Rep. Ileana Ros-Lehtinen has teamed up with First Lady Laura Bush and a bipartisan group of House members to launch a Congressional caucus with the aim of coordinating U.S. policy on fighting malaria.

By David Brown Washington Post Staff Writer Thursday, April 3, 2008; A04

The House of Representatives yesterday passed a five-year reauthorization of the Bush administration's global AIDS program, adding $20 billion to the $30 billion the president requested.

The program, originally known by the acronym PEPFAR (President's Emergency Plan for AIDS Relief), provides money to treat people infected with HIV and to help support their families, as well as for a long list of activities aimed at preventing infection.

Although it contained controversial features, including a heavy emphasis on abstinence-oriented prevention strategies, the global AIDS program has been popular with lawmakers in both parties and has been praised around the world.

The reauthorization passed 308 to 116. A motion to send the bill back to committee, which was offered by lawmakers unhappy with the $50 billion price tag, failed on a 248 to 175 vote.

The Senate version of the bill is out of committee and is awaiting floor action.

"It's a very big bill and an expensive one, but it does a lot of important things," said Howard L. Berman (D-Calif.), chairman of the House Foreign Affairs Committee. "I was pretty happy we maintained the essence of the bipartisan coalition on final passage."

Ileana Ros-Lehtinen (Fla.), the ranking Republican on the committee, said on the House floor that the bill "strengthens our national security" because AIDS is "destabilizing governments and societies" in entire regions around the world.

The original program, unveiled by the president in his 2003 State of the Union address, is spending $15 billion over five years. The reauthorized program would be bigger and broader in scope.

About $9 billion would go to fight tuberculosis and malaria, which are huge burdens in many countries where the AIDS epidemic is severe. Money would be used to buy food for AIDS patients and their families, provide clean water to communities, train health-care workers and provide "micro-credit" loans to women widowed by the disease or ostracized because they are infected.

Unlike the original PEPFAR, the renewed global AIDS bill would not stipulate the percentage of prevention spending that must be used to promote abstinence, but abstinence and sexual faithfulness would remain important strategies.

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A fragile compromise on President Bush’s international AIDS relief package passed the House Wednesday, but it’s unclear whether the agreement will survive opposition from both the left and the right in the Senate.

The bill would authorize $50 billion over five years for the President’s Emergency Plan for Aids Relief, an ongoing initiative to combat the spread of AIDS, Tuberculosis and Malaria, primarily in Africa. The bill more than triples the $15 billion allotted for the original five-year program, which expires this fall.

The measure, which passed the House by a 308 to 116 vote after an intense push from the White House, is the result of a compromise that was years in the making, the brainchild of two recently deceased former chairmen of the House Foreign Affairs Committee, Reps. Tom Lantos (D-Calif.) and Henry Hyde (R-Ill.).

The conservative Hyde broke with many pro-life advocates in 2003 by agreeing to give up a provision that would have prohibited funding from going to family planning organizations abroad that performed abortions. In exchange, Lantos agreed that a certain percentage of funds would be earmarked for abstinence-only programs.

The updated compromise — negotiated primarily by Lantos and Hyde’s successor on the committee, Rep. Ileana Ros-Lehtinen (R-Fla.) — increases the total budget for the program and removes the provision requiring 33 percent of all prevention funds go to abstinence- only programs but requires a report to Congress if spending on abstinence falls below certain levels. The deal however, keeps a contentious requirement that groups must have a policy opposing prostitution in order to receive funding.

The delicate agreement now faces challenges from both sides of the aisle in the Senate. Fiscal conservatives have balked at its $50 billion price tag, while some liberals are calling for more funding for family planning initiatives, which many experts believe can help greatly reduce AIDS rates by helping HIV-positive women avoid unplanned pregnancies.

“The Senate will be playing with fire if it takes this carefully crafted compromise and blows it apart,” said one House GOP aide who was involved in the negotiations.

The bill has already passed out of the Senate Foreign Relations Committee, and Senate Majority Leader Harry Reid (D-Nev.), who supports it, intends to take it up “as quickly as possible,” according to his spokesman, Jim Manley.

But Reid faces many tough decisions, especially over what amendments will be included in the Senate’s version of the bill.

