I want to thank the Chairman for holding this important hearing today.

When the Committee last met in April to discuss the President’s Emergency Plan for AIDS Relief, PEPFAR, attention was properly focused on what has been accomplished. 

Through PEPFAR, the American people have helped provide compassionate care for some 4.5 million people affected by HIV/AIDS, including 2 million orphans and vulnerable children. 

We have supported the provision of antiretroviral treatment for nearly one million people, with an estimated 50,000 new people gaining access to treatment each month. 

And we have made significant advances in preventing new infections from occurring, including by providing treatment for HIV positive mothers during over half a million pregnancies.

These accomplishments are a testament to the generosity of the American people, the bipartisan commitment of this body and Administration, and the tireless dedication of our implementing partners on the front lines of this pandemic. 

Still, we can not afford to waste too much time congratulating ourselves for the achievements of the past four years. 

More and more people become infected each day.  According to UNAIDS, an estimated 4.3 million new infections occurred in 2006 alone. 

Clearly, much more needs to be done.

In May, the President announced his intention to seek authorization from Congress to commit an additional $30 billion to the PEPFAR initiative over the next five years. 

The President’s demonstrated commitment to fighting the global scourge of HIV/AIDS through PEPFAR – and the supreme competence of the Global AIDS Coordinator, Ambassador Mark Dybul – have helped to set a positive tone as the Congress seeks to reauthorize the U.S. Leadership Against HIV/AIDS, Malaria and Tuberculosis Act, which will expire this year. 

But given the number of lives and the amount of money that are at stake, we can not afford to make mistakes in this reauthorization. 

We must focus our efforts on what works, and move toward sustainable solutions.

During the reauthorization debate, there will much discussion about how to transition PEPFAR from an emergency program to a sustainable one. 

To do this, some are advocating that PEPFAR take on additional challenges, including by placing greater emphasis on gender issues, deficits in health care systems, and the lack of food security for those with HIV/AIDS.

While there is a great deal of merit to some of these arguments, I urge caution in this process. 

If PEPFAR is directed to take on the universe of problems that plague the Focus Countries, we risk reducing it to a program that is a mile wide and an inch deep. 

We must remain focused on our central objective of providing care and treatment to those affected by HIV/AIDS, while expanding efforts to prevent new infections from occurring.

Members also will hear arguments in favor of “evidence-based decision making” with regard to our prevention, care, and treatment interventions.  I could not agree more.

I cannot imagine anyone making a rational argument for spending an additional $30 billion on a program that was anything less than effective.

Then, there are those who call for both sustainability and evidenced-based decision making, in the same breath that they advocate for the removal of the abstinence earmark in the Leadership Act.

Abstinence and fidelity programs are working, where the traditional focus on condom promotion that dominated the U.S. strategy for the first 17 years of the pandemic has failed. 

Yet, prior to the imposition of the earmark, the United States invested little, if anything in “AB” programs. 

If implementers had not been compelled to adjust their programs, I am not confident that they would have embraced the “A-B-C” approach – with a strong emphasis on “A” and “B” – that has proven effective in countries like Uganda, Botswana, Kenya, and elsewhere.

And even now that a consensus has emerged that “AB” programming is central to an effective prevention strategy, I am still not confident that it would be implemented if not for the earmark.

Dr. Norman Hearst, a respected leader in the field of HIV/AIDS treatment and epidemiology and prevention for the past 20 years, will testify to this today. 

Dr. Hearst was commissioned by UNAIDS to do a study on the impact of condom promotion in areas heavily impacted by HIV/AIDS. 

He will readily admit that he initially undertook the study with a bias toward condom promotion. 

However, his research revealed that the promotion of condoms in the absence of strong abstinence and fidelity programs actually led to increases in new infections.

When he reported this to UNAIDS, they refused to publish his work. 

Fortunately for us, his work has since been published and has become a part of a growing consensus among HIV professionals that while condoms play an important role in HIV/AIDS prevention, abstinence and fidelity programs are essential to successful and sustainable prevention efforts. 

I hope that Members on both sides of the aisle will heed the advice of the advocacy groups, and consider the evidence before making any decision to strike the “AB” earmark.

Mr. Chairman, the PEPFAR program is a magnificent demonstration of the good that can be done when Democrats and Republicans work together to solve the most serious of problems. 

I look forward to working with you and our colleagues to ensure that the Leadership Act is reauthorized, and that our PEPFAR program is as successful as possible.