Congressional Record, Volume 149 Issue 73 (Thursday, May 15, 2003)

[Congressional Record Volume 149, Number 73 (Thursday, May 15, 2003)]
[Senate]
[Pages S6415-S6421]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA
ACT OF 2003

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate now
proceed, as under the order, to the consideration of H.R. 1298, until
the hour of 2 p.m. today.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report.
The legislative clerk read as follows:

A bill (H.R. 1298) to provide assistance to foreign
countries to combat HIV/AIDS, tuberculosis, and malaria, and
for other purposes.

The PRESIDING OFFICER. The majority leader.
Mr. FRIST. Mr. President, the first speaker on the global HIV/AIDS
bill will be the chairman of the Foreign Relations Committee, Senator
Lugar, who has done yeoman's work in getting us to this point.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. LUGAR. Mr. President, I thank the Chair for the recognition, and
likewise I appreciate the majority leader giving us this hour of
debate, because today it is very important the Senate consider the
global HIV/AIDS bill.
For the past year, intense discussions have occurred in Congress and
between the executive and legislative branches on how our country can
best respond to the global AIDS crisis.
In June 2002, the Foreign Relations Committee unanimously approved an
HIV/AIDS bill, initially introduced by Senators Frist and Kerry, with a
large bipartisan group of co-sponsors. The Senate unanimously passed
that bill. However, the House of Representatives failed to act on it
before the end of the 107th Congress.
At the start of this Congress, the Foreign Relations Committee
undertook at the request of the new majority leader to reintroduce the
2002 Senate-passed bill, with some minor changes requested by the
Department of State. In addition, we revised portions of the bill to
take account of the President's AIDS initiative outlined in his 2003
State of the Union Address.
The Committee's efforts, therefore, incorporated many of the
modifications requested by the White House, including the addition of
new authorities for the Special HIV/AIDS Coordinator created by our
legislation last year and incorporated in the President's AIDS
initiative this year.
Our efforts resulted in S. 1009, currently on the Senate calendar.
Simultaneously, the House proceeded with its own bill to authorize the
President's AIDS initiative. The House passed that bill last month, and
it was placed on the Senate calendar.
Many Senators, including myself, come to this debate with preferences
on how a bill should be structured on this subject. Nevertheless, I
share the majority leader's hope that the Senate will move quickly to
pass the House bill before us so that HIV/AIDS funding will not be
delayed any further and so President Bush can have an AIDS initiative
in hand when he travels to the G-8 summit later this month of May. The
House passed their bill by a vote of 375 to 41. It is a good bill
worthy of the strong bipartisan support that it received.
The United States must have partners in the effort to stop HIV/AIDS.
Passage of this bill will maximize the President's ability to enlist
other nations in the fight against AIDS. American leadership is as
important as American contributions to this objective.
We must be mindful of the President's recent observation that, ``Time
is not on our side,'' in combating this disease. The global HIV/AIDS
pandemic is a humanitarian crisis of horrific proportions. In Africa,
nearly 10,000 people contract the HIV virus each day. The United States
has a clear moral obligation, as the most powerful nation on earth, to
respond generously and quickly to this crisis.

But beyond our moral obligations, we should recognize that this bill
is squarely in the self-interest of the United States and the American
people. If we are to protect our national security and overcome
terrorism, we must devote ourselves to strengthening democracy,
building free markets, and encouraging civil society in nations that
otherwise might become havens or breeding grounds for terrorists. We
must seek to encourage societies that can nurture and fulfill the
aspirations of their citizens and deny terrorists the uncontrolled
territory and abject poverty in which they thrive.
Few conditions do more harm to these objectives than the HIV/AIDS
pandemic. It has imposed a crushing burden on the economies of numerous
African nations; it has exacerbated undercurrents of political
instability that weaken the fundamentals of responsible government; and
it has destroyed millions of family units. Beyond the sick and the
dead, the disease has created a generation of orphans, whose prospects
for a fulfilling and productive life have been diminished by the loss
of parents and other family members.
The President has recognized the urgency of moving forward at this
moment in history and has announced his support very solidly. He
believes we need to fulfill our altruistic role in the world and to
protect U.S. national security. We must join him in this effort by
passing the bill before us.
The House bill would authorize the President's Emergency Plan for
HIV/AIDS Relief. This plan would provide $15 billion over the next 5
years for AIDS care, treatment and prevention in those countries
already facing an AIDS crisis and in those countries that have
experienced a dramatic increase in the disease.
The bill would establish the position of Coordinator for HIV/AIDS to
ensure an effective approach by the various agencies of the U.S.
Government involved in combating the global spread of AIDS.
The bill also would provide the President with the discretion to
devote up to $1 billion a year for the Global Fund to Fight AIDS,
Tuberculosis, and Malaria. In an effort to generate foreign
contributions to the global fund, the bill sets a ceiling for American
contributions at one-third of total contributions. In other words, we
hope to stimulate at least $2 in foreign contributions to the global
fund for each

