[Congressional Record Volume 147, Number 58 (Wednesday, May 2, 2001)]
[House]
[Pages H1848-H1855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
FIGHTING THE HIV-AID PANDEMIC
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2001, the gentlewoman from North Carolina (Mrs. Clayton) is
recognized for 60 minutes.
Mrs. CLAYTON. Mr. Speaker, I join with my colleagues today to talk
about an issue that is causing great human devastation internationally
and that continues to be a major health and quality-of-life problem
domestically.
The HIV-AIDS pandemic that now we refer to has deeply impacted the
African continent, particularly sub-Saharan Africa. Sub-Saharan Africa
has been far more severely affected by AIDS than any other part of the
world. In 16 countries, all in sub-Saharan Africa, more than one in ten
adults is infected with the HIV virus, affecting some 25 million
people.
According to the joint United Nations program on HIV and AIDS, three-
fourths of all deaths caused by AIDS are in sub-Saharan Africa since
the beginning of the epidemic. It is estimated that one-half or more of
all 15-year-old children may eventually die of AIDS in
[[Page H1849]]
some of the worst affected countries, such as Zambia, South Africa and
Botswana, unless, unless, the risk of contracting the disease is
sharply reduced.
Of the 34 million HIV-AIDS cases in the world, 24 million, or 70
percent, are in Africa. In Zambia, 20 percent of the adult population
is infected with HIV-AIDS. As a result of HIV-AIDS virus, 650,000
children may have been orphaned, and 99,000 Zambians died in 1999.
Zambia is centrally located among the sub-Saharan Africa nations,
bordered by eight different countries. There is a growing effort to
develop international disease-prevention intervention in Zambia because
of its location and its diverse African culture and language group. I
am encouraged that Duke University Medical School, along with other
pioneers, including the University of Alabama, are developing an HIV-
AIDS intervention program in Zambia.
Not only in Africa, but around the world, including Russia, China and
India, the HIV pandemic continues to grow. There were 5.3 million new
HIV infections worldwide during the year 2000, and 3 million people
died as a result of AIDS, more annual deaths than ever before.
I recently visited Botswana to see up close the destruction this
disease has caused. Approximately 35 percent of Botswana's adult
population is infected with HIV. AIDS has cut the life expectancy in
Botswana by nearly 30 years. It has resulted in the death of so many
people who otherwise would be in the prime of their life.
{time} 1930
The visit strengthened my conviction to do my part in bringing
awareness to this institution, and to work with my colleagues in
Congress, the national government, States, the local government, health
and human rights activists around the world, to do more for the people
who have the virus and to do more to prevent the spread of the disease.
We need to establish a partnership. We have heard of the African
saying, ``It takes a village to raise a child.'' It will take a global
village to adequately address the AIDS pandemic.
While sub-Saharan Africa is disproportionately affected by the virus,
it is by no means limited to Africa. As stated earlier, this truly is a
global epidemic that has moved to be a pandemic.
I was encouraged by the government of Botswana's response to the
crisis in that country. This is truly an issue that remains a top
priority with the President of that country. The government of Botswana
has formed partnerships in an effort to help its citizens with the
treatment and prevention of HIV-AIDS.
The government is in partnership with the Bill and Melinda Gates
Foundation to help set up youth centers that offer youth counseling
services, and with the Ted Turner Foundation to provide programs and
services to urban youth.
They are also in the planning stage of partnering with the Gates
Foundation and Merck to also bring about needed resources and medical
care to fight the crisis. There still, however, is a great need to
establish the health care infrastructure with trained health care
providers to administer the medication or vaccine if this partnership
is to have great impact.
Soon after I returned from Botswana, I sponsored an HIV/AIDS round
table discussion in my district that consisted of public health
officials, community activists, HIV-AIDS case management, community
health providers, and individuals suffering from HIV/AIDS. This round
table was sponsored because my district in eastern North Carolina has
an increased incidence of HIV. Eastern North Carolina accounts for 30
percent of the State HIV disease reported recently, while only
accounting for 12 percent of the North Carolina population. In my
district, there are far more female HIV/AIDS cases as compared to the
State average, and African Americans make up 87 percent of the new
disease reported in my district. Clearly, this is an issue that is
affecting us both domestically and internationally.
I will stop now and yield to my colleague, the gentleman from
Illinois (Mr. Rush), who also had an opportunity to visit Africa. He
has been very active on the issue of AIDS. I am glad he is joining me
in this special order.
Mr. RUSH. Mr. Speaker, I thank the gentlewoman for yielding to me.
Mr. Speaker, first of all, I want to commend my colleague, the
gentlewoman from North Carolina, for this special order. It certainly
shows her sensitivity, her commitment, and it shows that she is indeed
the type of person who, throughout her tenure in the Congress and since
I have known her, has taken the lead on issues that affect not only the
citizens of this Nation but citizens all across the world. I commend
her for this special order.
Mr. Speaker, it is with great pride that I stand before this Chamber
today to congratulate the South African people on their victory to
obtain access to anti-AIDS drugs and other medicines at lower costs.
AIDS activists, the South African government, and international
organizations deserve a round of applause for their efforts.
Also, I want to thank the 39 pharmaceutical companies for placing
humanitarian concerns over profits by dropping their suit against the
South African law and government.
However, before we celebrate this victory in the war against HIV-
AIDS, we must pause and take stock of how far we still have to go. HIV-
AIDS is truly a ruthless enemy of humanity. More than 25 million
Africans are now living with HIV, and last year alone, 2.4 million
Africans died from the HIV/AIDS disease.
HIV/AIDS shows no sign of relenting. It is estimated that each day
16,000 more people become infected. Mr. Speaker, to put this tragedy
into context, many companies in South Africa are forced to hire two
employees for every single available position because mortality rates
are so high.
Even with the substantial discounts in the drug prices that the South
African law garners, antiretroviral drugs will still cost around $300
per year. Also, many regions of Africa do not have the resources
necessary to distribute or administer these complicated medications.
