[Congressional Record Volume 149, Number 76 (Wednesday, May 21, 2003)]
[House]
[Pages H4375-H4382]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H4375]]
 UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                              ACT OF 2003


                       Motion Offered by Mr. Hyde

  Mr. HYDE. Mr. Speaker, pursuant to the unanimous consent agreement of 
yesterday, I offer a motion.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mr. Hyde moves to take from the Speaker's table the bill 
     (H.R. 1298) to provide assistance to foreign countries to 
     combat HIV/AIDS, tuberculosis, and malaria, and for other 
     purposes, with the Senate amendments thereto, and concur in 
     the Senate amendments.

  The Clerk read the title of the bill.
  The text of the Senate amendments is as follows:
       Senate amendments
       Page 3, before line 1 insert:

             TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS

Sec. 501. Modification of the Enhanced HIPC Initiative.
Sec. 502. Report on expansion of debt relief to non-HIPC countries.
Sec. 503. Authorization of appropriations.

       Page 96, after line 14, insert:

             TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS

     SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

       Title XVI of the International Financial Institutions Act 
     (22 U.S.C. 262p--262p-7) is amended by adding at the end the 
     following new section:

     ``SEC. 1625. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

       ``(a) Authority.--
       ``(1) In general.--The Secretary of the Treasury should 
     immediately commence efforts within the Paris Club of 
     Official Creditors, the International Bank for Reconstruction 
     and Development, the International Monetary Fund, and other 
     appropriate multilateral development institutions to modify 
     the Enhanced HIPC Initiative so that the amount of debt stock 
     reduction approved for a country eligible for debt relief 
     under the Enhanced HIPC Initiative shall be sufficient to 
     reduce, for each of the first 3 years after the date of 
     enactment of this section or the Decision Point, whichever is 
     later--
       ``(A) the net present value of the outstanding public and 
     publicly guaranteed debt of the country--
       ``(i) as of the decision point if the country has already 
     reached its decision point, or
       ``(ii) as of the date of enactment of this Act, if the 
     country has not reached its decision point,

     to not more than 150 percent of the annual value of exports 
     of the country for the year preceding the Decision Point; and
       ``(B) the annual payments due on such public and publicly 
     guaranteed debt to not more than--
       ``(i) 10 percent or, in the case of a country suffering a 
     public health crisis (as defined in subsection (e)), not more 
     than 5 percent, of the amount of the annual current revenues 
     received by the country from internal resources; or
       ``(ii) a percentage of the gross national product of the 
     country, or another benchmark, that will yield a result 
     substantially equivalent to that which would be achieved 
     through application of subparagraph (A).
       ``(2) Limitation.--In financing the objectives of the 
     Enhanced HIPC Initiative, an international financial 
     institution shall give priority to using its own resources.
       ``(b) Relation to Poverty and the Environment.--Debt 
     cancellation under the modifications to the Enhanced HIPC 
     Initiative described in subsection (a) should not be 
     conditioned on any agreement by an impoverished country to 
     implement or comply with policies that deepen poverty or 
     degrade the environment, including any policy that--
       ``(1) implements or extends user fees on primary education 
     or primary health care, including prevention and treatment 
     efforts for HIV/AIDS, tuberculosis, malaria, and infant, 
     child, and maternal well-being;
       ``(2) provides for increased cost recovery from poor people 
     to finance basic public services such as education, health 
     care, clean water, or sanitation;
       ``(3) reduces the country's minimum wage to a level of less 
     than $2 per day or undermines workers' ability to exercise 
     effectively their internationally recognized worker rights, 
     as defined under section 526(e) of the Foreign Operations, 
     Export Financing and Related Programs Appropriations Act, 
     1995 (22 U.S.C. 262p-4p); or
       ``(4) promotes unsustainable extraction of resources or 
     results in reduced budget support for environmental programs.
       ``(c) Conditions.--A country shall not be eligible for 
     cancellation of debt under modifications to the Enhanced HIPC 
     Initiative described in subsection (a) if the government of 
     the country--
       ``(1) has an excessive level of military expenditures;
       ``(2) has repeatedly provided support for acts of 
     international terrorism, as determined by the Secretary of 
     State under section 6(j)(1) of the Export Administration Act 
     of 1979 (50 U.S.C. App. 2405(j)(1)) or section 620A(a) of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2371(a));
       ``(3) is failing to cooperate on international narcotics 
     control matters; or
       ``(4) engages in a consistent pattern of gross violations 
     of internationally recognized human rights (including its 
     military or other security forces).
       ``(d) Programs To Combat HIV/AIDS and Poverty.--A country 
     that is otherwise eligible to receive cancellation of debt 
     under the modifications to the Enhanced HIPC Initiative 
     described in subsection (a) may receive such cancellation 
     only if the country has agreed--
       ``(1) to ensure that the financial benefits of debt 
     cancellation are applied to programs to combat HIV/AIDS and 
     poverty, in particular through concrete measures to improve 
     basic services in health, education, nutrition, and other 
     development priorities, and to redress environmental 
     degradation;
       ``(2) to ensure that the financial benefits of debt 
     cancellation are in addition to the government's total 
     spending on poverty reduction for the previous year or the 
     average total of such expenditures for the previous 3 years, 
     whichever is greater;
       ``(3) to implement transparent and participatory 
     policymaking and budget procedures, good governance, and 
     effective anticorruption measures; and
       ``(4) to broaden public participation and popular 
     understanding of the principles and goals of poverty 
     reduction.
       ``(e) Definitions.--In this section:
       ``(1) Country suffering a public health crisis.--The term 
     `country suffering a public health crisis' means a country in 
     which the HIV/AIDS infection rate, as reported in the most 
     recent epidemiological data for that country compiled by the 
     Joint United Nations Program on HIV/AIDS, is at least 5 
     percent among women attending prenatal clinics or more than 
     20 percent among individuals in groups with high-risk 
     behavior.
       ``(2) Decision point.--The term `Decision Point' means the 
     date on which the executive boards of the International Bank 
     for Reconstruction and Development and the International 
     Monetary Fund review the debt sustainability analysis for a 
     country and determine that the country is eligible for debt 
     relief under the Enhanced HIPC Initiative.
       ``(3) Enhanced hipc initiative.--The term `Enhanced HIPC 
     Initiative' means the multilateral debt initiative for 
     heavily indebted poor countries presented in the Report of G-
     7 Finance Ministers on the Cologne Debt Initiative to the 
     Cologne Economic Summit, Cologne, June 18-20, 1999.''.

     SEC. 502. REPORT ON EXPANSION OF DEBT RELIEF TO NON-HIPC 
                   COUNTRIES.

