[Congressional Record (Bound Edition), Volume 146 (2000), Part 11]
[Senate]
[Pages 16316-16321]
[From the U.S. Government Publishing Office, www.gpo.gov]



 PROVIDING FOR NEGOTIATIONS FOR THE CREATION OF A TRUST FUND TO COMBAT 
                           THE AIDS EPIDEMIC

  Mr. BENNETT. Mr. President, I ask unanimous consent that the Foreign 
Relations Committee be discharged from further consideration of H.R. 
3519, and the Senate then proceed to its immediate consideration.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report the bill by title.
  The legislative clerk read as follows:

       A bill (H.R. 3519) to provide for negotiations for the 
     creation of a trust fund to be administered by the 
     International Bank for Reconstruction and Development of the 
     International Development Association to combat the AIDS 
     epidemic.

  There being no objection, the Senate proceeded to consider the bill.


                           Amendment No. 4018

 (Purpose: To authorize additional assistance to countries with large 
 populations having HIV/AIDS, to provide for the establishment of the 
 World Bank AIDS Trust Fund, to authorize assistance for tuberculosis 
    prevention, treatment, control, and elimination, and for other 
                               purposes)

  Mr. BENNETT. Senator Helms, for himself and others, has a substitute 
amendment at the desk, and I ask for its consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Utah [Mr. Bennett] for Mr. Helms, for 
     himself, Mr. Biden, Mr. Frist, Mr. Kerry, Mr. Smith of 
     Oregon, Mrs. Boxer, and Mr. Feingold proposes an amendment 
     numbered 4018.

  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. BENNETT. Mr. President, I ask unanimous consent that the 
amendment be agreed to.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4018) was agreed to.
  Mr. HELMS. Mr. President, passage of the Global AIDS and Tuberculosis 
Relief Act is a priority for this Administration, but that is not why I 
support it. I am aware of the calamity inflicted by HIV/AIDS on many 
Third World countries, particularly in Africa.
  Children are the hardest hit and they, Mr. President, are the 
innocent victims of this sexually transmitted disease. In fact, the 
official estimate of 28 million children orphaned in Africa alone could 
easily prove to be a low estimate. This is among the reasons why 
Senator Bill Frist wrote the pending amendment, which is based on S. 
2845, with solid advice from and by Franklin Graham, president of 
Samaritan's Purse and son of Billy and Ruth. That is why I support it.
  Several items in the pending bill should be carefully noted. First, 
authorization for appropriations for the World Bank Trust Fund is 
scaled back from the House proposal of five years to two years. There 
is no obligation for the U.S. Government to support the trust fund 
beyond two years.
  If the trust fund performs as expected, Congress may decide at that 
time to make additional funds available. However, if the Trust Fund is 
not

[[Page 16317]]