Rather, it must be made clear that these drugs, while desperately
needed, treat HIV/AIDS and do not halt the spread of the disease. We
must make prevention a priority if we are to win the war against HIV/
AIDS. This includes seeking a vaccine, distributing drugs that prevent
transmission of AIDS from mother to child, and intensive educational
efforts on how HIV/AIDS is contracted.
Most importantly, more must be done to empower and assist women in
poor countries. Women in poor countries now are the fastest-growing
HIV-positive population.
I want to commend the administration for its focus on the
international fight against HIV/AIDS. The collaboration between
Secretary of State Colin Powell and Health and Human Services Secretary
Tommy Thompson to create a Marshall Plan to cope with the international
HIV/AIDS crisis is, indeed, commendable.
However, just like any other infectious disease outbreak, HIV/AIDS
knows no border or countries. While we must focus on the international
spread of HIV/AIDS, as my colleague indicated earlier, we cannot
forsake efforts domestically.
The President's budget takes a step backwards in the fight against
HIV/AIDS domestically by freezing the Ryan White AIDS program funding.
If we are to win the war against HIV/AIDS, we must expand our efforts,
both domestically and abroad. Only then can we have a victory against
this awesome enemy.
Mrs. CLAYTON. Mr. Speaker, I want to thank the gentleman from
Illinois for his thoughtful statement. He is right to commend the
government of South Africa, as well as the pharmaceutical companies, in
their withdrawing and the successful conclusion of the case that was
against South Africa, because indeed, South Africa did not need that
suit, and the people could not afford that.
I also think it is a victory for the pharmaceutical companies that
they saw the value of withdrawing the suit and trying to find ways of
reducing the cost of their drugs, and understood the plight, that
people were trying to import affordable drugs because they did not have
the money. But even as they reduce it, there will be millions of people
who just do not have enough money.
[[Page H1850]]
So the gentleman is absolutely right in that. I want to applaud the
gentleman for saying that we must make prevention, prevention, the key
in our fight against AIDS. There is no cure for AIDS, but there is
prevention from getting HIV. We can prevent that. There are ways to do
that. We need to find ways to do it.
I also agree with the gentleman, we cannot go backwards domestically
in our fight. The budget that the administration, the Bush
administration, has put forward certainly does not support his
commitment to be very strong on AIDS. I applaud him, too, in terms of
making AIDS an issue internationally, but also the budget needs to
reflect and be supportive of that.
Again, I thank the gentleman for his leadership.
Mr. RUSH. I just want to say to my colleague, she is an inspiration
in terms of the type of leadership she provides on this issue. As the
gentlewoman knows, I also had the privilege of visiting Africa over
this last month and was able to see firsthand the situation.
Mrs. CLAYTON. What are some of the countries the gentleman went to?
Mr. RUSH. We went to South Africa, Kenya, Nigeria, and North Africa;
a North African country, Tunisia. But in South Africa, it was driven
home most graphically the effects of this problem of HIV/AIDS and how
it affects the children. A lot of folk do not realize that in South
Africa, one of every three public school teachers is affected with
AIDS. That means that the future of South Africa is definitely
threatened by this dreaded disease.
Mrs. CLAYTON. That is an interesting observation. I was reading
something on the United Nations report. Poverty and HIV are related.
AIDS is not a disease of poverty, but they become intertwined and
connected because having AIDS moves one to the point where poverty will
be the case.
In fact, they said in this report that actually the more mobile, the
more intelligent, and more educated person, those who had great access
to move around and resources to facilitate that, they were the ones
getting the AIDS. So the teachers comment would be right in line with
that statement. That is the future of that continent.
Mr. RUSH. Really, one of the most salient examples is right here in
this Nation. When HIV/AIDS first became known, it was not poor people
who had it, it was educated people who were ignorant of not only the
disease, but how to prevent the disease.
Therefore, I agree, it is not a disease that strikes just those who
are poor, it is those who are ignorant in terms of how the disease is
contracted and those who have very little means to combat the disease,
and also those who are unaware how to prevent the disease. It is a
disease of ignorance more so than a disease of poverty.
Part of what we have to do in our community, for the gentlewoman's
recommendations, comments, and statements, we have to educate people
about how to prevent the disease of HIV/AIDS, and how to conduct
themselves in a manner that will not allow them to fall victim to the
disease.
Mrs. CLAYTON. I do not know in the gentleman's area, but I am looking
at health statistics and I am seeing an increase in sexually-
transmitted diseases domestically. We see syphilis, other transmissible
disease, things we thought were long cured or no longer existing. This
is emerging again. Again, there is just a lack of vigilance in health
standards or in protected hygiene, and in protected sex of adults, as
well.
Now, we are seeing not necessarily that one causes the other, but the
vulnerability that one puts oneself in and one's body when they have a
sexually-transmitted disease, it breaks down the immunity so the
likelihood that one would be susceptible to HIV/AIDS is increased
greatly.
So we are having to almost educate people we thought knew these
things and remind them that that is here. Certainly we have an
education and prevention challenge, also, internationally.
The gentleman is absolutely right, I think prevention is indeed the
answer. That is why it makes it so troubling that the Ryan White funds
are being reduced or flattened, because that is the outreach. We can
prevent, we cannot cure. I think we ought to invest in research, and I
commend that, but we do not have to do it either/or, we can do both.
Why spend so much money in trying to treat a disease that we cannot
cure when we have also the option to prevent the disease?
So we need to take care of those who are affected, but we certainly
need to be wise and prudent in investing in prevention. I thank the
gentleman for emphasizing that part.
Mr. RUSH. I just want to add that in my district and in my State,
sexually-transmitted diseases are also on the rise. I certainly share
the gentlewoman's comments. Syphilis, gonorrhea, all those diseases
that we thought had been abolished, eliminated, they are on the rise,
and primarily because information is not getting out to the people.
Information is not getting out to them in the way that they
communicate. There is no popular ad campaign dealing with this issue.
We can see advertisements all across the television and the radio
about every other thing except how to prevent HIV/AIDS. This is a real
serious epidemic, pandemic, as the gentlewoman indicated, across the
world, but it is an epidemic, and almost a pandemic in certain
communities here in this Nation.
