[Congressional Record Volume 146, Number 8 (Thursday, February 3, 2000)]
[Senate]
[Pages S318-S325]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HIV/AIDS IN AFRICA
Mrs. FEINSTEIN. Mr. President, this afternoon Senators will come to
the floor to speak about a problem we believe is a very serious one;
that is, the HIV/AIDS epidemic in Africa. I know the distinguished
Senator from Illinois, Mr. Durbin, will speak, and the Senator from
Wisconsin, Mr. Feingold will speak. I believe others will as well.
Mr. President, I rise to join my colleagues here this afternoon to
address what I consider to be one of the most pressing and important
national security and international health issues that we will face in
the coming decades: The HIV/AIDS pandemic, which is currently sweeping
Africa.
I wish to begin by giving my colleagues a sense of the scope and
scale of this problem.
Sub-Saharan Africa has been far more severely affected by AIDS than
any other part of the world. Today, 23.3 million adults and children
are infected with the HIV virus in Africa, which only has about 10
percent of the world's population, but nearly 70 percent of the
worldwide total of infected people.
Worldwide, about 5.6 million new infections will occur this year,
with an estimated 3.8 million in sub-Saharan Africa--3.8 million people
will contract HIV. Every day, 11,000 additional people are infected--1
every 8 seconds.
All told, over 34 million people in Africa--the population of my
State of California--have been infected with HIV since the epidemic
began, and an estimated 13.7 million Africans have lost their lives to
AIDS, including 2.2 million who died in 1998.
Each day, AIDS buries 5,500 men, women, and children. We saw a very
compelling documentary made by the filmmaker Rory Kennedy, which showed
the burials of some of these children as well as the enormous cultural
problems that exist in Africa because of HIV/AIDS. By 2005, if policies
do not change, the daily death toll will not be 5,500, it will be
13,000--double what it is now--with nearly 5 million AIDS deaths that
year alone, according to the White House Office of AIDS Policy.
AIDS has surpassed malaria as the leading cause of death in Africa,
and it kills many times more people on that continent than war.
The overall rate of infection among adults is about 8 percent,
compared with a 1.1-percent infection rate worldwide. In some countries
of southern Africa, 20 to 30 percent of the adults are infected.
AIDS has cut life expectancy by 4 years in Nigeria, 18 years in
Kenya, and 26 years in Zimbabwe. As these numbers suggest, AIDS is
devastating Africa.
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AIDS is swelling infant and child mortality rates, reversing the
declines that had been occurring in many countries during the 1970s and
1980s. Over 30 percent of all children born to HIV-infected mothers in
sub-Saharan Africa will themselves become HIV infected. Let me say
again, 30 percent of all of the children born to HIV-infected mothers
will become HIV infected.
There are many explanations for why this epidemic is sweeping across
sub-Saharan Africa. Certainly the region's poverty, which has deprived
much of Africa from effective systems of health information, health
education and health care, bears much of the blame. Cultural and
behavioral patterns, which have led to sub-Saharan Africa becoming the
only region in which women are infected with HIV at a higher rate than
men, may also play a role.
HIV/AIDS is becoming a major woman's issue. AIDS has largely impacted
the heterosexual community in Africa, and it has established itself in
such a way that it sweeps across and wipes out entire villages.
Because of the region's poverty, all too often treatment of AIDS
sufferers with medicines that can result in long-term survival has not
been widely used in Africa.
But I strongly believe that if the international community is to be
successful, we must make every effort to get appropriate medicine into
the hands of those in need.
For too many years there were no effective drugs that could be used
to combat HIV/AIDS, but now, thanks to recent medical research, we do
have effective drugs. For example, some recent pilot projects have had
success in reducing mother-to-child transmission by administering the
anti-HIV drug AZT, or a less expensive medicine, Nevirapine, during
birth and early childhood.
New studies indicate that Nevirapine can reduce the risk of mother-
to-child transmission by as much as 80 percent. NVP is given just once
to the mother during labor, once to the child within 3 days of birth.
Taking three or four pills can mean that a child is prevented from
being born with HIV. In fact, for $4 a tablet--a little more than the
cost of a large latte at Starbuck's, which is not a lot here, but a
great deal in Africa--this drug regime has created an unprecedented
opportunity for international cooperation in the fight against AIDS. I,
frankly, believe it is the single most cost-effective thing that can be
done. Currently, however, less than 1 percent of HIV-infected pregnant
women have access to interventions to reduce mother-to-child
transmission.
Administered in a treatment regimen known as HAART--highly active
antiretroviral therapy--antiretroviral drugs can allow people living
with AIDS to live a largely normal life and use of the drugs can lead
to long-term survival rather than early death. Such treatment is proven
highly effective in developed countries, including our very own.
My understanding is that most antiretrovirals are relatively
inexpensive to produce. AIDS Treatment News recently reported:
AZT in bulk can be purchased for 42 cents for 300
milligrams from the worldwide suppliers; this price reflects
profits not only to the manufacturer, but also to the
middleman bulk buyer. The same drug retails at my local
pharmacy for $5.82 per pill. This ridiculous price bears no
relation to the cost of production.
Unfortunately--and inexplicably, in my view--access for poor Africans
to costly combinations of AIDS medications, or antiretrovirals, is
perhaps the most contentious issue surrounding the response to the
African epidemic.
As the U.S. Development Program head, Mark Brown, said at the U.N.
Security Council meeting on AIDS in Africa last month:
We cannot lapse into a two-tier treatment regime: drugs for
the rich, no hope for the poor. While the emphasis must be on
prevention, we cannot ignore treatment, despite its costs.
