[House Report 106-548]
[From the U.S. Government Publishing Office]
106th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 106-548
======================================================================
WORLD BANK AIDS MARSHALL PLAN TRUST FUND ACT
_______
March 28, 2000.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Leach, from the Committee on Banking and Financial Services,
submitted the following
R E P O R T
together with
DISSENTING AND ADDITIONAL VIEWS
[To accompany H.R. 3519]
[Including cost estimate of the Congressional Budget Office]
The Committee on Banking and Financial Services, to whom
was referred the bill (H.R. 3519) to provide for negotiations
for the creation of a trust fund to be administered by the
International Bank for Reconstruction and Development or the
International Development Association to combat the AIDS
epidemic, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
The amendment is as follows:
Strike out all after the enacting clause and insert in lieu
thereof the following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``World Bank AIDS Marshall Plan Trust
Fund Act''.
SEC. 2. FINDING AND PURPOSES.
(a) Findings.--The Congress finds the following:
(1) According to the Surgeon General of the United States,
the epidemic of human immunodeficiency virus/acquired immune
deficiency syndrome (HIV/AIDS) will soon become the worst
epidemic of infectious disease in recorded history, eclipsing
both the bubonic plague of the 1300's and the influenza
epidemic of 1918-1919 which killed more than 20,000,000 people
worldwide.
(2) According to the Joint United Nations Programme on HIV/
AIDS (UNAIDS), 33,600,000 people in the world today are living
with HIV/AIDS, of which approximately 95 percent live in the
developing world.
(3) UNAIDS data shows that among children age 14 and under
worldwide, 3,600,000 have died from AIDS, 1,200,000, are living
with the disease; and in one year alone--1999--an estimated
570,000 became infected, of which over 90 percent were babies
born to HIV-positive women.
(4) Although sub-Saharan Africa has only 10 percent of the
world's population, it is home to 23,300,000--roughly 70
percent--of the world's HIV/AIDS cases.
(5) Worldwide, there have already been an estimated
16,300,000 deaths because of HIV/AIDS, of which 13,700,000--
over 80 percent--occurred in Sub-Saharan Africa.
(6) According to testimony by the Office of National AIDS
Policy, an entire generation of children in Africa is in
jeopardy, with one-fifth to one-third of all children in some
countries already orphaned and the figure estimated to rise to
40,000,000 by 2010.
(7) the 1999 annual report by the United States Nations
Children's Fund (UNICEF) states ``[t]he number of orphans,
particularly in Africa, constitutes nothing less than an
emergency, requiring an emergency response'' and that ``finding
the resources needed to help stabilize the crisis and protect
children is a priority that requires urgent action from the
international community.''
(8) A 1999 Bureau of the Census report states that the
average life expectancy in the Republic of Botswana, the
Republic of Zimbabwe, the Kingdom of Swaziland, the Republic of
Malawi, and the Republic of Zambia has decreased from
approximately age 65 to approximately age 40--the lowest life
expectancy in the world--due to high mortality rates from HIV/
AIDS.
(9) A January 2000 unclassified United States National
Intelligence Estimate (NIE) report on the global infectious
disease threat concluded that the economic costs of infectious
diseases--especially HIV/AIDS--are already significant and
could reduce GDP by as much as 20 percent or more by 2010 in
some sub-Saharan African nations.
(10) According to the same NIE report, HIV prevalence among
militias in Angola and the Democratic Republic of the Congo are
estimated at 40 to 60 percent, and at 15 to 30 percent in
Tanzania.
(11) The HIV/AIDS epidemic is of increasing concern in other
regions of the world with UNAIDS reporting, for example, that
there are 6 million cases in South and South-east Asia, that
the rate of HIV infection in the Caribbean is second only to
sub-Saharan Africa, and that HIV infections have doubled in
just two years in the former Soviet Union.
(12) Despite the grim statistics on the spread of HIV/AIDS,
some developing nations--such as Uganda, Senegal, and
Thailand--have implemented prevention programs that have
substantially curbed the rate of HIV infection.
(13) AIDS, like all diseases, knows no boundaries, and there
is no certitude that the scale of the problem in one continent
can be contained with that region.
(14) According to a 1999 study prepared by UNAIDS and the
Francois-Xavier Bagnoud Center for Health and Human Rights at
the Harvard School of Public Health, HIV/AIDS is spreading
three times faster than funding available to control the
disease.
(15) The United Nations Secretary General has stated ``[n]o
company and no government can take on the challenge of AIDS
along,'' and that what is needed is a new approach to public
health--combining all available resources, public and private,
local and global.''
(16) The World Bank, declaring AIDS not just a public health
problem but ``the foremost and fastest-growing threat to
development'' in Africa, has launched a new strategy for HIV/
AIDS in Africa, declaring it a top priority for the Bank on the
continent.
(17) The World Bank estimates that for Africa along
$1,000,000,000 to $2,300,000,000 annually is needed for
prevention in contrast to the approximately $300,000,000 a year
in official assistance currently available for HIV/AIDS in
Africa.
(18) Accordingly, United States financial support for medical
research, education, and disease containment as a global
strategy has beneficial ramifications for millions of Americans
and their families who are affected by this disease, and the
entire population which is potentially susceptible.
(b) Purpose.--The purposes of this Act are to prevent the spread of
HIV/AIDS and promote its eradication, prevent human suffering, and to
mitigate the devastating impact of the disease on economic and human
development, social stability, and security in the developing world,
through the creation of a trust fund which is designed to--
(1) work with governments, civil society, non-governmental
organizations, the Joint United Nations Program on HIV/AIDS
(UNAIDS), the International Partnership Against AIDS in Africa,
other international organizations, donor agencies, and the
private sector to intensify action against the HIV/AIDS
epidemic and to support essential field work in the most
affected countries to assist in the development of AIDS
vaccines; and
(2) seek to leverage financial commitments by the United
States in order to mobilize additional resources from other
donors, the private sector, non-governmental organizations, and
recipient countries to combat the spread of HIV/AIDS.
TITLE I--NEGOTIATIONS FOR THE CREATION OF A WORLD BANK AIDS TRUST FUND
SEC. 101. TRUST FUND TO ASSIST IN HIV/AIDS PREVENTION, CARE AND
TREATMENT, AND ERADICATION.
