Stop Tuberculosis (TB) Now Act of 2007

Madam Chairman, I yield myself such time as I may consume.

Madam Chairman, I thank my good friend, the new chairman of our Foreign Affairs Committee, Howard Berman. He has got a tough act to follow, because we all loved Tom Lantos. The gentleman from California (Mr. Berman) had a hard act to follow, but, boy, did he fill those big shoes very well. So, thank you, Mr. Chairman. This has been your first trial by fire, and you came out looking so well because you accommodated the concerns and the anxieties and the worries that so many of our Members had.

I want to thank on a bipartisan level all of the members of the Foreign Affairs Committee, from the most conservative to the most liberal. We were able to forge a compromise that reached a broad consensus on this vital and complex legislation. We couldn't have done it without the leadership of Chairman Berman, but also without his very able staff and the staff on our Republican side of the aisle as well.

The foundation of this bill, as Chairman Berman has pointed out, is the 2003 Leadership Act, which was the first comprehensive U.S. emergency response to the HIV/AIDS pandemic and which stands as a noble legacy of our two former chairmen, Henry Hyde and Tom Lantos. They understood, as do all of us, that millions of lives around the world depend on our country's willingness to battle this pandemic together. It does honor to our country that 5 years ago we undertook this true mission of mercy. We are fortunate to have the opportunity to reaffirm that commitment by our vote here today.

Since the passage of the original Leadership Act of 2003, extensive emergency treatment and prevention programs have begun to slow the advance of HIV/AIDS, tuberculosis and malaria. The success of these programs is well documented. I would like to cite some specifics.

According to the office of the Global AIDS Coordinator, more than 1.4 million people infected with the HIV virus are now being treated with the necessary drugs to fight this disease. PEPFAR has supported HIV testing and counseling for 30 million people, cared for million 6.7 million, and, as the chairman pointed out, including almost 3 million orphans and vulnerable children. We are on our way to achieving the 5- year goal of preventing the infection of 7 million people. PEPFAR has supplied medicines for approximately 800,000 expectant mothers, preventing an estimated 157,000 infant HIV infections. What a successful program.

The legislation before us keeps faith with the core principles of the Hyde-Lantos Act. We have modified the original blueprint by adding or adjusting a number of provisions based on 5 years of real-world experience regarding what works and what doesn't.

In addition to medicines and sophisticated methods of treatment, the 2003 act mandated that a more comprehensive approach be used that took into account local values and indigenous cultures, and the act before us does that.

With respect to this balanced approach, the wife of the President of Zambia said it best recently when she said, ``There are several ways in which we can reach the young people. One of the effective ways is abstinence. It brings back dignity and self-responsibility to young people, because they know their bodies are not supposed to be abused and they learn to say no.''

The compromise bill before us removes the specific directive in current law so that implementation, as the chairman has pointed out, can be better refined to reflect the varying circumstances in host countries. Nevertheless, the bill before us continues this comprehensive approach by requiring that the AIDS Coordinator provides a balanced approach for prevention activities for sexual transmission of HIV/AIDS and to ensure that abstinence and faithfulness programs are implemented and funded in a meaningful and equitable way.

The agreement that we have is carefully crafted and designed in the area of reproductive health and family planning to ensure that HIV funding for prevention is not misused to promote programs beyond the scope of this bill.

We can do that, if you wish, in other bills. But the bill ensures also that those working to fight these diseases are not required to choose between their conscience and receiving the assistance they need to carry out their work.

Also we worked a lot on the prostitution and the sex trafficking pledge. The bipartisan agreement maintains the existing certification requirement that any group or organization receiving PEPFAR funds explicitly oppose prostitution and sex trafficking. The U.S. Agency for International Development has implemented this prohibition by requiring that any group that receives funding sign a pledge affirming its opposition to these practices.

Let me be clear: Neither current law nor the pledge itself prevents organizations from working with prostitutes or other high risk groups, but it does mandate that that assistance to these individuals not be mistaken for approval or support of the activities that take their terrible toll on their bodies and that can only be described as destructive to human dignity.

We had issues with accountability and national security, and although this bill is absolutely motivated by the altruism of the American people, I believe that this legislation ensures that our interests are protected as well.

For example, U.S. contributions to the Global Fund will be subject to more stringent oversight than is currently provided by calling for the Fund to meet even higher benchmarks of transparency and accountability.

The legislation also includes a prohibition on taxation of our assistance by foreign governments to ensure that assistance intended to the afflicted not be siphoned off by unaccountable bureaucrats.

The bill also strengthens our national security. The HIV pandemic is first and foremost a health issue, but it also is one of the most significant global, economic, and security threats of our generation. General Charles Wald, the Former Deputy Commander of the US-European Command, has called HIV/AIDS the third greatest threat to our national security.

Together, HIV/AIDS, tuberculosis, and malaria kill millions of people during their most productive years, between the ages of 16 and 50. And in the hardest hit countries, the AIDS epidemic alone is killing a generation of parents, of teachers, of health care workers, bread winners, peacekeepers, shattering the economic and the social life of villages, communities, and, indeed, nations.

Losses on this scale have staggered the economies of the hardest hit countries. Without further prevention, without further treatment, without further care efforts, the AIDS pandemic will continue to spread its mix of death, poverty, and despondency that is further destabilizing governments and societies and undermining the security of entire regions.

Our former House colleague from Wisconsin, Mark Green, who now serves as the United States Ambassador to Tanzania, wrote to me following the committee's passage of this bill highlighting this security aspect. He said, ``In tearing apart the social fabric and leaving a generation of orphans, the scourge of HIV/AIDS could spread and create a long-term breeding ground of radicalism.''

PEPFAR programs in turn help to counter these precursor conditions. As General Wald has said, ``In addition to the obvious humanitarian efforts of PEPFAR, the program is one of our Nation's development activities that can help strengthen the social structure that keep communities and nations secure.''

The threat is not just in faraway lands, but in our own back yard. Many countries in the Caribbean have been particularly hard hit. This bill places a new emphasis on assistance to this region. It adds 14 Caribbean countries to the existing list of nations in which the Global AIDS Coordinator is given explicit statutory authority over HIV/AIDS programs.

Let me add that, although all of us share the goal of reducing the further spread of this pandemic, this is also a personal issue for me both professionally and morally. South Florida, which falls within my congressional district, ranks first in the State of Florida in the number of AIDS cases. Roughly 19 percent of the State total for those living with HIV reside in my district. So, I am all too familiar with the human cost of this disease, and hope for the day when its ravages are safely confined to the past.

Although not all Members will fully agree with every aspect of this complex compromise, it does contain the bipartisan approach that we have maintained throughout the years of work on HIV/AIDS in our committee. We have an opportunity, indeed, a responsibility, to continue the lifesaving work that began 5 years ago. This legislation is a means by which that can happen.

But the dry text of the legislation, nor the posters behind me, cannot adequately capture the human drama for which we are trying to write the exit strategy.

The poster behind me shows where PEPFAR has worldwide activities, the number of countries where it has positively had an impact. The second poster shows the number of adults and children estimated to be living with HIV just this last year. And, the third poster shows some of the faces of the children whom this legislation has saved.

Let me read, to conclude, from a Washington Post op ed authored by our chairman, Henry Hyde, 5 years ago. Mr. Hyde wrote,

``Not since the bubonic plague swept across the world in the last millennium has our world confronted such a horrible curse as we are now witnessing with the growing HIV/AIDS pandemic.

``This pandemic is more than a humanitarian crisis.

``To those who suggest that the United States has no stake in this pandemic, let me observe that the specter of failed states across the world is certainly our concern.

``The AIDS virus is a mortal challenge to our civilization.

``It is my hope that each of us will be animated by the compassion, and, yes, the vision, that has always defined what it means to be an American.''

Madam Chairman, endless numbers of children have already been orphaned and deprived of the protection and the love of their parents. We cannot make their world whole again, but there is much that we can do to comfort and care for them and to prevent others from suffering the same fate.

I ask my colleagues to join us in supporting this bill in a strong bipartisan manner, and thereby allow our country to continue our mission, our mission of mercy, for the waiting millions.

And with that, Madam Chairman, I reserve the balance of my time.

Madam Chairman, I yield 3 minutes to the gentleman from California (Mr. Royce) who is the ranking member of the Subcommittee on Terrorism, Nonproliferation, and Trade.

