Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008

TOM LANTOS AND HENRY J. HYDE UNITED STATES GLOBAL LEADERSHIP AGAINST HIV/AIDS, TUBERCUBERCULOSIS, AND MALARIA REAUTHORIZATION ACT OF 2008 -- (House of Representatives - April 02, 2008)

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Mr. SMITH of New Jersey. Madam Chairman, I rise in strong support of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, an admittedly long, but appropriate title for a bill that is long on substance, meaningful intervention, tangible compassion, and relief.

Aptly named for two of the giants of this institution who helped shepherd President George W. Bush's PEPFAR initiative through the Congress in 2003, H.R. 5501 will literally mean the difference between life and death to millions, especially in sub-Saharan Africa.

The bill before us today is consensus legislation, a delicate balance that if kept intact, and only if kept intact, will be signed into law. So I want to thank Chairman Berman and Ranking Member Ros-Lehtinen and other Members and staff for helping to forge today's PEPFAR consensus. I want to especially thank Sheri Rickert, Mary Noonan, Autumn Fredericks, Yleem Poblete, Peter Yeo, Pearl Alice Marsh, Dr. Bob King, Kristin Wells, and David Abramowitz for their extraordinary work in drafting this legislation.

Madam Chairman, as Members know, close to 70 percent of the estimated 33 million people with HIV live in sub-Saharan Africa. Of the 2.5 million children afflicted with this dreaded disease, 90 percent live in Africa as well.

When combined with opportunistic infections like tuberculosis--the number one killer of individuals with HIV--and malaria alone kills one million each year, again mostly in Africa--the HIV/AIDS pandemic compares among humanity's worst. Former Chairman Hyde frequently compared the sickness to the bubonic plague--the black death--an epidemic that claimed the lives of over 25 million people in Europe during the mid-1300s.

I know some Members are likely to wince at the cost of the bill--$50 billion over 5 years for PEPFAR, the Global Fund, Tuberculosis, and Malaria--but that sum of money will be used to prevent 12 million new HIV infections worldwide, and support treatment for 3 million people, including an estimated 450,000 children. That sum of money will provide care to 12 million individuals with HIV/AIDS, including 5 million orphans and vulnerable children, and will help train and deploy at least 140,000 new health care professionals and workers for HIV/AIDS prevention, treatment and care.

On the prevention side, the legislation requires that the Global AIDS Coordinator provide balanced funding for sexual transmission prevention including abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction. If less than 50 percent of the sexual transmission prevention moneys are spent on the Abstinence and the Be Faithful parts of the ABC model, the coordinator must provide a written justification. I note that currently, the coordinator exercises waiver authority in this regard without notifying Congress so this language ensures greater transparency and accountability.

Five years, Madam Chairman, after PEPFAR first began, the efficacy and importance of promoting abstinence and be faithful initiatives have been demonstrated beyond any reasonable doubt, and the evidence is compelling.

According to joint comments by the U.S. Department of State, USAID, and HHS on PEPFAR, ``Congressional directives have helped focus U.S. Government prevention strategies to be evidence based. Because of the data, ABC is now recognized as the most effective strategy to prevent HIV in generalized epidemics.

The original legislation's emphasis on AB activities has been an important factor in the fundamental and needed shift in U.S. government prevention strategies from a primarily ``C'' approach prior to PEPFAR to a balanced ABC strategy. The Emergency Plan developed a more holistic and equitable strategy, one that reflects the growing body of data that validates ABC behavioral change.

The U.S. government report goes on to say that recent data from Zimbabwe and Kenya mirrors the earlier successes of Uganda's ABC approach to preventing HIV. These three countries, with what is known as ``generalized epidemics,'' have demonstrated reductions in HIV prevalence. And in each country, the data point to significant AB, abstinence, be faithful; behavioral change; and modest, but important, changes to C.

So, I want to thank Mr. Pitts for writing the original AB earmark into the original law because it has instructed and has had a tremendously positive impact.

I would note to my colleagues that this past September the Foreign Affairs Committee heard from a world renowned expert, Dr. Norman Hearst, who said that 5 years ago he had been commissioned by U.N. AIDS to conduct a technical review of how well condoms had worked for AIDS prevention in the developing world. And he said, and I quote in part, ``my associates and I collected mountains of data, and here is what we found: When we looked for evidence of public health impact for condoms in generalized epidemics, to our surprise we couldn't find anything. No generalized HIV epidemic has ever been rolled back by a prevention strategy primarily based on condoms. Instead, a few successes in turning around generalized epidemics, such as Uganda, were achieved not through condoms, but by getting people to change their sexual behavior.''

He goes on to say that these are not just our conclusions. A recent consensus statement in the Lancet was endorsed by 150 AIDS experts, including Nobel Laureates, the President of Uganda, and officials of the most prominent international AIDS organizations. And it said, ``the priority for adults should be, B, limiting one's partners. The priority for young people should be A, not starting sexual activity too soon.'' And this contrasted with other funders that often officially endorse ABC, but in practice continue to put their money in the same old strategies that have been unsuccessful in Africa for the past 15 years.

A Washington Post article by Craig Timberg noted that ``men and women in Botswana continued to contract HIV faster than almost anyone else on Earth. Researchers increasingly attribute the resilience of HIV in Botswana, and in southern Africa generally, to the high incidence of multiple sexual relationships.''

``Researchers increasingly agree,'' and please, I ask my colleagues to take note of this, ``that curbing behavior is key to slowing the spread of AIDS in Africa.'' In a July report, southern African AIDS experts said that reducing multiple and concurrent partnerships was their first priority for stopping the spread.

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