To require a specific plan to help AIDS orphans.

UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA
ACT OF 2003--Continued

Mr. REID. Mr. President, what is the regular order?
The PRESIDING OFFICER (Mr. Coleman). H.R. 1298.
Mr. REID. Is that the global AIDS bill?
The PRESIDING OFFICER. Yes, it is.
Mr. REID. I ask unanimous consent that the Feinstein amendment be
next in order and there be 20 minutes equally divided in the usual
form.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from West Virginia.
Mr. BYRD. Mr. President, may I inquire of the leadership how much
longer the leadership expects to keep us in session today?
I inquire of the leadership as to how much longer the Senate will be
in session today. It is now 22 minutes until the hour of midnight.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. LUGAR. Mr. President, I respectfully respond to my colleague that
clearly we can pass the bill now, and that would end the session. I
would hope we would do that. If Members wish to continue offering
amendments, I will do the best I can to encourage each amendment be
defeated so we will have a clean bill.
In any event, I hope it will not be long, and with the cooperation of
all Members we can expedite it.
The PRESIDING OFFICER. The majority leader.
Mr. FRIST. Mr. President, I reiterate what the chairman of the
Foreign Relations Committee said. As I said at the outset of this week
and through this week, the intent is to finish this bill this week. A
number of Members on both sides of the aisle have requested that we
continue. If we are going to finish this bill, which we will, we will
finish it tonight. The plans are to finish the bill tonight. I know
there are a number of amendments. As my colleagues can see from the
amendments so far, the expectations are that we will be able to defeat
each amendment as it comes forward.
I encourage the other side of the aisle to look at the amendments. I
do not believe we have any amendments on our side of the aisle. I
encourage the other side to look at their amendments. This is the first
step, at least from my standpoint, in addressing this complex issue. We
are taking advantage of an opportunity at this point in time to move
forward in the best interest of the United States with the global
health community.
I can tell the Senator this is not the bill I started with, and
myself, Senator Kerry of Massachusetts, and a number of us have worked
on a whole range of bills--the Lugar-Biden, Biden-Lugar bill. We are
going to have plenty of opportunity to address this issue. This little
virus, I have said again and again, is going to be with us for the next
30 years. Even if we invent a vaccine tomorrow, we will have plenty of
opportunity to refine this bill or the framework upon which this bill
was started at a later date.
I again encourage all people who are considering amendments to not
offer those amendments. Our intent is to defeat each one. I remind
everybody, this is a bipartisan bill.
It did come from the House of Representatives, built on lots of other
bills on which we have been working, and only one Democrat and a
handful of Republicans voted against this bill. Therefore, I encourage
our colleagues to withdraw amendments.
We will be working together in a bipartisan fashion to improve this
fight against a devastating virus. The intent is to complete this bill
tonight.
The PRESIDING OFFICER. The Senator from West Virginia.
Mr. BYRD. If the majority leader will yield, would the majority
leader seek to ascertain how many amendments will indeed be called up
yet?
Mr. FRIST. Mr. President, indeed I hope the managers can agree on a
list of amendments. Again, I know a lot of people--we have been working
on colloquies, and we will continue to do that, if necessary, to show
what our intent is. Again, I am not sure if a final list has been
settled upon. I encourage it to be as small as possible. I inquire of
the other side.
The PRESIDING OFFICER. The Democratic leader.
Mr. DASCHLE. Mr. President, we are working on a definitive list as we
speak. There are some amendments that may only require a voice vote,
but at this point there are at least three or four amendments that may
require rollcalls but with very short time limits. I know of no one on
our side requesting more than 10 minutes in an effort to offer their
amendments. So we should be able to move these quickly.
Mr. FRIST. Mr. President, I do not believe we have any amendments on
our side to be offered tonight. I encourage my colleagues to yield back
time, again after careful explanations on their amendments so people
know what they are voting on, but yield back time accordingly.
I ask unanimous consent that all rollcall votes be 10 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BYRD. Mr. President, will the leadership try to determine how
many amendments are really going to be called up? We have cast 30 or 31
rollcall votes already today. It is now 17 minutes until midnight. We
used to ask for a show of hands as to which Senators were serious about
calling up amendments, and I would hope the leaders would do that. I
would like to stay around and finish action on the bill, but I am not
bound to do so. If we are going to have several, I will ask unanimous
consent for a leave of absence from the Senate for the rest of the
evening and be on my way home.
I would love to stay around and finish voting with other Senators. I
do not want to presume to be the leader tonight, but I have been known
to ask other Senators for a show of hands as to which Senators were
serious about calling up amendments.
The PRESIDING OFFICER. The majority leader.
Mr. FRIST. I respond by saying I am scared to death to ask the other
side how many amendments we actually have. We heard from the Democratic
leader that there are four amendments that will likely require rollcall
votes.
From our side of the aisle, we have no amendments. We made it very
clear what our strategy is, and that is to defeat the amendments. Why?
Because it is the clearest way to help the hundreds of thousands of
people who we know will benefit if we pass this bill tonight and get it
to the G-8 so that the President can use it appropriately.
The PRESIDING OFFICER. The Democratic leader.
Mr. DASCHLE. I suggest we get on with these amendments. The sooner we
do so, the sooner we will finish.
Mr. BYRD. I ask unanimous consent that I be granted a leave of
absence for the remainder of the evening.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from California.

Amendment No. 682

Mrs. FEINSTEIN. Mr. President, I send an amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from California (Mrs. Feinstein), for herself,
Mr. Leahy, Mrs. Clinton, Mr. Durbin, Mr. Jeffords, Mr.
Harkin, Mr. Lautenberg, Mr. Reid, Mr. Schumer, Mr. Corzine,
Mrs. Boxer, Mr. Feingold, and Mr. Biden, proposes an
amendment numbered 682.

Mrs. FEINSTEIN. Mr. President, I ask unanimous consent that the
reading of the amendment be dispensed with.

[[Page S6476]]

The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To modify provisions relating to the distribution of funding)

Beginning on page 94, strike line 19 and all that follows
through line 17 on page 95, and insert the following: ``301
of this Act), including promoting abstinence from sexual
activity and encouraging monogamy and faithfulness and
promoting the effective use of condoms for sexually active
people; and
``(4) 10 percent of such amounts for orphans and vulnerable
children.

``SEC. 403. ALLOCATION OF FUNDS.

``(a) Therapeutic Medical Care.--For fiscal years 2006
through 2008, not less than 55 percent of the amounts
appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance for each such
fiscal year shall be expended for therapeutic medical care of
individuals infected with HIV, of which such amount at least
75 percent should be expended for the purchase and
distribution of antiretroviral pharmaceuticals and at least
25 percent should be expended for related care.''.

The PRESIDING OFFICER. The Senator from California.
Mrs. FEINSTEIN. I rise today with Senators Leahy, Clinton, Durbin,
Jeffords, Harkin, Lautenberg, Reid, Schumer, Corzine, Boxer, Feingold,
and Biden to offer an amendment to strike the earmark included in the
bill which mandates that 33 percent of all prevention funds must be
used exclusively for abstinence before marriage programs.
I deeply believe this bill has one major flaw. I appreciate the bill,
and I know the effort that went into it. It is a big step forward. But
when it comes to AIDS, prevention is the name of the game.
Over one-half of the AIDS cases that are expected between today and
2010 can be prevented. The World Health Organization says of the 45
million new HIV cases anticipated, 29 million could be averted with
effective prevention.
I was mayor of San Francisco when AIDS was discovered. We had one of
the first AIDS program in the country. I spent 9 years of my life as
Mayor developing AIDS prevention programs, seeing what worked and what
did not work. What I found was that there has to be flexibility. What
works for one group of people or community might not necessarily work
for another.
I believe one of the major flaws of this bill is the earmark which
would require that 33 percent of the prevention funds--that is $1
billion over 5 years or $200 million a year--must be spent exclusively
on abstinence before marriage programs. Abstinence will not work for
everyone.
We offer this amendment not because we are opposed to abstinence
programs or do not want to see them funded. Rather, there are many
additional approaches that are also effective and we believe it is
critical that there be the necessary flexibility for a particular
community or country to design a prevention program that best meets the
needs of its people.
I deeply believe that when we look at prevention, we have to consider
a number of programs. Let me give a few examples of prevention programs
that should be funded under this bill:
Voluntary counseling and testing. This is an important component to
stop the spread of the virus. Access to testing is important to ensure
that one knows they are infected. Often, the disease is spread from
husband to wife because he does not even know he is HIV positive. So
testing is prevention.
Another form of prevention is stopping the spread of HIV from mother-
to-child. Nevirapine is effective in preventing the transmission of HIV
from a mother to her child. Studies have shown that combining drug
therapy with counseling and instruction on use of such drugs can reduce
transmission by 50 percent.
Blood safety is also an important preventive measure. While the U.S.
has taken the necessary steps to nearly eliminate the transmission of
HIV by blood transfusion, many countries lack resources and
infrastructure to take similar action including the creation of a
national blood supply, use of low-risk blood donors, screening of blood
donations, and reducing the number of unnecessary transfusions.
Sexually transmitted disease control is another prevention tool. Left
unchecked, sexually transmitted diseases can expand the risk of HIV/
AIDS two to five times.
Lastly, empowering women is an important component to prevention. In
Africa, women account for 58 percent of HIV/AIDS cases, and the number
is rising. This means that providing women around the world with health
and educational opportunities, equal rights before the law, protection
from sexual violence and sexual trafficking, can help them take control
of their lives and help reduce the spread of HIV.

It is unrealistic to think that sexual abstinence is the most
appropriate prevention strategy in every community. There has been
research conducted in our own society on how an abstinence only
approach fails to reach everyone. Therefore, I fail to understand then
how this approach will work in the developing world.
I deeply believe that the 33 percent earmark is the wrong approach to
take with this bill. The amendment we have submitted would replace that
33 percent earmark with language that would give local communities the
flexibility necessary to design prevention programs that work for them.
It includes abstinence. It includes faithfulness. It would also include
the use of condoms for sexually active people.
I believe our amendment is simple and straight forward. Let local
communities, working in conjunction with the USAID and others, develop
prevention programs that work for them. Congress should be passing
legislation that simply gives local communities and health care
providers the necessary resources to implement programs that are
effective given their unique cultural, social, and medical
circumstances.
I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. LUGAR. I yield to the Senator from Kansas.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. BROWNBACK. Mr. President, I thank the leader for yielding the
floor. I thank the Senator from California for the spirit in which she
is putting this amendment forward. She wants to see the best possible
happen. I appreciate the tenor and spirit she is putting forward.

I reiterate what the chairman of the committee said: We want to get a
bill through. If we put this amendment in, it is not going to get done
in time for the G-8 meeting.
The second issue, this week the First Lady of Uganda was visiting and
spoke to a number of us. Uganda has been a wonderful model with great
success thus far working on reducing the incidence of AIDS from a 21
percent level of infection of AIDS in their country in 1991 to 6
percent in 2002. She said very clearly and directly this is about a
change of culture, about pushing a model of ABC which started with
abstinence and be faithful. That was the key, the key area they needed
to push in that they got the most success, the right thing to do.
I point out in this area, the way the bill reads, in this actual
provision, 33 percent of 20 percent would be used for abstinence
programs, but not just abstinence programs. It would be abstinence and
other programs along with it. Effectively, we are talking about roughly
6.5, 6.7 percent of the money. This is a small amount. It is a clear
message we think needs to be sent along with an effective model that
worked very well in Uganda and is being implemented in Senegal, Zambia,
Ethiopia, and Jamaica because it has proven so successful.
This is an important provision to leave in because if we change it,
even with the good intentions of the Senator from California, it will
stall, if not really put the bill way back, because this issue involved
a major dispute with the House.
Second, the abstinence programs have worked, in the clear places they
have been used, particularly in Uganda, the model that has been most
frequently cited.
Third, it is a small portion of the funding; 6.7 percent is actually
in use here.
I urge for all those reasons my colleagues vote down the Feinstein
amendment and stay with the provisions of the bill as sent over from
the House.
I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. LEAHY. Mr. President, I have heard this interesting discussion by
two Senators I like a great deal. I cannot add to the experience the
distinguished Senator from California had as

[[Page S6477]]

mayor of San Francisco and, in fact, in her work as a national leader
in efforts to prevent AIDS.
I say also to my good friend from Kansas that I remember being in
Uganda at a time when they were first becoming aware of the fact they
had an AIDS problem. I was sitting with President Museveni when he got
his first real briefing, by USAID officials, of the calamity of AIDS in
his country. At that time he switched from opposing the use of condoms
as an acceptable way to protect against AIDS to supporting it.
It is one of the reasons Uganda is a model for Africa today. Of
course they support abstinence. So does the Senator from California. Of
course they support fidelity. So does the Senator from California. But
also in Uganda they know that does not always work. And they also
support the use of condoms.
I commend the Senator from California for her amendment. This
amendment addresses one of the serious flaws in a bill that has much
else to recommend it.
This bill, assuming the President requests the funds to implement it,
will be a major step forward in the fight against HIV/AIDS,
tuberculosis, and malaria.
I have pressed for significantly more funding to combat AIDS ever
since I first traveled to Africa in 1990 and saw the ravages of AIDS in
Uganda, South Africa, and Kenya.
We have had amendments brought up here within the past year to
appropriate emergency funds to combat AIDS, that were opposed by the
White House. Now the majority party has its own bill, a House bill and
they want us to pass it without amendment. I understand that. But this
is the Senate, not the House.
The amendment of the Senator from California would clarify several
matters.
First, we all support programs to promote abstinence among young
people who are not yet sexually active. We support that and her
amendment reaffirms that.
We also support programs to promote fidelity, because multiple
partners is a major cause of HIV transmission. The Senator's amendment
promotes fidelity.
But in many instances, and especially for women and girls in
countries like Uganda, Cambodia, India, or South Africa, abstinence is
not a realistic option. And fidelity may be an option for women, but it
makes no difference because they have no control over their male
partners. And that also goes for married women.
In many developing countries, women and girls have no say over when
or even with whom they have sexual relations. And for them, a condom is
their only protection against HIV. It is a matter of life and death.
That is true in Uganda, where I have been. We have heard a lot said
about how Uganda's rate of HIV infection was reduced because of
abstinence. That is not the whole story. In fact it is a distortion.
Promoting abstinence has been very important there, but it has been no
more important than other interventions, like promoting the use of
condoms.
Senator Feinstein's amendment supports abstinence. It supports
fidelity. And it supports the use of condoms. Like the Uganda model,
her amendment does not give one approach any more weight than the
other.

Most importantly, it does not mandate a certain amount of funds for
any one approach.
Whether 33 percent or 13 percent or 3 percent of the funds we make
available for AIDS prevention are used to promote abstinence is a
public health decision that should be made not by Congress, but by
experts working in the field.
The same goes for the amount spent on condoms. It is not for us to
decide that. It varies depending on the country and the target
population.
Among younger populations abstinence may be the best approach. Among
others it may be irrelevant and condoms may be the only practical
protection. That is consistent with Uganda's experience. It is
consistent with the experience of exports everywhere who are working to
stop the spread of AIDS. And it is consistent with what President Bush
himself has said.
It is also important to mandate that abstinence, fidelity, and
condoms are only three of the necessary approaches to AIDS prevention.
There is also counseling. There is voluntary testing. There is
treatment for sexually transmitted diseases. These are all essential to
any AIDS prevention strategy. Again, this has been true in Uganda, and
in many other countries.
So let us not earmark one approach--abstinence--when it is only one
of several necessary approaches. Senator Feinstein's amendment leaves
it to the Administration, and to the experts who implement these
programs, to decide. That is the only sensible and workable approach.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mrs. FEINSTEIN. I yield to the Senator from Wisconsin.
Mr. FEINGOLD. It is late, but I cannot let the characterization of
the AIDS program in Uganda pass without suggesting that the
characterization by the Senator from Kansas is an oversimplification of
how they reduced the AIDS incidence in Uganda.
Most importantly, what Uganda did is to destigmatize AIDS, to not
make people who have AIDS pariahs, and to talk about a range of
alternatives, not simply abstinence.
The House approach to this does not characterize the way in which
they succeed in Uganda. In fact, I suggest it does just the opposite.
I object to the use of the Uganda example, which is one of the
leading examples of the world. Without the ABC, all three of them, it
would not have succeeded. The House approach is too limited to save the
lives we all want to save.
Mr. LUGAR. Mr. President, let me clarify that if $2 billion is spent
in the first year for bilateral HIV programs and if 20 percent is for
prevention, only $132 million will be involved in the abstinence
programs. I simply say, it is a fairly small amount.
When the President addressed this issue at the White House, he
specifically said, there are three elements. There is abstinence,
faithfulness, and condoms. He said all three. There is a liberal amount
of money for a lot of flexibility.
I don't argue with the distinguished Senator from California. I just
say essentially the language accomplishes that.
Once again, we are faced with the fact that if we are determined to
amend it, we are back into the problem with the House, which debated
this. This was an important part of the compromise that brought those
375 votes in favor of the bill.
I yield back our time.
Mrs. FEINSTEIN. Mr. President, how much time remains on our side?
The PRESIDING OFFICER. Two minutes 10 seconds.
Mrs. FEINSTEIN. I yield 1 minute to Senator Durbin.
Mr. DURBIN. Having been to Uganda and having seen the success of this
program, the characterization on the floor is not correct. Secretary of
State Powell has made it clear the United States approach involves all
three--abstinence, fidelity, and condoms. And in the country of Uganda,
it has been successful.
Why in the world are we establishing a 33 percent requirement when it
comes to the abstinence programs? This afternoon we had tea with the
First Lady of Uganda, and we had a conversation with her and asked,
wouldn't you want to have the flexibility to apply these programs to
the communities and villages and situations in the most effective way
to fight this disease? She said, of course we would.
This House bill, which is now so sacred that we cannot change one
word, has put in 33 percent--not in the interest of global health but
in the interest of an American political agenda. That is unfortunate.
Mrs. FEINSTEIN. Mr. President, I yield the remaining balance of the
time and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the amendment of the Senator from
California.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from New Mexico (Mr.
Domenici) is necessarily absent.

[[Page S6478]]

Mr. REID. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from Massachusetts (Mr. Kerry) are necessary absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote aye.
The PRESIDING OFFICER (Mr. Talent). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 45, nays 52, as follows:

[Rollcall Vote No. 180 Leg.]

YEAS--45

Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Breaux
Cantwell
Carper
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham (FL)
Harkin
Hollings
Inouye
Jeffords
Johnson
Kennedy
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Wyden

NAYS--52

Alexander
Allard
Allen
Bennett
Bond
Brownback
Bunning
Burns
Campbell
Chafee
Chambliss
Cochran
Coleman
Collins
Cornyn
Craig
Crapo
DeWine
Dole
Ensign
Enzi
Fitzgerald
Frist
Graham (SC)
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Kyl
Lott
Lugar
McCain
McConnell
Miller
Murkowski
Nelson (NE)
Nickles
Roberts
Santorum
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Talent
Thomas
Voinovich
Warner

NOT VOTING--3

Byrd
Domenici
Kerry
The amendment (No. 682) was rejected.
Mr. LUGAR. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DASCHLE. Mr. President, the majority leader and I have been
discussing how we will continue. I know of no one who has asked for a
rollcall vote on final passage. It would be our hope that we could
voice vote final passage.
I also encourage my colleagues, to the degree possible, to accept
voice votes on these amendments as well. The hour is late, and each
vote takes at least 10 minutes. There will be a voice vote on final,
assuming everyone has agreed. To the extent possible, I encourage voice
votes on amendments as well.
The PRESIDING OFFICER. The Senator from Massachusetts.

Amendment No. 681

Mr. KENNEDY. Mr. President, I send an amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Massachusetts [Mr. Kennedy], for himself
and Mr. Feingold, Mr. McCain, Mrs. Feinstein, Mr. Levin, Mr.
Schumer, Mr. Pryor, and Mr. Johnson, proposes an amendment
numbered 681.