Madam Chairman, I am proud to yield 7 minutes to the gentleman from New Jersey (Mr. Smith), the ranking member of the Subcommittee on Africa and Global Health, who has worked so long and so hard on this topic.

Madam Chair, I yield 3 additional minutes to the gentleman.

Madam Chairman, before yielding to my distinguished colleague from Illinois, I would like to recognize the efforts of Yleem Poblete, our staff director on the GOP side, Mark Gage, Joan Condon, Sarah Kiko of our committee staff, they have all been working so hard, and our detailee, a valuable addition to our PEPFAR team, Ben Snyder. Thank you to everyone who has worked so hard.

Madam Chairman, I would like to yield 3 minutes to the gentleman from Illinois (Mr. Weller), an esteemed member of the Committee on Ways and Means.

I yield an additional 2 minutes to the gentleman from Illinois.

Madam Chairman, I would like to yield 5 minutes to the gentleman from Indiana, Congressman Pence, the ranking member on the Subcommittee on Middle East and South Asia, who spoke so eloquently during the committee markup on the need for this bill. 5 minutes.

(Mr. PENCE asked and was given permission to revise and extend his remarks.)

Madam Chairman, I would like to yield such time as he may consume to the gentleman from New Jersey (Mr. Smith) for the

purpose of engaging in a colloquy with our chairman, Mr. Berman of California.

Madam Chairman, at this time I am pleased to yield 1 minute to my colleague, my friend from California (Mr. Rohrabacher), who is the ranking member of the Subcommittee on International Organizations, Human Rights, and Oversight.

Madam Chairman, I yield the gentleman an additional 30 seconds.

Madam Chairman, I would like to yield myself such time as I may consume.

Madam Chairman, sometimes when we are negotiating legislative text or debating the merits of an important bill, such as the one before us today, we can lose sight of the extent of the impact that our decisions here can have on the lives of so many.

I would like to quote from some of the African leaders whose people and societies have been rescued from certain death by our PEPFAR programs. The President of Tanzania has said the following, ``There would have been so many orphans to date. Had it not been for PEPFAR, the care and treatment, so many parents now who would have been infected can now live. And some of them can live as many years as possible. So can you imagine if this program is discontinued or disrupted? There would be so many people who would lose hope, and certainly there would be death. You create more orphans. So my passionate appeal is for PEPFAR to continue.''

Or listen to the words of the President of Botswana when he said, ``PEPFAR is now a critical partner in the historic and heroic battle to save lives. PEPFAR has turned despair into hope. PEPFAR has galvanized donor countries and agencies alike to act in concert in the interest of humanity. If the fund is not renewed and if it is not replenished, the momentum generated by PEPFAR thus far will no doubt be lost, and the hope rekindled by the generosity of the American people will be extinguished. I say this to you,'' said the President of Botswana, ``and that's what I said to the congressional committees recently.''

So, Madam Chairman, these and so many other statements reflect the human contribution of this critical United States program. But they also demonstrate that PEPFAR programs are helping to win hearts and minds throughout the world. They are building and strengthening the bonds between the governments and the people of these countries and the United States of America. They are building good will toward our Nation and toward the American people.

Madam Chairman, after the deplorable attacks on our Nation on that fateful day almost 7 years ago, we in this Chamber committed ourselves to using the range of U.S. foreign policy tools, including soft power, to counter the conditions that breed hatred, intolerance and radicalism; radicalism that targets the United States, our interests and our allies, and seeks to undermine our freedom and democracy everywhere. The bill before us is a vital tool in that effort.

Again, as our former colleague, our Ambassador to Tanzania has said, ``I

want you to know that PEPFAR is crucial to my current mission as Ambassador to the United Republic of Tanzania. It is a tremendous public diplomacy tool that shows America at her best, a compassionate partner who is committed to helping Tanzania meet its enormous HIV/AIDS challenges.''

``I was asked to present remarks to the National Consultive Meeting of Islamic Leaders and Scholars here in Dar es Salaam,'' continues the Ambassador. ``This was a historic gathering, as it was the first time that the most esteemed Muslim leaders of Tanzania had gathered together to discuss their role in the fight against HIV/AIDS. They invited me to speak alongside the President because of their concern about HIV/AIDS and their awareness of America's historic contribution to HIV prevention, treatment and care programs.'' Why? Because of PEPFAR. ``So as we help to save lives and restore hope,'' the Ambassador ends, ``we are leaving a lasting impression on the people of this country.''

Madam Chairman, I hope that our colleagues will see the great merit of this program and that we will continue to build upon it to save many more lives.

With that, I reserve the balance of my time.

Thank you, Madam Chairman.

We have no further requests for time. I would like to yield back the balance of my time.

Madam Chairman, I ask unanimous consent to claim the time in opposition to the amendment for purposes of debate.

Madam Chairman, I yield myself such time as I may consume.

Madam Chairman, I support Mr. Blumenauer's amendment, which would add safe drinking water to nutrition and income security on the list of programs for which direct linkages are encouraged. For patients whose immune systems have been compromised by AIDS, the availability of safe, clean drinking water is vitally important. This is especially true for HIV positive women with young infants who use infant formula to avoid transmitting the virus to their babies during feeding. If the water used in the formula is not clean, their babies are at high risk for waterborne diseases. Therefore, this amendment would allow PEPFAR to link with existing safe drinking water programs in order to provide clean water to these treatment patients.

I yield to the gentleman from California.

Madam Chairman, I would also like to yield such time as he may consume to the gentleman from New Jersey (Mr. Payne).

Madam Chairman, I yield back the balance of my time.

Madam Chairman, I also support Mr. Fortenberry's amendment which would ensure that audits by the Global Fund Inspector General include information on subcontractors.

The U.S. government is the largest contributor to the Global Fund to fight HIV/AIDS, tuberculosis, and malaria. Since the fund was created, the U.S.

has appropriated and pledged $3.5 billion for contributions to the Global Fund, representing nearly one-third of the total budget of the Global Fund. It is an important component to the world's response to these three diseases, and has made progress on issues of transparency and accountability in recent years.

As the bill makes clear, continued support to the Global Fund should be based on the Fund's ability to meet certain transparency and accountability benchmarks.

This amendment builds on and clarifies the underlying text in order to ensure that the audits conducted by the Global Fund's Office of Inspector General cover both primary recipients of grant funding and subrecipients who perform smaller pieces of the grants. These audits are important. I thank the gentleman for the time, and I support the Fortenberry amendment on Inspector General audits at the Global Fund.

Madam Chairman, I actually support the McCollum- Jackson amendment, which would add Malawi, Swaziland and Lesotho to the list of countries in which the Global AIDS Coordinator is given explicit statutory authority.

Malawi, Swaziland, and Lesotho all face major HIV/AIDS epidemics and have received significant resources through PEPFAR in the first 5 years of implementation. By giving the Global AIDS Coordinator explicit authority over the U.S. Government's HIV/AIDS programs in these countries, the Congress is signaling that it believes the U.S. Government should continue to come alongside these nations' governments and their citizens to support them in the fight against HIV/AIDS, and I commend Ms. McCollum and Mr. Jackson for offering it.

I would like to yield the remaining time, Madam Chairman, to our chairman, Chairman Berman of California, as well as Mr. Payne of New Jersey, with Mr. Payne of New Jersey first.

Madam Chairman, if I could yield now to Chairman Berman, the gentleman from California.

Madam Chairman, first of all, I would like to thank Mr. Carson for his well-reasoned and important amendment. We all had the honor of serving with his grandmother, Julia Carson, for many years in this body, and I know that Congresswoman Carson is looking down at her grandson and saying she is mighty proud. So thank you so much for your amendment, and thank you for carrying on in her great legacy by presenting wonderful topics and themes for us to discuss on the floor.

I fully support the Carson amendment because it focuses on building human and institutional capacity in PEPFAR host countries. It directs the global AIDS coordinator and the USAID administrator to expand their plan by strengthening health systems of host countries by encouraging post secondary educational institutions, particularly those in the African continent, to collaborate with the post secondary educational institutions here in the United States, including historically black colleges and universities in training health care workers.

As other provisions of this bill made clear, an important component of the fight against HIV/AIDS, tuberculosis, and malaria, is the strengthening of the educational capacity in host countries to train health care workers. The Carson amendment does exactly that. I congratulate him for it. He is a welcome addition to our Chamber.

