[Congressional Record Volume 147, Number 171 (Tuesday, December 11, 2001)]
[House]
[Pages H9089-H9106]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
GLOBAL ACCESS TO HIV/AIDS PREVENTION, AWARENESS, EDUCATION, AND
TREATMENT ACT OF 2001
Mr. HYDE. Madam Speaker, I move to suspend the rules and pass the
bill (H.R. 2069) to amend the Foreign Assistance Act of 1961 to
authorize assistance to prevent, treat, and monitor HIV/AIDS in sub-
Saharan African and other developing countries, as amended.
The Clerk read as follows:
H.R. 2069
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Global Access to HIV/AIDS
Prevention, Awareness, Education, and Treatment Act of
2001''.
SEC. 2. FINDINGS; SENSE OF CONGRESS.
(a) Findings.--Congress makes the following findings:
(1) According to the Joint United Nations Programme on HIV/
AIDS (UNAIDS) more than 58,000,000 people worldwide have
already been infected with HIV/AIDS, a fatal disease that is
devastating the health and economies in dozens of countries
in Africa and increasingly in Asia, the Caribbean region, and
Eastern Europe.
(2) The HIV/AIDS pandemic has erased decades of progress in
improving the lives of families in the developing world and
has claimed 22,000,000 lives since its inception.
(3) More than 17,000,000 individuals have died from HIV/
AIDS in sub-Saharan Africa alone.
(4) The HIV/AIDS pandemic in sub-Saharan Africa has grown
beyond an international public health issue to become a
humanitarian, national security, and developmental crisis.
(5) The HIV/AIDS pandemic is striking hardest among women
and girls. According to UNAIDS, by the end of 2000, fifty-
five percent of the HIV-positive population in sub-Saharan
Africa and 40 percent of such population in North Africa and
the Middle East were women, infected mainly through
heterosexual transmission. In Africa, 6 out of 7 children who
are HIV positive are girls.
(6) An estimated 1,400,000 children under age 15 were
living with HIV/AIDS at the end of 2000, of which 1,100,000
were children living
[[Page H9090]]
in sub-Saharan Africa. An estimated 500,000 children died of
AIDS during 2000, of which 440,000 were children in sub-
Saharan Africa. In addition there are an estimated 13,200,000
children worldwide who have lost one or both of their parents
to HIV/AIDS, of which 12,100,000 are children in sub-Saharan
Africa.
(7) Mother-to-child transmission is the largest source of
HIV infection in children under age 15 and the only source
for very young children. The total number of births to HIV-
infected pregnant women each year in developing countries is
approximately 700,000.
(8) Counseling and voluntary testing are critical services
to help infected women accept their HIV status and the risk
it poses to their unborn child. Mothers who are aware of
their status can make informed decisions about treatment,
replacement feeding, and future child-bearing.
(9) Although the HIV/AIDS pandemic has impacted the sub-
Saharan Africa disproportionately, HIV infection rates are
rising rapidly in India and other South Asian countries,
Brazil, Russia, Eastern European countries, and Caribbean
countries, and pose a serious threat to the security and
stability in those countries.
(10) By 2010, it is estimated that approximately 40,000,000
children worldwide will have lost one or both of their
parents to HIV/AIDS.
(11) In January 2000, the United States National
Intelligence Council estimates that this dramatic increase in
AIDS orphans will contribute to economic decay, social
fragmentation, and political destabilization in already
volatile and strained societies. Children without care or
hope are often drawn into prostitution, crime, substance
abuse or child soldiery. The Council also stated that, in
addition to the reduction of economic activity caused by HIV/
AIDS to date, the disease could reduce GDP by as much as 20
percent or more by 2010 in some countries in sub-Saharan
Africa.
(12) The HIV/AIDS epidemic is not just a health crisis but
is directly linked to development problems, including chronic
poverty, food security and personal debt that are reflected
in the capacity of affected households, often headed by
elders or orphaned children, to meet basic needs. Similarly,
heavily-indebted countries are stripped of the resources
necessary to improve health care delivery systems and
infrastructure and to prevent, treat, and care for
individuals affected by HIV/AIDS.
(13) On March 7, 2001, the United States Secretary of State
testified before Congress that the United States has an
obligation `` . . . if we believe in democracy and freedom,
to stop this catastrophe from destroying whole economies and
families and societies and cultures and nations''.
(14) A continuing priority for responding to the HIV/AIDS
crisis should be to emphasize and encourage awareness,
education, and prevention, including prevention activities
that promote behavioral change, while recognizing that
behavioral change alone will not conquer this disease. In so
doing, priority and support should be given to building
capacity in the local public health sector through technical
assistance as well as through nongovernmental organizations,
including faith-based organizations where practicable.
(15) Effective use should be made of existing health care
systems to provide treatment for individuals suffering from
HIV/AIDS.
(16) Many countries in Africa facing health crises,
including high HIV/AIDS infection rates, already have well-
developed and high functioning health care systems.
Additional resources to expand and improve capacity to
respond to these crises can easily be absorbed by the private
and public sectors, as well as by nongovernmental
organizations, community-based organizations, and faith-based
organizations currently engaged in combatting the crises.
(17) An effective response to the HIV/AIDS pandemic must
also involve assistance to stimulate the development of sound
health care delivery systems and infrastructure in countries
in sub-Saharan Africa and other developing countries,
including assistance to increase the capacity and technical
skills of local public health professionals and other
personnel in such countries, and improved access to treatment
and care for those already infected with HIV/AIDS.
(18) Access to effective treatment for HIV/AIDS is
determined by issues of price, health care delivery system
and infrastructure, and sustainable financing and such access
can be inhibited by the stigma and discrimination associated
with HIV/AIDS.
(19) The HIV/AIDS crisis must be addressed by a robust,
multilateral approach such as the one envisioned by the
Congress in the Global AIDS and Tuberculosis Relief Act of
2000, which directed the United States Government to seek to
negotiate the creation of an international HIV/AIDS trust
fund involving the World Bank.
(20) The Secretary General of the United Nations has called
for a global fund to halt and reverse the spread of HIV/AIDS
and other infectious diseases. The Secretary General has also
called for annual expenditures of $7,000,000,000 to
$10,000,000,000, financed by donor governments and private
contributors, for all efforts to combat the HIV/AIDS pandemic
and, equally important, called on leaders from developing
countries to give a much higher priority in their budgets to
development of comprehensive health systems.
(21) The Administration has advocated a fiduciary role for
the World Bank in the Global Fund to Fight AIDS,
Tuberculosis, and Malaria and the Transitional Working Group
for that fund has decided to invite the World Bank to play
such a role.
(22) An effective United States response to the HIV/AIDS
crisis must also focus on the development of HIV/AIDS
vaccines to prevent the spread of the disease as well as the
development of microbicides, effective diagnostics, and
simpler treatments.
(23) The innovative capacity of the United States in the
commercial and public pharmaceutical research sectors is
among the foremost in the world, and the active participation
of both these sectors should be supported as it is critical
to combat the global HIV/AIDS pandemic.
(24) Appropriate treatment of individuals with HIV/AIDS can
prolong the lives of such individuals, preserve their
families and prevent children from becoming orphans, and
increase productivity of such individuals by allowing them to
lead active lives and reduce the need for costly
hospitalization for treatment of opportunistic infections
caused by HIV.
(25) United States nongovernmental organizations, including
faith-based organizations, with experience in healthcare and
HIV/AIDS counseling, have proven effective in combatting the
HIV/AIDS pandemic and can be a resource in assisting sub-
Saharan African leaders of traditional, political, business,
and women and youth organizations in their efforts to provide
treatment and care for individuals infected with HIV/AIDS.
(26) Most of the HIV infected poor of the developing world
die of deadly diseases such as tuberculosis and malaria.
Accordingly, effective HIV/AIDS treatment programs should
address the growing threat and spread of tuberculosis,
malaria, and other infectious diseases in the developing
world.
(27) Law enforcement and military personnel of foreign
countries often have a high rate of prevalence of HIV/AIDS,
and therefore, in order to be effective, HIV/AIDS awareness,
prevention, and education programs must include education and
related services to such law enforcement and military
personnel.
(28) Microenterprise development and other income
generation programs assist communities afflicted by the HIV/
AIDS pandemic and increase the productive capacity of
communities and afflicted households. Microenterprise
programs are also an effective means to support the
productive activities of healthy family members caring for
the sick and orphaned. Such programs should give priority to
women infected with the AIDS virus or in HIV/AIDS affected
families, particularly women in high-risk categories.
(29) The exploding global HIV/AIDS pandemic has created new
challenges for United States bilateral assistance programs
and will require a substantial increase in the capacity of
the United States Agency for International Development and
other agencies of the United States to manage and monitor
bilateral HIV/AIDS programs and resources. To meet this
challenge, the Agency will need to recruit and retain
appropriate technical expertise in the United States as well
as in foreign countries to help develop and implement HIV/
AIDS strategies in concert with multilateral agencies, host
country governments, and nongovernmental organizations.
(b) Sense of Congress.--It is the sense of Congress that--
(1)(A) combatting the HIV/AIDS pandemic in countries in
sub-Saharan Africa and other developing countries should be a
global effort and include the financial support of all
developed countries and the cooperation of governments and
the private sector, including faith-based organizations; and
(B) the United States should provide additional funds for
multilateral programs and efforts to combat HIV/AIDS and also
seek to leverage public and private resources to combat HIV/
AIDS on a global basis through the Global Development
Alliance Initiative of the United States Agency for
International Development and other public and private
partnerships with an emphasis on HIV/AIDS awareness,
education, prevention, and treatment programs;
(2)(A) in addition to HIV/AIDS awareness, education, and
prevention programs, the United States Government should make
its best efforts to support programs that safely make
available to public and private entities in countries in sub-
Saharan Africa and other developing countries pharmaceuticals
and diagnostics for HIV/AIDS therapy in order--
(i) to effectively and safely assist such countries in the
delivery of HIV/AIDS therapy pharmaceuticals through the
establishment of adequate health care delivery systems and
treatment monitoring programs; and
(ii) to provide treatment for poor individuals with HIV/
AIDS in such countries; and
(B) in carrying out such programs, priority consideration
for participation should be given to countries in sub-Saharan
Africa;
(3)(A) combatting the HIV/AIDS pandemic requires that
United States Government programs place a priority on the
vulnerable populations at greatest risk for contracting HIV;
(B) these populations should be determined through
qualitative and quantitative assessments at the local level
by local government, nongovernmental organizations, people
living with HIV/AIDS, and other relevant sectors of civil
society; and
(C) such assessments should be included in national HIV/
AIDS strategies;
[[Page H9091]]
(4) the United States should promote efforts to expand and
develop programs that support the growing number of children
orphaned by the HIV/AIDS pandemic;
(5) in countries where the United States Government is
conducting HIV/AIDS awareness, prevention, and education
programs, such programs should include education and related
services to law enforcement and military personnel of foreign
countries to prevent and control HIV/AIDS, malaria, and
tuberculosis;
(6) prevention and treatment for HIV/AIDS should be a
component of a comprehensive international effort to combat
deadly infectious diseases, including malaria and
tuberculosis, and opportunistic infections, that kill
millions annually in the developing world;
(7) programs developed by the United States Agency for
International Development to address the HIV/AID pandemic
should preserve personal privacy and confidentiality, should
not include compulsory HIV/AIDS testing, and should not be
discriminatory;
(8)(A) the United States Agency for International
Development should carry out HIV/AIDS awareness, prevention,
and treatment programs in conjunction with effective
international tuberculosis and malaria treatment programs and
with programs that address the relationship between HIV/AIDS
and a number of opportunistic diseases that include bacterial
diseases, fungal diseases, viral diseases and HIV-associated
malignancies, such as Kaposi sarcoma, lymphoma, and squamous
cell carcinoma; and
(B) effective intervention against opportunistic diseases
requires not only the appropriate drug or other medication
for a given medical condition, but also the infrastructure
necessary to diagnose the condition, monitor the
intervention, and provide counseling services; and
(9) the United States Agency for International Development
should expand and replicate successful microenterprise
programs in Uganda, Zambia, Zimbabwe, and other African
countries that provide poor families affected by HIV/AIDS
with the means to care for themselves, their children, and
orphans;
(10) the United States Agency for International Development
should substantially increase and improve its capacity to
manage and monitor HIV/AIDS programs and resources;
(11) the United States Agency for International Development
must recruit and retain appropriate technical expertise in
the United States as well as in foreign countries to help
develop and implement HIV/AIDS strategies in conjunction with
multilateral agencies, host country governments, and
nongovernmental organizations;
(12) the United States Agency for International Development
must strengthen coordination and collaboration between the
technical experts in its central and regional bureaus and
foreign country missions in formulating country strategies
and implementing HIV/AIDS programs;
(13) strong coordination among the various agencies of the
United States, including the Department of State, the United
States Agency for International Development, the Department
of Health and Human Services, including the Centers for
Disease Control and the National Institutes of Health, the
Department of the Treasury, the Department of Defense, and
other relevant Federal agencies must exist to ensure
effective and efficient use of financial and technical
resources within the United States Government; and
(14) to help alleviate human suffering, and enhance the
dignity and quality of life for patients debilitated by HIV/
AIDS, the United States should promote, both unilaterally and
through multilateral initiatives, the use of palliative and
hospice care, and provide financial and technical assistance
to palliative and hospice care programs, including programs
under which such care is provided by faith-based
organizations.
SEC. 3. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Assistance.--Section 104(c) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b(c)) is amended--
(1) by striking paragraphs (4) through (6); and
(2) by inserting after paragraph (3) the following:
``(4)(A) Congress recognizes that the alarming spread of
HIV/AIDS in countries in sub-Saharan Africa and other
developing countries is a major global health, national
security, and humanitarian crisis. Accordingly, the United
States and other developed countries should provide
assistance to countries in sub-Saharan Africa and other
developing countries to control this crisis through HIV/AIDS
prevention, treatment, monitoring, and related activities,
particularly activities focused on women and youth, including
mother-to-child transmission prevention strategies.
``(B)(i) The Administrator of the United States Agency for
International Development is authorized to provide assistance
to prevent, treat, and monitor HIV/AIDS, and carry out
related activities, in countries in sub-Saharan Africa and
other developing countries.
``(ii) It is the sense of Congress that the Administrator
should provide an appropriate level of assistance under
clause (i) through nongovernmental organizations in countries
in sub-Saharan Africa and other developing countries affected
by the HIV/AIDS pandemic.
``(iii) The Administrator shall coordinate the provision of
assistance under clause (i) with the provision of related
assistance by the Joint United Nations Programme on HIV/AIDS
(UNAIDS), the United Nations Children's Fund (UNICEF), the
World Health Organization (WHO), the United Nations
Development Programme (UNDP), other appropriate international
organizations, such as the World Bank and the relevant
regional multilateral development institutions, national,
state, and local governments of foreign countries, and other
appropriate governmental and nongovernmental organizations.
``(C) Assistance provided under subparagraph (B) shall, to
the maximum extent practicable, be used to carry out the
following activities:
``(i) Prevention of HIV/AIDS through activities including--
``(I) education, voluntary testing, and counseling
(including the incorporation of confidentiality protections
with respect to such testing and counseling), including
integration of such programs into women's and children's
health programs;
``(II) assistance to ensure a safe blood supply and to
provide post-exposure prophylaxis to victims of rape and
sexual assault; and
``(III) assistance through nongovernmental organizations,
including faith-based organizations, particularly those
organizations that utilize both professionals and volunteers
with appropriate skills and experience, to establish and
implement culturally appropriate HIV/AIDS education and
prevention programs.
``(ii) The treatment and care of individuals with HIV/AIDS,
including--
``(I) assistance to establish and implement programs to
strengthen and broaden indigenous health care delivery
systems and the capacity of such systems to deliver HIV/AIDS
pharmaceuticals and otherwise provide for the treatment of
individuals with HIV/AIDS, including clinical training for
indigenous organizations and health care providers;
``(II) assistance aimed at the prevention of transmission
of HIV/AIDS from mother to child, including medications to
prevent such transmission and access to infant formula and
other alternatives for infant feeding; and
``(III) assistance to strengthen and expand hospice and
palliative care programs to assist patients debilitated by
HIV/AIDS, their families, and the primary caregivers of such
patients, including programs that utilize faith-based
organizations.
``(iii) The monitoring of programs, projects, and
activities carried out pursuant to clauses (i) and (ii),
including--
``(I) monitoring to ensure that adequate controls are
established and implemented to provide HIV/AIDS
pharmaceuticals and other appropriate medicines to poor
individuals with HIV/AIDS; and
``(II) appropriate evaluation and surveillance activities.
