[House Report 108-60]
[From the U.S. Government Publishing Office]
108th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 108-60
======================================================================
UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA
ACT OF 2003
_______
April 7, 2003.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Hyde, from the Committee on International Relations, submitted the
following
R E P O R T
[To accompany H.R. 1298]
[Including cost estimate of the Congressional Budget Office]
The Committee on International Relations, to whom was
referred the bill (H.R. 1298) to provide assistance to foreign
countries to combat HIV/AIDS, tuberculosis, and malaria, and
for other purposes, having considered the same, reports
favorably thereon with an amendment and recommends that the
bill as amended do pass.
TABLE OF CONTENTS
Page
The Amendment.................................................... 1
Purpose and Summary.............................................. 23
Background and Need for the Legislation.......................... 24
Hearings......................................................... 27
Committee Consideration.......................................... 27
Summary of Amendments............................................ 28
Votes of the Committee........................................... 29
Committee Oversight Findings..................................... 31
New Budget Authority and Tax Expenditures........................ 31
Congressional Budget Office Cost Estimate........................ 31
Performance Goals and Objectives................................. 33
Constitutional Authority Statement............................... 33
Section-by-Section Analysis...................................... 33
New Advisory Committees.......................................... 37
Congressional Accountability Act................................. 37
Federal Mandates................................................. 37
Changes in Existing Law Made by the Bill, as Reported............ 37
The Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis
and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Pilot program for the placement of health care professionals
in overseas areas severely affected by HIV/AIDS, tuberculosis, and
malaria.
Sec. 305. Report on treatment activities by relevant executive branch
agencies.
Subtitle B--Assistance for Children and Families
Sec. 311. Findings.
Sec. 312. Policy and requirements.
Sec. 313. Annual reports on prevention of mother-to-child transmission
of the HIV infection.
Sec. 314. Pilot program of assistance for children and families
affected by HIV/AIDS.
Sec. 315. Pilot program on family survival partnerships.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) During the last 20 years, HIV/AIDS has assumed pandemic
proportions, spreading from the most severely affected regions,
sub-Saharan Africa and the Caribbean, to all corners of the
world, and leaving an unprecedented path of death and
devastation.
(2) According to the Joint United Nations Programme on HIV/
AIDS (UNAIDS), more than 65,000,000 individuals worldwide have
been infected with HIV since the epidemic began, more than
25,000,000 of these individuals have lost their lives to the
disease, and more than 14,000,000 children have been orphaned
by the disease. HIV/AIDS is the fourth-highest cause of death
in the world.
(3)(A) At the end of 2002, an estimated 42,000,000
individuals were infected with HIV or living with AIDS, of
which more than 75 percent live in Africa or the Caribbean. Of
these individuals, more than 3,200,000 were children under the
age of fifteen and more than 19,200,000 were women.
(B) Women are four times more vulnerable to infection than
are men and are becoming infected at increasingly high rates,
in part because many societies do not provide poor women and
young girls with the social, legal, and cultural protections
against high risk activities that expose them to HIV/AIDS.
(C) Women and children who are refugees or are internally
displaced persons are especially vulnerable to sexual
exploitation and violence, thereby increasing the possibility
of HIV infection.
(4) As the leading cause of death in sub-Saharan Africa,
AIDS has killed more than 19,400,000 individuals (more than 3
times the number of AIDS deaths in the rest of the world) and
will claim the lives of one-quarter of the population, mostly
adults, in the next decade.
(5) An estimated 2,000,000 individuals in Latin America and
the Caribbean and another 7,100,000 individuals in Asia and the
Pacific region are infected with HIV or living with AIDS.
Infection rates are rising alarmingly in Eastern Europe
(especially in the Russian Federation), Central Asia, and
China.
(6) HIV/AIDS threatens personal security by affecting the
health, lifespan, and productive capacity of the individual and
the social cohesion and economic well-being of the family.
(7) HIV/AIDS undermines the economic security of a country
and individual businesses in that country by weakening the
productivity and longevity of the labor force across a broad
array of economic sectors and by reducing the potential for
economic growth over the long term.
(8) HIV/AIDS destabilizes communities by striking at the
most mobile and educated members of society, many of whom are
responsible for security at the local level and governance at
the national and subnational levels as well as many teachers,
health care personnel, and other community workers vital to
community development and the effort to combat HIV/AIDS. In
some countries the overwhelming challenges of the HIV/AIDS
epidemic are accelerating the outward migration of critically
important health care professionals.
(9) HIV/AIDS weakens the defenses of countries severely
affected by the HIV/AIDS crisis through high infection rates
among members of their military forces and voluntary
peacekeeping personnel. According to UNAIDS, in sub-Saharan
Africa, many military forces have infection rates as much as
five times that of the civilian population.
(10) HIV/AIDS poses a serious security issue for the
international community by--
(A) increasing the potential for political
instability and economic devastation, particularly in
those countries and regions most severely affected by
the disease;
(B) decreasing the capacity to resolve conflicts
through the introduction of peacekeeping forces because
the environments into which these forces are introduced
pose a high risk for the spread of HIV/AIDS; and
(C) increasing the vulnerability of local
populations to HIV/AIDS in conflict zones from
peacekeeping troops with HIV infection rates
significantly higher than civilian populations.
(11) The devastation wrought by the HIV/AIDS pandemic is
compounded by the prevalence of tuberculosis and malaria,
particularly in developing countries where the poorest and most
vulnerable members of society, including women, children, and
those individuals living with HIV/AIDS, become infected.
According to the World Health Organization (WHO), HIV/AIDS,
tuberculosis, and malaria accounted for more than 5,700,000
deaths in 2001 and caused debilitating illnesses in millions
more.
(12) Together, HIV/AIDS, tuberculosis, malaria and related
diseases are undermining agricultural production throughout
Africa. According to the United Nations Food and Agricultural
Organization, 7,000,000 agricultural workers throughout 25
African countries have died from AIDS since 1985. Countries
with poorly developed agricultural systems, which already face
chronic food shortages, are the hardest hit, particularly in
sub-Saharan Africa, where high HIV prevalence rates are
compounding the risk of starvation for an estimated 14,400,000
people.
(13) Tuberculosis is the cause of death for one out of
every three people with AIDS worldwide and is a highly
communicable disease. HIV infection is the leading threat to
tuberculosis control. Because HIV infection so severely weakens
the immune system, individuals with HIV and latent tuberculosis
infection have a 100 times greater risk of developing active
tuberculosis diseases thereby increasing the risk of spreading
tuberculosis to others. Tuberculosis, in turn, accelerates the
onset of AIDS in individuals infected with HIV.
(14) Malaria, the most deadly of all tropical parasitic
diseases, has been undergoing a dramatic resurgence in recent
years due to increasing resistance of the malaria parasite to
inexpensive and effective drugs. At the same time, increasing
resistance of mosquitoes to standard insecticides makes control
of transmission difficult to achieve. The World Health
Organization estimates that between 300,000,000 and 500,000,000
new cases of malaria occur each year, and annual deaths from
the disease number between 2,000,000 and 3,000,000. Persons
infected with HIV are particularly vulnerable to the malaria
parasite. The spread of HIV infection contributes to the
difficulties of controlling resurgence of the drug resistant
malaria parasite.
(15) HIV/AIDS is first and foremost a health problem.
Successful strategies to stem the spread of the HIV/AIDS
pandemic will require clinical medical interventions, the
strengthening of health care delivery systems and
infrastructure, and determined national leadership and
increased budgetary allocations for the health sector in
countries affected by the epidemic as well as measures to
address the social and behavioral causes of the problem and its
impact on families, communities, and societal sectors.
(16) Basic interventions to prevent new HIV infections and
to bring care and treatment to people living with AIDS, such as
voluntary counseling and testing and mother-to-child
transmission programs, are achieving meaningful results and are
cost-effective. The challenge is to expand these interventions
from a pilot program basis to a national basis in a coherent
and sustainable manner.
(17) Appropriate treatment of individuals with HIV/AIDS can
prolong the lives of such individuals, preserve their families,
prevent children from becoming orphans, and increase
productivity of such individuals by allowing them to lead
active lives and reduce the need for costly hospitalization for
treatment of opportunistic infections caused by HIV.
(18) Nongovernmental organizations, including faith-based
organizations, with experience in health care and HIV/AIDS
counseling, have proven effective in combating the HIV/AIDS
pandemic and can be a resource in assisting indigenous
organizations in severely affected countries in their efforts
to provide treatment and care for individuals infected with
HIV/AIDS.
(19) Faith-based organizations are making an important
contribution to HIV prevention and AIDS treatment programs
around the world. Successful HIV prevention programs in Uganda,
Jamaica, and elsewhere have included local churches and faith-
based groups in efforts to promote behavior changes to prevent
HIV, to reduce stigma associated with HIV infection, to treat
those afflicted with the disease, and to care for orphans. The
Catholic Church alone currently cares for one in four people
being treated for AIDS worldwide. Faith-based organizations
possess infrastructure, experience, and knowledge that will be
needed to carry out these programs in the future and should be
an integral part of United States efforts.
(20)(A) Uganda has experienced the most significant decline
in HIV rates of any country in Africa, including a decrease
among pregnant women from 20.6 percent in 1991 to 7.9 percent
in 2000.
(B) Uganda made this remarkable turnaround because
President Yoweri Museveni spoke out early, breaking long-
standing cultural taboos, and changed widespread perceptions
about the disease. His leadership stands as a model for ways
political leaders in Africa and other developing countries can
mobilize their nations, including civic organizations,
professional associations, religious institutions, business and
labor to combat HIV/AIDS.
(C) Uganda's successful AIDS treatment and prevention
program is referred to as the ABC model: ``Abstain, Be
faithful, use Condoms'', in order of priority. Jamaica, Zambia,
Ethiopia and Senegal have also successfully used the ABC model.
Beginning in 1986, Uganda brought about a fundamental change in
sexual behavior by developing a low-cost program with the
message: ``Stop having multiple partners. Be faithful.
Teenagers, wait until you are married before you begin sex.''.
(D) By 1995, 95 percent of Ugandans were reporting either
one or zero sexual partners in the past year, and the
proportion of sexually active youth declined significantly from
the late 1980s to the mid-1990s. The greatest percentage
decline in HIV infections and the greatest degree of behavioral
change occurred in those 15 to 19 years old. Uganda's success
shows that behavior change, through the use of the ABC model,
is a very successful way to prevent the spread of HIV.
(21) The magnitude and scope of the HIV/AIDS crisis demands
a comprehensive, long-term, international response focused upon
addressing the causes, reducing the spread, and ameliorating
the consequences of the HIV/AIDS pandemic, including--
(A) prevention and education, care and treatment,
basic and applied research, and training of health care
workers, particularly at the community and provincial
levels, and other community workers and leaders needed
to cope with the range of consequences of the HIV/AIDS
crisis;
(B) development of health care infrastructure and
delivery systems through cooperative and coordinated
public efforts and public and private partnerships;
(C) development and implementation of national and
community-based multisector strategies that address the
impact of HIV/AIDS on the individual, family,
community, and nation and increase the participation of
at-risk populations in programs designed to encourage
behavioral and social change and reduce the stigma
associated with HIV/AIDS; and
(D) coordination of efforts between international
organizations such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the Joint United Nations
Programme on HIV/AIDS (UNAIDS), the World Health
Organization (WHO), national governments, and private
sector organizations, including faith-based
organizations.
(22) The United States has the capacity to lead and enhance
the effectiveness of the international community's response
by--
(A) providing substantial financial resources,
technical expertise, and training, particularly of
health care personnel and community workers and
leaders;
(B) promoting vaccine and microbicide research and
the development of new treatment protocols in the
public and commercial pharmaceutical research sectors;
(C) making available pharmaceuticals and
diagnostics for HIV/AIDS therapy;
(D) encouraging governments and faith-based and
community-based organizations to adopt policies that
treat HIV/AIDS as a multisectoral public health problem
affecting not only health but other areas such as
agriculture, education, the economy, the family and
society, and assisting them to develop and implement
programs corresponding to these needs;
(E) promoting healthy lifestyles, including
abstinence, delaying sexual debut, monogamy, marriage,
faithfulness, use of condoms, and avoiding substance
abuse; and
(F) encouraging active involvement of the private
sector, including businesses, pharmaceutical and
biotechnology companies, the medical and scientific
communities, charitable foundations, private and
voluntary organizations and nongovernmental
organizations, faith-based organizations, community-
based organizations, and other nonprofit entities.
(23) Prostitution and other sexual victimization are
degrading to women and children and it should be the policy of
the United States to eradicate such practices. The sex
industry, the trafficking of individuals into such industry,
and sexual violence are additional causes of and factors in the
spread of the HIV/AIDS epidemic. One in nine South Africans is
living with AIDS, and sexual assault is rampant, at a
victimization rate of one in three women. Meanwhile in
Cambodia, as many as 40 percent of prostitutes are infected
with HIV and the country has the highest rate of increase of
HIV infection in all of Southeast Asia. Victims of coercive
sexual encounters do not get to make choices about their sexual
activities.
(24) Strong coordination must exist among the various
agencies of the United States to ensure effective and efficient
use of financial and technical resources within the United
States Government with respect to the provision of
international HIV/AIDS assistance.
(25) In his address to Congress on January 28, 2003, the
President announced the Administration's intention to embark on
a five-year emergency plan for AIDS relief, to confront HIV/
AIDS with the goals of preventing 7,000,000 new HIV/AIDS
infections, treating at least 2,000,000 people with life-
extending drugs, and providing humane care for millions of
people suffering from HIV/AIDS, and for children orphaned by
HIV/AIDS.
(26) In this address to Congress, the President stated the
following: ``Today, on the continent of Africa, nearly
30,000,000 people have the AIDS virus--including 3,000,000
children under the age of 15. There are whole countries in
Africa where more than one-third of the adult population
carries the infection. More than 4,000,000 require immediate
drug treatment. Yet across that continent, only 50,000 AIDS
victims--only 50,000--are receiving the medicine they need.''.
(27) Furthermore, the President focused on care and
treatment of HIV/AIDS in his address to Congress, stating the
following: ``Because the AIDS diagnosis is considered a death
sentence, many do not seek treatment. Almost all who do are
turned away. A doctor in rural South Africa describes his
frustration. He says, `We have no medicines. Many hospitals
tell people, you've got AIDS, we can't help you. Go home and
die.' In an age of miraculous medicines, no person should have
to hear those words. AIDS can be prevented. Anti-retroviral
drugs can extend life for many years . . . Ladies and
gentlemen, seldom has history offered a greater opportunity to
do so much for so many.''.
(28) Finally, the President stated that ``[w]e have
confronted, and will continue to confront, HIV/AIDS in our own
country'', proposing now that the United States should lead the
world in sparing innocent people from a plague of nature, and
asking Congress ``to commit $15,000,000,000 over the next five
years, including nearly $10,000,000,000 in new money, to turn
the tide against AIDS in the most afflicted nations of Africa
and the Caribbean''.
SEC. 3. DEFINITIONS.
In this Act:
(1) AIDS.--The term ``AIDS'' means the acquired immune
deficiency syndrome.
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means the Committee on
Foreign Relations of the Senate and the Committee on
International Relations of the House of Representatives.
(3) Global fund.--The term ``Global Fund'' means the
public-private partnership known as the Global Fund to Fight
AIDS, Tuberculosis and Malaria established pursuant to Article
80 of the Swiss Civil Code.
(4) HIV.--The term ``HIV'' means the human immunodeficiency
virus, the pathogen that causes AIDS.
(5) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to
an individual, an individual who is infected with HIV or living
with AIDS.
(6) Relevant executive branch agencies.--The term
``relevant executive branch agencies'' means the Department of
State, the United States Agency for International Development,
and any other department or agency of the United States that
participates in international HIV/AIDS activities pursuant to
the authorities of such department or agency or the Foreign
Assistance Act of 1961.
SEC. 4. PURPOSE.
The purpose of this Act is to strengthen United States leadership
and the effectiveness of the United States response to certain global
infectious diseases by--
(1) establishing a comprehensive, integrated five-year,
global strategy to fight HIV/AIDS that encompasses a plan for
phased expansion of critical programs and improved coordination
among relevant executive branch agencies and between the United
States and foreign governments and international organizations;
(2) providing increased resources for multilateral efforts
to fight HIV/AIDS;
(3) providing increased resources for United States
bilateral efforts, particularly for technical assistance and
training, to combat HIV/AIDS, tuberculosis, and malaria;
(4) encouraging the expansion of private sector efforts and
expanding public-private sector partnerships to combat HIV/
AIDS; and
(5) intensifying efforts to support the development of
vaccines and treatment for HIV/AIDS, tuberculosis, and malaria.
SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.
With respect to the reports required by this Act to be submitted by
the President, to ensure an efficient use of resources, the President
may, in his discretion and notwithstanding any other provision of this
Act, consolidate or combine any of these reports, except for the report
required by section 101 of this Act, so long as the required elements
of each report are addressed and reported within a 90-day period from
the original deadline date for submission of the report specified in
this Act. The President may also enter into contracts with
organizations with relevant expertise to develop, originate, or
contribute to any of the reports required by this Act to be submitted
by the President.
TITLE I--POLICY PLANNING AND COORDINATION
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL STRATEGY.
(a) Strategy.--The President shall establish a comprehensive,
integrated, five-year strategy to combat global HIV/AIDS that
strengthens the capacity of the United States to be an effective leader
of the international campaign against HIV/AIDS. Such strategy shall
maintain sufficient flexibility and remain responsive to the ever-
changing nature of the HIV/AIDS pandemic and shall--
(1) include specific objectives, multisectoral approaches,
and specific strategies to treat individuals infected with HIV/
AIDS and to prevent the further spread of HIV infections, with
a particular focus on the needs of families with children
(including the prevention of mother-to-child transmission),
women, young people, and children (such as unaccompanied minor
children and orphans);
(2) as part of the strategy, implement a tiered approach to
direct delivery of care and treatment through a system based on
central facilities augmented by expanding circles of local
delivery of care and treatment through local systems and
capacity;
(3) assign priorities for relevant executive branch
agencies;
(4) provide that the reduction of HIV/AIDS behavioral risks
shall be a priority of all prevention efforts in terms of
funding, educational messages, and activities by promoting
abstinence from sexual activity and substance abuse,
encouraging monogamy and faithfulness, promoting the effective
use of condoms, and eradicating prostitution, the sex trade,
rape, sexual assault and sexual exploitation of women and
children;
(5) improve coordination among relevant executive branch
agencies, foreign governments, and international organizations;
(6) project general levels of resources needed to achieve
the stated objectives;
(7) expand public-private partnerships and the leveraging
of resources; and
(8) maximize United States capabilities in the areas of
technical assistance and training and research, including
vaccine research.
(b) Report.--
(1) In general.--Not later than 270 days after the date of
enactment of this Act, the President shall submit to the
appropriate congressional committees a report setting forth the
strategy described in subsection (a).
(2) Report contents.--The report required by paragraph (1)
shall include a discussion of the elements described in
paragraph (3) and may include a discussion of additional
elements relevant to the strategy described in subsection (a).
Such discussion may include an explanation as to why a
particular element described in paragraph (3) is not relevant
to such strategy.
(3) Report elements.--The elements referred to in paragraph
(2) are the following:
(A) The objectives, general and specific, of the
strategy.
(B) A description of the criteria for determining
success of the strategy.
(C) A description of the manner in which the
strategy will address the fundamental elements of
prevention and education, care, and treatment
(including increasing access to pharmaceuticals and to
vaccines), the promotion of abstinence, monogamy,
avoidance of substance abuse, and use of condoms,
research (including incentives for vaccine development
and new protocols), training of health care workers,
the development of health care infrastructure and
delivery systems, and avoidance of substance abuse.
(D) A description of the manner in which the
strategy will promote the development and
implementation of national and community-based
multisectoral strategies and programs, including those
designed to enhance leadership capacity particularly at
the community level.
(E) A description of the specific strategies
developed to meet the unique needs of women, including
the empowerment of women in interpersonal situations,
young people and children, including those orphaned by
HIV/AIDS and those who are victims of the sex trade,
rape, sexual abuse, assault, and exploitation.
(F) A description of the programs to be undertaken
to maximize United States contributions in the areas of
technical assistance, training (particularly of health
care workers and community-based leaders in affected
sectors), and research, including the promotion of
research on vaccines and microbicides.
(G) An identification of the relevant executive
branch agencies that will be involved and the
assignment of priorities to those agencies.
(H) A description of the role of each relevant
executive branch agency and the types of programs that
the agency will be undertaking.
(I) A description of the mechanisms that will be
utilized to coordinate the efforts of the relevant
executive branch agencies, to avoid duplication of
efforts, to enhance on-site coordination efforts, and
to ensure that each agency undertakes programs
primarily in those areas where the agency has the
greatest expertise, technical capabilities, and
potential for success.
(J) A description of the mechanisms that will be
utilized to ensure greater coordination between the
United States and foreign governments and international
organizations including the Global Fund, UNAIDS,
international financial institutions, and private
sector organizations.
(K) The level of resources that will be needed on
an annual basis and the manner in which those resources
would generally be allocated among the relevant
executive branch agencies.
(L) A description of the mechanisms to be
established for monitoring and evaluating programs,
promoting successful models, and for terminating
unsuccessful programs.
(M) A description of the manner in which private,
nongovernmental entities will factor into the United
States Government-led effort and a description of the
type of partnerships that will be created to maximize
the capabilities of these private sector entities and
to leverage resources.
(N) A description of the ways in which United
States leadership will be used to enhance the overall
international response to the HIV/AIDS pandemic and
particularly to heighten the engagement of the member
states of the G-8 and to strengthen key financial and
coordination mechanisms such as the Global Fund and
UNAIDS.
(O) A description of the manner in which the United
States strategy for combating HIV/AIDS relates to and
supports other United States assistance strategies in
developing countries.
(P) A description of the programs to be carried out
under the strategy that are specifically targeted at
women and girls to educate them about the spread of
HIV/AIDS.
(Q) A description of efforts being made to address
the unique needs of families with children with respect
to HIV/AIDS, including efforts to preserve the family
unit.
(R) An analysis of the emigration of critically
important medical and public health personnel,
including physicians, nurses, and supervisors from sub-
Saharan African countries that are acutely impacted by
HIV/AIDS, including a description of the causes,
effects, and the impact on the stability of health
infrastructures, as well as a summary of incentives and
programs that the United States could provide, in
concert with other private and public sector partners
and international organizations, to stabilize health
institutions by encouraging critical personnel to
remain in their home countries.
(S) A description of the specific strategies
developed to promote sustainability of HIV/AIDS
pharmaceuticals (including antiretrovirals) and the
effects of drug resistance on HIV/AIDS patients.
(T) A description of the specific strategies to
ensure that the extraordinary benefit of HIV/AIDS
pharmaceuticals (especially antiretrovirals) are not
diminished through the illegal counterfeiting of
pharmaceuticals and black market sales of such
pharmaceuticals.
(U) An analysis of the prevalence of Human
Papilloma Virus (HPV) in sub-Saharan Africa and the
impact that condom usage has upon the spread of HPV in
sub-Saharan Africa.
SEC. 102. HIV/AIDS RESPONSE COORDINATOR.
(a) Establishment of Position.--Section 1 of the State Department
Basic Authorities Act of 1956 (22 U.S.C. 265(a)) is amended--
(1) by redesignating subsection (f) as subsection (g); and
(2) by inserting after subsection (e) the following:
``(f) HIV/AIDS Response Coordinator.--
``(1) In general.--There shall be established within the
Department of State in the immediate office of the Secretary of
State a Coordinator of United States Government Activities to
Combat HIV/AIDS Globally, who shall be appointed by the
President, by and with the advice and consent of the Senate.
The Coordinator shall report directly to the Secretary.
``(2) Authorities and duties; definitions.--
``(A) Authorities.--The Coordinator, acting through
such nongovernmental organizations (including faith-
based and community-based organizations) and relevant
executive branch agencies as may be necessary and
appropriate to effect the purposes of this section, is
authorized--
``(i) to operate internationally to carry
out prevention, care, treatment, support,
capacity development, and other activities for
combatting HIV/AIDS;
``(ii) to transfer and allocate funds to
relevant executive branch agencies; and
``(iii) to provide grants to, and enter
into contracts with, nongovernmental
organizations (including faith-based and
community-based organizations) to carry out the
purposes of section.
``(B) Duties.--
``(i) In general.--The Coordinator shall
have primary responsibility for the oversight
and coordination of all resources and
international activities of the United States
Government to combat the HIV/AIDS pandemic,
including all programs, projects, and
activities of the United States Government
relating to the HIV/AIDS pandemic under the
United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 or any
amendment made by that Act.
``(ii) Specific duties.--The duties of the
Coordinator shall specifically include the
following:
``(I) Ensuring program and policy
coordination among the relevant
executive branch agencies and
nongovernmental organizations,
including auditing, monitoring, and
evaluation of all such programs.
``(II) Ensuring that each relevant
executive branch agency undertakes
programs primarily in those areas where
the agency has the greatest expertise,
technical capabilities, and potential
for success.
``(III) Avoiding duplication of
effort.
``(IV) Ensuring coordination of
relevant executive branch agency
activities in the field.
``(V) Pursuing coordination with
other countries and international
organizations.
``(VI) Resolving policy, program,
and funding disputes among the relevant
executive branch agencies.
``(VII) Directly approving all
activities of the United States
(including funding) relating to
combatting HIV/AIDS in each of
Botswana, Cote d'Ivoire, Ethiopia,
Guyana, Haiti, Kenya, Mozambique,
Namibia, Nigeria, Rwanda, South Africa,
Tanzania, Uganda, Zambia, and other
countries designated by the President,
which other designated countries may
include those countries in which the
United States is implementing HIV/AIDS
programs as of the date of the
enactment of the United States
Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003.
``(VIII) Establishing due diligence
criteria for all recipients of funds
section and all activities subject to
the coordination and appropriate
monitoring, evaluation, and audits
carried out by the Coordinator
necessary to assess the measurable
outcomes of such activities.
``(C) Definitions.--In this paragraph:
``(i) AIDS.--The term `AIDS' means acquired
immune deficiency syndrome.
``(ii) HIV.--The term `HIV' means the human
immunodeficiency virus, the pathogen that
causes AIDS.
``(iii) HIV/AIDS.--The term `HIV/AIDS'
means, with respect to an individual, an
individual who is infected with HIV or living
with AIDS.
``(iv) Relevant executive branch
agencies.--The term `relevant executive branch
agencies' means the Department of State, the
United States Agency for International
Development, the Department of Health and Human
Services (including the Public Health Service),
and any other department or agency of the
United States that participates in
international HIV/AIDS activities pursuant to
the authorities of such department or agency or
this Act.''.
(b) Resources.--Not later than 90 days after the date of enactment
of this Act, the President shall specify the necessary financial and
personnel resources, from funds appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
assistance, that shall be assigned to and under the direct control of
the Coordinator of United States Government Activities to Combat HIV/
AIDS Globally to establish and maintain the duties and supporting
activities assigned to the Coordinator by this Act and the amendments
made by this Act.
(c) Establishment of Separate Account.--There is established in the
general fund of the Treasury a separate account which shall be known as
the ``Activities to Combat HIV/AIDS Globally Fund'' and which shall be
administered by the Coordinator of United States Government Activities
to Combat HIV/AIDS Globally. There shall be deposited into the Fund all
amounts appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance, except for amounts
appropriated for United States contributions to the Global Fund.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.
(a) Findings.--Congress makes the following findings:
(1) Innovative partnerships between governments and
organizations in the private sector (including foundations,
universities, corporations, faith-based and community-based
organizations, and other nongovernmental organizations) have
proliferated in recent years, particularly in the area of
health.
(2) Public-private sector partnerships multiply local and
international capacities to strengthen the delivery of health
services in developing countries and to accelerate research for
vaccines and other pharmaceutical products that are essential
to combat infectious diseases decimating the populations of
these countries.
(3) These partnerships maximize the unique capabilities of
each sector while combining financial and other resources,
scientific knowledge, and expertise toward common goals which
neither the public nor the private sector can achieve alone.
(4) Sustaining existing public-private partnerships and
building new ones are critical to the success of the
international community's efforts to combat HIV/AIDS and other
infectious diseases around the globe.
(b) Sense of Congress.--It is the sense of Congress that--
(1) the sustainment and promotion of public-private
partnerships should be a priority element of the strategy
pursued by the United States to combat the HIV/AIDS pandemic
and other global health crises; and
(2) the United States should systematically track the
evolution of these partnerships and work with others in the
public and private sector to profile and build upon those
models that are most effective.
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS
AND MALARIA.
(a) Authority for United States Participation.--
(1) United states participation.--The United States is
hereby authorized to participate in the Global Fund.
(2) Privileges and immunities.--The Global Fund shall be
considered a public international organization for purposes of
section 1 of the International Organizations Immunities Act (22
U.S.C. 288).
(b) Reports to Congress.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for the duration of
the Global Fund, the President shall submit to the appropriate
congressional committees a report on the Global Fund, including
contributions pledged to, contributions (including donations from the
private sector) received by, and projects funded by the Global Fund,
and the mechanisms established for transparency and accountability in
the grant-making process.
(c) United States Financial Participation.--
(1) Authorization of appropriations.--In addition to any
other funds authorized to be appropriated for bilateral or
multilateral HIV/AIDS, tuberculosis, or malaria programs, of
the amounts authorized to be appropriated under section 401,
there are authorized to be appropriated to the President up to
$1,000,000,000 in the fiscal year 2004, and such sums as may be
necessary for the fiscal years 2005-2008, for contributions to
the Global Fund.
(2) Availability of funds.--Amounts appropriated under
paragraph (1) are authorized to remain available until
expended.
(3) Reprogramming of fiscal year 2001 funds.--Funds made
available for fiscal year 2001 under section 141 of the Global
AIDS and Tuberculosis Relief Act of 2000--
(A) are authorized to remain available until
expended; and
(B) shall be transferred to, merged with, and made
available for the same purposes as, funds made
available for fiscal years 2004 through 2008 under
paragraph (1).
(4) Limitation.--
(A)(i) At any time during fiscal years 2004 through
2008, no United States contribution to the Global Fund
may cause the total amount of United States Government
contributions to the Global Fund to exceed 33 percent
of the total amount of funds contributed to the Global
Fund from all other sources. Contributions to the
Global Fund from the International Bank for
Reconstruction and Development and the International
Monetary Fund shall not be considered in determining
compliance with this paragraph.
(ii) If, at any time during any of the fiscal years
2004 through 2008, the President determines that the
Global Fund has provided assistance to a country, the
government of which the Secretary of State has
determined, for purposes of section 6(j)(1) of the
Export Administration Act of 1979 (50 U.S.C. App.
2405(j)(1)), has repeatedly provided support for acts
of international terrorism, then the United States
shall withhold from its contribution for the next
fiscal year an amount equal to the amount expended by
the Fund to the government of each such country.
(B) Any amount made available under this subsection
that is withheld by reason of subparagraph (A) shall be
contributed to the Global Fund as soon as practicable,
subject to subparagraph (A), after additional
contributions to the Global Fund are made from other
sources.
(C)(i) The President may suspend the application of
subparagraph (A) with respect to a fiscal year if the
President determines that an international health
emergency threatens the national security interests of
the United States.
(ii) The President shall notify the Committee on
International Relations of the House of Representatives
and the Committee on Foreign Relations of the Senate
not less than 5 days before making a determination
under clause (i) with respect to the application of
subparagraph (A)(i) and shall include in the
notification--
(I) a justification as to why increased
United States Government contributions to the
Global Fund is preferable to increased United
States assistance to combat HIV/AIDS,
tuberculosis, and malaria on a bilateral basis;
and
(II) an explanation as to why other
government donors to the Global Fund are unable
to provide adequate contributions to the Fund.
(d) Interagency Technical Review Panel.--
(1) Establishment.--The Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, established
in section 1(f)(1) of the State Department Basic Authorities
Act of 1956 (as added by section 102(a) of this Act), shall
establish in the executive branch an interagency technical
review panel.
(2) Duties.--The interagency technical review panel shall
serve as a ``shadow'' panel to the Global Fund by--
(A) periodically reviewing all proposals received
by the Global Fund; and
(B) providing guidance to the United States persons
who are representatives on the panels, committees, and
boards of the Global Fund, on the technical efficacy,
suitability, and appropriateness of the proposals, and
ensuring that such persons are fully informed of
technical inadequacies or other aspects of the
proposals that are inconsistent with the purposes of
this or any other Act relating to the provision of
foreign assistance in the area of AIDS.
(3) Membership.--The interagency technical review panel
shall consist of qualified medical and development experts who
are officers or employees of the Department of Health and Human
Services, the Department of State, and the United States Agency
for International Development.
(4) Chair.--The Coordinator referred to in paragraph (1)
shall chair the interagency technical review panel.
(e) Monitoring by Comptroller General.--
(1) Monitoring.--The Comptroller General shall monitor and
evaluate projects funded by the Global Fund.