{time} 1945
And the awareness is not there. The commitment is not there.
I believe that the President needs to be reminded that he is sending
two different types of messages here. They are contradictory. If the
Secretary of HHS and the Secretary of State are developing a Marshall
Plan for AIDS internationally, and at the same time he is withdrawing
resources, vitally needed resources, dollars from the Ryan White
program here in America, well, then, that sends a contradictory
message. And he has to be clear. We need one voice, one approach to
dealing not only with AIDS internationally but also to deal with the
epidemic of AIDS right here at home.
Again, I want to thank my colleague for her outstanding leadership on
this particular issue.
Mrs. CLAYTON. Well, I want to thank the gentleman for his leadership,
because I know he has been very active in his community. I know a
wonderful AIDS initiative the gentleman has in Chicago, the coordinated
effort with all the medical schools working. I think it is probably one
of the finest there is in the country in terms of that effort. So I
thank the gentleman for his leadership.
We have been joined, Mr. Speaker, by the gentlewoman from California
(Ms. Millender-McDonald), who is very, very much engaged in this and
has been engaged in it for a number of years. Her particular emphasis
recently has also been with respect to women, but I know she is
interested in all of it. I thank her for joining us.
Ms. MILLENDER-McDONALD. I thank the gentlewoman from North Carolina,
especially for her leadership on this. I can say unequivocally, though,
that every member of the Congressional Black Caucus has made this a
centerpiece, a priority, in this Congress as well as Congresses before
and Congresses to come, because this is a very critical issue. And it
is so timely today given that just last Saturday I had my fifth annual
Minority Women and Children's AIDS Walk.
Mrs. CLAYTON. We did not give the gentlewoman any peanuts this year.
I usually give her peanuts every year to make sure they have energy
when they make this great march.
Ms. MILLENDER-McDONALD. Yes, the gentlewoman did give me peanuts. I
had them from North Carolina. They were there, and we had them in the
stuffed bags along with those from Alabama and Georgia.
But the one thing that we are happy to say is that that has now
presented us proceeds of over $600,000 that we are giving to different
health facilities to treat persons, especially women and children, with
this very deadly disease.
It was years ago that someone told me about this disease; and I
thought, well, I am in the State legislature, trying to pass laws, and
I really do not have time for this. But it was not until that next year
or so that someone brought me the facts, brought me the data; and that
is when I said, no, that is not their problem, it is our problem and,
more importantly, it is my problem to look at.
[[Page H1851]]
We know that HIV/AIDS continues to devastate women throughout the
world, and nowhere is it more overwhelming than on the African
continent. As news reports tell us daily, AIDS in Africa has reached
crisis proportions. In fact, it is a pandemic. Two-thirds of the
world's 33 million AIDS-infected victims live on the African continent.
Tragically, the epicenter of this disease is among African women, with
profound effects on their children. More than nine-tenths of 8 million
children were orphaned by AIDS last year, and those kids were in
Africa.
So when we ask ourselves, what can we do? Simply go around and have
an outreach program, an education program on this devastation. No one
needs to wait for groups like mine, the AIDS walk, or anyone else.
Simply just go to your churches and your organizations and your schools
encouraging folks to remain abstinent, because we cannot continue to
see the devastation that is affecting our children and this deadly
disease that is permeating communities of color.
I have a bill that is called the Mother-to-Child Transmission bill
which speaks of the drug therapy Nevirapine. Because if that drug is
given to the mother, the child will not come out of the womb of the
mother with this deadly disease. And programs like that new and
inexpensive drug treatment that help prevent mother-to-child
transmission need to be employed in Africa. This is what I am
concentrating on at this point, trying to see whether we can get
pharmaceutical companies to invest in Nevirapine on the continent of
Africa. And not only that but in India, China, Eastern Europe and
Central America. All of those areas we have found now have a very
alarming percentage of women and children who have been affected and
contracted this deadly disease.
Governments, corporations, nongovernmental organizations must
coordinate their strengths and their projects in addressing major
problem areas, including the critical absence of adequate
infrastructure throughout the continent. I heard the gentlewoman from
North Carolina (Mrs. Clayton) speak about that just a moment ago,
because there has to be the infrastructure to deal and to help those
who have been afflicted with this deadly disease. Ofttimes those who
are in villages and tribes and other places do not have the adequate
infrastructure. It is very important that we have and we look for
funding to expand and to bring about the infrastructure that is needed,
especially in Africa and in India.
Local capacity must be developed through education of the masses, the
search for a vaccine must be accelerated, and access to medicine must
be expanded as well. I again call on this administration to include
$150 million in its fiscal year 2002 budget for the World Bank AIDS
Trust Fund.
I was told just a month ago, and now in looking at the budget, that
the Ryan White Act program has been cut. We can ill afford to do that.
We must try to find some methodology by which we can include funds for
this dreadful deadly disease. The President has spoken in very
sensitive and very caring terms about persons afflicted with HIV/AIDS.
We are asking now that we have that so that we can expand the outreach,
expand the medicine, the therapy, and expand the education for this
deadly disease.
The landmark public-private partnership that was authored under the
Global AIDS and Tuberculosis Relief Act of 2000 is designed to leverage
contributions with additional resources from the international donor
community as well as from the private sector. We all know that money
alone, though, Mr. Speaker, will not solve this problem; but it is a
vital part of the solution. These funds are necessary to implement HIV/
AIDS best practices in countries hardest hit by HIV/AIDS.
While the HIV/AIDS disease continues to devastate humanity and the
human element, and finding a cure seems far into the future, we cannot
afford to give up. I will continue to fight and devote my time and
energy to finding solutions to the myriad difficulties surrounding the
treatment and fight against AIDS. I call on all of my colleagues to
support local and international efforts to fight this deadly disease at
home and abroad.
Again, my colleague, the gentlewoman from North Carolina (Mrs.
Clayton), I thank so much for her tenacity, for her leadership and for
her ongoing support of all of the efforts we have put on this floor
through legislation to try to find a cure for this.
