amfAR, The Foundation for AIDS Research

House Passes PEPFAR Reauthorization

April 3, 2008—Yesterday, in a vote of 308 to 116, the House of Representatives passed a bill to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), which has funded global HIV, malaria, and tuberculosis treatment since 2003. The Senate bill, which was passed by the Senate Foreign Affairs Committee last month, is expected to proceed to a floor vote within the next few weeks. The two versions of the bill will have to be reconciled before being forwarded to the president for passage into law.

Both Senate and House versions of the bill contain some positive steps forward in the U.S. fight against global AIDS. Each includes improved support for operations research on all three diseases, and for vaccine development. The legislation also funds broader HIV prevention services for injection drug users and strengthens strategies for improving health systems and training healthcare workforces. The legislation seeks to improve PEPFAR by including strategies specific to women and youth, such as the promotion of women’s empowerment, girls’ education, and reducing gender-based violence.

The Senate bill includes a provision that would strike down the U.S. policy restricting entry into the U.S. of people who are HIV positive. The U.S. is one of only 13 countries to maintain such a policy; others include China, Iraq, Libya, Saudi Arabia, and Sudan.

Unfortunately, neither version of the bill removes language requiring PEPFAR grantees to make an anti-prostitution pledge stating that they will not engage in any activities that promote prostitution. This policy has hampered organizational outreach to sex workers and their clients—two of the most vulnerable populations.

Despite scientific evidence that abstinence-until-marriage programs are ineffective at decreasing rates of HIV, both versions continue to incentivize these programs. The bill, ‘‘Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008’’ (H.R. 5501), replaces the requirement that one-third of all prevention funds be spent on abstinence-until-marriage programs with a requirement that the Global AIDS Coordinator report to Congress any countries that do not devote 50 percent of prevention funds to “behavioral change programs, including abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction.”

Neither bill adequately addresses the importance of linking family planning with HIV/AIDS services. The Senate bill is silent on providing contraceptive services to HIV-positive women—one of the World Health Organization’s four pillars of preventing mother-to-child transmission. The House bill allows for HIV counseling and testing to be provided at family planning sites, but limits this provision to those sites that are supported by the U.S. government.

More restrictive than current PEPFAR policy, this same provision reinforces the so-called Global Gag Rule, which denies U.S. family planning funds to any foreign NGO that uses its own money to give referrals on safe abortion options, provide facts about the consequences of unsafe abortion, or participate in even informal public debate that might improve access to safe abortion services. President Bush had previously waived this restriction on PEPFAR grantees in recognition of the important role family planning providers play in preventing HIV among women and girls.

Both versions of the bill authorize $50 billion in funding for the next five years, including $9 billion for tuberculosis and malaria, and the U.S. contribution of $10 billion over five years to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The remaining $31 billion will support PEPFAR HIV/AIDS programs. The $50 billion far exceeds the $30 billion requested by President Bush—a level that would have essentially flat funded the program over the course of the next five years.