(2) Report.--The Comptroller General shall on a biennial
basis shall prepare and submit to the appropriate congressional
committees a report that contains the results of the monitoring
and evaluation described in paragraph (1) for the preceding 2-
year period.
SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.
(a) Vaccine Fund.--Section 302(k) of the Foreign Assistance Act of
1961 (22 U.S.C. 2222(k)) is amended--
(1) by striking ``$50,000,000 for each of the fiscal years
2001 and 2002'' and inserting ``such sums as may be necessary
for each of the fiscal years 2004 through 2008''; and
(2) by striking ``Global Alliance for Vaccines and
Immunizations'' and inserting ``Vaccine Fund''.
(b) International AIDS Vaccine Initiative.--Section 302(l) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2222(l)) is amended by
striking ``$10,000,000 for each of the fiscal years 2001 and 2002'' and
inserting ``such sums as may be necessary for each of the fiscal years
2004 through 2008''.
(c) Support for the Development of Malaria Vaccine.--Section 302 of
the Foreign Assistance Act of 1961 (22 U.S.C. 2222)) is amended by
adding at the end the following new subsection:
``(m) In addition to amounts otherwise available under this
section, there are authorized to be appropriated to the President such
sums as may be necessary for each of the fiscal years 2004 through 2008
to be available for United States contributions to malaria vaccine
development programs, including the Malaria Vaccine Initiative of the
Program for Appropriate Technologies in Health (PATH).''.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.)
is amended--
(1) in section 104(c) (22 U.S.C. 2151b(c)), by striking
paragraphs (4) through (7); and
(2) by inserting after section 104 the following new
section:
``SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
``(a) Finding.--Congress recognizes that the alarming spread of
HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, and other
developing countries is a major global health, national security,
development, and humanitarian crisis.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to provide assistance for the prevention,
treatment, and control of HIV/AIDS. The United States and other
developed countries should provide assistance to countries in sub-
Saharan Africa, the Caribbean, and other countries and areas to control
this crisis through HIV/AIDS prevention, treatment, monitoring, and
related activities, particularly activities focused on women and youth,
including strategies to protect women and prevent mother-to-child
transmission of the HIV infection.
``(c) Authorization.--
``(1) In general.--Consistent with section 104(c), the
President is authorized to furnish assistance, on such terms
and conditions as the President may determine, for HIV/AIDS,
including to prevent, treat, and monitor HIV/AIDS, and carry
out related activities, in countries in sub-Saharan Africa, the
Caribbean, and other countries and areas.
``(2) Role of ngos.--It is the sense of Congress that the
President should provide an appropriate level of assistance
under paragraph (1) through nongovernmental organizations
(including faith-based and community-based organizations) in
countries in sub-Saharan Africa, the Caribbean, and other
countries and areas affected by the HIV/AIDS pandemic.
``(3) Coordination of assistance efforts.--The President
shall coordinate the provision of assistance under paragraph
(1) with the provision of related assistance by the Joint
United Nations Programme on HIV/AIDS (UNAIDS), the United
Nations Children's Fund (UNICEF), the World Health Organization
(WHO), the United Nations Development Programme (UNDP), the
Global Fund to Fight AIDS, Tuberculosis and Malaria and other
appropriate international organizations (such as the
International Bank for Reconstruction and Development),
relevant regional multilateral development institutions,
national, state, and local governments of foreign countries,
appropriate governmental and nongovernmental organizations, and
relevant executive branch agencies.
``(d) Activities Supported.--Assistance provided under subsection
(c) shall, to the maximum extent practicable, be used to carry out the
following activities:
``(1) Prevention.--Prevention of HIV/AIDS through
activities including--
``(A) programs and efforts that are designed or
intended to impart knowledge with the exclusive purpose
of helping individuals avoid behaviors that place them
at risk of HIV infection, including integration of such
programs into health programs and the inclusion in
counseling programs of information on methods of
avoiding infection of HIV, including delaying sexual
debut, abstinence, fidelity and monogamy, reduction of
casual sexual partnering, and where appropriate, use of
condoms;
``(B) assistance to establish and implement
culturally appropriate HIV/AIDS education and
prevention programs that focus on helping individuals
avoid infection of HIV/AIDS, implemented through
nongovernmental organizations, including faith-based
and community-based organizations, particularly those
organizations that utilize both professionals and
volunteers with appropriate skills, experience, and
community presence;
``(C) assistance for the purpose of providing
voluntary testing and counseling (including the
incorporation of confidentiality protections with
respect to such testing and counseling);
``(D) assistance for the purpose of preventing
mother-to-child transmission of the HIV infection,
including medications to prevent such transmission and
access to infant formula and other alternatives for
infant feeding;
``(E) assistance to ensure a safe blood supply and
sterile medical equipment; and
``(F) assistance to help avoid substance abuse and
intravenous drug use that can lead to HIV infection.
``(2) Treatment.--The treatment and care of individuals
with HIV/AIDS, including--
``(A) assistance to establish and implement
programs to strengthen and broaden indigenous health
care delivery systems and the capacity of such systems
to deliver HIV/AIDS pharmaceuticals and otherwise
provide for the treatment of individuals with HIV/AIDS,
including clinical training for indigenous
organizations and health care providers;
``(B) assistance to strengthen and expand hospice
and palliative care programs to assist patients
debilitated by HIV/AIDS, their families, and the
primary caregivers of such patients, including programs
that utilize faith-based and community-based
organizations; and
``(C) assistance for the purpose of the care and
treatment of individuals with HIV/AIDS through the
provision of pharmaceuticals, including antiretrovirals
and other pharmaceuticals and therapies for the
treatment of opportunistic infections, nutritional
support, and other treatment modalities.
``(3) Preventative intervention education and
technologies.--(A) With particular emphasis on specific
populations that represent a particularly high risk of
contracting or spreading HIV/AIDS, including those exploited
through the sex trade, victims of rape and sexual assault,
individuals already infected with HIV/AIDS, and in cases of
occupational exposure of health care workers, assistance with
efforts to reduce the risk of HIV/AIDS infection including
post-exposure pharmaceutical prophylaxis, and necessary
pharmaceuticals and commodities, including test kits, condoms,
and, when proven effective, microbicides.
``(B) Bulk purchases of available test kits, condoms, and,
when proven effective, microbicides that are intended to reduce
the risk of HIV/AIDS transmission and for appropriate program
support for the introduction and distribution of these
commodities, as well as education and training on the use of
the technologies.
``(4) Monitoring.--The monitoring of programs, projects,
and activities carried out pursuant to paragraphs (1) through
(3), including--
``(A) monitoring to ensure that adequate controls
are established and implemented to provide HIV/AIDS
pharmaceuticals and other appropriate medicines to poor
individuals with HIV/AIDS;
``(B) appropriate evaluation and surveillance
activities;
``(C) monitoring to ensure that appropriate
measures are being taken to maintain the sustainability
of HIV/AIDS pharmaceuticals (especially
antiretrovirals) and ensure that drug resistance is not
compromising the benefits of such pharmaceuticals; and
``(D) monitoring to ensure appropriate law
enforcement officials are working to ensure that HIV/
AIDS pharmaceuticals are not diminished through illegal
counterfeiting or black market sales of such
pharmaceuticals.
``(5) Pharmaceuticals.--
``(A) Procurement.--The procurement of HIV/AIDS
pharmaceuticals, antiviral therapies, and other
appropriate medicines, including medicines to treat
opportunistic infections.
``(B) Mechanisms for quality control and
sustainable supply.--Mechanisms to ensure that such
HIV/AIDS pharmaceuticals, antiretroviral therapies, and
other appropriate medicines are quality-controlled and
sustainably supplied.
``(C) Distribution.--The distribution of such HIV/
AIDS pharmaceuticals, antiviral therapies, and other
appropriate medicines (including medicines to treat
opportunistic infections) to qualified national,
regional, or local organizations for the treatment of
individuals with HIV/AIDS in accordance with
appropriate HIV/AIDS testing and monitoring
requirements and treatment protocols and for the
prevention of mother-to-child transmission of the HIV
infection.
``(6) Related activities.--The conduct of related
activities, including--
``(A) the care and support of children who are
orphaned by the HIV/AIDS pandemic, including services
designed to care for orphaned children in a family
environment which rely on extended family members;
``(B) improved infrastructure and institutional
capacity to develop and manage education, prevention,
and treatment programs, including training and the
resources to collect and maintain accurate HIV
surveillance data to target programs and measure the
effectiveness of interventions; and
``(C) vaccine research and development partnership
programs with specific plans of action to develop a
safe, effective, accessible, preventive HIV vaccine for
use throughout the world.
``(7) Comprehensive hiv/aids public-private partnerships.--
The establishment and operation of public-private partnership
entities within countries in sub-Saharan Africa, the Caribbean,
and other countries affected by the HIV/AIDS pandemic that are
dedicated to supporting the national strategy of such countries
regarding the prevention, treatment, and monitoring of HIV/
AIDS. Each such public-private partnership should--
``(A) support the development, implementation, and
management of comprehensive HIV/AIDS plans in support
of the national HIV/AIDS strategy;
``(B) operate at all times in a manner that
emphasizes efficiency, accountability, and results-
driven programs;
``(C) engage both local and foreign development
partners and donors, including businesses, government
agencies, academic institutions, nongovernmental
organizations, foundations, multilateral development
agencies, and faith-based organizations, to assist the
country in coordinating and implementing HIV/AIDS
prevention, treatment, and monitoring programs in
accordance with its national HIV/AIDS strategy;
``(D) provide technical assistance, consultant
services, financial planning, monitoring and
evaluation, and research in support of the national
HIV/AIDS strategy; and
``(E) establish local human resource capacities for
the national HIV/AIDS strategy through the transfer of
medical, managerial, leadership, and technical skills.
``(e) Annual Report.--
``(1) In general.--Not later than January 31 of each year,
the President shall submit to the Committee on Foreign
Relations of the Senate and the Committee on International
Relations of the House of Representatives a report on the
implementation of this section for the prior fiscal year.
``(2) Report elements.--Each report shall include--
``(A) a description of efforts made by each
relevant executive branch agency to implement the
policies set forth in this section, section 104B, and
section 104C;
``(B) a description of the programs established
pursuant to such sections; and
``(C) a detailed assessment of the impact of
programs established pursuant to such sections,
including--
``(i)(I) the effectiveness of such programs
in reducing the spread of the HIV infection,
particularly in women and girls, in reducing
mother-to-child transmission of the HIV
infection, and in reducing mortality rates from
HIV/AIDS; and
``(II) the number of patients currently
receiving treatment for AIDS in each country
that receives assistance under this Act.
``(ii) the progress made toward improving
health care delivery systems (including the
training of adequate numbers of staff) and
infrastructure to ensure increased access to
care and treatment;
``(iii) with respect to tuberculosis, the
increase in the number of people treated and
the increase in number of tuberculosis patients
cured through each program, project, or
activity receiving United States foreign
assistance for tuberculosis control purposes;
and
``(iv) with respect to malaria, the
increase in the number of people treated and
the increase in number of malaria patients
cured through each program, project, or
activity receiving United States foreign
assistance for malaria control purposes.
``(f) Funding Limitation.--Of the funds made available to carry out
this section in any fiscal year, not more than 7 percent may be used
for the administrative expenses of the United States Agency for
International Development in support of activities described in section
104(c), this section, section 104B, and section 104C. Such amount shall
be in addition to other amounts otherwise available for such purposes.
``(g) Definitions.--In this section:
``(1) AIDS.--The term `AIDS' means acquired immune
deficiency syndrome.
``(2) HIV.--The term `HIV' means the human immunodeficiency
virus, the pathogen that causes AIDS.
``(3) HIV/AIDS.--The term `HIV/AIDS' means, with respect to
an individual, an individual who is infected with HIV or living
with AIDS.
``(4) Relevant executive branch agencies.--The term
`relevant executive branch agencies' means the Department of
State, the United States Agency for International Development,
the Department of Health and Human Services (including its
agencies and offices), and any other department or agency of
the United States that participates in international HIV/AIDS
activities pursuant to the authorities of such department or
agency or this Act.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under
section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)) for such purpose or under any other provision of that
Act, there are authorized to be appropriated to the President,
from amounts authorized to be appropriated under section 401,
such sums as may be necessary for each of the fiscal years 2004
through 2008 to carry out section 104A of the Foreign
Assistance Act of 1961, as added by subsection (a).
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
(3) Allocation of Funds.--Of the amount authorized to be
appropriated by paragraph (1) for the fiscal years 2004 through
2008, such sums as may be necessary are authorized to be
appropriated to carry out section 104A(d)(4) of the Foreign
Assistance Act of 1961 (as added by subsection (a)), relating
to the procurement and distribution of HIV/AIDS
pharmaceuticals.
(c) Relationship to Assistance Programs to Enhance Nutrition.--In
recognition of the fact that malnutrition may hasten the progression of
HIV to AIDS and may exacerbate the decline among AIDS patients leading
to a shorter life span, the Administrator of the United States Agency
for International Development shall, as appropriate--
(1) integrate nutrition programs with HIV/AIDS activities,
generally;
(2) provide, as a component of an anti-retroviral therapy
program, support for food and nutrition to individuals infected
with and affected by HIV/AIDS; and
(3) provide support for food and nutrition for children
affected by HIV/AIDS and to communities and households caring
for children affected by HIV/AIDS.
(d) Eligibility for Assistance.--An organization that is otherwise
eligible to receive assistance under section 104A of the Foreign
Assistance Act of 1961 (as added by subsection (a)) or under any other
provision of this Act (or any amendment made by this Act) to prevent,
treat, or monitor HIV/AIDS shall not be required, as a condition of
receiving the assistance, to endorse or utilize a multisectoral
approach to combatting HIV/AIDS.
(e) Limitation.--No funds made available to carry out this Act, or
any amendment made by this Act, may be used to promote or advocate the
legalization or practice of prostitution or sex trafficking. Nothing in
the preceding sentence shall be construed to preclude the provision to
individuals of palliative care, treatment, or post-exposure
pharmaceutical prophylaxis, and necessary pharmaceuticals and
commodities, including test kits, condoms, and, when proven effective,
microbicides.
(f) Limitation.--No funds made available to carry out this Act, or
any amendment made by this Act, may be used to provide assistance to
any group or organization that does not have a policy explicitly
opposing prostitution and sex trafficking.
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.),
as amended by section 301 of this Act, is further amended by inserting
after section 104A the following new section:
``SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
``(a) Findings.--Congress makes the following findings:
``(1) Congress recognizes the growing international problem
of tuberculosis and the impact its continued existence has on
those countries that had previously largely controlled the
disease.
``(2) Congress further recognizes that the means exist to
control and treat tuberculosis through expanded use of the DOTS
(Directly Observed Treatment Short-course) treatment strategy,
including DOTS-Plus to address multi-drug resistant
tuberculosis, and adequate investment in newly created
mechanisms to increase access to treatment, including the
Global Tuberculosis Drug Facility established in 2001 pursuant
to the Amsterdam Declaration to Stop TB and the Global Alliance
for TB Drug Development.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to control tuberculosis, including the
detection of at least 70 percent of the cases of infectious
tuberculosis, and the cure of at least 85 percent of the cases
detected, not later than December 31, 2005, in those countries
classified by the World Health Organization as among the highest
tuberculosis burden, and not later than December 31, 2010, in all
countries in which the United States Agency for International
Development has established development programs.
``(c) Authorization.--To carry out this section and consistent with
section 104(c), the President is authorized to furnish assistance, on
such terms and conditions as the President may determine, for the
prevention, treatment, control, and elimination of tuberculosis.
``(d) Coordination.--In carrying out this section, the President
shall coordinate with the World Health Organization, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, and other organizations with
respect to the development and implementation of a comprehensive
tuberculosis control program.
``(e) Priority to DOTS Coverage.--In furnishing assistance under
subsection (c), the President shall give priority to activities that
increase Directly Observed Treatment Short-course (DOTS) coverage and
treatment of multi-drug resistant tuberculosis where needed using DOTS-
Plus, including funding for the Global Tuberculosis Drug Facility, the
Stop Tuberculosis Partnership, and the Global Alliance for TB Drug
Development. In order to meet the requirement of the preceding
sentence, the President should ensure that not less than 75 percent of
the amount made available to carry out this section for a fiscal year
should be expended for antituberculosis drugs, supplies, direct patient
services, and training in diagnosis and treatment for Directly Observed
Treatment Short-course (DOTS) coverage and treatment of multi-drug
resistant tuberculosis using DOTS-Plus, including substantially
increased funding for the Global Tuberculosis Drug Facility.
