UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA ACT OF 2003
(Senate - May 15, 2003)

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[Pages S6415-S6421]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                              ACT OF 2003

  Mr. FRIST. Mr. President, I ask unanimous consent that the Senate now 
proceed, as under the order, to the consideration of H.R. 1298, until 
the hour of 2 p.m. today.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The legislative clerk read as follows:

       A bill (H.R. 1298) to provide assistance to foreign 
     countries to combat HIV/AIDS, tuberculosis, and malaria, and 
     for other purposes.

  The PRESIDING OFFICER. The majority leader.
  Mr. FRIST. Mr. President, the first speaker on the global HIV/AIDS 
bill will be the chairman of the Foreign Relations Committee, Senator 
Lugar, who has done yeoman's work in getting us to this point.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. LUGAR. Mr. President, I thank the Chair for the recognition, and 
likewise I appreciate the majority leader giving us this hour of 
debate, because today it is very important the Senate consider the 
global HIV/AIDS bill.
  For the past year, intense discussions have occurred in Congress and 
between the executive and legislative branches on how our country can 
best respond to the global AIDS crisis.
  In June 2002, the Foreign Relations Committee unanimously approved an 
HIV/AIDS bill, initially introduced by Senators Frist and Kerry, with a 
large bipartisan group of co-sponsors. The Senate unanimously passed 
that bill. However, the House of Representatives failed to act on it 
before the end of the 107th Congress.
  At the start of this Congress, the Foreign Relations Committee 
undertook at the request of the new majority leader to reintroduce the 
2002 Senate-passed bill, with some minor changes requested by the 
Department of State. In addition, we revised portions of the bill to 
take account of the President's AIDS initiative outlined in his 2003 
State of the Union Address.
  The Committee's efforts, therefore, incorporated many of the 
modifications requested by the White House, including the addition of 
new authorities for the Special HIV/AIDS Coordinator created by our 
legislation last year and incorporated in the President's AIDS 
initiative this year.
  Our efforts resulted in S. 1009, currently on the Senate calendar. 
Simultaneously, the House proceeded with its own bill to authorize the 
President's AIDS initiative. The House passed that bill last month, and 
it was placed on the Senate calendar.
  Many Senators, including myself, come to this debate with preferences 
on how a bill should be structured on this subject. Nevertheless, I 
share the majority leader's hope that the Senate will move quickly to 
pass the House bill before us so that HIV/AIDS funding will not be 
delayed any further and so President Bush can have an AIDS initiative 
in hand when he travels to the G-8 summit later this month of May. The 
House passed their bill by a vote of 375 to 41. It is a good bill 
worthy of the strong bipartisan support that it received.
  The United States must have partners in the effort to stop HIV/AIDS. 
Passage of this bill will maximize the President's ability to enlist 
other nations in the fight against AIDS. American leadership is as 
important as American contributions to this objective.
  We must be mindful of the President's recent observation that, ``Time 
is not on our side,'' in combating this disease. The global HIV/AIDS 
pandemic is a humanitarian crisis of horrific proportions. In Africa, 
nearly 10,000 people contract the HIV virus each day. The United States 
has a clear moral obligation, as the most powerful nation on earth, to 
respond generously and quickly to this crisis.

  But beyond our moral obligations, we should recognize that this bill 
is squarely in the self-interest of the United States and the American 
people. If we are to protect our national security and overcome 
terrorism, we must devote ourselves to strengthening democracy, 
building free markets, and encouraging civil society in nations that 
otherwise might become havens or breeding grounds for terrorists. We 
must seek to encourage societies that can nurture and fulfill the 
aspirations of their citizens and deny terrorists the uncontrolled 
territory and abject poverty in which they thrive.
  Few conditions do more harm to these objectives than the HIV/AIDS 
pandemic. It has imposed a crushing burden on the economies of numerous 
African nations; it has exacerbated undercurrents of political 
instability that weaken the fundamentals of responsible government; and 
it has destroyed millions of family units. Beyond the sick and the 
dead, the disease has created a generation of orphans, whose prospects 
for a fulfilling and productive life have been diminished by the loss 
of parents and other family members.
  The President has recognized the urgency of moving forward at this 
moment in history and has announced his support very solidly. He 
believes we need to fulfill our altruistic role in the world and to 
protect U.S. national security. We must join him in this effort by 
passing the bill before us.
  The House bill would authorize the President's Emergency Plan for 
HIV/AIDS Relief. This plan would provide $15 billion over the next 5 
years for AIDS care, treatment and prevention in those countries 
already facing an AIDS crisis and in those countries that have 
experienced a dramatic increase in the disease.
  The bill would establish the position of Coordinator for HIV/AIDS to 
ensure an effective approach by the various agencies of the U.S. 
Government involved in combating the global spread of AIDS.
  The bill also would provide the President with the discretion to 
devote up to $1 billion a year for the Global Fund to Fight AIDS, 
Tuberculosis, and Malaria. In an effort to generate foreign 
contributions to the global fund, the bill sets a ceiling for American 
contributions at one-third of total contributions. In other words, we 
hope to stimulate at least $2 in foreign contributions to the global 
fund for each