``(iv) The conduct of related activities, including--
``(I) the care and support of children who are orphaned by
the HIV/AIDS pandemic, including services designed to care
for orphaned children in a family environment which rely on
extended family members;
``(II) improved infrastructure and institutional capacity
to develop and manage education, prevention, and treatment
programs, including the resources to collect and maintain
accurate HIV surveillance data to target programs and measure
the effectiveness of interventions;
``(III) vaccine research and development partnership
programs with specific plans of action to develop a safe,
effective, accessible, preventive HIV vaccine for use
throughout the world; and
``(IV) the development and expansion of financially-
sustainable microfinance institutions and other income
generation programs that strengthen the economic and social
viability of communities afflicted by the HIV/AIDS pandemic,
including support for the savings and productive capacity of
affected poor households caring for orphans.
``(D)(i) Not later than January 31 of each calendar year,
the Administrator shall submit to Congress an annual report
on the implementation of this paragraph for the prior fiscal
year.
``(ii) Such report shall include--
``(I) a description of efforts made to implement the
policies set forth in this paragraph;
``(II) a description of the programs established pursuant
to this paragraph and section 4 of the Global Access to HIV/
AIDS Prevention, Awareness, Education, and Treatment Act of
2001; and
``(III) a detailed assessment of the impact of programs
established pursuant to this paragraph, including the
effectiveness of such programs in reducing the spread of HIV
infection, particularly in women and girls, in reducing HIV
transmission from mother to child, in reducing mortality
rates from HIV/AIDS, and the progress toward improving health
care delivery systems and infrastructure to ensure increased
access to care and treatment.
``(iii) The Administrator shall consult with the Global
Health Advisory Board established under section 6 of the
Global Access to HIV/AIDS Prevention, Awareness, Education,
and Treatment Act of 2001 in the preparation of the report
under clause (i) and on other global health activities
carried out by the United States Agency for International
Development.
[[Page H9092]]
``(E)(i) There is authorized to be appropriated to the
President to carry out this paragraph $485,000,000 for fiscal
year 2002.
``(ii) Not more than six percent of the amount appropriated
pursuant to the authorization of appropriations under clause
(i) for fiscal year 2002, and not more than four percent of
the amount made available to carry out this paragraph for any
subsequent fiscal year, may be used for the administrative
expenses of the Agency in carrying out this paragraph.
``(iii) Amounts appropriated pursuant to the authorization
of appropriations under clause (i) are in addition to amounts
otherwise available for such purposes and are authorized to
remain available until expended.
``(F) In this paragraph:
``(i) The term `HIV' means infection with the human
immunodeficiency virus.
``(ii) The term `AIDS' means acquired immune deficiency
syndrome.''.
(b) Availability of Assistance Under Section 104(c).--
Section 104(c) of the Foreign Assistance Act of 1961 (22
U.S.C. 2151b(c)) is amended--
(1) by redesignating paragraph (7) as paragraph (5); and
(2) by adding at the end the following:
``(6) Assistance made available under any paragraph of this
subsection, and assistance made available under chapter 4 of
part II of this Act to carry out the purposes of any
paragraph of this subsection, may be made available
notwithstanding any other provision of law.''.
SEC. 4. ASSISTANCE FOR PROCUREMENT AND DISTRIBUTION OF HIV/
AIDS PHARMACEUTICALS AND RELATED MEDICINES.
(a) Assistance.--The Administrator of the United States
Agency for International Development shall provide assistance
to countries in sub-Saharan Africa and other developing
countries for--
(1) the procurement of HIV/AIDS pharmaceuticals, anti-viral
therapies, and other appropriate medicines; and
(2) the distribution of such HIV/AIDS pharmaceuticals,
anti-viral therapies, and other appropriate medicines to
qualified national, regional, or local organizations for the
treatment of individuals with HIV/AIDS in accordance with
appropriate HIV/AIDS testing and monitoring requirements and
for the prevention of transmission of HIV/AIDS from mother to
child.
(b) Additional Authority.--The authority contained in
section 104(c)(6) of the Foreign Assistance Act of 1961, as
amended by section 3(b) of this Act, shall apply to
assistance made available under subsection (a).
(c) Authorization of Appropriations.--There is authorized
to be appropriated to the President to carry out this section
$50,000,000 for fiscal year 2002.
SEC. 5. INTERAGENCY TASK FORCE ON HIV/AIDS.
(a) Establishment.--The President shall establish an
interagency task force (hereafter referred to as the ``task
force'') to ensure coordination of all Federal programs
related to the prevention, treatment, and monitoring of HIV/
AIDS in foreign countries.
(b) Duties.--The duties of the task force shall include--
(1) reviewing all Federal programs related to the
prevention, treatment, and monitoring of HIV/AIDS in foreign
countries to ensure proper coordination and compatibility of
activities and policies of such programs;
(2) exchanging information regarding design and impact of
such programs to ensure that the United States Government can
catalogue the best possible practices for HIV/AIDS
prevention, treatment, and monitoring and improve the
effectiveness of such programs in the countries in which they
operate; and
(3) fostering discussions with United States and foreign
nongovernmental organizations to determine how United States
Government programs can be improved, including by engaging in
a dialogue with the Global Health Advisory Board established
under section 6 of this Act.
(c) Membership.--
(1) Composition.--The task force shall be composed of the
Secretary of State, the Administrator of the United States
Agency for International Development, the Secretary of Health
and Human Services, the Secretary of the Treasury, the
Director of the National Institutes of Health, the Director
of the Centers for Disease Control, the Secretary of Defense,
and the head of any other agency that the President
determines is appropriate.
(2) Chairperson.--The Secretary of State shall serve as
chairperson of the task force.
(d) Public Meetings.--At least once each calendar year, the
task force shall hold a public meeting in order to afford an
opportunity for any person to present views regarding the
activities of the United States Government with respect to
the prevention, treatment, and monitoring of HIV/AIDS in
foreign countries. The Secretary of State shall maintain a
record of each meeting and shall make the record available to
the public.
(e) Availability of Funds.--Amounts made available for a
fiscal year pursuant to section 104(c)(4)(E)(ii) of the
Foreign Assistance Act of 1961, as amended by section 3(a) of
this Act, are authorized to be made available to carry out
this section for such fiscal year.
SEC. 6. GLOBAL HEALTH ADVISORY BOARD.
(a) Establishment.--There is established a permanent Global
Health Advisory Board (hereafter referred to as the
``Board'') to assist the President and other Federal
officials, including the Secretary of State and the
Administrator of the United States Agency for International
Development, in the administration and implementation of
United States international health programs, particularly
programs relating to the prevention, treatment, and
monitoring of HIV/AIDS.
(b) Duties.--
(1) In general.--The Board shall serve as a liaison between
the United States Government and private and voluntary
organizations, other nongovernmental organizations, and
academic institutions in the United States that are active in
international health issues, particularly prevention,
treatment, and care with respect to HIV/AIDS and other
infectious diseases.
(2) Specific activities.--In carrying out paragraph (1),
the Board--
(A) shall provide advice to the United States Agency for
International Development and other Federal agencies on
health and management issues relating to foreign assistance
in which both the United States Government and private and
voluntary organizations participate;
(B) shall provide advice on the formulation of basic
policy, procedures, and criteria for the review, selection,
and monitoring of project proposals for United States
Government international health programs and for the
establishment of transparency in the provision and
implementation of grants made under such programs;
(C) shall provide advice on the establishment of evaluation
and monitoring programs to measure the effectiveness of
United States Government international health programs,
including standards and criteria to assess the extent to
which programs have met their goals and objectives and the
development of indicators to track progress of specific
initiatives;
(D) shall review and evaluate the overall health strategy
for United States bilateral assistance for each country
receiving significant United States bilateral assistance in
the health sector;
(E) shall recommend which developing countries could
benefit most from programs carried out under United States
Government international health programs; and
(F) shall assess the impact and effectiveness of programs
carried out under section 104(c)(4) of the Foreign Assistance
Act of 1961, as amended by section 3(a) of this Act, in
meeting the objectives set out in the HIV/AIDS country
strategy established by the United States Agency for
International Development.
(c) Membership.--
(1) Composition.--The Board shall be composed of 12
members--
(A)(i) all of whom shall have a substantial expertise and
background in international health research, policy, or
management, particularly in the area of prevention,
treatment, and care with respect to HIV/AIDS and other
infectious diseases; and
(ii) of whom at least one member shall be an expert on
women's and children's health issues; and
(B) of whom--
(i) three members shall be individuals from academic
institutions;
(ii) five members shall be individuals from nongovernmental
organizations active in international health programs,
particularly HIV/AIDS prevention, treatment and monitoring
programs in foreign countries, of which not more than two
members may be from faith-based organizations;
(iii) two members shall be individuals from health policy
and advocacy institutes; and
(iv) two members shall be individuals from private
foundations that make substantial contributions to global
health programs.
(2) Appointment.--The individuals referred to in paragraph
(1) shall be appointed by the President, after consultation
with the chairman and ranking member of the Committee on
International Relations of the House of Representatives and
the Committee on Foreign Relations of the Senate.
(3) Terms.--
(A) In general.--Except as provided in subparagraph (B),
each member shall be appointed for a term of two years and no
member or organization shall serve on the Advisory Board for
more than two consecutive terms.
(B) Terms of initial appointees.--As designated by the
President at the time of appointment, of the members first
appointed--
(i) six members shall be appointed for a term of three
years; and
(ii) six members, to the extent practicable equally divided
among the categories described in clauses (i) through (iv) of
paragraph (1)(B), shall be appointed for a term of two years.
(4) Chairperson.--At the first meeting of the Board in each
calendar year, a majority of the members of the Commission
present and voting shall elect, from among the members of the
Board, an individual to serve as chairperson of the Board.
(d) Travel Expenses.--Each member of the Board shall
receive travel expenses, including per diem in lieu of
subsistence, in accordance with applicable provisions under
subchapter I of chapter 57 of title 5, United States Code.
(e) Availability of Funds.--Amounts made available for a
fiscal year pursuant to section 104(c)(4)(E)(ii) of the
Foreign Assistance Act of 1961, as amended by section 3(a) of
this Act, are authorized to be made available to carry out
this section for such fiscal year.
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SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR MULTILATERAL
EFFORTS TO PREVENT, TREAT, AND MONITOR HIV/
AIDS.
(a) Authorization.--There is authorized to be appropriated
to the President $750,000,000 for fiscal year 2002 for United
States contributions to a global health fund negotiated by
the United States consistent with the general principles in
the Global AIDS and Tuberculosis Relief Act of 2000 and the
initiative of the Secretary General of the United Nations or
other multilateral efforts to prevent, treat, and monitor
HIV/AIDS in countries in sub-Saharan Africa and other
developing countries, including efforts to provide hospice
and palliative care for individuals with HIV/AIDS.
(b) Characteristics of Global Health Fund.--It is the sense
of Congress that, consistent with the general principles
outlined in the Global AIDS and Tuberculosis Relief Act of
2000, United States contributions should be provided to a
global health fund under subsection (a) only if the fund--
(1) is a public-private partnership that includes
participation of, and seeks contributions from, governments,
foundations, corporations, nongovernmental organizations,
organizations that are part of the United Nations system, and
other entities or individuals;
(2) has the World Bank serving as the fiduciary agent of
the fund and in any other capacity deemed appropriate by the
international community;
(3)(A) includes donors, recipient countries, civil society,
and other relevant parties in the governance of the fund; and
(B) contains safeguards against conflicts of interest in
the governance of the fund by the individuals and entities
described in subparagraph (A);
(4) supports targeted initiatives to address HIV/AIDS,
tuberculosis, and malaria through an integrated approach that
includes prevention interventions, care and treatment
programs, and infrastructure capacity-building;
(5) permits strategic targeting of resources to address
needs not currently met by existing bilateral and
multilateral efforts and includes separate sub-accounts for
different activities allowing donors to designate funds for
specific categories of programs and activities;
(6) reserves a minimum of 5 percent of its grant funds to
support scientific or medical research in connection with the
projects it funds in developing countries;
(7) provides public disclosure with respect to--
(A) the membership and official proceedings of the
mechanism established to manage and disburse amounts
contributed to the fund; and
(B) grants and projects supported by the fund;
(8) authorizes and enforces requirements for the periodic
financial and performance auditing of projects and makes
future funding conditional upon the results of such audits;
and
(9) provides public disclosure of the findings of all
financial and performance audits of the fund.
SEC. 8. DEFINITION.
In this Act:
(1) HIV.--The term ``HIV'' means infection with the human
immunodeficiency virus.
(2) AIDS.--The term ``AIDS'' means acquired immune
deficiency syndrome.
SEC. 9. EXTENSION OF TIME FOR GAO REPORT ON TRUST FUND
EFFECTIVENESS.
Section 131(b) of the Global AIDS and Tuberculosis Relief
Act of 2000 (22 U.S.C. 6831(b)) is amended by striking ``of
the enactment of this Act'' and inserting ``the Trust Fund is
established''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) each
will control 20 minutes.
The Chair recognizes the gentleman from Illinois (Mr. Hyde).
General Leave
Mr. HYDE. Madam Speaker, I ask unanimous consent that all Members may
have 5 legislative days to revise and extend their remarks and include
extraneous material on the bill under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. HYDE. Madam Speaker, I yield myself such time as I may consume.
(Mr. HYDE asked and was given permission to revise and extend his
remarks.)
Mr. HYDE. Madam Speaker, once again the United States has an
opportunity, and the responsibility, to lead the world in confronting
one of the most compelling humanitarian and moral challenges facing us
today. I speak of the HIV/AIDS pandemic, a crisis unparalleled in
modern times and one that threatens the entire world, embracing
developed and developing countries alike.
The statistics are chilling: over 22 million people have already died
of AIDS throughout the world. More than 3 million died last year alone.
That is over 8,000 deaths each day, or nearly one death every 6
minutes. What is most alarming is that the number of infections and
deaths is growing and the pandemic is quickly spreading from sub-
Saharan Africa to India, China and Russia. An incredible 36 million
people are already infected with HIV; and 15,000 new infections occur
every day.
To illustrate the magnitude of the crisis, it is estimated that by
the year 2010, over 80 million people may have died from AIDS. By
comparison, that is more than all the military and civilian deaths
resulting from World War II. If the disease is left unchecked, we have
no idea what the statistics will be in 2015 or 2020, less than 20 years
from today. The most dramatic increase in infection rates is in the
developing world, where education, awareness and access to health care
is most seriously lacking. As is too often the case, it is the children
who suffer most. Millions are born HIV-infected even though mother-to-
child transmission is easily avoided if adequate training and health
care is provided. To this is added a widespread mortality among
parents: by the end of the decade, 40 million children are likely to be
orphaned as a consequence of AIDS. The impact on developing societies,
socially, politically and economically, is incalculable and threatens
the stability of many countries and societies around the globe.
Contrary to popular conceptions, the pandemic is not limited to
Africa, where AIDS continues to sweep forward virtually unchecked. The
disease has jumped to every continent. In Europe, last year Russia had
the highest rate of increase of new cases of any country on the planet.
That impoverished country's medical system is clearly unable to
adequately cope with the challenge, ensuring that it will continue to
spread. According to the National Intelligence Council, India is on the
verge of a catastrophic AIDS epidemic. Closer to home, the Caribbean
region has the second highest rate of HIV infections in the world.
The most appropriate comparison of this ever-widening threat is with
the 14th century, when the plague repeatedly swept through Europe,
killing a quarter of that continent's population, leaving no country
untouched, and decimating entire regions. This time, however, it is the
entire world that is at risk. If the world is to have a chance of
prevailing against this disease, the United States must take a leading
role in the efforts to combat it. To do so, we must advance along many
fronts, both bilateral and multilateral. The bill we consider today,
H.R. 2069, addresses both the bilateral and multilateral pillars of our
response to the AIDS crisis.
H.R. 2069 builds upon existing efforts by authorizing the Agency for
International Development to carry out a comprehensive program of HIV/
AIDS prevention, education and treatment at a level of $485 million
during fiscal year 2002. Moreover, Madam Speaker, H.R. 2069 authorizes
an additional $50 million pilot program to provide treatment for those
infected with HIV/AIDS by helping the public and private sectors of
developing countries procure HIV/AIDS pharmaceuticals and antiviral
therapies.
The novel bilateral treatment program that my bill authorizes is
vitally important, for it gives hope to those already suffering from
AIDS. By authorizing a pilot treatment program, we can work to extend
the productive lives of those infected by the virus. This is not only
the right thing to do, it has beneficial impact on treatment as well.