Mr. KENNEDY. Mr. President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide for the procurement of certain pharmaceuticals at
the lowest possible price for products of assured quality)

On page 54, strike lines 7 through 24, and insert the
following: ``medicines to treat opportunistic infections, at
the lowest possible price for products of assured quality (as
provided for in subparagraph (D)). Such procurement shall be
made anywhere in the world notwithstanding any provision of
law restricting procurement of goods to domestic sources.
``(B) Mechanisms for quality control and sustainable
supply.--Mechanisms to ensure that such HIV/AIDS
pharmaceuticals, antiviral therapies, and other appropriate
medicines are quality-controlled and sustainably supplied.
``(C) Distribution.--The distribution of such HIV/AIDS
pharmaceuticals, antiviral therapies, and other appropriate
medicines (including medicines to treat opportunistic
infections) to qualified national, regional, or local
organizations for the treatment of individuals with HIV/AIDS
in accordance with appropriate HIV/AIDS testing and
monitoring requirements and treatment protocols and for the
prevention of mother-to-child transmission of the HIV
infection.
``(D) Lowest possible price and assured quality.--
``(i) Lowest possible price.--With respect to an HIV/AIDS
pharmaceutical, an antiviral therapy, or any other
appropriate medicine, including a medicine to treat
opportunistic infections, the lowest possible price means the
lowest delivered duty unpaid price at which such medicine
(which includes all products of assured quality with the same
active ingredients) may be obtained in sufficient quantity in
either the United States or elsewhere on the world market.
``(ii) Assured quality.--An HIV/AIDS pharmaceutical, an
antiviral therapy, or any other appropriate medicine,
including a medicine to treat opportunistic infections, shall
be considered a product of assured quality if it is--

``(I)(aa) approved by the Food and Drug Administration;
``(bb) authorized for marketing by the European Commission;
``(cc) on the most recent edition of the list of HIV-
related medicines prequalified for procurement by the World
Health Organization's Pilot Procurement Quality and Sourcing
Project; or
``(dd) during the period that begins on the date of
enactment of this section and ending on December 31, 2004,
authorized for use by the national regulatory authority of
the country where the product will be used unless the
President determines that the product does not meet
appropriate quality standards; and
``(II) in compliance with--

``(aa) the intellectual property laws of the country where
the product is manufactured;
``(bb) the intellectual property laws of the country where
the product will be used; and
``(cc) applicable international obligations in the field of
intellectual property, to the extent consistent with the
flexibilities provided in the Agreement on Trade-Related
Aspects of Intellectual Property Rights (TRIPS), as
interpreted in the Declaration on the TRIPS Agreement and
Public Health, adopted by the World Trade Organization at the
Fourth Ministerial Conference at Doha, Qatar on November 14,
2001.
``(iii) Prices publicly available.--Prices paid for
purchases of HIV/AIDS pharmaceuticals, antiviral therapies,
and other appropriate medicines, including medicines to treat
opportunistic infections, of assured quality shall be made
publicly available.
``(iv) Application to appropriated funds.--Funds
appropriated under title IV of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 that
are used for the procurement of HIV/AIDS pharmaceuticals,
antiviral therapies, and other appropriate medicines,
including medicines to treat opportunistic infections, shall
be used to procure products of assured quality at the lowest
possible price, as determined under this subparagraph.
(E) Rule of construction.--Nothing in this paragraph
shall be construed to affect a decision regarding which
medicine is most medically appropriate for a specific disease
or condition.

Mr. KENNEDY. Mr. President, we know that 30 million people in Africa
are afflicted with HIV/AIDS, and millions more around the world are
also ill. Eight thousand people die in Africa each day from AIDS, and
many of them are children. Only 50,000--1 in every 600--receive the
drugs that we know can turn a deadly disease into a chronic one.
This legislation promises that funds will finally be available to buy
these lifesaving drugs. Our amendment is intended to see that these
drugs will help the largest number of people possible. It does that by
requiring that products be purchased at the lowest possible price. It
does not add a penny to the cost of this bill. But it also means that
we will get the greatest value for this very urgently needed investment
to stop the HIV/AIDS epidemic.
President Bush emphasized in his State of the Union Address
``antiretroviral drugs can extend life for many years. And the cost of
these drugs has dropped from $12,000 a year to under $300 a year--which
places a tremendous possibility within our grasp. Ladies and gentlemen,
seldom has history offered a greater opportunity to do so much for so
many.''
The best way to take advantage of this opportunity as identified by
the President is to require the purchase of AIDS drugs of assured
quality at the lowest possible price. That is now $300 a year--not
$12,000.
It is important that we understand the significance of this
difference. If we use the funds in this bill to buy a year's supply of
drugs for $12,000 a person, we will help only 100,000 persons. But if
we buy the drugs for $300, we will help over 4 million.
This amendment is based on the successful program of the Global Fund
to Fight AIDS, Tuberculosis, and Malaria. This program is proven to
work in getting safe, high-quality drugs to people in need in the
developing world at the lowest price.
The essence of this amendment is simple. It fulfills the President's
pledge to treat AIDS patients with drugs costing $300 per case. It
protects America's

[[Page S6479]]

intellectual property rights. It assures that drugs will be of the
highest quality. But, most of all, it means we will be able to save
millions of lives instead of thousands.
Let us put patients first--not the profits of the drug companies. Let
us buy drugs at the lowest possible price to treat the maximum number
of patients. Let us deliver the best medicine at the best price.
I yield to the Senator from Wisconsin.
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. FEINGOLD. Mr. President, I rise to speak in support of Senator
Kennedy's important amendment. The Senate should not be silent on this
issue. Senator Kennedy's amendment requires that pharmaceuticals
procured by the United States for treatment initiatives authorized in
this bill be purchased at the lowest possible cost while maintaining
high quality standards.
In the past, Congress has been reluctant to address treatment issues,
shying away from the complexities associated with providing treatment
and resources. But just because it has been difficult does not mean it
is impossible. And recognizing and accepting complexity is no excuse
for ignoring urgent needs.
I have served on the African Affairs Subcommittee in the Senate now
for almost 11 years, and I am pleased to be able to say that it appears
that the tide is finally beginning to turn on this issue after so many
years with people cavalierly dismissing the notion of providing access
to antiretroviral drugs in the developing world.
I often recall the very end of almost a marathon meeting with the
Senegalese public health community. An extraordinary group of
Senegalese doctors, nurses, and volunteers and religious leaders had
come out on a Saturday to spend hours talking with me and others about
their coordinated campaign to fight AIDS. We were wrapping up when a
gentleman who had been among those briefing me stood up, and speaking
softly he told me that he was HIV positive. He wanted to know if there
would be any help for him, any assistance with the kind of treatment
that is out of reach for some in Africa.
There has to be an answer to his question. I heard the President of
the United States answer positively in the State of the Union that
basic human decency tells us that we cannot stand by while tens of
millions die and societies collapse.
Recently, in South Africa I met with pediatricians whose exhaustion
showed on their faces and their posture and in their tired, angry
voices. They were tired of watching children die when they know that
the treatment actually exists to save them.
There is much more to say about what we have seen in Africa. But what
we are talking about here is a tremendous commitment of U.S. resources
in this bill and in this time of crises. I think we have to get the
most that we can for our money.
The amendment is about using taxpayer dollars wisely. It would be
beyond shameful and almost reprehensible for us to use the resources
authorized in this bill for what might end up being sweetheart deals
with big pharmaceutical companies for their products if we could get
equally safe and effective products at a better price.
The amendment is in no way targeted to the pharmaceutical industry.
It does not prejudge anyone's intentions. It does not exclude any
single provider of safe and effective drugs. It simply demands that the
U.S. Government get the quality we need at the best available price.
I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. LUGAR. Mr. President, just as a matter of common sense, the U.S.
Government will attempt to purchase pharmaceutical products of the
highest quality at the best price. But I would just simply urge my
colleagues to consider the fact that mandating this, while it appears
reasonable, and has some reliance upon the World Health Organization's
pilot program, we ought to recognize that the World Health Organization
actually dealing in countries with a high incidence of HIV/AIDS does
not guarantee the quality of the medicine. It is probably unable to do
that.
The facts are--and I respect the distinguished Senator from
Massachusetts and, likewise, the Senator from Wisconsin; they have
experience, I am sure, in the field looking at these programs--the
testimony of people I have visited with at Indiana University, who have
been in the field, indicates that the whole idea of the treatment is a
very provisional situation.
We are grasping as a world at what works. And this is why flexibility
has been encouraged thus far. We also are simply up against the fact
that the problem is so overwhelming that attempting to obtain
pharmaceutical products from anybody around the world has been
extremely difficult. And a good number of pharmaceutical companies have
been prepared to make enormous price concessions. And most physicians
then point out, you need a physician to help the patient make certain
the doses are right, the combination of drugs is right, the discipline
of dealing with this is correct.
It is not a matter of mandating the lowest cost drugs, and failing to
do that denying people treatment. The fact is, 80 percent of the people
with AIDS in the world are getting no treatment at all. That is why we
are trying to pass a bill tonight as opposed to having several months
more discussion, attempting to perfect the bill. I have said from the
beginning, as Dr. Frist, that all of us could perfect this bill in a
number of ways. Our problem is to get a bill through two Houses now so
it might be of some benefit to our President in his diplomacy and
advocacy as he approaches the other wealthy countries of the world,
starting at least on the first of January, if not before.
Therefore, Mr. President, I am hopeful that Members understand the
importance of getting drugs at the best price and mandating the highest
quality and attempting to get as many companies all over the world
interested in this as we can. But the amendment, it seems to me, once
again, obstructs the fact of getting any bill at all, any relief for
the people we are talking about. Therefore, I ask Senators to vote no.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, we have just seen the World Health
Organization deal with one of the great challenges of modern times; and
that is with SARS. The World Health Organization has been commended all
over the world for the way it has worked with countries all over the
world, and we have joined in that commendation.
We have been working with the Global Fund to Fight AIDS,
Tuberculosis, and Malaria to ensure quality products are used to treat
patients with HIV/AIDS. We are investing money in these quality
products through the Global Fund to Fight AIDS, Tuberculosis, and
Malaria. All we are saying in this amendment is that you are going to
have the same assured product at the lowest possible price.
If the American Government is, through the Global Fund, buying these
quality products, then you ought to be willing to accept this
amendment. All it does is make sure we have the best prices for these
products of assured quality. We are not saying we have to buy the
antiretroviral drugs for HIV for $300, but they do have to be purchased
at the best available price, with the quality assured.
I do not understand how we can refuse to say, if we are going to
invest the taxpayers' money in this endeavor, then we should get the
maximum in terms of the results, in terms of the number of people
helped. We should make sure that helping the most people possible is
the policy of the United States.
Mr. GREGG. Will the Senator from Massachusetts yield?
Mr. KENNEDY. I am happy to yield.
Mr. GREGG. I was wondering if the Senator from Massachusetts would be
willing to enter into a time agreement, say, 2 minutes on each side,
and then have a vote?
Mr. KENNEDY. We were trying to reach 10 minutes for ourselves. We
probably have 2 more minutes for the Senator to speak and then we are
finished.
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. FEINGOLD. Mr. President, one quick point to reinforce what
Senator Kennedy said in response to what the Senator from Indiana said.

[[Page S6480]]

Obviously, the Senator from Massachusetts and I are not going to
offer an amendment to provide unsafe treatments. In fact, the WHO
guarantees the bioequivalency of a given product. And that just means
they actually verify that it is exactly the same as a product that has
been thoroughly tested for safety by an institution such as the FDA.
So it is not a valid point that somehow this approach that we are
suggesting will lead to products that are not safe. They are as safe as
the ones we would use ourselves.
Mr. McCAIN. Mr. President, this amendment, like this bill, addresses
a specific pandemic that demands our attention and our action.
According to the most recent data available, at least 20 million people
have died of HIV/AIDS globally, orphaning 14 million children. On the
African continent, approximately 30 million people have the AIDS
virus--3 million of whom are children under the age of 15.
In the spirit of the underlying bill, I have joined my friend Senator
Kennedy in cosponsoring this amendment to ensure that this bill saves
as many lives as possible. Our amendment will allow for the purchase of
many more drugs to treat those suffering from HIV/AIDS, stretching the
taxpayers' dollars as far and as effectively as possible.
This amendment allows U.S. taxpayer dollars to go towards the
purchase of safe, but less expensive equivalent medications on the
global market if they are available. It enables the U.S. Agency for
International Development (USAID) to use Federal funds to procure drugs
at the lowest possible price on the global market to treat HIV/AIDS
patients, provided that they are approved for treatment in the U.S.;
the EU; have been selected by the World Health Organization's, WHO,
Pilot Procurement Quality and Sourcing Project for HIV-related
medicines; or are authorized for use by the country where the product
will be used. These are the same qualifications used by the United
Nations Global Fund to procure drugs.
This amendment does not give preference to a particular treatment for
HIV/AIDS. Patients will not be precluded from receiving the drug
treatments that are medically necessary; however, if there is a less
expensive equivalent drug included in that treatment, this amendment
will require the purchase of that lower-cost drug.
As a proponent of free trade and a staunch supporter of upholding our
global trade obligations, I don't believe this amendment violates
carefully negotiated agreements on intellectual property rights at the
World Trade Organization, WTO, nor does it weaken the position of our
trade representatives in future intellectual property negotiations. The
language of this amendment closely tracks the most recent intellectual
property rights agreements at the WTO.
I urge my colleagues to choose to make treatments available to many
more people suffering from this terrible disease and vote for this
amendment.
The PRESIDING OFFICER. Is there further debate on the amendment?
The Senator from Nevada.
Mr. REID. Mr. President, I have checked with both managers of the
bill. I ask unanimous consent that the only amendments in order be the
following: Senator Feingold, who is going to offer his amendment;
Senator Clinton; Senator Lautenberg; Senator Leahy; Senator Landrieu;
Senator Dodd; Senator Boxer. And it is my understanding the manager of
the bill has an amendment to offer. Oh, I am sorry. There he is. And
the Boxer amendment will be 20 minutes, equally divided.
Mrs. BOXER. I don't need that much time.
Mr. REID. Five minutes equally divided.
Mrs. BOXER. Ten minutes.
Mr. REID. That is what I said.
Mrs. BOXER. You said 20 minutes. I need 10 minutes.
Mr. REID. OK, Senator Boxer, 20 minutes, equally divided. Senator
Dodd, 20 minutes.
Mr. LUGAR. Senator Boxer, 10 minutes, evenly divided.
Mr. REID. I think we have been here 17 hours. What do you think?
Senator Clinton is going to speak for a short time. She will take a
voice vote. Senator Lautenberg is going to enter into a colloquy.
Senator Leahy is going to offer and withdraw. Senator Landrieu is going
to enter into a colloquy. Senator Feingold is going to offer and
withdraw.
I ask unanimous consent that the order of the amendments be:
Feingold, Clinton, Lautenberg, Leahy, Landrieu, Dodd, and Boxer, and
the final vote be that of Senator Biden, and there be no second-degree
amendments in order.
The PRESIDING OFFICER. Is there objection?
Mr. DODD. Reserving the right to object, I don't mind going last. I
will be happy going last.
Mr. BIDEN. No, Mr. President, I will go last.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. KENNEDY. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to amendment No. 681.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from New Mexico (Mr.
Domenici) is necessarily absent.
Mr. REID. I announce that the Senator from West Virginia (Mr. Byrd),
the Senator from Hawaii, (Mr. Inouye) and the Senator from
Massachusetts (Mr. Kerry) are necessarily absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote ``aye.''
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 42, nays 54, as follows:

[Rollcall Vote No. 181 Leg.]

YEAS--42

Akaka
Bayh
Biden
Bingaman
Boxer
Cantwell
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham (FL)
Harkin
Hollings
Jeffords
Johnson
Kennedy
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCain
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Wyden

NAYS--54

Alexander
Allard
Allen
Baucus
Bennett
Bond
Breaux
Brownback
Bunning
Burns
Campbell
Carper
Chafee
Chambliss
Cochran
Coleman
Collins
Cornyn
Craig
Crapo
DeWine
Dole
Ensign
Enzi
Fitzgerald
Frist
Graham (SC)
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Kyl
Lott
Lugar
McConnell
Miller
Murkowski
Nelson (NE)
Nickles
Roberts
Santorum
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Talent
Thomas
Voinovich
Warner

NOT VOTING--4

Byrd
Domenici
Inouye
Kerry
The amendment (No. 681) was rejected.
Mr. LUGAR. Mr. President, I move to reconsider the vote.
Mr. REID. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. DASCHLE. Mr. President, we have two other amendments that require
rollcalls. Very short time limits will be used to present the
amendments is my understanding. We have no other requests for
rollcalls. Other Senators will be offering amendments requiring voice
votes. I think at that point Senators will be free to leave. I ask that
the Boxer amendment be the next in order.
Mr. LUGAR. Mr. President, I ask for information now on the time
limits on the two amendments.
Mr. REID. The Boxer amendment is 10 minutes. It is already an order.
Mr. LUGAR. On the Dodd amendment?
The PRESIDING OFFICER. There was no time limit established.
Mr. DASCHLE. It is my understanding that there was 20 minutes on the
Dodd amendment, 10 minutes on the Boxer amendment, evenly divided.
The PRESIDING OFFICER. There was no time limit--
Mr. DASCHLE. I ask unanimous consent for that.

[[Page S6481]]

Mr. REID. Mr. President, I don't want to belabor the point, but when
I said we were in the 17th hour, we did ask for time on the Boxer
amendment.
The PRESIDING OFFICER. Yes, the Boxer amendment has a 10-minute time
limit.
Mr. REID. Senator Dodd has agreed to 20 minutes.
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. FEINGOLD. Mr. President, I withdraw my amendment.
The PRESIDING OFFICER. The amendment of the Senator from Wisconsin is
withdrawn.
The Senator from California is recognized.

Amendment No. 684

Mrs. BOXER. Mr. President, I know we are all exhausted and I am
really sorry to be here for an extra few minutes. I feel I don't
deserve to really be in the Senate because we are talking about global
AIDS, which is turning into a weapon of mass destruction. I feel very
bad about what we are doing here tonight.
First, I send my amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from California (Mrs. Boxer) proposes an
amendment numbered 684.

Mrs. BOXER. Mr. President, I ask unanimous consent that further
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To require a specific plan to help AIDS orphans)

On Page 29, line 15, insert before the semicolon the
following: ``, including the development and implementation
of a specific plan to provide resources to households headed
by an individual who is caring for one or more AIDS
orphans''.

Mrs. BOXER. Mr. President, I feel very badly about what we are doing
tonight. We are passing an inferior bill that was passed by the other
body so that the President can hold in his hand a piece of AIDS
legislation. How better it would be if it were a fine piece of
legislation, if it were a more thoughtful piece of legislation, if it
were a more effective piece of legislation.
But the fix is in. All amendments are being voted down because of the
President's schedule. Well, I didn't get elected from the largest State
in the Union, that has been fighting the AIDS epidemic ever since
Senator Feinstein was a mayor and I was on the county board of
supervisors, to rush through something like this. I think it is really
very sad that we are being governed by the schedule of the executive
branch.
I want to tell you very quickly what my amendment does. It restores a
focus on AIDS orphans. You cannot think of anything more tragic. AIDS
orphans were the focus of the bills that passed the Senate before. They
are no longer the focus. More than 10 million children have been
orphaned by AIDS. It is estimated that, by the year 2010, there will be
over 40 million children left orphaned by this horrendous disease. That
is a population so large that it is more than California's 37 million
residents. It is 8 Wisconsins or 70 North Dakotas. You get the point.
In the vast majority of cases, single women and young girls, 16 years
old, 17 years old, 15 years old, are taking responsibility for the care
of these orphaned children. Just read about it. It is heartbreaking.
All my amendment says is that a specific plan will be developed by
the AIDS coordinator and implemented to provide resources, especially
to households headed by an individual who is caring for one or more
AIDS orphans.
This bill is silent on this point. We do nothing specific about this.
This bill is vague. Even though you have committed to vote against
everything, it will take only 2 minutes for the President to call Tom
DeLay and say: Help the orphans, vote for this amendment. I hope we
will all vote aye.
The PRESIDING OFFICER. Who yields time?
Mr. LUGAR. Mr. President, I am unfamiliar with the amendment of the
distinguished Senator from California. I have listened carefully to her
argument, and obviously the bill before us addresses the needs of women
and orphans in a great number of places. I must argue again, I suspect
that the best in this case should not be the enemy of the better.
We have a bill here that I believe is sound on these issues. As we
have admitted again and again, each one of us might perfect it in
various ways. The distinguished Senator from California is attempting
to do so now. But I encourage Senators to vote against the amendment
for the same reasons I have encouraged Senators to vote against each of
the perfecting amendments--realizing that each one of us, in the event
we were to write the bill, could do better. But we have two bodies
working on a procedure whereby we are on the threshold of having a
significant breakthrough for the people we are attempting to assist and
save.
The Senator has made an eloquent case for why we ought to have action
now and ought to encourage other countries to join us. I ask Senators,
once again, to oppose the Boxer amendment.
The PRESIDING OFFICER. Who yields time?
Mrs. BOXER. I yield back the remainder of my time.
Mr. LUGAR. We yield back our time.
Mrs. BOXER. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to amendment No. 684. The clerk will call
the roll.
The legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from New Mexico (Mr.
Domenici) is necessarily absent.
Mr. REID. I announce that the Senator from West Virginia (Mr. Byrd),
the Senator from Hawaii (Mr. Inouye), the Senator from Massachusetts
(Mr. Kerry), and the Senator from Louisiana (Ms. Landrieu) are
necessarily absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote ``aye.''
The result was announced--yeas 45, nays 50, as follows:

[Rollcall Vote No. 182 Leg.]