[[Page S6416]]

dollar contributed by the United States.
The Senate can make history this week by passing this bill and
sending the measure to the President for his signature. We should do so
without delay.
I add, finally, this thought to the debate. The President of the
United States, during the ceremonies in which the new members of NATO
were ratified by this body last week, and introduced to the public at
the White House by the President, took aside Members who were there,
and even at a historic moment in which we were discussing NATO, he
discussed with us the HIV/AIDS legislation. He indicated that he was
going to the summit of the G-8, that it is critical that other nations
join us. It is critical today that we pass this legislation.
But in order for the HIV pandemic to be arrested, other nations must
be involved. The President emphasized to me and to others that his own
advocacy, his own power in that meeting with regard to this issue, is
dependent upon having a bill. In a very pragmatic way, the President
indicated the House bill, which passed by a large majority, is a good
bill. I suspect if the President were to offer all of his amendments,
if I were to offer those I have already suggested in the Foreign
Relations Committee, likewise the distinguished ranking member, Members
of the House and the Senate, who have a variety of ways in which we can
improve the situation, we could have a remarkable debate. As a matter
of fact, we might have a substantial study of this situation for much
of the rest of this Congress. Feelings are very strong on many of these
issues.
I am sensitive to this in many ways, having tried, as chairman of the
Foreign Relations Committee, from the beginning of this year, to
wrestle with this very piece of legislation and how we could bring it
to fulfillment.
The President's response to all of this is that the House has passed
a good bill. Please pass the same bill without amendment. Please send
it to me so I can sign it next week and take it in this month of May to
the G-8 summit to make a powerful statement in behalf of the world and
in behalf of our leadership.
That has led to my course of action in which I have indicated to my
colleagues that I intend to support the President. I intend to support
this bill that is before us. I will oppose amendments to the bill
because that will clearly complicate the process. A conference would be
required. It is not clear how rapidly the conferees could either meet
or come to conclusion, and we have a recess 1 week from now, which
leaves the President in limbo without a bill.
It is those considerations that I hope Members will keep in mind,
will understand, and will in fact support. But at least I appreciate in
this opening statement an opportunity to state my own convictions, my
own course of action, and the leadership, at least in this body, that I
advocate.
I yield the floor.
The PRESIDING OFFICER (Mr. Bunning). The Senator from Delaware.
Mr. BIDEN. Mr. President, I understand fully the situation of my
friend from Indiana. As my colleague, Barry Goldwater--and we both
served with him--used to say: In your heart you know we could have a
better bill.
But we have a time problem. We have a circumstance where the House
had, frankly, thumbed its nose at us last time. We passed unanimously a
bill which was much more significant than this bill, led by our
majority leader and by my friend from Massachusetts, Senator Kerry.
They put together a real robust, significant bill.
This is a mere shadow of that bill in my view. But I end up almost
the same place as my friend from Indiana, my chairman does. That is,
you play the hand you are dealt. The House doesn't give a darn about
this bill. Frankly, they are threatening if we add any amendments to
just ditch it. So once again we are yielding to the lowest common
denominator.
The fact is, they have a whip hand right now. The fact is, I want the
President to be able to have a bill when he goes to the G-8 because I
believe he is committed to trying to get the rest of the world to do
more than they are doing. He wants to be able, to use a phrase he likes
to use, lay his cards on the table. He wants to be able to ante up and
say: This is what I am ready to do. Now, what are you all going to do?
I am willing to help him do that, even though this is not--this is
not--the best bill. The best bill was the Kerry-Frist bill. That was
the best bill we had, and we passed it. I think we voted it out
unanimously last time. It was much more significant than the bill we
have now. Then my friend and I, both faced with a similar dilemma, came
along with what, a Lugar-Biden/Biden-Lugar bill, which was better than
this bill.
But I am not here to talk about that. I am here to say we need a
bill. I want everyone to know we are trying our best. I hope the
majority leader would attest to the fact I have been straight up with
him. We want to add a couple of amendments. Frankly, we are going to
have a rough road to hoe. I think we will get one--I hope so, because I
think the House may accept it if it is added on--which I think is very
important.
Parochially, Senator Santorum and I, although he is not the one
pushing it and I am--one is on the debt relief, which is something my
friend from Indiana and I have worked on for years in various forums.
And I think we should get the global AIDS fund up to that minimum
threshold of $500 million.
Last July, the Senate unanimously approved a bill initiated in the
Committee on Foreign Relations by Senators Kerry, Frist, Helms and
myself. It stalled in the other body. There was little interest
expressed by the Bush administration, and the bill died.
In January of this year, as one of the first orders of business, we
began discussions in the Committee on Foreign Relations on moving
forward on the Kerry-Frist-Helms-Biden bill. Unfortunately, each time
we tried to proceed with the bill, the White House or the majority
leader asked the chairman to delay, because the administration wanted
more time to work on its proposal.
We might have passed a very strong bill months ago. But we did not.
Now we are told that time is up, that we must take up the House bill,
and that we must not amend the House bill.
I must say that I find it curious that we were asked to delay, and
now we are told we cannot amend this bill. But I will return to that
subject in a moment.
HIV/AIDS is the worst epidemic that mankind has ever seen. It is a
source of instability. It is highly damaging to economic development in
some of the poorest countries of the world. It is a humanitarian
disaster. It is, in short, a national security issue, and will be for
the foreseeable future.
It is right and proper that the Congress and the President work
together to develop a comprehensive program of assistance.
As the world's leading economic power, we have a responsibility to
lead the world in fighting this plague. I commend the President for
focusing attention on this important question. It has clearly helped us
push this legislation toward the finish line.
But now that we are nearing that finish line, I think we need to make
a few modifications. The bill before us was passed by the House with, I
am sure, the best of intentions.
It does not, however, as the title suggests, provide leadership. I
believe there is considerable room for improvement in the House-passed
bill.
I acknowledge that the bill does some useful things.
First and foremost, it acknowledges the severity of the HIV/AIDS
epidemic, and authorizes substantial funds over a 5 year period to
address it--$15 billion over 5 years, to be exact. That's a heck of a
lot of money, and well above the current budgets for these programs.
It provides for a strategy, and a coordinator to pull together all
the agencies working on this issue. These are all good things.
Unfortunately, the House bill has several flaws.
The bill gives no guidance on the amount of our contributions to the
Global Fund. In Fiscal Year 2004, the bill authorizes ``up to'' $1
billion. So it could be $1 or $1 billion. Which one is it? What do we
really expect the Committee on Appropriations to provide? The
President's budget requests just $200 million for the fund, which is
far from adequate.
For the remaining 4 years the bill, there is no specific amount set
forth. It

