims $2 billion total for FY 2004. We should remember that the Admin claims $1.3 billion is _already_ being spent on global AIDS (& who knows what the heck they are counting from the still unresolved 2003 bills, but we dispute at least $400 million of that figure under the latest funding charts as being _for_ global AIDS). At any rate, it we have only $700 million (roughly) new for 2004. This is an awfully lot less than the projected need of $3 billion or more.
B) the neglect and continued starvation of the GFATM is absurd and horrible. However, if there will someday be more AIDS money in the pipeline, there is more to move around in congress to where it is actually needed and can be efficiently used. USAID CDC have no capacity or desire to implement the programs called for by President Bush.
C) the funding levels are fraudulent.
We mustn't be fooled.
Under this spread, or under any five year average, this is _less_ by 2008/(7?) than the community's FY _2003_ request of $2.5 billion! This is desprately less than the US fair share of projected global need.
More precise analysis is difficult right now without knowledge of the schedule of scale up.
Messaging & the ask: After
last night's speech, perhaps our media / advocacy push should
By accumulating numbers over arbitrary lengths of time and backloading until the distant future, the Admin makes a little look like a lot. Lets remember that the UNAIDS numbers are _annual_ numbers, and the USG will have fallen behind by more than it is contributing in five years.
For Immediate Release ____ For More Information, Contact:
January 29, 2003 ____ ____ Robert Weissman, 202-387-8030
STATEMENT BY ROBERT WEISSMAN, ESSENTIAL ACTION
ON THE PRESIDENT'S GLOBAL AIDS ANNOUNCEMENT AND GENERIC DRUGS
While the Bush administration has now, finally, jumped at the opportunity created by lower prices to commit the United States to treating people with HIV and saving lives, it is, at the same time, working to adopt global trade rules which will prevent such price reductions in the future.
The only reason triple-drug therapy costs below $300 a year is because of generic competition. Indeed, the low prices cited last night by President Bush are the generic, not brand-name prices.
The United States is, right now, aggressively pushing for global trade rules that will undermine the ability of countries to enjoy the benefits of generic competition.
At the World Trade Organization, the Bush administration is reneging on commitments made in Doha to support interpretations of the WTO intellectual property agreement (known as TRIPS) that are "supportive of WTO members' right to protect public health and, in particular, to promote access to medicines for all." Right now, the administration is aggressively pushing proposals that will undermine small market countries' effective ability to rely on generic competition to lower the price of patented medicines -- even as larger market countries will retain this effective right.
In bilateral and regional trade negotiations now underway or recently completed -- including the Free Trade Area of the Americas, a trade agreement with Central America, a trade agreement with Southern Africa and bilateral agreements with Jordan, Singapore, Chile and Morocco -- the administration is pushing for intellectual property rules that will substantially impair countries' ability to do compulsory licensing and introduce generic competition for on-patent medicines.
There is much to applaud in President Bush's announcement on AIDS yesterday, and much more to be learned.
But one thing is clear: There is a complete contradiction between the President's reliance on the benefits of generic competition and his administration's efforts on behalf of Big Pharma to thwart generic competition in the future.
It is time, now, for the administration to stop supporting policies that undermine access to essential medicines.
NEWS UPDATES . March / April 2003
March 28, 2003
The New York Times Editorial
AIDS Funding and Politics
Throughout the Bush administration, programs to protect the health of women and young people have been sacrificed to the far right's agenda. Effective safe-sex programs in America and abroad and financing for family planning and condom distribution have been cut to placate religious conservatives. But never has the far right's agenda been as potentially disruptive as it is now on the crucial issue of fighting AIDS overseas.
At first, abortion politics imperiled Mr. Bush's major initiative to fight global AIDS, which he promised in his State of the Union address. Opponents of abortion wanted to prohibit AIDS initiative money from going to groups that counsel or perform abortions. To its credit, the White House understood that this could cripple anti-AIDS programs, especially in places like rural Africa, where the only care available may be a single clinic. Instead, the White House is saying that groups simply cannot use AIDS money to perform or counsel abortion.
To placate the religious conservatives, however, the groups that provide family planning services to refugee women and refuse to stop providing abortion services or counseling have had their financing suspended.
