Markup: Amending the Foreign Assistance Act of 1961 to Authorize Assistance to Prevent, Treat and Monitor HIV/AIDS in Sub-Saharan Africa and Other Developing Countries; and Expressing the Sense of Congress in Support of Victims of Torture

SPEAKERS       CONTENTS       INSERTS

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73–451PS
2001
AMENDING THE FOREIGN ASSISTANCE ACT OF 1961 TO AUTHORIZE ASSISTANCE TO PREVENT,
TREAT AND MONITOR HIV/AIDS IN
SUB-SAHARAN AFRICA AND OTHER DEVELOPING
COUNTRIES; AND EXPRESSING THE SENSE OF CONGRESS IN SUPPORT OF VICTIMS OF TORTURE

MARKUP

BEFORE THE

COMMITTEE ON
INTERNATIONAL RELATIONS
HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

ON
H.R. 2069 and H. Con. Res. 168

JUNE 27, 2001

Serial No. 107–28

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Printed for the use of the Committee on International Relations

Available via the World Wide Web: http://www.house.gov/international—relations

For sale by the Superintendent of Documents, U.S. Government Printing Office
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Mail: Stop SSOP, Washington, DC 20402–0001

COMMITTEE ON INTERNATIONAL RELATIONS

HENRY J. HYDE, Illinois, Chairman

BENJAMIN A. GILMAN, New York
JAMES A. LEACH, Iowa
DOUG BEREUTER, Nebraska
CHRISTOPHER H. SMITH, New Jersey
DAN BURTON, Indiana
ELTON GALLEGLY, California
ILEANA ROS-LEHTINEN, Florida
CASS BALLENGER, North Carolina
DANA ROHRABACHER, California
EDWARD R. ROYCE, California
PETER T. KING, New York

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STEVE CHABOT, Ohio
AMO HOUGHTON, New York
JOHN M. McHUGH, New York
RICHARD BURR, North Carolina
JOHN COOKSEY, Louisiana
THOMAS G. TANCREDO, Colorado
RON PAUL, Texas
NICK SMITH, Michigan
JOSEPH R. PITTS, Pennsylvania
DARRELL E. ISSA, California
ERIC CANTOR, Virginia
JEFF FLAKE, Arizona
BRIAN D. KERNS, Indiana
JO ANN DAVIS, Virginia

TOM LANTOS, California
HOWARD L. BERMAN, California
GARY L. ACKERMAN, New York
ENI F.H. FALEOMAVAEGA, American Samoa
DONALD M. PAYNE, New Jersey
ROBERT MENENDEZ, New Jersey
SHERROD BROWN, Ohio
CYNTHIA A. McKINNEY, Georgia
EARL F. HILLIARD, Alabama
BRAD SHERMAN, California

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ROBERT WEXLER, Florida
JIM DAVIS, Florida
ELIOT L. ENGEL, New York
WILLIAM D. DELAHUNT, Massachusetts
GREGORY W. MEEKS, New York
BARBARA LEE, California
JOSEPH CROWLEY, New York
JOSEPH M. HOEFFEL, Pennsylvania
EARL BLUMENAUER, Oregon
SHELLEY BERKLEY, Nevada
GRACE NAPOLITANO, California
ADAM B. SCHIFF, California
DIANE E. WATSON, California

THOMAS E. MOONEY, SR., Staff Director/General Counsel
ROBERT R. KING, Democratic Staff Director
DANIEL FREEMAN, Counsel/Parliamentarian
ADOLFO FRANCO, Counsel
MARILYN C. OWEN, Staff Associate

C O N T E N T S

Markup of H.R. 2069, To amend the Foreign Assistance Act of 1961 to authorize assistance to prevent, treat and monitor HIV/AIDS in Sub-Saharan Africa and other developing countries

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    Markup of H. Con. Res. 168, Expressing the sense of Congress in support of victims of torture

STATEMENTS SUBMITTED FOR THE RECORD

    The Honorable Henry J. Hyde, a Representative in Congress from the State of Illinois, and Chairman, Committee on International Relations: Prepared statement regarding H.R. 2069
Prepared statement regarding H. Con. Res. 168

    The Honorable Christopher H. Smith, a Representative in Congress from the State of New Jersey: Prepared statement regarding an amendment to H.R. 2069

    The Honorable Joseph Crowley, a Representative in Congress from the State of New York: Prepared statement regarding H.R. 2069

APPENDIX

Bills and Amendments:

    H.R. 2069

Amendment in the Nature of a Substitute to H.R. 2069 offered by Mr. Hyde, Mr. Lantos, Ms. Lee, and Mr. Leach

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Amendment offered by Mr. Smith of New Jersey to the Amendment in the Nature of a Substitute

    H. Con. Res. 168

Additional Statements Submitted for the Record:

    The Honorable Earl Blumenauer, a Representative in Congress from the State of Oregon

    The Honorable Benjamin A. Gilman, a Representative in Congress from the State of New York

AMENDING THE FOREIGN ASSISTANCE ACT OF 1961 TO AUTHORIZE ASSISTANCE TO PREVENT, TREAT AND MONITOR HIV/AIDS IN SUB-SAHARAN AFRICA AND OTHER DEVELOPING COUNTRIES; AND EXPRESSING THE SENSE OF CONGRESS IN SUPPORT OF VICTIMS OF TORTURE

WEDNESDAY, JUNE 27, 2001

House of Representatives,
Committee on International Relations,
Washington, DC.

    The Committee met, pursuant to call, at 10:25 a.m. in Room 2172, Rayburn House Office Building, Hon. Henry Hyde, (Chairman of the Committee) presiding.

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    Mr. HYDE. The Committee will now come to order.

    Pursuant to notice, I now call up the Bill H.R. 2069 for purposes of markup and move its favorable recommendation to the House.

    Without objection, the bill will be considered as read and open for amendment at any point.

    The Chair has an amendment in the nature of a substitute at the desk, which he offers on his own behalf and on behalf of the following Members of this Committee: Mr. Lantos, Ms. Lee and Mr. Leach.

    The clerk will report the amendment.

    Ms. BLOOMER. Amendment in the nature of a substitute to H.R. 2069. Strike all after the enacting clause . . .

    Mr. HYDE. I ask unanimous consent that further reading of the amendment be dispensed with.

    Without objection, so ordered.

    The Chair yields himself 5 minutes for purposes of presenting a statement.

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    The time has come once again for the United States to lead the world in surmounting one of the most compelling humanitarian and moral challenges of our time. I speak of the HIV/AIDS pandemic that threatens the stability of both the developing and developed world, a crisis unparalleled in modern times.

    The statistics are chilling. Over 22 million people have died of AIDS throughout the world. More than 3 million died last year alone. That is over 8000 deaths each day or nearly one death every 6 minutes. What is most alarming is that the number of infections and deaths is growing and the pandemic is quickly spreading from sub-Saharan Africa to India, China and Russia. An incredible 36 million people are infected with HIV today and 15,000 new infections occur each day.

    Tragically, most of the dramatic increase in infection rates is in poor countries, where education, awareness and access to health care is seriously lacking. To illustrate the magnitude of the crisis, it is estimated that by the year 2010 over 80 million people could be dead of AIDS.

    Children suffer inordinately from the cruel AIDS pandemic. Millions are born HIV infected, even though mother-to-child-transmission can be easily avoided if adequate training and health care is provided.

    By the end of the decade, 40 million children will be orphaned as a consequence of AIDS. The impact on developing society socially, politically, economically is incalculable and threatens the stability of the globe.

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    The pandemic is not limited to Africa. The Caribbean region has the second highest rate of HIV infections in the world, only a few hundred miles from the United States. Russia has the highest increase rate of any country last year. The social upheaval that could arise in Russia as the result of this crisis could have serious consequences for global security. According to the National Intelligence Council, India is on the verge of a catastrophic AIDS epidemic.

    For these reasons, the United States must lead the world in an effort to combat and ultimately rid the globe of this modern-day plague. The problem is monumental and our response needs to be both bilateral and multilateral. However, as with any problem, financial resources are not the sole answer to a problem and the generosity of the American people must be well managed.

    We must provide resources at a pace at which they can be absorbed and used wisely. We must continue to encourage and support faith-based organizations and churches that are doing good works to educate the poor about HIV and AIDS. We must also insist that other developed nations join us in this global effort. The President has already signaled our nation's intention to lead by committing $200 million for a multilateral effort to combat HIV/AIDS through a global AIDS war chest that will be designed and implemented in the months to come.

    Mindful of the colossal threat posed by the HIV/AIDS pandemic, I am proud that this Committee has chosen to embark upon a courageous and bipartisan course that constitutes a declaration of war on the pandemic. The amendment in the nature of a substitute to H.R. 2069, the bill the Committee marks up today, is a true and meaningful bipartisan effort that provides adequate resources for both the bilateral and multilateral pillars of our response to the AIDS crisis.

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    I wish to thank Mr. Lantos, the Ranking Member of the Committee, and his staff for their good faith efforts to fashion legislation that we can jointly support and that will make a true difference.

    I am also appreciative of the support of the gentlelady from California, Ms. Lee, and the gentleman from Iowa, Mr. Leach, distinguished Members of our Committee, and the support of the gentlelady from California who is not a Member of our Committee, Ms. Millander-McDonald.