I agree with that. Although it is true that the cost of combination
therapy is beyond the means of most people living with HIV/AIDS and
governments in sub-Saharan Africa--combination therapy in South Africa,
incidentally, was estimated at $334 a month, or $4,000 per individual
per year, and UNAIDS reports that Brazil treated 75,000 people with
antiretrovirals in 1999 at a cost of $300 million--or, again, $4,000 a
person.
I believe we have a strong moral obligation to try to save lives when
the medications for doing so exist. There are several things the United
States can do to increase access to lifesaving drugs.
First, the U.S. should work with others in the international
community to provide support to make these drugs affordable and to
strengthen African health care systems so that drug therapies can be
effectively administered. The plan for combating HIV/AIDS in Africa
recently put forward by the President and Vice President goes a long
way towards seeing that the U.S. meets its commitment to this goal.
Second, it should be possible for African governments and donor
agencies to achieve reductions in the cost of antiretrovirals through
negotiated agreements with drug manufacturers. The British
pharmaceutical firm Glaxo Wellcome, a major producer of
antiretrovirals, has already stated that it is committed to
``differential pricing,'' which would lower the cost of AIDS drugs in
Africa.
Third, I strongly believe that the United States must work to
advocate ``parallel imports'' of drugs and ``compulsory licensing'' by
African governments to lower the price of patented medications so that
HIV/AIDS drugs are more affordable, and more people in Africa will be
able to have access to them.
Through parallel importing, patented pharmaceuticals could be
purchased from the cheapest source, rather than from the manufacturer.
Under ``compulsory licensing'' an African government could order a
local firm to produce a drug and pay a negotiated royalty to the patent
holder.
Both parallel imports and compulsory licensing are permitted under
the World Trade Organization agreement for countries facing health
emergencies. There can be little doubt that Africa is facing a health
emergency of monumental proportions.
That is why I, along with my colleague from Wisconsin, introduced an
Amendment to the Africa Growth and Opportunity Act last year to allow
the countries of Sub-Saharan Africa to pursue ``compulsory licensing''.
Without ``compulsory licensing'', which would allow access to cheaper
generic drugs, more people in Sub-Saharan African will suffer and die.
For those of my colleagues who may be concerned that this Amendment
may undermine wider Intellectual Property Rights, this Amendment
acknowledges that the World Trade Organization (WTO) Agreement on Trade
Related Aspects of Intellectual Property (TRIPS) is the presumptive
legal standard for intellectual property rights (IPR).
The WTO, however, allows countries flexibility in addressing public
health concerns, and the compulsory licensing process under this
Amendment is consistent with the WTO's approach to balancing the
protection of intellectual property with a moral obligation to meet
public health emergencies such as the HIV/AIDS epidemic in Africa.
In other words, this Amendment does not create new policy or a new
approach on IPR issues under TRIPS, nor does it require IPR rights to
be rolled back or weakened. All it asks is that in approaching HIV/AIDS
in Africa, U.S. policy on compulsory licensing remains consistent with
what is accepted under international trade law.
By doing so, this Amendment will allow the countries of Sub-Saharan
Africa to continue to determine the availability of HIV/AIDS
pharmaceuticals in their countries, and provide their people with
affordable HIV/AIDS drugs.
These drugs exist. We need to get them to where this epidemic is
reaching monumental proportions.
I was pleased to work with the Managers of this bill when the African
Growth and Opportunity Act was on the floor of the Senate last
November, to modify my Amendment to meet some of their concerns, and to
have their support in seeing it included in the final Senate-passed
version of this bill.
Unfortunately, several pharmaceutical manufacturers are strongly
opposed to this measure, and, as I understand it, there are efforts to
have this Amendment taken out of the final bill that will be reported
out of Conference.
I believe that such efforts are reprehensible, and I am determined
not to allow this to happen.
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And if, behind closed doors, this amendment is indeed removed from
this bill, I intend to do all I can to--I hope I will be joined by my
colleagues--make sure that an African Growth and Opportunity bill
without this provision does not pass this Congress.
What good is an African trade bill if Africa is going to get wiped
out from AIDS?
It is clearly in the interest of the United States to prevent the
further spread of HIV/AIDS in Africa, and I believe that the
``compulsory licensing'' amendment was a necessary addition to the
Africa Growth and Opportunity Act if we are to continue to assist the
countries of this region in halting the number of premature deaths from
AIDS. Antiretroviral drugs can do much to improve quality and length of
life. The United States has the power to make these life-saving drugs
more affordable and accessible to Africans. We cannot turn our backs on
Africa. Our assistance is truly a matter of life and death.
I thank the Chair. I yield the floor.
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. FEINGOLD. Mr. President, I ask unanimous consent that the Senator
from Illinois, Mr. Durbin, be recognized after my remarks.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. FEINGOLD. Thank you, Mr. President.
Let me first thank my colleague from California, Senator Feinstein,
for her comments and leadership on this issue, and in particular the
work we started together last fall and her determination with regard to
the amendment that we are quite determined to make sure stays in the
African Growth and Opportunity Bill.
I also especially thank Senator Durbin, who came back from Africa in
December with a tremendous passion on this issue, for using his
enormous leadership skills to bring us together on a bipartisan basis
to try to help fight this problem. I am grateful for his leadership and
for his having the idea that we should come together in the Chamber to
make some comments.
As the ranking member of the Subcommittee on Africa, I have always
felt very strongly about the issue of AIDS in Africa. I have raised it
in the context of the African debate. I have had success in some areas
but not in others. I had a chance to raise it in December in personal
meetings in their own countries with 10 different African Presidents.