Mrs. CLAYTON. Well, I thank the gentlewoman for her leadership and
for her statement; and I also thank her for bringing us up to date on
her successful tradition and raising funds to combat and bring
awareness to the whole issue of HIV/AIDS. And the gentlewoman is right
to bring the attention to women and how it disproportionately affects
women, not only in this country but in Africa.
I think the gentlewoman is also right to bring the attention that we
need to have more funds in order to do the work. We have been very
fortunate in this country in the sense that it has not spread as fast,
but because we have had efforts like those of the gentlewoman and
others across the country, and because this Congress has been committed
to it too. So we certainly do not want to go back. We are moving in the
right direction to try to find both the appropriate care and
medication, but we also want to try to provide prevention in all the
communities. And to the extent that we pull that out, we will lose so
much in that battle.
Ms. MILLENDER-McDONALD. And may I please add that women now over 50
we are finding by data, mostly African American women, are contracting
this HIV/AIDS. And it is so devastating because they are fearful of
disclosure, because their ministers will find out and family members.
And it is a very hard thing when we talk with the women who are over 50
who have now contracted this. So it is not just the young women, the
young men; it is the older women as well.
So we do have quite a battle, but I know with the help of the
gentlewoman from North Carolina, and the help of this Congress, which
the gentlewoman is right, there is not a Member who has not been
sensitive to this issue, we will continue to do both.
Mrs. CLAYTON. We are simply trying to raise their sensitivity with
this. I just think people of good conscience cannot look at the
epidemic and turn away. If you do, it says just volumes about where you
are not, not where you are.
Ms. MILLENDER-McDONALD. Like you said, I tried to put my head in the
sand, but that head was lifted rather quickly when I saw the data that
was presented to me. So I do not think anyone can really shy away from
it.
Mrs. CLAYTON. Again, I want to thank the gentlewoman for her
contribution.
Mr. Speaker, given the loss of lives AIDS has caused internationally,
the destruction of entire communities, and the long-term impact of
economic growth, we should strengthen our commitment and effort to
fight the devastating disease. With children dying at the age of 15 or
younger, with the life expectancy of only 45 years for children born in
many countries now in the latter part of the 1900s and 2000 in Africa,
clearly this is a human tragedy, an epidemic unknown to mankind and
current civilization. To ignore the problem is to our peril. To know
the impact of AIDS and to ignore it is indeed to our shame.
Secretary Colin Powell has stated that HIV/AIDS is a national-
international security issue that the Bush administration plans to
address, and I applaud them for that effort. I also applaud the
pharmaceutical industry for dropping its lawsuit. We heard one of our
colleagues talking about that earlier, the gentleman from Illinois (Mr.
Rush), and to prevent the South African Government from importing
cheaper anti-AIDS drugs and other medicines to respond to those who
have the virus. Now we must increase the effort to provide affordable,
and the emphasis is on affordable for Africa and affordable for those
living in developing countries, affordable anti-AIDS drugs to all who
need them.
I challenge the pharmaceutical industry, countries worldwide, and the
United States to engage in a collective effort to make available
affordable necessary drugs to people affected by HIV and AIDS. It is
important to form these partnerships, because even if cheaper drugs are
purchased by countries, they still are out of reach for far too many.
According to a recent Washington Post article entitled ``A War Chest to
Fight AIDS,'' dramatic reductions in price for anti-retroviral drugs
[[Page H1852]]
are key to treatment; but the cost would be now $400 or $500 per
person, some 10,000, which is a great reduction, but there are many
people, many people that do not make $400 per year and could not afford
that.
The United States must respond to this need by allocating more
dollars than proposed by the Bush administration in their current
budget. So I want to challenge them to really put more monies in there.
I am greatly encouraged about the recent news that the world's
richest countries are close to committing billions of dollars a year to
fight against AIDS and other infectious diseases in parts of Africa,
Asia, and the Caribbean where they have reached pandemic proportions.
The World Bank and the United Nations would be involved in setting up a
global trust fund to help countries suffering from the HIV and AIDS
pandemic. Again, the United States must be a vital part of this effort
and the trust fund.
{time} 2000
A global trust fund, coupled with efforts introduced by the
gentlewoman from California (Ms. Waters) and the gentlewoman from
California (Ms. Lee), that would provide debt relief for these
countries suffering greatest from HIV-AIDS, this indeed would help
relieve that burden. More than 6,000 people die every day in African
nations from AIDS, yet their governments lack sufficient financial
resources to help them or to relieve the suffering.
In addition to the burden of repaying the debt often incurred by
unaccountable government officials, these countries also must pay user
fees and interest for these medications. These conditions require
action by this Congress. The legislation introduced by my colleagues
and myself is extremely important and has bipartisan support. It means
economic relief for those countries.
There needs to be a comprehensive partnership waging a global
campaign to prevent HIV and care for AIDS-affected patients. We are
reminded of the complicated world surrounding global AIDS.
In developing countries like Africa, AIDS is one of several burdens
or conditions that must be endured. In Africa, often AIDS is in the
midst of severe poverty, inadequate food, severe poverty, and lack of
housing; therefore, the effect of AIDS has been and continues to make
these problems worse. It has posed the greatest threat to the very
generation of young people who are the most productive and are poised
to take Africa into a brighter future economically.
Those countries most affected by AIDS are oftentimes the same ones
suffering from hunger and food insecurity. Nutrition and HIV operate in
tandem at the level of both the individual and the community. For many
individuals, nutrition deficiency probably makes people more
susceptible to disease and infection. At the social level, food
insecurity is a major cause for vulnerability to HIV.
Reduced agriculture production is also one of the impacts of HIV.
Therefore, the legislation, H.Con.Res. 102, Hunger to Harvest
Resolution, A Decade of Concern for Africa, which has been introduced
in the House by the gentleman from Iowa (Mr. Leach) and the gentleman
from New Jersey (Mr. Payne), I am also a cosponsor, should be
supported. This legislation will combat AIDS, provide education for all
children, strengthen farming and small business, promote peace and good
government. This legislation has a proposed commitment of $1 billion.
