[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2069 Engrossed Amendment Senate (EAS)]
In the Senate of the United States,
July 12 (legislative day, July 10), 2002.
Resolved, That the bill from the House of Representatives (H.R.
2069) entitled ``An Act to amend the Foreign Assistance Act of 1961 and
the Global AIDS and Tuberculosis Relief Act of 2000 to authorize
assistance to prevent, treat, and monitor HIV/AIDS in sub-Saharan
African and other developing countries.'', do pass with the following
AMENDMENTS:
Strike out all after the enacting clause and insert:
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 2002''.
(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.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. Comprehensive plan to empower women to prevent the spread of
HIV/AIDS.
Sec. 103. HIV/AIDS Response Coordinator.
Sec. 104. Report on reversing the exodus of critical talent.
TITLE II--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--MULTILATERAL EFFORTS
Sec. 301. Improvement of the Enhanced HIPC Initiative.
Sec. 302. Reports on implementation of improvements to the Enhanced
HIPC Initiative.
TITLE IV--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 401. Assistance to combat HIV/AIDS.
Sec. 402. Assistance to combat tuberculosis.
Sec. 403. Assistance to combat malaria.
Sec. 404. Pilot program for the placement of health care professionals
in overseas areas severely affected by HIV/
AIDS, tuberculosis, and malaria.
Sec. 405. Department of Defense HIV/AIDS prevention assistance program.
Sec. 406. Report on treatment activities by relevant Executive branch
agencies.
Subtitle B--Assistance for Children and Families
Sec. 411. Findings.
Sec. 412. Policy and requirements.
Sec. 413. Annual reports on prevention of mother-to-child transmission
of the HIV infection.
Sec. 414. Pilot program of assistance for children and families
affected by HIV/AIDS.
TITLE V--BUSINESS PRINCIPLES
Sec. 501. Principles for United States firms operating in countries
affected by the HIV/AIDS pandemic.
TITLE VI--ADDITIONAL AUTHORITIES
Sec. 601. Authority of the Department of Health and Human Services.
Sec. 602. Microbicide research at the National Institutes of Health.
Sec. 603. Authority of the Department of Labor.
Sec. 604. Authority for international programs.
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 region,
sub-Saharan Africa, 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 60,000,000 people worldwide have been
infected with HIV since the epidemic began; more than
22,000,000 of these have lost their lives to the disease; and
more than 13,000,000 children have been orphaned by the
disease. HIV/AIDS is the fourth-highest cause of death in the
world.
(3) At the end of 2001, an estimated 40,000,000 people were
infected with HIV or living with AIDS. Of these, more than
2,700,000 were children under the age of fifteen and more than
17,600,000 were women. Women are four times more vulnerable to
infection than are men and are becoming infected at
increasingly high rates because in many societies women lack
control over sexual encounters and cannot insist on the use of
protective measures. Women and children who are refugees or are
internally displaced persons are especially vulnerable to
sexual violence, thereby increasing the possibility of HIV
infection.
(4) As the leading cause of death in sub-Saharan Africa,
AIDS has killed more than 17,000,000 people (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 1,800,000 people in Latin America and the
Caribbean and another 7,100,000 people 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. 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; and
(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.
(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 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) 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.
(13) 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.
(14) Although HIV/AIDS is first and foremost a health
problem, successful strategies to stem the spread of the
pandemic will require not only 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 but also measures to address the
social and behavioral causes of the problem and its impact on
families, communities, and societal sectors.
(15) 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.
(16) 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.
(17) 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) encouraging governments and community-based
organizations to adopt policies that treat HIV/AIDS as
a multisectoral problem affecting not only health but
other areas such as education, the economy, the family
and society, and assisting them to develop and
implement programs corresponding to these needs; and
(D) 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.
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) Designated congressional committees.--The term
``designated congressional committees'' means the Committee on
Foreign Relations and the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on
International Relations and the Committee on Energy and
Commerce of the House of Representatives.
(4) Global fund.--The term ``Global Fund'' means the
public-private partnership known as the Global Fund to Fight
AIDS, Tuberculosis and Malaria that was established upon the
call of the United Nations Secretary General in April 2001.
(5) HIV.--The term ``HIV'' means the human immunodeficiency
virus, the pathogen that causes AIDS.
(6) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to
an individual, an individual who is infected with HIV or living
with AIDS.
(7) 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
Centers for Disease Control and Prevention, the Health
Resources and Services Administration, the National Institutes
of Health, the Agency for Health Care Research and Quality, and
the Food and Drug Administration), the Department of Labor, the
Department of Commerce, the Department of the Treasury, and the
Department of Defense.
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.
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 promotes
the goals and objectives of the Declaration of Commitment on HIV/AIDS,
adopted by the United Nations General Assembly at its Special Session
on HIV/AIDS in June 2001, and strengthens the capacity of the United
States to be an effective leader of the international campaign against
HIV/AIDS. Such strategy 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 women, young people, and
children;
(2) assign priorities for relevant Executive branch
agencies;
(3) improve coordination among relevant Executive branch
agencies and foreign governments and international
organizations;
(4) project general levels of resources needed to achieve
the stated objectives;
(5) expand public-private partnerships and the leveraging
of resources; and
(6) 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 180 days after the date of
enactment of this Act, the President shall submit to designated
congressional committees a report setting forth the strategy
described in subsection (a).
(2) Report elements.--The report required by paragraph (1)
shall include a discussion of 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
and microbicides when available; research, including
incentives for vaccine development and new protocols;
and training of health care workers, and the
development of health care infrastructure and delivery
systems.
(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.
(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.
(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 relevant Executive
agencies.
(L) A description of the mechanisms to be
established for monitoring and evaluating programs 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 manner in which the United
States strategy for combating HIV/AIDS relates to and
promotes the goals and objectives of the United Nations
General Assembly's Declaration of Commitment on HIV/
AIDS.
(O) 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.
(P) A description of the manner in which the United
States strategy for combating HIV/AIDS relates to and
enhances other United States assistance strategies in
developing countries.
SEC. 102. COMPREHENSIVE PLAN TO EMPOWER WOMEN TO PREVENT THE SPREAD OF
HIV/AIDS.
(a) Statement of Policy.--It is in the national interest of the
United States--
(1) to assist in empowering women socially, economically,
and intellectually to prevent coercive practices which
contribute to the spread of HIV/AIDS;
(2) to ensure that there are affordable effective female
controlled preventative technologies widely available;
(3) to assist in providing adequate pre- and post-natal
care to women infected with HIV or living with AIDS to prevent
an increase in the number of AIDS orphans; and
(4) to educate communities in order to lessen the stigma
facing women who are infected with HIV or living with AIDS.
