[Congressional Record Volume 159, Number 165 (Tuesday, November 19, 2013)]
[House]
[Pages H7232-H7238]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PEPFAR STEWARDSHIP AND OVERSIGHT ACT OF 2013
Mr. ROYCE. Mr. Speaker, I move to suspend the rules and pass the
Senate bill (S. 1545) to extend authorities related to global HIV/AIDS
and to promote oversight of United States programs.
The Clerk read the title of the bill.
The text of the bill is as follows:
S. 1545
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``PEPFAR Stewardship and
Oversight Act of 2013''.
SEC. 2. INSPECTOR GENERAL OVERSIGHT.
Section 101(f)(1) of the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7611(f)(1)) is amended--
(1) in subparagraph (A), by striking ``5 coordinated annual
plans for oversight activity in each of the fiscal years 2009
through 2013'' and inserting ``coordinated annual plans for
oversight activity in each of the fiscal years 2009 through
2018''; and
(2) in subparagraph (C)--
(A) in clause (ii)--
(i) in the heading, by striking ``Subsequent'' and
inserting ``2010 through 2013''; and
(ii) by striking ``the last four plans'' and inserting
``the plans for fiscal years 2010 through 2013''; and
(B) by adding at the end the following new clause:
``(iii) 2014 plan.--The plan developed under subparagraph
(A) for fiscal year 2014 shall be completed not later than 60
days after the date of the enactment of the PEPFAR
Stewardship and Oversight Act of 2013.
``(iv) Subsequent plans.--Each of the last four plans
developed under subparagraph (A) shall be completed not later
than 30 days before each of the fiscal years 2015 through
2018, respectively.''.
SEC. 3. ANNUAL TREATMENT STUDY.
(a) Annual Study; Message.--Section 101(g) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7611(g)) is amended--
(1) in paragraph (1), by striking ``through September 30,
2013'' and inserting ``through September 30, 2019'';
(2) by redesignating paragraph (2) as paragraph (3);
(3) by inserting after paragraph (1) the following new
paragraph:
``(2) 2013 through 2018 studies.--The studies required to
be submitted by September 30, 2014, and annually thereafter
through September 30, 2018, shall include, in addition to the
elements set forth under paragraph (1), the following
elements:
``(A) A plan for conducting cost studies of United States
assistance under section 104A of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151b-2) in partner countries, taking into
account the goal for more systematic collection of data, as
well as the demands of such analysis on available human and
fiscal resources.
``(B) A comprehensive and harmonized expenditure analysis
by partner country, including--
``(i) an analysis of Global Fund and national partner
spending and comparable data across United States, Global
Fund, and national partner spending; or
``(ii) where providing such comparable data is not
currently practicable, an explanation of why it is not
currently practicable, and when it will be practicable.'';
and
(4) by adding at the end the following new paragraph:
``(4) Partner country defined.--In this subsection, the
term `partner country' means a country with a minimum United
States Government investment of HIV/AIDS assistance of at
least $5,000,000 in the prior fiscal year.''.
SEC. 4. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS,
TUBERCULOSIS, AND MALARIA.
(a) Limitation.--Section 202(d)(4) of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7622(d)(4)) is amended--
(1) in subparagraph (A)--
(A) in clause (i), by striking ``2013'' and inserting
``2018'';
(B) in clause (ii)--
(i) by striking ``2013'' and inserting ``2018''; and
(ii) by striking the last two sentences; and
(C) in clause (vi), by striking ``2013'' and inserting
``2018''; and
(2) in subparagraph (B)--
(A) by striking ``under this subsection'' each place it
appears;
(B) in clause (ii), by striking ``pursuant to the
authorization of appropriations under section 401'' and
inserting ``to carry out section 104A of the Foreign
Assistance Act of 1961''; and
(C) in clause (iv), by striking ``2013'' and inserting
``2018''.
(b) Withholding Funds.--Section 202(d)(5) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7622(d)) is amended by--
(1) in paragraph (5)--
(A) by striking ``2013'' and inserting ``2018'';
(B) in subparagraph (C)--
(i) by inserting ``in an open, machine readable format''
after ``site'';
(ii) by amending clause (v) to read as follows:
``(v) a regular collection, analysis, and reporting of
performance data and funding of grants of the Global Fund,
which covers all principal recipients and all subrecipients
on the fiscal cycle of each grant, and includes the
distribution of resources, by grant and principal recipient
and subrecipient, for prevention, care, treatment, drugs, and
commodities purchase, and other purposes as practicable;'';
(C) in subparagraph (D)(ii), by inserting ``, in an open,
machine readable format,'' after ``audits'';
(D) in subparagraph (E), by inserting ``, in an open,
machine readable format,'' after ``publicly'';
(E) in subparagraph (F)--
(i) in clause (i), by striking ``; and'' and inserting a
semicolon; and
(ii) by striking clause (ii) and inserting the following
new clauses:
``(ii) all principal recipients and subrecipients and the
amount of funds disbursed to each principal recipient and
subrecipient on the fiscal cycle of the grant;
``(iii) expenditure data--
``(I) tracked by principal recipients and subrecipients by
program area, where practicable, prevention, care, and
treatment and reported in a format that allows comparison
with other funding streams in each country; or
``(II) if such expenditure data is not available, outlay or
disbursement data, and an explanation of progress made toward
providing such expenditure data; and
``(iv) high-quality grant performance evaluations measuring
inputs, outputs, and outcomes, as appropriate, with the goal
of achieving outcome reporting;''; and
(F) by amending subparagraph (G) to read as follows:
``(G) has published an annual report on a publicly
available Web site in an open, machine readable format, that
includes--
``(i) a list of all countries imposing import duties and
internal taxes on any goods or services financed by the
Global Fund;
``(ii) a description of the types of goods or services on
which the import duties and internal taxes are levied;
``(iii) the total cost of the import duties and internal
taxes;
``(iv) recovered import duties or internal taxes; and
``(v) the status of country status-agreements;''.