transparent, if there is not strict accountability--and if money is 
squandered on second rate or politicized projects--I intend to do 
everything in my power to ensure that Congress does not provide another 
farthing.
  The pending bill requires that twenty percent of U.S. bilateral 
funding for HIV/AIDS programs be spent to support orphans in Africa. 
That could be as much as $60 million. This is one of the provisions on 
which I insisted, and I wish it could have been an even higher 
percentage.
  I suggest that A.I.D. get together with Nyumbani Orphanage in 
Nairobi, Kenya, Samaritan's Purse, and the other groups working in the 
field to develop a plan to address the crisis.
  Finally, I insisted that the lions share of bilateral funding, 
specifically, 65 percent--or as much as $195 million, be available to 
faith-based groups and I am gratified that my colleagues have consented 
to this. At last, it has dawned on Senators that HIV/AIDS legislation 
and programs designed to address the spread of AIDS are worthless 
unless they recognize and address seriously the moral and behavioral 
factors associated with the transmission of the disease.
  There is only one 100 percent effective way to stop the spread of 
AIDS, and that, of course, is abstinence and faithfulness to one's 
spouse. And it is through churches that this message will be 
effectively promoted and accepted, not through government 
bureaucracies. It is no exaggeration to say that policymakers refusing 
to face up to this obvious fact will be culpable in the deaths of 
millions.
  Mr. President, approval of this bill will be an important 
accomplishment, and if its provisions are properly implemented it will 
save lives. The Foreign Relations Committee will work diligently over 
the next two years to ensure that the intent of Congress is understood 
and carried out.
  Mr. BIDEN. Mr. President, I cannot tell you how pleased I am that the 
Senate will finally pass the Global AIDS and Tuberculosis Relief Act. 
HIV/AIDS has been acknowledged as the 21st century's bubonic plague. It 
is having a devastating impact in Sub-Saharan Africa, destroying the 
very fabric of African societies. And while Africa is the present day 
epicenter, there is no guarantee that the disease will not spread 
throughout the world in a manner that is just as devastating. No corner 
of the globe is immune.
  HIV/AIDS is the only health related issue that has ever been the 
subject of a meeting of the United Nations Security Council, and the 
only one that has been the subject of a Security Council Resolution. 
Why? Because it poses a severe risk to every nation in the 
international community, but most especially to developing nations 
which do not have the means to either treat those living with the 
disease, or to educate those at risk of contracting the disease about 
how to avoid infection.
  I believe that it is past time for the United States to step forward 
and lead the way in efforts aimed at stopping the spread of the HIV/
AIDS. This bill does just that. The funding levels this bill authorizes 
significantly increase the level of U.S. assistance to combat HIV/AIDS. 
One of the key elements of this legislation is an authorization for the 
Secretary of the Treasury to enter into negotiations with the World 
Bank to create a Trust Fund, the purpose of which is the eradication 
and prevention of the spread of the virus.
  The Trust Fund will allow donations and contributions from 
governments--the bill authorizes $150 million as the U.S. 
contribution--as well as the private sector, so that all sectors in 
society are working together at an international level to address this 
crisis. It is truly the best way to do so. The statistics are grim. 
According to UNAIDS, in 1999 alone 5.4 million people were infected 
with HIV/AIDS, bringing the total to 34.4 million infections world 
wide. 2.8 million people died of the disease last year. This does not 
have to be. We know how to prevent the spread of the disease. We have 
the means to treat the virus and the opportunistic diseases that kill 
those infected with HIV/AIDS. Millions of lives can be saved through 
both treatment and prevention. Through cooperation we can be 
successful. We must challenge other donors to dedicate the necessary 
resources to achieve our aim.
