Congress Moves Global AIDS Legislation

As the second and final session of the 110^th Congress comes to a close and members prepare for the upcoming congressional and presidential elections, the House and Senate have focused on passing legislation that responds to downturns in the U.S. economy and the evolving housing crisis—in contrast to the first session, which focused on legislation related to the Iraq War. This refocusing is largely due to constituency concerns but also reflects a shift in strategy. To avoid a repeat of the democratic majority’s failed first-session efforts to secure higher funding levels for HIV/AIDS and end the war in Iraq—all of which were vetoed by President Bush—the Congress will delay final action on most appropriations bills until after the November elections. This delay will require the Congress to fund government spending for Fiscal Year (FY) 2009, which begins October 1, 2008, through a continuing resolution that extends current funding levels until after the elections. Delaying these funding decisions robs the Bush administration of the veto over the new funding priorities of a Congress with larger democratic majorities. 

Despite the partisan atmosphere on Capitol Hill, the Senate passed a provision in the budget resolution that would establish an HIV Medicaid demonstration program—along the lines of the Early Treatment for HIV Act (ETHA)—allowing states to expand Medicaid access to financially eligible individuals living with HIV but not AIDS diagnosed. And both the House of Representatives and the Senate have moved forward on legislation that will reauthorize an important legislative legacy of the Bush Administration, the President’s Emergency Plan for AIDS Relief (PEPFAR). 

On March 13, 2008, the Senate Foreign Relations Committee approved S. 2731, the Senate’s version of “The Tom Lantos, Henry J. Hyde, Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008.” Importantly, the Senate version contains a repeal of the statutory restriction on HIV-positive people entering the United States and returns to the Secretary of Health and Human Services the determination whether people with HIV present a public health threat. (Earlier this year, Bay Area Congresswoman Barbara Lee [D-CA] introduced freestanding legislation to accomplish this goal.).  

On April 2, 2008, the full House passed its version of the global AIDS bill, H.R. 5501, by a vote of 308 to 116. Unlike the Senate version, the House bill does not repeal the U.S. ban on entry by HIV-positive people and does not eliminate the requirement that recipients of funding pledge their opposition to prostitution. The House bill does, however, include some significant improvements to the original PEPFAR legislation: it increases the funding levels from $15 billion to $50 billion over five years, expands the list of eligible countries, enhances accountability, creates specific HIV prevention resources targeted to women and children, and supports flexibility in local resource allocation by eliminating the one-third spending requirement for abstinence-only HIV prevention programs.  

Conference negotiations are underway to settle the differences between the two bills and to address outstanding member concerns in an effort to get the bill signed into law prior to President Bush’s July meeting with the G8 countries. However, Senate action on S. 2731 is being opposed by Senators Jim DeMint (R-SC) and Tom Coburn (R-OK), so it is unclear how quickly the bill will move. The San Francisco AIDS Foundation will work to ensure that the key improvements in this legislation are maintained in the final version.