Global AIDS Relief Program Poised to Reap Rare Bipartisan Support

JOHANNESBURG, SOUTH AFRICA - Sister Sally Naidoo administers an HIV test on a young boy at the Right To Care AIDS clinic on January 27, 2012, in Johannesburg, South Africa. The Right to Care non-governmental organisation has, with U.S. funding from PEPFAR, managed to revive their AIDS clinic, which provides medical treatment to more than 8,000 patients.
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Billy House
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Billy House
Nov. 18, 2013, 11:17 a.m.

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.
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