       (a) In General.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary of the Treasury shall 
     submit to Congress a report on--
       (1) the options and costs associated with the expansion of 
     debt relief provided by the Enhanced HIPC Initiative to 
     include poor countries that were not eligible for inclusion 
     in the Enhanced HIPC Initiative;
       (2) options for burden-sharing among donor countries and 
     multilateral institutions of costs associated with the 
     expansion of debt relief; and
       (3) options, in addition to debt relief, to ensure debt 
     sustainability in poor countries, particularly in cases when 
     the poor country has suffered an external economic shock or a 
     natural disaster.
       (b) Specific Options To Be Considered.--Among the options 
     for the expansion of debt relief provided by the Enhanced 
     HIPC Initiative, consideration should be given to making 
     eligible for that relief poor countries for which outstanding 
     public and publicly guaranteed debt requires annual payments 
     in excess of 10 percent or, in the case of a country 
     suffering a public health crisis (as defined in section 
     1625(e) of the Financial Institutions Act, as added by 
     section 501 of this Act), not more than 5 percent, of the 
     amount of the annual current revenues received by the country 
     from internal resources.
       (c) Enhanced HIPC Initiative Defined.--In this section, the 
     term ``Enhanced HIPC Initiative'' means the multilateral debt 
     initiative for heavily indebted poor countries presented in 
     the Report of G-7 Finance Ministers on the Cologne Debt 
     Initiative to the Cologne Economic Summit, Cologne, June 18-
     20, 1999.

     SEC. 503. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the President such sums as may be necessary for the fiscal 
     year 2004 and each fiscal year thereafter to carry out 
     section 1625 of the International Financial Institutions Act, 
     as added by section 501 of this Act.
       (b) Availability of Funds.--Amounts appropriated pursuant 
     to subsection (a) are authorized to remain available until 
     expended.

  The SPEAKER pro tempore. Pursuant to the order of the House of 
Tuesday, May 20, 2003, the gentleman from Illinois (Mr. Hyde) and the 
gentleman from California (Mr. Lantos) each will control 30 minutes.
  The Chair recognizes the gentleman from Illinois (Mr. Hyde).


                             General Leave

  Mr. HYDE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
to include extraneous material on H.R. 1298, the legislation under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Illinois?
  There was no objection.
  Mr. HYDE. Mr. Speaker, I yield myself such time as I may consume.
  Rarely does Congress act with decisiveness for the benefit of so many 
suffering in the developing world. But this is precisely what we are 
doing today in enacting H.R. 1298, the United States

[[Page H4376]]

Leadership Against HIV/AIDS Act of 2003.
  With each passing day, HIV/AIDS claims more and more innocent 
victims. Not since the bubonic plague swept across the world in the 
last millennium has our world confronted such a horrible, unspeakable 
curse as we are now witnessing with the growing HIV/AIDS pandemic. The 
number of dead or dying is grotesquely high: 25 million already dead 
worldwide, and the number growing at a rate of 8,500 every day, with 
the prospects of entire villages populated only by orphans because the 
adults are dead or dying from AIDS.
  The bill we are considering today is the very same bill which passed 
the House May 1 by a vote of 375 to 41, with the exception of a minor 
amendment regarding debt forgiveness in poor countries. The Hyde-Lantos 
bill authorizes the President's 5-year $15 billion emergency plan for 
treatment and prevention of AIDS in those countries already facing 
crisis.
  The legislation creates a more responsive, coordinated, and effective 
approach among the various agencies of the U.S. Government involved in 
the global fight against HIV/AIDS. During consideration of the Hyde-
Lantos measure last week, the Senate added an amendment encouraging the 
administration to work with other countries to extend additional debt 
relief to poor countries most affected by HIV/AIDS. I support this 
amendment, and it is my hope that this legislation may be presented for 
the President's signature prior to his participation in the G-8 summit 
in France in June.
  The Hyde-Lantos legislation promotes an approach that provides for 
antiretroviral therapy for more than 2 million people living with HIV. 
It encourages a strategy that extends palliative care to people living 
with AIDS. It supports efforts to find vaccines for HIV/AIDS and 
malaria. It emphasizes the need to keep families together, with 
particular focus on the needs of children and young people with HIV. 
The bill endorses prevention programs that stress sexual abstinence and 
monogamy as the first line of defense against the spread of this 
disease. And it contributes to multilateral initiatives that leverage 
the funds of other donor nations.
  Many organizations and individuals from diverse backgrounds 
participated in the crafting of this legislation, including members of 
the Congregation of the Franciscan Sisters in Wheaton, Illinois; 
missionaries in Uganda; AIDS treatment access groups in downtown 
Chicago; and caregivers who administer assistance and counseling to 
people living with AIDS. The Committee on International Relations heard 
from African ambassadors, church leaders, and citizens from around the 
world who are calling for action. Your support for this legislation 
today answers their call for action. But our work now is only beginning 
in this fight to save lives and rescue families and villages from this 
scourge.
  Mr. Speaker, today I urge all of my colleagues to support H.R. 1298, 
the Hyde-Lantos bill. The HIV/AIDS pandemic is more than a humanitarian 
crisis. Increasingly, it is a threat to the security of the developed 
world. Left unchecked, this plague will further rip the fabric of 
developing societies, pushing fragile governments and economies to the 
point of collapse.
  America does not have to take on the HIV/AIDS crisis alone. But as is 
often the case, American leadership, political or financial, is 
necessary if our friends around the world are to bear their fair share 
of the burden. This is what the President's proposal does. It sets a 
pattern of American leadership that others, we believe, will follow.
  Today, we have an opportunity to do something of significant and 
lasting importance, an obligation to do something reflecting our 
commitment to human solidarity, and the privilege of doing something 
truly compassionate. The AIDS virus is a mortal challenge to our 
civilization. I know today my colleagues will be animated by the 
compassion and vision that has always defined what it means to be an 
American and answer this call for help.
  Before I close, I want to thank, in particular, the distinguished 
gentleman from California (Mr. Lantos), the ranking Democrat member. It 
is absolutely clear we would not be gathered in this Chamber about to 
celebrate the passage of such monumental legislation without the 
leadership, courage, and vision of the gentleman from California. From 
the start, he has been a leader in the fight against AIDS, tenacious in 
fighting for the Global Fund, and for increased funding for bilateral 
efforts.
  Yet during the past 3 years we have been working on this issue, he 
has always defended and represented his position with grace and 
eloquence. I would also like to recognize the essential and excellent 
contributions made to this legislation by his staff, in particular 
Peter Yeo and Pearl Alice Marsh. My own staff, Walker Roberts and Peter 
Smith, are also to be commended for their fine work and contributions 
to this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. LANTOS. Mr. Speaker, I yield myself such time as I may consume, 
and I rise in strong support of H.R. 1298.
  Mr. Speaker, the House of Representatives would not be considering 
the United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act today if it were not for the personal commitment of the 
gentleman from Illinois (Mr. Hyde) to seeing this initiative signed 
into law. We all owe him a profound debt of gratitude, and I am 
delighted to pay public tribute to him for his principled and effective 
leadership.
  Mr. Speaker, as we near final congressional approval of H.R. 1298, 
let us recall the humanitarian impetus for this historic initiative. 
Since this virus first mutated into its deadly shape, 25 million people 
have died of HIV/AIDS worldwide. This number is greater than the 
populations of New York City, Los Angeles, Chicago, Houston, 
Philadelphia, Phoenix, San Diego, Dallas, San Antonio, Detroit, San 
Jose, and Indianapolis combined. It is more than nine times the total 
number of casualties we have suffered in all armed conflicts in our 
Nation's history combined. It is a number beyond comprehension.
  This number, Mr. Speaker, represents much more than a statistic. It 
represents real people, with real families, real stories, and real 
futures. As we consider H.R. 1298, we remember these victims and pass 
this legislation in their name.
  We remember Simon, a former seminary student and a student leader in 
South Africa who struggled against apartheid, but died at the young age 
of 31 years, hardly fulfilling his potential as a national leader.
  We remember Srey, a poor illiterate Cambodian woman who had been 
infected by her husband. And this cruel killer showed no mercy, 
prolonging her agony long enough to see it claim the precious life of 
her baby son before consuming her.
  We remember Jean David, a Haitian man whose brother sold his small 
house and three cows to pay for medicine. These desperate lifesaving 
measures proved futile. Jean David died, leaving his family 
impoverished, with no way to care for his son, who was also infected 
with HIV/AIDS.
  But, Mr. Speaker, this legislation is also about life. It will ensure 
that there are fewer deaths due to HIV/AIDS, fewer parents grieving 
over the loss of their child to HIV/AIDS, and fewer children growing up 
without parents who have succumbed to this disease.
  Our legislative work to combat HIV/AIDS worldwide does not end with 
today's vote. Today, I call on President Bush to do everything in his 
power to obtain the $3 billion in HIV/AIDS funding this year, and I 
call on our Committee on Appropriations to fund that amount as well.
  And Congress must continue to play a strong oversight role to ensure 
that our Nation's HIV/AIDS programs are run effectively and 
efficiently. We have created a strong HIV/AIDS coordinator at the 
Department of State, and we expect that this coordinator will work hand 
in glove with the Agency for International Development.
  We have required that 33 percent of HIV/AIDS prevention funds in this 
legislation be used for abstinence-until-marriage programs, and we 
expect that abstinence programs funded as part of larger multisectoral 
grants will count towards this 33 percent requirement.
  We have provided a conscience clause to organizations implementing 
these programs, and we fully expect that all NGOs will only provide 
medically accurate and complete information about HIV/AIDS prevention 
methods.