I would like to yield to Ms. Lee of California who has been working on this issue for a long time, Madam Chairman.

Madam Chairman, I yield such time as he may consume to the gentleman from New Jersey (Mr. Payne).

Madam Chairman, I yield myself such time as I may consume.

Madam Chairman, on the President's request 5 years ago, Congress launched a global campaign to stop the spread of HIV/AIDS and to treat and care for those who are already afflicted. The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act was a bipartisan bill from its inception. Today, the Foreign Affairs Committee again brings a bipartisan global HIV/AIDS bill to the floor, and again this important reauthorization bill enjoys strong support from the White House.

The negotiations that brought forth this compromise bill were conducted in the same bipartisan spirit that guided the 2003 act into law, a spirit made possible by close cooperation between two former chairmen of the Foreign Affairs Committee, our late colleagues Tom Lantos and Henry Hyde, and I am pleased to note that this important reauthorization bill is named for these two foreign policy titans in recognition of their contributions to battling HIV/AIDS overseas.

As a direct result of the extraordinarily successful law we passed 5 years ago, the United States has provided lifesaving drugs to nearly 1.5 million men, women and children; supported care for nearly 7 million people, including 2.7 million orphans and vulnerable children; and prevented an estimated 150,000 infant infections around the world.

The 2003 legislation firmly established the United States as the leading provider in the world of HIV/AIDS assistance for prevention, treatment and care. It has reminded the global community that Americans are a compassionate and generous people, and so has helped to repair our Nation's badly-damaged image overseas. In many ways, that legislation has had great healing power.

Most importantly, with this initiative we have ensured that HIV/AIDS is no longer the certain death sentence it was just 5 short years ago. Hospital corridors that were jammed with AIDS patients waiting to die now brim with hope as lifesaving drugs are dispensed.

The reauthorization bill before the House today reaffirms our commitment to the programs and policies established 5 years ago. The 2003 legislation

worked well as an emergency intervention, but it must now be modified to reflect the constantly changing nature of the HIV/AIDS crisis. We also have 5 years of experience under our belts and we know what works and what does not.

The law we passed in 2003 was designed to deal with the emergency phase of the global HIV/AIDS crisis. The Lantos-Hyde bill will move our programs towards long-term sustainability that will keep the benefits of U.S. global HIV/AIDS programs flowing to those in need. With this reauthorization act, host governments will also gain the ability to plan, direct and manage prevention treatment and care programs that have been established with U.S. assistance.

The 2003 legislation authorized $15 billion over 5 years. In response to the desperate need for lifesaving medicine and a greater number of trained health care workers in nations hard hit by HIV/AIDS, the bill before us authorizes $50 billion over 5 years for these three pandemics.

The 2003 law relied upon the health care workforce already in place in the developing world, yet in many of the hardest hit areas of the world there are simply not enough doctors and other health care workers to meet the challenges of this pandemic. The Lantos-Hyde legislation invests new funds in training new professionals and paraprofessionals, as well as building existing capacity.

The 2003 law focused on creating new programs to tackle the HIV/AIDS crisis. The reauthorization bill increases the number of individuals receiving prevention, treatment and care services. It also builds stronger linkages between the global HIV/AIDS initiative and existing programs designed to alleviate hunger, improve health care, and bolster HIV education in schools, an approach endorsed by the President's Global AIDS Coordinator just a few short weeks ago.

The 2003 law gave inadequate attention to the needs of women and girls. The new legislation remedies this situation by strengthening prevention and treatment programs aimed at this especially vulnerable population.

The reauthorization legislation also eliminates the one-third abstinence-only earmark, but requires a balanced approach to HIV/AIDS sexual transmission prevention programs and a report regarding this approach in countries where the epidemic has become generalized.

The bill before you today is a compromise in the best sense of the word, and it is in the true spirit of the great leaders of this committee who guided the 2003 act into law, Chairmen Lantos and Hyde. This bill is the result of more than a year of preparatory work and weeks of discussions, concluding with a bipartisan agreement with the White House. President Bush has indicated his support and his intention to sign it into law as soon as Congress acts.

For all its strengths, the bill before the House today is not perfect. No compromise ever is. No one got everything they wanted in this compromise legislation. But with this agreement, we have maintained the strong, bipartisan coalition behind the global HIV/AIDS initiative which has been critical to winning rapidly increasing funding levels for this important initiative.

Madam Chairman, 20 million innocent men, women and children have perished from HIV/AIDS, and 40 million around the globe are HIV positive. Each and every day another 6,000 people become infected with HIV. We have a moral imperative to act, and to act decisively.

I will speak more lengthily about the subject, but I do want to initially extend my particular appreciation to our ranking member, Ileana Ros-Lehtinen, who played a critical role in working with the majority to reach this compromise. A number of Members on her side from the committee were active. Don Payne, the gentleman from New Jersey, the chairman of the Africa Subcommittee, was critically involved, as was Congresswoman Barbara Lee from California, who played such a key role in the 2003 law, as well as a number of other people, such as Congressman Carnahan. I can't mention everyone who was involved, but this was truly a collaborative effort that started long before I became Chair of the committee, with great work by Chairman Lantos last year and with the staff of the committee.

Madam Chairman, I reserve the balance of my time.

Madam Chairman, I thank the gentlelady for her wonderful statement, and I yield 3\1/2\ minutes to the gentleman from Massachusetts (Mr. McGovern).

Madam Chairman, before I respond with my views, I would like to yield 1 minute to the gentleman from New Jersey (Mr. Payne) to express his views on the subject of this colloquy.

I yield the gentleman an additional 30 seconds.

Madam Chairman, I yield myself 1\1/2\ minutes to respond to the concerns raised during this colloquy. I thank my colleagues for raising these important concerns.

H.R. 5501 provides clear and specific instructions to the USAID Administrator and the Global AIDS Coordinator to address the food and nutrition needs of individuals with HIV/AIDS and other affected individuals, including orphans and vulnerable children; and to fully integrate food and nutrition support in HIV/AIDS prevention, treatment, and care programs carried out under this act.

I would like to emphasize that the committee and I personally share our colleagues' concerns about the negative effect rising costs are having on our long-term and emergency food aid programs. This is a matter that has our most serious attention, because it affects a wide array of our food aid and development programs, including the effectiveness and success of this program.

I want to reassure my colleagues that I will be working over the coming weeks to strengthen and clarify in the bill that food security and nutrition programs, especially those referred to as wrap-around services, are not to be funded with monies diverted from other standing commitments to address food and security elsewhere in the world or in these countries.

I yield 30 seconds' additional time to the gentleman from Massachusetts.

Madam Chairman, I am pleased to yield 5 minutes to the gentleman from New Jersey (Mr. Payne), the chairman of the Foreign Affairs Subcommittee on Africa and Global Health, and a key architect of this legislation.

I yield the gentleman an additional minute.

Madam Chairman, I am very pleased to yield 3 minutes to the chairman of the Foreign Affairs Subcommittee on the Western Hemisphere. And remember, this is a bill about HIV/AIDS, malaria, and tuberculosis. He played a major role in the tuberculosis section of the bill, the gentleman from New York (Mr. Engel).

Madam Chairman, I am very pleased to yield to my friend from California, someone who has been heavily invested in getting our attention on this issue and passing the legislation, putting, fashioning and passing the legislation in 2003 and again this time, our gentlelady from California, Barbara Lee, for 5 minutes.

I yield the gentlelady an additional 2 minutes.

Madam Chairman, I am pleased to yield 1 liberal minute to the majority leader, the gentleman from Maryland (Mr. Hoyer).

I appreciate the gentleman yielding, and the gentleman is absolutely correct. Part 2 of the report is the definitive report on the legislation being considered by the House today.

Madam Chairman, I am pleased to yield 2 minutes to my colleague from California (Ms. Woolsey), the chairman of the Education and Labor Subcommittee on Workforce Protections and a member of the Foreign Affairs Committee.

Madam Chairman, I am pleased to yield 2 minutes to my friend and colleague from California, the gentlelady, Maxine Waters.

MS. WATERS. Madam Chairman and Members, I am pleased and proud to be here today to commend not only Chairman Berman but the late Tom Lantos and Henry Hyde for their wisdom and their foresight in putting together this most important legislation.

Ladies and gentlemen, I just returned from south Africa and I am pleased to announce that while I was there, I was recognized and given the Order of the Companions of Oliver Tombo Award for my work to help dismantle apartheid in South Africa, and basically for being a friend of south Africa's. I was very proud.