I applaud the United Nations Security Council's decision to address
the crisis last month. I want to especially mention our Ambassador to
the U.N., Richard Holbrooke, whose idea it was to have such a session,
and I support the administration's call to increase the resources
directed at the crisis. I am especially pleased to stand with my
colleagues to raise the issue again today.
I have heard some of the statistics, but I think they bear
repetition.
In 1998 alone, AIDS killed 2 million Africans. At least 12 million
Africans have been killed by AIDS since the onset of the crisis. Africa
accounts for over half of the world's cases of HIV. According to World
Bank President James Wolfensohn, the disease has left 10 million
African children in its wake.
In Botswana, Namibia, Zambia, and Zimbabwe, 25 percent of the people
between the ages of 15 and 19 are HIV positive.
By 2010, sub-Saharan Africa will have 71 million fewer people than it
would have had if there has been no AIDS epidemic.
My recent trip to 10 African countries only renewed my resolve to
address this matter with the urgency and seriousness it deserves.
In Namibia, HIV-positive citizens pulled up to a meeting in a van
with curtained windows, and they hurried to the safety of the meeting
room as soon as they arrived. They feared that their identity would be
revealed, and that the stigma still attached to the disease would cause
them to lose their jobs and perhaps even to be disowned by their
families. It was shocking--in a country gripped by the epidemic, people
are still afraid to acknowledge the crisis.
In Zambia I visited an orphanage of sorts, where 500 children, many
of them orphaned when AIDS killed their parents, gathered by day. At
night, there is only room for 50 of them--the rest must make their own
arrangements, and many end up sleeping on the streets, sometimes
prostituting themselves--thereby risking exposure to HIV in their
struggle to survive.
In Zimbabwe, life expectancy has dropped from 65 to 39. Let me repeat
that: life expectancy in Zimbabwe dropped from 65 to 39. Walking past
the Parliament building one day, I asked how old one had to be to
become a legislator there. The answer was 40. That exchange helped me
to grasp how far-reaching the consequences of this disease really are--
no society is structured in a way that prepares it to deal with an
unchecked epidemic like AIDS.
In July 1999, the National Institutes of Health released a report on
the effectiveness of a drug called nevirapine, the drug Senator
Feinstein mentioned, in preventing mother-to-child transmission of HIV.
Studies indicate that this drug can reduce the risk of mother-to-child
transmission by as much as 80 percent.
As she said, NVP costs $4 per tablet. This relatively simple and
inexpensive drug regimen has created an unprecedented opportunity
for international cooperation in the fight against the vertical
transmission of HIV.
It should be recognized that Uganda is making real headway with
regard to prevention. Since 1992, the Ugandan government's very frank
and high-profile public education efforts have helped to reduce the
incidence of HIV infection by more than 15 percent.
But despite these positive signs, there are many fronts on which
there has been very little progress. Virtually no one has access to
drugs to treat the disease. Prevention is unquestionably the most
important element of the equation, but treatment cannot be ignored.
Poverty should not be a death sentence--not when the infectious disease
that is destroying African society can be treated.
Again, because Senator Feinstein and I, and I know Senator Durbin,
are determined on this, we offered an amendment to the African Growth
and Opportunity Act that was accepted into the Senate version of that
legislation. It prohibits federal money from being used to lobby
governments to change TRIPS-compliant laws allowing access to HIV/AIDS
drugs. Basically, it just says that taxpayer money shouldn't be used to
prevent countries from taking international legal measures in this AIDS
emergency. I strongly urge the conferees to support that amendment.
The AIDS crisis in Africa is just what the TRIPS agreement was meant
to address. This is a crisis, an emergency on an incomprehensibly vast
scale. This is the rare and urgent situation that calls for something
beyond a dogmatic approach to intellectual property rights.
If allowing for a TRIPS-compliant response seems expensive, think how
expensive it will be, in the long run, not to do so. Even beyond the
human tragedy, there are vast economic costs to this epidemic. AIDS
affects the most productive segment of society. It is turning the
future leaders of the region into a generation of orphans.
It is simply unconscionable for the U.S. government to fight the
legal efforts of African states to save their people from this plague.
I cannot imagine why any of my colleagues would support such action.
Those dissatisfied with the TRIPS agreement should focus their efforts
on changing it--not on twisting the arms of countries in crisis who
comply with international law.
I thank my colleague from Illinois and I look forward to all the
efforts we will take on together on this issue, and I look forward to
working with Members of the other party on this as well.
I yield the floor.
The PRESIDING OFFICER. The Senator from Illinois.
Mr. DURBIN. Mr. President, I thank my colleagues, Senators Feinstein
and Feingold, for joining me to speak about AIDS today. I might add
there are others who were not able to be here because of scheduling
problems.
I, too, have just returned from a trip to Africa. Let me say at the
outset there are some who question the value of Congressional travel. I
wish they would look at it from a different perspective. I think the
Senators who spoke on the floor on this issue, Senator Feingold
included, have benefited greatly from traveling to Africa, not just
because we have seen firsthand
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this epidemic and its devastation, but frankly because it is
energizing. Seeing people, real people and their travails, their
hardships because of this epidemic, causes many of us to dedicate
ourselves to do something.
