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

Floor Speech

TOM LANTOS AND HENRY J. HYDE UNITED STATES GLOBAL LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA REAUTHORIZATION ACT OF 2008 -- (Senate - July 15, 2008)

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DARFUR

Mr. DURBIN. Mr. President, most of us are aware of the genocide in Darfur. We have read about it for years. The best estimates are that 400,000 people have died as a result of the terrible tragedy in the Sudan. Another 2 million or more have been displaced.

Just this week, the International Criminal Court has named the President of Sudan as a person to be indicted for war crimes, crimes against humanity, and genocide. It is an indication of the severity of this crisis and the fact that the world is taking note.

What we also know is that other things are happening in this world that are just as devastating, and some of them are within our grasp to change.

A few years ago, I made my first trip to Africa in an effort to see the feeding programs available for people in some of the poorest places on Earth. I also wanted to take a look at the microcredit programs that elevate women and give them a chance to finally raise their families properly and to have a future.

But I found that no matter where I went in Africa, the same issue commanded my attention. That was the global AIDS crisis. It was a crisis which was just starting at that point, but the numbers were so alarming that you could see trends developing that would be devastating to communities and families and even countries.

At the time, it seemed there was nothing we could do. The drugs that were being developed in the United States were few and very expensive, and the notion of bringing those antiretroviral drugs into Africa seemed beyond our grasp. So they encouraged people in Africa, in those days, to get tested. But many of them ignored it because they knew if they were tested positive it was a simple death sentence, and they would have to resign themselves to the obvious fate.

But things have changed, thank goodness, and they have changed for the better. Under President Bush, he described and started an initiative to deal with the global AIDS crisis. As I have said on the floor many times, I have disagreed with the President on so many things, but I certainly believe this was an inspired position which he took, that the United States would lead the world in dealing with the global AIDS crisis.

We were not only going to address HIV and AIDS, but also tuberculosis and malaria. In many countries, more people are dying from the latter two than even HIV/AIDS. The President chose 15 countries that the United States would deal with directly in the President's program. Then for the rest of the world in need, we would work with other countries in what is known as the Global Fund.

Before us today on the floor of the Senate is the President's program for dealing with global AIDS. I think it is one of the most important votes we are going to cast this year. The success of this program has brought us a long way in the last 5 or 6 years.

Mr. President, 5 or 6 years ago, only 50,000 people in Sub-Saharan Africa were receiving treatment--50,000. Today, PEPFAR and the Global Fund reach nearly 2 million people, primarily in Africa.

In the 15 PEPFAR focus countries, the program has helped prevent mother-to-child HIV transmission during nearly 12.7 million pregnancies. An HIV-positive mother nursing a child, if she is not treated properly, could transmit the disease. The treatment is very inexpensive, and a mother taking this drug before she delivers the baby can protect her child through childbirth and perhaps afterwards. We have done that now for 12.7 million pregnancies.

We have provided antiretroviral prophylaxis for well over 800,000 women who were determined to be HIV positive and prevented over 150,000 new infections of newborn children just through this program.

We have cared for more than 6.6 million people, including more than 2.7 million orphans and children.

We have provided over 33 million HIV counseling and testing sessions for men, women, and children.

From fiscal year 2004 through 2007, PEPFAR, the President's program on AIDS, supported nearly 2.6 million training and continuing education encounters for health care workers.

That is a remarkable record of progress in just 5 years. This situation on the ground in Africa has been literally transformed because of the efforts of the United States--and other countries--but the efforts of the United States through PEPFAR and the Global Fund.

The bill before us authorizes $50 billion over 5 years, including $9 billion for tuberculosis and malaria. It is a large sum of money, but put it in context. Each month, we spend $12 to $15 billion on the war in Iraq. We are talking about spending $10 billion over the course of a year to deal with the global AIDS crisis, tuberculosis, and malaria.

The bill requires the President to develop a strategy for spending that will prevent 12 million new infections, that will treat and care for at least 14 million people, including 5 million children, make sure women have universal access to prevention of mother-to-child transmission, and will build the health care capacity of the countries that are most affected.

I went to the Congo--the Democratic Republic of the Congo--with Senator Brownback of Kansas a few years ago, and we visited the city of Goma. Goma is in the northeastern section of the Democratic Republic of the Congo. It is a very poor city, and it has so many--so many--challenges: hunger, disease, war, and, on top of that, a volcano.

We visited a hospital there that was packed with people, in this case with women who were seeking a surgery for obstetric fistula. They were women, because of sexual assault or a birth at a very early age, ended up with serious internal problems that required surgery, and there was nowhere to turn. They were shunned in their villages and by their families because of the problems associated with this condition.

