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United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003

By:
Date:
Location: Washington, DC

Mr. KERRY. Mr. President, I am extraordinarily grateful, not just for the yielding by my colleague from Delaware, and my friend of many years here, but I am also very grateful for the comments he just made. I appreciate enormously his acknowledgment of the work that has gone into this legislation from the Foreign Relations Committee. Senator Frist and I did start this effort a number of years ago. In fact, we chaired a major bipartisan, frankly apolitical, completely nonpolitical effort nationally, bringing together most of the people involved in this issue for a long period of time to solicit from them their thoughts about the best way to try to put together, for the first time, a comprehensive approach to the issue of AIDS.

The reason for wanting to make it comprehensive, obviously, is that everything else was failing. There was and is a sense of implosion in continents and countries as a consequence of what is happening.

No country ever had the capacity to provide as much leadership or to provide as much resource as the United States of America to help to deal with this issue. It is good that we are at least on the floor of the Senate today for some brief period of time dealing with this question of the HIV/AIDS, Tuberculosis and Malaria Act which comes over to us from the House. The scope of the AIDS epidemic really cannot be underestimated. It is now spreading to the Caribbean. It is in East European former Soviet bloc countries. It is in Asia. The nondiscriminating way that AIDS kills women and children, men and boys, young and old alike, tears up families, and destroys human infrastructure, is beyond people's belief, absent an extraordinary effort comprehensively to begin to coordinate a global effort to combat it. It is the worst public health, social, and humanitarian crisis of our age.

It is imperative the United States lead the efforts to deal with it. It should not only be on our agenda today, but it needs to be on our agenda in the months and years to come.

Obviously, Congress should send to the President legislation that substantially increases funding for our global AIDS programs, and indeed this bill will do that. But we need to leave no doubt in the world's mind that we are going to be at the forefront of that fight in the years to come.

To underscore what the ranking member of the Foreign Relations Committee just said, the President could have had this legislation last year, or even earlier this year, had the administration and Republican allies in Congress wanted it. Last July, the Senate unanimously passed and sent to the House the bipartisan United States leadership effort against HIV/AIDS.

I thank the majority leader for his efforts to join me in again a completely nonpartisan effort to try to behave in a globally responsible way and in a way that lives up to the highest values and standards of our country.

I introduced that bill a year ago today, along with Senators FRIST, BIDEN, HELMS, DASCHLE, and some 10 other cosponsors. That bipartisan bill was the most comprehensive global HIV/AIDS bill ever introduced in the Congress. It authorized more than double the annual $1 billion level of funding for AIDS, TB, and malaria programs over each fiscal year of 2003 and 2004, it created an HIV/AIDS coordinator in the Department of State, it ensured the Government had a comprehensive 5-year global strategy on HIV/AIDS, and it provided USAID, CDC, and other HHS agencies with the necessary authorities and resources to carry out an effective program of prevention and treatment abroad.

The House of Representatives had ample opportunity to act on this bill before Congress adjourned last November, but it failed to even take it up. Nor was the House interested in conferencing the full bill. The administration provided no impetus, no leadership, and no effort in order to try to get the House to do so. Apparently the comprehensiveness of the bill was too much for the House Republicans to handle.

Speaking to this point on November 13 of last year, Congressman HYDE, chairman of the House International Relations Committee, stated that "Discussions have broken down between the Senate and the House over the size and the scope of the bill." And there was no intervention whatsoever by the administration to try to bring those parties together at any time.

It is more than regrettable that our colleagues in the House refused to act last year. Although this bill predated President Bush's AIDS initiative announced this year in his State of the Union Address, that very worthy initiative could easily have been funded and carried out under the provisions of the Senate-passed bill. We had a missed opportunity, one that could have saved lives. As Chairman HYDE wrote earlier this week in his own op-ed in the Washington Post, "In the five minutes or so required to read this column, another 30 people will die and another 55 will become infected."

Just think how many people could have been helped had the administration and the House not missed the opportunity offered by the Senate last year to ramp up our efforts.