    The amendment to H.R. 2069 authorizes the Agency for International Development to carry out a comprehensive program of HIV/AIDS prevention, education and treatment at a level of $560 million in fiscal year 2002. Although this is more than has been requested by the Administration for these purposes in fiscal year 2001, with each passing day we grow more aware and concerned about the global threat posed by HIV/AIDS and the need to do more.

    This bill also authorizes an additional $50 million pilot program to provide treatment for those infected with HIV/AIDS by assisting the public and private sectors of developing countries in the procurement of HIV/AIDS pharmaceuticals and antiviral therapies.

    Accordingly, through our bilateral efforts, the United States will demonstrate its commitment to address all facets of the HIV/AIDS challenge and to do so in a responsible and meaningful manner and thereby challenging the remainder of the developed world to emulate our example.

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    The amendment to H.R. 2069 also authorizes the President to contribute to multilateral efforts to combat HIV/AIDS at a level of $750 million in fiscal year 2002. America must contribute its fair share as we work to leverage additional funds for this crusade from other developing countries. By providing this level of authorization, we can ensure that the contributions made by the United States will be adequate and also yield the commitments from other countries to make this effort a truly global war on AIDS.

    The novel bilateral treatment program that my bill authorizes is vitally important, for it gives hope to those already suffering from AIDS. By authorizing a pilot treatment program, we can work to extend the productive lives of those infected by the virus.

    This is not only the right thing to do, aside from humanitarian concerns, but it is the smart thing to do for treatment makes prevention work. Without some expectation of hope or care, the poor have no reason to be tested for AIDS or to seek help. I am fully cognizant of the challenge posed by treatment programs in developing countries.

    I want to thank the many organizations that have supported this legislation and our bipartisan approach to addressing the HIV/AIDS pandemic. I am grateful for the strong support provided by many non-governmental organizations and for the guidance provided by the Agency for International Development.

    Simply stated, the AIDS virus is one of the great moral challenges of our era, for it is a scourge of unparalleled proportions in modern times. Every citizen has a stake in what tragically could be the plague of the 21st century. Accordingly, we should do all we can to meet this test by reaching out now to those most in need. It is the right thing to do for our children, our country and our world.

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    I cannot terminate my statement without making a comment about the extraordinary cooperation we have received from the Democratic side on this very difficult issue. The negotiations have been intense, they have been informed, they have been honorable, they have been straightforward. Mr. Lantos gives the words bipartisan and honorable and integrity real meaning in this Committee, and I am most grateful to him and his staff.

    I urge my colleagues to support this very important bill that we are marking up this morning, and I am pleased to recognize the Ranking Member, Mr. Lantos.

    [The prepared statement of Mr. Hyde follows:]

PREPARED STATEMENT OF THE HONORABLE HENRY J. HYDE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS, AND CHAIRMAN, COMMITTEE ON INTERNATIONAL RELATIONS

    The time has come once again for the United States to lead the world in surmounting one of the most compelling humanitarian and moral challenges of our time. I speak of the HIV/AIDS pandemic that threatens the stability of both the developing and developed world—a crisis unparalleled in modern times.

    The statistics are chilling. Over 22 million people have died of AIDS throughout the world. More than 3 million died last year alone. That is over 8,000 deaths each day, or nearly one death every six minutes. What is most alarming is that the number of infections and deaths is growing and the pandemic is quickly spreading from sub-Saharan Africa to India, China, and Russia.

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    An incredible 36 million people are infected with HIV today—and 15,000 new infections occur each day. Tragically, most of the dramatic increase in infection rates is in poor countries where education, awareness, and access to healthcare is seriously lacking. To illustrate the magnitude of the crisis, it is estimated that by the year 2010 over 80 million people could be dead of AIDS.

    Children suffer inordinately from the cruel AIDS pandemic. Millions are born HIV-infected even though mother-to-child transmission can be easily avoided if adequate training and healthcare is provided. By the end of the decade, 40 million children will be orphaned as a consequence of AIDS. The impact on developing societies—socially, politically, and economically—is incalculable, and threatens the stability of the globe.

    The pandemic is not limited to Africa. The Caribbean region has the second highest rate of HIV infections in the world—only a few hundred miles from the United States. Russia had the highest increase rate of any country last year. The social upheaval that could arise in Russia as a result of this crisis could have serious consequences for global security. According to the National Intelligence Council, India is on the verge of a catastrophic AIDS epidemic.

    For these reasons, the United States must lead the world in the effort to combat and ultimately rid the globe of this modern-day plague. The problem is monumental, and our response needs to be both bilateral and multilateral. However, as with any problem, financial resources are not the sole answer to a problem, and the generosity of the American people must be well-managed.

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    We must provide resources at a pace at which they can be absorbed and used wisely. We must continue to encourage and support faith-based organizations and churches that are doing good works to educate the poor about HIV and AIDS. We must also insist that other developed nations join us in this global effort. The President has already signaled our nation's intention to lead by committing $200 million for a multilateral effort to combat HIV/AIDS through a global AIDS war chest that will be designed and implemented in the months to come.

    Mindful of the colossal threat posed by the HIV/AIDS pandemic, I am proud that this Committee has chosen to embark upon a courageous and bipartisan course that constitutes a declaration of war on the pandemic.

    The Amendment in the Nature of a Substitute to H.R. 2069, the bill the Committee marks up today, is a true and meaningful bipartisan effort that provides adequate resources for both the bilateral and multilateral pillars of our response to the AIDS crisis. I wish to thank Mr. Lantos, the Ranking Member of the Committee, and his staff, for their good faith efforts to fashion legislation that we can jointly support, and that will make a true difference. I am also appreciative of the support of the gentle lady from California, Ms. Lee, and the gentleman from Iowa, Mr. Leach, distinguished Members of our Committee, and the support of the gentle lady from California, Ms. Millender-McDonald.

    The amendment to H.R. 2069 authorizes the Agency for International Development to carry out a comprehensive program of HIV/AIDS prevention, education, and treatment at a level of $560 million in fiscal year 2002. Although this is more than has been requested by the Administration for these purposes in Fiscal Year 2001, with each passing day we grow more aware and concerned about the global threat posed by the HIV/AIDS pandemic and the need to do more. This bill also authorizes an additional $50 million pilot program to provide treatment for those infected with HIV/AIDS by assisting the public and private sectors of developing countries in the procurement of HIV/AIDS pharmaceuticals and anti-viral therapies. Accordingly, through our bilateral efforts, the United States will demonstrate its commitment to address all facets of the HIV/AIDS challenge and to do so in a responsible and meaningful manner, and thereby challenging the remainder of the developed world to emulate our example.

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    The amendment to H.R. 2069 also authorizes the President to contribute to multilateral efforts to combat HIV/AIDS at a level of $750 million in Fiscal Year 2002. America must contribute its fair share as we work to leverage additional funds for this crusade from other developing countries. By providing this level of authorization, we can ensure that the contributions made by the United States will be adequate, and also yield the commitments from other countries to make this effort a truly global war on AIDS.

    The novel bilateral treatment program that my bill authorizes is vitally important, for it gives hope for those already suffering from AIDS. By authorizing a pilot treatment program, we can work to extend the productive lives of those infected by the virus. This is not only the right thing to do—aside from humanitarian concerns—but it is the smart thing to do for treatment makes prevention work. Without some expectation of hope or care, the poor have no reason to be tested for AIDS or to seek help. I am fully cognizant of the challenge posed by treatment programs in developing countries.

    I want to thank the many organizations that have supported this legislation and our bipartisan approach to addressing the HIV/AIDS pandemic. I am grateful for the strong support provided by many non-governmental organizations and for the guidance provided by the Agency for International Development.

    Simply stated, the AIDS virus is one of the great moral challenges of our era, for it is a scourge of unparalleled proportions in modern times. Every citizen has a stake in what tragically could be the plague of the 21st century. Accordingly, we should do all we can to meet this test by reaching out now to those most in need—it is the right thing to do for our children, our country, and our world.

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    I urge my colleagues to support this very important bill that we mark up this morning.

    Mr. LANTOS. Thank you very much, Mr. Chairman. Thank you very much for your very kind comments.

    I fully identify myself with the Chairman's observations, and since he has outlined our bipartisan legislation, I shall not be repetitive by reviewing the provisions that he has discussed.

    First of all, Mr. Chairman, I would like to commend you for taking the lead on legislation—historic legislation, I might add—to help combat the global HIV/AIDS crisis.

    You have shown real courage and integrity and true statesmanship in tackling this issue when you could have relied upon others to legislate on this front, and I personally appreciate it.

    Many do not see the global HIV/AIDS crisis as a U.S. priority and question the need to spend significant U.S. funds toward preventing and treating this horrendous disease; but you, Mr. Chairman, recognize not only the severity of the epidemic, but our moral, humanitarian and national security interests in stemming the tide of the HIV/AIDS pandemic. I again want to thank you and members of your staff for the remarkably open-minded and bipartisan spirit in which you approached our negotiations.

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    I would also like to commend my friend and colleague from California, Ms. Barbara Lee, for her bold and unwavering leadership in the global fight against HIV/AIDS. Barbara Lee has played a critical role in setting this Congress on the right course on this humanitarian disaster.

    For the past several weeks, we have consulted non-stop with Members of our Committee, other Committees, our constituents, advocacy groups, governmental, intergovernmental, international organizations, all in an effort to arrive at a bipartisan agreement on both the policy provisions in this legislation which are extremely important and the funding levels for both bilateral assistance programs and contributions to multilateral efforts.