The Secretary of the Treasury shall seek to enter into negotiations
with the International Bank for Reconstruction and Development or the
International Development Association, and with the member nations of
such institutions and with other interested parties for the creation of
a trust fund which would be authorized to solicit and accept
contributions from governments, the private sector, and non-
governmental entities of all kinds and use the contributions to address
the HIV/AIDS epidemic in countries eligible to borrow from such
institutions, as follows:
(1) Program objectives.--The trust fund would provide only
grants, including grants for technical assistance, to support
measures to build local capacity in national and local
government, civil society, and the private sector to lead and
implement effective and affordable HIV/AIDS prevention,
education, treatment and care services, and research and
development activities, including affordable drugs. In carrying
out this objective, the trust fund would coordinate its
activities with governments, civil society, nongovernmental
organizations, the Joint United Nations Program on HIV/AIDS
(UNAIDS), the International Partnership Against AIDS in Africa,
other international organizations, the private sector, and
donor agencies working to combat the HIV/AIDS crisis.
(2) Priority.--In providing such grants, the trust fund would
give priority to countries that have the highest HIV/AIDS
prevalence rate or are at risk of having a high HIV/AIDS
prevalence, rate, and that have or agree to carry out a
national HIV/AIDS program which--
(A) has a government commitment at the highest level
and multiple partnerships with civil society and the
private sector;
(B) invests early in effective prevention efforts;
(C) requires cooperation and collaboration among many
different groups and sectors, including those who are
most affected by the epidemic, religious and community
leaders, nongovernmental organizations, researchers and
health professionals, and the private sector.
(D) is decentralized and uses participatory
approaches to bring prevention care programs to
national scale; and
(E) is characterized by community participation in
government policy-making as well as design and
implementation of the program, including implementation
of such programs by people living with HIV/AIDS,
nongovernmental organizations, civil society, and the
private sector.
(3) Governance.--
(A) In general.--The trust fund would be administered
as a trust fund of the International Bank for
Reconstruction and Development. Subject to general
policy guidance from the President of the United States
and representatives of the other donors to the trust
fund, the Trustee would be responsible for managing the
day-to-day operations of the trust fund.
(B) Selection of projects and recipients.--In
consultation with the President and other donors to the
trust fund, the Trustee would establish criteria, that
have been agreed on by the donors, for the selection of
projects to receive support from the trust fund,
standards and criteria regarding qualifications of
recipients of such support, as well as such rules and
procedures as would be necessary for cost-effective
management of the trust fund. The trust fund would not
make grants for the purpose of project development
associated with bilateral or multilateral development
bank loans.
(C) Transparency of operations.--The Trustee shall
ensure full and prompt public disclosure of the
proposed objectives, financial organization, and
operations of the trust fund.
(D) Advisory board.--
(i) Appointment.--The President of the United
States and representatives of other
participating donors to the trust fund would
establish an Advisory Board, and appoint to the
Advisory Board renowned and distinguished
international leaders who have demonstrated
integrity and knowledge of issues relating to
development, health care (especially HIV/AIDS),
and Africa.
(ii) Duties.--The Advisory Board would, in
consultation with other international experts
in related fields (including scientists,
researchers, and doctors), advise and provide
guidance for the trust fund on the development
and implementation of the projects receiving
support from the trust fund. Once the Advisory
Board is established the Secretary of the
Treasury shall ensure that the Trustee provides
the Advisory Board complete access to all
information and documents of the trust fund
necessary to the effective functioning of the
Advisory Board.
TITLE II--UNITED STATES FINANCIAL PARTICIPATION
SEC. 201. LIMITATIONS ON AUTHORIZATION OF APPROPRIATIONS.
In addition to any other funds authorized to be appropriated for
multilateral or bilateral programs related to AIDS or economic
development, there are authorized to be appropriated to the Secretary
of the Treasury $200,000.000 for each of fiscal years 2001 through 2005
for payment to the trust fund established as a result of negotiations
entered into pursuant to section 101.
TITLE III--REPORTS
SEC. 301. REPORTS TO THE CONGRESS.
(a) Annual Reports.--Not later than 1 year after the date of the
enactment of this Act, and annually thereafter for the duration of the
trust fund established pursuant to section 101, the Secretary of the
Treasury shall submit to the appropriate committees of the Congress a
written report on the trust fund, the goals of the trust fund, the
programs, projects, and activities, including any vaccination
approaches, supported by the trust fund, and the effectiveness of such
programs, projects, and activities in reducing the worldwide spread of
AIDS.
(b) Appropriate Committees Defined.--In subsection (a), the term
``appropriate committees'' means the Committees on Appropriations, on
International Relations, and on Banking and Financial Services of the
House of Representatives and the Committees on Appropriations, on
Foreign Relations, and on Banking, Housing, and Urban Affairs of the
Senate.
TITLE IV--HIV/AIDS PREVENTIONS AND CARE
SEC. 401. STRENGTHENING LOCAL CAPACITY IN SUB-SAHARAN AFRICA TO
IMPLEMENT HIV/AIDS PREVENTION AND CARE PROGRAMS.
Title XVI of the International Financial Institutions Act (22
U.S.C. 262p-262p-7) is amended by adding at the end the following:
``SEC. 1625. STRENGTHENING LOCAL CAPACITY IN SUB-SAHARAN AFRICA TO
IMPLEMENT HIV/AIDS PREVENTION AND CARE PROGRAMS.
``The Secretary of the Treasury shall instruct the United States
Executive Director at the International Bank for Reconstruction and
Development to use the voice and vote of the United States to encourage
the Bank to work with Sub-saharan African countries to modify projects
financed by the Bank and develop new projects to build local capacity
to manage and implement programs for the prevention of human
immunodeficiency virus (HIV) and acquired immune deficiency syndrome
(AIDS) and the care of persons with HIV/AIDS, including through health
care delivery mechanism which facilitate the distribution of affordable
drugs for persons infected with HIV.''.
purpose and summary
The purpose of H.R. 3519, the World Bank AIDS Marshall Plan
Trust Fund Act, as reported out of the Committee on Banking and
Financial Services with an amendment, is to provide increased
U.S. support for global efforts to combat HIV/AIDS (human
immunodeficiency virus/acquired immune deficiency syndrome). As
articulated in section 2(b) of the bill, the specific purposes
of the bill are to prevent the spread of HIV/AIDS and promote
its eradication, prevent human suffering, and mitigate its
devastating effects on economic development and security,
through a trust fund that would work with governmental and non-
governmental organizations and leverage a U.S. contribution to
mobilize additional resources from other donors.