  The bill also authorizes $300 million in bilateral assistance to stop 
the spread of the disease, and to treat it. While I strongly believe 
that a multilateral approach must be developed to respond to the HIV/
AIDS epidemic, I also believe that the United States should do all it 
can right now to deliver targeted assistance to specific regions and 
specific treatment programs. The problem of HIV/AIDS is urgent. 
Bilateral assistance programs can be funded and programs carried out 
right away, and they should be.
  Assistance is desperately needed, for example, in Africa. The 
countries in the sub-Saharan region cannot wait for the negotiation of 
a Would Bank Trust Fund; they must have help now. The news which came 
out of the International AIDS Conference in Durban was grim. Gross 
Domestic Product could be cut by as much as 20% due to the impact of 
HIV/AIDS in some African countries, according to a study released at 
the conference. African countries are among the poorest in the world. 
They cannot afford to have their incomes diminished to such a degree. 
According to the World Bank,

       AIDS is now the fourth leading cause of death worldwide and 
     the leading cause of death in Sub-Saharan Africa. At all 
     levels, the impact of AIDS in Africa is staggering: At the 
     regional level, more than 13 million Africans have already 
     died, and another 23 million are now living with HIV/AIDS. 
     That is two-thirds of all cases on earth. At the national 
     level, the 21 countries with the highest HIV prevalence in 
     the world are in Africa. In Botswana and Zimbabwe, one in 
     four adults is infected. In at least 10 other African 
     countries, adult prevalence rates exceed 10 percent. At the 
     individual level, a child born in Zambia or Zimbabwe today is 
     more likely than not to die of AIDS at some point in her 
     lifetime. In many other African countries, the lifetime risk 
     of dying of AIDS is greater than one in three. The HIV/AIDS 
     epidemic is not only an unparalleled public health problem 
     affecting large parts of Sub-Saharan Africa, it is an 
     unprecedented threat to the region's development. In many 
     countries, the disease is reversing decades of hard-won 
     development progress.

  We cannot ignore these facts. The time to act is now. The sooner we 
address this crisis in Africa as well as the rest of the developing 
world, the better. The directives in this bill represent the best of 
the current proposals to do so. The World Bank and the Export-Import 
Bank of the United States both recently announced that they would make 
funds available for loans to African countries to help them purchase 
drugs to treat HIV/AIDS. While I welcome any efforts to procure drugs 
for this purpose, I do not believe that extending more loans to nations 
currently facing crippling debt burdens will, in the long run, prove to 
be the most useful strategy. Grants and no strings attached assistance, 
the aid provided in this bill, are what is needed.
  I want to make it clear that this bill represents only the beginning 
of the United States' commitment to fighting HIV/AIDS. Sustained 
dedication of resources will be needed to continue the fight, and we in 
the Senate must ensure that such resources continue to be channeled 
towards eliminating the threat of HIV/AIDS. This bill is a good first 
step in our efforts.
  Mr. FRIST. Mr. President, a bipartisan group of members of the Senate 
Foreign Relations Committee have today sent to the Senate for 
consideration a landmark legislative initiative to combat one of the 
great human tragedies of our time, the HIV/AIDS epidemic. The Global 
AIDS and Tuberculosis Relief Act of 2000 reflects the combination of 
many initiatives proposed by members of the Foreign Relations 
Committee. All initiatives share a common purpose of arresting the 
progress of the disaster and caring for the victims so far.
  The initiative cannot come too soon. The cost in human life and 
productivity, as well as the potential societal and economic 
disruptions AID has and will cause assure us of one distinct 
possibility: All goals of the United States in Africa and the 
developing world--goals we share with them--will be seriously 
compromised, if not completely undermined, by AIDS. Growing trade,

