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Implementers, Advocates, Researchers Call on Congress to Honor Lantos' Commitment to Public Health and Human Rights by Placing Evidence over Ideology
Date:2/26/2008

WASHINGTON, Feb. 26 /PRNewswire-USNewswire/ -- On Wednesday, February 27, 2008 the House Foreign Affairs Committee will convene for the first time since the death of Chairman Tom Lantos to take up what Lantos himself referred to as the most important piece of legislation before the committee this year -- reauthorization of the US Global AIDS Act of 2003 (otherwise known as the President's Emergency Plan for AIDS Relief or PEPFAR).

The draft bill -- originally authored by Lantos -- would provide a minimum of $50 billion over 5 years for global AIDS, Tuberculosis and Malaria programs and would support building the long-term capacity of health care systems in Africa. The Chairman's bill reflects recommendations on best practices from the World Health Organization (WHO), the Institutes of Medicine (IOM), the Government Accountability Office (GAO), and the Office of the Global AIDS Coordinator (OGAC), as well as input from countless individual health experts and program implementers.

The bill also lifts restrictions on prevention programs placed in the original PEPFAR legislation that have been proven by numerous studies to be undermining efforts to slow the spread of new HIV infections. Among other changes, the new bill strikes an earmark requiring that 33 percent of all funding for prevention activities be spent on abstinence-until-marriage programs and eliminates a requirement that organizations sign a "pledge" opposing prostitution.

"These changes are critical to preventing the greatest number of new infections possible," said Dr. Joia Mukherjee, a physician and the Medical Director of Partners in Health. "There are roughly 2.5 million new infections each year worldwide, and approximately 7 new infections for every new person put on treatment. A sustainable response to the HIV epidemic clearly requires that we use the most effective strategies possible to stopping the spread of HIV in the first place."

Mukherjee is one of a diverse group of advocates, implementers and researchers supporting removal of restrictions on prevention programs and calling on members of the Committee to honor the legacy of Mr. Lantos' commitment to public health and human rights by placing evidence over ideology.

A report by the Government Accountability Office based on evidence collected in 20 countries, stated that the earmark "limits some country teams' ability to shift program focus to meet changing prevention needs." Another study by the Institute of Medicine conducted across 15 PEPFAR countries found that, "The earmark has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care, and treatment programs and that target those at greatest risk."

Despite these findings, a small but vocal minority of opponents in the House have threatened to kill the bill. "The opposition to this bill is bewildering," said Jodi Jacobson, Director of Advocacy for American Jewish World Service, an international humanitarian and development organization with partners in 36 countries. "The draft is based on the best available evidence from leading authorities in public health. We have a moral, ethical and fiscal responsibility to spend US funds on programs that give people the tools needed to avoid infection in the first place and a wealth of evidence and field experience that make clear the changes in strategy needed to dramatically strengthen our response to HIV and AIDS."

"This bill offers more choices for effective programs than the current strategy," asserts James Wagoner, President of Advocates for Youth. "Critics have misrepresented what the bill does support. This bill underscores the need for comprehensive efforts to encourage the delay of sexual debut, partner reduction, and fidelity -- as well as efforts identified by experts to help prevent the spread of HIV among sexually active people, including information about the correct and consistent use of condoms," stated Wagoner. "As more and more states reject abstinence-only-until-marriage programs in the United States, it is unconscionable that our government continues to export our failed policies to the rest of the world."

Support for efforts to strengthen prevention of mother-to-child transmission (PMTCT) programs and better meet the needs of HIV positive women also have come under fire from House Republicans. Implementers such as Dr. Mardge Cohen, a physician who oversees the Women's Equity in Access to Care and Treatment Program in Rwanda serving more than 5,000 women, cites the growing need to offer HIV-positive women receiving PMTCT services the option of family planning information and methods. "Ninety percent of women we see in our clinics are interested in delaying or spacing births or have completed their families," said Cohen.

"Women need one-stop access to both HIV and reproductive health services," said Pat Daoust, Director of Physicians for Human Rights' Health Action AIDS Campaign. "PEPFAR's own 2008 report to Congress and a wide array of international development agencies are calling for linkages between family planning services and HIV programs. WHO cites this as one of the four pillars of programs that prevent mother-to-child transmission. In resource-poor settings, the ability to provide as many health care services as possible in one location is sensible and cost effective -- and it eliminates the stigma that women face in visiting an HIV clinic."

"While the chairman's bill is a solid step forward, it isn't perfect -- we wanted stronger support for reproductive health programs that will address HIV through the health services that women use -- not simply expect them to show up at an HIV testing center," said Adrienne Germain, President of the International Women's Health Coalition. "The interplay between HIV and other sexually transmitted infections, with pregnancy, safe delivery and breastfeeding means that women will be most efficiently served in reproductive health centers. Though the bill doesn't go this far, it does support other actions for more effective prevention, and we're behind it."


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SOURCE American Jewish World Service
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