[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1298 Enrolled Bill (ENR)]
H.R.1298
One Hundred Eighth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the seventh day of January, two thousand and three
An Act
To provide assistance to foreign countries to combat 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 2003''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis
and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Pilot program for the placement of health care professionals
in overseas areas severely affected by HIV/AIDS, tuberculosis,
and malaria.
Sec. 305. Report on treatment activities by relevant executive branch
agencies.
Sec. 306. Strategies to improve injection safety.
Sec. 307. Study on illegal diversions of prescription drugs.
Subtitle B--Assistance for Children and Families
Sec. 311. Findings.
Sec. 312. Policy and requirements.
Sec. 313. Annual reports on prevention of mother-to-child transmission
of the HIV infection.
Sec. 314. Pilot program of assistance for children and families affected
by HIV/AIDS.
Sec. 315. Pilot program on family survival partnerships.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Assistance from the United States private sector to prevent
and reduce HIV/AIDS in sub-Saharan Africa.
TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS
Sec. 501. Modification of the Enhanced HIPC Initiative.
Sec. 502. Report on expansion of debt relief to non-HIPC countries.
Sec. 503. Authorization of appropriations.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) During the last 20 years, HIV/AIDS has assumed pandemic
proportions, spreading from the most severely affected regions,
sub-Saharan Africa and the Caribbean, to all corners of the world,
and leaving an unprecedented path of death and devastation.
(2) According to the Joint United Nations Programme on HIV/AIDS
(UNAIDS), more than 65,000,000 individuals worldwide have been
infected with HIV since the epidemic began, more than 25,000,000 of
these individuals have lost their lives to the disease, and more
than 14,000,000 children have been orphaned by the disease. HIV/
AIDS is the fourth-highest cause of death in the world.
(3)(A) At the end of 2002, an estimated 42,000,000 individuals
were infected with HIV or living with AIDS, of which more than 75
percent live in Africa or the Caribbean. Of these individuals, more
than 3,200,000 were children under the age of 15 and more than
19,200,000 were women.
(B) Women are four times more vulnerable to infection than are
men and are becoming infected at increasingly high rates, in part
because many societies do not provide poor women and young girls
with the social, legal, and cultural protections against high risk
activities that expose them to HIV/AIDS.
(C) Women and children who are refugees or are internally
displaced persons are especially vulnerable to sexual exploitation
and violence, thereby increasing the possibility of HIV infection.
(4) As the leading cause of death in sub-Saharan Africa, AIDS
has killed more than 19,400,000 individuals (more than 3 times the
number of AIDS deaths in the rest of the world) and will claim the
lives of one-quarter of the population, mostly adults, in the next
decade.
(5) An estimated 2,000,000 individuals in Latin America and the
Caribbean and another 7,100,000 individuals in Asia and the Pacific
region are infected with HIV or living with AIDS. Infection rates
are rising alarmingly in Eastern Europe (especially in the Russian
Federation), Central Asia, and China.
(6) HIV/AIDS threatens personal security by affecting the
health, lifespan, and productive capacity of the individual and the
social cohesion and economic well-being of the family.
(7) HIV/AIDS undermines the economic security of a country and
individual businesses in that country by weakening the productivity
and longevity of the labor force across a broad array of economic
sectors and by reducing the potential for economic growth over the
long term.
(8) HIV/AIDS destabilizes communities by striking at the most
mobile and educated members of society, many of whom are
responsible for security at the local level and governance at the
national and subnational levels as well as many teachers, health
care personnel, and other community workers vital to community
development and the effort to combat HIV/AIDS. In some countries
the overwhelming challenges of the HIV/AIDS epidemic are
accelerating the outward migration of critically important health
care professionals.
(9) HIV/AIDS weakens the defenses of countries severely
affected by the HIV/AIDS crisis through high infection rates among
members of their military forces and voluntary peacekeeping
personnel. According to UNAIDS, in sub-Saharan Africa, many
military forces have infection rates as much as five times that of
the civilian population.
(10) HIV/AIDS poses a serious security issue for the
international community by--
(A) increasing the potential for political instability and
economic devastation, particularly in those countries and
regions most severely affected by the disease;
(B) decreasing the capacity to resolve conflicts through
the introduction of peacekeeping forces because the
environments into which these forces are introduced pose a high
risk for the spread of HIV/AIDS; and
(C) increasing the vulnerability of local populations to
HIV/AIDS in conflict zones from peacekeeping troops with HIV
infection rates significantly higher than civilian populations.
(11) The devastation wrought by the HIV/AIDS pandemic is
compounded by the prevalence of tuberculosis and malaria,
particularly in developing countries where the poorest and most
vulnerable members of society, including women, children, and those
individuals living with HIV/AIDS, become infected. According to the
World Health Organization (WHO), HIV/AIDS, tuberculosis, and
malaria accounted for more than 5,700,000 deaths in 2001 and caused
debilitating illnesses in millions more.
(12) Together, HIV/AIDS, tuberculosis, malaria and related
diseases are undermining agricultural production throughout Africa.
According to the United Nations Food and Agricultural Organization,
7,000,000 agricultural workers throughout 25 African countries have
died from AIDS since 1985. Countries with poorly developed
agricultural systems, which already face chronic food shortages,
are the hardest hit, particularly in sub-Saharan Africa, where high
HIV prevalence rates are compounding the risk of starvation for an
estimated 14,400,000 people.