(b) Development of Plan.--The United States Agency for
International Development, working in conjunction with other relevant
Executive branch agencies, shall develop a comprehensive plan to
empower women to protect themselves against the spread of HIV/AIDS. The
plan shall include--
(1) immediately providing women greatly increased access to
and program support for currently available prevention
technologies for women and microbicides when they become
available;
(2) providing funding for research to develop safe,
effective, usable microbicides, including support for--
(A) development and preclinical evaluation of
topical microbicides;
(B) the conduct of clinical studies of candidate
microbicides to assess safety, acceptability, and
effectiveness in reducing the HIV infection and other
sexually transmitted infections;
(C) behavioral and social science research relevant
to microbicide development, testing, acceptability, and
use; and
(D) introductory studies of safe and effective
microbicides in developing countries;
(3) increasing women's access to microfinance programs;
(4) comprehensive education for women and girls including
health education that emphasizes skills building on negotiation
and the prevention of sexually transmitted infections and other
related reproductive health risks and strategies that emphasize
the delay of sexual debut;
(5) community-based strategies to combat gender-based
violence and sexual coercion of women and minors;
(6) expansion of peer education strategies for men which
emphasize responsible sexual behavior and consultation with
their wives and partners in making decisions about sex and
reproduction;
(7) resources for households headed by females caring for
AIDS orphans;
(8) followup monitoring of and care and support for post-
natal women living with HIV or at high risk of infection; and
(9) targeted plans to reduce the vulnerability of HIV/AIDS
for women, young people, and children who are refugees or
internally displaced persons.
(c) Requirement.--The plan shall specify, for the assistance to
achieve each of the objectives set forth in paragraphs (1) through (9)
of subsection (b), the section of the Foreign Assistance Act of 1961 or
other law that authorizes such assistance.
(d) Staffing.--The Administrator of the United States Agency for
International Development shall ensure that the Agency dedicates a
sufficient number of employees to implementing the plan described in
subsection (b).
(e) Report.--Not later than 270 days after the date of enactment of
this Act and every year for the next 3 years thereafter, the
Administrator of the United States Agency for International Development
shall submit to the appropriate congressional committees a report on
the plan being implemented by the United States Agency for
International Development on empowering women in order to prevent the
spread of HIV/AIDS. The report shall include a description of--
(1) the programs being carried out that are specifically
targeted at women and girls to educate them about the spread of
HIV/AIDS and the use and availability of currently available
prevention technologies for women, together with the number of
women and girls reached through these programs;
(2) the steps taken to increase the availability of such
technologies; and
(3) the progress on developing a safe, effective, user-
friendly microbicide.
SEC. 103. 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 subsections (f) and (g) as subsections
(g) and (h), respectively; and
(2) by adding after subsection (e) the following:
``(f) HIV/AIDS Response Coordinator.--
``(1) In general.--There shall be within the Department 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 of State
and shall have the rank and status of ambassador.
``(2) Duties.--
``(A) In general.--The Coordinator shall have
primary responsibility for the oversight and
coordination of all activities of the United States
Government to combat the international HIV/AIDS
pandemic, including all programs, projects, and
activities of the United States Government under titles
I through V of the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2002 or any
amendment made by those titles.
``(B) Specific duties.--The duties of the
Coordinator shall specifically include the following:
``(i) Ensuring program and policy
coordination among the relevant Executive
branch agencies.
``(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) Enhancing onsite coordination.
``(v) Pursuing coordination with other
countries and international organizations.
``(vi) Resolving policy, program, and
funding disputes among the relevant Executive
branch agencies.''.
(b) First Coordinator.--The President may designate the incumbent
Special Representative of the Secretary of State for HIV/AIDS as of the
date of enactment of this Act as the first Coordinator of United States
Government Activities to Combat HIV/AIDS Globally.
SEC. 104. REPORT ON REVERSING THE EXODUS OF CRITICAL TALENT.
(a) In General.--Not later than one year after the date of
enactment of this Act, the President shall submit a report to
designated congressional committees analyzing 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.
(b) Elements of the Report.--The report shall include--
(1) an analysis of the causes for the exodus of such
personnel, the present and projected trend lines, and the
impact on the stability of health infrastructures; and
(2) a description 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.
TITLE II--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 to Fight
AIDS, Tuberculosis and Malaria.
(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 one 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, contributions received (including donations from
the private sector), projects funded, 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 funds
otherwise available for such purpose, there are authorized to
be appropriated to the President $1,000,000,000 for the fiscal
year 2003 and $1,200,000,000 for the fiscal year 2004 for
contributions to the Global Fund.
(2) Availability of funds.--Amounts appropriated pursuant
to 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 year 2002 under paragraph (1).
(4) Statutory construction.--Nothing in this Act may be
construed to substitute for, or reduce resources provided under
any other law for bilateral and multilateral HIV/AIDS,
tuberculosis, and malaria programs.
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'' and all that follows
through ``2002'' and inserting ``$60,000,000 for the fiscal
year 2003 and $70,000,000 for the fiscal year 2004''; 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'' and all that follows through ``2002'' and
inserting ``$12,000,000 for the fiscal year 2003 and $15,000,000 for
the fiscal year 2004''.
(c) Malaria Vaccine Initiative of the Program for Appropriate
Technologies in Health (PATH).--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
$5,000,000 for the fiscal year 2003 and $6,000,000 for the fiscal year
2004 to be available only for United States contributions to the
Malaria Vaccine Initiative of the Program for Appropriate Technologies
in Health (PATH).''.
(d) Effective Date.--The amendments made by this section shall take
effect October 1, 2002.
TITLE III--MULTILATERAL EFFORTS
SEC. 301. IMPROVEMENT OF THE ENHANCED HIPC INITIATIVE.
(a) Amendment of the International Financial Institutions Act.--
Title XVI of the International Financial Institutions Act (22 U.S.C.
262p-262p-5) is amended by adding at the end the following new section:
``SEC. 1625. IMPROVEMENT OF THE ENHANCED HIPC INITIATIVE.
