Statements on Introduced Bills and Joint Resolutions

Floor Speech

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - June 06, 2007)

By Mrs. FEINSTEIN (for herself, Ms. Snowe, Mr. Leahy, Mr. Durbin, Mr. Lautenberg, Mrs. Clinton, Mr. Brown, Mr. Kerry, Mr. Dodd, Mrs. Murray, Mr. Feingold, and Mrs. Boxer):

S. 1553. 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 and empower the people on the ground who are fighting this disease to design the most effective and appropriate HIV prevention program.

The bill is cosponsored by Senator Leahy, Senator Durbin, Senator Clinton, Senator Lautenberg, Senator Brown, Senator Kerry, Senator Boxer, Senator Dodd, Senator Murray, and Senator Feingold.

This bill simply strikes the provision in the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 that mandates that at least 33 percent of HIV prevention funding in the President's Emergency Plan for AIDS Relief, PEPFAR, be set aside ``abstinence-until-marriage'' programs.

Let me be clear from the beginning: this bill does not prohibit the administration from funding ``abstinence-until-marriage'' programs.

In fact, if the bill becomes law, the administration would still be able to spend all of our HIV prevention funding on abstinence-until-marriage programs if it decided do so.

This bill is about giving the administration and HIV/AIDS workers the flexibility to design the most effective HIV prevention program without having to worry about artificial earmarks that are based on politics, not science.

Indeed, in the fight against the HIV/AIDS pandemic, we cannot afford to tie ourselves down with undue restrictions.

Worldwide, 40 million people are infected with HIV. Each day, approximately 12,000 people are newly infected with HIV. In 2006, there were 4.3 million new HIV infections around the world, 2.8 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 adult population is 6 percent. Mr. President, 2.1 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.

The 2003 HIV/AIDS legislation 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.

Yet instead of allowing HIV/AIDS workers and doctors the ability to use all of the prevention tools at their disposal to respond to local needs, we required them to spend at least 33 percent on ``abstinence-until marriage'' programs.

The question has to been asked: Why 33 percent? Why not 15 percent? Why not 50 percent? What scientific study concluded that 33 percent of HIV prevention funds for abstinence only programs was appropriate?

There was no study and it begs the question: when you are fighting a pandemic that has already cost so many lives, who should decide how to allocate funding among different types of HIV prevention programs, Congress or the people with the knowledge and expertise on how to fight this disease?

I support abstinence programs as a critical part of our HIV prevention programs. But mandating an earmark has negative consequences for other effective tools.

It means 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.

Indeed, the evidence clearly shows that the one-third earmark has inhibited the ability of local communities to design a multipronged HIV prevention program that works best for them.

Last year, the Government Accountability Office 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 health 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, in order for the administration to meet the overall 33 percent earmark.

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.''

Last month, a congressionally mandated review by the Institute of Medicine on the first 3 years of the President's Emergency Plan for AIDS Relief also found significant problems with the abstinence earmark. It concluded: there is no evidence to support a 33 percent abstinence only earmark; the 33 percent earmark does not allow country teams on the ground the flexibility they need to respond to local needs.

Our bill seeks to address the problems highlighted in the GAO and the Institute of Medicine reports and provide local communities the necessary flexibility to achieve the goal we all share: stopping the spread of HIV, especially among young people.

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 firsthand 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.

We do not have time to lose. I urge my colleagues to support this legislation and support a pro-abstinence, multipronged approach to preventing the spread of HIV.

I ask unanimous consent that the 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. 1553

BREAK IN TRANSCRIPT

Source