[[Page S6417]]

merely authorizes ``such sums as may be necessary.'' This is an
abdication of Congressional responsibility. It's like giving a
contractor money to build a house without stating what you want the
house to look like. Who would do something that unwise?
I believe that it is our job to set priorities, and funding levels.
The voice of Congress should be heard on this issue. There will be an
amendment by one of our colleagues authorizing a responsible
contribution of the fund.
The House-passed bill does not deal with the issue of debt relief for
countries suffering the burden of an AIDS epidemic.
Last year the Senate-passed bill included a provision, authored by
myself and Senator Santorum, extending increased debt relief to
countries with a severe public health crisis such as AIDS. We should do
no less this year.
The House-passed bill contains language that I think is bad policy.
It contains a requirement that one-third of all dollars devoted to
prevention must be earmarked for abstinence-only until marriage
programs.
I am concerned that this limitation is impractical.
I believe that the Agency for International Development and other
agencies working on the ground are competent to decide how much money
to spend on abstinence-only programs based on local conditions.
We should not assign arbitrary percentages to one element of a
comprehensive strategy to prevent the spread of AIDS without a
rationale. How did the other body come to the conclusion that 33
percent was appropriate? I do not know. I doubt that anyone does.
There are other problems with the bill. Some are more serious than
others.
We will try, with a few amendments, to fix them in an expeditious
way.
The majority leader has suggested that we must not amend this bill
because there is no time for a conference or for consideration by the
other body. With all respect to the leader, I believe he is mistaken.
The reconciliation bill we just passed will not go to conference. The
leadership of both bodies intends to bring back the conference report
on that bill before the recess. I can assure the leader that any
conference on this bill would be far simpler than the conference on the
reconciliation bill.
Morever, the bill need not even go to conference--it could go through
the House again, containing the amendments by the Senate. That happens
all the time around here. There's no reason that action cannot be
scheduled promptly--if the House leadership wants it.
What the leader is really saying is this: we must be a rubber-stamp
for the other body. We cannot amend it, not even one word, or else the
bill will be in trouble.
I simply don't believe that.
The Senate has a duty to debate and vote on amendments. If you oppose
amendments, vote them down. But don't vote them down because you think
an amendment will doom the bill.
Let us have a debate. We will do it quickly. We have no intention of
delaying passage of this legislation. I urge my colleagues to support a
limited number of amendments. Then we can send it to the other body,
and get it to the President by the end of next week.
Frankly, I feel a little bit like I was misleading the public at
large, as if I were the leader on this subject. The leader on this
subject has been Senator John Kerry, on our side of the aisle. So I
would like, with the permission of my colleagues, to yield to Senator
Kerry to make the substantive opening statement on this bill, since I
will have an opportunity to manage it. Again, I compliment him and
Senator Frist, who, frankly, were the emotional, political, and
intellectual engines getting this going.
If there is no objection, I yield the floor to my friend from
Massachusetts.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KERRY. Mr. President, I am extraordinarily grateful, not just for
the yielding by my colleague from Delaware, and my friend of many years
here, but I am also very grateful for the comments he just made. I
appreciate enormously his acknowledgment of the work that has gone into
this legislation from the Foreign Relations Committee. Senator Frist
and I did start this effort a number of years ago. In fact, we chaired
a major bipartisan, frankly apolitical, completely nonpolitical effort
nationally, bringing together most of the people involved in this issue
for a long period of time to solicit from them their thoughts about the
best way to try to put together, for the first time, a comprehensive
approach to the issue of AIDS.
The reason for wanting to make it comprehensive, obviously, is that
everything else was failing. There was and is a sense of implosion in
continents and countries as a consequence of what is happening.
No country ever had the capacity to provide as much leadership or to
provide as much resource as the United States of America to help to
deal with this issue. It is good that we are at least on the floor of
the Senate today for some brief period of time dealing with this
question of the HIV/AIDS, Tuberculosis and Malaria Act which comes over
to us from the House. The scope of the AIDS epidemic really cannot be
underestimated. It is now spreading to the Caribbean. It is in East
European former Soviet bloc countries. It is in Asia. The
nondiscriminating way that AIDS kills women and children, men and boys,
young and old alike, tears up families, and destroys human
infrastructure, is beyond people's belief, absent an extraordinary
effort comprehensively to begin to coordinate a global effort to combat
it. It is the worst public health, social, and humanitarian crisis of
our age.
It is imperative the United States lead the efforts to deal with it.
It should not only be on our agenda today, but it needs to be on our
agenda in the months and years to come.
Obviously, Congress should send to the President legislation that
substantially increases funding for our global AIDS programs, and
indeed this bill will do that. But we need to leave no doubt in the
world's mind that we are going to be at the forefront of that fight in
the years to come.
To underscore what the ranking member of the Foreign Relations
Committee just said, the President could have had this legislation last
year, or even earlier this year, had the administration and Republican
allies in Congress wanted it. Last July, the Senate unanimously passed
and sent to the House the bipartisan United States leadership effort
against HIV/AIDS.
I thank the majority leader for his efforts to join me in again a
completely nonpartisan effort to try to behave in a globally
responsible way and in a way that lives up to the highest values and
standards of our country.
I introduced that bill a year ago today, along with Senators Frist,
Biden, Helms, Daschle, and some 10 other cosponsors. That bipartisan
bill was the most comprehensive global HIV/AIDS bill ever introduced in
the Congress. It authorized more than double the annual $1 billion
level of funding for AIDS, TB, and malaria programs over each fiscal
year of 2003 and 2004, it created an HIV/AIDS coordinator in the
Department of State, it ensured the Government had a comprehensive 5-
year global strategy on HIV/AIDS, and it provided USAID, CDC, and other
HHS agencies with the necessary authorities and resources to carry out
an effective program of prevention and treatment abroad.
The House of Representatives had ample opportunity to act on this
bill before Congress adjourned last November, but it failed to even
take it up. Nor was the House interested in conferencing the full bill.
The administration provided no impetus, no leadership, and no effort in
order to try to get the House to do so. Apparently the
comprehensiveness of the bill was too much for the House Republicans to
handle.
Speaking to this point on November 13 of last year, Congressman Hyde,
chairman of the House International Relations Committee, stated that
``Discussions have broken down between the Senate and the House over
the size and the scope of the bill.'' And there was no intervention
whatsoever by the administration to try to bring those parties together
at any time.
It is more than regrettable that our colleagues in the House refused
to act last year. Although this bill predated President Bush's AIDS
initiative announced this year in his State of the