[[Page H4377]]

  Mr. Speaker, today we vote to create a top-flight bilateral HIV/AIDS 
program and to support the advancement of the Global Fund. I urge all 
of my colleagues across the aisle to once again support passage of this 
legislation in the name of all those who have already fallen victim to 
HIV/AIDS and in the hope that millions of lives will be saved by our 
actions.
  Mr. Speaker, I reserve the balance of my time.
  Mr. HYDE. Mr. Speaker, I am pleased to yield 2 minutes to the 
distinguished gentleman from New Jersey (Mr. Smith).

                              {time}  1045

  Mr. SMITH of New Jersey. Mr. Speaker, I thank the gentleman for 
yielding.
  Mr. Speaker, I rise in very strong support of this legislation, H.R. 
1298, a truly historic piece of legislation authored by the gentleman 
from Illinois (Mr. Hyde) and the gentleman from California (Mr. 
Lantos). The compassion, tenacity and vision of the gentleman from 
Illinois (Mr. Hyde) has always been inspirational to so many of us, but 
on this piece of legislation Chairman Hyde's leadership was 
extraordinary. In astoniship speed, Mr. Hyde has now shepherded through 
the House and Senate a bill that will soon be signed by President Bush 
that is absolutely landmark in that it will help save the lives of 
millions and mitigate suffering in the lives of many more. Many 
particularly in sub-Saharan Africa, who are suffering from this 
disease, will be aided by this bill.
  The number of deaths due to the AIDS epidemic is horrifying. It is 
estimated that 25 million people have died from AIDS thus far, and 
another 30 million are infected, and approximately 8,500 people die 
every day. Thankfully, we are acting swiftly; and the sooner this 
legislation and the appropriations that will follow are passed, we can 
mitigate some of this disaster. Because if we do not, there will be as 
many as 80 million deaths by 2010, and 40 million AIDS orphans can be 
expected.
  Mr. Speaker, statistics about specific countries and age groups are 
also staggering. In Botswana, for example, nearly 40 percent of the 
adult population is infected. In Africa, there are 3 million children 
under the age of 15 living with HIV-AIDS.
  Mr. Speaker, today in sub-Saharan Africa it is estimated that only 
50,000 out of 4 million people in need of drug treatment are receiving 
it. This legislation puts us on track to get that very important drug 
treatment to these individuals.
  This is an outstanding piece of legislation. Again, on behalf of all 
of us, we thank the gentleman from Illinois (Mr. Hyde) for his 
tremendous leadership, courage and compassion.
  Mr. LANTOS. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Northern California (Ms. Lee), my friend and colleague, who has shown 
years of leadership in bringing us to this point.
  Ms. LEE. Mr. Speaker, I want to thank the gentleman from California 
(Mr. Lantos), the ranking member, for those very kind remarks and also 
for his leadership. I want to thank the gentleman from Illinois 
(Chairman Hyde) for his leadership and commitment; and, to them 
together, I think this is the best in terms of how we work together and 
can work together in a bipartisan fashion. I thank the gentleman from 
Iowa (Mr. Leach) for his years of dedication and years of hard work as 
we negotiated this bill.
  Also to our staff, we would not be here today without them. I would 
like express my appreciation to Christos Tsentas in my office and to 
Pearl Marsh and to Peter Yeo and to my former staff, Michael Riggs, and 
all of the minority and majority staff for their commitment and 
technical expertise but, most of all, their clear understanding of the 
reason why we are doing this today.
  This bill we have before us, as we have all said, has been shaped for 
the most part by a very long and bipartisan and bicameral compromise 
that has largely focused on the needs of those most affected by the 
AIDS, tuberculosis and malaria pandemics.
  I applaud the other body for adding an amendment to strengthen the 
Enhanced Heavily Indebted Poor Countries Initiative, but I am 
disappointed that they did not vote to include other amendments that 
were put forth by our colleagues, particularly the amendment offered by 
my colleague from California, to balance our HIV and AIDS prevention 
spending among all viable approaches by striking the 33 percent 
designation for abstinence-until-marriage programs. The balanced 
approach, the ABC approach, is what is working in Uganda; and I hope as 
we move forward we understand that strategy very clearly.
  Although I do believe that the debt relief provisions should be 
strengthened to say instruct the Secretary of Treasury to enter into 
negotiations to expand HIPC, rather than just advising him to do so, I 
think it is critical for us to address the issue of debt cancellation 
whenever we discuss the global AIDS pandemic, particularly in the 
Africa context.
  I am delighted that this amendment is in. It did not go far enough, 
but it is a beginning.
  The passage, of course, of this legislation is historic. But, again, 
we should not be too quick I do not think to pat ourselves on the back, 
because we must urge our President and our colleagues on the Committee 
on Appropriations to fully fund the $3 billion authorization beginning 
this year. AIDS will not wait, and neither can we.
  As part of our commitment to fight AIDS, we must also work to ensure 
that other donor nations contribute to the global effort. We would urge 
the President, along with Secretary Powell and Secretary Thompson to 
encourage the international community to provide a substantial and 
consistent contribution to fight TB, AIDS and malaria on a consistent 
basis beginning next week in France at the G8 summit that they will 
attend.
  I would just like to close by saying, as we pass this very historic 
bill today, we cannot forget our own domestic AIDS crisis. Just under a 
million people are estimated to be infected in the United States, and a 
quarter of those do not even know they are infected. The Centers for 
Disease Control estimates that 40,000 are newly infected each year in 
our own country. We must attack this disease on a domestic and 
international basis. This is a major step in the right direction.
  I thank the gentleman from Illinois (Mr. Hyde) and the gentleman from 
California (Mr. Lantos) for their leadership and for ensuring that the 
people of Africa now have some hope as a result of the United States 
policy.
  Mr. HYDE. Mr. Speaker, I yield 4 minutes to the gentleman from 
Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Speaker, I thank the gentleman from 
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) for 
their work on this important issue.
  The bill that we will approve today emphasizes the model of Uganda. 
Uganda has helped people avoid exposure and infection to HIV/AIDS. They 
have saved lives. The world can take a lesson from Uganda, including 
the United States.
  Uganda understood as a developing country working to build its way 
back from tyranny and exploitation it had to act to save itself. It had 
little money, no expertise, few resources. But Uganda had faith. Uganda 
had faith in God and in its people to save themselves.
  President Museveni asked his people to change their behavior in order 
to stay alive. That is not a message that is dependent on cultural 
interpretation. It does not require technical or scientific 
understanding. It is a message that gave hope and health to the general 
population of Uganda; and it has worked and continues to work in 
Uganda, as well as Zambia, Jamaica and Namibia.
  The bill that is before us is landmark legislation because it sets a 
course for what works in saving people's lives from the certain death 
of HIV/AIDS. It emphasizes treatment through antiretroviral therapy, 
care by assisting families and children affected by HIV/AIDS, and 
prevention by emphasizing education to help people avoid exposure.
  This legislation makes a very important distinction between 
preventive activities and intervention activities. The bill details 
that are included regarding prevention and other activities are 
intended to help people avoid exposure by reducing the number of sexual

