[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2525 Reported in Senate (RS)]






                                                       Calendar No. 482
107th CONGRESS
  2d Session
                                S. 2525

                          [Report No. 107-206]

To amend the Foreign Assistance Act of 1961 to increase assistance for 
  foreign countries seriously affected by HIV/AIDS, tuberculosis, and 
                    malaria, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                 May 15 (legislative day, May 9), 2002

 Mr. Kerry (for himself, Mr. Frist, Mr. Biden, Mr. Helms, Mr. Daschle, 
Mr. Leahy, Mr. Feingold, Mr. Dodd, Mr. Hagel, Mrs. Boxer, Mr. Sarbanes, 
    Mr. Smith of Oregon, Mr. DeWine, Mr. Wellstone, Mr. Lugar, Mr. 
Santorum, and Mr. Durbin) introduced the following bill; which was read 
        twice and referred to the Committee on Foreign Relations

                              July 3, 2002

  Reported under the authority of the order of the Senate of June 26, 
                 2002, by Mr. Biden, without amendment

_______________________________________________________________________

                                 A BILL


 
To amend the Foreign Assistance Act of 1961 to increase assistance for 
  foreign countries seriously affected by HIV/AIDS, tuberculosis, and 
                    malaria, and for other purposes.

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

SECTION 1. SHORT TITLE; 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.

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 President 
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) 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 
        this Act or any amendment made by this Act.
            ``(B) 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 out migration 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 (as in effect 
        immediately before the date of enactment of this Act)--
                    (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.

    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 the Decision Point--
                            ``(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.''.

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 inserting after paragraph (3) the 
following new paragraph (4):
            ``(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 for 
        the Department of State $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 shall 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 shall 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 shall provide for the 
activities under the program--
            (1) to be carried out in connection with the conduct of 
        United States peacekeeping operations by the Armed Forces; and
            (2) to include HIV/AIDS-related voluntary counseling and 
        testing and HIV/AIDS-related surveillance.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to the Department of Defense $50,000,000 for fiscal year 
2003 and $55,000,000 for the fiscal year 2004 for carrying out the 
program described in subsection (a) as expanded pursuant to this 
section.
    (e) Country Suffering a Public Health Crisis Defined.--In this 
section, the term ``country suffering a public health crisis'' means a 
country in which the HIV/AIDS infection rate, as reported in the most 
recent epidemiological data for that country compiled by the Joint 
United Nations Program on HIV/AIDS, is at least 5 percent among women 
attending prenatal clinics or more than 20 percent among individuals in 
groups with high-risk behavior.

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 Administrator of 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 Administrator 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.




                                                       Calendar No. 482

107th CONGRESS

  2d Session

                                S. 2525

_______________________________________________________________________

                                 A BILL

To amend the Foreign Assistance Act of 1961 to increase assistance for 
  foreign countries seriously affected by HIV/AIDS, tuberculosis, and 
                    malaria, and for other purposes.

_______________________________________________________________________

                              July 3, 2002

  Reported under the authority of the order of the Senate of June 26, 
                        2002, without amendment