[[Page 16318]]

better education and health, stronger democracies, efforts toward 
peace--all will be undermined by a disease that is positioned to sap 
the life from the most promising and productive generations.
  Two characteristics of this pandemic that distinguish it from the 
other great killers have impressed me the most and shaped the Senate's 
recent initiative to support the efforts to combat HIV/AIDS worldwide.
  The first is the fact that AIDS affects the younger members of a 
community in their most productive years. It thus contorts and 
eventually turns on its head the already strained economic equation by 
effectively reversing the proposition of dependants to productive 
members of a family. In short, it has struck at the heart of the 
extended families, changing the breadwinners from a source of needed 
food or income to a burden. That is to say nothing of the grief, 
personal loss and often shame associated with death from AIDS.
  The second is that the estimated number of orphans from AIDS in 
Africa, for example, already exceeds 10 million, and is expected to 
approach 40 million in coming years. Many of those children will 
themselves be HIV-positive. The prospect of 40 million children without 
hope, health and often without any support whatsoever is as dangerous 
as it is tragic. These children are susceptible to substance abuse, 
prostitution, banditry or, as we have seen so often on the continent, 
child soldiery. It will be an economic strain on weakening or 
completely broken economies, and an extremely volatile element in 
strained societies.
  The human cost of AIDS is already alarmingly high, and the trends are 
increasingly terrifying--even apocalyptic.
  Sub-Saharan Africa has been far more severely affected by AIDS than 
any other part of the world. It is our greatest challenge. I have seen 
the effects of its ravages on the people of that continent firsthand. 
The potential is clearly written in the appalling statistics of the 
disease today.
  According to December 1999 United Nations data, some 23.3 million 
adults and children are infected with the HIV virus in the region, 
which has about 10 percent of the world's population but nearly 70 
percent of the worldwide total of infected people. In Botswana, 
Namibia, Zambia, and Zimbabwean estimated 20 percent to 26 percent of 
adults are infected with HIV, and 13 percent of adults in South Africa 
were infected as the end of 1997.
  An estimated 13.7 million Africans have lost their lives to AIDS, 
including 2.2 million who died in 1998. The overall rate of infection 
among adults in sub-Saharan Africa is about 8 percent compared with a 
1.1 percent infection rate worldwide.
  AIDS has surpassed malaria as the leading cause of death in sub-
Saharan Africa, and it kills many times more people than Africa's armed 
conflicts.
  Sub-Saharan Africa is the only region in which women are infected 
with HIV at a higher rate than men. According to UNAIDS, women make up 
an estimated 55 percent of the HIV-positive adult population in sub-
Saharan Africa, as compared with 35 percent in the Caribbean, the next 
highest-ranking region, and 20 percent in North America. Young women 
are particularly at risk. A U.N. study found girls aged 15-19 to be 
infected at a rate of 15 percent to 23 percent, while infection rates 
among boys of the same age were 3 percent to 4 percent.
  The African AIDS epidemic is having a much greater impact on children 
than is the case in other parts of the world. An estimated 600,000 
African infants become infected with HIV each year through mother to 
child transmission, either at birth or through breast-feeding.
  At least 7.8 million African children have lost either their mother 
or both parents to AIDS, and thus are regarded by UNAIDS as ``AIDS 
orphans.'' South Africa is expected to have one million AIDS orphans by 
2004. An estimated 10 million or more African children will have lost 
either their mother or both parents to AIDS by the end of the year 
2000. In some urban areas of Africa, orphans comprise up to 15 percent 
of all children. Many of these children are themselves infected with 
HIV/AIDS and often face rejection from their extended families and from 
their communities.
  In its January 17, 2000 issue. Newsweek projected that there will be 
10.4 million African AIDS orphans by the end of 2000. UNAIDS reports 
that AIDS orphans, suspected of carrying the disease, generally run a 
greater risk of being malnourished and of being denied an education.
  At current infection and growth rates for HIV/AIDS, the National 
Intelligence Council estimates that the number of AIDS orphans 
worldwide will increase dramatically, potentially increasing three-fold 
or more in the next ten years, contributing to economic decay, social 
fragmentation, and political destabilization in already volatile and 
strained societies. Children without care or hope are often drawn into 
prostitution, crime, substance abuse or child soldiery.
  The majority of governments in areas of sub-Saharan Africa facing the 
greatest burden of AIDS orphans are largely ill-prepared to adequately 
address the rapid growth in the number of children who have no means of 
support, no education nor access to other opportunities.
  Donors must focus on adequate preparations for the explosion in the 
number of orphans and the burden they will place on families, 
communities, economies, and governments. Support structures and 
incentives for families, communities and institutions which will 
provide care for children orphaned by HIV/AIDS, or for the children who 
are themselves infected by HIV/AIDS, will become increasingly important 
as the number of AIDS orphans increases dramatically.
  By providing a knowledge, skills, and hope orphaned children might 
not otherwise have, education is an especially critical part of a long 
term strategy. Education is the key to providing opportunity and 
fighting poverty, and education is essential to winning the battle 
against the HIV/AIDS epidemic.
  The legislation does not focus solely on Africa, but reflects the 
fact that the grip of the disease is tightening around the developing 
world. Some of the mechanisms are new and yet untested. But in their 
design, their potential for being the most effective tools at our 
disposal is clear.
  We need to be mindful that the United States can be a great force for 
good in the world. Certainly, Americans are very charitable and 
compassionate people, and the political will exists to take a more 
aggressive posture toward combating AIDS.
  However, our job is to determine how best to use our limited 
resources to maximize their potential for good on the African 
continent. These are life and death decisions which cannot be addressed 
simply by allocating more funds, confident that we have thus done our 
part. How we direct or allocate those resources has the potential to 
significantly affect the situation.
  Questions and issues involved in life and death decisions are not 
easy. They are decisions based on the understanding that you cannot 
help or save all in need in a situation, but must make decisions based 
on the best information and understanding of your strengths and 
limitations.
  Over the next two years, the legislation authorizes $300 million per 
year for ongoing HIV/AIDS programs worldwide. That represents a 
significant increase in our commitment and is well above the 
President's request. The United States has been a leader in AIDS 
prevention programs and in AIDS treatment and programs to mitigate the 
devastating societal and economic effects of the epidemic. We should 
continue that leadership and even strengthen it.
  Additionally, the legislation authorizes $100 million to the Global 
Alliance for Vaccines Initiative, know by its acronym, GAVI, which 
receives both public and private funding to provide existing vaccines 
to children worldwide, and to provide incentives for the development of 
new vaccines. Often, companies determine that it is not possible to 
commit the capital to research and development toward developing 
vaccines for diseases such as malaria. While the potential number of 
recipients is great,