YEAS--45

Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Breaux
Campbell
Cantwell
Carper
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham (FL)
Harkin
Hollings
Jeffords
Johnson
Kennedy
Kohl
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Mikulski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Wyden

NAYS--50

Alexander
Allard
Allen
Bennett
Bond
Brownback
Bunning
Burns
Chafee
Chambliss
Cochran
Coleman
Collins
Cornyn
Craig
Crapo
DeWine
Dole
Ensign
Enzi
Fitzgerald
Frist
Graham (SC)
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Kyl
Lott
Lugar
McCain
McConnell
Miller
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Talent
Thomas
Voinovich
Warner

NOT VOTING--5

Byrd
Domenici
Inouye
Kerry
Landrieu
The amendment (No. 684) was rejected.
Mr. LUGAR. Mr. President, I move to reconsider the vote.
Mr. LEAHY. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from Connecticut.

Amendment No. 685

Mr. DODD. Mr. President, I send an amendment to the desk and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Connecticut [Mr. Dodd] proposes an
amendment numbered 685.

Mr. DODD. Mr. President, I ask unanimous consent that the reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To add CARICOM Countries and the Dominican Republic to
Priority List of HIV/AIDS Coordinator)

On page 31, line 19, insert the following after the second
comma on that line:
``Antigua and Barbuda, the Bahamas, Barbados, Belize,
Dominica, Grenada, Jamaica,

[[Page S6482]]

Montserrat, St. Kitts and Nevis, St. Vincent and the
Grenadines, St. Lucia, Suriname, Trinidad and Tobago,
Dominican Republic,''

Mr. DODD. Mr. President, I apologize to my colleagues. I know it is
now after 1 in the morning. People are tired. It has been a long day. I
have great respect for this institution and do not normally like to
test the patience of my colleagues, but as tired as all of us are at
this very hour, there are some 250,000 orphans right now, 80,000 of
whom live in the Caribbean, who are orphaned because their families,
their parents, contracted AIDS.
There are half a million people in the 14 CARICOM countries who will
not be included as a part of this bill, for reasons that have never
been explained adequately to me, who are suffering a lot more than just
fatigue tonight because they will not get the kinds of medicines and
support they deserve.
I apologize for raising an amendment that is brought up at a late
hour. I am sorry we are not going to be here tomorrow to debate some of
these issues. The decision to be here at this hour is certainly not
that of those who are offering these amendments.
This is a very important bill. I have great respect for the
President, who has made this an important issue, who wants to bring it
up and see to it that these issues can be debated when he goes to the
G-8.
My amendment simply says that for the countries that suffer the
second largest incidents of AIDS in the world, the Caribbean countries
where 10 million American tourists go every year, ought to be included
as part of this package.
I do not think our colleagues in the House of Representatives,
Democrats or Republicans, would reject this legislation because we add
14 countries where 5 million people live, where half a million people
are suffering from AIDS, second only to that of sub-Saharan Africa. If
they would object to the bill on that grounds, I do not understand
this. Yet we have excluded all but two countries from being recipients
of this aid. So my amendment merely says we ought to include these
countries as part of this package.
The average age of death in the Caribbean countries is 45 years of
age. Twenty-five percent of all hospital beds in these Caribbean
countries are now filled with people infected by AIDS. Few of these
patients receive any treatment at all. The mother-to-child
transmissions are the highest in the Americas. The AIDS epidemic has
already left 80,000 orphans in these Caribbean countries. Globally,
half of all infected are in children between the ages of 15 and 24,
except in the Caribbean. There it is, 10 years of age.
I know it is late, but it is getting later for these kids. It is
getting a lot later for them. So I am asking my colleagues in the
Senate to ask our colleagues in the House to accept an amendment that
would include people who live only a few minutes from our shores, who
deserve a little more than they are getting tonight. If you are a 10-
year-old child and you are suffering from AIDS, you are one of 80,000
orphans in the Caribbean and you deserve better than being told that
this bill cannot be changed, not one dot, not one comma, not one word.
I know in fact this bill will be changed before we leave tonight. So
the argument somehow that we cannot do this is specious. We ought to be
doing better than that. We are the Senate. We are dealing with a
critically important global issue. It deserves more of our time,
attention, and concern than the argument that we are fatigued and
tired, that we do not have the patience to go back to our colleagues in
the House and say we can do better. I urge my colleagues to support
this amendment. It is not asking too much to say to half a million
people who are a few miles from our shore that we want to include them
as part of this effort to make this world a better and safer place. I
urge its adoption.
Mr. BIDEN. Mr. President, how much time is remaining?
The PRESIDING OFFICER. The Senator has 6 minutes.
Mr. BIDEN. Will the Senator yield?
Mr. DODD. I will be happy to yield.
Mr. BIDEN. Mr. President, I, quite frankly, not only agree with every
point the Senator has made, but, quite frankly, I have not heard a more
compelling case, a more logical case, and a more--how can I say it?--
reasoned indictment of our failure to be willing to confront the House
with what I cannot believe, particularly if the President said he
supported this, that we would not be able to get it done.

It is true that I believe the House is willing to accept some changes
in this bill. The fact is, as the Senator knows, the bill we had did
exactly what he is talking about providing for these folks.
Even though everyone says there is no possibility of anything being
accepted beyond this, I find it hard to believe, if this body, which
passed this before, which unanimously said this made sense, and a
President who says he is overwhelmingly concerned not only about AIDS
worldwide but about our Latin American friends to our south--remember,
he started his whole initiative in foreign policy; he was looking in
this hemisphere south.
I realize everyone thinks this would not happen, many think this
would not occur, but it is clearly worth taking a chance. I am willing
to bet, if it passes, it gets accepted. I cannot imagine it being
turned down. I cannot imagine the President of the United States saying
he would not accept this amendment.
All these amendments have been important, but there is simply no
logic whatever--none--to refuse this amendment.
I yield the floor.
Mr. DODD. I am prepared to yield back my time.
Mr. GRAHAM of Florida. I would like to add to your comments and those
of Senator Biden that we have talked mainly this evening about the
humanitarian aspects of this issue.
If I could bring it a little closer to home, in large part because of
the health care conditions in the Caribbean, my State has suffered from
time to time outbreaks of tuberculosis and other serious diseases. We
now have a significant percentage infected with HIV. These are not
5,000 miles away; they are just a few minutes away.
We have a very direct national interest in arresting this problem,
preventing its outbreak in the future, and therefore protecting the
people of the United States. I hope this amendment will be adopted. It
not only is the right thing to do for the people involved, it is the
right thing to do for our people involved.
Mr. LUGAR. Mr. President, I will make a short comment and yield to my
distinguished colleague from Pennsylvania.
I point out, without for a moment arguing with the distinguished
Senator from Connecticut about the urgency of Latin America, our
friends right here in the Caribbean, that the language of the bill with
regard to the United States coordinator does list 14 countries, but it
also then has these words: ``and other countries designated by the
President.''
It appears to me this language is fairly flexible. It might have been
better if all of the countries had been listed, but it does enumerate
the Latin American countries that the Senator from Connecticut has
pointed to and gives the power of the President to designate other
countries.
I yield to the distinguished Senator from Pennsylvania and then the
distinguished Senator from Kansas.
Mr. SPECTER. I have not spoken on this bill. From my experience, I
know that few, if any minds, are changed by speeches. But I think it is
important to note that we are not fatigued. We have almost 100 Senators
on the floor. We have been here since 9:15, but we are robust and we
are able to take on the country's business and we are not fatigued. We
will give ample consideration to any amendments which anyone seeks to
offer.
But it ought to be a point of focus that it is possible--barely, but
possible--that somebody might be watching these proceedings on C-SPAN.
And you might think those who are voting against these amendments are
hard-hearted. But the fact is that unless we pass a bill, a clean bill,
a virtually clean bill, what is agreed to by the House, this bill is
not going to be ready when the President has to make a very important
international trip. The President will be carrying a legislative
package of $15 billion. That is a hefty sum of money and can go a long
way on this hideous disease. With that kind of a package, the President
will be in a position to leverage and get funds from other countries.

[[Page S6483]]

I certainly agree with the Senator from California who talked about
prevention. I certainly agree it would be good to cover more children.
It would be good to have lower prices. It would be good to have an
explicit coverage to the Caribbean, although as the Senator from
Indiana pointed out, there is flexibility to do that.
When we vote against these amendments, it is not because we do not
think they are good or that we are in a hurry or we are fatigued. We
are focused. But the principal objective is to get it passed and get it
signed.
People ought to know, if they have not seen the beltway scene, that
relations between the Senate and the House are not too good. If we put
a lot of amendments on this bill, nothing will happen. We ought to get
on with it. Fifteen billion is significant. It will really go to the
heart of the matter. And then it can be revisited at a later time.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. BROWNBACK. Mr. President, the hour is late and I point out to my
colleagues, I am told this is the 36th vote of the day. According to
some, that is a record for this body in a 24-hour period. This appears
to be the last one.
I appreciate the spirit in which this is being put forward by my
colleague from Connecticut who has a lot of interest and is focused on
this region a great deal. This is coming from his heart.
However, we can do this, and what he is asking for, under this bill
as it is. What is in this bill would provide that opportunity to do it.
Really, by his raising this, it will elevate the focus, the
possibilities in the Caribbean.
I read directly from the bill, ``directly approving all activities of
the United States relating to combating HIV/AIDS,'' and it lists some
14 countries. Then it says ``and other countries designated by the
President.''
I hope the facts he has put forward tonight will be considered by the
administration. I believe they will be in combating this and we would
use the funds--this is a large portfolio of funds we put forward, $15
billion--to focus and get results. We are on the edge of accomplishing
something historic, of helping a lot, and we can do what our colleague
from Connecticut says under the plain language of this bill.

I hope we can go ahead and vote on this.
I yield the floor.
Mr. DODD. I am happy to yield.
Mr. LEAHY. Mr. President, we want to get this bill off to the
President so he will have it when he goes abroad. I agree with that,
although I don't think that was a reason for opposing the amendments
that were offered tonight. We could have passed those amendments, gone
to conference with the House, and sent this bill to the President in
plenty of time. But that was not what the majority wanted. They wanted
to rubber stamp the House bill, despite its defects which were obvious
to everyone.
Let's be realistic about what is going on here.
This is an authorization bill. It does not actually appropriate one
dime. The President will be taking a promise when he goes abroad,
nothing more. In fact, his budget request for 2004 does not include the
amount authorized in this bill that people have been talking about. Not
only that, while this bill authorizes $1 billion for the Global Fund to
Fight AIDS, TB and Malaria, the President's 2004 budget includes only
$200 million for the Global Fund, a $150 million cut from last year.
And not only does this bill not appropriate any money, his 2004
budget would cut many other global health programs. It would cut
funding for child survival and maternal health by 12 percent. It would
cut funding for programs to protect vulnerable children by 63 percent.
It would cut programs to combat other infectious diseases--diseases
which kill millions of children each year, by 32 percent. I wonder how
many Senators know this.
So I hope that soon after the President signs this bill he will send
us a budget amendment for the rest of the $3 billion authorized here
that is missing from his 2004 budget request.
I hope he also asks for the funds to replace the cuts his budget
makes in other global health programs. Because those cuts are going to
mean fewer children will be vaccinated against measles and polio, and
fewer pregnant women will have access to medical care. Each year, over
half a million women die needlessly from pregnancy related causes.
There are real consequences to cutting these programs.
Mr. LUGAR. Mr. President, I am prepared to yield back time on our
side. Before doing so, may I clarify with the Chair that the only two
remaining amendments are to be offered by the distinguished Senator
from New York, Senator Clinton, and the distinguished Senator from
Delaware, Senator Biden, and that these will have voice votes at the
conclusion of the two amendments, and then we will have final passage
on a voice vote. Is that interpretation correct?
The PRESIDING OFFICER. There were other amendments authorized,
amendments by Senators Lautenberg, Leahy, and Landrieu.
Mr. LUGAR. Mr. President, I ask unanimous consent the only two
remaining amendments be amendments of Senator Clinton and Senator
Biden, with voice votes to follow, and a voice vote on final passage.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. LEAHY. Reserving the right to object, and I shall not, I will
withhold my amendment.
Mr. LUGAR. I thank the Senator.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. DODD. I appreciate the comments of the chairman of the committee
about the discretion of the President and, certainly, going on record
as this being important, that additional countries are to be included
as part of this package.
I ask unanimous consent a letter signed by the Ambassadors of all
these countries asking these nations be included as part of this bill
be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

May 14, 2003.
President George Bush,
The White House,
Washington, DC.
Dear Mr. President: Addressing the AIDS pandemic in the
Caribbean has been a major concern of the Caribbean Community
of countries' (CARICOM), we therefore commend your efforts to
address the AIDS epidemic in the Caribbean through your
Emergency Plan for AIDS Relief. We are writing however,
because we believe that a more inclusive approach to
addressing AIDS in the region is needed, which is why we are
requesting that you expand your initiative to include all
Caribbean countries in the region.
As you know, the number of HIV/AIDS infection rates in the
Caribbean is only surpassed by that of sub-Saharan Africa. In
fact, prevalence rates in the Caribbean region are similar to
what they were in sub-Saharan Africa prior to the explosion
of the virus in the general population.
Like you, were greatly concerned about the AIDS crisis in
the Caribbean and realize that aid from international donors
such as the U.S. is necessary if we are to address the
crisis. The slumping tourism industry has negatively affected
our already weakened economies, making it difficult for our
countries to provide resources that will adequately address
the AIDS epidemic. Inadequate funding is then increasingly
putting us at-risk for the further spread of the epidemic to
the general population commensurate with current prevalence
rates in sub-Saharan Africa.
We realize that high prevalence rates can overwhelm our
health care capacity, destabilize our economies, and increase
migration flow--which could pose a real security risk for the
U.S. due to its proximity to he Caribbean. It is for these
reasons that we are interested in supporting approaches to
fighting the AIDS epidemic that fully take into consideration
our special circumstances on the Caribbean.
Our AIDS epidemic is driven by heterosexual contact and a
mobile population. For example, over 10 million persons from
the U.S. visit the Caribbean annually. Population movements
between the U.S. and the Caribbean for business purposes and
tourism, including large numbers of U.S. and Caribbean
students moving back and forth for study and leisure
purposes, argue strongly for an inclusive approach to
combating AIDS in the Caribbean.
As such, our own AIDS initiatives have been developed in
response to the high mobility of the region. For example, the
Pan Caribbean AIDS Partnership, administered through CARICOM
is a collaboration between Caribbean countries, Caribbean
regional institutions, and international agencies that work
together to fight AIDS across the region. Similarly, programs
implemented by your government have also taken regional
approaches. USAID administers AIDS initiatives in the
Dominican Republic, Guyana, Haiti, Jamaica, and through the
Caribbean Regional Program, which is a Caribbean wide program
that targets countries where USAID does not have a presence.

[[Page S6484]]

Because a regional approach is crucial to addressing the
AIDS epidemic in our highly mobile population, we are
requesting that you expand under your Emergency AIDS
Initiative to the entire Caribbean region. Expansion of the
program would allow for your initiative to include countries
such as the Bahamas, which has an adult AIDS prevalence rate
of 3.5 percent, and Trinidad and Tobago and the Dominican
Republic who are suffering with prevalence rates of 2.5
percent. Additionally, countries such as Barbados and Jamaica
with AIDS rates approaching 2 percent could receive funding
for prevention efforts.
Without a regional approach to the Caribbean AIDS crisis,
we fear that AIDS will lower life expectancy, increase the
number of AIDS orphans, further threaten our already fragile
economies, increase migration flow out of the region, and
increase the threat to the U.S.
We therefore hope that you will seriously consider our
request to include the entire Caribbean in your Emergency
AIDS Relief Initiative.
Sincerely,
Lionel Hurst, Ambassador of Antigua and Barbuda. Joshua
Sears, Ambassador of Bahamas. Michael King, Ambassador
of Barbados. Lisa M. Shoman, Ambassador of Belize.
Denis G. Antoine, Ambassador of Grenada. M.A. Odeen
Ishmael, Ambassador of Guyana. Seymour Mullings,
Ambassador of Jamaica. Izben Williams, Ambassador of
St. Kitts and Nevis. Elsworth John, Ambassador of St.
Vincent and the Grenadines. Sonia Johnny, Ambassador of
St. Lucia. Henry Lothar Illes, Ambassador of Suriname.
Marina Annette Valere, Ambassador of Trinidad and
Tobago. Harry Franz Leo, Minister Counsellor, Charge d'
Affaire a.i., of Haiti.

Mr. DODD. Mr. President, I ask for the yeas and nays on my amendment.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The yeas and nays were ordered.
The PRESIDING OFFICER. Is all time yielded back? All time is yielded
back.
The majority leader is recognized.

Schedule

Mr. FRIST. Mr. President, in regard to the schedule, as mentioned,
the votes as outlined will be planned for the remainder of the evening.
The vote we are about to have will be the last rollcall vote of the
evening. I thank all Members for their patience. We have been here
about 17 hours of consecutive voting.
The Senate will not be in session tomorrow. We will return for
business on Monday.
Mr. REID. We won't be in session today.
Mr. FRIST. That's right, we will not be in session later today. We
will return for business on Monday.
On Monday, the Senate will begin consideration of the Department of
Defense authorization bill. The next rollcall vote will occur at 5:30
on Monday.
Again, this will be the last rollcall vote of the morning.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
The yeas and nays have been ordered. The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. McCONNELL. I announce that the Senator from New Mexico (Mr.
Domenici) is necessarily absent.
Mr. REID. I announce that the Senator from West Virginia (Mr. Byrd),
the Senator from Hawaii (Mr. Inouye), the Senator from Massachusetts
(Mr. Kerry) and the Senator from Louisiana (Ms. Landrieu) are
necessarily absent.
I further announce that, if present and voting, the Senator from
Massachusetts (Mr. Kerry) would vote ``aye''.
The result was announced--yeas 44, nays 51, as follows:

[Rollcall Vote No. 183 Leg.]

YEAS--44

Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Breaux
Cantwell
Carper
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham (FL)
Harkin
Hollings
Jeffords
Johnson
Kennedy
Kohl
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Mikulski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Wyden

NAYS--51

Alexander
Allard
Allen
Bennett
Bond
Brownback
Bunning
Burns
Campbell
Chafee
Chambliss
Cochran
Coleman
Collins
Cornyn
Craig
Crapo
DeWine
Dole
Ensign
Enzi
Fitzgerald
Frist
Graham (SC)
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Kyl
Lott
Lugar
McCain
McConnell
Miller
Murkowski
Nickles
Roberts
Santorum
Sessions
Shelby
Smith
Snowe
Specter
Stevens
Sununu
Talent
Thomas
Voinovich
Warner

NOT VOTING--5

Byrd
Domenici
Inouye
Kerry
Landrieu
The amendment (No. 685) was rejected.
Mr. LUGAR. I move to reconsider the vote.
Mr. BROWNBACK. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The Senator from New York is recognized.

Amendment No. 652

Mrs. CLINTON. Mr. President, I call up amendment No. 652, which is at
the desk.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from New York [Mrs. Clinton] for herself, Mrs.
Boxer, Mrs. Murray, and Mr. Leahy, proposes an amendment
numbered 652.

Mrs. CLINTON. Mr. President, I ask unanimous consent reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To improve women's health and empowerment and reduce women's
vulnerability to HIV/AIDS)

On page 23, line 24, insert before the semicolon the
following: ``, including the pursuit of sexual relations with
adolescent girls''.
On page 24, strike lines 2 through 4, and insert the
following: ``developed to address the access of women and
adolescent girls to employment opportunities, income,
education and training, productive resources, and
microfinance programs;''.
On page 27, strike lines 19 through 23, and insert the
following:
(W) An analysis of strategies to reduce deaths from
cervical cancer caused by high risk strains of human
papillomavirus in women over 30 living in sub-Saharan Africa.
(X) A description of a comprehensive 5-year global AIDS
plan that shall be developed by the President to address
issue effecting, and promote specific strategies to overcome,
the extreme vulnerability of adolescent girls to HIV
infection, including self esteem, access to education, safe
employment and livelihood opportunities, pressures to marry
at an early age and bear children, and norms that do not
allow for safe and supportive family life and marriages.
(Y) A description of the programs, and the number of women
and girls reached through these programs--
(i) to increase women's access to currently available
prevention technologies and the steps taken to increase the
availability of such technologies;
(ii) that provide prevention education and training for
women and girls;
(iii) addressing violence and coercion; and
(iv) increasing access to treatment.
(Z) A description of the progress made on developing a
safe, effective, and user-friendly microbicide.
On page 51, line 8, strike ``and''.
On page 51, line 12, strike the period and insert a
semicolon.
On page 51, between lines 12 and 13, insert the following:
``(I) assistance for programs to dramatically increase
women's access to currently available female-controlled
prevention technologies and to microbicides when these become
available, and for the training and skills needed to use
these methods effectively;
``(J) assistance for research to develop safe, effective,
and usable microbicides;
``(K) assistance for programs to provide comprehensive
education for women and girls, including health education
that emphasizes skills building on negotiation and the
prevention of sexually transmitted infections and other
related reproductive health risks and strategies that
emphasize the delay of sexual debut;
``(L) assistance for strategies to prevent and address
gender-based violence and sexual coercion of women and
minors;
``(M) assistance to reduce the vulnerability of HIV/AIDS
for women, young people, and children who are refugees or
internally displaced persons; and
``(N) assistance for community-based strategies to reduce
the stigma faced by women affected by HIV and AIDS.
On page 52, line 3, strike ``; and'' and insert a
semicolon.
On page 52, line 10, strike the period and insert a
semicolon.
On page 52, between lines 10 and 11, insert the following:
``(D) assistance for programs that promote equitable access
to treatment and care for all women, by--
``(i) reducing economic and social barriers faced
disproportionately by women;
``(ii) directly increase women's access to affordable
drugs; and

[[Page S6485]]

``(iii) providing adequate pre- and post-natal care to
pregnant women and mothers infected with HIV or living with
AIDS to prevent an increase in the number of AIDS orphans;
and
``(E) assistance to increase resources for households
headed by females caring for AIDS orphans.
On page 81, after line 24, add the following:
(9) At the United Nations Special Session on HIV/AIDS in
June 2001, the United States also committed itself to the
specific goals with respect to reducing HIV prevalence among
youth, as specified in the Declaration of Commitment on HIV/
AIDS adopted by the United Nations General Assembly at the
Special Session.

