Mr. Chairman, I offer an amendment. Mr. Chairman, I yield myself such time as I may consume. Mr. Chairman, United Nations program on HIV/AIDS report estimates that there are 40 million people infected with HIV/AIDS worldwide, and like…
Mr. Chairman, I offer an amendment.
Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, United Nations program on HIV/AIDS report estimates that there are 40 million people infected with HIV/AIDS worldwide, and like everyone else, I am deeply saddened by this reality.
However, I am also filled with hope because recent evidence indicates that the current prevention strategy is helping to produce behavioral change that has significantly decreased people's risk of contracting this deadly disease.
The current HIV/AIDS prevention strategy was carefully crafted in the PEPFAR authorization bill to reflect a balanced approach, and the good news is that this balanced approach is working.
The PEPFAR authorization bill, which became law in 2003, included a provision that required one-third of the 20 percent for prevention funding, that is approximately 7 percent of the total PEPFAR funds, to be spent on abstinence and fidelity programs.
Prior to the implementation of this spending directive, the U.S. promoted an unbalanced condoms-only approach. The U.S. remains the largest distributor of condoms in the world. But for the first time the behavior factor is getting real attention under the current program rules. And the result: falling HIV/AIDS prevalence rates in 7 of the 15 focus countries.
The current prevention strategy is based on the comprehensive ABC model, first established in Uganda, developed by Uganda. The ABC model stands for A, abstinence; B, be faithful; C, condoms. A comprehensive, balanced approach.
After implementation of this model in Uganda, the number of young males age 15 to 24 reporting premarital sex decreased from 60 percent in 1989 to 23 percent in 1995. For females, the decline was 53 percent to 16 percent. The program actually helped change the behavior in women and men, a fact I hope my colleagues take seriously.
Opponents of this approach claim that behavioral change is unrealistic. Dr. Edward Green, a researcher at Harvard University, was an opponent of the ABC model and in particular of abstinence until he saw what happened in Uganda. He testified before the Energy and Commerce Committee saying: ``Many of us in the AIDS and public health communities did not believe that abstinence or delay and faithfulness were realistic goals. It now seems we were wrong.''
Not only has Uganda seen a society transformed by behavioral change, we can now add Kenya, Zimbabwe, Ethiopia, Namibia, Tanzania, and Zambia to the list of countries that are experiencing a decrease in HIV/AIDS prevalence rates.
Experts continue to testify to the fact that behavioral change continues to be the key indicator of HIV/AIDS prevention. Yet for some reason, some of my colleagues have decided to make a crucial provision of this successful strategy optional. This crucial provision ensures that the ``abstinence'' and ``be faithful'' components are incorporated into the approach. Never mind the fact that PEPFAR is expected to be reauthorized later this year, and never mind the fact that the reauthorization might be the more appropriate forum to debate this critical component that was agreed to.
Some of my colleagues argue that we need a comprehensive approach, but I remind them that abstinence and fidelity education are fundamental to the comprehensive ABC approach.
Some of my colleagues argue that we need an approach that saves lives. I remind them that the ABC model, with the A and the B spending requirement intact, is continuing to save more and more lives. In countries that have relied predominantly on condom distribution, HIV/ AIDS prevalence rates have not improved. Meanwhile, countries that promote behavioral change have seen significant improvement.
Mr. Chairman, a balanced, evidence-based approach is essential if we are going to effectively fight HIV/AIDS in Africa. The current policy is the balanced approach. It is the evidence-based approach. It is the approach that is working. Why change what works?
I urge my colleagues to vote for my amendment and keep abstinence and fidelity in the AIDS program, and in doing so, to vote for an approach that is saving lives.
Mr. Chairman, I reserve the balance of my time.
Mr. Chairman, I yield 2 minutes to the gentleman from Michigan (Mr. Walberg).
Mr. Chairman, at this time I yield to the distinguished gentleman from Florida, Dr. David Weldon, 2 minutes.
Mr. Chairman, I didn't know I was going to get a biblical lesson here, but I would just ask the man rhetorically, is abstinence biblical? Is faithfulness biblical? That's what we're speaking on behalf of.
I yield 2 minutes to the gentleman from Nebraska who is a member of the Africa Subcommittee, Mr. Fortenberry.
Mr. Chairman, I yield the balance of my time to the gentleman from New Jersey (Mr. Smith), who is ranking member of the Africa Subcommittee.
Mr. Chairman, there is flexibility in the existing program. Countries can apply for a waiver. Every country that has applied has received a waiver. Our friends say that all they want to do is provide flexibility and more condoms.
Well, for 20 years of fighting AIDS, the bureaucrats who run these programs tried the same approach over and over again. It never worked. When Uganda came up with a comprehensive approach that would, they still opposed it.
Well, the buck stops here in Congress, and we told them in 2003 to do what works, and it's working. Without this amendment, this bill will allow them to go back to the failed policies of the passed. So many on the other side are saying we need to listen to the other experts on the ground; we need to follow their advice.
That's true. They even raise this point with the Centers for Disease Control in a letter signed by several of my colleagues on the other side of the aisle, including the distinguished subcommittee chairwoman, Mrs. Lowey. That letter highlighted the report that was written by the world's leading HIV/AIDS experts, was endorsed by more than 100 leaders from 36 countries, people like the President of Uganda, people like Archbishop Desmond Tutu and the HIV/AIDS director of the World Health Organization, researchers from Johns Hopkins and other leading medical institutions.
Allow me to quote from what these people, the experts, are saying about what's working to reduce AIDS prevalence: ``When targeting young people for those who have not started sexual activity, the first priority should be to encourage abstinence or delay of sexual onset, hence emphasizing risk avoidance as the best way to prevent HIV and other sexually transmitted infections, as well as unwanted pregnancies.'' Abstinence, behavior change, that is what the experts are stressing. I agree, the experts know best.
