[Congressional Record Volume 147, Number 52 (Tuesday, April 24, 2001)]
[House]
[Pages H1528-H1530]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1930
HIV AND AIDS PANDEMIC HAS DEVASTATED MANY COUNTRIES IN AFRICA
The SPEAKER pro tempore (Mr. Rogers of Michigan). Under a previous
order of the House, the gentlewoman from North Carolina (Mrs. Clayton)
is recognized for 5 minutes.
Mrs. CLAYTON. Mr. Speaker, I rise before my colleagues to talk about
the HIV and AIDS pandemic. The AIDS pandemic has devastated many
countries in Africa, leaving few men and women and children untouched.
Sub-Sahara Africa has been far more severely infected by AIDS than any
other part of the world. In 16 countries, all in sub-Sahara Africa,
more than 1 in 10 adults is affected by the HIV virus.
According to a joint report issued by the United Nations Program on
HIV and AIDS, one-half or more of all 15 year-olds will eventually die
of AIDS in some of the worst areas affected such as Zambia, South
Africa, and Botswana. Over 34 million HIV/AIDS cases are in the world,
and 24 million or 70 percent are in Africa.
I recently visited Botswana to see up close the destruction this
disease has caused. Approximately 35 percent of Botswana's adult
population is affected by HIV. AIDS has cut the life expectancy in
Botswana from 71 years to 39, according to Karen Stanecki of the United
States Census Bureau during an appearance at an international AIDS
conference held in South Africa in July of 2000.
The visit that I made strengthened my conviction to do my part in
bringing the awareness to this issue and to work with my colleagues in
Congress, national governments, State and local governments, and
activists around the world to do more for the people who have the virus
and to do more to stop the spread of the disease.
Soon after I returned from Botswana, I sponsored an HIV/AIDS
roundtable discussion in my district that consists of public health
officials, community activists, HIV/AIDS case managers, community
health providers, doctors, individuals suffering from HIV/AIDS. I
sponsored this roundtable because my district in eastern North Carolina
has a high incidence of HIV/AIDS.
Eastern North Carolina, which includes more than my district, all on
the south side of 95 North, the Interstate, about 25 counties indeed
have 30 percent of the State's HIV disease. That only represents, by
the way, only 20 percent of our population. Clearly this is an issue
that is affecting us both domestically as well as internationally.
Given the loss of lives AIDS has caused, the destruction of entire
communities, the long-term impact of economic growth, we must step up
our effort to fight the devastating disease. With children dying at the
age of 15 and the life expectancy in most of Africa of 45 years for
children born in some countries, something must be done. Indeed,
children being born in these countries cannot expect to live long.
There is very little future.
To ignore the problem is to our own peril, but to know the impact of
AIDS and then to ignore it is to our own shame.
I applaud the pharmaceutical companies for dropping the lawsuit to
prevent South Africa from importing cheaper anti-AIDS drugs and
medicines. Now we must increase efforts to provide affordable anti-AIDS
drugs to all who need them. I challenge the pharmaceutical industry,
countries worldwide, and the United States government to engage in a
collected effort to get the necessary drugs to people infected with
HIV/AIDS.
Mr. Speaker, I include for the Record two publications on this issue,
one from The New York Times and the other from The Washington Post, as
follows:
[From the New York Times, Apr. 21, 2001]
Despite Legal Victory, South Africa Hesitates on AIDS Drugs
(By Rachel L. Swarns)
Johannesburg, April 20.--With the Champagne consumed and
the celebration over, advocates for AIDS patients today
turned their attention from the South African government's
legal victory over the drug industry and looked to the
future.
With sinking hearts, many concluded that the next big
barrier to expanding access to AIDS drugs might well be the
government itself.
The drug industry conceded South Africa's right to import
cheaper brand-name medicines, but the governing African
National Congress was not aggressively charting the way
forward.
Instead, in its online newspaper, the party was ticking off
countless reasons why the country should think twice about
providing lifesaving AIDS cocktails.