Mrs. CLINTON. Mr. President, I offer this amendment on my own behalf,
along with Senators Boxer, Murray, and Leahy.
First, I commend the leadership as well as the President for bringing
this important issue of global HIV/AIDS to the floor this evening,
although the hour is obviously very late.
While I am pleased with many aspects of this bill, and the commitment
it represents, I do believe the bill is flawed in a very important and
fundamental respect; and that is, with regard to the treatment of and
concern for girls and women.
As many of us know who have traveled in Africa, the Caribbean, and
other places where the HIV/AIDS pandemic has ravaged so many people,
young girls, girls barely in their teens, adolescents, young women, are
all too often the victims of this disease because of the way they are
treated.
I believe in abstinence. I went to Uganda in 1997. I was impressed,
as many of my colleagues have been, by what I saw with respect to the
program that Uganda undertook and certainly the results.
But I am concerned that abstinence is not a prevention tool
realistically available to many girls and women throughout Africa. So
many of the prevention tools are controlled by men, and by customs and
by traditions, in communities where the expectation may very well be
for a young girl to be married at a very young age.
In Africa, the seroprevalence for women ages 15 to 17 is five times
the rate it is for boys of the same age. Now, why does that happen?
Certainly the leaders in Africa who are now undertaking their own
campaigns against HIV/AIDS are well aware of the uphill climb they
face.
Two years ago, Mozambique's Prime Minister, after a comprehensive
study, found that there was an explanation for the higher rates among
young women, and it was--and I quote him--

Not because the girls are promiscuous, but because nearly
three out of five are married by age 18, [and] 40 percent of
them [are married] to much older, sexually experienced men,
who may expose their wives to HIV/AIDS. Abstinence is not an
option for these child brides. Those who try to negotiate
condom use commonly face violence or rejection.

That is why I have offered this amendment to specifically address not
just women's health but also women's empowerment, because empowering
women and girls is the clearest way to give them the tools to be able
to not only say no but to actually implement that belief.
It is also imperative to reduce economic and other dependence, to
combat gender discrimination and stigma, to recognize that the
effective prevention strategies for women, who now represent the
majority of people worldwide suffering from HIV/AIDS, must be addressed
immediately, urgently, and with resources.
Research shows that the most effective policies are those that
include an understanding of the relevance and impact of the roles that
culture and society assign men, women, boys, and girls. But the bill
that we are considering overlooks and neglects this important aspect of
the problem.
Our amendment would correct that neglect by providing assistance for
programs that increase women's access to female-controlled prevention
technologies, including microbiocides when they become available; and
by providing assistance for programs that improve the health education,
and skills-building efforts for women and girls, increasing women's
ability to protect themselves from unwanted sex, safeguarding
themselves when they are sexually active, and reducing the stigma faced
by women affected by HIV and AIDS.

One of the reasons the prevalence of HIV/AIDS among younger and
younger girls is occurring in Africa is for two interrelated causes:
One, because many of these young girls are available, they are healthy;
and, secondly, because there is this myth that very young girls will
not transmit HIV. And because we do not have widespread testing, many
of the men do not even know that they are infected.
Thirdly, we have to recognize that gender inequality is a part of
this epidemic. Women who lack access to education, or any kind of
skills training, who are exposed to gender-based violence in their home
or their larger community, who are sexually coerced or otherwise
vulnerable, make up many of the victims that, unfortunately, suffer
from HIV/AIDS.
We also should be boosting women's access to pre- and postnatal care,
and increasing resources for female-headed households caring for
orphans and victims of AIDS, as my colleague from California, Senator
Boxer, so eloquently argued.
In addition, we should increase focus on other women's health
threats, including cervical cancer, which can be caused by high-risk
strains of human papilloma virus.
I hope we can assure we pay particular attention to young people.
Much of the language that is included in this amendment has already
passed the Senate unanimously last year in S. 2525. It is not
controversial, at least in this body.
I understand the fast track we are on, and the fact that the majority
does not wish to have any amendments, but I hope that when we revisit
this, as we must, in the appropriations process--when we take the bill
and rid it of the contradictions and the conflicts that it inherently
has in its language--that this amendment will be accepted. It will help
to guarantee that we address these very particular problems that affect
women.
When we are talking about women's health and looking at all of the
problems women have, it is important that we not focus just on HIV/AIDS
as though that is some separate, abstract problem that can be removed
from cervical cancer and sexually transmitted diseases and other
problems that women suffer from so grievously, not only in Africa but
in many countries around the world.
I ask the positive, affirmative support of those who remain in the
Chamber on a voice vote for this amendment that specifically stands up
for the girls and women of Africa in this important cause we are now
undertaking.
The PRESIDING OFFICER. Is there further debate on the amendment? The
Senator from Indiana.
Mr. LUGAR. Mr. President, the Senator from New York has made a very
eloquent and important statement, and I appreciate it. My response has
to be the one I have made throughout the evening, and that is that it
is different, and it will cause conference. In my judgment, there is
merit in what she has to say. That has been true of many amendments
this evening. But it is something that I must oppose. I am hopeful
Senators will vote no on the Clinton amendment.
The PRESIDING OFFICER. Is there further debate on the amendment?
If not, the question is on agreeing to amendment No. 652.
The amendment (No. 652) was rejected.
Mr. LUGAR. Mr. President, I move to reconsider the vote.
Mr. BROWNBACK. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. BIDEN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BIDEN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BIDEN. Mr. President, I understand the regular order is that my
amendment on debt relief would be in order now.
The PRESIDING OFFICER. The Senator is correct.

Amendment No. 686

Mr. BIDEN. Mr. President, the hour is extremely late. The bottom line
of this is that this provides for debt relief

[[Page S6486]]

for the very countries we are trying to help with AIDS. They are
swamped by debt. It is legislation that we have been through before. My
staff and I sat with the White House, the National Security Agency. We
sat down with the White House today, the National Security Agency
representative for hours. We negotiated the exact language.
I send the amendment to the desk and ask for its immediate
consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Delaware [Mr. Biden], for himself and Mr.
Leahy, proposes an amendment numbered 686.

(Purpose: To amend the International Financial Institutions Act to
provide for modification of the Enhanced Heavily Indebted Poor
Countries (HIPC) Initiative)

At the end of the bill, insert the following:
TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS

SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

Title XVI of the International Financial Institutions Act
(22 U.S.C. 262p--262p-7) is amended by adding at the end the
following new section:

``SEC. 1625. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

``(a) Authority.--
``(1) In general.--The Secretary of the Treasury should
immediately commence efforts within the Paris Club of
Official Creditors, the International Bank for Reconstruction
and Development, the International Monetary Fund, and other
appropriate multilateral development institutions to modify
the Enhanced HIPC Initiative so that the amount of debt stock
reduction approved for a country eligible for debt relief
under the Enhanced HIPC Initiative shall be sufficient to
reduce, for each of the first 3 years after the date of
enactment of this section or the Decision Point, whichever is
later--
``(A) the net present value of the outstanding public and
publicly guaranteed debt of the country, (i) as of the
decision point if the country has already reached its
decision point, or (ii) as of the date of Enactment of this
Act, if the country has not reached its decision point, to
not more than 150 percent of the annual value of exports of
the country for the year preceding the Decision Point; and
``(B) the annual payments due on such public and publicly
guaranteed debt to not more than--
``(i) 10 percent or, in the case of a country suffering a
public health crisis (as defined in subsection (e)), not more
than 5 percent, of the amount of the annual current revenues
received by the country from internal resources; or
``(ii) a percentage of the gross national product of the
country, or another benchmark, that will yield a result
substantially equivalent to that which would be achieved
through application of subparagraph (A).
``(2) Limitation.--In financing the objectives of the
Enhanced HIPC Initiative, an international financial
institution shall give priority to using its own resources.
``(b) Relation to Poverty and the Environment.--Debt
cancellation under the modifications to the Enhanced HIPC
Initiative described in subsection (a) should not be
conditioned on any agreement by an impoverished country to
implement or comply with policies that deepen poverty or
degrade the environment, including any policy that--
``(1) implements or extends user fees on primary
education or primary health care, including prevention and
treatment efforts for HIV/AIDS, tuberculosis, malaria, and
infant, child, and maternal well-being;
``(2) provides for increased cost recovery from poor
people to finance basic public services such as education,
health care, clean water, or sanitation;
``(3) reduces the country's minimum wage to a level of
less than $2 per day or undermines workers' ability to
exercise effectively their internationally recognized worker
rights, as defined under section 526(e) of the Foreign
Operations, Export Financing and Related Programs
Appropriations Act, 1995 (22 U.S.C. 262p-4p); or
``(4) promotes unsustainable extraction of resources or
results in reduced budget support for environmental programs.
``(c) Conditions.--A country shall not be eligible for
cancellation of debt under modifications to the Enhanced HIPC
Initiative described in subsection (a) if the government of
the country--
``(1) has an excessive level of military expenditures;
``(2) has repeatedly provided support for acts of
international terrorism, as determined by the Secretary of
State under section 6(j)(1) of the Export Administration Act
of 1979 (50 U.S.C. App. 2405(j)(1)) or section 620A(a) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2371(a));
``(3) is failing to cooperate on international narcotics
control matters; or
``(4) engages in a consistent pattern of gross violations
of internationally recognized human rights (including its
military or other security forces).
``(d) Programs To Combat HIV/AIDS and Poverty.--A country
that is otherwise eligible to receive cancellation of debt
under the modifications to the Enhanced HIPC Initiative
described in subsection (a) may receive such cancellation
only if the country has agreed--
``(1) to ensure that the financial benefits of debt
cancellation are applied to programs to combat HIV/AIDS and
poverty, in particular through concrete measures to improve
basic services in health, education, nutrition, and other
development priorities, and to redress environmental
degradation;
``(2) to ensure that the financial benefits of debt
cancellation are in addition to the government's total
spending on poverty reduction for the previous year or the
average total of such expenditures for the previous 3 years,
whichever is greater;
``(3) to implement transparent and participatory
policymaking and budget procedures, good governance, and
effective anticorruption measures; and
``(4) to broaden public participation and popular
understanding of the principles and goals of poverty
reduction.
``(e) Definitions.--In this section:
``(1) Country suffering a public health crisis.--The term
`country suffering a public health crisis' means a country in
which the HIV/AIDS infection rate, as reported in the most
recent epidemiological data for that country compiled by the
Joint United Nations Program on HIV/AIDS, is at least 5
percent among women attending prenatal clinics or more than
20 percent among individuals in groups with high-risk
behavior.
``(2) Decision point.--The term `Decision Point' means
the date on which the executive boards of the International
Bank for Reconstruction and Development and the International
Monetary Fund review the debt sustainability analysis for a
country and determine that the country is eligible for debt
relief under the Enhanced HIPC Initiative.
``(3) Enhanced hipc initiative.--The term `Enhanced HIPC
Initiative' means the multilateral debt initiative for
heavily indebted poor countries presented in the Report of G-
7 Finance Ministers on the Cologne Debt Initiative to the
Cologne Economic Summit, Cologne, June 18-20, 1999.''.

SEC. 502. REPORT ON EXPANSION OF DEBT RELIEF TO NON-HIPC
COUNTRIES.

(a) In General.--Not later than 90 days after the date of
enactment of this Act, the Secretary of the Treasury shall
submit to Congress a report on--
(1) the options and costs associated with the expansion
of debt relief provided by the Enhanced HIPC Initiative to
include poor countries that were not eligible for inclusion
in the Enhanced HIPC Initiative;
(2) options for burden-sharing among donor countries and
multilateral institutions of costs associated with the
expansion of debt relief; and
(3) options, in addition to debt relief, to ensure debt
sustainability in poor countries, particularly in cases when
the poor country has suffered an external economic shock or a
natural disaster.
(b) Specific Options To Be Considered.--Among the options
for the expansion of debt relief provided by the Enhanced
HIPC Initiative, consideration should be given to making
eligible for that relief poor countries for which outstanding
public and publicly guaranteed debt requires annual payments
in excess of 10 percent or, in the case of a country
suffering a public health crisis (as defined in section
1625(e) of the Financial Institutions Act, as added by
section 501 of this Act), not more than 5 percent, of the
amount of the annual current revenues received by the country
from internal resources.
(c) Enhanced HIPC Initiative Defined.--In this section,
the term ``Enhanced HIPC Initiative'' means the multilateral
debt initiative for heavily indebted poor countries presented
in the Report of G-7 Finance Ministers on the Cologne Debt
Initiative to the Cologne Economic Summit, Cologne, June 18-
20, 1999.

SEC. 503. AUTHORIZATION OF APPROPRIATIONS.

(a) In General.--There are authorized to be appropriated
to the President such sums as may be necessary for the fiscal
year 2004 and each fiscal year thereafter to carry out
section 1625 of the International Financial Institutions Act,
as added by section 501 of this Act.
(b) Availability of Funds.--Amounts appropriated pursuant
to subsection (a) are authorized to remain available until
expended.

Mr. BIDEN. Mr. President, as we consider legislation today on the
global epidemic of HIV/AIDS, I urge my colleagues to think about this:
While the poorest nations of the world lack the resources to provide
the most basic public health care and the most basic education, they
still send money to the international financial institutions
established by the wealthiest nations of the world.
The 26 countries currently qualified to receive debt relief under the
heavily indebted poor country--HIPC--program continue to pay more than
$2 billion annually on debt service.
That money goes to the World Bank and the International Monetary Fund
here in Washington, as well as other lenders, to pay the interest on
loans they have received over the years.
Unless we act now on this HIV/AIDS bill to reduce that debt burden,
we run the real risk that the resources we are providing them today
will find their

[[Page S6487]]

way back, not only to Washington, but to other lenders, such as France,
Germany, and Japan.
Deeper debt relief for those poor countries is essential to make the
work we are doing on this HIV/AIDS legislation as effective as
possible, and to make sure that funds do not leak out through the
mandatory spending these countries must do to service their debts every
year.
Money is money and the problem of these debt payments is very real
for these poor countries. As long as they face these mandatory debt
payments, the resources we are providing in this HIV/AIDS bill will be
less effective.
But deeper debt relief is also needed because the current HIPC
Program is not working.
In fact, last year the Bank and the fund honestly admitted that under
the current formula, many countries will simply not reach a sustainable
level of debt.
The amendment I am offering tonight aims to make the HIPC Program
itself more likely to succeed.
It is essentially the legislation Senator Santorum and I introduced
in the last congress, with the support of Senators Frist, Nickles,
Chafee, DeWine, and Specter on the majority side, along with Senators
Kerry and Sarbanes, Feingold, Murray, and others on this side of the
aisle.
Specifically, for the many countries facing a public health crisis--
such as the HIV/AIDS epidemic--we say that no more than 5 percent of
their revenues should go to service their debt to other nations and
international institutions.
For those who do not face such a crisis, debt service should exceed
no more than 10 percent of their budget.
Some debate remains about the most appropriate way to measure a
country's ability to pay its debt and still provide basic public goods
in the areas of health, education, and infrastructure.
So our amendment gives the administration the flexibility to find an
alternative measure that would achieve an equivalent level of debt
reduction--a level that these poor countries can sustain.
Only countries that quality for the existing HIPC Program--that sets
standards of economic reform and human rights--will participate.
The bottom line is that unless the U.S. and our G-7 partners reduce
debt service payment to manageable levels--no more than 10 percent of
Government revenue, 5 percent if the country has a major health
crisis--these nations will be unable to devote the necessary resources
to the fight against HIV/AIDS.
This amendment was part of the HIV/AIDS bill that passed the Senate
last year. It belongs on this legislation, too.
Although there is some confusion about how we got there, I believe in
retrospect the chairman, quite frankly, unknown to me, was not brought
into the loop on this. I assure him the reason I agreed to a voice vote
is because we had every Democrat, and I believe from personal
discussion we had at least four Republicans supporting the amendment. I
understand, without getting into all the detail, the bottom line is the
amendment has been signed off on by the White House in direct
discussions with my staff this afternoon. I would move the adoption of
the amendment.
I ask for a voice vote.
The PRESIDING OFFICER. The Senator from Utah is recognized.
Mr. BENNETT. Mr. President, I would like to ask the distinguished
ranking member of the Foreign Relations Committee if he knows--and I
see the majority leader here and I will ask him the same question--if
the House of Representatives has indicated they would accept this
amendment? I have been standing shoulder to shoulder with the chairman
of the full committee all night, voting against every amendment on the
basis that the House would not accept an amendment.
Now, the ranking member, Senator Biden, has said the White House has
indicated they would accept this amendment and that is very powerful
medicine for us. I do not want to abandon my chairman and the position
he has taken in support of the House bill, unless I can be assured that
on this amendment, unlike all of the others, the House leadership has
indicated they are willing to accept it.
I ask the ranking member and the majority leader, if either one of
them could respond, would the House be willing, contrary to what we
have been told about all the other amendments, to accept this
amendment?
Mr. BIDEN. Mr. President, I will respond to what I know firsthand. I
can only speak firsthand to the White House. It is my understanding,
and it has been asserted to me, that there have been discussions with
senior Republicans--I assume that that was shared by everybody, with
both the speaker and with Mr. Delay, and that they had signed on to
this. But I will respectfully suggest that I yield to Senator Santorum,
who may be able to give you a more direct answer. I personally, for the
record, have not spoken with anybody in the House of Representatives.
Mr. SANTORUM. Mr. President, this amendment has been agreed to by the
White House and has been agreed to by the speaker and the majority
leader. This, in the amended form, has been changed substantially from
the proposal that the Senator from Delaware originally put forward. It
is now not mandating the State Department to do anything; it is
suggesting that they should do this.
So it is a flexible amendment. It expresses the sentiments of this
body, and it will express the sentiment of the House when they agree to
this amendment as well as the underlying bill. This is an issue they
should take seriously and give due consideration to. Both the speaker
and the majority leader, having talked to their people in their
respective committee jurisdictions, are comfortable with this
language--the ``should'' language as opposed to the ``shall'' language.
That was the main issue. Because of its advisory nature, as opposed to
a mandatory nature, they are willing to accept it.
Mr. BIDEN. If the Senator will yield. In addition, I agreed with the
White House to further amend my amendment to change the effective date,
which was a very important element to the White House. They wanted the
original language we had in Lugar-Biden that we moved off of to go to
the House bill, and in previous language that we had in other bills,
including the original bill which came out of the committee and passed
out of here. It had language relating to the effective date when
countries could qualify to meet the test for this. The White House
wanted it tighter, wanted it more stringent.
We took the better part of the afternoon, 3 or 4 hours, negotiating
back and forth. We yielded on that point as well. That is the point at
which the White House spokesperson from the National Security Agency
said to us, ``We have a deal.'' That is when it then got scrubbed. That
was even more palatable, I am told, to the speaker and the majority
leader. That is as much as I can say firsthand.
Mr. BENNETT. I thank the Senator. Mr. President, I had stayed here
prepared to vote against the amendment, to vote against all amendments,
not knowing that the Senator from Delaware had these conversations with
people at the White House and the Senator from Pennsylvania had these
conversations with the leadership of the House. Therefore, I feel
released from my previous commitment to oppose all amendments when I
discover that passage of this amendment will not only not impede
passage of the bill--as was the case with the other amendments--it
would in fact enhance passage of the bill on the basis that both the
House and the White House were willing.
So I appreciate knowing this new information. On the basis of this
information, it will cause me to change my position. I thank the
Senator for sharing this information with me.
Mr. LUGAR. Mr. President, I have been listening to all of this
information. Let me simply say that, throughout the evening, I have
asked Senators to vote against amendments. That was based upon the
feelings of our colleagues in the House of Representatives, who passed
the bill--namely, my friends Henry Hyde, Tom Lantos, and likewise in
the course of this debate, I have mentioned conversations with the
President himself, who wanted this bill unamended so there would not be
a need for a conference and for difficulty. I have not been apprised by
anybody at the White House, or in the House leadership, of any other
situation.

