	Background

		HIV/AIDS

			Revised Epidemic Estimates

The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that 33.2 million people are living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS); some 16% fewer people than it initially estimated in 2006 (about 39.5 million). UNAIDS predicts that 2.5 million people will contract HIV in 2007, compared to the estimated 3.2 million who became HIV-positive in 2001. In FY2006, Congress provided $3.4 billion for global HIV/AIDS, tuberculosis (TB), and malaria programs ( Table 3 ). Policy Options for Congress

In 2003, Congress authorized $3 billion for each fiscal year from 2004 through 2008 to support the President's Emergency Plan for AIDS Relief (PEFAR). The United States remains the largest single donor for global HIV/AIDS efforts in the world, providing nearly 50% of all donor funds. As Congress prepares to consider whether, and at what level, to reauthorize PEPFAR, there has been considerable debate about the effectiveness of PEPFAR. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 ( P.L. 108-25 ), requires the President to submit annual reports to appropriation committees that describe how U.S. funds support efforts to prevent HIV/AIDS, TB, and malaria and provide care and treatment for those affected by the three diseases. However, since President Bush launched the President's Malaria Initiative (PMI) in June 2005, the Office of the Global AIDS Coordinator (OGAC) determined that it would no longer include malaria spending in its annual reports to Congress and that budgetary requests for the disease would be made separately from HIV/AIDS and TB requests. The Administration requests support for PMI through the U.S. Agency for International Development (USAID) as the coordinating agency. In 2001, about 240,000 people had access to anti-retroviral treatment (ARVs); in 2006, more than 2 million were treated. In 2006, 4.3 million people contracted HIV, 2.8 million of whom were African (65%), and 2.9 million people died of AIDS, 2.1 million of whom were African (72%). Increase Prevention of Mother to Child HIV Transmission (PMTCT) Initiatives

Many health experts advocate greater spending on PMTCT initiatives. UNAIDS estimates that in 2005, just less than 8% of pregnant women in low- and middle-income countries had access to services that could prevent the transmission of HIV to their babies. The House and Senate included language in their reports ( H.Rept. The Administration asserted that WHO's prequalification process was inadequate, and that generic drugs purchased with PEPFAR funds had to be first inspected by the U.S. Food and Drug Administration (FDA). In March 2007, IOM found that in many of the Focus Countries, a number of those implementing HIV/AIDS programs complained that the U.S. treatment policy complicated national treatment efforts. According to WHO, Africa is the only region in the world where incidence of new TB infections continues to rise, due in large part to HIV/AIDS co-infection. The report also asserted that PEPFAR should increase support to the education of new health professionals. The Bank estimates that it has lent $15 billion in health, nutrition, and population funds from 1997 to 2006; an average of about $1.5 billion per year. Nearly 90% of all HIV-positive children live in sub-Saharan Africa. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 authorizes 10% of HIV/AIDS funds to be used to support children affected by the virus. According to UNAIDS, more than 2.5 million children and infants are living with HIV/AIDS worldwide, representing more than 7% of all cases; and some 420,000 children under 15 years are expected to contract the virus in 2007, almost 17% of all new HIV infections.
The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that 33.2 million people are living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The U.N. organization believes that in 2007, some 2.5 million people will contract HIV and it will kill about 2.1 million. Sub-Saharan Africa is the most affected region, with about 68% of the world's HIV-positive population, 90% of all HIV-infected children, and more than 11 million children who have lost one or both parents to the virus. UNAIDS anticipates that in 2007, about 420,000 children will contract HIV, due in large part to inadequate access to drugs that prevent mother-to-child HIV transmission; about 8% of pregnant women in low- and middle-income countries have access to PMTCT services.
In January 2003, President George Bush proposed that the United States spend $15 billion over five years to combat HIV/AIDS, tuberculosis (TB), and malaria through the President's Emergency Plan for AIDS Relief (PEPFAR). The President proposed concentrating most of the resources ($9 billion) in 15 countries, where the Administration estimated 50% of all HIV-positive people lived. The proposal allotted $5 billion of the funds to research and other bilateral HIV/AIDS, TB, and malaria programs, and $1 billion for contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). The President estimated that from FY2004 to FY2008, PEPFAR funds would support the purchase of anti-retroviral treatments (ARV) for 2 million people; the prevention of 7 million HIV infections; and care for 10 million people affected by HIV/AIDS, including children orphaned by AIDS.
In May 2003, Congress passed the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25), which authorized funds for PEPFAR and created the Office of the Global AIDS Coordinator (OGAC) to manage U.S. funds aimed at addressing the three diseases in 15 Focus Countries. As of March 31, 2007, PEPFAR has supported the treatment of 1.1 million people; and as of September 30, 2006, supported PMTCT service provision during more than 6 million pregnancies and facilitated care for nearly 4.5 million people, including more than 2 million orphans and vulnerable children. From FY2004 to FY2007, Congress provided nearly $13.5 billion for U.S. global HIV/AIDS, TB, and malaria programs. In FY2008, the President requested $5.8 billion for global HIV/AIDS, TB, and malaria efforts; the House and Senate proposed spending almost $6.2 billion and nearly $6.1 billion, respectively.
On May 30, 2007, President Bush requested that Congress authorize $30 billion to fund PEPFAR an additional five years. The President asserts that from FY2009 to FY2013, the plan would support treatment for 2.5 million people, prevent more than 12 million new infections, and care for more than 12 million people, including 5 million orphans and vulnerable children. Supporters of the Administration's plan applauded the President and congratulated him for leading global efforts to address HIV/AIDS. Critics asserted that PEPFAR could treat more than 2.5 million HIV-infected people and that PEPFAR's spending requirements should be eliminated. This report focuses on some of the key issues that Congress might consider as it faces the issue of whether, and at what level, to reauthorize PEPFAR.