[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2845 Placed on Calendar Senate (PCS)]






                                                       Calendar No. 671
106th CONGRESS
  2d Session
                                S. 2845

                          [Report No. 106-336]

To authorize additional assistance to countries with large populations 
 having HIV/AIDS, to authorize assistance for tuberculosis prevention, 
      treatment, control, and elimination, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 11, 2000

   Mr. Helms, from the Committee on Foreign Relations, reported the 
    following original bill; which was read twice and placed on the 
                                calendar

_______________________________________________________________________

                                 A BILL


 
To authorize additional assistance to countries with large populations 
 having HIV/AIDS, to authorize assistance for tuberculosis prevention, 
      treatment, control, and elimination, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Global AIDS and Tuberculosis Relief 
Act of 2000''.

TITLE I--ASSISTANCE TO COUNTRIES WITH LARGE POPULATIONS HAVING HIV/AIDS

SEC. 101. SHORT TITLE.

    This title may be cited as the ``Global AIDS Research and Relief 
Act of 2000''.

SEC. 102. DEFINITIONS.

    In this title:
            (1) AIDS.--The term ``AIDS'' means the acquired immune 
        deficiency syndrome.
            (2) Association.--The term ``Association'' means the 
        International Development Association.
            (3) Bank.--The term ``Bank'' or ``World Bank'' means the 
        International Bank for Reconstruction and Development.
            (4) HIV.--The term ``HIV'' means the human immunodeficiency 
        virus.
            (5) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to 
        an individual--
                    (A) an individual having HIV but not AIDS; or
                    (B) an individual having HIV and AIDS.

SEC. 103. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) According to statistics of the World Bank, more than 90 
        percent of all adults and children with HIV/AIDS live in the 
        developing world--62 percent in sub-Saharan Africa, 24 percent 
        in Asia, and 6.9 percent in Latin America and the Caribbean.
            (2) According to UNAIDS, nearly 4,500,000 children under 15 
        years of age have been infected with HIV since the AIDS 
        epidemic began. More than 3,000,000 have already died of AIDS. 
        Children are becoming infected at about the rate of 1 child 
        every minute, and the overwhelming majority of these children 
        acquire the infection from their mothers.
            (3) The gap between rich and poor countries in terms of 
        transmission of HIV from mother to child has been increasing. 
        Moreover, AIDS threatens to reverse years of steady progress of 
        child survival in developing countries. UNAIDS believes that by 
        the year 2010, AIDS may have increased mortality of children 
        under 5 years of age by more than 100 percent in regions most 
        affected by the virus.
            (4) In Africa, the death toll from AIDS has reached 
        13,000,000, while 23,000,000 others live with the disease, and 
        more than 10,000,000 children have been infected or orphaned by 
        it.
            (5) The World Bank, declaring AIDS not just a public health 
        problem but the ``foremost and fastest-growing threat to 
        development'' in Africa, has launched a new strategy for HIV/
        AIDS in Africa, declaring it a top priority for the World Bank 
        on that continent.
            (6) AIDS, like all diseases, knows no boundaries, and there 
        is no certitude that the scale of the problem in one continent 
        can be contained within that region.
            (7) Accordingly, United States financial support for 
        medical research, education, and disease containment as a 
        global strategy has beneficial ramifications for millions of 
        Americans and their families who are affected by this disease, 
        and the entire population which is potentially susceptible.
            (8) The discovery of a relatively simple and cheap means of 
        interrupting the transmission of HIV from an infected mother to 
        the unborn child--namely with nevirapine (NVP), which costs 
        US$4 a tablet--has created a great opportunity for an 
        unprecedented partnership between the United States Government 
        and the governments of Asian, African and Latin American 
        countries to combat mother-to-child transmission (also known as 
        ``vertical transmission'') of HIV.
            (9) According to UNAIDS, this strategy will decrease the 
        proportion of orphans that are HIV-infected and decrease infant 
        and child mortality rates in these developing regions.
            (10) At current infection and growth rates for HIV/AIDS, 
        the National Intelligence Council estimates that the number of 
        AIDS orphans worldwide will increase dramatically, potentially 
        increasing threefold or more in the next 10 years, contributing 
        to economic decay, social fragmentation, and political 
        destabilization in already volatile and strained societies. 
        Children without care or hope are often drawn into 
        prostitution, crime, substance abuse, or child soldiery.
            (11) Donors must focus on adequate preparations for the 
        explosion in the number of orphans and the burden they will 
        place on families, communities, economies, and governments. 
        Support structures and incentives for families, communities, 
        and institutions which will provide care for children orphaned 
        by HIV/AIDS, or for the children who are themselves infected by 
        HIV/AIDS, will be essential.
            (12) A mother-to-child antiretroviral drug strategy can be 
        a force for social change, providing the opportunity and 
        impetus needed to tackle often long-standing problems of 
        inadequate services and the profound stigma associated with 
        HIV-infection and the AIDS disease. Strengthening the health 
        infrastructure to improve mother-and-child health, antenatal, 
        delivery and postnatal services, and couples counseling 
        generates enormous spillover effects toward combating the AIDS 
        epidemic in developing regions.
    (b) Purposes.--The purposes of this title are to--
            (1) prevent human suffering; and
            (2) ensure the viability of economic development, 
        stability, and national security in the developing world by 
        advancing research to--
                    (A) understand the causes associated with HIV/AIDS 
                in developing countries; and
                    (B) assist in the development of an AIDS vaccine.