Findings in Section 2(a) of the bill describe the stunning
dimensions of the worldwide HIV/AIDS crisis, particularly its
disproportionate impact on the nations of sub-Saharan Africa.
The bill requires the Secretary of the Treasury to seek to
enter into negotiations with the World Bank, its members, and
other interested parties to create a trust fund to provide
grants to HIV/AIDS affected countries to implement HIV/AIDS
prevention, education, treatment and care, and research and
development activities. Priority consideration would be given
to countries with the highest HIV/AIDS infection rates (or at
risk of such rates) and which are committed to national HIV/
AIDS programs. The fund would be administered by the World
Bank, subject to guidance from the U.S. and other donors on
project selection and cost-effective management of the fund.
Full and prompt disclosure of the fund's financing and
operations would also be required. An advisory board,
consisting of international experts appointed by the U.S. and
other donors, would provide guidance to the fund.
The bill authorizes an annual U.S. contribution to the
trust fund of $200 million for five years, FY 2001-2005, and
requires annual reports on the activities of the fund and their
effectiveness in stemming the global spread of HIV/AIDS.
background and need for legislation
According to the U.S. Surgeon General, HIV/AIDS will soon
become the worst epidemic of infectious disease in recorded
history, eclipsing both the bubonic plague of the 1300's and
the influenza epidemic of 1918-19 which killed more than 20
million worldwide. Indeed, the global HIV/AIDS epidemic might
fairly be described as a disease of Biblical proportion.
Recent statistics in the ``AIDS epidemic update: December
1999,'' prepared by the Joint United Nations Programme on HIV/
AIDS (UNAIDS), reveal that 16.3 million people have died from
AIDS worldwide and 33.6 million people are living with the
deadly disease.
Among all regions of the world, sub-Saharan Africa has been
hardest hit by the disease. Although it has only 10 percent of
the world's population, it accounts for 80 percent of global
AIDS deaths and nearly 70 percent of the world's current HIV/
AIDS cases. According to Dr. James Sherry of UNAIDS, these
numbers have outpaced all projections. He cited 1991
projections by the World Health Organization (WHO) that an
estimated 9 million would be infected and 5 million dead from
AIDS in Africa by 1999. Instead, current estimates are double
to triple those numbers.
Millions of children have died or been orphaned. Director
Sandra Thurman of the White House Office of National AIDS
Policy testified at the Committee's March 8, 2000, hearing
that, ``In Africa, an entire generation of children is in
jeopardy.'' She reported that in several sub-Saharan African
countries, an estimated one-fifth to one-third of all children
have already been orphaned by the disease and that the worst is
yet to come. She cited projections that some 40 million
children will lose one or both parents to AIDS within the next
10 years. The United Nations Children's Fund (UNICEF), in its
1999 annual report, called the number of orphans, particularly
in Africa, ``nothing less than an emergency'' requiring
``urgent action from the international community.'' Ms. Mary
Fisher, founder and chair of the Family AIDS Network, testified
at the hearing about her own visit to Africa, observing that:
But what dominates the African landscape is orphans.
Acres of orphans--orphans raising orphans, because
there is no one else left to do it. Tough children take
to the streets. Weak children die of starvation. Many
just sit, docile and sick, a vast, human ocean of
orphans, mostly infected and doomed.
U.S. Ambassador to the United Nations Richard C. Holbrooke
described the findings of a December 1999 mission to Africa
during which his delegation saw first hand, ``the terrible
costs reaped by AIDS--from the thousands of orphans in Lusaka,
Zambia who were forced to live in a bus depot, many of whom
were already infected with HIV; to the six pregnant women in
Windhoek Namibia, all of whom were infected with AIDS and who
had to meet with our delegation secretly because of the
stigmatization associated with the disease.''
The Committee also heard compelling testimony from
Ambassador Mary M. Kanya of Swaziland regarding the impact of
HIV/AIDS on her country. Although Swaziland is the size of New
Jersey and has just under a million people, it has an HIV
infection rate of 22 percent. Eighty percent of in-patient beds
in major hospitals are reportedly occupied by HIV/AIDS cases.
And she warned that as children drop out of school to fend for
dying parents or simply to fend for themselves, the number of
street children will increase. The crisis in Swaziland led the
King to declare HIV/AIDS a national disaster a year ago.
Africa's disproportionately high incidence of HIV/AIDS may
be due to several factors. The pervasive lack of basic health
infrastructure--clinics, medical personnel, etc.--in many
countries is stymieing efforts to provide HIV/AIDS testing,
counseling, and treatment. A reluctance on the part of some
national governments to openly address the issue--in part
because of cultural taboos--is also a critical factor in the
lack of national prevention programs.
As staggering as the public health statistics are, experts
increasingly note that the HIV/AIDS epidemic is no longer
singularly a health issue; it has become a major issue for
economic development. Assessments by World Bank officials call
HIV/AIDS ``the foremost and fastest-growing threat to
development'' in Africa. An unclassified January 2000 National
Intelligence Estimate (NIE) report on the global infectious
disease threat concluded that the economic costs of infectious
diseases, particularly HIV/AIDS, are already significant and
could reduce GDP by as much as 20 percent or more by 2010 in
some sub-Saharan African nations. The economic cost of the
disease is illustrated by two studies: a Namibian study which
concluded that AIDS cost the country nearly 8% of GDP in 1996,
and a study of Kenya which projected GDP in 2005 would be 14.5%
lower than it would be without AIDS.
According to Director Thurman, professionals--including
civil servants, engineers, teachers, and others--have been
particularly hard hit in sub-Saharan Africa. The impact of the
disease on the working age population is also illustrated by
data from a 1999 U.S. Census Bureau report, showing that
average life expectancy in Botswana, Zimbabwe, Swaziland,
Malawi, and Zambia has decreased from approximately age 65 to
approximately age 40--the lowest life expectancy in the world.
In terms of net global costs from AIDS, the NIE cites
estimates by the Global AIDS Policy Coalition at Harvard
University suggesting that by this year--2000--the cumulative
direct and indirect costs of AIDS are likely to have exceeded
$500 billion.
HIV/AIDS poses a threat to global security as well.
