Senate Defeats Two Republican Amendments to PEPFAR Reauthorization Measure

The Senate on Tuesday defeated two Republican amendments to legislation (S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief by "overwhelming margins," suggesting that a broad majority could pass the measure through the chamber "unscathed," CQ Today reports.

According to CQ Today, the Senate voted 70-24 to table an amendment by Sen. Jim DeMint (R-S.C.) that would have limited funding to 15 low-income countries where PEPFAR already operates. Sen. Jim Bunning's (R-Ky.) amendment to reauthorize the program for five years at $15 billion also failed by a vote of 16-80.The current legislation would reauthorize PEPFAR for five years at $50 billion, $20 billion more than what President Bush originally requested. Sen. Joseph Biden (D-Del.), chair of the Senate Foreign Relations Committee, said, "At the time of the authorization, it was clear to everyone that ($15 billion) was not nearly sufficient to deal with what is a worldwide dilemma, a worldwide problem," adding, "We've learned a great deal more since then. We should not, in fact, turn back the clock." The Senate on Wednesday is scheduled to consider another amendment from DeMint that would reduce funding to $35 billion, according to CQ Today.

The vote on DeMint's amendment to limit PEPFAR to its current 15 focus countries also effectively defeated a second-degree amendment he proposed that would have added language concerning abortions overseas (Graham-Silverman, CQ Today, 7/15). The amendment would have barred funding from groups that support "coercive abortion and forced sterilization" in China (Kaiser Daily HIV/AIDS Report, 7/15). According to DeMint, the Global Fund To Fight AIDS, Tuberculosis and Malaria has provided funding to Chinese agencies that perform abortions. DeMint said, "Voting to table this amendment means that you're supporting using (the program) funds, which are supposed to be for AIDS in Africa," adding, "You're supporting using those funds to promote forced abortions and forced sterilization in China and other countries." However, officials from the Global Fund, which would receive $2 billion in fiscal year 2009 under the PEPFAR legislation, said money never has been used to conduct abortions, voluntary or otherwise (Graham-Silverman, CQ Today, 7/15).

The Senate version of the PEPFAR reauthorization bill passed the Foreign Relations Committee in March, and the House version was approved in April. Both the Senate and House versions of the bill would reauthorize PEPFAR at $50 billion over five years. A Senate agreement reached last month with some of the bill's detractors would ensure that more than half of PEPFAR funding would go to treatment. The agreement also would require that antiretroviral drugs used in PEPFAR programs be approved by FDA or another approved regulatory agency. Some senators have continued to express concern about the measure, including its price tag (Kaiser Daily HIV/AIDS Report, 7/15).

HIV/AIDS-Related Travel Restrictions
The Senate on Wednesday is scheduled to consider a provision included in the PEPFAR legislation that would end restrictions on HIV-positive visitors to the U.S. (CQ Today, 7/15). Under the provision, sponsored by Sens. John Kerry (D-Mass.) and Gordon Smith (R-Ore.), HIV would be considered equivalent to other communicable diseases for which medical and public health experts at HHS -- not consular officials at U.S. embassies -- determine eligibility for admission. Under the amendment, HIV-positive individuals seeking legal permanent residency still would have to demonstrate they have the resources to live in the U.S. and would not become a "public charge."

"There's no excuse for a law that stigmatizes a particular disease," Kerry said, adding that it is "time to move beyond an antiquated, knee-jerk reaction" to people living with HIV/AIDS. However, Sen. Jeff Sessions (R-Ala.) might offer an amendment to eliminate the Kerry-Smith provision, citing Congressional Budget Office estimates that new immigrants coming to the U.S. under the relaxed policy could cost the government more than $80 million over a 10-year period. The amendment would offset the cost of new immigrants by increasing the price of applying for a visitor's visa by $1 for three years and $2 for the next five years. Although the House version of the PEPFAR legislation does not include the travel and immigration provision, some advocates have said that it will be included in the final version that is sent to Bush (Abrams, AP/Google.com, 7/16).

Measure To Include Provisions for American Indians
The PEPFAR reauthorization measure also is expected to include an amendment that would allocate $2 billion for American Indians, according to Sen. John Thune (R-S.D.). The amendment would include $1 billion for water projects on American Indian reservations, $750 million for tribal law enforcement and $250 million for American Indian health care services. Under the provision, the money would be added to the PEPFAR bill with no objections and no roll call vote. Thune said, "While I applaud U.S. leadership when it comes to combating HIV/AIDS overseas, my amendment seeks to ensure that we don't turn our backs on some of the most critical issues here at home (Jalonick, AP/St. Paul Pioneer Press, 7/15).

The Senate also is scheduled to consider an amendment by Sen. Judd Gregg (R-N.H.) that would create an inspector general for PEPFAR, as well as another amendment by Sen. David Vitter (R-La.) that would establish a similar role for the Global Fund (CQ Today, 7/15).

Related Editorial
It "would be irresponsible to pass the PEPFAR bill before the Senate in anything resembling its current form," a Washington Times editorial says. According to the Times, Republican senators and conservative critics raise "legitimate concerns" about the bill, including the role of the Global Fund in supporting abortions and needle-exchange programs and overturning the ban on HIV travel restrictions (Washington Times, 7/16).