SEC. 5. ANNUAL REPORT.
Section 104A(f) of the Foreign Assistance Act of 1961 (22
U.S.C. 2151b-2(f)) is amended to read as follows:
``(f) Annual Report.--
``(1) In general.--Not later than February 15, 2014, and
annually thereafter, the President shall submit to the
Committee on Foreign Relations of the Senate and the
Committee on Foreign Affairs of the House of Representatives
a report in an open, machine readable format, on the
implementation of this section for the prior fiscal year.
``(2) Report due in 2014.--The report due not later than
February 15, 2014, shall include the elements required by law
prior to
[[Page H7233]]
the enactment of the PEPFAR Stewardship and Oversight Act of
2013.
``(3) Report elements.--Each report submitted after
February 15, 2014, shall include the following:
``(A) A description based on internationally available
data, and where practicable high-quality country-based data,
of the total global burden and need for HIV/AIDS prevention,
treatment, and care, including--
``(i) estimates by partner country of the global burden and
need; and
``(ii) HIV incidence, prevalence, and AIDS deaths for the
reporting period.
``(B) Reporting on annual targets across prevention,
treatment, and care interventions in partner countries,
including--
``(i) a description of how those targets are designed to--
``(I) ensure that the annual increase in new patients on
antiretroviral treatment exceeds the number of annual new HIV
infections;
``(II) reduce the number of new HIV infections below the
number of deaths among persons infected with HIV; and
``(III) achieve an AIDS-free generation;
``(ii) national targets across prevention, treatment, and
care that are--
``(I) established by partner countries; or
``(II) where such national partner country-developed
targets are unavailable, a description of progress towards
developing national partner country targets; and
``(iii) bilateral programmatic targets across prevention,
treatment, and care, including--
``(I) the number of adults and children to be directly
supported on HIV treatment under United States-funded
programs;
``(II) the number of adults and children to be otherwise
supported on HIV treatment under United States-funded
programs; and
``(III) other programmatic targets for activities directly
and otherwise supported by United States-funded programs.
``(C) A description, by partner country, of HIV/AIDS
funding from all sources, including funding levels from
partner countries, other donors, and the private sector, as
practicable.
``(D) A description of how United States-funded programs,
in conjunction with the Global Fund, other donors, and
partner countries, together set targets, measure progress,
and achieve positive outcomes in partner countries.
``(E) An annual assessment of outcome indicator
development, dissemination, and performance for programs
supported under this section, including ongoing corrective
actions to improve reporting.
``(F) A description and explanation of changes in related
guidance or policies related to implementation of programs
supported under this section.
``(G) An assessment and quantification of progress over the
reporting period toward achieving the targets set forth in
subparagraph (B), including--
``(i) the number, by partner country, of persons on HIV
treatment, including specifically--
``(I) the number of adults and children on HIV treatment
directly supported by United States-funded programs; and
``(II) the number of adults and children on HIV treatment
otherwise supported by United States-funded programs;
``(ii) HIV treatment coverage rates by partner country;
``(iii) the net increase in persons on HIV treatment by
partner country;
``(iv) new infections of HIV by partner country;
``(v) the number of HIV infections averted;
``(vi) antiretroviral treatment program retention rates by
partner country, including--
``(I) performance against annual targets for program
retention; and
``(II) the retention rate of persons on HIV treatment
directly supported by United States-funded programs; and
``(vii) a description of supportive care.
``(H) A description of partner country and United States-
funded HIV/AIDS prevention programs and policies, including--
``(i) an assessment by country of progress towards targets
set forth in subparagraph (B), with a detailed description of
the metrics used to assess--
``(I) programs to prevent mother to child transmission of
HIV/AIDS, including coverage rates;
``(II) programs to provide or promote voluntary medical
male circumcision, including coverage rates;
``(III) programs for behavior-change; and
``(IV) other programmatic activities to prevent the
transmission of HIV;
``(ii) antiretroviral treatment as prevention; and
``(iii) a description of any new preventative interventions
or methodologies.
``(I) A description of the goals, scope, and measurement of
program efforts aimed at women and girls.
``(J) A description of the goals, scope, and measurement of
program efforts aimed at orphans, vulnerable children, and
youth.
``(K) A description of the indicators and milestones used
to assess effective, strategic, and appropriately timed
country ownership, including--
``(i) an explanation of the metrics used to determine
whether the pace of any transition to such ownership is
appropriate for that country, given that country's level of
readiness for such transition;
``(ii) an analysis of governmental and local
nongovernmental capacity to sustain positive outcomes;
``(iii) a description of measures taken to improve partner
country capacity to sustain positive outcomes where needed;
and
``(iv) for countries undergoing a transition to greater
country ownership, a description of strategies to assess and
mitigate programmatic and financial risk and to ensure
continued quality of care for essential services.
``(L) A description, globally and by partner country, of
specific efforts to achieve and incentivize greater
programmatic and cost effectiveness, including--
``(i) progress toward establishing common economic metrics
across prevention, care and treatment with partner countries
and the Global Fund;
``(ii) average costs, by country and by core intervention;
``(iii) expenditure reporting in all program areas,
supplemented with targeted analyses of the cost-effectiveness
of specific interventions; and
``(iv) import duties and internal taxes imposed on program
commodities and services, by country.
