House Approves Amended $15B International AIDS Bill With ‘More Conservative Cast’; Bush Urges Quick Passage in Senate

The House yesterday approved 375-41 an international HIV/AIDS bill (HR 1298), which would authorize $15 billion over five years to fight AIDS in Africa and the Caribbean, with amendments that give the bill a "more conservative cast," the Washington Post reports (Eilperin/Goldstein, Washington Post, 5/2). The bill, sponsored by Rep. Henry Hyde (R-Ill.), would authorize $3 billion a year for five years to international HIV/AIDS programs, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Hyde's bill endorses the "ABC" HIV prevention model -- abstinence, be faithful, use condoms -- which has had success in lowering AIDS prevalence rates in Uganda. The bill also allows international organizations that counsel about abortion to receive U.S. funding on the condition that family planning and abortion programs be financed and run separately (Kaiser Daily HIV/AIDS Report, 5/1). The bill would also establish a new federal task force to act as a shadow for the Global Fund as part of an effort to allay fears among many Republicans that the fund is inefficient (Kaiser Daily HIV/AIDS Report, 3/20).

Appropriations Concerns
President Bush lauded the House for "acting quickly to pass historic legislation that is consistent" with the plan he announced in his January State of the Union address. He added, "Today's action is an important step toward providing critically needed treatment and care for millions of people suffering from AIDS, and proven prevention programs for millions more who are at risk." Bush called on the Senate to "act quickly so that we can turn the tide against this disease and give the hope of life to millions of people in the world's most afflicted countries" (White House release, 5/1). Some lawmakers said they were concerned that the measure could "fall short of its goals unless Bush and the Republican leadership" seek additional funding for the global HIV initiative during the appropriations process, the Post reports (Washington Post, 5/2). The amount the bill authorizes is "significantly more than even the White House requested" in its budget, and "Republicans provided still less room for the Appropriation Committees in the [fiscal year 2004] spending plan adopted last month," the Wall Street Journal reports. Rep. Jim Kolbe (R-Ariz.) said, "The budget resolution doesn't permit fiscal 2004 funding anywhere near the $1 billion" allocated for the Global Fund. House Minority Leader Nancy Pelosi (D-Calif.) said, "The proof of the pudding will be when we go to appropriations and see what the funding is in there," adding, "We have something dramatic [in this bill], and I applaud it and hope it will be sustained" (Rogers, Wall Street Journal, 5/2).

Amendments
The approved bill includes several amendments, including one proposed by Rep. Joseph Pitts (R-Pa.) that would specifically allocate one-third of the bill's HIV/AIDS prevention funding for abstinence programs. The amendment was approved 220-197, the New York Times reports. Democrats argued that requiring funding for abstinence programs could detract from other prevention methods, such as condom use, which also played a role in reducing AIDS prevalence rates in Uganda. Pelosi said, "We must support what works." However, Hyde said that the provisions in Pitts' amendment would not "stifle other approaches," adding, "It simply says as we move forward in this war [on HIV/AIDS], don't forget abstinence" (Hulse, New York Times, 5/2). Another amendment, sponsored by Rep. Christopher Smith (R-N.J.), would strengthen "conscience" language already in the bill to ensure that religious groups will receive funding even if they object to certain aspects of prevention programs, including condom distribution (Kaiser Daily HIV/AIDS Report, 5/1). The House approved the Smith amendment on a voice vote, the Los Angeles Times reports. Smith said that he wanted a "maximum army of volunteers" in the fight against the disease (Anderson, Los Angeles Times, 5/2). According to the Washington Times, the amendment was opposed by "most" Democrats, who opposed the prioritized ABC approach and favored physicians and health officials using "any mixture of the three options" (Lakely, Washington Times, 5/2). But Rep. Tom Lantos (D-Calif.) said he was concerned that the Smith amendment could permit some groups opposed to condom use to "criticize those who do," adding, "No group should be required to have anything to do with a program to which it has religious objections, but I'm concerned some groups will use this to undermine other organizations" (Epstein, San Francisco Chronicle, 5/2). Lantos added, "We should not use federal funds to tell people in Uganda to not use condoms because they are morally wrong" (Washington Times, 5/2). The House also approved an amendment from Rep. Joseph Crowley (D-N.Y.) that calls for educating men and boys about gender equality, the Long Island Newsday reports. Crowley said, "In addition to ABC, they should also learn the big 'R,' respect" (Povich, Long Island Newsday, 5/2). Other amendments include:

