[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.

                          ____________________