``(M) A description of partnership framework agreements
with countries, and regions where applicable, including--
``(i) the objectives and structure of partnership framework
agreements with countries, including--
``(I) how these agreements are aligned with national HIV/
AIDS plans and public health strategies and commitments of
such countries; and
``(II) how these agreements incorporate a role for civil
society; and
``(ii) a description of what has been learned in advancing
partnership framework agreements with countries, and regions
as applicable, in terms of improved coordination and
collaboration, definition of clear roles and responsibilities
of participants and signers, and implications for how to
further strengthen these agreements with mutually accountable
measures of progress.
``(N) A description of efforts and activities to engage new
partners, including faith-based, locally-based, and United
States minority-serving institutions.
``(O) A definition and description of the differentiation
between directly and otherwise supported activities,
including specific efforts to clarify programmatic
attribution and contribution, as well as timelines for
dissemination and implementation.
``(P) A description, globally and by country, of specific
efforts to address co-infections and co-morbidities of HIV/
AIDS, including--
``(i) the number and percent of people in HIV care or
treatment who started tuberculosis treatment; and
``(ii) the number and percentage of eligible HIV positive
patients starting isoniazid preventative therapy.
``(Q) A description of efforts by partner countries to
train, employ, and retain health care workers, including
efforts to address workforce shortages.
``(R) A description of program evaluations completed during
the reporting period, including whether all completed
evaluations have been published on a publically available
Internet website and whether any completed evaluations did
not adhere to the common evaluation standards of practice
published under paragraph (4).
``(4) Common evaluation standards.--Not later than February
1, 2014, the Global AIDS Coordinator shall publish on a
publically available Internet website the common evaluation
standards of practice referred to in paragraph (3)(R).
``(5) Partner country defined.--In this subsection, the
term `partner country' means a country with a minimum United
States Government investment of HIV/AIDS assistance of at
least $5,000,000 in the prior fiscal year.''.
SEC. 6. ALLOCATION OF FUNDING.
(a) Orphans and Vulnerable Children.--Section 403(b) of the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7673(b)) is amended--
(1) by striking ``2013'' and inserting ``2018''; and
(2) by striking ``amounts appropriated pursuant to the
authorization of appropriations under section 401'' and
inserting ``amounts appropriated or otherwise made available
to carry out the provisions of section 104A of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2)''.
(b) Funding Allocation.--Section 403(c) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7673(c)) is amended--
(1) by striking ``2013'' and inserting ``2018''; and
(2) by striking ``amounts appropriated for bilateral global
HIV/AIDS assistance pursuant to section 401'' and inserting
``amounts appropriated or otherwise made available to carry
out the provisions of section 104A of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-2)''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Royce) and the gentleman from New York (Mr. Engel) each
will control 20 minutes.
The Chair recognizes the gentleman from California.
General Leave
Mr. ROYCE. Mr. Speaker, I ask that all of our Members have 5
legislative
[[Page H7234]]
days to revise and extend their remarks and to include any extraneous
materials that they might wish to include on this resolution.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. ROYCE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in support of S. 1545. They call this the PEPFAR
Stewardship and Oversight Act of 2013.
It was just over a decade ago that AIDS threatened to decimate an
entire generation of men and women and children around the world, and
particularly in Africa. Without access to lifesaving treatment, there
was then no incentive to get tested. Without testing, it was impossible
to detect and prevent new infections.
In the hardest-hit countries, an estimated 35 percent of the
population was HIV positive, and life expectancy in those countries
dropped to as low as 34 years.
The global AIDS pandemic was a massive humanitarian challenge, but it
also threatened our economic and national security. The pandemic struck
down men and women in their most productive years. The economies of
emerging trade partners contracted. Socioeconomic conditions
deteriorated.
Tens of millions of orphaned children, forced to fend for themselves,
became vulnerable to trafficking. They became vulnerable to criminality
and recruitment by extremists.
Infections among security forces in southern Africa was disturbingly
high.
It was against this backdrop that the United States mounted the most
significant effort of any nation to combat a single disease in history.
Authorized by Congress in 2004, and reauthorized in 2008, the
President's Emergency Plan For AIDS Relief, or PEPFAR, as we call it
today, was a game-changer, and has since become among the most
successful U.S. foreign aid programs since the Marshall Plan. Like many
of my colleagues, I have been to Africa and witnessed the saved lives.
Today, nearly 10 million people receive treatment supported by
PEPFAR. Thirteen countries have reached a tipping point in their AIDS
epidemic, the point where the number of adults on treatment exceeds the
number of new infections. So across Africa, the new infections have
declined by 33 percent.
There is now hope that an AIDS-free generation may be within reach.
We should be proud of that effort. But the United States cannot and
should not do this alone. It is in our interest to ensure that our
bilateral programs, our programs like PEPFAR, are complemented by an
effective, efficient, and accountable global fund to fight AIDS,
malaria, and tuberculosis.
The PEPFAR Stewardship and Oversight Act of 2013 provides a framework
for the continuation of PEPFAR's success. Among other things, this
legislation locks in important social values provisions mandated in the
2004 and 2008 bills that could be jettisoned if we don't move forward
with this legislation.