“It is a very, very delicate balance right now,” said White House spokesman Tony Fratto.

So far, the Senate bill makes no mention of family planning, but advocates are pinning their hopes on Sen. Barbara Boxer (D-Calif.), who is contemplating an amendment to expand family planning funding that could potentially reopen the abortion fight and endanger the support of many conservatives.

“I hope the Democrats get their act together, stand strong on these issues and not cave,” said Serra Sippel, the executive director of the Center for Health and Gender Equity, a public health watchdog group that favors an expanded role for family planning in AIDS prevention.

Boxer said Tuesday she has not yet made up her mind on how to proceed.

“Either we will introduce the amendment or we will make it clear that family planning is not impacted by this bill in any way,” she said.

Although the $50 billion price tag has turned off some budget hawks on the right, the AIDS program’s success to date has won over all but the most hard-core fiscal conservatives.

So far, the program has provided AIDS drugs to more than 1.4 million people and care for more than 6.6 million, prompting former Bush speechwriter Michael Gerson to call it “perhaps the most successful foreign assistance effort since the Marshall Plan.”

Behind the scenes, the White House is working furiously to make sure the Senate doesn’t undo the House compromise. Getting PEPFAR passed, the White House believes, is a way to help secure the president’s legacy.

“This is one of the president’s highest priorities,” said Fratto. “We do lots of programs in [the international arena], but few others provide such direct dollars to a sick person who is very likely to do die. ... This is saving lives."

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By JIM ABRAMS – 1 hour ago

WASHINGTON (AP) — The House voted Wednesday to triple to more than $10 billion a year U.S. humanitarian spending on fighting AIDS, malaria and tuberculosis in Africa and other stricken areas of the world.

About $41 billion of the $50 billion over five years would be devoted to AIDS, significantly expanding a program credited with saving more than 1 million lives in Africa alone in the largest U.S. investment ever against a single disease.

Every day another 6,000 people are infected with the HIV virus, said House Foreign Affairs Committee Chairman Howard Berman, D-Calif. "We have a moral imperative to act and to act decisively," he said.

The House voted 308-116 to extend and broaden the scope of the $15 billion President's Emergency Plan for AIDS Relief that President Bush promoted and Congress enacted in 2003. It has been hailed as a noteworthy foreign policy success of the Bush presidency.

The White House, which backs the House bill, said the program is supporting anti-retroviral treatment for about 1.45 million people and is on track to meet its goals of backing treatment for 2 million, preventing 7 million new infections and providing care for 10 million, including orphans and vulnerable children.

In 2007, 33 million people worldwide were living with HIV and AIDS, according to the United Nations.

Rep. Ileana Ros-Lehtinen of Florida, top Republican on the Foreign Affairs Committee, added that while the program is based on altruism, it has strengthened U.S. security.

Without addressing the AIDS pandemic, she said, it "will continue to spread its mix of death, poverty and despondency that is further destabilizing governments and societies, and undermining the security of entire regions."

The compromise bill was one of the last endeavors of the former Foreign Affairs Committee chairman, Tom Lantos, D-Calif., who died of cancer in February. The measure is named after Lantos and his predecessor as Foreign Affairs chairman, the late Rep. Henry Hyde, R-Ill., who worked together on the 2003 act.

The Senate Foreign Relations Committee has approved a similar $50 billion bill, and the legislation is seen as having a good chance of passing in an election year in which few major bills will reach the president's desk.

To advance the legislation, conservatives had to give up a provision in the 2003 act requiring that one-third of all HIV prevention funds be spent on abstinence programs. Instead it directs the administration to promote "balanced funding for prevention activities" in target countries.

Liberals, in turn, had to accept some restrictions on family planning groups participating in AIDS programs. Conservatives, concerned that money might be diverted to abortion promotion, pushed for a provision that allows the use of funds for HIV/AIDS testing and counseling services in those family planning programs supported by the U.S. government.

A measure in the 2003 act requiring groups receiving funds to have a policy explicitly opposing prostitution and sex trafficking, opposed by some health groups as impeding efforts among sex workers, was also left intact.

The White House, which originally promoted doubling the program to $30 billion, has expressed concern over the $50 billion figure but not opposed it.

