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…
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.