Since the beginning of this year, Senator Biden and I have worked consistently with Senator Lugar, chairman of the Foreign Relations Committee, to produce a bipartisan global HIV/AIDS bill. Regrettably—and I do regret—each step of the way those efforts were repeatedly frustrated by the White House and some Members on the other side of the aisle. Our most recent effort, S. 1009, the United States Emergency Plan for AIDS Relief Act of 2003, introduced by Senator Lugar on May 7 and cosponsored by Senators BIDEN, DASCHLE, and SARBANES, was based on the very draft the majority leader, Senator Frist, brought us for consideration after consultation and input from the White House. But that effort, too, died on the vine.

The White House and the Senate majority leader have made it abundantly clear that the President now wants the Senate to move quickly to pass the bill without amendment. Having been at the forefront of the legislative effort to combat this, I am delighted the President now wants to have a bill in hand when he meets with the G-8 leaders in June. I agree that we can and must leverage other nations to increase their efforts and their resources to combat the AIDS pandemic. And I am confident the President will be able to tell his colleagues and the Congress that we are united in the fight against AIDS. However, the bill we send him ought to not only provide substantially increased resources to fight AIDS, but it should also embody comprehensive, balanced, and effective policies and programs.

The pending House bill does well in resources in terms of authorization—$15 billion over the next 5 years for the three most infectious global diseases, HIV/AIDS, TB, and malaria. Like last year's bipartisan Senate bill on which it is modeled, the House bill established an HIV/AIDS coordinator, and it mandates a coordinated, comprehensive, and integrated U.S. 5-year strategy. But the bill remains flawed. If left unaddressed, those flaws will seriously undermine the effectiveness and the comprehensiveness of the U.S. AIDS programs.

The House bill provides insufficient resources for the Global Fund to Fight AIDS, TB and Malaria, the public-private partnership established in 2001 with the strong support of President Bush and United Nations Secretary General Kofi Annan. The global fund reflects the international community's determination to marshal increased resources to combat not only HIV/AIDS but also TB and malaria. Tommy Thompson, Secretary of Health and Human Services, currently chairs the global fund's board of directors. Whereas the Bush administration's new AIDS initiative is focused on only 14 countries—12 in Africa and 2 in the Caribbean—the global fund's scope is worldwide, covering not only countries where AIDS is rampant, but also countries such as Russia, China, and India, where the epidemic is growing rapidly.

The Bush administration's preference for bilateral efforts over multilateral efforts, in my judgment, is discernible because of the way the allocation of funds within the President's announced initiative takes place. The President promised $15 billion over 5 years. But only $1 billion of those funds—that is $200 million a year—would go to the global fund. This annual figure of $200 million a year is already $150 million less than we have provided in fiscal year 2003 alone. The President's proposal provides for no increases over the 5-year period.

The House bill authorizes "up to $1 billion" for the global fund for fiscal year 2004. On the face of it, that looks like an improvement. It is calculated to look like an improvement, but it is not an improvement. The House bill fails to guarantee any specific funding level, and it caps U.S. contributions at 25 percent of the fund's total contributions.

This is simply not adequate. We can, and we should, do more. At a minimum, we should be able to guarantee that our contributions to the fund for fiscal year 2004 are significantly increased over the 2003 level.

I know some of my colleagues believe other countries are not contributing enough to the fund. I share that concern, but I am proud that the United States of America is the largest donor to the fund, and we ought to be. In my view, that is commensurate with leadership, and leadership is what is needed. However, other countries can and should do more, and if leveraging our contributions will enable Chairman Thompson and the leadership of the global fund to raise more resources, I am all for that.