Now a main obstacle for the AIDS bill in Congress is, bizarrely enough, condom promotion. Millions of deaths into the AIDS epidemic, why is anyone still arguing about this? The religious right is concerned that the AIDS initiative is becoming, as the Family Research Council said, "an airlift for condoms."
Both the Senate and House versions of the bill do promote abstinence, but in the view of some in Congress and the White House, not enough. The Senate Foreign Relations Committee is stalled while senators slug it out.
In this ideologically charged atmosphere, an unlikely hero has emerged: Representative Henry Hyde, Republican of Illinois. Mr. Hyde, a fierce abortion opponent, understands that the priority is preventing AIDS deaths. As chairman of the House International Relations Committee, he has wrangled bipartisan support in the House for a very good AIDS bill, $3 billion for the first year - more than Mr. Bush proposed - with no abortion distractions. But Mr. Hyde's bill may not prevail because for others, promoting a doctrine comes before saving millions of people from AIDS. How pro-life is that?
Global AIDS Bill Hits Snag in
By JIM ABRAMS The Associated Press
WASHINGTON (AP) - In trying to agree on how to spend the billions of dollars President Bush promised for a global fight against AIDS, Congress can't get past the basic questions like whether it's more important to advise people to abstain from sex or to give them condoms.
The House International Relations Committee, set to vote Wednesday on a five-year, $15 billion AIDS package that should win support from both parties, is at odds with the White House on where the money should go. The Senate was still searching for a consensus approach, and AIDS funding advocates were not optimistic for success.
In his State of the Union address to Congress in January, Bush asked for $15 billion over five years, including $10 billion in new money, to fight AIDS, particularly the epidemic in Africa. ``Seldom has history offered a greater opportunity to do so much for so many,'' he said.
White House differences with Congress, however, have resulted in postponed votes in both the House International Relations Committee and its Senate counterpart in recent weeks.
The House, led by committee chairman Henry Hyde, R-Ill. Is seeking $3 billion a year and would funnel up to $1 billion of that in the 2004 budget year to the Swiss-based, Global Fund to Combat AIDS, Tuberculosis and Malaria, administered by the United Nations.
The White House has questioned the efficiency of the fund, even though it recently picked Health and Human Services Secretary Tommy Thompson as its chairman, and wants to give it only $200 million a year. The Global Fund gives money to the U.N. Population Fund, mistrusted by conservative groups because it supports groups that carry out or advise women about abortion.
Hyde, a leader of anti-abortion lawmakers, has avoided that controversy so far by not including language, appearing in other foreign aid bills, that restricts aid to health and family planning groups that promote abortion.
Conservative groups are not happy with that and also are intent on changing language in the bill dealing with condoms.
The bill endorses the ``ABC'' approach that has had some success in Uganda, which stresses abstinence, being faithful and, when appropriate, condoms. But Connie Mackey of the Family Research Council said it doesn't go far enough toward making abstinence a priority over condom distribution.
The Uganda experience, Mackey said, is proof of what works. ``We're hoping the bill will better reflect that,'' she said.
Negotiators reportedly are considering language to make sure religious organizations that promote abstinence and oppose condom distribution will be eligible for AIDS funding.
The House bill also ensures closer monitoring of the Global Fund and recommends that 55 percent of the money go to treatment, 15 percent to hospice care and 20 percent to prevention, with the rest for other purposes.
In the Senate, Foreign Relations Committee Chairman Dick Lugar, R-Ind., also has tried to find a consensus that would satisfy the White House, the conservatives and the Democrats. ``It's going to take a little longer,'' Lugar's spokesman, Andy Fisher, said.
``The worst possible outcome is to see it descend into partisan rancor,'' said Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation. ``It's a matter of such urgency that it is crucial the parties come together.''
``The idea of a bipartisan bill seems to be losing ground on the Senate side,'' warned Paul Zeitz, executive director of the Global AIDS Alliance. The war in Iraq has distracted attention, he said, and the window of opportunity for moving the bill through Congress may be closing.
Even without a bill, Congress can still respond to the president's request for more global AIDS money later in the year when it passes spending bills for the coming budget year. That path, advocates said, would leave Congress without the blueprint it needs on the best way to deal with the epidemic.