Without some expectation of care, the poor have little reason to be
tested for AIDS or to seek help. I am fully cognizant of the challenge
posed by treatment programs in developing countries. However, it is my
hope that successful treatment programs such as those carried out by
the AIDS Healthcare Foundation will be replicated in developing
countries. Madam Speaker, there simply is no option other than
treatment if we are ever to stem the tide of this pandemic.
Through our bilateral efforts, the United States will demonstrate its
commitment to address all facets of the HIV/AIDS challenge and thereby
challenge the entire developed world to emulate the example of the
United States. It is also my hope that faith-based organizations such
as Catholic Relief Services will play a very significant and meaningful
role in advising
[[Page H9094]]
USAID on the most effective approaches to combat the HIV/AIDS pandemic.
In addition to our bilateral efforts, the President has already
signaled our Nation's intention to lead the multilateral campaign by
committing at least $200 million to combat HIV/AIDS through a global
AIDS war chest that will be designed and implemented in the months to
come.
The Global Access to HIV/AIDS Prevention, Awareness, Education, and
Treatment Act of 2001 also authorizes the President to contribute to
multilateral efforts to combat HIV/AIDS at a level that the
administration deems appropriate and at such time as a fund is
established and criteria developed to ensure its sound management.
America will contribute its fair share as we work to leverage
additional funds for this effort from other developed countries.
By providing the President with this flexibility, we can ensure that
the contributions made by the United States will be adequate and also
yield the commitments from other countries to make this effort a truly
global war on AIDS.
As with any problem, however, financial resources cannot serve as the
sole answer, and the generosity of the American people must be well
managed. We must provide resources at a pace at which these can be
absorbed and used wisely. We must continue to encourage and support
those faith-based organizations and churches that are on the front
lines in the effort to educate the poor about HIV and AIDS and
treatment and prevention. We must also insist that any program designed
to combat the AIDS pandemic include abstinence as a core component.
In closing, I wish to thank the many Members and staff who have
contributed to the passage of this landmark legislation. I am
especially grateful to the gentleman from California (Mr. Lantos) the
committee's ranking member, and to the gentlewoman from California (Ms.
Lee) for their leadership in crafting this legislation.
I am also appreciative of the invaluable support of the gentleman
from New York (Mr. Gilman), the committee's chairman emeritus; the
gentleman from Nebraska (Mr. Bereuter); and the gentleman from Iowa
(Mr. Leach). I am also very grateful for the generous support offered
by the gentleman from Arizona (Mr. Kolbe). I also wish to thank Nisha
Desai, David Abramowitz, Pearl Alice Marsh, and Michael Riggs of the
Democratic staff for their many contributions and dedication to make
this bill come to fruition.
{time} 1430
My greatest appreciation, however, goes to Adolfo Franco, a member of
my own staff, whose tireless work made this bill a reality. He is
leaving the staff to go to a very important job with the
administration, and he will be sorely missed.
Madam Speaker, I wish to reiterate what I think is a consensus in
Congress. Simply stated, the AIDS virus is one of the great moral
challenges of our era. It is a scourge of unparalleled proportions in
modern times. Every citizen has a stake in preventing what otherwise
might well become the bubonic plague of the 21st century. We must do
all that lies in our power to do if we are to meet this threat, first
of all, by reaching out now to those most in need. It is not only the
most sensible thing to do, it is the right thing to do for our
children, our country and for the world.
I urge all of my colleagues to vote for H.R. 2069.
Madam Speaker, I reserve the balance of my time.
Mr. LANTOS. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in strong support of this legislation.
Madam Speaker, I first would like to commend my good friend, the
distinguished chairman of the Committee on International Relations, for
his leadership, his vision and his commitment to help combat the global
HIV-AIDS crisis. The gentleman from Illinois (Mr. Hyde) has shown
courage and integrity in tackling this issue, when he could have relied
upon others to legislate on this front. Many do not see the global HIV-
AIDS crisis as a United States priority and question the need to spend
significant U.S. funds toward preventing and treating this disease, but
the gentleman from Illinois (Chairman Hyde) recognizes not only the
severity of the epidemic, but our moral, humanitarian and national
security interests in stemming the tide of the HIV-AIDS pandemic.
I would also like to commend my colleague, the gentlewoman from
California (Ms. Lee), for her unwavering leadership in the global fight
against HIV-AIDS. She has played a critical role in setting this
Congress on the right course on this human disaster and in fashioning
this legislation.
Madam Speaker, the bill reflects an extraordinary process of
consultation that involves not only members of our committee, but
advocacy groups, non-governmental organizations, the administration and
the staff of the United Nations. The result is a landmark, bipartisan
agreement that outlines both a policy framework and funding levels for
U.S. bilateral and multilateral assistance to fight the global AIDS
pandemic. I want to join the gentleman from Illinois (Chairman Hyde) in
praising members of the Republican and Democratic staffs who played
such a key role in bringing us to this point.
Madam Speaker, the bill before us represents a broad consensus, and I
urge all of my colleagues to support it. I truly believe that our
legislation lays the foundation for a long-term commitment by the
United States to eradicate this devastating disease.
Our bill authorizes $535 million in bilateral U.S. assistance to
education, prevention, treatment and care of HIV-AIDS and those highly
infectious diseases associated with it. In addition, our bill commits
$750 million towards a global health fund to coordinate both funding
and comprehensive programs in the fight against this disease, to which
governments the private sector, foundations and individual
philanthropists will contribute.
Madam Speaker, in this post-September 11 world, it is all too easy to
lose sight of the HIV-AIDS crisis as we focus on the most pressing
problem of global terrorism and the devastating conditions in
Afghanistan, but it is precisely in this post-September 11 era that we
must strive to maintain our commitment to HIV-AIDS and other crises of
global magnitude. AIDS has devastated entire societies, and it is
leaving in its wake a generation lost in despair. It is these children,
raised without hope, who often provide fertile grounds for the
terrorists and criminal networks to sow their evil seeds.
As our Secretary of State, Colin Powell, said at the UN special
session on AIDS, ``From this moment on, our response to AIDS must be no
less comprehensive, no less relentless, and no less swift than the
pandemic itself.''
If we have learned anything through our terrible national tragedy, it
is that the world's problems are our problems, and if we do not deal
with these problems overseas, we will be dealing with them on our own
doorstep.
The resurgence of HIV-AIDS and tuberculosis in some parts of the
United States is just one ominous indication of how the problems of the
developing world can soon become our own problems if we do not act
decisively. The new bilateral program authorized by our legislation
will guarantee that the American people are directly engaged in
providing education, prevention, treatment and care to those suffering
in poor countries. It will improve the quality of the U.S. aid programs
in the HIV-AIDS field and provide those who are suffering with AIDS
opportunities to live better and more productive lives.
Our proposed 1-year multilateral expenditure of $750 million is a
major investment on our part toward a global effort to secure a better
future for millions suffering from this deadly disease. It is a signal
to the world, and particularly those suffering from this disease, that
the United States is a partner in the international battle against HIV-
AIDS.
Lastly, Madam Speaker, I want to tell schoolteachers, health workers,
women and men, grandparents and orphans in poor countries suffering
from the HIV-AIDS pandemic that we are fighting for and with them. Men,
women and children in Africa, South Asia, Europe, the Western
Hemisphere, are all affected, and we must all work
[[Page H9095]]
together to find a solution. I urge my colleagues to support H.R. 2069.
Madam Speaker, I reserve the balance of my time.
Mr. HYDE. Madam Speaker, I am pleased to yield 4 minutes to the
distinguished gentleman from Nebraska (Mr. Bereuter).
Mr. BEREUTER. Madam Speaker, I rise in strong support of this
legislation, and I thank the distinguished chairman for yielding me
time. I want to thank him also for his leadership in introducing this
legislation and for the effort to move it to the House floor so
expeditiously. Also I would like to thank the distinguished ranking
member of the House Committee on International Relations, the gentleman
from California (Mr. Lantos) and the distinguished gentlewoman from
California (Ms. Lee), among others mentioned by the gentleman from
Illinois (Chairman Hyde), for their very positive efforts regarding
H.R. 2069.
I am pleased to be a member of the Committee on International
Relations, but today I speak primarily as a chairman of a subcommittee
of the Committee on Financial Services, the Subcommittee on
International Monetary Policy and Trade. It is in that respect that I
thank the gentleman from Illinois (Mr. Hyde), the chairman, and the
gentleman from California (Mr. Lantos), and others, for working with
the distinguished gentleman from Ohio (Chairman Oxley) and this Member
by incorporating into H.R. 2069 language suggested by us to recognize
the World Bank's fiduciary role for the Global Health Fund on HIV-AIDS.
The statistics on HIV-AIDS are staggering, as we heard a few minutes
ago. According to the joint United Nations Programme on HIV-AIDS, as of
December 2001, an estimated 40 million people worldwide live with HIV-
AIDS, which includes an estimated 28.1 million people in Sub-Saharan
Africa. Furthermore, in the year 2001 alone, there were an estimated 5
million new HIV-AIDS infections worldwide, with 3.4 million of these
cases being in Sub-Saharan Africa. In addition to Africa, HIV infection
rates are also rising dramatically in India and the other South Asian
countries, as well as Russia, the Eastern European countries, Brazil
and the Caribbean countries.
As the chairman of the Subcommittee on International Monetary Policy
and Trade, this Member conducted a hearing on May 15, 2001, which
focused on the activities in Africa of the International Monetary Fund,
the World Bank, the African Development Bank and African Development
Fund, including their efforts to combat HIV-AIDS. As a result of this
hearing, which included testimony from the Joint United Nations
Programme on HIV-AIDS, this Member introduced H.R. 2209. This
legislation increases the authorization for the multilateral world AIDS
trust for FY 2002 from $150 million to $200 million.
The World Bank AIDS Trust Fund was established with American support
through what became Public Law 106-264, primarily authored by the
distinguished gentleman from Iowa (Mr. Leach). This law directed the
United States Government to seek to negotiate the creation of an
international HIV-AIDS trust fund which would be established within the
World Bank.
The Global Access to HIV-AIDS Prevention, Awareness, Treatment, and
Education Act of 2001, this bill, provides both multilateral and
bilateral authorization funding to help prevent, treat and monitor HIV-
AIDS. This dual approach is very important as the United States combats
the global plague of HIV-AIDS with our neighbors and outer countries
throughout the world.
This Member would like to particularly emphasize the $750 million
multilateral authorization for FY 2002 to the Global Health Fund to
combat HIV-AIDS. This legislation, H.R. 2069, states that this Global
Health Fund is consistent with the global AIDS and Tuberculosis Relief
Act of 2000, which established the U.S. negotiations for the World Bank
AIDS Trust Fund.
The World Bank has the most extensive global infrastructure to
provide the multilateral assistance needed to help prevent, treat and
monitor HIV-AIDS. This Member fully supports the Bush administration's
position to abdicate a fiduciary role for the World Bank in this Global
Health Fund to fight HIV-AIDS. It should be noted that the Transitional
Working Group, a multilateral institution for this Global Health Fund,
has recently invited the World Bank to play that fiduciary role as a
trustee for the fund.
I urge support of this legislation. I think the two committees worked
well together to merge the two bills together.
Mr. LANTOS. Madam Speaker, I yield 4 minutes to the gentlewoman from
California (Ms. Lee). No Member has worked harder and more diligently
on this issue than my friend and colleague from California.
Ms. LEE. Madam Speaker, I rise first to thank the gentleman from
Illinois (Chairman Hyde), our ranking member, the gentleman from
California (Mr. Lantos), the gentleman from Iowa (Mr. Leach), and also
the gentleman from Nebraska (Mr. Bereuter), for their commitment and
real diligence in working to develop H.R. 2069, legislation that will
comprehensively fight the global AIDS, TB and malaria pandemics.
This bipartisan legislation that we are considering today is
important because it authorizes the desperately needed resources to
address the multifaceted and multigenerational challenges presented by
the global AIDS, TB and malaria pandemics.
It has been over 20 years since the first AIDS diagnosis. Since then,
HIV and AIDS has infected over 56 million people worldwide and has
claimed over 25 million lives, including 4 million children. The events
of September 11 have turned the world's attention appropriately on
combatting international terrorism. However, we cannot forget the
global will scourge of HIV and AIDS. It is a national security threat
of staggering proportions. AIDS, like many diseases, knows no borders
and discriminates against no one. Each day, AIDS, TB and malaria claim
over 17,000 lives. So, just as we fight terrorism, we must also fight
these diseases.
According to UN, AIDS left unchecked, it is estimated that over 100
million people will be infected worldwide by 2007.
{time} 1445
AIDS is decimating the continent of Africa and leaving millions of
orphans in its wake.
Today, the number of orphans in Africa is the equivalent of the total
population of children in America's public schools. Left unchecked,
Africa will be home to more than 40 million orphans by 2010; and
unfortunately, Africa is only the epicenter. We must not sacrifice this
generation of children on the alter of indifference.
The AIDS pandemic has cut life expectancy by 25 years in some
countries. In Botswana, the population growth due to AIDS is negative.
This means that there are more people dying from AIDS than there are
being born. The AIDS, TB, and malaria pandemics constitute a crisis of
biblical proportions in Africa and puts the very survival of the
continent at stake. These pandemics are not only a humanitarian crisis,
but they are potentially an economic, political, and social
catastrophe. Therefore, it is important that we continue to beat the
drum to raise awareness. Our efforts at home must reach far beyond our
shores.
When the House Committee on International Relations marked this bill
up earlier this year, the gentleman from Illinois (Mr. Hyde), the
chairman of the committee, the gentleman from California (Mr. Lantos),
the gentleman from Iowa (Mr. Leach), and the gentleman from Nebraska
(Mr. Bereuter) worked on this bill day and night to increase bilateral
funding for AIDS, TB, and malaria and also to increase the U.S.
contribution to our multilateral AIDS program. The program, under this
bill's $750 million, includes a contribution to the Global AIDS Trust
Fund, which the gentleman from Iowa (Mr. Leach) and I cosponsored last
year. This was actually signed into law as the Global AIDS and TB
Relief Act of 2000, which the gentleman from Nebraska (Mr. Bereuter)
earlier referred to.
So today, the House is sending a strong message that America can and
must do more.
Also, I want to state for the record that all HIV-infected persons
have a basic right to vital medicines for prevention and treatment of
AIDS and also must have access to drugs for treatment of opportunistic
infections
[[Page H9096]]
and to anti-retroviral agents. We have the knowledge and we have the
technology to prevent the spread of AIDS. We have the necessary drugs
that can substantially reduce the rate of mother-to-child transmission
and also prolong the lives of people who are infected.
In addition to all of the barriers we face addressing this global
crisis, basic health care infrastructure remains an issue. This bill
addresses that also.
So I just once again want to thank my colleagues, the gentleman from
Illinois (Mr. Hyde), the chairman of the committee; the gentleman from
California (Mr. Lantos), the ranking member; the gentleman from Iowa
(Mr. Leach); and the gentleman from Nebraska (Mr. Bereuter) for their
commitment, and also for our staffs' work. I want to thank the staff
for diligently working on this. Our dedication and their dedication to
the future of the human family will surely have a ripple effect.
Mr. HYDE. Madam Speaker, I ask unanimous consent that each side be
granted an additional 6 minutes for purposes of debate.
The SPEAKER pro tempore (Mrs. Biggert). Is there objection to the
request of the gentleman from Illinois?
There was no objection.
Mr. HYDE. Madam Speaker, I yield 3 minutes to the gentleman from
Arizona (Mr. Kolbe).
(Mr. Kolbe asked and was given permission to revise and extend his
remarks.)
Mr. KOLBE. Madam Speaker, I thank the gentleman for yielding me this
time.
When I became chairman of the Subcommittee on Foreign Operations of
the Committee on Appropriations, I said that one of my highest
priorities was to fund the battle against HIV/AIDS that is becoming a
pandemic globally. With that in mind, I want to thank the distinguished
chairman of the Committee on International Relations for his leadership
and his interest in fighting HIV and other infectious diseases. We
share this as a priority, and I am very pleased to work with the
chairman on this important matter.
The authorization for bilateral assistance through the United States
Agency for International Development is virtually identical to the
amount recommended by the House and Senate conferees on the Foreign
Operations, Export Financing, and Related Programs Appropriations Act
for fiscal year 2002. We hope to file that conference report on the
bill in the very near future. We completed the work on our conference
in November and are awaiting a signal from the leadership to file that
agreement.
Having said that, however, I think it is important to tell the House
and Members here that the $750 million authorization that is included
in this bill for the multilateral assistance is unlikely to be funded
in fiscal year 2002. The chairman indicated in his own remarks that he
understood that that was going to be the case.
Members need to know, should know, that the multilateral fund does
not yet exist. It is a concept, and we are working on it; but its
structure, its objectives, its voting methodology has not yet been
determined and is not likely to occur until the middle of next year.
