[Congressional Record Volume 148, Number 12 (Tuesday, February 12, 2002)]
[Senate]
[Pages S664-S665]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN:
  S. 1936. A bill to address the international HIV/AIDS pandemic; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. DURBIN. Mr. President, I rise to introduce the Global 
Coordination of HIV/AIDS Response Act, known as the Global CARE Act. 
HIV/AIDS is a national security issue, an economic issue, a health and 
safety issue, and most importantly a moral issue. It is for these 
reasons I am proposing comprehensive legislation to address the global 
HIV/AIDS pandemic. This bill will not solve all these problems. But it 
does set the bar where the need is, and it does offer innovative ideas 
to address the global AIDS crisis in a strategic, coordinated, 
accountable manner.
  Since the tragedy of September 11, we have all been focused on 
combating the war on terrorism, and rightfully so. But as we all know, 
perhaps even more clearly since September, fighting and preventing 
terrorism, preparing for and preventing bioterrorist attacks, 
maintaining international stability, and promoting global economic 
cooperation and growth require not only a military and political 
response but also a social and humanitarian effort.
  Today's reality is a world in which geographical borders seem to hold 
less and less significance. As we work to maintain economic prosperity 
and safety in our own Nation, we must face the fact that globalization 
is upon us. This has never been more true than in the case of disease. 
The HIV/AIDS pandemic, tuberculosis and other life threatening 
infectious diseases know no borders. They cannot be prevented by a 
missile defense system. We cannot halt the spread of AIDS with bombing 
raids.
  Whether deliberately spread as a man made bioterrorist threats or a 
naturally occurring, infectious diseases are a pressing national 
security issue. A CIA report last year noted the link between disease 
and political chaos, saying that rampant AIDS, tuberculosis and other 
infectious illnesses were ``likely to aggravate, and in some cases, may 
even provoke, economic decay, social fragmentation and political 
destabilization in the hardest hit countries.''
  The epidemic is not confined to Africa. HIV has reached epidemic 
proportions in India. The World Bank estimates that if effective 
prevention efforts are not implemented immediately and sustained, India 
could have more than 37 million people infected with HIV by the year 
2005. This is roughly equal to the total number of HIV infections in 
the world today. The AIDS epidemic is sweeping across Eastern Europe, 
where HIV infection rates are rising faster in the former Soviet Union 
than anywhere else in the world according to a U.N. Report on AIDS. The 
Baltic nation of Estonia reported 10 times as many new infections last 
year as it did in 1999. In China, the number of people living with AIDS 
now tops one million. This is a moral issue that cannot be ignored.
  The rising rates of infection and the rising death toll are draining 
national budgets and depriving local economies of their workforce. Last 
November United Nations officials predicted that some of the most 
affected African nations could lose more than 20 percent of their Gross 
Domestic Product, GDP, by 2020 because of AIDS. Recent studies by the 
World Health Organization's Commission on Macroeconomics and Health 
show that infections and disease are not only the product of poverty; 
they also create poverty. By investing in health in developing 
countries we can save lives and produce clear and measurable financial 
returns. For example, the Commission reported that well-targeted 
spending of shared among nations in the amount of $66 billion a year by 
2015 could save as many as 8 million lives a year and generate six-fold 
economic benefits, more than $360 billion a year by 2020.
  AIDS is also the single largest contributor to a worldwide resurgence 
in Tuberculosis, TB. The spread of TB in the developing world has a 
direct effect on the health and safety of Americans. Last month, forty-
eight people in Mobile, Alabama, tested positive for exposure to 
tuberculosis, three weeks after a graduate student at Spring Hill 
College died of the disease. The Student, from Nairobi, Kenya, is 
thought to have contracted TB before coming to the U.S. Also last 
month, health officials in Mecklenburg County, North Carolina, 
announced they were treating five people for drug-resistant TB. All 
were immigrants from countries where TB flourishes. Just last week, the 
Centers for Disease Control and Prevention indicated that the number of 
new cases of TB in this country declined in 2000 but the number of 
cases occurring in the foreign-born U.S. population increased. The 
point is clear: we cannot maintain our own safety if we neglect the 
health needs of the developing world.
  For all these reasons--national security, economic stability, public 
health, and our moral obligation, I have introduced the Global CARE 
Act. It is critically important that we demonstrate the political will 
to act on this issue. I think it would be productive for Congress to 
establish clear policy goals and funding targets that represent the 
real need. It is also our job to ensure that there is accountability 
for the money that we appropriate, and that we are able to articulate 
the results of our U.S. investment. It is my hope that by doing this we 
will secure a serious, effective financial commitment that to date has 
been woefully inadequate.
  The Global Coordination of HIV/AIDS Response Act is grounded in the 
principles of leadership and accountability.
  The policy goals I have set forth in this bill are the following: 
better coordination among the myriad of U.S. agencies active in the 
global AIDS fight; a more focused strategic planning initiative that 
makes the best use of U.S bilateral assistance; increased 
accountability for the health and policy objectives we seek to achieve 
with our financial and human investment in AIDS-ravaged countries; the 
ability to mobilize the most effective human and capacity-building 
tools to provide some of the building blocks that are needed; and a 
clear articulation of the broader issues that need to be addressed to 
have a real impact on HIV/AIDS, including not just prevention but 
treatment and care, and not just health initiatives but also economic 
investments.
  The Global CARE Act provides specific funding authorizations for the 
key agencies working on global AIDS, as well as for the Global Fund. 
Both bilateral and multilateral assistance is needed to address this 
problem. Before the Leadership and Investment in Fighting and Epidemic, 
LIFE, initiative authorized USAID to conduct activities specifically 
focused on global AIDS in FY2000, there was little direction from 
Congress on this issue. And up until the United Nations and President 
Bush specifically requested money for the Global Fund, there was little 
agreement about what was needed. It is now time for Congress to step up 
to the plate and provide some direction.
  The authorized funding levels in the Global CARE Act represent a need 
that