    The Hyde-Lantos-Lee-Leach-Millander-McDonald amendment before us reflects this agreement, and I strongly urge all of my colleagues on both sides of the aisle to support it. I truly believe that this compromise delays the foundation for a long-term commitment by the United States to eradicate this devastating disease.

    Our bill authorizes $560 million in bilateral U.S. assistance to education, prevention, treatment and care, and another $50 million for the purchase of drugs to treat HIV/AIDS and those highly infectious diseases associated with it.

    Additionally, our bill commits $750 million toward a global health fund to coordinate both funding and comprehensive programs in the fight against the disease to which governments, the private sector foundations and individual philanthropists can, should and must contribute.

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    As Secretary of State Colin Powell said earlier this week at the U.N. special session on AIDS, and I quote, ''From this moment on, our response to AIDS must be no less comprehensive, no less relentless and no less swift than the pandemic itself. I was a soldier. I know of no enemy in war more insidious or vicious than AIDS, an enemy that poses a clear and present danger to the world. The war against AIDS has no front lines.''

    As the Secretary's speech makes clear, this global crisis is an American priority, one which demands the full use of our nation's economic, political, security and moral resources. As the richest and most powerful nation on the planet, we have an economic and moral obligation to make a substantial contribution to this global effort.

    The bilateral program authorized by our legislation will guarantee that the American people are directly engaged in providing education, prevention, treatment and care to those suffering in poor countries.

    Our proposed 1-year, multilateral expenditure of $750 million is a major investment on our part toward a global effort to secure a better future for the millions suffering from this deadly disease. It is a signal to the world and particularly to those suffering from AIDS that the United States is a true partner in the battle against this pandemic.

    Mr. Chairman, I again want to thank you for your leadership on this issue. I look forward to our continuing efforts to pass this legislation that will put our great nation in the forefront of the global fight against HIV/AIDS, and I want to thank you for your courtesies.

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    Mr. HYDE. Thank you, Mr. Lantos, and if you will yield to me for a just a couple of minutes, I want to make a point about the levels of funding to my colleagues.

    Conservatives will look at this and say it is much, too much money. Liberals will look at this and say it is woefully inadequate. I want to stress to everybody on this Committee that these numbers have been agonized over, have been worked on, have been scrutinized, have been evaluated. We believe there is a limit to how much money can be absorbed and well managed in this very difficult global problem. We think we have arrived at a workable figure that is not too low and is not too high.

    And I just want to say that there will be people who will quarrel with these figures, but they have been thought out and worked on by both sides on this, and I just wanted you to know these were not picked out of the air. These have been very painfully and I think professionally worked out.

    Thank you very much.

    Mr. LANTOS. May I take a moment, Mr. Chairman?

    Mr. HYDE. Yes. Surely.

    Mr. LANTOS. I want to associate myself with the Chairman's remark. We have a commitment on our part, Mr. Chairman, that there will not be amendments with respect to funding levels at the Committee by any of the Democratic Members of the Committee. Democratic Members have reserved the right to offer amendments on the floor, but we have every intention in good faith to support the levels in this amendment and to get out of our Committee on a bipartisan basis a powerful message that we are committed to dealing with this issue.

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    Thank you, Mr. Chairman.

    Mr. HYDE. I thank you very much, Mr. Lantos.

    Mr. Gilman?

    Mr. GILMAN. Thank you, Mr. Chairman. I strongly support our Committee's intention to authorize reasonable, substantial HIV/AIDS funding for the Agency for International Development in fiscal year 2002, and I commend Chairman Hyde and Congressman Lantos for working out this creative bipartisan, comprehensive strategy on this highly critical global issue. Thanks to this bipartisan proposal and other U.S. Government and private sector efforts, hopefully we will begin to make significant progress in our fight against the HIV/AIDS virus throughout the world.

    The HIV/AIDS virus has been one of the great moral tests of our era. Having made progress at home, the question now is whether we can act to effectively help those in more distant lands. This legislation points us in the right direction and I am pleased to urge the support of our Committee for the Chairman's measure, H.R. 2069, the Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment Act of 2001.

    And I thank the Chairman for yielding.

    Mr. HYDE. Thank you.

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    The gentlelady from California, Ms. Lee.

    Ms. LEE. Thank you, Mr. Chairman. I want to thank you also for demonstrating your leadership on this important issue and for calling for today's markup on H.R. 2069, the Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment Act. I think it is very important that this title remain because this is about prevention, awareness, education and treatment.

    I want to especially thank you for negotiating a level of funding that sets us in the right direction on this issue and a special thank you to Ranking Member Mr. Lantos for his leadership, his guidance and his counsel as we moved through the negotiations.

    We all realize that this amount—at least I am one of those who truly believes that this amount—does not come close to what is necessary to address the global AIDS pandemic, but, once again, it is a step in the right direction.

    We all know that in order to comprehensively address the global AIDS pandemic, the United States will have to make a major increase in its bilateral assistance and will have to go far beyond the President's current commitment to the multilateral global health fund.

    I want to say, Mr. Chairman, that my staff and Congressmen Lantos' and Leach's staffs have really worked very closely with your staff to reach this agreement that we all can support. And I also want to thank the staff for their very tireless efforts.

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    In light of the call for billions of dollars by world leaders, HIV/AIDS experts and economists and people living with AIDS in developing countries really do believe that we are slowly moving closer to what the United States' contribution should be, and that is billions and billions of dollars each year.

    We are the world's richest country and we must do more.

    Now, I want to reiterate that, yes, we have come to an agreement on this substitute which calls for $560 million, a doubling of the United States bilateral HIV and AIDS programs, and also for $750 for the United States' contribution to a global AIDS fund. It retains the $50 million for a drug procurement program.

    I believe also that the bill contains many provisions necessary for a comprehensive and multi-faceted approach in terms of the policies that are actually incorporated in the bill.

    So once again, it is a major step in the right direction, but I do intend to move forward with my efforts to increase these amounts as we move through this legislative process this year. The world community is looking to the United States for guidance on this matter, and the United States' contribution will be the measure against which other countries make their own contributions.

    Now, I was a member of the United States delegation to the United Nations General Assembly on HIV and AIDS, the special session that is being held this week. This delegation was led by our Secretary of State, General Colin Powell. I can tell you that the entire world community expects us and needs us to lead the assault against this global disaster.

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    United Nations Secretary General Kofi Annan has called for the establishment of an international AIDS trust fund and has called for a war chest of $7 billion to $10 billion a year as a response to the African AIDS crisis and the global AIDS pandemic.

    These funds are desperately needed to curb the devastating impact that AIDS is having in many developing nations throughout the world, particularly those in sub-Saharan Africa. As you know, each day, over 6000 people alone in Africa die from AIDS. In many African nations, people live on less than $1 a day, yet addressing the AIDS crisis through prevention, education and treatment will cost billions and billions of dollars a year.

    Last year, Congressman Leach and I led a bipartisan effort actually to establish an international AIDS trust fund at the World Bank that would provide grants, not loans. I want to make that perfectly clear once again that this was a fund established for grants—we did not want the World Bank involved in any more loan granting for AIDS pandemic efforts in terms of addressing these efforts, but we did establish the World Bank AIDS trust fund so African nations, civil societies and NGOs could better respond to this pandemic. So I am pleased to see that we are now hearing and learning of considerable movement on this initiative in the international community.

    Just for the record, it is my understanding that last week on Friday, representatives from the Administration briefed our Members' staffs about the progress of an international AIDS trust fund which they expect to be established and fully functioning by the end of this year.

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    So we stressed last year, Congressman Leach and I, that this was not a Republican or a Democratic issue, but was so important that only a bipartisan solution would work. I want to thank Chairman Hyde and our Ranking Member for helping us once again this year to stay out front as a Committee to make sure that we provide a massive response to what is a massive, deadly plague that is devastating the continent of Africa and other developing countries.

    I urge my colleagues to express their strong support for the substitute and urge us to move this bill out of Committee. This is a matter of life and death. It is in our national interests to tackle this issue until it is wiped from the face of the earth.

    Thank you, Mr. Chairman, and thank you, Mr. Lantos, once again for this.

    Mr. HYDE. I thank the gentlelady.

    The next to be heard will be the distinguished gentleman from Iowa, Mr. Leach. However, there is a vote that has just been called. It takes some of us longer to get over there than others and out of respect for those who take longer to get over there, we are going to recess and come right back after the vote.

    We have many more people to hear from and this bill is very important. We want to mark it up today.

    The Committee will stand in recess.

    [Recess.]

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    Mr. HYDE. The Committee will come to order.

    The Chair recognizes the gentleman from Iowa, Mr. Leach.

    Mr. LEACH. Mr. Chairman, I will be very brief.

    In terms of the crisis, I think as Chairman you laid out as thoughtful an overview as I have heard on the subject, and I want to personally thank you very much for your leadership and that of Mr. Lantos and Ms. Lee.

    I would just like to make a couple of brief comments on the multilateral dimension of this act, which augments a law that was passed in the prior Congress. I would only say first that the funding levels laid out by the Chairman are quite credible. No one has, however, any idea whatsoever what the absorptive capacity of the international community is on this kind of circumstance.

    What we do know it is it is the largest international issue today, nothing compares with this particular circumstance of this disease and its need for control. And so numerically I have always believed in extreme edge of what is happening, but I would say to the Chairman these are very credible numbers.

    Having said that, it is astonishing to me how in the last Congress we made a multi-hundred million dollar authorization commitment but an exceptionally modest appropriations commitment, and the challenge here is going to be on the appropriations side.

