Early this month Congress approved a bill that will extend the President’s Emergency Program for AIDS Relief (PEPFAR) another five years – and triple the budget from $15 billion to $50 billion. The money will help combat the spread of AIDS abroad. “For our country to be healthy, for the eradication of these diseases to take place, we must have a global approach,” said Nancy Pelosi, speaker of the house. “Disease knows no borders and boundaries (.) There is a moral imperative to fight this epidemic.”

Supported by both major parties and the President, the bill passed by 308 votes to 116; it is expected to do equally well in the Senate. Money to fight malaria and tuberculosis is included in the package as well.

“This is the biggest achievement of the last eight years of the Bush administration,” said Harper Bokum-Fauth, AIDS activist and International Studies major. “Only the United States is capable of doing something like this.”

The original PEPFAR five-year plan (PEPFAR 1) focused $15 billion on 15 predominantly sub-Saharan African nations where, according to the United Nations, two-thirds of the world’s HIV-positive population resides. Haiti and Vietnam were the only two non-African countries provided for.

PEPFAR 1 proved controversial because it required that one-third of the funds be allocated to promoting abstinence-only education, a tactic that the medical community has condemned for years as ineffective.

PEPFAR 2 strikes the abstinence-only requirement from the bill, although if recipient nations spend less then 50 percent of their funding for sexual-transmission prevention on abstinence-based programs they must defend that choice to Congress.

“You have to deal with gender oppression to be able to effectively prevent HIV,” said Martha Lang, visiting assistant professor of sociology and anthropology and medical sociologist. “And you can’t do that with abstinence-only education. In societies where women are oppressed and have no choice but to engage in sex work for survival abstinence-only education is immoral and doomed to failure.”

Another controversial aspect of the bill enforces the “anti-prostitution loyalty oath,” which equates sex work with human trafficking. Practically, this means that PEPFAR denies money to organizations that medically treat sex workers in impoverished nations.

Controversy over the bill has generally come from organizations that decry the culturally conservative provisions remaining in the program or from Republican congressional representatives who think the money can be better spent at home.

“What concerns me is that funding is lacking for HIV-positive people in this country,” Lang said. “While I’m thankful that PEPFAR has so much support I’m concerned about the growing invisibility and inertia around people living with HIV in the U.S. This isn’t a populist ‘us before the world’ argument. (It is just that) HIV is a growing problem in a number of American communities.”

It is estimated that 1,180,00 people living in the United States are HIV positive, according to the international AIDS charity AVERT. Marginalized groups, including African-American, Latino, and American Indian communities, tend to have higher exposure rates.