The President and Congress must keep this as a top priority. The
pharmaceutical companies must be urged to provide needed drugs to
Africa at substantially reduced prices and may want to consider making
that as a donation. Drugs should be made available not only to
populations that can afford it, but also the populations who
desperately need it. This is a declaration that no country has to fight
this battle alone, and no nation should stand by without offering help.
I am pleased to be joined by my colleague, the gentlewoman from Texas
(Ms. Jackson-Lee) who has been a strong fighter and provides valuable
leadership.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I was pleased to join the
gentlewoman from North Carolina (Mrs. Clayton) in our recent trip to
Botswana. Your leadership was evident there as we both listened to the
briefings and visited sites where the persons who had full-blown AIDS
were being cared for. We noted that they were in great need of hospital
personnel, certainly more beds, but the individuals that were working
were certainly working with a spirit that they were willing to fight
the good fight.
I think that is the spirit under which we come to the floor today,
because I am sure as we debate and speak to this issue on the floor of
the House, maybe Americans who may be much more informed about HIV-AIDS
and HIV the infection, and then full-blown AIDS, might think that we
are speaking too frequently and too often and all is well; and they
know this is a disease, but it will not happen to them.
I believe that it is important that the administration realize that
the momentum that had been created, not in a partisan manner but in a
bipartisan manner under the leadership of the past President, President
Clinton, and Sandy Thurman whom we all worked with at the White House
office. Her task was not easy, working with Members of Congress who had
different perspectives, and then Congress working with several
perspectives, but we finally came to the point of being able to focus,
I think, about a year or two ago, $100 million on the AIDS issue. And
then, of course, we came forward with a bill by the gentleman from Iowa
(Mr. Leach) and the gentlewoman from California (Ms. Lee) which had to
do with the Marshall Plan. We joined the gentlewoman from California
(Ms. Waters) on debt relief, and now we are moving forward with
legislation that both of us are cosponsoring.
We have been on an journey. Even as we discuss the African Growth and
Opportunity Act, some two sessions ago, or maybe the beginning of the
106th Congress, there were several amendments to that trade bill. We
had indicated that we would not let that trade bill move through the
Congress without acknowledging if multinationals benefited from doing
trade with Africa, that they needed to also engage in the issues of
survival, and that was to put money aside. One of our pharmaceuticals
did just that, put money aside to provide assistance.
But I think there are some key elements that we need to focus on, and
I would like to share with you these elements even though we may have
already had this come to our attention. This is a plague. It is a
pandemic. I note my comments on my remarks say ``biblical proportions''
because we think of the flood and we understand what that means. It has
claimed 17 million lives in recent decades, and unlike the Black Plague
in the 14th century in Europe, the means to control AIDS are known. We
know prevention, and so we understand that.
We are gratified that there has been some compromise on the lawsuit
in South Africa, and we hope as South Africa begins to work steadily in
its effort to fight the devastation in South Africa, we all accept that
poverty is not good to help people get better. We do know that HIV is a
virus that infects you and that it can result in full-blown AIDS.
On the other side of full-blown AIDS there is the question of
survival, how long and what kind of medication is available to you.
So I think the focus should be to encourage the administration to say
it will not work and we will not be successful if we start and stop. If
we undermine the funding and the efforts that have been made to provide
sub-Saharan Africa and other parts of Africa with the infrastructure
that they need, the prescription drugs that they need, the medical
personnel, support system that they need, then we are going to regress.
I would like to speak to the fact that it is not just giving money to
the continent, it is also looking at their problems. Botswana is a good
example. They are a small country and they are trying to work against
this tide. They have about a 39 percent infected population, yet the
president is very sensitive to it. He speaks about it. He takes this to
the national bully pulpit, and his constituencies are working very
hard. His medical director or health director is working very hard. His
physicians, his nurses are working very hard.
[[Page H1853]]
What they said to me when I went to one of their sites,
infrastructure is important. In order to get the drugs from the
airport, they need good roads. In order to be able to monitor those who
need to take the drugs, they need medical personnel.
So our appropriations process should look at how we can
constructively collaborate, the World Health Organization, USAID,
United Nations, and how we get the right kind of funding and we do not
want to see the funding undermined and diminished. In particular, we
will see all of the progress that we have made clearly go back to point
zero.
As I spoke to an infected person who had been infected for 5 or 6
years, living with AIDS, he said it was a great leap from when he was
infected to now. Now his whole family knows of his condition. They are
accepting and educated about it, and they are preventing it from
spreading. This is the kind of information that can be enhanced by the
resources that we need.
I indicated this was a pandemic. Since the beginning of this, over 80
percent of all AIDS deaths have occurred in sub-Saharan Africa. By the
end of 2000, there were an estimated 25.3 million people in sub-Saharan
Africa living with HIV-AIDS, 70 percent of the total number of adults
and 80 percent of the total number of children infected, worldwide.
I do not want this to be seen as a condemnation of the continent. It
is a wonderful continent. It is a continent that is seeking after
technology. It is seeking after education and building schools. I
believe the gentlewoman from North Carolina was excited about the
opportunities for rural America in collaborating in agriculture. It is
a continent that is alive.
Frankly, I think we should view this as the potential dynamic of the
world. As I traveled to India with the President, I believe last
session, there was talk of its moving to India. There is talk of its
moving to China. Those are huge population centers.
Mr. Speaker, I rise to join my democratic colleague Representative
Eva Clayton from North Carolina in expressing our concerns about the
ravages of HIV/AIDS both abroad and in our own country. The African
continent has been particularly hard hit by this deadly disease. For
this reason I am in favor of any effort by this body to increase access
to HIV/AIDS treatment and education throughout the world, but
especially on the continent of Africa.
HIV/AIDS has been declared the world's deadliest disease by the World
Health Organization. HIV/AIDS has become a plague on the Continent of
Africa of biblical proportions by claiming over 17 million lives in
recent decades. Unlike the Black Plague in 14th century Europe, which
took half as many lives, the means to control AIDS are known. I, too,
rejoice in the good news that the pharmaceutical companies have
withdrawn their lawsuit in South Africa so that the South African
government can provide affordable HIV/AIDS drugs to those in need.