[[Page H4378]]

partners and, if they are adolescents, delaying sexual activity until 
they are married. This is a realistic and effective public health 
strategy to help end the grip of HIV/AIDS. This legislation does not 
eliminate the utilization of interventions that are intended to reduce 
the risk of infection, especially for specific high-risk populations. 
The distinction between prevention and intervention is important.
  I am a physician who has treated AIDS patients dying from, in many 
instances, an avoidable disease. We need to emphasize risk avoidance 
but continue to provide options for risk reduction. This approach, 
called ABC, is a sound approach meant for the general population to 
save as many lives as possible. It is a comprehensive approach to AIDS 
prevention that recognizes that people are different and a range of 
behavioral options for AIDS prevention needs to be presented.
  In 2 days I will be traveling to Uganda to see for myself the Uganda 
experience. One of the things I want to investigate in Uganda is if it 
is staying true to the ABC approach. Since the mid-1990s, there has 
been less of an emphasis on sexual behavior and more on medical 
solutions. In recent years, there has been a small but disturbing trend 
towards riskier sexual behavior, and for the first time in a decade 
there has been a slight increase in the national infection rate in 
Uganda.
  The Uganda ABC model of the earlier period is the one that seems to 
have worked the best and is the one that has the most to teach the rest 
of the world. That is why I am so pleased to support this bill. I know 
it provides real solutions and real hope to people in Africa, and that 
is why I am pleased to go to Uganda in 2 days to see this firsthand 
myself.
  Mr. Speaker, I commend the ranking member and the chairman for their 
work, and credit goes to President Bush for initiating this process.
  Mr. LANTOS. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson-Lee), a leader on this issue.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman from 
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) for 
one of the most unique and collaborative efforts, which simply rings 
out to the entire world about saving lives. I thank them for their 
vision on this important legislation.
  Mr. Speaker, might I remind this House about 6 years ago, in 1997, 
then President Clinton designated a presidential mission. Three Members 
of Congress were able to participate in that mission, and we visited 
the nations of Uganda, Zambia and South Africa. During that time, we 
heard stories about individuals who admitted that they were HIV 
positive and being stoned to death.
  It was the first time that a 13-year-old boy came to my attention in 
South Africa, and he began to be a national spokesperson to challenge 
the world on the question of care, treatment and prevention.
  I am gratified that today the United States Congress, through the 
journey of many of us who saw the works of Uganda, began to understand 
that we must balance a cultural understanding with the need for 
prevention, care and treatment.
  This bill is an outstanding bill for many reasons. It deals with 
these issues, but in addition, it deals with malaria and tuberculosis. 
This is a devastating pandemic. The numbers are staggering in terms of 
whom we have lost. We expect to see by 2005 40 million African children 
who have lost their parents to HIV/AIDS. It is gratifying to see that 
the ABC plan in Uganda has worked, particularly that there are less 
sexually active teenagers. But we must be realistic. I am glad this 
legislation deals with prevention and the use of condoms.
  It is important to remember that AIDS is an epidemic in the United 
States, but it is also an important reality that there is a provision 
that helps to diminish or be able to support the idea of debt relief 
because these countries will not be able to get the various drugs 
necessary if we do not have the debt relief that is necessary as well.
  Finally, Mr. Speaker, let me say I had an amendment that encourages, 
if you will, seeks to have the corporate community contribute to the 
global fund. This is crucial because more monies are needed.
  I conclude by saying simply that we must do the same thing for the 
extreme famine in Africa, particularly in Ethiopia and that region. I 
would ask my colleagues as they support this wonderful legislation, 
that as we move toward appropriation, we support this legislation in 
appropriation, and we also support dollars that will help bring down 
the famine in Africa. I ask my colleagues to vote for this legislation.

                              {time}  1100

  Mr. LANTOS. Mr. Speaker, I am very pleased to yield 2 minutes to the 
gentleman from Virginia (Mr. Moran).
  Mr. MORAN of Virginia. Mr. Speaker, we all strongly support this bill 
as a needed and overdue national commitment. AIDS is a global crisis 
which threatens the security of every government in every nation, even 
including the United States. It has destroyed societies, and it will 
destabilize democratic governments. According to UNAIDS, nearly 22 
million people have lost their lives and over 36 million people today 
are living with HIV and AIDS. Fewer than 2 percent of them have access 
to life-prolonging therapies or basic treatment. That is the problem. 
And we are the only ones with the resources to really do something 
about it. The number of new infections of HIV is estimated at 15,000 
people a day, and it is growing.
  In Africa, which has 70 percent of the AIDS cases, 22 million people 
are living with this disease. In some countries, 20 percent or more are 
infected; and in a number of countries that recently visited in Africa, 
34 percent of women of childbearing age are infected. That means that 
an estimated 600,000 African children become infected with AIDS every 
single year as a result of mother-to-child transmission either at birth 
or through breast feeding. The deaths of parents with HIV/AIDS will 
result in 40 million orphans this decade alone. They have nowhere to 
go. They do not inherit anything. The boys go in to gangs, the girls 
too often into sexual slavery or some form of servitude.
  This bill, while it is a terribly important step, raises concerns 
about the intent to limit our flexibility to do everything we can to 
combat this problem. Abstinence, for example, while a prevention 
strategy, is not a public health program. It is an education approach 
based on moral or religious belief. We do not argue with that moral or 
religious belief, but this is an urgent matter. We have to do 
everything possible that will work. The fact is that in the developing 
world, too many women do not have the option of abstinence. That is the 
reality they have to deal with. Their rights are almost nonexistent. 
Many of them do not have the option to say no to sex from men, control 
the number of partners or protect themselves from sexual assault. That 
is true, that is reality, and that is what we have to deal with. Even 
the restrictive provision on prostitution limits our effectiveness. We 
have got to get access to women who are endangered, whatever it takes 
to save their lives.
  I urge the administration to use all the flexibility and common sense 
they can. We are talking about saving lives here. We are talking about 
a horrible reality. But we have got to roll up our sleeves and do what 
is necessary, do what is the moral imperative for this Nation to do 
today. All of us will strongly support the bill.
  Mr. LANTOS. Mr. Speaker, I am delighted to yield 3 minutes to my dear 
friend and good neighbor, the gentlewoman from California (Ms. 
Millender-McDonald), who has been a leader on this issue ever since we 
began this project.
  Ms. MILLENDER-McDONALD. Mr. Speaker, I want to take this time to 
thank Chairman Hyde and ranking member Lantos for being the driving 
force behind such an important bill, H.R. 1298, United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. I 
would also like to commend the President for his leadership on this 
issue. I hope that other countries and their leaders follow his 
leadership on HIV/AIDS. This bill embodies true leadership on the part 
of the United States, dramatically increasing the U.S. participation in 
addressing the pandemic that is ravaging whole regions and millions of 
people. This unprecedented bill acknowledges