[[Page 16319]]

the potential number of purchasers is very small. By providing a clear 
purchaser for the future, GAVI addresses much of the questions 
involving the risks of investing in such research.
  The legislation goes beyond incentives alone. Over two years, it 
commits $20 million to the International AIDS Vaccine Initiative, or 
IAVI, a group which is committed to developing the ultimate weapon 
against the continued spread of HIV: a vaccine.
  The legislation does not seek to act unilaterally, but has two 
critical elements which will help use our leadership position to 
leverage greater cooperation to combat the epidemic.
  First, it seeks to establish a global trust for programs to combat 
the transmission of HIV and to respond to the devastation of AIDS. 
Under the legislation, the United States can contribute up to $150 
million per year for two years to capitalize the fund. Of that, $50 
million annually is specifically targeted to address the great human 
tragedy and most daunting challenge of AIDS orphans. Undoubtedly, the 
initial generous contribution of the United States will spur many more 
commitments from other nations.
  The legislation does not leave the question of orphans to the trust 
fund alone. It also directs the United States to begin coordinating a 
global strategy to address the orphans crisis, especially in caring for 
them and educating them. This is in addition to the specific focus on 
education and care of orphans in Africa mandated in the initial 
authorization of ongoing programs and in the trust fund. Only education 
can provide the tools for these children to escape the poverty, 
violence and exploitation that they will often face. The strong 
emphasis on this explosive and frightening problem is one of the most 
forward looking approaches to international health yet considered by 
Congress. I cannot overemphasize the importance of these provisions.
  The legislation also addresses the increasing threat of tuberculosis 
worldwide. The diseases' resurgence is a clear and direct threat to the 
United States' public health. Astonishingly, the World Health 
Organization estimates that one third of the world's population is 
infected with tuberculosis. With the increasingly drug resistant 
strains of the disease emerging yearly, the urgency of the initiative 
is critical. The legislation authorizes $60 million each year for two 
years for programs to combat the disease. That figure represents a 
substantial increase in our efforts to ensure our own safety and health 
and to combat the scourge worldwide.
  Overall, this legislation represents a clear recognition of the 
importance to our own health and security to combating infectious 
disease worldwide. More significantly, though, it is a monumental new 
commitment by the United States to combat the death and suffering of 
our fellow humans. It is a great demonstration of America's generosity 
and our hope to improve the lives and potential of all people.
  Mr. KERRY. I am pleased to join the distinguished chairman of the 
Foreign Relations Committee, Mr. Helms, and the Chairman of the Africa 
Subcommittee, Dr. Frist, in bringing this very important bill to the 
Senate.
  Mr. President, the human toll of the AIDS crisis in Africa is 
stupefying. More than 30 million people now live with AIDS and annual 
AIDS-related fatalities hit a record 2.6 million last year. Ninety-five 
percent of all cases are found in the developing world. AIDS is now the 
leading cause of death in Africa and the fourth leading cause of death 
in the world. In at least 5 Africans countries, more than 20 percent of 
adults are HIV-positive.
  The AIDS epidemic is more devastating than wars: in 1998 in Africa, 
200,000 people died from armed conflict; 2.2 million died from AIDS--
more than 5,000 Africans died every day from the disease.
  This week, the U.S. Census Bureau announced new demographic findings 
for Africa. Because of AIDS, Botswana, Zimbabwe and South Africa will 
experience negative population growth in the next five years. Without 
AIDS, these countries would have experienced a 2-3 percent increase in 
population. Children born within the past 5 years in Namibia, Swaziland 
and Zimbabwe can expect to die before the age of 35. Without AIDS, 
their life expectancy would have been 70. In addition, a new and very 
troubling statistic was announced this week: UNAIDS reported that 55 
percent of all HIV-infections were in women. So AIDS is not only 
robbing societies of young women but also of the child they might have 
had.
  It is not hyperbole to say that this is Africa's worst social 
catastrophe since slavery, and the world's worst health crisis since 
the bubonic plague.
  Other parts of the world are going down the same path as Africa. 
Infection rates in Asia are climbing rapidly, with several countries, 
especially India, on the brink of large-scale expansion of the 
epidemic. When I was in India in December, epidemiologist from our 
government as well as Indian officials admitted that the number of 
cases in Asia could surpass those of Africa by the year 2010.
  In addition, countries of the former Soviet Union and Eastern Europe 
are especially vulnerable, as Russia is experiencing one of the highest 
increases in infection rates of any single country in the world last 
year. Is this the kind of world we want for the 21st century? In this 
age of remarkable biotechnical and biomedical breakthroughs, when we 
have cures of impotence and treatments for depression, do we want to 
ignore a public health crisis of biblical proportions? When we're 
talking about the democratization of the developing world, when we're 
talking about the triumph of capitalism and open markets, when we're 
talking about the benefits of globalization, we cannot remain silent--
as rich as we are in talent, technology and money--about the threat 
AIDS poses to our national security.
  Mr. President, last week, the 13th annual International Conference on 
AIDS was taking place in Durban, South Africa. It was the first time 
this international conference is being held in a country in the 
epicenter of the AIDS pandemic in the developing world.
  A number of important breakthroughs have been announced from the 
Conference and the Senate should be aware of them:
  Pharmaceutical companies have announced that they are prepared to 
offer their life-extending therapies to the developing world at no cost 
or at a very discounted rate. Merck will provide Botswana with $100 
million in medicine over the next five years. Abbott Laboratories 
confirmed that it will initiate a charitable program in Tanzania, 
Burkina Faso, Romania and India. Boehringer Ingelheim will give away 
one of the most important drugs in preventing the transmission of HIV 
from mother to child--Viramune--to developing countries over the next 5 
years. Similarly, Pfizer recently promised to give South Africa its 
effective product--Diflucan--which is used for treating a deadly brain 
infection associated with AIDS.
  These are all important developments. Access to these pharmaceutical 
products has historically been prevented by high price, and these 
companies should continue to work with governments and philanthropies 
like the Bill & Melinda Gates Foundation--which today is announcing 
another $90 million in grants to combat AIDS in the developing world. 
The contribution made by Bill and Melinda Gates to fighting infectious 
diseases cannot be overstated. Through their philanthropy, they have 
given countries which are being ravaged by disease a fighting chance.
  Fighting and winning the war against AIDS is more than just giving 
away medicine. We must continue to bolster the research into a cure. To 
this end, a number of significant biomedical breakthroughs have come 
out of Durban. The most significant is the announcement by the 
International AIDS Vaccine Initiative of human trials of a new vaccine 
candidate against AIDS. Development of an effective AIDS vaccine is 
critical especially in Africa where preventive measures--such as 
encouraging change in high-risk behaviors and debunking deadly myths--
will do little to slow the spread of HIV in countries which have a 20 
or 25 percent infection rate. It is clear

