PEPFAR Stewardship and Oversight Act of 2013

Mr. Speaker, I thank the gentleman for yielding and for his kind words.

It is just that I have been here such a long time, when I first came to Congress, the mere mention of the word ``AIDS'' on the floor was something I thought was the most natural thing to do but was something that some of my colleagues squirmed at. We have, indeed, come a long way from that time.

So today is a proud day as Democrats and Republicans come together to extend and reauthorize our efforts to fight the global HIV/AIDS and infectious diseases in the poorest countries around the world.

I thank Chairman Royce and Ranking Member Engel for working together to bring this important legislation to the floor today, and I thank Congresswoman Barbara Lee for her unwavering leadership on these issues since day one that you came to the Congress. So many of our colleagues deserve recognition, and the gentlewoman has acknowledged some of them.

I will just add that this marks the 10th anniversary of the historic Tom Lantos and Henry Hyde U.S. Global Leadership Against AIDS, Tuberculosis, and Malaria Act. This legislation has been the foundation of the U.S. initiative to provide sustained constructive leadership in the global fight against AIDS.

The original PEPFAR authorizing legislation, followed by the excellent work of the Appropriations Committee over the last decade, has provided lifesaving antiretroviral treatment, care, and prevention for millions of people, especially focused on the most vulnerable infants and children.

I have traveled on this AIDS issue for a very long time in our country and abroad, and I have seen firsthand the difference that PEPFAR has made. I have been to clinics, as have my colleagues Mr. McDermott, Congresswoman Lee, the head of the Congressional Black Caucus Health Braintrust, Congresswoman Christensen, as well as others who are here, and now newer Members, Messrs. Himes and Cicilline.

What was wonderful about it was we went to places where people were so poor and so desperate, but they were not so desperate that they were without hope. And PEPFAR gave them hope because, as they said, Originally we wouldn't even want anybody to know that we had AIDS. Why would we even be tested for AIDS? People found out that we had AIDS, but why would we even come to a clinic? What hope did we have?

Well, PEPFAR gave them hope. It gave them a path.

So today we know--and Congresswoman Lee mentioned some of the figures. Some bear repeating and some others I will mention:

Treatment for over 5 million people; antiretroviral drugs for 750,000 pregnant women living with HIV to prevent mother-to-child transmission of HIV averted 230,000 infant HIV infections in 2012 alone; HIV testing and counseling for almost 47 million people; and this

year, the 1 millionth baby will be born HIV-free because of PEPFAR support. That means a child that might have been born HIV-infected.

Congresswoman Lee mentioned that Dr. Goosby lives in her district. His parents and where he was raised is in my district. So we all take great pride in his work.

Over the years, we have made tremendous progress. First, with President Clinton, we increased the bilateral programs to fight HIV/ AIDS, and we helped create, authorize, and fund the Global Fund. Then, under the leadership of President Bush--and this has to be a source of great pride for President Bush and an important part of his legacy--we established PEPFAR and provided the necessary funding to ramp up the emergency response to the crisis.

And I might add my thanks to Bono for the role that he played in, again, ramping up the resources and making sure the public understood, as did those of us in elected office and especially in the executive branch, where maybe this was a newer issue to them, that we needed to have the resources to make this happen. So thank you to Bono. Not only did he help us with the loan forgiveness to some of these same countries, but now to the alleviation of poverty, the eradication of disease. That is part of his agenda. And he worked with us to enhance our efforts.

President Obama has provided leadership as well and has strengthened those efforts and has boosted our investments to put us on the brink of an AIDS-free generation. President Obama also is to be commended for lifting the travel ban on those with HIV, enabling the International AIDS Conference to return to the United States in 2012.

I remember, as a brand-new Member attending the conference in 1987 when this ban was in existence, it was an embarrassment that scientists could not come here or people coming here with HIV/AIDS from whom we could learn and there could be scientific collaboration. Well, that was not allowed because of the travel ban. So thank you, President Obama, for lifting it so that we could have a truly scientific, truly comprehensive conference in 2012 in the United States, very proudly.

Today the Congress will pass legislation to extend our global AIDS investment. Even in these difficult fiscal times, we know that cutting back is a false economy that costs us more in the future. HIV/AIDS is still adapting, and so must we. It is a very resourceful virus. It just keeps finding ways, mutating and finding ways, and we have to be more resourceful in our fight against it.