[[Page H1529]]
In this, the ruling party was echoing the health minister,
Dr. Manto Tshabalala-Msimang, who dashed the hopes of her
allies on Thursday when she made it clear that providing AIDS
drugs was not a government priority, even though the drug
industry had just dropped its objections to a law that allows
South Africa to import brand-name drugs at the lowest prices
available.
When pressed about her plans for treating the nation's 4.7
million people infected with H.I.V., Dr. Tshabalala-Msimang
insisted that the government was already offering adequate
care without costly AIDS drugs.
Mark Heywood, a lawyer who helped organize the street
protests that applied pressure on the drug industry to drop
its lawsuit against South Africa, said today that the
minister's remarks felt ``like a stab in the back.'' And her
comments and those from the A.N.C. have revived concerns
about the government's commitment to providing the medicines
in a country with more people infected with H.I.V. than any
other.
This morning, Mr. Heywood and other advocates for AIDS
patients gathered to consider a new campaign to pressure drug
companies to lower prices of AIDS drugs in the private
sector. But they also decided to focus on the government, and
to turn up the heat if necessary, to persuade health
officials to work harder to bring the AIDS drugs readily
available in the West to the poor in South Africa.
``Our work on the court case shows our willingness to enter
into partnership, but we will not shirk from very difficult
engagements with the government,'' Mr. Heywood said.
``Yesterday was an important and empowering victory. But
we're measuring success by bringing real medicines to real
people.''
On Thursday, 39 drug companies agreed to drop a lawsuit
intended to block a law that would expand access to cheaper
medicines. Among other things, it would allow the government
to buy brand-name drugs that advocates say are sold more
cheaply in India and Brazil than in South Africa.
But the law, which will take effect in several months, is
unlikely to expand access significantly. The drugs are still
expensive for South Africa, and the health care system here,
particularly in rural areas, is still largely unprepared to
administer such complicated medicines and to monitor
patients.
Advocates for AIDS patients acknowledge those obstacles.
Still, many had hoped to hear a sense of urgency from the
government about addressing them.
Other African countries that are poorer than South Africa
and that have even weaker health systems have already moved
ahead with pilot programs that provide anti-retrovirals at a
low cost. The countries include Ivory Coast, Uganda and
Senegal.
Botswana, a relatively wealthy African country, hopes to
provide the medicines to all of its citizens who need them by
the end of the year.
Many people here hoped South Africa would be next. AIDS
activists want the government to consider financing plans, to
start training nurses and doctors and upgrading local
hospitals and to put together a national treatment plan.
Other activists are pressuring the government to apply for
special permission to import cheap generic versions of the
patented AIDS drugs, which would finally bring the
``cocktails'' within reach.
But the government is clearly reluctant to take the
preliminary steps to get those drugs to the dying.
Some suspect this reluctance may come from President Thabo
Mbeki, who has publicly questioned the safety of the drugs
and whether H.I.V. causes the disease. After being assailed
here and abroad for his stance, Mr. Mbeki withdrew from the
AIDS debate last year.
And in recent months, the government has taken positive
steps, announcing a pilot program to distribute anti-
retrovirals to pregnant women to prevent transmission to
newborn; accepting a drug company donation to treat
opportunistic infections; and developing guidelines for the
proper use of anti-retrovirals in the private sector.
But Dr. Thabalala-Msimang emphasized that programs to
provide anti-retrovirals for adults were not coming anytime
soon.
``For the moment, the best advice is to treat opportunistic
infections,'' she said on Thursday. She added that such
treatment, along with improved diet and counseling, would
``allow people with H.I.V. to manage their lives and
participate adequately.''
``We are indeed treating people who are H.I.V. positive,''
Dr. Thabalala-Mismang continued, in response to repeated
questions about when anti-retroviral programs might be
available. ``It is not correct to say that just because we do
not provide anti-retrovirals that we are not treating
people.''
