Statements on Introduced Bills and Joint Resolutions
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - July 13, 2006)
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By Mrs. FEINSTEIN (for herself and Ms. Snowe:)
S. 3656. A bill to provide additional assistance to combat HIV/AIDS among young people, and for other purposes; to the Committee on Foreign Relations.
Mrs. FEINSTEIN. Mr. President, I rise today with Senator Snowe to introduce legislation to strengthen our international HIV prevention efforts for youth and empower the people on the ground who are fighting this disease to design the most effective and appropriate HIV prevention program.
Our legislation does three things. First, it expresses the sense of the Senate that sexually active youth who live in a country where HIV infection is spreading through the general population should be considered at high risk of contracting HIV and provided with information on the complete range of tools to prevent the spread of HIV.
To date, the Office of the Global AIDS Coordinator has focused prevention programs for youth on abstinence only and ignored other prevention techniques such as the use of condoms.
Second, it defines ``abstinence-until-marriage'' programs as those programs that place the highest, rather than exclusive, priority on encouraging individuals who have not yet married to abstain from sexual activity.
And finally, it reserves at least one-third of funds for prevention of the sexual transmission of HIV--rather than one-third of all prevention programs--for abstinence-until marriage programs. This recognizes that HIV prevention includes many types of activities and those that target the sexual transmission of HIV/AIDS, such as abstinence-until-marriage programs, are only a subset.
In 2003, I was proud to join my colleagues in passing the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, a historic piece of legislation that expressed our resolve to see the United States take a leadership role in the fight against the global HIV/AIDS pandemic.
The bill recognized that prevention--along with care and treatment--is an essential component of that fight and demands a multipronged approach. It endorsed the ``ABC'' model for prevention of the sexual transmission of HIV: Abstain, Be Faithful, use Condoms.
That bill also contained a provision that mandated that at least one-third of global HIV/AIDS prevention funds be set aside for ``abstinence-until-marriage programs.''
Three years later, we still face an uphill battle against the HIV/AIDS pandemic. Worldwide, 40 million people are infected with HIV. Each day, approximately 13,400 people are newly infected with HIV. In 2005, there were 5 million new HIV infections around the world, 3.2 million in Sub-Saharan Africa alone. Sub-Saharan Africa is home to almost two-thirds of the estimated 40 million people currently living with HIV.
Across sub-Saharan Africa, the prevalence rate for the general population is 8 percent; 2.4 million adults and children died of AIDS in 2005.
Despite these devastating numbers, according to UNAIDS, less than one in five people at risk for infection of HIV have access to basic prevention services. Studies have shown that two-thirds of new HIV infections could be averted with effective prevention programs.
Clearly, we still have a long ways to go to rein in this disease.
During the debate on the global HIV/AIDS bill, I expressed concern that we were placing politics over science by requiring that at least one-third of prevention funds go to ``abstinence only'' programs.
I argued that such an artificial earmark--which, by the way, was not based on any scientific study or conclusive evidence--would tie the hands of HIV/AIDS workers and doctors on the ground and severely inhibit the ability of the administration to fund the most effective HIV prevention programs.
It would mean less money for funds to prevent mother-to-child transmission; less money to promote a comprehensive prevention message to high risk groups such as sexually active youth; and fewer funds to protect the blood supply.
Unfortunately, the evidence clearly shows that the one-third earmark has had a negative impact on our prevention efforts and inhibited the ability of local communities to design a multipronged HIV prevention program that works best for them.
Last month, the Government Accountability Office, GAO, issued a report that found ``significant challenges'' associated with meeting the abstinence-until-marriage programs. The report concluded that:
The 33 percent abstinence spending requirement is squeezing out available funding for other key HIV prevention programs such as mother-to-child transmission and maintaining a healthy blood supply. Country teams that are not exempted from the one-third earmark have to spend more than 33 percent of prevention funds on abstinence-until-marriage activities, sometimes at the expense of other programs. The spending requirement limited or reduced funding for programs directed to high-risk groups, such as sexually active youth and; the majority of country teams on the ground reported that meeting the spending requirement ``challenges their ability to develop interventions that are responsive to local epidemiology and social norms.''
Clearly, we are placing constraints on our ability to protect high-risk populations around the world from HIV transmission and fund the wide range of prevention programs, such as mother-to-child transmission.
Our bill seeks to address the problems highlighted in the GAO report and provide local communities the necessary flexibility to achieve the goal we all share: stopping the spread of HIV, especially among young people.
Let me be clear: our bill does not strike the 33 percent earmark for ``abstinence-until-marriage'' programs.
In fact, our legislation is pro-abstinence. It maintains abstinence as a critical part our prevention efforts and places no limits on programs that lead to this result. It even allows the administration to spend more than one third of funds for the prevention of HIV on ``abstinence-until-marriage'' programs if the administration decides that is the best use of those funds.
Simply put, our bill balances congressional priorities with public health needs. Under our legislation, country teams can take into account country needs including cultural differences, epidemiology, population age groups and the stage of the epidemic in designing the most effective prevention program.
One size does not fit all. A prevention program in one country may look a lot different than a prevention program in another country.
A May 2003 report from the Bill and Melinda Gates Foundation and Henry J. Kaiser Foundation highlights that proven prevention programs include: behavior change programs, including delay in the initiation of sexual activity, faithfulness and correct and consistent condom use; testing and treatment for sexually transmitted diseases; promoting voluntary counseling and testing; harm reduction programs for IV drug users; preventing the transmission of HIV from mother to child; increasing blood safety; empowering women and girls; controlling infection in health care settings, and; devising programs geared towards people living with HIV.
For example, studies have shown that combining drugs with counseling and instruction on use of such drugs reduces mother-to-child transmission by 50 percent.
Such cost effective programs are not related to abstinence and should not be constrained by the 33 percent earmark on funds for prevention.
I understand the importance of teaching abstinence. It is and will remain a key part of our strategy in preventing the spread of HIV.
But let us listen to the words of someone with first hand experience about the challenges sub-Saharan African countries face in combating HIV/AIDS and the constraints the ``abstinence-until-marriage'' earmark places on those efforts.
In an August 19, 2005 op-ed in the New York Times, Babatunde Osotimehin, chairman of the National Action Committee on AIDS in Nigeria, wrote:
Abstinence is one critical prevention strategy, but it cannot be the only one. Focusing on abstinence assumes young people can choose whether to have sex. For adolescent girls in Nigeria and in many other countries, this is an inaccurate assumption. Many girls fall prey to sexual violence and coercion ..When dealing with AIDS, we must address the realities and use a multipronged approach to improving education and health systems, one that can reach all of our people.
He concludes:
National governments must have the freedom to employ the very best strategies at our disposal to help our people.
I could not agree more.
If we want to help the girls of Nigeria and the youth of sub-Saharan Africa, we cannot limit the information they receive about keeping them safe from acquiring HIV.
Mr. President, I have been heartened to witness Republicans and Democrats coming together to support a robust U.S. assistance package to fight the HIV/AIDS pandemic. We all share the same goal of the President's Emergency Plan for AIDS Relief to prevent 7 million new HIV infections by 2010.
This bill is about helping us achieve that goal. When we put our faith in the people on the front lines of this fight and allow them to use all the tools and strategies at their disposal, we are one step closer to making that goal a reality.
We do not have time to lose. I urge my colleagues to support our legislation and support a pro-abstinence, multi-pronged approach to preventing the spread of HIV.
I ask unanimous consent that the full text of the bill be printed in the RECORD.
There being no objection, the text of the bill was ordered to be printed in the RECORD, as follows:
S. 3656
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