[[Page S6416]]

dollar contributed by the United States.
  The Senate can make history this week by passing this bill and 
sending the measure to the President for his signature. We should do so 
without delay.
  I add, finally, this thought to the debate. The President of the 
United States, during the ceremonies in which the new members of NATO 
were ratified by this body last week, and introduced to the public at 
the White House by the President, took aside Members who were there, 
and even at a historic moment in which we were discussing NATO, he 
discussed with us the HIV/AIDS legislation. He indicated that he was 
going to the summit of the G-8, that it is critical that other nations 
join us. It is critical today that we pass this legislation.
  But in order for the HIV pandemic to be arrested, other nations must 
be involved. The President emphasized to me and to others that his own 
advocacy, his own power in that meeting with regard to this issue, is 
dependent upon having a bill. In a very pragmatic way, the President 
indicated the House bill, which passed by a large majority, is a good 
bill. I suspect if the President were to offer all of his amendments, 
if I were to offer those I have already suggested in the Foreign 
Relations Committee, likewise the distinguished ranking member, Members 
of the House and the Senate, who have a variety of ways in which we can 
improve the situation, we could have a remarkable debate. As a matter 
of fact, we might have a substantial study of this situation for much 
of the rest of this Congress. Feelings are very strong on many of these 
issues.
  I am sensitive to this in many ways, having tried, as chairman of the 
Foreign Relations Committee, from the beginning of this year, to 
wrestle with this very piece of legislation and how we could bring it 
to fulfillment.
  The President's response to all of this is that the House has passed 
a good bill. Please pass the same bill without amendment. Please send 
it to me so I can sign it next week and take it in this month of May to 
the G-8 summit to make a powerful statement in behalf of the world and 
in behalf of our leadership.
  That has led to my course of action in which I have indicated to my 
colleagues that I intend to support the President. I intend to support 
this bill that is before us. I will oppose amendments to the bill 
because that will clearly complicate the process. A conference would be 
required. It is not clear how rapidly the conferees could either meet 
or come to conclusion, and we have a recess 1 week from now, which 
leaves the President in limbo without a bill.
  It is those considerations that I hope Members will keep in mind, 
will understand, and will in fact support. But at least I appreciate in 
this opening statement an opportunity to state my own convictions, my 
own course of action, and the leadership, at least in this body, that I 
advocate.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Bunning). The Senator from Delaware.
  Mr. BIDEN. Mr. President, I understand fully the situation of my 
friend from Indiana. As my colleague, Barry Goldwater--and we both 
served with him--used to say: In your heart you know we could have a 
better bill.
  But we have a time problem. We have a circumstance where the House 
had, frankly, thumbed its nose at us last time. We passed unanimously a 
bill which was much more significant than this bill, led by our 
majority leader and by my friend from Massachusetts, Senator Kerry. 
They put together a real robust, significant bill.
  This is a mere shadow of that bill in my view. But I end up almost 
the same place as my friend from Indiana, my chairman does. That is, 
you play the hand you are dealt. The House doesn't give a darn about 
this bill. Frankly, they are threatening if we add any amendments to 
just ditch it. So once again we are yielding to the lowest common 
denominator.
  The fact is, they have a whip hand right now. The fact is, I want the 
President to be able to have a bill when he goes to the G-8 because I 
believe he is committed to trying to get the rest of the world to do 
more than they are doing. He wants to be able, to use a phrase he likes 
to use, lay his cards on the table. He wants to be able to ante up and 
say: This is what I am ready to do. Now, what are you all going to do?
  I am willing to help him do that, even though this is not--this is 
not--the best bill. The best bill was the Kerry-Frist bill. That was 
the best bill we had, and we passed it. I think we voted it out 
unanimously last time. It was much more significant than the bill we 
have now. Then my friend and I, both faced with a similar dilemma, came 
along with what, a Lugar-Biden/Biden-Lugar bill, which was better than 
this bill.
  But I am not here to talk about that. I am here to say we need a 
bill. I want everyone to know we are trying our best. I hope the 
majority leader would attest to the fact I have been straight up with 
him. We want to add a couple of amendments. Frankly, we are going to 
have a rough road to hoe. I think we will get one--I hope so, because I 
think the House may accept it if it is added on--which I think is very 
important.
  Parochially, Senator Santorum and I, although he is not the one 
pushing it and I am--one is on the debt relief, which is something my 
friend from Indiana and I have worked on for years in various forums. 
And I think we should get the global AIDS fund up to that minimum 
threshold of $500 million.
  Last July, the Senate unanimously approved a bill initiated in the 
Committee on Foreign Relations by Senators Kerry, Frist, Helms and 
myself. It stalled in the other body. There was little interest 
expressed by the Bush administration, and the bill died.
  In January of this year, as one of the first orders of business, we 
began discussions in the Committee on Foreign Relations on moving 
forward on the Kerry-Frist-Helms-Biden bill. Unfortunately, each time 
we tried to proceed with the bill, the White House or the majority 
leader asked the chairman to delay, because the administration wanted 
more time to work on its proposal.
  We might have passed a very strong bill months ago. But we did not. 
Now we are told that time is up, that we must take up the House bill, 
and that we must not amend the House bill.
  I must say that I find it curious that we were asked to delay, and 
now we are told we cannot amend this bill. But I will return to that 
subject in a moment.
  HIV/AIDS is the worst epidemic that mankind has ever seen. It is a 
source of instability. It is highly damaging to economic development in 
some of the poorest countries of the world. It is a humanitarian 
disaster. It is, in short, a national security issue, and will be for 
the foreseeable future.
  It is right and proper that the Congress and the President work 
together to develop a comprehensive program of assistance.
  As the world's leading economic power, we have a responsibility to 
lead the world in fighting this plague. I commend the President for 
focusing attention on this important question. It has clearly helped us 
push this legislation toward the finish line.
  But now that we are nearing that finish line, I think we need to make 
a few modifications. The bill before us was passed by the House with, I 
am sure, the best of intentions.
  It does not, however, as the title suggests, provide leadership. I 
believe there is considerable room for improvement in the House-passed 
bill.
  I acknowledge that the bill does some useful things.
  First and foremost, it acknowledges the severity of the HIV/AIDS 
epidemic, and authorizes substantial funds over a 5 year period to 
address it--$15 billion over 5 years, to be exact. That's a heck of a 
lot of money, and well above the current budgets for these programs.
  It provides for a strategy, and a coordinator to pull together all 
the agencies working on this issue. These are all good things.
  Unfortunately, the House bill has several flaws.
  The bill gives no guidance on the amount of our contributions to the 
Global Fund. In Fiscal Year 2004, the bill authorizes ``up to'' $1 
billion. So it could be $1 or $1 billion. Which one is it? What do we 
really expect the Committee on Appropriations to provide? The 
President's budget requests just $200 million for the fund, which is 
far from adequate.
  For the remaining 4 years the bill, there is no specific amount set 
forth. It