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    I also remain mystified that the last Administration gave such a low priority to international multilateral efforts as contrasted with bilateral and to this day have no idea whatsoever why they did not fight for greater appropriations.

    But having said that, I would only say as strongly as I can to the Administration and to the appropriators that I know of no issue for which emergency supplementals are more appropriate than the AIDS issue. I would be very hopeful in the wake of this conference in New York that the State Department would give exceptional consideration to a definitive, separate appropriations call that may well follow the constraints of this bill—it may be a slight modification of it.

    But I think this is the kind of thing that our appropriators cannot deal with in terms of the constraints in the current appropriations process, that a call by the Administration of a definitive supplemental on this issue alone I think would be well received by the Congress. It is what is called for at this time in terms of intergovernment relations as well as inter-institutional relations.

    I thank the Chairman for yielding.

    Mr. HYDE. I thank the gentleman.

    Mr. Brown of Ohio?

    Mr. BROWN. I thank the Chairman very much and I particularly want to show my appreciation to Chairman Hyde, to Mr. Lantos, to Ms. Lee, for their efforts and their good faith efforts on AIDS funding and for the international global health fund and what that means.

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    I echo the comments of Mr. Leach in that while we have authorized more money than last year under President Clinton, the multilateral fund was not really formed to the degree that it is now and with the sort of direction it has now. So while I would liked to have seen this Congress and the President last year do better than they have done, I think this year we are on course to do that.

    I particularly appreciate the Chairman's good faith effort in upping the rather paltry sum that President Bush with bells and whistles bragged about a week or so ago.

    I empathize with the Chairman, unfortunately, though, with the predicament we are in. We have authorized a significant amount of money. Ms. Lee and, I think, most of the Members, if not all the Members on this side of the aisle and many of the Republicans, too, would like to do significantly more because clearly this nation has not done enough, even if we are able to follow through with this authorization and the appropriation.

    I empathize with the predicament that the Chairman and all of us find ourselves in. When it comes to the appropriation, as Mr. Leach warned, we are working within a construct that this Congress put itself in with giving tax cuts to the richest people in the country, so that we cannot do things for the poorest people in the world.

    We also cannot do prescription drugs, we also cannot do the kind of educational programs, we also cannot do a lot of other things we should be doing, but we sort of pat ourselves on the back about all that we are going to do. This Committee is better about that than others in this Congress, but when it comes to appropriation time, we know we will not do as well as we should.

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    We almost dislocate our shoulders by patting ourselves on the back for all the great work we are doing, but this Congress because of this tax cut and the budget situation we find ourselves in, we know we will not do as well in the appropriation as this Committee would like, as Mr. Hyde would like, and surely as what we should do as a wealthy country in dealing with the problems of AIDS. And, I might add, with the problems of tuberculosis.

    Almost half the people in sub-Saharan Africa who die of AIDS actually die of tuberculosis. A third of the people on earth, 2 billion people, carry the TB bacteria in their bodies. Most will not get the active disease, but many, many will. Eleven hundred people a day in India die from tuberculosis.

    We are not paying much attention. Ms. Lee and her efforts and the efforts of the United Nations and the World Health Organization and others at the international and global health fund are a major step, but understand with the tax cut that this Congress passed, we are not able to do what we ought to do. That is something that people need to remember as we reexamine down the road what direction we are going as a country.

    I applaud the Chairman for his efforts. I wish we could do more. I hope that all of us that vote for this in Committee today will follow up with the appropriators in the same enthusiastic way in which they cast the votes.

    Thank you, Mr. Chairman.

    Mr. HYDE. Mr. Bereuter?

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    Mr. BEREUTER. Thank you very much, Mr. Chairman. I want to commend you and Mr. Lantos and Mr. Leach and Mrs. Lee for your efforts in crafting this legislation, and I think there will be few Members in the Congress who would be in disagreement with the objectives that you have in crafting and moving forward with this legislation.

    Unfortunately, there are many people in this country and across the world who did not understand the development of this pandemic and who are in a state of denial about the causes of it. To some extent, that still is the case, so it seems to me we are getting a very late start, but I applaud the President's initiative, Secretary General Kofi Annan's initiative and others who are attempting to lead an effort.

    I hope that by the authorization and subsequent appropriations that we send a message to the nations of the European Union, to other wealthy countries in Europe, to those in Asia and to the Middle East that the need to step forward and generously support an AIDS fund that is recommended by the Secretary General.

    I have only one very specific concern and that is addressed indirectly by section 7, which is the authorization of appropriations for multilateral efforts to prevent, treat and monitor HIV.

    The Leach-Lee Act enacted last year, P.L. 106–264, I think gave a very important direction to our Administration to seek to have the administration or distribution of the grant fund through the International AIDS fund of the World Bank. They have the mechanisms for that grant distribution and for monitoring and for review of how the money is spent.

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    There is little confidence, I would suggest, in this body and in the American public for a direct distribution effort of funds by the United Nations; and the creation of a separate entity, which was also discussed internationally, for the implementation of this anti-AIDS effort would be, I think, very time consuming, very expensive. The most important priority we have is to get this money to where it needs to be, hopefully by the end of this calendar year. Otherwise, we could be talking about a delay of several years, and the effectiveness of the money spent would be less than desirable, for sure.

    What the Lee-Leach Act called for is that the U.S. negotiators would push for a fund that would be housed in the World Bank in terms of responsibility for distribution and management and oversight, but they also called for a separate board of trustees, so there would be a board independent of the World Bank to run the fund. I think they hit on exactly the right formula in that legislation.

    So I would urge our Administration to keep up its effort to make sure that in fact the World Bank is the distribution entity for the HIV/AIDS trust fund. Whether this decision is to be made in New York or in Genoa, I think that must be the effort if you expect to have strong support from the donor community and from the United States, and specifically from the Congress.

    I had hoped to work out an arrangement for an amendment so that the Financial Services Committee could avoid a sequential referral and so that I would not have to mark up separate legislation which I have introduced in the Subcommittee that I chair on Financial Services. We have substantial overlap in membership, senior and not-so-senior Members on both sides of the aisle. I hope we do not fall into a jurisdictional fight between the two Committees. It seems to me it would be unnecessary.

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    I visited very briefly with the Chairman and the Ranking Minority Member just a few minutes ago hoping that we might find some agreement for an amendment that could be supported in the Rules Committee, and I am happy to work with you, Mr. Chairman and Mr. Lantos, and the staff to see if that is possible. I am not anxious, when we come back, to mark up one more bill on the Subcommittee and the full Financial Services Committee. I would like to go forward as a united front with one we can all support.

    I think how we implement this fund is really crucial.

    Thank you very much, Mr. Chairman. I would be happy to have any comments you might want to make in response or just simply let it close at this point.

    Mr. HYDE. I just want to say we will work with you, Mr. Bereuter, including appearing before the Rules Committee, supporting an amendment that you might want to offer and asking that it be made in order. So we will work with you.

    Mr. BEREUTER. Thank you, Mr. Chairman. It would be very consistent with the original Leach-Lee Act. That is what I would intend.

    Mr. HYDE. Very well.

    Mr. Meeks of New York?

    Mr. MEEKS. Thank you, Mr. Chairman.

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    I want to thank you and Ranking Member Lantos for working very diligently and hard on this bill and coming up with some agreement and making a step, I believe, clearly in the right direction. I particularly want to thank my friend and colleague, Barbara Lee, who since coming to Congress has been unrelenting on her fight against the HIV/AIDS pandemic, particularly in sub-Saharan Africa and throughout the world. She has come and brought her talent and her insight, and I just want to join her and thank her for her strong commitment.

    As we sit here, the camera of history is really recording what is going on and looking at the United States and us in our role as the richest and most powerful nation probably in the history of the earth. We are probably also living in the moral issue of our time, so the question is what will happen, what will the camera of history record 50, 100 years from now? How will they look at what we are doing with reference to this pandemic that is sweeping particularly some of the poorer countries of the world?

    We have talked about it, I know I have read in history about the Black Plague and how bad that was. This pandemic is worse than the Black Plague ever was. So the action that we are taking today in this Committee is clearly a step in the right direction; but I agree with my colleague Barbara Lee in that it is a step, and we have to make sure that we make contributions in far greater numbers if we are going to be serious about stomping out the pandemic that is now sweeping many of the underdeveloped countries of this world.

    So, again, Mr. Chairman and Mr. Lantos, thank you for at least taking us much further down the road so that the cameras of history will record us in a favorable light. I look forward to working with you and others and my colleague Barbara Lee in the future as we add additional dollars to make sure that we are really serious and we are putting our money where our mouths are.

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    I yield back.

    Mr. HYDE. I thank the gentleman.

    Mr. Tancredo of Colorado.

    Mr. TANCREDO. Thank you, Mr. Chairman.

    I certainly also applaud your efforts in this regard, but I must remind all of us of the hearing that we held last year on AIDS in Africa, sub-Saharan Africa in particular. We spent almost a whole day, we had a wide range of witnesses, all of them testifying to the level of the problem and how it was, of course, getting worse.

    One of the most difficult things I think we had to deal with at the time was the realization that our efforts in terms of ''education'' as a preventative measure were completely fruitless; that in fact the groups in which the AIDS epidemic is growing more dramatically and more quickly than any other in the area were among teachers and nurses. Astoundingly, it almost defies logic, but that is what they testified to.