[[Page S6488]]

I am perfectly willing to accept, on good faith, the assertions of my
colleagues who have had these conversations. But for the sake of the
Record, when the voice vote comes, I will vote no because I have asked
my colleagues to vote no on each amendment. I will continue in that
frame of mind.
But I have listened carefully and I understand what, apparently, have
been conversations and agreements and I appreciate that.
I know of no reason to extend the debate, unless the majority leader
has something.
The PRESIDING OFFICER. The question is on agreeing to the amendment.
The amendment (No. 686) was agreed to.

microbicides: hiv prevention's new hope

Mr. CORZINE. Mr. President, today we are considering landmark
legislation to provide $15 billion to expand prevention, treatment, and
care in the developing world to address the AIDS epidemic and other
infectious diseases.
We know that the heart of the global HIV epidemic is in Africa. We
also know that the center of the epidemic in Africa is among women.
Biologically, women are four times more vulnerable to HIV infection
then men. And tragically, in Africa, and indeed throughout the
developing world, it is widely understood that a woman's single
greatest risk factor for contracting HIV is being married and
monogamous.
This astounding and tragic fact bears repeating: The typical woman
who gets infected with HIV has only one partner--her husband. Women's
vulnerability increases due to their lack of economic and social power
in many societies, where they often cannot control sexual encounters or
insist on protective measures such as abstinence or mutual monogamy.
This trend devastates families and puts children at risk.
If we pass legislation today that ignores this stark reality, we will
be back here a few years from now, scratching our heads and wondering
what we can do to stem the tide of infections. If we want to contain
the epidemic, we have to help women.
Women need HIV-prevention tools that they can control to safeguard
their health and that of their families and communities. One of the
most promising prevention tools is microbicides. Once developed,
microbicides and vaccines would serve as complimentary prevention
technologies, with microbicides giving women the power of prevention.
It is important to emphasize that microbicides are being designed
first and foremost to protect against infections, not necessarily
against pregnancy. This issue has nothing to do with birth control. It
has nothing to do with spermicide Nonoxynol-9, which prevents
pregnancy, but not disease. Microbocides are about preventing HIV.
Scientists are hopeful that they can develop microbicides that would
allow women to protect themselves from this and other sexually
transmitted diseases--while also enabling them to conceive a child.
While the bill we are considering today acknowledges microbicides as
a promising prevention tool, it does not go nearly far enough in
supporting this area of research and development. I introduced
legislation last Congress and again this session to give greater
Federal support to microbicides research and development.

While microbicides are not a magic bullet, once available, many
researchers believe that could prevent millions of infections. And with
leading scientists concluding that a vaccine is likely to be more than
10 years away, we need to make a strong commitment to developing
complementary prevention tools such as microbicides. Even when we get a
vaccine or vaccines to tackler this epidemic, complementary prevention
strategies such as microbicides will be needed for decades to come.
Let me take a minute to review the state of the science in this
field. Scientists are currently testing approximately 65 different
microbicide compounds to determine whether they will help to protect
against HIV and/or other STDs. Of these, I7 are in clinical trials that
will assess their safety for human use, and 4 are being readied for
large trials that will assess their effectiveness. If one of these
leads proves successful and investment is sufficient, a microbicide
could be publicly available in 5 to 7 years.
The cost of developing the existing pipeline of microbicide candidate
products has been estimated at $775 million over 5 years. Currently,
however, U.S. Federal funding for microbicides is only about $75
million annually. Microbicides are a public health good for which the
social benefits are high but economic incentives to private investment
are low. Despite the potential market size, neither pharmaceutical nor
major biotech companies have made large investments in the field
because many of the benefits of microbicides are public benefits for
which manufacturers will not be directly compensated. Like other public
health goods, such as vaccines, public funding must fill the gap left
by market failure.
The National Institutes of Health, principally through the National
Institute of Allergy and Infectious Diseases, NIAID, spends the
majority of Federal dollars in this area. However, microbicide research
at NIH is currently conducted with no single line of administrative
accountability or specific funding coordination. What is needed is for
the Director of NIAID to establish a branch dedicated explicitly to
microbicide research and development, and to provide this new branch
with appropriate staff and funding.
In addition, other Federal agencies such as CDC and USAID undertake
microbicides research and development activities. Because there is no
Federal coordination, however, there is a risk of inefficiencies and
duplication of effort. Through a variety of committees, Congress has
requested that NIH and its Office of AIDS Research provide Congress
with a ``Federal coordination plan'' for research and development in
this area, but formal submission of this plan has been repeatedly
delayed.
Will the Senate majority leader join me in urging NIH to consider
establishing a branch dedicated explicitly to microbicide research and
development, and to provide this new branch with appropriate staff and
funding?
Mr. FRIST. I agree with the Senator from New Jersey about the
critical importance of research on microbicides, and I commend him for
his leadership on this important issue. I applaud his efforts to better
coordinate research conducted at USAID, CDC, and NIH, and to increase
Federal funding. I urge the leadership at NIH to five his proposal
prompt and careful consideration.
Mr. CORZINE. I thank the distinguished majority leader for his
comments and for his support of this important initiative.

ASSISTANCE FOR ORPHANS AND VULNERABLE CHILDREN AFFECTED BY HIV/AIDS

Ms. LANDRIEU. Mr. President, to date, approximately 14 million
children have lost their parents to the AIDS virus. In many cases, this
devastating disease has robbed them of their parents, their aunts,
uncles, cousins, brothers and sisters. At a time when they are most in
need of the care of loving adults, millions of children are left
without anyone to call their own. Some of them are sick themselves,
infected often at birth. If we are serious about $1.5 billion for
programs aimed at assisting children orphaned by AIDS, then we must do
all that we can to ensure that these programs reflect their many needs.
I would suggest that the language in the underlying bill is remiss in
that it does not address perhaps their most urgent need, the need for a
permanent, loving home. I would like to commend the majority leader and
the committee chairman for their foresight in insisting that 10 percent
of the funds allocated in the bill be used to serve the educational,
development and health needs of these young people. Yet, if these
programs are not also focused on connecting children to at least one,
caring adult, these programs will undoubtedly fall short of their
potential. Every child needs a home. A child whose family has been
devastated by disease is no exception. As a member of the Foreign
Operations Appropriations subcommittee, I hope that we could address
this issue at some point. Again, I thank the majority leader for his
leadership and look forward to working with him.
Mr. FRIST. Mr. President. I commend the Senator from Louisiana for
her leadership in the area of adoption. She is right to suggest that we
focus these programs on an orphan child's

[[Page S6489]]

need to find a permanent, loving home. I would be happy to work with
her toward this end.

eligibility for assistance

Mr. LAUTENBERG. Mr. President, I see the distinguished majority
leader, Senator Frist, and wonder if I could ask him to address a
concern I and other Senators have about a provision entitled
``Eligibility for Assistance'' which is located on page 61, line 18 of
the bill.
Mr. FRIST. I would be happy to.
Mr. LAUTENBERG. This provision says that an organization that is
otherwise eligible to receive assistance authorized by this Act to
prevent, treat, or monitor HIV/AIDS, shall not be required, as a
condition of receiving that assistance, to endorse or utilize a
multisectoral approach to combating HIV/AIDS, or to endorse, utilize,
or participate in a prevention method or treatment program to which the
organization has a religious or moral objection.
Again, I support this provision, because there are faith-based groups
that are playing a crucial role in HIV/AIDS prevention and treatment
which do not, for example want to distribute condoms. I understand
that. There are other ways that they can be effective, through
counseling, treatment, care and other services. They should not have to
distribute condoms if they have a religious or moral objection.
But there is a problem, which this provision fails to explicitly
address. Some of these same groups that object to distributing condoms,
have actively sought to discourage people from using condoms. They have
told people who have come to them for advice and counseling that
condoms are bad, that they should not use them, and, erroneously, that
condoms usually fail.
This is wrong. It is wrong from a medical point of view and it is
wrong from an ethical point of view, because the consequence of
providing this type of inaccurate or misleading information can quite
possibly be death. Yet this provision does not address this very real,
and very serious, problem. I would ask the majority leader how we can
be sure that when these organizations, receive Federal funds, any
information they provide about approaches to HIV/AIDS prevention is
complete and medically accurate, including both the public health
benefits and failure rates of the approach involved.
Mr. FRIST. I thank the Senator from New Jersey for his question. This
is an important issue. I fully agree that it is essential that
information about approaches to HIV/AIDS prevention be medically
accurate, including both the public health benefits and failure rates
of the approach involved. That is what is intended by this provision.
In fact, the provision uses the words ``an organization that is
otherwise eligible to receive assistance''. I believe that ``otherwise
eligible'' should be interpreted to require explicit assurances by such
organization that when it provides information about HIV/AIDS
prevention approaches it will meet this standard of accuracy.
Mr. LAUTENBERG. I thank the majority leader. I agree that these
assurances are needed and that they should be routinely spelled out in
any contract or grant agreement between the U.S. Government and such
organization in order to clarify the intent of this provision.

Global Epidemic of Tuberculosis

Mrs. BOXER. Mr. President, I want to highlight one critical area of
this important legislation, and that is the global epidemic of
tuberculosis. While I appreciate the language on TB that was included
in this bill at my request, I am disappointed that there is not a
specific earmark for TB programs.
The Kerry-Frist bill that passed the Senate last year included
specific increases for funding for international tuberculosis programs.
That bill authorized $150 million bilaterally for international
tuberculosis in fiscal 2003 and $200 million for 2004.
It is critically important that funding for tuberculosis remain a
priority. There is a particular need to highlight the need for expanded
tuberculosis funds given that the President's 2004 budget request calls
for a reduction in funding to combat TB. We must not only protect but
significantly expand funds for programs that combat tuberculosis. Here
is why:
TB is an immense global killer. Nine million people become sick with
active TB every year and 2 million people are killed by the disease.
Tuberculosis is medically linked with the global AIDS pandemic. TB is
the leading killer worldwide of people with HIV, because those who
contract HIV suffer from weakened immune systems and they develop
active TB. TB rates have increased five-fold in some African nations in
conjunction with AIDS.
But there is hope. Basic TB treatment is incredibly effective and can
cure over 90 percent of cases even in resource-poor settings, even in
people with HIV/AIDS. This treatment, called DOTS, which stands for
Directly Observed Therapy Short-course, uses drugs that cost just $10,
for a full 6 months of treatment. Few health interventions are so
effective and affordable.
There is even a mechanism for getting high-quality drugs to poor
countries, called the Global TB Drug Facility. The TB Drug Facility is
a critical part of the global effort to combat TB. The TB Drug Facility
needs just $50 million per year in order to reach its goals of averting
25 million TB deaths by 2020, but the U.S. has only contributed a
little over $3 million to the Drug Facility so far. The U.S. must
contribute more to this important mechanism.
And, the U.S. must do more to help expand access to DOTS treatment
for those who are sick with TB. Currently, fewer than one in three
people who need basic TB treatment have access to it. And only a
fraction of those with drug-resistant TB are receiving needed
treatment. The need is clear. We must do everything we can to ensure
that access to treatment for tuberculosis is expanded, before drug-
resistance and TB's interaction with HIV make this into an unstoppable
epidemic.
I want to thank my friend from Oregon, Senator Smith, who has been so
helpful in working with me over the past several years to make sure
that international TB programs remain a priority.
Mr. SMITH. Mr. President, it has been my great pleasure to work with
my colleague, Senator Boxer, over the past years to put global
tuberculosis control on the map as an important priority for U.S.
funding.
I share the Senator's concern that the United States continue to
protect and expand the funds we allocate to this important cause.
We must indeed not lose our focus on combating global TB even as we
respond efficiently and effectively to SARS. We must remember that
failing to protect and expand funds to combating TB means needless
death for 2 million people in the developing world each year--people
who are teachers, doctors, civil servants, and people who are parents
to young children who need their protection, financial support, and
guidance. We must remember that the problem of tuberculosis is
inextricably linked together with the growing problem of global HIV. TB
is the biggest killer of those with HIV, and TB also accelerates the
course of AIDS. Treating TB can save lives and slow the progression of
AIDS.
We also must remember that treating tuberculosis works. We know what
to do and that we have some of the key elements in place to
successfully control this disease. As Senator Boxer mentioned, we have
the Global TB Drug Facility in place. And we have a Global Plan to Stop
TB. And the new Global Fund to Fight AIDS, TB, and Malaria is adding to
the bilateral efforts of the U.S. and other nations.
So we must use these mechanisms and use our window of opportunity to
expand access to TB treatment before it is too late, before drug-
resistant TB and HIV/AIDS turn TB into a disease that is nearly
untreatable and an epidemic that is at best very difficult to deal with
and at worst perhaps uncontrollable.
Does the majority leader agree that global tuberculosis control ought
to receive adequate increased funds from the U.S. in the next fiscal
year?
Mr. FRIST. Mr. President, I appreciate the points raised by Senator
Boxer and Senator Smith and will work with them to ensure that adequate
funding is provided for U.S. bilateral TB programs.
Mr. DeWINE. Mr. President, this is an historic day. I am very pleased
that the Senate is moving forward with this AIDS relief bill--a bill
that represents an unprecedented commitment to

[[Page S6490]]

fighting the global scourge of HIV and AIDS. It is a good bill. It is a
bill that has both bicameral and bipartisan support. It is a place to
start--a beginning, not an end.
I would like to take just a moment to thank my colleagues both in the
Senate and in the House who have been working tirelessly in this fight
against AIDS. They have spent countless hours crafting a bill that is
going to make a difference--a bill that is going to help save and
prolong the lives of millions worldwide. I especially commend Majority
Leader Frist for his leadership and vision and Senators Lugar, Durbin,
Santorum, Biden, and Kerry for their dedication to this fight, as well
as Representatives Hyde and Lantos for crafting a bill in the House
that recently passed by an overwhelming vote of 375 to 41.
I thank them all for their efforts, for their compassion, and for
their commitment.
I also applaud the President and Secretary of State Powell for their
dedication to easing the worldwide suffering caused by the HIV/AIDS
pandemic. They understand that we, as a nation, have an obligation to
fight this disease. We have the ability to fight it. We have the tools.
And, it is our duty--as a leader in the world--to move forward now and
do the right thing.
To be sure, there are a number of issues--very important public
policy issues--and differences that still need to be resolved as we
move ahead. However, while those issues are important, we must not lose
sight of the urgent need to do something about AIDS now. This HIV/AIDS
relief package is a public health initiative of a magnitude never
before undertaken in this country.
It is an enormous task that will require a coordinated effort among
the State Department, Department of Health and Human Services, and
USAID and multiple NGOs and faith-based organizations. Because of that,
we need to start putting the infrastructure in place--today.
We need to start coordinating efforts--today.
We need to get the programming started--today.
We need to do all of these things so we can be ready to go when the
money gets appropriated--so that on ``Day One'' when the money is
available in the field, people in these impoverished nations who
desperately need anti-retroviral treatment drugs can start receiving
them and prolong their lives--so that pregnant, HIV-infected mothers
can get the drugs they need so they don't transfer the disease to their
children.
Ultimately, Mr. President, this bill represents a starting point.
Each one of us who has studied the HIV/AIDS issue would have changes to
the bill if we were writing it just ourselves, and frankly, no one
knows the future and can see exactly the landscape of the new ground we
are plowing here. So really, none of us here can be sure that the
precise approach we have taken or the precise figures and precise
percentage allocation of dollar amounts for certain things is correct.
But, we have to start somewhere. The most important thing is that we
start--and this is the start. This is the beginning. It is a major
first step.
This bill is different than anything we have done in the past. It is
a holistic approach to fighting global AIDS. It will have to be
followed with appropriations money, and we will need to come back year
after year to get that funding, but this bill gives us a place to
start. It takes a balanced, comprehensive approach to combat the
scourge of HIV/AIDS, Tuberculosis, and Malaria.
It will focus funds on education and prevention and treatment--
treatment in terms of mother-to-child transmission, treatment of
mothers who already have children, and treatment of all infected adults
and children who have AIDS. This type of comprehensive approach, Mr.
President, can and will make a difference.
As I said, Mr. President, I believe this is a good bill--a good
starting place--a major first step. Underscoring all of the major
provisions of this bill is the moral imperative to fight this horrible,
tragic disease. Over the last few months and years, we have heard
countless statistics about the devastation AIDS is causing. Those
statistics are troubling. They are disturbing. But, until there is a
face and a name attached, those suffering from the disease remain
statistics. I would like to take a few minutes to talk to my colleagues
about the faces I have seen--the faces of children and babies with
AIDS.
In February, my wife Fran and I traveled to Haiti--our 12th trip--and
we saw once again what this disease is doing to this nation and its
people.
In Haiti today, a nation of approximately 8 million people--300,000
currently live with AIDS. We have seen the devastation this is causing.
We have held dying babies in our arms--babies who could have been
saved--babies who could live and grow up if they only could get the
treatment drugs they need to stay alive.
We traveled to Guyana in February, as well, and saw the same
devastation--too many children and adults dying of this horrible
disease and too few drugs to go around to help treat them and keep them
alive. Right now in Guyana--a nation of roughly 800,000 people, 35,000
have been identified as HIV-positive or as having AIDS. Of those 35,000
people, only 200--less than one percent--are getting anti-retroviral
drug treatment. And, of the many children in Guyana with AIDS, only one
of those children--only one--is receiving anti-retroviral drugs!
In Haiti, we visited an orphanage that has an entire floor just for
AIDS babies. What you see is truly tragic--row after row of steel cribs
with babies at various stages of the disease--none of whom are
receiving any sort of anti-retroviral drug treatment.
I remember seeing a little boy--he was about four or five years old--
named Francois. He had AIDS and was very close to death. He was laid
out on a makeshift bed on the cold, concrete floor. He had an I.V.
attached to him, and he was getting some fluids. The wonderful people
who were caring for him explained that little Francois was no longer
able to keep any food down. He was within days of death. There were no
drugs available to treat him. So, the people caring for him were loving
him, nurturing him, and were doing what they could to make him as
comfortable as possible in the little time he had remaining.
I will never forget that child--I will never forget little Francois.
I will never forget him for the rest of my life.
Another little boy who I will never forget appeared the opposite of
little Francois. This little boy was about 7 years old, and also has
AIDS, but he seemed to be very healthy. He was lively and content and
thriving. But, that won't last.
Very likely, unless something changes--unless he gets the treatment
drugs that he'll eventually need--this 7 year-old boy, whom I cannot
get out of my mind, will also eventually die.
His death will be a needless one. It will be needless because these
drugs are available. It is just that the folks caring for this little
boy do not have access to them. Money is not available. The drugs are
not available. That is an injustice. It is wrong. And, it is a great
human tragedy.
Let me conclude, Mr. President, by again thanking my colleagues for
their efforts in getting this bill passed. We are telling the world
that the United States cares and that we will lead the fight against
this dreaded disease. We can make a difference, Mr. President--and we
will make a difference. There is hope. This bill gives us more hope.
We are moving ahead. We are moving in the right direction. We are
finally doing the right thing.
Mr. McCAIN. Mr. President, Senate passage of this bill authorizing
the expenditure of $15 billion over 5 years to combat HIV/AIDS sends an
important message: that the United States is committed not only to
making this a safer world, by ending threats posed by terrorists and
rogue states, but also a better, more humane world, by helping people
in need in Africa, Asia, and elsewhere cope with the ravages of the
HIV/AIDS pandemic.
The spread of HIV/AIDS, and the efforts of the international
community to combat it, will be remembered by history as one of the
defining issues of our time. Until recently, we have been losing the
battle: the disease has infected 68 million people to date. It has
already brought disaster to Africa, where AIDS has taken over 20
million lives and has surpassed malaria as the leading cause of death.
UNAIDS estimates that by 2020, an additional 55

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million Africans will lose their lives to the disease. There are
currently 11 million AIDS orphans in Africa. Average life expectancy in
Sub-Saharan Africa is currently estimated at 47 years, but it would be
62 years in the absence of AIDS.
These numbers are staggering. The ethical implications of not doing
everything in our power to slow the spread of this disease are severe.
The most basic morality requires that we commit ourselves to combating
HIV/AIDS everywhere. The social and political implications of allowing
this disease to claim its grim toll are grave: countries cannot survive
the death of a quarter or more of their populations without severe
unrest, impoverishment, even radicalization and revolution. In Africa,
more women are infected with HIV/AIDS than men; their central role in
family life means their deaths have disproportionate effect. Millions
of children cannot lose their parents without lasting damage to
themselves and their societies. In many countries, the army has higher
infection rates than the general population. Mass death among uniformed
personnel will have profound implications for political stability and
national security in these countries, as armies literally become unable
to fulfill their basic duties.
As the CIA assessed in 2000 for the 20-year period through 2020,

At least some of the hardest-hit countries, initially in
sub-Saharan Africa and later in other regions, will face a
demographic catastrophe as HIV/AIDS and associated diseases
reduce human life expectancy dramatically and kill up to a
quarter of their populations over the period of this
estimate. This will further impoverish the poor, and often
the middle class, and produce a huge and impoverished orphan
cohort unable to cope and vulnerable to exploitation and
radicalization.

