Senate Votes to Reauthorize PEPFAR, Increasing Global AIDS Funding and Repealing HIV Positive Travel Ban

By Liz Highleyman

On July 16, the U.S. Senate voted to reauthorize the President's Emergency Plan for AIDS Relief, or PEPFAR, which provides funding for HIV/AIDS prevention and treatment in resource-limited countries. The bill will also overturn a long-standing ban on HIV positive visitors and immigrants.

PEPFAR supports prevention, antiretroviral therapy, and other medical care for people with HIV/AIDS in the poorest countries in Africa and the Caribbean. The program, which President George W. Bush introduced in his 2003 State of the Union address, has been widely praised. According to Senator Joseph Biden (D-DE), PEPFAR is "the single most significant thing the president has done." Some critics, however, have argued that U.S. aid should instead be funneled through the multinational Global Fund to Fight AIDS, Tuberculosis and Malaria.

Wednesday's 80-16 vote came after a prolonged delay while the bill was blocked by conservative Senators, including Tom Coburn (R-OK), who demanded concessions related to the proportion of funding to be spent on HIV treatment, as well as provisions related to promotion of abstinence and marital fidelity.

The current PEPFAR program is set to expire in September. In the new bill - dubbed the Lantos/Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act -- the Senate agreed to triple funding from the present $15 billion to $50 billion over the next 5 years, after thwarting amendments by fiscal conservatives to cut funding and add language regarding abortion.

In a move hailed by advocates, the Senate bill also includes a measure, proposed by John Kerry (D-MA) and Gordon Smith (R-OR), to overturn a ban on HIV positive visitors and immigrants to the U.S.

Dating from the late 1980s, the ban treats HIV differently than other diseases; while HIV is explicitly excluded by Congress, in other cases the Department of Health and Human Services determines what constitutes a "communicable disease of public health significance." Tourists, students, and other HIV positive visitors could obtain waivers, but this was a bureaucratic headache that forced them reveal their HIV status.

The widely criticized policy led the International AIDS Society to refuse to hold its annual AIDS conferences in the U.S. since the early 1990s. Last week, 160 health and AIDS advocacy organizations issued a letter urging Congress to rescind the ban.

"Today we are one step closer to ending a discriminatory practice that stigmatizes all those living with HIV, squanders our moral authority, and sets us back in the fight against AIDS," Kerry said, adding that the ban "has no foundation in public health or common sense."

HIV positive blogger Andrew Sullivan, himself a British immigrant to the U.S., called the ban "a relic of the days when HIV was a source of fear and stigma and terror." People with HIV who seek permanent residence will still be required to demonstrate they will not become a "public charge."

The newly passed Senate bill also allocates $2 billion for health care, water projects, and law enforcement for Native Americans in the U.S.

The House of Representatives passed its version of the PEPFAR reauthorization bill in April, also approving $50 billion. The House and Senate are expected to agree on a compromise version with little debate, and Bush has indicated that he is eager to sign the measure.

"Continuation of PEPFAR ensures expansion and sustainability of the greatest global heath initiative in history," said Ronald Johnson of AIDS Action. "The lifting of the travel and immigration bar removes the blemish on the United States leadership on HIV and AIDS."

7/18/08

Sources

J Abrams. Senate agrees to triple anti-AIDS funding. Associated Press. July. 16, 2008

AIDS Action. AIDS Action Commends Senate Passage of PEPFAR Reauthorization. Press release. July 16, 2008.

Kaiser Family Foundation. Senate Defeats Two Republican Amendments to PEPFAR Reauthorization Measure. Kaiser Daily HIV/AIDS Report. July 16, 2008.

National Partnership for Women and Families. Senate GOP Continues To Block Bill To Reauthorize Global HIV/AIDS Bill Despite Bush's Support. Daily Women's Health Policy Report. July 1, 2008.