[[Page S6417]]

merely authorizes ``such sums as may be necessary.'' This is an 
abdication of Congressional responsibility. It's like giving a 
contractor money to build a house without stating what you want the 
house to look like. Who would do something that unwise?
  I believe that it is our job to set priorities, and funding levels. 
The voice of Congress should be heard on this issue. There will be an 
amendment by one of our colleagues authorizing a responsible 
contribution of the fund.
  The House-passed bill does not deal with the issue of debt relief for 
countries suffering the burden of an AIDS epidemic.
  Last year the Senate-passed bill included a provision, authored by 
myself and Senator Santorum, extending increased debt relief to 
countries with a severe public health crisis such as AIDS. We should do 
no less this year.
  The House-passed bill contains language that I think is bad policy. 
It contains a requirement that one-third of all dollars devoted to 
prevention must be earmarked for abstinence-only until marriage 
programs.
  I am concerned that this limitation is impractical.
  I believe that the Agency for International Development and other 
agencies working on the ground are competent to decide how much money 
to spend on abstinence-only programs based on local conditions.
  We should not assign arbitrary percentages to one element of a 
comprehensive strategy to prevent the spread of AIDS without a 
rationale. How did the other body come to the conclusion that 33 
percent was appropriate? I do not know. I doubt that anyone does.
  There are other problems with the bill. Some are more serious than 
others.
  We will try, with a few amendments, to fix them in an expeditious 
way.
  The majority leader has suggested that we must not amend this bill 
because there is no time for a conference or for consideration by the 
other body. With all respect to the leader, I believe he is mistaken.
  The reconciliation bill we just passed will not go to conference. The 
leadership of both bodies intends to bring back the conference report 
on that bill before the recess. I can assure the leader that any 
conference on this bill would be far simpler than the conference on the 
reconciliation bill.
  Morever, the bill need not even go to conference--it could go through 
the House again, containing the amendments by the Senate. That happens 
all the time around here. There's no reason that action cannot be 
scheduled promptly--if the House leadership wants it.
  What the leader is really saying is this: we must be a rubber-stamp 
for the other body. We cannot amend it, not even one word, or else the 
bill will be in trouble.
  I simply don't believe that.
  The Senate has a duty to debate and vote on amendments. If you oppose 
amendments, vote them down. But don't vote them down because you think 
an amendment will doom the bill.
  Let us have a debate. We will do it quickly. We have no intention of 
delaying passage of this legislation. I urge my colleagues to support a 
limited number of amendments. Then we can send it to the other body, 
and get it to the President by the end of next week.
  Frankly, I feel a little bit like I was misleading the public at 
large, as if I were the leader on this subject. The leader on this 
subject has been Senator John Kerry, on our side of the aisle. So I 
would like, with the permission of my colleagues, to yield to Senator 
Kerry to make the substantive opening statement on this bill, since I 
will have an opportunity to manage it. Again, I compliment him and 
Senator Frist, who, frankly, were the emotional, political, and 
intellectual engines getting this going.
  If there is no objection, I yield the floor to my friend from 
Massachusetts.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KERRY. Mr. President, I am extraordinarily grateful, not just for 
the yielding by my colleague from Delaware, and my friend of many years 
here, but I am also very grateful for the comments he just made. I 
appreciate enormously his acknowledgment of the work that has gone into 
this legislation from the Foreign Relations Committee. Senator Frist 
and I did start this effort a number of years ago. In fact, we chaired 
a major bipartisan, frankly apolitical, completely nonpolitical effort 
nationally, bringing together most of the people involved in this issue 
for a long period of time to solicit from them their thoughts about the 
best way to try to put together, for the first time, a comprehensive 
approach to the issue of AIDS.
  The reason for wanting to make it comprehensive, obviously, is that 
everything else was failing. There was and is a sense of implosion in 
continents and countries as a consequence of what is happening.
  No country ever had the capacity to provide as much leadership or to 
provide as much resource as the United States of America to help to 
deal with this issue. It is good that we are at least on the floor of 
the Senate today for some brief period of time dealing with this 
question of the HIV/AIDS, Tuberculosis and Malaria Act which comes over 
to us from the House. The scope of the AIDS epidemic really cannot be 
underestimated. It is now spreading to the Caribbean. It is in East 
European former Soviet bloc countries. It is in Asia. The 
nondiscriminating way that AIDS kills women and children, men and boys, 
young and old alike, tears up families, and destroys human 
infrastructure, is beyond people's belief, absent an extraordinary 
effort comprehensively to begin to coordinate a global effort to combat 
it. It is the worst public health, social, and humanitarian crisis of 
our age.
  It is imperative the United States lead the efforts to deal with it. 
It should not only be on our agenda today, but it needs to be on our 
agenda in the months and years to come.
  Obviously, Congress should send to the President legislation that 
substantially increases funding for our global AIDS programs, and 
indeed this bill will do that. But we need to leave no doubt in the 
world's mind that we are going to be at the forefront of that fight in 
the years to come.
  To underscore what the ranking member of the Foreign Relations 
Committee just said, the President could have had this legislation last 
year, or even earlier this year, had the administration and Republican 
allies in Congress wanted it. Last July, the Senate unanimously passed 
and sent to the House the bipartisan United States leadership effort 
against HIV/AIDS.
  I thank the majority leader for his efforts to join me in again a 
completely nonpartisan effort to try to behave in a globally 
responsible way and in a way that lives up to the highest values and 
standards of our country.
  I introduced that bill a year ago today, along with Senators Frist, 
Biden, Helms, Daschle, and some 10 other cosponsors. That bipartisan 
bill was the most comprehensive global HIV/AIDS bill ever introduced in 
the Congress. It authorized more than double the annual $1 billion 
level of funding for AIDS, TB, and malaria programs over each fiscal 
year of 2003 and 2004, it created an HIV/AIDS coordinator in the 
Department of State, it ensured the Government had a comprehensive 5-
year global strategy on HIV/AIDS, and it provided USAID, CDC, and other 
HHS agencies with the necessary authorities and resources to carry out 
an effective program of prevention and treatment abroad.
  The House of Representatives had ample opportunity to act on this 
bill before Congress adjourned last November, but it failed to even 
take it up. Nor was the House interested in conferencing the full bill. 
The administration provided no impetus, no leadership, and no effort in 
order to try to get the House to do so. Apparently the 
comprehensiveness of the bill was too much for the House Republicans to 
handle.
  Speaking to this point on November 13 of last year, Congressman Hyde, 
chairman of the House International Relations Committee, stated that 
``Discussions have broken down between the Senate and the House over 
the size and the scope of the bill.'' And there was no intervention 
whatsoever by the administration to try to bring those parties together 
at any time.
  It is more than regrettable that our colleagues in the House refused 
to act last year. Although this bill predated President Bush's AIDS 
initiative announced this year in his State of the