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Union Address, that very worthy initiative could easily have been
funded and carried out under the provisions of the Senate-passed bill.
We had a missed opportunity, one that could have saved lives. As
Chairman Hyde wrote earlier this week in his own op-ed in the
Washington Post, ``In the five minutes or so required to read this
column, another 30 people will die and another 55 will become
infected.''
Just think how many people could have been helped had the
administration and the House not missed the opportunity offered by the
Senate last year to ramp up our efforts.
Since the beginning of this year, Senator Biden and I have worked
consistently with Senator Lugar, chairman of the Foreign Relations
Committee, to produce a bipartisan global HIV/AIDS bill. Regrettably--
and I do regret--each step of the way those efforts were repeatedly
frustrated by the White House and some Members on the other side of the
aisle. Our most recent effort, S. 1009, the United States Emergency
Plan for AIDS Relief Act of 2003, introduced by Senator Lugar on May 7
and cosponsored by Senators Biden, Daschle, and Sarbanes, was based on
the very draft the majority leader, Senator Frist, brought us for
consideration after consultation and input from the White House. But
that effort, too, died on the vine.
The White House and the Senate majority leader have made it
abundantly clear that the President now wants the Senate to move
quickly to pass the bill without amendment. Having been at the
forefront of the legislative effort to combat this, I am delighted the
President now wants to have a bill in hand when he meets with the G-8
leaders in June. I agree that we can and must leverage other nations to
increase their efforts and their resources to combat the AIDS pandemic.
And I am confident the President will be able to tell his colleagues
and the Congress that we are united in the fight against AIDS. However,
the bill we send him ought to not only provide substantially increased
resources to fight AIDS, but it should also embody comprehensive,
balanced, and effective policies and programs.
The pending House bill does well in resources in terms of
authorization--$15 billion over the next 5 years for the three most
infectious global diseases, HIV/AIDS, TB, and malaria. Like last year's
bipartisan Senate bill on which it is modeled, the House bill
established an HIV/AIDS coordinator, and it mandates a coordinated,
comprehensive, and integrated U.S. 5-year strategy. But the bill
remains flawed. If left unaddressed, those flaws will seriously
undermine the effectiveness and the comprehensiveness of the U.S. AIDS
programs.
The House bill provides insufficient resources for the Global Fund to
Fight AIDS, TB and Malaria, the public-private partnership established
in 2001 with the strong support of President Bush and United Nations
Secretary General Kofi Annan. The global fund reflects the
international community's determination to marshal increased resources
to combat not only HIV/AIDS but also TB and malaria. Tommy Thompson,
Secretary of Health and Human Services, currently chairs the global
fund's board of directors. Whereas the Bush administration's new AIDS
initiative is focused on only 14 countries--12 in Africa and 2 in the
Caribbean--the global fund's scope is worldwide, covering not only
countries where AIDS is rampant, but also countries such as Russia,
China, and India, where the epidemic is growing rapidly.
The Bush administration's preference for bilateral efforts over
multilateral efforts, in my judgment, is discernible because of the way
the allocation of funds within the President's announced initiative
takes place. The President promised $15 billion over 5 years. But only
$1 billion of those funds--that is $200 million a year--would go to the
global fund. This annual figure of $200 million a year is already $150
million less than we have provided in fiscal year 2003 alone. The
President's proposal provides for no increases over the 5-year period.
The House bill authorizes ``up to $1 billion'' for the global fund
for fiscal year 2004. On the face of it, that looks like an
improvement. It is calculated to look like an improvement, but it is
not an improvement. The House bill fails to guarantee any specific
funding level, and it caps U.S. contributions at 25 percent of the
fund's total contributions.

