WASHINGTON - House leaders from both parties and the White House reached agreement yesterday on a bill that would more than triple in size the Bush administration's global AIDS program, already the largest foreign aid initiative aimed at fighting a single disease in US history.
The bill loosens the requirement for abstinence messages in AIDS prevention strategies, a source of constant criticism of the program since it was unveiled by President Bush in 2003.
The bill authorizes $50 billion over five years to prevent infection, treat people already ill from HIV, and care for children orphaned by the epidemic. The program, known as the President's Emergency Program for AIDS Relief (PEPFAR), provided $15 billion over its first five years.
"This historic agreement will save millions of lives," said Paul Zeitz, a physician who heads the Global AIDS Alliance, a vocal critic of some original PEPFAR provisions. "With bipartisan support, Congress is beginning to fix aspects of the AIDS program that were clearly not working."
Many observers consider PEPFAR the Bush administration's most successful foreign policy initiative. Its acronym is now a widely known word in sub-Saharan Africa, where the program assists everything from national ministries of health to village-level church groups.
The original PEPFAR law's requirement that one-third of prevention dollars be used to promote abstinence set off a rhetorical war between the program's State Department leaders and much of the rest of the AIDS community. The new bill appears to signal a truce.
The reauthorized bill requires PEPFAR's chief to provide "balanced funding" for prevention and to ensure that abstinence and faithfulness activities "are implemented and funded in a meaningful and equitable way." If a country spends less than 50 percent of its sexual-transmission prevention funding on the promotion of abstinence and faithfulness, the program must justify that decision to Congress.
PEPFAR's overseers in the State Department, however, said that in practice they have been more lenient than the original law's language suggested. They say the one-third-for-abstinence requirement applies only to programs aimed at preventing sexual transmission of the virus, not all prevention efforts. Other prevention activities include treating pregnant women with antiviral drugs so they won't infect their newborns. Furthermore, they say, "abstinence" was broadened to include "be faithful" messages as well - two thirds of the so-called ABC strategy. The C stands for "condom use".
However, a requirement that every organization receiving PEPFAR money adopt a specific policy against "prostitution and human trafficking" - which many activist groups also find rankling - remains in the new bill.
The renewed PEPFAR would be broader than the original.
About $9 billion would go to fight tuberculosis and malaria, two diseases that often simultaneously infect AIDS patients in Africa. It would underwrite purchase of food supplements for AIDS patients, an underappreciated component of successful medical treatment of the disease. It would also finance "microcredit" loans to women widowed by the disease or ostracized because of their infection.
The bill now goes to the Senate, where the Senate Foreign Relations Committee is at work on a bipartisan proposal "consistent with the way this committee operates," a senior aide said, speaking on background because he is not an authorized spokesman.
"This bill is not perfect, but no compromise ever is," said Howard Berman, Democrat of California, who became acting chairman of the committee upon the death this month of Tom Lantos, Democrat of California. The measure is named in honor of Lantos and the late Henry Hyde, Republican of Illinois, the committee chairman who helped push the original bill to passage in 2003.