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Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2004

Location: Washington, DC



Mr. DeWINE. Mr. President, I returned this past Friday from a 10-day trip to southern Africa with Majority Leader BILL FRIST as well as Senator Warner, Senator Enzi, Senator Coleman, and Senator Alexander. We traveled to South Africa, Mozambique, Botswana, and Namibia. We traveled there to assess each of the HIV/AIDS crises in these countries. We wanted to see where things are now and where we need to go in the future to help them deal with the terrible crisis they face.

The fact is we are in a critical stage in this attempt to help them and other countries fight this global AIDS battle. We passed the global AIDS authorizing legislation a few months ago and shortly we will pass the appropriations bill to fund these programs. As we start to plan how to spend this significant amount of money, we are now at a critical stage. We are at a critical stage because it is so very important that this be done right, that it be done correctly, and that it be done quickly, because millions of lives are at stake.

All four countries we visited have, of course, been designated by the President and now by Congress to be recipients of our global AIDS assistance. So these Members of the Senate wanted to find out how we could most effectively and efficiently give this assistance to these nations, how we could make sure our money would be well spent. In doing so, we wanted to know specifically what these countries' respective governments were doing. We wanted to know what the nongovernment organizations, the NGOs as they are referred to, are currently doing; what the church groups—we refer to them as faith-based groups—are doing; and what the businesses, the private sector groups, are doing as well.

We wanted to know what was the state of the health infrastructure, the public health sector in each of these countries. We also wanted to assess where our own Government was. We wanted to talk to our embassy officials and see how their planning was coming along.

Finally, and certainly most important, we wanted to ask the leaders of these countries—we wanted to talk to their health professionals and social workers, actually the people out in the field in these nations—what their needs were, what they thought they needed. We asked them: What do you need from us? What can we do to help you do your job to help save lives? We went to the very people who every single day watch the AIDS victims die—the people who try desperately to treat, to help, and to save them, and the people who try to prevent people from coming down with AIDS.

We have some answers.

The spread of HIV/AIDS in poor countries is, as we know, rampant. It is a grave human tragedy. When it comes to the HIV/AIDS crisis, the sheer numbers are staggering. We can't let these numbers numb us. We have to keep reminding ourselves that these are statistics; that behind each one of these statistics are human beings; and that these statistics represent real people, real mothers, real fathers, children and babies. These are real people and real lives.

The statistics are unbelievable. In South Africa, 5 million people are HIV positive. In Mozambique, 13 percent of the people have HIV or AIDS. The disease has created by some estimates 370,000 to 425,000 orphans, and by the year 2010, it is estimated that in Mozambique the life expectancy is estimated to plummet to only 39 years. There are only 524 doctors in the whole country, a country of 18.6 million people.

In Botswana, a nation of 1.7 million people, there is a 38.8-percent HIV rate among those between the ages of 15 and 49. It is a staggering figure. There are 330,000 people, it is estimated, HIV positive, and 18 percent of the deaths in that country are the result of AIDS. Thirty-five percent of pregnant women are HIV positive. By the year 2010, it is projected that the life expectancy rate will be 31.6 years, if nothing is changed, if the situation is not changed, and if there is no intervention.

The next country we visited was Namibia, a nation of 1.8 million people. Twenty-two percent of the adult population has AIDS or are HIV positive. Twenty-three percent of pregnant mothers are HIV positive. By the year 2010, the life expectancy rate is expected to be 39.6 years of age.

We know the statistics. We certainly can learn from them. We can see the victims and we can talk to them and talk to those
who care for them. We can do all of these things and still not comprehend the gravity of this human tragedy.

One of Africa's great leaders is Graca Machel, a woman we met within Mozambique. We had a delightful meeting with her for over an hour. She is one of the most articulate persons I have ever met with in my life. When we met with her in Mozambique, she was talking about a country that she loves so well. This is what she said:

I can know the statistics, but I don't really understand what it means to have 13 percent of my people HIV positive *    *    *. [Our countries] are facing extinction *    *    * and we still face the worst.

The mind cannot comprehend the gravity of this tragedy. This certainly was for me, and I am sure for all of my colleagues, a deeply troubling, gut-wrenching trip. But it was a very productive trip.

We were accompanied on the trip by President Bush's AIDS adviser, Dr. Joseph O'Neal. His experience and his expertise proved invaluable to us on our trip. Our ability to talk with him, share ideas, go back and forth and compare notes of what we had seen was very valuable.

Each one of us on the trip, I am sure, has come back with different impressions but with a lot of the same impressions. This
afternoon I would like to take a few minutes to share with my colleagues some of my thoughts. They are, of course, my thoughts and my thoughts alone. I would guess that there will be a lot of similarities between my thoughts and other colleagues'. But these are mine. These are my impressions and my thoughts from this trip to Africa.

