Thursday, July 17, 2008

Billions in HIV Funding and the Ban is Lifted

Woo woo for the U.S. Senate! Yesterday, they rocked in the fight against HIV.

First, they approved a $50 billion in international funding over the next five years, which will help in areas such as Africa and Asia - via PEPFAR - the President's Emergency Plan for AIDS Relief. Language on microbicides is in the bill.

Meanwhile, the Senators also voted to lift the travel ban on HIV-positive travelers.

…A measure added to the Senate bill by Sens. John Kerry, D-Mass., and Gordon Smith, R-Ore., [reverses] a policy that has made it difficult for HIV-positive foreigners to visit or seek residency in the United States.

“For 20 years the United States has barred HIV-positive travelers from entering the country even for one day,” said Rachel B. Tiven, executive director of Immigration Equality. “Today the Senate said loud and clear that AIDS exceptionalism must come to an end.”

The bill will goes back to the House, which approved the aid back in April, but did not have language about the immigration ban. It is hoped they will just take up the Senate version of the bill.

[love to queerty for the great summary]


AFC Action Alert said...

The AIDS Foundation of Chicago (AFC) commends the U.S. Senate for yesterday’s bipartisan passage of the $48 billion reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR). After months of direct negotiation and intense grassroots advocacy, this landmark legislation will fund desperately needed treatment and prevention services for millions of people living with and at risk for HIV/AIDS around the globe.

“We applaud the historic authorization of nearly $50 billion for the global fight against HIV/AIDS,” says AFC President/CEO Mark Ishaug. “With it, Congress has sent a clear signal that the United States will continue to be a world leader in funding HIV/AIDS services at the highest possible levels. We urge Congress to move quickly towards final passage of the legislation.”

AFC thanks Senate Majority Leader Harry Reid (D-NV), Senate Foreign Relations Committee Chairman Joe Biden (D-DE) and Ranking Member Richard Lugar (R-IN) for their leadership in securing passage of the bill. In addition, AFC thanks Illinois Senators Dick Durbin (D-IL) and Barack Obama (D-IL) for their leadership and stewardship of the reauthorization process.

The Senate bill also includes language that removes the United States’ fear-based travel and immigration ban on foreigners living with HIV.

With House-passage of its own version of the legislation secured in April, Congress must now reconcile the two versions of the bill. The U.S. House of Representatives may decide to approve the Senate’s version without changes in order to send it to President Bush to become law. The second option would be for the House and Senate to convene a conference committee to reconcile differences between their two versions of the bill. The conference committee bill would then need to be approved by both the House and Senate. AFC urges Congress to take the most direct path toward removing the ban.

Jim Pickett said...

I thought I would share this commentary from Elizabeth Pisani - on her Wisdom of Whores blog


Looking the PEPFAR gift horse in the mouth

The bill allowing another US$ 50 billion of US taxpayer’s cash to be spent on HIV in developing countries has finally been given the thumbs up by the Senate. There’s good and bad drafted on to the PEPFAR legislation. The good is the dropping of a law which forbids foreigners with HIV from sullying the shores of the United States. The bad is a panoply of silly rules which mean that the money will do very little to prevent new HIV infections in adults. In fact, PEPFAR will almost certainly lead to more HIV infection in Africa, not less.

Most of the money will be spent on drugs to keep people with HIV alive. This is necessary, and wonderful for the individuals who are getting the drugs. But it does mean that there will be more people with HIV. It also means there are more people who can pass it on. Granted, HIV treatment reduces the amount of virus in body fluids, and makes it more difficult to pass on. It also prevents AIDS, sickness and death. So it makes the consequences of HIV less visible. The evidence suggests that this in turn makes uninfected people more careless about who they have sex with, and sloppy about using condoms. And that in turn makes them more likely to have unprotected sex with someone who is infected but not yet on treatment. Newly-infected people are both most likely to be highly infectious and least likely to be on treatment. Indeed most still count themselves among the uninfected. So while treatment decreases the likelihood of infection for individuals on meds, it can increase new HIV infections across a whole population.

That’s what seems to be happening among gay men in countries where access to treatment is near-perfect: in Britain, the Netherlands, Canada, the United States and Australia, new HIV infections among gay men are rising. The effect of rising risk behaviour weighs more than the effect of lower viral loads. In Africa, it’s likely to be worse. Crappy health and transport systems and erratic incomes may mean people have difficulty getting the drugs they need when they need them. Other STIs are high too, and both of those things can send viral loads bouncing all over the place, even for those on treatment.

Of course we need to get antiretrovirals to as many people in need as possible. But if we want that to remain plausible and affordable, we have to stop people getting newly infected, too. The only developing country that’s managed to prevent new infections while putting everyone in need on meds is Brazil. The country invests very heavily in needle exchanges for drug injectors, in promoting condoms to young people, and in good health services for sex workers. So will PEPFAR copy this shining example? Uhhh, no. There’s US$ 50 billion on the table, but not a cent for clean needles for injectors. Not a cent for sensible prevention programmes in the sex trade. A full half of the prevention money (some five billion dollars in all) must be spent telling kids to cross their legs, even though we know that abstinence programmes don’t work. (If people allocating PEPFAR money in countries want to throw less than half of their prevention money into this black hole, they have to make a special report to Congress.)