But as I sat there talking with President Umbeke and others, I was reminded that in south Africa there is an estimated 5.5 million people living with HIV and AIDS. That is more than any other country in the world. Over 18 percent of the adult population of south Africa is infected by HIV. Infected persons include thousands of well-educated professionals, such as doctors, nurses, civil servants, and teachers.

In recognizing that we have done a great job in helping to promote democracy and get rid of apartheid, the enemy now is HIV and AIDS and tuberculosis. They are losing all of their professionals. They don't have the personnel to carry out the plan that they have put together to continue to move south Africa to where south Africa needs to be.

I was very proud that they had built 2.3 million new houses over the last 10 years. But, again, tuberculosis, HIV and AIDS is destroying this population. This legislation will help this country and other countries. These are our friends. They love us. And they love us for having been involved in the struggle to help save them. These are countries that we will be able to count on in the world because we have come to their aid.

Let me also recognize that there were many Americans traveling in South Africa. Those Americans who were there are being served by people who live in areas where tuberculosis and HIV is rampant.

So we need this for protection and security of all peoples.

Might I inquire of the remaining time.

Madam Chairman, we have no further requests for time. I would like to make a few closing comments, and I yield myself such time as I may consume.

It is an accident of fate and hanging around a long time that put me in the position of managing this bill today, and it is the first bill not on the Suspension Calendar that has come out of the committee since I have become Chair. But the fact is the work on this legislation began a very long time before I became the Chair.

They have been mentioned before, but there are so many new initiatives and so much thoughtful logic underlying this legislation that I thought it would pay to once again mention a group of staff people who, working under the leadership of our staff director, Dr. Bob King, spent a huge amount of time working for Chairman Lantos, working with the minority staff, to craft what became a strong, bipartisan piece of legislation:

Peter Yeo; Pearl Alice Marsh; Kristin Wells; David Abramowitz; Macani Toungara; Heather Flynn from Chairman Payne's Africa Subcommittee; Christos Tsentas from Congresswoman Barbara Lee's staff; Naomi Seiler and Jessica Boyer from the Government Oversight Committee staff, all played important roles on our side in working on this legislation. Yleem Poblette on the minority staff made major contributions.

The result is a bipartisan product where in a way we have internalized on our side the logic of efforts to change behavior and recognized the validity of abstinence programs in the context of a comprehensive approach to this problem and accepted the value of faith- based organizations, and the minority has accepted the logic that this is a fundamental, moral and humanitarian concern that we should address and be willing to put a lot of value to, because we know it works.

We know there is a direct relationship between the resources we put into this program and the lives saved, the people who can avoid and prevent it, and that it has implications beyond just the moral and humanitarian dimension, as Speaker Pelosi and Congresswoman Ros- Lehtinen said, in terms of security and economic welfare and economic growth in so many parts of the world, which ultimately all inure to our benefit and our national interest.

So, once again, I am very pleased to be part of this process with my partner, the ranking member.

Madam Chairman, I yield back the balance of my time.

Madam Chairman, will the gentlewoman yield?

Madam Chairman, I appreciate the gentlewoman yielding, and I rise to join you in supporting the gentleman's amendment. What was interesting to me was to learn, and there are many things I learned in this bill that I didn't know, but one was that about 1.2 billion people globally lack safe water to consume in the least-developed countries, and up to 90 percent of AIDS patients, 90 percent, suffer and frequently die from the chronic diarrheal diseases that the gentleman discussed. These diseases are caused by the use of unsafe water.

This is a compelling amendment. I join the gentlewoman in supporting it.

Madam Chairman, while I do not oppose the amendment, I ask unanimous consent to take the time in opposition.

Madam Chairman, the gentleman's amendment, and I have spoken to him about it, encourages the Global Fund Inspector General to not only audit its grantees, but also the subgrantees and subrecipients who receive Global Fund money.

Obviously, I share the gentleman's concern that transparency and accountability in the use of HIV/AIDS assistance provided through the Global Fund is critically important for all the reasons that he stated. The Global Fund, in all fairness, I do want to point out, has shown, I believe, its commitment to that transparency and accountability. It has a new inspector general, and has instituted an enhanced accounting system that focuses on improving accountability among subrecipients. But the principle of this amendment makes sense. While there are some technical issues I will want to talk to him about as we move through the legislative process, I look forward to working with him on it and I certainly urge the adoption of the amendment.

I yield 1 minute to the gentlelady from Florida, the ranking member.

Madam Chairman, I yield 1 minute to the chairman of the Africa Subcommittee, the gentleman from New Jersey (Mr. Payne).

Madam Chairman, I have no further requests for time, and I yield back the balance of my time.

I thank the gentlelady for yielding.

I support this amendment. I congratulate Representatives McCollum and Jackson for their leadership in adding these hard-hit nations to the focus country list.

All three of these Southern African countries suffer from both high HIV/AIDS prevalence rates and high poverty rates, with devastating effects. The statistics in all three countries regarding AIDS have been put on the record by both the gentlelady from Minnesota and the gentleman from New Jersey, so I will just add my words of support for the amendment.

Madam Chairman, I demand a recorded vote.

Mr. Speaker, I rise to oppose the motion to recommit.

Thank you, Mr. Speaker.

First, I appreciate the compliments of my friend from Wisconsin. I prefer that the compliments be withheld and the motion to slash this bill by 40 percent be rejected, although I do appreciate the implication of his comments that a recommittal motion that is forthwith is not intended to kill the bill and that, therefore, the recommittal motions that are not forthwith are intended to kill the bills they are made to.

But getting to the merits of this. The purpose of my comments is directly to the other side. I know the easy vote, even for those who support this bill, is to vote both to cut some money and to support the minority on their motion to recommit.

But I would like to suggest that in this particular case, given what has transpired in terms of putting together this bipartisan bill, both on the merits of the motion to recommit and on the message it sends about how we can work on a bipartisan basis in the future, this motion is wrong and that Members on the other side should oppose it along with the Members on our side.

First, on the facts. The administration supports this bill and supports our number on this bill. To the extent they have concerns about what the level of appropriations may be in this year, their statement of administration position directly says, talk about the level of appropriation; don't cut the authorization.

Secondly, the U.N. HIV/AIDS commission, which I'm not a fan of a lot of different agencies that start with ``U.N.,'' but this one is the preeminent authority, talks about the incredible remaining need. And in the issue of absorptive capacity, this was the same argument made in 2003 against a $15 billion authorization for which the Republican Congress appropriated far more than the authorization because we were able to see an absorptive capacity, and we saved well over a million lives.

But here we are dealing with a situation where there are 35 million people worldwide that are still living with HIV/AIDS. This is a program that works. The combination of changing behavior, prevention, and treatment is saving lives. I don't like to throw the words ``moral imperative'' around. It's usually used for anything people feel passionately about. But talk about pro-life, I can't think of any single program that I have been involved with where we are going to be more pro-life than in pushing this with programs that work, with the capacity that can be absorbed. No one is saying we are going to spend $50 billion in the next 5 years. We are going to obligate, based on the appropriation moneys, and those moneys will be spent probably over the course of 8 to 10 years. That's the way this appropriation process works, as everyone knows.

My final point is the ranking member and I, the White House directly, the President and his chief of staff were directly involved, the Republican leadership in this body, we put together a bipartisan bill. Part of the key negotiation was about the number. In return for that, a number of issues of importance to the minority were preserved in this bill: the preservation of the concept of behavior change through abstinence and faithfulness; the understanding that approved family planning programs would be the ones that were funded. A variety of different aspects. The belief in the use of faith-based institutions.

How are we, in the future, going to come together on bipartisan programs where the deal is made and then all of a sudden a key part of the quid pro quo, the other side says ``no'' to?

I would suggest, sure there are issues about what is our fiscal condition and what can we do, and the appropriations could be weighing these very carefully. But this was a fundamental agreement to maintain a bipartisan tradition on this legislation named after Henry Hyde and Tom Lantos, both of whom worked in that capacity.

I think this motion to recommit massively undercuts that whole bipartisan approach, and I would urge my colleagues to defeat it.

I would be happy to yield to the gentleman from New Jersey.

Mr. Speaker, I demand a recorded vote.

