Health Action AIDS

PEPFAR Reauthorization Update

PEPFAR reauthorization bills have been introduced into both houses of US Congress (the House of Representatives and the Senate). The two bills, one in the House and one in the Senate, differ slightly and were quickly approved with strong bipartisan support in initial foreign affairs committees. They now face consideration by the full House and Senate. If each is approved, then a compromise bill will be hammered out between representatives of both houses of Congress. The compromise bill will then be sent to President Bush to sign in to law.

Both the House and Senate versions of the bill could still be amended; the process is continuing throughout the month of March, 2008 and is expected to continue at least into April, 2008.

President Bush originally proposed that PEPFAR reauthorization be funded at $30 billion over five years, but PHR and other advocates have successfully pushed that amount to $50 billion over five years. It now looks like the bill may pass at this much higher level; a huge achievement that will benefit  people living with HIV.

Both the House and Senate versions of PEPFAR 2 would greatly strengthen programs for women and girls, who comprise 61% of adults with HIV in sub-Saharan Africa and as many as 75% of young people in the region. The bill would support interventions that elevate the status of women, like promoting basic education and the property and inheritance rights of women.

PHR is concerned, however, that the House bill will limit the integration of family planning services with HIV testing and counseling services.  Vague language in the bill appears to limit PEPFAR funding only to family planning groups which comply with the "global gag rule" prohibiting provision of or referral to abortion services. The Senate bill does not even mention the need for integration of HIV services with family planning.  And language in both bills, while different from PEPFAR 1, still allows substantial funding of abstinence-only programs that have been shown to be ineffective. In addition, both bills continue the US mandate that groups receiving PEPFAR funding sign a statement opposing prostitution, which prevents some groups from addressing the needs of marginalized sex workers who are vulnerable to AIDS.

PHR has been a leader in advocating for remedies for Africa's health worker shortage, and both versions of the bill would train and retain 140,000 new African health workers. The US's fair share of health workers needed to achieve universal access to HIV programs. We are calling, however, for PEPFAR to support at least 140,000 health professionals (nurses, doctors, clinical officers).  Many more health workers are needed, but we want the reauthorized PEPFAR program to at least train, retain and support a corps of new health professionals in addition to other health workers, such as community health workers. PHR is advocating for lawmakers to change the language so that there is no room for confusion.

In keeping with PHR's recommendations, both versions of the bill would provide U.S. technical support for countries so that they could develop five year plans to address their health worker shortages and overall health systems issues. The US would also provide technical assistance for countries that seek to strengthen their health workforces and would help them track and better utilize the health workers they do have.

Both bills would also explicitly support safer working conditions for health workers, who often must tend to sick patients without masks, gloves, or other basic equipment.

An important element of the Senate version of the bill is a provision that would lift the ban on travel to the US by people living with HIV/AIDS. There is currently a waiver system by which some people can overcome the ban, but such waivers can be time consuming and difficult, if not impossible, to obtain.

PHR's members and allies in the US, Uganda, and Kenya have played a critical role in building political pressure to end the ban. Late in 2007, they wrote hundreds of letters to US officials calling for the ban to be lifted. This pressure, coupled with pivotal PHR-organized press coverage, lead to the introduction of language that would lift the ban in the Senate's PEPFAR reauthorization bill.