[Congressional Record Volume 154, Number 115 (Monday, July 14, 2008)]
[Senate]
[Pages S6618-S6619]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               HIV/AIDS, TB, AND MALARIA REAUTHORIZATION

  Mr. FEINGOLD. Mr. President, I rise today to express my strong 
support for the Tom Lantos and Henry J. Hyde HIV/AIDS, TB, and Malaria 
Reauthorization Act. Although we have made significant headway over the 
last 5 years, the HIV/AIDS pandemic remains one of the world's worst 
public health crises, with millions of people infected around the globe 
and millions more who have already perished. As chairman of the Senate 
Foreign Relations subcommittee on Africa, and because of the disease's 
disproportionate impact on sub-Saharan Africa, I would like to focus my 
remarks today on that region to illustrate just how critical--and 
urgent--it is that we pass this bill.
  Despite some progress, AIDS remains a severe public health concern in 
Africa. Indeed, HIV continues to spread, with many countries on the 
continent experiencing unprecedented drops in population, economic 
decline, decimation of militaries, and the creation of an entire 
generation of orphans who know no other life but that of the streets. 
These societal disruptions have profound consequences for the 
continent's future and security; already, they are impeding development 
in the part of the world least able to contain the epidemic or treat 
its victims.
  In December 2007, the Joint United Nations Program on HIV/AIDS--
UNAIDS--reported that worldwide, approximately 35 million people live 
with HIV/AIDS. Similar organizations report that at the current rate, 
by 2015 more than 62 million people could become newly infected. 
Currently, over two-thirds of HIV cases are in Africa, which means 
there are somewhere between 20 million and 24 million adults and 
children in that continent who are HIV-positive. And these are just the 
cases we know of--these are just the reported and documented cases. As 
a point of comparison, the region with the next highest infection rate 
is Southeast Asia--with some 4 million individuals living with HIV.
  Since 2003 there has been a significant bipartisan effort to address 
this crisis with the creation of the President's Emergency Plan for 
AIDS--or PEPFAR as it is more commonly known. PEPFAR authorized some 
$19 billion over 5 years for HIV/AIDS, tuberculosis and malaria and yet 
in 2007 alone, 2.5 million people around the globe were infected with 
HIV--or the equivalent of some 6,800 per day, 4,600 of whom live in 
Africa. And while 4,600 Africans are being infected every day, some 
6,000 Africans are dying from AIDS-related illness--many without ever 
realizing they were HIV-positive or, if they did know, without ever 
having access to any treatment for their illness. In other words, 
despite a ground-breaking initiative to raise the profile of the 
disease, to work with local communities and national health systems, 
and to coordinate among the international community, Africa's future 
remains in peril.

  HIV/AIDS is spreading in African countries that are already hard hit 
by a range of other problems including rampant poverty, political 
instability and a lack of basic services and education. The result is 
decreased state capacity and an undermining of the development of civil 
society. HIV does not discriminate, and it is hitting members of 
Africa's political leadership, its college-trained professionals, and 
its skilled labor forces. And as it takes its toll on these groups, it 
is having a devastating effect on entire generations. I saw this 
firsthand just under a decade ago when I traveled to Zimbabwe, and I 
have seen it since in other trips to Africa.
  At that time, reports were noting that life expectancy had dropped 
from 65 to 39 because of the epidemic. As I walked past the parliament 
building in Harare, I asked how old one had to be to become a 
legislator. The answer? Forty. And now, even as it copes with a new, 
devastating political and humanitarian crisis, Zimbabwe is experiencing 
even lower life expectancy rates--37 for men and just 34 for women--
even lower than the minimum age to be elected a member of Parliament in 
that country.
  Despite the critical assistance of the United States, the cold hard 
facts--the numbers of those infected and dying--show that even more 
help is needed from the international community. Last August, on a trip 
to Uganda, I met with a number of health experts--from government 
health workers to civil society representatives--to discuss how the 
United States can build on the good work that began with PEFPAR, and 
provide a more vigorous response to the disease.

  We discussed what had worked and what had not, and they told me very 
clearly that in order to put a dent in the devastating impact of this 
pandemic, we need to focus not only on treatment but equally, if not 
more, on prevention. They shared examples of why, in order to help 
those most vulnerable, HIV/AIDS efforts need to include programs that 
address gender inequity, family planning, food and nutrition, and 
social stigma. And they were unequivocally clear that we need to work 
closely with national governments and local communities to help

[[Page S6619]]

build strong, sustainable health infrastructures that can provide 
assistance to their own citizens.
  I mention Uganda because it has been a rare example of success on the 
continent. The government's early recognition of the crisis and its 
initial comprehensive policies--including a well-organized public 
education campaign--are credited with helping to bring adult HIV 
prevalence down from around 15 percent in the early 1990s to just over 
5 percent in 2001. Unfortunately by 2006, scientists were suggesting 
that Uganda's HIV prevalence rates were once again rising. Indeed, I 
heard that same concern from most, if not all, of the people I met 
there, as well as from the President of Uganda himself.
  The underlying message was that focusing on treatment is not enough. 
In the case of Uganda, given the rising infection rates--as with many 
other parts of the world--the emphasis on treatment fails to address 
the factors driving the epidemic. Don't get me wrong--Ugandans are 
grateful for U.S. HIV/AIDS funding--but they made it clear that future 
support would be more effective if it were more comprehensive, and 
corresponded more closely to national needs, conditions, and 
initiatives.
  It has become a common refrain that we cannot treat our way out of 
this global pandemic and I continue to believe that is the case. As 
long as infection rates are rising, treatment and care costs will 
increase, as will the disease's burden on key vulnerable populations as 
well as their families, communities, and countries.

  Scientific evidence supports the anecdotal evidence I heard from many 
in Uganda. It confirms there is much to be gained by integrating the 
treatment and care of other diseases--particularly tuberculosis but 
also more common, preventable ailments--with HIV programs and expanded 
informational awareness campaigns that encourage health knowledge and 
capacities. Part of the challenge of addressing HIV/AIDS is that the 
disease does not sit easily within any particular policy area and 
although there are important domestic components related to health and 
human services, these are also clearly questions of foreign policy and 
international assistance. All of these need to be integrated into a 
harmonious whole.
  And that is why today I encourage my colleagues to support The Tom 
Lantos and Henry J. Hyde HIV/AIDS, TB, and Malaria Reauthorization Act 
and to reject any amendments that would undermine this bipartisan 
legislation. This bill is not perfect but, if passed, it will put 
global AIDS programs on the road to greater sustainability and will 
significantly increase our commitment to reversing the crisis.
  We all know there can be no quick fix or shortcut to success, but we 
have before us now legislation that maintains and expands the United 
States' response to the HIV/AIDS pandemic. Passing this bill will 
ensure the continuation of U.S. leadership to prevent, contain, and 
combat HIV/AIDS, tuberculosis, and malaria in a way that advances a 
broader range of global health and development objectives. To do 
anything less would not only be bad policy, it would be short-sighted 
and counter-productive.
  The PRESIDING OFFICER. The majority leader is recognized.

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