As the World Bank and others have reported, AIDS affects the most
economically vibrant group within society, the working-age men and
women who account for most national output. With one quarter of a
country's population facing impending death, labor markets would be
ravaged, the benefits of education lost, and health-care spending
rationed on what should be a society's most fit citizens. Resources
that would have been used for productive investments would instead be
apportioned for health care, orphan care, and funerals. Decades of
gains in social welfare could be rolled back. National productivity and
economic growth would be set back for generations.
HIV/AIDS is decimating Africa, but its next frontier lies in Eurasia.
More than 7 million people in China, Russia, and India carry the
disease, but as we have seen in Africa, an infection rate of that
magnitude can jump into the tens of millions within a decade. As
Nicholas Eberstadt has written, ``The coming Eurasian pandemic
threatens to derail the economic prospects of billions and alter the
global military balance.'' Africa's plight alone is reason enough to
pass this bill. Given the economic size and military stature of India,
China, and Russia, the world will simply not be able to ignore the
consequences of the coming AIDS crisis in Eurasia.
Given the scale of human disaster and socio-political turmoil we
confront from HIV/AIDS, enactment of the bill before us represents a
critical step in the direction of leading the world in a common
response to a crisis that affects us all. This bill nearly triples the
U.S. commitment for international AIDS assistance. It targets most
assistance at the 14 most afflicted countries in Africa and the
Caribbean, but can incorporate other afflicted countries if necessary.
It demonstrates the United States' commitment to leading a global
campaign against a disease that has already killed 25 million people.
As Uganda in particular has shown, AIDS can be managed and contained.
Often the biggest challenges are political will, which has been sorely
lacking in much of Africa, and government competence to effectively
diagnose and treat victims, backed by a decent health care
infrastructure. Afflicted nations with whom we partner to fight this
disease must know that we expect a level of governance, transparency,
and effectiveness from them in order to make the fullest use of AIDS
assistance.
The scale of the AIDS crisis, and the consequences of inaction in the
face of a pandemic that threatens the global order, call for the type
of bold leadership reflected in this bill. Our commitment must be
sustained, and we must enjoy the partnership of other wealthy nations
in this effort. We cannot afford to fail.
Mr. ENZI. Mr. President, I rise today in support of H.R. 1298, the
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003. I urge my colleagues to join me in passing this bill
without amendment.
Why am I speaking on this subject? Why I am so committed to the swift
passage of this bipartisan global AIDS bill? No one in my family and
none of my close friends has AIDS. Nor have I traveled to Africa to
care for people suffering from AIDS, as has our distinguished majority
leader, Dr. Frist.
Well, I am speaking on this subject for one reason and one reason
only: I believe that passing this bill as soon as possible is the right
thing to do. We have a responsibility to fulfill--and an opportunity we
cannot squander.
Millions of people are dying needlessly. We have the ability to make
an investment that will save millions of lives and give hope and
security to millions more. Doing nothing is not an option.
We live in a highly interconnected world. Today more than ever,
creating a more peaceful and secure environment for the people of one
region translates into more peace and security for people around the
globe. By increasing our commitment to fight AIDS in Africa and the
Caribbean, we also will be helping our nation and the rest of the
international community. The world awaits our response.
As the cries for help from Africa increase, and the world watches to
see what we will do, President Bush has challenged the Congress to
provide the assistance that would begin to rid the world of this deadly
menace.
If we pass this bill, we will provide the people of Africa with hope
for a better and more secure future. If we do not, history will not
soon forgive--or forget--that a nation blessed with all the resources
we have at our disposal failed to act when we heard the cries of the
people of Africa.
Let me remind my colleagues what the President has challenged us to
do. He asked us to send him a bill that would prevent 7 million new
infections--or 60 percent of the projected new infections in the target
countries. He asked for a bill that would treat 2 million HIV-infected
people in the target countries--as opposed to fewer than 100,000
today--using the latest advances in drug therapy. He also asked for a
bill that would provide care and comfort for 10 million HIV-infected
people and AIDS orphans.
The bill before us today would do all of these things. It represents
the first global effort to provide advanced anti-retroviral treatment
on such a large scale in the poorest and most afflicted countries. This
bill also would make the successful Ugandan model of prevention--in
other words, putting abstinence first--the basis of our global
prevention strategy.
The bill would require accountability and transparency from both the
Global Fund and our bilateral efforts. The recent GAO report on the
Global fund raises some legitimate concerns about how this 16-month-old
organization manages its contributions and monitors its projects. The
bill before us would mandate careful scrutiny of and accounting for how
the Global Fund spends the contributions it receives.
In short, this bill both reflects American values and recognizes that
we need the active involvement of all countries in the struggle against
AIDS. It also reflects a bipartisan compromise. This bill passed the
House 375 to 41, with only 1 Democrat in opposition.
Now I realize that no one is completely satisfied with this bill. I
have colleagues on both sides of the aisle who might prefer to change
one section or another to make it a better bill. However, we cannot
afford to let the perfect be the enemy of the good.
We don't have time to let the legislative process drag on while
people around the world are dying--waiting for us to act. Time is not
on our side--or theirs!
I know many of my colleagues strongly support the Global Fund.
President Bush supports the Global Fund too. In fact, his Secretary of

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Health and Human Services, Tommy Thompson, is the fund's new chairman.
The President has pledged to continue our commitment to the Global
Fund even as he proposes expanding and targeting our bilateral country-
to-country initiatives to fight AIDS. By providing both bilateral and
multilateral funding, this bill doesn't pin all of our hopes--or our
taxpayers' money--on any one approach to addressing this crisis.

If you support the Global Fund, you know that the Senate's delay
would mean a missed opportunity to increase the international
commitment to fighting AIDS globally.
The United States is the single largest donor to the Global Fund. As
of April 1, the United States had pledged nearly half of the $3.37
billion in total pledges to the Global Fund. We have already
appropriated $650 million to the Global Fund, and we have pledged an
additional $1 billion over the next 5 years.
We are already doing more than our fair share for the Global Fund.
What we need to do now is to encourage the rest of the international
community to step up to the plate.
President Bush is traveling to France next month for the G-8 Summit.
This summit is a meeting of the political leaders of the world's
largest economies. When would there be a better time to encourage other
countries to increase their own contributions to the Global Fund?
If you are concerned with the future viability of the Global Fund,
you also should be concerned about passing this bill now. Our swift
action will demonstrate our commitment to seeing this battle through.
It will also give the President a great tool with which to leverage
additional funding from other nations.
On the other hand, amending this bill will result in a lengthy
conference with the House. If we don't get this bill to the President
until the summer, we will miss a golden opportunity to encourage more
financial support for the Global Fund from the G-8 members. If we don't
finish action on this bill until the fall, then the State Department
will have lost the time it will need to get ready for the coming year's
appropriations for our expanded bilateral AIDS initiatives.
Clearly, these are not artificial timelines. Even less artificial are
the timelines that AIDS places on a person's life and a family's
future.
In the 3 months since President Bush announced his emergency plan,
nearly 800,000 people have died from AIDS. In those 3 months, 1.2
million people have been infected with HIV, and more than 175,000
babies have been born with the virus. Every day we spend debating this
bill on the Senate floor or in a conference with the House means more
lives lost--lives that could have been saved had we acted sooner.
Our Founding Fathers were never more inspirational than when they
wrote that our Creator has endowed us with certain unalienable rights--
and among these are life, liberty and the pursuit of happiness.
Swift passage of this bill will again show the world that these
aren't just words on a piece of paper. Swift passage will again show
that these words apply to every citizen of every country--not just our
own.
In Africa and the Caribbean, the scourge of AIDS is robbing people of
their natural rights. We know the thief is a virus. We also know how we
can stop this thief from stealing the lives of people--from stealing
fathers and mothers from their children. But with this knowledge comes
an obligation to use it.
For so long we could only treat the symptoms of AIDS and provide
comfort to the dying. Today, we have the ability to fight back against
HIV itself. Today we have medicines that can effectively halt the
evolution of HIV and help people live a normal life. In other words, we
have the technology and the know-how to stop AIDS from killing people,
destroying families, and destabilizing societies.
By sending this legislation to the President, we will save the lives
of millions of people and liberate them from the tyranny of AIDS. And
we will demonstrate, once again, that we are a principled nation that
leads through actions, not words.
I urge my colleagues to vote for this bipartisan bill and send it
without amendment to the President.
Mr. HATCH. Mr. President, I rise to speak in support of the pending
legislation.
I think it is important for the Senate to endorse the work of the
House on the issue of international AIDS funding.
As with many of our colleagues, I was absolutely thrilled to hear
President Bush use the State of the Union Address as an occasion to
display his leadership on the critical issue of the pandemics of HIV,
tuberculosis, and malaria in Africa, the Caribbean, and the developing
world.
We must give President Bush, Vice President Cheney, and Secretaries
Powell and Thompson a lot of credit for urging the Congress and
American public to give a higher priority and more resources to these
deadly, intertwined epidemics. An estimated 30 million of our African
neighbors are infected with HIV. About 11,000 Africans become infected
each day.
Tragically, of the 25 million who have died due to HIV infection
worldwide, about 20 million, or 80 percent, were Africans.
Unfortunately, it is likely that many more millions will follow them to
an early death unless significant efforts are made to turn the tide of
these epidemics. For example, about 40 percent of the citizens of
Botswana are infected with HIV and the infection rate in many other
countries is in the 1-in-5 and 1-in-4 range.
The Bush administration deserves a lot of credit for making this
issue a priority at a time when the Federal budget is once again facing
severe strains.
If our Nation takes a leadership role in helping nations in the
developing world address the problems associated with infectious
diseases such as HIV, TB, and malaria, these nations will remember us
as an ally who helped them when they most needed aid.
Let me be frank. There are many citizens in the developing world who
sometimes question the motives of the United States in international
affairs. We saw this dynamic at play in the debates leading up to and
in the aftermath of the recent war in Iraq.
It seems to me that in undertaking this important public health
initiative at this time when we are once again struggling to regain
control of the Federal budget--there can be no question that the motive
of our country is nothing more than to try to help millions of people
from perishing from a group of deadly infectious diseases that threaten
to destabilize sub-Saharan Africa and the Caribbean for decades to
come. If such longtime NATO allies such as France and Germany do not
see eye to eye with us on certain aspects of Mideast policy, perhaps
they and the rest of the developed world can agree with us that now is
the time to roll up our sleeves and make the commitment of necessary
resources to help those developing nations fight the interconnected
scourge of HIV, TB, and malaria.
This is exactly the type of challenge that President Bush will issue
at the upcoming G-8 meeting. I hope and trust that the leaders of these
countries will work together with us on reversing the course of these
epidemics.
I have been active in developing legislation related to AIDS since
the onset of the epidemic. In my former capacity as a member--and
chairman--of the Senate Labor Committee, I was a coauthor of the Ryan
White CARE Act, the Terry Beirn AIDS Research Act, and worked to
increase appropriations for research and services related to AIDS.
I am a conservative. I share the concerns many have expressed that
this bill could fund activities with which we disagree. To be clear, I
very much disapprove of many of the behaviors by which HIV is
transmitted.
That being said, early on in this epidemic, I learned the wisdom of
the old adage, ``Hate the sin, but love the sinner.''
High-risk behaviors--for example, intravenous drug abuse--are hard to
break. But, as a society, can we use behaviors with which many of us
vigorously disagree as an excuse to abandon our responsibility to help
individuals who are trying to kick their dependency on drugs? I think
not.
It is important to employ proven public health strategies to prevent
the spread of HIV, even if some of these techniques and educational
messages can be viewed as controversial if taken

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out of context of a public health crisis. We must also recognize
geographic differences in what strategies are most proven and
acceptable. Appropriate public health education prevention and
education tactics are often different in Salt Lake City and New York
City, or for that matter, Ho Chi Minh City.

There was a spirited debate in the House over the proper balance
between abstinence and other risk reduction techniques such as the role
of condoms. I don't want to replay the whole debate over the rule that
33 percent of prevention funds must be devoted to reenforcing an
abstinence message. I believe in abstinence. I also am mindful of the
fact that in some geographic regions such an inflexible rule may not
represent an optimum use of prevention dollars.
There are elements of the House bill that I do not like. But I must
salute the efforts of Chairman Hyde and Representative Lantos for
working so long and hard to find a consensus and get this legislation
out of the House.
Let me just add that I have heard the frequent--and not unjustified
complaints to my mind--of the House leaders who observe that they are
often faced with the prospect of passing what they consider watered
down Senate versions of legislation after the House has taken action.
It is well known that the House majority leadership views the tax
legislation we just adopted earlier this evening to be a prime example
of this dynamic.
When all is said and done, the Constitution set forth a bicameral
legislative body with different membership criteria and different
election cycles. It is not surprising that it is often the case that
the House and Senate come up with different legislative provisions. In
the normal case, these differences can be ironed out by the vehicle of
a conference committee.
However, sometimes the regular order of the conference report is in
tension with outside events. The case of the upcoming G-8 meeting is
just one of those circumstances. As my friend Chairman Hyde wrote in an
op-ed piece earlier this week, the development of a Senate version of
the bill--normally a positive--may have a material adverse effect of
the very type of international cooperation that the bill seeks to
kindle and redouble.
As Congressman Hyde noted, ``A new bill only delays the pressure on
House and Senate appropriators to pony up the $15 billion requested by
the President over the next five years. . . .
`` . . . for the President in his meeting with G-8 leaders in June, a
new bill only delays an opportunity he will have at this meeting to use
enactment of this legislation to leverage support for worldwide AIDS
efforts from our wealthy partners.''
We need to take this view into account. I say this as one for whom
the version of the bill developed and introduced by Senators Lugar,
Kerry, and Biden is more attractive than what emerged from the House.
All in the Senate should commend Senators Lugar, Kerry, Biden, and
Frist for their longstanding leadership in this area. From a purely
public health standpoint, I think their legislation has a number of
advantages over the House bill that we are taking up on the floor
today.
I also have the utmost respect and praise for what the House
accomplished by passing a bill that resolved a number of very difficult
issues that lingered for many months. I want to associate myself with
the remarks made earlier today by Chairman Lugar and Senator Biden in
which they took the position that, despite the Lugar-Kerry-Biden bill's
many virtues, the bottom line reality is that to go to conference with
a new Senate version of the bill is to risk losing a critical
opportunity at the G-8 meeting.
Our majority leader, Dr. Frist, who has spent so much of his own time
helping the people of Africa, also noted that the bill he called up may
not be the perfect bill, but it represents a major step forward in
advancing the program that President Bush laid out in the State of the
Union Address.
As the great philosopher Mick Jagger once noted, you can't always get
what you want, but sometimes you find you get what you need.
I think that the President's $15 billion proposal and the House bill
are exactly what the people of Africa and the Caribbean need. Although
I can think of some ways to refine the House language--as Senators
Lugar, Kerry, and Biden have suggested, my view is that we can not let
the perfect become the enemy of the very good.
I urge my colleagues to support H.R. 1298. It is a good bill. The
House worked for a long time and came up with a product of which we can
all be proud and supportive. We will have ample opportunity in the
months ahead and during the appropriations process to fine tune this
legislation. But I agree with Senator Frist, let's get this done job
done.
Now is the time to send the President to France with an enacted bill
with which he can attempt to leverage additional support from our
closest allies. Being able to put the $15 billion bill on the table as
a finished product will do much more benefit than a progress report on
the Conference Committee.
I believe that H.R. 1298 will be viewed as an important step forward
with respect to public health. I cannot help but think that many of the
developing world--the very same people we want to enlist with us to
fight the battle against terrorism and to resist the entreaties of
those who seek to undermine the role of America in world affairs--will
take note of our action tonight. They will see that, even at a time
when the domestic U.S. economy is struggling to recover, Americans
found both the will and wallet to launch a major humanitarian effort
against diseases that are severely lowering the quality of life in the
developing world.
Mr. President, I support H.R. 1298 as a clean bill. I urge my
colleagues to support this important measure.
Mrs. DOLE. Mr. President, I rise in strong support of H.R. 1298.
Our world is in the midst of a crises. HIV/AIDS has taken hold of
many parts of the world and left death and destruction in its wake.
Millions have been affected, wives have lost husbands, parents have
lost sons and daughters, small children have been left alone, orphaned
after AIDS took the life of parents.
The Joint United Nations Program on HIV/AIDS reports that as of the
year 2002, there were 29.4 million people living with this disease.
Sadly, most of them are in sub-Saharan Africa. Estimates are that by
the year 2020, an additional 55 million Africans will lose their lives
to the epidemic.
Women are particularly affected and make up 58 percent of the HIV-
positive population in sub-Saharan Africa. Perhaps even more troubling,
6 to 11 percent of women aged 15 to 24 were HIV positive in 2001,
compared to 3 to 6 percent of young men. Women are dwarfed by men in
economic and political affairs, and far too many of these women have no
way to protect themselves. The political and cultural standards in many
countries have left them unable to defend themselves from unwanted
sexual activity and advances and their reluctance to submit to male
domination. With this pandemic, these women are victimized yet again.
During my time as President of the American Red Cross, I saw
firsthand the poverty and countless other socio-economic factors that
make Africa particularly vulnerable to the spread of AIDS. Rwanda, for
instance, is one of the areas with a high rate of adults infected with
HIV. And Mr. President, while there, and in Goma, Congo, where a
million Rwandans had fled from the bloodshed in their country, I saw
100s of children with no parents, no home, no food, no clothes, no
hope. To this day, I can close my eyes and see a little boy sitting by
himself on a mound of dirt. He was probably 13 or 14 his face was
covered with dust and he was crying. The tears left little paths down
his cheeks. I sat beside him, and put my arm around him to try to
comfort him but there was no reaction. Nothing moved, not a muscle
moved, as the tears flowed. He was traumatized. This is the challenge
we face, ending the poverty and despair of that little boy, and
replacing them with hope and life.
Due to AIDS, the region is in a dangerous cycle that affects global
health, the global economy and global security. Consider this: labor
forces are decreasing because of the disease. Since there are fewer
workers to farm the land, harvests are depleted, and famine is running
rampant. As hopelessness sinks in, people become vulnerable and
susceptible to evil terrorist predators.