____
[From the Washington Post, Apr. 23, 2001]
Global AIDS Strategy May Prove Elusive; More Funds Available, But
Consensus Lacking
(By Karen DeYoung)
After a string of victories in the long battle for lower-
priced AIDS drugs in poor countries, health care experts,
AIDS activists and major donors are facing what might be an
even tougher challenge--agreeing on a unified strategy to
fight the pandemic.
``Now is when the hard part starts,'' said Johnathan Quick,
head of the essential medicines division of the Geneva-based
World Health Organization.
One debate among health experts and activists concerns
whether to concentrate new resources on sophisticated
treatment--even at newly reduced prices--to improve and
prolong the lives of those in advanced stages of the disease,
or on AIDS prevention, less expensive treatment of AIDS-
related diseases and basic health programs aimed at stopping
the disease's spread. More than 36 million people worldwide,
the vast majority of them in sub-Saharan Africa, are infected
with the human immunodeficiency virus (HIV), which causes
AIDS.
Resolving this and other differences has taken on new
urgency as donors have indicated willingness to provide
substantial new funds for a global AIDS campaign. Uneasy
about a lack of coordination, some donors, led by Britain's
Department for International Development, this month issued
what some described as an ultimatum to UNAIDS--the consortium
of U.N. agencies and the World Bank that oversees
international AIDS efforts.
``They told us they want something put on the table,'' said
a senior representative of a UNAIDS member. ``They challenged
us to have a common view.''
At a meeting in London today, members of UNAIDS are
scheduled to present a broad proposal for an international
AIDS trust fund administered by both contributing and
recipient countries. Participating in the meeting will be
delegates from the United States, Britain and other members
of the Group of 8; the Scandinavian countries and the
Netherlands; and major private donors, including the Gates
Foundation. Questions about how to spend the money would be
decided by a joint governing committee formed of donors and
aid recipients.
Getting various organizations and countries in line for a
common approach has not been easy. The United Nations was
thrown into an uproar late last month when Carol Bellamy,
executive director of the U.N. Children's Fund, declared in a
New York Times op-ed article that ``UNICEF is prepared to
step forward as the lead United Nations agency in the
procurement of anti-retroviral drugs on behalf of individual
countries.''
That offer, reportedly not cleared with U.N. Secretary
General Kofi Annan, upset WHO Director General Gro Harlem
Brundtland, who saw it as a premature policy proposal, as
well as a public challenge to WHO's primacy on AIDS. U.N.
agencies in charge of development and population, among
others, voiced disapproval, even as they, too, clamored to
claim a share of money that is not yet available.
``They are sort of like sharks when there's blood in the
water,'' said one close observer of the U.N. process. ``There
is money in the air.''
Apart from the United Nations, others have proposed uses
for new funding. Early this month, Harvard economist Jeffrey
Sachs proposed establishment of a massive global AIDS fund
to purchase anti-retroviral drugs for Africa. AIDS
activists criticized the proposal, which would involve
patent-holding pharmaceutical companies, for not favoring
generic producers who have offered even cheaper prices.
Two days later, Microsoft founder Bill Gates called a news
conference to warn that the treatment emphasis risked
undermining prevention efforts. Gates's family foundation has
given hundreds of millions of dollars to the international
fight against AIDS--the most of any single donor.
After years of being shamed by international pressure, the
major pharmaceutical companies are now offering the three-
drug anti-retroviral AIDS ``cocktail'' to some poor countries
for less than a tenth of the developed world's $10,000 per
patient per year starting price. Patent-busting generic
producers have offered even lower prices.
Nongovernmental activists riding high after humbling the
pharmaceutical industry on the price issue are calling on
African governments to immediately start positioning
themselves to provide the drugs. They point to Brazil, whose
government produces its own anti-retrovirals and distributes
them for free.
``I think the big decisions are not with the co-opted
northern bureaucrats,'' said James Love of the Washington-
based Consumer Project on Technology, a Ralph Nader-
affiliated group that analyzes drug pricing. Love, who along
with other activists advocates bypassing the big companies
and going straight into import and production of generic
drugs, called on African governments to ``have the guts'' to
move forward with new authorizing laws.
