A sub-committee of the Senate Appropriations Committee last night approved a Fiscal Year 2010 Appropriations bill that zeroes out funding for abstinence-only-until-marriage funding, increases funding for HIV prevention and health research, but retains a ban on syringe exchange.

Abstinence-only and teen pregnancy prevention

The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies eliminated funding for Community-Based Abstinence Education programs (CBAE), for years the main source of support for now-discredited abstinence-only programs.  The elimination of these funds parallels similar action in the House of Representatives, so unless amendments are proposed, accepted and passed during either the full committee vote or on the Senate floor, this bill spells "the end of abstinence-only programs as we know them," said one advocate, "at least for this year."

In place of these programs, both the House and Senate have approved funding for a teen pregnancy prevention initiative, along the lines of what was proposed in President Obama’s budget earlier this year.  There are, however, what many see as key differences, including levels of funding and who decides how to spend it.

The Senate bill allocates $104 million for the initiative and directs these funds be placed with the Office of the Secretary of Health and Human Services (HHS).  The House bill allocates $114.5 million, but directs the money go to the Administration for Children and Families (ACF), an agency within HHS that originally oversaw the CBAE program and which still retains staff people from the previous administration.  Advocates have been pushing for the funds to go to and be controlled by the Centers for Disease Control (CDC) because, as one put it, "CDC is the U.S. public health agency, and this is a public health issue…it should be driven by public health experts."  Placing the funding with the Office of the Secretary at HHS will ensure greater oversight on how the funds are used and by whom, without necessarily cutting ACF completely out of the picture.

Another issue still to be addressed is the scope and breadth of the teen pregnancy initiative.  As previously reported on Rewire, a coalition of 175 state and national organizations in the public health community have been urging both the House and the Senate to ensure funds can be used comprehensively for the purposes of reducing teen pregnancy and sexually transmitted infections while at the same time addressing the needs of gay, lesbian and transgender youth, sexual violence and coercion, and building life-long skills critical to safe and healthy reproductive and sexual lives.  Senate staffers have indicated that their bill will eventually reflect such an approach.

For now, the advocacy community is delighted at the elimination of abstinence-only funding.  "We thank Chairman Harkin and his staff for their leadership," said Bill Smith, Vice President for Public Policy at the Sexuality Information and Education Council of the US. 

"We are one step further toward a major national shift in policy that is direly needed.  Last week, the CDC released a wake up call in showing conclusive evidence that we are losing ground when it comes to good reproductive and sexual health outcomes.  Ending failed ab-only programs and funding programs that work isn’t just the right thing to do, it is what the public health evidence compels us to do.

HIV Prevention

The current version of the bill provides a modest funding increase for HIV prevention and surveillance, recommending that CDC receive  $711 million for these programs, an increase of $19 million over funding provided in FY 2009, but lower than the $75 million recommended by the parallel committee in the House of Representatives.  At the same time, however, the sub-committee ironically retained the ban on syringe exchange for intravenous drug users, proven to be the single most effective means of preventing the spread of HIV among this vulnerable population and from it to the general population. 

The House Appropriations bill passed last week with language removing the ban in theory, but retaining it in practice by forbidding federal funding of syringe exchange programs within 1,000 feet of any school, park, playground or community center.  Advocates’ hopes to remove the ban and the "1,000 foot rule" in conference committee (where the House and Senate work to craft one bill out of their respective versions) were bolstered by a comment by Senator Tom Harkin (D-IA) who, according to a report by Congressional Quarterly (CQ), stated that the syringe exchange ban is “a matter for conference."

Research Funding

The Senate bill also increased funding for the National Institutes of Health (NIH) to the level requested in the President’s budget, $30.76 billion.  This represents an increase of $442 million over FY 09.  The House voted for slightly higher levels of funding, $31.26 billion, but also accepted an amendment to the bill defunding critical HIV prevention research, all for ideological reasons.  HIV prevention and treatment advocacy groups intend to lobby hard to remove this amendment during the conference committee.

While the news out of this vote is by and large good for evidence-based programs, CQ warns there may be more controversy later on:

Tuesday’s subcommittee markup was quick and polite, with the two Republicans in attendance — Richard C. Shelby of Alabama and Thad Cochran of Mississippi, who is the ranking Republican for the Appropriations Committee — both praising the measure as a good compromise.  But as with most spending bills in the Senate, significant fights will likely be reserved for the floor.