It improves transparency and reporting in a way that reflects the
current direction of the program, and it extends limitations on U.S.
participation in the Global Fund, including a 33 percent limitation on
U.S. contributions and a 20 percent withholding requirement linked to
transparency and management reforms at the Global Fund.
So this bill is time-sensitive. During the week of December 1, the
Global Fund will convene a donors' conference. Without the 33 percent
cap and 20 percent withholding requirements firmly in place, which is
what the bill does, the ability of the United States to leverage both
our contributions and our reforms would be diminished.
So I urge my colleagues to support this important, timely measure.
Mr. Speaker, I reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I rise in strong support of S. 1545, the
PEPFAR Stewardship and Oversight Act, and I yield myself as much time
as I may consume.
I echo the words of my friend, the chairman. This important
legislation, which passed the Senate by unanimous consent, reauthorizes
key authorities that have helped the President's Emergency Plan For
AIDS Relief, called PEPFAR, change the trajectory of the HIV/AIDS
epidemic around the world.
Before President Bush announced PEPFAR in his 2003 State of the Union
address, and Congress passed authorizing legislation in May of that
year, HIV and AIDS were ravaging the continent of Africa. By then, more
than 25 million people had died from HIV/AIDS, and 14 million children
had been left as orphans.
Another 42 million people were infected and, though lifesaving
treatments had been developed, far too many people had no access to the
medications necessary to save their lives. Therefore, PEPFAR became and
remains the largest commitment by any nation to combat a single disease
internationally.
Today, nearly 6 million people are receiving life-sustaining anti-
retroviral treatment.
Last year, more than 46 million people received HIV testing and
counseling. Of these, more than 11 million were pregnant women, and, as
a result of treatment, the one-millionth baby was born HIV-free this
year.
HIV/AIDS is no longer threatening to wipe out an entire generation on
the continent of Africa. In fact, a sustained commitment by the United
States to fighting this epidemic has made it possible for experts and
researchers to talk about achieving an AIDS-free generation.
PEPFAR is in the midst of an important transition as countries take
on greater ownership of their HIV/AIDS programs. At this critical
juncture, the PEPFAR Stewardship and Oversight Act is an important
demonstration of our ongoing, bipartisan support for the fight against
HIV/AIDS.
This legislation also contains critical provisions that will enable
Congress to provide the oversight necessary to ensure PEPFAR continues
to save millions of lives, while protecting our taxpayers' hard-earned
money.
The bill calls for continued coordination by the inspectors general
for the State Department, Department of Health and Human Services, and
the U.S. Agency for International Development in conducting audits and
oversight of the PEPFAR program.
It also requires a more robust annual report from the Office of the
U.S. Global AIDS Coordinator, which will ensure better accountability.
This legislation also extends key funding requirements for the
treatment and care portion of the program, as well as funding for
orphans and vulnerable children.
Historically, the United States contribution to the Global Fund has
been capped at 33 percent of total contributions. This cap has been an
effective tool to leverage contributions from other countries, as well
as to push for reforms, if necessary, within the Global Fund.
However, when PEPFAR's authorization ended at the end of September,
this 33 percent cap lapsed as well. I believe it is crucial that this
33 percent cap be reinstated going into the Global Fund replenishment
conference, which will be held the first week of December here in
Washington, and this legislation would accomplish this important policy
objective.
Mr. Speaker, by all accounts, PEPFAR has been an incredible success
and a program we should all be proud to be a part of.
I would like to thank Ambassador Eric Goosby, the recently departed
United States Global AIDS Coordinator, for his hard work on behalf of
PEPFAR and his lifelong dedication to those living with HIV/AIDS.
I commend Chairman Royce, Representative Lee, and Representative Ros-
Lehtinen, as well as Senator Menendez and Senator Corker, for their
hard work on this legislation. It has been a pleasure working with all
of them in such a bipartisan and bicameral manner.
I would like to thank the House leadership for allowing this to come
to the floor in a timely manner. Again, I think that Chairman Royce and
I have shown that bipartisanship does exist in this Congress. It
certainly exists on our Foreign Affairs Committee, and this is a
product of that bipartisan comity.
So I urge my colleagues to support this legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. ROYCE. Mr. Speaker, I continue to reserve the balance of my time.
[[Page H7235]]
Mr. ENGEL. Mr. Speaker, it is my honor to yield 4 minutes to the
gentlewoman from California (Ms. Lee), who has been so instrumental in
fighting for this legislation and other AIDS legislation for so many
years in the Congress.
Ms. LEE of California. Mr. Speaker, first, let me thank our ranking
member for yielding, but also, let me just thank you so much for your
tremendous leadership on this issue and on the Foreign Affairs
Committee, and for your recognition and hard work in achieving and
seeking to achieve an AIDS-free generation.
I want to say it is a real pleasure to be with you today and to be
back with you today, actually, with the committee that I served on for
8 years. So thank you, again, so much.
Let me also thank the chair of the Foreign Affairs Committee,
Chairman Royce, for ensuring that PEPFAR continues as a bipartisan
effort, and for your commitment to an AIDS-free generation. I just want
to thank you for that leadership because, oftentimes, we wonder if
there is bipartisanship in this body. Well, I think today, once again,
we can cite that when it comes to saving lives, PEPFAR is a clear
example of how we work together to do just that.
{time} 1645
And, of course, I must thank my cochair on the Congressional HIV/AIDS
Caucus, Congresswoman Ileana Ros-Lehtinen from Florida. I have to thank
her for her work on HIV/AIDS initiatives, both international and
domestic.