    When we asked how this could be, how in the world could this be the two professions in which this disease was growing so rapidly, the answer was because most of the people who occupied the positions, most of them women, were highly desirable. There was a cultural issue with which we really were not able to deal. It was apparent, absolutely clear, that simply educating people about the way in which you get this disease did not in fact change behaviors.

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    Now, I wish that there was something in this bill—when we talk about authorizing AID to carry out education, awareness and prevention programs, I wish we could be a little bit more definitive about what we mean about education programs, specifically, programs that work, if they are out there.

    I will be the first one to tell you, I do not know what they are, because I would have relied upon the conventional wisdom that simply bringing education to people about how HIV/AIDS is contracted, would be something to prevent the spread of the disease. I believed that that was the course we should take and I, of course, would have been very enthusiastic about providing support to increase that activity, the activity of education.

    If that is not the case, then simply adding the word education to this bill—I know it makes us feel good, it is certainly one of those salving things—we can then argue about what is the right level. We can attack the Administration and all that, which is always enjoyable and fun, but the reality is we will pass this bill, no doubt, and Ms. Lee will still have to be as diligent as she has been in the past in fighting the spread of this disease because it will not prevent the spread of the disease. That is what they told us in the Committee hearing that we had here, and that is the testimony that was provided.

    Now, we can simply ignore it, which we have done, because we have no other idea what to do and I cannot tell you that I have a solution here. I can just tell you that we are providing false hope to think that all the efforts in ''education'' will have some positive effect on the rising rates. That was not the testimony we had in front of our Committee at the time, and until we find out exactly what we can do to prevent that, I am loathe to support increased funding.

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    Thank you, Mr. Chairman.

    Mr. HYDE. Ms. Napolitano of California?

    Ms. NAPOLITANO. Thank you, Mr. Chairman. I respectfully disagree with my colleague because education is one of the strongest ways of being able to deal with issues such as this, at least part of the solution.

    I do share the same sentiments as my other colleagues and Members of this Committee; and those same sentiments are shared by millions of Americans, many in my area. We cannot continue to turn our backs on the poor and the helpless people around the world whose dreams of a productive life have been shattered by the HIV/AIDS pandemic. We also can no longer turn our backs on the millions of children that are left homeless because of this HIV/AIDS pandemic.

    We are the richest country in the world and we have a moral obligation. We must continue to take the leadership role in this battle against this indiscriminate killer that has turned out to be scourge of the world. We are taking action today which has been long overdue, and it does also signal to the rest of the world that we take our moral and financial obligations seriously.

    I do commend my colleagues for their fine leadership of this Committee: Chairman Hyde, our Ranking Member, Tom Lantos, and Barbara Lee, a colleague of mine from California, for taking the leadership in this important issue. Hopefully we will be able to make a dent and continue to address this issue.

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    I yield back the balance of my time.

    Thank you.

    Mr. HYDE. I thank the gentlelady.

    Mr. Smith of Michigan?

    Mr. SMITH. Thank you, Mr. Chairman.

    Earlier, there was a comment that if we had not had a tax reduction we could have more money to do good things. I would just respectfully suggest that historically in the United States we have not exceeded 18 percent of total earnings as a budget for the Federal Government, so it would seem to me that there is some reasonable level that we tax people.

    Right now, the average taxpayer in Michigan is paying 41 cents out of every dollar they earn in taxes at the local, state and national level. So it should be a question of not just simply continuing to increase taxes because we can find a use for the money, it should be a prioritization of those funds that represents a reasonable level of taxation. Personally, I think 18 percent of GDP for the Federal level is reasonable.

    In this particular case, I also have a concern that the money be effectively spent. I happen to chair the Research Subcommittee of the Science Committee, and to the extent that this expanded fund takes away from research and the National Science Foundation, research in NIH that might develop the kind of vaccines and medications that help cure HIV/AIDS or malaria or tuberculosis, then it becomes a balance that this Committee needs to also consider.

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    I thank you, Mr. Chairman and Mr. Lantos, for allowing a slight change at least in the sense of Congress that we do not diminish our efforts in malaria and tuberculosis, which are greater killers in the world, even though those with HIV/AIDS succumb to these diseases also. But we now have language on page 11, line 12, that says we need to include our efforts in tuberculosis, malaria and other infectious diseases along with our total efforts in HIV/AIDS.

    And so I echo the concern of Mr. Bereuter that we also look at the effect of spending and how this is going to be handled. I have reservations whether we should be setting up a new bureaucracy in the United Nations to do this; and I hope we can do it through the World Bank, as it has already established some credibility in effectively handling this kind of fund.

    I yield back.

    Mr. HYDE. I thank the gentleman.

    Mr. Schiff of California?

    Mr. SCHIFF. Thank you, Mr. Chairman.

    I would like to begin also by acknowledging the work that you have done, Mr. Chairman, along with Ranking Member Lantos and Barbara Lee's continuing strong leadership in this area.

    Ten years ago when scientists predicted the possible growth of the epidemic of AIDS, few believed them. None wanted to believe them and few would believe them. Even now, the numbers are so staggering that it is difficult to gather our thoughts and our minds and our recognition of the size of this tragedy.

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    Attacking this problem is a moral imperative. The loss of life, the orphaning of countless, countless children around the world, makes this a moral imperative for this country. We are citizens of the world.

    It would be a moral imperative even if the United States were not impacted, but, of course, we are. We are impacted here at home with infection rates that are intolerably high. We are affected with loss of life here at home, with tragedy here at home. And we are also impacted by its impact on nations around the world, the problem of the growth of AIDS in Russia and the destabilization in that country, the crumbling of economies because of the health care costs associated, all of this has a very direct impact here at home as well.

    In light of this moral imperative, in light of this very direct tragic impact on all of us, no effort is too great. To those who prophesy 10 years from now the growth of this pandemic, I say only our tireless efforts now can prevent that reality from taking place.

    Again, Mr. Chairman, I want to thank you and the other Committee Members. I will also be joining Barbara Lee and others in continuing to make sure that this is the first step, that we push harder and harder, more and more, to deal with this almost incomprehensible tragedy.

    Thank you, Mr. Chairman.

    Mr. HYDE. Thank you.

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    The gentleman from Arizona, Mr. Flake.

    Mr. FLAKE. Thank you, Mr. Chairman.

    I want to also thank the Chairman and Ranking Member for their work on this bill. I have spent 3 years of my life in southern Africa, and it just breaks my heart to see what is happening there with this epidemic.

    I am supportive of AIDS funding for Africa. I believe, as my colleague from California mentioned, it is a moral imperative, but we also have a moral imperative as Members of Congress to stay within the budget guidelines that we have set. It worries me that this is $200 million over the President's request and that there are no offsets spelled out as yet. So I wish that I could support it, but I cannot on that basis.

    Thank you.

    Mr. HYDE. Ms. Watson of California?

    Ms. WATSON. Mr. Chairman and the Ranking Member, and Congresswoman Barbara Lee, I, too, want to thank you on this piece of legislation. Just a question which alludes to Mr. Bereuter's statement.

    The bill says a 1-year authorization. I am looking at page 11, lines 6 to 8, for fiscal years 2002, 2003. Since there is a mechanism required in the bill to set up the apparatus, can we roll the money over into a subsequent fiscal year if we cannot distribute the money in a timely fashion within that year? Is there language that would allow the distribution at which time these mechanisms are set up, if the time exceeds the fiscal year 2003?

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    Is there someone that can respond?

    Mr. HYDE. I am informed by staff that you are looking at the original unamended version, and that this is a 1-year authorization and we will not have to roll it over.

    Ms. WATSON. If the money cannot be distributed within that given time, within that year's time, can it still be used?

    Mr. HYDE. It is available until expended.

    Ms. WATSON. Thank you very much.

    Mr. HYDE. Very well.

    Mr. Rhorabacher?

    Mr. RHORABACHER. Thank you very much.

    I am inclined to help people who are going through a major crisis in Africa or anywhere else. If there are volcanos going off or things like that, if people are dying by the tens of thousands, and in this case the millions, then I do think we have an obligation, a moral obligation to try to help people out.

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    However, and I hate to say this, but it seems to me after looking at what we are talking about, we are trying to provide money to help people die with dignity. I hope that what we are trying to do with this money is more than that, but it may not be.

    But even that, by the way, might be a laudatory goal, if people are going to have to go through pain and agony and torture for a year of their life before they pass away, to help them. I would hope that for this bill—because even right now, we know there is no cure for AIDS right now.

    With that said, let me say one more thing. I am concerned that quite often we have a habit in this Congress of posturing ourselves with legislation that will prove that we care about people.

    I think the budget process, although it is often not explained in this way, proves whether or not we really care about people. The budget process tells people that we have a high priority over the things that we are talking about. If we do have a high priority of helping those people in Africa who are infected with AIDS, to try to give them some relief, to try to find a cure, to try to help them get through this crisis, then we will find offsets for this money in the budget.

    I agree with my friend Mr. Flake, who is trying to be responsible. Unless there is something that says this money is coming from somewhere else, all of the rhetoric about caring so much about people is nothing more than rhetoric. We have to put both our money where our mouth is and where our hearts are, and we know in the foreign aid budget that a huge chunk of the foreign aid budget goes to two countries: Egypt and Israel.

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    Now, are we going to take some money out of that account, or take some money from another account where we do not believe the money is being as well spent or would have as good a humanitarian impact and allocate it for this $500 million?