[[Page S6418]]

Union Address, that very worthy initiative could easily have been 
funded and carried out under the provisions of the Senate-passed bill. 
We had a missed opportunity, one that could have saved lives. As 
Chairman Hyde wrote earlier this week in his own op-ed in the 
Washington Post, ``In the five minutes or so required to read this 
column, another 30 people will die and another 55 will become 
infected.''
  Just think how many people could have been helped had the 
administration and the House not missed the opportunity offered by the 
Senate last year to ramp up our efforts.
  Since the beginning of this year, Senator Biden and I have worked 
consistently with Senator Lugar, chairman of the Foreign Relations 
Committee, to produce a bipartisan global HIV/AIDS bill. Regrettably--
and I do regret--each step of the way those efforts were repeatedly 
frustrated by the White House and some Members on the other side of the 
aisle. Our most recent effort, S. 1009, the United States Emergency 
Plan for AIDS Relief Act of 2003, introduced by Senator Lugar on May 7 
and cosponsored by Senators Biden, Daschle, and Sarbanes, was based on 
the very draft the majority leader, Senator Frist, brought us for 
consideration after consultation and input from the White House. But 
that effort, too, died on the vine.
  The White House and the Senate majority leader have made it 
abundantly clear that the President now wants the Senate to move 
quickly to pass the bill without amendment. Having been at the 
forefront of the legislative effort to combat this, I am delighted the 
President now wants to have a bill in hand when he meets with the G-8 
leaders in June. I agree that we can and must leverage other nations to 
increase their efforts and their resources to combat the AIDS pandemic. 
And I am confident the President will be able to tell his colleagues 
and the Congress that we are united in the fight against AIDS. However, 
the bill we send him ought to not only provide substantially increased 
resources to fight AIDS, but it should also embody comprehensive, 
balanced, and effective policies and programs.
  The pending House bill does well in resources in terms of 
authorization--$15 billion over the next 5 years for the three most 
infectious global diseases, HIV/AIDS, TB, and malaria. Like last year's 
bipartisan Senate bill on which it is modeled, the House bill 
established an HIV/AIDS coordinator, and it mandates a coordinated, 
comprehensive, and integrated U.S. 5-year strategy. But the bill 
remains flawed. If left unaddressed, those flaws will seriously 
undermine the effectiveness and the comprehensiveness of the U.S. AIDS 
programs.
  The House bill provides insufficient resources for the Global Fund to 
Fight AIDS, TB and Malaria, the public-private partnership established 
in 2001 with the strong support of President Bush and United Nations 
Secretary General Kofi Annan. The global fund reflects the 
international community's determination to marshal increased resources 
to combat not only HIV/AIDS but also TB and malaria. Tommy Thompson, 
Secretary of Health and Human Services, currently chairs the global 
fund's board of directors. Whereas the Bush administration's new AIDS 
initiative is focused on only 14 countries--12 in Africa and 2 in the 
Caribbean--the global fund's scope is worldwide, covering not only 
countries where AIDS is rampant, but also countries such as Russia, 
China, and India, where the epidemic is growing rapidly.
  The Bush administration's preference for bilateral efforts over 
multilateral efforts, in my judgment, is discernible because of the way 
the allocation of funds within the President's announced initiative 
takes place. The President promised $15 billion over 5 years. But only 
$1 billion of those funds--that is $200 million a year--would go to the 
global fund. This annual figure of $200 million a year is already $150 
million less than we have provided in fiscal year 2003 alone. The 
President's proposal provides for no increases over the 5-year period.
  The House bill authorizes ``up to $1 billion'' for the global fund 
for fiscal year 2004. On the face of it, that looks like an 
improvement. It is calculated to look like an improvement, but it is 
not an improvement. The House bill fails to guarantee any specific 
funding level, and it caps U.S. contributions at 25 percent of the 
fund's total contributions.