Madam Chairman, there's a terminology that we use to describe joyous occasions. Sometimes it describes freedom. The Fisk Singers in Tennessee were called the Jubilee Singers, and it was because they organized around slavery and after slavery and the ability to be free with jubilation, and, therefore, they were called the Jubilee Singers.

I think today is a day of jubilation, and it certainly is a time to express the jubilation that we feel with the passage, or the intended passage, of this legislation.

Let me thank the chairman of the subcommittee, Mr. Payne, for persistence and determination and wisdom. Let me also acknowledge his ranking member, Mr. Smith; and, of course, our chairman, Mr. Berman; and the ranking member of the full committee, Ms. Ileana Ros-Lehtinen for working with us.

But I do want to spend some time acknowledging that we have named this bill after the late former Chairman Tom Lantos and Henry J. Hyde. That is a jubilation. It is something to express great excitement about because these two distinct figures, in many instances with common views but many instances different views, came together around this lifesaving legislation, Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria. And it is particularly important because we have added malaria and tuberculosis as an element that is not a partner but results thereof and/or stands alone, but all of them kill.

I am reminded of the first mission to Zimbabwe, to Zambia, and to South Africa, where we went on a Presidential mission, three Members of Congress, to look closely at the devastation of HIV/AIDS. It was in 1996/1997. And it was there that I saw a 4 year old taking care of a dying grandparent, the last person surviving who had tuberculosis and HIV/AIDS. So this legislation is crucial, and it is particularly crucial because it recognizes the devastation of all of them.

It is likewise crucial because we have not won the war. The jubilation is that the bill is on the floor, but we have not won this war. And I might also say that we have not won the war in education, the ability to prevent all of these diseases.

So let me ask my colleagues to support this legislation.

Madam Speaker, I rise today in strong support of H.R. 5501, The Global HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. I believe that the legislation we are considering today makes vital improvements to

what is already a groundbreaking program. I would like to thank Chairman Berman for his ongoing leadership on this issue, and for bringing this legislation to the floor today. I would also like to thank the Committee's Ranking Member, Congresswoman Ros-Lehtinen, and my colleagues across the aisle, for working toward a compromise, to develop legislation of which we can all be proud. Today's legislation is a crucial step toward transforming PEPFAR from an emergency response to a sustainable program.

I would also like to thank both Chairman Berman and the Chairman of the Subcommittee on African and Global Health, Congressman Payne, for working with me to include important language in this legislation. My language, in Section 301 of this bill, addresses the necessity of making children a priority among individuals with HIV for proper food and nutritional support. Section 301, with my language included, states that it is the sense of Congress that ``for the purposes of determining which individuals infected with HIV should be provided with nutrition and food support--

(i) children with moderate or severe malnutrition, according to WHO standards, shall be given priority for such nutrition and food support; and

(ii) adults with a body mass index, BMI of 18.5 or less, or at the prevailing WHO-approved measurement for BMI, should be considered `malnourished' and should be given priority for such nutrition and food support;''

Madam Chairman, as Chair of the Congressional Children's Caucus, I believe that this language is crucial, and I thank the Chairman for including it in the text of the bill. HIV-infected children have been underrepresented among beneficiaries of PEPFAR-supported programs. As this legislation cites in the findings section, ``of those infected with HIV, 2.5 million are children under 15 who also account for 460,000 of the newly-infected individuals.'' And even these large numbers are deceiving, as children die much quicker from AIDS than do adults. UNICEF reports that every minute, a child dies from an AIDS- related illness, and only 1 child in 20 who needs HIV treatment receives it. I am pleased to see this language, which focuses attention on the plight of these children, and makes serving their needs a priority.

I am particularly pleased to support an amendment offered by my colleague Congressman Carson. Representative Carson's amendment would direct the Coordinator of United States Government Activities to Combat HIV/AIDS Globally and the Administrator of the United States Agency for International Development to expand their plan for strengthening health systems of host countries by allowing for postsecondary educational institutions, particularly in Africa, to collaborate with United States postsecondary educational institutions and specifically historically black colleges and universities. I believe that such educational exchanges would be extremely beneficial for students both in our own Nation and in developing nations. I urge my colleagues to join me in supporting this amendment.

In addition, I am also pleased to support the amendment offered by my colleague Congressman Blumenauer. This amendment adds safe drinking water to nutrition and income security on the list of programs for which direct linkages are encouraged. People with HIV/AIDS are at increased risk for diarrheal diseases, and these illnesses leave HIV- infected patients with a reduced ability to absorb antiretroviral and other medications. The availability of safe drinking water must be part of any sustainable strategy of HIV prevention and treatment.

As this House is aware, it is estimated that HIV/AIDS, tuberculosis, TB, and malaria together kill more than 6 million people each year. In January 2003, President Bush announced the President's Emergency Plan for AIDS Relief, or PEPFAR. As its name implies, PEPFAR was envisioned as an emergency response; the bill before us today represents a crucial first step in the process of transitioning to a sustainable program to address these global epidemics.

Seventeen years after the first cases were diagnosed, AIDS remains the most relentless and indiscriminate killer of our time, with 39.5 million people worldwide now living with HIV or AIDS. Despite pouring billions and billions of private and Federal dollars into drug research and development to treat and ``manage'' infections, HIV strains persist as a global health threat by virtue of their complex life cycle and mutation rates. Of those infected, 24.7 million, or about 63 percent, live in Sub-Saharan Africa, a region with just 11 percent of the world's population. 61 percent of those infected in this region are women. Though Africa, and even more specifically African women, bears the brunt of the AIDS pandemic, Americans should be reminded that HIV/ AIDS does not discriminate, with well over a million people in our own country currently living with HIV or AIDS.

Tragically, 6 percent of the 39.5 million people currently infected with HIV/AIDS are children under 15 years of age. In 2006, the virus killed 380,000 children (13 percent of all HIV/AIDS deaths), and 90 percent of all children living with HIV reside in sub-Saharan Africa. According to UNAIDS statistics from 2005, 1,500 children worldwide became newly infected with HIV every single day, due largely to inadequate access to drugs that prevent the transmission of HIV from mother to child. Only 8 percent of pregnant women in low- and middle- income countries were offered services to prevent HIV transmission to their newborns.

Madam Chairman, HIV/AIDS continues to represent a serious and large- scale challenge throughout much of the world. It goes far beyond a simple health problem, and it hinders attempts to foster economic development and political stability. As we reauthorize PEPFAR, I believe it is crucial that we emphasize the long-term sustainability of our HIV efforts, and that we integrate AIDS prevention and treatment within our larger-scale development initiatives. I believe that the legislation before us today makes groundbreaking strides toward moving the Global HIV/AIDS program beyond emergency implementation and toward sustainability. It dramatically boosts HIV/AIDS programming related to women and girls, strengthens health systems in countries hardest-hit by the HIV virus, increases U.S. contributions to the Global Fund, and authorizes HIV/AIDS programs to include linkages to food, nutrition, education, and health care programs.

Though we have drugs that are effective in managing infections and reducing mortality by slowing the progression to AIDS in an individual, they do little to reduce disease prevalence and prevent new infections. For this reason, there is growing consensus among health experts that we must put greater emphasis on comprehensive prevention programs, which are perhaps the most critical aspect of any initiative to combat global HIV/AIDS. Even as increasing numbers of people have access to anti-retroviral drugs, ARVs, an estimated 5.1 million people who needed treatment did not receive it in 2006. In sub-Saharan Africa, the percentage of individuals needing treatment who actually received it rose substantially, from 2 percent in 2003 to 28 percent in 2006. This growth is impressive, and represents a significant step forward, but it also means that 72 percent of sub-Saharan Africans requiring treatment did not receive it.

Madam Chairman, despite our concerted efforts, we continue to face a serious and persistent health threat. I believe that it is imperative that we ensure that American taxpayer dollars are used to greatest effect, not to bolster ideology. This legislation makes important strides forward by removing elements of the original authorization that speak more to ideology than actual conditions in the field. Under the current law, one-third of all prevention funds under PEPFAR must be used on abstinence-only education, which neglects the real needs of populations both in America and abroad. These stipulations hurt the ability of PEPFAR to adapt its activities in accordance with local HIV transmission patterns, and they impair efforts to coordinate with national health plans. Though AIDS is clearly a global problem, it does not affect every nation equally or in the same manner.