[[Page 16320]]

that the only hope for these countries is a cure: that means, 
developing an effective vaccine and assuring its affordable 
distribution.
  And, we have a responsibility to act in this increasingly intertwined 
world because, together with all the benefits associated with 
globalization, we also now are facing a range of new threats that know 
no borders and move without prejudice--international crime, cyber-
terrorism, drug-trafficking and infectious diseases.
  We are seeing a rise in the number of previously unknown lethal and 
potent disease agents identified since 1973--the ebola virus, hepatitis 
C, drug-resistant tuberculosis, West Nile virus and HIV. These diseases 
affect all of us, including American citizens. New Yorkers know the 
scare associated with these heretofore unknown diseases--last summer 
New York City was held captive by an encephalitis scare and new 
outbreaks this year have already been spotted in pigeons. There was a 
shock in the scientific community when it was discovered that outbreak 
of the mosquito-borne disease in New York was not, as scientists had 
believed, St Louis encephalitis: instead, it was a deadly variant of 
West Nile virus, a disease hitherto found only in Africa, the Middle 
East and parts of West Asia. United States health officials now fear 
that the disease may now become prevalent in the Americans. Similarly, 
it is foolhardly and dangerous to believe that any infectious disease 
can be adequately contained in one region. We are all at-risk.
  Militaries are not immune; in fact, they are in some cases even more 
susceptible to upheaval and instability from infectious diseases, 
especially AIDS. Some militaries in Africa have HIV-infection rates 
which top 40 percent. These military forces could be part of the 
solution for democratization in Africa in terms of peacekeeping and 
conflict prevention; instead, African armed services are losing their 
military effectiveness and adding to the social instability.
  It is projected that Africa will be home to 40 million children, 
orphaned by AIDS, by the year 2010. Zambia is a country of 11 million 
people--half a million of them will be AIDS orphans. We know from other 
regions of the world--like Cambodia and Burma--that exploited children 
are common targets by rogue militias and narco- and other criminal 
organizations. It is clearly in our interest to stem this activity.
  Likewise, economies are not immune. In fact, development of the last 
20 years is being reversed in the countries hardest-hit by AIDS. AIDS 
cost Namibia almost 8 percent of its GDP in 1996. Tanzania will 
experience a 15 to 25 percent drop in its GDP because of AIDS over the 
next decade. Over the next few years, Kenya's GDP will be 14.5 percent 
less than it would have been absent AIDS. AIDS consumes more than 50 
percent of already meager health budgets. In many African countries, 
the total annual per capita health-care budget is $10. 80 percent of 
the urban hospital beds in Malawi are filled with AIDS patients--all is 
a direct threat on evolving democratic development and free-market 
transition. Mozambique and Botswana have two of the world's fastest 
growing economies but this economic growth cannot be maintained when 
those countries' workforces are being decimated with the daily deaths 
of hundreds of people in their most productive years. In the Cote 
d'Ivoire, a teacher dies of complications associated with AIDS every 
school day. In South Africa, businesses owners often hire and train two 
employees for one job, knowing that one will probably die from AIDS.
  As we celebrated the passage this year of the Africa Trade bill, how 
can we seriously think that a vibrant market for products or investment 
can be formed on a continent which will lose up to 20 percent of its 
population in the next decade? To lure investors, the continent has 
already had to battle underdevelopment and racism, but now, some people 
in the developed world will see Africa as only as a place of disease. 
This is wrong and it is a direct threat to our national economic 
interests.
  Governments are not immune. This epidemic is causing leadership 
crises in some African countries. President Benjamin Mkapa of Tanzania 
reported last week that ``some ministries lose about 20 employees each 
month to AIDS.''
  African governments are grappling with the devastation wrought by HIV 
on their economies and their societies. It is difficult to fathom the 
challenges they face with this public health crisis, and some of the 
actions sometimes baffle western observers. Some critics have recently 
pointed to the questions raised by President Thabo Mbeki of South 
Africa as to the origins of AIDS and as to the proper course of 
treatment. When it comes to dealing with AIDS, there are moral 
questions, there are budgetary constraints, there are political 
decisions. But there are also some biomedical truths. Senator Frist and 
I have discussed these issues with the distinguished ambassador from 
South Africa and followed up with President Mbeki when he came to 
Washington on a state visit. Leadership is necessary from both the 
United States and from Africa--this issue cannot be solved by one 
nation alone. But no one country can ignore it either. President Mbeki 
has focused his attention on fighting the AIDS epidemic by fighting 
poverty. In his remarks in Durban, he missed an opportunity by refusing 
to state unequivocally that HIV causes AIDS. And, I fear, his questions 
will allow those who engaged in risky and unsafe practices to continue. 
Only bashing pharmaceutical companies is not helpful in the fight 
against AIDS, and the participants at the International Conference on 
AIDS rightly passed a resolution in support of the tested science of 
AIDS.
  One can argue--and I do not at all subscribe to that argument--that 
Africa does not matter to the security interests of the United States. 
Some even mock the suggestion. I believe that this is not an issue of 
which any decent rational human being can be dismissive. One 
humanitarian terms, on political terms, on cultural terms, on economic 
terms, on historical terms, no one should dare be dismissive. We are 
linked to everything that is happening in Africa, starting back to our 
nation's and civilization's earliest history, and we are now tied by 
the new forces of globalization and technology. And I hope that we will 
always be tied by who we are and what we are as nation. This really 
tests the fiber of our country, in a sense, and questions whether we 
are prepared to deal with this threat.
  But even if you subscribe to the view that the AIDS disaster in 
Africa is not a threat to our national security, you have to at least 
recognize that unfettered spread of this horrendous virus to other 
regions of the world--including North America--is certainly a threat. 
As goes Africa, so goes India and China--and no one in this Senate can 
make the argument that an India or a China, destabilized by a public 
health catastrophe, can be ignored in terms of our national security 
interests.
  The window of opportunity is now open to making a real difference in 
Africa and improving global health, and that is why I am so pleased 
that the Senate is acting with all dispatch to make a significant 
contribution to fighting the epidemic in Africa. This bill builds upon 
the work of many of our most thoughtful and distinguished colleagues. 
It includes initiatives that Congresswoman Nancy Pelosi, Senator Frist 
and I began many months ago to speed vaccine development, to deal with 
AIDS orphans and to alleviate the suffering of those infected with HIV 
on the African continent. It also incorporates the plan Senator Frist, 
Congressman Leach and I have devised to inaugurate AIDS prevention 
grants from the World Bank. Senator Durbin and I proposed a plan to 
assist AIDS orphans, and the spirit of that legislation is found 
throughout this bill. Senator Boxer and Senator Gordon Smith have 
called for funding increases to AIDS prevention programs in Africa; 
Senator Moynihan and Senator Feingold have a proposal to target money 
to prevent further infection among infants. Their contributions can be 
seen in this bill.
  The work of the appropriators has been and will continue to be vital 
in funding programs to assist Africa. I