``(f) Definitions.--In this section:
``(1) DOTS.--The term `DOTS' or `Directly Observed
Treatment Short-course' means the World Health Organization-
recommended strategy for treating tuberculosis.
``(2) DOTS-plus.--The term `DOTS-Plus' means a
comprehensive tuberculosis management strategy that is built
upon and works as a supplement to the standard DOTS strategy,
and which takes into account specific issues (such as use of
second line anti-tuberculosis drugs) that need to be addressed
in areas where there is high prevalence of multi-drug resistant
tuberculosis.
``(3) Global alliance for tuberculosis drug development.--
The term `Global Alliance for Tuberculosis Drug Development'
means the public-private partnership that brings together
leaders in health, science, philanthropy, and private industry
to devise new approaches to tuberculosis and to ensure that new
medications are available and affordable in high tuberculosis
burden countries and other affected countries.
``(4) Global tuberculosis drug facility.--The term `Global
Tuberculosis Drug Facility (GDF)' means the new initiative of
the Stop Tuberculosis Partnership to increase access to high-
quality tuberculosis drugs to facilitate DOTS expansion.
``(5) Stop tuberculosis partnership.--The term `Stop
Tuberculosis Partnership' means the partnership of the World
Health Organization, donors including the United States, high
tuberculosis burden countries, multilateral agencies, and
nongovernmental and technical agencies committed to short- and
long-term measures required to control and eventually eliminate
tuberculosis as a public health problem in the world.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under
section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)) for such purpose or under any other provision of that
Act, there are authorized to be appropriated to the President,
from amounts authorized to be appropriated under section 401,
such sums as may be necessary for each of the fiscal years 2004
through 2008 to carry out section 104B of the Foreign
Assistance Act of 1961, as added by subsection (a).
(2) Availability of funds.--Amounts appropriated pursuant
to the authorization of appropriations under paragraph (1) are
authorized to remain available until expended.
(3) Transfer of prior year funds.--Unobligated balances of
funds made available for fiscal year 2001, 2002, or 2003 under
section 104(c)(7) of the Foreign Assistance Act of 1961 (22
U.S.C. 2151b(c)(7) (as in effect immediately before the date of
enactment of this Act) shall be transferred to, merged with,
and made available for the same purposes as funds made
available for fiscal years 2004 through 2008 under paragraph
(1).
SEC. 303. ASSISTANCE TO COMBAT MALARIA.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.),
as amended by sections 301 and 302 of this Act, is further amended by
inserting after section 104B the following new section:
``SEC. 104C. ASSISTANCE TO COMBAT MALARIA.
``(a) Finding.--Congress finds that malaria kills more people
annually than any other communicable disease except tuberculosis, that
more than 90 percent of all malaria cases are in sub-Saharan Africa,
and that children and women are particularly at risk. Congress
recognizes that there are cost-effective tools to decrease the spread
of malaria and that malaria is a curable disease if promptly diagnosed
and adequately treated.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to provide assistance for the prevention,
control, and cure of malaria.
``(c) Authorization.--To carry out this section and consistent with
section 104(c), the President is authorized to furnish assistance, on
such terms and conditions as the President may determine, for the
prevention, treatment, control, and elimination of malaria.
``(d) Coordination.--In carrying out this section, the President
shall coordinate with the World Health Organization, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, the Department of Health and
Human Services (the Centers for Disease Control and Prevention and the
National Institutes of Health), and other organizations with respect to
the development and implementation of a comprehensive malaria control
program.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under
section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)) for such purpose or under any other provision of that
Act, there are authorized to be appropriated to the President,
from amounts authorized to be appropriated under section 401,
such sums as may be necessary for fiscal years 2004 through
2008 to carry out section 104C of the Foreign Assistance Act of
1961, as added by subsection (a), including for the development
of anti-malarial pharmaceuticals by the Medicines for Malaria
Venture.
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
(3) Transfer of prior year funds.--Unobligated balances of
funds made available for fiscal year 2001, 2002, or 2003 under
section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c) (as in effect immediately before the date of enactment
of this Act) and made available for the control of malaria
shall be transferred to, merged with, and made available for
the same purposes as funds made available for fiscal years 2004
through 2008 under paragraph (1).
(c) Conforming Amendment.--Section 104(c) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b(c)), as amended by section 301 of this
Act, is further amended by adding after paragraph (3) the following:
``(4) Relationship to other laws.--Assistance made available under
this subsection and sections 104A, 104B, and 104C, and assistance made
available under chapter 4 of part II to carry out the purposes of this
subsection and the provisions cited in this paragraph, may be made
available notwithstanding any other provision of law that restricts
assistance to foreign countries, except for the provisions of this
subsection, the provisions of law cited in this paragraph, subsection
(f), section 634A of this Act, and provisions of law that limit
assistance to organizations that support or participate in a program of
coercive abortion or involuntary sterilization included under the Child
Survival and Health Programs Fund heading in the Consolidated
Appropriations Resolution, 2003 (Public Law 108-7).''.
SEC. 304. PILOT PROGRAM FOR THE PLACEMENT OF HEALTH CARE PROFESSIONALS
IN OVERSEAS AREAS SEVERELY AFFECTED BY HIV/AIDS,
TUBERCULOSIS, AND MALARIA.
(a) In General.--The President should establish a program to
demonstrate the feasibility of facilitating the service of United
States health care professionals in those areas of sub-Saharan Africa
and other parts of the world severely affected by HIV/AIDS,
tuberculosis, and malaria.
(b) Requirements.--Participants in the program shall--
(1) provide basic health care services for those infected
and affected by HIV/AIDS, tuberculosis, and malaria in the area
in which they are serving;
(2) provide on-the-job training to medical and other
personnel in the area in which they are serving to strengthen
the basic health care system of the affected countries;
(3) provide health care educational training for residents
of the area in which they are serving;
(4) serve for a period of up to three years; and
(5) meet the eligibility requirements in subsection (d).
(c) Eligibility Requirements.--To be eligible to participate in the
program, a candidate shall--
(1) be a national of the United States who is a trained
health care professional and who meets the educational and
licensure requirements necessary to be such a professional such
as a physician, nurse, physician assistant, nurse practitioner,
pharmacist, other type of health care professional, or other
individual determined to be appropriate by the President; or
(2) be a retired commissioned officer of the Public Health
Service Corps.
(d) Recruitment.--The President shall ensure that information on
the program is widely distributed, including the distribution of
information to schools for health professionals, hospitals, clinics,
and nongovernmental organizations working in the areas of international
health and aid.
(e) Placement of Participants.--
(1) In general.--To the maximum extent practicable,
participants in the program shall serve in the poorest areas of
the affected countries, where health care needs are likely to
be the greatest. The decision on the placement of a participant
should be made in consultation with relevant officials of the
affected country at both the national and local level as well
as with local community leaders and organizations.
(2) Coordination.--Placement of participants in the program
shall be coordinated with the United States Agency for
International Development in countries in which that Agency is
conducting HIV/AIDS, tuberculosis, or malaria programs. Overall
coordination of placement of participants in the program shall
be made by the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally (as described in section
1(f) of the State Department Basic Authorities Act of 1956 (as
added by section 102(a) of this Act)).
(f) Incentives.--The President may offer such incentives as the
President determines to be necessary to encourage individuals to
participate in the program, such as partial payment of principal,
interest, and related expenses on government and commercial loans for
educational expenses relating to professional health training and,
where possible, deferment of repayments on such loans, the provision of
retirement benefits that would otherwise be jeopardized by
participation in the program, and other incentives.
(g) Report.--Not later than 18 months after the date of enactment
of this Act, the President shall submit to the appropriate
congressional committees a report on steps taken to establish the
program, including--
(1) the process of recruitment, including the venues for
recruitment, the number of candidates recruited, the incentives
offered, if any, and the cost of those incentives;
(2) the process, including the criteria used, for the
selection of participants;
(3) the number of participants placed, the countries in
which they were placed, and why those countries were selected;
and
(4) the potential for expansion of the program.
(h) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available
for such purpose, there are authorized to be appropriated to
the President, from amounts authorized to be appropriated under
section 401, such sums as may be necessary for each of the
fiscal years 2004 through 2008 to carry out the program.
(2) Availability of funds.--Amounts appropriated pursuant
to the authorization of appropriations under paragraph (1) are
authorized to remain available until expended.
SEC. 305. REPORT ON TREATMENT ACTIVITIES BY RELEVANT EXECUTIVE BRANCH
AGENCIES.
(a) In General.--Not later than 15 months after the date of
enactment of this Act, the President shall submit to appropriate
congressional committees a report on the programs and activities of the
relevant executive branch agencies that are directed to the treatment
of individuals in foreign countries infected with HIV or living with
AIDS.
(b) Report Elements.--The report shall include--
(1) a description of the activities of relevant executive
branch agencies with respect to--
(A) the treatment of opportunistic infections;
(B) the use of antiretrovirals;
(C) the status of research into successful
treatment protocols for individuals in the developing
world;
(D) technical assistance and training of local
health care workers (in countries affected by the
pandemic) to administer antiretrovirals, manage side
effects, and monitor patients' viral loads and immune
status;
(E) the status of strategies to promote
sustainability of HIV/AIDS pharmaceuticals (including
antiretrovirals) and the effects of drug resistance on
HIV/AIDS patients; and
(F) the status of appropriate law enforcement
officials working to ensure that HIV/AIDS
pharmaceutical treatment is not diminished through
illegal counterfeiting and black market sales of such
pharmaceuticals;
(2) information on existing pilot projects, including a
discussion of why a given population was selected, the number
of people treated, the cost of treatment, the mechanisms
established to ensure that treatment is being administered
effectively and safely, and plans for scaling up pilot projects
(including projected timelines and required resources); and
(3) an explanation of how those activities relate to
efforts to prevent the transmission of the HIV infection.
Subtitle B--Assistance for Children and Families
SEC. 311. FINDINGS.
Congress makes the following findings:
(1) Approximately 2,000 children around the world are
infected each day with HIV through mother-to-child
transmission. Transmission can occur during pregnancy, labor,
and delivery or through breast feeding. Over ninety percent of
these cases are in developing nations with little or no access
to public health facilities.
(2) Mother-to-child transmission is largely preventable
with the proper application of pharmaceuticals, therapies, and
other public health interventions.
(3) The drug nevirapine reduces mother-to-child
transmission by nearly 50 percent. Universal availability of
this drug could prevent up to 400,000 infections per year and
dramatically reduce the number of AIDS-related deaths.
(4) At the United Nations Special Session on HIV/AIDS in
June 2001, the United States committed to the specific goals
with respect to the prevention of mother-to-child transmission,
including the goals of reducing the proportion of infants
infected with HIV by 20 percent by the year 2005 and by 50
percent by the year 2010, as specified in the Declaration of
Commitment on HIV/AIDS adopted by the United Nations General
Assembly at the Special Session.
(5) Several United States Government agencies including the
United States Agency for International Development and the
Centers for Disease Control are already supporting programs to
prevent mother-to-child transmission in resource-poor nations
and have the capacity to expand these programs rapidly by
working closely with foreign governments and nongovernmental
organizations.
(6) Efforts to prevent mother-to-child transmission can
provide the basis for a broader response that includes care and
treatment of mothers, fathers, and other family members who are
infected with HIV or living with AIDS.
(7) HIV/AIDS has devastated the lives of countless children
and families across the globe. Since the epidemic began, an
estimated 13,200,000 children under the age of 15 have been
orphaned by AIDS, that is they have lost their mother or both
parents to the disease. The Joint United Nations Program on
HIV/AIDS (UNAIDS) estimates that this number will double by the
year 2010.
(8) HIV/AIDS also targets young people between the ages of
15 to 24, particularly young women, many of whom carry the
burden of caring for family members living with HIV/AIDS. An
estimated 10,300,000 young people are now living with HIV/AIDS.
One-half of all new infections are occurring among this age
group.
SEC. 312. POLICY AND REQUIREMENTS.
(a) Policy.--The United States Government's response to the global
HIV/AIDS pandemic should place high priority on the prevention of
mother-to-child transmission, the care and treatment of family members
and caregivers, and the care of children orphaned by AIDS. To the
maximum extent possible, the United States Government should seek to
leverage its funds by seeking matching contributions from the private
sector, other national governments, and international organizations.
(b) Requirements.--The 5-year United States Government strategy
required by section 101 of this Act shall--
(1) provide for meeting or exceeding the goal to reduce the
rate of mother-to-child transmission of HIV by 20 percent by
2005 and by 50 percent by 2010;
(2) include programs to make available testing and
treatment to HIV-positive women and their family members,
including drug treatment and therapies to prevent mother-to-
child transmission; and
(3) expand programs designed to care for children orphaned
by AIDS.
SEC. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
OF THE HIV INFECTION.
(a) In General.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for a period of five
years, the President shall submit to appropriate congressional
committees a report on the activities of relevant executive branch
agencies during the reporting period to assist in the prevention of
mother-to-child transmission of the HIV infection.
(b) Report Elements.--Each report shall include--
(1) a statement of whether or not all relevant executive
branch agencies have met the goal described in section
312(b)(1); and
(2) a description of efforts made by the relevant executive
branch agencies to expand those activities, including--
(A) information on the number of sites supported
for the prevention of mother-to-child transmission of
the HIV infection;
(B) the specific activities supported;
(C) the number of women tested and counseled; and
(D) the number of women receiving preventative drug
therapies.
(c) Reporting Period Defined.--In this section, the term
``reporting period'' means, in the case of the initial report, the
period since the date of enactment of this Act and, in the case of any
subsequent report, the period since the date of submission of the most
recent report.
SEC. 314. PILOT PROGRAM OF ASSISTANCE FOR CHILDREN AND FAMILIES
AFFECTED BY HIV/AIDS.
(a) In General.--The President, acting through the United States
Agency for International Development, should establish a program of
assistance that would demonstrate the feasibility of the provision of
care and treatment to orphans and other children and young people
affected by HIV/AIDS in foreign countries.
(b) Program Requirements.--The program should--
(1) build upon and be integrated into programs administered
as of the date of enactment of this Act by the relevant
executive branch agencies for children affected by HIV/AIDS;
(2) work in conjunction with indigenous community-based
programs and activities, particularly those that offer proven
services for children;
(3) reduce the stigma of HIV/AIDS to encourage vulnerable
children infected with HIV or living with AIDS and their family
members and caregivers to avail themselves of voluntary
counseling and testing, and related programs, including
treatments;
(4) provide, in conjunction with other relevant executive
branch agencies, the range of services for the care and
treatment, including the provision of antiretrovirals and other
necessary pharmaceuticals, of children, parents, and caregivers
infected with HIV or living with AIDS;
(5) provide nutritional support and food security, and the
improvement of overall family health;
(6) work with parents, caregivers, and community-based
organizations to provide children with educational
opportunities; and
(7) provide appropriate counseling and legal assistance for
the appointment of guardians and the handling of other issues
relating to the protection of children.
(c) Report.--Not later than 18 months after the date of enactment
of this Act, the President should submit a report on the implementation
of this section to the appropriate congressional committees.
(d) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available
for such purpose, there are authorized to be appropriated to
the President, from amounts authorized to be appropriated under
section 401, such sums as may be necessary for each of the
fiscal years 2004 through 2008 to carry out the program.
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.
(a) Purpose.--The purpose of this section is to authorize the
President to establish a program, through a 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 mother-to-child transmission of HIV in countries with or at
risk for severe HIV epidemic with particular attention to resource
constrained countries.
(b) Grants.--
(1) In general.--The President is authorized to establish a
program for the award of grants to eligible administrative
organizations to enable such organizations to award subgrants
to eligible entities to expand activities to prevent the
mother-to-child transmission of HIV by providing medical care
and support services to HIV infected parents and their
children.
(2) Use of funds.--Amounts provided under a grant awarded
under paragraph (1) shall be used--
(A) to award subgrants to eligible entities to
enable such entities to carry out activities described
in subsection (c);
(B) for administrative support and subgrant
management;
(C) for administrative data collection and
reporting concerning grant activities;
(D) for the monitoring and evaluation of grant
activities;
(E) for training and technical assistance for
subgrantees; and
(F) to promote sustainability.
(c) Subgrants.--
(1) In general.--An organization awarded a grant under
subsection (b) shall use amounts received under the grant to
award subgrants to eligible entities.
(2) Eligibility.--To be eligible to receive a subgrant
under paragraph (1), an entity shall--
(A) be a local health organization, an
international organization, or a partnership of such
organizations; and
(B) demonstrate to the awarding organization that
such entity--
(i) is currently administering a proven
intervention to prevent mother-to-child
transmission of HIV in countries with or at
risk for severe HIV epidemic with particular
attention to resource constrained countries, as
determined by the President;
(ii) has demonstrated support for the
proposed program from relevant government
entities; and
(iii) is able to provide HIV care,
including antiretroviral treatment when
medically indicated, to HIV positive women,
men, and children with the support of the
project funding.