This is simply not adequate. We can, and we should, do more. At a
minimum, we should be able to guarantee that our contributions to the
fund for fiscal year 2004 are significantly increased over the 2003
level.
I know some of my colleagues believe other countries are not
contributing enough to the fund. I share that concern, but I am proud
that the United States of America is the largest donor to the fund, and
we ought to be. In my view, that is commensurate with leadership, and
leadership is what is needed. However, other countries can and should
do more, and if leveraging our contributions will enable Chairman
Thompson and the leadership of the global fund to raise more resources,
I am all for that.
S. 1009, the Lugar-Biden-Kerry bill that was introduced earlier this
month, would authorize $1 billion for the fund for fiscal year 2004,
and $500 million of this would be available without any strings
attached. To receive the additional $500 million, the fund would have
to raise $2 billion in contributions from sources other than the United
States. So it provides real leverage, and that is what we ought to be
doing. In effect, the United States would be providing one-third of the
fund's resources--a figure with which all of us ought to be able to
live. I will support changes in the House bill to strike the House
language on the fund and achieve those higher funding levels.
Second, the House bill mandates that one-third of the funds spent on
prevention go only to abstinence-until-marriage programs. Now, none of
us disagrees that abstinence is an important component of AIDS
education. It is important as a matter of values, and of course we
ought to engage in that effort. But the effectiveness of these programs
depends literally on their comprehensiveness and on their relevancy to
the population you are targeting. That means you need all three
components of the so-called ABC model: abstinence; be faithful, which
includes reducing the number of partners; and the use of condoms.
Obviously, abstinence does not apply to all target populations. For
example, take a situation where you have people who are married or they
are in a monogamous relationship. It is well and good to promote the
concept of abstinence, which we should do, but abstinence-until-
marriage programs have their greatest resonance with young people, and
I believe we ought to fund those types of programs. But we should not
tie the President's hands by specifically earmarking the percentage of
funds to be spent on these programs because that denies the reality of
what you find on the ground in terms of the targeted population.
I will support an amendment to strike this earmark. We ought to be
rational enough as human beings to understand that you do not want to
just promote abstinence. What happens when somebody falls short of the
abstinence, as everyone in the world knows occurs? Then you want at
least to have that person also educated as to what the possibilities
are to still prevent the spread of the disease.
In my view, we should be providing the administration with maximum
flexibility to ensure that our assistance programs are well targeted to
the countries in which we are working. Regrettably, the House bill
contains a number of earmarks and limitations ideologically driven but
not practically driven, which reduce the flexibility and undermine the
capacity to work with various high-risk populations at the epicenter of
the HIV/AIDS pandemic.

The House bill guarantees that faith-based organizations may
participate in U.S. Government-funded HIV/AIDS programs even if they
choose not to participate in all elements of the program. For example,
they can be involved in the component that respects abstinence but they
may choose not to be involved in providing counseling on safe sex and
distributing condoms.
Faith-based organizations are on the front lines of the fight against
HIV/AIDS, and I respect that. We welcome that. And they should be. We
need them there. I do not believe we should ask any organization,
faith-based or otherwise, to compromise their principles in this
effort, and I would not do that. But if the U.S. Government is