[[Page H4379]]

our moral responsibility to address the pandemic that has already 
resulted in the deaths of millions. I am so proud to be a part of this 
legislation, this distinguished body and this country.
  H.R. 1298 contains a provision of mine included in the committee 
markup which my good friend, the gentlewoman from California (Mrs. 
Napolitano), offered for me as a member of that committee. While much 
attention is being paid to preventing mother-to-child transmission, we 
must turn to addressing the needs and rights of the child to grow up 
with parents so that millions more are not orphaned before he or she 
can even walk.
  My language gives priority preference for Federal funds to groups 
that are currently administering a privately funded program to prevent 
mother-to-child transmission and provide lifelong care and treatment in 
family-centered programs so that children do not grow up as orphans. 
This would benefit programs by letting them hit the ground running, to 
treat immediately as many people as possible. My language benefits 
programs such as the MTCT-Plus Initiative, which is administered by 
Columbia University's Mailman School of Public Health. The MTCT-Plus 
Initiative is supported by United Nations Secretary-General Kofi Annan 
and the First Ladies of Africa and has $50 million in funding from 
several private philanthropic foundations, including the Bill and 
Melinda Gates, the William and Flora Hewlett, the Robert Wood Johnson 
and other foundations.
  Family survival programs like the MTCT-Plus Initiative are critical 
to address the issues of millions of children orphaned by HIV/AIDS on a 
scale unrivaled in history. In sub-Saharan Africa, family and societal 
structures are breaking down because of the deaths of a generation of 
parents. The number of children in the developing world who have been 
orphaned by the AIDS pandemic will nearly double from 13.4 million to 
25.4 million by the end of this decade. Today, 5.5 million children in 
Africa have lost both parents, and in most cases at least one of them, 
to AIDS; and that number will rise to 7.9 million by 2010.
  Again let me thank the chairman and the ranking member for their 
leadership.
  Older women are also profoundly affected since the responsibility for 
caring for the supporting grandchildren orphaned by AIDS infected 
parents often falls on the shoulders of the elderly.
  Thank you again, Chairman Hyde and Ranking Member Lantos, for 
agreeing to include my amendment, and thank you too, to Congresswoman 
Napolitano for offering my amendment during the Committee markup.
  Mr. Speaker, I also offered an amendment on the floor which was 
accepted that concerns Section 314 which calls for a pilot program of 
assistance for children and families affected by HIV/AIDS. My amendment 
requires that pilot program to ensure the importance of inheritance 
rights of women, particularly women in African countries, are included 
in this program. The relationship of the denial of inheritance rights 
for women, increased HIV/AIDS infection in women and the resulting 
exponential growth in the numbers of young widows, orphaned girls, and 
grandmothers becoming heads of households needs to be further studied 
and documented. My language does just that.
  This is necessary because a majority of those infected by HIV/AIDs in 
African are women of all classes, ethnic groups, and levels of 
education. Women with AIDS are condemned to an early death when their 
homes, lands, and other property are taken. They not only lose assets 
they could use for medical care, but also the shelter they need to 
endure this disease.
  The failure to ensure equal property and inheritance rights upon 
separation or divorce discourages women from leaving violent marriages. 
HIV risk is especially high for women in situations of domestic 
violence, which often involves coercive sex, diminished ability to 
negotiate with partners for safer sex, and impeded women from seeking 
health information and treatment.
  In some places, widows are forced to undergo sexual practices such as 
``wife inheritance'' or ritual ``cleansing'' in order to keep their 
property. ``Wife inheritance'' occurs when a male relative of the dead 
husband takes over the widow as a wife, often in a polygamous 
environment. ``Cleansing'' usually involves sex with a social outcast 
who is paid by the dead husband's family, supposedly to cleanse the 
woman of her dead husband's evil spirits. In both of these rituals, 
safe sex is seldom practiced and sex is often forced. Such women are at 
increased risk of contracting and spreading HIV.
  For example, there are areas of Kenya where the wife inheritance and 
cleansing practices have created an alarmingly high rate of HIV/AIDS 
infection. Fully 22 percent of the population between ages 15 and 49 in 
the Nyanza province are infected, and 35 percent of ante-natal women in 
one district within that province are infected. Girls and young women 
in the Nyanza province are infected at six times the rate of their male 
counterparts.
  Finally, in the last Congress Representative Eva Clayton and I 
introduced H. Con. Res. 421, recognizing the importance of inheritance 
rights of women in Africa, and its relationship to the HIV/AIDS 
pandemic. I have also chaired two briefings on this issue. Our 
resolution was very strongly supported by this body. It had 90 original 
cosponsors with bipartisan support. My amendment today to the 
underlying bill includes the crux of H. Con. Res. 421, which I have 
reintroduced as H. Con. Res. 158.
  Thank you so much for putting H.R. 1298 on a fast track to present to 
the President for his signature. I look forward to the next step of 
actually ensuring that H.R. 1298 receives funds in the appropriations 
process giving this authorizing bill the teeth it needs to prevent 
infection and provide real relief to those suffering under the HIV/AIDS 
pandemic abroad.
  Mr. LANTOS. Mr. Speaker, I am very pleased to yield 2 minutes to the 
gentleman from Ohio (Mr. Brown), a distinguished member of the 
Committee on International Relations. He was the leader on the 
tuberculosis issue in this legislation, which is a significant and 
important and integral part of this bill.
  Mr. BROWN of Ohio. I thank my friend from California for yielding me 
this time.
  Mr. Speaker, I am pleased we are considering final passage of this 
global AIDS legislation. I want to recognize the hard work of Chairman 
Hyde and his good faith and strong efforts to make this legislation as 
good as it has become and to especially thank my friend, the gentleman 
from California (Mr. Lantos), the ranking Democrat on the committee, 
and the minority and majority staff of the Committee on International 
Relations and the terrific work that they did. I also want to recognize 
the gentlewoman from California (Ms. Lee), who has been working on this 
since her first election and her former and current staff, Michael 
Riggs and Christos Tsentas.
  Last year, almost 3 million people died of AIDS, 2 million died of 
tuberculosis, and 1 million died of malaria. In this bill, we are 
responding to this pandemic on a scale that can absolutely make a 
difference in saving hundreds of thousands, perhaps millions, of lives. 
This bill recognizes that the intersection of AIDS and tuberculosis is 
like the perfect storm, causing the most devastating epidemic since the 
bubonic plague of the 14th century where 20 million people died. 
Already, 25 million around the world have died of AIDS, 42 million 
people are infected with HIV/AIDS, and 1,100 people every day in India 
die of tuberculosis. This bill begins to recognize that the Global Fund 
to Fight AIDS, TB and Malaria represents the best tool that we have to 
fight three epidemics that kill 6 million people each year.
  This is good legislation, but it falls a bit short in a couple of 
areas. One of those is it limits flexibility so that local governments, 
local communities, local health departments, local nongovernment 
organizations are not able to be as flexible and I think as effective 
as they could be. I hope we can address that in the years ahead. It 
also fails to take as comprehensive an international approach as many 
of us hoped it would by underfunding, unfortunately, the Global Fund to 
Fight AIDS, TB and Malaria. That fund is more flexible, believes in 
local control, has standards to make sure that the dollars are well 
spent, and has more accountability than any other kind of aid program. 
I am hoping we can address that in the future.
  Every day we fail to act, Mr. Speaker, thousands die. I am here today 
to say I am proud we have done something. We have done much.
  Mr. LANTOS. Mr. Speaker, I yield myself such time as I may consume.
  In closing, I would like to express my appreciation to Chairman 
Hyde's staff, Walker Roberts and Peter Smith; the staff of the 
gentlewoman from California (Ms. Lee), Christos Tsentas; and to my 
staff, Pearl Alice Marsh, Peter Yeo, David Abramowitz, and Bob King who 
have done an extraordinary job. I again want to express my profound 
personal thanks to the chairman of the