(3) Local health and international organizations.--For
purposes of paragraph (2)(A)--
(A) the term ``local health organization'' means a
public sector health system, nongovernmental
organization, institution of higher education,
community-based organization, or nonprofit health
system that provides directly, or has a clear link with
a provider for the indirect provision of, primary
health care services; and
(B) the term ``international organization'' means--
(i) a nonprofit international entity;
(ii) an international charitable
institution;
(iii) a private voluntary international
entity; or
(iv) a multilateral institution.
(4) Priority requirement.--In awarding subgrants under this
subsection, the organization shall give priority to eligible
applicants that are currently administering a program of proven
intervention to HIV positive individuals to prevent mother-to-
child transmission in countries with or at risk for severe HIV
epidemic with particular attention to resource constrained
countries, and who are currently administering a program to HIV
positive women, men, and children to provide life-long care in
family-centered care programs using non-Federal funds.
(5) Selection of subgrant recipients.--In awarding
subgrants under this subsection, the organization should--
(A) consider applicants from a range of health care
settings, program approaches, and geographic locations;
and
(B) if appropriate, award not less than 1 grant to
an applicant to fund a national system of health care
delivery to HIV positive families.
(6) Use of subgrant funds.--An eligible entity awarded a
subgrant under this subsection shall use subgrant funds to
expand activities to prevent mother-to-child transmission of
HIV by providing medical treatment and care and support
services to parents and their children, which may include--
(A) providing treatment and therapy, when medically
indicated, to HIV-infected women, their children, and
families;
(B) the hiring and training of local personnel,
including physicians, nurses, other health care
providers, counselors, social workers, outreach
personnel, laboratory technicians, data managers, and
administrative support personnel;
(C) paying laboratory costs, including costs
related to necessary equipment and diagnostic testing
and monitoring (including rapid testing), complete
blood counts, standard chemistries, and liver function
testing for infants, children, and parents, and costs
related to the purchase of necessary laboratory
equipment;
(D) purchasing pharmaceuticals for HIV-related
conditions, including antiretroviral therapies;
(E) funding support services, including adherence
and psychosocial support services;
(F) operational support activities; and
(G) conducting community outreach and capacity
building activities, including activities to raise the
awareness of individuals of the program carried out by
the subgrantee, other communications activities in
support of the program, local advisory board functions,
and transportation necessary to ensure program
participation.
(d) Reports.--The President shall require that each organization
awarded a grant under subsection (b)(1) to submit an annual report that
includes--
(1) the progress of programs funded under this section;
(2) the benchmarks of success of programs funded under this
section; and
(3) recommendations of how best to proceed with the
programs funded under this section upon the expiration of
funding under subsection (e).
(e) Funding.--There are authorized to be appropriated to the
President, from amounts authorized to be appropriated under section
401, such sums as may be necessary for each of the fiscal years 2004
through 2008 to carry out the program.
(f) Limitation on Administrative Expenses.--An organization shall
ensure that not more than 7 percent of the amount of a grant received
under this section by the organization is used for administrative
expenses.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
President to carry out this Act and the amendments made by this Act
$3,000,000,000 for each of the fiscal years 2004 through 2008.
(b) Availability.--Amounts appropriated pursuant to the
authorization of appropriations in subsection (a) are authorized to
remain available until expended.
(c) Availability of Authorizations.--Authorizations of
appropriations under subsection (a) shall remain available until the
appropriations are made.
SEC. 402. SENSE OF CONGRESS.
(a) Increase in HIV/AIDS Antiretroviral Treatment.--It is a sense
of the Congress that an urgent priority of United States assistance
programs to fight HIV/AIDS should be the rapid increase in distribution
of antiretroviral treatment so that--
(1) by the end of fiscal year 2004, at least 500,000
individuals with HIV/AIDS are receiving antiretroviral
treatment through United States assistance programs;
(2) by the end of fiscal year 2005, at least 1,000,000 such
individuals are receiving such treatment; and
(3) by the end of fiscal year 2006, at least 2,000,000 such
individuals are receiving such treatment.
(b) Effective Distribution of HIV/AIDS Funds.--It is the sense of
Congress that, of the amounts appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
assistance, an effective distribution of such amounts would be--
(1) 55 percent of such amounts for treatment of individuals
with HIV/AIDS;
(2) 15 percent of such amounts for palliative care of
individuals with HIV/AIDS;
(3) 20 percent of such amounts for HIV/AIDS prevention
consistent with section 104A(d) of the Foreign Assistance Act
of 1961 (as added by section 301 of this Act); and
(4) 10 percent of such amounts for orphans and vulnerable
children.
SEC. 403. ALLOCATION OF FUNDS.
For fiscal years 2006 through 2008, not less than 55 percent of the
amounts appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance for each such fiscal year
shall be expended for therapeutic medical care of individuals infected
with HIV, of which such amount at least 75 percent should be expended
for the purchase and distribution of antiretroviral pharmaceuticals and
at least 25 percent should be expended for related care.
Purpose and Summary
The United States Leadership Against HIV/AIDS Act of 2003
(H.R. 1298), as ordered favorably reported out of the Committee
on International Relations with an amendment in the nature of a
substitute incorporating the 10 amendments adopted by the
Committee, authorizes the expansion of United States efforts to
fight HIV/AIDS in Africa, the Caribbean, and other countries in
the developing world.
Specifically, H.R. 1298 authorizes the provision of care
and treatment to individuals and families affected by HIV/AIDS;
promotes the preservation of the family unit so that fewer
children will be orphaned by AIDS; promotes the ABC approach
successfully employed in Uganda's fight against AIDS
(``Abstinence, Be Faithful, Condoms''); endorses the work of
non-governmental organizations (including faith-based and
community-based organizations) which are essential partners in
effective AIDS prevention; and provides increased emphasis on
mother-to-child transmission activities, as well as support for
the routine voluntary counseling and testing of pregnant women
and access to treatment by women and children.
H.R. 1298 authorizes a multisectoral approach to fighting
AIDS, and endorses education, research, prevention, treatment
and care of those infected with HIV and those individuals
living with AIDS. H.R. 1298 is consistent with and endorses
President Bush's $15 billion, 5-year strategy to arrest the
spread of HIV, the virus that causes AIDS, and will provide the
President with great flexibility to use the various agencies of
the Federal Government to fight AIDS and assist those infected
with the disease.
H.R. 1298 authorizes a significant increase over existing
levels of assistance, and over the course of the 5-year
authorization (FY2004-FY2008) will result in an additional $10
billion made available to fight AIDS worldwide. The bill
creates accountability through the establishment of a position
in the U.S. State Department of Coordinator for HIV/AIDS
Assistance. H.R. 1298 will authorize the use of life-extending
pharmaceuticals and the provision of other drugs to reduce
mother-to-child transmission. The bill amends the Foreign
Assistance Act of 1961 to update it with the President's
proposal that emphasizes treatment and care of those
individuals infected with HIV and living with AIDS. It endorses
and supports United States financial participation in the
Global Fund, authorizing up to $1 billion in FY2004 and such
sums as may be necessary in 2005 through 2008. The legislation
requires that the U.S. contribution be limited to one third of
all contributions to the Fund in any given year in order to
promote burden-sharing and the follow-through of pledges by
other countries. The bill creates an oversight body within the
Executive Branch that will carefully review all Global Fund
applications in order to recommend coherence with U.S. policies
and laws.
H.R. 1298, as ordered favorably reported, plays a critical
role in building capacity within affected countries to educate
youth and society at large of the tremendous risk that AIDS
creates to individual and public health, agricultural
production, culture and society, the education sector, and
national security. The legislation will assist in reducing the
threat that AIDS presents to social stability and security, in
particular on the African continent, in Asia, and closer to
home, in the Caribbean.
Background and Need for the Legislation
The HIV/AIDS pandemic is a crisis that threatens the
stability, economy and democratic institutions of many nations.
The United States National Intelligence Council estimates that
the disease could reduce Gross Domestic Product in some sub-
Saharan African countries by 20 percent or more by 2010. The
U.S. Census Bureau estimates that the average human lifespan in
certain nations will decrease well below the age of 40 by the
end of the decade.
AIDS is a disease that affects and afflicts women, men and
children. Caused by a virus that is changing the face of
families in Africa, Asia, Europe, and the Americas, AIDS
creates orphans, breaks apart families, and erases the gains of
development. AIDS is responsible for a catastrophic reduction
in the life expectancy of tens of millions of people with whom
we share this planet. Not a day goes by when Americans are not
exposed to images of AIDS and its destructive impact.
To date, 40 million people are infected and 25 million have
died of AIDS worldwide, including more than 3 million last
year. More than 8,600 persons die daily from complications and
opportunistic infections brought on by this disease.
Tragically, the number is growing, and by the end of this
decade, AIDS may claim up to 80 million lives.
The HIV/AIDS pandemic is more than a humanitarian crisis.
Increasingly, it is a threat to the security of the developed
world. Left unchecked, this plague will further rip the fabric
of developing societies, pushing fragile governments and
economies to the point of collapse. There can be no question
that the spectre of failed states across the world most
certainly threatens U.S. security interests, particularly at a
time where unstable nations have proven fertile ground for the
development of terrorist organizations.
In this regard, Africa is a central concern. Today radical
Islam is spreading in several African countries, especially
Nigeria. This trend threatens to undercut democracy and make
Nigeria a failed state. It is in American interests to counter
this movement by doing what we can to help build democracy and
a growing economy in Nigeria and elsewhere. The spread of HIV/
AIDS frustrates this most important mission. We also have a
strong interest is seeing the development of professional
African militaries; militaries capable of maintaining stability
in their country, but also capable of contributing to
peacekeeping operations elsewhere. Yet, an examination of the
HIV/AIDS rates among the armed forces of key African countries,
including Nigeria, South Africa and Kenya, reveals infection
rates between 30 and 40 percent. Military and police forces in
other countries with high HIV/AIDS prevalence rates are among
the highest risk populations in the world. The increase in HIV-
infected military personnel is weakening the capacity of these
forces to defend their nations and to serve as peacekeepers in
crisis situations. High prevalence rates among police forces
undermine their ability to maintain civil order. AIDS indeed
presents a national security threat--a threat to the stability
and viability of many nations in the developing world.
Building on the bipartisan work accomplished in the 107th
Congress, the Committee reports favorably an updated AIDS bill
that focuses on treatment, prevention and care, and authorizes
treatment for more than 2 million people.
In the 107th Congress, the Committee on International
Relations reported favorably H.R. 2069, introduced by Chairman
Henry J. Hyde, the ``Global Access to HIV/AIDS Prevention,
Awareness, Education and Treatment Act of 2001.'' That bill was
passed by the House and sent to the Senate, which struck all
after the enacting clause and inserted a new text and returned
H.R. 2069 to the House as the ``United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002.'' The
House and Senate were unable to reconcile the two versions of
the bill, but both chambers agreed upon the need for expanded
assistance to fight the HIV/AIDS pandemic. Both versions of the
bill supported increases in funding for bilateral and
multilateral approaches to fighting HIV/AIDS. Both bills
stressed the urgency of the need for the President to develop a
comprehensive strategy to expand U.S. assistance to encompass
treatment of HIV/AIDS through the use of antiretroviral
therapy.
Chairman Hyde, accompanied by Ranking Member Lantos,
Representative Weldon of Florida, Representative Lee and
Representative Leach, introduced H.R. 1298 on March 17, 2003.
The bill supports the President's plan to increase U.S.
assistance for AIDS relief, and will create a more responsive,
coordinated and effective approach among the various agencies
of the U.S. Government involved in the global fight against
HIV/AIDS. H.R. 1298 builds on the Chairman's bill, H.R. 2069,
from the 107th Congress.
H.R. 1298 includes important protections for accountability
and transparency of the Global Fund. As reported, the
legislation authorizes up to $1 billion for fiscal year 2004
for contributions to the Global Fund, and such sums as may be
necessary for the fiscal years 2005-2008. While the President's
budget request is expected to be $200 million for each of the
next 5 fiscal years for the Global Fund, in FY2003 the Congress
appropriated nearly twice the amount requested by the
President. The one billion dollar figure represents a carefully
crafted compromise that builds bipartisan support for the bill
while at the same time includes additional safeguards. United
States financial support would be limited to 33 percent of the
total amounts contributed by other donors. This means that in
order for the U.S. to provide $350 million, other donors would
have to actually contribute $700 million in the same year. This
provision promotes better burden-sharing and follow-through for
the donations of other countries. H.R. 1298 requires continual
monitoring and evaluation of the Global Fund by the Comptroller
General, and requires him to issue a report every 2 years on
the Global Fund, including whether objectives are being met by
projects supported by the Global Fund. The legislation creates
a U.S. Government interagency technical review panel that will
``shadow'' the work of the Global Fund's Technical Review
Panel. This will ensure that all grant applications submitted
to the Global Fund will undergo thorough review, and that
concerns and questions about problematic proposals can be
provided to U.S. persons who sit on the panels of the Global
Fund.
H.R. 1298 stresses the importance of behavior change
(including the promotion of abstinence, faithfulness, the delay
of ``sexual debut,'' and the effective use of condoms) as the
foundation of efforts to fight AIDS. The legislation expands
U.S. efforts at combating the HIV/AIDS pandemic in the
developing world--in those countries already facing crisis of
unprecedented proportions, and also in those countries with
alarming recent increases in HIV prevalence.
It encourages a strategy that extends palliative care for
people living with AIDS and supports efforts to find vaccines
for HIV/AIDS and malaria. H.R. 1298 emphasizes the need to keep
families together, with particular focus on the assistance
needs of children and young people with HIV and of orphans and
other vulnerable children caused by the HIV/AIDS pandemic. The
bill also contributes to multilateral initiatives that leverage
the funds of others, and endorses wider application of the
successful ``ABC'' approach that has reduced HIV prevalence in
certain countries by acknowledging the importance of individual
behavior change in fighting this disease.
The legislation creates a position within the U.S.
Department of State--a ``Coordinator of United States
Government Activities to Combat HIV/AIDS Globally,'' who will
be appointed by the President. The coordinator will ensure
cohesion and unity of effort among the various agencies of the
United States Government that contribute to our overall AIDS
effort. H.R. 1298 updates the AIDS-related authorities in the
Foreign Assistance Act--authorities for the President to
support the widest variety of AIDS treatment and prevention
programs overseas. The legislation endorses prevention programs
that include the promotion of abstinence, faithfulness, the
delay of ``sexual debut,'' and the effective use of condoms,
and authorizes United States participation in the Global Fund
to Fight AIDS, Tuberculosis and Malaria.
Education is one of the most effective ways to combat HIV/
AIDS. Education systems provide a cost-effective infrastructure
for delivering HIV/AIDS prevention messages and life skills
training to two vital populations, particularly girls--those
least likely to be infected (children ages 5 to 14) and those
most vulnerable to infection (youths 15 to 24 years old)--but
also to the broader population through the engagement of
parents and community leaders in activities in and around
schools.
Funds designed for educational efforts can most effectively
be used in conjunction with other efforts and institutions
engaged in schools and educational institutions. Relevant
education activities include developing and integrating HIV/
AIDS materials in the educational curriculum, training teachers
in such curriculum, and strengthening the capabilities of
schools so that they are better able to address health
education needs.
At the same time that education systems are vital to
combating HIV/AIDS, they are also its victims. The disease is
decimating teacher corps, undermining the quality of education,
and straining already tight national education budgets as
countries try to train replacements.
The HIV/AIDS pandemic is also one of the great moral
challenges of our era, and is a scourge of unparalleled
proportions in modern times. Entire villages of orphans are
being created because adults are dead or dying from this
plague. The United States has an obligation to use its
leadership and resources to stop this virus and the destruction
it causes. The AIDS pandemic touches our national security, our
civilization, and our humanity. We can and should leverage
other countries to contribute to help prevent and fight the
spread of HIV and furnish care, treatment and cure for those
individuals infected with this terrible disease. Compromise
must be at the heart and soul of this process. Certain groups
and interests disagree with specific elements of H.R. 1298.
While no piece of legislation will please all quarters, the
Committee on International Relations has done its best to craft
a compromise that demonstrates our common cause against AIDS.
Members of the Committee may differ on approaches, but do agree
on goals and objectives.
As our Nation wages war in Iraq, the American people can
and must fight on many fronts to protect our interests, promote
our values, and provide hope to captive, destitute and
vulnerable people across the globe.