In an epidemic of such Biblical proportions as the AIDS epidemic in
Africa, many of us are humbled, as we should be. I came back and met up
with Senator Feingold, whom I know had a similar interest, and Senator
Feinstein, who helped introduce the amendment which was discussed
earlier, and I spoke with Senator Orrin Hatch, a Senator from Utah, who
has a similar passion on this issue. I have spoken to Senator Bill
Frist, a Senator from Tennessee, chairman of the Foreign Relations
Subcommittee on African Affairs. I sincerely believe on this issue,
more than any other issue, we should put party labels aside. I think we
are dealing with not merely another political issue, and certainly not
any political agenda; when we speak of AIDS in Africa we are dealing
with a Holocaust without a Hitler. We are dealing with the greatest
moral challenge of our time. Those are large statements, I understand.
But as you listen to the statistics that have been noted in earlier
debate about the epidemic, I do not believe I am overstating it at all.
Sub-Saharan Africa has been far more severely affected by AIDS than
any other part of the world. Approximately 23 million adults and
children are infected with HIV in that part of the world. They have
about 10 percent of the world's population, 70 percent of the world's
HIV-infected people. Though an estimated 13.7 million Africans have
already lost their lives to AIDS, including 2.2 million who died in
1998, we are going to see these numbers increase dramatically.
This was my first trip to Africa. I tried to make an earlier trip
with a Congressional delegation 10 years ago, and I was denied a visa
by the South African Government. Those were the days of apartheid, and
as a Congressman I had voted consistently against apartheid. They
obviously had read my voting record and said they wanted me to stay
home; they did not want me to visit their country.
Things have changed. Apartheid is over. There is majority rule in
South Africa. Under the inspired leadership of Nelson Mandela and now
President Mbeki, this country has a great future. They offered a visa
and an invitation to come visit, and I did. I visited Kenya and Uganda
as well.
I started out this trip thinking I would focus on issues I am
familiar with such as food aid. I have been involved in agriculture and
food assistance for as long as I have been in the House of
Representatives and the Senate. I think these programs are so
essential, where America takes its bounty and shares it with people who
are hungry, people who are starving, around the world.
I also wanted to focus on microcredit. Ten years ago in Bangladesh, I
learned of the Grameen Bank and similar microcredits that were
producing miraculous results. These are small loans, $50, $100, $200,
primarily to women to give them a chance to buy a cow or some chickens
or some goats or some tools or to expand their stall at the
marketplace. Mr. President, 98 percent of these microcredit loans are
repaid. It is a wonderful program, and it elevates people to a much
higher level in terms of their living standards.
So I went looking for food and microcredit programs, realizing I
would be discussing the AIDS issue as part of it. I quickly came to the
realization that AIDS is an issue which is overwhelming the continent
of Africa. Every other issue takes second tier to the AIDS issue. That
became the focal point of the trip.
The three countries we visited, South Africa, Kenya, and Uganda,
represent such different attitudes and different approaches when it
comes to the AIDS epidemic.
South Africa: I have a photo I took and have blown up. This is a
rural health clinic in Ndwedwe, which is right outside of Durban, South
Africa. This was a lovely young mother and her beautiful little boy who
sat in the front row of this clinic which I visited.
Americans help this clinic stay open. Americans help this clinic have
a nurse come in each day and have a doctor come in once a month. These
villagers walk sometimes hours to bring their children and members of
their families in for medical care.
This beautiful little boy, as you can see--maybe you cannot see on
the television--has the traditional Zulu bracelet made out of hair. His
mother has the scarring on the cheeks, which is part of the ceremony of
the Zulu tribes. They invited me to this clinic to meet some of the
people being served.
There was a lady sitting right behind this mother and child, and she
came up to speak. When she stood up, you could tell she was nervous.
She had on a T-shirt and, over that, a long-sleeved shirt. This was a
few weeks ago, and it was very warm in South Africa at that time.
As she came forward, she was clearly nervous about speaking with us.
She very calmly buttoned every button on her shirt all the way up to
her neck. She stood in front of this assembled group, and she was very
quiet. Then she said in Zulu: Unity, unity, unity, unity; in unity
there is strength. Every time she said the word, the crowd answered
her. Then she summoned her courage and told her story about how 2 years
ago she was diagnosed with tuberculosis and has heart problems and may
need surgery and how important this clinic is to her.
At the very end of her talk, she said: And I have AIDS, and I don't
know what will happen to my children. And she started crying.
The man who was the master of ceremonies at this little gathering
asked her to sit down on a bench next to me as she was crying. I
reached up and put my arm on her shoulder, and this audience, wide-
eyed, gasped that I would touch her. A doctor who traveled with us
stood up and said to the people assembled on this porch: Do you see
this? Do you see this American politician? He is touching her. You will
not get this AIDS epidemic if you just touch someone.
That reflects the level of ignorance, the level of denial in South
Africa about an epidemic that has reached and touched 4 million people
out of some 40 million. They do not understand the basics.
In 1998 on World AIDS Day, a South African woman stood up and said: I
have AIDS. She returned to her village that evening and was beaten to
death because they believed that was how you could end the scourge.
The Chicago Tribune did an amazing series about the AIDS epidemic,
one that I took out of the paper recently. They talked about another
town in South Africa, Esidubwini, and they told a story about a lady,
Thandiwe Mwandla, who was diagnosed with AIDS, and after the diagnosis,
no one would buy her sugarcane, her bananas, her peaches. They would
not buy anything she touched. She said at one point that her neighbors
walked a broad circle around her. She had the stigma of AIDS. She said:
We get sick, and we get poor, and we die lying to ourselves.
The Tribune wrote in this story what I consider to be a very
inspiring paragraph:
Staring into the abyss of an incomprehensibly brutal
epidemic, it is plain how the 23 million people who live with
HIV in Africa can drift easily into numbing fatalism, or a
fierce, hardening shell of denial.