• A measure sponsored by Rep. Sheila Jackson Lee (D-Texas) that calls for the United States to urge business and private groups to provide to nations in sub-Saharan Africa assistance to help fight the HIV/AIDS epidemic, coordinated through a privately subsidized fund.
  
• A measure sponsored by Rep. Cliff Stearns (R-Fla.) that would require a deduction from next year's appropriation to the Global Fund that is equivalent to every dollar paid to any one Global Fund staff member in the previous year that is over the amount of the U.S. vice president's salary. The president could waive this provision for national security reasons.
  
• An amendment proposed by Lantos that calls for a pilot program aimed at providing assistance to children and families affected by HIV/AIDS, including assurances of women's inheritance rights.
  
• An amendment presented by Rep. Betty McCollum (D-Minn.) that would allocate a minimum of 10% of the bill's proposed funding for FY 2006 through FY 2008 to programs aimed at orphans and "vulnerable children" affected by HIV/AIDS, including those sponsored by nongovernmental organizations and faith-based groups.
  
• A measure sponsored by Rep. Frank Ballance (D-N.C.) that would "expres[s] the sense of Congress that African nations that object to U.S. food aid on non-scientific grounds should accept this food assistance to improve nutrition."
  
• An amendment sponsored by Rep. Judy Biggert (R-Ill.) that calls for the president to establish an outreach and awareness campaign about the Global Fund, encouraging private donations, developing public service announcements and establishing a Web site.
  
• A measure sponsored by Rep. Billy Tauzin (R-La.) that calls for priorities on the "distribution of resources" to specific countries based on size, demographics and other factors to "ensure the countries that need assistance the most receive it first." The amendment also commissions the Institute of Medicine to conduct a report to compare the success of different HIV/AIDS prevention programs and methods proposed in the bill (House floor proceedings, 5/1).
  

Reaction
Rep. Barbara Lee (D-Calif.) said that the bill's passage sends a message to the world that "the United States will not sit idly by and allow AIDS to wreak havoc," adding, "Each village, each organization knows what strategy works best in addressing this problem. ... We have to marshal every way to fight this pandemic, and we need a balanced approach." Ken Conner, president of the Family Research Council, said, "Today's vote shows the efforts of the pro-family lobby paid off. Simply tossing out condoms and creating the illusion of safe sex does not work. Teaching abstinence ... does work" (San Francisco Chronicle, 5/2). Irish rock star and AIDS and debt relief advocate Bono said, "This is the America that put a man on the moon, that's getting ready to lead the war against AIDS in Africa." He added, "On to the Senate, where we're hoping for a victory as soon as possible" (Zuckman, Chicago Tribune, 5/2). Kate Carr, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, said, "We were really hoping that the Pitts amendment would not be included," adding, "We'd rather see a more flexible approach" (Washington Times, 5/2). Gloria Feldt, president of the Planned Parenthood Federation of America, said, "Tying the hands of health care providers by imposing anti-condom, abstinence-only restrictions will cause increased suffering and more deaths" (Chatterjee, Philadelphia Inquirer, 5/2). Nils Daulaire, president of the Global Health Council, said that the funding requirements included in the Pitts amendment are "Washington-centric" and could impose "an enormous amount of bureaucracy and paperwork for people who should be out there doing the work." However, Daulaire added that the approval of the bill is "remarkable" and that the United States is "really going to take the leadership in responding to AIDS around the world" (Washington Post, 5/2).