[[Page H4380]]

committee, the gentleman from Illinois (Mr. Hyde), without whose 
leadership we would not be able to pass this legislation.
  Ms. WATERS. Mr. Speaker, I rise to support H.R. 1298, the U.S. 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act. This 
bipartisan bill would provide $15 billion over the next 5 years to 
combat HIV/AIDS, tuberculosis and malaria. The text of this bill now 
includes the language of H.R. 1298 as passed by the House, along with a 
Senate amendment to recommend that the Secretary of the Treasury 
negotiate deeper debt relief for poor countries, especially those 
suffering from public health crises. I have been working on the issues 
of global HIV/AIDS and debt relief for over 4 years, and I know how 
interrelated they are.
  Debt relief is desperately needed by poor countries trying to combat 
the HIV/AIDS epidemic. These countries cannot afford to provide health 
care to their people or educate their people about HIV/AIDS prevention 
because of their debts. At Least 18 heavily indebted poor countries are 
spending more money on debt payments than they are on health care. Debt 
relief will allow these countries to invest their resources in health, 
education, poverty reduction and HIV/AIDS treatment and prevention 
programs.
  Zambia provides an excellent illustration of why deeper debt relief 
is necessary. Zambia is a deeply impoverished country with a per capita 
income of only $330 per year. Almost 20 percent of the adult population 
is infected with the AIDS virus, and 650,000 children have been 
orphaned by AIDS. The HIV/AIDS epidemic has also ravaged the 
educational system by causing a shortage of trained teachers. Yet, 
Zambia still spends more than twice as much money on debt payments as 
it does on health care.
  Debt relief is critical to worldwide HIV/AIDS treatment and 
prevention efforts. I urge all of my colleagues to support this bill 
and enable poor countries to use their resources to address this 
devastating epidemic.
  Mr. EVERETT. Mr. Speaker, I rise in reluctant opposition to this 
motion to concur in the Senate Amendment to H.R. 1298, the U.S. 
Leadership Against HIV/AIDS, Tuberculosis & Malaria Act of 2003. 
Although the intentions of this legislation are well placed to help 
stem the tide of these highly infectious diseases, I am deeply 
concerned about the management of these scarce Federal dollars by the 
UN Global Fund to Fight AIDS, Tuberculosis and Malaria. Past practices 
of this organization leave me with little hope that these monies will 
be spent wisely to curtail these deadly diseases.
  Notwithstanding my opposition to this bill, I hope that USAID will 
work closely with the Global Fund to ensure that these funds are 
managed properly. In the event products are needed to be procured to 
prevent the spread of these diseases, I strongly encourage that the 
U.S. Buy America Act be employed. The expenditure of Federal, taxpayer 
dollars should support American companies whenever possible.
  Mr. OXLEY. Mr. Speaker, I rise today to support H.R. 1298, the United 
States Leadership on HIV/AIDS, Tuberculosis, and Malaria Act of 2003. 
This legislation affirms our commitment to stop the spread of these 
diseases which have ravaged much of the world. The President has made 
this a priority for the administration, and it is an opportunity for 
the United States to demonstrate our commitment to leadership on this 
issue. This is a comprehensive piece of legislation that will not only 
authorize our contribution to the Global AIDS Fund, promote 
transparency and accountability in the expenditure of these funds; it 
will also work to reduce the debt burdens of countries facing public 
health crisis.
  The House Financial Services Committee has a key role in crafting 
U.S. policy in the international financial institutions, and this 
Committee has been examining the role of these institutions in 
preventing AIDS and reducing debt burdens. I would like to thank 
Representatives Leach and Biggert of the Financial Services Committee 
for their leadership on U.S. global AIDS policy. They have been 
instrumental in ensuring that the World Bank remains the trustee of the 
Global AIDS Fund and in encouraging private contributions to the Global 
AIDS Fund. Additionally, Subcommittee Chairman Spencer Bauchus has been 
a strong supporter of common sense debt relief policy over the years. 
It is his leadership that has brought the issue of debt relief to the 
attention of Congress.
  Today we consider the House legislation with an amendment added by 
the Senate. This amendment encourages the Secretary of the Treasury to 
pursue debt relief initiatives in the international financial 
institutions. I have agreed to accept this amendment added by the 
Senate in order to ensure that the President can have this legislation 
on his desk this week and we can begin working to stop HIV/AIDS, 
tuberculosis, and malaria.
  I urge my colleagues to support this bill and demonstrate the U.S. 
Commitment to eliminating HIV/AIDS, tuberculosis, and malaria.
  Mr. BLUMENAUER. Mr. Speaker, with the passage of this landmark 
legislation, the United States has taken an immense step towards 
recognizing both the severity of the global HIV/AIDS epidemic, and our 
own humanitarian interest in treating and preventing the spread of this 
disease.
  The HIV/AIDS crisis is just the tip of the iceberg for health in 
developing nations. The task of building communities that are safe, 
healthy and economically secure at home and abroad cannot be achieved 
when a disabling portion of our global population is sick, orphaned or 
dying. The HIV/AIDS pandemic is affecting all races, all ages and all 
nations and we must all work together to solve this serious public 
health crisis.
  We have more at stake these days than just dealing with the AIDS 
epidemic, important as it is. I hope that the thoughtful approach taken 
by the administration and Congress on this measure will be a template 
for moving forward in other critical areas we must address, such as 
homeland security, our stalled economy, and other perilous issues in 
the international arena.
  Mr. SCHIFF. Mr. Speaker, I rise in support of this important 
legislation that will enable us to effectively combat the global 
scourges of HIV/AIDS, tuberculosis, and malaria. I am pleased with the 
bill as amended by the Senate, which will provide unprecedented funding 
to fight this deadly trio of diseases that are global in scope. I am 
grateful for the bipartisan leadership of my House colleagues who 
authored and were original co-sponsors of this bill, especially 
Chairman Hyde, Ranking Member Lantos, Mr. Weldon, Ms. Lee, and Mr. 
Leach.
  This legislation enables the United States to take a strong 
leadership role to ameliorate, and, we hope, ultimately to eradicate 
one of the most devastating diseases that man has ever encountered. We 
count the victims of HIV/AIDS in the tens and hundreds of millions, 
worldwide. It is a disease that affects men and women, adults and 
children. Its impact is most devastating on the poorest, those with the 
least capacity to deal with the ravages of this disease or to act 
effectively to prevent its spread. By affecting so many millions across 
societal cross-sections, this disease presents a humanitarian crisis of 
unprecedented magnitude. Furthermore, the HIV/AIDS pandemic is a 
potentially destabilizing force that presents a grave threat to 
international security.
  The African nations have been especially hard hit by the epidemic of 
HIV/AIDS and other diseases. Together, HIV/AIDS, tuberculosis, malaria, 
and related diseases are undermining agricultural production throughout 
Africa--aggravating disease with hunger.
  This bill will address these global problems by authorizing $15 
billion to combat HIV/AIDS, tuberculosis, and malaria, through a 
comprehensive 5-year integrated strategy. This legislation will use 
these funds effectively by promoting inter-agency coordination, 
supporting the expansions of public/private partnerships, and using 
targeted programs that will especially benefit children and families 
affected by HIV/AIDS.
  Of course we must continue to work aggressively to combat the spread 
of this disease here in the United States and to continue our efforts 
to research a cure and to aid our own countrymen afflicted with this 
terrible illness.
  I am proud to have been a co-sponsor of the House version of this 
vital legislation to attack one of the most significant threats to 
global health. I urge my colleagues to support this bill.
  Mr. WELDON of Florida. Mr. Speaker, the motion we will approve today 
emphasizes the model of Uganda. Uganda has helped people avoid exposure 
and infection to HIV/AIDS. They have saved lives.
  The world can take a lesson from Uganda--including the United States.
  Uganda understood that, as a developing country working to build its 
way back from tyranny and exploitation, it had to act to save itself. 
It had little money, it had no expertise, it had few resources.
  But Uganda had faith. Uganda had faith in God and in its people to 
save themselves.
  President Museveni asked his people to change their behavior in order 
to stay alive. That is not a message that is dependent on cultural 
interpretation. It is not a message that requires specific technical or 
scientific understanding. It is a message that gave hope and health to 
the general population of Uganda.
  And it has worked and continues to work in Uganda, Zambia, Jamaica, 
an Namibia.
  The motion to agree to the Senate amendment that is before us is 
landmark legislation because it sets a course for what works in saving 
people's lives from the certain death of HIV/AIDS. It emphasizes 
treatment through antiretroviral therapy, care by assisting families 
and children affected by HIV/AIDS, and prevention by emphasizing 
education to help people avoid exposure.
  This legislation makes a very important distinction between 
prevention activities and

