The U.S. House of Representatives passed reauthorization of America's global fight against HIV, tuberculosis and malaria by a vote of 308-116 on April 2. The program is most commonly referred to by the acronym PEPFAR. Opposition came entirely from Republicans and was largely on the grounds of cost in a time of budget deficits.
The measure allows for spending up to $50 billion over the next five years. That is a significant increase over the $15 billion authorized for the last five years and the $30 billion that President George W. Bush had proposed. Nonetheless, the White House signaled its support for the bill, even while point out remaining areas of contention.
Four amendments were allowed from the floor during debate, and were passed. They allowed funds to be used to provide safe drinking water; tightened accountability requirements; encouraged collaboration with historically black colleges and universities; and further expanded coverage to allow for work in smaller nations in Africa, joining an earlier expansion that embraced islands in the Caribbean.
Among the changes won by AIDS advocates is a modification of provisions dealing with abstinence only education. A fixed minimum percentage of spending on abstinence programs no longer is required, but abstinence must remain a significant part of an overall prevention strategy that is tailored to the needs of individual countries.
The current program prohibits granting of funds to agencies that provide abortion services or that counsel on the procedure even if they do not directly provide them. The new law eases that and allows those organizations to receive prevention funding.
'For our country to be healthy, for the eradication of these diseases to take place, we must have a global approach to them. Disease knows no borders and boundaries,' said Speaker of the House Nancy Pelosi during the floor debate. 'The legislation before us today will move us from the emergency phase to the sustainability phase in fighting AIDS, tuberculosis and malaria.'
The Senate Foreign Relations Committee has passed a similar measure, though its future on the floor of the Senate is a bit cloudy, due to the rules of that chamber.
Conservative Sen. Tom Coburn, R-Okla., has circulated a letter to his colleagues suggesting that he might block consideration of the bill. He said both versions of PEPFAR 'contain dramatic policy reversals coupled with irresponsible spending levels.' He also wants to require that 55 percent of funds be spent on treating HIV, and mandate increased testing for the disease.
Coburn has opposed most spending increases that have come before the Senate.
Sen. Jim DeMint, R-S.C., co-signed the letter. He called the tripling of spending from current levels the 'height of irresponsibility in the middle of a war and surging debts.'
Senate rules, including legislative holds and a filibuster during debate on the floor, give individual Senators significant power in halting the progress of a bill. That is particularly true during a presidential election year when campaigning compresses the legislative calendar and time becomes more precious.
In a separate action in the House, Rep. Sam Farr, D-Calif., used the opportunity of an Appropriations Committee hearing to press the FDA to review and change its policy barring gay men from donating blood.
Calling the policy discriminatory and outdated, Farr said, 'The science doesn't seem to support the policy,' which was adopted in the 1980s. Technology for testing blood for the presence of HIV has improved dramatically since then and the major national organizations working with blood products have urged the FDA to lift its lifetime ban on gay men donating blood.
