Global Health Bill Highlights Ideological Divide

A global health aid package worth tens of billions of dollars is being debated in the House of Representatives this week. Among the items under consideration is whether to integrate money for family planning into AIDS prevention efforts.

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Congress is considering how and how much the U.S. should spend on some of the world's deadly diseases. Today a House committee examines legislation that sets U.S. global policy on AIDS, tuberculosis and malaria. The bill would increase funding to $50 billion. The program has enjoyed strong bipartisan support, except when it doesn't.

NPR's Brenda Wilson reports.

BRENDA WILSON: For all the praise the president's global AIDS plan has enjoyed on both sides of the aisle, there hasn't exactly been a consensus about everything in the law. Some organizations that do HIV prevention object to a pledge they are required to make opposing prostitution, even when they work with prostitutes.

But in the past, the ideological lines were really drawn over requiring a third of all HIV prevention money to be spent for abstinence-only programs.

Dr. Helene Gayle is the head of Care International that receives federal funding for HIV/AIDS.

Dr. HELENE GAYLE (President, CARE International): I can tell you that the restrictions make it harder for CARE and other NGOs to help people in difficult circumstances. Just to cite one example, a married woman who was faithful to her husband becomes HIV positive because her husband isn't faithful to her. So in a situation like this, giving her abstinence or faithfulness counsel isn't just a disservice, it's actually medically inappropriate.

WILSON: Democrats on the House Foreign Affairs committee removed the abstinence restrictions after a number of studies showed that it discouraged the groups from doing HIV prevention. Conservatives are objecting to this and other changes in the bill, including one that would codify an effort that was already under way by the administration - combining family planning and HIV/AIDS services, which are now separate.

Reverend Mpho Tutu of the Institute for Prayer and Pilgrimage says it is important not to lose sight of the effect of such policies on the lives of women in Africa.

Reverend MPHO TUTU (Institute for Prayer and Pilgrimage): In this country people have good transportation infrastructure. In many places in Africa people do not. And so, you know, it's a day's journey to go to one place and then another day's journey to go to the second place for the information that you need. And to put those kinds of stumbling blocks in the path of women who want to do the right thing is, I think, unconscionable.

WILSON: For conservatives the very idea of including reproductive health services in the global AIDS program means opening the way to abortion. But there are faith-based organizations involved in AIDS work that don't object to family planning groups providing HIV/AIDS services.

Bill O'Keefe of Catholic Relief Services fears that integrating family planning into HIV services would divert money away from saving lives.

Mr. BILL O'KEEFE (Catholic Relief Services): Faith-based groups like Catholic Relief Services that provide much of the healthcare in Africa, particularly the poor, rural areas, those institutions are not going to be able to participate. And what that means is those people who are served by those institutions are not going to be able to get the services that they need.

WILSON: A conscious clause is included in the bill that would protect some groups from doing things, such as distributing condoms, that they don't want to do for moral or ethical reasons. O'Keefe says that tilts the balance in favor of those who do provide family planning. Still, he holds out hope of a compromise.

Mr. O'KEEFE: It's probably the best well-known positive foreign assistance program our country has done since the Marshall Plan, so I have infinite confidence in the goodwill of the players to work something out.

WILSON: The challenge is to preserve the idea at least of bipartisan support.

Brenda Wilson, NPR News.

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