``(a) Authority.--In order to ensure that the Enhanced HIPC
Initiative achieves the objective of substantially increasing resources
available for human development and poverty reduction in heavily
indebted poor countries, the Secretary of the Treasury is authorized
and requested to conclude as soon as possible an agreement within the
Paris Club of Official Creditors, as well as the International Bank for
Reconstruction and Development (World Bank), the International Monetary
Fund, and other appropriate multilateral development institutions to
accomplish the modifications in the Enhanced HIPC Initiative described
in subsection (b).
``(b) Agreement.--The agreement referred to in subsection (a) is an
agreement that provides the following:
``(1) Level of exports and revenues.--
``(A) In general.--The amount of debt stock
reduction approved for a country eligible for debt
relief under the Enhanced HIPC Initiative shall be
sufficient to reduce, for at least each of the first 3
years after date of enactment of this section or the
Decision Point, whichever is later--
``(i) the net present value of the
outstanding public and publicly guaranteed debt
of the country to not more than 150 percent of
the annual value of exports of the country for
the year preceding the Decision Point; and
``(ii) the annual payments due on such
public and publicly guaranteed debt to not more
than 10 percent or, in the case of a country
suffering a public health crisis (as defined in
subsection (c)), not more than 5 percent, of
the amount of the annual current revenues
received by the country from internal sources.
``(B) Limitation.--In financing the objectives of
the Enhanced HIPC Initiative, an international
financial institution shall give priority to using its
own resources.
``(2) Relation to poverty and the environment.--The debt
cancellation under the Enhanced HIPC Initiative shall not be
conditioned on any agreement by an impoverished country to
implement or comply with policies that deepen poverty or
degrade the environment, including any policy that--
``(A) implements or extends user fees on primary
education or primary health care, including prevention
and treatment efforts for HIV/AIDS, tuberculosis,
malaria, and infant, child, and maternal well-being;
``(B) provides for increased cost recovery from
poor people to finance basic public services such as
education, health care, clean water, or sanitation;
``(C) reduces the country's minimum wage to a level
of less than $2 per day or undermines workers' ability
to exercise effectively their internationally
recognized worker rights, as defined under section
526(e) of the Foreign Operations, Export Financing and
Related Programs Appropriations Act, 1995 (22 U.S.C.
262p-4p); or
``(D) promotes unsustainable extraction of
resources or results in reduced budget support for
environmental programs.
``(3) Foreign government policies.--A country shall not be
eligible for cancellation of debt under the Enhanced HIPC
Initiative if the government of the country--
``(A) has repeatedly provided support for acts of
international terrorism, as determined by the Secretary
of State under section 6(j)(1) of the Export
Administration Act of 1979 (50 U.S.C. App. 2405(j)(1))
or section 620A(a) of the Foreign Assistance Act of
1961 (22 U.S.C. 2371(a)); and
``(B) engages in a consistent pattern of gross
violations of internationally recognized human rights
(including its military or other security forces).
``(4) Programs to combat hiv/aids, tuberculosis, and
malaria.--A country that is otherwise eligible to receive
cancellation of debt under the Enhanced HIPC Initiative may
receive such cancellation only if the country has agreed--
``(A) in the case of a country suffering a public
health crisis (as defined in subsection (c)), to ensure
that, where practicable, 10 to 20 percent of the
financial benefits of debt cancellation are applied to
programs to combat HIV/AIDS, tuberculosis, and malaria
in that country;
``(B) to ensure that the financial benefits of debt
cancellation are applied to programs to combat poverty
(in particular through concrete measures to improve
basic services in education, nutrition, and health),
and to redress environmental degradation;
``(C) to ensure that the financial benefits of debt
cancellation are in addition to the government's total
spending on programs to combat HIV/AIDS and poverty
reduction for the previous year or the average total of
such expenditures for the previous 3 years, whichever
is greater;
``(D) to implement transparent and participatory
policymaking and budget procedures, good governance,
and effective anticorruption measures; and
``(E) to broaden public participation and popular
understanding of the principles and goals of poverty
reduction.
``(c) Definitions.--In this section:
``(1) Country suffering a public health crisis.--The term
`country suffering a public health crisis' means--
``(A) a country in which HIV/AIDS, tuberculosis, or
malaria is causing significant family, community, or
societal disruption; and
``(B) a country that has rapidly rising rates of
incidence of at least one of such diseases that is
likely to lead to conditions described in subparagraph
(A).
``(2) Decision point.--The term `Decision Point' means the
date on which the executive boards of the World Bank and the
International Monetary Fund review the debt sustainability
analysis for a country and determine that the country is
eligible for debt relief under the Enhanced HIPC Initiative.
``(3) Enhanced hipc initiative.--The term `Enhanced HIPC
Initiative' means the multilateral debt initiative for heavily
indebted poor countries presented in the Report of G-7 Finance
Ministers on the Cologne Debt Initiative to the Cologne
Economic Summit, Cologne, June 18-20, 1999.''.
(b) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated to
the President such sums as may be necessary for the fiscal year
2003 and each fiscal year thereafter to carry out section 1625
of the International Financial Institutions Act, as added by
subsection (a).
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
SEC. 302. REPORTS ON IMPLEMENTATION OF IMPROVEMENTS TO THE ENHANCED
HIPC INITIATIVE.
(a) Initial Report.--Not later than 180 days after the date of
enactment of this Act, the Secretary of the Treasury shall submit to
the appropriate congressional committees a report describing the
progress made in concluding an agreement under section 1625(b) of the
International Financial Institutions Act (as added by section 301 of
this Act) to modify the Enhanced HIPC Initiative.
(b) Subsequent Report.--Not later than one year after the date of
submission of the initial report under subsection (a), the Secretary of
the Treasury shall submit to the appropriate congressional committees a
report describing the actions taken by countries to satisfy the
conditions set forth in the agreement referred to in subsection (a).
TITLE IV--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
SEC. 401. 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 and other developing
countries is a major global health, national security, 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 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 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, to prevent,
treat, and monitor HIV/AIDS, and carry out related activities,
in countries in sub-Saharan Africa 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 in
countries in sub-Saharan Africa 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) education, voluntary testing, and counseling
(including the incorporation of confidentiality
protections with respect to such testing and
counseling), including integration of such programs
into health programs and the inclusion in counseling
programs of information on methods of preventing
transmission of the HIV infection, including delaying
sexual debut, abstinence, reduction of casual sexual
partnering, and, where appropriate, the use of condoms;
``(B) 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;
``(C) assistance to ensure a safe blood supply, to
provide--
``(i) post-exposure prophylaxis to victims
of rape and sexual assault and in cases of
occupational exposure of health care workers;
and
``(ii) necessary commodities, including
test kits, pharmaceuticals, and condoms;
``(D) assistance through nongovernmental
organizations, including faith-based organizations,
particularly those organizations that utilize both
professionals and volunteers with appropriate skills
and experience, to establish and implement culturally
appropriate HIV/AIDS education and prevention programs;
``(E) research on microbicides which prevent the
spread of HIV/AIDS; and
``(F) bulk purchases of available prevention
technologies for women and for appropriate program
support for the introduction and distribution of these
technologies, as well as education and training on the
use of the technologies.