We saw that shell of denial in South Africa, a country which looks
more like Europe than any other part of Africa, a country which
accounts for 30 percent of the economy of sub-Saharan Africa, a country
where many people are pinning their hopes that they see the rebirth of
Africa in the 21st century. Yet, devastated by this disease, it has
been unwilling to face it.
From there we went to Kenya. In Kenya, there is a different
circumstance--some positive, some not so positive. First, this is a
photo we took of this little fellow in a slum in Nairobi, Kenya. It is
called Kibera. It is a squatters slum in the middle of the city. People
from the rural countryside who cannot make a living pile into this
slum. They squat, set up their huts, and try to create a life and
existence.
I asked how many people live in this slum. They said: Somewhere
between 500,000 and 800,000; we are not sure, it changes so quickly.
There is virtually no sanitation, no water. It all has to be brought
in. And there certainly is no health care.
Kenya is ravaged by AIDS as well. Sadly, for a long period of time
they denied it. They did little about it. Just
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recently there was an indication that they are going to start admitting
it and dealing with it. This political denial is part of the problem,
and we in the United States have to be part of the solution in
convincing these governments in Africa that what is at stake is not
just this little boy but the future of a continent.
From Kenya we went to Uganda, and thank God it was the last stop on
the trip because what we saw in Uganda suggested to me that there is no
reason to despair, we should keep our hope alive, there is a chance to
deal with this epidemic.
The reason Uganda is so far ahead of many other Third World countries
is an interesting story.
About 10 years ago, President Museveni of Uganda sent some of his
Ugandan soldiers to Cuba to be trained to fight rebels in the
countryside. After a few weeks, he received a message from the Cuban
Government. They said: We are sending your soldiers home. Of course,
his Government asked why. And they said: Because half your soldiers you
sent to Cuba have HIV.
That was 10 years ago. It was stunning for them to realize that what
they thought was an isolated disease now infected half of the military.
We met some of the soldiers--in fact, some were HIV positive--in each
of these countries who have now come forward and dealt with this in a
more open and forthright way.
When those soldiers came back from Cuba to Uganda, at about that same
time, one of the more prominent figures in music in Uganda, a man by
the name of Philly Lutaaya, announced publicly that he had AIDS. By
going public and talking to the people of Uganda, he achieved, in many
ways, what Magic Johnson achieved in the United States. He suddenly
raised our eyes from our other life's undertakings to look straight
into the eyes of someone whom we knew and admired and thought this
would never happen to.
Uganda then set out on a program to reduce the incidence of HIV
infection, and when they tested the pregnant women of that country,
they found that 30 percent of them were HIV positive. They started
pushing for abstinence, faithfulness, and condoms as an effort to
reduce the incidence of HIV infection. Ten years later, they cut that
down from 30 percent of pregnant women to 15 percent--a dramatic
improvement. Yet, in this country of 17 million people, there are some
1.7 million AIDS orphans today.
If you travel around Uganda and see how they have dealt with this
epidemic and the success they have achieved, you come to understand
human nature and the strengths of people who are facing the worst
possible outcome: an early death from an incurable disease.
We went to a clinic called The AIDS Support Organization, TASO. It
started many years ago with a handful of people and has grown into tens
of thousands of HIV-positive people who come there when they have a
problem, when they are fighting off an infection. They do not have the
AZT cocktail. They can never dream of that. Countries which spend $2,
$3 per capita annually on public health cannot even imagine spending
$1,000 to treat AIDS. It is beyond their comprehension.
How do they get by? With the basics: With some antibiotics to try to
get through each infection. They talk about nutrition and improving
their lifestyle, eliminating alcohol and all sorts of things to make
them stronger so they can cope with these infections.
There is another element that is equally, if not more, important. At
TASO, there is a choir, a group of about 30, who perform for those who
visit. They are all men and women, mothers and fathers, who have AIDS
themselves. They sing when you come by.
In Africa, it is not unusual that when you go to a group, they will
sing, hello; when you leave, they sing, good-bye. When you are there,
they sing about what they are thinking about. It is an African style
that really grows on you.
But the TASO choir sang some songs they had written. Some of them are
very basic--``When We Come Together We Feel Strong.'' This support
group keeps the people going, day in and day out, to know that others
suffer from this disease and that they can rely on one another for
consoling and for strength. I am proud that the U.S. Government,
through the US Agency for International Development, helps support this
TASO clinic.
As I watched this choir and listened to them sing--and they were very
good--I looked into their eyes and thought: There must be some anger or
resentment about this.
There is almost a resignation to this disease, this HIV. One of the
songs, which a young lady named Grace had written for the TASO choir is
entitled ``Why Me?'' It just breaks your heart to hear them sing: ``Why
me? Why him? Why her? Why you? Why me?"
We went to another project, which I think is a good investment, a
support group called NACWOLA, the National Community of Women Living
with AIDS. It is a group that counsels women with AIDS and children.
They have a little house in which they come together and meet on a
regular basis. They talk to one another and try to help one another.
They have a special project. It is called the ``Memory Book.''
Mothers sit down and try to write their life's story in this book, with
family photos, and they talk about where they came from and who their
parents were and experiences they have had. And they talk about their
children because, you see, they want to leave these books for their
kids, so that when they are gone--and they know that day is coming--
their children will have this memory book to look at.
I sat on the porch there at the NACWOLA house in Kampala, Uganda, as
two of the mothers, Beatrice and Jackie, read to me from their books. I
realized then that I was in a nation that had turned into a hospice.