There’s still a little bit of negotiating to do on the bill because the versions passed by the House and the Senate are different. (This means that the understandable jubilation over the end of the HIV travel ban may just be premature.) But if all the current amendments stick, the US tax payer may well be financing the growth of the HIV epidemic.

For a blow-by-blow account of the Senate debate, read Scott Swensen’s account.

This post was published on 17/07/08 in Money and AIDS, The sex trade.

jim pickett said...

Analysis from CQ Today


July 17, 2008 – 12:53 p.m.

House to Clear Senate AIDS Bill

By Adam Graham-Silverman, CQ Staff

The House will take up and clear the Senate version of global AIDS legislation as soon as next week, paving the way for President Bush to sign the measure, leaders said Thursday.

The Senate passed its bill (S 2731) Wednesday by 80-16. The measure would authorize $48 billion over the next five years to fight AIDS and other diseases overseas.

The House Foreign Affairs Committee said it would accept the Senate version. The House on April 2 passed its own bill (HR 5501) by 308-116.

Bush, who championed the original law in 2003 (PL 108-25) and pushed for reauthorization this year, is expected to sign the legislation.

Bush hailed the Senate action, praising “both sides of the aisle who came together today to ensure that America’s generosity in battling HIV/AIDS, malaria, and other diseases around the globe will continue in a manner consistent with the program’s successful founding principles.”

The largest difference between the House and Senate bills is their price tags. Both would authorize $50 billion, but with an amendment adopted Wednesday the Senate diverted $2 billion to American Indian health care, law enforcement and clean water programs.

The 2003 law authorized $15 billion for the program’s first five years; Congress subsequently provided about $19 billion. Bush had requested a $30 billion reauthorization, but signed on to the $50 billion number in a bipartisan compromise that was struck in February.

The Senate bill also lacks some of the spending mandates in the House bill. Several government reports said some of the mandates in the original AIDS law hampered countries’ flexibility to spend the money as needed. The House version would require 20 percent of money to go to HIV prevention activities, while the Senate contains no similar requirement.

The Senate bill would require that more than half of the program’s bilateral aid go toward AIDS treatment and care — a provision missing from the House bill and inserted into the Senate version at the insistence of Tom Coburn, R-Okla. His language includes a goal of putting 2 million people into AIDS drug treatment, but that number would increase with spending and as the cost of the drugs drops.

The Senate bill makes no mention of family planning programs, which play an important role in HIV prevention and testing on the ground. Family planning advocates sought to strengthen the ties between their work and the AIDS programs, but ran into opposition from conservatives who contend that could link the program to abortion.

The House bill would authorize family planning groups to provide education, testing and condoms; the Senate bill avoided the debate altogether.

Both bills would overturn an existing law requiring that one-third of prevention money be spent on abstinence education. Instead they would require a report to Congress if abstinence and fidelity programs fall below half of prevention spending in a given country.

Both would direct 10 percent of the money to programs for orphans and children, and both would authorize $2 billion in fiscal 2009 for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Congress provided $845 million for the fund in fiscal 2008.

The bills would preserve an existing requirement that organizations have an explicit policy opposing prostitution in order to be eligible, which is the subject of ongoing First Amendment legislation.

The Senate bill would repeal a ban on HIV-positive visitors to the United States. The ban has been in place since 1987 and the United States is one of only 12 countries that still have such a law.

The bill would include new linkages between AIDS and nutrition programs, and set a target of recruiting 140,000 health care workers. Advocates say providing drugs or building clinics is counterproductive without adequate nutrition and doctors, but the provisions led critics to complain of the program’s “mission creep.”

Both bills would set aside $5 billion for malaria and $4 billion for tuberculosis. Activists said the money for those diseases would be top targets in spending the $48 billion, rather than the $50 billion in the original bill.

jim pickett said...

I wanted to share this perspective from SIECUS


Statement of Joseph DiNorcia, Jr., President and CEO of SIECUS, on the Senate’s Passage of PEPFAR (website for SIECUS -

“It is a shame that something as noble and good as PEPFAR has become tainted by the ideological nonsense of the outgoing administration. This bill represents the same war on evidence-based prevention that it did five years ago and, if left unchanged, will likely only continue to destroy a comprehensive approach to prevention. Provisions such as an ongoing and disproportionate emphasis on abstinence-until-marriage, a prostitution pledge which has nearly obliterated outreach to this population, a lack of common sense integration between family planning and HIV-prevention work, and a stricter conscience clause all represent the worst of our politics. Further, these provisions will continue to undermine what ought to be the most outstanding evidence of American compassion because they extend the domestic, social-conservative assault on mainstream American values into an international arena in the most cynical of ways.

“It speaks volumes that President Bush is certain to sign this bill with enthusiasm, and to champion these same ideological provisions in the process. Certainly, there are things to laud in the bill. It lifts the travel ban on HIV-positive persons, explicitly recognizes the needs of men who have sex with men in tackling the epidemic, and significantly increases investment in treatment. But, the continued denial of HIV services to sex workers and the failure to explicitly support the integration of family planning/reproductive health services with HIV services are inexcusable omissions.

“In large part, it is money that has corrupted the process of reauthorizing this law, and it is money that made many advocates and members of Congress turn a blind eye to the ongoing denigration of prevention efforts. Therefore we call on the next administration to work with a new Congress to ensure that future prevention investments reflect authentic compassion for those countries and people affected by HIV and AIDS.”

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