But some have warned that such a strategy is ultimately
counterproductive. They point out that Africa has neither the
health infrastructure nor the personnel to support widespread
use of the complicated treatment regime. There are currently
14 anti-retroviral drugs, patented by a handful of major
companies, used in various combinations to compose the three-
drug cocktail. New drugs will be needed as existing compounds
become less effective, and many companies are involved in the
search for a vaccine.
The companies have argued that generic producers do not pay
for research and development, and unless the world trade
system can guarantee that future patents will be protected,
research funds will be diminished.
Many Africans say they don't want to be pushed. ``We
wouldn't like any further delay'' in caring for South
Africa's more than 4 million HIV-infected people, Foreign
Minister Nkosazana Dlamini-Zuma said last week as the major
pharmaceutical companies withdrew from a three-year lawsuit
to
[[Page H1530]]
prevent her government from authorizing import and production
of generic drugs. ``But regulations have to be done before
any laws can be implemented. We'll do what we can, not
because of pressure, but because we think it's right.''
Other African seemed caught between their desire to get to
the front of the line for new funding and early resentment of
the expected new onslaught of advice and dictates from
developed countries. ``A Ugandan colleague told me that the
biggest epidemic lately is the epidemic of initiatives,'' one
European aid official said.
The proposal that was to be outlined today in London leaves
open the question of how much should be spent on drugs.
UNAIDS has estimated that a minimum of $3 billion a year is
needed to establish basic HIV prevention and non-anti-
retroviral treatment in sub-Saharan Africa alone. Adding the
anti-retroviral drugs, even at bargain-basement prices, would
bring that total to about $10 billion.
International contributions currently total less than $1
billion a year. According to a General Accounting Office
report released last month, Africa expenditures in the fight
against HIV/AIDS in fiscal 2000 by the U.S. Agency for
International Development--the largest national donor--
totaled $114 million. The GAO report noted that amount
``translated into per capita expenditures for 23 sub-
Saharan African countries'' ranging from $0.78 in Zambia
to $0.03 in the Democratic Republic of Congo.
In its budget resolution passed this month, the Senate
voted to increase total international AIDS spending to $1
billion over the next two years, although President Bush's
budget proposes only a small fraction of that amount.
The European Union, as well as its individual members, and
Japan have said they are prepared to provide major new funds.
But nobody believes that $10 billion is a realistic
expectation for the near or middle term, and choices will
have to be made.
``The exclusive focus on the issue of patent rights and
prices of drugs really has overridden the much more
fundamental question of how you actually get these services
out and how you blunt the epidemic itself,'' said one
international health official who asked not to be identified.
``If all of these resources go to treating the terminally
ill, then we can in fact see this process turn into one
that's really negative for the development of effective
prevention programs.
``It's so politically incorrect to say, but we may have to
sit by and just see these millions of [already infected]
people die,'' he said, acknowledging that this was an option
that would be considered unacceptable in the developed world.
``Very few public health professionals are willing to take on
the wrath of AIDS activists by saying that. But a whole lot
of them talk about this in private.''
Mr. Speaker, I mentioned the life expectancy of some in Africa of 45.
To continue to watch this disease shorten the lives of most people,
again, is a challenge to us morally; and it is to our peril if we do
not understand the implication it has, not only on global trade, but
also in national security.
South African government also now has an opportunity and also a
challenge. They must respond to the victory of the pharmaceutical
companies withdrawing their lawsuit by seeking medications for the 4.3
million people. They cannot stand by and do nothing.
In the United States, people have been living longer with HIV virus
and with AIDS. While not a cure for AIDS, certainly the drugs have
allowed many American citizens and citizens living in developing
countries to live longer. These drugs are out of reach to most in
Africa. Until we find a cure for AIDS, treatment must be affordable and
accessible. Treatment can prolong life, indeed give substantially more
quality of life. In the United States, we now have AIDS-related
treatments and that has added to the mortality.
Mr. Speaker, I urge my colleagues to act on this.
____________________