Christine Stencel, a spokeswoman for the Institute of Medicine, said individual countries and leaders implementing the program "on the ground" are more qualified to determine what funds are needed and where they should go.
The House passed its version of the bill by a nearly 3-1 margin in April. But a small number of Republican senators raised objections to the bipartisan bill, which is co-sponsored by both major parties' presidential candidates, Sen. Barack Obama (D-Ill.) and Sen. John McCain (R-Ariz.).
The bill authorizes $50 billion over five years, but senators set aside $2 billion for health and safety projects on American Indian reservations.
Sen. Jim DeMint (R-S.C.) voted for the 2003 legislation but wanted to reduce this year's bill to $35 billion. Another Republican, Sen. Jim Bunning of Kentucky, offered an amendment that would reauthorize the program for $15 billion, the amount it received in 2003. It was easily defeated.
"It's not a good time to be talking about spending billions of American dollars around the world, no matter how good the cause might be," DeMint said.
Democrats also cited issues Americans find troubling in making their case for supporting the bill: "Each month, we spend $12 to $15 billion on the war in Iraq," said Sen. Richard J. Durbin (D-Ill.), noting that the AIDS measure would cost $10 billion a year through 2013.
The legislation now goes to a House-Senate conference committee, where lawmakers can work out differences before sending the measure to Bush.
"With passage of today's bill, we are one step closer to ensuring that this excellent program continues to help those in need," Bush said in a statement Wednesday night.
One provision in the Senate bill would end a ban on immigration and travel to the U.S. by people with HIV. It would lift the 1993 prohibition imposed by Congress and allow the Department of Health and Human Services to decide whether to take HIV off its list of communicable diseases. The disease has been on the department's list since 1987.
"The key piece is that Congress should not substitute its judgment for the judgment of Health and Human Services," said Rachel B. Tiven, executive director of Immigration Equality, a New York-based group that advocates repealing the ban. "Public health should be left to the public health experts."
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vimal.patel@latimes.com
