[Congressional Record (Bound Edition), Volume 149 (2003), Part 2]
[Senate]
[Pages 2217-2218]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    FUNDING TO FIGHT HIV/AIDS ABROAD

  Mr. SMITH. Mr. President, I rise to laud President Bush's 
announcement in his State of the Union Address of a $15 billion, 5-year 
emergency plan for AIDS relief, with $10 billion in new money to combat 
the global AIDS pandemic, provides new hope for many of the 42 million 
men, women, and children living with AIDS right now. This initiative, 
which I enthusiastically support, represents a critical first step in 
scaling up the world's response to the global AIDS pandemic. Combined 
with expanded, though still relatively small, bilateral resources to 
fight tuberculosis, the leading killer of people with AIDS, this 
initiative can save many lives. I commend the President for his 
leadership in this effort.
  In truth, however, this effort has just begun. This initiative should 
be just a

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first downpayment by the U.S. in our fight against AIDS. We must fully 
fund this initiative in 2004 and do more. It is also up to us to now 
work with the President to shape this initiative for maximum impact. We 
must invest wisely to protect and save as many lives as possible as 
quickly as possible. As we work with the administration to take this 
initiative from an idea into action, we have important decisions to 
make. I offer you a few key points today regarding how we can use these 
funds in order to save the greatest number of lives and protect our 
global health and stability.
  We must frontload this money, and ensure that it reaches as many 
countries as possible.
  These funds are needed immediately, and if we do not invest enough 
now, we will pay far more later, in money, in lives lost, and in the 
social, economic, and spiritual cost to the families, communities, 
nations, which are hardest hit. There are 10 million children in sub-
Saharan Africa alone, children who ought to be free to play, to learn, 
to enjoy their young lives who have lost one or both parents to AIDS. 
This represents a country the size of Belgium. In 10 years, at current 
rates, this number will quadruple. But we have a choice. Will we allow 
this to happen? Every year we delay, the slower we are to scale up, the 
greater the cost. This epidemic is not waiting for us, it is 
accelerating. So we must accelerate our response. We must increase 
funding in the fiscal year 2004 budget we will soon consider.
  The 14 countries in Africa and the Caribbean targeted by President 
Bush are important ones. However, there are many, additional countries 
where we must urgently address AIDS now. For instance, in Lesotho, 
Malawi, Swaziland and Zimbabwe, where 60 percent of all deaths under 60 
are due to AIDS, TB, and malaria, people need help immediately too.
  Our own National Intelligence Council has identified five populous 
nations of strategic importance to the United States as the ``next 
wave'' of the HIV/AIDS epidemic, including India and Russia. India 
alone contains some one-third of the world's tuberculosis burden, and 
since HIV fuels the TB epidemic, TB rates will skyrocket in these 
countries as HIV spreads. HIV rates are growing faster in Russia than 
any other region of the world, and the dangerous drug-resistant strains 
of TB that are more prevalent in Russia than anywhere in the world will 
pose a serious, deadly and expensive medical problem if they explode in 
synergy with AIDS. We cannot wait; we must act now.
  Another point of key importance regarding the President's proposed 
initiative is we must allocate far greater resources to the important 
new global fund to fight AIDS, TB, and malaria, but the initiative 
fails so far to do so.
  I fear that the President's emergency plan for AIDS relief may 
underfund the global fund, our best new means of addressing these 
epidemics. This is particularly ironic given that Secretary Tommy 
Thompson has just been appointed the chair of the global fund's board. 
The global fund is a relatively new mechanism that is centrally 
important in scaling up the global response to AIDS. The global fund is 
innovative. It is independent. It is efficient. And it is fully 
operational. By tomorrow, at the close of their meeting in Geneva, 
Switzerland, the fund's board will announce a second round of grant 
awards to programs in affected countries that are providing needed 
prevention, treatment, and care for these three diseases. In this 
second round, the fund will approve projects that will produce the 
following estimated results:
  For just $325 million, or about 2 percent of the proposed $15 
billion, 270,000 more people will receive antiretroviral, ARV, drugs in 
developing countries, adding to 220,000 people who will receive ARVs 
from the first round of the global fund's grants. In total, the global 
fund will support a sixfold increase in the number of people being 
treated with ARVs in Africa.
  With $300 million, some 2 million more people will be treated for 
tuberculosis over the next 5 years through expansion of the highly 
effective DOTS, Directly Observed Therapy, Short-course, treatment 
services.
  For just $18 million, or one-tenth of one percent of $15 billion, 10 
million more people in Africa will be treated for malaria through the 
use of the new and highly effective anti-malarials, arteminisin-based 
treatments.
  This work is highly impressive, and it is critically important.
  The global fund estimates very conservatively that it will need $6.3 
billion in 2003 and 2004, to be able to finance the high-quality 
proposals it anticipates receiving. The U.S. should provide at least $2 
billion or more in 2004, with additional resources in 2003, scaling up 
in future years.
  Now, after this second round of grants is announced on Friday, the 
fund will be virtually out of money, and unable to even request a third 
round of proposals later this year. I commend the efforts of my many 
colleagues over the past year, colleagues from both sides of the aisle, 
led by Senators Frist, Kerry, DeWine, Durbin, Boxer, and many others--
who have provided leadership toward expanding the United States' 
investment in the global fund. Now is not the time to back down on U.S. 
leadership at the global fund, but the time to greatly increase our 
investment in the fund to rapidly and effectively scale up global 
efforts. Providing our fair share of global fund resources as a part of 
a new AIDS initiative would leverage major increases in other donor 
contributions as well.
  One more point on funding. It is of vital importance that the 
President's emergency plan for AIDS relief not draw resources away from 
existing development programs such as bilateral tuberculosis or child 
survival efforts or other development priorities.
  And, finally, we must look at the problem of AIDS in conjunction with 
the problem of tuberculosis, for the two are inextricably linked from a 
medical perspective. Tuberculosis, which is the leading killer of 
people with HIV worldwide, is carried by one in three people worldwide. 
The disease drains human resources from struggling economies and 
poverty-stricken regions.
  Tuberculosis is readily curable with drugs that cost as little as $10 
per patient in developing countries with the DOTS treatment, but only 
one in four people who need DOTS have access to it. If we do not act 
now to bring tuberculosis under control globally, then TB infection 
rates will rise precipitously with the spread of HIV; and this is of 
particular concern given the existence of dangerous drug-resistant 
strains, which are far more expensive and difficult to treat. With just 
$200 million invested annually, the United States can provide its fair 
share of the resources needed to meet international TB control targets 
by 2005, as laid out in a groundbreaking blueprint called the Global 
Plan to Stop TB.
  In closing, I again salute President Bush for his wise and 
compassionate leadership in proposing a bold new U.S. initiative to 
fight global AIDS. I urge that this be just a first step in our scaled 
up response, and that we invest resources aggressively Now, that we 
reach as many affected countries as possible, and that we provide our 
fair U.S. share of the total resources needed by the global fund to 
fight AIDS, TB, and malaria.

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