I thank the authors of the legislation, to the chair and ranking minority member, for bringing the bill to the floor and adapting our policies to meet the continued challenges posed by AIDS, TB, malaria, and deadly diseases around the world. I am so pleased that we will probably have a unanimous vote on this important bill, and that is, indeed, an honor to be a part of.

Mr. Speaker, I move to suspend the rules and pass the Senate bill (S. 1545) to extend authorities related to global HIV/AIDS and to promote oversight of United States programs.

Mr. Speaker, I ask that all of our Members have 5 legislative

days to revise and extend their remarks and to include any extraneous materials that they might wish to include on this resolution.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise in support of S. 1545. They call this the PEPFAR Stewardship and Oversight Act of 2013.

It was just over a decade ago that AIDS threatened to decimate an entire generation of men and women and children around the world, and particularly in Africa. Without access to lifesaving treatment, there was then no incentive to get tested. Without testing, it was impossible to detect and prevent new infections.

In the hardest-hit countries, an estimated 35 percent of the population was HIV positive, and life expectancy in those countries dropped to as low as 34 years.

The global AIDS pandemic was a massive humanitarian challenge, but it also threatened our economic and national security. The pandemic struck down men and women in their most productive years. The economies of emerging trade partners contracted. Socioeconomic conditions deteriorated.

Tens of millions of orphaned children, forced to fend for themselves, became vulnerable to trafficking. They became vulnerable to criminality and recruitment by extremists.

Infections among security forces in southern Africa was disturbingly high.

It was against this backdrop that the United States mounted the most significant effort of any nation to combat a single disease in history. Authorized by Congress in 2004, and reauthorized in 2008, the President's Emergency Plan For AIDS Relief, or PEPFAR, as we call it today, was a game-changer, and has since become among the most successful U.S. foreign aid programs since the Marshall Plan. Like many of my colleagues, I have been to Africa and witnessed the saved lives.

Today, nearly 10 million people receive treatment supported by PEPFAR. Thirteen countries have reached a tipping point in their AIDS epidemic, the point where the number of adults on treatment exceeds the number of new infections. So across Africa, the new infections have declined by 33 percent.

There is now hope that an AIDS-free generation may be within reach. We should be proud of that effort. But the United States cannot and should not do this alone. It is in our interest to ensure that our bilateral programs, our programs like PEPFAR, are complemented by an effective, efficient, and accountable global fund to fight AIDS, malaria, and tuberculosis.

The PEPFAR Stewardship and Oversight Act of 2013 provides a framework for the continuation of PEPFAR's success. Among other things, this legislation locks in important social values provisions mandated in the 2004 and 2008 bills that could be jettisoned if we don't move forward with this legislation.

It improves transparency and reporting in a way that reflects the current direction of the program, and it extends limitations on U.S. participation in the Global Fund, including a 33 percent limitation on U.S. contributions and a 20 percent withholding requirement linked to transparency and management reforms at the Global Fund.

So this bill is time-sensitive. During the week of December 1, the Global Fund will convene a donors' conference. Without the 33 percent cap and 20 percent withholding requirements firmly in place, which is what the bill does, the ability of the United States to leverage both our contributions and our reforms would be diminished.

So I urge my colleagues to support this important, timely measure.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I continue to reserve the balance of my time.

Mr. Speaker, I do think Mr. Eliot Engel of New York should feel proud about this bill. He is the original author of the House- passed version.

I would say that, in the interest of expediting this measure, we on the Foreign Affairs Committee worked, frankly, not only across party lines but across Chambers in order to draft legislation that preserves congressional prerogatives, that advances U.S. interests, and, as Eliot Engel said so succinctly, that saves lives. This bill does that. It achieves these objectives. We worked in tandem with the Senate on Mr. Engel's original draft to get this done.

This bill does not affect direct spending. It doesn't affect revenues. It does not create new programs or include major new policy provisions. I want the Members to understand that.

It is a streamlined, bipartisan measure that does extend critical PEPFAR authorities that expired, and it maintains the gains achieved through the 2008 reauthorization process.

Besides the leadership of Mr. Engel on this bill, I would like to recognize the work of Representatives Ros-Lehtinen and Lee to shape this measure, as well as efforts by our leadership to ensure that we do not miss this narrow window of opportunity to send this bill to the President's desk without further delay.

I would also share with our Members that it helps get us on a path towards graduating countries from assistance. It conditions and limits assistance to the Global Fund.

I urge my colleagues to support this bill, and I yield back the balance of my time.

