March 19, 2003
Representatives Henry Hyde (Republican-Illinois) and Tom Lantos (Democrat-California), respectively the chair and ranking minority member of the House International Relations Committee, were instrumental in putting the compromise bill together. It appears to overcome points of disagreement between the parties that have stalled progress on the relief plan that President Bush set as a priority during his January 28, 2003, State of the Union address.
"This legislation is worthy of the support of the international HIV community," said IAPAC President/CEO José M. Zuniga. "It resolves deficiencies in President Bush's original proposal and avoids several questionable alterations to that plan that have been discussed in the White House and in Congress."
The legislation differs from the administration's original proposal in three ways.
"These are laudable changes," Zuniga said. "We have seen time and again in the 20-plus years of this pandemic that money is most effective when it is spent sooner rather later; the increase in funding levels in the first years of the plan, therefore, was a crucial agreement. IAPAC supports the Global Fund because, quite simply, global cooperation is imperative in fighting global health problems and because the three diseases of poverty the Global Fund combats can most efficiently be addressed together."
The Hyde/Lantos legislation is also notable for its omission of the "Mexico City Policy," which denies US aid to international health organizations that provide legal abortions. The question of whether or not to include such a provision in an AIDS relief plan was perhaps the largest point of contention in Congress, and it is one that may arise again if other Senators and Representatives refuse to accept a plan that would give funding to hospitals and other organizations that work to treat and prevent AIDS but also carry out legal abortions.
Zuniga encouraged the House and Senate not to attach such restrictions to AIDS funding, saying that, "the President was right to make the fight against global AIDS a national priority. Unrelated political agendas should not get in the way of that priority."
Leaving the Mexico City Policy out of the House legislation might be seen as a compromise that favors the Democratic side of the debate. Zuniga was encouraged as well, however, by another aspect of the bill that, by its inclusion, may be viewed as the Republicans' share of the compromise: namely, the so-called "ABC" strategy of prevention education. This approach, which prioritizes abstinence, monogamy, and condoms -- in that order -- is noted for its success in reducing HIV incidence rates in Uganda.
"ABC has proven effective in preventing the spread of HIV in Uganda," Zuniga said. "All prevention efforts must include condom distribution and education. ABC does that. The fact that it also empowers individuals to choose other methods of protecting themselves does not warrant its being dismissed as a backward 'abstinence only' approach."
Zuniga added that the introduction of H.R. 1298 is a promising step, but it does not mean that an appropriate and effective relief effort has actually been put in place. "The legislation has yet to pass both houses of Congress and receive the President's signature. Even if this legislation survives those steps intact, a separate appropriations process must be held, during which individual programs would be chosen to receive the funding that the legislation makes available," he explained.
The international public health community, including IAPAC's global membership, should follow the legislation through this process, Zuniga said, and advise lawmakers on putting in place a plan that is as effective as possible in fighting the pandemic. The same can be said, Zuniga continued, for provisos to support for the Global Fund that are attached to the bill. A nod to US legislators who have expressed concern that the Global Fund does not have the capacity to spend funding efficiently, these provisions call for a "shadow" task force that would verify that US contributions are well spent and stipulate that the US share of the Global Fund's budget may not exceed 33 percent of the total.
"It is not unreasonable that the U.S. would wish to track the way its contributions are being spent," Zuniga said. "But lawmakers should assure that assessments are made fairly, with broad-based input. There should be no seizing on some small misstep as an example of 'wastefulness' and an excuse to withdraw support to the Global Fund."