Senate set to debate global AIDS relief

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By Sean Lengell

Senators on Monday will take up a $50 billion package to fight AIDS globally, despite some Republican concerns the bill could divert money to unrelated programs.

The upper chamber on Friday voted 65-3 to proceed to a final vote to fund the President's Emergency Plan for AIDS Relief (PEPFAR) for another five years. President Bush started the program in 2003 to combat HIV/AIDS, malaria and tuberculosis in Africa and other afflicted parts of the world.

The House overwhelmingly passed a similar bill in early April, but resistance from a handful of conservative Republican senators had kept it off the Senate floor until now. The current act expires at the end of September.

A main sticking point is a current program mandate that requires 55 percent of the money go to treatment programs. Writers of the new bill dropped the provision, arguing that health care workers on the ground - not Washington politicians - can better determine what programs are most effective.

But Sen. Tom Coburn, Oklahoma Republican and a longtime supporter of PEPFAR, has spearheaded an effort to get the requirement restored, saying the mandate is necessary to prevent money from getting diverted into unrelated development and poverty-relief programs.

Some conservative Senate Republicans also oppose the use of money dedicated to groups involved with the distribution of condoms, with male circumcision and with family planning.

Sen. Jim DeMint, South Carolina Republican, also has complained that Senate Majority Leader Harry Reid, Nevada Democrat, was trying to "ram" the bill through the Senate without a "full and open debate."

"He continues to operate under the assumption that he can dictate the timing, duration and substance of our debates," Mr. DeMint said.

But Mr. Reid on Friday announced he would allow votes on 10 Republican amendments and criticized Mr. DeMint and other Republicans for holding up funding for a program that has supported anti-retroviral treatment for more than 1.5 million people in 15 focus countries in sub-Saharan Africa, Asia and the Caribbean.

"While we're fiddling around here on this in Washington, people are dying," Mr. Reid told a gathering of reporters Thursday. "This is big-time stuff, this is very important to one whole continent."

PEPFAR long has been criticized from both sides of the political spectrum. Liberals say the bill is influenced too heavily by political and social groups with "moral" rather than public health agendas, while conservatives complain some of the money could be used for abortions.

The new bill will kept intact the program's so called "ABC" approach to preventing AIDS, which includes abstinence, "being faithful" and proper use of condoms.

Mr. Bush first announced the program at his 2003 State of the Union address, dedicating $15 billion for five years to focus on prevention, treatment and care.

The president last year asked Congress to double funding to $30 billion for another five years, and the Democrat-controlled Congress responded with a plan for $50 billion. Despite the funding increase, the White House says it strongly supports the bill.

The bill "would reauthorize the emergency plan in a manner consistent with the program´s successful founding principles and would maintain a continued focus on quantifiable HIV/AIDS prevention, treatment, and care goals," said a White House statement released Friday.

"The AB programs - abstinence, delay of sexual debut, monogamy, fidelity, partner reduction - must continue to be a central part of the U.S. Government´s comprehensive approach to preventing HIV/AIDS."

But the Center for Health and Gender Equity has criticized the program for monetary restrictions on several prevention activities, including groups that work with prostitutes to educate them of the dangers of AIDS, and needle exchange programs for intravenous drug users.

The administration, which calls PEPFAR the largest commitment ever by a nation for an international health initiative dedicated to a single disease, says the program is on target of reaching its initial five-year goal of treating 2 million people, preventing 7 million new infections and provide care for 10 million people, including children.