Oct 8 2002 - Now that appropriations committees in both houses of Congress have passed foreign assistance legislation, the stage is set once again for a difficult tug of war over spending and policy for U.S.-funded international family planning and related programs. Proposed overall spending on foreign economic and military assistance differs by about $200 million, with the higher, House version of the bill coming in at $16.55 billion.
When it comes to family planning assistance, however, the Senate bill comes out ahead, with $450 million allocated for programs administered by the U.S. Agency for International Development. It also earmarks $50 million for the UN Population Fund (UNFPA) and includes language aimed at framing more narrowly those situations where the U.S. can deny funds to such organizations — given the Bush Administration’s very broad interpretation of existing language that resulted in UNFPA losing all $34 million in U.S. support this year. The Senate bill would also make reproductive health supplies, notably contraceptives and condoms, exempt from any policy restrictions that inhibit their provision to countries around the world.
At this writing, it is uncertain whether floor action on foreign assistance bills in either house will take place before the October pre-election recess, if ever. But, as a new report from PAI indicates, time is running out when it comes to the need for greater donor support — including by the United States — for condoms in countries affected by HIV/AIDS.
For more than two years, PAI has been working in concert with a small group of organizations to raise awareness about shortfalls in supplies for reproductive health programs — supplies such as condoms for HIV/AIDS prevention, contraceptives, diagnostic tests and the like. Continuing this effort, PAI is releasing Condoms Count: Meeting the Need in the Era of HIV/AIDS.
In Condoms Count, PAI documents the many barriers to condom use and supply, from taboos about discussing sex and the stigma — and fears — surrounding condom use itself, to insufficient financial support and weak supply systems. We identify the lack of political will to confront AIDS head-on as among the most important barriers, one that is reflected in the paucity of support from wealthy donor nations for condom promotion and distribution in those countries most threatened by HIV/AIDS.
In keeping with previous PAI Report Cards, the report documents the costs of such an effort and what each of the major donor countries, including the United States, has contributed over the past decade. Condoms Count also includes country-by-country data for ten indicators relating to HIV/AIDS, including life expectancy, health expenditures per person, and the latest data on HIV infection rates from UNAIDS.
“Condoms” come up missing in legislation and elsewhere
Ambivalence towards condoms plays out in the language and actions of policymakers in the United States also. The word “condom” appears only twice in the 70-page U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2002 (S. 2525) and it resorts to euphemisms in discussing the female condom, despite the urgent need for women-controlled methods. This past summer, at the International AIDS Conference, HHS Secretary Tommy Thompson delivered a speech —unheard by the audience due to protesters — that made no mention of condoms.
Contrasts in foreign assistance bills extend to HIV/AIDS
With floor action on any spending bills uncertain before the Congress adjourns for elections, key differences between House and Senate foreign assistance bills are likely to be resolved behind closed doors — or by the next Congress after it takes office in January of 2003. What PAI hopes will not be lost, however, are some important policy provisions and proposed increases in funding for core health and development programs: $670 million in additional spending in the Senate bill and nearly $630 million under the House version.
On specific issues, of course, each bill has its strengths and weaknesses. The Senate bill includes more funding and positive policy provisions in the family planning arena, as described above, while the House appears to win the day on HIV/AIDS. On family planning, the House bill would hold funding for USAID-administered programs to $425 million, and while an earmarked contribution of $25 million to UNFPA is included, it is attached to conditions with which UNFPA — as a multilateral organization — would find it very difficult to comply. The House bill also fails to address the Global Gag Rule, which the Senate addresses in two ways: first, with language that would require “equal treatment” for foreign and U.S.-based organizations using non-U.S. funds for either advocacy or lobbying, and second, by calling for an end to restrictions that impede the flow of supplies to family planning and related programs.
Regarding HIV/AIDS, the House would allocate $250 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria against the Senate’s $200 million, while USAID would receive $536 million for HIV/AIDS efforts from the House versus $550 million from the Senate.
With elections coming and war in the air, the fate of one year’s foreign assistance bill might seem unworthy of attention. After all, what’s $16 billion compared with the $396 billion going to defense? The answer is “not enough.”
For more information— or to arrange an interview with PAI President Amy Coen or Vice President of Public Policy Terri Bartlett, please contact Kimberley Cline as linked above.
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