First, time is clearly not on our side. It is not on the side of victims in Africa nor on the side of victims of these four countries. We don't have time. We don't have much time. We don't have time to wait. Facing this global AIDS crisis cannot be business as usual. It cannot be bureaucracy as usual. We cannot treat this crisis the same way we have done with others.
We don't have the luxury of time. For each moment that we delay, obviously people die. People are dying as we speak today. They die every moment.

We saw groups in each country, and organizations and individuals, that are ready now to receive our money and our assistance and our help and who are ready to go into action to deal with the problem. We need to get them the money and allow them to get about the business of saving lives. That is good news. And it was heartwarming to talk to them, to see them.

These are groups that have a proven track record. These are groups that are already doing good work. We just need to give them more resources so they can expand what they are already doing.

Mr. President, Members of the Senate, as we do this, we cannot be timid. Quite frankly, we need to take chances. We need to be willing to say that once in a while we will fail with some of these groups, so we need to say to our own bureaucracy:
Do not be afraid of failure. There will be some failures. There will be some foul-ups. But we need to move forward. Lives are at stake. And we will hold you—those of us in the Congress—accountable for being timid. Do not be timid. Move forward.

We need to find these groups that can move forward. We saw many of them on our trip. We need to find these groups, these individuals. We need to fund them, and we need to move on.

For example, Dr. Donny McGrath, who is with the Africa Centre, is ready to go. He has a plan for a 5-year program to establish a model HIV/AIDS treatment prevention program in a rural part of South Africa. He has the structural support necessary to pull off this program that could deliver and will deliver care and treatment to this remote area. We met with him. I think everyone was impressed. And he has the structure of the Africa Centre behind him.

Dr. Tammy Meyers, we met with her. She would like to begin providing treatment for children with AIDS out of South Africa's biggest hospital in Johannesburg. We were told actually it is the biggest hospital in the world. The tragedy is, today they are not—with the exception of a handful of kids—giving kids treatment because they do not have the resources to do it. We are told that in the area of Johannesburg, South Africa, there are 6,000 or 7,000 children who right today are dying, children who should be on treatment for HIV, children who have AIDS, who could be receiving treatment but yet cannot get these drugs. Dr. Tammy Meyers would like to move forward. We need to get her that help. We need to give that hospital that help.

The Salvation Army is also doing great work in many of these countries. We were so impressed when we went into a Salvation Army orphanage that was providing drug treatment for children they had under their charge in that orphanage. As an organization, the Salvation Army has a proven track record. As I said, they are involved in many of the countries in the world where HIV is a problem, where AIDS is running rampant. We need to say to groups such as the Salvation Army, who have a proven track record: Tell us what you need. What are the resources you need? Tell us what you can do. Let's work together. Let's save lives.

So there are many things we can do, and we can do quickly, and we need to do it. We need to save lives.

Second, in all four nations we visited, when we asked what the No. 1 need was, almost invariably, no matter who we asked, the answer we got back was: We need training. From the doctors to the nurses, when we talked to people who were
delivering services right down at the grassroots level, people pled with us: Give us more training. Train our doctors. Train our nurses. Help us.

The fact is, AIDS treatment and prevention is a specialized field of medical care. We need to put more and more specialists in place, doctors who can train other doctors to fight this disease and provide treatment.

Now, I do not have all the answers as to how to do this, but we need to think about it. And as we do the things we can do quickly and relatively easy—as I said before, plug into the existing groups, the existing organizations that are ready to go right now—at the same time, we have to look at what we do in the long run over the next year, 2 years, 3 years, 4 years to deal with this crisis, to answer the call of these countries when people say: We need doctors, specialists. We need the training.

So we need to develop a cadre of doctors. Do we use our Peace Corps? Maybe we use our Peace Corps to do this. Maybe we use the U.S. Public Health Service Corps, revamp it in some way to do this. Maybe what we do is take residents, when they finish their residency in this country, and work out some way so that it is advantageous to them to interrupt their career, in a sense—or really maybe a better way of looking at it is enhancing their career—and give them the opportunity to go and spend a few years working in these African countries, specializing in this area, taking that specialization then and training doctors in these countries—the multiplier effect—so that these countries will then have trained specialists of their own who will stay in their countries and we will help save lives.

That is the type of multiplication and training of doctors we are going to have to think through and figure out over the long run as to how we are going to help them answer that call that we heard time and time again: How are we going to get the training? That is the long run.