S. 1009, the Lugar-Biden-Kerry bill that was introduced earlier this month, would authorize $1 billion for the fund for fiscal year 2004, and $500 million of this would be available without any strings attached. To receive the additional $500 million, the fund would have to raise $2 billion in contributions from sources other than the United States. So it provides real leverage, and that is what we ought to be doing. In effect, the United States would be providing one-third of the fund's resources—a figure with which all of us ought to be able to live. I will support changes in the House bill to strike the House language on the fund and achieve those higher funding levels.
Second, the House bill mandates that one-third of the funds spent on prevention go only to abstinence-until-marriage programs. Now, none of us disagrees that abstinence is an important component of AIDS education. It is important as a matter of values, and of course we ought to engage in that effort. But the effectiveness of these programs depends literally on their comprehensiveness and on their relevancy to the population you are targeting.
That means you need all three components of the so-called ABC model: abstinence; be faithful, which includes reducing the number of partners; and the use of condoms.

Obviously, abstinence does not apply to all target populations. For example, take a situation where you have people who are married or they are in a monogamous relationship. It is well and good to promote the concept of abstinence, which we should do, but abstinence-until-marriage programs have their greatest resonance with young people, and I believe we ought to fund those types of programs. But we should not tie the President's hands by specifically earmarking the percentage of funds to be spent on these programs because that denies the reality of what you find on the ground in terms of the targeted population.

I will support an amendment to strike this earmark. We ought to be rational enough as human beings to understand that you do not want to just promote abstinence. What happens when somebody falls short of the abstinence, as everyone in the world knows occurs? Then you want at least to have that person also educated as to what the possibilities are to still prevent the spread of the disease.

In my view, we should be providing the administration with maximum flexibility to ensure that our assistance programs are well targeted to the countries in which we are working. Regrettably, the House bill contains a number of earmarks and limitations ideologically driven but not practically driven, which reduce the flexibility and undermine the capacity to work with various high-risk populations at the epicenter of the HIV/AIDS pandemic.
The House bill guarantees that faith-based organizations may participate in U.S. Government-funded HIV/AIDS programs even if they choose not to participate in all elements of the program. For example, they can be involved in the component that respects abstinence but they may choose not to be involved in providing counseling on safe sex and distributing condoms.

Faith-based organizations are on the front lines of the fight against HIV/AIDS, and I respect that. We welcome that. And they should be. We need them there. I do not believe we should ask any organization, faith-based or otherwise, to compromise their principles in this effort, and I would not do that. But if the U.S. Government is funding their programs, it is important, with respect to the expenditure of our dollars, that we guarantee that those dollars be spent in the most effective way and that we need to respect the interventions that, in fact, prevent HIV infection, even those they object to on a moral or religious ground.

An organization that does not wish to give out condoms should absolutely not be required to do so, but it also ought to be required to give accurate and medically sound advice on the effectiveness of that method. I will support an amendment to the House bill that makes it clear that all organizations that are funded by the U.S. Government in this fight must follow that policy.

Last year, the Senate-passed AIDS bill contained a title on debt reduction that was authored by Senators BIDEN and SANTORUM. It urged the Secretary of the Treasury to renegotiate the Enhanced HPIC Initiative to provide funds for HIV/AIDS programs through greater debt reduction. The House bill we are now considering contains no such title, despite strong support for it from many quarters, including the Catholic and other churches. This deficiency in the House bill ought to be corrected. I strongly support Senator Biden's amendment to put that title back in the bill.

This bill has been a long time in coming. It is here now. Obviously, it is important for the Senate to advance our efforts with respect to AIDS. In my judgment, the amendments that are being offered will improve this legislation in terms of its resources, in terms of its policy, and the flexibility for the President.

I hope those amendments will be adopted, notwithstanding the Chair's desire not to have any amendments, because they will provide us with the capacity to have the full measure of the policy we ought to be passing in order to deal with this issue. It is better to have something that is comprehensive and effective than something that merely meets political cosmetic needs and does less than what is needed to address this extraordinary challenge.

I also believe there is time yet. There is time, if there is good will on both sides and if there is Presidential leadership, to conference a bill with these amendments. There is no reason we should not make that available to the Senate. We can guarantee the President, on our side, that if we do that in good faith, he will have a bill before he goes to the G-8 summit. But if our efforts to improve this bill fail, I will still support it, Mr. President, imperfect as I think it is, because stemming the AIDS pandemic is the goal and any measure that begins the steps towards that cannot be ignored and is better than none.

I yield the floor.

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