Juanita Millender-McDonald

International HIV/AIDS Legislation - April 2, 2003

Juanita Millender-McDonald
April 02, 2003— Washington D.C.
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Thank you Chairman Kolbe and Ranking Member Lowey for affording me the opportunity to speak today on issues important to me. Since coming to Congress I have carried the mother-to-child transmission of HIV/AIDS legislation and I come before this distinguished panel as a long-standing advocate in educating the public on the prevention of mother to child transmission of HIV/AIDS.

I have introduced bills since the 105th Congress addressing the growing crisis of the transmission of HIV/AIDS from infected mothers to their newborn children. While this is now commonly referred to as the prevention of MTCT, early on, worldwide concern about the pandemic in Africa and India wiping out millions and millions of people due to AIDS was just beginning to emerge.

I, along with millions of people around the world, was delighted when I heard the President’s State of the Union address committing $15 billion over the next five years. I wrote a letter to the President following his speech commending him for his leadership in addressing HIV/AIDS in a meaningful way. I would like to submit my letter along with these remarks for the record.

I have two requests addressing HIV/AIDS and both of my requests ask for inclusion in FY2004 appropriations.


First, with respect to the Peace Corps, the President requested an increase in his FY04 budget for Peace Corps volunteers, some of whom assist host countries and local communities in addressing HIV/AIDS prevention and care. I support that increase. My bill, HR 1145, provides an additional $5 million for the Peace Corps for health volunteers focused solely in the area of HIV/AIDS.

And I would like to take this time to thank Congresswoman Marcy Kaptur for cosponsoring HR 1145.

According to the latest figures, there are 6,678 Peace Corps volunteers serving in 69 countries, but only 2,128 of them work part time on HIV/AIDS activities. A mere 1,460 of those are spread out over 24 countries in Africa, and in addition to addressing the HIV/AIDS pandemic, must divide their attentions to providing several other necessary services like improving education of students, encouraging economic development, and increasing the agricultural capability of farming communities.

Mr. Chairman and Ranking Member Lowey, my bill asks for $5 million which would fund 125 additional Peace Corps volunteers who would work just on HIV/AIDS, and solely on train-the-trainer programs to educate and improve the skills of professionals, local organizations, and indigenous people in HIV/AIDS prevention and treatment. I respectfully request this distinguished panel to consider my legislation for the FY2004 appropriations. This is a small price to pay for immediate intervention of a pandemic we all recognize is overwhelming in countries and on continents.

I was recently sent an email from a Peace Corps volunteer who has served in Sierra Leone and India, and was the Country Director in Mongolia. He writes that he strongly supports my bill HR 1145 and quote: “Knows how cost effective this bill will be in the field. It will positively affect many lives and build goodwill, understanding and peace.”

Mr. Zober’s statement is especially poignant at a time when we are fighting a war abroad and fear further terrorism on our own land. Mr. Zober is a graduate of San Diego State University, was a Board Member of the National Peace Corps Association, and is currently serving in the Peace Corps in Israel.

I believe there are some former Peace Corps workers who have returned from their assignments and have worked in the area of HIV/AIDS. Let me just quickly introduce them, since they took the time off from their jobs to come here and support my legislation:

  • Lauren Hale, who served in the Ivory Coast;
  • Carrie Hessler-Radelet, who served in the Samoa Islands;
  • Carolyn Baer, who served in Burkina Faso;
  • Virginia Taggert, who served in Uganda; and
  • Dana Aronovich, who served in Mali.


My second legislation is the MTCT-Plus Initiative.

Mr. Chairman and Ranking Member Lowey, while much attention is being paid to preventing mother to child transmission (MTCT) of HIV/AIDS, we must turn to addressing the needs and rights of that child to grow up with parents so that millions of children are not left orphans before he or she can even walk. My bill, HR 1485, does this.

Any effective program to make significant inroads in addressing the HIV/AIDS pandemic must go beyond just breaking the cycle of transmission of HIV/AIDS from mother-to-child to a comprehensive program that takes care of the whole family after the birth of the child. In sub-Saharan Africa, family and societal structures are breaking down because of the deaths of a generation of parents.

For societies to continue providing food, education, healthcare, shelter, and other basic necessities of life, we must continue to care for the mother, father and other adult families members which is necessary for the child to grow and thrive.

Each year, more than 2.5 million women become infected, more than 500,000 transmit the virus to their infants and more than 1.5 million women die each year from AIDS. The number of children in the developing world who have been orphaned by the AIDS pandemic will nearly double from 13.4 million to 25.4 million by the end of this decade. Today, 5.5 million children in Africa have lost both parents, and in most cases, at least one of them to AIDS, and that number will rise to 7.9 million by 2010.