[[Page 16321]]

commend Senator Leahy and Senator McConnell for increasing funding for 
the existing appropriations accounts on global health in the Foreign 
Operations bill and I am very grateful that they have agreed to fund 
the Global Alliance for Vaccines and Immunizations (GAVI) which I have 
been urging for a year now.
  I would also like to acknowledge the significant contribution of the 
distinguished Senator from North Carolina, Mr. Helms. I commend the 
Chairman and our ranking member, Senator Biden, for their leadership. 
They have ensured that this session will not close until we have passed 
the largest single response by our Nation to the global AIDS epidemic.
  It is my hope that the other body will move to pass these vital 
proposals with all necessary speed. It is clearly in our national 
interests--security, economic, political, health and moral--to do all 
we can to solve this crisis. Let me be clear on this, Mr. President, my 
commitment to this issue is not transitory. I will not rest on this 
legislative victory. I will be back next year and every year after that 
until this public health disaster is over.
  Mr. FEINGOLD. Mr. President, I rise in support of the Global AIDS and 
Tuberculosis Relief Act of 2000. This bill recognizes the awesome and 
terrible scope of the HIV/AIDS epidemic, and responds with what is 
truly required to address it--a program far more comprehensive and 
substantial than what is entailed in the status quo.
  The numbers one must use to describe the crisis are numbing. More 
than 70 percent of all people living with AIDS live in sub-Saharan 
Africa, and as the ranking member of the Senate Subcommittee on Africa, 
I have seen firsthand the devastating toll that the disease has taken 
in the region. In Africa alone, 15,900,000 people have died because of 
AIDS, and the World Bank has identified the disease as the fastest-
growing threat to development in the region. Life expectancies are 
dropping dramatically, and the social fall- out from this horrific 
upheaval has forced us to confront the disease not just as an 
epidemiological threat, but as a security threat as well. Nearly 
4,500,000 children have HIV and more are being infected at the rate of 
one child every minute. According to UNAIDS, by the end of 1999, AIDS 
had left 13,200,000 orphaned children in its wake.
  This bill is a serious effort to confront this monstrous crisis. It 
will provide hundreds of millions of dollars in assistance to 
strengthen prevention efforts, to combat mother-to-child transmission, 
to improve access to testing, counseling, and care, and to assist the 
orphans left in the wake of the disease. Through a new AIDS trust fund, 
it will leverage U.S. assistance with a multilateral approach and 
through innovative partnerships with the private sector. The bill 
provides support to the Global Alliance for Vaccines and Immunizations 
and to the International AIDS Vaccine Initiative, so that even as we 
address the urgent needs of the present, we work toward a solution in 
the future. The bill insists that AIDS education be provided to troops 
trained under the auspices of the African Crisis Response Initiative. 
It recognizes the inextricable link between HIV/AIDS and the resurgence 
of tuberculosis. It goes beyond the President's request and beyond 
anything that this Congress has contemplated since the epidemic began.
  The bill is not perfect, of course. The needs are great and the 
problem multi-faceted. I would still like to see this Congress address 
the important issue of access to pharmaceuticals, and to put strong 
language into statute that would prohibit the executive branch from 
pressuring countries in crisis to revoke or change laws aimed at 
increasing access to HIV/AIDS drugs, so long as the laws in question 
adhere to existing international regulations governing trade. This bill 
does not absolve this Senate of a continued responsibility to address 
the global AIDS crisis. But it is remarkable, all the same.
  This bill has the unanimous support of the Senate Foreign Relations 
Committee. Senators Helms, Boxer, Frist, Kerry, and Biden have worked 
on it tirelessly. It includes provisions originally drafted in the 