These people were not crying. They were not angry. They were doing all
they could do. They were trying to get by every day and leave a legacy
for the kids who were playing in the yard.
The kids gathered around us and started singing. When they started
singing, they talked about their future. They know their parents have
AIDS. They know their lives are uncertain. They said: We hope we don't
end up with cruel stepparents. We hope we don't end up on the streets.
As they were singing, I looked behind me, and there were the mothers
holding the Memory Books.
That is the state of Africa today. Some people ask: Why should we
care? It is half a world away. We will never see these people. Of
course, a lot of things have devastated Africa through the generations.
I think there is more to the story.
The AIDS epidemic, most people believe, started in Africa. It is
questionable when it started, but most people think it started there.
It is now a worldwide epidemic. It is naive to believe that you can
contain this kind of health problem and believe that it is not going to
travel beyond other countries' borders.
Equally important, I think we understand, as Americans, one of the
things that makes us different from some other people in the world is
that we do care and we do try to make a difference. I think we can make
a significant difference when it comes to this AIDS epidemic in Africa.
Let me tell you some of the things we can do and some of the things
we are doing.
Senator Feingold talked about the medical research going on in
Africa. It is not at the same level as medical research in the United
States. You do not have drug companies that are inspired by huge
profits and think if they can find the cure to AIDS they are going to
make billions of dollars. That isn't going to happen. These folks are
looking at medical research at a much different level.
At Mulago Hospital in Kampala, Uganda, they have a project underway
where they are testing this drug, Nevirapine. Nevirapine has been
mentioned on the floor a couple times. A dosage of this drug to a
mother at the time she goes into labor, and then a dose to the baby,
basically cuts in half the transmission of AIDS from mother to child.
This is a simple drug, at $4 a dose, which can make a big difference.
It is not likely to be a big seller in the United States because no
drug company will get rich at $4 a dose. But it works. It appears to
work very well.
Thank goodness the Centers for Disease Control--part of our
Government--Johns Hopkins University in Baltimore, and this hospital
have come together. They are showing how it can make a difference.
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They are looking for supplements to diet--for example, whether
additional vitamin A can mean that a person with HIV can live longer
and be healthier.
They are operating at a lower level because that is all they have to
work with. It is a survivalist approach. But it is making life better
and longer for a lot of people. It is working. We are helping it to
work. I am glad the United States is part of that.
There is a woman who has become somewhat legendary. Anyone who has
not seen this I hope will get a chance to see this Newsweek cover
story: ``10 Million Orphans.'' It talks about the AIDS epidemic in
Africa. Her name is Bernadette Nakayima, and she lives near Kampala,
Uganda. She had 11 children. Ten of her children died of AIDS. They are
buried on a hillside by their home. The one surviving daughter lives
nearby.
This 69-year-old grandmother, after her 10 children died, brought in
the orphans to her home. She has 35 orphans in her home. How does she
get by? Well, according to the Newsweek story, at one point she did not
think she could. She gathered all the children in a room and said:
Close the doors and lock them. We're just going to starve to death
here. We can't make it. But luckily somebody knocked on the door and
said: Come out. We're going to try to help you. People are trying to
help.
As I speak here on the floor today, Sandra Thurman, who is the head
of the effort to deal with AIDS, is in the gallery. I was in Africa
with her. She has visited Bernadette many times. She draws the same
inspiration, as everyone who goes there, to think of the strength of
this woman who, in advancing years, is trying to raise 35
grandchildren, one of whom, incidentally, is HIV positive.
How is she getting by? It points to another thing at which we should
look; that is the fact that she is part of something called FINCA.
FINCA is a microcredit program in Africa. Microcredit, as I mentioned
earlier, is a small loan, primarily to women where they can
dramatically improve their lives by having a little additional income.
Women like Bernadette are able to bring in AIDS orphans and help them
lead normal lives in a family setting rather than on the streets.
One of the meetings I had with a FINCA group was in Lugazi, Uganda. I
will not soon forget where we had the meeting. Our meeting of 20 women,
who were coming to report on their loans and to seek additional credit
assistance, took place in a little hut that a few days before had been
a chicken coop. The chickens, who had been moved out of that coop to
the adjoining room, squawked during the whole meeting. But these ladies
were not going to be deterred by a few angry roasters. They were there
to get on with the business. The business was borrowing money to
improve their lives.
I asked one of the ladies: What have these microcredit loans meant to
you? She said, through an interpreter: Because of these loans, my knees
have gone soft. I had no idea what she was talking about. She
explained. She said: Before I had microcredit, before I had more
income, I used to have to crawl on my knees to my husband to beg for
money for food for the children and to send the kids to school. Now I
have some money. I don't have to crawl. My knees are going soft.
That story was repeated over and over again by the 20 women gathered
there. I said: How many of you who are borrowing this money, by these
small loans that make such a difference, have brought in AIDS orphans
to your home? Half of them raised their hand--two children here, and
four here, and six here. They had the wherewithal to do it.
In countries where people survive on 30 cents a day, it does not take
much to dramatically improve the quality of life and keep these
children within the extended family. It can help. It can work.
The second thing that is helping is food assistance. We are directing
food assistance in areas where we know that we have serious problems
with AIDS orphans. We need to do more in this regard.
I use these examples so that people who might otherwise want to throw
up their hands and say: Well, it is a problem we should worry about,
but how can we possibly address it if there are so many people
victimized by it? There are things we can do, small things for a great
nation to do, that can make a great difference, small things that can
save lives and give families a chance.
