[Congressional Record (Bound Edition), Volume 153 (2007), Part 7]
[Extensions of Remarks]
[Page 10165]
[From the U.S. Government Publishing Office, www.gpo.gov]




            PEPFAR: AN ASSESSMENT OF PROGRESS AND CHALLENGES

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                        Tuesday, April 24, 2007

  Mr. SMITH of New Jersey. Madam Speaker, this morning the Committee on 
Foreign Affairs held a hearing in anticipation of the reauthorization 
of the President's Emergency Plan for AIDS Relief. I concur on the 
importance of examining the extraordinary successes of this program, as 
well as the means by which we can ensure that it continues to meet the 
needs of those impacted by the pandemic.
  In my travels abroad, particularly in Africa and Vietnam, I have seen 
for myself how the intervention has transformed lives and infused hope 
in individuals, families and communities affected by HIV/AIDS. One 
experience that struck me, in particular, was in Uganda when I visited 
there last year. I had the privilege of meeting Mr. John Robert Ongole, 
who is 29 years old and the first person to benefit from the first 
treatment program funded by PEPFAR. I was told that when he first 
started receiving the anti-retroviral therapy, he looked like a walking 
skeleton. When I met him, he was healthy and energetic, leading an 
active life and caring for his family. I have recently learned that he 
has almost completed his bachelor's degree in teaching. He and 
countless others have expressed their profound gratitude to President 
Bush and the American people for giving them a new lease on life in the 
face of this devastating disease.
  Perhaps the most controversial aspect of PEPFAR here in Congress is 
the requirement that one-third of prevention funding be expended on 
abstinence and fidelity programs, known as the A and B aspects of the 
ABC (abstinence, be faithful and condoms) prevention model. Some have 
called for the removal of this requirement in favor of an evidence-
based approach, free from legislative constraints, that takes into 
account the particular situation of the individual country. What these 
people fail to take into account is that the ABC model is evidence-
based, and those countries with generalized epidemics that have 
experienced declines in prevalence have emphasized behaviors of 
abstinence, and fidelity in relationships between un-infected partners.
  In a statement published in 2004 in the prestigious scientific 
journal, The Lancet, over 160 scientists and the President of Uganda 
noted that ``when targeting young people, for those who have not 
started sexual activity, the first priority should be to encourage 
abstinence or delay of sexual onset, hence emphasizing risk avoidance 
as the best way to prevent HIV and other sexually transmitted 
infections as well as unwanted pregnancies. After sexual debut, 
returning to abstinence or being mutually faithful with an uninfected 
partner are the most effective ways of avoiding infection.''
  In the past, even those considered ``experts'' on the ground have 
resisted implementing the ABC strategy with the proper emphasis on A 
and B, and so the spending requirement was necessary. I have met 
representatives of USAID who acknowledged that they were initially 
skeptical of the possibility of changing people's behavior as a key 
element of HIV/AIDS prevention, but due to their experience of 
implementing the PEPFAR abstinence and fidelity programs they had 
become convinced of their efficacy.
  I would strongly encourage my fellow Members to examine the growing 
evidence regarding the success of the ABC model in HIV/AIDS prevention. 
It is, fundamentally, a matter of life and death.

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