[[Page H4381]]

intervention activities. The bill details that included in prevention 
are those activities intended to help people avoid exposure by reducing 
the number of sexual partners and--if they are adolescents--delaying 
sexual activity until they are married.
  This is a realistic and effective public health strategy to help end 
the grip of HIV/AIDS.
  This legislation does not eliminate the utilization of interventions 
that are intended to reduce the risk of infection, especially, for 
specific high risk populations.
  The distinction between prevention and intervention is important. As 
a physician who has treated AIDS patients, dying from in most instances 
an avoidable disease, we need to emphasize risk avoidance but continue 
to provide options for risk reduction.
  This approach, called ABC, is a sound approach meant for the general 
population to save as many lives as possible. It is a comprehensive 
approach to AIDS prevention that recognizes that people are different 
and a range of behavioral options for AIDS prevention needs to be 
presented.
  In 2 days I will be traveling to Uganda to see for myself the Uganda 
experience. One of the things I want to investigate in Uganda is if it 
is staying true to the ABC approach. Since the mid 90s, there has been 
less of an emphasis on sexual behavior and more on medical solutions. 
In recent years, there has been a small but disturbing trend toward 
riskier sexual behavior, and for the first time in a decade there has 
been a slight up-tick in national infection rates.
  The Uganda ABC model of the earlier period, the one that seems to 
have worked the best, is the one that has most to teach the rest of the 
world. That is why I am so pleased to support this motion and provide 
real solutions and real hope to the people of the world.
  Ms. McCollum. Mr. Speaker, I ask that the following article from 
today's Washington Post be inserted in the Record.

          In Another Break With Past, Kenyans See Hope on AIDS

                             (By Emily Wax)