I am very proud to have played a role in the creation of PEPFAR and
am proud of the leadership of the Congressional Black Caucus and our
chair at that time, the gentlewoman from Texas, Congresswoman Eddie
Bernice Johnson. Even before the world knew about this program,
Congresswoman Johnson knew the importance of Presidential leadership
and put this on the Congressional Black Caucus' agenda during our very
first meeting with President Bush.
To quote from a 2002 letter to President Bush, the CBC called for an
``expanded U.S. initiative'' to respond to the greatest plague in
recorded history. And then following that, in President Bush's 2003
State of the Union speech, he laid out what this important initiative
should look like and made a serious commitment to this effort.
So over the last decade, we have worked closely with the late
Chairman Hyde, Chairman Lantos, as well as Senator Kerry, the late
Senator Jesse Helms, Senator Bill Frist, Congressman Jim Leach,
Congressman McDermott, Congresswoman Donna Christensen, Leader Pelosi,
and so many others. And I share this because I think it is important
that society recognize that the history of this has been bipartisan
because we kept our eye on the prize. We knew that we wanted to save
lives and we wanted to see an AIDS-free generation, and so many people,
so many Members of this body, so many outside organizations, and our
staff have worked so hard to get us to this point.
So now, a decade later, I am especially proud, once again, to be a
coauthor of the bill before us today. As I said, this is a bipartisan
compromise, and in the end, I think we have a very good bill.
We agreed on the need to protect funding for HIV treatment and
programs for orphans and vulnerable children. We agreed on the need to
preserve support and extend the expired 33 percent cap on United States
contributions to the Global Fund. This cap is a proven tool for
leveraging donor funding and is especially important as the United
States prepares to host the Fourth Replenishment Conference for the
Global Fund next month.
Our bill also updates the annual report to better guide PEPFAR's
transition toward greater country ownership while enhancing oversight.
And I am especially pleased that we included reporting requirements on
efforts to engage key stakeholders, including faith-based organizations
and United States minority-serving institutions.
I can tell you, as a member of the Appropriations Committee, PEPFAR
has transitioned from--and this is very important. And I want to thank
Ranking Member Engel and Chairman Royce for helping us realize the need
to transition from an emergency response to a means of supporting
country leadership in their work towards an AIDS-free generation. So
this bill will fundamentally help continue to move our programs in that
direction.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. ENGEL. I yield an additional 30 seconds to the gentlewoman.
Ms. LEE of California. Thank you very much.
I want to thank Ambassador Goosby for his tremendous leadership, who
actually lives in my congressional district in northern California, and
also Dr. Mark Dybul, who now leads the Global Fund, and so many more.
PEPFAR has supported nearly 6 million people on lifesaving treatment,
more than 11 million pregnant women who have received HIV testing and
counseling, and 1 million babies born HIV-free this year. So this bill
represents the real achievements that we can make when we put aside our
differences and work together to achieve an AIDS-free generation.
Mr. ROYCE. I reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, it is my great honor now to yield 1 minute to
the gentlewoman from California (Ms. Pelosi), our Democratic leader who
has, I think, done more than anyone else to fight for these things from
almost the time that she came to Congress.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding and for
his kind words.
It is just that I have been here such a long time, when I first came
to Congress, the mere mention of the word ``AIDS'' on the floor was
something I thought was the most natural thing to do but was something
that some of my colleagues squirmed at. We have, indeed, come a long
way from that time.
So today is a proud day as Democrats and Republicans come together to
extend and reauthorize our efforts to fight the global HIV/AIDS and
infectious diseases in the poorest countries around the world.
I thank Chairman Royce and Ranking Member Engel for working together
to bring this important legislation to the floor today, and I thank
Congresswoman Barbara Lee for her unwavering leadership on these issues
since day one that you came to the Congress. So many of our colleagues
deserve recognition, and the gentlewoman has acknowledged some of them.
I will just add that this marks the 10th anniversary of the historic
Tom Lantos and Henry Hyde U.S. Global Leadership Against AIDS,
Tuberculosis, and Malaria Act. This legislation has been the foundation
of the U.S. initiative to provide sustained constructive leadership in
the global fight against AIDS.
The original PEPFAR authorizing legislation, followed by the
excellent work of the Appropriations Committee over the last decade,
has provided lifesaving antiretroviral treatment, care, and prevention
for millions of people, especially focused on the most vulnerable
infants and children.
I have traveled on this AIDS issue for a very long time in our
country and abroad, and I have seen firsthand the difference that
PEPFAR has made. I have been to clinics, as have my colleagues Mr.
McDermott, Congresswoman Lee, the head of the Congressional Black
Caucus Health Braintrust, Congresswoman Christensen, as well as others
who are here, and now newer Members, Messrs. Himes and Cicilline.
What was wonderful about it was we went to places where people were
so poor and so desperate, but they were not so desperate that they were
without hope. And PEPFAR gave them hope because, as they said,
Originally we wouldn't even want anybody to know that we had AIDS. Why
would we even be tested for AIDS? People found out that we had AIDS,
but why would we even come to a clinic? What hope did we have?
Well, PEPFAR gave them hope. It gave them a path.
So today we know--and Congresswoman Lee mentioned some of the
figures. Some bear repeating and some others I will mention:
Treatment for over 5 million people; antiretroviral drugs for 750,000
pregnant women living with HIV to prevent mother-to-child transmission
of HIV averted 230,000 infant HIV infections in 2012 alone; HIV testing
and counseling for almost 47 million people; and this
[[Page H7236]]
year, the 1 millionth baby will be born HIV-free because of PEPFAR
support. That means a child that might have been born HIV-infected.
