House Passes PEPFAR Reauthorization Measure

The House on Thursday voted 303-115 to approve a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief, the AP/New York Times reports. According to the AP/Times, President Bush supports the bill, which would allocate $48 billion for PEPFAR. The passage of the bill was "born out of a willingness to work together and put the United States on the right side of history when it comes to this global pandemic," Rep. Barbara Lee (D-Calif.) said. Rep. Howard Berman (D-Calif.) said that with the bill, the U.S. has "given hopes to millions infected with HIV, which just a few years ago was tantamount to a death sentence" (AP/New York Times, 7/25).

The legislation allocates a total of $50 billion -- $48 billion of which would go to PEPFAR and $2 billion of which would go to American Indian issues. The bill also includes an amendment intended to increase oversight of the Global Fund To Fight AIDS, Tuberculosis and Malaria and encourage cost-sharing and transition strategies as part of agreements with countries that receive PEPFAR aid. The measure also includes a provision that would ease U.S. HIV/AIDS travel restrictions.

One primary difference between the original House version of the legislation and the version passed on Thursday is that the original version would have allowed groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill passed on Thursday does not mention family planning programs.

The measure approved on Thursday also includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. In addition, it would overturn an existing law that requires one-third of prevention funds be spent on abstinence and fidelity programs, instead requiring a report to Congress if countries do not spend half of prevention money on such programs. The bill also would direct 10% of funding to programs for orphans and vulnerable children, as well as allocate $2 billion for the Global Fund in fiscal year 2009. The legislation contains an existing requirement that organizations receiving PEPFAR aid have a policy that opposes commercial sex work. The bill would create links between HIV/AIDS and nutrition programs and set a target of recruiting 140,000 health care workers. In addition, the measure would allocate $5 billion for malaria programs and $4 billion for tuberculosis initiatives (Kaiser Daily HIV/AIDS Report, 7/24).

Although Bush is expected to sign the legislation next week, some advocates are voicing concerns that Congress will not be able to provide the funding increase outlined in the bill, according to CQ Today. Congress developed its FY 2009 spending plan before the PEPFAR bill had taken its final form, and lawmakers might pass a continuing resolution to keep FY 2008 funding levels, CQ Today reports. "It terms of funding, it appears there is more rhetoric than reality," David Bryden of the Global AIDS Alliance said, adding that each year the U.S. falls behind in spending makes it even harder to catch up. Bush on Thursday said, "The challenge for future presidents and future Congresses will be to continue this commitment, so that we can lift the shadow of malaria and HIV/AIDS and other diseases once and for all" (Graham-Silverman, CQ Today, 7/24).

Some Republicans expressed concerns about the bill's cost, according to Reuters. "We have big hearts, but we need to use our brains," Rep. Dana Rohrabacher (R-Calif.) said, adding, "We cannot afford $50 billion of generosity to foreigners." Rep. Henry Waxman (D-Calif.) praised the compromise bill but expressed concerns that it does not "explicitly encourage the close integration of HIV programs with family planning and other reproductive health services" (Cowan, Reuters, 7/24). "This bill will save millions of lives around the world," AIDS Healthcare Foundation President Michael Weinstein said, adding, "Congress is to be commended for swiftly adopting and ratifying the Senate version of the bill which preserves PEPFAR's priority on lifesaving treatment" (AHF release, 7/24).

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