``(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) Monitoring.--The monitoring of programs, projects,
and activities carried out pursuant to paragraphs (1) and (2),
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; and
``(B) appropriate evaluation and surveillance
activities.
``(4) 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.
``(5) 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;
``(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; and
``(D) the development and expansion of financially
sustainable microfinance institutions and other income
generation programs that strengthen the economic and
social viability of communities afflicted by the HIV/
AIDS pandemic, including support for the savings and
productive capacity of affected poor households caring
for orphans.
``(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 to implement
the policies set forth in this section;
``(B) a description of the programs established
pursuant to this section; and
``(C) a detailed assessment of the impact of
programs established pursuant to this section,
including--
``(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 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.
``(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 this
section. 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.''.
(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
$800,000,000 for the fiscal year 2003 and $900,000,000 for the
fiscal year 2004 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.--
(A) Research on microbicides.--Of the amounts
authorized to be appropriated by paragraph (1) for the
fiscal years 2003 and 2004, $20,000,000 for the fiscal
year 2003 and $24,000,000 for the fiscal year 2004 are
authorized to be available to carry out section
104A(d)(1)(D) of the Foreign Assistance Act of 1961 (as
added by subsection (a)), relating to research on
microbicides which prevent the spread of HIV/AIDS.
(B) Pharmaceuticals.--Of the amounts authorized to
be appropriated by paragraph (1) for the fiscal years
2003 and 2004, $100,000,000 for the fiscal year 2003
and $120,000,000 for the fiscal year 2004 are
authorized to be available 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.
(4) Transfer of prior year funds.--Unobligated balances of
funds made available for the fiscal year 2001 or the fiscal
year 2002 under section 104(c)(6) of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151b(c)(6) (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 year 2003 under paragraph (1).
SEC. 402. 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 401 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
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.
``(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, the Department of Health and
Human Services (including 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 tuberculosis control program.
``(e) Annual Report.--Not later than January 31 of each year, the
President shall submit a report to the Committee on Foreign Relations
of the Senate and the Committee on International Relations of the House
of Representatives specifying the increases in the number of people
treated and the increases in number of tuberculosis patients cured
through each program, project, or activity receiving United States
foreign assistance for tuberculosis control purposes.
``(f) Priority to DOTS Coverage.--In furnishing assistance under
subsection (c), the President shall give priority to activities that
increase directly observed treatment shortcourse (DOTS) coverage,
including funding for the Global Tuberculosis Drug Facility and the
Stop Tuberculosis Partnership.
``(g) 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) 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.
``(3) 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
$150,000,000 for the fiscal year 2003 and $200,000,000 for the
fiscal year 2004 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 paragraph (1) are authorized to remain available until
expended.
(3) Transfer of prior year funds.--Unobligated balances of
funds made available for the fiscal year 2001 or the fiscal
year 2002 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 year 2003 under paragraph (1).
SEC. 403. 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 401 and 402 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.
``(e) Annual Report.--Not later than January 31 of each year, the
President shall submit a report to the Committee on Foreign Relations
of the Senate and the Committee on International Relations of the House
of Representatives specifying the increases in the number of people
treated and the increases in number of malaria patients cured through
each program, project, or activity receiving United States foreign
assistance for malaria control purposes.''.
(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
$70,000,000 for the fiscal year 2003 and $80,000,000 for the
fiscal year 2004 to carry out section 104C 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) Transfer of prior year funds.--Unobligated balances of
funds made available for the fiscal year 2001 or the fiscal
year 2002 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 year 2003 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 401 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 such other
sections of this Act, may be made available in accordance with
this subsection and such other provisions of this Act
notwithstanding any other provision of law.''.
SEC. 404. 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 shall establish a program to
demonstrate the feasibility of facilitating the service of American
health care professionals in 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 two 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, nurse practitioner, pharmacist, or other
individual determined to be appropriate by the President; or
(2) 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.--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.
(f) Extended Period of Service.--The President may extend the
period of service of a participant by an additional period of 6 to 12
months.
(g) 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.
(h) Report.--Not later than 18 months after the date of enactment
of this Act, the President shall submit a report to the designated
congressional committees 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.
(i) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available
for such purpose, there is authorized to be appropriated to the
President $10,000,000 for the fiscal year 2003 and $20,000,000
for the fiscal year 2004 to carry out the program.
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
SEC. 405. DEPARTMENT OF DEFENSE HIV/AIDS PREVENTION ASSISTANCE PROGRAM.
(a) Expansion of Program.--The Secretary of Defense is authorized
to expand, in accordance with this section, the Department of Defense
program of HIV/AIDS prevention educational activities undertaken in
connection with the conduct of United States military training,
exercises, and humanitarian assistance in sub-Saharan African
countries.
(b) Eligible Countries.--The Secretary of Defense may carry out the
program in all eligible countries. A country shall be eligible for
activities under the program if the country--
(1) is a country suffering a public health crisis (as
defined in subsection (e)); and
(2) participates in the military-to-military contacts
program of the Department of Defense.
(c) Program Activities.--The Secretary of Defense shall provide for
the activities under the program--
(1) to focus, to the extent possible, on military units
that participate in peace keeping operations; and
(2) to include HIV/AIDS-related voluntary counseling and
testing and HIV/AIDS-related surveillance.
(d) Authorization of Appropriations.--
(1) In general.--Of the amount authorized to be
appropriated to the Department of Defense for operation and
maintenance of the Defense Health Program for the fiscal year
2003, $30,000,000 may be available for carrying out the program
described in subsection (a) as expanded pursuant to this
section.
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
(e) Country Suffering a Public Health Crisis Defined.--In this
section, the term ``country suffering a public health crisis'' means a
country that has rapidly rising rates of incidence of HIV/AIDS or in
which HIV/AIDS is causing significant family, community, or societal
disruption.