Many of them marched and trekked hundreds of miles to get to this hospital. It is called DOCS Hospital. It is supported by the Protestant Churches of America. We saw the women waiting outside, huddled around little fires making their food, waiting for the chance for their surgery. Sometimes they waited for months, and oftentimes they needed a repeat surgery.

After the surgery, they would go into these wards with beds, and the patients were two to a single bed. There just was no place to turn. This was their only hope. Thanks to the United Nations, they had a modern surgical suite, but clearly they did not have the health capacity to deal with this obvious problem.

I asked them: How many surgeons do you have in this area of the Congo?

They said: We have one surgeon for every 1 million people.

I am proud to represent the city of Chicago. I cannot imagine the city of Chicago with three surgeons. But that is what they face in parts of Africa. The same thing is true when it comes to other professionals: doctors and nurses. Part of the problem is just not their failure to train these medical professionals, but the fact that we in the West, with our voracious appetite for medical care, are poaching the best and brightest of the medical professionals in the developing world.

Take a look around your city, go to your local hospital. I just visited a Chicago hospital over the weekend and was introduced to a number of the members of the staff. I asked two of the women where they were from, and they said Ghana. Ghana is in Africa, obviously. My guess is that the community they left needed their medical care as much if not more than the United States. But they were drawn to the United States for obvious reasons.

The surgeons I mentioned in the Congo are paid by the Government. If they are fortunate enough to be paid--and they are not always paid--they are paid $600 a month.

Well, a surgeon in the United States is going to do much better than that. So the United States, England, France, and Germany recruit these medical professionals from the poorest places on Earth, and those countries, then faced with HIV/AIDS, tuberculosis, malaria, and other obvious surgical needs, don't have the professionals.

What difference does it make to us? We feel content that we have that nurse at our beck and call when we are in a hospital. We want all of our family to have the very best medical care. However, we have to accept the reality that a medical crisis halfway around the world can be visited on the United States of America within a matter of days. What used to result in a trip across the ocean in a ship where the sickly would die on the way no longer occurs. People take airplanes and in a matter of hours they are here, and they bring with them not only their foreign culture but many times their foreign diseases. So a public health crisis in some other part of the world has to be a genuine concern of ours as well.

This bill we have before us recognizes that. It takes into account the need to expand the health care capacity of some of the poorest places on Earth, including training community health workers to deliver primary health care and preventive services. It includes some provisions I have worked on earlier, and I salute the committee for adding them relative to expanding the health care capacity in Africa. I had introduced a bill with five of my colleagues--S. 805--the African Health Capacity Act, and some of the provisions are included.

I might say parenthetically that we need to find a solution to our problem in the United States, because we need nurses and doctors here as well, and the answer is pretty obvious. We need homegrown talent. This year, in my State of Illinois, we turned away 2,000 qualified nursing students. We didn't have enough classrooms or teachers or clinical opportunities. Two thousand would-be nurses were told: No, you won't be given admission to an Illinois school this year. When we consider the shortage in health care professionals, we can't afford to do that. Whether it is doctors or nurses or other health professionals, we need to be actively recruiting more in the United States so we aren't reaching out to the poorest places on Earth, poaching their talent, when they desperately need it as well.

This bill goes on to expand current programs. It funds the testing, counseling, treatment and new protocols to address drug resistance in treating tuberculosis. Our colleague, Senator Sherrod Brown of Ohio, has been a leader in the House, and now in the Senate, on the issue of tuberculosis. Most of us pay little attention to this because it is an illness and disease that affects the poor. However, we probably noted in the news not long ago when there was a person who wasn't poor who was banned from travel because he was carrying this disease--this drug-resistant, rather, form of tuberculosis. So we understand this can affect others outside of those who are impoverished. The goal is to do more work worldwide to deal with this with testing, counseling, and treatment.

Incidentally, the treatment of tuberculosis in its most common form is inexpensive. It requires a dutiful process to make sure the person takes their medicine on a regular basis. Some countries such as India have found out how to do this and are leading the way and we should follow their example.

This bill also strengthens the role of the U.S. malaria coordinator. It increases the U.S. contribution to the Global Fund with additional safeguards and oversight, and it funds research on microbicides to help prevent the spread of HIV. It is a good bill and it covers a lot of different things.

We are at a point now where we are in a battle with many forces in this world who are trying to define the United States and tell people around the world who we are. Many of those representations are false and misleading. Unfortunately, they create enemies of the United States--people who should be our friends. I think when the United States embarks on this kind of effort--a global health effort--with tangible results in countries around the world, we demonstrate our values and our caring. That is why I think this bill is so important. I am sorry it has been held up for a number of months, but the good news is it is on the floor now and we have a chance to pass it.