According to the January 2000 NIE, HIV/AIDS prevalence rates in
selected sub-Saharan militaries range from 10-60 percent. For
example, the prevalence rates in the militaries of Angola and
the Democratic Republic of the Congo are estimated at 40 to 60
percent, and in Tanzania at 15 to 30 percent. The disease can
also affect security in less direct ways. Treasury
Undersecretary Timothy F. Geithner told the committee in his
testimony that the national economic distress and political
instability accompanying significant human losses can undercut
the world economy and regional stability. Ambassador Holbrooke
also noted that HIV/AIDS is a security issue, pointing out that
the UN Security Council for the first time in its history of
4,086 meetings held a session January 10, 2000, to address a
health issue as a security threat.
The epidemic, as horrific as it is in sub-Saharan Africa,
is far from confined to that region. The NIE cites UNAIDS
epidemiologists who warn that Asia alone is likely to outstrip
sub-Saharan Africa in the absolute number of HIV carriers by
2010. Current UNAIDS estimates show some 6 million HIV/AIDS
cases in South and Southeast Asia, a rate of HIV infection in
the Caribbean second only to sub-Saharan Africa, and a doubling
of HIV infections in just two years in the former Soviet Union.
Clearly the United States has a strong national interest in
combating the global HIV/AIDS crisis. Infectious diseases, like
HIV/AIDS, know no borders. Although HIV/AIDS was first
identified in the U.S. in 1983, scientists believe it
originated in sub-Saharan Africa. The number of Americans
travelling abroad--often to countries posing a high risk of
infectious diseases of all kinds--has increased significantly.
In fact, more than 57 million Americans traveled abroad in
1998, more than double the number a decade earlier. Travel and
commerce will remain key factors in the spread of infectious
diseases like HIV/AIDS.
Despite the grim statistics on the global HIV/AIDS
epidemic, there is reason for hope. Several nations--including
Uganda and Senegal in Africa and Thailand in Asia--have
implemented national HIV/AIDS programs that have curtailed the
incidence of infection in their own populations. Dr. James
Sherry of UNAIDS told the Committee that, ``We are far from
powerless against this epidemic. We have solid experience with
what works . . .'' Another witness, Dr. Gary Slutkin, argued
that the successes of Uganda could be replicated elsewhere. He
testified that, ``There was nothing that was facilitated or
supported in Uganda that could not have happened in the
majority of the remaining countries currently overwhelmed by
the AIDS epidemic.''
In the area of mother-to-child transmission, Dr. Catherine
Wilfert testified about a joint U.S./Uganda study of a
promising new and affordable drug treatment--nevirapine--that
could reduce mother to child transmission of HIV by 47 percent.
Dr. Thomas Welty, a medical epidemiologist with the Cameroon
Baptist Convention Health Board, submitted written testimony on
a pilot study of the same drug in Cameroon. A study published
in the March 1, 2000, issue of the Journal of the American
Medical Association (JAMA) also demonstrates that avoidance of
breast-feeding can significantly decrease the risk of mother-
to-child transmission of HIV/AIDS for infants not already
infected before or during birth. The data on the above programs
as well as other research suggests that effective programs
worthy of consideration in curbing the risk of mother-to-child
transmission include testing, counseling, treatment, and making
feeding supplies available to HIV-infected mothers who choose
not to continue breast-feeding.
Broad multilateral planning efforts to combat HIV/AIDS in
Africa are underway as well. UN agencies, African and other
national governments, international donors and private
organizations are nearing completion of an action plan for AIDS
in Africa called, the ``International Partnership against HIV/
AIDS in Africa.''
Despite these promising developments, resources to support
these initiatives are not keeping pace. According to a 1999
study prepared by UNAIDS and the Francois-Xavier Bagnoud Center
for Health and Human Rights at the Harvard School of Public
Health, HIV/AIDS is spreading three times faster than funding
available to control it. The World Bank recently estimated that
$1 billion to $2.3 billion is needed annually for prevention in
Africa alone. That figure is far in excess of approximately
$350 million that international donors are estimated to be
providing for the region. While U.S. assistance has accounted
for roughly half of that, significantly greater resources are
needed.
The legislation before the Committee--H.R. 3519--seeks to
address the urgent need for global AIDS resources by leveraging
a U.S. contribution of $200 million a year over the next five
years to mobilize potentially more than a billion dollars a
year from other governmental and private sector donors.
In addition to its role as one of six co-sponsoring members
of UNAIDS, along with UNICEF and the World Health Organization,
the World Bank has launched its own strategy to combat HIV/AIDS
in Africa, declaring it a top priority for the Bank in the
region. Its role as an international financial institution and
its commitment to combating HIV/AIDS make the Bank a logical
vehicle for expanded multilateral financing.
The trust fund approach, as proposed in H.R. 3519, has
ample precedent at the World Bank and allows donors to target
resources to specific problems. Such trust funds are highly
flexible financial arrangements between the Bank and one or
more donors under which the donor(s) entrust the Bank to
administer funds for specific development-related activities.
The objectives and policies of the trust fund are established
by the donor(s). The trust fund policy objectives should,
however, be in harmony with international development
priorities and the Bank's country assistance strategies. The
trust fund envisioned in the bill will ensure that the U.S. and
other donors will be able to establish policies for the fund
and its activities, and to require full transparency of all of
its financing and operations.
By utilizing the trust fund mechanism, the Committee is
emphasizing a multilateral, burden-sharing approach to the
global AIDS crisis. Using the World Bank also sends an
important signal to affected countries. As Undersecretary
Geithner said, ``Health issues are not usually considered the
province of Finance Ministries, but they should be.'' As such,
H.R. 3519 helps to underscore the necessity for this issue to
be dealt with at the highest levels of government.
hearings
H.R. 3519, the World Bank AIDS Prevention Trust Fund Act,
was introduced on January 24, 2000, by Chairman James A. Leach
(R-IA), and has 25 cosponsors.
On March 8, 2000, the Committee held a hearing on H.R.
3519. Testifying at the hearing were: the Honorable John F.
Kerry, United States Senator; the Honorable Amo Houghton,
United States Representative; the Honorable Richard C.
Holbrooke, United States Ambassador to the United Nations; the
Honorable Sandra L. Thurman, Director of the White House Office
of National AIDS Policy; the Honorable Timothy F. Geithner,
Undersecretary, U.S. Department of Treasury; Ms. Mary Fisher,
Founder and Chair of the Family AIDS Network; Ms. Mpule
Kwelagobe, Miss Universe 1999; Her Excellency Mary M. Kanya,
Ambassador from the Kingdom of Swaziland; Dr. James Sherry,
Director of Program Development and Coordination at UNAIDS; Dr.