SEC. 406. 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 designated
congressional committees a report on the programs and activities of the
United States Agency for International Development, the Centers for
Disease Control and Prevention, and other 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; and
(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;
(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. 411. 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 that
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, 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. 412. 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 set by the
United Nations General Assembly Declaration of Commitment on
HIV/AIDS 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. 413. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
OF THE HIV INFECTION.
(a) In General.--Beginning 270 days after the date of enactment of
this Act, and annually thereafter for the ensuing eight years, the
President shall submit to designated 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 adopted the targets set by the United
Nations General Assembly at the Special Session for HIV/AIDS,
held June 25 to 27, 2001, with respect to mother-to-child
transmission of the HIV infection;
(2) a description of efforts made by the United States
Agency for International Development and the Centers for
Disease Control and Prevention 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;
(3) a statement of the percentage of funds expended out of
the budget of each relevant Executive branch agency for
activities to prevent mother-to-child transmission of the HIV
infection and, in the case of United States Agency for
International Development, whether or not its expenditures on
bilateral assistance have met the 8.3 percent target in section
104(c)(6)(D) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)(6)(D)), as in effect immediately before the date of
enactment of this Act, with respect to strategies to prevent
mother-to-child transmission of the HIV infection;
(4) a discussion of the extent to which the programs of the
relevant Executive branch agencies are meeting targets set by
the United Nations General Assembly; and
(5) a description of efforts made by the Centers for
Disease Control and Prevention and the United States Agency for
International Development to expand care and treatment services
for families at established sites for the prevention of mother-
to-child transmission of HIV infection.
(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. 414. 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, shall 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 shall--
(1) build upon and be integrated into programs administered
as of the date of enactment of this Act by the United States
Agency for International Development 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, acting through the United States Agency for
International Development, shall submit a report on the implementation
of this section to the appropriate congressional committees. The report
shall include a plan for scaling up the program over the following
year.
(d) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available
for such purpose, there is authorized to be appropriated to the
President $15,000,000 for the fiscal year 2003 and $30,000,000
for the fiscal year 2004 to carry out the program.
(2) Availability of funds.--Amounts appropriated pursuant
to paragraph (1) are authorized to remain available until
expended.
TITLE V--BUSINESS PRINCIPLES
SEC. 501. PRINCIPLES FOR UNITED STATES FIRMS OPERATING IN COUNTRIES
AFFECTED BY THE HIV/AIDS PANDEMIC.
(a) Findings.--Congress finds that the global spread of HIV/AIDS
presents not only a health crisis but also a crisis in the workplace
that affects--
(1) the productivity, earning power, and longevity of
individual workers;
(2) the productivity, competitiveness, and financial
solvency of individual businesses; and
(3) the economic productivity and development of individual
communities and the United States as a whole.
(b) Sense of Congress.--It is the sense of Congress that United
States firms operating in countries affected by the HIV/AIDS pandemic
can make significant contributions to the United States effort to
respond to this pandemic through the voluntary adoption of the
principles and practices described in subsection (c).
(c) Principles and Practices.--The principles and practices
referred to in subsection (b) are the following:
(1) With respect to employment and health policies and
practices, the treatment of HIV/AIDS in the same manner as any
other illness.
(2) The promotion of policies and practices that eliminate
discrimination and stigmatization against employees on the
basis of real or perceived HIV/AIDS status, including--
(A) assessing employees on merit and ability to
perform;
(B) not subjecting employees to personal
discrimination or abuse; and
(C) imposing disciplinary measures where
discrimination occurs.
(3) A prohibition on compulsory HIV/AIDS testing for
recruitment, promotion, or career development.
(4) An assurance of the confidentiality of an employee's
HIV/AIDS status.
(5) Permission for employees with HIV/AIDS-related
illnesses to work as long as they are medically fit and, when
they are no longer able to work and sick leave has been
exhausted, an assurance that the employment relationship will
be terminated in accordance with antidiscrimination and labor
laws and respect for general procedures and full benefits.
(6) An assurance that employment practices will comply, at
a minimum, with national and international employment and labor
laws and codes.
(7) The involvement of employees and individuals infected
with HIV or living with AIDS, drawn from the workplace or the
community, in the development and assessment of HIV/AIDS
policies and programs for the workplace.
(8) An offer to all employees of access to culturally
appropriate preventive education programs and services to
support those programs.
(9) An assurance that programs offered in the workplace
will support and be integrated into larger community-based
responses to the problems posed by HIV/AIDS.
(10) Work with community leaders to expand the availability
of treatment for those employees and others infected with HIV
or living with AIDS.
TITLE VI--ADDITIONAL AUTHORITIES
SEC. 601. AUTHORITY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.
(a) In General.--Title III of the Public Health Service Act (42
U.S.C. 241 et seq.) is amended by adding at the end the following:
``PART R--HIV/AIDS, TUBERCULOSIS, AND MALARIA PREVENTION, CARE AND
TREATMENT IN DEVELOPING COUNTRIES
``SEC. 399AA. GENERAL AUTHORITY OF THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
``(a) Purpose.--It is the purpose of this section to provide the
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, with the authority to act internationally to
carry out prevention, care, treatment, support, capacity development,
and other activities (determined appropriate by the Secretary) for HIV/
AIDS, tuberculosis, and malaria in countries determined by the
Secretary to have or be at risk for severe HIV epidemic with particular
attention to resource constrained countries.