The United States Congress has waited too long to address
the global HIV/AIDS crisis in a truly systematic and
comprehensive way. This is one of the most ambitious pieces of
legislation in the Committee's long history--$15 billion
authorized in the United States Leadership Against HIV/AIDS,
Tuberculosis and Malaria Act of 2003 is an enormous sum by any
measure. It is five times the amount we considered for the
cause in the 107th Congress through the Committee's
consideration of H.R. 2069. As impressive as these amounts
appear, they are no more than this crisis demands. Every day,
AIDS claims the lives of innocent men and women, old and young,
sick and able-bodied, destitute and affluent, unemployed and
professional, African, Asian, American, atheist and faithful.
This disease does not discriminate. It targets us all. In so
doing, it ruins families, communities and whole nations; and it
fuels violence and bloodshed across borders. The political,
economic, social and health impacts of HIV/AIDS cannot be
contained in one region or one population. It is a global human
challenge that demands a global humanitarian response with the
United States in the lead. H.R. 1298 is unprecedented
legislation that will lead the way for increased U.S.
engagement and leadership to contain the spread of the
pandemic.
Hearings
The Committee did not hold hearings on HIV/AIDS during the
108th Congress prior to consideration of H.R. 1298.
Committee Consideration
H.R. 1298 was introduced by Chairman Hyde on March 17,
2003, and was referred to the Committee on International
Relations. On April 2, 2003, the Committee met in open session,
pursuant to notice, to consider the bill. A motion offered by
Chairman Hyde to favorably report H.R. 1298 to the House of
Representatives, as amended, was agreed to by a record vote of
37 ayes to 8 noes, a quorum being present.
Summary of Amendments
The Committee adopted several amendments. The first was
offered by Chairman Hyde as an en bloc amendment (#1), and was
approved by voice vote.
Rep. Pitts (R-PA) offered an amendment (#2) to provide
prioritized funding for programs promoting abstinence over
those that focus on condom use. Rep. Lee (D-CA) offered a
substitute amendment (#3) to the Pitts amendment. The Lee
amendment requires the President's AIDS prevention strategy to
prioritize behavioral risk reduction by promoting abstinence,
encouraging monogamy and faithfulness, promoting the effective
use of condoms, and eradicating prostitution, the sex trade,
rape, sexual assault and the sexual exploitation of women and
children. The Lee substitute amendment was approved by a record
vote of 24 ayes to 20 nays [Record Vote #1]. The Pitts
amendment, as amended by the Lee amendment, was agreed to by
voice vote.
The Committee approved by voice vote an amendment (#4)
offered by Rep. Brown (D-OH), as amended by Chairman Hyde's
amendment (#5), to Section 302 of the bill requiring the
President to ensure that not less than 75 percent of
tuberculosis funding should be spent on antituberculosis drugs,
supplies, direct patient services, and training.
The Committee approved by voice vote an amendment (#6)
offered by Rep. Rohrabacher (R-CA) recommending that 10% of the
funding be used to help orphans and vulnerable children
affected by HIV/AIDS.
The Committee approved by voice vote an amendment (#7)
offered by Rep. Napolitano (D-CA) regarding awarding subgrants
in a new pilot program on family survival partnerships--giving
priority for consideration to groups that already provide
mother-to-child HIV transmission prevention programs.
The Committee defeated, by a record vote of 15 ayes to 25
nays, an amendment (#8) offered by Rep. Smith (R-MI) that would
have reduced the authorization levels in fiscal years 2004 and
2005, and shifted such funds to fiscal years 2007 and 2008
[Record Vote #2].
The Committee approved by voice vote an amendment (#9)
offered by Rep. Berman (D-CA) that would include, as eligible
to receive funding, the public-private partnership ``Medicines
for Malaria Venture'' for developing new anti-malarial
medicines.
The Committee approved by voice vote an amendment (#10)
offered by Rep. Flake (R-AZ), as amended by the Lantos (#11)
and Berman (#12) amendments, that would reduce the amount of
Federal funding for the Global Fund by an amount equal to the
amount provided by the Fund to governments on the State
Department's terrorist list.
The Committee approved by voice vote an amendment (#13)
offered by Rep. McCollum (D-MN) that would make physician's
assistants eligible to participate in a pilot program for the
placement of health care professionals in countries severely
affected by HIV/AIDS, TB and malaria.
An amendment (#14) to add Malawi to the list of countries
specifically listed to receive HIV/AIDS assistance was offered
and withdrawn by Rep. McCollum.
The Committee approved by unanimous consent an en bloc
amendment (#15) with language by Rep. Harris (R-FL) to add the
word ``abstinence'' to the list of other methods that should be
promoted to reduce HIV/AIDS, and language by Rep. Davis (R-VA)
that would require an analysis of Human Papilloma Virus (HPV)
in sub-Saharan Africa and the impact that condom usage has upon
the spread of HPV in sub-Saharan Africa.
The Committee defeated, by a record vote of 21 ayes to 23
noes [Record Vote #3], an amendment (#16) offered by Rep. Pitts
which would have required the HIV/AIDS Coordinator to respect
the views of faith-based organizations by not requiring such
organizations to participate in any aspect of any assistance
program if it violated their views as a matter of conscience.
The Committee approved, by a record vote of 24 ayes to 22
noes [Record Vote #5], an amendment (#17) offered by Rep. Smith
(R-NJ) that would prohibit funds from going to any group or
organization that does not have a policy ``explicitly opposing
prostitution and sex trafficking.'' The Committee defeated, by
a record vote of 21 ayes to 22 noes, an amendment (#18) offered
by Rep. Lantos (D-CA) to the Smith amendment that would have
provided exceptions to the prostitution policy [Record Vote
#4].
By a record vote of 37 ayes to 8 noes, the Committee
favorably reported to the House H.R. 1298, as amended [Record
Vote #6].
By unanimous consent the Committee ordered H.R. 1298
reported as a single amendment in the nature of a substitute
incorporating the perfecting amendments adopted during markup.
Votes of the Committee
Clause (3)(b) of rule XIII of the Rules of the House of
Representatives requires that the results of each record vote
on an amendment or motion to report, together with the names of
those voting for or against, be printed in the Committee
report.
Description of Amendment, Motion, Order, or Other Proposition:
Vote #1 (11:34 a.m.): Lee substitute amendment (#3) [to
Pitts amendment (#2)] regarding the approach to a reduction of
HIV/AIDS behavioral risks.
Voting yes: Leach, Houghton, Lantos, Berman, Ackerman,
Payne, Menendez, Brown, Sherman, Wexler, Engel,
Delahunt, Meeks, Lee, Crowley, Hoeffel, Blumenauer,
Berkley, Napolitano, Schiff, Watson, Smith (WA),
McCollum and Bell.
Voting no: Hyde, Smith (NJ), Burton, Gallegly,
Ballenger, Rohrabacher, Royce, Chabot, Tancredo, Paul,
Smith (MI), Pitts, Flake, Davis, Green, Weller, Pence,
McCotter, Janklow and Harris.
Ayes 24. Noes 20.
Vote #2 (1:42 p.m.): Smith (MI) amendment (#8) regarding
gradual increases for the authorized funding for FY04-08.
Voting yes: Bereuter, Ballenger, Rohrabacher, Royce,
Chabot, Houghton, Smith (MI), Pitts, Flake, Davis,
Green, Pence, McCotter, Janklow and Harris.
Voting no: Hyde, Leach, King, Weller, Lantos, Berman,
Ackerman, Payne, Menendez, Brown, Wexler, Engel,
Delahunt, Meeks, Lee, Crowley, Hoeffel, Blumenauer,
Berkley, Napolitano, Schiff, Watson, Smith (WA),
McCollum and Bell.
Ayes 15. Noes 25.
Vote #3 (3:25 p.m.): Pitts amendment (#16) regarding
respecting the views of faith-based organizations when carrying
out assistance relating to matters of conscience.
Voting yes: Hyde, Leach, Bereuter, Smith (NJ),
Ballenger, Rohrabacher, Royce, King, Chabot, Tancredo,
Paul, Smith (MI), Pitts, Flake, Davis, Green, Weller,
Pence, McCotter, Janklow and Harris.
Voting no: Houghton, Lantos, Berman, Ackerman, Payne,
Menendez, Brown, Sherman, Wexler, Engel, Delahunt,
Meeks, Lee, Crowley, Hoeffel, Blumenauer, Berkley,
Napolitano, Schiff, Watson, Smith (WA), McCollum and
Bell.
Ayes 21. Noes 23.
Vote #4 (3:50 p.m.): Lantos amendment (#18) [to Smith (NJ)
amendment (#17)] regarding funds to organizations that do not
have a policy opposing sexual trafficking and prostitution--
adding exceptions to the policy.
Voting yes: Leach, Lantos, Berman, Ackerman, Payne,
Menendez, Brown, Wexler, Engel, Delahunt, Meeks, Lee,
Crowley, Hoeffel, Blumenauer, Berkley, Napolitano,
Schiff, Watson, Smith (WA) and McCollum.
Voting no: Hyde, Bereuter, Smith (NJ), Burton,
Gallegly, Ballenger, Rohrabacher, Royce, King, Chabot,
Houghton, Tancredo, Paul, Pitts, Flake, Davis, Green,
Weller, Pence, McCotter, Janklow and Harris.
Ayes 21. Noes 22.
Vote #5 (4:00 p.m.): Smith (NJ) amendment (#17) providing
that no funds may be made available to organizations that do
not have a policy opposing sexual trafficking and prostitution.
Voting yes: Hyde, Leach, Bereuter, Smith (NJ), Burton,
Gallegly, Ballenger, Rohrabacher, Royce, King, Chabot,
Houghton, Tancredo, Paul, Smith (MI), Pitts, Flake,
Davis, Green, Weller, Pence, McCotter, Janklow and
Harris.
Voting no: Lantos, Berman, Ackerman, Payne, Menendez,
Brown, Sherman, Wexler, Engel, Delahunt, Meeks, Lee,
Crowley, Hoeffel, Blumenauer, Berkley, Napolitano,
Schiff, Watson, Smith (WA), McCollum and Bell.
Ayes 24. Noes 22.
Vote #6 (4:04 p.m.): Report H.R. 1298, as amended,
favorably to the House.
Voting yes: Hyde, Leach, Bereuter, Smith (NJ), Burton,
Gallegly, Ballenger, Rohrabacher, Royce, King,
Houghton, Green, Weller, McCotter, Janklow, Harris,
Lantos, Berman, Ackerman, Payne, Menendez, Brown,
Sherman, Wexler, Engel, Delahunt, Meeks, Lee, Crowley,
Hoeffel, Berkley, Napolitano, Schiff, Watson, Smith
(WA), McCollum and Bell.
Voting no: Chabot, Tancredo, Paul, Smith (MI), Pitts,
Flake, Davis, and Pence.
Ayes 37. Noes 8.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the Committee reports that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
New Budget Authority and Tax Expenditures
Clause 3(c)(2) of House Rule XIII is inapplicable because
this legislation does not provide new budgetary authority or
increased tax expenditures.
Congressional Budget Office Cost Estimate
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, the Committee sets forth, with
respect to the bill, H.R.1298, the following estimate and
comparison prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, April 7, 2003.
Hon. Henry J. Hyde, Chairman,
Committee on International Relations,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1298, the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Joseph C.
Whitehill, who can be reached at 226-2840.
Sincerely,
Douglas Holtz-Eakin.
Enclosure
cc:
Honorable Tom Lantos,
Ranking Member.
H.R. 1298--United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003.
SUMMARY
H.R. 1298 would require the President to develop a
comprehensive strategy for the prevention, treatment, and
monitoring of acquired immune deficiency syndrome (AIDS) caused
by the human immunodeficiency virus (HIV) and would authorize
the appropriation of $3 billion a year over the 2004-2008
period to fund those efforts. Specifically, the bill would
authorize appropriations for contributions to the Global Fund
to Fight AIDS, Tuberculosis, and Malaria and to various
international vaccine funds. It would authorize funding for
bilateral assistance programs to prevent, treat, and monitor
HIV/AIDS, tuberculosis, and malaria and for assistance to the
families and children of persons affected by those diseases.
Assuming appropriation of the authorized amounts, CBO estimates
implementing H.R. 1298 would cost $568 million in 2004 and $11
billion over the 2004-2008 period. The bill would not affect
direct spending or receipts.
H.R. 1298 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no significant costs on the budgets of state,
local, or tribal governments.
ESTIMATED COST TO THE FEDERAL GOVERNMENT
The estimated budgetary impact of H.R. 1298 is shown in the
following table. The costs of this legislation fall within
budget functions 150 (international affairs) and 550 (health).
For this estimate, CBO assumes that the bill will be enacted by
September 30, 2003, that authorized amounts will be provided in
annual appropriation acts near the start of each fiscal year,
and that outlays will follow historical spending patterns.
By fiscal year, in millions of dollars
----------------------------------------------------------------------------------------------------------------
2003 2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for 1,639 0 0 0 0 0
International HIV/AIDS, Tuberculosis,
Malaria, and Vaccine Programs
Budget Authority \1\
Estimated Outlays 955 1,098 382 167 78 21
Proposed Changes 0 3,000 3,000 3,000 3,000 3,000
Authorization Level
Estimated Outlays 0 568 2,107 2,606 2,817 2,924
Spending Under H.R. 1298 1,639 3,000 3,000 3,000 3,000 3,000
Authorization Level \1\
Estimated Outlays 955 1,666 2,489 2,773 2,895 2,945
----------------------------------------------------------------------------------------------------------------
\1\ The 2003 level is the amount appropriated for that year.
BASIS OF ESTIMATE
H.R. 1298 would identify HIV/AIDS as being of particular
concern to the United States and would require the President to
develop a comprehensive strategy to combat it on a global
basis. The bill would establish within the Department of State
the position of Coordinator of U.S. Government Activities to
Combat HIV/AIDS Globally with the responsibility to oversee and
to coordinate U.S. programs with those of other countries and
international organizations. The bill also would require
numerous reports to the Congress, and it would permit a portion
of the authorized amounts to be used for administrative
expenses.
The bill would give the Coordinator discretion to allocate
funds to the various programs authorized. For the purpose of
the estimate, CBO assumed that programs under the Public Health
Services agencies would be funded at the amounts identified in
the President's budget request for 2004 and that the additional
amounts authorized by H.R. 1298, about $0.9 billion of the $3
billion annual authorization, would be allocated by the
Coordinator consistent with the plan to be developed by the
President.
INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT
H.R. 1298 contains no intergovernmental or private-sector
mandates as defined in UMRA and would impose no significant
costs on the budgets of state, local, or tribal governments.
Performance Goals and Objectives
The goals and objectives of this legislation are to provide
for the national security of the United States and other
nations by increasing HIV/AIDS assistance to those countries
most affected by the pandemic for the purpose of reducing the
spread of the pandemic and its effects on the health of
populations in the developing world.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds the authority for
this legislation in article I, section 8, clause 18 of the
Constitution (relating to making all laws necessary and proper
for carrying into execution powers vested by the Constitution
in the Government of the United States).
Section-by-Section Analysis and Discussion
Section 1. Short Title. Section 1 contains a short title
and table of contents.
Section 2. Findings. Section 2 articulates findings on the
state of the HIV/AIDS pandemic in the developing world,
including latest statistics on the numbers infected and dead;
the particular effect of AIDS on, and the vulnerability of,
women and children; the effect of the AIDS crisis on the
economic security of countries; its effect on society, labor,
military readiness and peacekeeping; the relationship of HIV/
AIDS to tuberculosis and malaria; the types of strategies
appropriate for dealing with the pandemic; the importance of
treatment and care of people living with AIDS; the role of NGOs
and faith-based organizations in assisting those people living
with AIDS; the positive track record of countries such as
Uganda in facing AIDS directly, resulting in significant
progress by adopting strategies based on behavior change; the
demand for a comprehensive, long-term international response,
founded upon addressing the crisis, reducing the spread, and
ameliorating the consequence of the pandemic; that
prostitution, sex trafficking and sexual violence are
additional causes and factors in the spread of HIV/AIDS; the
need for strong coordination among the various agencies of the
United States to ensure effective and efficient use of
financial and technical resources with respect to the provision
of international HIV/AIDS assistance; and findings summarizing
and emphasizing the importance of the President's support of
greatly increased and expanded United States efforts to control
the pandemic.
Section 3. Definitions. Section 3 defines terms used
throughout the bill.
