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PHR's Position on PEPFAR Reauthorization Bills

For Immediate Release

PEPFAR reauthorization legislation has now been introduced into both Houses of Congress. Below is a summary of PHR's positions on some of the salient provisions of the two bills. The bills are similar, but not identical. Both are named the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The Senate bill number is S.2731; the House bill number is H.R. 5501.

PHR supports both the House and Senate current versions of PEPFAR reauthorization legislation. The increase in the proposed budget for PEPFAR 2 from $30 billion to $50 billion for AIDS, TB, and malaria, spurred by grassroots support from AIDS advocates (including PHR) is, if passed into law, a major victory for people with AIDS and their supporters. The increased budget promises to save literally millions of lives. But, before the bill is signed into law, there are several important changes that PHR would like to see made.

Below are PHR's positions on key components of the bills.

Injection drug use (IDU) policy—PHR welcomes the increased attention given to IDUs in the proposed legislation, which favors increased access to HIV prevention for this group. Neither bill calls for an end to the ban on US funding for syringe exchange programs. NGOs, including PHR, successfully pushed for more achievable language calling for increased attention to IDUs and linkages and referrals to a broader range of services for IDUs.

In PEPFAR reauthorization legislation, five-year plans must include, "where appropriate," IDU prevention, including education and "services demonstrated to be effective in reducing the transmission of HIV infection without increasing drug use." As the bill moves forward it will be extremely important to protect this language.

In addition, there is a reporting requirement that PEPFAR must track the number of IDUs reached by PEPFAR services in each affected country, including users at risk of becoming infected with HIV. The inclusion of prevention services for users not yet HIV-positive is a breakthrough and differs from PEPFAR 1, which only targeted HIV-positive injection drug users.

Women: PHR supports the focus given in the bill to programs to combat HIV/AIDS among women. Women's unique vulnerability to HIV is explicitly discussed in both House and Senate versions of the bill, more than in PEPFAR 1. There is language in both bills to support significant and substantial initiatives intended to boost the status of women and reduce their vulnerability to HIV/AIDS.

Family Planning: It is critical that HIV services are integrated with family planning services. Health professionals on the ground facing the realities of an increasingly feminized epidemic know that integration of family planning and HIV services can save the lives of thousands of women. This integration would greatly expand access to HIV services in sexually active women at risk for HIV. Family planning services is the entry point to the health system for the majority of women. Accessing HIV prevention, care and treatment services as early as possible will result in women living longer, healthier lives. Integration would also help reduce the number of unintended pregnancies and babies born with HIV.

The integration of family planning services and HIV services is not discussed in the Senate version. The House version does address integration, and uses language that may restrict PEPFAR funding only to groups in compliance with the global gag rule, which bars clinics that perform abortions from receiving PEPFAR funds. PHR is calling for the integration of family planning and HIV services in the final PEPFAR reauthorization legislation.

Finally, PHR is calling for funding for improved food security as part of a strategy to reduce women's vulnerability to HIV.

Funding: While the current broad bipartisan support for the $50 billion authorization in both chambers of Congress makes an increase beyond this level unlikely, the US share of the investments required to address AIDS, tuberculosis, malaria, and related health systems strengthening exceeds this amount by at least $10-$15 billion over the next five years. PHR will continue to call for necessary levels of funding, through the annual appropriation processes and other advocacy opportunities.

Health workforce: PHR supports the health workforce initiatives proposed in both versions of PEPFAR reauthorization legislation. In PEPFAR 1, there was little mention of the issue.

PHR welcomes, but wants to improve:

  1. Provisions to support national health workforce strategy and health system strengthening; the Senate language on health workforce strategies could be strengthened significantly.

    Current language calls for a policy to train at least 140,000 new health workers. PHR would like to eliminate the ambiguity in this provision as it is currently written. PHR is calling for the education and retention of new health workers that goes beyond HIV training, in order to strengthen current health systems. PHR also wants the language to place more emphasis on "health professionals." PHR recognizes that while more community health workers and paraprofessionals, are needed, support for new health professionals, e.g. physicians and nurses, is unlikely without clear Congressional direction.

  2. PHR also seeks a Senate amendment that would provide health care for health workers themselves – an issue not addressed in the Senate bill – and stronger language about safe working conditions. The House version contains good provisions on health care for health workers and health worker safety, though the health worker safety provisions should be strengthened.

Comprehensive Prevention: PHR opposes injecting ideology into decisions about which groups should receive funding; these decisions should be based on science and sound public health principles. Groups should not be denied funding for ideological reasons. Both bills heavily favor abstinence and ABC approaches; PHR would like more focus on human rights and comprehensive, evidence-based prevention initiatives.

Abstinence Earmark: PHR applauds the removal of the abstinence earmark; there is significant evidence that abstinence-only programs do not work and are muddling US prevention policy in PEPFAR countries. In its place, there is a reporting requirement: The Office of the Global AIDS Coordinator must justify its strategy if in a given country less than 50% of prevention funds are spent on behavioral change activities including abstinence and partner reduction. PHR would like to see this requirement removed in the final legislation.

HIV Travel Ban: PHR strongly supports the removal (in the Senate version) of the longstanding ban preventing people with HIV from visiting the US, and calls for this language to be included in the final legislation.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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