Despite that, the Committee on Appropriations is in the process of
providing a total of $250 million in three separate bills for the
proposed global fund to fight HIV, tuberculosis, and malaria; and that
is an amount that is $50 million greater than had been requested in the
President's budget.
Now, more funds are possible; but I do not want anybody to have
unrealistic expectations for the FY 2002 budget. First, it is very
important that this fund get created and that we begin to demonstrate
success. That is not going to happen yet until at least well into this
fiscal year. Until the Congress concurs with the proposed terms and
conditions under which our initial $250 million could be used, it is
not prudent, in my view, to leave the impression that there is another
$500 million available or required at this time for the global fund.
Madam Speaker, I support this bill, because we must continue to
dedicate an increasing amount of resources to fight the global pandemic
of HIV/AIDS, but I do not want my support for the bill to be viewed as
an endorsement of the $750 million level authorized for the proposed
global fund, at least not at this time. We have more work to do before
we are going to be ready to spend any of the funds set aside for the
global trust fund, much less an amount as large as $250 million. I know
the chairman understands that.
So this is a proactive, leading-the-way authorization, and I
appreciate that. I do think that we can carry out the policies and
provide for the ongoing and expanded bilateral programs. I thank the
chairman for his leadership.
Mr. LANTOS. Madam Speaker, I am delighted to yield 2 minutes to the
gentlewoman from California (Ms. Pelosi), the incoming whip of the
Democratic Party, my friend and neighbor in San Francisco, who has been
a national leader in the fight against HIV/AIDS for years.
Ms. PELOSI. Madam Speaker, I thank the gentleman for yielding me this
time, and I thank him for his leadership on this issue. I commend the
gentleman from Illinois (Mr. Hyde), the chairman of the committee; the
gentleman from Nebraska (Mr. Bereuter), the gentleman from Iowa (Mr.
Leach), and the gentlewoman from California (Ms. Lee) for their
extraordinary leadership in bringing this bill to the floor. I know it
was difficult, and I congratulate them in doing it.
I am pleased to follow the gentleman from Arizona (Mr. Kolbe), my
distinguished chairman on the Subcommittee on Foreign Operations, a
longtime member on that committee. Following the lead of my own
constituents, we put the first money for international AIDS into that
bill several years ago. We could never get the attention that he is
getting here today on this issue. I know how hard it is, and I commend
him for it. We tried to get the attention of the G-7 to put AIDS on the
agenda a dozen years ago in both Democratic and Republican
administrations, and only recently have the ramifications of AIDS been
recognized at that level.
So it is with great enthusiasm that I commend all of my colleagues,
and I rise in support of H.R. 2069.
Madam Speaker, we must never forget that every single day, 8,000
people die of AIDS; 8,000 people die every day of AIDS. Think of it. It
is so staggering. It is unimaginable, almost. But we are concerned
about every single one of them and about protecting every single child
in the world and person in the world from contracting HIV and AIDS in
the future.
The United States must take the lead in the global effort to end the
global AIDS pandemic and the havoc it is creating in the developing
world. Halting this crisis can only happen with new resources, and the
dramatic step that is being taken today is a very, very important and
significant step forward.
The social, economic, security, national security, and human rights
cost of this crisis are devastating entire nations. Projections show
that by 2010, South Africa's GDP will be 17 percent below where it
would have been without AIDS, and the United Nations has estimated that
AIDS could kill up to 26 percent of the workforce in Africa. India
already has more infected people than Africa.
Madam Speaker, I will submit my full statement for the Record
because, again, the statistics are staggering. Madam Speaker, $750
million is an excellent step forward. We need to do more.
Experts are predicting that without significant prevention and
treatment efforts the number of Indians living with HIV/AIDS could
surpass the combined number of cases in all African countries within
two decades.
Developing countries will be unable to turn the tide on this epidemic
if even the most basic health care is unavailable for most of their
citizens. People must be educated about HIV and how to prevent its
spread. Increased testing and counseling opportunities are desperately
needed. Basic care and treatment that can be delivered in homes or
makeshift clinics is essential. And the need for support for the
growing number of children orphaned by AIDS looms large.
We know that prevention and treatment work. Comprehensive prevention
efforts have turned around HIV epidemics in Uganda and Thailand, and
averted an epidemic in Senegal. In a small village in Haiti, community
health workers have been trained to deliver high quality care,
including the advanced medicines used to treat AIDS in our country. The
provisions of H.R. 2069 will help impoverished
[[Page H9097]]
countries expand and replicate effective programs, and strengthen the
capacity of indigenous health care systems to deliver HIV/AIDS
pharmaceuticals.
Our investment in the fight against the global AIDS pandemic not only
has a direct impact, but is also promises to leverage significant funds
from other countries and multilateral institutions. Specifically, the
$750 million authorized for multilateral assistance will demonstrate
this country's dedication to the new United Nations Global Fund, and
other international efforts. Fighting AIDS requires a real, sustained
commitment, and the money we provide is a signal to other nations that
we will do our part.
The fight ahead of us against the global AIDS pandemic is a long one.
We have no choice but to engage in the fight and to prevail. I urge my
colleagues to support H.R. 2069.
Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the
gentlewoman from Maryland (Mrs. Morella).
Mrs. MORELLA. Madam Speaker, I thank the gentleman for yielding me
this time.
I rise in strong support of H.R. 2069, the Global Access to HIV and
AIDS Prevention Act, to authorize nearly $1.4 billion to combat HIV/
AIDS in sub-Saharan Africa and other developing countries.
I certainly want to applaud the leadership of the gentleman from
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) for
their efforts in bringing this bill to the floor today. Because of
their work and the work of so many of my friends and colleagues here in
Congress, we are seeing a vast change in the global AIDS crisis in sub-
Saharan Africa and other parts of the world. What I am referring to is
a rapidly changing and increased level of awareness and concern, not
only about the horrific damage the virus is wreaking, but about the
future costs, costs in cultural, political, and economic stability in
Africa.
New figures released on December 1, which was World AIDS Day, show
that more than 40 million people are now living with the virus. The
vast majority of them are in sub-Saharan Africa where the devastation
is so acute it has become one of the main obstacles to development. I
could go on with the various statistics. An estimated 24.5 million
people in sub-Saharan Africa are infected with the HIV virus. That is
71 percent of the world's total.
What can we do? The United States is uniquely positioned to lead the
world in the prevention and eradication of HIV and AIDS. This year's
House-passed Foreign Operations Appropriations bill provides $474
million for AIDS prevention and control. But we must also pass this
bill, H.R. 2069, The Global Access to HIV and AIDS Prevention Act. It
authorizes $560 million in bilateral assistance programs for the
various AIDS treatment and prevention programs administered by USAID.
It also authorizes $750 million in 2002 for the United States
contributions to the Global AIDS Fund.
So I would certainly say that this bill is good news. The bad news is
it has taken so long.
Mr. LANTOS. Madam Speaker, I am pleased to yield 2 minutes to the
gentleman from Texas (Mr. Rodriguez), our distinguished colleague.
Mr. RODRIGUEZ. Madam Speaker, I rise in support of the Global Access
to HIV/AIDS Prevention Act, H.R. 2069. I would like to commend the
gentlewoman from California (Ms. Lee). I want to thank her for her hard
work and her dedication as well. I want to thank her specifically for
when she first sent that letter for us to sign to get on board, and I
was very pleased to see that. I also want to thank the gentleman from
California (Mr. Lantos) for his efforts and the gentlewoman from
California (Ms. Pelosi) and some of the other speakers that have been
speaking on this issue, as well as the gentleman from Illinois (Mr.
Hyde). I thank him for allowing us this opportunity to move forward on
this issue.
This year marks the 20th year of HIV/AIDS, and in that time the virus
has taken the lives of more than 25 million people throughout the
world. In claiming lives, the virus has destroyed families and
communities. It has devastated economies and created instability. It
has changed the very way we interact with our neighbors.
The continued spread of the virus calls for a multilateral strategy
in the struggle to reduce infections. Domestic and international
efforts, prevention as well as treatment, as well as research and
development and education, are critical. These are the parts of the
equation that will help us change the outcome.
We must remember that disease has no borders and especially
infectious diseases. We cannot afford to ignore the plight of our
neighbors, because sooner or later, it will come and knock on our door.
By investing in the international efforts to eradicate this virus, we
will be assuring and protecting Americans' health and prosperity. We
will also show ourselves as a Nation committed to alleviating human
sufferings everywhere else. It is the right thing to do for our
neighbors and ourselves and for our constituents and for our children,
for untreated and mistreated HIV/AIDS can hamper us all. For not
treating appropriately, other types of strains can be created that will
cause us more harm.
{time} 1500
Madam Speaker, I urge my colleagues to support H.R. 2069, the Global
Access to HIV/AIDS Prevention Awareness, Education, and Treatment Act
of 2001.
Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the
distinguished gentleman from Florida, (Mr. Weldon).
Mr. WELDON of Florida. Madam Speaker, I thank the gentleman for
yielding time to me.
Madam Speaker, I did my internship and residency in San Francisco in
the early eighties when AIDS was ravaging the homosexual community in
that city. Prior to coming here to the U.S. House, I practiced
infectious diseases and primarily treated AIDS, so I have seen
firsthand the devastation that this disease can cause. I certainly
commend all those involved with working to bring this bill to the
floor.
I am particularly pleased that the chairman was willing to work with
me to add language to emphasize the importance of a safe blood supply
and the importance of prophylactic drugs for victims of rape and sexual
assault; certainly, also, the language to emphasize access to infant
formula and other alternatives for infant feeding.
Many babies are born to HIV mothers and survive the birth process
without contracting AIDS, to only go on, unfortunately, to contract the
disease through the process of breast feeding.
I do remain concerned, Madam Speaker, that the bill does not
sufficiently stress abstinence. Abstinence programs have shown to be
helpful in Uganda and Senegal; and abstinence, of course, is the only
approach that actually guarantees that AIDS will not be spread.
I have served in the past on the board of a faith-based group that
has worked in Nigeria on abstinence-based education. I think the bill,
as it moves through the conference process and gets signed by the
President, should have some stronger language inserted to deal with the
importance of abstinence.
Also, I would like to see the makeup of the board, the advisory
board, structured in such a way that faith-based organizations will be
guaranteed a place at the table. There are currently hundreds of faith-
based organizations in Africa. As I said, I have worked with one of
them firsthand. They need to be included in this process.
Mr. LANTOS. Madam Speaker, I am pleased to yield 2 minutes to my good
friend and my distinguished colleague, the gentlewoman from North
Carolina (Mrs. Clayton).
Mrs. CLAYTON. Madam Speaker, I thank the gentleman for yielding time
to me.
Madam Speaker, I rise in support of the Global to Access HIV/AIDS
Prevention, Awareness, Education, and Treatment Act of 2001, H.R. 2069.
I also want to commend the leadership on this bill, the gentleman
from Illinois (Chairman Hyde) and the gentleman from California (Mr.
Lantos), and all others involved in sponsoring this, the gentleman from
Nebraska (Mr. Bereuter), the gentlewoman from California (Ms. Lee), and
those who have been carrying this fight on and have been strong
advocates for ridding the world of this disease.
This legislation provides crucial funding for the prevention,
treatment, and monitoring of AIDS in sub-Saharan Africa and other parts
of the developing world, and an increased amount
[[Page H9098]]
of assistance through education and treatment programs, as well as
assistance and aid for the prevention and transmission of HIV/AIDS from
mother to child.
Madam Speaker, this legislation is essential to fighting the HIV/AIDS
epidemic in many parts of the world, including that part of Africa. HIV
is worldwide and actually knows no border, as we said earlier.
Madam Speaker, I include for the Record information on the AIDS
epidemic provided by the World Health Organization.
The material referred to is as follows:
AIDS Epidemic Update--December 2001
Global overview
Twenty years after the first clinical evidence of acquired
immunodeficiency syndrome was reported, AIDS has become the
most devastating disease humankind has ever faced. Since the
epidemic began, more than 60 million people have been
infected with the virus. HIV/AIDS is now the leading cause of
death in sub-Saharan Africa. Worldwide, it is the fourth-
biggest killer.
At the end of 2001, an estimated 40 million people globally
were living with HIV. In many parts of the developing world,
the majority of new infections occur in young adults, with
young women especially vulnerable. About one-third of those
currently living with HIV/AIDS are aged 15-24. Most of them
do not know they carry the virus. Many millions more know
nothing or too little about HIV to protect themselves against
it.
Eastern Europe and Central Asia--still the fastest-growing
epidemic
Eastern Europe--especially the Russian Federation--
continues to experience the fastest-growing epidemic in the
world, with the number of new HIV infections rising steeply.
In 2001, there were an estimated 250,000 new infections in
this region, bringing to 1 million the number of people
living with HIV. Given the high levels of other sexually
transmitted infections, and the high rates of injecting drug
use among young people, the epidemic looks set to grow
considerably.
Asia and the Pacific--narrowing windows of opportunity.
In Asia and the Pacific, an estimated 7.1 million people
are now living with HIV/AIDS. The epidemic claimed the lives
of 435,000 people in the region in 2001. The apparently low
national prevalence rates in many countries in this region
are dangerously deceptive. They hide localized epidemics in
different areas, including some of the world's most populous
countries. There is a serious threat of major, generalized
epidemics. But, as Cambodia and Thailand have shown, prompt,
large-scale prevention programmes can hold the epidemic at
bay. In Cambodia, concerted efforts, driven by strong
political leadership and public commitment, lowered HIV
prevalence among pregnant women to 2.3 percent at the end of
2000--down by almost a third from 1997.
Sub-Saharan Africa--the crisis grows
AIDS killed 2.3 million African people in 2001. The
estimated 3.4 million new HIV infections in sub-Saharan
Africa in the past year mean that 28.1 million Africans now
live with the virus. Without adequate treatment and care,
most of them will not survive the next decade. Recent
antenatal clinic data show that several parts of southern
Africa have now joined Botswana with prevalence rates among
pregnant women exceeding 30 percent. In West Africa, at least
five countries are experiencing serious epidemics, with adult
HIV prevalence exceeding 5 percent. However, HIV prevalence
among adults continues to fall in Uganda, while there is
evidence that prevalence among young people (especially
women) is dropping in some parts of the continent.
The Middle East and North Africa--slow but marked spread
In the Middle East and North Africa, the number of people
living with HIV now totals 440,000. The epidemic's advance is
most marked in countries (such as Djibouti, Somalia and the
Sudan) that are already experiencing complex emergencies.
While HIV prevalence continues to be low in most countries in
the region, increasing numbers of HIV infections are being
detected in several countries, including the Islamic Republic
of Iran, the Libyan Arab Jamahiriya and Pakistan.
High-income countries--resurgent epidemic threatens
A larger epidemic also threatens to develop in the high-
income countries, where over 75,000 people acquire HIV in
2001, bringing to 1.5 million the total number of people
living with HIV/AIDS. Recent advances in treatment and care
in these countries are not being consistently matched with
enough progress on the prevention front. New evidence of
rising HIV infection rates in North America, parts of Europe
and Australia is emerging. Unsafe sex, reflected in outbreaks
of sexually transmitted infections, and widespread injecting
drug use are propelling these epidemics, which, at the same
time, are shifting more towards deprived communities.
Latin America and the Caribbean--diverse epidemics
An estimated 1.8 million adults and children are living
with HIV in Latin America and the Caribbean--a region that is
experiencing diverse epidemics. With an average adult HIV
prevalence of approximately 2 percent, the Caribbean is the
second-most affected region in the world. But relatively low
national HIV prevalence rates in most South and Central
American countries mask the fact that the epidemic is already
firmly lodged among specific population groups. These
countries can avert more extensive epidemics by stepping up
their responses now.
Stronger commitment
Greater and more effective prevention, treatment and care
efforts need to be brought to bear. During the year 2001, the
resolve to do so became stronger than ever.
History was made when the United Nations General Assembly
Special Session on HIV/AIDS in June 2001 set in place a
framework for national and international accountability in
the struggle against the epidemic. Each government pledged to
pursue a series of many benchmark targets relating to
prevention, care, support and treatment, impact alleviation,
and children orphaned and made vulnerable by HIV/AIDS, as
part of a comprehensive AIDS response. These targets include
the following: To reduce HIV infection among 15-24-year-olds
by 25 percent in the most affected countries by 2005 and,
globally, by 2010; by 2005, to reduce the proportion of
infants infected with HIV by 20 percent, and by 50 percent by
2010; by 2003, to develop national strategies to strengthen
health-care systems and address factors affecting the
provision of HIV-related drugs, including affordability and
pricing. Also, to urgently make every effort to provide the
highest attainable standard of treatment for HIV/AIDS,
including antiretroviral therapy in a careful and monitored
manner to reduce the risk of developing resistance; by 2003,
to develop and, by 2005, implement national strategies to
provide a supportive environment for orphans and children
infected and affected by HIV/AIDS; by 2003, to have in place
strategies that begin to address the factors that make
individuals particularly vulnerable to HIV infection,
including under-development, economic insecurity, poverty,
lack of empowerment of women, lack of education, social
exclusion, illiteracy, discrimination, lack of information
and/or commodities for self-protection, and all types of
sexual exploitation of women, girls and boys; and by 2003, to
develop multisectoral strategies to address the impact of the
HIV/AIDS epidemic at the individual, family, community and
national levels.