Section 4. Purpose. Section 4 articulates in general terms
the purposes of the act: to establish a comprehensive, 5-year
strategy; to provide increased resources for bilateral and
multilateral efforts to fight the pandemic; to encourage the
expansion of private sector efforts and public-private
partnerships; and to intensify care and treatment for
individuals with HIV/AIDS, and development of vaccines for HIV/
AIDS, tuberculosis, and malaria.
Section 5. Authority to consolidate and combine reports.
Section 5 authorizes the President to consolidate the various
reports required by the act, and to enter into contracts for
the purpose of developing, originating, or contributing to any
of the required reports.
Title I--Policy Planning and Coordination
Section 101. Development of a comprehensive, 5-year global
strategy. Section 101 requires the President to: establish a
comprehensive, integrated 5-year strategy to combat HIV/AIDS
globally, and articulates that the required elements of the
strategy should include objectives and approaches to treat
those infected, and prevent further spread of infections;
improve coordination and assign priorities for relevant
executive branch agencies; expand public-private partnerships;
maximize U.S. capabilities in the areas of technical
assistance, training, and research; and report on the strategy
not later than 270 days after the date of enactment of the law.
Section 102. HIV/AIDS Response Coordinator. Section 102(a)
creates the position of Coordinator of United States Government
Activities to Combat HIV/AIDS Globally and enumerates the
duties and responsibilities of that individual, generally and
specifically. Section 102(b) requires the President to specify
the necessary financial resources that shall be assigned to,
and under the direct control of, the Coordinator. Section
102(c) establishes a separate account in the Treasury into
which shall be deposited all amounts appropriated pursuant to
the authorization of appropriations under section 401, except
for amounts appropriated for U.S. contributions to the Global
Fund.
Title II--Support for Multilateral Funds, Programs, and Public-Private
Partnerships
Section 201. Sense of Congress on public-private
partnerships. Section 201 includes findings and a Sense of
Congress supportive of public-private partnerships in
strengthening the delivery of health services and accelerating
research in the fight against HIV/AIDS.
Section 202. Participation in the Global Fund to Fight
AIDS, Tuberculosis and Malaria. Section 202 authorizes U.S.
financial participation in the Global Fund to Fight AIDS,
Tuberculosis and Malaria (the Global Fund), and requires an
annual report on contributions pledged to, received by, and
projects funded by the Global Fund, and the mechanisms
established for transparency and accountability in the grant-
making process. It authorizes up to $1 billion for fiscal year
2004, and such sums as may be necessary for FY2005-2008,
available until expended, with the limitation that the U.S.
contribution may not be more than 33 percent of the total
amounts contributed to the Fund from all other sources, unless
the President waives this requirement. It also requires the
establishment of an interagency technical review panel that
will analyze proposals received by the Global Fund and provide
recommendations to U.S. representatives on the committees,
panels and executive board of the Global Fund. It requires the
GAO to monitor and evaluate projects and report to Congress
every 2 years the results of the monitoring and evaluation.
Section 203. Voluntary contributions to international
vaccine funds. Section 203 authorizes such sums as may be
necessary to be contributed by the United States Government to
the ``Vaccine Fund,'' the ``International AIDS Vaccine
Initiative (IAVI),'' and malaria vaccine development programs
such as the ``Malaria Vaccine Initiative of the Program for
Appropriate Technologies in Health.''
Title III--Bilateral Efforts
Subtitle A--General Assistance and Programs
Section 301. Assistance to combat HIV/AIDS. Section 301(a)
amends and updates the Foreign Assistance Act (FAA) by
inserting a new section, Section 104A--``Assistance to Combat
HIV/AIDS.'' This new section: recognizes that the alarming
spread of HIV/AIDS in developing countries is a major health,
national security, development and humanitarian crisis; states
that a major objective of the foreign assistance program of the
United States is to provide assistance for the prevention,
treatment and control of HIV/AIDS; authorizes the President to
furnish assistance to prevent, treat and monitor HIV/AIDS, and
carry out related activities in sub-Saharan Africa and other
countries and areas; describes in general the types of
assistance activities that shall be supported to the maximum
extent practicable (prevention, treatment, prevention
intervention education and technologies, monitoring,
pharmaceuticals, and related activities); requires an annual
report on the implementation of the new Section 104A; provides
a limitation on administrative expenses for activities
described in Section 104(c) and Sections104A, 104B, and 104C;
and defines terms used in Section 104A. Section 301(b)
authorizes the appropriation of such sums as may be necessary
for FY2004-2008 to carry out the new Section 104A of the FAA as
added by Section 301(a), and authorizes such sums to remain
available until expended.
In order to promote effective and efficient use of
financial and technical resources with respect to the provision
of U.S. HIV/AIDS assistance, the Committee expects that the
Coordinator will establish in-country mechanisms under which
all organizations receiving U.S. HIV/AIDS funds in a particular
country will closely coordinate their activities to decrease
overlap in programming and ensure maximum success for each
program supported by U.S. funds.
Section 302. Assistance to combat tuberculosis. Section 302
amends the FAA by adding a new section, Section 104B, that
authorizes assistance to combat tuberculosis, and authorizes
the appropriation of such sums as may be necessary to carry out
this new section of the FAA.
Section 303. Assistance to combat malaria. Section 303
amends the FAA by adding a new Section 104C that authorizes
assistance to combat malaria, and authorizes the appropriation
of such sums as may be necessary to carry out this new Section
104C of the FAA.
Section 304. Pilot program for the placement of health care
professionals in overseas areas severely affected by HIV/AIDS,
tuberculosis, and malaria. Section 304 authorizes the President
to establish a pilot program for the placement of health care
professionals in overseas areas severely affected by HIV/AIDS,
tuberculosis and malaria, including foreign-born health care
workers living permanently in the United States; and from the
amounts authorized to be appropriated to the President under
Section 401, authorizes the appropriation of such sums as may
be necessary for FY2004-2008 to carry out the program.
Section 305. Report on treatment activities by relevant
executive branch agencies. Section 305 requires a report by the
President on the programs and activities of relevant executive
branch agencies that are directed to the treatment of
individuals in foreign countries infected with HIV or living
with AIDS.
Subtitle B--Assistance for Children and Families
Section 311. Findings. Section 311 includes findings on the
effect of AIDS on children and families in foreign countries.
Section 312. Policy and requirements. Section 312 states
that the United States Government response to the pandemic
should place a high priority on the prevention of mother-to-
child transmission, the care and treatment of family members,
and the care of children orphaned by AIDS.
Section 313. Annual reports on prevention of mother-to-
child transmission of the HIV infection. Section 313 requires
an annual report on the activities of relevant executive branch
agencies to assist in the prevention of mother-to-child
transmission of HIV infection.
Section 314. Pilot program of assistance for children and
families affected by HIV/AIDS. Section 314 authorizes the
President to establish a pilot program to demonstrate the
feasibility of the provision of care and treatment to orphans
and other children and young people affected by HIV/AIDS in
foreign countries, and from the amounts authorized to be
appropriated to the President under Section 401, authorizes the
appropriation of such sums as may be necessary for FY2004-2008
to carry out the program.
Section 315. Pilot programs on family survival
partnerships. Section 315 authorizes the President to establish
a program, through a 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 mother-to-child transmission of HIV in countries
with or at risk for severe HIV epidemic, with particular
attention to resource-constrained countries, and from the
amounts authorized to be appropriated to the President under
Section 401, authorizes the appropriation of such sums as may
be necessary for FY2004-2008 to carry out the program.
Title IV--Authorization of Appropriations.
Section 401. Authorization of Appropriations. Section 401
authorizes to be appropriated to the President to carry out the
act and the amendments made by the act $3 billion for each of
the fiscal years 2004 through 2008. Amounts are authorized to
remain available until expended and the authorization of
appropriations therein shall remain available until the
appropriations are made.
Section 402. Sense of Congress. Section 402(a) includes a
sense of the Congress that an urgent priority of U.S.
assistance programs to fight HIV/AIDS should be the rapid
increase in distribution of antiretroviral treatment (ARV) so
that by the end of FY2004, at least 500,000 individuals are
receiving ARV; by the end of FY2005, at least 1,000,000
individuals are receiving such treatment; and by the end of
FY2006, at least 2,000,000 individuals are receiving treatment.
Section 402(b) includes a sense of the Congress that of the
amounts appropriated pursuant to the authorization of
appropriations under Section 401 for HIV/AIDS assistance, an
effective distribution of such funds would be 55 percent for
treatment of individuals with HIV/AIDS, 15 percent for
palliative care of individuals with HIV/AIDS, 20 percent for
HIV/AIDS prevention, and 10 percent for orphans and vulnerable
children.
Section 403. Allocation of Funds. Section 403 requires that
for fiscal years 2006 through 2008, not less than 55 percent of
the amounts appropriated under Section 401 for HIV/AIDS
assistance for each fiscal year shall be expended for
therapeutic medical care of individuals infected with HIV, of
which at least 75 percent should be expended for the purchase
and distribution of ARV drugs and at least 25 percent should be
expended for related care.
New Advisory Committees
H.R. 1298 does not establish or authorize any new advisory
committees.
Congressional Accountability Act
H.R. 1298 does not apply to the legislative branch.
Federal Mandates
H.R. 1298 imposes no Federal mandates.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
SECTION 1 OF THE STATE DEPARTMENT BASIC AUTHORITIES ACT OF 1956
ORGANIZATION OF THE DEPARTMENT OF STATE
Section 1. (a) * * *
* * * * * * *
(f) HIV/AIDS Response Coordinator.--
(1) In general.--There shall be established within
the Department of State in the immediate office of the
Secretary of State a Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, who
shall be appointed by the President, by and with the
advice and consent of the Senate. The Coordinator shall
report directly to the Secretary.
(2) Authorities and duties; definitions.--
(A) Authorities.--The Coordinator, acting
through such nongovernmental organizations
(including faith-based and community-based
organizations) and relevant executive branch
agencies as may be necessary and appropriate to
effect the purposes of this section, is
authorized--
(i) to operate internationally to
carry out prevention, care, treatment,
support, capacity development, and
other activities for combatting HIV/
AIDS;
(ii) to transfer and allocate funds
to relevant executive branch agencies;
and
(iii) to provide grants to, and
enter into contracts with,
nongovernmental organizations
(including faith-based and community-
based organizations) to carry out the
purposes of section.
(B) Duties.--
(i) In general.--The Coordinator
shall have primary responsibility for
the oversight and coordination of all
resources and international activities
of the United States Government to
combat the HIV/AIDS pandemic, including
all programs, projects, and activities
of the United States Government
relating to the HIV/AIDS pandemic under
the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act
of 2003 or any amendment made by that
Act.
(ii) Specific duties.--The duties
of the Coordinator shall specifically
include the following:
(I) Ensuring program and
policy coordination among the
relevant executive branch
agencies and nongovernmental
organizations, including
auditing, monitoring, and
evaluation of all such
programs.
(II) Ensuring that each
relevant executive branch
agency undertakes programs
primarily in those areas where
the agency has the greatest
expertise, technical
capabilities, and potential for
success.
(III) Avoiding duplication
of effort.
(IV) Ensuring coordination
of relevant executive branch
agency activities in the field.
(V) Pursuing coordination
with other countries and
international organizations.
(VI) Resolving policy,
program, and funding disputes
among the relevant executive
branch agencies.
(VII) Directly approving
all activities of the United
States (including funding)
relating to combatting HIV/AIDS
in each of Botswana, Cote
d'Ivoire, Ethiopia, Guyana,
Haiti, Kenya, Mozambique,
Namibia, Nigeria, Rwanda, South
Africa, Tanzania, Uganda,
Zambia, and other countries
designated by the President,
which other designated
countries may include those
countries in which the United
States is implementing HIV/AIDS
programs as of the date of the
enactment of the United States
Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act
of 2003.
(VIII) Establishing due
diligence criteria for all
recipients of funds section and
all activities subject to the
coordination and appropriate
monitoring, evaluation, and
audits carried out by the
Coordinator necessary to assess
the measurable outcomes of such
activities.
(C) Definitions.--In this paragraph:
(i) AIDS.--The term ``AIDS'' means
acquired immune deficiency syndrome.
(ii) HIV.--The term ``HIV'' means
the human immunodeficiency virus, the
pathogen that causes AIDS.
(iii) HIV/AIDS.--The term ``HIV/
AIDS'' means, with respect to an
individual, an individual who is
infected with HIV or living with AIDS.
(iv) Relevant executive branch
agencies.--The term ``relevant
executive branch agencies'' means the
Department of State, the United States
Agency for International Development,
the Department of Health and Human
Services (including the Public Health
Service), and any other department or
agency of the United States that
participates in international HIV/AIDS
activities pursuant to the authorities
of such department or agency or this
Act.
[(f)] (g) Qualifications of Certain Officers of the
Department of State.--
(1) * * *
* * * * * * *
----------
FOREIGN ASSISTANCE ACT OF 1961
* * * * * * *
PART I
Chapter 1--Policy; Development Assistance Authorizations
* * * * * * *
Sec. 104. Population and Health.--(a) * * *
* * * * * * *
(c) Assistance for Health and Disease Prevention.--(1) * *
*
* * * * * * *
[(4)(A) Congress recognizes the growing international
dilemma of children with the human immunodeficiency virus (HIV)
and the merits of intervention programs aimed at this problem.
Congress further recognizes that mother-to-child transmission
prevention strategies can serve as a major force for change in
developing regions, and it is, therefore, a major objective of
the foreign assistance program to control the acquired immune
deficiency syndrome (AIDS) epidemic.
[(B) The agency primarily responsible for administering
this part shall--
[(i) coordinate with UNAIDS, UNICEF, WHO, national
and local governments, and other organizations to
develop and implement effective strategies to prevent
vertical transmission of HIV; and
[(ii) coordinate with those organizations to
increase intervention programs and introduce voluntary
counseling and testing, antiretroviral drugs,
replacement feeding, and other strategies.
[(5)(A) Congress expects the agency primarily responsible
for administering this part to make the human immunodeficiency
virus (HIV) and the acquired immune deficiency syndrome (AIDS)
a priority in the foreign assistance program and to undertake a
comprehensive, coordinated effort to combat HIV and AIDS.
[(B) Assistance described in subparagraph (A) shall include
help providing--
[(i) primary prevention and education;
[(ii) voluntary testing and counseling;
[(iii) medications to prevent the transmission of
HIV from mother to child; and
[(iv) care for those living with HIV or AIDS.
[(6)(A) In addition to amounts otherwise available for such
purpose, there is authorized to be appropriated to the
President $300,000,000 for each of the fiscal years 2001 and
2002 to carry out paragraphs (4) and (5).
[(B) Of the funds authorized to be appropriated under
subparagraph (A), not less than 65 percent is authorized to be
available through United States and foreign nongovernmental
organizations, including private and voluntary organizations,
for-profit organizations, religious affiliated organizations,
educational institutions, and research facilities.
[(C)(i) Of the funds authorized to be appropriated by
subparagraph (A), not less than 20 percent is authorized to be
available for programs as part of a multidonor strategy to
address the support and education of orphans in sub-Saharan
Africa, including AIDS orphans.
[(ii) Assistance made available under this subsection, and
assistance made available under chapter 4 of part II to carry
out the purposes of this subsection, may be made available
notwithstanding any other provision of law that restricts
assistance to foreign countries.
[(D) Of the funds authorized to be appropriated under
subparagraph (A), not less than 8.3 percent is authorized to be
available to carry out the prevention strategies for vertical
transmission referred to in paragraph (4)(A).
[(E) Of the funds authorized to be appropriated by
subparagraph (A), not more than 7 percent may be used for the
administrative expenses of the agency primarily responsible for
carrying out this part of this Act in support of activities
described in paragraphs (4) and (5).
[(F) Funds appropriated under this paragraph are authorized
to remain available until expended.
[(7)(A) Congress recognizes the growing international
problem of tuberculosis and the impact its continued existence
has on those nations that had previously largely controlled the
disease. Congress further recognizes that the means exist to
control and treat tuberculosis, and that it is therefore a
major objective of the foreign assistance program to control
the disease. To this end, Congress expects the agency primarily
responsible for administering this part--
[(i) to coordinate with the World Health
Organization, the Centers for Disease Control, the
National Institutes of Health, and other organizations
toward the development and implementation of a
comprehensive tuberculosis control program; and
[(ii) to set as a goal the detection of at least 70
percent of the cases of infectious tuberculosis, and
the cure of at least 85 percent of the cases detected,
in those countries in which the agency has established
development programs, by December 31, 2010.
[(B) There is authorized to be appropriated to the
President, $60,000,000 for each of the fiscal years 2001 and
2002 to be used to carry out this paragraph. Funds appropriated
under this subparagraph are authorized to remain available
until expended.]