  This is simply not adequate. We can, and we should, do more. At a 
minimum, we should be able to guarantee that our contributions to the 
fund for fiscal year 2004 are significantly increased over the 2003 
level.
  I know some of my colleagues believe other countries are not 
contributing enough to the fund. I share that concern, but I am proud 
that the United States of America is the largest donor to the fund, and 
we ought to be. In my view, that is commensurate with leadership, and 
leadership is what is needed. However, other countries can and should 
do more, and if leveraging our contributions will enable Chairman 
Thompson and the leadership of the global fund to raise more resources, 
I am all for that.
  S. 1009, the Lugar-Biden-Kerry bill that was introduced earlier this 
month, would authorize $1 billion for the fund for fiscal year 2004, 
and $500 million of this would be available without any strings 
attached. To receive the additional $500 million, the fund would have 
to raise $2 billion in contributions from sources other than the United 
States. So it provides real leverage, and that is what we ought to be 
doing. In effect, the United States would be providing one-third of the 
fund's resources--a figure with which all of us ought to be able to 
live. I will support changes in the House bill to strike the House 
language on the fund and achieve those higher funding levels.
  Second, the House bill mandates that one-third of the funds spent on 
prevention go only to abstinence-until-marriage programs. Now, none of 
us disagrees that abstinence is an important component of AIDS 
education. It is important as a matter of values, and of course we 
ought to engage in that effort. But the effectiveness of these programs 
depends literally on their comprehensiveness and on their relevancy to 
the population you are targeting. That means you need all three 
components of the so-called ABC model: abstinence; be faithful, which 
includes reducing the number of partners; and the use of condoms.
  Obviously, abstinence does not apply to all target populations. For 
example, take a situation where you have people who are married or they 
are in a monogamous relationship. It is well and good to promote the 
concept of abstinence, which we should do, but abstinence-until-
marriage programs have their greatest resonance with young people, and 
I believe we ought to fund those types of programs. But we should not 
tie the President's hands by specifically earmarking the percentage of 
funds to be spent on these programs because that denies the reality of 
what you find on the ground in terms of the targeted population.
  I will support an amendment to strike this earmark. We ought to be 
rational enough as human beings to understand that you do not want to 
just promote abstinence. What happens when somebody falls short of the 
abstinence, as everyone in the world knows occurs? Then you want at 
least to have that person also educated as to what the possibilities 
are to still prevent the spread of the disease.
  In my view, we should be providing the administration with maximum 
flexibility to ensure that our assistance programs are well targeted to 
the countries in which we are working. Regrettably, the House bill 
contains a number of earmarks and limitations ideologically driven but 
not practically driven, which reduce the flexibility and undermine the 
capacity to work with various high-risk populations at the epicenter of 
the HIV/AIDS pandemic.

  The House bill guarantees that faith-based organizations may 
participate in U.S. Government-funded HIV/AIDS programs even if they 
choose not to participate in all elements of the program. For example, 
they can be involved in the component that respects abstinence but they 
may choose not to be involved in providing counseling on safe sex and 
distributing condoms.
  Faith-based organizations are on the front lines of the fight against 
HIV/AIDS, and I respect that. We welcome that. And they should be. We 
need them there. I do not believe we should ask any organization, 
faith-based or otherwise, to compromise their principles in this 
effort, and I would not do that. But if the U.S. Government is

