WASHINGTON — In early February, a discussion draft of a House bill to reauthorize funds for the global HIV/AIDS fight ignited a political firestorm.
Pro-family leaders charged the bill contained so many family planning and “reproductive health” agendas it would “permit abortion at taxpayers’ expense” and “help eliminate Africa’s next generation.”
The bill died in committee.
A compromise measure forged in late February by House leaders and the White House has won cautious bipartisan support, but pro-family activists say serious concerns remain.
The reauthorization bill for the President’s Emergency Plan for AIDS Relief (Pepfar), approved by the House Foreign Affairs Committee on Feb. 27, would more than triple funding from $15 billion to $50 billion over five years.
“This bill really reflects the mainstream consensus of what this program should look like,” said Bill O’Keefe, senior director for advocacy at Catholic Relief Services. O’Keefe applauded “the strong leadership and vision that has put the interests of millions of people affected by HIV above partisan battles.”
“It’s a bill that many of the groups that would have opposed it only a few days ago will now support,” said Shepherd Smith, president and founder of the D.C.-based Institute for Youth Development.
Global AIDS Alliance head Paul Zeitz, a physician and vocal critic of Bush’s original Pepfar initiative, said, “This historical agreement will save millions of lives.”
Zeitz added, “The biggest worry I have now is that this bill will not be fully funded.”
If passed by Congress, the bill has the potential over the next five years to prevent 12 million new HIV infections, treat 3 million people already infected, and care for an additional 12 million people, including 5 million orphans and vulnerable children, the U.S. Conference of Catholic Bishops observed.
About $9 billion in the new bill would go to fight tuberculosis and malaria, two potentially fatal diseases that often strike HIV-infected people with compromised immune systems. The remaining money — about $41 billion — would go for programs that directly fight HIV.
“We welcome this strong affirmation of U.S. leadership in the fight against HIV/AIDS, TB and malaria on behalf of millions of the world’s most vulnerable people and communities,” said Bishop Thomas Wenski of Orlando, Fla., chairman of the U.S. bishops’ Committee on International Justice and Peace.
Cardinal Justin Rigali of Philadelphia, chairman of the bishops’ Committee on Pro-Life Activities, said, “It is vital to preserve and expand proven life-saving programs — especially abstinence and fidelity education — while refusing to dilute and distort a successful AIDS relief program with family planning and ‘reproductive health’ activities.”
Tony Perkins, head of the D.C.-based Family Research Council, charged that the earlier draft bill could have permitted “abortion at taxpayers’ expense,” given “a U.S. stamp of approval to global sex trafficking and prostitution” and helped “eliminate Africa’s next generation.”
Perkins said this new bill is “better than we expected,” but “it’s still far from perfect.”
One of his and others’ major concerns is that there is no clear percentage of funding required for abstinence and fidelity education. The first Pepfar bill required that 33% of sexual-transmission-prevention funds be spent on abstinence and fidelity.
In the new bill, all formula percentages are removed. Rather, the bill calls for “balanced funding” for behavioral change programs, “including abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction.”
If at least 50% of prevention monies are not spent on abstain/be faithful programs, the executive branch must report it to Congress.
The abstain/be faithful requirement is still there in a nuanced way, Smith said. “But it’s debatable whether it’s as strong as it was.”
Whether or not the requirement will be enforced may depend on the administration. “I think if we end up with a Republican administration, it will be as strong or stronger. If we end up with a Democratic administration, it will probably be less strong than what we had,” Smith said.
Also of concern to many is the sheer amount of the appropriation: $50 billion is the equivalent of about $165 from each and every man, woman and child in the United States.
Perkins said, “If we’re going to spend that money, and it looks as if it’s on track to be spent, we need to make sure it’s spent in a way that promotes a pro-family agenda and not an anti-family agenda.”
Medical anthropologist Edward Green, director of the AIDS Prevention Research Project at Harvard Center for Population and Development Studies, is concerned that although the ABC (Abstain, Be faithful, or use a Condom) formula appears to be in the bill to mollify conservatives and the religious, in fact, very few programs for fidelity or abstinence/delay will actually be funded on the ground.
“I predict they will be very scarce if they will exist at all,” Green said. “I hate to think of the many lives that will be lost because of ineffective AIDS prevention — prevention that satisfies the biases of the West and serves the self-interest of the AIDS multi-billion-dollar industry — but not the needs of the poor of Africa or elsewhere.”
Among the new bill’s most vocal critics from the family-planning side of the debate is Serra Sippel, executive director of the feminist Center for Health and Gender Equality (CHANGE) in Takoma Park, Maryland.
Change called the new plan “two steps forward, three steps back,” claiming that it “does not adequately address the vulnerabilities of women and girls.”
Aspects of the bill Sippel found disturbing were the facts it “restricts funding to U.S.-funded family planning programs,” continues to require that Pepfar recipients “pledge their opposition to prostitution” and leaves the language about abstinence funding “dangerously ambiguous.”
Echoing Sippel’s concerns, Zeitz, of Global AIDS Alliance, expressed “dismay” that “this agreement does not specify that U.S. AIDS funding can be used for family planning.”
Zeitz added, “We are also troubled that this agreement does not remove the requirement that HIV/AIDS programs sign a statement signaling their opposition to prostitution. This requirement has led many important programs to turn down U.S. funding.”
On what Sippel regarded as “a more positive note,” the bill “supports linkages between family planning and HIV/AIDS programs, and for the first time, recognizes the vital role of female condoms in HIV prevention.”
Catholics for the Common Good Institute proclaimed the bill “a victory” in that the attempt to give Pepfar funds to overseas organizations that commit or promote abortion was successfully thwarted.
But Catholic Relief Service’s O’Keefe cautioned, “In congressional process, there’s no such thing as a slam dunk.”
He pointed out the battle isn’t over until the president signs a bill into law.
To secure passage of this vital bill, O’Keefe said, “plenty of work remains.”
Sue Ellin Browder is based in