Increasingly, other stakeholders, including nongovernmental
organizations and private companies worldwide, are making
clear their determination to boost those efforts.
New resources are being marshalled to lift spending to the
necessary levels, which UNAIDS estimates at US$7-10 billion
per year in low- and middle-income countries. The global fund
called for by United Nations Secretary-General Kofi Annan has
attracted about US$1.5 billion in pledges. In addition, the
World Bank plans major new loans in 2002 and 2003 for HIV/
AIDS, with a grant equivalency of over US$400 million per
year. All the while, more countries are boosting their
national budget allocations towards AIDS responses. Several
``least developed countries'' have received, or are in line
for, debt relief that could help them increase their spending
on HIV/AIDS.
More private companies are also stepping up their efforts.
Guiding some of their interventions is a new international
code of conduct on AIDS and the workplace, which was ratified
earlier this year by members of the International Labour
Organization (the new, eighth cosponsoring organization of
UNAIDS).
The challenge now is to build on the new-found commitment
and convert it into sustained action--both in the countries
and regions already hard hit, and in those where the epidemic
began later but is gathering steam.
Beyond complacency
The diversity of HIV's spread worldwide is striking. But in
many regions of the world, the HIV/AIDS epidemic is still in
its early stages. While 16 sub-Saharan African countries
reported overall adult HIV prevalence of more than 10 percent
by the end of 1999, there remained 119 countries of the
world where adult HIV prevalence was less than 1 percent.
Low national prevalence rates can, however, be very
misleading. They often disguise serious epidemics that are
initially concentrated in certain localities or among
specific population groups and that threaten to spill over
into the wider population.
Nationwide prevalence in Myanmar, for instance, has been
put at 2 percent. Yet, national HIV rates as high as 60
percent are being registered among injecting drug users and
almost 40 percent among sex workers. Moreover, in vast
populous countries such as China, India and Indonesia (where
individual provinces or states often have more inhabitants
than most countries), national prevalence all but loses
meaning. The Indian states of Maharashtra, Andhra Pradesh and
Tamil Nadu (each with at least 55 million inhabitants), have
registered HIV prevalence rates of over 2 percent among
pregnant women in one or two sentinel sites and over 10
percent among sexually transmitted infection patients--rates
far higher than the national average of less than 1 percent.
In the absence of vigorous prevention efforts, there is
considerable scope for further HIV spread.
[[Page H9099]]
Even HIV prevalence rates as low as 1 percent or 2 percent
across Asia and the Pacific (which is home to about 60
percent of the world's population) would cause the number of
people living with HIV/AIDS to soar.
All countries have, at some point in their epidemic
histories, been low-prevalence countries. HIV prevalence
among pregnant women attending antenatal clinics in South
Africa was less than 1 percent in 1990 (almost a decade after
the first HIV diagnosis there in 1982). Yet, a decade later,
the country was experiencing one of the fastest growing
epidemics in the world, with prevalence among pregnant women
at 24.5 percent by the end of 2000.
Low-prevalence settings present special challenges. At the
same time, they offer opportunities for averting large
numbers of future infections. Today, we are seeing rapidly
emerging epidemics in several countries that had previously
recorded relatively low rates of HIV infection--proof that
the epidemic can emerge quickly and unexpectedly, and that no
society is immune. In Indonesia, where recorded infection
rates were negligible until very recently (even among some
high-risk groups), there is new evidence of striking
increases in the infection rates of HIV. Prevalence has risen
significantly among female sex workers in three cities at
opposite ends of the Indonesian archipelago, with similar
increases also evident at other sites. Among women working in
massage parlours in the capital, Jakarta, HIV prevalence was
measured at 18 percent in 2000. Blood donor data now show a
tenfold rise in HIV prevalence since 1998.
Elsewhere, longer-standing epidemics could be on the verge
of spreading more rapidly and widely. Nepal and Viet Nam, for
example, have registered marked increases in HIV infection in
recent years, while in China--home to a fifth of the world's
people--the virus seems to be moving into new groups of the
population.
In other areas of the world, too, time is fast running out
if much larger AIDS epidemics are to be averted. For
instance, in the Russian Federation, only 523 HIV infections
had been diagnosed by 1991. A decade later, that number had
climbed to more than 129,000. In a country where injecting
drug use among young people is rife (and there are higher
levels of sexually transmitted infections in the wider
population), there is an urgent need for action to avoid an
even larger number of new infections.
Prompt, focused prevention
Countires that still have low levels of HIV infection
should avert the epidemic's potential spread, rather than
take comfort from current infection rates. The key to success
in low-prevalence settings where HIV is not yet at risk to
the wider population is to enable the most vulnerable groups
to adopt safer sexual and drug-injecting behaviour, interrupt
the virus's spread among and between those groups, and buy
time to bolster the wider population's ability to protect
itself against the virus.
This means, first, determining which population groups are
at highest risk of infection and, second mustering the
political will to safeguard them against the epidemic. At the
same time, it is vital to defuse the stigma and blame so
often attached to vulnerable groups and to deepen the wider
public's knowledge and understanding of the epidemic.
Young people are a priority on this front. Twenty years
into the epidemic, millions of young people know little, if
anything, about HIV/AIDS. According to UNICEF, over 50
percent of young people (aged 15-24) in more than a dozen
countries, including Bolivia, Botswana, Cote d'Ivoire, the
Dominican Republic, Ukraine, Uzbekistan and Viet Nam, have
never heard of AIDS or harbour serious misconceptions
about how HIV is transmitted. Providing young people with
candid information and life skills is a prerequisite for
success in any AIDS response.
Reclaiming the future
The impact of the AIDS epidemic is being increasingly felt
in many countries across the world. Southern Africa continues
to be the worst affected area, with adult prevalence rates
still rising in several countries. But elsewhere, also, in
countries often already burdened by huge socioeconomic
challenges, AIDS threatens human welfare, developmental
progress and social stability on an unprecedented scale.
The AIDS epidemic has a profound impact on growth, income
and poverty. It is estimated that the annual per capita
growth in half the countries of sub-Saharan Africa is falling
by 0.5-1.2 percent as a direct result of AIDS. By 2010, per
capita GDP in some of the hardest hit countries may drop by 8
percent and per capita consumption may fall even farther.
Calculations show that heavily affected countries could lose
more than 20 percent of GDP by 2020. Companies of all types
face higher costs in training, insurance, benefits,
absenteeism and illness. A survey of 15 firms in Ethiopia has
shown that, over a five-year period, 53 percent of all
illnesses among staff were AIDS-related.
Devastating cycles
An index of existing social and economic injustices, the
epidemic is driving a ruthless cycle of impoverishment.
People at all income levels are vulnerable to the economic
impact of HIV/AIDS, but the poor suffer most acutely. One
quarter of households in Botswana, where adult HIV prevalence
is over 35 percent can expect to lose an income earner within
the next 10 years. A rapid increase in the number of very
poor and destitute families is anticipated. Per capita
household income for the poorest quarter of households is
expected to fall by 13 percent, while every income earner in
this category can expect to take on four more dependents as a
result of HIV/AIDS.
In sub-Saharan Africa, the economic hardships of the past
two decades have left three-quarters of the continent's
people surviving on less than US $2 a day. The epidemic is
deepening their plight. Typically, this impoverished majority
has limited access to social and health services, especially
in countries where public services have been cut back and
where privatized services are unaffordable. In hard-hit
areas, households cope by cutting their food consumption and
other basic expenditures, and tend to sell assets in order to
cover the costs of health care and funerals.
Studies in Rwanda have shown that households with a HIV/
AIDS patient spend, on average, 20 times more on health care
annually than households without an AIDS patient. Only a
third of those households can manage to meet these extra
costs.
According to a new United Nations Food and Agricultural
Organization (FAO) report, seven million farm workers have
died from AIDS-related causes since 1985 and 16 million more
are expected to die in the next 20 years. Agricultural
output--especially of staple products--cannot be sustained in
such circumstances. The prospect of widespread food shortages
and hunger is real. Some 20 percent of rural families in
Burkina Faso are estimated to have reduced their agricultural
work or even abandoned their farms because of AIDS. Rural
households in Thailand are seeing their agricultural output
shrink by half. In 15 percent of these instances, children
are removed from school to take care of ill family members
and to regain lost income. Almost everywhere, the extra
burdens of care and work are deflected onto women--especially
the young and the elderly.
Families often remove girls from school to care for sick
relatives or assume other family responsibilities,
jeopardizing the girls' education and future prospects. In
Swaziland, school enrollment is reported to have fallen by 36
percent due to AIDS, with girls most affected. Enabling young
people--especially girls--to attend school and, hopefully,
complete their education, is essential. South Africa's and
Malawi's universal free primary education systems point the
way. Schemes to provide girls with second-chance schooling
are another option.
Development and stability threatened
Meanwhile, the epidemic is claiming huge numbers of
teachers, doctors, extension workers and other human
resources. In some countries, health-care systems are losing
up to a quarter of their personnel to the epidemic. In Malawi
and Zambia, for example, five-to-six-fold increases in health
worker illness and death rates have reduced personnel,
increasing stress levels and workload for the remaining
employees.
Teachers and students are dying or leaving school, reducing
both the quality and efficiency of educational systems. In
1999 alone, an estimated 860,000 children lost their teachers
to AIDS in sub-Saharan Africa. In the Central African
Republic, AIDS was the cause of 85 percent of the 300 teacher
deaths that occurred in 2000. Already, by the late 1990s, the
toll had forced the closure of more than 100 educational
establishments in that country. In Guatemala, studies have
shown that more than a third of children orphaned by HIV/AIDS
drop out of school. In Zambia, teacher deaths caused by AIDS
are equivalent to about half the total number of new teachers
the country manages to train annually.
Replacing skilled professionals is a top priority,
especially in low-income countries where governments depend
heavily on a small number of policy-makers and managers for
public management and core social services. In heavily
affected countries, losing such personnel reduces capacity,
while raising the costs of recruitment, training, benefits
and replacements. A successful response to AIDS requires that
essential public services, such as education, health,
security, justice and institutions of democratic governance,
be maintained. Each sector has to take account of HIV/AIDS in
its own development plans and introduce measures to sustain
public sector functions. Such actions might include fast-
track training, as well as the recruitment of key civil
servants and the reallocation of budgets towards the most
essential services. Countries that explore innovative ways of
maintaining and rebuilding capacity in government will be
better equipped to contain the epidemic. Equally valuable are
labour and social legislation changes that boost people's
rights, more effective and equitable ways of delivering
social services, and more extensive programmes that benefit
those worst hit by the epidemic (especially women and
orphans).
Coping with crisis
In the worst-affected countries, steep drops in life
expectancies are beginning to occur, most drastically in sub-
Saharan Africa, where four countries (Botswana, Malawi,
Mozambique and Swaziland) now have a life expectancy of less
than 40 years. Were it not for HIV/AIDS, average life
expectancy in sub-Saharan Africa would be approximately 62
years; instead, it is about 47 years. In South Africa, it is
estimated that average life expectancy is only 47 years,
instead of 66, if AIDS were not a factor. And, in Haiti, it
has dropped to 53 years (as opposed to 59).
[[Page H9100]]
The number of African children who had lost their mother or
both parents to the epidemic by the end of 2000--12.1
million--is forecast to more than double over the next
decade. These orphans are especially vulnerable to the
epidemic, and the impoverishment and precariousness it
brings.
As more infants are born HIV-positive in badly affected
countries, child mortality rates are also rising. In the
Bahamas, it is estimated that some 60 percent of deaths among
children under the age of five are due to AIDS, while, in
Zimbabwe, the figure is 70 percent.
Unequal access to affordable treatment and adequate health
services is one of the main factors accounting for
drastically different survival rates among those living with
HIV/AIDS in rich and poor countries and communities. Public
pressure and UN-sponsored engagements with pharmaceutical
corporations (through the Accelerating Access Initiative),
along with competition from generic drug manufacturers, has
helped drive antiretroviral drug prices down. But prices
remain too high for public-sector budgets in low-income
countries where, in addition, health infrastructures are too
frail to bring life-prolonging treatments to the millions who
need it.
Backed by a strong social movement, Brazil's government has
shown that those barriers are not impregnable and that the
use of cheaper drugs can be an important element of a
successful response. Along with Brazil, countries such as
Argentina and Uruguay also guarantee HIV/AIDS patients free
antiretroviral drugs. In Africa, several governments are
launching programmes to provide similar drugs through their
public health system, albeit on a limited scale, at first.
In all such cases, though, clearing the hurdle of high
prices is essential but not enough. Also indispensable are
functioning and affordable health systems. Massive
international support is needed to help countries meet that
challenge.
eastern europe and central asia
HIV incidence is rising faster in this region than anywhere
else in the world. There were an estimated 250,000 new
infections in 2001, raising to 1 million the number of people
living with HIV.
In the Russian Federation, the startling increase in HIV
infections of recent years is continuing, with new reported
diagnoses almost doubling annually since 1998. In 2001, more
than 40,000 new HIV-positive diagnoses were reported in the
first six months. The total number of HIV infections reported
since the epidemic began came to more than 129,000 in June
2001--up from the 10,993 reported for the end of 1998. The
actual number of people now living with HIV in the Russian
Federation is estimated to be many times higher than these
reported figures.
At 1 percent, the adult HIV prevalence rate in Ukraine is
the highest in the region. While injecting drug use is
currently responsible for three-quarters of HIV infections in
Ukraine, the proportion of sexually transmitted HIV
infections is increasing. In Estonia, reported HIV infections
have soared from 12 in 1999 to 1,112 in the first nine months
of 2001. Outbreaks of HIV-related injecting drug use are also
being reported in several Central Asian republics, including
Kazakhstan and, most recently, Kyrgyzstan, Tajikistan and
Uzbekistan.
Given the current evidence, a much larger and more
generalized epidemic is a real threat. However, the epidemic
is still at an early stage in the region and massive
prevention efforts could curtail its scale and extent. Such
efforts would require a comprehensive response to reduce
risky sexual and drug-injecting behaviour among young people,
and tackle the socioeconomic and other factors that promote
the spread of the virus.
In the Russian Federation and other parts of the former
Soviet Union, the vast majority of reported HIV infections
are related to injecting drug use, which has become unusually
widespread among young people, especially young men. An
estimated 1 percent of the population of those countries is
injecting drugs. Given the high odds of transmission through
needle sharing, the fact that the young people are also
sexually active, and the high levels of sexually transmitted
infections in the wider population, a huge epidemic may be
imminent. As well, the male-female ratio among newly detected
HIV cases has narrowed from 4:1 to 2:1, indicating that young
women are increasingly at risk of HIV infection.
Several factors are creating a fertile setting for the
epidemic; mass unemployment and economic insecurity beset
much of the region; social and cultural norms are being
increasingly liberalized; and public health services are
steadily disintegrating.
Reported rates of other sexually transmitted infections are
very high and compound the odds of HIV being transmitted
through unprotected sex. The incidence of syphilis (the
reported number of infections in a given year) in the Russian
Federation in 2000 stood at 157 per 100,000 persons, compared
to 4.2 per 100,000 persons in 1987. Similar general trends
are visible in the Baltic States, Belarus, the Central Asian
republics, the Republic of Moldova, and Ukraine.
Unprecedented numbers of young people are not completing
their secondary schooling. With jobs in short supply, many
are at special risk of joining groups of vulnerable
populations, by resorting to injecting drug use and (regular
or occasional) sex work. Among young people in the Russian
Federation, for instance, drug use is almost three times
more prevalent than it was five years ago. Drug use is
steadily becoming a more frequent feature of secondary
school life in many cities. Needle sharing is common
practice among injecting drug users--and a common cause of
HIV transmission. Surveys in some cities in the Russian
Federation show that most sex workers are 17-23 years old
and that condom use in the sex industry is erratic, at
best.
HIV risk is high among men who have sex with men, among
whom multiple partners and unprotected sex are widespread.