    I would be very interested in supporting that, but it seems to me that until we actually are responsibly approaching the problem by actually finding out where the money is coming from that all the talk about caring is irrelevant.

    So I would just challenge my colleagues, let us find out where the money is coming from, let us put the money in there from a real source, let us set our priorities and say our priorities are helping people of Africa through this terrible crisis they are in, and if we do that, then you will have my support.

    If it is just that we are going to supposedly get money out of nowhere and not going to be taking into consideration the budget restraints that we are under, well, then that is not responsible.

    Thank you very much, Mr. Chairman.

    Mr. HYDE. I thank the gentleman and very briefly would suggest that when the gentleman talks about Africa he forgets the Caribbean: Haiti, where 13 percent of the adults are infected, growing by 2 percent annually; Jamaica, 7 percent; the HIV rate in South America, 10 percent in Brazil. This is a worldwide threat and it can be and will be a matter of national security.

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    So I think the Appropriations Committee has the responsibility of finding the money for this. The budget is a matter of priorities, what is first, what is second and what is third. Somewhere in that list of priorities, the latter-day Bubonic Plague which is sweeping Asia, India, Africa and the world, has to be addressed and I do not want to look the other way when we have an opportunity to do something.

    Mr. Payne of New Jersey?

    Mr. PAYNE. Thank you very much, Mr. Chairman.

    I certainly applaud you for the statement that you just made and I could not agree with you more. I would like to commend you and Mr. Lantos, and of course Mr. Leach and Ms. Lee, for relentlessly pushing this issue.

    I think there are several things that have been mentioned. One, my good friend from Colorado talked about education and that education is perhaps not necessarily working.

    Senegal, because of a strong education program, has less than a 2 percent rate of infection because they dealt with education. And education is more than saying this is a sexually transmitted disease. Education says that that is the way it is spread, but then the education processes go into different ways in which you go toward preventing the disease. You talk to people in local communities and they talk about customs or habits or behaviors, and education goes to changing these ways.

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    That happened in Uganda, where there has been a leveling off and actually a decrease. I sat with President Museveni for several years in a row urging him to change the policy of the country that would not allow condoms to be mentioned publicly or for it to be published anywhere. After strong opposition, he eventually told me that he was changing the policy and that they were going to allow condoms to be introduced and other educational programs and the behavior changes through education.

    So education is not just to say AIDS is sexually transmitted, and you leave. It goes beyond that. And so I think there is a misnomer of what the education process is that Mr. Tancredo mentioned.

    Also, I hate to see the money taken from research because I do think that we need to have funds to come up with a prevention—a vaccine. I think the tragedy is that we have to say it has to be taken away from research. We should have the money for research and for this project, too. I think the whole budget process is flawed.

    It makes no sense that we are giving $2 trillion back, when my friend has this moral indignation that we have this responsibility to the people of America and therefore we cannot afford this money because we are elected to keep the integrity of the budget process. It is absolutely ludicrous, insane and immoral that people are talking about the integrity of the budget process. What caused a $319 billion military budget to be increased last week by $8.9 billion, making it $330 billion, which will be $400 billion in the next 2 or 3 years? Because that is the effect of China bringing a plane down? So what is the moral high ground for that?

    We will spend more money on defense next year than the 189 members of the United Nations will spend in the next decade. And we are talking about not having the money to spend to save lives in a pandemic that is going to take the whole world over?

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    It is flawed. It is immoral and it makes no sense for people even to take this high ground that we do not have the money.

    I yield back the balance of my time.

    Mr. HYDE. The gentleman from New Jersey, Mr. Mendendez, who will be the final speaker, and we will then try to move the bill. So, please, do not anybody leave the room. Lock the doors.

    Mr. Menendez.

    Mr. MENENDEZ. Thank you, Mr. Chairman, and I will try to expedite it so that we do not lose anyone.

    Let me applaud your efforts along with the Ranking Democrat and Ms. Lee for moving the bill at this stage and bringing to it the type of emphasis I think we need to send as a message worldwide, that we collectively believe in the necessity of addressing in a very serious and significant way the AIDS crisis.

    While we have certainly focused on the pandemic that has impacted the sub-Saharan region of Africa disproportionately, HIV infection rates are rapidly rising in India and other south Asian countries, in Brazil, in the Caribbean, in Russia. So they pose a serious threat, a very serious threat, to the security and stability in those countries and therefore should be of great concern to us.

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    This is not, in my mind, as some have suggested, simply an humanitarian gesture. This is an act in the national interests of the United States. And while we have spoken here in the context of Africa, the reality is that AIDS knows no borders, discriminates against no one. It ravages men and women, mothers and fathers, sons and daughters, children who did nothing to contract the virus.

    To believe that education does not and will not work is to deny in the first place that it has worked here at home, and there is no reason to believe that it cannot work abroad. It is to deny the reality that in fact U.S. volunteers with skills in health care and HIV/AIDS counselling and prevention programs have proven effective in combating the pandemic and can be a resource in assisting sub-Saharan Africa tribal leaders as well as other leaders of traditional political, business and youth organizations in their efforts to prevent the spread of AIDS through awareness and educational programs.

    It also would deny the view that if education and prevention is not worthy of funding, that ultimately we would be destined simply to provide resources for treatment and never to try to stem the tide, which would be clearly the wrong message to send and clearly the wrong path to take as public policy.

    So this is a multilateral attack. It is an attack, yes, directly in providing research and development. It is providing resources for treatment, but it must also be about education and prevention so that we do not destine people toward a greater possibility of contracting the virus.

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    So I think that those statements are wrong, and sometimes our problem is that we seek instant gratification in our public policy. We want to see something instantaneously turn the tide and if it does not, we do not stick with it very long.

    Well, in the fast paced society in which we live, there are certain things in public policy for which instant gratification just simply cannot be expected. You have to wait a bit to see the results of those efforts.

    So let me finally close by simply saying I appreciate the efforts being made here today. I do and will support the gentlelady from California in her efforts to increase the amount. I know that there is discussion as to whether it can be effectively used. I believe it can be effectively used.

    I believe it is an amount that is in the national interests of the United States and that ultimately would reap enormous dividends, not only in human lives, but also in terms of the challenges the United States will face at its borders in the future.

    So having said that, Mr. Chairman, I will be supporting the legislation, but look forward to supporting the gentlelady on the floor.

    I yield back the balance of my time.

    Mr. HYDE. The Chair recognizes the gentleman from New Jersey, Mr. Smith, for purposes of an amendment.

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    Mr. SMITH. Mr. Chairman, I do have an amendment at the desk.

    Mr. HYDE. The clerk will report the amendment.

    Ms. BLOOMER. Amendment offered by Mr. Smith. Page 5 after line 9, insert the following and redesignate subsequent paragraphs . . .

    Mr. HYDE. Without objection, further reading of the amendment is dispensed with.

    The gentleman is recognized for 5 minutes in support of his amendment.

    Mr. SMITH. Thank you very much, Mr. Chairman. I will be brief and would ask that my full statement be made part of the record.

    The amendment I am offering will enhance what is already an excellent piece of legislation, and I want to thank you as our distinguished Chairman, Mr. Hyde, for your extraordinary leadership and vision in authorizing this important piece of legislation. I want to thank Mr. Lantos and all of those on both sides of the aisle who will be supporting this bill.

    The amendment that I am offering today would expand the definition of treatment services in the bill to include an extremely important component of care that is often overlooked or simply non-existent because of scarcity of resources, and that is hospice and palliative care.

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    As we all know, the situation in many developing nations, particularly in sub-Saharan Africa, is so desperate that for most HIV/AIDS patients therapeutic treatment is simply not an option. Millions either do not have the funds to pay for treatment or they have been denied treatment because of the non-availability of medicine, and perhaps denial plays a part in precluding them from these very important medicines.

    These individuals usually die a slow, painful death. Many die alone, as the stigma and fear associated with dying of AIDS means that there are few persons who are available to wash, to provide them a drink of water, to turn them in bed and perhaps counsel them about their fears or concerns.

    Those who helped dying AIDS patients are usually untrained and they are ill equipped. For a majority of HIV/AIDS patients in Africa, institutional care facilities are often taxed to overflowing, so these individuals are sent home.

    My amendment seeks to expand a network of hospice and palliative care networks to help fill this enormous void. Currently, there are some networks in existence, some in South Africa, for example. I recently met with Bishop Kevin Dowling from the Diocese of Luxembourg as well as Sister Alison Monroe, the Director of the National AIDS Office of the South African Catholic Bishops Conference, and they told me and my staff some horror stories, but also some very hopeful stories about people who have been helped with a broad array of services, and also with the hospice care that they had provided.

    This amendment helps, I think, to further that important part of care, and I do hope that the Members will support it.

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    [The prepared statement of Mr. Smith follows:]

PREPARED STATEMENT OF THE HONORABLE CHRISTOPHER H. SMITH, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY

    The amendment I am offering will enhance what is already an excellent piece of legislation. The Smith amendment will expand the definition of treatment services in the bill to include an extremely important component of care that is often overlooked—hospice and palliative care.

    The situation in many developing nations—particularly in Africa—is so desperate that for most H1V/Al1DS patients, therapeutic treatment is simply not an option. They either do not have the funds to pay for treatment, or they avoided treatment because they have lived in denial of their condition until their symptoms have left them debilitated. These individuals often die slow, painful, deaths. Many die alone, as the stigma and fear associated with a dying HIV/AIDS patient means there are few persons there to help them wash, drink a glass of water, turn them in bed, and counsel them about their fears and concerns. Those who want to help dying HIV/AIDS patients are usually untrained and ill equipped.

