This week, President Bush signed into law the Lantos-Hyde U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. This is the culmination of over a year’s worth of very work by many legislators, from both sides of the aisle, and their staffs.

This bill will expand American leadership, not only on AIDS but also on TB and malaria and care and support for millions of orphaned children. The amount authorized per year, about $10 billion, is less than 1% of this year’s federal budget. That is small price to pay for a program that will save millions of lives and foster good will around the world.

US global AIDS programs are already making a big difference. In the last year, thanks in large part to the US, the number of new HIV infections among children dropped by 40,000, from 410,000 to 370,000. That means at least 40,000 children have been saved from HIV/AIDS.

But even as we celebrate the bill being signed into law, we need to look honestly at how hard this journey was in Congress, the minefields we had to dodge, and what additional steps need to be taken before this bill can save even a single life.

The bill’s originators had to cope with myths and half-truths from opponents that several times threatened to derail the entire bill.

For instance, in the House, some members, like Rep. Chris Smith, Rep. Mike Pence and others, claimed that a provision to facilitate family planning services for HIV positive women would lead to US financing of abortion, even though such financing is already prohibited by US law.

In fact, many HIV-positive women are taking AIDS medications that can
cause birth defects and they, and other women, need the option of using contraceptives to prevent pregnancy. This argument was not good enough for Smith or the Catholic Church. In the end, the provision had to be dropped for the bill to have more than token Republican support, and in fact the version signed into law avoids the issue of family planning altogether.

In the Senate, Senator Tom Coburn delayed the bill considerably by insisting on a requirement that 50% of funding be reserved for medical care and treatment, despite the urgency of prevention. He won that change, along with a complicated new target for how many people the US should aim to put on treatment. The ironic result is that the bill specifies a lower minimum number for how many people the US should put on treatment (2 million) than was included in the original Senate version (3 million).

Much of the new funding in the bill is not actually for PEPFAR but rather for bilateral TB and malaria programs, which these Senator Kyl and others termed “mission creep.” Senator Kyl decried the bill’s effort to address nutrition, the inheritance rights of women and orphaned children, and women’s lack of economic opportunities, even though anyone who has spent any time in Africa knows that these issues are central to an effective and realistic approach to HIV/AIDS. In the end, amendments to narrow the bill failed, though Kyl won an amendment that reduced funding in the bill for AIDS, TB and malaria programs by $2 billion.

But the biggest challenge the bill has now is the funding for actual implementation. For fiscal year 2009, Rep. John Spratt (D-SC) and Sen. Kent Conrad (D-ND) approved a budget for international programs that was smaller than what President Bush requested. Then, just two weeks ago, Rep. Nita Lowey (D-NY) and Sen. Patrick Leahy (D-VT), who lead key appropriations subcommittees in the House and Senate, approved funding for AIDS, TB and malaria programs at a level far below that suggested by the bill.

The appropriations committees approved only very small increases for TB and malaria for 2009, and they provided nothing specific to address the crippling shortage of health care personnel. The committees also provided essentially no increase for the Global Fund to Fight AIDS, TB and Malaria, even though it is a crucial means of leveraging more money from non-US donors. Congress, and the next President, must revisit these decisions on funding for 2009. We cannot afford to wait until 2010 for the new programs and funding increases this bill authorizes.

Members from both sides of the aisle will also need to work together for smart policies on reproductive health take into account the real-world needs of women. We can save many lives with the AIDS bill, but our victory is incomplete without policies that fully and honestly take into account the complexity of women’s health needs.

This entry was posted on Thursday, July 31st, 2008 at 11:14 am and is filed under Politics .