While laws penalizing homosexual activities with imprisonment
have been struck off the statute books in the Russian
Federation and in most (though not all) other countries of
the former Soviet Union, men who have sex with men remain
highly stigmatized socially. Currently, there are very few
examples of HIV prevention activities targeting this group.
In south-eastern Europe, rates of sexually transmitted
infections and injecting drug use are also on the rise,
although still at considerably lower levels than elsewhere in
the region. Drug trafficking, along with the economic and
psychological aftermath of recent conflicts, are increasing
the likelihood that HIV epidemics will emerge in this region.
In Central Europe, there is cause for tempered optimism.
There is little indication, at this stage, of a potential
rise in HIV infections. By mounting a strong national
response, the Polish Government has successfully curtailed
the epidemic among injecting drug users and prevented it from
gaining a foothold in the general population. Prevalence
remains low in countries such as the Czech Republic, Hungary
and Slovenia, where well-designed national HIV/AIDS
programmers are in operation.
More than 150 HIV/AIDS prevention projects among injecting
drug users have been set up across the region in the past
five years, along with projects focusing on other vulnerable
populations such as prison inmates, sex workers and men who
have sex with men. Although comparatively few in number, many
of these projects are laying the foundations for larger, more
extensive prevention work.
At the same time, there are signs of growing political
commitment in the region. Following the UN General Assembly
Special Session on HIV/AIDS, countries of the Commonwealth of
Independent States are developing a special declaration on
the epidemic and are preparing a regional work plan to guide
a coordinated response. In countries such as Bulgaria,
Romania, the Russian Federation and Ukraine, the budgets of
national AIDS programmes have increased substantially. The
strong partnerships being forged between the government,
private sector and nongovernmental organizations in Ukraine
are setting a positive example for the rest of the region. In
June 2001, the President of Ukraine declared 2002 the year of
the fight against AIDS.
Vigorous prevention efforts are needed to equip young
people with the knowledge and services (such as HIV/AIDS
information, condom promotion, life-skills training) they
need to protect themselves against the virus. Given that
young people (especially women) are bearing the brunt of the
economic transitions in the region, socioeconomic programmes
that can reduce the vulnerability of young men and women are
also vital.
Special steps are needed to include HIV-related life-skills
education in school curricula and to extend peer education to
vulnerable young people who are in institutions or out of
school and employment. Much more comprehensive efforts are
needed to address the complex issues related to HIV and
injecting drug use among young people.
ASIA AND THE PACIFIC
HIV/AIDS was late coming to Asia. Until the late 1980s, no
country in the region had experienced a major epidemic and,
in 1999, only Cambodia, Myanmar and Thailand had documented
significant nationwide epidemics. This situation is now
rapidly changing. In 2001, 1.07 million adults and children
were newly infected with HIV in Asia and the Pacific,
bringing to 7.1 million the total number of people living
with HIV/AIDS in this region. Of particular concern are the
marked increases registered in some of the world's most
heavily populated countries.
Surveillance data on China's huge population are sketchy,
but the country's health ministry estimates that about
600,000 Chinese were living with HIV/AIDS in 2000. Given the
recently observed rises in reported HIV infections and
infection rates in many sub-populations in several parts of
the country, the total number of people living with HIV/AIDS
in China could well have exceeded one million by late
2001. Reported HIV infections rose by 67.4 percent in the
first six months of 2001, compared with the previous year,
according to the country's ministry of health. Increasing
evidence has emerged of serious epidemics in Henan
Province in central China, where many tens of thousands
(and possibly more) of rural villages have become infected
since the early 1990s by selling their blood to collecting
centres that did not follow basic blood donation safety
procedures.
HIV levels in specific groups are known to be rising in
several other areas. Seven Chinese provinces were
experiencing serious labor HIV epidemics in 2001, with
prevalence higher than 70 percent among injecting drug
[[Page H9101]]
users in a number of areas, such as Yili Prefecture in
Xinjiang and Ruili Country in Yunnan. Another nine provinces
are possibly on the brink of HIV epidemics among injecting
drug users because of very high rates of needle sharing.
There are also signs of heterosexually transmitted HIV
epidemics in at least three provinces (Yunnan, Guangxi and
Guangdong), with HIV rates reaching 4.6 percent (up from 1.6
percent in 1999) in Yunnan and 10.7 percent in Guangxi (up
from 6 percent) among sentinel sex worker populations in
2000.
Vast and populous India faces similar challenges. At the
end of 2000, the national adult HIV prevalence rate was under
1 percent, yet this meant that an estimated 3.86 million
Indians were living with HIV/AIDS--more than in any other
country besides South Africa. Indeed, median HIV prevalence
among women attending antenatal clinics was higher than 2
percent in Andhra Pradesh and exceeded 1 percent in five
other states (Karnataka, Maharashtra, Manipur, Nagaland and
Tamil Nadu) and in several major cities (including Bangalore,
Chennai, Hyderabad and Mumbai). India's epidemic is also
strikingly diverse, both among and within states.
Indonesia--the world's fourth-most populous country--offers
an example of how suddenly a HIV/AIDS epidemic can emerge.
After more than a decade of negligible rates of HIV, the
country is now seeing infection rates increase rapidly among
injecting drug users and sex workers, in some places, along
with an exponential rise in infection among blood donors (an
indication of HIV spread in the population at large). HIV
infection in injection drug users was not considered worth
measuring until 1999/2000, when it had already reached 15
percent. Within another year, 40 percent of injectors in
treatment in Jakarta were already infected. In Bogor, in West
Java Province, 25 percent of injecting drug users tested were
HIV-infected, while among drug-using prisoners tested in
Bali, prevalence was 53 percent.
Behaviours that bring the highest risk of infection in Asia
and the Pacific are unprotected sex between clients and sex
workers, needle sharing and unprotected sex between men. But
infections do not remain confined to those with higher-risk
behaviour. Many countries have been major epidemics grow out
of initially relatively contained rates of infection in these
populations. Northern Thailand's epidemic in the late 1980's
and early 1990s was primed in this way. Over 10 percent of
young men became infected before strong national and local
prevention efforts, including the ``100 percent programme'',
reduced high-risk behaviour, encouraged safer sex and lowered
HIV prevalence.
Commercial sex provides the virus with considerable scope
for growth. The limited national behavioural data collected
in the region to date show that, over the past decade, the
percentage of surveyed adult men who reported having visited
a sex worker in a given year ranged from 5 percent in some
countries to 20 percent in others. India and Viet Nam are
countries where levels of infection among clients and sex
workers are rising. In Ho Chi Minh City, the percentage of
sex workers with HIV has risen sharply since 1998, reaching
more than 20 percent by 2000.
Few countries are acting vigorously enough to protect sex
workers and clients from the HIV virus. Yet, it is from the
comparatively small pool of sex workers first infected by
their clients that HIV steadily enters the larger pool of
still-uninfected clients who eventually transmit the virus to
their wives and partners. Although recent behaviour
surveillance surveys show that, in 11 out of 15 Asian
countries and Indian states, over two-thirds of sex workers
report using a condom with their last client, the need to
boost condom use remains. In Bangladesh, Indonesia, Nepal and
the Philippines, for instance, fewer than half of sex workers
report using condoms with every client.
Sharing injecting equipment is a very efficient way of
spreading HIV, making prevention programmes among injecting
drug user populations another top priority. Upwards of 50
percent of injecting drug users have acquired the virus in
Myanmar, Nepal, Thailand, China's Yunnan Province and Manipur
in India. Recent surveys show that a third of injecting drug
users in Viet Nam said they recently shared needles with
other users, while 55 percent of male injecting drug users in
northern Bangladesh and 75 percent in the central region
report sharing injecting equipment at least once in the week
prior to being questioned.
Extensive harm reduction programmes can and do work. By the
1980s, Australia had prevented a major epidemic from
occurring among injecting drug users and, quite likely, from
spreading beyond them. Such examples are being followed by
several other countries, but in an isolated fashion. The
SHAKTI Project in Dhaka, Bangladesh, offers injecting drug
users needle exchange, safer injecting options and safer sex
education, as well as condoms. IKHLAS, in the Malaysian
capital of Kuala Lumpur, provides peer support services, but
the estimated 5000 injecting drug users reached are only a
fraction of the country's drug-injecting population.
The need to expand such programmes nationally is patent is
these concentrated epidemics are to be brought under control
before they spill into the wider population. Many injecting
drug users are sexually active young men. Many have steady
partners; others buy sex. The overlap between injecting drug
use and buying sex is striking. In some Vietnamese cities, 17
percent of male injecting drug users reported having recently
bought unprotected sex. Between half and three-quarters of
male injecting drug users in several cities of Bangladesh
have reported buying sex from women during the past year,
with fewer than one-quarter of them saying they had used a
condom the last time they paid for sex. There also is
increasing evidence of female sex workers taking up injecting
drug use in Viet Nam.
Some self-identified ``gay'' communities exist throughout
the region but, in most of Asia, many additional categories
of men engage in same-sex intercourse. Many men who prefer
sex with men also have sex with women. Indeed, many marry and
raise families. This creates a huge potential for men who
have unprotected sex with men to act as ``bridges'' for the
virus in the wider population. In Cambodia, for instance,
some 40 percent of men who have sex with men reported also
having had sex with women in the month prior to being
surveyed.
At the same time, there is ample evidence that early,
large-scale and focused prevention programmes, which include
efforts directed at both those with higher-risk behavior and
the broader population, can keep infection rates lower in
specific groups and reduce the risk of extensive HIV spread
among the wider population. Cambodia's prevention measures,
which began in earnest in 1994-95, saw high-risk behavior
among men fall and condom use rise consistently in the late
1990s. As a consequence, HIV prevalence among pregnant women
declined from 3.2 percent in 1997 to 2.3 percent at the end
of 2000, suggesting that the country is beginning to bring
its epidemic under control.
Thailand's well-funded, politically-supported and
comprehensive prevention programmes, which accelerated in the
early 1990s have trimmed annual new HIV infections to about
30,000, from a high of 140,000 a decade ago. Although an
estimated 700,000 Thais are living with HIV today, Thailand's
prevention efforts probably averted millions of HIV
infections. Nonetheless, one-in-60 Thais in this country of
62 million people is infected with HIV, and AIDS has become
the leading cause of death, despite the country's prevention
successes. There are indications that transmission between
spouses is now responsible for more than half of new
infections--a reminder that mainly targeting high-risk groups
is inadequate, and that countries need to carefully track
patterns of HIV spread and adapt their responses accordingly.
Furthermore, ongoing high rates of HIV infection through
needle sharing in Thailand highlight the need to sustain
prevention efforts as the epidemic evolves.
In large parts of Asia and the Pacific, prevention
programmes are poorly funded and resourced. Typically, small
projects are scattered across countries and do not acquire
the scale or coherence that is needed to halt the epidemic's
spread. Because many high-risk practices are frowned upon and
even criminalized, there are serious political hurdles to
prevention.
SUB-SAHARAN AFRICA
Sub-Saharan Africa remains the region most severely
affected by HIV/AIDS. Approximately 3.4 million new
infections occurred in 2001, bringing to 28.1 million the
total number of people living with HIV/AIDS in this region.
The region is experiencing diverse epidemics in terms of
scale and maturity. HIV prevalence rates have risen to
alarming levels in parts of southern Africa, where the most
recent antenatal clinic data reveal levels of more than 30
percent in several areas. In Swaziland, HIV prevalence among
pregnant women attending antenatal clinics in 2000 ranged
from 32.3 percent in urban areas to 34.5 percent in rural
areas; in Botswana, the corresponding figures were 43.9
percent and 35.5 percent. In South Africa's KwaZulu-Natal
Province, the figure stood at 36.2 percent in 2000.
At least 10 percent of those aged 15-49 are infected in 16
African countries, including several in southern Africa,
where at least 20 percent are infected. Countries across the
region are expanding and upgrading their responses. But the
high prevalence rates mean that even exceptional success on
the prevention front will now only gradually reduce the human
toll. It is estimated that 2.3 million Africans died of AIDS
in 2001.
This notwithstanding, in some of the most heavily affected
countries there is growing evidence that prevention efforts
are bearing fruit. One new study in Zambia shows urban men
and women reporting less sexual activity, fewer multiple
partners and more consistent use of condoms. This is in line
with earlier indications that HIV prevalence is declining
among urban residents in Zambia, especially among young women
aged 15-24.
According to the South African Ministry of Health, HIV
prevalence among pregnant women attending antenatal clinics
reached 24.5 percent in 2000. About one-in-nine South
Africans (or 4.7 million people) are living with HIV/AIDS.
Yet, there are possibly heartening signs that positive trends
might be increasingly taking hold among adolescents, for whom
prevalence rates have dropped slightly since 1998. Large-
scale information campaigns and condom distribution
programmes appear to be bearing fruit. In South Africa, for
instance, free male condom distribution rose from 6 million
in 1994 to 198 million five years later. In recent surveys,
approximately 55 percent of sexually active teenage girls
reported that they always use a condom during sex. But these
[[Page H9102]]
developments are accompanied by a troubling rise in
prevalence among South Africans aged 20-34, highlighting the
need for greater prevention efforts targeted at older age
groups, and tailored to their realities and concerns.
Progress is also being made on the treatment and care
front. In the southern African region, relatively prosperous
Botswana has become the first country to begin providing
antiretroviral drugs through its public health system, thanks
to a bigger health budget and drug price reductions
negotiated with pharmaceutical companies.
Within the context of a public/private partnership between
five research-and-development pharmaceutical companies and
five United Nations agencies, there is increasing access to
antiretroviral therapy in Africa. As of the end of 2001, more
than 10 African countries were providing antiretroviral
therapy to people living with HIV/AIDS.
In five West African countries--Burkina Faso, Cameroon,
Cote d'Ivoire, Nigeria and Togo--national adult prevalence
rates already passed the 5 percent mark in 2000. Countries
such as Nigeria are boosting their spending on HIV/AIDS and
extending their responses nationwide. This year, Nigeria
launched a US $240-million HIV/AIDS Emergency Action Plan.
Determined prevention efforts in Senegal continue to bear
fruit, thanks to the prompt political support for its
programmes.
On the eastern side of the continent, the downward arc in
prevalence rates continues in Uganda--the first African
country to have subdued a major HIV/AIDS epidemic. HIV
prevalence in pregnant women in urban areas has fallen for
eight years in a row, from a high of 29.5 percent in 1992 to
11.25 percent in 2000. Focusing heavily on information,
education and communication, and decentralized programmes
that reach down to village level, Uganda's efforts have also
boosted condom use across the country. In the Masindi and
Pallisa districts, for instance, condom use with casual
partners in 1997--2000 rose from 42 percent and 31 percent,
respectively, to 51 percent and 53 percent. In the capital,
Kampala, almost 98 percent of sex workers surveyed in 2000
said they had used a condom the last time they had sex.
But despite such success, huge challenges remain. New
infections continue to occur at a high rate. Most people with
HIV do not have access to antiretroviral therapy. Already, by
the end of 1999, 1.7 million children had lost a mother or
both parents to the disease. Providing them with food,
housing and education will test the resources and resolve of
the country for many years to come.
Uganda's experience underlines the fact that even a rampant
HIV/AIDS epidemic can be brought under control. The axis of
any effective response is a prevention strategy that draws on
the explicit and strong commitment of leaders at all levels,
that is built on community mobilization, and that extends
into every area of the country.
Although they are exceptionally vulnerable to the epidemic,
millions of young African women are dangerously ignorant
about HIV/AIDS. According to UNICEF, more than 70 percent of
adolescent girls (aged 15-19) in Somalia and more than 40
percent in Guinea Bissau and Sierra Leone, for instance, have
never heard of AIDS. In countries such as Kenya and the
United Republic of Tanzania, more than 40 percent of
adolescent girls harbor serious misconceptions about how the
virus is transmitted. One of the targets fixed at the UN
General Assembly Special Session on HIV/AIDS in June 2001 was
to ensure that at least 90 percent of young men and women
should, by 2005, have the information, education and services
they need to defend themselves against HIV infection. As in
other regions of the world, most countries in sub-Saharan
Africa are a considerable way from fulfilling that pledge.
The vast majority of Africans living with HIV do not know
they have acquired the virus. One study has found that 50
percent of adult Tanzanian women know where they could be
tested for HIV, yet only 6 percent have been tested. In
Zimbabwe, only 11 percent of adult women have been tested for
the virus. Moreover, many people who agree to be tested
prefer not to return and discover the outcome of those tests.
However, other obstacles remain. A study in Abidjan, Cote
d'Ivoire, shows that 80 percent of pregnant women who agree
to undergo a HIV test return to collect their results. But of
those who discover they are living with the virus, fewer than
50 percent return to receive drug treatment for the
prevention of mother-to-child transmission of the virus.