However, most African and other foreign governments make no more than a
modest level of effort to address the spread of the disease. For these
reasons, I have and will continue to support additional funding for
medication to be made available to the millions of poor around the
world to fight the growing death toll attributed to HIV/AIDS.
This crisis is having a direct impact on the future viability of many
sub-Saharan African communities. I recently witnessed the effects of
HIV/AIDS while I was traveling with Congresswoman Clayton and other
congressional members in Botswana. This disease deprives nations of
parents, workers, and teachers, destabilizing the social and economic
framework of the nation.
The impact of the HIV/AIDS epidemic on sub-Saharan Africa has been
especially severe. Since the beginning of the epidemic, over 80 percent
of all AIDS deaths have occurred in sub-Saharan Africa. By the end of
2000, there were an estimated 25.3 million people in sub-Saharan Africa
living with HIV/AIDS--70 percent of the total number of adults and 80
percent of the total number of children infected worldwide. 3.8 million
people were newly infected in this region in 2000 alone. There, over
five thousand AIDS-related funerals occur per day.
According to the UNAIDS Update report on HIV/AIDS infection rates, in
many countries up to 35 percent of all adults are infected with the
disease. Nearly 4.2 million of South Africa's 45 million people are
infected with the virus, more than in any other country. The report
also estimates that half of today's teenage population in parts of
Africa will perish from HIV/AIDS. The most vulnerable group being
affected by HIV/AIDS are the women of Africa; their infection rate is
far greater than males. In sub-Saharan Africa, 55 percent of all adults
living with HIV are women, and this rate is expected to continue to
rise in countries where poverty, poor health systems and limited
resources for prevention and care are present. What fuels the spread of
this disease? Ignorance, misinformation, unsafe cultural practices,
apathetic leadership and neglect by nations who have the resources to
fight the disease.
At least by the early 1990s, the world knew the size of the coming
catastrophe in Africa and had the means available to slow its
progression. Estimates from the World Health Organization in 1990 and
1991 projected a caseload, and eventual death toll, in the tens of
millions by 2000.
Less than 20 years after doctors first described its symptoms, HIV
has infected 57.9 million people. So far, nearly 22 million have died;
this is roughly the population along the Amtrak route from New York to
Washington, DC.
Pharmaceutical corporation Bristol-Myers has pledged $115 million
towards fighting this epidemic in sub-Saharan Africa. However, this
effort will only benefit just a few of the millions of victims of HIV/
AIDS in Africa. We must do more.
I offer that the drug manufacturers and the Congressional Black
Caucus should be on the same side in this effort. It is only a matter
of funding, and this Administration can take the lead in gathering from
the global community of wealthier nations. Congress and drug
manufacturers should make leading this effort a top priority. We could
see an end to unnecessary deaths and suffering by the close of this
year if we make the commitment to do so today.
The cost of HIV/AIDS treatment for those living in the third world is
estimated to be about $10,000 a year. It is estimated that even if
treatment costs were reduced to only $1,000 a year it would still be
far too expensive for Third World countries.
Drug therapies that have significantly extended the lives of people
living with HIV/AIDS in the United States and other developed countries
could cost between $4,000 and $20,000 per person per year in sub-
Saharan Africa.
In the United States, where the treatment has become standard, the
AIDS-related mortality rate fell 75 percent in three years.
The therapies, which use various combinations of antiviral drugs that
emerged in Western countries five years ago have transformed the health
and future of AIDS patients who took them.
Since that time the gap in medical care between rich and poor
countries has grown tremendously--our nation along with others should
be ashamed at this condition.
I would like to commend Congresswoman Clayton for her efforts to
offer a clear perspective on the HIV/AIDS epidemic both internationally
and domestically.
Now, more than ever, the leadership of the United States is needed in
order to avert a tragedy on the Continent of Africa. Therefore, I
implore my fellow colleagues of the House to commit the desperately
needed funds for this critical area.
Many people have asked why this is important to the United States.
Aside from the humanitarian perspective, HIV/AIDS has become a threat
to our national security. HIV/AIDS undermines democracy and progress in
many African nations and the developing world. Left to its own course
HIV/AIDS will lead to political instability and may result in civil
wars, which may affect the global balance of power as well as economic
viability of many African nations. In many of these instances, our
military service personnel may be pressed into service in order to
defend American interest in any attempt to bring stability to those
nations that decline into civil strife because of the ravages of HIV/
AIDS. HIV/AIDS, like any epidemic, cannot be contained in any specific
geographical area. It does not discriminate between rich and poor
nations. Unfortunately, when this dreaded disease came to our shores,
many believed that it was a calamity only for homosexuals and drug
users. But AIDS knows no boundaries. With globalization, we also must
be conscious of the potential for AIDS and other infectious diseases to
be carried across borders.
The World Health Organization estimates that 36.1 million children
and adults worldwide are living with HIV and/or AIDS. We must work to
bring this tragic situation under control using all means at our
disposal as a nation, which includes acting in a leadership capacity to
encourage other nations to join in an effort to address this mammoth
health crisis.
I would ask my colleagues not to continue to bury their minds under
useless words, but to apply our collective resources to find solutions
to the problem of HIV/AIDS in Africa.
Mrs. CLAYTON. Mr. Speaker, the gentlewoman is absolutely right. It is
in Russia, China and India, as you indicated, so it is worldwide. In
fact, there are 33 million people who have died of it, 33 million; 24
million of them were in Africa. But HIV-AIDS is in Russia, China, India
and other parts of Asia.
[[Page H1854]]
This is something, if we fail to contain it where it is most severe,
you are right, we will regret that later.
Ms. JACKSON-LEE of Texas. That is why your special order this evening
and this discussion is very important. I am hoping that people will not
get tired of listening to how they can protect themselves and how they
can help by indicating to their Members of Congress and indicating to
the administration that this is a health problem of such proportion
that any slow-up would be devastating.
I do want to acknowledge that we have had some success with our
corporations. I know that Bristol-Myers had put aside $115 million
towards fighting the epidemic, but we need more of that along with the
public complement, if you will, the public dollars. You can maximize
them or match with private dollars, but they also send a signal about
the fact that we are committed to the war.
