House Approves PEPFAR Reauthorization Bill
The House on Wednesday voted 308 to 116 to approve a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief, the Washington Post reports (Brown, Washington Post, 4/3). The measure, which was approved in February by the House Foreign Affairs Committee, would allocate $50 billion for PEPFAR over the next five years. President Bush had called on Congress to authorize a $30 billion, five-year extension of PEPFAR (Kaiser Daily HIV/AIDS Report, 4/2). The House on Wednesday rejected an amendment to the bill that would have reduced funding to the $30 billion Bush initially requested (Graham-Silverman, CQ Today, 4/2).
The bill also would remove a requirement that at least one-third of HIV prevention funds that focus countries receive through PEPFAR be used for abstinence-until-marriage programs. It would require "balanced funding" for abstinence, fidelity and condom programs based on evidence in each PEPFAR focus country. In addition, the bill would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work. The bill would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill also would require reports to Congress if abstinence and fidelity programs compose less than half of country-level spending on programs aimed at preventing sexual transmission of the virus.
Of the $50 billion allocated in the bill, $9 billion would be allocated to fight tuberculosis and malaria, which often affect HIV-positive people in Africa. That amount also would underwrite food supplements for people living with HIV/AIDS. The bill would provide loans to women widowed by the disease or ostracized because of their HIV-positive status. The measure also would add Lesotho, Malawi and Swaziland as PEPFAR focus countries; include clean water programs; encourage countries to work with historically black colleges to improve their health infrastructures; and expand inspector general authority (Kaiser Daily HIV/AIDS Report, 4/2). In addition, the bill would add 14 Caribbean countries to the program (Dunham, Reuters, 4/2). The bill strengthens a "conscience clause" that would allow groups to not endorse prevention methods that they find religiously or morally objectionable (CQ Today, 4/2).
Of the $41 billion specifically allocated for HIV/AIDS under the measure, up to $2 billion would be included annually for the Global Fund To Fight AIDS, Tuberculosis and Malaria, the AP/International Herald Tribune reports. The bill limits U.S. contributions to the Global Fund to one-third of total contributions, according to the AP/Herald Tribune (AP/International Herald Tribune, 4/3).
The measure aims to shift PEPFAR from an emergency response program toward a long-term, sustainable plan, CQ Today reports. It would provide training for 140,000 new health care workers, target vulnerable groups such as women and girls, and add nutrition and other secondary services to PEPFAR. It aims to double the number of people receiving antiretroviral drugs to three million, prevent 12 million new HIV cases and provide care for 12 million people (CQ Today, 4/2).
After the House approval on Wednesday, the White House issued a statement that "strongly" supported the bill's passage, the Los Angeles Times reports. The Congressional Budget Office last month estimated that the government would only spend $1.5 billion of the $10 billion appropriated for 2009 under the bill because it would "take some time to expand existing programs and develop new procedures and activities" (Hohmann, Los Angeles Times, 4/3).
"It's a very big bill and an expensive one, but it does a lot of important things," Rep. Howard Berman (D-Calif.), chair of the House Foreign Affairs Committee, said, adding that he is "pretty happy we maintained the essence of the bipartisan coalition on final passage" (Washington Post, 4/3). Rep. Ileana Ros-Lehtinen (R-Fla.), the ranking member of the Foreign Affairs Committee, said, "The program that we are authorizing today is now recognized as perhaps the most successful foreign assistance program for the United States of America since the Marshall Plan."
Rep. Dana Rohrabacher (R-Calif.) said that the bill is "totally irrational generosity," adding, "We have people who can't take care of their own health needs and are at risk of losing their homes, and we are going to spend $50 billion in Africa?" (CQ Today, 4/2). Michael Weinstein, president of the AIDS Healthcare Foundation said that AHF considers the "bill a massive retreat on AIDS treatment in the world" (Los Angeles Times, 4/3).
The Senate version of the bill passed the Foreign Relations Committee last month and is awaiting floor consideration (Washington Post, 4/3).