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HEALTH-US: Rare Consensus Behind 50-Billion-Dollar AIDS Plan

Jim Lobe

WASHINGTON, Feb 28 2008 (IPS) - In an increasingly unusual display of bipartisanship, both the White House and the Republican and Democratic leadership of the House of Representatives have agreed on a bill that, if passed, would provide 50 billion dollars to fight AIDS, malaria and tuberculosis over the next five years.

The bill, which would extend and expand the U.S. Global Leadership Act against AIDS, Tuberculosis and Malaria of 2003, will provide 20 billion dollars more than what President George W. Bush had requested in his State of the Union address last month and also eases curbs that Bush and his fellow Republicans placed on the 15 billion dollars the President’s Emergency Plan for AIDS Relief (PEPFAR) has spent over the last five years.

Included in the proposed package, which was passed by the House Foreign Affairs Committee Wednesday and will likely be approved by the full House by mid-March, are five billion dollars for fighting malaria and another four billion dollars to address TB.

While almost all of the funding would be for bilateral programmes, a total of four billion dollars would also be earmarked for the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria, which is based in Geneva.

Despite the significant increase in the funding above Bush’s request, the president, who just returned from a week-long trip to Africa during which he touted PEPFAR’s impact there, urged strong support for the package during a White House press conference Thursday.

“(D)uring my trip, (I) urged Congress to reauthorise the Emergency Plan and increase our commitment, and they did. They approved a good, bipartisan bill that maintains the principles that have made this programme effective,” he told reporters, adding that he would meet lawmakers who negotiated the bill at the White House later Thursday to thank them.

“Obviously, our hope is now that the House will act quickly and send the bill reauthorising PEPFAR to the Senate, and I’d like to sign it into law as quickly as possible.” he said.

AIDS and global health activists praised the package as a major step forward, although some complained that the Democratic leadership gave in too easily to Republican demands for restrictions on PEPFAR funding – largely at the behest of the anti-abortion forces in the Christian Right – which critics say will continue to undermine the effectiveness of U.S. AIDS programmes.

“This historic agreement will save millions of lives, if approved by the full Congress and then fully funded,” said Paul Zeitz, executive director of the Global AIDS Alliance (GAA). “Much to our dismay, however, this agreement does not allow the use of U.S. AIDS funding for family planning,” he added, noting an earlier draft of the package that would have permitted money to be used for “reproductive health” was dropped during the final negotiations.

Under PEPFAR, no funding could be provided to family-planning clinics or groups that performed abortions or even lobbied for relaxing anti-abortion laws in their home countries. Under the new package, the ban will remain in effect, although some funding could be provided to family-planning groups, but strictly for the purpose of AIDS testing, counseling or treatment, according to Capitol Hill aides.

In addition, the package retains a ban on aid to any organisation that declines to refuse to adopt an explicit policy against “prostitution and human trafficking”. Such a requirement – another demand by the Christian Right – often hobbles the ability of organisations to work with women engaged in commercial sex who are often most at risk of becoming infected with the HIV virus.

“As a population that is highly vulnerable to HIV infection and transmission, enlisting the support of female and male sex workers is central to combating the global AIDS pandemic,” according to Serra Sippel, executive director of the Centre for Health and Gender Equity here. “Requiring organisations to oppose sex work severely undermines their capacity for providing sex workers with effective prevention interventions.”

PEPFAR, which was announced by Bush on the eve of Washington’s invasion of Iraq five years ago, has been one of his administration’s most popular foreign policy initiatives. Indeed, it is about the only one that has long enjoyed strong bipartisan support.

And while the 15 billion dollars committed to the programme from 2004 through 2008 amounts only to slightly more than what the Pentagon currently spends in Iraq and Afghanistan each month, that an unprecedented jump in Washington’s aid commitment to global health initiatives in general and to sub-Saharan Africa, in particular. More than nine in 10 dollars under the programme is spent in that region, with the balance going to programmes in the Caribbean and Vietnam.

Among other work, PEPFAR funding is currently providing anti-retroviral treatment for over 1.3 million people living with HIV/AIDS in sub-Saharan Africa alone, up from 50,000 in 2003, according to the White House. The programme has also helped provide care for more than 2.7 million AIDS orphans and children infected with HIV.

While AIDS activists have applauded PEPFAR for the amount of money it has invested, the programme has also been criticised for being unduly restrictive.

In addition to the ban on aid for organisations that use or promote abortion or that refused to denounce prostitution, PEPFAR has also required that one-third of all funds allocated for AIDS prevention be spent on projects designed to promote sexual abstinence and fidelity in marriage. Most experts believe that such strategies have little or no effect on the spread of the disease and may even prove counter-productive.

A 2006 study by the General Accounting Office (GAO), for example, found that spending more on abstinence and fidelity programmes resulted in cuts to projects designed to prevent the disease from passing from mother to child.

In addition to greatly increasing the financial commitment to fighting AIDS, the proposed package makes these requirements more flexible. It requires PEPFAR’s administrators to provide “balanced funding” for prevention and to ensure that abstinence and fidelity strategies “are implemented and funded in a meaningful and equitable way”.

That vagueness was well received by AIDS activists. “Promotion of abstinence and fidelity has its place, but I have seen how the funding requirement has harmed AIDS programmes,” said Beatrece Were, GAA’s Africa Programme director. “So, as a women’s rights activist, I see this change as a major step forward, and I must congratulate all who made it possible.”

The bill also provides that the government establish a single person to coordinate all of Washington’s anti-malaria efforts and endorses Washington’s adoption of the World Health Organisation’s (WHO) two-year-old “Stop TB” strategy.

Still, others argued that of the 50 billion dollars, only 37 billion dollars would be devoted to AIDS-specific programmes and that more is required to address immediate needs.

“As written, the bill proposes to ensure that only three million people are treated, which is one million less than the number who would be treated by the U.S. commitment to provide AIDS treatment to one-third of those in critical need,” said Kaytee Riek from Health Global Access Project (HealthGAP).