House Passes Bush’s AIDS Spending Plan

The House on Thursday resoundingly approved President Bush’s plan for a new global campaign against AIDS, authorizing billions of dollars to help fight a rampaging epidemic that has killed or infected tens of millions and threatens political stability in some of the world’s poorest countries.

The legislation, which passed 375 to 41 despite the misgivings of some influential conservatives, breaks new ground for a Republican-led Congress often skeptical of foreign aid.

Its commitment of $15 billion over five years to fight AIDS and two other diseases -- tuberculosis and malaria -- that often afflict AIDS patients would dwarf the $1.6 billion the United States now spends annually on the international health crisis.

Also significant is the approach the bill embraces to prevent sexual transmission of AIDS: abstinence, fidelity and condoms.

For social conservatives who wield great clout in Congress and at the White House, the first two prongs of this approach have long been their primary strategy for stopping AIDS. But the third, which acknowledges the role of premarital and extramarital sex in the spread of the disease, is anathema to many conservatives.

Amendments Added

For that reason, a conservative bloc of House Republicans added an amendment to the bill to ensure that AIDS relief groups opposed to condom distribution would qualify for funds. Another successful amendment would set aside a sizable portion of the bill’s money for abstinence education. But those skirmishes were overshadowed by the House’s bipartisan resolve to back the initiative Bush announced in January in his State of the Union address.

Senate leaders said they were equally intent on passing their version of the bill sometime this month. Bush has asked lawmakers to send him a final bill by Memorial Day, a goal congressional leaders hope to meet.

With the death toll from AIDS at 25 million worldwide in the last two decades -- and with millions more infected by the AIDS virus -- the bill’s House backers likened the devastation wreaked by the disease in sub-Saharan Africa and the Caribbean to what the bubonic plague had done in medieval Europe.

Fighting AIDS in countries such as Nigeria, Kenya, South Africa and Haiti, they said, is a matter of national security for the United States.

“The HIV/AIDS pandemic is more than a humanitarian crisis,” said Rep. Henry J. Hyde (R-Ill.), chairman of the House International Relations Committee, referring to the disease and the human immunodeficiency virus that causes it. “Increasingly, it’s a threat to the security of the developed world. Left unchecked, this plague will further rip the fabric of developing societies, pushing fragile governments and economies to the brink of collapse.”

Controversial Provisions

Hyde’s role in shepherding the bill was critical. With a long record of supporting conservative causes, Hyde was well-positioned to persuade other conservatives to keep controversial provisions on abortion and other issues out of the bill.

Rep. Tom Lantos (D-San Mateo), who co-wrote the bill with Hyde, noted that its total funding is a quantum leap from what Congress had considered approving less than a year ago.

“For those of us who have long called for a real commitment of resources to address the HIV/AIDS crisis,” Lantos said, “our day has arrived.”

For Bush, House approval of the AIDS bill was a major victory in his drive to portray his administration as both compassionate and conservative -- a message he increasingly wants to send as the 2004 campaign nears. The president savored an uncommon instance of near-unanimous Democratic support for his administration’s position in a House usually polarized on partisan lines.

“Today’s action is an important step toward providing critically needed treatment and care for millions of people suffering from AIDS, and proven prevention programs for millions more who are at risk,” Bush said after the vote. “Time is of the essence, and I urge the Senate to act quickly so that we can turn the tide against this disease and give the hope of life to millions of people in the world’s most afflicted countries.”

Under the bill, Congress would authorize $3 billion a year for the global AIDS battle over five years, starting Oct. 1, with the money directed toward countries in sub-Saharan Africa, the Caribbean and other areas severely hit by the disease.

The bill also attempts to secure aid from other countries. In the first year, up to $1 billion of U.S. funds would be authorized for a recently created global AIDS fund. But for every U.S. dollar sent to that fund, $2 would be required from elsewhere. Of the money authorized, the bill recommends spending 55% on treatment of people infected with the AIDS virus; 15% on palliative care for people living with AIDS; 20% on preventing the spread of the disease; and the remaining 10% on helping children of parents who have died or are suffering from the disease.

For treatment, the bill focuses on antiretroviral drugs, calling for 2 million infected individuals to receive such therapies by 2006. It also funds efforts to develop an AIDS vaccine.

Much of the House debate centered on prevention strategies.

Rep. Christopher H. Smith (R-N.J.) argued that the bill as drafted might shut out charities that do not support condom distribution, such as those associated with the Catholic or Muslim religions.

Over Democratic protest, he won House approval on a voice vote for an amendment to clarify that such groups would be eligible for funds under the bill. Smith said he wanted a “maximum army of volunteers” mobilized to fight AIDS.

Rep. Joseph R. Pitts (R-Pa.) argued that the bill should set aside 33% of money spent on disease prevention to teach the health benefits of abstaining from sex until marriage.

Extolling abstinence, House Majority Leader Tom DeLay (R-Texas) said: “It works -- and we can’t let the fog of politics obscure that fact.”

Most Democrats derided the amendment. “Abstinence works perfectly if it’s used perfectly,” said Rep. Joseph M. Hoeffel (D-Pa.) “But it isn’t. Not everyone abstains.”

Bipartisan Coalition

The amendment passed 220 to 197, largely along party lines. But the Pitts and Smith amendments were both significantly scaled back from what conservative groups had sought when the bill was in committee. The Bush administration supported both proposals, confident that they would not break the bipartisan coalition backing the bill.

The vote also was a milestone for international activists that have lobbied wealthy nations to agree to increased AIDS relief for the poor.

“With this overwhelming vote, the House sends a message of hope to Africa that America will help the 30 million people with AIDS,” said Jamie Drummond, executive director of Debt, AIDS, Trade in Africa, an organization affiliated with the rock star Bono.

In the vote, 183 Republicans joined 191 Democrats and the House’s one independent member to pass the bill. Forty Republicans and Democratic Rep. Gene Taylor of Mississippi opposed the measure.

Of California’s 53 House members, 49 backed the bill and three missed the vote: Reps. David Dreier (R-San Dimas), Xavier Becerra (D-Los Angeles) and Howard L. Berman (D-Van Nuys).

The lone Californian to vote against it was Rep. Gary G. Miller (R-Brea). Miller, calling the bill fiscally irresponsible, said he was “concerned that this proposal could shortchange health care needs here at home.”