Madam Chairman, I am extremely pleased that the legislation we are considering today removes these restrictive provisions, allowing PEPFAR to better address the requirements of each country, making more efficient and effective use of taxpayer dollars in serving the millions affected by this disease. According to studies by both the Government Accountability Office and the National Academy of Science's Institute of Medicine, the abstinence-only earmark has forced a reduction in mother-to-child transmission programs, reduced prevention efforts with high-risk groups, and undermined efforts to implement Abstinence, Faithfulness, and Condoms, ABC, prevention programs.

Under the provisions of today's compromise legislation, the administration will be directed to promote a ``balanced'' prevention program in target countries. This will include all elements of the ABC approach to HIV prevention. The legislation will require that the administration report to Congress if behavioral change programs do not receive 50 percent of funds devoted to the prevention of sexual transmission of HIV in countries in which there is a generalized epidemic. I believe this language is extremely important, as it not only recognizes that HIV is transmitted in other ways, besides sexual activity, but it also acknowledges that the epidemic is not the same in every country. By requiring a report, rather than earmarking the expenditure of funds, this legislation provides guidance while still affording organizations working in the field the flexibility to respond to nuanced circumstances.

I am proud to be part of this Democratic Congress, which will produce legislation reauthorizing a Global HIV/AIDS program driven by facts, rather than ideology. The removal of the abstinence-only earmark will make this reauthorization legislation stronger than the original

2003 legislation that it will replace, and I strongly urge my colleagues to oppose any efforts that might attempt to reinstate it.

In addition, I believe it is crucial that we dedicate greater attention to strengthening local health infrastructure. Health experts have expressed concern that the high amount of spending directed toward HIV/AIDS initiatives has drawn health workers away from public health facilities and other important programs. This merely compounds a chronic shortage of qualified health workers, which, according to WHO's 2006 World Health Report, is the single most important health issue facing countries today. This need is felt particularly sharply in Southeast Asia and sub-Saharan Africa.

Many health experts also continue to advocate greater integration between PEPFAR and other health programs, including those focused on nutrition, maternal and child heath, and other infectious diseases. These experts note that HIV is intricately linked to these other areas of concern; for example, malnutrition and lack of food may heighten exposure to HIV, raise the likelihood of engaging in risky behavior, increase susceptibility to infection, and complicate efforts to provide anti-retroviral, ARV, medication. Further, an HIV epidemic will likely worsen food insecurity, by depleting the agricultural workforce. I believe it is necessary, to ensure maximum effectiveness, that we integrate PEPFAR with other aspects of our international health outreach and development programs. The legislation before us today does that.

Madam Chairman, while I recognize the importance of compromise, and I am glad we were able to reach an accord with our colleagues on the other side of the aisle, I am disappointed that the compromise text does not include a repeal of the language, known as the pledge requirement, requiring that all funding recipients to ``have a policy explicitly opposing prostitution and sex trafficking.''

Madam Chairman, the removal of the prostitution pledge was a critical facet of the bill we are considering today. The pledge currently restricts recipients' privately funded HIV prevention programs. No funds may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking. Funding recipients must refrain from speech or conduct that is inconsistent with the Government's views on prostitution, even when they use private funds. Organizations must refrain from some effective HIV prevention strategies, for fear that the Government will view it as ``pro-prostitution.'' A repeal of the prostitution pledge language would leave in place language ensuring that U.S. Government funds may not be used to ``promote or advocate the legalization or practice of prostitution and sex trafficking.''

Madam Chairman, the prostitution pledge undermines prevention efforts targeting one of the populations most vulnerable to HIV transmission. Because high-risk populations such as sex workers are extremely marginalized, it is crucial that any intervention promotes a level of trust between sex workers and service providers. Failure to provide sex workers with information and services that will help them protect themselves and their partners from HIV transmission and other sexually- transmitted diseases also puts the broader community at risk. I am disappointed that this legislation does not remove this vague and counterproductive requirement.

This legislation also contains crucial provisions with regards to malaria and tuberculosis prevention and treatment. It incorporates H.R. 1567, the Stop Tuberculosis, TB, Now Act of 2007 sponsored by Congressman Engel, important legislation which I am proud to cosponsor. Today's legislation emphasizes the linkages between HIV/AIDS and TB, and it also creates new strategies for attacking MDR and XDR forms of drug-resistant TB. The bill also requires the President to develop a comprehensive 5-year strategy to combat malaria globally and strengthen United States leadership against this disease, and creates a new Coordinator of United States Government Activities to Combat Malaria Globally.

If we are to turn the tide of turmoil and tragedy that HIV/AIDS, malaria, and tuberculosis cause to millions around the world, and hundreds of thousands right here in our backyard, it is imperative that we continue to fund and expand medical research and education and outreach programs. However, the only cure we currently have for HIV/ AIDS is prevention. While we must continue efforts to develop advanced treatment options, it is crucial that those efforts are accompanied by dramatic increases in public health education and prevention measures. Investments in education, research and outreach programs continue to be a crucial part of tackling and eliminating this devastating disease.

As Americans, we have a strong history, through science and innovation, of detecting, conquering and defeating many illnesses. We must and we will continue to fight HIV/AIDS until the battle is won.

Mr. Chairman, as you know, the provision on food and nutrition security in the bill currently under consideration is drawn directly from a bill I introduced in December, H.R. 4914, the Global HIV/AIDS Food Security and Nutrition Support Act of 2007. I introduced the bill after chairing a hearing in the Subcommittee on Africa and Global Health to determine whether the Global HIV/AIDS program was adequately addressing the nutritional needs of its beneficiaries.

The hearing corroborated what I had already heard in the field on numerous visits to Africa over the past 5 years: PEPFAR is falling short in this critical area. I share the concerns of the gentleman from Massachusetts and the gentlelady from Missouri about the increasing cost of food aid. Just last week, the World Food Program had to issue an appeal for an additional $500 million to offset the increased costs of food and fuel.

Without the extra $73 million, people who rely on WFP for their daily sustenance may have their rations cut. This is a truly alarming situation, and it is not my intent for the provision of this bill to exacerbate it. The language under consideration very clearly states that these activities are to be funded from amounts authorized under section 401 of this bill. I used this language deliberately, as I strongly believe that the food assistance and nutritional support we are providing under the Global AIDS program must be on top of the food aid we are already providing.

Madam Chairman, let me begin by commending Chairman Berman of the committee for bringing forth this tremendous, important legislation, and for the support in this bipartisan effort from Ranking Member

Ros-Lehtinen, and for her support of this very important legislation.

I rise in strong support of the legislation currently under consideration. I am very pleased to be an original cosponsor of H.R. 5501, the Tom Lantos and Henry Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.

This bill is appropriately named because it was under the leadership of the late Henry Hyde, then chairman of the Foreign Affairs Committee, that the PEPFAR legislation was originally authorized. And under the leadership of the late Tom Lantos, reauthorization began. Both of these tireless giants who have left us should be remembered by this legislation. I might also note that under the leadership of the original authorization, Congresswoman Barbara Lee and the Congressional Black Caucus were very strong advocates to push the leadership of the House and the President to consider this very important legislation.

In the 5 years, there has certainly been a pandemic that the world is facing, and there has not been a pandemic similar to this since the plague during medieval days in Europe. So I am pleased that we are finally dealing with this pandemic in the way that it should be.

In the 5 years since Congress passed the original legislation authorizing the President's Emergency Plan for AIDS Relief, or PEPFAR, as it is well known, it has become an historic program. In my opinion, this will be remembered as the single most significant achievement of President Bush's two terms in office.

And from my recent conversations with the President, I know that he has worked very hard on this reauthorization, and it is with the support of the White House and the staff, they helped us craft this bipartisan legislation.

Prior to PEPFAR, the United States did very little in supporting AIDS treatment programs abroad. In fact, Members may recall a high-ranking USAID official said that treatment was not feasible in Africa, the most heavily AIDS-infected region of the world, because Africans cannot tell time and therefore would not be able to take the required medication properly. As we know, it was foolish to say that at the time; and as we have seen the results, it has proven once again to have been a foolish statement.

These officials advocated limiting our activities only to education and prevention, a position that would have in effect sentenced millions of HIV-infected men, women and children to die if it were only that program. And so I am very pleased we expanded it to where it is today.

Fortunately, the Congress and the President did not agree with that position. And because we were willing to find a way to provide treatment for over 800,000 people, today they are receiving antiretroviral medication to prevent AIDS in the 15 focus countries, 12 of which are in sub-Saharan Africa.

