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WASHINGTON, Jun 18 2008 (IPS) - AIDS and global health activists are calling on the U.S. Senate leadership to urgently approve a record five-year, 50-billion-dollar bill to fight AIDS, malaria, and tuberculosis primarily in Africa so that President George W. Bush can take it with him when he meets with other western leaders at next month's Group of Eight (G8) summit in Japan.
The activists believe that Congressional approval of the package will give Bush greater leverage in persuading his counterparts from Europe and Japan to commit substantially more of their own money to the same cause.
The bill, an extension of Bush's own five-year, 15-billion-dollar President's Emergency Plan for AIDS Relief (PEPFAR), enjoys strong bipartisan support. But it is opposed in its present form by a handful of right-wing Republican lawmakers who have placed a hold on the legislation and hinted that they are prepared to tie up the Senate with procedural manoeuvres if the leadership sends it to the floor.
The group's leader, Oklahoma Sen. Tom Coburn, has demanded that the bill require that at least 55 percent of the money be spent on the treatment of AIDS victims, a demand that proponents of the bill insist would deny local authorities the flexibility they need to decide what strategies, including prevention, would be most effective to fight spread of the disease.
But the same group of senators has also said they object to the total amount of the bill, the fact that 10 billion dollars of the total would be routed through the multilateral Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria over which Washington exercises less control, and that its provisions would support or permit "morally questionable activities", such as needle distribution to drug users.
The bill represents "the height of irresponsibility in the middle of a war and surging debts," according to Sen. Jim DeMint, one of seven signatories of a letter sent in April to Senate Republican Leader Mitch McConnell objecting to the bill.
"Negotiations are underway now," according to Paul Zeitz, who directs the Global AIDS Alliance (GAA), a strong supporter of the bill, who added that McCain could play a key role in breaking the impasse. "It's in the interests of the United States and the Democratic Congress that Bush go to the G8 with this legislation in hand."
PEPFAR, which Bush announced on the eve of the U.S. invasion of Iraq in March 2003, has been widely recognised as perhaps the most successful and least controversial foreign policy initiative of his presidency, both because of the bipartisan support that it has enjoyed and because of the unprecedented magnitude of funding it has provided to the fight against infectious diseases that continue to kill millions of people each year, particularly in Africa. The programme has mainly targeted sub-Saharan countries, but substantial funding has also gone to several Caribbean nations and Vietnam.
Among other achievements, the programme is estimated to have provided treatment for approximately two million people, prevented some seven million new infections, and provided care to another 10 million people, including several million AIDS orphans. PEPFAR, along with the President's Malaria Initiative (PMI), a project designed to cut malaria deaths in 15 African countries by 50 percent through 2011, has also provided millions of bed nets and related supplies to the continent.
In his State of the Union Address in January, Bush asked Congress to authorise 30 billion dollars to expand PEPFAR over the next five years, but the House of Representatives voted 306 to 116 to increase the total to 50 billion dollars in April. The Senate Foreign Relations Committee approved the House version in an 18-3 vote the following month.
As drafted, the bill amounts to a compromise between Democrats, who generally championed the big boost in funding, and anti-abortion Republicans, who insisted on adding certain restrictions on how the money could be spent.
Under the bill, for example, none of the funding can be provided to family planning clinics or groups that perform abortions or even lobbied for relaxing anti-abortion laws in their home countries or that decline to explicitly denounce "prostitution and human trafficking".
The bill also requires that the programme's administrators ensure that abstinence and fidelity strategies to prevent the spread of the disease – strategies that many public health experts believe are generally not as effective as condom distribution – "are implemented and funded in a meaningful and equitable way."
The bill would provide a total of nearly 31 billion dollars for bilateral programmes aimed at treating three million AIDS victims, preventing 12 million HIV new infections, and caring for another 12 million victims, including five million orphans.
In addition, it would provide 10 billion dollars – or two billion dollars a year – to the cash-strapped Global Fund, which works in many more countries than those covered by PEPFAR and with fewer restrictions on how its funding can be spent.
Four billion dollars would be spent on fighting tuberculosis, the leading cause of death among people who are infected with HIV, and five billion dollars more would be earmarked for malaria. The remainder would be roughly split between AIDS research and developing capacity for indigenous health systems and personnel in target countries.
The Senate's arcane rules make it possible for a small minority to tie up the chamber's work through filibusters and amendments. Because its calendar until the Jul. 4 recess is already quite full, both the Democratic and Republican leadership are reportedly worried that placing the AIDS bill on the agenda without reaching an agreement with the dissenters could result in stalling other major legislation. If, however, the legislation does not pass by the recess, there will be no other opportunity to vote on it before the G8 Summit.
As a result, pressure is mounting on both the Senate leadership and on Coburn to strike an acceptable compromise, according to the activists. Fourteen Republican senators have called on McConnell to move the legislation, while Democrats are pressing Majority Leader Harry Reid to do the same. On Wednesday, visiting Kenyan Prime Minister Raila Odinga and South African Archbishop Desmond Tutu both called for the bill's passage.
"Passing this bill will be a signal to the (G8) countries that the U.S. is fully committed and that they should also move forward boldly with their own commitments," said Joanne Carter, associate executive director of RESULTS, a development group here.
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