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It is an endless cycle of despair, a boiling pot that cannot go
unchecked.
This Nation, the world's global leader, cannot sit idly by. We must
pass this bill today. An entire generation is in danger of being wiped
out by HIV/AIDS.
This legislation takes a historic step in fighting this battle. It
commits $15 billion dollars over the next five years to fight AIDS,
tuberculosis and malaria. It establishes within the Department of State
a coordinator of United States Government Activities to Combat HIV/AIDS
so that the U.S. can continue to lead on this issue. And it commits $1
billion dollars for the Global Fund to fight AIDS, Tuberculosis and
Malaria.
The legislation is the important springboard to real changes in
Africa related to AIDS. It brings together many nations to participate
in this effort, and through the conscience clause, allows for non-
governmental and faith-based organizations to lend their efforts to
eradicating this epidemic. This clause and the participation of
community and faith-based organizations are vitally important.
The funding will work two-fold, through public private partnerships,
to offer prevention and treatment.
At the Red Cross, I was also able to work firsthand on AIDS
prevention education. Ours was the first nationwide effort, so I know
the benefits. The Red Cross has provided AIDS prevention education to
more than 18 million people across the United States since 1985. More
than 30,000 have been trained as HIV/AIDS education instructors. In the
time since, our nation has made great strides in battling AIDS. People
are taking precautions and living longer.
But I also know firsthand that prevention efforts can sometimes get
bogged down in controversy. There are so many different views and
beliefs. But this is not the time for the Senate to engage in partisan
or ideological delays. America is needed in this crisis; we are needed
now, not next month, not next year. Lives are literally hanging in the
balance on this bill. Saving them should be our only focus. We must
step forward now to help our global neighbors, to offer a helping hand
to those who need it, to end the death and destruction. We must pass
this bill.
Ms. STABENOW. Mr. President, I rise today to support the United
States Leadership against HIV/AIDS, Tuberculosis, and malaria Act of
2003.
This legislation authorizes $15 billion over 5 years, $3 billion per
year through 2008. This bill also establishes an HIV/AIDS response
coordinator and advisory panel, and requires a 5-year comprehensive,
integrated, global strategy to fight this deadly disease. I am pleased
to join a bipartisan group of Senators supporting this legislation.
According to the United Nations, more than 65 million people
worldwide have been infected with HIV, more than 25 million have died
of the disease, and more than 14 million children have been orphaned.
At the end of 2002, an estimated 42 million people were infected with
HIV or were living with AIDS, of which more than 75 percent live in
Africa or the Caribbean. AIDS is the leading cause of death in sub-
Saharan Africa, where more than 19.4 million have died.
Basic interventions to prevent new HIV infections and to bring care
and treatment to people living with AIDS have achieved meaningful
results. Nonetheless, of the more than 30 million people in Africa with
HIV, only 50,000 receive necessary medicines.
We must do everything to reverse this horrible trend and fight this
pandemic. But we can't do it on the cheap. Fighting this disease will
take a lot of money because the problem is so widespread.
The Global H.I.V. Prevention Working Group, funded jointly by the
Kaiser Family Foundation and the Gates Foundation, has issued a report
stating that: ``Globally, fewer than one in five people have access to
basic HIV prevention programs--the information and services that can
help save lives and reverse the AIDS epidemic.''
The Working Group's analysis of global HIV prevention funding finds
that annual spending from all sources in 2002 was $3.8 billion short of
what will be needed by 2005.
The report also finds that access to proven prevention interventions
is extremely limited, and highly variable, depending on region and the
intervention.
As you can see, this problem is bigger than what our response will be
here today. We must view this legislation as the first step in an
ongoing battle to end the AIDS epidemic once and for all.
The bill before us is an important bill, but it is only an
authorization bill. Now, we must focus on the upcoming appropriations
bills to make good on the promise of the bill before us today.
Mr. SMITH. Mr. President, I support the global AIDS bill. I, like
many of my colleagues, do not believe the House version of this
legislation is perfect. I have reservations about the bill--in
particular more funding is needed to fight the spread of tuberculosis
and malaria. Nevertheless, I enthusiastically support this legislation
as a vital first step in the international response to the global AIDS
pandemic. Coupled with expanded--though still relatively small--
bilateral resources to fight tuberculosis, the leading killer of people
infected with AIDS, this initiative will save many, many lives. I
commend the President for his leadership in this effort, and the
House's overwhelming support of this important legislation and the
global fund.
Today, there are an estimated 42 million people worldwide living with
HIV. Of the 42 million people infected with the virus, 3.2 million are
children and half women. These numbers will tragically increase. In
2002, there were 14,000 new HIV infections each day, resulting in an
estimated 5 million new cases worldwide.
The HIV/AIDS pandemic is devastating for millions of men, women,
children, and families. Moreover, it threatens the economic and
political stability of many developing countries. More than 95 percent
of the new HIV/AIDS cases were contracted in developing countries. It
is estimated that AIDS will diminish economic growth by up to 1 percent
of GDP annually and consume more than half of health care budgets in
the hardest-hit countries. With ever fragile infrastructures and
inadequate funding for health, this economic drain will further hamper
developing nations' prospects for a peaceful transition to democracy.
The ability of these developing countries to prevent the further
spread of the AIDS virus is limited without our help. Accordingly, it
is imperative that we join with the President and House and offer our
assistance to those struggling countries. This bill will provide the
much-needed support and financial assistance to foreign countries
struggling to combat the spread of HIV/AIDS, tuberculosis, and malaria.
Along with a comprehensive 5-year plan to combat the global spread of
HIV and AIDS, the bill authorizes funding and enables the U.S. to
participate in the global fund through 2008.
While passage of this legislation is essential, it ought to be
remembered that this effort has just begun. This initiative is just a
first downpayment by the U.S. in our fight against the global spread of
AIDS. We must fully fund this bill in 2004 and still do more. We must
invest wisely to protect and save as many lives as possible and as soon
as possible. These funds are needed immediately, and if we do not
invest enough now, we will pay far more later--in money, in lives lost,
and in the social, economic, and spiritual cost to the families,
communities, nations, which are hardest hit. There are ten million
children in sub-Saharan Africa alone--children who ought to be free to
play, to learn, to enjoy their young lives--who have lost one or both
parents to AIDS. This represents a country the size of Belgium. In 10
years, at current rates, this number will quadruple. But we have a
choice. Will we allow this to happen? Every year we delay, the greater
the cost. This epidemic is not waiting for us, it is here and
accelerating. So, we too must accelerate our response.
I again salute President Bush for his compassionate leadership and
commitment to fighting HIV/AIDS at the global level. With passage of
this bill, the U.S. will demonstrate its unwavering belief in the
dignity of life, and as a nation, that we take seriously our moral duty
to bring an end to preventable human suffering. I urge my colleagues to
consider this just a first step in our response to fighting global HIV/
AIDS, to invest our resources judiciously, and

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to act immediately. We must not wait another day to pass this
legislation, because we cannot afford to have another life needlessly
taken by AIDS. I look forward to ensuring that this legislation will be
full funded in this year's appropriations bills.
Mr. SARBANES. Mr. President, pending before the Senate is legislation
that marks a major step forward in addressing the HIV/AIDS pandemic.
Although in my view we have been slow to come to terms with the
enormity of the problem, we now have a broad bipartisan consensus on
the urgent need for increased funding to address the HIV/AIDS crisis,
which is reflected in two proposals before the Senate: H.R. 1298, the
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 and S. 1009, the United States Emergency Plan for AIDS
Relief Act of 2003.
While they are broadly similar in their provisions, one, in my view,
will equip us better with the tools we need. That is S. 1009, which I
am cosponsoring. Within its overall authorization figures of $2.8
billion for fiscal year 2004 and $3.2 billion for fiscal year 2005 for
HIV/AIDS initiatives, it obligates specified amounts for bilateral
programs, The Global Fund to Fight Aids Tuberculosis, TB, and Malaria,
The Vaccine Fund, The International AIDS Vaccine Initiative,
tuberculosis programs and the Malaria Vaccine Initiative. It promotes
an integrated and balanced approach to fighting the disease, while at
the same time embracing a wide range of established HIV/AIDS treatment
and prevention programs. Indeed, S. 1009 is designed to complement and
support existing development and relief funds, which have already
proved their value.
Today in sub-Saharan Africa and other parts of the globe we confront
the tragic consequences of ignorance about HIV/AIDS, indifference to
its effects and delay in marshalling worldwide efforts to contain and
ultimately to eliminate it. First diagnosed in Los Angeles just over 20
years ago, it rapidly spread worldwide, especially as major mechanisms
of transmission, like blood transfusions and unsterilized needles, were
overlooked. While concerted efforts of the medical community and the
public at large have helped control the number of new cases and reduced
the death rate, the disease continues to spread in some parts of the
world. According to the most recent report of the Joint United Nations
Programme on HIV/AIDS, UNAIDS, on the Global HIV/AIDS Epidemic, 3.5
million people were infected last year in Africa alone.
If not effectively treated, HIV/AIDS takes a truly terrible toll. In
economic terms, the pandemic has turned back the clock on decades of
development gains, creating a vicious cycle that exacerbates poverty
among the already poor and reduces others to poverty. It displaces or
marginalizes populations, making them even more susceptible to HIV
infection. In South Africa, where the epidemic's grip has been
especially deadly, AIDS has caused major social and economic
disruption. What began as a health issue is now also a development
crisis.
In every country where HIV/AIDS rages out of control, all sectors are
affected. Public health services have been particularly hard hit,
because the demand from the services of public health workers has
increased. IMF indicators suggest that in the most afflicted countries
health services have been overwhelmed by the epidemic, even as the
number of patients is projected to double over the next few years.
HIV/AIDS has hit hardest in countries with limited budget resources.
Scarce funds have been allocated to rising health care costs, at the
expense of other critical public services. Additionally, because the
disease debilitates and incapacitates well before it kills, and because
it crosses all socioeconomic lines, it has effectively deprived
struggling governments of a generation of civil servants--of urgently
needed leadership, experience and expertise. This loss of human
resources constitutes a new and insidious form of brain drain that
governments can ill afford as they work to promote economic growth,
alleviate poverty and improve the quality of life for its citizens.
Education in the affected countries has been particularly hard hit.
Even if the demand for education falls over time as fertility rates
decline, it will be difficult, if not impossible, to maintain pupil-
teacher ratios at constant levels. IMF indicators suggest that by 2010
the proportion of newly trained teachers replacing teachers who have
died of AIDS will reach a staggering 67 percent--two in every three.
The magnitude of this tragic epidemic further complicates the challenge
of raising literacy rates in the developing world. The World Bank
estimates that even absent the impact of HIV/AIDS, 55 of the world's
poorest countries will be unable to achieve universal primary
enrollment by 2015.
HIV/AIDS affects the private sector just as much as the public
sector. As mortality rates rise and the working-age population declines
in size, employers lose trained, experienced and productive workers.
Medical care, death-related benefits and also absenteeism--a very
important factor--all contribute to rising personnel costs.
The macroeconomic impacts are clear. When the HIV infection rate
exceeds 5 percent in a country, HIV/AIDS begins to have significant
economy-wide impacts. At least 24 African nations, along with Haiti,
now fit into this category. The consequences are grim. UNAIDS estimates
a loss of more than 20 percent of GDP by 2020 in the worst affected
countries. The number of destitute families will rise as they face
lower incomes, greater numbers of dependents and sharply higher
healthcare expenditures. The ripple effects of continued reductions in
labor, savings, and investment will mean lower economic output in the
affected countries, inevitably slowing economic growth and causing
trade balances to deteriorate further.
The economic ramifications of HIV/AIDS are one aspect of the crisis;
the human dimension is another. According to UNAIDS, 42 million people
worldwide are living with HIV. Of these cases, more than 28 million are
in Africa alone. In 2002, 5 million people were newly infected with
HIV; 28 million people have thus far died from the disease; 14 million
children have been orphaned by AIDS without having contracted the
disease themselves. Given the high mortality rates among young adults,
the orphan population will inevitably increase; a recent report issued
jointly by UNICEF/UNAIDS/USAID estimates that by the end of this decade
the number of orphans will reach 25 million, an increase of nearly 80
percent. Social support systems in the affected countries are
tragically inadequate in the face of the crisis. Children thus become
part of a vicious cycle, with no one to care for them, still vulnerable
to the disease, seeking to survive in a gang or militia--exacerbating
social problems in these countries.
Available statistics tell only part of the story, since AIDS often
goes unreported. There is no system of accessible AIDS testing and many
cases go undiagnosed, given the sensitivity and social stigma too often
surrounding AIDS. On the basis of what is available, however, experts
agree that in Africa alone the disease threatens an entire generation
that will either be lost to HIV/AIDS or severely affected by plummeting
life expectancy, collapsing social institutions and decimated
workforces.
As we consider our approach to AIDS, our recent experience with SARS
should be instructive. With SARS we have learned in a few months what
it took years to understand about HIV/AIDS: awareness, early
intervention and international cooperation are critical factors in
keeping the disease from spreading and in saving lives. We must apply
the lessons we are learning from SARS to our efforts to treat and
control HIV/AIDS.
A person infected with the HIV/AIDS virus may appear to show signs of
the flu, or no symptoms at all for months or even years. Yet diagnosed
in time, the disease is treatable. In the industrialized world, for
example, research and intervention have reduced mother-to-child
transmission of the HIV virus to less than 2 percent. Rigorous testing
and surveillance can keep the blood supply safe. Effective, low-cost
interventions have been developed. In high-risk groups in
industrialized countries intensive education, vigorous political action
and extensive drug therapy have been combined to bring the disease
largely under control. Now we must

[[Page S6496]]

apply these strategies in the developing world, where the disease is
raging out of control. Of the total HIV population worldwide, 95
percent live in the developing world. While there is no cure, we know
that prompt intervention mitigates the terrible effects of the disease.
S. 1009 is not directed exclusively to HIV/AIDS; it includes
important provisions addressed to tuberculosis and malaria. Unlike HIV/
AIDS, which was first diagnosed less than a quarter-century ago, these
two terrible diseases have been known and feared for centuries.
Tuberculosis claims nearly 3 million lives every year--more than all
other infectious diseases combined. Among HIV/AIDS patients, it is the
single most common cause of death. In fact, HIV patients are up to 50
percent more likely to convert the latent form of TB into the active,
contagious form. Unlike many other infectious diseases, tuberculosis is
an airborne disease transmitted like the common cold. Nearly one-third
of the world's population is already infected, and cases of multidrug
resistant strains, which are far more difficult and expensive to treat,
are rising. Overall, tuberculosis is responsible for 25 percent of all
preventable deaths in the developing world. S. 1009 authorizes $150
million for fiscal year 2004 and $170 million for fiscal year 2005 for
programs devoted to tackling TB.
The developing world, especially sub-Saharan Africa is also in the
grip of resurgent malaria, as resistance grows to traditionally
effective antimalarial drugs. Resurgent malaria is estimated to cause 1
to 3 million deaths annually, and WHO projects between 300 to 500 new
cases every year. S. 1009 authorizes $105 million for fiscal year 2004
and $125 million for fiscal year 2005 to malaria programs and to the
Malaria Vaccine Initiative.
With the worst effects of the pandemic still to come, S. 1009 is
timely and urgent. It will help to stop the terrible downward spiral in
living standards in the countries it has ravaged, and the
destabilization that occurs when families and communities are torn
apart. It can save lives.
We can beat back this disease. In my view, S. 1009 provides us with
the tools most urgently needed by those on the front lines in the fight
against HIV/AIDS. It is vastly superior in its provisions to H.R. 1298.
Nonetheless, I will work with my colleagues to strengthen the
underlying bill. I urge my colleagues to join me in this effort.
Mr. SESSIONS. Mr. President, I rise today to discuss the issue of
health care transmissions of HIV/AIDS in Africa. I want to clarify some
important provisions of the bill addressing the spread of HIV/AIDS and
other infectious diseases in Africa and the developing world through
the health care setting and more specifically the reuse of syringes and
needles, in other words, injection devices.
The reuse of syringes and needles is a well-documented practice in
the developing world. Scientists from the WHO, Duke University and the
Gates Children Vaccine Program report that the percentage of unsafe
injections in sub-Saharan Africa vary from greater than 50 percent to
as high as 90 percent in Burkina Faso. In some countries in the study,
60 percent of centers reused syringes/needles. The Safe Injection
Global Network, SIGN, an organization affiliated with the World Health
Organization, WHO, reports that, ``Transmission of bloodbourne
pathogens, including hepatitis B virus, HBV, Hepatitis C virus, HCV,
and acquired immunodeficiency virus, HIV, through unsafe injections has
long been reported and causes a heavy burden of disease.''
A December, 2002 paper co-authored by physicians from WHO and CDC
estimated that in the developing regions that were studied, almost 40
percent of injections were given with reused injection devices. The
same study found that unsafe injection practices in developing
countries in the year 2000 alone caused 22 million hepatitis B
infections, 2 million Hepatitis C infections and resulted in the
transmission of the HIV virus to 260,000 people.
The cumulative number of people with HIV, Hep B and Hep C over the
years is a significant number that cannot be ignored.
In response to the overwhelming evidence of diseases spread through
needle and syringe reuse, and the recognition of the effectiveness of
needles with technology features that prevent reuse to stop the spread
of disease, Section 306 of this bill includes legislative language
``promoting sterile injection practices and technologies.''
I want to make the point that sterile injection practices and
technologies referred to in Section 306 include injection devices with
reuse prevention features.
Furthermore, it is my understanding that ``sterile injection
practices and technologies'' referred to in Section 306 should include
injection devices with reuse prevention features, especially since
needles or syringes that can be reused are only guaranteed to be
sterile during their use. This section should not be interpreted to
support needle exchange programs. It is also my understanding that
availability and use of reuse prevention injection devices will limit
not only the spread of HIV/AIDS, but also have the additional benefit
of reducing the incidence of Hepatitis B, Hepatitis C, and other
infectious diseases such as the Ebola virus, through non-sterile and
unsafe injection practices.
This clarification is important to ensure that the Coordinator of the
HIV/AIDS Program at the State Department understands the importance of
providing injection devices with reuse prevention features to prevent
the spread of HIV/AIDS and other infectious diseases.
Studies may vary as to exact percentage of infectious disease spread
by various known causes. But all should agree that the use of sterile
injection devices with reuse prevention features is one effective,
economical, and immediately available step that can be taken to prevent
one of the most significant causes of the spread of infectious
diseases, especially among children who receive injections for
immunization and other health care.
It has been estimated that there are about 1.5 billion injections
administered in Africa each year. Since some injection devices with
reuse prevention features can be obtained for as little as
approximately 5 cents each, the entire continent of Africa could be
supplied with safe injection devices at a cost of less than $100
million dollars per year. Doing so could virtually eliminate the spread
of HIV and other diseases in Africa from injection device re-use, in a
manner that is cost-effective and with measurable results.
During a March 27, 2003 hearing I chaired in the Senate Health,
Education, Labor and Pensions Committee on the transmission of AIDS in
Africa, David Gisselquist, PhD, testified that, ``From the 16 available
large studies in Africa with sufficient data on injections, an average
of 28 percent of HIV infections is associated with medical
injections.''
In a December 2002 WHO report the authors list four studies with
findings of 8 percent, 15 percent, 41 percent and 45 percent
attributable to contaminated injections resulting in HIV infections,
thus suggesting that the WHO 2.5 percent model was conservative. Even
the WHO in its own report stated ``[i]n the year 2000, four decades
after the widespread availability of single-use injection equipment and
two decades into the HIV pandemic, contaminated injections account for
close to a third of new HBV infections, 40 percent of new HCV
infections and 5 percent of new HIV infections. These infections
translate to a substantial preventable burden of acute hepatitis, AIDS,
hepatocellular carcinoma and end-stage liver disease.''
Even if the proportion of cases from injections is much lower than
that by heterosexual transmission, it is an important component of the
problem and we must act quickly. If healthcare procedures account for a
high percentage of the cases of HIV infections in Africa, then we must
immediately and radically change our prevention procedures.
Therefore, I plan to work with the Secretary of the Department of
Health and Human Services to request an independent group to examine
the available studies on the number of HIV/AIDS cases that are caused
by the unsafe re-use of needles. This study will help clarify and
highlight the dangerous impact of needle re-use in the spread of HIV/
AIDS. I recommend that the independent organization draw a panel of
experts from different public health organizations to compile this
study and make available their findings in 90 days.

[[Page S6497]]