Gary Slutkin, Professor of International Health at the
University of Illinois School of Public Health and Formerly
Chief of Prevention of the WHO Global Programme on AIDS; Dr.
Catherine Wilfert, Scientific Director of the Elizabeth Glaser
Pediatric AIDS Foundation; and former Member of Congress Ronald
Dellums, President of Healthcare International Management
Company and Chairman of the Constituency for Africa. Written
testimony was provided by the Honorable Richard A. Gephardt,
Minority Leader of the U.S. House of Representatives; Dr.
Thomas K. Welty, Medical Epidemiologist, Cameroon Baptist
Convention Health Board; Mr. Kenneth Weg, Vice Chairman of the
Bristol-Myers Squibb Company; actor Danny Glover; and the Ford
Motor Company.
committee consideration and votes
On March 15, 2000, the full Committee met in open session
to mark up H.R. 3519. The Committee called up a Manager's
Amendment as original text for purposes of amendment. The
Manager's Amendment, developed in close coordination with
Ranking Member John LaFalce and Committee member Barbara Lee,
herself the author of the AIDS Marshall Plan Fund for Africa
Act (H.R. 2765), clarified that Trust Fund operations would be
tightly coordinated with the Joint United Nations Program on
HIV/AIDS (UNAIDS), the International Partnership Against AIDS
in Africa, and other agencies and donors in order to maximize
its catalytic impact; that the Trust Fund's purpose is to
maximally leverage U.S. financial commitments in order to
mobilize additional resources from other donors, the private
sector, NGOS, and recipient countries; that the Trust Fund
would only provide grant assistance, and not loans; that in
providing grants, the trust fund would give priority to
countries that have the highest HIV/AIDS prevalence rates, or
are at risk of having a high HIV/AIDS prevalence rates, and
that have shown a strong governmental commitment to combating
HIV/AIDS, by developing partnerships with the private sector,
communities, NGOS, and people infected or affected by HIV; that
Trust Fund operations would be fully and promptly disclosed to
the public; that the Trust Fund would receive advice from a
distinguished international Advisory Board; and that
accountability to Congress and the public would be strengthened
by requiring annual reports on the trust fund, its goals,
programs, projects, and activities, and the effectiveness of
such activities in reducing the worldwide spread of AIDS.
During the markup, several amendments were offered. Ms.
Schakowsky offered an amendment to clarify that HIV/AIDS
programs funded by grants should be ``affordable'' and that
funds for research and development could include affordable
drugs. The amendment was adopted on a voice vote.
An amendment was offered by Ms. Waters to authorize the
trust fund to provide technical assistance to grant recipients
and to include in the ``priority'' provisions governments that
may not yet have national HIV/AIDS programs but have agreed to
implement such programs. The amendment was adopted by voice
vote after agreement was reached that the technical assistance
could be provided by way of grants for such purposes since the
fund would be expected to have little staff.
Another amendment was offered by Ms. Waters to double the
authorization level for a U.S. contribution to the World Bank
trust fund in Section 201 from $100 million a year for five
years to $200 million a year for five years. Opponents
indicated sympathy for Ms. Water's views but expressed concern
that such a high level of spending might derail the bill and
make it more difficult to bring it to the House Floor. The
amendment was adopted by a vote of 13 to 12.
YEAS NAYS
Mr. LaFalce Mr. Leach
Mr. Frank Mrs. Roukema
Ms. Waters Mr. Bereuter
Mrs. Maloney Mr. Lazio
Mr. Bentsen Mr. Royce
Mr. Maloney Mr. Metcalf
Mr. Sherman Mr. Barr
Mr. Meeks, G. Mrs. Kelly
Ms. Lee Dr. Paul
Ms. Schakowsky Mr. Sweeney
Mr. Moore Mrs. Biggert
Mrs. Jones Mr. Terry
Mr. Capuano
An amendment offered by Mr. LaFalce and Ms. Waters to
require the Secretary of the Treasury to direct the U.S.
Executive Director to the World Bank to use his or her voice
and vote to promote the availability of affordable HIV/AIDS
drugs was also adopted by voice vote.
The Manager's Amendment, as amended, was adopted by a voice
vote. Subsequently, H.R. 3519, as amended, was ordered reported
by a vote of 27-4.
YEAS NAYS
Mr. Leach Mr. Metcalf
Mr. Bereuter Mr. Barr
Mr. Lazio Dr. Paul
Mr. King Mr. Riley
Mrs. Kelly
Mrs. Biggert
Mr. LaFalce
Mr. Frank
Ms. Waters
Mr. Sanders
Mrs. Maloney
Mr. Gutierrez
Ms. Velazquez
Mr. Watt
Mr. Ackerman
Mr. Bentsen
Mr. Maloney
Ms. Carson
Mr. Sherman
Mr. Sandlin
Mr. Meeks, G.
Ms. Lee
Mr. Inslee
Ms. Schakowsky
Mr. Moore
Mrs. Jones
Mr. Capuano
committee oversight findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the Committee reports that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
committee on government reform and oversight findings
In compliance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, no oversight findings have
been submitted to the Committee by the Committee on Government
Reform.
constitutional authority
In compliance with clause 3(d)(1) of rule XIII of the Rules
of the House of Representatives, the Constitutional Authority
for Congress to enact this legislation is derived from Article
I, section 8, clause 1 (relating to the general welfare of the
United States): Article I, section 8, clause 3 (relating to
Congressional power to regulate commerce); Article 1, section
8, clause 5 (relating to the power ``to coin money'' and
``regulate the value thereof''); Article I, section 8, clause
18 (relating to making all laws necessary and proper for
carrying into execution powers vested by the Constitution in
the government of the United States).
new budget authority and tax expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, please see the attached
Congressional Budget Office cost estimate.
advisory committee statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
congressional accountability act
The reporting requirement under section 102(b)(3) of the
Congressional Accountability Act (P.L. 104-1) is inapplicable
because this legislation does not relate to terms and
conditions of employment or access to public services or
accommodations.
congressional budget office cost estimate and unfunded mandates
analysis
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 22, 2000.
Hon. James A. Leach,
Chairman, Committee on Banking and Financial Services, House of
Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3519, the World
Bank AIDS Marshall Plan Trust Fund Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Joseph C.
Whitehill.
Sincerely,
Barry B. Anderson
(For Dan L. Crippen, Director).
Enclosure.