       Nairobi.--The preacher's message to his 3,000-member 
     congregation inside the Kenyan Local Believers Evangelical 
     Church on a rainy Sunday was a simply one: Condoms don't 
     protect against AIDS.
       The crowd responded with a ringing ``Eh,'' meaning yes, 
     nodding as they clapped and rocked to his confident voice and 
     his message.
       ``In fact, if you have sex using a condom 10 times, you 
     will get 10 percent of the AIDS each time,'' thundered the 
     pastor, Solomon Ndoria, wearing a mustard-colored three-piece 
     suit and pumping his hands in the air. ``Then you will 
     actually have AIDS. So just abstain from sex.''
       One day later, Lucy Wanjiku's message to the man in her 
     dark metal shack, standing beside her thin foam mattress, was 
     a simple one, too. But she mumbled it.
       She needed cash. She had to feed her 4-year-old son. So the 
     30-year-old woman who usually sold African crafts was selling 
     her body.
       Wanjiku, one of the many members of Ndoria's church who 
     live in Kangemi, a Nairobi slum, had listened to her pastor's 
     words. But she had also heard discussions at the local health 
     clinic and seen posters downtown, and she wanted her client 
     to use a condom.
       He refused, slapping her face. Then in the dark must of her 
     room, on her cot, with her son crying nearby, they had sex, 
     she said. Afterwards, she had enough money for pounded maize. 
     Now she has the virus that causes AIDS. She said she believes 
     she will die soon.
       The preacher and the prostitute exemplify the emotional 
     debate over AIDS in Africa and its life-and-death 
     consequences. As of the end of last year, an estimated 29.4 
     million people in sub-Saharan Africa had AIDS or HIV, 
     according to U.N. estimates. About 3.5 million were infected 
     during 2002, and an estimated 2.4 million people died of AIDS 
     complications that year.
       In Kenya, a nation of 31 million, 15 percent of adults have 
     AIDS or HIV, U.S. statistics indicate. An estimated 500 to 
     700 Kenyans will die each day this year from AIDS-related 
     causes. Yet after two decades of outside assistance and 
     internal debate, Kenya, like most of its neighbors, has yet 
     to find an effective strategy for preventing the disease or 
     for treating those who contract it. And AIDS continues to 
     kill entire villages, to wipe out generations.
       When the country's first free and fair elections in 
     December brought an end to 24 years of autocratic rule by 
     Daniel arap Moi, many hailed it as a decisive moment not only 
     in Kenya's political history but in its fight against AIDS. 
     The new president, Mwai Kibaki, proclaimed a ``total war on 
     AIDS.'' He has committed his government to help pay for the 
     treatment of 40,000 patients and abandoned Moi's self-
     described ``shy'' policy about condom use, taking a stand 
     supporting condoms in addition to abstinence until marriage.
       After Kibaki's election, more than 500,000 condoms were 
     distributed in western Kenya, where HIV infection is most 
     prevalent. Kibaki's government ordered 50 million condoms 
     from German prophylactic maker Condomi, and Kibaki said he 
     will now implement the country's dormant AIDS prevention 
     strategy, which long included plans to distribute condoms in 
     hair salons, banks, restaurants and bars in addition to 
     health facilities. Kibaki said the government will use a $100 
     million ``soft'' loan from the World Bank to pay for 300 
     million condoms over a four-year period.
       Kibaki maintains that if the AIDS problem is not tackled, 
     none of his government's other programs will matter. ``We 
     must all come out and fight and eradicate this disease, 
     because there won't be any point of improving the welfare of 
     people who are going to die,'' he said last month. ``I would 
     want us to look back and say, `That is the disease that used 
     to kill us.' ''
       Anti-AIDS crusaders say they hope Kibaki continues to 
     follow a path that diverges sharply from the practice of many 
     African governments to keep silent about condom use and AIDS. 
     Ghana and Rwanda, largely Christian nations, are still 
     unclear about prevention policies. In contrast, Botswana, 
     with its tiny population of 1.6 million and its massive 
     infection rate of 36 percent, has been aggressive both in 
     rhetoric and treatment.
       The most widely praised example in Africa is Kenya's 
     neighbor, Uganda, where the policies of President Yoweri 
     Museveni are credited with helping bring HIV infection rates 
     down from 30 percent to 5 percent. Museveni set up 
     aggressive and candid campaigns that included condom 
     distribution and a national plan to attract aid donors to 
     the country of 24.7 million.
       ``I think saving these lives is feasible in Kenya--right 
     now,'' said Christa Cepuch, a Kenya-based pharmacist with the 
     French medical aid group Doctors Without Borders. ``I think 
     with political will anything can happen. If Kibaki sat down 
     at his desk and made this happen, it would be a different 
     country in 10 years. Uganda did it and now Kenya can, too.''
       In Africa's impoverished countries, the debate over whether 
     to tackle AIDS by trying to prevent it, through abstinence or 
     condom use, or by treating it with expensive antiretroviral 
     drugs, or both, is a complicated tangle that involves every 
     level of society--preachers, prostitutes and their clients, 
     farmers, orphans, drug companies and politicians.
       As AIDS drugs decrease in price and advocates around the 
     globe lobby for more funding for their purchase, some AIDS 
     experts say they are seeing the first signs that treatment 
     might become affordable for poor countries. But at the 
     moment, they say, prevention is the more pressing issue.
       Few Kenyans take issue with the idea that abstinence from 
     sex is an almost foolproof way to avoid AIDS. But in a 
     country where more than half the people live on less than a 
     dollar a day, it's not always that simple.
       Because rural jobs are scarce, many Kenyans migrate to the 
     cities for work, leaving their families behind in small 
     villages. When spouses are separated for long periods, sexual 
     relations outside marriage become common. Or when there are 
     no jobs, it is not uncommon for a woman to sell her body--
     perhaps just a few times in a lifetime--to feed her family 
     for a few days.
       ``Let's not be so naive and so bashful as to think people 
     are not going to have sex,'' said Wilson Ndgu, an energetic 
     Kenyan doctor who distributes condoms at bars and in health 
     clinics around the slums of Nairobi. ``People are having sex, 
     so we should be promoting condoms as a way to save lives. 
     That is the ethical and, frankly, the most Christian 
     response.''
       Most Kenyans--78 percent--practice Christianity, and most 
     Christian denominations in Africa oppose condoms, some on the 
     grounds that they promote sex outside marriage, others 
     because they are a form of birth control. Only a few socially 
     liberal church leaders have come out in favor of condom use.
       ``To be honest, Kibaki is in for some real serious work 
     here. The scale of the epidemic and complete lack of response 
     to it has created a nation where a lot of people feel they 
     are helpless,'' said Chris Ouma, a Kenyan who is national 
     coordinator for the Action AIDS/HIV program. ``There is a lot 
     of education to do and a lot of working with the churches. 
     I've never seen such prominent leaders pray for people's 
     lives and then tell people not to use condoms.''
       This All Africa Conference of Churches, with 168 members 
     from all branches of Christianity, is torn on the issue of 
     promoting condom use and backs a plan that tells worshipers 
     to wait until marriage to have sex. But Kibaki is now asking 
     church leaders to spend the first 15 minutes of every Sunday 
     sermon preaching the policy of ABC.
       ABC stands for ``Abstain, Be faithful or use Condoms,'' the 
     approach successfully adopted in Uganda and copied by other 
     countries. President Bush, who has pledged $15 billion to 
     help pay for drugs in Africa and the Caribbean, has made ABC 
     official U.S. policy. The U.S. Senate approved a $15 billion 
     bill Friday that earmarks $3 billion a year for the next five 
     years for programs in Africa that include education about 
     condom use and promotion of faithfulness and abstinence.
       Still, some church leaders refuse to support ABC, saying it 
     goes too far.
       ``This issue may be tougher than ever finding affordable 
     drugs for AIDS patients,'' said Melaku Kifle, outgoing 
     general secretary of the All Africa Conference of Churches. 
     ``And Kibaki is trying to take a stand by pushing the ABC 
     policy. What will happen? No one really knows. Kibaki's 
     leadership in the coming years will be critical.''
       As times change, there are signs that attitudes may be 
     changing, too.

[[Page H4382]]

       On the television soap opera ``Saints and Sinners,'' the 
     characters talk about AIDS. In newspapers and on the radio, 
     the new government has launched an ad campaign that talks 
     about it, too. The ads say: ``Three people die every five 
     minutes from AIDS in Kenya. What are you doing about it?''
       Kenyan doctors now hand out condoms in bars and talk about 
     prevention over warm Tusker beer. Even the national museum is 
     addressing the issue, running an exhibit this month on how 
     treatment and prevention improve the lives of patients.
       ``All of my friends say using condoms is like eating a 
     banana with the skin on,'' said Walter Koga, 22, a jobless 
     man who was hanging out with his friends at a barbershop in 
     Kangemi. ``Men just won't wear them because of stubbornness. 
     People say it's not manly. But attitudes are changing. People 
     don't want to be diseased, suffer horribly and die. I 
     actually thought I would never wear one and now I do. I've 
     changed.''
       As a group of Koga's friends gathered to joke about how 
     they still don't want to use condoms, Lucy Wanjiku hovered 
     nearby, listening. She folded her arms over her chest and 
     rolled her eyes. She told a group of women standing nearby 
     about a friend of hers who had asked a man to use a condom 
     and ended up getting beaten.
       She wanted to tell Koga's friends to stop joking, but she 
     didn't. Instead she went inside her dark metal shack to rest. 
     She was too sick and weak to fight with them.
  Mr. LANTOS. Mr. Speaker, I yield back the balance of my time.
  Mr. HYDE. Mr. Speaker, I want to thank my friend, the gentleman from 
California (Mr. Lantos), for his generosity. Believe me, he is 
indispensable to this effort, too.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. LaHood). All time for debate has 
expired.
  Pursuant to the order of the House of Tuesday, May 20, 2003, the 
previous question is ordered.
  The question is on the motion offered by the gentleman from Illinois 
(Mr. Hyde).
  The motion was agreed to.
  A motion to reconsider was laid on the table.

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