Los Angeles Times - July 17, 2008
Vimal Patel, vimal.patel@latimes.com

WASHINGTON -- The Senate on Wednesday approved a $48-billion program to treat and prevent AIDS, malaria and tuberculosis, tripling the amount set aside in landmark legislation first passed five years ago.

The legislation, approved 80 to 16, came after an impassioned debate that had stalled for weeks over objections by conservatives about the bill's cost, the role of abstinence education and control over how money is spent.

Most Senate Republicans joined Democrats in backing the measure, which had the support of the White House. President Bush called for the 2003 initiative in his State of the Union speech that year, and favored renewal of the program this year. In Congress, the effort was seen as an important U.S. foreign policy initiative.

"It's one of the strongest ways the U.S. has made an impact on a number of countries where our diplomacy hasn't been effective in the past," said Sen. Richard G. Lugar (R-Ind.), adding that the measure is aimed at "the alleviation of extraordinary suffering on Earth."

The bill, known as the President's Emergency Plan for AIDS Relief, sets an ambitious five-year goal of helping prevent 7 million HIV infections and caring for 10 million people who have HIV or AIDS.

The program supports lifesaving antiretroviral treatment for more than 1.7 million people living with HIV or AIDS in 15 countries in sub-Saharan Africa, Asia and the Caribbean. When Bush called for the program, only 50,000 people in sub-Saharan Africa received treatment, the White House said.

With Bush's approval ratings at home and abroad at record lows, the AIDS program could provide a cornerstone to salvage part of his foreign policy legacy.

"I have been extremely critical of President Bush's foreign policy," said Sen. Joseph R. Biden Jr. (D-Del.), chairman of the Senate Foreign Relations Committee. "But I must say, the president of the United States has led us to this incredible moment."

Advocates of AIDS prevention and treatment praised the measure, but they also expressed concern over provisions that increase the amount of money required to go toward abstinence education.

A report last year by the federally funded Institute of Medicine recommended elimination of the requirement.

"Some of its mandates aren't grounded in evidence, and politics is put ahead of science," Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, said in an interview from South Africa, where he is attending meetings on HIV prevention research.

Christine Stencel, a spokeswoman for the Institute of Medicine, said individual countries and leaders implementing the program "on the ground" are more qualified to determine what funds are needed and where they should go.

The House passed its version of the bill by a nearly 3-1 margin in April. But a small number of Republican senators raised objections to the bipartisan bill, which is co-sponsored by both major parties' presidential candidates, Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.).

The bill authorizes $50 billion over five years, but senators set aside $2 billion for health and safety projects on American Indian reservations.

Sen. Jim DeMint (R-S.C.) voted for the 2003 legislation but wanted to reduce this year's bill to $35 billion. Another Republican, Sen. Jim Bunning of Kentucky, offered an amendment that would reauthorize the program for $15 billion, the amount it received in 2003. It was easily defeated.

"It's not a good time to be talking about spending billions of American dollars around the world, no matter how good the cause might be," DeMint said.

Democrats also cited issues Americans find troubling in making their case for supporting the bill: "Each month, we spend $12 to $15 billion on the war in Iraq," said Sen. Richard J. Durbin (D-Ill.), noting that the AIDS measure would cost $10 billion a year through 2013.

The legislation now goes to a House-Senate conference committee, where lawmakers can work out differences before sending the measure to Bush.

"With passage of today's bill, we are one step closer to ensuring that this excellent program continues to help those in need," Bush said in a statement Wednesday night.

One provision in the Senate bill would end a ban on immigration and travel to the U.S. by people with HIV. It would lift the 1993 prohibition imposed by Congress and allow the Department of Health and Human Services to decide whether to take HIV off its list of communicable diseases. The disease has been on the department's list since 1987.

"The key piece is that Congress should not substitute its judgment for the judgment of Health and Human Services," said Rachel B. Tiven, executive director of Immigration Equality, a New York-based group that advocates repealing the ban. "Public health should be left to the public health experts."

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