A bipartisan coalition in the House voted Wednesday to significantly expand a popular program aimed at combating HIV and AIDS around the world, renewing the President’s Emergency Plan for AIDS Relief by authorizing $50 billion -- $20 billion more than the White House requested -- over five years.
“There is a moral imperative to combat this epidemic,” said House Speaker Nancy Pelosi (D-San Francisco). “Few crises have called out more for sustained, constructive American leadership.”
Forty million people worldwide are believed to be HIV-positive, Pelosi said, and an estimated 20 million have died from AIDS.
Ever since the global AIDS initiative began in 2003, focusing on 15 countries primarily in sub-Saharan Africa, 30 million people have been tested or received counseling for HIV, according to government statistics, and 1.4 million have received anti-retroviral medications.
The legislation, which was approved 308-116, required compromise on both sides.
Conservatives gave up a demand that abstinence be the centerpiece of efforts to fight AIDS; when the program began five years ago, the Republican majority then in control of Congress included language requiring that one-third of all funds spent on prevention go toward abstinence-related initiatives. The legislation approved Wednesday mandated “balanced funding” to support a so-called A-B-C strategy: abstain from sex until marriage; be faithful; and use condoms.
Liberals agreed to accept some restrictions on activities by family planning organizations. Under the bill, funding may go to family planning clinics to pay for HIV/AIDS testing and education but not abortions. Faith-based organizations will also continue to receive funding.
“For all its strengths, the bill before the House today is not perfect,” said Rep. Howard L. Berman (D-Valley Village), who helped craft the package as chairman of the House Foreign Affairs Committee. “No compromise ever is. No one got everything they wanted.”
The bill, which authorizes expenditures of $10 billion a year through 2013, dramatically expands the scope of the program beyond HIV/AIDS and Africa. The reauthorized program will provide substantial food aid and clean water programs for millions of people in the developing world.
In addition to approving $41 billion for HIV/AIDS, the new package includes $5 billion to fight malaria and $4 billion for tuberculosis. Three additional countries in Africa and 14 nations in the Caribbean region will be included in the program. Some advocates fear that help won’t get to those who need it most. Michael Weinstein, president of Los Angeles-based AIDS Healthcare Foundation, said that the bill got rid of the requirement that 55% of the money would go toward treatment.
“We consider the bill a massive retreat on AIDS treatment in the world,” he said. “We think this gives license to the bureaucracy to spend the money on anything they wish.”
An effort to reduce the $50-billion commitment was voted down along party lines. During his State of the Union address in January, President Bush requested $30 billion, but the total rose as legislators worked out details.
An Office of Management and Budget memo released Tuesday expressed concern about the $20-million increase, but the White House issued a strongly supportive statement after the bill passed Wednesday. The Senate is expected to consider similar legislation in the coming weeks.
The California delegation was split largely along party lines. With the exception of Rep. Ellen O. Tauscher of Alamo, who did not vote, all Democrats supported the bill.
Republicans were split, with Reps. Mary Bono Mack (Palm Springs), David Dreier (San Dimas), Darrell Issa (Vista), Jerry Lewis (Redlands), Dan Lungren (Gold River) and Devin Nunes (Visalia) in favor of the bill. All others were opposed.
Rep. Dana Rohrabacher (R-Huntington Beach) said the bill would drive up the deficit.
“We cannot afford such totally irrational generosity,” he said. “This is benevolence gone wild.”
The Congressional Budget Office estimated last month that the government would only be able to spend about $1.5 billion of the $10 billion appropriated for 2009 because it would “take some time to expand existing programs and develop new procedures and activities.”
The TB vaccine, for instance, cannot be widely administered until after it gets past the final stages of development.
Supporters say expanding the scope of the effort will build goodwill overseas and bolster U.S. national security by improving human health. A few Democrats said the initiative might have been Bush’s best decision.
“There has not been a pandemic similar to this since the plague in the medieval days of Europe,” said Rep. Donald M. Payne (D-N.J.). “In my opinion, this will be remembered as the single most significant achievement of the president during his two terms in office.”