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New AIDS law contains anti-condom provisions
By Cynthia Dailard
Senior Public Policy Associate
The Alan Guttmacher Institute
At the end of May, President Bush signed into law the "United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act," which is sweeping legislation designed to provide relief for HIV/AIDS in Africa and the Caribbean and authorizing funding of up to $15 billion over five years. While the law represents the first articulation of a U.S. global AIDS policy and is being hailed as landmark legislation by all sides, it contains a number of troublesome provisions that have the potential to undermine established public health strategies to reduce the risk of HIV transmission through condom use.
The action started in the House when Rep. Joe Pitts (R-PA) offered an amendment that would require that no less than 33% of all HIV/AIDS prevention funds be reserved for "abstinence-until-marriage" programs. This controversial provision provoked a heated debate, with opponents arguing that abstinence education that denies people full and accurate information about condoms is tantamount to a death sentence for many people living in sub-Saharan Africa, given its enormously high rates of HIV/AIDS. Nonetheless, the amendment passed by a vote of 220-197.
In addition, Rep. Chris Smith (R-NJ), seeking to elevate the status of faith-based organizations seeking federal HIV/AIDS funding and to accommodate their special concerns, included language in the House bill that specifically exempts any organization from having to "endorse, utilize, or participate in" any prevention strategy it may object to on moral or religious grounds. During House debate, Smith made clear that this "conscience clause" would permit organizations receiving federal funds to disparage condoms and to portray them as ineffective.
After House consideration, the bill then moved to the Senate. However, the hopes of family planning and HIV prevention advocates to delete or alter the Pitts and Smith provisions were dashed when the Senate decided to abandon its own version of a global AIDS bill — or even adding its own imprint to the legislation — and to take up the House bill instead. As a result, in the wee hours of night, the Senate passed essentially the same bill as the House. The Senate leadership, under intense pressure from the Bush administration, enforced a no-amendments strategy on the Senate floor that resulted in the defeat of all amendments. This included one authored by Sen. Dianne Feinstein (D-CA) to remove the earmark for abstinence-until-marriage programs and to replace it with language emphasizing the importance of a comprehensive approach to prevention. Thus, at the end of the day, the Pitts abstinence earmark and the Smith conscience clause became law.
Along these lines, the law also includes language authored by Rep. JoAnn Davis (R-VA) requiring an analysis of the prevalence of human papillomavirus (HPV) in sub-Saharan Africa and a study to assess the impact that condom use has had on the spread of HPV. Davis argued that because condoms cannot entirely reduce the risk of HPV, only abstinence until marriage and lifelong monogamy can protect women around the world from cervical cancer deaths related to HPV. Unfortunately, the Davis provision fails to devote any resources to bringing women in sub-Saharan African or other developing nations the cervical cancer screening and treatment programs they need to reduce deaths from cervical cancer.
Finally, on a much more positive note, Sen. Jon Corzine (D-NJ) engaged in a verbal colloquy with Senate Majority Leader Bill Frist (R-TN) during Senate consideration of the bill, where he asked for and received Frist’s support for increased funding for microbicide development. Frist joined Corzine in urging the National Institutes of Health to consider establishing a microbicides branch within the National Institutes for Allergy and Infection Diseases. Corzine is the sponsor of the Microbicide Development Act introduced in April that would encourage investment in microbicide research at several federal agencies, expedite the implementation of the National Institutes of Health’s five-year strategic plan for microbicide research, and expand coordination among federal agencies already involved in this research.
Now, the Bush administration must take steps to implement the global AIDS bill through the various agencies charged with this responsibility, particularly the U.S. Agency for International Development and the Department of Health and Human Services. To be sure, family planning and HIV prevention advocates will be watching closely.