I am going to introduce legislation today which is entitled: ``The
AIDS Orphans Relief Act of 2000.'' It addresses microcredit to try to
increase it as an effort to help AIDS orphans find homes and to
increase food assistance for that same purpose.
This is not going to solve the problem, by a long shot. There is so
much we need to do in the areas of research and prevention, creating an
infrastructure for distributing the medicines that are available in
Africa. I hope this will be one part of an agenda, that we can gather
together and speak, as Senator Feingold and Senator Feinstein did,
about the pharmaceutical side of it, address the larger issues that the
World Bank might be able to help us with, through Senator John Kerry's
bill and Congressman Jim Leach's bill, and invite all of the Members of
the Senate to focus on this issue in a bipartisan fashion. I believe
sincerely we can make a difference.
It has been said earlier that this devastating disease is lowering
the life expectancy of people in Africa. You find, when you go to some
countries, such as South Africa, that employers will hire two people
for a skilled position because they know one is not going to survive.
Those are the odds. That is what they are up against. It calls on us to
focus on what we can do to help.
A little while ago we had a meeting of Democratic Senators not far
from the floor, and Sandy Thurman, our AIDS director, was there, as
well as a young woman named Rory Kennedy. She is the daughter of Robert
Kennedy. She has been recognized for her skill as a producer of
documentary films. She presented for us a 12-minute documentary film on
the AIDS epidemic in Africa. It is a film she put together when she
visited with a group not that long ago. It really does put in human
terms what I am trying to say in words.
You see the faces of those little children. You see the trips to the
graveyard to bury babies who have died because of HIV. You go down the
road, as you would in Kampala, Uganda, and you notice the stalls of
produce. Then at the end, you see the huge sign that says ``coffins.''
When I spoke to the Ambassador, Martin Brennan, he told of going to a
village outside of Kampala and seeing in the town square stacks and
stacks of coffins. It, unfortunately, is a big growth industry in
Africa. It calls on us to address this in so many different ways.
Let me tell you another way that may not seem obvious that is part of
this as well. While we were traveling in Uganda, we went to an
agricultural research station. This is a station which brought together
some ag research which the United States has supported for years.
Cassava is a basic root crop used as a staple for the diet of many
people in central and eastern Africa. Not that long ago, there was this
virus that affected this crop and dramatically reduced it. People were
going hungry and starving to death. Because of this research at this
station they have found ways to end this so-called mosaic virus. People
are now seeing this cassava grow, and they are once again feeding their
families.
It was a little thing, lost in the budget of the Department of
Agriculture, which means that millions have a chance to live. Some
people will question ag research from time to time, even mock it. Yet
we see day to day in Africa and in the United States that it pays off.
This is a part of the world that has been ravaged by civil war, ravaged
by famines as bad as the potato famine, ravaged by epidemic, now as bad
as the bubonic plague, all of these things are coming down on central
Africa like four horsemen of the apocalypse. They are coping with it
every single day.
We need to do all we can to make sure that our country, working with
other countries, can try to stop this crisis from getting any worse.
The lessons we will learn in Africa will help us save lives there. It
will help us take the message to other parts of the world, such as
India and other parts of Asia, that are threatened with this epidemic.
But there is something else we will learn. We will learn from the
courage and compassion of the people who
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live in this area that there is strength in the darkest hour.
I came back from this trip determined to do something. I hope that
with this meeting today of several Senators on the floor of the Senate
we can start this dialog. I think we cannot only reach across the aisle
to my friends on the Republican side and share our feelings, but reach
out beyond this Chamber and beyond this Government. I think we can
reach out to churches across America.
I have written a letter to the Catholic bishops in my home State of
Illinois. There, as a little boy growing up, I used to give pennies and
nickels every day to the missions. It was something they did
automatically in Catholic schools when you were growing up. I didn't
know where that money was going. I barely knew what the missions were.
But when I went to Sunday Mass at the basilica in Nairobi, Kenya, and
saw 2,000 people, standing room only, I found out where that money
went. It converted a lot of people to Catholicism, as the Anglican
Church converted a lot of people to their religion. Now we have a
chance to say to some of these religions, such as Catholicism and
others: We made an investment in Africa at a time when they needed our
help, and now they need it again. Can we bring together the religions
of the United States that have focused on Africa and try to cope with
this crisis?
The head of the National AIDS Commission in Uganda is a retired
Catholic bishop. I think that says a lot. It says that they are
crossing religious boundaries in an attempt to deal with this epidemic
and this crisis.
When it comes to the security side of this issue, I have spoken about
the military in Uganda, and I am afraid it is the case in so many other
countries. They, too, are infected, and that is a source of concern for
all of us. If your military cannot respond to a crisis in the country,
it fosters instability. It creates security problems which reach far
beyond that country, that may even involve the United States, as in the
past 10 years we have been to Africa on peacekeeping missions, some
with tragic results.
So if we can work, and I hope we can, through our skills and our
military to help them cope with this disease in the ranks of the
militaries in Africa, it is good for them and their countries. It is
good for our world. I will be working with my colleagues to see if we
can achieve that.
Let me close by thanking the Chair for this opportunity to speak. I
have gone beyond the usual allotment of time. I thank the Chair for his
patience in that regard. I hope in this session of Congress we can come
together as they do at TASO in Kampala, Uganda, and find the strength
and support to care for people halfway around the world, people perhaps
of different color from some of us, but people who are our brothers and
sisters.
I yield the floor.
Mr. KENNEDY. Mr. President, HIV/AIDS in Africa has become a global
emergency unlike anything that public health has seen in this century.
According to Archbishop Desmond Tutu of South Africa, ``AIDS in Africa
is a plague of biblical proportions. It is a holy war that we must
win.''