H.R. 3519--World Bank AIDS Marshall Plan Trust Fund Act
Summary: H.R. 3519 would authorize the Secretary of the
Treasury to negotiate with the World Bank and other donor
countries to create a new trust fund within the bank. The trust
fund would provide grants to countries eligible to borrow from
the bank to help them deal with the HIV/AIDS epidemic. The bill
would authorize the appropriation of $200 million a year over
the 2001-2005 period for contributions to the fund. Based on
experience with other facilities administered by the bank, CBO
estimates that appropriation of the authorized amounts would
result in additional outlays of $338 million over the next five
years. Because H.R. 3519 would not affect direct spending or
receipts, pay-as-you-go procedures would not apply.
H.R. 3519 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 3519 is shown in the following table.
The costs of this legislation fall within budget function 150
(international affairs).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars
-----------------------------------------------------------
2000 2001 2002 2003 2004 2005
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPRORPIATION
Authorization level................................. 0 200 200 200 200 200
Estimated outlays................................... 0 0 12 62 112 152
----------------------------------------------------------------------------------------------------------------
For purposes of this estimate, CBO assumes the enactment of
H.R. 3519 and subsequent appropriation of the authorized
amounts. Based on experience with other facilities operated by
multilateral development banks, CBO estimates that it will take
the bank and donor community more than one year to organize the
operations of the trust fund and to begin making grants. CBO
assumes that project selection and subsequent grants would
augment lending by the bank, thus limiting administrative
overhead. We also assume that the appropriated amounts would be
provided to the trust fund as a letter of credit that would be
drawn upon as needed to finance the grants, thus spreading
outlays over a number of years. Using those assumptions, CBO
estimates that approximately one-third of the authorized
amounts would be disbursed over the next five years. CBO also
estimates that the costs of negotiations and reporting
requirements would be negligible.
Pay-as-you-go considerations: None.
Intergovernmental and private-sector impact: H.R. 3519
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal costs: Joseph C. Whitehill;
impact on State, local, and tribal governments: Leo Lex; impact
on the private sector: Patrice Gordon.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
SECTION-BY-SECTION ANALYSIS
Section 1. Short title
This section cites the short title of the bill as the
``World Bank AIDS Marshall Plan Trust Fund Act''.
Section 2. Findings and purposes
Subsection (a) of this section articulates several
Congressional findings of fact including that the HIV/AIDS
epidemic will soon become the worst epidemic in recorded
history; that 33.6 million people are living with AIDS, of
which 95 percent are in the developing world; that 3.6 million
children 14 and under have died of AIDS and that 1.2 million
are living with it; that sub-Saharan Africa which has only 10
percent of the world's population has had more than 80 percent
of AIDS deaths and has nearly 70 percent of current cases; that
an entire generation of children in Africa is in jeopardy with
nearly 40 million expected to be orphaned by 2010; that UNICEF
has declared the number of orphans in Africa an emergency; that
the U.S. Census Bureau is reporting significant declines in
life expectancy in several African nations; that a recent
National Intelligence Estimate says the economic costs of
infectious diseases, especially HIV/AIDS, could cut GDP by as
much as 20 percent in some sub-Saharan nations by 2010; that
HIV infection rates in certain African nations are 15 to 60
percent; that the epidemic is threatening other regions
including Asia, the Caribbean, and the former Soviet Union;
that some countries have effectively implemented HIV/AIDS
programs; that AIDS has no boundaries; that the disease is
spreading three times faster than funding to control it; that
the UN Secretary General says the problem cannot be handled by
any one country; that the World Bank says HIV/AIDS is the
fastest growing threat to economic development in Africa and
that $1 billion to $2.3 billion is needed annually for
prevention in that region alone; and U.S. support for HIV/AIDS
research, education, and containment will have benefits for
American and their families who are affected by or susceptible
to this disease.
Subsection (b) declares the purposes of the Act to prevent
the spread of HIV/AIDS and promote its eradication, to prevent
human suffering, and to mitigate the disease's impact on
development, stability, and security in the developing world
through the creation of a trust fund to: (1) work with
governments at all levels and the private sector to intensify
action against the disease and to support field work in
affected countries to help develop AIDS vaccines; and (2)
leverage U.S. contributions in order to mobilize additional
resources from other governmental and private sector donors.
Title I. Negotiations for the Creation of a World Bank Aids Trust Fund
Section 101. Trust fund to assist in HIV/AIDS prevention, care and
treatment, and eradication
Section 101 requires the Secretary of the Treasury to seek
to enter into negotiations with the World Bank, its members,
and other interested parties, to create a trust fund which
would be authorized to solicit and accept contributions from
governments, the private sector, and non-governmental entities.
Trust fund proceeds would be used to address the HIV/AIDS
epidemic in affected countries by providing grants for local
capacity building to implement effective HIV/AIDS prevention,
education, treatment and care, and reserve and development
activities. The trust fund is to coordinate its activities with
other governments, international organizations, and private
sector groups. Funding priority is to be given to nations with
the highest HIV infection rates (or at risk of having high
rates) and which have (or are committed to having) national
HIV/AIDS programs characterized by top level government
commitment and multiple partnerships with those affected by the
disease, religious and community leaders, health professionals,
and other entities.
The trust fund is to be administered by the World Bank, as
``trustee,'' subject to policy guidance from the United States
and other donors. The trustee, in consultation with the
President and other donors, will establish criteria regarding
selection of projects, qualifications of recipients, and rules
for cost-effective management. Grants are not be extended for
the purpose of project development associated with bilateral or
multilateral development bank loans. The trustee is to ensure
full and prompt public disclosure of the finances and
operations of the trust fund.
The President of the United States and representatives of
other donors to the trust fund are to establish an advisory
board of international experts to provide guidance to the trust
fund on projects to be supported.
Title II. United States Financial Participation
Section 201. Limitations on authorization of appropriations
This section provides that in addition to other funds
authorized for AIDS or economic development programs, there are
authorized to be appropriated $200 million each year for five
years (fiscal years 2001 to 2005) for payment to the trust
fund.
Title III. Reports
Section 3. Reports to the Congress
The Secretary of the Treasury is required to submit annual
reports to appropriate committees of Congress on the trust
fund, its goals, programs, projects, and activities, including
any vaccination approaches, and the effectiveness of such
programs in reducing the worldwide spread of AIDS.
Title IV. HIV/AIDS Prevention and Care
Section 401. Strengthening local capacity in sub-Saharan Africa to
implement HIV/AIDS prevention and care programs.