We are also pleased that we are increasing the number of countries to the 14 Caribbean countries. And as cochair of the bipartisan Caribbean Caucus, and under the leadership of Representative Donna Christensen, at a meeting she convened in her district, we had health ministers admit that the Caribbean also needed substantial help.

Our progress, while significant, is not enough. Only 28 percent of Africans needing antiretrovirals are receiving them. Shockingly, over 85 percent of African children who need ARVs are going without them. A mere 11 percent of HIV-positive women who need drugs to prevent mother- to-child transmission of HIV during child birth are getting them.

In light of these troubling facts, we have taken steps in this legislation to transform PEPFAR from an emergency response to a sustainable program by expanding the program beyond a series of medical interventions. For example, the committee incorporated the provision that I discussed earlier about food security into the legislation in order to address the nutritional needs of HIV patients, their families, and communities heavily affected by the disease.

Lack of food and nutrition support has been, up to now, a major impediment to the adherence of HIV/AIDS treatment regimens.

H.R. 5501 also contains provisions to build and strengthen health systems in developing countries. The committee has given the Office of Global AIDS Coordinator the flexibility to do prevention, care and treatment programs tailored to the characteristics of the epidemic in the country in which they are operating by eliminating cumbersome earmarks that the GAO said were ineffective.

Finally, the bill authorizes significant funds, $50 billion over the next 5 years, in order to accomplish the goals of the bill. I urge the House to pass this legislation.

I recognize the gentleman from Missouri (Mr. Carnahan) for 2 minutes.

We will now have the gentleman from New York (Mr. Crowley) for 2 minutes, a member of the Foreign Affairs Committee.

(Mr. CROWLEY asked and was given permission to revise and extend his remarks.)

Madam Chairman, I yield an additional minute to the gentleman from New York.

Madam Chairman, I yield 3 minutes to the gentleman from the Ways and Means Committee, from the State of Washington (Mr. McDermott).

(Mr. McDERMOTT asked and was given permission to revise and extend his remarks.)

Madam Chairman, it is my pleasure to yield to a member of the Foreign Affairs Committee, the gentleman from Florida (Mr. Klein) for 2 minutes.

Madam Chairman, I yield to the vice chairperson of the Subcommittee on Africa, a member, of course, of the Foreign Affairs Committee, the gentlewoman from California (Ms. Watson) for 2 minutes.

Madam Chairman, I thank Representative Watson for her kind remarks.

Madam Chairman, at this time I would like to yield 3 minutes to the gentlewoman from Texas, a member of the Foreign Affairs Committee and Africa Subcommittee (Ms. Jackson-Lee).

(Ms. JACKSON-LEE of Texas asked and was given permission to revise and extend her remarks.)

It is my pleasure to recognize the Speaker of the House for 1 minute, the gentlewoman from California, Speaker Pelosi.

Madam Chairman, I rise in support of Mr. Blumenauer's amendment to ensure that safe drinking water is a component of our HIV/ AIDS strategy. Congressman

Blumenauer, the lead sponsor of the Water for the Poor Act of 2005, has been a strong advocate on this issue for years, and he was kind enough to testify about the challenge of clean water in Africa at a hearing of the Subcommittee on Global Health I chaired in May of 2007.

During the course of that hearing, it became clear that in Africa, the region hardest hit by the AIDS pandemic, the problem of safe water is particularly acute. The total number of people without access to potable water in the region has actually increased by 60 million in the past half decade. That is why Mr. Blumenauer and I, along with other Members of Congress, successfully secured $300 million for safe drinking water and sanitation projects for fiscal year 2008.

We all know that HIV compromises the immune system. Those infected with the disease are far more likely to succumb to the illness caused by unsafe drinking water, especially if they are children, and there is no way that people can take ARVs if they do not have access to clean drinking water.

I strongly support Mr. Blumenauer's amendment, and thank him for his cosponsorship of H. Res. 318, supporting the goals of the United Nations International Year of Sanitation. His resolution encourages international communities to achieve the target of halving the proportion of people without access to safe drinking water and basic sanitation. I encourage my colleagues to support the Blumenauer amendment.

Madam Chairman, I rise to speak on the amendment offered by Mr. Fortenberry. We appreciate the work that he does on the subcommittee and he contributes greatly.

We feel that the Inspector General has been doing an adequate job; however, we do not oppose this amendment. The Office has approved over $10 billion for programs in 136 countries around the world so far, which amounts to 21 percent of all donor HIV/AIDS spending, and two- thirds of all the donor spending on malaria and tuberculosis. Through the Global Fund, 1.4 million people have been treated with life-saving antivirals, 3.3 million cases of TB have been treated; and, in a new area, 46 million bed nets have been distributed to protect children against malaria. And I am pleased to say that Ray Chambers from New Jersey and my congressional district has been appointed ambassador for the U.N. to combat malaria.

So, we do not oppose this amendment, and we look forward to the bill's passage.

I thank the gentlelady for yielding. I rise in strong support of the amendment offered by the gentlelady from Wisconsin.

Southern Africa has the highest rate of HIV and AIDS in the entire world. In Lesotho, we have heard, a country with an HIV/AIDS prevalence rate of 38 percent among pregnant women, only 19 percent of those in need of treatment for the disease have access for it. Even more troubling is the fact that only 5 percent of HIV-positive mothers get drugs to prevent the transmission of the virus to their children during childbirth. Life expectancy for women is 44 years, and for men a mere 39.

In Malawi, the situation is a little better; men are expected to live 41 years, women 42. The health care worker shortage in the country remains a major obstacle.

Circumstances in Swaziland are equally grim: 26 percent of adults are HIV positive. In a country of just over 1 million, there are 70,000 AIDS orphans. Clearly, HIV and AIDS pose a dire threat in these countries and must be urgently addressed. Therefore, I commend the gentlewoman, Ms. McCollum, for her amendment to make Swaziland, Lesotho, and Malawi focus countries, and I urge my colleagues to support this amendment.

Madam Chairman, I appreciate the gentlelady, the ranking member, yielding me this time, and I rise in strong support of the Carson amendment relating to the building of human capacity to fight HIV/AIDS through collaborations between U.S. colleges and universities and those in the developing world.

I, too, am very pleased to see this piece of legislation by Mr. Carson. We all knew Julia Carson. She came to my district to deal with health disparities in my district in New Jersey, and traveled to Africa with me on a trip dealing with this problem. So this is very appropriate, and let me commend you again.

In May of 2007, Doctors Without Borders released a report that found that in southern Africa, a shortage of trained health care workers was the main barrier to increasing access to antiretroviral treatment.

The report found that in Mozambique, people had to wait up to 2 months to start ARVs because there were not enough doctors and nurses to manage it. In one health district in Lesotho, nearly half of the nursing posts were vacant. Malawi has only two doctors per 100,000 people. The minimum standard according to the WHO is 20 doctors per 100,000 people.

I am pleased to say that the bill under consideration seeks to address those problems. It calls on the United States to train 140,000 new health care workers and professionals so people can start on life- saving therapy.

University partnerships are a logical and effective means through which to support this goal. So I once again commend Mr. Carson for his amendment, and urge my colleagues to support it.

Let me thank the gentleman from New Jersey for his leadership and the ranking member, the chairperson of the full committee, Mr. Berman, and pay tribute to our good friends the late Tom Lantos and Henry J. Hyde, who have captured, in essence, what our war against HIV/AIDS is all about. It has to be comprehensive and expansive. It has to recognize the overlapping impact of tuberculosis and malaria.

Mr. Speaker, I think one of the most telling scenes that I was able to experience, sadly so, was walking into a little hut in Zambia and seeing an emaciated body or person, if you will, being taken care of by a 4 year old. That individual had HIV/AIDS and tuberculosis.

So this legislation is crucial in the overall comprehensive war against the devastating diseases when there is no water, no nutrition, and poverty. This targets 12 million new HIV infections. It is treating millions of people. It's supporting care for 12 million. It has a focus on women and girls. It provides a focus on the anti-retroviral treatment that is so important that goes after opportunistic infections. It provides a certain amount of money, $9 billion, for malaria and tuberculosis over 5 years. It goes to the very essence of a 4 year old being the only remaining healthy person in his family having to care for sick relatives suffering from HIV/AIDS and tuberculosis and many suffering from malaria.

