[Congressional Record Volume 154, Number 39 (Friday, March 7, 2008)]
[Senate]
[Pages S1742-S1743]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BIDEN (for himself, Mr. Lugar, Mr. Kennedy, and Mr. 
        Sununu):
  S. 2731. A bill to authorize appropriations for fiscal years 2009 
through 2013 to provide assistance to foreign countries to combat HIV/
AIDS, tuberculosis, and malaria, and for other purposes; to the 
Committee on Foreign Relations.
  Mr. BIDEN. Mr. President, today I am pleased to join Senators Lugar, 
Kennedy, and Sununu in introducing legislation to reauthorize our 
Government's effort to combat HIV/AIDS, tuberculosis, and malaria 
overseas. Entitled the Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008--in recognition of the great service to 
this issue by our recently departed friends from the House of 
Representatives--the bill would continue and expand the revolutionary 
public health program begun 5 years ago at the initiative of President 
Bush.
  In his State of the Union address in 2003, the President announced a 
dramatic proposal--to spend $15 billion over 5 years to combat HIV/AIDS 
globally, particularly in sub-Saharan Africa, which has been hardest 
hit by the pandemic. Congress responded promptly, authorizing the full 
amount requested by the President just a few months later.
  In the last 5 years, the work of the U.S. Government and its 
implementing partners around the world has been nothing short of 
miraculous. Well over a million people have been saved from almost 
certain death by the provision of anti-retroviral drugs. Mr. President, 
150,000 babies have been born without HIV because of efforts to prevent 
the transmission of the disease from mothers who were so infected. 
Millions of people suffering from AIDS have received treatment and 
care. Over two million orphans and vulnerable children have received 
care, education and support. Across Africa, in communities large and 
small, we have given millions of people hope for a better and longer 
life.
  Even the most optimistic among us would not have predicted these 
dramatic results. History will record that this was President Bush's 
finest hour--he challenged our Government, and the governments in 
Africa, to respond to one of the most profound crises of our time. They 
have met and exceeded that challenge. While implementation of the 
program has not been problem-free, it has proceeded at a pace and scale 
that was unimaginable to most of us. The credit for this success goes 
to thousands of dedicated people serving here and abroad, and to the 
American people, for their generosity in supporting this program.
  We cannot, however, rest on this success. We have made progress, but 
the disease is still winning. Thousands of new infections occur every 
day. For every person enrolled in a treatment program last year, six 
more became infected.
  Last spring, the President challenged us again--to reauthorize the 
program at a level of $30 billion over the next 5 years. In the course 
of last summer and fall, the Committee on Foreign Relations has closely 
reviewed the President's request and the operation of our current 
programs. To review the programs in the field, teams of committee staff 
traveled to most of the 15 ``focus'' countries that have received the 
bulk of the funding. They visited dozens of clinics, hospitals, and 
care centers. They talked to hundreds of government officials, 
community members and health staff working against the disease, people 
living with HIV/AIDS, and children orphaned by the disease. We have 
learned what is working--and more important, what is not working. Last 
fall, the committee held formal hearings to take testimony from experts 
from within and without the Government. The committee has also closely 
reviewed numerous studies performed by government agencies and 
nongovernmental organizations working in this field.

  The Congress is now ready to act, and we are ready to respond to the 
President's call. The bill that we introduce today will reauthorize the 
Global HIV/AIDS programs for the next 5 fiscal years. It will provide 
authorization of appropriations of $50 billion over this period, of 
which $9 billion is devoted to fighting malaria and tuberculosis, two 
diseases that are also major causes of death in the developing world. 
This higher figure is justified because the President's figure of $30 
billion is too low--it will barely keep pace with inflation, as we are 
already funding current programs at a rate above $6 billion a year. 
Additionally, the President's request dealt only with HIV/AIDS, 
although the initial legislation in 2003 covered all three deadly 
diseases.
  The bill that we introduce will keep the basic framework of the 
program intact, but makes important adjustments based on lessons 
learned over the past 5 years. First, the bill removes most earmarks in 
the original law that delineated the percentages that should be devoted 
to treatment, to care, and to prevention. A major, congressionally 
mandated study by the Institute of Medicine, as well as one by the 
Government Accountability Office, concluded that these earmarks unduly 
limit flexibility for the people implementing the programs. We need to 
lift these restrictions in order to let our Government and local 
officials tailor their responses to local conditions. The only earmark 
that is retained is a 10 percent allocation for orphans and vulnerable 
children, for which there appears to be universal support.
  The bill also seeks to coordinate our HIV/AIDS programs with other 
health and development programs. The disease does not exist in a 
vacuum. Across the

[[Page S1743]]

developing world, people afflicted with HIV/AIDS face many other health 
and economic challenges. We need to better coordinate all of our health 
programs to promote efficiencies and expand the number of people we 
reach. Nutrition is the best example of how we could positively affect 
people's lives by improving our coordination. The bill promotes local 
health capacity--an enormous challenge in Africa in combating this 
disease. Further, the bill pushes the U.S. Government to plan for the 
long-term. We need to move from responding to an emergency toward 
building sustainability--so our local partners that have the resources 
can take over this effort, with our technical assistance.
  Perhaps most important, this legislation attempts to put major 
emphasis on prevention. Simply put, we cannot win the fight against 
HIV/AIDS unless we expand and improve efforts to prevent its spread. 
Such efforts must include the so-called ``ABC'' approach--abstinence, 
being faithful, and proper use of condoms. But they must involve much 
more; in some places successful prevention will require major societal 
and cultural change that must be initiated and led by local governments 
and leaders.
  Last week, the House Committee on Foreign Affairs approved a 
reauthorization bill on a bipartisan basis. The legislation was 
sponsored by the acting chairman, Mr. Berman, and the ranking member, 
Ms. Ros-Lehtinen. It is endorsed by the President, who, having just 
returned from visiting Africa, personally urged several of us to act 
quickly on the reauthorization bill. The bill that we introduce today 
mirrors the compromise in the House in several major respects, which 
will facilitate a prompt conference with the other body.
  In partnership with Senator Lugar, who chaired our committee when the 
original legislation was approved in 2003, I have scheduled a markup in 
the Committee on Foreign Relations next week. I am hopeful of strong 
support to report the bill, and that the full Senate will act on the 
bill soon after the Easter recess.
                                 ______