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funding their programs, it is important, with respect to the
expenditure of our dollars, that we guarantee that those dollars be
spent in the most effective way and that we need to respect the
interventions that, in fact, prevent HIV infection, even those they
object to on a moral or religious ground.
An organization that does not wish to give out condoms should
absolutely not be required to do so, but it also ought to be required
to give accurate and medically sound advice on the effectiveness of
that method. I will support an amendment to the House bill that makes
it clear that all organizations that are funded by the U.S. Government
in this fight must follow that policy.
Last year, the Senate-passed AIDS bill contained a title on debt
reduction that was authored by Senators Biden and Santorum. It urged
the Secretary of the Treasury to renegotiate the Enhanced HPIC
Initiative to provide funds for HIV/AIDS programs through greater debt
reduction. The House bill we are now considering contains no such
title, despite strong support for it from many quarters, including the
Catholic and other churches. This deficiency in the House bill ought to
be corrected. I strongly support Senator Biden's amendment to put that
title back in the bill.
This bill has been a long time in coming. It is here now. Obviously,
it is important for the Senate to advance our efforts with respect to
AIDS. In my judgment, the amendments that are being offered will
improve this legislation in terms of its resources, in terms of its
policy, and the flexibility for the President.
I hope those amendments will be adopted, notwithstanding the Chair's
desire not to have any amendments, because they will provide us with
the capacity to have the full measure of the policy we ought to be
passing in order to deal with this issue. It is better to have
something that is comprehensive and effective than something that
merely meets political cosmetic needs and does less than what is needed
to address this extraordinary challenge.
I also believe there is time yet. There is time, if there is good
will on both sides and if there is Presidential leadership, to
conference a bill with these amendments. There is no reason we should
not make that available to the Senate. We can guarantee the President,
on our side, that if we do that in good faith, he will have a bill
before he goes to the G-8 summit. But if our efforts to improve this
bill fail, I will still support it, Mr. President, imperfect as I think
it is, because stemming the AIDS pandemic is the goal and any measure
that begins the steps towards that cannot be ignored and is better than
none.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
The majority leader.
Mr. FRIST. Mr. President, I will be speaking for about 10 minutes or
so. The Senator from Illinois and I were just discussing all of us who
want to speak on, and that we, the Senator from Illinois and the
Senator from Massachusetts, from whom we just heard, have worked so
hard on this effort.
I think what I will do is get my opening statement out of the way,
and then we will come back to the bill a little later today.
I will yield a minute or so to the Senator from Illinois, if he would
like to make a comment. I know we are a little constrained for time. We
are going back to the growth bill in about 9 minutes.
The PRESIDING OFFICER. The Senator from Illinois.
Mr. DURBIN. Mr. President, I thank the majority leader for yielding 1
minute.
Mr. President, I think this is a historic piece of legislation. I
think the United States is making a commitment to a world problem that
is going to haunt us for decades to come.
I salute President Bush for his leadership. I am glad this has been
bipartisan. My only regret is that it comes to the floor in a very
tight procedural situation. I hope we will have time to have an honest
discussion about a few issues and still deal with this bill on a timely
and dispatched basis.
I salute the Senator from Tennessee, the majority leader, for his
commitment, as well as the Senator from Massachusetts, and my good
friend and neighbor from Indiana, Senator Lugar.
I am going to withhold any further statements for a little later on
in the bill. As we get into the dialog, I will offer a few ideas.
Mr. FRIST. Mr. President, we really only have 35 minutes to speak on
the bill itself, now that we are officially on the bill. My colleagues
can tell from the comments today that this initiative is a huge
bipartisan initiative that is supported strongly by Democrats and
Republicans. I think they will see as the debate goes forward that
nobody thinks the bill is absolutely perfect in the sense that they
don't as individuals agree with everything in the bill itself. Again,
reflected in the comments we have just heard, if we step back, we are
seeing an unprecedented commitment on behalf of this institution, the
Senate, the House of Representatives, the Congress, with passage of a
bill that follows the leadership of President Bush of $15 billion over
a 5-year period.
I especially appreciate the comments of the Senator from
Massachusetts because, indeed, Senator Kerry and I have been working on
this issue for years, in an apolitical way, in working with CSIS, which
is a nonprofit group that all of us know, and we have brought in the
experts from all over the world. They have done a beautiful job. We
have sent delegations to China to look at the issue and broadly support
it.
I think that is what this bill is all about. So much of what we do
appears so partisan and, indeed, we will disagree on dollars and how
much should go to the global fund. Some people feel passionately it
needs to be more. Others say: Let's give a little more time to the
fund. At the end of the day, when we pass this bill, this bipartisan
bill--it comes from the House, but it is an assimilation of all the
ideas we have been working on--it is something of which we can be quite
proud.
The chairman of the Foreign Relations Committee, Senator Lugar, his
made comments I especially appreciate because it walked through the
challenges we face in addressing an issue that is very difficult for a
lot of people because it involves stigma, a virus that wasn't even
around 23 years ago. The HIV, when I was doing medical school and the
internship and the early years of residency, had never been heard of,
not talked about in the textbooks until 1981, when we saw the first
three or four viruses. That virus has now killed 23 million people, has
40 million people infected, and will kill, in the best of all worlds,
another 60 million people.
As history looks back at this day or at this year or at these
Senators in this body, it will be able to say we did everything
possible to reverse the course of that destruction. At the end of today
we will say, yes, for this point in time--we have lots of other steps
to take--this is the first major step. This is what I wanted to say to
my colleagues on both sides of the aisle. This is not going to cure the
virus. We have no cure. We have no vaccine. We can reverse that trend,
but this is the first major step.
The President took the lead in the State of the Union Message. It is
very complementary to the work I have worked with Senator Kerry and
Senator Lugar and Senator Biden and Senator Durbin on over the years.
That is most important. This little HIV virus is only about 100
nanometers. That is tiny. It is microscopic. It is invisible to the
naked eye. A meter is about that big. It is a billionth of a meter in
terms of size, 12,000 times smaller than a human hair. So it is
amazing. We are just entering this era where we understand viruses and
how we can fight them to the point that we can effectively combat them,
but something that small can cause so much destruction.