More than half of the women who know they have acquired
HIV, and who were surveyed by Kenya's Population Council this
year, said they had not disclosed their HIV status to their
partners because they feared it would expose them to violence
or abandonment. Not only are voluntary counselling and
testing services in short supply across the region, but
stigma and discrimination continue to discourage people from
discovering their HIV status.
Accumulating over the past year have been many encouraging
developments. Thirty-one countries in the region have now
completed a national HIV/AIDS strategic plan and another 12
are developing such a plan. Several regional initiatives to
roll back the epidemic are under way. Some, such as those
grouping countries in the Great Lakes region, the Lake Chad
Basin and West Africa, are concentrating their efforts on
reducing the vulnerability of refugee and other mobile
populations. The political commitment to turn the tide of
AIDS appears stronger than ever. Gatherings such as the 200
African Development Forum meeting last December, and the
Organization of African Unity Summit HIV/AIDS, Tuberculosis
and Other Related Infectious Diseases in April 2001, appear
to be cementing that resolve. At the latter meeting, Heads of
State agreed to devote at least 15 percent of their
countries' annual budgets to improving health sectors. Fewer
than five countries had reached that level in 2000.
AIDS has become the biggest threat to the continent's
development and its quest to bring about an African
Renaissance. Most governments in sub-Saharan Africa depend on
a small number of highly skilled personnel in important areas
of public management and core social services. Badly affected
countries are losing many of these valuable civil servants to
AIDS. Essential services are being depleted at the same time
as state institutions and resources come under greater strain
and traditional safety nets disintegrate. In some countries,
health-care systems are losing up to a quarter of their
personnel to the epidemic. People at all income levels are
vulnerable to these repercussions, but those living in
poverty are hit hardest. Meanwhile, the ability of the state
to ensure law and order is being compromised, as the epidemic
disrupts institutions such as the courts and the police. The
risks of social unrest and even socio-political instability
should not be underestimated.
the middle east and north africa
In the countries of the Middle East and North Africa, the
visible trend is also towards increasing HIV infection rates,
though still at very low levels. Existing surveillance
systems remain inadequate, but it is estimated that 80,000
people acquired the virus in 2001, bringing to 440,000 the
number of people living with HIV/AIDS. The need for early,
effective prevention is becoming manifest throughout this
region.
Unfortunately, factors driving the epidemic are still too
seldom systematically analysed in most countries in the
region. As a result, HIV/AIDS responses are rarely based on a
clear understanding of infection patterns or knowledge of
particular high-risk groups.
Based on current knowledge, however, factors putting people
at risk are varied, though sexual intercourse remains the
dominant route of transmission. A local study in Algeria has
revealed prevalence rates of 1 percent among pregnant women.
Outbreaks now appear to be occurring elsewhere, including in
the Libyan Arab Jamahiriya, where all but a fraction of the
570 new HIV infections reported in 2000 were among drug
users. Djibouti and the Sudan are facing growing epidemics
that are being driven by combinations of socioeconomic
disparities, large-scale population mobility and political
instability.
The rate of HIV infection is increasing significantly in
other vulnerable groups. Among prisoners in the Islamic
Republic of Iran, rates of HIV infection have risen from 1.37
percent in 1999 to 2.28 percent in 2000. Besides the Sudan
and the Republic of Yemen, all countries in the region have
reported HIV transmission through injecting drug use. Unless
addressed promptly through harm reduction and other
prevention approaches, the epidemic among these
subpopulations of injecting drug users could grow
dramatically and spread into the wider population.
There are also signs that the double disease burden of HIV
and tuberculosis is growing in some countries. Rates of HIV
infection among tuberculosis patients are rising and, by mid-
2001, stood at 8 percent in the Sudan, 4.8 percent in Oman,
4.2 percent in the Islamic Republic of Iran and 2.1 percent
in Pakistan.
At the same time, the political will to mount a more potent
response to the epidemic is visible in several countries,
some of which are introducing innovative approaches. Examples
include the mobilization of nongovernmental organizations
around prevention programmes in Lebanon, and harm reduction
work among injecting drug users in the Islamic Republic of
Iran.
HIGH-INCOME COUNTRIES
Unless averted with renewed and more effective prevention
efforts, resurgent epidemics will continue to threaten high-
income countries, where over 75,000 people became infected
with HIV in 2001.
In Australia, Canada, the United States of America (USA)
and countries of Western Europe, a pronounced rise in unsafe
sex is triggering higher rates of sexually transmitted
infections and, in some cases, higher levels of HIV incidence
among men who have sex with men. The prospect of rebounding
HIV/AIDS epidemics looms as a result of widespread public
complacency and stalled, sometimes inappropriate, prevention
efforts that do not reflect changes in the epidemic. In
Japan, meanwhile, HIV infections are also on the rise.
The rise in new HIV infections among men who have sex with
men is striking. In Vancouver, Canada, HIV incidence among
young men who have sex with men rose from an average of 0.6
percent in 1995-1999 to 3.7 percent in 2000. In London,
United Kingdom, reported HIV infections among gay men are
also on the rise. In Madrid, reported HIV infections rose
almost twofold (from 1.16 percent to 2.16 percent in 1996-
2000, whereas, in San Francisco, it rose from 1.1 percent in
1997 to 1.7 percent in 2000 and appears to be rising still,
according to recent studies. Among gay men
[[Page H9103]]
who inject drugs in that city, the infection rate climbed
from 2 percent in 1997 to 4.6 percent in 2000.
Rising incidence of other sexually transmitted infections
among men who have sex with men (in Amsterdam, Sydney, London
and southern California, for instance) confirms that more
widespread risk-taking is eclipsing the safer-sex ethic
promoted so effectively for much of the 1980s and 1990s.
Similar trends are being detected among the heterosexual
populations of some countries, especially among young people.
Diagnoses of gonorrhea and syphilis among men and women have
hit their highest levels for 13 years in England and Wales,
for instance.
Part of the explanation could lie in the visibly life-
saving effects of antiretroviral therapy, introduced in high-
income countries in 1996. Deaths attributed to HIV in the
USA, for instance, fell by a remarkable 42 percent in 1996-
97, since the decline has levelled off. However, this wide
access to antiretroviral therapy has encouraged
misperceptions that there is now a cure for AIDS and that
unprotected sex poses a less daunting risk. High-risk
behaviour is increasing, as a result.
Prevention efforts, as well as treatment and care
strategies, have to contend with other, significant shifts in
the epidemic, such as its slow but apparently inexorable
shift towards other vulnerable populations. At play appears
to be an overlap of racial discrimination with income,
health and other inequalities. In high-income countries
there is evidence that HIV is moving into poorer and more
deprived communities, with women at particular risk of
infection. Young adults belonging to ethnic minorities
(including men who have sex with men) face considerably
greater risks of infection than they did five years ago in
the USA. African-Americans, for instance, make up only 12
percent of the population of the USA, but constituted 47
percent of AIDS cases reported there in 2000. As elsewhere
in the world, young disadvantaged women (especially
African-American and Hispanic women) in the USA are being
infected with HIV at higher rates and at younger ages than
their male counterparts.
In the USA, men having sex with men is still the main mode
of transmission (accounting for some 53 percent of new HIV
infections in 2000), but almost one-third of new HIV-positive
diagnoses were among women in 2000. In this latter group, an
overlap of injecting drug use and heterosexual intercourse
appears to be driving the epidemic. Indeed, injecting drug
use has become a more prominent route of HIV infection in the
USA, where an estimated 30 percent of new reported AIDS cases
are related to this mode of transmission. In Canada, women
now represent 24 percent of new HIV infections, compared to
8.5 percent in 1995.
The HIV epidemic in western and central Europe is the
result of a multitude of epidemics that differ in terms of
their timing, their scale and the populations they affect.
Portugal faces a serious epidemic among injecting drug users.
Of the 3733 new HIV infections reported there in 2000, more
than half were caused by injecting drug use and just under a
third occurred via heterosexual intercourse. Reports of new
HIV infections also indicate that sex between men is an
important transmission route in several countries, including
Germany, Greece and the United Kingdom. Unfortunately, HIV
reporting data are uneven in several of the more affected
countries, including some of those believed to be most
affected by the epidemic among injecting drug users.
In Japan, the number of HIV infections detected in men who
have sex with men has risen sharply in recent years, with
male-male sex now accounting for more than twice as many
infections in men as heterosexual sex. This is a major
departure from past patterns: until two years ago, the number
of new infections reported in both groups was roughly equal.
There are also signs that the sexual behavior of youth in
Japan could be changing significantly and putting this group
at greater risk of HIV infection. Higher rates of Chlamydia
among females and gonorrhoea infections among males, as well
as a doubling of the number of induced abortions among
teenage women in the past five years, suggest increased rates
of unprotected sexual intercourse. Behavioral data,
meanwhile, show low condom use, both in the general
population and among sex workers.
LATIN AMERICA AND THE CARIBBEAN
Major differences in epidemic levels and patterns of HIV
transmission are evident in Latin America and the Caribbean,
where an estimated 1.8 million adults and children are living
with HIV--including the 190,000 people who acquired the virus
in the past year. Some 1.4 million people are living with
HIV/AIDS in Latin America and 420,000 in the Caribbean.
In Central America and the Caribbean, HIV is mainly
heterosexually transmitted, with unsafe sex and frequent
partner exchange among young people high among the factors
driving the epidemic. Other powerful dynamics are abetting
the spread of HIV, notably the combination of socioeconomic
pressures and high population mobility (including tourism).
The Caribbean is the second-most affected region in the
world, with adult HIV prevalence rates only exceeded by those
of sub-Saharan Africa. In several Caribbean countries, HIV/
AIDS has become a leading cause of death. Worst affected are
Haiti and the Bahamas, where adult HIV prevalence rates are
above 4 percent. But the epidemic is by no means concentrated
only in the Caribbean.
Along with Barbados and the Dominican Republic, several
Central American and Caribbean countries had adult HIV
prevalence rates of at least 1 percent at the end of 1999,
including Belize, Guyana, Honduras, Panama and Suriname. By
contrast, prevalence is lowest in Bolivia, Ecuador and other
Andean countries. Almost three-quarters of AIDS cases
reported in Central America are the result of sex between men
and women. On some Caribbean islands, the phenomenon of young
women having sex with older men is especially prominent,
and is reflected in the fact that the HIV rate among girls
aged 15-19 is up to five times that of boys in the same
age group. Research among sex workers in Guyana's capital,
Georgetown, has found that 46 percent of surveyed sex
workers were living with HIV/AIDS, that more than one-
third of them never used a condom with their clients, and
that almost three-quarters did not use condoms with their
regular partners. The probability of the virus passing
into the wider population is therefore high.
In Costa Rica, Mexico, Nicaragua and parts of the Andean
region, sex between men is the more prominent route of HIV
transmission. Recent studies among men who have sex with men
in Mexico have shown that just over 14 percent were HIV-
positive. Prevalence rates among heterosexual sex workers and
sexually transmitted infection patients in Mexico, meanwhile,
appear still to be low. Injecting drug use is a main route of
HIV transmission in Argentina, Chile and Uruguay, and also
plays a major role in Brazil. Patterns of transmission can
also differ markedly within countries--a reminder that
universal national programmes are inappropriate. In
Colombia's highlands, for instance, unprotected sex between
men accounts for most HIV infections, while, on the coast,
heterosexual intercourse is the main route of transmission.
Countries' commitment to stem the epidemic and limit its
effects has grown markedly. Several countries have launched
or are developing government programmes to distribute
antiretroviral drugs to HIV/AIDS patients. But there are wide
disparities in the quality and scope of different countries'
antiretroviral treatment programmes. The wide access to
treatment that people living with HIV/AIDS have in countries
such as Argentina, Brazil and Uruguay is not yet matched in
most other countries of the Americas. Up to recently, Central
America experienced a large gap in access to treatment. Now,
however, countries such as Costa Rica and Panama are
providing treatment access. Caribbean countries are currently
developing a regional strategy to speed up and expand access
to treatment and care for people living with HIV/AIDS.
Countries such as Barbados and Trinidad and Tobago are
preparing to implement new national programmes.
In Brazil, a substantial decline in HIV prevalence among
injecting drug users has been observed recently in several
large metropolitan areas. This suggests that HIV/AIDS
prevention and harm reduction programmes in those cities have
made possible safer injection habits among these populations.
Brazil's prevention efforts are being balanced with an
extensive treatment and care programme that guarantees state-
funded antiretroviral therapy for those living with HIV/AIDS.
The number of people living with the virus in Brazil has
reached about 600,000, according to the country's Health
Ministry--up from 540,000 in 1999. An estimated 105,000
Brazilians are receiving antiretrovial drugs through the
public health system.
A new political resolve is also apparent in several
regional initiatives. Launched in February 2001, the Pan-
Caribbean Partnership against HIV/AIDS, for instance, links
the resources of governments and the international community
with those of civil society to boost national and regional
responses. It is being coordinated by the Caribbean Community
Secretariat (CARICOM). On the basis of the Nassau Declaration
issued in July 2001, as follow-up to the UN General Assembly
Special Session on HIV/AIDS, Caribbean Heads of Government
are also devising ways to support each other's national HIV/
AIDS programmes and jointly negotiate affordable prices for
antiretrovial drugs.
Meanwhile, protecting vulnerable populations on the move is
now the focus of a regional initiative in Central America.
Argentina, Chile, Paraguay and Uruguay are collaborating in
harm-reduction schemes for injecting drugs users. National
AIDS programmes have also joined a collaborative scheme to
share technical assistance throughout Latin America and the
Caribbean. Known as the Horizontal Technical Cooperation
Group, it brings together more than 20 countries of the
region.
explanatory note about unaids/who estimates
The UNAIDS/WHO estimates in this document are based on the
most recent available data on the spread of HIV in countries
around the world. They are provisional. UNAIDS and WHO,
together with experts from national AIDS programmes and
research institutions, regularly review and update the
estimates as improved knowledge about the epidemic becomes
available, while also drawing on advances made in the methods
for deriving estimates.
The estimates and data provided in the graphs and tables
are given in rounded numbers. However, unrounded numbers were
used
[[Page H9104]]
in the calculation of rates and regional totals, so there may
be small discrepancies between the global totals and the sum
of the regional figures.
In 2001, new software was developed to model the course of
HIV/AIDS around the world and to further enhance the quality
of estimates of HIV/AIDS prevalence and impact. As a result,
this year's estimates incorporate, in particular, new
knowledge and assumptions about survival times for adults and
children living with HIV/AIDS. Because of this, some of the
new estimates cannot be compared directly with estimates from
previous years.
UNAIDS and WHO will continue to work with countries,
partner organizations and experts to improve data collection.
These efforts will ensure that the best possible estimates
are available to assist governments, nongovernmental
organizations and others in gauging the status of the
epidemic and monitoring the effectiveness of their
considerable prevention and care efforts.
HIV/AIDS accounts for 70 percent of all cases of AIDS worldwide.
Since its inception, more than 58 million individuals have been
infected with HIV/AIDS, while 22 million have lost their lives, 17
million alone in sub-Saharan Africa. It is clearly the leading cause of
death in sub-Saharan Africa. Further, 90 percent of the world's orphans
reside in this region.
Given the loss of life AIDS has caused, the destruction of entire
communities, and the long-term impact of economic growth, we must step
up our efforts to fight this devastating disease. I have worked with
the officials in Botswana who are struggling to combat the impact of
HIV on their young adults, their most productive sector of their
community. Therefore, we must do all we can.
I want to commend all involved and ask that we not only pass this
bill, but do other things to fight this global pandemic.
Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the
distinguished gentleman from Iowa (Mr. Leach).
Mr. LEACH. Madam Speaker, I thank the gentleman for yielding time to
me.
Let me first express my appreciation for the leadership of the
gentleman from Illinois (Chairman Hyde), the gentleman from California
(Mr. Lantos), the gentleman from Nebraska (Mr. Bereuter), and of course
the gentlewoman from California (Ms. Lee) on this issue.
There should be no doubt that the United States confronts two wars
simultaneously. One is the war on terrorism, waged with the scourge of
biological weapons. The other is war on the devastating disease that is
pandemic in so many poor parts of the world.
Einstein once said that splitting the atom has changed everything
save our mode of thinking. Atom-splitting produced the potential for
great good through nuclear energy, and the potential for great harm
through weapons of mass destruction.
Now, the splitting of genes has come to symbolize an even greater
change: the biological discoveries that promise to enrich and lengthen
life on the one hand, and the possibility of biological weapons on the
other that jeopardize life itself on the planet.
What we must be about is constraining the forces of evil and
expanding the forces of life. We cannot win the war that terrorism has
brought to our shore without waging with equal vigor the war on disease
everywhere that it exists.