They are saying that a comprehensive approach that includes behavioral change is crucial to winning the fight against AIDS.
I would yield.
That's the quote that I read from the statement he signed.
That's correct.
That's correct. Every country that requested waivers has received one.
Mr. Chairman, I submit for the Record the copies of the letters and the statement.
Congress of the United States,
Washington, DC, January 7, 2005.
Hon. Julie Gerberding,
Director, Centers for Disease Control and Prevention, Clifton
Road, Atlanta, GA.
Dear Dr. Gerberding: On November 27, 2004, the Lancet
published a statement entitled ``The Time Has Come for Common
Ground on Preventing Sexual Transmission of HIV.'' Signed by
more than 100 religious, political, health and scientific
leaders from across the developed and developing world, this
statement called for an end to ``polarizing debate'' and
urged the international community ``to unite around an
inclusive evidence-based approach to slow the spread of
sexually transmitted HIV.'' We are writing to ask whether you
support this statement.
The statement describes key elements of successful HIV
prevention. These include:
1. Ensuring prevention activities are grounded in the
science of epidemiology, supported at the local level, and
respectful of human rights;
2. Promoting abstinence among those young people who are
not yet sexually active, encouraging mutual monogamy among
sexually active adults, and helping individuals who engage in
high-risk activities to stop;
3. Encouraging correct and consistent condom use among
individuals who are engaging in high-risk activities and
those who are sexually active with a partner whose HIV status
is unknown;
4. Expanding prevention programs for young people both in
and out of school, supporting parents ``in communicating
their values and expectations about sexual behavior''; and
5. Employing community-based approaches that involve
religious organizations, women's and men's organizations,
care groups, youth organizations, health workers, local
media, and traditional and governmental leadership.
The statement also notes that expanding access to services
for testing, counseling and treatment of HIV/AIDS and other
sexually transmitted infections, preventing mother-to-child
transmission, and enhancing access to family planning
services are all essential in order to achieve the
prevention, care and treatment objectives of the President's
Emergency Plan for AIDS and other global initiatives. It
endorses continuing review of potential interventions such
as microbicides, new antibiotic treatments, and vaccines.
The statement was written by several of the world's leading
HIV experts, and endorsed by more than 100 leaders in the
fight against AIDS from 36 countries across a range of
disciplines. Notable endorsers include: Uganda's President
Yoweri Museveni, Archbishop Desmond Tutu of the Anglican
Church of Southern Africa, UN Special Envoy for HIV/AIDS in
Africa Stephen Lewis, and HIV/AIDS Director at the World
Health Organization Jim Kim.
The statement has also been endorsed by representatives
from the World Bank; the Global Fund to Fight AIDS,
Tuberculosis, and Malaria; and the heads of HIV/AIDS programs
in several countries including Ethiopia, India, Jamaica, and
Uganda. Leaders and representatives from major faith- and
community-based nongovernmental organizations from the United
States and around the world also back the statement.
Given the broad international and domestic support for the
Lancet statement and the importance of collaboration in AIDS
prevention efforts worldwide, we would like to know whether
you, as a key leader in this administration in combating HIV/
AIDS, support this statement.
We would appreciate a response by January 24, 2005.
Sincerely,
Henry A. Waxman, Ranking Minority Member, Committee on
Government Reform, House of Representatives; Nita M.
Lowey, Ranking Minority Member, Subcommittee on Foreign
Operations, Export Financing and Related Programs,
Committee on Appropriations, House of Representatives;
Fortney Pete Stark, Ranking Minority Member,
Subcommittee on Health, Committee on Ways and Means,
House of Representatives; Sherrod Brown, Ranking
Minority Member, Subcommittee on Health, Committee on
Energy and Commerce, House of Representatives; Barbara
Lee, Chair, Global AIDS Initiative, Congressional Black
Caucus, House of Representatives.
Jesse L. Jackson, Jr., Member of Congress; Betty
McCollum, Member of Congress; Howard L. Berman, Member
of Congress; Lois Capps, Member of Congress; Richard J.
Durbin, U.S. Senator.
The only thing your amendment would do is remove the A and the B from the ABC model.
And the President could remove the A and the B, and just have the C. And when Ambassador Dybul was asked if any of the countries wanted waivers, they all said no.
Mr. Chairman, I demand a recorded vote.
Mr. Chairman, I rise to oppose the Lowey amendment because it does not address the underlying problem. Whether we support pro- abortion organizations through cash donations or items of cash value, the result is the same. The amendment before us today attempts to undermine the Mexico City policy. The Mexico City policy exists to draw a bright line between U.S. family planning policy and abortion. However, it appears that there are some out there who wish to blur this line. Mr. Chairman, a blurred line is what leads to coercive abortions and forced sterilizations.
The Mexico City policy is critical for several reasons. First, money is fungible. Every U.S. tax dollar or commodity that goes to an abortion provider frees up funds to pay for more abortions and more pro-abortion lobbying. Secondly, our population grantees are seen as representatives of the United States in the countries in which we operate. When organizations prominently associated with United States family planning programs perform and promote abortions, people in these countries logically associate these activities with the United States.
It is important to note that this policy does not in any way reduce funds for family planning. As this chart shows, before Smith-Stupak, there are $441 million for international family planning, including contraceptive commodities. After Smith-Stupak, there will still be $441 million for international family planning, including contraceptive commodities. It simply requires that any foreign nongovernmental organizations that receive taxpayer dollars agree not to perform or actively promote abortions.
I urge my colleagues to oppose the Lowey amendment, support the Smith-Stupak amendment to restore the Mexico City policy and to protect the taxpayers' rights to neither directly nor indirectly fund abortion.