``(b) Activities and Assistance.--In carrying out the purpose
described in subsection (a), the Secretary, acting through the Director
of the Centers for Disease Control and Prevention, in coordination with
the Administrator of the United States Agency for International
Development and the Administrator of the Health Resources and Services
Administration, may provide support and assistance under this section
relating to--
``(1) HIV prevention services provided through--
``(A) education and voluntary counseling and
testing activities, including rapid testing, the
development and application of confidentiality
protections with respect to such counseling and
testing, and the integration of such activities into
programs serving women and children;
``(B) programs to reduce the mother-to-child
transmission of HIV, including the treatment and care
of HIV-infected women, their children, and families,
and including the involvement of fathers in such
programs;
``(C) activities involving behavioral interventions
for youth, women, and other vulnerable populations;
``(D) programs to prevent the transmission of HIV
and other pathogens at health care facilities
(including the use of universal precautions, equipment
sterilization, post-exposure prophylaxis for health
care workers and other individuals determined to be
appropriate, and other interventions appropriate to the
resources available), and to support the use of post
exposure prophylaxis, when indicated, for patients;
``(E) activities to ensure a safe blood supply;
``(F) programs to provide prevention, care,
treatment, and patient management services for sexually
transmitted infections to infected individuals and
individuals at risk of infection; and
``(G) activities, including laboratory support, to
collect and maintain accurate HIV/AIDS surveillance and
epidemiologic data, to target and monitor programs, and
to measure the effectiveness of interventions;
``(2) HIV/AIDS care and treatment services provided
through--
``(A) programs to provide care and treatment,
integrated with prevention services to further reduce
the transmission of HIV, for individuals living with
HIV/AIDS, including the treatment of opportunistic
infections (including tuberculosis) and the provision
of antiretroviral therapies and nutritional services;
``(B) programs to provide support services that are
needed to enhance the effectiveness of health services
and to promote family stability, including services for
family members affected by, but not infected with, HIV
such as children orphaned by AIDS; and
``(C) programs that link care and treatment
services to proven prevention programs, including
linkages with voluntary counseling and testing efforts
(including rapid testing);
``(3) infrastructure and training through--
``(A) activities to improve the health
infrastructure and institutional capacity within
participating countries, including the training of
appropriate personnel, and to assist such countries in
expanding and improving the availability of health care
facilities, to enable such countries to develop and
manage HIV/AIDS education, prevention, care and
treatment programs and to conduct evaluations of such
programs; and
``(B) activities to provide laboratory support as
well as technical assistance and training to increase
the capacity for the diagnosis, care, and treatment of
HIV/AIDS and related health conditions (including rapid
testing);
``(4) HIV/AIDS treatment protocols through--
``(A) the provision of support and assistance to
countries determined by the Secretary to have or be at
risk for severe HIV epidemic with particular attention
to resource constrained countries for the development
of treatment protocols for the delivery of HIV/AIDS
treatment and prevention services; and
``(B) the provision of assistance to countries
determined by the Secretary to have or be at risk for
severe HIV epidemic with particular attention to
resource constrained countries, and to be ready to
implement the protocols described in subparagraph (A);
and
``(5) other activities determined appropriated by the
Secretary.
``(c) Utilization of Existing Capacities.--In carrying out
activities under subsection (b), the Secretary, acting through the
Director of the Centers for Disease Control and Prevention and in
coordination with the Administrator of the United States Agency for
International Development and the Administrator of the Health Resources
and Services Administration, shall, to the maximum extent practicable,
utilize existing indigenous capacity in developing countries, including
coordinating with relevant government ministries and carrying out
activities in partnership with non-governmental organizations and
affected communities.
``(d) Health Resources and Services Administration.--In carrying
out activities under paragraphs (2) and (3) of subsection (b), the
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall enter into interagency agreements,
monetary transfers, and contracts with the Administrator of the Health
Resources and Services Administration to ensure that such activities
benefit from the specialized expertise of such Administration related
to the assessment of needs as well as the development and
implementation of community-based systems of care and appropriate
infrastructure, including the training of health care providers and
community workers.
``(e) Blood Supply.--In carrying out activities under subsection
(b)(1)(E), the Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall assist participating
countries in developing national, regional, or local systems to--
``(1) monitor, manage, and test the blood supply to ensure
that such supply is screened for HIV;
``(2) increase recruitment and retention of appropriate
blood donors; and
``(3) provide for technology transfer and capacity building
in proven best blood safety practices appropriate to local
conditions, including anemia prevention efforts.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $400,000,000 for fiscal year
2003, and such sums as may be necessary for fiscal year 2004. Of the
amount appropriated under the preceding sentence for each fiscal year,
the Secretary shall make available $45,000,000 in fiscal year 2003 and
$30,000,000 in fiscal year 2004 to carry out section 399DD. Amounts
appropriated under this subsection shall remain available until
expended.
``SEC. 399BB. GENERAL AUTHORITY OF THE HEALTH RESOURCES AND SERVICES
ADMINISTRATION.
``(a) Purpose.--It is the purpose of this section to provide the
Secretary, acting through the Administrator of the Health Resources and
Services Administration, with the authority to act internationally to
carry out prevention, care, treatment, support, capacity development,
and other activities (determined appropriate by the Secretary) for HIV/
AIDS, tuberculosis, and malaria in countries determined by the
Secretary to have or be at risk for severe HIV epidemic with particular
attention to resource constrained countries.
``(b) Activities and Assistance.--In carrying out the purpose
described in subsection (a), the Secretary, acting through the
Administrator of the Health Resources and Services Administration, in
coordination with the Director of the Centers for Disease Control and
Prevention and the Administrator of the United States Agency for
International Development, may provide assistance under this section
relating to--
``(1) activities to assist communities in assessing the
strengths and capabilities of the existing system of care and
treatment relating to HIV/AIDS and other opportunistic
infections, including critical unmet needs;
``(2) activities to assist communities in the development
and implementation of appropriate systems of care that provide
for a continuum of HIV/AIDS-related services for prevention,
treatment, palliative care, and hospice services based on an
assessment under paragraph (1);
``(3) activities to improve the health-related
infrastructure and institutional capacity of participating
countries, including the training of health care providers and
community workers, to enable such countries to develop and
manage HIV/AIDS education, prevention, care and treatment
programs and to conduct evaluations of such programs;
``(4) activities to assist in the development of training
modules and curricula on HIV/AIDS and associated conditions as
part of the professional training programs for physicians,
nurses, dentists, pharmacists, and other health care providers;
``(5) activities to improve the coordination between
American medical centers and hospitals and indigenous hospitals
and clinics in participating countries; and
``(6) other activities determined appropriated by the
Secretary.
``(c) Utilization of Existing Capacities.--In carrying out
activities under subsection (b), the Secretary, acting through the
Administrator of the Health Resources and Services Administration and
in consultation with the Director of the Centers for Disease Control
and Prevention and the Administrator of the United States Agency for
International Development, shall, to the maximum extent practicable,
utilize existing indigenous capacity in countries determined by the
Secretary to have or be at risk for severe HIV epidemic with particular
attention to resource constrained countries, including coordinating
with relevant government ministries and carrying out activities in
partnership with non-governmental organizations and affected
communities.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $40,000,000 for fiscal year
2003, and such sums as may be necessary for fiscal year 2004. Amounts
appropriated under this subsection shall remain available until
expended.
``SEC. 399CC. HIV/AIDS TRAINING PARTNERSHIP.
``(a) In General.--The Secretary, acting through the Director of
the National Institutes of Health and in coordination with the
Administrator of the Health Resources and Services Administration,
shall award supplemental grants to eligible entities to enable such
entities to provide support for clinical education and training in the
delivery of HIV/AIDS care and treatment services.
