The US Senate voted Wednesday night to reauthorize PEPFAR – the President's Emergency Plan for AIDS Relief. But in doing so, it also boosted spending to $48 billion over five years. That's up from $15 billion. What's more, it lifts the travel ban on those who are HIV positive, who want to come to the United States; and it supports efforts to overcome the healthcare worker shortage.
The legislation now goes back to the House of Representatives where members will consider the senate revisions.
Among those praising the reauthorization of PEPFAR is John Bradshaw, Washington director for Physicians for Human Rights. He spoke to VOA English to Africa Service reporter Joe De Capua about the effects of the updated legislation.
"The first thing this will do is send a real message to people in Africa and elsewhere, who have been benefiting from PEPFAR programs, that the United States has renewed and reenergized our commitment to battling AIDS, tuberculosis and malaria. So, there's an important symbolic signal being sent," he says.
The legislation has dramatically raised the amount of money that would be spent. "The bill authorized $48 billion…we still have to get through the appropriations process and get that money out there. So there will be some delay before it actually has a direct impact on the ground," he says.
It may be sometime next year before the legislation is finalized. In the meantime, funding would continue at current levels.
Bradshaw says the latest version of PEPFAR reflects lessons learned in the first five years. "One really important lesson was that we can't really get our hands around the AIDS epidemic unless we increase the number of health care professionals in Africa and paraprofessionals. So this is one of the really important new innovations in this bill compared to the original PEPFAR. There's a target of training and retaining 140,000 new health care professionals and paraprofessionals. And that's really the largest or the most significant commitment any developed nation has ever made to tackle that problem," he says.
He says that PEPFAR also addresses the issue of women's particular vulnerability to AIDS. "You have to have programs to empower women and to help them address some of these legal and social obstacles that prevent them from getting proper care, and also make them more vulnerable to infection," he says.
During PEPFAR's first five years, there was much debate and controversy over whether it emphasized abstinence over condom use. Bradshaw says there was no such public controversy this time. "The controversy was minimized. I think there was a lot of important work behind the scenes with congressional staff and members along with the human rights and ngo community to try to avoid the really most contentious issues. But the so-called abstinence earmark that mandated that one third of all prevention funding go to abstinence-only programs has been eliminated, which we think is a big step forward," he says.
Bradshaw says a comprehensive approach is needed to address HIV/AIDS. "The programs that focus only on abstinence have been shown to be not as effective as these comprehensive, evidence-based programs," he says. Some abstinence programs will remain, however.
He also praises a provision in the legislation lifting the 20-year-old travel ban on those who are HIV positive and want to come to the United States. He says, "This is a great victory that's contained in this bill… There was never any justification for this travel ban… There was no public health justification."The US Department of Health and Human Services would take over authority of deciding if anyone was a health risk if he or she entered the country. The travel ban has been part of immigration policy.