SEC. 104. ADDITIONAL ASSISTANCE AUTHORITIES TO COMBAT HIV AND AIDS.

    (a) Assistance for Prevention of HIV/AIDS and Vertical 
Transmission.--Section 104(c) of the Foreign Assistance Act of 1961 (22 
U.S.C. 2151b(c)) is amended by adding at the end the following new 
paragraphs:
    ``(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, 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 in 
        scale 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 
providing--
            ``(i) primary prevention and education;
            ``(ii) voluntary testing and counseling;
            ``(iii) medications to prevent the transmission of HIV and 
        AIDS 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 fiscal year 2001 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 subparagraph may be 
made available notwithstanding any other provision of law.
    ``(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.''.
    (b) Training and Training Facilities in Sub-Saharan Africa.--
Section 496(i)(2) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2293(i)(2)) is amended by adding at the end the following new sentence: 
``In addition, providing training and training facilities, in sub-
Saharan Africa, for doctors and other health care providers, 
notwithstanding any provision of law that restricts assistance to 
foreign countries.''.

SEC. 105. VOLUNTARY CONTRIBUTION TO GLOBAL ALLIANCE FOR VACCINES AND 
              IMMUNIZATIONS AND INTERNATIONAL AIDS VACCINE INITIATIVE.

    (a) Authorization of Appropriations.--Section 302 of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2222) is amended by adding at the end 
the following new subsections:
    ``(j) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the President 
$50,000,000 for fiscal year 2001 to be available only for United States 
contributions to the Global Alliance for Vaccines and Immunizations.
    ``(k) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the President 
$10,000,000 for fiscal year 2001 to be available only for United States 
contributions to the International AIDS Vaccine Initiative.''.
    (b) Report.--At the close of fiscal year 2001, the President shall 
submit a report to the appropriate congressional committees on the 
effectiveness of the Global Alliance for Vaccines and Immunizations and 
the International AIDS Vaccine Initiative during that fiscal year in 
meeting the goals of--
            (1) improving access to sustainable immunization services;
            (2) expanding the use of all existing, safe, and cost-
        effective vaccines where they address a public health problem;
            (3) accelerating the development and introduction of new 
        vaccines and technologies;
            (4) accelerating research and development efforts for 
        vaccines needed primarily in developing countries; and
            (5) making immunization coverage a centerpiece in 
        international development efforts.
    (c) Appropriate Congressional Committees Defined.--In subsection 
(b), 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.

SEC. 106. MULTILATERAL LIFESAVING VACCINE PURCHASE FUND.

    (a) Negotiations.--The President should enter into negotiations 
with officials of foreign governments and other interested parties for 
the establishment of an international vaccine purchase fund that 
would--
            (1) accept contributions from governments of developed 
        countries;
            (2) use such contributions to purchase and distribute in 
        developing countries vaccines for--
                    (A) malaria,
                    (B) tuberculosis,
                    (C) HIV, and
                    (D) any infectious disease (of a single etiology) 
                which causes the deaths of over 1,000,000 people 
                worldwide each year; and
            (3) be a significant market incentive for private sector 
        vaccine research.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, and annually thereafter, the President shall submit a report 
to Congress on--
            (1) the status of negotiations under subsection (a); and
            (2) if such fund is established, any recommendations for 
        further action.

