Verbatim, as delivered

“PEPFAR: An Assessment of Progress and Challenges”

Four years ago, when this committee produced the landmark legislation we review today, HIV/AIDS was the most urgent public health issue in the world, bar none. It remains so today. More than 40 million people suffer from HIV/AIDS – a number that has jumped by 2.6 million over the past three years despite all of our collective efforts. This scourge has already stolen nearly 30 million lives – more than any war in human history with the exception of World War II.

But this war will continue without end if we let it. We cannot allow complacency and contentment to slow our steadfast determination to end this disease. AIDS may not be a new phenomenon, but it is as lethal as ever.

The devastation from this virus goes far beyond those who suffer directly from it. It has caused massive upheaval to political, social, and cultural structures, including the most important one – the family. As a father and as a grandfather, it disturbs me to no end that more than 15 million children worldwide have been orphaned by AIDS. These are utterly shattered lives. The cold, sober reality is that no assistance program can ever make them whole. But we can help prevent more children from being added to this long and dreadful list.

So I state today, for the record: Congress will re-authorize this crucial HIV/AIDS law and will fully fund HIV and AIDS programs in the poorest of countries on our planet.

Four years ago, my friend Henry Hyde and I labored long hours – together with many of the members in this room today, to produce a strong bi-partisan bill. It authorized $15 billion for 15 of the hardest-hit nations in Africa and elsewhere, establishing the United States as the world leader in the global battle against AIDS. And those who occasionally complain that we have lost our moral authority better take notice of this figure. There is no nation on the planet which would have made a remotely comparable effort. Our groundbreaking legislation, the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, was comprehensive in both scope and scale.


So far, we can say that this critically important legislation is working. It has supplied lifesaving antiretroviral therapy to more than 800,000 adults and children, provided invaluable testing and counseling for 19 million, supported essential services to prevent mother-to-child transmission to more than 6 million women, and served 4.5 million people with desperately-needed care and support. These numbers represent solid progress toward the program’s stated five-year goal of 2 million treated with antiretrovirals, 7 million infections averted, and care provided to 10 million patients.

But, my colleagues, there is still a long way to go. The battle against HIV/AIDS is a marathon, it is not a sprint.

Significantly, working with the White House, the legislation rightly focused on providing emergency services in the war against HIV/AIDS. We decided to work on an urgent basis with governments and NGOs in the 15 most ravaged countries. But now we must take a step back. We must make sure these countries can sustain the momentum. That is why the next version of the law will include provisions to transform the program from “emergency” to “enduring.” That will necessitate more funding for the target nations and better integration into existing health programs.

As the committee moves to reauthorize this most important program, we will also carefully examine the effectiveness of our HIV/AIDS prevention efforts. When the committee wrote this law, some of our Republican members insisted that at least one-third of total funding for prevention initiatives be used for abstinence-until-marriage education. Despite our strong reservations, this 33% requirement was included in the final draft.

A new report from the prestigious Institute of Medicine, however, says that this provision has impeded the prevention arm from achieving its goals. The report says, “the abstinence-until-marriage budget allocation in the … Act hampers these efforts and thus [the program’s] ability to meet the targets.” The Institute of Medicine states that sexual contact accounts for some 80 to 90 percent of new infections in sub-Saharan Africa, yet education on condoms and proper protection gets precious little funding. It seems that the famed ‘ABC’ prevention mantra – abstinence, be faithful, use condoms – is distorted toward the very beginning of the alphabet.

The non-partisan Government Accountability Office also reports that the 33-percent clause has challenged the country teams’ “ability to integrate the components of the ABC model and respond to local needs, local epidemiology, and distinctive social and cultural patterns.”

Clearly, we need to and we shall revisit this 33-percent provision as the law comes up for re-authorization. We should take a hard look at the consequences of this funding scheme and consider its wisdom.

Programs to educate, prevent, and treat are essential. But any serious discussion about eliminating HIV and AIDS must include the Holy Grail: the potential for a vaccine. It is imperative that we significantly boost funding to research promising experimental vaccines – not only to protect Americans, but to help millions around the world. The U.S. ought to step up its efforts to help bring this plague to an end once and for all.

So as we look to the future, let me assure the people in these disease-wracked nations: the United States Congress fully understands that there is no work more important, no mission so imperative, than beating HIV and AIDS.