In terms of process, which people have referred to, we will begin
legislation later today on this $15 billion 5-year effort to combat the
worldwide HIV/AIDS epidemic. The bipartisan support is reflected in the
fact that the bill that I, in talking to the leadership on the other
side of the aisle, said, how can we best immediately begin the response
to the destruction of this virus, meaning not put it off 6 months or 12
months or 3 months or a year, and it is using this piece of legislation
which will come to the floor later today.
Some have suggested, you kind of knock out the deliberative process
by

[[Page S6420]]

going to the House bill. I disagree. We have put together various
bills. If you look at the House bill, while not everybody agrees with
everything in it, it really is an assimilation of the proposals put
forward that looks at prevention, care, and treatment. That is what is
beautiful. It is the amount of money, $15 billion, about $3 billion a
year for 5 years, the money, but also it is the first time in
legislation that we have linked a public health approach, which you
need, to this greatest of all humanitarian and public health
tragedies--challenges, as Senator Kerry has just said on the floor,
that you link prevention, care, and treatment. With that, over time, we
will be able to reverse the course of this virus.
The treatment strategies themselves have to do with antiretroviral
drugs. Some people say, let's put all the money there. We don't have a
cure yet, so to put all the money there doesn't make sense. We have to
go back and look at both prevention, which we know is 100-percent
effective, the prevention strategies--I refer back to Uganda, and what
is being done there--and also the care. How do you manage people with
HIV/AIDS? It could be other antibiotics. It could be nutrition. It
could be care. That is why the overall planning and the comprehensive
nature of this bill is so important.
The bill before us does represent a lot of coming together into a
focus of agreement and consensus on a range of issues--not all of the
issues, but on, I would say, most of the issues. That is why we can't
let the perfect be the enemy of what the good is in this particular
bill.
It is true that in less than 3 weeks the President of the United
States, if we pass this bill, will be able to go to the G-8 conference,
and that is important. That is not necessarily the driving reason to do
it, but it does give us an additional reason to do it--in addition to
the fact it will save lives, which is the most important issue to all
of us--that the President of the United States can show that we are a
caring nation, we are not just a good nation but we are a great nation
in terms of reaching out, the caring, the compassion as we go forward.
We will be able to lead--yes, we are a powerful nation--and get other
nations to participate because we can't solve this problem by
ourselves. The United States can't do it. We don't know the answer. We
don't have enough money to do it. But when we can bring the family of
nations, contributing both commitment and money, we will be able to
cure this little virus as we go forward.
There are lots of issues in the bill we will talk about later. One of
the most important is that we can start immediately. We will have a
skilled coordinator--that is part of the underlying package--will be
able to move forward, begin the planning, begin the implementation.
Then through the appropriations process we will be able to add the
appropriate money.
Let me close as I opened: Again, we will have the opportunity to talk
later tonight at greater length. History, ultimately, will judge how we
respond. We have done a pretty good job through study, committees,
through bills, through proposals, through debates, through the
appropriations process, but this gives us the first disciplined,
dedicated, focused, comprehensive response which links the public
health with the scientific. That is what this is about.
History will look back on this day as the first major step in
reversing this greatest of humanitarian challenges of the 21st century.
We do have a choice. We could put it off for later or we could choose
to do it now. I believe we will choose to act tonight, ultimately pass
this bill, and, with that, it will be a demonstration of why we are not
just a good Nation but a great nation.
I yield the floor.
The PRESIDING OFFICER. The minority leader.
Mr. DASCHLE. Mr. President, I want to thank the majority leader for
bringing this important piece of legislation to the Senate floor. It is
desperately needed. The Senate passed something very similar to this
proposal 9 months ago. Despite our urgent and repeated requests,
Republican leaders in the House refused to act on that bill. But
something important happened between then and now. In his State of the
Union Address to the Nation, President Bush proposed an historic U.S.
commitment to the global AIDS fight. We applaud the President's
support. I also want to acknowledge Secretary of State Colin Powell,
who has shown great leadership on this issue of global AIDS and taken
some criticism for it.
Our colleagues in the House of Representatives, especially
Congressmen Henry Hyde and Tom Lantos, also deserve thanks for their
commitment to this cause. Here in the Senate, many of us have seen the
face of AIDS in Africa and the Caribbean personally. This fight has
benefitted from their leadership. I especially want to acknowledge the
work of Senators Durbin, Kerry, Biden, Leahy, Feingold, Kennedy, Frist,
Lugar, and DeWine.
Last August, I traveled with several of our colleagues to South
Africa, Kenya, Botswana, and Nigeria. We wanted to get a clear look at
the development challenges in Africa. The challenges are myriad and
massive. They include investment and trade, education and agriculture.
One of Africa's greatest challenges is health care--particularly AIDS.
In South Africa, I had the privilege to deliver 1,000 pounds of
clothes and toys, donated by the people of South Dakota to children in
South Africa affected by HIV/AIDS. Those toys provided some glimmer of
hope to the South African children who received them. But this bill
offers the beginning of real hope. This bill holds out the promise that
some of those children will grow to be adults and perhaps have children
on their own.
On that trip, I met a young girl named Mary. She lives in Soweto. She
had recently lost both of her parents to AIDS. She had been left to
care for her four younger siblings. She was 12 years old. Mary and her
siblings are among the world's more than 14 million ``AIDS orphans''--
children who have lost their mother, or both parents, to AIDS.
Worldwide, more than 30 million people have already died from AIDS.
Last year, AIDS and AIDS-related illnesses claimed the lives of 3.1
million people. And 5 million more people became newly infected. Today,
more than 42 million people are infected with HIV or living with AIDS.
More than 75 percent of them live in Africa or the Caribbean.
I am convinced that, if we combine America's resources and technology
and the great compassion of the American people with the courage and
hope shown by Mary and so many others, we will defeat this disease.
HIV/AIDS is the great humanitarian crisis of our time. But it is more
than a humanitarian crisis. AIDS is a national security issue. It is a
public health issue. It is an economic issue. And it is a moral issue.
We have the tools to fight this disease. It is our duty and our
obligation to use them. The U.S. commitment to the global AIDS fight
has increased significantly in the last few years. But we could have,
and should have, done far more, far sooner. We must not delay any more.
This bill is another step in our fight. It would more than double
current U.S. spending for international AIDS programs. It calls for a
comprehensive strategy that integrates prevention, treatment, research
for a vaccine and help support children--like Mary, orphaned by the
disease.
The President is right in calling for us to target nations in Sub-
Saharan Africa and the Caribbean. These nations represent the epicenter
of the global AIDS crisis. But a crisis is looming in Asia and Central
and Eastern Europe. We must do now in those areas what we did not do
soon enough in Africa. We must intervene now to stop the spread of HIV/
AIDS before it reaches the epic proportions experts warn we could see.
For that reason, Democrats will offer an amendment to this bill to
guarantee a robust American commitment to the Global Fund to Fight
AIDS, Tuberculosis and Malaria. The bilateral efforts aimed at Africa
and the Caribbean are needed to address today's crisis. A strong U.S.
commitment to the Global AIDS Fund is needed to prevent tomorrow's
crisis.
We will also offer an amendment to give the President the flexibility
he needs to confront this epidemic. The House bill ties the President's
hands on prevention programs. Abstinence must be a central piece of any
successful prevention program. But earmarking 33 percent of prevention
funds for one approach is counter-productive.
We will also offer other important amendments. One will relieve the
debt