Mother-to-Child HIV Prevention Act, a bill authored by Senator Moynihan 
of which I was proud to be an original co-sponsor. It reflects the 
admirable work of the House and in particular of Congresswoman Barbara 
Lee and Congressman Leach, and it should reach the President's desk 
quite quickly. Rarely does such a substantive, ground-breaking bill 
enjoy this degree of bipartisan consensus. It is a tribute to my 
colleagues and a testimony to the undeniable magnitude and urgency of 
the crisis that the Senate stands ready to pass this legislation today.
  Just days ago, U.S. Ambassador to the United Nations Richard 
Holbrooke testified before the Senate Foreign Relations Committee. When 
he was speaking about the AIDS crisis, he spoke of its impact and of 
the place the epidemic has already taken in history, and said, ``All of 
us will have to ask ourselves, when our careers are done, did we 
address this problem?'' This bill is an important part of the answer to 
that question.
  Mrs. BOXER. Mr. President, today the Senate is taking a big step 
forward in the fight against international AIDS and Tuberculosis. 
Today's passage of H.R. 3519, the Global AIDS and Tuberculosis Relief 
Act of 2000, will help those throughout the world who are suffering 
from these deadly infectious diseases.
  I am particularly pleased that this legislation includes two bills 
that I introduced earlier in the 106th Congress. In February, I 
introduced the Global AIDS Prevention Act (S. 2026). This legislation 
authorizes $300 million in bilateral aid for those nations most 
severely affected by HIV and AIDS. It calls on the United States Agency 
for International Development to make HIV and AIDS a priority in its 
foreign assistance program and undertake a comprehensive, coordinated 
effort to combat HIV and AIDS. This assistance will include primary 
prevention and education, voluntary testing and counseling, medications 
to prevent the transmission of HIV and AIDS from mother to child, and 
care for those living with HIV or AIDS.
  H.R. 3519 also includes legislation I introduced last year, the 
International Tuberculosis Control Act (S. 1497). This bill authorizes 
$60 million in aid to fight the growing international problem of 
tuberculosis. With this legislation, the United States Agency for 
International Development will coordinate with the World Health 
Organization, the Centers for Disease Control, the National Institutes 
of Health, and other organizations toward the development and 
implementation of a comprehensive tuberculosis control program. This 
bill also sets as a goal the detection of at least 70 percent of the 
cases of infectious tuberculosis and the cure of at least 85 percent of 
the cases detected by 2010.
  H.R. 3519 has other important provisions as well. The bill includes a 
$10 million contribution to the International AIDS Vaccine Initiative 
and a $50 million contribution to the Global Alliance for Vaccines and 
Immunizations. It also contains provisions calling for the 
establishment of a World Bank AIDS Trust Fund with the Secretary of the 
Treasury authorized to provide $150 million for payment to the fund.
  I want to thank all of the members of the Senate Foreign Relations 
Committee for their work on this legislation. I am particularly 
grateful for the efforts of Chairman Helms in pushing this bill 
forward.
  This is an important step in the fight against AIDS and TB. I have no 
doubt that greater resources will be needed in future years to continue 
this effort. I am hopeful that the Senate will continue to treat the 
issue of infectious diseases with the seriousness it deserves.
  There are 34 million people today living with HIV/AIDS, and one-third 
of the world's population is infected with tuberculosis. Much more 
needs to be done, and I am proud of the Senate for taking this action 
today.
  Mr. BENNETT. Mr. President, I ask unanimous consent that the bill be 
read a third time and passed, as amended, the motion to reconsider be 
laid


upon the table, and that any statements relating to the bill be printed 
in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (H.R. 3519), as amended, was read the third time and passed.

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