House Panel Nixes Needle Exchange Ban, Senate Sets Funding for Global HIV/AIDS and TB

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A key House subcommittee has called for lifting the ban on funding for needle-exchange programs, a significant step forward in the hard-fought battle for evidence-based treatment of HIV/AIDS.

Disease experts, particularly those who specialize in treating HIV/AIDS, have long argued that the ban on needle exchange unnecessarily impeded HIV/AIDS prevention efforts. Rep. David Obey, D-Wis., chairman of the House Appropriations Committee, noted as much in a statement today announcing the proposed change in policy.

“Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing HIV/AIDS infectious and do not promote drug use,” Obey said in this statement.

The provision lifting the prohibition on funding for needle exchange programs was approved Friday by the House appropriations subcommittee on health and labor programs. It’s a small but significant first step in the legislative process. If it wins final approval by the House and Senate and is signed into law by President Obama, it would give states and local jurisdictions the ability to use federal funds for needle exchange programs. 

Also of note in that proposed spending bill are funding levels for the Centers for Disease Control and Prevention and the National Institutes for Health. The committee has called for directing $6.68 billion to the CDC, which is $67.2 million over the FY09 funding level and $38.4 million over the White House request. NIH would get about $30.96 billion in the House plan. The White House asked for $30.46 billion; NIH’s FY09 funding was about $30.02 billion

Meanwhile, the Senate Appropriations Committee took its turn at determining global health funding for FY2010 yesterday, and the outcome does not bode well for global AIDS and TB programs.

On both PEPFAR and bilateral TB, the Senate panel called for spending significantly less than the House. The two chambers will now move to reconcile their competing versions of the legislation before moving to final passage.

Overall, the Senate committee approved $7.77 billion for global health programs, which is $178 million above President Obama’s request and $434 million above the FY09 funding level.

The committee provided $5.709 billion to combat HIV/AIDS, which is $100 million above the White House request but $500,000 under the House level. The Senate’s lower figure is due to a smaller allocation for the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Senate called for contributing $700 million to the fund, while the House called for $750 million. These proposed increases in overall HIV/AIDS spending–at a time of deep economic distress in the developing world–could seriously hinder progress in treating and preventing HIV/AIDS.

Tuberculosis programs also got short-shrift by the Senate panel, which approved $201 million for TB programs at a time when disease experts are increasing worried about the threat of drug-resistant TB and fear that, because of HIV/TB co-infection, this ancient scourge could unravel all the progress we’ve made in treating HIV. The House has a modestly better proposal, setting aside $252 million for TB, well over the president’s $173 million request.

Here’s a chart outlining the key differences:

FUNDING FOR GLOBAL HEALTH

Dollars in Millions

  FY2009 PEPFAR II Obama FY2010 House FY2010 Senate FY2010
Global AIDS $5.159 $6.5 $5.259 $5.759 $5.709
Global Fund $600 $2 Billion $600 $750 $700
Tuberculosis $163 $650 $173 $252 $201

 

Notes: The reauthorization bill did not contain specified year by year funding levels with the exception of the Global Fund which was authorized at $2 billion.   The amounts listed under PEPFAR II for bilateral Global AIDS and TB are extrapolated from the overall 5 year funding levels authorized in the bill.

 

For family planning and reproductive health programs, the Senate committee provided $628.5 million, including $50 million for the UN Population Fund. That’s $83.5 million above the FY09 funding level and $35 million above the president’s request.

The Senate panel called for spending $555 million on child survival and maternal health; that’s $31.5 million above the White House proposal and $60 million above the FY09 level.

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