This section amends the International Financial
Institutions Act to require the Secretary of the Treasury to
instruct the U.S. Executive Director at the World Bank to use
the voice and vote of the United States to encourage the Bank
to work with sub-Saharan African countries to modify existing
Bank projects and develop new projects to build local capacity
to manage and implement HIV/AIDS prevention and care programs,
including through health care delivery mechanisms which
facilitate the distribution of affordable drugs.
The Committee notes that the availability of affordable
drugs--even drugs which have been donated free-of-charge--will
be of little utility to those suffering from HIV/AIDS if the
health systems and infrastructure necessary to distribute and
administer such medications is lacking. For example, according
to experts, in order for antiretroviral drug therapies to be
used effectively against HIV/AIDS in Africa, there must be
functioning health systems, trained health professionals,
access to testing and early diagnosis, counseling on adherence
to the medication's regime, and regular monitoring. According
to the International Federation of Pharmaceutical Manufacturers
Associations, inappropriate use of powerful anti-retroviral
drugs ``can and has resulted in strains of HIV developing which
are resistant to all known treatments, making our search for a
cure even more difficult.''
DISSENTING VIEWS
While the AIDS epidemic is a real problem and should be
addressed, we are concerned that the approach in this bill will
make a bad situation worse. HR 3519, the World Bank AIDS
Prevention Trust Fund Act, duplicates existing programs, is
costly, will very likely be counter-productive and comes at a
most inopportune time.
The bill would establish a World Bank program to duplicate
the efforts of existing bilateral and multilateral programs
through the US Agency for International Development and the
United Nations, for example. USAID has had an AIDS program for
Africa since 1986. The United States appropriates $200 million
a year for AIDS-related foreign aid (of which $104 million goes
for programs in Africa). In addition, the United States funds
United Nations programs that spend hundreds of millions of
dollars annually. All money diverted to fund a new, duplicative
bureaucracy is money that could have been used for AIDS
prevention or treatment programs.
The new program will prove to be very costly. The $2
billion appropriation over the next five years spends the
budget surplus that is needed to shore up the Social Security
Trust Fund and return some of the hard-earned money back to the
taxpayers.
Despite the best intentions of the supporters of the
legislation, the World Bank AIDS Prevention Trust Fund will
most likely only exacerbate the problem: Because aid money is
fungible, it pays for foreign and civil wars and feeds
corruption. HIV infection rates are high among soldiers in
Africa who are a common route of transmission. In addition, the
World Bank lent Russia $100 million, part of a package of more
than $750 million, despite the Chechen military crisis; replied
Grigory Yavlinsky, leader of a liberal reformist party, ``It's
senseless to give money to Russia until corruption has been
reduced'' (Financial Times, Dec. 29, 1999).
The World Bank aided the Sharif government in Pakistan in a
partisan investigation of corruption of the regime's political
enemies. The Bank recently set up a $50 million ``leveraged
insurance facility for trade and investment'' program in
Kazakhstan to compensate foreign companies that suffer lost
revenues as a result of corruption, legal changes or political
instability. The program mirrors one in the former Soviet bloc
where World Bank and IMF funds are well known to feed the
corruption that it now aims to ``insure'' against and
investigate.
Aid money stifles local movements toward democracy and
better domestic government by channeling money through existing
(often well-entrenched) governments that created the policies
conducive to the poverty and lack of education that facilitated
the spread of AIDS. The success or failure of AIDS prevention
depends on local will as the success in Senegal demonstrates.
According to James Wolfensohn, president of the World Bank,
Latin America is no better off now after two decades of IMF/
World Bank reforms: the gap between rich and poor was the worst
in the world, 80% of the region's 30 million indigenous live in
poverty, and 40 million more people live below the poverty line
now than 20 years ago (Financial Times Feb 4, 2000). There is
no reason to believe that the World Bank's record preventing
AIDS will be any more successful than its poverty reduction
programs.
The Congressionally-mandated International Financial
Institution Advisory Commission recently issued its report
mapping out a blueprint of substantive, constructive reforms
for the Bretton Woods institutions. Ideally, Congress would
pass HR 1147, the Bretton Woods Sunset Act, in order to force a
badly needed debate about the role of the Bretton Woods
institutions.
One member of the commission, Adam Lerrick, formerly head
of product development at Credit Suisse First Boston, outlined
a critique of the World Bank in a December 1999 Euromoney
article, ``Has the World Bank Lost its way?'' In the article,
he points out that only eleven countries (including the
Communist regime in China, the kleptocracy in Russia, the
world's longest-serving one-party ``democracy'' Mexico, and the
brutal Suharto dictatorship in Indonesia) received 70% of World
Bank resources between 1993 and 1999 with 145 other nations
fighting for the remaining 30%. Those privileged eleven had
ready access to private capital: World Bank resources amounted
to only one percent and private sector resources 99% of
resources received over the same period. ``The Bank's own
research shows that flows under these [current lending]
conditions are not beneficial and may even be counter-
productive,'' he explained.
For the reasons outlined above, we believe that the World
Bank is not the preferred institution to address successfully
the AIDS prevention question and that any funding for World
Bank AIDS prevention programs should result from a re-
orientation of its existing resources.
Ron Paul.
Bob Barr.
ADDITIONAL VIEWS
It is important to note that AIDS is a global issue. What
happens overseas always affects what happens in the U.S. It is
in America's national interest to ensure that we do all we can
to assist all countries in addressing HIV/AIDS, not only
because of the potential for a tremendous loss of life, but for
economic, political and security reasons.
Globally, about 2.6 million people worldwide will die of
AIDS this year, the most of any year since the epidemic began,
according to a report by the United Nations AIDS program. About
16.3 million people have already died of AIDS since 1981. In
addition, about 5.6 million new infections with the human
immunodeficiency virus (HIV) will occur this year, raising the
number of people currently living with the disease to about
33.6 million, with more than 23 million of those individuals
being in sub-Saharan Africa. More than 1.3 million individuals
living with HIV and AIDS are in Latin America and some 360,000
are in the Caribbean. It is estimated that some 920,000
individuals living with HIV and AIDS are in North America.
Some 300,000 American are infected with HIV and do not know
it since they have never been tested for HIV infection. Sadly,
my own city of San Antonio has experienced over 3,704 cases of
people with AIDS. 53% of these people have died. This means
that over 1,950 people in San Antonio have died from this
disease. Of the reported cases of AIDS in San Antonio, 48% are
in the Hispanic community, 39% are White and 11% are Black. The
majority of San Antonio's population is of Hispanic origin and
maintains close ties to Mexico and other countries in Central
and South America. Many return to visit, to work and live, and
then return to the United States. Many of my constituents are
very interested in reuniting with their families, bring family
members to the U.S. to visit or become U.S. citizens.