    For the majority of HIV/AIDS patients in Africa, institutional health care facilities are packed to overflowing. So they are sent home. My amendment seeks to expand a network of existing hospice and palliative care networks to help fill this enormous void. There are many such networks in place in many African nations—particularly in South Africa. What these palliative care networks need is funding and support. They already have the manpower and the dedicated volunteers willing to do the work.

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    For example, the Good Shepherd Hospice in Middleburg, South Africa, helps train the home-based volunteers who do the bulk of the palliative care provided for most HIV/AIDS patients. There are four facilities where patients can receive treatment. But the impact of the Good Shepherd Hospice goes far beyond these four facilities. The key to their successful program is their training of volunteers, who fan out into the surrounding areas and provide care directly into the homes of suffering HIV/AIDS victims. The kind of palliative care we are talking about is very, very basic—but critical nonetheless to making sure that terminally ill patients are allowed to face the end with a measure of dignity and humanity. Thus, the volunteers will help patients with various household chores that the patients are too sick to take care of anymore, bathing the patient, cooking for them, cleaning their houses so that the risk of opportunistic infections are reduced, and providing needed companionship and counsel for patients facing a lot of fear and anxiety.

    The Smith amendment would allow for additional resources to expand efforts like those in South Africa. There are literally hundreds, if not thousands, of similar institutions and programs across the African continent. I have had the honor of meeting with Bishop Kevin Dowling, of the Diocese of Rustenberg, as well as Sister Allison Munro, Director of the National AIDS Office of the South African Catholic Bishops Conference. Both told me horror stories about the crying need for all kinds of care—including palliative and hospice care.

    Bishop Dowling and the Catholic Relief Services desperately need additional resources and support for their vital work and compassion. The Smith amendment helps provide a mechanism by which these organizations and individuals can leverage their resources—both human and financial—to the maximum extent. The hub and spoke approach often used by hospice and palliative care networks in Africa means that each dollar goes far. Unlike many well-intentioned medicine programs, where the drugs sit in warehouses and do not get to the people who need them, hospice and palliative care programs are grass-roots oriented. The networks are already there. We do not need to create them.

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    I urge you to support the Smith amendment.

    Mr. HYDE. The gentleman from California, Mr. Lantos?

    Mr. LANTOS. Thank you, Mr. Chairman.

    Before commenting on my colleague's amendment, may I ask unanimous consent that a statement by Mr. Crowley be inserted in the record?

    Mr. HYDE. Without objection, so ordered.

    [The prepared statement of Mr. Crowley follows:]

PREPARED STATEMENT OF THE HONORABLE JOSEPH CROWLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK

Mr. Chairman, I am pleased to support the Hyde-Lantos-Lee compromise amendment.

It is hard to ignore the pressing issue of the global HIV/AIDS pandemic and it is hard to deny that the resources required to address this catastrophic health crisis are sizable. The compromise amendment is a good beginning.

HIV/AIDS does not discriminate. It affects young and old, women and men, mothers and fathers, rich and the poor.

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Five young adults between the ages of 15–29 contract HIV/AIDS every minute. It is projected that more than half of today's teenagers in the developing world will become infected and die of AIDS. In Africa, 6 out of 7 children who are HIV positive are girls.

In fact, women and children of all ages are bearing the brunt of the pandemic. Women
often cannot protect themselves because of cultural stigmas and stereotypes.

Moreover, women also become the primary caretakers of family members infected with HIV/AIDS, which not only strains them physically, but also places them more at risk of being infected.

Over 13 million children across the globe have lost one or both of their parents to AIDS. By 2010, it is estimated that approximately 40 million children worldwide will have experienced the death of one or both of their parents.

AIDS orphans contribute to economic decay, social fragmentation, and political destabilization.

Children without care or hope are often targets for prostitution, crime, drug abuse, or child soldiery. Therefore, the HIV/AIDS pandemic is related to economic, developmental, and social problems.

This compromise measure is a good first step toward addressing the global HIV/AIDS pandemic.

I applaud the efforts of my colleagues to reach a compromise that nearly doubles our support for USAID's AIDS programs and provides a significant authorization for the global health and HIV/AIDS fund.

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In addition, I am pleased that we are moving forward in our ability to provide care and treatment to the millions of people suffering from HIV/AIDS with a $50 million authorization for AID to work with countries to purchase and distribute medicines.

But, we must also continue to provide increases to the other global health programs if we hope to make a difference in the lives of those living in the developing world. For example, 10 million children die every year before their fifth birthday of preventable infectious diseases, such as pneumonia.

In addition, millions of women will give birth in the developing world and maternal health programs are a great entry into their health care world.

With 62 of my colleagues, I have introduced H.R. 1269, the Global Health Act, which seeks to increase funding for all of these programs.

Many of my colleagues on this committee are co-sponsors of the bill, and I look forward to working with this committee to put needed attention on the other health problems as well.

I think it is especially fitting that we are approving this bill on the last day of the UN Special Session on AIDS that is taking place in New York.

As the world's leader on global health spending, we are further strengthening our commitment to these programs today in a bipartisan

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    Mr. LANTOS. Mr. Chairman, I want to commend my good friend and colleague from New Jersey, and I strongly support his amendment. Hospice is one of the most underrated and most significant institutions in all societies.

    We have to recognize, Mr. Chairman, that as we try to prevent HIV/AIDS and search for treatment and cures, millions of individuals will die. Those individuals deserve to leave this life with dignity. The family members who are in charge of their care need support during the final months or days or hours of life.

    HIV/AIDS is affecting millions of people who are living in countries and cultures where western hospital-based death is neither affordable nor feasible nor desirable. People die with their family present and they are buried among their ancestors. This is an important and singularly sensitive amendment to the substitute bill, and I encourage all of my colleagues to support this without reservations.

    Mr. HYDE. I thank the gentleman.

    I commend the gentleman from New Jersey for offering his compassionate amendment and encourage its adoption.

    If there is no further discussion, the question occurs upon the amendment offered by the gentleman from New Jersey.

    All in favor, say aye.

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    [Chorus of ayes.]

    Mr. HYDE. Opposed, nay.

    [No response.]

    Mr. HYDE. The ayes have it and the amendment is agreed to.

    Are there any further amendments?

    [No response.]

    Mr. HYDE. If not, the question occurs on the amendment in the nature of the substitute as amended.

    All in favor, say aye.

    [Chorus of ayes.]

    Mr. HYDE. Opposed, nay.

    [No response.]

    Mr. LANTOS. Mr. Chairman?

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    Mr. HYDE. Yes?

    Mr. LANTOS. Mr. Chairman, I request a recorded vote.

    Mr. HYDE. The question occurs on the amendment in the nature of the substitute as amended.

    All in favor, say aye.

    [Chorus of ayes.]

    Mr. HYDE. Opposed, nay.

    [No response.]

    Mr. HYDE. The ayes have it. The amendment is agreed to.

    The question occurs on the motion to report the bill, H.R. 2069, favorably as amended.

    The gentleman from California has requested a rollcall.

    The clerk will call the roll.

    Ms. BLOOMER. Mr. Gilman?

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    Mr. GILMAN. Aye.

    Ms. BLOOMER. Mr. Gilman votes yes. Mr. Leach?

    Mr. LEACH. Yes.

    Ms. BLOOMER. Mr. Leach votes yes. Mr. Bereuter?

    Mr. BEREUTER. Aye.

    Ms. BLOOMER. Mr. Bereuter votes yes. Mr. Smith?

    Mr. SMITH. Aye.

    Ms. BLOOMER. Mr. Smith votes yes. Mr. Burton?

    [No response.]

    Ms. BLOOMER. Mr. Gallegly?

    Mr. GALLEGLY. Yes.

    Ms. BLOOMER. Mr. Gallegly votes yes. Ms. Ros-Lehtinen?

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    [No response.]

    Ms. BLOOMER. Mr. Ballenger?

    Mr. BALLENGER. No.

    Ms. BLOOMER. Mr. Ballenger votes no. Mr. Rohrabacher?

    Mr. ROHRABACHER. I abstain for now.

    Ms. BLOOMER. Mr. Royce?

    Mr. ROYCE. Aye.

    Ms. BLOOMER. Mr. Royce votes yes. Mr. King?

    [No response.]

    Ms. BLOOMER. Mr. Chabot?

    [No response.]

    Ms. BLOOMER. Mr. Houghton?

    Mr. HOUGHTON. Yes.

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    Ms. BLOOMER. Mr. Houghton votes yes. Mr. McHugh?

    [No response.]

    Ms. BLOOMER. Mr. Burr?

    Mr. BURR. Aye.

    Ms. BLOOMER. Mr. Burr votes yes. Mr. Cooksey?

    [No response.]

    Ms. BLOOMER. Mr. Tancredo?

    [No response.]

    Ms. BLOOMER. Mr. Paul?

    Mr. PAUL. No.

    Ms. BLOOMER. Mr. Paul votes no. Mr. Smith?

    Mr. SMITH. Yes.

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    Ms. BLOOMER. Mr. Smith votes yes. Mr. Pitts?

    [No response.]

    Ms. BLOOMER. Mr. Issa?

    Mr. ISSA. Aye.