Congresswoman Lee mentioned that Dr. Goosby lives in her district.
His parents and where he was raised is in my district. So we all take
great pride in his work.
Over the years, we have made tremendous progress. First, with
President Clinton, we increased the bilateral programs to fight HIV/
AIDS, and we helped create, authorize, and fund the Global Fund. Then,
under the leadership of President Bush--and this has to be a source of
great pride for President Bush and an important part of his legacy--we
established PEPFAR and provided the necessary funding to ramp up the
emergency response to the crisis.
And I might add my thanks to Bono for the role that he played in,
again, ramping up the resources and making sure the public understood,
as did those of us in elected office and especially in the executive
branch, where maybe this was a newer issue to them, that we needed to
have the resources to make this happen. So thank you to Bono. Not only
did he help us with the loan forgiveness to some of these same
countries, but now to the alleviation of poverty, the eradication of
disease. That is part of his agenda. And he worked with us to enhance
our efforts.
President Obama has provided leadership as well and has strengthened
those efforts and has boosted our investments to put us on the brink of
an AIDS-free generation. President Obama also is to be commended for
lifting the travel ban on those with HIV, enabling the International
AIDS Conference to return to the United States in 2012.
I remember, as a brand-new Member attending the conference in 1987
when this ban was in existence, it was an embarrassment that scientists
could not come here or people coming here with HIV/AIDS from whom we
could learn and there could be scientific collaboration. Well, that was
not allowed because of the travel ban. So thank you, President Obama,
for lifting it so that we could have a truly scientific, truly
comprehensive conference in 2012 in the United States, very proudly.
Today the Congress will pass legislation to extend our global AIDS
investment. Even in these difficult fiscal times, we know that cutting
back is a false economy that costs us more in the future. HIV/AIDS is
still adapting, and so must we. It is a very resourceful virus. It just
keeps finding ways, mutating and finding ways, and we have to be more
resourceful in our fight against it.
I thank the authors of the legislation, to the chair and ranking
minority member, for bringing the bill to the floor and adapting our
policies to meet the continued challenges posed by AIDS, TB, malaria,
and deadly diseases around the world. I am so pleased that we will
probably have a unanimous vote on this important bill, and that is,
indeed, an honor to be a part of.
Mr. ROYCE. I reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I now yield 2 minutes to the gentleman from
Rhode Island (Mr. Cicilline), a very valued member of the Foreign
Affairs Committee.
Mr. CICILLINE. I thank the gentleman for yielding, and I thank
Chairman Royce, Ranking Member Engel, Leader Pelosi, and my colleague
Congresswoman Lee for their strong leadership.
Mr. Speaker, as a longtime advocate for a strong government response
to the HIV/AIDS public health crisis in my home State of Rhode Island
and now as a member of the House Foreign Affairs Committee, I rise
today to strongly support the President's Emergency Plan for AIDS
Relief reauthorization.
This year, we mark the 10th anniversary of PEPFAR, which has always
enjoyed broad bipartisan support. First, in 2003, there was bipartisan
support for addressing this public health emergency; then, in 2008, in
response to some progress, PEPFAR transitioned into a more sustainable
program with greater country ownership.
Over the past decade, PEPFAR has significantly expanded access to
antiretroviral therapy for those suffering from HIV and AIDS, which has
led to a decrease in deaths from this devastating disease all around
the world. We have made real progress because of PEPFAR, and we must
remain vigilant and build upon this progress.
The fight is not over. According to the World Health Organization, to
date, almost 70 million people have been infected with the HIV virus,
and about 35 million have died of AIDS. It is critical that the United
States continue to be a leader in an increasingly international effort
to eradicate this disease.
Mr. Speaker, the role of the United States remains critical to
combating the worldwide HIV/AIDS epidemic, and the PEPFAR Stewardship
and Oversight Act is a necessary and commonsense piece of legislation.
This bill extends vital authority and strengthens oversight of the
PEPFAR program. Most importantly, the bill would also extend the
expired 33 percent limitation on U.S. contributions to the Global Fund.
This cap has proven to be an effective tool for leveraging funding from
other donor countries.
Just 30 years ago, we knew almost nothing about HIV and AIDS, and we
were not able to treat those who were suffering from this disease. To
have made such progress since then is remarkable, and it is a real
testament to what we can achieve when we work together in a bipartisan
way.
I urge my colleagues to vote ``yes'' and to continue our efforts
toward an AIDS-free generation which, for the first time, may be within
our reach.
Mr. ROYCE. I reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I now yield 2 minutes to the gentleman from
Washington (Mr. McDermott), a classmate of mine.
(Mr. McDERMOTT asked and was given permission to revise and extend
his remarks.)
Mr. McDERMOTT. Mr. Speaker, I associate myself with all the remarks
of my friends.
We have had a remarkable occurrence in my time in the Congress. This
was once a death sentence. Today, we are on the verge of being able to
produce an AIDS-free generation.
Now, it is great and we are always excited when we do something new
and big and exciting, but maintaining and pushing forward to finish the
project is really where we are. This bill will pass without a vote
against it, I am quite sure. But the real question is: What do we put
in the budget? Because if we don't maintain what is going on in the
world today, we will lose. We will go backward.
{time} 1700
It is like we have built a dike and we are holding back the sea. But
the fact is if we don't have the drugs available when mothers deliver
children and you do that intervention right at the appropriate time,
you will not prevent the children from getting it. You will not be able
to give the long-term care to the mothers as they raise these children.