[[Page S6419]]

funding their programs, it is important, with respect to the 
expenditure of our dollars, that we guarantee that those dollars be 
spent in the most effective way and that we need to respect the 
interventions that, in fact, prevent HIV infection, even those they 
object to on a moral or religious ground.
  An organization that does not wish to give out condoms should 
absolutely not be required to do so, but it also ought to be required 
to give accurate and medically sound advice on the effectiveness of 
that method. I will support an amendment to the House bill that makes 
it clear that all organizations that are funded by the U.S. Government 
in this fight must follow that policy.
  Last year, the Senate-passed AIDS bill contained a title on debt 
reduction that was authored by Senators Biden and Santorum. It urged 
the Secretary of the Treasury to renegotiate the Enhanced HPIC 
Initiative to provide funds for HIV/AIDS programs through greater debt 
reduction. The House bill we are now considering contains no such 
title, despite strong support for it from many quarters, including the 
Catholic and other churches. This deficiency in the House bill ought to 
be corrected. I strongly support Senator Biden's amendment to put that 
title back in the bill.
  This bill has been a long time in coming. It is here now. Obviously, 
it is important for the Senate to advance our efforts with respect to 
AIDS. In my judgment, the amendments that are being offered will 
improve this legislation in terms of its resources, in terms of its 
policy, and the flexibility for the President.
  I hope those amendments will be adopted, notwithstanding the Chair's 
desire not to have any amendments, because they will provide us with 
the capacity to have the full measure of the policy we ought to be 
passing in order to deal with this issue. It is better to have 
something that is comprehensive and effective than something that 
merely meets political cosmetic needs and does less than what is needed 
to address this extraordinary challenge.
  I also believe there is time yet. There is time, if there is good 
will on both sides and if there is Presidential leadership, to 
conference a bill with these amendments. There is no reason we should 
not make that available to the Senate. We can guarantee the President, 
on our side, that if we do that in good faith, he will have a bill 
before he goes to the G-8 summit. But if our efforts to improve this 
bill fail, I will still support it, Mr. President, imperfect as I think 
it is, because stemming the AIDS pandemic is the goal and any measure 
that begins the steps towards that cannot be ignored and is better than 
none.
  I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  The majority leader.
  Mr. FRIST. Mr. President, I will be speaking for about 10 minutes or 
so. The Senator from Illinois and I were just discussing all of us who 
want to speak on, and that we, the Senator from Illinois and the 
Senator from Massachusetts, from whom we just heard, have worked so 
hard on this effort.
  I think what I will do is get my opening statement out of the way, 
and then we will come back to the bill a little later today.
  I will yield a minute or so to the Senator from Illinois, if he would 
like to make a comment. I know we are a little constrained for time. We 
are going back to the growth bill in about 9 minutes.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Mr. President, I thank the majority leader for yielding 1 
minute.
  Mr. President, I think this is a historic piece of legislation. I 
think the United States is making a commitment to a world problem that 
is going to haunt us for decades to come.
  I salute President Bush for his leadership. I am glad this has been 
bipartisan. My only regret is that it comes to the floor in a very 
tight procedural situation. I hope we will have time to have an honest 
discussion about a few issues and still deal with this bill on a timely 
and dispatched basis.
  I salute the Senator from Tennessee, the majority leader, for his 
commitment, as well as the Senator from Massachusetts, and my good 
friend and neighbor from Indiana, Senator Lugar.
  I am going to withhold any further statements for a little later on 
in the bill. As we get into the dialog, I will offer a few ideas.
  Mr. FRIST. Mr. President, we really only have 35 minutes to speak on 
the bill itself, now that we are officially on the bill. My colleagues 
can tell from the comments today that this initiative is a huge 
bipartisan initiative that is supported strongly by Democrats and 
Republicans. I think they will see as the debate goes forward that 
nobody thinks the bill is absolutely perfect in the sense that they 
don't as individuals agree with everything in the bill itself. Again, 
reflected in the comments we have just heard, if we step back, we are 
seeing an unprecedented commitment on behalf of this institution, the 
Senate, the House of Representatives, the Congress, with passage of a 
bill that follows the leadership of President Bush of $15 billion over 
a 5-year period.
  I especially appreciate the comments of the Senator from 
Massachusetts because, indeed, Senator Kerry and I have been working on 
this issue for years, in an apolitical way, in working with CSIS, which 
is a nonprofit group that all of us know, and we have brought in the 
experts from all over the world. They have done a beautiful job. We 
have sent delegations to China to look at the issue and broadly support 
it.
  I think that is what this bill is all about. So much of what we do 
appears so partisan and, indeed, we will disagree on dollars and how 
much should go to the global fund. Some people feel passionately it 
needs to be more. Others say: Let's give a little more time to the 
fund. At the end of the day, when we pass this bill, this bipartisan 
bill--it comes from the House, but it is an assimilation of all the 
ideas we have been working on--it is something of which we can be quite 
proud.
  The chairman of the Foreign Relations Committee, Senator Lugar, his 
made comments I especially appreciate because it walked through the 
challenges we face in addressing an issue that is very difficult for a 
lot of people because it involves stigma, a virus that wasn't even 
around 23 years ago. The HIV, when I was doing medical school and the 
internship and the early years of residency, had never been heard of, 
not talked about in the textbooks until 1981, when we saw the first 
three or four viruses. That virus has now killed 23 million people, has 
40 million people infected, and will kill, in the best of all worlds, 
another 60 million people.
  As history looks back at this day or at this year or at these 
Senators in this body, it will be able to say we did everything 
possible to reverse the course of that destruction. At the end of today 
we will say, yes, for this point in time--we have lots of other steps 
to take--this is the first major step. This is what I wanted to say to 
my colleagues on both sides of the aisle. This is not going to cure the 
virus. We have no cure. We have no vaccine. We can reverse that trend, 
but this is the first major step.
  The President took the lead in the State of the Union Message. It is 
very complementary to the work I have worked with Senator Kerry and 
Senator Lugar and Senator Biden and Senator Durbin on over the years. 
That is most important. This little HIV virus is only about 100 
nanometers. That is tiny. It is microscopic. It is invisible to the 
naked eye. A meter is about that big. It is a billionth of a meter in 
terms of size, 12,000 times smaller than a human hair. So it is 
amazing. We are just entering this era where we understand viruses and 
how we can fight them to the point that we can effectively combat them, 
but something that small can cause so much destruction.