AIDS has affected Hispanics in San Antonio more than in
most other communities around the country. One thing we can all
do is to continue to educate our friends and relatives about
AIDS, not only as to its causes but also on its impact on our
local, national and global community. We can also push for
increased funds for research and treatment of this deadly
disease.
Our efforts targeting African Americans here in the United
States, and our efforts to address AIDS in Africa and elsewhere
are to be commended and expanded. We must do more for those
most in need, and we must do more to prevent HIV from becoming
a problem in those areas where it has not yet established
itself. To do any less is to allow a disease that we can
prevent. And we must begin now to look at how we address AIDS
in Latin America so that we can prevent it from becoming the
next epicenter of the epidemic. Public health practices have
shown that it is must more effective to prevent an illness than
to treat an illness. Clearly, what we do now in our efforts to
address HIV will affect the quality of our lives tomorrow.
We must fight the complacency that is threatening our
efforts to address HIV and AIDS in the U.S. and worldwide. Yes,
new drug combination therapies have prolonged the lives of many
Americans who have access to them, who can afford them, and who
can tolerate them. Unfortunately, not all have access or can
afford them. Imagine how difficult it will be for those in
countries outside the U.S. whose average health care
expenditures are less than a few hundred dollars a year to pay
for drugs which can cost up to $14,000 a year in the United
States. Unfortunately, many of our leaders are still afraid to
discuss HIV/AIDS in public. This silence is also evident in
many Latin American countries where AIDS is just starting to
take hold. This silence only leads to continued denial that
AIDS is affecting Latinos, and it will only lead to additional
infections and deaths. By not publicly discussing HIV/AIDS, we
send a message to our community that AIDS is not an issue of
concern to us or that it is taboo. The number of cases, new
infections, and deaths in our community have shown that our
silence has been deadly.
The Congressional Hispanic Caucus, of which I am a member,
is proud of its role in securing additional funding and in
providing leadership in this area. But we have a long way to
go. We need the Hispanic community, especially our Hispanic
leaders both here in the U.S. and in other countries, to expand
their efforts. The Congressional Hispanic Caucus believes that
health issues that disproportionately affect Latinos must be
addressed openly and publicly. The Caucus understands the
importance of public leadership in addressing HIV/AIDS as a
means to educate the public of the impact that HIV/AIDS is
having on the Latino community both here and internationally.
I submit these comments to honor those from the Hispanic
and other communities who have lost their lives to this dreaded
disease and to remind the House, the country and the world that
AIDS is indeed threatening the lives of a wide variety of
people.
Charles A. Gonzalez.
ADDITIONAL VIEWS
I am pleased with the leadership and commitment
demonstrated by both Chairman Leach and Ranking Member LaFalce
have shown in addressing the AIDS crisis in Africa. I believe
that the diligence of the hearing and mark up on H.R. 3519, the
World Bank AIDS Prevention Trust Fund Act, represents the
necessary response to the urgency of the AIDS crisis in Africa.
The World Bank AIDS Marshall Plan Trust Fund Act represents the
most effective, bipartisan strategy possible to push this issue
to the national forefront.
As we work to establish partnerships and relationships with
African countries, whether as healthcare experts, business
people, activists or policy makers, it is imperative that we
unite to focus both attention and resources on the global
emergency of HIV/AIDS, which wreaks havoc in developing
countries, most tragically in Sub-Saharan Africa.
Because the AIDS virus is insidious in nature, and
prevention demands a multi-faceted approach, I have advocated
for policies that will aggressively fight HIV/AIDS both
domestically and internationally.
Last April, I participated in a Presidential Delegation to
Southern Africa to examine the growing crisis of African
Children orphaned by AIDS. These children now total 7.8 million
and are estimated to reach 40 million by 2010. The 1999 UNICEF
report states that ``the number of orphans, particularly in
Africa, constitutes nothing less than an emergency, requiring
an emergency response from the international community.''
The orphan crisis alone, reinforces our moral imperative to
address this pandemic. HIV/AIDS in Africa has created an
economic crisis, crippling Africa's workforce in many areas and
creating even greater economic instability where poverty is
ever-present. For example, some companies are now hiring two
employees for each skilled job, assuming that one will die from
AIDS. Successful and sustainable economic partnerships with
African nations cannot be created, these include initiatives
that are vital to many businesses in the Bay Area.
HIV/AIDS also poses serious national security concerns not
only to the continent of Africa, but the worldwide. Perhaps the
most stunning example is the National Intelligence Estimate
which indicates that militias in Angola and the Democratic
Republic of the Congo show HIV prevalence rates of 40-60%.
The United States must take the lead in developing an
immediate and sustained response to this crisis in Africa and
globally. The World Bank AIDS Marshall Plan Trust Fund Act
should serve as a replicable model for addressing this crisis
on a local, national or regional level.
Despite the grim statistics on the spread of HIV/AIDS, we
know that countries like Uganda, Senegal and Thailand have
implemented prevention programs that have substantially curbed
the rate of infection. AIDS experts have identified strategies
that would make a difference in regions where AIDS cases
continue to escalate.
So, our message is clear: today we must press forward with
our commitment to fight the war against HIV/AIDS and to stem
the tide of death.
AIDS, like all diseases, knows no boundaries. There is no
guarantee that the scale of the problem in one continent can be
contained within that region.
It is estimated that 6000 people die of AIDS each day in
Africa. Since I introduced the AIDS Marshall Plan last August,
nearly 1.3 million people have died.
Everyday, evidence that justifies our actions mounts.
Evidence showing how we can marshal our support and resources
to help fight this war, save lives and prevent the spread of
HIV becomes clearer.
The question has arisen, why Africa, why now? As it is most
simply put, the house is burning down and there are people who
are alive still inside. We have to get them out by any means
necessary. In this time of unprecedented surpluses, I believe
that we have the capacity and we should provide even more
support to fight AIDS in Africa and throughout the world.
Congress must pass legislation to address the AIDS pandemic in
Africa.
I commend the Chairman and Ranking Member for their
leadership and challenge my colleagues to join in this historic
and monumental effort.
Thank you.
Barbara Lee.