``(b) Eligible Entities.--To be eligible to receive a supplemental
grant under subsection (a), an entity shall--
``(1) be a recipient of an international HIV/AIDS clinical
research, education, or training grant awarded by the National
Institutes of Health or the Health Resources and Services
Administration;
``(2) provide assurances to the Secretary that the entity
has developed a partnership with a hospital-based or community-
based health care entity in the host country for the purpose of
providing services under each grant; and
``(3) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require, including a description of the
activities to be carried out with amounts received under the
grant.
``(c) Use of Funds.--An entity shall use amounts received under a
supplemental grant under subsection (a) to provide clinical education
and training in the delivery of HIV/AIDS care and treatment services.
Such education and training shall be designed to develop health care
provider capacity to deliver HIV/AIDS care and treatment services in a
variety of institutional and community-based settings.
``(d) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to applicants that will carry out
activities that assess existing provider capacity and address the
training needs of a range of health care providers (from physicians to
nurses to other health care providers).
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $50,000,000 for fiscal year
2003, and such sums as may be necessary for fiscal year 2004. Amounts
appropriated under this subsection shall remain available until
expended.
``SEC. 399DD. FAMILY SURVIVAL PARTNERSHIPS.
``(a) Purpose.--The purpose of this section is to provide support,
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,
as determined by the Secretary.
``(b) Grants.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, is
authorized to award a grant to an eligible administrative
organization to enable the organization 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) Administrative organization.--To be eligible to
receive a grant under paragraph (1), an administrative
organization shall--
``(A) have a demonstrable record in managing large
scale maternal and child health programs in countries
with or at risk for severe HIV epidemic with particular
attention to resource constrained countries, as
determined by the Secretary, and sufficient HIV/AIDS
expertise;
``(B) have established relationships with major
international organizations and multilateral
institutions;
``(C) provide an assurance to the Secretary that
the organization will contribute (either directly or
through private sector financial support) non-Federal
funds to the costs of the activities to be carried out
under this section in an amount that is not less than
the amount of funds provided to the organization under
a grant this section; and
``(D) prepare and submit an application to the
Secretary at such time, in such manner, and accompanied
by such information as the Secretary may require.
``(3) 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;
``(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 Secretary;
``(ii) serves a catchment area with a
minimum HIV seroprevalence of 3 percent in
pregnant women;
``(iii) has demonstrated support for the
proposed program from relevant government
entities;
``(iv) 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; and
``(v) has the ability to enroll a minimum
of 250 HIV infected women per service site,
based on the current uptake rate, into existing
HIV mother-to-child transmission programs; and
``(C) prepare and submit to the awarding
organization an application at such time, in such
manner, and containing such information as the
organization may require.
``(3) Local health and international organizations.--For
purposes of paragraph (2)(A)--
``(A) the term `local health organization' means a
public sector health system, non-governmental
organization, institution of higher education,
community-based organization, or non-profit 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 non-profit international entity;
``(ii) an international charitable
institution;
``(iii) a private voluntary international
entity; or
``(iv) a multilateral institution.
``(4) Selection of subgrant recipients.--In awarding
subgrants under this subsection, the organization shall--
``(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.
``(5) 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, including--
``(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.--Not later than 6 months after the date of enactment
of this section, and annually thereafter, an administrative
organization awarded a grant under subsection (b)(1) shall submit to
the Secretary and the appropriate committees of Congress, a 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.--In making amounts available under section 399AA(f)
to carry out this section, the Secretary shall ensure that not less
than--
``(1) $45,000,000 is made available to carry out this
section for fiscal year 2003; and
``(2) $30,000,000 is made available to carry out this
section for fiscal year 2004.
``(f) Limitation on Administrative Expenses.--An administrative
organization shall ensure that not more than 12 percent of the amount
of a grant received under this section by the organization is used for
the administrative activities described in subparagraphs (B), (C), (D),
and (E) of subsection (b)(3) and subsection (b)(5)(E).
``SEC. 399EE. INTRA-AGENCY COORDINATION OF GLOBAL HIV/AIDS INITIATIVES.
``(a) In General.--The Secretary, acting through the Director of
the Office of Global Health Affairs (referred to in this section as the
`Director') of the Department of Health and Human Services (referred to
in this section as the `Department'), shall ensure--
``(1) the coordination of all Department programs related
to the prevention, treatment, and monitoring of HIV/AIDS,
tuberculosis, and malaria in countries with or at risk for
severe HIV epidemic with particular attention to resource
constrained countries, as determined by the Secretary (referred
to in this section as `Department programs'); and
``(2) that global HIV/AIDS, tuberculosis, and malaria
activities are conducted in a coordinated, strategic fashion,
utilizing the expertise from the various agencies within the
Department, to the maximum extent practicable.
``(b) Duties.--In carrying out this section, the Secretary shall--
``(1) review all Departmental programs to ensure proper
coordination and compatibility of the activities, strategies,
and policies of such programs; and
``(2) ensure that the Departmental programs utilize the
best possible practices for HIV/AIDS prevention, treatment, and
monitoring to improve the effectiveness of Department programs
in countries in which the Department operates.
``(c) Report.--
``(1) In general.--The Director shall prepare an annual
report that--
``(A) describes the actions that are being taken to
coordinate the multiple roles and policies of, and
foster collaboration among, the offices and agencies of
the Department that contribute to global HIV/AIDS
activities;
``(B) describes the respective roles and activities
of each of the offices and agencies of the Department;
``(C) contains any recommendations for legislative
and funding actions that are needed to create a
coherent, effective departmental approach to global
HIV/AIDS that achieves the goals for Department
programs; and
``(D) describes the progress made towards meeting
the HIV/AIDS goals and outcomes as identified by the
Director.
``(2) Submission to congress.--Not later than 1 year after
the date of enactment of this part, and annually thereafter,
the Secretary shall submit the report described in paragraph
(1) to the appropriate committees of Congress.''.
(b) Extension of Tuberculosis Prevention Program.--Section 317E(g)
of the Public Health Service Act (42 U.S.C. 247b-6(g)) is amended--
(1) in paragraph (1)(A), by striking ``2002'' and inserting
``2004'';
(2) in paragraph (2), by striking ``2002'' and inserting
``2004''; and
(3) by adding at the end the following:
``(3) Coordination.--Activities under this section shall,
to the extent practicable, be coordinated with related
activities carried out under title VI of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2002 (and the amendments made by that title).''.