  In terms of process, which people have referred to, we will begin 
legislation later today on this $15 billion 5-year effort to combat the 
worldwide HIV/AIDS epidemic. The bipartisan support is reflected in the 
fact that the bill that I, in talking to the leadership on the other 
side of the aisle, said, how can we best immediately begin the response 
to the destruction of this virus, meaning not put it off 6 months or 12 
months or 3 months or a year, and it is using this piece of legislation 
which will come to the floor later today.
  Some have suggested, you kind of knock out the deliberative process 
by

[[Page S6420]]

going to the House bill. I disagree. We have put together various 
bills. If you look at the House bill, while not everybody agrees with 
everything in it, it really is an assimilation of the proposals put 
forward that looks at prevention, care, and treatment. That is what is 
beautiful. It is the amount of money, $15 billion, about $3 billion a 
year for 5 years, the money, but also it is the first time in 
legislation that we have linked a public health approach, which you 
need, to this greatest of all humanitarian and public health 
tragedies--challenges, as Senator Kerry has just said on the floor, 
that you link prevention, care, and treatment. With that, over time, we 
will be able to reverse the course of this virus.
  The treatment strategies themselves have to do with antiretroviral 
drugs. Some people say, let's put all the money there. We don't have a 
cure yet, so to put all the money there doesn't make sense. We have to 
go back and look at both prevention, which we know is 100-percent 
effective, the prevention strategies--I refer back to Uganda, and what 
is being done there--and also the care. How do you manage people with 
HIV/AIDS? It could be other antibiotics. It could be nutrition. It 
could be care. That is why the overall planning and the comprehensive 
nature of this bill is so important.
  The bill before us does represent a lot of coming together into a 
focus of agreement and consensus on a range of issues--not all of the 
issues, but on, I would say, most of the issues. That is why we can't 
let the perfect be the enemy of what the good is in this particular 
bill.
  It is true that in less than 3 weeks the President of the United 
States, if we pass this bill, will be able to go to the G-8 conference, 
and that is important. That is not necessarily the driving reason to do 
it, but it does give us an additional reason to do it--in addition to 
the fact it will save lives, which is the most important issue to all 
of us--that the President of the United States can show that we are a 
caring nation, we are not just a good nation but we are a great nation 
in terms of reaching out, the caring, the compassion as we go forward. 
We will be able to lead--yes, we are a powerful nation--and get other 
nations to participate because we can't solve this problem by 
ourselves. The United States can't do it. We don't know the answer. We 
don't have enough money to do it. But when we can bring the family of 
nations, contributing both commitment and money, we will be able to 
cure this little virus as we go forward.
  There are lots of issues in the bill we will talk about later. One of 
the most important is that we can start immediately. We will have a 
skilled coordinator--that is part of the underlying package--will be 
able to move forward, begin the planning, begin the implementation. 
Then through the appropriations process we will be able to add the 
appropriate money.
  Let me close as I opened: Again, we will have the opportunity to talk 
later tonight at greater length. History, ultimately, will judge how we 
respond. We have done a pretty good job through study, committees, 
through bills, through proposals, through debates, through the 
appropriations process, but this gives us the first disciplined, 
dedicated, focused, comprehensive response which links the public 
health with the scientific. That is what this is about.
  History will look back on this day as the first major step in 
reversing this greatest of humanitarian challenges of the 21st century. 
We do have a choice. We could put it off for later or we could choose 
to do it now. I believe we will choose to act tonight, ultimately pass 
this bill, and, with that, it will be a demonstration of why we are not 
just a good Nation but a great nation.
  I yield the floor.
  The PRESIDING OFFICER. The minority leader.
  Mr. DASCHLE. Mr. President, I want to thank the majority leader for 
bringing this important piece of legislation to the Senate floor. It is 
desperately needed. The Senate passed something very similar to this 
proposal 9 months ago. Despite our urgent and repeated requests, 
Republican leaders in the House refused to act on that bill. But 
something important happened between then and now. In his State of the 
Union Address to the Nation, President Bush proposed an historic U.S. 
commitment to the global AIDS fight. We applaud the President's 
support. I also want to acknowledge Secretary of State Colin Powell, 
who has shown great leadership on this issue of global AIDS and taken 
some criticism for it.
  Our colleagues in the House of Representatives, especially 
Congressmen Henry Hyde and Tom Lantos, also deserve thanks for their 
commitment to this cause. Here in the Senate, many of us have seen the 
face of AIDS in Africa and the Caribbean personally. This fight has 
benefitted from their leadership. I especially want to acknowledge the 
work of Senators Durbin, Kerry, Biden, Leahy, Feingold, Kennedy, Frist, 
Lugar, and DeWine.
  Last August, I traveled with several of our colleagues to South 
Africa, Kenya, Botswana, and Nigeria. We wanted to get a clear look at 
the development challenges in Africa. The challenges are myriad and 
massive. They include investment and trade, education and agriculture. 
One of Africa's greatest challenges is health care--particularly AIDS.
  In South Africa, I had the privilege to deliver 1,000 pounds of 
clothes and toys, donated by the people of South Dakota to children in 
South Africa affected by HIV/AIDS. Those toys provided some glimmer of 
hope to the South African children who received them. But this bill 
offers the beginning of real hope. This bill holds out the promise that 
some of those children will grow to be adults and perhaps have children 
on their own.
  On that trip, I met a young girl named Mary. She lives in Soweto. She 
had recently lost both of her parents to AIDS. She had been left to 
care for her four younger siblings. She was 12 years old. Mary and her 
siblings are among the world's more than 14 million ``AIDS orphans''--
children who have lost their mother, or both parents, to AIDS. 
Worldwide, more than 30 million people have already died from AIDS. 
Last year, AIDS and AIDS-related illnesses claimed the lives of 3.1 
million people. And 5 million more people became newly infected. Today, 
more than 42 million people are infected with HIV or living with AIDS. 
More than 75 percent of them live in Africa or the Caribbean.
  I am convinced that, if we combine America's resources and technology 
and the great compassion of the American people with the courage and 
hope shown by Mary and so many others, we will defeat this disease.
  HIV/AIDS is the great humanitarian crisis of our time. But it is more 
than a humanitarian crisis. AIDS is a national security issue. It is a 
public health issue. It is an economic issue. And it is a moral issue. 
We have the tools to fight this disease. It is our duty and our 
obligation to use them. The U.S. commitment to the global AIDS fight 
has increased significantly in the last few years. But we could have, 
and should have, done far more, far sooner. We must not delay any more.
  This bill is another step in our fight. It would more than double 
current U.S. spending for international AIDS programs. It calls for a 
comprehensive strategy that integrates prevention, treatment, research 
for a vaccine and help support children--like Mary, orphaned by the 
disease.
  The President is right in calling for us to target nations in Sub-
Saharan Africa and the Caribbean. These nations represent the epicenter 
of the global AIDS crisis. But a crisis is looming in Asia and Central 
and Eastern Europe. We must do now in those areas what we did not do 
soon enough in Africa. We must intervene now to stop the spread of HIV/
AIDS before it reaches the epic proportions experts warn we could see. 
For that reason, Democrats will offer an amendment to this bill to 
guarantee a robust American commitment to the Global Fund to Fight 
AIDS, Tuberculosis and Malaria. The bilateral efforts aimed at Africa 
and the Caribbean are needed to address today's crisis. A strong U.S. 
commitment to the Global AIDS Fund is needed to prevent tomorrow's 
crisis.
  We will also offer an amendment to give the President the flexibility 
he needs to confront this epidemic. The House bill ties the President's 
hands on prevention programs. Abstinence must be a central piece of any 
successful prevention program. But earmarking 33 percent of prevention 
funds for one approach is counter-productive.
  We will also offer other important amendments. One will relieve the 
debt