Mr. LANTOS. Madam Speaker, I am very pleased to yield 2 minutes to my
dear friend and distinguished colleague, the gentlewoman from
California (Ms. Watson), who served our Nation with great distinction
as a United States ambassador.
Ms. WATSON of California. Madam Speaker, we have already heard the
figures of the number of Africans infected with HIV and AIDS. They are
staggering, but deserve to be repeated once again: sub-Saharan Africa
has only 10 percent of the world's population, but accounts for 70
percent of all HIV/AIDS cases and 80 percent of all HIV/AIDS-related
deaths. The infection rate in some African nations now exceeds 30
percent; and in a few countries, it is approaching 40 percent of the
total population.
Finally, the United States National Intelligence Council estimates
that the disease could reduce the gross domestic product in some sub-
Saharan Africa countries by as much as 20 percent or more by 2010. The
social and economic consequences of this disease are not like any other
public health threat that the world has faced in modern times.
Important and hard-won economic gains made by African nations could be
wiped out in less than a decade. Moreover, social dislocation caused by
the high rates of death among HIV-infected mothers and fathers is
already straining the outer bounds of fragile African nation states.
H.R. 2069, and I commend the sponsors, authorizes additional spending
levels in excess of $1 billion for bilateral and multilateral HIV/AIDS
assistance to African nations that is more in keeping with our
international assistance obligations.
Madam Speaker, the HIV/AIDS pandemic in Africa not only presents us
with a profoundly humanitarian, economic, and social dilemma, it also,
in the very near term, if more is not done, may challenge the very
notion of law-based nation states.
I support this legislation, and I would urge everyone else to do so.
Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the
distinguished gentleman from New Jersey (Mr. Smith).
Mr. SMITH of New Jersey. Madam Speaker, I thank my good friend for
yielding time to me.
Madam Speaker, I rise in strong support of H.R. 2069 and believe the
gentleman from Illinois (Chairman Hyde) deserves special recognition
and thanks for his persistence on behalf of all who are weak and
vulnerable, including AIDS victims.
As my colleagues know, and has been said on the floor today, the
scourge of AIDS around the globe has reached catastrophic proportions,
particularly in sub-Saharan Africa. A December report by U.N. AIDS
indicated that nearly 25.3 million adults and children are infected
with the HIV virus in sub-Saharan Africa. To put this in perspective,
this region has about 10 percent of the world's population, but more
than 70 percent of the HIV/AIDS patients.
Madam Speaker, among the most tragic of the victims are the children
who contact HIV via vertical transmission, from mother to child, during
or shortly after childbirth. Some estimates place the number of
vertical transmission cases at 600,000 babies annually in Africa. Madam
Speaker, vertical transmission is specifically addressed in this bill.
In an age where we already have proven drug regimens and methods to
prevent mother-to-child transmission, and we have had them for sometime
now, Madam Speaker, it is outrageous that so many children around the
world are still contracting HIV/AIDS in this manner. This could be
stopped, and this bill goes a long way to doing so.
I would also point out to my colleagues that during markup I offered
an amendment in the area of hospice and palliative care. Madam Speaker,
unfortunately, today, when people, particularly in Africa, get AIDS,
they are treated as lepers, like we had in Biblical times: People go
nowhere near them, even when they are family members.
Thankfully, there is an effort under way in Africa and elsewhere to
reach out to these people so they can die in dignity, and hopefully
with the least amount of pain as is humanly possible. In South Africa,
the Catholic Church and Catholic Relief Services and others are doing
incredible jobs of networking, of bringing the news that you can take
care of an AIDS patient in your home without the fear of contamination
yourself. There are methods and procedures that need to be followed;
and thankfully, that word is getting out.
Madam Speaker, this legislation does address that and will target
some resources in that direction.
Madam Speaker, this is a great bill. I hope Members will support it,
and congratulations to the gentleman from Illinois (Chairman Hyde).
Mr. LANTOS. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, again I want to thank the gentleman from Illinois
(Chairman Hyde) for his extraordinary leadership. I want to thank all
my colleagues and staff for working on this landmark legislation, and I
urge all of my colleagues to support it.
Madam Speaker, I yield back the balance of my time.
Mr. HYDE. Madam Speaker, I yield myself the balance of my time.
[[Page H9105]]
Madam Speaker, we got an awful lot done in this committee because of
the great cooperation of the gentleman from California (Mr. Lantos) and
his staff; and I deeply appreciate it, particularly on this bill.
Mr. GILMAN. Madam Speaker, I rise in strong support for H.R. 2069,
The Global Access to HIV/AIDS Prevention, Awareness, Education, and
Treatment Act of 2001.
More than 58 million people worldwide are infected with HIV/AIDS
making it more than just a humanitarian issue . . . it has become a
national security, and developmental crisis. It is reported that ninety
five percent of the world's HIV-infected people live in developing
countries. Right next door, infection rates are rising rapidly in Haiti
and the Caribbean, where an estimated 5 percent of the population has
AIDS or is HIV-infected.
Madam Speaker, our nation has only begun to properly tackle AIDS and
HIV infection in our nation. Our friends and neighbors in lesser
developed nations are breaking under the pressure of the destruction
that this terrible disease has brought to bear on them. H.R. 2069 helps
to alleviate some of the suffering and will help to strengthen the
social structures that are crumbling under the weight of the burden of
carrying for so many.
Secretary Powell said it well when he stated that the United States
has an obligation to do more ``if we believe in democracy and freedom
(then we must work) to stop this catastrophe from destroying whole
economies and families and societies and cultures and nations.''
Accordingly, Madam Speaker, I urge my colleagues to support H.R.
2069.
Ms. SCHAKOWSKY. Madam Speaker, I rise in strong support of H.R. 2069,
The Global Access to HIV/AIDS Prevention Act of 2001. I want to commend
and thank the distinguished Chairman (Mr. Hyde) and Ranking Member (Mr.
Lantos) of the International Relations Committee, the authors of this
important legislation for their efforts and for their leadership. I
also want to commend the gentlewoman from California (Ms. Lee) for her
continuing leadership and commitment on this critical issue. The bill
we have before us today is another step in the right direction for the
global struggle against HIV/AIDS.
H.R. 2069 authorizes a total of $1.3 billion for the prevention,
treatment, and monitoring of acquired immune deficiency syndrome (AIDS)
in sub-Saharan Africa and other developing countries. The bill
authorizes $560 million in bilateral assistance for various AIDS
treatment/prevention programs administered by the U.S. Agency for
International Development (AID), and it authorizes a $750 million U.S.
commitment to multilateral efforts to fight the pandemic. The bill also
authorizes $50 million for AIDS drug procurement.
Funds in this measure will be used to cover many of the needs created
by HIV/AIDS. The bill is directed toward prevention, education, testing
and counseling, including strengthening and broadening the capacity of
indigenous health care systems. The bill also includes assistance aimed
at mother-to-child transmission prevention, and strengthening and
expanding hospice and palliative care programs, as well as care for
children orphaned by HIV/AIDS, improved infrastructure, and vaccine
research. Finally, H.R. 2069 includes funds for income generation
programs targeting assistance to HIV/AIDS affected populations,
particularly those groups and individuals who are at the highest risk
of being infected, including women.
I am particularly pleased that this body has recognized the
importance of providing end of life care for those that are losing
their struggle with AIDS and that we have acknowledged the particular
plight that AIDS means for women and children.
We have all heard some of the staggering statistics about AIDS.
However, I believe that at least some of them need to be repeated time
and again until necessary results are achieved.
Since the HIV-AIDS pandemic began, it has claimed over 22 million
lives. Over 17 million men, women and children have died due to AIDS in
sub-Saharan Africa alone. Over 40 million people are infected with the
HIV virus today. Over 25 million of them live in sub-Saharan Africa. By
2010, approximately 40 million children worldwide will have lost one or
both of their parents to HIV-AIDS.
Each day AIDS kills more than 7,000 people in sub-Saharan Africa
alone, and the pandemic continues to escalate in the Caribbean, Asia,
Russia and elsewhere with more than 8,000 people around the world
perishing from AIDS each day. This human catastrophe is unlike anything
the world has known.
While an encouraging symbol of progress, awareness, and compromise,
the funding set forth by this bill alone will not be enough. In order
to satisfy the demands posed by the AIDS pandemic, it has been
estimated that sub-Saharan Africa will need as much as $15 billion a
year.
I want to take this opportunity to include for the Record a
compelling article from the December 6 New York Times. The article goes
a long way toward dispelling the myth that robust drug treatment
programs cannot be implemented in poor developing nations. I agree with
the article that what we can learn from the example of Haiti is that,
``if we do not treat the millions of Africans dying of AIDS, it is
because we have chosen not to, not because we can't.'' Indeed, we can
and should help Africans and all of those struggling against the
scourge of AIDS. The virus knows no bounds and failing to attack it
with every resource at our disposal would not only be morally
reprehensible, it will leave this nation more vulnerable to perhaps the
greatest threat we have ever faced.
Again, I commend all of those who helped to bring this important
measure to the floor and urge all members to vote in support of H.R.
2069.
Learn From Haiti
(By Howard Hiatt)
Of the 28 million people in Africa with AIDS, no more than
25,000 have access to medications. Officials of both Western
nations and some affected countries--like South Africa, which
has millions in immediate need of treatment--have said that
poor countries have too few clinics and doctors and that
their populations are too poorly educated to allow treatment
of all infected people. This contention has become familiar
in the debate over international financing to treat H.I.V.
But it is a misconception. At a health center in Haiti, a
country at the very bottom of the economic heap, H.I.V.
infections are controlled as effectively as in America. And
the success at this health center, sponsored by Partners in
Health, a non-profit charity affiliated with Harvard Medical
School, could be replicated all over the world if the wealthy
nations chose to provide the financing. The barrier to the
use of AIDS drugs for all H.I.V. patients is not some
physical or educational impossibility; it is lack of will.
The center is in Cange, an impoverished village of small
houses with corrugated roofs and dirt floors. There and
nearby, care is delivered with skill and personal attention
comparable to that in American teaching hospitals.
The compound was begun in 1983 by Paul Farmer, a physician
and anthropologist now at Harvard Medical School, and the
Rev. Fritz Lafontant, a Haitian Episcopal priest. Working
with Dr. Farmer and Jim Yong Kim, another American physician-
anthropologist, are Haitian doctors and nurses and about 200
community health workers, who make this model of health care
succeed.
About 1,400 of the patients have H.I.V.; of these, 100 of
the sickest receive the advanced medicines used to treat AIDS
in the United States and now function normally. Their care is
supervised by the local health workers, who are trained at
the clinic. The health center's operations are financed by
donations, and the doctors will treat another 100 desperately
ill patients with the AIDS drugs if they can persuade drug
companies to donate them.
Partners in Health also applies the principles used in
Cange at a center in Peru and one in Mexico. In each case,
training community health workers allows the development of a
system that can offer sustained treatment for people ill with
hard-to-cure diseases. The center in Lima has cured more than
80 percent of patients with drug-resistant tuberculosis--
something many tuberculosis experts and even the World Health
Organization had thought impossible.
What these doctors do to treat H.I.V. infection is a small
effort against a huge worldwide problem. But they have shown
that if we do not treat the millions of Africans who are
dying of AIDS, it is because we have chosen not to, not
because we can't.
Mrs. CHRISTENSEN. Madam Speaker, I rise in support of H.R. 2069, the
Global Access to HIV/AIDS Prevention, Awareness, Education and
Treatment Act of 2001 and I commend my colleagues Chairman Hyde,
Ranking Member Lantos and my friend Congresswoman Barbara Lee for their
work in bringing this bill to the floor today.
Madam Speaker, H.R. 2069 is badly needed, and my only regret is that
we didn't pass it sooner. Just 10 days ago we celebrated World Aids Day
to call attention to the global scourge of HIV/AIDS which has, to date,
claimed an estimated four million children world wide and the news gets
worse, every day. Everyday AIDS kills more than 7,000 people in sub-
Saharan Africa. The AIDS pandemic continues to escalate in the
Caribbean, Asia, and Russia and according to today's New York Times;
the Chinese central government is taking steps to address its growing
AIDS problem. This pandemic is now projected to infect over 100 million
people with a deadly incurable virus by 2007.
We must realize that we are no longer a world where any one country,
or even one neighborhood can labor under the impression that they are
isolated. The devastation and the disruptive effects of the HIV/AIDS
pandemic may be at its very worse in far away, exotic lands but the
dire effects will ripple until they reach our shores.
The Global Access to HIV/AIDS Prevention, Awareness, Education and
Treatment Act of 2001 is a step in the right direction in this regard,
because it urges the United States and
[[Page H9106]]
other developed countries to provide assistance to sub-Saharan Africa
and other developing countries, with respect to activities supported in
connection with health programs, to control the HIV/AIDS pandemic
through HIV/AIDS prevention, treatment, monitoring and related
activities, particularly focused on women and youth--including mother-
to-child transmission prevention strategies.
I urge my colleagues to support this important and badly need bill.
Ms. JACKSON-LEE of Texas. Madam Speaker, I rise in strong support of
H.R. 2069, the Global Access to HIV/AIDS Prevention, Awareness,
Education and Treatment Act of 2001. This bill authorizes assistance to
combat the HIV/AIDS pandemic in countries in sub-Saharan Africa and
other developing countries. This pandemic is more than an international
public health issue, but also a humanitarian, national security, and
development crisis.
Sub-Saharan Africa has been the hardest hit region and has been
disproportionately affected by the deadly disease. Only 10 percent of
the world's population live south of the Sahara, but the region is home
to two-thirds of the world's HIV-positive suffering people, accounting
for more than 80 percent of all AIDS deaths. In fact, Botswana has an
estimated infection rate of 36 percent the highest in the world.
Zimbabwe's infection rate is 25 percent, and South Africa's infection
rate is 20 percent.
Today, forty million people around the world live with and suffer
from HIV/AIDS. Twenty-eight million of them live in the Sub-Saharan
African region alone. On the continent of Africa, there are an
estimated 11,000 new infections per day, and by the end of this year,
approximately 2.3 million Africans will have died from HIV infection.
AIDS does not discriminate against color, and regrettably, it does
not discriminate against age. In Africa, 3.8 million children under the
age of 15 have died since the beginning of the epidemic 20 years ago.
Throughout Africa, 6 out of 7 children who are HIV positive are little
girls. Many children are also being orphaned by HIV; losing their
mothers or both parents to AIDS. So far, the AIDS pandemic has left
behind 13 million orphans, of whom 9 percent currently live in Africa.
By 2010, if we do nothing, an estimated 40 million children will be
orphaned by this tragic disease. These numbers will lead to the
absolute decay of many African societies. As a consequence to losing
their parents, children are drawn into prostitution, crime, substance
abuse, and child soldiery, and to the kind of destitution unbelievable
to most Americans.
Madam Speaker, I traveled to the South African region in 1999 and in
July of this year, and what I witnessed was unbelievable! It was a
life-altering event to see and meet with the people infected by this
deadly virus. But what affected me the most was witnessing the
thousands of orphaned children whose parents had died from AIDS.
On November 28, the Global Health Alliance released a report entitled
``Pay Now or Pay More Later: An Independent Report on the Response to
the Global HIV/AIDS Pandemic''. The following day, the African
Ambassadors Group and International AIDS Trust sponsored a briefing on
Refocusing and Reaffirming our Commitment to AIDS''. This is clearly a
global issue and it is everyone's problem. The key to fighting this
virus must involve a comprehensive approach that includes prevention,
education, and support of a health care infrastructure. H.R. 2069
prescribes such an approach. H.R. 2069 also authorizes funds to improve
orphan care, encourage hospice and palliative care, strengthen existing
health care systems, and to procure medicines and anti-viral therapies
to treat the disease. HIV prevention efforts must take into account
social and economic factors, such as poverty, underemployment, and poor
access to health care, all of which disproportionately affects African
societies.
As Members of Congress, we must continue to fight the struggle and
persist in obtaining increased funding for the global AIDS response.
This is one of the great challenges of our time and of this generation.
H.R. 2069 gives us the tools to help overcome this challenge and I urge
my colleagues to support this legislation.
Mr. HYDE. Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mrs. Biggert). The question is on the motion
offered by the gentleman from Illinois (Mr. Hyde) that the House
suspend the rules and pass the bill, H.R. 2069, as amended.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the bill, as amended, was passed.
The title was amended so as to read:
``A bill to amend the Foreign Assistance Act of 1961 and the Global
AIDS and Tuberculosis Relief Act of 2000 to authorize assistance to
prevent, treat, and monitor HIV/AIDS in sub-Saharan African and
other developing countries.''.
A motion to reconsider was laid on the table.
____________________