No. 3, clean water. On our trip it became very clear just how essential clean water is to fighting AIDS, and also it is essential just to save lives. It is essential to keeping young children alive worldwide. Some 60 percent of all infant mortality worldwide is linked to infectious and parasitic diseases, most of them water related. Furthermore, diseases from dirty water are killing more than 5 million people each year—that is one figure, and I think other estimates, frankly, are much higher than that—while an additional several billion people get sick from unclean water each year.

In just one country, Mozambique, for example, diarrheal diseases are the third largest cause of death in children under 5 years of age. That is the equivalent of 55 deaths per day. Potable water is accessible to only 26 percent of the rural population in Mozambique. Imagine that. Get outside the city, and only one in four of the population has good water, and only 40 percent of the urban population in Mozambique.

The reality is that we cannot effectively treat and fight AIDS without clean water supplies. In impoverished nations, up to 90 percent of AIDS patients suffer from chronic diarrheal diseases, which contribute to an increase in these deaths. One of the complications of AIDS is the development of thrush, which can be alleviated by drinking sufficient quantities of water. Caregivers need to be able to wash their hands before and after caring for an infected person. Mothers infected with
HIV/AIDS may choose to use formula to feed their infant children and would need clean water to mix formula.
Providing access to clean water is about the most cost-effective use of our AIDS money because it would provide a double
benefit. Digging wells in a village provides the whole village with clean water, not just those stricken with HIV or AIDS.

Providing clean water is a cheap thing to do, and good groups are already doing it. We saw some of those groups during our trip. For example, Lifewater International, a group that we saw, is a partnership of U.S.-based organizations working globally to improve drinking water supplies, hygiene, and sanitation in Third World nations. They are making a difference, and they can do more if we just give them the resources they need. This is a simple and cost-effective strategy, and it is the right thing to do. There are groups such as this all over the world. All we need to do is to take some of these resources, plug into these groups, let them multiply already what they are doing, and we will save hundreds of thousands of lives.

No. 4 of the thoughts I have: Care for the dying. As we focus on saving and prolonging lives, we must not forget the millions who, despite our best efforts, will surely die. Precious little is being done to help them die with dignity. We talked with people who deal with these individuals. We talked with people who see them die. We talked with people who watch them die every day. Those people whose job it is to deal with the dying looked us in the eye and pled with us; they said: Give us the tools, the drugs to allow these people who are dying not to suffer so much and to die with dignity.

The global AIDS bill we passed this May allows us to do this. There are groups out there ready to help, groups capable of helping. We should give them the ability to help the suffering and to help the dying.

No. 5, let me just talk for a moment about government attitude and political leadership in regard to the issue of AIDS. We visited four countries. The governments of Namibia, Mozambique, and Botswana are all fully engaged in this struggle against AIDS. That political leadership is essential in the battle against AIDS. We can only hope the recent public statement by the fourth country, South Africa, in favor of the use of antiretroviral drugs will be followed by an aggressive government attack on the problem.

For those who have not followed this, this is a change in policy. The government in the past had not embraced the use of antiretroviral drugs to treat the AIDS problem. So this has been a change. We can only hope this is a profound change. We can only hope the Government of South Africa will now become much more aggressive in this endeavor.

Some local units of government from South Africa have been aggressive, but unfortunately the tragedy is the central government has not been as aggressive. And while we talked to many people in South Africa who are doing wonderful things, unfortunately there are some people in the South African Government who still would appear to be in a form of denial about this problem. It would appear that progress is being made. We would hope progress will continue to be made.

The sixth point I would like to make is the killing power of stigma. We cannot underestimate the killing power of stigma, people's feelings of shame and disgrace with this disease. Stigma kills. Stigma prevents pregnant women from getting tested for HIV/AIDS. Stigma prevents people from getting treatment. Stigma prevents us from dealing with this crisis head on.
There is tremendous denial. People hide the fact they are sick, even if that means risking their lives or even if it means risking the lives of their unborn children.

On our trip we heard doctors speak of women with AIDS who were told they could take drugs that might prevent their child who was about to be born from testing HIV-positive, drugs that could reduce the odds of the children being born with AIDS by 50 percent. Yet despite hearing this news, we heard about some women who left the clinic never to return because of the stigma attached to having AIDS, never to return because of the ridicule their husbands, their family might inflict upon them. That is a horrible tragedy—a stigma so powerful, so powerful these women would risk the lives of their unborn children, something it is hard for us to understand.

I heard a story that was also hard to understand. I talked to a doctor in South Africa who was intimately involved in drug treatment, who had set up a program of drug treatment. He told me a story about a woman who worked in his house. She had worked there for some time. One day she left, disappeared. He couldn't figure out where she had gone. The days went on. Then the weeks went on. After about 7 weeks, he decided he was going to go look for her. So he got in his car and drove to her village. It turned out it was a drive of 7 hours. He drove and drove and got to her village. When he got there and started asking about her, he found that she had died the day before. This is a woman who died from AIDS, a woman who died rather than acknowledge she had AIDS, who worked for a doctor who was treating people with AIDS. As the doctor said to me: I would have paid for her drugs. I would have taken care of her. I would have done anything. But she wouldn't tell him.