[[Page S6421]]

burden on the world's poorest nations--many of whom are burdened also 
by this AIDS crisis. Another will provide American food aid to people 
suffering from AIDS in desperately poor nations. We know that many 
people who suffer from AIDS actually die from starvation and 
malnutrition. Emergency food aid from America's farmers can help keep 
them alive.
  It is important to note, however, that this is just an authorization 
bill. By itself, it does not commit one dime to prevent AIDS or help 
its victims. The real test of our commitment to children like Mary and 
others living with and threatened by AIDS will be whether we fund this 
promise. A prescription you can't afford to fill does no good at all. 
The President calls his proposal an ``emergency plan.'' He is right. 
This is an emergency. We should treat it like an emergency. After we 
pass this bill, we must appropriate the full amount it prescribes.
  We can react to the plight of AIDS orphans like Mary with denial and 
despair. Or we can respond--as this proposal does--with a determination 
to save those children and the millions of others threatened by HIV/
AIDS.
  In Uganda, mothers with AIDS create ``memory books'' for their 
children. In their dying days, they gather together photos and stories 
they want their children to know. They know that they will not live to 
see their children grow up. With this bill, we have a chance to write a 
different book--a different kind of history in this fight against AIDS. 
Let us write that book. Let us pass this bill today. Then, let us 
quickly agree to commit the resources it promises.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Alexander). The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. COLEMAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COLEMAN. Mr. President, are we in morning business? What is the 
status of where we are, Mr. President?
  The PRESIDING OFFICER. The Senate is to resume consideration of the 
tax reconciliation bill.
  Mr. COLEMAN. I ask unanimous consent to have an opportunity to 
address the global AIDS bill very briefly.
  The PRESIDING OFFICER. Is there objection?
  Mr. REID. Objection.
  The PRESIDING OFFICER. Objection is heard.

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