Bush says he will sign PEPFAR reauthorization

President Bush on Saturday during his weekly radio address said he is eager to sign legislation (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief through 2013, the AP/Google.com reports (Reichmann, AP/Google.com, 7/26).

The House on Thursday approved the measure 303-115. The legislation allocates a total of $50 billion -- $48 billion of which would go to PEPFAR and $2 billion of which would go to American Indian issues. The bill also includes an amendment intended to increase oversight of the Global Fund To Fight AIDS, Tuberculosis and Malaria and encourage cost-sharing and transition strategies as part of agreements with countries that receive PEPFAR aid. The measure also includes a provision that would ease U.S. HIV/AIDS travel restrictions. The bill passed on Thursday does not mention family planning programs.

The final version of the measure also includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. In addition, it would overturn an existing law that requires one-third of prevention funds be spent on abstinence and fidelity programs, instead requiring a report to Congress if countries do not spend half of prevention money on such programs. The bill also would direct 10% of funding to programs for orphans and vulnerable children, as well as allocate $2 billion for the Global Fund in fiscal year 2009. The legislation contains an existing requirement that organizations receiving PEPFAR aid have a policy that opposes commercial sex work. The bill would create links between HIV/AIDS and nutrition programs and set a target of recruiting 140,000 health care workers. In addition, the measure would allocate $5 billion for malaria programs and $4 billion for TB initiatives (Kaiser Daily HIV/AIDS Report, 7/25).

Bush praised Congress for "working" with the administration to pass the legislation, adding that he "will be honored to sign it into law" this week (AP/Google.com, 7/26). Bush added the legislation will enable the U.S. to "expand access to lifesaving antiretroviral drugs" and "help prevent millions of new HIV infections from occurring." He added that the legislation will help the U.S. "bolster our efforts to help developing nations combat other devastating diseases like malaria and tuberculosis" (Blake, The Hill, 7/26).

In related news, the Washington Post on Saturday examined the implications of PEPFAR's commitment to provide HIV/AIDS services in developing countries "for an indefinite period of time." The reauthorization bill "extends an implicit pledge that has little precedent in the history of U.S. foreign assistance: to continue purchasing lifesaving drugs for millions of individual people in developing countries for an indefinite period of time," according to the Post. Health care assistance traditionally has been used to construct buildings, purchase equipment and train workers, the Post reports. Direct medical care for "individuals was limited to one-time interventions such as vaccinations, emergency treatment after natural disasters, and curative treatments of limited duration for diseases such as tuberculosis or leprosy," according to the Post. PEPFAR is different and has purchased large quantities of antiretrovirals and supported medical care of more than 1/4 million people. "It is the first time I can think of where we have foreign aid treating a chronic disease," Michael Merson, director of Duke University's Global Health Institute and a former head of the World Health Organization's AIDS office, said, adding, "It's a challenge to take this on. I think the questions it raises are going to be important ones for the future."

It is unlikely that PEPFAR focus countries would be able to provide HIV prevention, treatment and support services without assistance, and it would be "immoral" for PEPFAR to withdraw funding unless another group replaces it, according to some experts. In addition, some experts are concerned that foreign aid for other programs will decrease as PEPFAR commitments grow (Brown, Washington Post, 7/26).