We did some of that when we went to the United Nations when, in
actuality, the U.N. Security Council declared HIV-AIDS as a security
risk for all of those very prominent world countries that are sitting
around the U.N. Security Council. They were convinced that as their
military personnel travels from place to place, if there is infection,
the potential of the military becoming infected there and bringing it
back home was enormous.
I think if we can think along those lines, we begin not to be
isolated about this issue. I know that when we were in Botswana, one of
the doctors said if the number of people that were dying in sub-Saharan
Africa were moved, it would be comparable to the United States, it
would be almost like 13,000 persons a day dying in America.
So the challenge that we have is to not frighten people into
inaction. The challenge that we have to the President, although he has
mandated a 4 percent across-the-board cut, which I think is going to be
very difficult, and that is why there is a lot of debate about this
$1.5 million tax cut, I hear $1.2 trillion, it is certainly something
that troubles me, because I believe in giving the people back a return
on their investment certainly.
{time} 2015
I for one was for a straight out $60 billion tax cut this year, give
it to people and infuse the economy, but I am really uncertain about
whether we do have a $5 trillion surplus, and what is going to happen
in this war against HIV/AIDS. I just want to steer back to personal
experience and that is in my congressional district. I do not know if
we have spoken about our own personal experiences, but I think we
should.
Mrs. CLAYTON. I did mention a little bit about the incidence
increasing in my district. I live in a rural district, as the
gentlewoman knows. She has been to my district. Sometimes in a rural
area, we do not think what happens to cities happens to a rural area,
like crime. We get crime, too. But surprisingly for a number of
reasons, it has not been reported or people were not reporting
themselves and all of a sudden the incidence is going up.
In fact, we represent, in eastern North Carolina, a little more than
my district, though, I represent about 30 percent of all the new HIV
reported. We represent only 12 percent of the population in my
district. So the disproportion of the increase has been that people are
lax, they do not have the information, they are not taking the
precaution, and also there is not this kind of sophisticated
infrastructure both in community and education and medical to bring the
awareness.
We are now forming this partnership in the community to bring to the
attention that in our local area, we do not have a pandemic, I am not
trying to scare, as you say, people to things that are not there, but
we are alarming them of what things are there and the potential. And
people are coming forward to say what their conditions are, how they
are struggling, either they do not have homes or once they know they
have AIDS sometimes their family puts them out. There are all kinds of
human tragedies and stories we hear.
We have a cultural issue to look on, we have an education issue and
an awareness issue. The gentlewoman is absolutely right. We have to
focus on our local area as well.
Ms. JACKSON-LEE of Texas. I think it is important that we have this
discussion as it relates to our local areas. I was about to mention the
fact that I had the United States Surgeon General in my district the
entire day this past Monday, April 30. We started about 7:30 in the
morning and went straight through to different health areas, different
health facilities and different issues until about 5 o'clock.
A part of our day was spent in focusing on the question of HIV/AIDS
in Houston. In the 18th Congressional District, in particular my
district, showed that 53 percent of the new AIDS cases were African
Americans; and I have the highest number of those. This is not a
condemnation. I hope we will step away from condemning because there
are a variety of sources of contacting this disease, but the one thing
that we knew was important, we focused on, and I know that might be
what you are focusing on, is education and prevention and getting
people tested.
I was very delighted that one of my constituents, a Mr. Ernie
Jackson, put forward a very, very powerful presentation on how we were
collaborating with various community groups and various concerts, if
you will, rallies to encourage people to come and be tested. We were up
into the thousands. We are going to continue. I might compliment one of
our famous gospel singers, Yolanda Adams, did a gospel concert. The
tickets were given away free, and the persons were to be tested. But
really what it shows is that we will have to be creative.
Some of this we can do with just elbow grease, some of this we can do
with private sector contributions or collaboration. The church or
faith-based community, we are trying to get them involved and engaged,
but we cannot afford to do this without Ryan White treatment dollars
for the whole population here in the United States, now I am over into
the United States, that will continue treating problems, without the
public hospital system where many of these people go because they are
uninsured or underinsured.
Nor can we do this without the support of the funds that have been
helping our various health agencies, in counseling money, prevention
money and education money. And then let me just say and complement as I
close, that we certainly cannot do this if we do not keep the Foreign
Ops or the funding either under HHS or Foreign Ops that in particular
goes to helping fight the pandemic internationally. It is crucial.
I hope that we are not sounding like, forgive me for saying this, a
broken record. I hope that this is not taken as ``we have heard this
before.'' I really do. Because I think both of us saw this firsthand.
We heard those numbers. We were startled; were we not?
Mrs. CLAYTON. We were very startled.
Ms. JACKSON-LEE of Texas. They clearly are not because people are not
trying to overcome.
Mrs. CLAYTON. I think we are all sensitive when we raise a flag and
say this is a problem, that people will want to reject us because
indeed we are repeating. But we have to do what we have to do to get
them to know. I am confident that when people understand the
seriousness of it, they will respond appropriately. I am hopeful that
the education and prevention will get people aware enough to take some
things in their own hands.
I have also been startled by the increase of sexually transferred
disease, which we thought had been abolished almost. That has been
increasing. Again that is something people can take responsibility for
and control. Education is a key in that. We need to get our churches
involved. As you said, the condemnation needs to be put in perspective
of educating people to take responsibility now that they know they need
to do these things.
You and I both are interested in the whole issue of teenage
pregnancy, this is related. If indeed we do not involve our young
people very early in the whole issue of abstinence and telling them
about a far more productive life and giving them some opportunities to
expand their life beyond being in an environment that is conducive to
destructive behavior. In addition to that, we also have to be honest
about the whole sexual education and protecting young people and giving
them information that empowers them to know the consequences of their
behavior. When they do that, again I have confidence,
[[Page H1855]]
people will take information and use it for their advantage and become
empowered because of it.
