[Congressional Record (Bound Edition), Volume 148 (2002), Part 3]
[Senate]
[Pages 3796-3799]
[From the U.S. Government Publishing Office, www.gpo.gov]




                NEXT STEPS IN THE FIGHT AGAINST HIV/AIDS

  Mr. BIDEN. Mr. President, by now I hope that all of my colleagues are

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aware of the extent of the HIV/AIDS epidemic. The spread of the disease 
is of grave humanitarian and security concern to the United States.
  Last year alone, 3 million people died as a result of the disease. I 
have yet to see a study or data which suggests that the number will not 
increase in 2002.
  In January of 2000 the National Intelligence Council released a 
National Intelligence Estimate entitled ``The Global Infectious Disease 
Threat and its Implications for the United States.'' The report stated 
that ``the severe social and economic impact of infectious diseases, 
particularly HIV/AIDS, and the infiltration of these diseases into the 
ruling political and military elites and middle classes of developing 
countries are likely to intensify the struggle for political power to 
control scarce state resources. This will hamper the development of a 
civil society and other underpinnings of democracy and will increase 
pressure on democratic transitions in regions such as the FSU [former 
Soviet Union] and Sub-Saharan Africa where the infectious disease 
burden will add to economic misery and political polarization.''
  On February 13 of this year I chaired a hearing on the future of 
America's bilateral and multilateral response to the epidemic. What I 
learned was both encouraging and discouraging. First, the bad news. The 
disease continues to spread. Last year, five million people were 
infected with HIV/AIDS, bringing the total number of people with the 
disease to 40 million. There are more AIDS orphans than ever before, 
over 10.4 million, and that number is expected to more than double in 
the next 8 years as more and more adults fall ill and die.
  In some parts of the world, women are becoming infected at rates 
comparable to men. This change in the infection pattern is tragic not 
only because the increase is a reflection of women and girls' inability 
to say no, in many instances, to unwanted sexual advances, but also 
because the more women who are infected, the greater the number of 
babies there are who are liable to contract HIV during birth or from 
drinking their infected mother's breast milk.
  The good news is that the international community is beginning not 
only to recognize the need for more action, it is beginning to take 
more action. We are beginning to go beyond rhetoric towards concrete 
steps. We have established Global Funds for HIV/AIDS, Tuberculosis and 
Malaria. The U.S. Government has increased the amount of spending on 
bilateral programs. The problem is that we have not yet gone far 
enough. Despite our efforts to date, the problem continues to grow.
  There are no easy solutions. I will not stand here and say that I 
have a magic formula for stopping the spread of HIV/AIDS. We must 
recognize, however, that while the problem is not going away any time 
soon, there are some steps we can take immediately and in the long-term 
that will help mitigate the effects of the disease and eventually stop 
it in its tracks.
  A serious commitment is required. A lot of times when we talk about 
commitment in this chamber we are talking about 6 to 18 months. I am 
talking about a commitment of years. Not 2 years. Not 3 years. Start 
thinking in terms of a decade or more. According to the UN, studies of 
middle and low-income countries where interventions have slowed the 
spread of the disease, we need to spend $7 to $10 billion annually on 
treatment, care and support in the developing world for the next 10 
years if we are to change current trends.
  The UN estimates that if we are going to bring HIV infection rates 
down, by the year 2005 the international community is going to have to 
scale up spending to $9.2 billion. That money does not include funds 
for improving the health and education infrastructure in developing 
countries. It only covers prevention care and support programs. 2001 
expenditures, according to this same report were only $1.8 billion.
  We have a long way to go. And we will have to readjust our mind-sets 
such that we are prepared to stay the course financially for a long 
time to come, or nothing we do is going to have a lasting impact.
  So what is to be done if we are willing to adopt such an approach?
  The ultimate solution to this problem is the development of a 
vaccine. Scientists are working on one, but Dr. Anthony Fauci, director 
of the National Institute of Allergy and Infectious Diseases at the 
National Institutes of Health was quoted in the Los Angeles Times on 
March 16 as saying that this could take at least ten more years. In the 
meantime, we have got to undertake action to bring the infection rate 
down as far as possible, and to care for those who have contracted the 
disease.
  Part of the problem we are having in stopping the spread of HIV/AIDS 
is the basic barrier of underdevelopment. One of the things that has 
facilitated the spread of the disease in developing nations has been 
lack of infrastructure, mainly in the communication, education and 
health sectors. People in remote villages in a poor country do not have 
the luxury of picking up a local paper or watching the local news on 
their televisions. There is no easy way to spread the word about the 
HIV/AIDS. If there are schools, they are irregularly attended, which 
blocks another avenue of informing people about the disease.
  Health in poor countries are deplorable. Helping countries improve 
basic health services will go a long way towards addressing HIV/AIDS. 
This includes training medical personnel, building and or repairing 
clinics and providing medical supplies and equipment. The benefits of 
improved health infrastructure are enormous. HIV/AIDS is not the only 
disease affecting poor countries. By improving health infrastructure, 
we improve the level of access to basic health care for other diseases 
such as tuberculosis and malaria. And devoting more resources to 
improving the health sector has the advantage of laying down the 
groundwork for AIDS treatment activities.
  Addressing educational needs and health infrastructure are two long-
term investments that the United States, in conjunction with our 
international partners need to make. This disease is going to be around 
for a long time. Especially if we fail to act.
  What should we do in the short term to address the global epidemic? 
There are several things that we can do immediately to enhance our 
response.
  First, we should strengthen coordination of U.S. agencies so that we 
are dealing with the problem in the most efficient way. The President 
has taken some steps to address it, naming Secretary of State Colin 
Powell and Tommy Thompson, Secretary of Health and Human Services, as 
co-chairs of a Cabinet-level task force on the global HIV/AIDS threat. 
I do not believe, however that this really solves the problem.
  Developing an integrated U.S. response to the global AIDS epidemic 
will require more time and energy than two Cabinet-level Secretaries 
can devote to it. We need someone working full time on integrating the 
great work that different U.S. agencies are doing. He or she must have 
the authority to develop a U.S. policy response that is informed by all 
U.S. government agencies spending money on HIV/AIDS. This person should 
be accountable for the implementation of the strategy, and required to 
report on the implementation of the consolidated U.S. strategy on a 
yearly basis.
  The coordinator must have the authority to bring the point people on 
HIV/AIDS programs in all the different agencies to one table and have 
them figure out what tasks their respective agencies should be 
undertaking based on areas of comparative advantage and expertise. 
Finally, the coordinator needs the authority to eliminate overlaps 
where possible, identify gaps and decisively settle turf disputes among 
agencies about areas of responsibility.
  The second step to enhancing the U.S. response is beginning the 
process of providing deeper levels of debt relief to poor nations. It 
may take a while for countries to realize these savings, but we have 
got to begin negotiations for an enhanced Heavily Indebted Poor 
Countries Initiative right away. We

