Washington Blade - June 20, 2008
Lou Chibbaro Jr.

Both Republican and Democratic lawmakers agree that the repeal measure is in danger because of opposition to parts of a larger, global AIDS relief bill to which it is attached, not because of opposition to the repeal provision itself.

But Senate Republican and Democratic leaders are blaming each other for the failure so far of the two sides to reach a compromise that would lead to Senate approval of the reauthorization of the PresidentÆs Emergency Plan for AIDS Relief, or PEPFAR, a proposed $50 billion program to help developing countries in Africa, Asia and the Caribbean fight AIDS.

Gay and AIDS activists expressed optimism in March when the Senate Foreign Relations Committee approved the PEPFAR bill with a clause attached that would repeal a law passed in 1993 that prohibits all foreign visitors who test positive for HIV from entering the United States. The 1993 law, initiated by former Sen. Don Nickles (R-Okla.), also bans foreigners with HIV from immigrating to the U.S.

Efforts to repeal the HIV ban were boosted last week when United Nations Secretary Gen. Ban Ki-Moon reiterated the U.N.Æs longstanding opposition to all forms of discrimination against people with HIV.

"I call for a change in laws that uphold stigma and discrimination, including restrictions on travel for people living with HIV," Ki-Moon said in a June 10 address before the U.N. General Assembly in New York.

In the U.S., a broad coalition of groups calling for repeal of the HIV visitors and immigration ban, including civil liberties and human rights advocates, were hopeful that attaching the repeal measure to the highly popular PEPFAR bill would greatly increase its chances of passing.

Their expectations were dampened, however, when Sen. Tom Coburn (R-Okla.) and at least six other conservative GOP senators placed a hold on the PEPFAR bill, preventing it from coming up for a vote unless at least 60 senators vote to break the hold.

Coburn said his main concern was the decision by PEPFAR backers to drop from the existing 1993 PEPFAR law a requirement that at least 55 percent of AIDS relief funds be used for AIDS treatment, including the use of life-saving anti-retroviral drugs. The 1993 law expires in September.

Coburn has also called for a new provision in the bill that would require that at least 7 million people receive medical treatment from PEPFAR over the next five years. The bill, as currently written, requires that only 3 million people receive medical treatment during that same period. The PEPFAR law set to expire in September requires that 2 million people receive medical treatment under the program.

Coburn has argued that raising the treatment figure from 2 million to just 3 million people is unacceptable for a reauthorization bill that raises the U.S. expenditure for the program from $15 billion to $50 billion.

The Bush administration, at the recommendation of U.S. Global AIDS Coordinator Mark Dybul, a gay official appointed by Bush, supports the decision to drop the 55 percent treatment floor. A number of prominent Republican senators also support the decision to drop the treatment floor. Nearly all Senate Democrats also support dropping the 55 percent floor for treatment.

They cite recommendations by the National Academy of ScienceÆs Institute of Medicine and the U.S. Government Account-ability Office (GAO) that the 55 percent treatment floor be eliminated on grounds that it prevents developing countries from deciding on their own whether they use more funds for HIV prevention programs and for improvement of health care facilities.

Coburn has said removing the floor on medical treatment would open the way for diverting PEPFAR funds to projects and programs that benefit "those wanting to help people with HIV rather than people with HIV." Advocacy groups aligned with Coburn have said removing the treatment floor would make it easier for corrupt bureaucrats in developing nations, especially in Africa, to steal large amounts of PEPFAR money.

Jim Manning, spokesperson for Senate Majority Leader Harry Reid (D-Nev.), said Reid is reluctant to bring the PEPFAR reauthorization bill to the Senate floor because Coburn and other Republican senators have vowed to introduce dozens of amendments, taking up a week or more of valuable Senate floor time. Manning said Reid is uncertain whether supporters of the bill can line up the 60 votes needed to end an expected filibuster against the bill by opponents, even if Reid allowed a week or more floor time to be used up in debate over the amendments.

Manning said Reid supports the bill, including the provision to repeal the HIV immigrant and visitors ban.

But Congressional Quarterly Today, a publication specializing in the inner workings of Congress, reported this week that advocacy groups aligned with the Senate GOP leadership believe Reid and other Democratic leaders are not negotiating in good faith with the aim of postponing a vote on the PEPFAR bill until next year when they hope a Democrat will be in the White House.

"ThereÆs no political win for [Reid] if it passes," CQ Today quoted an unidentified Capitol Hill advocacy group representative as saying. The advocacy group representative believes Senate Democrats donÆt want to bring the prestigious PEPFAR bill to the floor because it would "give Bush an item for his legacy on his way out of office," CQ Today reported.

"We categorically reject that," said Manning. "This bill has broad, bipartisan support, and we are working closely with Republicans to pass it."

Victoria Neilson, legal director of Immigration Equality, a gay-supportive legal rights group that has called for repeal of the HIV visitor and immigrant ban, said Senate staffers have told her they expect a compromise to be reached over the PEPFAR reauthorization bill within the next few weeks.

"WeÆre cautiously optimistic that the bill could pass this year," Neilson said.

Michael Weinstein, president of the AIDS Healthcare Foundation, which supports CoburnÆs effort to restore the 55 percent treatment floor said he, too, has heard from Capitol Hill insiders that a compromise is imminent in the next week or two.

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