SEC. 107. WORLD BANK TRUST FUND FOR AIDS PREVENTION AND ERADICATION.

    (a) Negotiations for the Creation of a World Bank Trust Fund To 
Assist in Aids Prevention and Eradication.--The Secretary of the 
Treasury shall enter into negotiations with the World Bank or the 
Association, with the member nations of such institutions, and with 
other interested parties for the creation of a trust fund, to be 
administered by the Bank or the Association, as appropriate, which 
would--
            (1) accept contributions from governments, the private 
        sector, and nongovernmental entities of all kinds; and
            (2) use such contributions to address the AIDS epidemic in 
        countries eligible to borrow from the Association.
    (b) Authorization of Appropriations.--In addition to any other 
funds authorized to be appropriated for multilateral or bilateral 
programs related to AIDS, there is authorized to be appropriated to the 
President $100,000,000 for fiscal year 2001 for payment to the trust 
fund established as a result of the negotiations entered into pursuant 
to subsection (a).
    (c) Report to Congress.--Beginning 1 year after the date of 
enactment of this Act, and annually thereafter, the Secretary of the 
Treasury shall submit to the Committees on Banking and Financial 
Services and on International Relations of the House of Representatives 
and the Committees on Banking, Housing, and Urban Affairs and on 
Foreign Relations of the Senate a written report on the trust fund 
established pursuant to subsection (a), the goals of the trust fund, 
the programs, projects, and activities, including any vaccination 
approaches, supported by the trust fund, and the effectiveness of such 
programs, projects, and activities in reducing the worldwide spread of 
AIDS.

SEC. 108. NEGOTIATIONS FOR THE CREATION OF A WORLD BANK TRUST FUND FOR 
              EDUCATION OF ORPHANS IN SUB-SAHARAN AFRICA.

    (a) Negotiations.--The Secretary of the Treasury shall enter into 
negotiations with the World Bank or the Association, with member 
nations of such institutions, and with other interested parties, for 
the creation of a trust fund which could accept contributions from 
governments, the private sector, and nongovernmental entities of all 
kinds, and use such contributions to provide support for or the 
establishment of programs which provide primary and secondary education 
for orphans in sub-Saharan
Africa.
    (b) Authorization of Appropriations.--In addition to funds 
otherwise available for the purposes of subsection (a), there is 
authorized to be appropriated to the President $50,000,000 for the 
fiscal year 2001 for payment to the trust fund established as a result 
of the negotiations entered into pursuant to subsection (a).

SEC. 109. COORDINATED DONOR STRATEGY FOR SUPPORT AND EDUCATION OF 
              ORPHANS IN SUB-SAHARAN AFRICA.

    Chapter 1 of part I of the Foreign Assistance Act of 1961 (22 
U.S.C. 2151 et seq.) is amended by adding at the end the following new 
section:

``SEC. 131. COORDINATED DONOR STRATEGY FOR SUPPORT AND EDUCATION OF 
              ORPHANS IN SUB-SAHARAN AFRICA.

    ``(a) Statement of Policy.--It is in the national interest of the 
United States to assist in mitigating the burden that will be placed on 
sub-Saharan African social, economic, and political institutions as 
these institutions struggle with the consequences of a dramatically 
increasing AIDS orphan population, many of whom are themselves infected 
by HIV/AIDS. Effectively addressing that burden and its consequences in 
sub-Saharan Africa will require a coordinated multidonor strategy.
    ``(b) Development of Strategy.--The President shall coordinate the 
development of a multidonor strategy to provide for the support and 
education of AIDS orphans and the families, communities, and 
institutions most affected by the HIV/AIDS epidemic in sub-Saharan 
Africa.
    ``(c) Definition.--In this section, the term `HIV/AIDS' means, with 
respect to an individual, an individual who is infected with--
            ``(1) the human immunodeficiency virus (HIV); or
            ``(2) HIV and the acquired immune deficiency virus 
        (AIDS).''.