Mr. Speaker, first, let me thank our ranking member for yielding, but also, let me just thank you so much for your tremendous leadership on this issue and on the Foreign Affairs Committee, and for your recognition and hard work in achieving and seeking to achieve an AIDS-free generation.

I want to say it is a real pleasure to be with you today and to be back with you today, actually, with the committee that I served on for 8 years. So thank you, again, so much.

Let me also thank the chair of the Foreign Affairs Committee, Chairman Royce, for ensuring that PEPFAR continues as a bipartisan effort, and for your commitment to an AIDS-free generation. I just want to thank you for that leadership because, oftentimes, we wonder if there is bipartisanship in this body. Well, I think today, once again, we can cite that when it comes to saving lives, PEPFAR is a clear example of how we work together to do just that.

And, of course, I must thank my cochair on the Congressional HIV/AIDS Caucus, Congresswoman Ileana Ros-Lehtinen from Florida. I have to thank her for her work on HIV/AIDS initiatives, both international and domestic.

I am very proud to have played a role in the creation of PEPFAR and am proud of the leadership of the Congressional Black Caucus and our chair at that time, the gentlewoman from Texas, Congresswoman Eddie Bernice Johnson. Even before the world knew about this program, Congresswoman Johnson knew the importance of Presidential leadership and put this on the Congressional Black Caucus' agenda during our very first meeting with President Bush.

To quote from a 2002 letter to President Bush, the CBC called for an ``expanded U.S. initiative'' to respond to the greatest plague in recorded history. And then following that, in President Bush's 2003 State of the Union speech, he laid out what this important initiative should look like and made a serious commitment to this effort.

So over the last decade, we have worked closely with the late Chairman Hyde, Chairman Lantos, as well as Senator Kerry, the late Senator Jesse Helms, Senator Bill Frist, Congressman Jim Leach, Congressman McDermott, Congresswoman Donna Christensen, Leader Pelosi, and so many others. And I share this because I think it is important that society recognize that the history of this has been bipartisan because we kept our eye on the prize. We knew that we wanted to save lives and we wanted to see an AIDS-free generation, and so many people, so many Members of this body, so many outside organizations, and our staff have worked so hard to get us to this point.

So now, a decade later, I am especially proud, once again, to be a coauthor of the bill before us today. As I said, this is a bipartisan compromise, and in the end, I think we have a very good bill.

We agreed on the need to protect funding for HIV treatment and programs for orphans and vulnerable children. We agreed on the need to preserve support and extend the expired 33 percent cap on United States contributions to the Global Fund. This cap is a proven tool for leveraging donor funding and is especially important as the United States prepares to host the Fourth Replenishment Conference for the Global Fund next month.

Our bill also updates the annual report to better guide PEPFAR's transition toward greater country ownership while enhancing oversight. And I am especially pleased that we included reporting requirements on efforts to engage key stakeholders, including faith-based organizations and United States minority-serving institutions.

I can tell you, as a member of the Appropriations Committee, PEPFAR has transitioned from--and this is very important. And I want to thank Ranking Member Engel and Chairman Royce for helping us realize the need to transition from an emergency response to a means of supporting country leadership in their work towards an AIDS-free generation. So this bill will fundamentally help continue to move our programs in that direction.

Thank you very much.

I want to thank Ambassador Goosby for his tremendous leadership, who actually lives in my congressional district in northern California, and also Dr. Mark Dybul, who now leads the Global Fund, and so many more.

PEPFAR has supported nearly 6 million people on lifesaving treatment, more than 11 million pregnant women who have received HIV testing and counseling, and 1 million babies born HIV-free this year. So this bill represents the real achievements that we can make when we put aside our differences and work together to achieve an AIDS-free generation.

Mr. Speaker, I rise in strong support of S. 1545, the PEPFAR Stewardship and Oversight Act, and I yield myself as much time as I may consume.

I echo the words of my friend, the chairman. This important legislation, which passed the Senate by unanimous consent, reauthorizes key authorities that have helped the President's Emergency Plan For AIDS Relief, called PEPFAR, change the trajectory of the HIV/AIDS epidemic around the world.

Before President Bush announced PEPFAR in his 2003 State of the Union address, and Congress passed authorizing legislation in May of that year, HIV and AIDS were ravaging the continent of Africa. By then, more than 25 million people had died from HIV/AIDS, and 14 million children had been left as orphans.

Another 42 million people were infected and, though lifesaving treatments had been developed, far too many people had no access to the medications necessary to save their lives. Therefore, PEPFAR became and remains the largest commitment by any nation to combat a single disease internationally.