[[Page S6421]]

burden on the world's poorest nations--many of whom are burdened also
by this AIDS crisis. Another will provide American food aid to people
suffering from AIDS in desperately poor nations. We know that many
people who suffer from AIDS actually die from starvation and
malnutrition. Emergency food aid from America's farmers can help keep
them alive.
It is important to note, however, that this is just an authorization
bill. By itself, it does not commit one dime to prevent AIDS or help
its victims. The real test of our commitment to children like Mary and
others living with and threatened by AIDS will be whether we fund this
promise. A prescription you can't afford to fill does no good at all.
The President calls his proposal an ``emergency plan.'' He is right.
This is an emergency. We should treat it like an emergency. After we
pass this bill, we must appropriate the full amount it prescribes.
We can react to the plight of AIDS orphans like Mary with denial and
despair. Or we can respond--as this proposal does--with a determination
to save those children and the millions of others threatened by HIV/
AIDS.
In Uganda, mothers with AIDS create ``memory books'' for their
children. In their dying days, they gather together photos and stories
they want their children to know. They know that they will not live to
see their children grow up. With this bill, we have a chance to write a
different book--a different kind of history in this fight against AIDS.
Let us write that book. Let us pass this bill today. Then, let us
quickly agree to commit the resources it promises.
I yield the floor and I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Alexander). The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. COLEMAN. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. COLEMAN. Mr. President, are we in morning business? What is the
status of where we are, Mr. President?
The PRESIDING OFFICER. The Senate is to resume consideration of the
tax reconciliation bill.
Mr. COLEMAN. I ask unanimous consent to have an opportunity to
address the global AIDS bill very briefly.
The PRESIDING OFFICER. Is there objection?
Mr. REID. Objection.
The PRESIDING OFFICER. Objection is heard.

____________________