SEC. 602. MICROBICIDE RESEARCH AT THE NATIONAL INSTITUTES OF HEALTH.
Subpart I of part D of title XXIII of the Public Health Service Act
(42 U.S.C. 300cc-40 et seq.) is amended by inserting after section 2351
the following:
``SEC. 2351A. MICROBICIDES FOR PREVENTING TRANSMISSION OF HIV AND OTHER
SEXUALLY TRANSMITTED INFECTIONS.
``(a) Expansion and Coordination of Activities.--The Secretary,
acting through the Director of the Office of AIDS Research and in
coordination with other relevant institutes and offices, shall expand,
intensify, and coordinate the activities of all appropriate institutes
and components of the National Institutes of Health with respect to
research on the development of microbicides to prevent the transmission
of HIV and other sexually transmitted infections (in this section
referred to as `microbicide research').
``(b) Research Plan.--The Secretary, acting through the Director of
the Office of AIDS Research and in consultation with the Director of
the Institute of Allergy and Infectious Diseases, shall expedite the
implementation of the strategic plan for the conduct and support of
microbicide research, and shall annually review and as appropriate
revise the plan. In developing, implementing, and reviewing the plan,
the Director of the Office of AIDS Research shall coordinate with the
heads of other Federal agencies, including the Director of the Centers
for Disease Control and Prevention and the Administrator of the United
States Agency for International Development, involved in microbicide
research, with the microbicide research community, and with health
advocates.
``(c) Microbicide Research and Development Teams.--
``(1) In general.--The Secretary, acting through the
Director of the National Institutes of Health, shall award
grants or contracts to public and private entities for the
development and operation of multidisciplinary teams to conduct
research on innovative microbicide concepts, including
combination microbicides.
``(2) Peer review requirement.--The Director shall award a
grant or contract to an entity under paragraph (1) only if the
grant or contract has been recommended after technical and
scientific peer review in accordance with regulations under
section 492.
``(d) Report.--Not later than 1 year after the date of the initial
submission of the research plan under subsection (b), and annually
thereafter, the Secretary, acting through the Director of the Office of
AIDS Research and in consultation with the Director of the Institute of
Allergy and Infectious Diseases, shall submit to the Committee on
Energy and Commerce and the Committee on Appropriations of the House of
Representatives and the Committee on Health, Education, Labor, and
Pensions and the Committee on Appropriations of the Senate a report
that describes the activities of the National Institutes of Health
regarding microbicide research. Each such report shall include--
``(1) an updated research plan;
``(2) a description and evaluation of the progress made,
during the period for which such report is prepared, in
research on microbicides;
``(3) a summary and analysis of expenditures made, during
the period for which the report is made, for activities with
respect to microbicides research conducted and supported by the
National Institutes of Health, including the number of full-
time equivalent employees; and
``(4) recommendations as the Director of the Office of AIDS
Research considers appropriate.
``(f) Definition.--In this section, the term `HIV' means the human
immunodeficiency virus. Such term includes acquired immune deficiency
syndrome.''.
SEC. 603. AUTHORITY OF THE DEPARTMENT OF LABOR.
(a) Purpose.--It is the purpose of this section to provide the
Secretary of Labor with the authority to carry out workplace-based HIV/
AIDS programs in countries with or at risk for severe HIV epidemic with
particular attention to resource constrained countries, as determined
by the Secretary.
(b) Activities and Assistance.--In carrying out the purpose
described in subsection (a), the Secretary of Labor, in coordination
with the Secretary of Health and Human Services and the Administrator
of the United States Agency for International Development, may provide
assistance under this section relating to--
(1) the establishment and implementation of workplace HIV/
AIDS prevention and education programs in countries with or at
risk for severe HIV epidemic with particular attention to
resource constrained countries, as determined by the Secretary,
including programs that emphasize protections against
discrimination and the creation of supportive environments for
individuals living with HIV/AIDS;
(2) the development and implementation of on-site care and
wellness programs that enhance the health and productivity of
the workforce in countries with or at risk for severe HIV
epidemic with particular attention to resource constrained
countries, as determined by the Secretary;
(3) activities to strengthen collaboration among
governments, business, and labor leaders to respond to the HIV/
AIDS pandemic; and
(4) other activities determined appropriated by the
Secretary.
(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $10,000,000 for fiscal year
2003, and such sums as may be necessary for fiscal year 2004. Amounts
appropriated under this subsection shall remain available until
expended.
SEC. 604. AUTHORITY FOR INTERNATIONAL PROGRAMS.
Section 307 of the Public Health Service Act (42 U.S.C. 242l) is
amended--
(1) in subsection (b)--
(A) in paragraph (6), by adding ``and'' at the end;
(B) in paragraph (7), by striking ``; and'' and
inserting a period;
(C) in the flush sentence after paragraph (7), by
inserting ``new'' before ``facility in any foreign
country''; and
(D) by striking paragraph (8); and
(2) by adding at the end the following:
``(d)(1) The Secretary is authorized to utilize the authority
contained in section 2 of the State Department Basic Authorities Act of
1956 (22 U.S.C. 2669), subject to the limitations set forth in
subsection (e).
``(2) The Secretary is authorized to use the authority contained in
section 1 of the Act of April 18, 1930 (46 Stat. 177; 22 U.S.C. 291)
and section 1 of the Foreign Service Buildings Act (22 U.S.C. 292)
directly or through contract, grant, or cooperative agreement to lease,
alter, or renovate facilities in foreign countries as necessary to
conduct programs of assistance for international health activities,
including activities relating to HIV/AIDS and other infectious
diseases, chronic and environmental diseases, and other health
activities abroad.
``(e) In exercising the authority set forth in paragraphs (1) and
(2) of subsection (d), the Secretary shall consult with the Secretary
of State to ensure that planned activities are within the legal
strictures of the State Department Basic Authorities Act of 1956 and
other applicable laws.''.
Amend the title so as to read: ``An Act to amend the
Foreign Assistance Act of 1961 to increase assistance for
foreign countries seriously affected by HIV/AIDS, tuberculosis,
and malaria; to amend the Public Health Service Act with
respect to the authority of the Department of Health and Human
Services to act internationally with respect to HIV/AIDS,
tuberculosis, and malaria; and for other purposes.''.
Attest:
Secretary.
107th CONGRESS
2d Session
H. R. 2069
_______________________________________________________________________
AMENDMENTS