Today, nearly 6 million people are receiving life-sustaining anti- retroviral treatment.

Last year, more than 46 million people received HIV testing and counseling. Of these, more than 11 million were pregnant women, and, as a result of treatment, the one-millionth baby was born HIV-free this year.

HIV/AIDS is no longer threatening to wipe out an entire generation on the continent of Africa. In fact, a sustained commitment by the United States to fighting this epidemic has made it possible for experts and researchers to talk about achieving an AIDS-free generation.

PEPFAR is in the midst of an important transition as countries take on greater ownership of their HIV/AIDS programs. At this critical juncture, the PEPFAR Stewardship and Oversight Act is an important demonstration of our ongoing, bipartisan support for the fight against

Mr. Speaker, it is my honor to yield 4 minutes to the gentlewoman from California (Ms. Lee), who has been so instrumental in fighting for this legislation and other AIDS legislation for so many years in the Congress.

I yield an additional 30 seconds to the gentlewoman.

Mr. Speaker, it is my great honor now to yield 1 minute to the gentlewoman from California (Ms. Pelosi), our Democratic leader who has, I think, done more than anyone else to fight for these things from almost the time that she came to Congress.

Mr. Speaker, I now yield 2 minutes to the gentleman from Rhode Island (Mr. Cicilline), a very valued member of the Foreign Affairs Committee.

Mr. Speaker, I now yield 2 minutes to the gentleman from Washington (Mr. McDermott), a classmate of mine.

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

Mr. Speaker, I yield 2 minutes to the gentlewoman from the Virgin Islands, Dr. Donna Christensen.

Mr. Speaker, may I ask how much time is remaining.

I yield 2 minutes to the gentleman from Connecticut (Mr. Himes).

Mr. Speaker, I am very happy to yield 1 minute to the gentlewoman from Illinois (Ms. Schakowsky).

Mr. Speaker, I yield myself the balance of my time.

In closing, let me just, again, say what I said at the outset. I want to thank Chairman Royce. I am really proud of this legislation. It is truly a bipartisan product.

We are doing something really, really good here today. We are doing something that we can be proud of today. We are saving lives, and we are showing once again that the United States is the most compassionate Nation on Earth. When all is said and done, isn't this really one of the greatest things that we can do?

So I urge my colleagues on both sides of the aisle to support this bill, and I yield back the balance of my time.

Mr. Speaker, I rise today in support of S. 1545, the PEPFAR Stewardship and Oversight Act. Since its establishment in 2003, the U.S. President's Emergency Plan for AIDS Relief, known as PEPFAR, has become arguably the most effective global health program that the U.S. government has ever administered. Already, nearly 15 million AIDS victims have been served; let us not stop there.

The HIV/AIDS epidemic threatened to eliminate an entire generation in Africa. Economies were threatened and health care systems were wholly unequipped to handle the magnitude of the epidemic. Through PEPFAR, the

U.S. government and its local partners provided diagnostic testing, administered antiretroviral treatment (ART), and expanded HIV/AIDS programs to lower the rate of transmission. These efforts achieved significant success. This year the millionth HIV-free baby was born due to PEPFAR-supported prevention of mother-to-child transmission. In 13 countries, the rate of infection is below the increasing rate of adults requiring treatment. Now we can finally work toward an AIDS-free generation.

S. 1545 extends our commitment to PEPFAR and the U.N. Global Fund through 2018. It maintains the 10 percent funding requirement for orphans and vulnerable children, and at least 51 percent for treatment programs. This bill does not address the changing priorities in the second phase of PEPFAR, giving PEPFAR the bandwidth to strengthen health systems, explore public-private partnerships, and increase country ownership.

Local partnership and ownership is essential to the sustainability of PEPFAR's programs. This partnership has already begun; the effects can be seen in broader administration of medical services, though the parallel expansion of social services for the HIV community has lagged. The continuation of the 33 percent funding cap for the U.N. Global Fund ensures local partnership to address such problems.

One of the most notable changes to this legislation is its increase in oversight. I look forward to receiving the annual, joint oversight and auditing plans that will be developed by the Inspectors General of the Department of State, USAID, and HHS, thus increasing Congressional oversight as well. It will include per-patient cost studies and analysis of the shift toward greater country ownership. PEPFAR is no longer a start-up program, and the oversight associated with its shift toward long-term sustainability must be adjusted accordingly.

Yesterday, the Senate passed this bill with unanimous consent. It is our turn to do the same.