The United States international AIDS effort—the President's Emergency Plan for AIDS Relief ( PEPFAR ) —has been renewed for another five years.
Conservatives in the Senate used legislative tactics to try to scale back spending and re-impose greater ideological constrictions on how the money might be spent. Some of those restrictions had been eased during reauthorization. Minor accommodations were made to the conservatives but they largely failed in a series of votes over July 15-16.
The PEPFAR budget will more than triple to $50 billion over the life of the program. Another major provision is lifting travel and immigration restrictions on persons who are HIV-positive. HIV will now be treated like every other infectious disease.
The procedural logjam began to break up July 11 when the Senate voted 65-3 to close debate and vote on PEPFAR the following week. Conservative opponent Jim DeMint, R-S.C., had angered colleagues by demanding the recorded vote late on a Friday afternoon, and then didn't even bother to stick around to vote.
The key first vote July 15 was on an amendment by DeMint that sought to limit PEPFAR to the 15 low-income countries that are the focus of current operations. The Senate tabled it by a vote of 70-24. All Democrats supported the motion and were joined by about half the Republicans. Barack Obama and John McCain did not vote.
An amendment by Jim Bunning, R-Ky., would have limited spending to $15 billion, the same amount as the current program. It was resoundingly defeated, 16-80. Another amendment, to reduce overall spending to $35 billion, went down 31-64. The final bill passed the Senate 80-16.
The legislation carries the names of Henry Hyde and Tom Lantos, the late Republican and Democratic leaders in the House who had championed a bipartisan U.S. international AIDS effort. Perhaps the most minor but also the most offensive amendment was to add the name of the recently departed Jesse Helms to the legislation, offered by Elizabeth Dole, R-N.C.
Helms had been the most intransient opponent of funding for AIDS programs, foreign and domestic. However, Dole's amendment was only introduced, not considered.
Hopes are that the House will accept the minor changes by the Senate. President George W. Bush has pushed for the legislation, which is likely to be one of the few positive legacies of his tenure in the White House.
Senate repeals HIV travel ban
Senators John Kerry, D-Mass., and Gordon Smith, R-Ore., led the effort to drop U.S. travel and immigration restrictions on persons who are HIV-positive that had been in place for decades. The Foreign Relations Committee agreed to that, but Jeff Sessions, R-Ala., vowed to reinstate the provisions.
The Congressional Budget Office had said that lifting the restrictions could cost the United States an estimated $83 million in additional medical costs over the next ten years. A compromise increased the visa application fee by $1 and the immigration application fee by $2 to cover anticipated increased medical costs for a variety of illnesses. And Sessions was placated with a substitute amendment.
Gay pundit Andrew Sullivan had been among those pushing for the revision. He was ecstatic with passage. 'For those of us who have long dreamed of becoming Americans, and have been prevented by the 1993 law from even being able to enter or leave the U.S. without waivers or fear of humiliation, this is a massive burden lifted.
'I'm not exaggerating when I say that it's one of the happiest days of my whole life … the lifting of this threat—the sense that I now have a home I know will be secure for me and my husband—is indescribable.'
Michael Saag, vice chair of the HIV Medical Association, said 'It is gratifying to know that my HIV-positive colleagues from other countries will finally be allowed to come to the United States to share their expertise.'
'We applaud the Senate for rejecting this unjust and sweeping policy that deems HIV-positive individuals inadmissible to the United States,' said Joe Solmonese, president of the Human Rights Campaign. It played a leading role in lobbying repeal of the provision.