Groundbreaking progress has been made in the prevention of mother-to-child transmission. However, these programs offer little or no HIV care for the mothers. The tragedy is that most of the children saved by MTCT programs are likely to be motherless by the time they can walk. Senator Bill Frist, physician, and leader in the fight against HIV/AIDS, attended the 14th International AIDS Conference in Barcelona, July, 2002, and was quoted as saying:

“People realize today that when you knock out an entire generation of productive people, the teachers, the military, the people who support the civil institutions of the elected officials, which is what’s happening in many countries around the world, you do create 10 million orphans in Africa, going to 40 million, orphans who don’t have mentors, who don’t have the structure of civil society or of discipline. As we address this issue of increasing terrorism over time, clearly, we have to be concerned when we have what could be a lawless society. … We have what I believe is the greatest moral challenge of our time.”

In December 2001, United Nations Secretary General Kofi Annan met with leaders from several private philanthropic foundations including the Bill and Melinda Gates, the William and Flora Hewlett, the Robert Wood Johnson and other foundations, and announced a major program called the MTCT-Plus Initiative which is being administered by the Columbia University’s Mailman School of Public Health.

The Initiative is one program doing groundbreaking work on addressing the orphan issue. The Mailman School’s MTCT-Plus Initiative has already committed $50 million to target 40 sites in eight African and Asian countries to extend care beyond just the blocking of vertical transmission of HIV/AIDS from the mother to the child.

All of the Initiative’s sites have MTCT programs where currently pregnant women are offered HIV testing, and if they are positive they are offered one or two pills of antiretroviral medicine to prevent mother-to-child transmission. The “Plus” in the MTCT-Plus Initiative goes further by extending care to mothers, giving them antiretrovirals continuously, as well as care for tuberculosis and other infections commonly incurred with HIV infection.

MTCT-Plus will provide antiretroviral drug treatment and life-long care to more than 10,000 pregnant HIV-infected women, children, and other family members in a family-centered care model that can be replicated around the world, decreasing the chances of a child growing up as an orphan. The MTCT-Plus Initiative is presently supporting HIV/AIDS care and treatment activities at 12 demonstration sites – eleven of them in sub-Saharan Africa and one in Thailand.

It is important to note that Senate Majority Leader Bill Frist is an original cosponsor of Senator Kennedy’s bill S 2649, the International AIDS Treatment and Prevention Act of 2002, which was favorably reported out of the Senate Health, Education, Labor and Pensions Committee in the last Congress. This bill supports initiatives like the MTCT-Plus Initiative in its section titled “Family Survival Partnerships.” The Senate bill provides $75 million over two years to

“Support, through public-private partnership, for the provision of medical care and support services to HIV positive parents and their children identified through existing programs to prevent MTCT of HIV in countries with or at risk for severe HIV epidemic with particular attention to resource constrained countries...”

Other cosponsors of the Frist/Kennedy bill include Senators Santorum and DeWine, as well as my California colleague Senator Feinstein.

The House International Relations Committee is scheduled to markup up HR 1298 which has in Section 315 of that bill a similar provision for a family survival partnership pilot program.

Providing $75 million to the MTCT-Plus Initiative would expand the program in a number of ways to provide treatment to additional patients at existing sites where the demand for care and treatment greatly exceeds the current capacity to deliver such care. The Initiative does not reinvent the wheel; it uses current programs and infrastructure and with additional funding would expand the services at existing demonstration sites.

Mr. Chairman and Ranking Member Lowey, I would like to add one more point, about the importance of addressing HIV/AIDS in the interest of women around the world.

In early March in my office, I met with Madame Jeannette Kagame, the First Lady of the Republic of Rwanda. We discussed the HIV/AIDS pandemic in Africa, its disproportionate impact on women and children; it was this critical issue that gave the impetus to her starting the “African First Ladies’ Alliance Against HIV/AIDS” with other First Ladies of Africa. First Lady Kagame reiterated at our meeting what she had said at the Global Health Council Conference in May 2002. Speaking for other African countries ravaged by HIV/AIDS, she referred to the MTCT-Plus Initiative as the “family package” program.

Furthermore, at the 14th International AIDS Conference in Barcelona, July, 2002, Peter Piot, the Joint Director of UNAIDS, attended the announcement of the Mailman School’s MTCT-Plus Initiative, and called it

“Pioneering, because for once we will be able to say that it will be women who benefit first from a technology, a new initiative.”

I close my remarks underscoring the urgency. If we do not fund the MTCT-Plus Initiative now, it will be too late to tell the millions who are being infected and who are dying that help is on the way for them and for their children. I respectfully request this be given priority consideration for FY 2004.

Thank you for your time and your consideration of HR 1145 and HR 1485.