    Ms. BLOOMER. Mr. Issa votes yes. Mr. Cantor?

    Mr. CANTOR. Yes.

    Ms. BLOOMER. Mr. Cantor votes yes. Mr. Flake?

    Mr. FLAKE. No.

    Ms. BLOOMER. Mr. Flake votes no. Mr. Kerns?

    Mr. KERNS. No.

    Ms. BLOOMER. Mr. Kerns votes no. Ms. Davis?

    Ms. DAVIS. Aye.

    Ms. BLOOMER. Ms. Davis votes yes. Mr. Lantos?

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    Mr. LANTOS. Aye.

    Ms. BLOOMER. Mr. Lantos votes yes. Mr. Berman?

    [No response.]

    Ms. BLOOMER. Mr. Ackerman?

    Mr. ACKERMAN. Yes.

    Ms. BLOOMER. Mr. Ackerman votes yes. Mr. Faleomavaega?

    [No response.]

    Ms. BLOOMER. Mr. Payne?

    Mr. PAYNE. Aye.

    Ms. BLOOMER. Mr. Payne votes yes. Mr. Menendez?

    Mr. MENENDEZ. Aye.

    Ms. BLOOMER. Mr. Menendez votes yes. Mr. Brown?

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    Mr. BROWN. Aye.

    Ms. BLOOMER. Mr. Brown votes yes. Ms. McKinney?

    [No response.]

    Ms. BLOOMER. Mr. Hilliard?

    Mr. HILLIARD. Aye.

    Ms. BLOOMER. Mr. Hilliard votes yes. Mr. Sherman?

    Mr. SHERMAN. Yes.

    Ms. BLOOMER. Mr. Sherman votes yes. Mr. Wexler?

    Mr. WEXLER. Yes.

    Ms. BLOOMER. Mr. Wexler votes yes. Mr. Davis?

    [No response.]

    Ms. BLOOMER. Mr. Engel?

    Mr. ENGEL. Aye.

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    Ms. BLOOMER. Mr. Engel votes yes. Mr. Delahunt?

    Mr. DELAHUNT. Yes.

    Ms. BLOOMER. Mr. Delahunt votes yes. Mr. Meeks?

    Mr. MEEKS. Yes.

    Ms. BLOOMER. Mr. Meeks votes yes. Ms. Lee?

    Ms. LEE. Aye.

    Ms. BLOOMER. Ms. Lee votes yes. Mr. Crowley?

    Mr. CROWLEY. Yes.

    Ms. BLOOMER. Mr. Crowley votes yes. Mr. Hoeffel?

    [No response.]

    Ms. BLOOMER. Mr. Blumenauer?

    [No response.]

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    Ms. BLOOMER. Ms. Berkley?

    Ms. BERKLEY. Yes.

    Ms. BLOOMER. Ms. Berkley votes yes. Ms. Napolitano?

    Ms. NAPOLITANO. Yes.

    Ms. BLOOMER. Ms. Napolitano votes yes. Mr. Schiff?

    Mr. SCHIFF. Aye.

    Ms. BLOOMER. Mr. Schiff votes yes. Ms. Watson?

    Ms. WATSON. Aye.

    Ms. BLOOMER. Ms. Watson votes yes. Mr. Hyde?

    Mr. HYDE. Aye.

    Ms. BLOOMER. Mr. Hyde votes yes.

    Mr. HYDE. Mr. McHugh?

    Mr. MCHUGH. Aye.

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    Ms. BLOOMER. Mr. McHugh votes yes.

    Mr. HYDE. Have all voted who wish?

    Ms. BLOOMER. Mr. Rohrabacher?

    Mr. ROHRABACHER. I abstain.

    Ms. BLOOMER. Mr. Rohrabacher abstains.

    Mr. HYDE. The clerk will report.

    [Pause.]

    Mr. HYDE. Mr. Hoeffel, would you care to be recorded?

    Mr. HOEFFEL. Yes. I vote yes.

    Mr. HYDE. Mr. Hoeffel votes in the affirmative.

    Ms. BLOOMER. Thank you.

    [Pause.]

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    Mr. HYDE. The clerk will report.

    Ms. BLOOMER. On this vote, there were 32 ayes and four noes.

    Mr. HYDE. The ayes have it, and the motion to report favorably is adopted.

    Without objection, the Chairman is authorized to move to go to conference pursuant to House Rule 22 and, without objection, the staff is directed to make any technical and conforming changes.

    We have one more bill to go, folks, so please do not leave.

    I ask unanimous consent that a motion to report H. Con. Res. 168 favorably be considered as adopted.

    [The prepared statement of Mr. Hyde follows:]

PREPARED STATEMENT OF THE HONORABLE HENRY J. HYDE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS, AND CHAIRMAN, COMMITTEE ON INTERNATIONAL RELATIONS

    I want to thank and congratulate Ileana Ros-Lehtinen, the Chairman of the Subcommittee on International Operations and Human Rights, on this thoughtful and timely resolution declaring the support of Congress for torture victims here in the United States and around the world. As the resolution points out, torture is an unspeakable act not just because it is inherently evil, but also because it is used by repressive governments to resist freedom and democracy by eliminating natural leaders and by intimidating the general public.

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    Torture is designed to dehumanize people. It turns them into objects, and thereby attempts to deny the essential truth that every human being is created in the image and likeness of God.

    In recent years Congress has adopted important legislation on the subject of torture victims, almost all of which originated in this Committee. In 1998 we enacted the Torture Victims Relief Act, whose principal sponsor was the Vice Chairman of our Committee, Representative Chris Smith, and which authorizes assistance for care and rehabilitation for torture survivors in the United States and around the world. In 1999 we reauthorized and expanded the authorities in the Torture Victims Relief Act.

    Later that same year, as part of the Foreign Relations Authorization Act for fiscal years 1998 and 1999, Congress implemented the provision of the United Nations Convention Against Torture that prohibits forcibly returning people to places where they face a likelihood of torture. This is a record of which our Committee and the whole Congress can be proud.

    House Concurrent Resolution 168 reiterates our determination to stand with these brave people and against those who have brutalized them. I strongly recommend its passage.

    Mr. HYDE. Without objection, so ordered.

    Without objection, any Member may place his or her remarks in the record of today's proceedings.

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    The Committee stands adjourned.

    [Whereupon, at 12:10 p.m., the Committee was adjourned.]





A P P E N D I X

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PREPARED STATEMENT OF THE HONORABLE EARL BLUMENAUER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF OREGON

    Mr. Chairman, I would like to thank you and the Committee for bringing legislation to help combat the global HIV/AIDS crisis before the Committee for consideration. I am pleased that the Committee has reached a consensus on both the policy-related language in this bill and the necessary funding levels.

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    The United States has a duty to recognize both the severity of the global HIV/AIDS epidemic, and our own humanitarian interest in treating and preventing the spread of this disease. Comprehensive action by the international community is needed and the United States, as the nation with the greatest productive capacity, must play a lead role. U.N. Secretary General Kofi Annan has called on the global community to help provide $7 to $10 billion annually for direct assistance, and I believe that the level of funding provided for treatment and prevention in this bill is a step in the right direction.

    As we all know, the statistics on this disease are frightening. More than 25.3 million adults and children in sub-Saharan Africa are infected, and an estimated 17 million Africans have died from AIDS, 2.4 million people in the year 2000 alone. The disease has lead to a dangerously high number of orphaned children worldwide, 6.5 million children today—a number that could rise to 15 million by the year 2010. In addition, in 1997, 41 percent of all HIV/AIDS cases worldwide were women, and in just three years this figure has climbed to 47 percent. In sub-Saharan Africa, 55 percent of people who test positive are women.

    The HIV/AIDS crisis is just the tip of the iceberg for health in developing nations. There are a startling number of treatable and preventable diseases and severe health problems affecting primarily developing nations worldwide. Malaria is now one of the top three deadly diseases worldwide; measles kills nearly one million children a year in developing nations, and treatment of TB has faltered because of inconsistent treatment and monitoring. Hepatitis B, worms and a retrovirus that kills 600,000 children are also among the problems that health care workers are still tackling. While the cost of treating a single HIV/AIDS patient in sub-Saharan Africa is estimated to cost $1,100 annually, providing vaccinations for children costs a few pennies and saves over three million lives every year. Both are equally important endeavors. In addition to focusing our attention on the HIV/AIDS pandemic, we must ensure that the fight against other equally deadly health problems in sub-Saharan Africa continues.

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    The task of building communities that are safe, healthy and economically secure at home and abroad cannot be achieved when a disabling portion of our global population is sick, orphaned or dying. The HIV/AIDS pandemic is affecting all races, all ages and all nations, and we must all work together to solve this serious public health crisis. I thank the Chairman and urge my colleagues to support this bill.



PREPARED STATEMENT OF THE HONORABLE BENJAMIN A. GILMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK

    Mr. Chairman, I am proud to be a co-sponsor of H.Con. Res 168, which expresses solidarity with the victims of torture. While we are sheltered from these kinds of monstrous abuses of state power in our country, we must never remain indifferent to the fact that torture is still used as a political instrument in many parts of the world.

    As the Resolution points out, its effects remain with the victims everyday of their lives even if they find freedom outside their native countries. Torture also victimizes the children of these survivors.

    Let the U.S. Government, including the Congress, the media, and non-governmental organizations, continue to shine their light on these grotesque abuses until they are eradicated from the entire world and relegated to a distant nightmare.

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I commend my colleagues for this effort.