This bill would require that more than half of the money appropriated for addressing local HIV/AIDS be spent on antiretroviral drug treatment and care, controlling other infections that can occur. It provides nutrition and food support and other medical care essential to HIV/AIDS treatment.

The critics of this bill say it goes too far--not just in the money spent, which I disagree with--but in what they call mission creep. They argue that nutrition and safe drinking water and empowerment of women and girls bears little relation to the fight against global AIDS. They believe you should give individuals a pill and send them on their way. Well, common sense suggests otherwise. If you visit the poorest places on Earth and have time to ask only one question, I have found that the question you should ask, if you want to know whether this country has a chance to overcome its problems, is this: How do you treat your women? If women are treated like property, slaves, or chattel, if they have no voices in decisions of the family or community, it is likely that some of the worst medical conditions and economic conditions will continue and will worsen; but if women have a role--if they are educated; if they have a voice in their communities and in their government--it makes all the difference in the world.

So in this bill, when we talk about empowering women and girls through education, training, and self-awareness, it is money well spent. These are the women who will guide that country in the future and who will be a strong voice in a family where otherwise they might be mistreated or infected without even being able to speak a word.

I also think it is obvious that handing medicine to someone who is infected isn't enough. I have been to Nairobi and Kenya. I have seen the clinic where women who are receiving these expensive antiretroviral drugs were dying before my eyes--not of HIV/AIDS, but of malnutrition. They were, with limited funds, providing for their children and not giving themselves enough to eat, so even the antiretroviral drugs weren't working.

So when this bill talks about providing basic nutrition for people around the world, particularly women, so that the drugs will work, it is common sense. The same thing for safe drinking water. If there is one thing that causes more medical problems on this Earth, it is filthy drinking water which causes people, and children especially, to get sick and die. When we talk about safe drinking water as part of this whole program in dealing with global health, it is imminently sensible; and those who argue that it goes too far, we shouldn't include it in this bill, haven't taken the time to meet the people who live under these terrible circumstances.

I hope this bill will pass and I hope it passes soon. We have been waiting for some time. Condoleezza Rice, our Secretary of State, and President Bush have asked us to move this bill forward to provide the technical and financial assistance to help countries develop their national health workforce, expand worker training and retention, build clinics and health networks.

This bill sets a target of training and retaining 140,000 professionals and paraprofessionals. If we can build that work force in the focus countries, we will have the minimum staffing levels of doctors and nurses and midwives recommended by the World Health Organization. We have to change the situation on the ground. Villages will continue to depend on donors for medicine and clinics until they develop their own health care capacity. We can start to change the situation with the technical assistance and financial aid authorized in this bill.

The best response to the global AIDS crisis is to help these countries build a more sustainable, locally driven public health system. The bill is named after two former Members of the House of Representatives: Tom Lantos of California, who recently passed away, and Henry Hyde of Illinois, both of whom supported this legislation. In their name and in their honor, we should pass it and pass it as quickly as we can.

I recall my first trip to Africa. I went to Uganda. There was a clinic there before any of the drugs had arrived where people had been diagnosed with HIV/AIDS. Some of the women at that clinic who had small children were involved in a project called the Memory Book. They would sit on the porch of this clinic while their children played on the playground. They were assembling their life story with photographs, telling about memories of their family and memories of their children when they were born and as they grew up. This memory book was going to be handed off to the child, still very young, to hold on to so that when mother was gone, having died of HIV/AIDS, there would at least be some evidence that she lived, some evidence of her love for that child.

At this same clinic in the days before antiretroviral drugs, they had a choir. It is not unusual. Almost every place you go in Africa, they sing. They sing when they greet you, they sing when you leave, they will sing in the middle of a meeting. It is beautiful. This choir at this clinic was a choir made up of men and women who had been diagnosed with HIV/AIDS and had nowhere to turn. They knew they were all doomed. They came together to sing songs they had written about their plight, and one of them--they gave me a small tape recording--is entitled ``Why Me?'' It was a song that broke your heart as you heard them sing it: Why her, why him, why you, why me--trying to figure out why this had happened to them, that they came down with this deadly disease and knew they would die.

It wasn't that long ago when I made that trip. Today, things have changed. It has changed because the United States and the caring people of this country are stepping forward. Millions of people are now alive today. Millions of children who would have been orphaned now have a chance. Is this an important thing for us to do? I think it is. I think it is important in moral terms, but it is important in political terms too, to make sure that all around the world, people understand who we are, what our values are, and that we are a caring and compassionate people.

Mr. President, I yield the floor, and I suggest the absence of a quorum.

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