Information is power. We ought to spread the good news that there are
things you can do. You can prevent it. Prevention is a key. In fact,
the United Nations report says that as bad as the statistics are, this
is someone addressing the United Nations, all the African heads, we are
encouraged because there are practices we know that will work. They
cited Brazil. They cited Uganda. They cited some other areas where they
are beginning to be part of a fabric of showing that you can cut down
the incidence of HIV. No cure for AIDS but you can cut down the
incidence of HIV.
Those are the kinds of things we want to bring awareness to. The
partnership, the gentlewoman and I were struck, I know I was impressed
by the partnership that had been formed in Botswana with the President
of Botswana taking the lead and serving as the chair of that program.
Yet although those resources were on the table, you are correct. We
need the infrastructure. That is what we are working toward.
Ms. JACKSON-LEE of Texas. I am not sure whether or not the word is
getting out of the great work that is being done in Botswana. Certainly
Uganda should be cited. I just briefly want to add that we need to
include in our discussion malaria and tuberculosis. I was very
gratified in the meeting I had in my district. A number of us have
signed a list, if you will, to organize, to see how more resources can
get into these American districts, these urban districts to help these
communities. I think we should not step away from the resources that
are needed nationally.
Mrs. CLAYTON. I am glad the gentlewoman mentioned malaria as well as
the tuberculosis, because there is data that shows that if a person has
HIV and also contracts tuberculosis, that pulls the immunity down
further and the likelihood of dying is increased. So you increase the
chance of the person not living long with HIV but in fact causing the
death. Malaria is another of those infectious diseases. There are
treatments for malaria and there is prevention for tuberculosis. That,
we can prevent. It does not cost a lot of money. There are vaccines and
things we can do. We are hopeful that our colleagues and others who we
know care about this issue will help. I am also encouraged by the
present administration. Colin Powell has reaffirmed that this is a
national security issue and that AIDS is going to be on their radar. We
just want to make sure that the money will be there to support it.
General Leave
Ms. CLAYTON. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks on the subject of my special order today.
The SPEAKER pro tempore (Mr. Cantor). Is there objection to the
request of the gentlewoman from North Carolina?
There was no objection.
Mrs. MORELLA. Mr. Speaker, I want to thank my good friend and
colleague Congresswoman Eva Clayton for arranging this special order on
AIDS in Africa. We are becoming more and more aware that--as CNN
reported, the African AIDS epidemic is ``the worst health calamity
since the Middle Ages and one likely to be the worse ever.''
Statistics of the economic, social and personal devastation of the
disease in sub-Saharan Africa are staggering.
23.3 million of the 33.6 million people with AIDS worldwide reside in
Africa.
3.8 million of the 5.6 million new HIV infections in 2000 occurred in
Africa.
African residents accounted for 85 percent of all AIDS-related deaths
in 2000.
10 million of the 1.3 million children orphaned by AIDS live in
Africa.
Life expectancy in Africa is expected to plummet from 59 years to 45
years between 2005 and 2010.
Many experts attribute the spread of the virus to a number of
factors, including poverty, ignorance, costly treatments, lack of sex
education and unsafe sexual practices. Some blame the transient nature
of the workforce. Many men, needing to leave their families to drive
trucks, work in mines or on construction projects, engage in sex with
commercial sex workers of whom an estimated 90 percent are HIV
positive. In addition many men go untested and unknowingly spread the
virus.
Many of those infected cannot afford the potent combination of HIV
treatment available in Western countries. In some countries only 40
percent of the hospitals in some capital cities have access to basic
drugs.
While efforts are continuing to find an AIDS vaccine, many experts
fear that some African countries hardest hit by the epidemic lack the
basic infrastructure to deliver the vaccine to those most in need.
More than 25 percent of working-aged adults are estimated to carry
the virus. Counties have lost 10 to 20 years of life expectancy due to
this disease.
80 percent of those dying from AIDS were between ages 20 and 50, the
bulk of the African workforce.
40 million children will be orphaned by the disease by 2010. Many of
these children will be forced to drop out of school to care for a dying
parent or take care of younger children.
Children themselves are being infected with the disease many through
maternal-fetal transmission. While drugs like AZT have been proven
effective in reducing the risk of an HIV positive mother infecting her
newborn child, those drugs are too costly for most nations.
However, today unprecedented opportunities exist to improve health
around the world. The private sector, led by the Gates foundation, has
provided additional resources for health programs in developing
countries.
Last weekend, members of the World Bank, the International Monetary
Fund and the Group of Seven met in Washington and articulated the fact
that HIV/AIDS is no longer just a health problem but a global health
development problem, threatening to reverse many of the development
gains made over the past half-century. What came out of these meetings
was an agreement that what is needed is a war chest and a war strategy
against HIV/AIDS.
Money alone will not solve the problem--but it is a critical part of
the solution. Total global support for HIV/AIDS in developing countries
last year was under $1 billion, less than a third of the estimated need
in Africa alone. For FY 2001 Congress provided $315 million to USAID
for global HIV/AIDS, a $115 million increase over the previous year.
USAID was instructed to provide $10 million for the International AIDS
Vaccine Initiative; $15 million for research on microbicides and up to
$20 million for the International AIDS Trust Fund at the World Bank.
However, our forward progress must continue. The creation of new drugs
and vaccines cannot stand alone and we must also continue to invest in
the development of public health infrastructure. It is estimated that
it will take as much as $6 billion to address the pandemic.
The United States is uniquely positioned to lead the world in the
prevention and eradication of HIV/AIDS. Some believe that the year 2000
was a turning point in the international response to the epidemic. We
can be encouraged by this trend; however, we must not become
complacent. We must continue to provide the drugs, and the care to
lessen the pain and the suffering of millions of men, women and
children throughout the world who are infected with HIV.
The Global Health Act of 2001 which I strongly support will provide
an additional $275 million or HIV/AIDS, an additional $225 million for
child survival, an additional $200 million for infectious diseases, an
additional $200 million for international family planning services and
an additional $100 million for maternal health.
Mr. Speaker, the Global Health Act in conjunction with a global AIDS
trust fund must be our goal. Confronting AIDS in Africa as well as the
rest of the world is one of the most important international
humanitarian battles we face today.
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