In my view, that is really where we are.
This was the crowning achievement, I think, of the administration of
George Bush. His starting this was a statement to the world that the
United States cared about an epidemic that affected the entire face of
the universe. And we have done a good job.
But I say this because I worry about the sequester. What does
sequester mean to this? What will be the reductions? Because I am
getting calls from my friends in South Africa, Zambia, Zimbabwe,
Uganda, and Kenya, saying, How much money is there going to be next
year? Will we be able to expand the program, keep it the same, or are
we going to have to retrench?
That is what the world is watching as we face this upcoming vote on
the budget.
I hope that we have as many votes for funding the program as we do
for reauthorizing it here today in this bill.
Mr. ROYCE. I continue to reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I yield 2 minutes to the gentlewoman from the
Virgin Islands, Dr. Donna Christensen.
Mrs. CHRISTENSEN. I thank my colleague for yielding.
Mr. Speaker, I, too, rise today in strong support of H.R. 3177, the
PEPFAR Stewardship and Oversight Act of 2013.
This year marks the 10th anniversary of PEPFAR, a program that has
literally saved lives in Africa and other hard-hit nations around the
globe. Thanks to PEPFAR, more than 5 million people have received HIV/
AIDS
[[Page H7237]]
treatments; more than 46 million have received confidential HIV testing
and counseling. In 2012 alone, 750,000 pregnant women living with HIV
received antiretroviral drugs to prevent transmission to their babies.
This bill builds on the enormous strides that PEPFAR has made in its
10 years and bolsters oversight and reporting requirements. It also
includes provisions that will expand international donor support, as
well as continue to empower and enhance country ownership in health,
thus promoting sustainability.
Mr. Speaker, more than 100 organizations, most of which are on the
front lines fighting this pandemic throughout Asia, Africa, Middle
East, the Caribbean, and other highly affected countries, strongly
support this bill. Our HBCUs, who have an important role to play, have
also been advocates for it.
I have visited PEPFAR programs in Africa and the Caribbean and seen
their effectiveness firsthand. They save lives.
As a physician who practiced for more than 20 years before coming
here, I know what happens when individuals who are at great risk for
HIV infection do not get accurate testing, education, and counseling,
or when those who are infected do not receive antiretroviral drugs. The
outcome is disastrous.
As a Member representing a U.S. territory in the Caribbean--the
world's second hardest hit region by HIV/AIDS--I cannot stress more
strongly how vitally important our passing the PEPFAR Stewardship and
Oversight Act of 2013 is today. The lives of millions of individuals in
our global community who are currently battling HIV/AIDS depend upon
it. The health and wellness of millions more who are at risk for
infection but currently HIV-free depend on it.
We have not agreed on much that is health and health care-related as
of late, but this is one bill that we can, and I am sure will, agree
on. So I strongly urge all my colleagues to support H.R. 3177.
Mr. ROYCE. I continue to reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, may I ask how much time is remaining.
The SPEAKER pro tempore. The gentleman for New York has 4 minutes
remaining.
Mr. ENGEL. I yield 2 minutes to the gentleman from Connecticut (Mr.
Himes).
Mr. HIMES. Mr. Speaker, I thank Mr. Engel for yielding.
I would like to thank the chairman and the ranking member of the
Foreign Affairs Committee for the bipartisanship with which they led
this bill and which I think we will accomplish some very good things
tomorrow.
The figures around this program speak for themselves: the millions of
lives saved, the orphanages which are no longer full, the many pregnant
women who will not transmit a deadly virus to their children. These
things speak for themselves.
Without question, PEPFAR and the Global Fund are two of the most
effective foreign aid programs ever conceived in this Chamber. But
Americans might ask in good faith, Why spend money in places like
Africa, Asia, and in the Caribbean when the needs are so intense right
here at home? And the answer to that question could not be clearer.
Africa and Asia, where PEPFAR and the Global Fund do the most good,
are areas of great instability but of great promise, where countries
like China are buying up commodities, are exerting their influence, and
are throwing their weight around.
We have the opportunity through the continuation of programs such as
PEPFAR and the Global Fund to win for generations the hearts and minds
of people who will think back on American assistance as the reason that
their family had continuity, as the reason that their country continued
to develop.
So the question we are answering when we think about continuing these
programs and our involvement and our taxpayer dollars should really be,
Are we a country that offered the opportunity to continue to save
lives? Will we do that? Do we want to save lives, if we can? Do we want
to be known just for our economic and military strengths, or do we want
to also be known as an unqualified force for good in this world?
I would say that at this point in our history our ability to say that
it is not just about economic and military power, but it is about a
quality of mercy that we all cherish. And this is a wonderful
opportunity for us to say who we are by supporting this legislation.
Mr. ROYCE. I continue to reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I am very happy to yield 1 minute to the
gentlewoman from Illinois (Ms. Schakowsky).
Ms. SCHAKOWSKY. Mr. Speaker, we can celebrate PEPFAR's 10 years of
success in saving millions of lives by passing the bipartisan PEPFAR
Stewardship and Oversight Act.
Nearly 6 million people are receiving life-sustaining anti-retroviral
treatments and providing care and support to more than 4.5 million
orphans and vulnerable children. That is PEPFAR.
This bill extends critical authorities and strengthens program
oversight to ensure access to essential prevention and treatment
services. Most importantly, this bill extends existing funding
requirements for treatment of orphans and vulnerable children.