On the Net: Global Aids Alliance: http://www.globalaidsalliance.org/
Elizabeth Glaser Pediatric AIDS Foundation: http://www.pedaids.org/
Family Research Council: http://www.frc.org/
"Conservatives also want to mandate that most of the money go toward treatment
and to limit the amount given to the Global Fund to Fight AIDS, Tuberculosis and Malaria,
because they say there is no way to control how the international group spends the money."
House panel weighs global AIDS
Amy Fagan, The Washington Times Published April 2, 2003
The House International Relations Committee today will consider a bill aimed at preventing and treating AIDS worldwide, but panel conservatives want changes, including a stronger emphasis on abstinence over condom use. They say the current bill - crafted by Rep. Henry J. Hyde, Illinois Republican and panel chairman - does not reflect President Bush's vision of what the program should look like. "It's unacceptable and I will vote against it," said Rep. Joe Pitts, Pennsylvania Republican. "As we address the global AIDS crisis, we don't want to offend the values we came here to promote," said Rep. Mike Pence, Indiana Republican. He added, however, that Mr. Hyde is sensitive to these concerns and "there has been progress made."
The AIDS initiative is a top priority for Mr. Bush, but Congress is having problems agreeing on the details. Both Mr. Hyde and Sen. Richard G. Lugar, Indiana Republican and chairman of the Foreign Relations Committee - have postponed votes on their bills in recent weeks, amid objections from the White House and congressional conservatives. An administration official, while not embracing every aspect of Mr. Hyde's bill, seemed more hopeful late yesterday. "We believe there is a bipartisan consensus emerging in helping to get this legislation moving in the House," the aide said. "We think it is moving in a direction that reflects what the president outlined and we hope the Senate gets moving as well."
Mr. Hyde's bill would provide $15 billion over five years - as the president's plan laid out - to fight HIV/AIDS, tuberculosis and malaria in Africa and the Caribbean. It supports efforts to treat and care for people living with AIDS, to find vaccines for AIDS and malaria, and to care especially for children and young people with HIV, the virus that causes AIDS. "I'm afraid if we start getting into all these fights, it'll derail the bill," said Rep. Howard L. Berman, California Democrat and panel member.
Conservatives say the Hyde bill, among other faults, does not closely follow Uganda's notably successful campaign to reduce HIV infections. Uganda emphasized the "ABC" approach - abstinence, being faithful, and condoms, in that order - and Mr. Bush wants the U.S. initiative to do the same. "The science is clear here: Promoting abstinence and being faithful effectively reduces HIV," said one House Republican aide, adding that under the Hyde bill, "the status quo - which has largely been the social marketing and distribution of condoms - will continue."
Mr. Pitts said Republicans may be able to work out the ABC priority issue, but noted there are other problems with the bill. He and others want the bill to take a strong stance to eradicate prostitution and to protect the rights of religious groups to opt out of such anti-AIDS strategies as condom distribution. Conservatives also want to mandate that most of the money go toward treatment and to limit the amount given to the Global Fund to Fight AIDS, Tuberculosis and Malaria, because they say there is no way to control how the international group spends the money.
House conservatives worked with Mr. Hyde recently to craft a package of amendments that addressed many of their concerns. But Republican aides say Mr. Hyde will offer a different, Democrat-approved package of amendments. The details of the second package were not known and Mr. Hyde's office did not returns calls yesterday. Conservatives still plan to offer many amendments today. But aides conceded the efforts would likely fail because they will not have the support of the panel's more liberal Republicans - Reps. Jim Leach of Iowa and Amo Houghton of New York. "I suspect the only way we'll make improvements is if we do it on the House floor," one aide said. Meanwhile, Rep. Billy Tauzin, Louisiana Republican and chairman of the Energy and Commerce Committee, is crafting his own global HIV/AIDS bill, which some conservatives hope will be a better alternative. "We intend to work closely with the president so that any money approved for his AIDS initiative achieves meaningful results," said Ken Johnson, spokesman for Mr. Tauzin's committee.