Some conservatives still objected. "This is irrational generosity," said Rep. Dana Rohrabacher, R-Calif., saying the country doesn't have enough money to help veterans and the elderly. "This is benevolence gone wild."

The bill authorizes $10 billion a year, or $50 billion through 2013. Of that, $41 billion is for AIDS prevention and treatment, $4 billion for tuberculosis and $5 billion for malaria. The actual dollars still have to be approved in annual spending bills, but over the last five years Congress exceeded the $15 billion goal, appropriating $19 billion for global AIDS and related programs.

The $41 billion includes up to $2 billion a year for the international Global Fund to Fight AIDS, Tuberculosis and Malaria. The bill limits U.S. contributions to the Global Fund to one-third of total contributions.

It expands the program, originally focused on 15 mainly sub-Saharan African countries, to include Caribbean nations as well as Malawi, Swaziland and Lesotho in Africa. The goal of the next five years is to prevent 12 million new infections, provide anti-retroviral treatment for 3 million, and train more than 140,000 health care workers. The bill increases coordination with drinking water and nutrition programs and efforts to educate girls and women.

"This will be remembered as the single most significant achievement of President Bush's two terms in office," said Rep. Donald Payne, D-N.J., chairman of the Foreign Affairs subcommittee on Africa.

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Wed 2 Apr 2008, 19:13 GMT

By Will Dunham

WASHINGTON, April 2 (Reuters) - The U.S. House of Representatives on Wednesday passed a bill to more than triple spending to fight AIDS in Africa and other parts of the world, one of President George W. Bush's foremost foreign aid quests.

The measure, a bipartisan compromise backed by the White House and passed by a vote of 308 to 116, calls for $50 billion in funding for AIDS, tuberculosis and malaria programs over the next five years. It marks a big hike from the $15 billion authorized over the first five years of the initiative.

Bush had initially proposed doubling the program to $30 billion. The Democratic-led House boosted it to $50 billion.

A similar bill is heading toward passage in the Democratic-led Senate.

The initiative aims to prevent infection by the human immunodeficiency virus, which causes AIDS, treat people already infected and care for children left as orphans by AIDS.

"There is a moral imperative to combat this epidemic," said House Speaker Nancy Pelosi, a California Democrat.

The White House said the current program is supporting life-saving treatment for 1.45 million people.

The program launched by Bush in 2003 provides support programs and drugs in 15 countries, 12 in Africa plus Vietnam, Guyana and Haiti. The new bill would add 14 more countries in the Caribbean basin, and an amendment approved by the House would add three more African countries.

Bill opponents said it was simply too expensive, and that there were pressing needs at home that need to be addressed.

The bill would discard a current requirement criticized by some Democrats and AIDS activists that a third of all HIV prevention funds be spent on sexual abstinence education. It instead calls for "balanced funding" for abstinence, fidelity and condom programs.

There are 33 million people worldwide infected with HIV, the virus that causes AIDS, with two-thirds of them in sub-Saharan Africa, according to U.N. estimates.

Rep. Ileana Ros-Lehtinen, a Florida Republican, said the bill would save millions of lives around the world and help maintain stability in a key region of the world.

"The program that we are authorizing today ... is now recognized as perhaps the most successful foreign assistance program of the United States of America since the Marshall Plan," Ros-Lehtinen said, referring to the costly U.S. plan to rebuild Europe after World War II.

Bush sees his efforts against AIDS and malaria as foreign policy successes in a presidency dominated by the unpopular war in Iraq. During a trip to Africa in February, Bush was given a hero's welcome in part for U.S. AIDS and malaria programs.

The White House calls the anti-AIDS initiative the largest commitment ever by any nation for an international health initiative dedicated to a single disease.

New Jersey Democratic Rep. Donald Payne said the initiative will go down as Bush's single most important achievement.

But opponents said it costs too much. "It is terrible that millions of Africans are suffering AIDS. But we cannot afford such totally irrational generosity. This is benevolence gone wild," said California Republican Rep. Dana Rohrabacher.

"We can't take care of our own veterans when they come home from the war. We can't take care of our elderly. We have people who can't take care of their own health needs and are at risk of losing their homes," Rohrabacher added. "We have big hearts. But we need to use our brains."

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