That is the power of the stigma that is attached to this. It kills people. She preferred to die alone, hiding her disease.

What is the solution? I don't know that we have a solution, but there are some things we know. First, in these nations, wherever it occurs, we need to educate people, whether it is in this country or any other country. We need to educate people about AIDS. Second, political leaders need to talk openly about the disease. Leaders in Botswana and Namibia and Mozambique have been forthright and up front and open to public discussions about the disease.

Third, we need to have treatment available so people have hope. No one is going to get tested for HIV/AIDS if there is no treatment and you are told to just go home and die. As Graca Machel said: There is "no effective prevention without treatment."

People must be able to see that they are getting something themselves. By treating people, it offers hope, and it offers incentive for more and more people to get tested. That, by itself, will save lives. That is the reality, Mr. President.

My seventh thought has to do with children. In the four nations we visited, really we are just barely getting started in providing treatment for children who are HIV positive or who already have AIDS. There are—and it is a good news story—some mothers-to-children transmission preventive programs in the early stages. We have heard from people who are very thankful to the United States, people who are thankful to President Bush, thankful to us and our country, about these programs. Some of these programs are programs we put in place.

We heard some very good success stories about many of these programs. They show very promising results. With these programs and the drugs they provide, we are seeing HIV/AIDS transmission rates from a mother who has AIDS to a child about to be born, and then born, drop from 30 percent to 5 to 10 percent. What do we mean by that? Well, the doctors tell us that if a mother is HIV positive and she is not treated, the odds are approximately 30 percent that she is going to give birth to a child who will be HIV positive. In these developing countries, with treatment—and usually a fairly simple treatment and it costs about $3—we can reduce those numbers to about 5 to 10 percent. That is a dramatic drop in the number of children who would be born HIV positive. If given the proper medication, the odds go dramatically down.

The challenge, of course, is getting these mother-to-child transmission programs going and then getting the pregnant women into the program.

We also have to face the challenge of treating children who do develop AIDS. That is a different ball game, a different problem. Treatment for these kids is, as I said when I referenced South Africa—and it is true of all the other three
countries—is virtually nonexistent, just like the treatment for adults.

In Johannesburg, to take one example—and you can replicate these numbers or use similar numbers across all of Africa, or at least all the countries where HIV is prevalent—there are 6,000 to 7,000 kids in need of antiretroviral treatment, yet fewer than 100 kids are getting any treatment at all. The good news is that there are good people in the hospitals who are ready now to treat these kids. Dr. Tammy Meyers is ready now to start a program to provide drug treatment for these children.

In conclusion, on this trip we saw the human face of Africa. We saw the human face of AIDS. I have seen this face before in Haiti and Guyana. That human face will remain with all of us who went on this trip after all the specific statistics have faded.

I will always remember Graca Machel telling us about her going out in the rural area visiting a grandfather and his two wives. He is 83 and his wives are 73 and 76. They lost their eight children. They saw them die one by one, each one claimed by AIDS. Now these elderly people are caring for their 30 grandchildren after having lost each 1 of these 8 children. I will remember that.

I will remember watching a young teenager as he described losing his parents to AIDS and then having to go from home to home to home, relative to relative, to see others of his relatives die of AIDS, being handed from one family to another.

I will remember an HIV-positive mother describe giving birth to a child who developed AIDS, a little baby, who died shortly after birth. I will remember watching her describe that child as that child died.

I will also remember an HIV-positive mother who described getting the help she needed, having someone reach out to her, getting the drug treatment she needed before giving birth to her child, and described the joy she felt to know her child was not HIV positive, that her child was a healthy child. We listened to her joyfully describe that child and the future that child now has. Her baby was born HIV free. Her story doesn't need to be the exception.

With our HIV/AIDS money, more and more babies can be born free of AIDS. We need to move quickly. Time is not on our side. We need to move now. We need to invest in the people who are ready to go and in the programs that already work.
We need to do all we can to address the human tragedy of global AIDS. We have the ability to ease this suffering, and it is our moral obligation to lead this fight. We are at a critical time in world history. I believe history will judge us well by what we are doing today. It is our obligation at this critical time to make sure that we not only begin this fight—and we
have—but that we carry it out, that we stay with it, that we do it effectively, that we do it correctly, and that we stay with it day after day after day.

Mr. President, I yield the floor and suggest the absence of a quorum.

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