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must make sure that countries where there is a severe HIV/AIDS 
emergency and which are at or beyond a decision point in the HIPC 
process are paying no more than 5 percent their fiscal revenue in debt 
servicing. Countries where there is no health emergency should be 
paying no more than 10 percent of fiscal revenue in debt servicing.
  Why enhance debt relief? Because all the early indicators are that 
debt relief works. According to the World Bank, Burkina Faso, Uganda, 
and Malawi are all using debt relief saving to fight HIV/AIDS. Now is 
not the time to be come complacent, but to make a bold move forward, to 
capitalize on this success by taking debt relief one step farther.
  Part and parcel with enhanced debt relief should be the provision of 
technical assistance to countries, to ensure that an adequate amount of 
debt relief savings are devoted to programs to combat HIV/AIDS.
  We must expand the provision of crucial interventions such as 
voluntary testing and counseling if we are to enhance the U.S. response 
to HIV/AIDS. Voluntary testing and counseling is a cornerstone of 
intervention. One particular study conducted in three African countries 
showed that given the opportunity for such testing, 60 percent of 
adults would take advantage. It also showed that only 15 percent of 
those same people had access to this service. Think about it. Fifteen 
percent of those who wanted to know if they had HIV/AIDS were able to 
get an answer.
  The importance of voluntary testing and counseling cannot be 
overstated. Once people find out whether or not they are infected with 
HIV, they are able to make decisions about behavior change that can 
save their lives and the lives of their partners, spouses and children. 
It is crucial that we provide the funds to training more counselors, 
and deliver more rapid test kits to areas of need so that those who 
want testing and counseling can obtain it.
  In addition to the above activities, I encourage the administration 
to expand its efforts to help developing nations craft and implement 
national blood transfusion policies including policies to prevent HIV 
infection through blood transfusions. Such programs are especially 
needed in Africa. Some people might contend that this should be a 
relatively low priority as the HIV infection rate from blood 
transfusion is only 5 percent. I would argue that we have to do 
everything we can to address the spread of the disease, and that this 
is an intervention that is straightforward, and that has benefits that 
extend beyond combating HIV/AIDS.
  At the Foreign Relations Committee hearing on HIV/AIDS on February 
13, USAID Administrator Natsios indicated that to the best of his 
knowledge less than fifty percent of African countries have developed a 
national blood transfusion policy and less than one third of African 
countries have a system in place to limit HIV transmission through 
blood transfusions. Here in America we have virtually eliminated the 
threat of contacting HIV/AIDS through blood transfusion by adopting 
screening and evaluation policies.
  We have the expertise to see that health care workers in Africa and 
elsewhere are properly trained in appropriate clinical use of blood 
transfusions and in proper transfusions techniques. We can teach best 
practices for testing. We can show countries how to recruit and retain 
non-remunerated blood donors from uninfected portions of the population 
so that a safe, tested bloods supply is available. Last year in Africa, 
3.4 million people were infected with HIV. If there had been national 
systems to monitor, manage and test the blood guppy for HIV, perhaps as 
many as 170,000 of those people might be HIV free today.
  Another way to strengthen U.S. response is to expand programs that 
specifically focus on women and girls. Due to biological vulnerability, 
and economic and social pressures, women and girls in Africa are far 
more likely to contract HIV than boys and men the same age. According 
to UNAIDS, girls age 15 to 19 are almost eight times more likely to be 
infected with HIV/AIDS than their male counterparts. Women aged 20 to 
24 were 3 times more likely to be HIV-positive chant their male peers.
  There is no easy way to counteract this phenomenon, but there are a 
number of steps which can be taken. In the long term, social and 
cultural norms must be changed to increase the economic and social 
independence of women. It is easier for a woman to reject unwanted 
sexual advances if she is able to provide materially for herself and 
her children. Men must be educated as to the dangers of unprotected 