The number of HIV-infected individuals in Africa has now reached 22.5
million. As a nation, America is all too familiar with the devastation
that AIDS causes. Nearly 10 years ago, Senator Hatch and I sponsored
the Ryan White CARE act, the legislation that helped begin the long
battle to deal with the AIDS epidemic in this country. The situation
has steadily improved in the United States, because extensive efforts
have been made and needed systems of care have been put in place. The
CARE Act has helped us make great progress.
We began our fight against AIDS in the United States with the
advantage of having the world's most advanced health care
infrastructure, but the situation in the developing world is much
different. Resources are scarce, infrastructure is limited, and the
people of Africa face a situation that is not improving but is steadily
growing worse.
Officials at UNICEF have described the situation that many nations in
sub-Saharan Africa face as a ``tripod of deprivation'' that involves
poverty, debt and AIDS. Any of these three crises would be severe on
its own. Taken together they are devastating. The result for the
African continent is enormous pain, suffering, and death. Decades of
progress on economic growth, infant mortality, and life expectancy are
all threatened. The AIDS virus is infecting every aspect of life for
the people of Africa, from work and family to education and even
national stability.
The effect on the African workforce is especially ominous. African
nations have worked hard for the economic development that is emerging.
But HIV is striking vast numbers of individuals during their most
productive years, and all of this recent progress is being placed in
jeopardy. AIDS directly undermines productivity by increasing
absenteeism. It raises the cost of business through increased need for
benefits. Costs of recruiting and training employees are rising, as
current employees die or become disabled. Higher costs also threaten
international investment in Africa, which is essential for future
economic development.
Over 8 million children have already been orphaned by AIDS in Africa.
In the next decade, that number will reach 40 million, a number equal
to the total number of children in the United States who live east of
the Mississippi River. Children are forced to leave their schools in
order to care for dying parents and put food on the table for
themselves and their family. Many of these children are already
suffering emotionally from the loss of one or both of their parents,
and now they are losing the vital educational opportunities they need
and deserve.
HIV infection rates are as high as 80 percent in some African
military forces, and the disease is threatening the security and
stability of these nations. Forces that have been weakened by
disease are less capable of defending their nations, maintaining order,
or protecting citizens. The concern is immediate. A 1998 UNAIDS study
reported that in both Zimbabwe and Cameroon, HIV infection rates were
three to four times higher in the military than in the civilian
population.
While new therapies have begun to offer hope in the fight against
AIDS in the United States, the cost of these treatments has put them
out of reach for developing countries, where the epidemic is raging out
of control. During the past six years, there has been a 300 percent
increase in annual cases of HIV/AIDS in sub-Saharan Africa. Yet until
this year, U.S. funding for AIDS programs overseas had remained level-
funded at $125 million. When inflation is taken into account, level
funding means a 25 percent decrease between 1993 and 1999.
Last year, many of us in Congress and the administration worked hard
to obtain an additional $100 million to fight the HIV/AIDS epidemic in
Africa. This funding was a vital first step towards turning the tide,
but it is not nearly enough. This money will be used for prevention
efforts, counseling and testing, direct medical services, and also to
assist the millions of children orphaned by AIDS in the region. The
additional $100 million that President Clinton has included in his
FY2001 budget will enable us to reach an even greater proportion of
people infected with HIV in Africa.
Yesterday I cosponsored the bipartisan legislation introduced by
Senator Barbara Boxer and Senator Gordon Smith that extends the U.S.
commitment to sub-Saharan Africa through 2005. We know that increased
U.S. aid for Africa is essential. In partnership with other donors, the
U.S. invested $46 million in HIV prevention and care in Uganda, and
helped cut the HIV rates by more than half.
Prevention is effective, but it costs money. Treatment and care also
cost money. Yet the nations of sub-Saharan Africa are among the poorest
in the world, and they cannot and should not bear this burden alone.
The U.S. is the leading donor of development assistance for HIV/AIDS
prevention and control in the developing world, but our response to
this crisis has so far been inadequate. The United States currently
ranks ninth in terms of the percentage of GNP devoted to international
AIDS programs. This is not the leadership that this country has shown
in the past, when nations have been torn apart by tragedy.
I recently learned about a couple in Senegal who were both stricken
by HIV. They have a small shop that sells newspapers, candy and other
goods,
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and are economically well-off in comparison to many of their fellow
citizens. Their financial situation allowed them to afford some AIDS
drugs, but the cost of basic treatment for one person takes thirty
percent of their monthly income. They have been forced to choose which
one of them will take these life-saving medications. That is a decision
that no couple should have to make.
The rate at which AIDS has spread in developing countries should
alarm all nations and peoples. The world is too small for us to think
that a virus which has infected 34 million people and killed 14 million
is under control and will not continue to infect our own country.
This global epidemic has already taken more lives than all but one of
the major conflicts of this century. Only World War II surpasses AIDS
in terms of human devastation in this century. We cannot stand by and
let this level of suffering continue.
We can and must do more as a nation to fight this growing global
epidemic. It is estimated that by the year 2005 more than 100 million
people worldwide will have become infected with HIV--100 million
people. The magnitude of the emergency is immense. What will we tell
our children and our grandchildren about how we faced the largest human
tragedy of our time? I hope that we can tell them that we reached
across the aisle and then across the ocean to help those caught in this
relentless epidemic. This is not about Democrats or Republicans.
This is about America, and what we stand for as a nation and as a
world leader. I urge my colleagues to do all we can to save lives and
ease this tragic suffering.
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