We have brought to the world a tipping point in the fight against
AIDS, and I urge all my colleagues to vote ``yes'' on this very
important bill. I thank my colleagues, like Barbara Lee, who have
supported and initiated this amazing help for saving millions of lives.
Mr. ROYCE. I continue to reserve the balance of my time.
Mr. ENGEL. Mr. Speaker, I yield myself the balance of my time.
In closing, let me just, again, say what I said at the outset. I want
to thank Chairman Royce. I am really proud of this legislation. It is
truly a bipartisan product.
We are doing something really, really good here today. We are doing
something that we can be proud of today. We are saving lives, and we
are showing once again that the United States is the most compassionate
Nation on Earth. When all is said and done, isn't this really one of
the greatest things that we can do?
So I urge my colleagues on both sides of the aisle to support this
bill, and I yield back the balance of my time.
Mr. ROYCE. Mr. Speaker, I do think Mr. Eliot Engel of New York should
feel proud about this bill. He is the original author of the House-
passed version.
I would say that, in the interest of expediting this measure, we on
the Foreign Affairs Committee worked, frankly, not only across party
lines but across Chambers in order to draft legislation that preserves
congressional prerogatives, that advances U.S. interests, and, as Eliot
Engel said so succinctly, that saves lives. This bill does that. It
achieves these objectives. We worked in tandem with the Senate on Mr.
Engel's original draft to get this done.
This bill does not affect direct spending. It doesn't affect
revenues. It does not create new programs or include major new policy
provisions. I want the Members to understand that.
It is a streamlined, bipartisan measure that does extend critical
PEPFAR authorities that expired, and it maintains the gains achieved
through the 2008 reauthorization process.
Besides the leadership of Mr. Engel on this bill, I would like to
recognize the work of Representatives Ros-Lehtinen and Lee to shape
this measure, as well as efforts by our leadership to ensure that we do
not miss this narrow window of opportunity to send this bill to the
President's desk without further delay.
I would also share with our Members that it helps get us on a path
towards graduating countries from assistance. It conditions and limits
assistance to the Global Fund.
I urge my colleagues to support this bill, and I yield back the
balance of my time.
Mr. WAXMAN. Mr. Speaker, I rise today in support of S. 1545, the
PEPFAR Stewardship and Oversight Act. Since its establishment in 2003,
the U.S. President's Emergency Plan for AIDS Relief, known as PEPFAR,
has become arguably the most effective global health program that the
U.S. government has ever administered. Already, nearly 15 million AIDS
victims have been served; let us not stop there.
The HIV/AIDS epidemic threatened to eliminate an entire generation in
Africa. Economies were threatened and health care systems were wholly
unequipped to handle the magnitude of the epidemic. Through PEPFAR, the
[[Page H7238]]
U.S. government and its local partners provided diagnostic testing,
administered antiretroviral treatment (ART), and expanded HIV/AIDS
programs to lower the rate of transmission. These efforts achieved
significant success. This year the millionth HIV-free baby was born due
to PEPFAR-supported prevention of mother-to-child transmission. In 13
countries, the rate of infection is below the increasing rate of adults
requiring treatment. Now we can finally work toward an AIDS-free
generation.
S. 1545 extends our commitment to PEPFAR and the U.N. Global Fund
through 2018. It maintains the 10 percent funding requirement for
orphans and vulnerable children, and at least 51 percent for treatment
programs. This bill does not address the changing priorities in the
second phase of PEPFAR, giving PEPFAR the bandwidth to strengthen
health systems, explore public-private partnerships, and increase
country ownership.
Local partnership and ownership is essential to the sustainability of
PEPFAR's programs. This partnership has already begun; the effects can
be seen in broader administration of medical services, though the
parallel expansion of social services for the HIV community has lagged.
The continuation of the 33 percent funding cap for the U.N. Global Fund
ensures local partnership to address such problems.
One of the most notable changes to this legislation is its increase
in oversight. I look forward to receiving the annual, joint oversight
and auditing plans that will be developed by the Inspectors General of
the Department of State, USAID, and HHS, thus increasing Congressional
oversight as well. It will include per-patient cost studies and
analysis of the shift toward greater country ownership. PEPFAR is no
longer a start-up program, and the oversight associated with its shift
toward long-term sustainability must be adjusted accordingly.
Yesterday, the Senate passed this bill with unanimous consent. It is
our turn to do the same.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in
support of S. 1545, The President's Emergency Plan for AIDS Relief
Stewardship and Oversight Act (PEPFAR). Eleven years ago, as the Chair
of the Congressional Black Caucus, I initiated PEPFAR talks with
President George Bush to discuss the necessity of an international
response to the HIV/AIDS pandemic. President Bush helped make a $15
billion commitment to worldwide AIDS relief.
Not only has PEPFAR driven down the cost of commodities, it has seen
real success targeting each country's specific epidemic by coordinating
resources within numerous AIDS responses.
PEPFAR is a vital emergency response and it has been able to
transition to long-term sustainability through country ownership. This
bill not only strengthens all that PEPFAR has achieved, it extends
critical oversight and authority in order to continue its success.
While PEPFAR has been a major accomplishment, we must continue to
support its efforts. The U.S. investment in the Global Fund is key to
the success of PEPFAR.
Our contributions have not only secured resources but also helped to
increase coverage of health services and saved millions of lives. I
urge my colleagues to vote in favor of S. 1545 and continue to support
this critical program.
The SPEAKER pro tempore (Mr. Wenstrup). The question is on the motion
offered by the gentleman from California (Mr. Royce) that the House
suspend the rules and pass the bill, S. 1545.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
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