[[Page S665]]

has been well documented. The World Health Organization's 
Marcoeconomics and Health Commission has determined that by 2007, the 
international community--donor and affected countries--should be 
spending $14 billion in response to the AIDS pandemic. Last year, the 
United Nations called for roughly $10 billion annually.
  America has by far the greatest giving capacity, yet we devote the 
smallest percentage of our overall wealth to efforts aimed at 
alleviating global poverty and disease. Last year the United States 
gave one-tenth of 1 percent of its GNP to foreign aid--or $1 for every 
thousand dollars of its wealth, the lowest giving rate of any rich 
nation. By comparison, Canada, Japan, Austria, Australia and Germany 
each gave about one-quarter of 1 percent, of $2.50 for every thousand 
dollars of wealth. Many other countries give even more, at rates 8 to 
10 times higher than the United States. Based on its share of global 
GNP, the United States should contribute at least 25 percent of the 
total AIDS response cost in 2003. Twenty-five percent of the estimated 
$10 billion needed next year would be $2.5 billion. Hundreds of civic 
groups and religious leaders have joined together, calling on Congress 
to provide at least $2.5 billion to combat the pandemic.

  The Global CARE Act establishes broad policy goals and activities 
that are embodied in an international HIV/AIDS Prevention and Capacity 
Building Initiative and an International Care and Treatment Access 
Initiative. These goals and activities, which range from education, 
voluntary testing and counseling, to helping preserve families and 
ameliorate the orphan crisis, are not parceled out to the various 
agencies we know are actively engaged in this issue such as the U.S. 
Agency for International Development (USAID) and the Centers for 
Disease Control and Prevention (CDC). Rather this legislation generally 
relies on the existing authorities of the agencies to carry out these 
broad activities with the requirement that they coordinate their 
activities with each other and with host country needs and host country 
plans.
  The development of a coordinated, effective, and sustained plan for 
U.S. bilateral aid in relation to multilateral aid and other nation's 
bilateral aid is paramount. The U.S. has the opportunity to provide the 
requisite leadership in this global effort though operating 
strategically, and in an accountable and transparent manner.
  To provide an incentive for such coordination, the bill establishes 
an interagency working group charged with ensuring that global HIV/AIDS 
activities are conducted in a coordinated, strategic fashion. Members 
of this working group include agencies within the Department of State, 
specifically USAID; agencies within the Department of Health and Human 
Services, including the Centers for Disease Control and Prevention, the 
Health Resources and Services Administration, and the National 
Institutes of Health; the Department of Defense, Labor, Commerce and 
Agriculture, and the Peace Corps.
  This is policy working group with representatives from the agency 
programs doing the real work. It is my intention that the working group 
help to ensure that the various agencies we fund to provide bi-lateral 
assistance are making the most of the money we appropriate; that they 
are not duplicating efforts; that they are learning from each others' 
programmatic experience and research in order to implement the best 
practices; and that they are accountable to Congress and the American 
people for achieving measurable goals and objectives. In fact, the 
function of this group is very similar to the interagency working group 
established in H.R. 2069--legislation that passed the House of 
Representatives last year.
  The Global CARE Act very specifically directs the working group to 
report back to the Senate Committee on Foreign Relations, the Senate 
Committee on Health, Education, Labor and Pensions, and the Senate 
Appropriations Committee, and the corresponding Committees in the House 
of Representatives, with the following information: 1. The actions 
being taken to coordinate multiple roles and policies, and foster 
collaboration among Federal agencies contributing to the global HIV/
AIDS activities; 2. A description of the respective roles and 
activities of each of the working group member agencies; 3. A 
description of actions taken to carry out the goals and activities 
authorized in the International AIDS Prevention and Capacity Building 
Imitative and the International AIDS Care and Treatment Access 
Initiative set out in the legislation; 4. Recommendation to specific 
Congressional committees regarding legislative and funding actions that 
are needed carry out the activities articulated in the bill; and 5. The 
results of the HIV/AIDS goals and outcomes as established by the 
working group. In my view, only by requiring very specific reporting 
requirements will the working group actually work.
  The Global CARE Act includes a number of other provisions. Some have 
been discussed on the Hill, others have not. It authorizes a Global 
Physician Corps to utilize the human capital we have in our working and 
retired physicians by providing a mechanism for them to serve overseas 
where their expertise is so needed.
  The bill authorizes a small amount for USAID to work on development 
and implementing initiatives to improve injection safety. According to 
the World Health Organization (WHO), each year the overuse of 
injections and unsafe injections combine to cause an estimated 8 to 16 
million hepatitis B virus infections, 2.3 million to 4.7 million 
hepatitis C infections and 80,000 to 160,000 HIV infections. Together, 
these chronic infections are responsible for an estimated 10 million 
new infections, more than 1.8 million deaths, 26 million years of life 
lost, and more than $535 million in direct medical costs.
  It includes a new pilot program to provide a limited procurement of 
antirectoriviral drugs and technical assistance to programs in host 
countries. And it includes a very important orphan relief and 
microcredit component that acknowledges that addressing the AIDS 
problem requires both an economic and social investment in women and 
families.
  I hope my colleagues will consider the framework and policy I have 
developed as we work to introduce a unified proposal to address the 
HIV/AIDS problem. Tackling this pandemic will take more than one good 
bill--it will take a concerted effort to combine the best ideas and 
realistic initaitives to get the job done.

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