This is an important step forward. And, yes, we have many responsibilities in this Congress. I join my friend from Iowa. We will be working hard to provide the support systems that those individuals need. But at the same time, this is a tribute to great leaders like our former and late chairpersons of this committee, Chairman Hyde and Chairman Lantos, who recognized that to those who are given much, much is expected.

This bill responds to the devastation and need around the world. I ask my colleagues to support this legislation.

Thank you, Mr. Speaker, for allowing me to speak on not only an important issue in this country but around the world. I can only note that it gives me great pause that my colleague, Congressman Tom Lantos, did not live to see the fruit of his hard work on this bill. However, I know his family and his colleague Congressman Henry Hyde have kept this legislation alive and moving through this Congress.

Mr. Speaker, thank you for allowing for H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 on PEPFAR to come to the floor today.

jackson-lee amendment

I would also like to thank both Chairman Berman and the Chairman of the Subcommittee on African and Global Health, Congressman Payne, for working with me to include important language in this legislation. My language, in Section 301 of this bill, addresses the necessity of making children a priority among individuals with HIV for proper food and nutritional support. Section 301, with my language included, states that it is the sense of Congress that ``for the purposes of determining which individuals infected with HIV should be provided with nutrition and food support--(i) children with moderate or severe malnutrition, according to WHO standards, shall be given priority for such nutrition and food support; and (ii) adults with a body mass index, BMI, of 18.5 or less, or at the prevailing WHO-approved measurement for BMI, should be considered `malnourished' and should be given priority for such nutrition and food support;''

Mr. Speaker, as Chair of the Congressional Children's Caucus, I believe that this language is crucial, and I thank the Chairman for including it in the text of the bill. HIV-infected children have been underrepresented among beneficiaries of PEPFAR-supported programs. As this legislation cites in the findings section, ``of those infected with HIV, 2.5 million are children under 15 who also account for 460,000 of the newly-infected individuals.'' And even these large numbers are deceiving, as children die much quicker from AIDS than do adults. I am pleased to see this language, which focuses attention on the plight of these children, and makes serving their needs a priority.

pepfar

In January 2003, President Bush announced the President's Emergency Plan for AIDS Relief, or PEPFAR. As its name implies, PEPFAR was envisioned as an emergency response; we are here today to discuss how to transition to a sustainable program to address these global epidemics.

HIV/AIDS continues to represent a serious and large-scale challenge throughout much of the world. It goes far beyond a simple health problem, and it hinders attempts to foster economic development and political stability. As we begin the process of reauthorizing PEPFAR, I believe it is crucial that we emphasize the long-term sustainability of our HIV efforts, and that we integrate AIDS prevention and treatment within our larger-scale development initiatives.

Though we have drugs that are effective in managing infections and reducing mortality by slowing the progression to AIDS in an individual, they do little to reduce disease prevalence and prevent new infections. For this reason, there is growing consensus among health experts that we must put greater emphasis on prevention programs, which are perhaps the most critical aspect of any initiative to combat global HIV/AIDS. Even as increasing numbers of people have access to anti-retroviral drugs, ARVs, an estimated 5.1 million people who needed treatment did not receive it in 2006.

tuberculosis

The World Health Organization, WHO, estimates that throughout the world someone contracts TB every second and that one third of all people in the world are currently infected with TB. Tuberculosis spreads easily from one person to another: when the infected person coughs, the bacilli or TB germs are spread into the air and another person need only to inhale a small number of the bacilli to be infected. The World Health Organization, WHO, estimates that each person left untreated with active TB will infect, on average, between 10 and 15 people every year. Although the TB bacilli can lie dormant in the body for years and its effects may not be immediately felt, if one has a weakened immune system, such as through HIV/AIDS, the chances of becoming sick will increase.

In 2005, nearly 9 million people contracted tuberculosis, of which 84 percent occurred in high burden countries, with all but two of the high burden countries in Africa and Asia. This demonstrates the necessity for special attention to these high burden countries, particularly in Africa. Among the 15 countries with the highest estimated TB incidence rates, 12 were in Africa, due in part to relatively high rates of HIV co-infection. About 80 percent of all cases in the world were found in 22 countries, all but 4 were found in Africa or Asia.

Some 2.97 million people in Southeast Asia were newly infected with TB and about 2.57 million in sub-Saharan Africa. In 2004, sub-Saharan Africa was the only region in the world where TB prevalence was growing; elsewhere the number of cases was stable or falling. Despite our concerted efforts, we continue to face a serious and persistent health threat. I believe that it is imperative that we ensure that American taxpayer dollars are used to greatest effect, not to bolster ideology.

Current restrictions on PEPFAR mandating that \1/3\ of all prevention funds must be used on abstinence-only education neglect the real needs of populations both in America and abroad. These stipulations hurt the ability of PEPFAR to adapt its activities in accordance with local HIV transmission patterns, and they impair efforts to coordinate with national health plans. Though AIDS is clearly a global problem, it does not affect every nation equally or in the same manner. Removing these stipulations would allow PEPFAR to better address

the requirements of each country, making more efficient and effective use of taxpayer dollars in serving the millions affected by this disease.

In addition, I believe it is crucial that we dedicate greater attention to strengthening local health infrastructure. Health experts have expressed concern that the high amount of spending directed toward HIV/AIDS initiatives has drawn health workers away from public health facilities and other important programs. This merely compounds a chronic shortage of qualified health workers, which, according to WHO's 2006 World Health Report, is the single most important health issue facing countries today. This need is felt particularly sharply in Southeast Asia and sub-Saharan Africa.

Many health experts also continue to advocate greater integration between PEPFAR and other health programs, including those focused on nutrition, maternal and child heath, and other infectious diseases. These experts note that HIV is intricately linked to these other areas of concern; for example, malnutrition and lack of food may heighten exposure to HIV, raise the likelihood of engaging in risky behavior, increase susceptibility to infection, and complicate efforts to provide anti-retroviral, ARV, medication. Further, an HIV epidemic will likely worsen food insecurity, by depleting the agricultural workforce. I believe it is necessary, to ensure maximum effectiveness, that we integrate PEPFAR with other aspects of our international health outreach and development programs.

Mr. Speaker, if we are to turn the tide of turmoil and tragedy that HIV/AIDS causes to millions around the world, and hundreds of thousands right here in our backyard, it is imperative that we continue to fund and expand medical research and education and outreach programs.

hiv/aids

I want to share briefly the importance of continued action in awareness for this virulent disease and the nexus between TB and HIV/ AIDS, another issue which I am passionate about and would like to see eradicated as I am sure many of my colleagues would. According to the World Health Organization, there were 33.2 million people living with HIV/AIDS worldwide in 2007.

People living with HIV/AIDS are at a greater risk of becoming infected with TB because of their weakened immunity. In 2004, out of the more than 740,000 people who contracted TB and were co-infected with HIV/AIDS, 600,000 of those co-infected were found in sub-Saharan Africa.

Similar to TB, HIV/AIDS has risen to epidemic levels particularly for our African countrymen. According to UNAIDS, in 2005, there were 3.2 million newly infected Africans and 2.4 million Africans who died of HIV/AIDS related complications. The current life expectancy for a person living with AIDS in Africa is 47 years old.

Such high rates of infection can be prevented. The transmission of HIV can be reduced through proper education and resources. Additionally, proper resources can help the treatment of HIV. We must make these resources more accessible to those who need it most.

malaria

Malaria is another disease that must be addressed. According to the World Health Organization, more than 500 million people become severely ill with malaria and more than one million people die of malaria every year, mostly infants, young children and pregnant women. Perhaps most shocking is WHO's estimate that a child dies of malaria every 30 seconds. More than 90 percent of malaria cases occur in sub-Saharan Africa.

Mr. Speaker, malaria is both preventable and curable. Early and effective treatment can shorten its duration and prevent the development of complications and the great majority of deaths.

concluding statements

Key factors that contribute to continuing high rates of HIV/AIDS, Tuberculosis, and Malaria include: weak health care systems, poor access to health facilities, insufficient staffing and other human resource constraints, ill equipped and substandard laboratory services, and little collaboration between TB and HIV programs.

Mr. Speaker, what is so striking about these factors is that they are all preventable. We must address and work to rectify these human factors that have led to such unnecessarily high fatality rates throughout the world, particularly in African nations. I urge my fellow colleagues to join me in support of PEPFAR and H.R. 5501.