With the introduction of the PEPFAR Stewardship and Oversight Act of 2013 Senators Robert Menendez and Bob Corker launched a bill Tuesday that both tweaks and extends the authorities of the 2003 legislation that started the United States President’s Emergency Plan For AIDS Relief.
With House Foreign Affairs Committee leaders Reps. Ed Royce and Eliot Engel set to introduce an identical bill in the House today, the proposed legislation is the product of bipartisan and bicameral collaboration to maintain support for the program for the next five years. The bill is anticipated to have the support Rep. Barbara Lee (D-CA) a longtime PEPFAR champion.
Unlike the 2008 Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria, the bill, S. 1545, does not explicitly renew authorization of the President’s Emergency Plan For AIDS Relief, but by extending “authorities related to global HIV/AIDS” it could protect the program from congressional challenges against appropriating funding without authorization. In addition, in seeking to “promote oversight of United States Programs,” it implies those programs will continue to exist with their current missions. It addresses provisions for Orphans and Vulnerable Children authorized by PEPFAR, extending the 10 percent of funding allocation for those populations and the requirement that at least 50 percent of the funding be allocated for treatment, care and support, through 2018. The bill calls for a plan for conducting cost studies of assistance to “partner countries,” expenditure analyses by partner countries, and defines “partner countries” as those receiving at least $5 million annually in U.S. funds for HIV/AIDS responses.
The bill does not address components of the 2008 PEPFAR reauthorizing legislation related to funding for responses to tuberculosis and malaria, both diseases highly associated with deaths of people living with HIV. It does, however, include in its reporting requirements “a description of supportive care, including management of co-morbidities.” It does not seek to update requirements to address some components of the U.S. response to the global epidemic that have shifted in recent years, including greater investments in local health workforces. At the same time, it does not revisit requirements that have proven divisive in the past, including ones restricting funds for reproductive health and programs addressing the needs of people engaged in sex work.
The bill does call for additional reporting to allow improved measures of the effectiveness of efforts, underscoring broad support of program goals. Among new requirements are:
- Reporting on yearly targets for prevention, treatment, and care efforts that include how the target will lead reducing the numbers of new HIV infections below the numbers of deaths among people living with HIV;
- Reporting on HIV treatment coverage rates by country;
- Reporting on retention rates in antiretroviral treatment programs;
- Reporting on how agreements with countries incorporate a role for civil society.
While these requirements are geared to reveal more information than has previously been required, they do not meet concerns that have been previously raised by global health advocates.
“My worries are that reporting requirements don’t go nearly far enough to allow Congress and Civil Society to truly understand PEPFAR’s activities,” Matthew Kavanagh, of Health Global Access Project said today.
“Specifically, the best way to provide oversight for the operation of PEPFAR would be for Country Operational Plans to be publicly available immediately after they are approved instead of years after they are out of date, with all of the substantive data redacted,” Kavanagh said. He welcomes the bill however, he added.
“It’s a huge step forward that PEPFAR will continue, and that policy agreements under Lantos-Hyde will be extended,” he said. “So for that reason we think it’s an incredibly important bill that needs to move forward.”
The bill’s introduction is an encouraging sign to global HIV response advocates who have watched funding flatline in a tight fiscal, and contentious political environment.
“This is an important thing that has happened,” Catherine Connor, Senior Director, Public Policy and Advocacy for the Elizabeth Glaser Pediatric AIDS Foundation, said today. “Having bipartisan and bicameral committee leadership introduce this legislation is a strong signal of support for the program. If it passes, it will be an even stronger signal to appropriators that this program remains a priority for the Congress.”
But, she added, “It’s also important to recognize that this is the start of a process.”
Senators Menendez and Corker plan to schedule a vote on the bill in committee, which could bring amendments. The bill will in any case then have to pass the House and Senate, where new members have not previously weighed in on PEPFAR.
Introduction of the bill, Connor said, could be an impetus for advocates of the U.S. response to the global HIV epidemic to educate legislators who are not familiar with PEPFAR’s history and impact.