The bill has since stalled, because
of White House insistence that it
contain a clause allowing organizations administering AIDS programs to
refrain from discussing condoms or to discourage their use altogether,
according to a House Democratic aide familiar with the negotiations.
The Bush Administration reportedly
also continues to object to the bill's
call for $1 billion in annual U.S. contributions to the Global Fund to Fight
HIV/AIDS, Malaria, and Tuberculosis. President Bush (news - web sites) also
wants to spend $15 billion on international AIDS programs over five years
but has proposed to spend just $200 million per year on the fund.
Lawmakers at Odds Over U.S. HIV Strategy
By Todd Zwillich
WASHINGTON (Reuters Health) - Senate Republicans questioned the U.S.'s overseas HIV prevention strategies Thursday, as lawmakers and the White House continued to struggle to agree on how to fund relief efforts for poor countries devastated by AIDS .
Several G.O.P. senators expressed skepticism that a strategy concentrating on prevention efforts such as sexual abstinence, marital fidelity, and condom use would be effective in stemming AIDS in African nations with high infection rates. The sexual behavior strategy has gained support among AIDS experts and many lawmakers who credit it with helping Uganda reduce its HIV infection rates after years of sharp increases. But a study published in February by an international team of researchers surprised AIDS experts by suggesting that unsanitary medical practices, including the use of contaminated needles, cause more HIV infections in African than does unprotected sex. The study's authors estimated that 28 percent of all HIV infections are caused by contaminated injections alone, roughly equal to the number caused by heterosexual transmission of the virus.
The World Health Organization (WHO) quickly attacked the study's methodology, saying that its authors "speculated" on infection trends using biased statistical methods and old data relying on primitive HIV testing from the mid-1980s. The organization maintains that unsafe medical practices cause only two to three percent of Africa's HIV infections. Sen. Jeff Sessions, R-Ala., expressed skepticism about the sexual behavior-based strategy, suggesting that medical organizations were ignoring the findings on unsafe health care. "The establishment basically still says, 'we can't be wrong,"' he said.
A Bush Administration health official stood by the WHO estimates, saying that reliable studies show that sexual behavior accounts for approximately 90 percent of infections on the continent. "We believe that the primary mode of HIV transmission continues to be sexual," said Claude Allen the deputy Secretary of Health and Human Services (HHS). Sen. Mike Enzi, R-Wyo., said that researchers may have to conduct further studies to look at the role of unsafe sex in the HIV epidemic in Africa. "If we need further research, the results of such studies should certainly be factored into our global prevention strategies," Enzi said at a hearing of the Senate Health, Education, Labor, and Pensions Committee.
The hearing comes as House and Senate lawmakers struggle to reach agreement with the White House over a bill outlining the structure of U.S. AIDS prevention and treatment strategies for the next five years. Republicans and Democrats in the House announced two weeks ago that they had reached agreement on a five-year, $15 billion bill authorizing HIV programs overseas. The bill has since stalled, because of White House insistence that it contain a clause allowing organizations administering AIDS programs to refrain from discussing condoms or to discourage their use altogether, according to a House Democratic aide familiar with the negotiations.
The Bush Administration reportedly
also continues to object to the bill's call for $1 billion in
annual U.S. contributions to the Global Fund to Fight HIV/AIDS,
Malaria, and Tuberculosis. President Bush (news - web sites) also
wants to spend $15 billion on international AIDS programs over
five years but has proposed to spend just $200 million per year
on the fund. The Global Fund "is still a major issue"
preventing the bill from moving forward, the House aide said.
The debate has also helped stall negotiations over a bipartisan
AIDS relief bill in the Senate. "They will just not go for
more than $200 million in the Global Fund," Sen. Joseph Biden,
D-Del., the ranking member on the Senate Foreign Relations Committee,
said in an interview. Biden said that committee talks over the
bill had broken down and that Democrats had decided to "let
the White House send over their own proposal." The Global
Fund became an issue in the final hours of debate over the fiscal
2004 budget Wednesday, when Sen. John F. Kerry, D-Mass., offered
an amendment allowing for approximately $725 million to be spent
on the Fund
next year. Fifty-one senators voted to defeat the measure, including Majority Leader Bill Frist, R-Tenn., who helped author a similar Senate package last year.
to be continued
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