SEC. 110. AFRICAN CRISIS RESPONSE INITIATIVE AND HIV/AIDS TRAINING.

    (a) Findings.--Congress finds that--
            (1) the spread of AIDS constitutes a threat to security in 
        Africa;
            (2) civil unrest and war may contribute to the spread of 
        the disease to different parts of the continent;
            (3) the percentage of soldiers in African militaries who 
        are infected with HIV/AIDS is unknown, but estimates range in 
        some countries as high as 40 percent; and
            (4) it is in the interests of the United States to assist 
        the countries of Africa in combating the spread of HIV/AIDS.
    (b) Education on the Prevention of the Spread of AIDS.--In 
undertaking education and training programs for military establishments 
of in African countries, the United States shall ensure that classroom 
training under the African Crisis Response Initiative includes 
military-based education on the prevention of the spread of AIDS.

              TITLE II--INTERNATIONAL TUBERCULOSIS CONTROL

SEC. 201. SHORT TITLE.

    This title may be cited as the ``International Tuberculosis Control 
Act of 2000''.

SEC. 202. FINDINGS.

    Congress makes the following findings:
            (1) Since the development of antibiotics in the 1950s, 
        tuberculosis has been largely controlled in the United States 
        and the Western World.
            (2) Due to societal factors, including growing urban decay, 
        inadequate health care systems, persistent poverty, 
        overcrowding, and malnutrition, as well as medical factors, 
        including the HIV/AIDS epidemic and the emergence of multi-drug 
        resistant strains of tuberculosis, tuberculosis has again 
        become a leading and growing cause of adult deaths in the 
        developing world.
            (3) According to the World Health Organization--
                    (A) in 1998, about 1,860,000 people worldwide died 
                of tuberculosis-related illnesses;
                    (B) one-third of the world's total population is 
                infected with tuberculosis; and
                    (C) tuberculosis is the world's leading killer of 
                women between 15 and 44 years old and is a leading 
                cause of children becoming orphans.
            (4) Because of the ease of transmission of tuberculosis, 
        its international persistence and growth pose a direct public 
        health threat to those nations that had previously largely 
        controlled the disease. This is complicated in the United 
        States by the growth of the homeless population, the rate of 
        incarceration, international travel, immigration, and HIV/AIDS.
            (5) With nearly 40 percent of the tuberculosis cases in the 
        United States attributable to foreign-born persons, 
        tuberculosis will never be controlled in the United States 
        until it is controlled abroad.
            (6) The means exist to control tuberculosis through 
        screening, diagnosis, treatment, patient compliance, 
        monitoring, and ongoing review of outcomes.
            (7) Efforts to control tuberculosis are complicated by 
        several barriers, including--
                    (A) the labor intensive and lengthy process 
                involved in screening, detecting, and treating the 
                disease;
                    (B) a lack of funding, trained personnel, and 
                medicine in virtually every nation with a high rate of 
                the disease;
                    (C) the unique circumstances in each country, which 
                requires the development and implementation of country-
                specific programs; and
                    (D) the risk of having a bad tuberculosis program, 
                which is worse than having no tuberculosis program 
                because it would significantly increase the risk of the 
                development of more widespread drug-resistant strains 
                of the disease.
            (8) Eliminating the barriers to the international control 
        of tuberculosis through a well-structured, comprehensive, and 
        coordinated worldwide effort would be a significant step in 
        dealing with the increasing public health problem posed by the 
        disease.

SEC. 203. ASSISTANCE FOR TUBERCULOSIS PREVENTION, TREATMENT, CONTROL, 
              AND ELIMINATION.

    Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b(c)), as amended by section 103(a) of this Act, is further amended 
by adding at the end the following:
    ``(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 fiscal year 2001 to be used to carry out this 
paragraph. Funds appropriated under this subparagraph are authorized to 
remain available until expended.''.
                                                       Calendar No. 671

106th CONGRESS

  2d Session

                               H. R. 2845

                          [Report No. 106-336]

_______________________________________________________________________

                                 A BILL

To authorize additional assistance to countries with large populations 
 having HIV/AIDS, to authorize assistance for tuberculosis prevention, 
      treatment, control, and elimination, and for other purposes.

_______________________________________________________________________

                             July 11, 2000

                 Read twice and placed on the calendar