The House Banking and Financial Services Committee held a March 8 hearing to discuss the HIV/AIDS crisis in Africa. Members of the committee heard testimony on the World Bank AIDS Prevention Trust Fund Act (H.R. 3519), which would establish a trust fund within the World Bank whereby governments, nongovernmental organizations, and private companies would be able to make contributions to the fund to combat the HIV/AIDS epidemic in Africa. The bill would authorize a U.S. contribution of $100 million in FY2001 and each year through FY2005. Committee Chair James Leach (R-IA), sponsor of the bill, opened the hearing, saying, “Silently, relentlessly, the disease [HIV/AIDS] is exacting a deadly toll on millions of Africa’s working adults, children and mothers, soldiers, teachers, and virtually all sectors of society.”
In 1991, the World Health Organization (WHO) predicted that by 1999 there would be 9 million individuals infected with HIV and 5 million deaths from AIDS in Africa alone. However, current estimates shatter the prediction with 23.5 million infected individuals and 13.7 million deaths in Africa. Additionally, roughly 10 million children are orphaned, and it is estimated that women constitute 55 percent of HIV-infected adults in Africa. Estimates now predict that by 2005 more than 100 million individuals will be infected with HIV worldwide. “People are dying in a war…and the world has stood by quietly and watched this happen,” stated former Congressman Ron Dellums of the Healthcare International Management Company and the Constituency for Africa.
Emphasizing the global scale of the HIV/AIDS pandemic, witnesses said that HIV/AIDS is no longer simply a health issue. “It is increasingly clear that few issues are as threatening to global economic prosperity and development, international security, and our common humanity as the threat presented by HIV/AIDS,” stated U.S. Ambassador to the United Nations Richard C. Holbrooke. He added that the severity of the issue spurred the United Nations Security Council to hold a January 10 meeting “solely to address AIDS as a security threat.” It was the first time the Security Council discussed a health issue as a security threat.
Sandra Thurman of the White House Office of National AIDS Policy told the committee that “AIDS is having a dramatic effect on productivity, trade, and investment—striking down workers in their prime, driving up the cost of doing business, impeding trade and investment, and reducing GNP.” According to the World Bank, Tanzania’s GNP will decrease by 15-25 percent as a result of AIDS, and in 1996 AIDS cost Namibia eight percent of its GNP.
Acknowledging the immediate and desperate need for relief, Ms. Thurman detailed the administration’s FY2000 global HIV/AIDS initiative. The $100 million cross-agency initiative includes prevention strategies, especially for women and youth, home and community-based care, care of children orphaned by AIDS, and the development of infrastructure to enable the delivery of services. The President requested an additional $100 million for the initiative in his FY2001 budget request.
While discussing the economics of HIV/AIDS, several witnesses attempted to put a human face on the issue. Miss Universe 1999 Mpule Kwelagobe detailed the plight of her country, Botswana.
According to WHO, 25 percent of the adult population of Botswana is infected with HIV, and 40 percent of all pregnant women are infected with HIV. “Simply put, AIDS is destroying my country,” she said. Ms. Kwelagobe pointed to cultural taboos that prevented women from asking their sexual partners to use protection as one of several reasons for the rapid spread of HIV/AIDS in Botswana. “Making matters worse, our culture considers promiscuity a virtue. And poverty has driven many young women into the arms of disreputable men,” she said.
The government of Botswana has responded to the crisis by establishing a research facility to study the HIV-1C subtype as well as ways to prevent mother-to-child transmission, and the government is partnering with nongovernmental organizations to conduct educational campaigns focusing on youth. Ms. Kwelagobe asked for increased support from the international community, particularly to aid its efforts to provide AZT to pregnant women infected with HIV.
Although AZT has been successful in reducing mother-to-child transmission in the United States by 75 percent, the drug’s cost, complicated dosing, side effects, and societal stigma regarding HIV/AIDS have not led to widespread use in Africa. Catherine Wilfert of the Elizabeth Glaser Pediatric AIDS Foundation told the committee of a recent U.S./Uganda study that found a 47 percent reduction in perinatal transmission with the drug nevirapine. The drug, which costs $4, is given orally once to the woman during labor and once to the baby within three days of birth. “The simplicity of this intervention makes it feasible for many developing nations lacking sophisticated health care infrastructure,” she said.
Noting the cultural, religious, and societal barriers facing women in Africa, Rep. Barbara Lee (D-CA) asked witnesses if Africa is ready to embrace women’s empowerment. “Women in Africa realize that they have a role to play,” stated Ms. Kwelagobe, adding: “Women who are strong need to be identified and speak out because they will be listened to, not someone from the outside.”
Mary Fisher of the Family AIDS Network called upon Congress, the administration, and the global HIV/AIDS community to coordinate a comprehensive response to the pandemic. “If the purpose of this hearing, or this legislation, is simply to justify a claim of openness or a show of compassion, you must stop this. Such theater simply raises false hope among those who are most hungry for hope,” she said, adding: “Merely appropriating additional monies to the international fight against AIDS will not be enough. Merely directing the Secretary of the Treasury to enter into negotiations with the World Bank won’t be enough. But if this [H.R. 3519] is the launch of a comprehensive and sustained commitment by the Congress, the Administration, and the international community—it is just the right thing to do.” The committee will mark up H.R. 3519 on March 15.