extramarital sex. In addition, we must emphasize education programs. It 
is imperative that young people know how to prevent the spread of HIV/
AIDS. There are solutions which we must work on with renewed vigor.
  Right now, today, we must channel more resources towards research 
into female controlled and initiated methods of prevention such as the 
female condom and microbicides.
  A usable microbicide must be developed so that women, with or without 
the consent of a partner, can protect themselves from HIV/AIDS. We are 
at least five years away from the availability of a first generation 
product. Not only must we see that one is developed, we must make sure 
that it is usable and made available in developing countries, that 
women are informed about its availability, and that they are instructed 
in its use.
  We should put more money into increasing the availability of the 
female condom, and continuing to refine the product. The female condom 
is not a miracle solution. Critics contend that women cannot use them 
without the knowledge of their partners, therefore it is redundant to 
make them available when the male condom is so readily available. What 
I would say is that if we are willing to make the choice available to 
men to use protection, we should be willing to give women a choice 
about protecting themselves as well.
  Right now part of the reason that female condoms are not available is 
price. A bulk purchase would serve to lower the cost to the consumer. 
Another problem is information. We must teach people about the female 
condom's existence, and show people how to use it.
  The female condom is the only female initiated method of prevention 
available right now to women living in societies where their ability to 
make choices about when and with whom they are physically intimate are 
in some cases limited, and in other cases non-existent. Since the 
beginning of the epidemic, 10 million women have died of HIV/AIDS, over 
a million of them in the past year. Women are becoming increasingly 
affected. We must use every means we have to reverse these trends.
  I would also submit that it is important that the United States give 
generously to the Global Fund for AIDS, Tuberculosis and Malaria. The 
U.S. must consistently show leadership in our donations. In May of last 
year, the President pledged $200 million in seed money for the fund. 
Other nations followed suit. None of them pledged more than the United 
States. The UK, Japan, and Italy all pledged $200 million. This is a 
perfect example of the fact that where the U.S. leads, others will 
follow. There are now almost $2 billion in pledges for the fund; $800 
million is expected to be available this year. The call for proposals 
went out in January, and the first grants are expected to be made in 
April.
  While I in no way fault the President for his initial pledge, I can't 
help but wonder how much money would have been donated to the Global 
Fund this past year if America's contribution had been $500 million 
instead of $200 million.
  The Global Fund is a welcome addition to the fight against HIV/AIDS, 
but it must be just that--an addition. Contributions must not take the 
place of bilateral programs.
  Finally, I submit that the job of defeating HIV/AIDS is too big for 
the United States to handle alone. We need the help of the 
international community. I cannot state this in strong enough terms. We 
must encourage other donors to do their share to help halt the 
epidemic. The U.S. Government provides nearly 50 percent of HIV/

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AIDS assistance funds. This is 4 times as much as the next donor. It is 
imperative that other donors be full partners in this fight both in 
their bilateral programs and their pledges to the Global Fund. We 
cannot win this war without their help.
  The steps I have outlined above are just that. None of what I have 
talked about is a prescription for a solution to the AIDS epidemic. 
Most of it is not new. I simply stand here before you today to point 
out that despite our best efforts the virus is marching on. However the 
situation is not hopeless by any means. The United States has been an 
innovator, devising effective programs to mitigate and reverse the 
global spread of AIDS. We cannot stop.
  I hope that Congress and the Administration can work together to 
reinvigorate and enhance current efforts to stem the tide of HIV/AIDS 
infection and care for and support those with the disease. Failure to 
do so will mean the death of an entire generation of people. That is 
much too steep a price to pay.

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