Senate Approves $15 Billion for Global Fight Against AIDS

The Senate early today approved legislation authorizing $15 billion over five years to fight AIDS in sub-Saharan Africa, the Caribbean and other regions, marking a significant expansion of the U.S. commitment to wage war on the pandemic.

With a culminating voice vote of approval after midnight, the Senate passed a global AIDS bill that would carry out an initiative President Bush announced in January.

The action followed House approval of the bill on May 1 by a 375-41 vote. Senators from both parties predicted the House would swiftly agree to a Senate amendment on debt relief and clear the bill for Bush’s signature.

Enactment of the bill will give the president a significant achievement he can tout in a summit in France next month with world leaders and will buttress the White House’s claim to be carrying out a compassionate social agenda.

At the White House’s urging, Senate Republican leaders worked to whisk the House-passed bill through their chamber with just one change. To do so, they beat back several amendments proposed by Democrats, agreeing to only one by Sen. Joseph R. Biden Jr. (D-Del.) that expanded debt relief for poor countries.

The Senate action was a victory not only for Bush but also for Senate Majority Leader Bill Frist (R-Tenn.), a physician who has made international AIDS funding a priority.

Frist said the bill, deepening the U.S. financial commitment to treating and preventing an illness that has killed, sickened and infected tens of millions worldwide in the last two decades, would “open up hope” in impoverished countries that have few public health resources. In a news conference at the Capitol with African ambassadors, Frist said such initiatives are “what makes us not just a good nation, not just a powerful nation, but a great nation.”

Bush administration officials say the $15 billion authorized by the bill to fight acquired immune deficiency syndrome and two other highly infectious diseases -- tuberculosis and malaria -- would roughly triple what the United States previously was projected to spend on international programs to combat the health crisis.

But congressional budget experts estimate that the first year’s authorization of $3 billion would represent an increase of only about $1.4 billion over the $1.6 billion currently being spent.

What’s more, under congressional procedures, authorizations of discretionary funding must be followed up with separate annual bills to appropriate money. That means the global AIDS program will face repeated tests this year and coming years; as a result, the $15 billion is by no means guaranteed.

Nonetheless, lawmakers of both parties said the bill represents a milestone -- a huge leap over what the United States has previously done.

Under the bill, the United States would direct a portion of the money to the Global Fund to Fight AIDS, Tuberculosis and Malaria -- made up of governments, nongovernmental organizations, the private sector and affected communities -- in hopes of leveraging additional contributions from other industrialized nations.

The rest of the money would directly assist countries affected by AIDS, through grants to charities and other nongovernmental organizations and other aid.

Specific amounts would be set aside for treating people infected with the virus that causes AIDS, for palliative care, for prevention and for assistance to children of AIDS victims.

For prevention, potentially the most controversial topic, the bill embraces an approach pioneered in Uganda known as ABC, for “abstinence, being faithful and using condoms when appropriate.”

That combination defused much of the ideological conflict that the bill might have otherwise spawned.

Social conservatives were able to stress abstinence and fidelity, while liberals were grateful that the legislation acknowledged that condoms could play an effective role in protecting people who are sexually active outside of marriage.

Senators waged battle over Democratic proposals to amend the House bill sponsored by Reps. Henry J. Hyde (R-Ill.) and Tom Lantos (D-San Mateo). A House-passed provision, backed by Bush, would set aside one-third of prevention money for abstinence programs; Sen. Dianne Feinstein (D-Calif.) sought to kill that requirement.

“When it comes to AIDS, prevention is the name of the game,” Feinstein said, citing her experience as San Francisco mayor when the disease first became widely known in the 1980s. “This is where this bill is flawed.”

Feinstein urged the Senate to take a more flexible approach, even as she acknowledged that some “don’t want to mention” the word “condom.” But her amendment was defeated, 52 to 45.

Republicans defeated other Democratic amendments to guarantee financial commitments to the global AIDS fund and provide more money for food assistance.

They also turned back a proposal by Sen. Edward M. Kennedy (D-Mass.) to alter the bill to ensure the availability of antiretroviral drugs, which treat AIDS, at the lowest possible price.

Republicans, who hold a narrow 51-48 majority in a Senate with one Democratic-leaning independent, pushed for speedy action on the House-passed bill.

“We don’t need to delay,” Sen. Jeff Sessions (R-Ala.) said. “We need to move. Everybody agrees [the House version] is a good bill. It will do the job.”