I plan to request this study to help understand the true impact of
health care transmission and especially unsafe needle re-use in the
spread of HIV in Africa and to ensure that our policies reflect the
best science about the causes of the HIV/AIDS epidemic in Africa and
other parts of the developing world.
I am glad this evening to join with my colleagues in support of the
President's initiative to combat global HIV/AIDS and to deliver a bill
prior to his departure for the G-8 summit in France which commences on
June 1, 2003. The bill authorizes $15 billion over 5 years for HIV/AIDS
programs and it is my desire that some of this money be used to
eliminate the transmission of HIV/AIDS in the health care setting and
especially by the re-use of injection devices.
Mr. ALEXANDER. Mr. President, this is an historic moment for us. The
United States Senate is going to step up to the plate and declare in a
bipartisan manner that we will meet our moral obligation and help those
countries most afflicted by HIV/AIDS.
The scourge of AIDS knows no borders; it is the greatest plague of
our time. Over 40 million people worldwide are infected with HIV/AIDS
today. Thirty million of those are in Africa. Nearly half, or twenty
million, of those infected are in the fourteen countries highlighted
for special attention in the President's Emergency Plan for AIDS
Relief, which is authorized in the bill before us today.
Now is the time for the Senate to act. I support the bipartisan
global AIDS bill that passed the House, and urge my colleagues to do
the same. The Bipartisan Global AIDS bill authorizes the President's 5-
year, $15 billion plan to combat HIV/AIDS, mirroring President Bush's
emphasis on treatment and care. The bill provides funding to the Global
Fund to Fight AIDS--up to $1 billion per year--but it limits
contributions to be no more than one-third of those monies contributed
by other sources. This limitation provides the President with leverage
to encourage other countries to donate to the global fund.
The bill supports the approach that Uganda has had so much success
with called ``ABC,'' which stands for: abstain, be faithful, and use a
condom. When I met with the First Lady of Uganda Tuesday, she told me
how this approach of emphasizing abstinence was a return to traditional
African values that is working well. From 1991 to 2001, the prevalence
of HIV/AIDS among pregnant women in Uganda has declined from 21 percent
to 6 percent, thanks largely to ``ABC.'' In Botswana, by contrast, a
nurse told me 97 percent of the pregnant patients she saw were HIV-
positive, and the national rate was 43 percent among pregnant women in
2000--seven times Uganda's rate. In fact, on Monday, I will be chairing
a hearing in the African Affairs Subcommittee to look more closely at
the Ugandan model and how it can be applied in other countries.
Thirteen million ``AIDS orphans'' around the world have lost their
parents to AIDS--the bill authorizes funds to aid those children. Time
is of the essence. Every moment we delay, more people are dying and
becoming infected.
I know many of us see imperfections in the bill, and want to amend
it. I'm one of them. In fact, I've introduced an AIDS Corps bill that
would make a great amendment to this bill. I'm going to withhold that
amendment in the interest of getting a good bill quickly to the
President's desk, but I want to take a moment to talk about it in hope
that we can adopt this proposal or something similar in the future.
The House bill includes language to establish a program where health
professionals can volunteer their services to travel abroad to
countries most afflicted by HIV/AIDS and provide training and care.
This is a needed service. One exacerbating problem for poorer countries
afflicted by HIV/AIDS Is the lack of a strong health care
infrastructure. In many African countries, traditional healers are more
relied upon than medical doctors--these traditional healers may have
little or no knowledge about testing for HIV or providing advice on how
to prevent or treat it.
Health professionals from countries like the United States can take a
couple of months away from their practice to travel to other countries
in need and provide necessary training to allow in-country care-
providers to better respond to the HIV/AIDS pandemic.
And American health professionals have shown an interest in answering
the call. A number of non-profit groups help doctors volunteer their
services, groups like Doctors Without Borders, US Doctors for Africa,
and the International Medical Corps.
My amendment takes the language from the House bill and improves on
it in three important ways:
No. 1, it names the volunteers the ``AIDS Corps'' to help increase
the profile of the group so as to better attract qualified medical
professionals to give of their time and volunteer.
No. 2, it provides more flexibility for the length of time health
professionals can serve--so that those who can only volunteer for a few
months won't be excluded.
No. 3, it provides the same liability coverage to volunteering
doctors as is provided for federal employees who provide health care
services.
I hope that at some future date we can consider these changes that
will allow any new corps of medical volunteers established by the
President under this act to function more effectively.
Now is not the time to put such an amendment forward.
We need to pass this bill quickly so the administration can begin its
implementation and President Bush can use it to encourage other
countries to join us in this effort at the upcoming G-8 summit.
I urge my colleagues, let us pass this bill without amendment tonight
so that the President can sign it as early as tomorrow, and we will be
one step closer to reversing the trend of this growing menace and start
reducing its impact around the world.
Mr. DODD. Mr. President, no challenge is more daunting in scope or
immediate in need than the Global AIDS crisis. I rise today with the
utmost urgency to speak of this modern-day plague and to urge my
colleagues to ensure that the legislation currently pending before the
United States Senate is both swift in its passage and effective in its
nature.
The global AIDS pandemic threatens to undermine all of our other
efforts to bring stability and prosperity to the world. AIDS is an
unparelled crisis, and it threatens to have a potentially irreversible
effect. Every country around the globe will, in one way or another,
feel the devastating impact of this disease; no nation will be spared.
Certainly, I applaud the administration for its initiative on this
important issue. We all do. And, the bill currently before this
chamber--which closely reflects the Administration's requests--provides
a good framework for battling this crisis. However, it has some serious
shortcomings--shortcomings that will greatly impact its chances of
success. That is why this chamber must ensure that any AIDS legislation
it passes will be effective on the ground. In order to do this, we must
look carefully at the facts, and at the reality of the situation. This
must be our first priority.
Mr. President, there are well over 42 million people currently living
with HIV/AIDS. In 2001 alone, there were approximately five million new
infections. Even worse is that the number of infections continues to
grow at an alarming rate. There are 15,000 new infections every day,
and half of these infections--half--are in children between 15 and 24
years of age.
Without a doubt, the region hardest hit by this pandemic is sub-
Saharan Africa. Approximately 70 percent of the worldwide total of
people with HIV/AIDS live in that part of the world, and well over 29
million people are currently infected. The overall rate of infection
among adults in the region is close to nine percent, compared with 1.2
percent worldwide, and in seven countries, the infection rate is over
20 percent.
Experts contend that the severity of the AIDS pandemic in that region
is directly related to its wide-spread poverty, lack of education, ill-
equipped and underfunded health systems, and local taboos that
stigmatize and ostracize those who are infected. Even more devastating
to the region is that the AIDS pandemic creates a vicious circle of
events that, despite international aid, increasingly hinders the
ability of affected societies to help themselves.

[[Page S6498]]

This vicious circle is pervasive throughout all sectors of society.
Skilled workers, teachers, farmers, management executives, and
government officials alike are falling prey to AIDS. In fact, according
to UNAIDS, by 2020, the most affected countries will experience a loss
of more than 20 percent of their gross domestic product.
AIDS is also having a debilitating effect on our hemisphere. In
Guyana, almost 3 percent of the adult population is infected, and in
Haiti, a nation long-suffering from substantial economic and political
instability, more than 6 percent of its adult population are living
with the virus. Indeed, throughout Latin America and the Caribbean,
over 1.9 million people are infected, and in some Caribbean countries,
the rates of prevalence are second only to sub-Saharan Africa.
Throughout the world, AIDS is killing millions of parents, and often
leaves young children in the precarious position of having to supply
food, money, and medicine for their families. The World Bank estimates
that there are currently 15.6 million AIDS orphans, and this number is
expected to double by 2010. Many of these children, especially girls,
quit school and become victims of sexual violence or commercial sex
workers. And, due to lack of resources and education, only a fraction
of these children know that they are infected. Most do not even believe
that they are at risk or know how AIDS is spread.
I urge my colleagues to carefully examine this situation. Many of
these children are not promiscuous because of childish recklessness.
Certainly, children do not desire to become commercial sex workers.
They are children. Given the chance, they would play games and go to
school, as do most children. However, in many cases, their reality, as
well as the obligation to provide for their families, forces them into
this lifestyle.
I know that citing the successful efforts in the nation of Uganda,
some of my colleagues argue that United States AIDS assistance should
focus on the promotion of abstinence among children. Certainly,
encouraging young, unmarried children to abstain is a worthy goal. We
can teach them to abstain, we can urge them to abstain, and we should.
However, we can not ignore the multitude of factors with which we are
faced. We must remember that the Uganda plan worked because it
encouraged abstinence, monogamy, and distributed condoms--the ``ABC''
model. Most of all, it worked because the President of that nation made
it a national priority to educate his people about HIV/AIDS.
In my view, the most important distinction among regions of the world
has been the ability of affected nations to deal with the AIDS crisis
and to educate their people about it, as well as the ability of
infected people to pay for a variety of life-saving or life-prolonging
treatments.
I know we can all remember a time in the United States when in
schools, television advertisements, and billboards, we strove to
educate Americans about HIV/AIDS. In fact, this effort continues, and
with much success. Coupled with access to state-of-the-art treatments,
Americans with HIV are able to live longer and healthier lives than
ever before. But it is important to realize that the methods used to
progress in one area of the world will not necessarily be effective in
another. In many regions, AIDS infection stems from an intricate social
reality--one with many contributing factors. In most of these
countries, poverty deprives the people of effective systems of health
information, health education, and health care. AIDS counseling is
often unavailable, and HIV testing is difficult for many to obtain.
Lack of resources to buy and distribute the expensive drugs that
prolong life for those infected with HIV, as well as the rarity of sex
education and prevention methods, have compounded these problems.

Therefore, we must not ignore the widespread destitution caused by
this disease, which forces many people--children and adults--into a
lifestyle that dramatically increases their risk of infection. Any
effort to fight AIDS must be accompanied by an effort to fight poverty
and build infrastructure; it must be focused on helping people to help
themselves. It is my hope that as the Senate addresses the issue of
foreign aid in the coming year, it pays particular attention to the
other myriad needs on the continent of Africa, as well as in other
poverty-stricken regions throughout the world.
In addition, we must not ignore existing institutions, such as the
Global Fund to Fight AIDS, Tuberculosis, and Malaria. While I strongly
support the provision in this bill authorizing up to $1 billion for the
Global Fund in fiscal year 2004, I am concerned that the Bush
Administration will instead choose to follow its fiscal year 2004
budget request, and only allocate $200 million for this important
institution. Indeed, such a decision would threaten the ability of the
Global Fund to continue its important work; it would be a step
backwards in our fight against AIDS.
And lastly, although this bill will serve to combat HIV/AIDS in
twelve African countries, as well as Haiti and Guyana, it is absolutely
essential that we focus our efforts not only on these countries, but on
the world at large. HIV/AIDS is a global problem and it needs a global
response. My amendment designating Caribbean countries as priority
countries for United States support was an attempt to give additional
attention where it is most needed.
To highlight the necessity of this global approach, I would like to
bring to the attention of my colleagues a report on AIDS, which was
published in January 2000 by the Central Intelligence Agency, CIA. This
report states that by 2010, the focal point of infections will most
likely shift from sub-Saharan Africa to Nigeria, Ethiopia, India,
Russia, and China. There will be approximately 50 to 75 million
infected people in these countries alone, and according to the CIA, the
AIDS crisis will contribute to political instability and slow
democratic development. These are dire predictions, and we have an
obligation to address them.
Our intentions are noble and our conviction is real. But in order to
achieve all of these vital goals, we must fully and sensibly commit
ourselves to the fight against AIDS. That means providing the necessary
resources to prevent and treat this illness, sufficiently funding
important organizations and vaccine research, educating people about
AIDS, providing a truly global response, and ensuring that our efforts
are effective and grounded on the realities of those in need. And, as
we consider this bill, it is crucial to remember that it is only a
first step. In order to succeed, we must also change the reality in
which this disease thrives.
If we don't act with urgency, sensibility, clarity, and deliberation,
we will be condemning to death countless men, women, and children
throughout the world. We must act now. We can not afford to fail.
Mr. SESSIONS. Mr. President, the underlying bill provides too much
money to the global fund. The administration requested $200 million
next year for the global fund. This bill funds the global fund to the
tune of $1 billion.
Let me begin by saying I do not think we should be giving the global
fund anything. They have not earned our trust. They have not proven
they can do a better job of fighting AIDS than the President can do
through direct assistance.
Let me share an exchange I had with Sir Elton John at a hearing on
the AIDS issue.

Sessions. Thank you for that commitment. It has made a
difference. I talked to a businessman who does a lot of work
around the world, and he said that in developing nations, the
absolute key is not to give the money too high up the ladder.
If you are giving the money to the people doing the work,
they will work wonderfully, and things will happen
beautifully. If you give it too high up, it does not get to
the people who do the work in an effective way. Many of you
have foundations and are leading groups that are smaller,
where you can be more effective. We are talking about, if we
were to do what Ms. Thurman asked, tripling our contribution
to $2.5 billion. Do you have any suggestions as to how we can
make sure that that money actually reaches its greatest
potential?
Sir Elton John. I concur with you totally. What that money
has to go toward is training people to build an
infrastructure so that people can get the drugs they need in
remote parts of countries, and it needs to run on a
government level. But I know what you are saying. I do not
know how you do that, because I am just a singer. This is
something that the politicians have to make sure that when
the money goes to governments, the money is spent in the
right way. I have said before that we are a very small AIDS
organization; we can control where everything

[[Page S6499]]

goes, and we do. We know where every penny goes. But when you
get to these vast sums of money that we are talking about
there today, you are going to run into those kinds of
problems, and I do not personally know myself how you solve
them, but I do concur with you that that is a major problem.

Sir Elton John's statement is relevant to the issue of whether to
take massive amounts of money and give it to this global bureaucracy.
The General Accounting Office recently completed an exhaustive study
of the global fund. I strongly recommend that my colleagues read this
report.
Here are some of the findings.
The Secretariat's office has 63 staff members who have an average
salary of $174,603. This is the average.
Compared to recipient countries' average annual salaries, or even to
the U.S.'s average annual salary, no country even comes close.
The average annual salary of the 73 recipient countries where such
figures are known is $3,020, over $171,000 less than the average global
fund salary.
Even the average U.S. citizen only makes $36,300 a year. A job with
the global fund would give a U.S. worker a potential $138,000 payraise.
Americans work hard to pay their taxes. In times of economic trouble,
they have to work even harder. We have a fiduciary duty to the
taxpayers.
We owe it to them to make sure these precious resource are used as
wisely as possible, especially when we are deciding how to address a
deadly epidemic.
Disease specialists within the United Nations estimate that it would
cost $1,400 to $4,200 a year per patient to treat HIV/AIDS effectively
in sub-Saharan Africa with antiretroviral drugs. That means that by
simply eliminating one average Secretariat employee's wages, between 42
and 125 AIDS patients could be helped to lead better lives.
I want these funds in the hands of someone I can trust. Do I have
concerns about giving money to the Federal bureaucracy? Of course. But
this is a judgment call. Who do you trust most with these dollars, the
global fund, or President Bush?

I trust President Bush. I trust the United States of America.
Our of $862 million in funds received, the global fund has only
distributed $20 million to actual AIDS prevention grants. Meanwhile,
they are spending exorbitant amounts on salary and bureaucracy.
President Bush has a proven record. He gets results. I cannot say the
same for the global fund.
The Democratic Leader says he will offer an amendment to ``guarantee
a robust American commitment to the Global Fund to fight AIDS.''
This statement implies three things--
1. That America's current commitment to the global fund is not
robust. Not true.
2. That the bill we are considering does not provide a robust
commitment. Not true.
3. By voting for this amendment,you will guarantee a commitment to
the global fund that is more robust than you would by voting against
it. Not true.
Let me take these one at a time. First, Is America's current
commitment to the global fund robust? Absolutely.
To date, we have contributed a total of $300 million out of a total
$862 million, 32 percent. Our commitment next year is $350 million out
of $832 million. The next highest nation is Italy at $100 million.
Does the bill we are considering represent a robust commitment to the
global fund? I submit that $1 billion is an overly robust commitment.
The President stated that $200 million for the global fund is what is
needed next year. This bill authorizes $1 billion. This bill is five
times what the President requested.
The bill is more than every nation's pledges combined. Last year, the
total was $832 million. This bill provides $1 billion. I guess too much
is never enough for the other side.
Third, the majority leader is implying that by voting for this
amendment, you will guarantee a commitment to the global fund that is
more robust than you would by voting against it.
The House is not going to spend more than $1 billion on the global
fund. So you can vote to increase the funding, but that will just send
the bill to conference where the funding will be reduced to the House
amount, or preferably, lower.
Here is the real point. The President has indicated his determination
in having Congress send him a final bill before he departs for the June
1-3 G8 Summit in Evian, France.
At the G8 Summit, the President intends to use this bill as a
catalyst and leverage in requesting that the world's leading powers
make combating global HIV/AIDS a significant element in their foreign
assistance programs.
If this amendment is adopted, the President will not have it for the
G8 summit. He will not be able to use our $1 billion commitment to
leverage other nations to make similarly generous commitments.
The other G8 countries contributions are paltry compared to ours. The
next highest country is Italy who contributed $100 million. The rest
are half that amount. The Gates Foundation contributes more to the
global fund than most G8 countries.
If my colleagues want to maximize the global contribution to the
global fund, they should vote against this amendment so we can get this
bill signed into law and President Bush can have the strongest possible
hand at this summit.
In conclusion, there is a lot in this bill I do not like. There are
provisions I would change. I think there is way too much money in this
bill for the global fund.
I have amendments I would like to offer. Some are pretty important.
Some would be adopted overwhelmingly. But if it means we avoid a
lengthy conference and allow the President to make the strongest
possible case at the summit in June, I am willing to withhold. There
will be other chances to improve this bill. I urge my colleagues to do
the same.
Ms. MIKULSKI. Mr. President, I support the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.
For 20 years, HIV/AIDS has spread from the devastated region of sub-
Saharan Africa to the entire world. It is the fourth leading cause of
death in the world, killing over 22 million people.
But HIV/AIDS doesn't just kill people. It destroys economies. It
ruins nations. It menaces our children and stifles hope.
Forty-two million people worldwide have HIV/AIDS. Thirteen million
children are now orphans because of its wrath. Three million children
are infected. The vast majority of the afflicted live in Africa, but
the disease continues to spread at an alarming rate. The peoples of
Eastern Europe, China, India and Central Asia are under assault. The
world cannot afford a mediocre response to this disease's assault on
human life.
While the experts know how this disease spreads, we can't afford to
rely on one solution. Abstinence, being faithful and condoms is an
approach that has been successful in Uganda. The ABC approach is now
being followed in other countries as well. But this won't stop rape,
sexual abuse and prostitution. We cannot expect women and children
refugees to overcome their vulnerability to HIV/AIDS by themselves.
They deserve real help--help with empowerment, help in fighting the sex
and trafficking industries, and help in keeping their predators away.
We also need to help the families that are ruined by AIDS. The costs
of caring for a family member afflicted with AIDS are severe, even
worse if the person affected is the family's primary wage earner.
America must stand up and ensure that families can afford the treatment
and care they need to dull the spread and impact of HIV/AIDS.
This disease affects whole societies and nations, not just the
infected individuals and their families. Economies suffer when labor
forces can no longer survive, much less be productive. When the most
educated and vital members of society get HIV, economies contract
rather than grow. National security suffers when military forces
contract HIV, often at rates up to 5 times as high as civilians.
But the HIV/AIDS pandemic is not the only threat we need to fight.
Tuberculosis and malaria compound the problems of HIV/AIDS in
developing countries, where 6 million people died of HIV/AIDS,
tuberculosis, or malaria in 2002.
The nations and peoples of the world must share the burden of
responding to the HIV/AIDs pandemic. Eliminating

[[Page S6500]]

the scourge of AIDS won't be easy and it won't be cheap.
That's why the U.S. needs to make a real contribution to the Global
Fund to Fight AIDS, Tuberculosis, and Malaria. The $500 million the
U.S. has pledged to the fund falls far short of the $7 billion it will
need over the next two years to carry out its critical mission. We can
do better. We must.
America also needs to encourage concerted international action beyond
these important monetary contributions. HIV/AIDS is not a unilateral
threat. The world must make a sustained, comprehensive global effort to
provide a coordinated program of treatment, care and prevention.
Together, we must combine the best of our values, service, technology,
expertise and diplomacy to fight the great international menace of HIV/
AIDS.
The United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 is a good step toward this goal. I applaud
President Bush for joining our cause by proposing an Emergency Plan for
AIDS Relief, a new mission to help countries in Africa and the
Caribbean region address the HIV/AIDS pandemic by providing money,
expertise and training. This measure recognizes the critical link
between HIV/AIDS care, treatment, prevention, and education efforts. It
also responds to the need for health care systems that actually provide
the right treatment.
I'm proud to vote for this bill because I see as a culmination of our
efforts here in the Senate to make this issue less about partisanship,
and more about people. I've fought for so many years to provide a more
adequate response to HIV/AIDS. I commend my colleagues for uniting in
this effort.
There are certainly provisions in this bill that concern me. I've
voted to try to change some of them. But I'm not going to let those
concerns stand in the way of my support for a stronger U.S. and
international response to the AIDS pandemic. While this bill is not
perfect, it is a good start that may save millions of lives.
By passing this bill, the United States is taking real action to live
up to its responsibilities as the strongest country in the world. We
can show that we really do care about improving the lives and futures
of people in the developing world. The American people should be proud
of this American leadership.
The PRESIDING OFFICER. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed for a third reading, was read
the third time, and passed, as follows:
(The bill will be printed in a future edition of the Record.)
Mr. LUGAR. Mr. President, I thank all Senators for their diligence
and faithfulness in working to this late hour. I thank our leader,
Senator Frist; likewise, Senator Daschle. I always appreciate working
with my colleague, Senator Biden. We have a good relationship on the
committee, and we are very appreciative that the Senate has given us
this bill this evening.
The PRESIDING OFFICER. Does the Senator move to reconsider the vote?
Mr. LUGAR. I move to reconsider the vote, and I move to lay that
motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The majority leader.
Mr. FRIST. Mr. President, what we have just done is significant in
many ways. We have addressed for the first time in a comprehensive way
one of the greatest humanitarian, moral, and public health challenges
this country has ever seen, and, I would argue, the greatest
humanitarian challenge we have had to face in the last 100 years.
We addressed this health challenge in a comprehensive way. We
addressed it with an authorization for $15 billion over 5 years. It was
just a few years ago we were spending a total of $100 million a year,
and now it is going to be approximately $3 billion a year.
As has been stated again and again over the course of the evening,
the afternoon, and around lunch when we first began talking on the
bill, what we have done is shown that the United States is not just a
good nation but is indeed a great nation, that we will lead in the
global fight against this destructive virus that has killed 23 million
people, that is affecting the lives of over 45 million people today,
and that, as we have said today, will likely take the lives of 60
million others and will create probably another 40 million orphans over
the next two decades.
This is our first step. I congratulate the chairman of the Foreign
Relations Committee for bringing us to this point. Many of us have been
working for 3, 4, and 5 years even to bring us to this point. I thank
him for his tremendous leadership in accomplishing this goal.
I will be happy to yield to my colleague, Senator Enzi.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, I congratulate everybody who was involved in
the bill. This was not easy work. There were a lot of different
personalities and opinions. It is a huge issue with a lot of detail.
There is a lot of room for error and misunderstandings and different
amendments.
I am so pleased that people on both sides of the aisle worked through
all the difficulties, both ends of the building worked through all the
difficulties, and that we arrived at this position.
I particularly congratulate the majority leader for the outstanding
job he has done through all the years he has worked on AIDS. This would
not have come to our attention and a vote tonight if it had not been
for the diligence of Senator Frist.
I also thank the chairman of the Foreign Relations Committee for all
the work he has done on the bill. He has been through more variations
of this bill than almost anybody, except Senator Frist, and was willing
to find a position that would get this bill passed. He did that in the
best kind of spirit and took some stands against a bill that had his
name on it. That is very difficult work for a Senator to do, and he did
it in the best spirit of making sure we were taking care of the work.
It is one of the more universal bills we have done since I have been
in the Senate.
I congratulate everyone for coming together and finishing this bill.

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