In a year of scant bipartisanship on Capitol Hill, one issue with a history of strong Republican and Democratic support is set to reemerge this week in action to extend a global AIDS relief program.
The GOP-led House is to take up the five-year measure, now known as the President's Emergency Plan for AIDS Relief Stewardship and Oversight Act, on its noncontroversial suspension calendar this week. That House vote would follow Senate action expected as early as Monday night.
Placing the measure on that House suspension calendar means floor debate will be limited, and a two-thirds majority support will be required for it to pass, reflecting the expectation from leaders that the measure will face little opposition.
This would be the second time the program is extended or reauthorized since it was enacted in 2003—when then-President George W. Bush was facing an overwhelming HIV/AIDS epidemic that threatened to eliminate a generation of people. The 2008 version authorized funding under the program for another five years at $48 billion, and it received strong bipartisan support.
This year's bill does not include a specific authorization number, nor does it include sums on funding levels for specific programs. That leaves the levels functionally the same, according to congressional aides.
According to a memo on the bill prepared for lawmakers, the PEPFAR program remains the largest commitment by any nation to combat a single disease internationally.
Under the program, nearly 6 million people are now receiving life-sustaining anti-retroviral treatment. The memo also states that more than 11 million pregnant women received HIV testing and counseling last year, while the one-millionth baby born HIV-free as a result of treatment was born this year. PEPFAR has provided care and support to nearly 15 million people, including more than 4.5 million orphans and vulnerable children, the memo states.
The new five-year extension is also described as extending important provisions and reporting requirements to strengthen oversight of the program, including:
- Protecting the existing funding allotment for HIV treatment (setting it to at least 50 percent of total program funding), and specifically 10 percent for orphans and vulnerable children.
- Extending the current 33 percent cap on U.S. contributions to the Global Fund, and proportional withholding requirements related to countries listed as state sponsors of terrorism, along with a 20 percent withholding requirement related to Global Fund management reforms. The 33 percent cap is meant to serve as an effective tool for leveraging other donor funding.
- Extending a reporting requirement intended to capture per-patient costs for PEPFAR-supported treatment and care. This is intended to be an element of oversight and a tool for monitoring treatment costs.
- Extending authorization for the State Department, USAID, and Health and Human Services inspectors general to develop annual joint audit plans.
- Updating the requirements for annual reports on PEPFAR to better reflect the program's shift from being strictly U.S.-supported and toward greater ownership by partner countries.