If Africa and the world community are to fight the tragic pandemic of AIDS, certain crucial issues must be addressed, now. Not only is affordable access to HIV medications needed, but also a more comprehensive approach that would consider the health infrastructure, U.S. development aid issues, and the broader context of poverty.

What are the issues before Congress and the Administration that concern us in the faith-based communities? We would like to see culturally-sensitive prevention programs, treatment, and compassionate care.

Appropriations

Today in Washington, the way to address prevention and treatment is through the appropriations process. This holds the potential to handle development aid as well as AIDS-specific and Africa-specific funding. There is also a variety of legislation that addresses specific issues, from affordable medications to mother-to-child transmission.

AIDS does not exist in isolation, and confronting the pandemic demands attention to the reality of poverty, to other crucial health needs, and to the temptation simply to shift money around, for example, taking funds away from TB programs and putting them into AIDS. It there- fore is important to affirm that suitable development aid, global health assistance, and AIDS- and Africa-specific support are all interrelated. Development aid can help Africa to:

• Bolster health infrastructure,
• Provide safe water,
  
• Enhance education (especially the much-neglected education of girls),
  
• Promote farming and rural development. Such aid directly promotes the health of Africa's people and contributes to the fight against AIDS.
  

Remedies

Given the tragic predominance of Africa in global AIDS statistics, and the stunning impact AIDS is having upon African society, we need to support a comprehensive AIDS agenda-from education and prevention to treatment for infections and HIV; from sensitive care for patients to ministry of families and health care workers.

The call for $1 billion in new development aid for Africa (by Bread for the World); for $1 billion in new funds for various global health concerns (through the Global Health Act, HR 1269); and for a minimum of $1 billion for African AIDS programs (found in a budget amendment before Congress) all affirm the interrelatedness of aid, broad health concerns, and AIDS- and Africa-specific support.

There are many pieces to the complex treatment challenge, but most of the recent controversy is about access to affordable HIV/AIDS medications.

Pharmaceuticals have vigorously opposed African nations' using the legal process called compulsory licensing (making their own generic drugs while the drug remains under patent), and parallel imports (simply shopping for the best price of drugs-which are still under patent and sold at very different prices-in order to obtain medications at more affordable prices).

Two bills now in Congress seek to prevent the U.S. from retaliating against African nations who use those provisions; Rep. Waters' Affordable HIV/AIDS Medicines for Poor Countries Act (HR 933), and Sens. Feinstein and Feingold's Global Access to AIDS Treatment Act (S 463).

Legislation

Members of Congress have shown their concern about the crisis by developing a variety of AIDS-related bills. The Feinstein/Feingold bill addresses more than access issues: It also authorizes $25 million a year in grants from U.S. AID to developing countries, to create and implement programs to strengthen and broaden the health care infrastructure; and $1 million a year for a loan repayment and deferment program for physicians, nurses, pharmacists, physician assistants, nurse practitioners, public health workers and health professionals to provide HIV/AIDS treatment and care in developing countries.

Rep. Millender-McDonald has introduced A bill to authorize assistance for mother-to-child HIV/AIDS transmission prevention efforts (HR 684), which calls for the Centers for Disease Control (CDC) to establish pilot programs in Africa and India to prevent such transmission, using partnerships with NGOs and university-based research facilities. Funds of $5 million for each of the next three fiscal years are requested, in addition to amounts already available for these purposes.

Sens. Boxer and Smith are introducing the Global AIDS Act, which calls for our foreign aid program to give HIV/AIDS prevention high priority, and authorizes increasing funding, with 50 percent of such funds to be used in sub-Saharan Africa.

Of special interest, given the strong faith community commitment to debt relief, is a bill Rep. Barbara Lee (D-Cal.) is introducing that relates AIDS to debt cancellation. This is a crucial issue, for the most indebted and impoverished nations in Africa are still devoting more funds to servicing debts than to providing basic health care. Since much of the debt between the U.S. and some African nations has been relieved, the key obstacle now is multilateral debt, mainly between the IMF or World Bank and African nations. This bill seeks cancellation of multilateral debt held by these two international financial institutions, using resources they already hold.

Where do we wisely place our energies? The ecumenical Washington Office on Africa, of which PCUSA is a sponsoring faith community, argues that appropriations are key.

First, we must keep the three appropriations priorities before this Administration and Congress.

Second, we need to ensure that affordable access to medicine is not undermined by U.S. preoccupation with 'drugs as commodities.' (Legislation that prevents the U.S. government from retaliating against African nations that use legal means to secure affordable drugs is another concern.)

And third, relating the debt burden to AIDS prevention, care and treatment is especially meaningful. The Barbara Lee bill deserves our attention.
(Written by Leon Spencer, Washington Office on Africa)

General Assembly Guidelines

We acknowledge that we are a global community. While the scourge of AIDS is devastating to the United States, it is much greater in magnitude in other parts of the world community. We recognize our responsibility to encourage AIDS education and prevention policies, especially in the global religious programs we support.

We challenge our society. Because economic disparity and poverty are major contributing factors in the AIDS pandemic and barriers to prevention and treatment, we call upon all sectors of society to seek ways of eliminating poverty in a commitment to a future hope and security.

(Church & Society, July/August 1994)