(4) Relationship to other laws.--Assistance made available
under this subsection and sections 104A, 104B, and 104C, and
assistance made available under chapter 4 of part II to carry
out the purposes of this subsection and the provisions cited in
this paragraph, may be made available notwithstanding any other
provision of law that restricts assistance to foreign
countries, except for the provisions of this subsection, the
provisions of law cited in this paragraph, subsection (f),
section 634A of this Act, and provisions of law that limit
assistance to organizations that support or participate in a
program of coercive abortion or involuntary sterilization
included under the Child Survival and Health Programs Fund
heading in the Consolidated Appropriations Resolution, 2003
(Public Law 108-7).
* * * * * * *
SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Finding.--Congress recognizes that the alarming spread
of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean,
and other developing countries is a major global health,
national security, development, and humanitarian crisis.
(b) Policy.--It is a major objective of the foreign
assistance program of the United States to provide assistance
for the prevention, treatment, and control of HIV/AIDS. The
United States and other developed countries should provide
assistance to countries in sub-Saharan Africa, the Caribbean,
and other countries and areas to control this crisis through
HIV/AIDS prevention, treatment, monitoring, and related
activities, particularly activities focused on women and youth,
including strategies to protect women and prevent mother-to-
child transmission of the HIV infection.
(c) Authorization.--
(1) In general.--Consistent with section 104(c),
the President is authorized to furnish assistance, on
such terms and conditions as the President may
determine, for HIV/AIDS, including to prevent, treat,
and monitor HIV/AIDS, and carry out related activities,
in countries in sub-Saharan Africa, the Caribbean, and
other countries and areas.
(2) Role of ngos.--It is the sense of Congress that
the President should provide an appropriate level of
assistance under paragraph (1) through nongovernmental
organizations (including faith-based and community-
based organizations) in countries in sub-Saharan
Africa, the Caribbean, and other countries and areas
affected by the HIV/AIDS pandemic.
(3) Coordination of assistance efforts.--The
President shall coordinate the provision of assistance
under paragraph (1) with the provision of related
assistance by the Joint United Nations Programme on
HIV/AIDS (UNAIDS), the United Nations Children's Fund
(UNICEF), the World Health Organization (WHO), the
United Nations Development Programme (UNDP), the Global
Fund to Fight AIDS, Tuberculosis and Malaria and other
appropriate international organizations (such as the
International Bank for Reconstruction and Development),
relevant regional multilateral development
institutions, national, state, and local governments of
foreign countries, appropriate governmental and
nongovernmental organizations, and relevant executive
branch agencies.
(d) Activities Supported.--Assistance provided under
subsection (c) shall, to the maximum extent practicable, be
used to carry out the following activities:
(1) Prevention.--Prevention of HIV/AIDS through
activities including--
(A) programs and efforts that are designed
or intended to impart knowledge with the
exclusive purpose of helping individuals avoid
behaviors that place them at risk of HIV
infection, including integration of such
programs into health programs and the inclusion
in counseling programs of information on
methods of avoiding infection of HIV, including
delaying sexual debut, abstinence, fidelity and
monogamy, reduction of casual sexual
partnering, and where appropriate, use of
condoms;
(B) assistance to establish and implement
culturally appropriate HIV/AIDS education and
prevention programs that focus on helping
individuals avoid infection of HIV/AIDS,
implemented through nongovernmental
organizations, including faith-based and
community-based organizations, particularly
those organizations that utilize both
professionals and volunteers with appropriate
skills, experience, and community presence;
(C) assistance for the purpose of providing
voluntary testing and counseling (including the
incorporation of confidentiality protections
with respect to such testing and counseling);
(D) assistance for the purpose of
preventing mother-to-child transmission of the
HIV infection, including medications to prevent
such transmission and access to infant formula
and other alternatives for infant feeding;
(E) assistance to ensure a safe blood
supply and sterile medical equipment; and
(F) assistance to help avoid substance
abuse and intravenous drug use that can lead to
HIV infection.
(2) Treatment.--The treatment and care of
individuals with HIV/AIDS, including--
(A) assistance to establish and implement
programs to strengthen and broaden indigenous
health care delivery systems and the capacity
of such systems to deliver HIV/AIDS
pharmaceuticals and otherwise provide for the
treatment of individuals with HIV/AIDS,
including clinical training for indigenous
organizations and health care providers;
(B) assistance to strengthen and expand
hospice and palliative care programs to assist
patients debilitated by HIV/AIDS, their
families, and the primary caregivers of such
patients, including programs that utilize
faith-based and community-based organizations;
and
(C) assistance for the purpose of the care
and treatment of individuals with HIV/AIDS
through the provision of pharmaceuticals,
including antiretrovirals and other
pharmaceuticals and therapies for the treatment
of opportunistic infections, nutritional
support, and other treatment modalities.
(3) Preventative intervention education and
technologies.--(A) With particular emphasis on specific
populations that represent a particularly high risk of
contracting or spreading HIV/AIDS, including those
exploited through the sex trade, victims of rape and
sexual assault, individuals already infected with HIV/
AIDS, and in cases of occupational exposure of health
care workers, assistance with efforts to reduce the
risk of HIV/AIDS infection including post-exposure
pharmaceutical prophylaxis, and necessary
pharmaceuticals and commodities, including test kits,
condoms, and, when proven effective, microbicides.
(B) Bulk purchases of available test kits, condoms,
and, when proven effective, microbicides that are
intended to reduce the risk of HIV/AIDS transmission
and for appropriate program support for the
introduction and distribution of these commodities, as
well as education and training on the use of the
technologies.
(4) Monitoring.--The monitoring of programs,
projects, and activities carried out pursuant to
paragraphs (1) through (3), including--
(A) monitoring to ensure that adequate
controls are established and implemented to
provide HIV/AIDS pharmaceuticals and other
appropriate medicines to poor individuals with
HIV/AIDS;
(B) appropriate evaluation and surveillance
activities;
(C) monitoring to ensure that appropriate
measures are being taken to maintain the
sustainability of HIV/AIDS pharmaceuticals
(especially antiretrovirals) and ensure that
drug resistance is not compromising the
benefits of such pharmaceuticals; and
(D) monitoring to ensure appropriate law
enforcement officials are working to ensure
that HIV/AIDS pharmaceuticals are not
diminished through illegal counterfeiting or
black market sales of such pharmaceuticals.
(5) Pharmaceuticals.--
(A) Procurement.--The procurement of HIV/
AIDS pharmaceuticals, antiviral therapies, and
other appropriate medicines, including
medicines to treat opportunistic infections.
(B) Mechanisms for quality control and
sustainable supply.--Mechanisms to ensure that
such HIV/AIDS pharmaceuticals, antiretroviral
therapies, and other appropriate medicines are
quality-controlled and sustainably supplied.
(C) Distribution.--The distribution of such
HIV/AIDS pharmaceuticals, antiviral therapies,
and other appropriate medicines (including
medicines to treat opportunistic infections) to
qualified national, regional, or local
organizations for the treatment of individuals
with HIV/AIDS in accordance with appropriate
HIV/AIDS testing and monitoring requirements
and treatment protocols and for the prevention
of mother-to-child transmission of the HIV
infection.
(6) Related activities.--The conduct of related
activities, including--
(A) the care and support of children who
are orphaned by the HIV/AIDS pandemic,
including services designed to care for
orphaned children in a family environment which
rely on extended family members;
(B) improved infrastructure and
institutional capacity to develop and manage
education, prevention, and treatment programs,
including training and the resources to collect
and maintain accurate HIV surveillance data to
target programs and measure the effectiveness
of interventions; and
(C) vaccine research and development
partnership programs with specific plans of
action to develop a safe, effective,
accessible, preventive HIV vaccine for use
throughout the world.
(7) Comprehensive hiv/aids public-private
partnerships.--The establishment and operation of
public-private partnership entities within countries in
sub-Saharan Africa, the Caribbean, and other countries
affected by the HIV/AIDS pandemic that are dedicated to
supporting the national strategy of such countries
regarding the prevention, treatment, and monitoring of
HIV/AIDS. Each such public-private partnership should--
(A) support the development,
implementation, and management of comprehensive
HIV/AIDS plans in support of the national HIV/
AIDS strategy;
(B) operate at all times in a manner that
emphasizes efficiency, accountability, and
results-driven programs;
(C) engage both local and foreign
development partners and donors, including
businesses, government agencies, academic
institutions, nongovernmental organizations,
foundations, multilateral development agencies,
and faith-based organizations, to assist the
country in coordinating and implementing HIV/
AIDS prevention, treatment, and monitoring
programs in accordance with its national HIV/
AIDS strategy;
(D) provide technical assistance,
consultant services, financial planning,
monitoring and evaluation, and research in
support of the national HIV/AIDS strategy; and
(E) establish local human resource
capacities for the national HIV/AIDS strategy
through the transfer of medical, managerial,
leadership, and technical skills.
(e) Annual Report.--
(1) In general.--Not later than January 31 of each
year, the President shall submit to the Committee on
Foreign Relations of the Senate and the Committee on
International Relations of the House of Representatives
a report on the implementation of this section for the
prior fiscal year.
(2) Report elements.--Each report shall include--
(A) a description of efforts made by each
relevant executive branch agency to implement
the policies set forth in this section, section
104B, and section 104C;
(B) a description of the programs
established pursuant to such sections; and
(C) a detailed assessment of the impact of
programs established pursuant to such sections,
including--
(i)(I) the effectiveness of such
programs in reducing the spread of the
HIV infection, particularly in women
and girls, in reducing mother-to-child
transmission of the HIV infection, and
in reducing mortality rates from HIV/
AIDS; and
(II) the number of patients
currently receiving treatment for AIDS
in each country that receives
assistance under this Act.
(ii) the progress made toward
improving health care delivery systems
(including the training of adequate
numbers of staff) and infrastructure to
ensure increased access to care and
treatment;
(iii) with respect to tuberculosis,
the increase in the number of people
treated and the increase in number of
tuberculosis patients cured through
each program, project, or activity
receiving United States foreign
assistance for tuberculosis control
purposes; and
(iv) with respect to malaria, the
increase in the number of people
treated and the increase in number of
malaria patients cured through each
program, project, or activity receiving
United States foreign assistance for
malaria control purposes.
(f) Funding Limitation.--Of the funds made available to
carry out this section in any fiscal year, not more than 7
percent may be used for the administrative expenses of the
United States Agency for International Development in support
of activities described in section 104(c), this section,
section 104B, and section 104C. Such amount shall be in
addition to other amounts otherwise available for such
purposes.
(g) Definitions.--In this section:
(1) AIDS.--The term ``AIDS'' means acquired immune
deficiency syndrome.
(2) HIV.--The term ``HIV'' means the human
immunodeficiency virus, the pathogen that causes AIDS.
(3) HIV/AIDS.--The term ``HIV/AIDS'' means, with
respect to an individual, an individual who is infected
with HIV or living with AIDS.
(4) Relevant executive branch agencies.--The term
``relevant executive branch agencies'' means the
Department of State, the United States Agency for
International Development, the Department of Health and
Human Services (including its agencies and offices),
and any other department or agency of the United States
that participates in international HIV/AIDS activities
pursuant to the authorities of such department or
agency or this Act.
SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Findings.--Congress makes the following findings:
(1) Congress recognizes the growing international
problem of tuberculosis and the impact its continued
existence has on those countries that had previously
largely controlled the disease.
(2) Congress further recognizes that the means
exist to control and treat tuberculosis through
expanded use of the DOTS (Directly Observed Treatment
Short-course) treatment strategy, including DOTS-Plus
to address multi-drug resistant tuberculosis, and
adequate investment in newly created mechanisms to
increase access to treatment, including the Global
Tuberculosis Drug Facility established in 2001 pursuant
to the Amsterdam Declaration to Stop TB and the Global
Alliance for TB Drug Development.
(b) Policy.--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis, including the detection of at least 70 percent of
the cases of infectious tuberculosis, and the cure of at least
85 percent of the cases detected, not later than December 31,
2005, in those countries classified by the World Health
Organization as among the highest tuberculosis burden, and not
later than December 31, 2010, in all countries in which the
United States Agency for International Development has
established development programs.
(c) Authorization.--To carry out this section and
consistent with section 104(c), the President is authorized to
furnish assistance, on such terms and conditions as the
President may determine, for the prevention, treatment,
control, and elimination of tuberculosis.
(d) Coordination.--In carrying out this section, the
President shall coordinate with the World Health Organization,
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and
other organizations with respect to the development and
implementation of a comprehensive tuberculosis control program.
(e) Priority to DOTS Coverage.--In furnishing assistance
under subsection (c), the President shall give priority to
activities that increase Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis where needed using DOTS-Plus, including funding
for the Global Tuberculosis Drug Facility, the Stop
Tuberculosis Partnership, and the Global Alliance for TB Drug
Development. In order to meet the requirement of the preceding
sentence, the President should ensure that not less than 75
percent of the amount made available to carry out this section
for a fiscal year should be expended for antituberculosis
drugs, supplies, direct patient services, and training in
diagnosis and treatment for Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis using DOTS-Plus, including substantially increased
funding for the Global Tuberculosis Drug Facility.
(f) Definitions.--In this section:
(1) DOTS.--The term ``DOTS'' or ``Directly Observed
Treatment Short-course'' means the World Health
Organization-recommended strategy for treating
tuberculosis.
(2) DOTS-plus.--The term ``DOTS-Plus'' means a
comprehensive tuberculosis management strategy that is
built upon and works as a supplement to the standard
DOTS strategy, and which takes into account specific
issues (such as use of second line anti-tuberculosis
drugs) that need to be addressed in areas where there
is high prevalence of multi-drug resistant
tuberculosis.
(3) Global alliance for tuberculosis drug
development.--The term ``Global Alliance for
Tuberculosis Drug Development'' means the public-
private partnership that brings together leaders in
health, science, philanthropy, and private industry to
devise new approaches to tuberculosis and to ensure
that new medications are available and affordable in
high tuberculosis burden countries and other affected
countries.
(4) Global tuberculosis drug facility.--The term
``Global Tuberculosis Drug Facility (GDF)'' means the
new initiative of the Stop Tuberculosis Partnership to
increase access to high-quality tuberculosis drugs to
facilitate DOTS expansion.
(5) Stop tuberculosis partnership.--The term ``Stop
Tuberculosis Partnership'' means the partnership of the
World Health Organization, donors including the United
States, high tuberculosis burden countries,
multilateral agencies, and nongovernmental and
technical agencies committed to short- and long-term
measures required to control and eventually eliminate
tuberculosis as a public health problem in the world.
SEC. 104C. ASSISTANCE TO COMBAT MALARIA.
(a) Finding.--Congress finds that malaria kills more people
annually than any other communicable disease except
tuberculosis, that more than 90 percent of all malaria cases
are in sub-Saharan Africa, and that children and women are
particularly at risk. Congress recognizes that there are cost-
effective tools to decrease the spread of malaria and that
malaria is a curable disease if promptly diagnosed and
adequately treated.
(b) Policy.--It is a major objective of the foreign
assistance program of the United States to provide assistance
for the prevention, control, and cure of malaria.
(c) Authorization.--To carry out this section and
consistent with section 104(c), the President is authorized to
furnish assistance, on such terms and conditions as the
President may determine, for the prevention, treatment,
control, and elimination of malaria.
(d) Coordination.--In carrying out this section, the
President shall coordinate with the World Health Organization,
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the
Department of Health and Human Services (the Centers for
Disease Control and Prevention and the National Institutes of
Health), and other organizations with respect to the
development and implementation of a comprehensive malaria
control program.
* * * * * * *
Chapter 3--International Organizations and Programs
* * * * * * *
Sec. 302. Authorization.--(a) * * *
* * * * * * *
(k) In addition to amounts otherwise available under this
section, there is authorized to be appropriated to the
President [$50,000,000 for each of the fiscal years 2001 and
2002] such sums as may be necessary for each of the fiscal
years 2004 through 2008 to be available only for United States
contributions to the [Global Alliance for Vaccines and
Immunizations] Vaccine Fund.
(l) In addition to amounts otherwise available under this
section, there is authorized to be appropriated to the
President [$10,000,000 for each of the fiscal years 2001 and
2002] such sums as may be necessary for each of the fiscal
years 2004 through 2008 to be available only for United States
contributions to the International AIDS Vaccine Initiative.
(m) In addition to amounts otherwise available under this
section, there are authorized to be appropriated to the
President such sums as may be necessary for each of the fiscal
years 2004 through 2008 to be available for United States
contributions to malaria vaccine development programs,
including the Malaria Vaccine Initiative of the Program for
Appropriate Technologies in Health (PATH).
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