(13) Tuberculosis is the cause of death for one out of every
three people with AIDS worldwide and is a highly communicable
disease. HIV infection is the leading threat to tuberculosis
control. Because HIV infection so severely weakens the immune
system, individuals with HIV and latent tuberculosis infection have
a 100 times greater risk of developing active tuberculosis diseases
thereby increasing the risk of spreading tuberculosis to others.
Tuberculosis, in turn, accelerates the onset of AIDS in individuals
infected with HIV.
(14) Malaria, the most deadly of all tropical parasitic
diseases, has been undergoing a dramatic resurgence in recent years
due to increasing resistance of the malaria parasite to inexpensive
and effective drugs. At the same time, increasing resistance of
mosquitoes to standard insecticides makes control of transmission
difficult to achieve. The World Health Organization estimates that
between 300,000,000 and 500,000,000 new cases of malaria occur each
year, and annual deaths from the disease number between 2,000,000
and 3,000,000. Persons infected with HIV are particularly
vulnerable to the malaria parasite. The spread of HIV infection
contributes to the difficulties of controlling resurgence of the
drug resistant malaria parasite.
(15) HIV/AIDS is first and foremost a health problem.
Successful strategies to stem the spread of the HIV/AIDS pandemic
will require clinical medical interventions, the strengthening of
health care delivery systems and infrastructure, and determined
national leadership and increased budgetary allocations for the
health sector in countries affected by the epidemic as well as
measures to address the social and behavioral causes of the problem
and its impact on families, communities, and societal sectors.
(16) Basic interventions to prevent new HIV infections and to
bring care and treatment to people living with AIDS, such as
voluntary counseling and testing and mother-to-child transmission
programs, are achieving meaningful results and are cost-effective.
The challenge is to expand these interventions from a pilot program
basis to a national basis in a coherent and sustainable manner.
(17) Appropriate treatment of individuals with HIV/AIDS can
prolong the lives of such individuals, preserve their families,
prevent children from becoming orphans, and increase productivity
of such individuals by allowing them to lead active lives and
reduce the need for costly hospitalization for treatment of
opportunistic infections caused by HIV.
(18) Nongovernmental organizations, including faith-based
organizations, with experience in health care and HIV/AIDS
counseling, have proven effective in combating the HIV/AIDS
pandemic and can be a resource in assisting indigenous
organizations in severely affected countries in their efforts to
provide treatment and care for individuals infected with HIV/AIDS.
(19) Faith-based organizations are making an important
contribution to HIV prevention and AIDS treatment programs around
the world. Successful HIV prevention programs in Uganda, Jamaica,
and elsewhere have included local churches and faith-based groups
in efforts to promote behavior changes to prevent HIV, to reduce
stigma associated with HIV infection, to treat those afflicted with
the disease, and to care for orphans. The Catholic Church alone
currently cares for one in four people being treated for AIDS
worldwide. Faith-based organizations possess infrastructure,
experience, and knowledge that will be needed to carry out these
programs in the future and should be an integral part of United
States efforts.
(20)(A) Uganda has experienced the most significant decline in
HIV rates of any country in Africa, including a decrease among
pregnant women from 20.6 percent in 1991 to 7.9 percent in 2000.
(B) Uganda made this remarkable turnaround because President
Yoweri Museveni spoke out early, breaking long-standing cultural
taboos, and changed widespread perceptions about the disease. His
leadership stands as a model for ways political leaders in Africa
and other developing countries can mobilize their nations,
including civic organizations, professional associations, religious
institutions, business and labor to combat HIV/AIDS.
(C) Uganda's successful AIDS treatment and prevention program
is referred to as the ABC model: ``Abstain, Be faithful, use
Condoms'', in order of priority. Jamaica, Zambia, Ethiopia and
Senegal have also successfully used the ABC model. Beginning in
1986, Uganda brought about a fundamental change in sexual behavior
by developing a low-cost program with the message: ``Stop having
multiple partners. Be faithful. Teenagers, wait until you are
married before you begin sex.''.
(D) By 1995, 95 percent of Ugandans were reporting either one
or zero sexual partners in the past year, and the proportion of
sexually active youth declined significantly from the late 1980s to
the mid-1990s. The greatest percentage decline in HIV infections
and the greatest degree of behavioral change occurred in those 15
to 19 years old. Uganda's success shows that behavior change,
through the use of the ABC model, is a very successful way to
prevent the spread of HIV.
(21) The magnitude and scope of the HIV/AIDS crisis demands a
comprehensive, long-term, international response focused upon
addressing the causes, reducing the spread, and ameliorating the
consequences of the HIV/AIDS pandemic, including--
(A) prevention and education, care and treatment, basic and
applied research, and training of health care workers,
particularly at the community and provincial levels, and other
community workers and leaders needed to cope with the range of
consequences of the HIV/AIDS crisis;
(B) development of health care infrastructure and delivery
systems through cooperative and coordinated public efforts and
public and private partnerships;
(C) development and implementation of national and
community-based multisector strategies that address the impact
of HIV/AIDS on the individual, family, community, and nation
and increase the participation of at-risk populations in
programs designed to encourage behavioral and social change and
reduce the stigma associated with HIV/AIDS; and
(D) coordination of efforts between international
organizations such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the Joint United Nations Programme on
HIV/AIDS (UNAIDS), the World Health Organization (WHO),
national governments, and private sector organizations,
including faith-based organizations.
(22) The United States has the capacity to lead and enhance the
effectiveness of the international community's response by--
(A) providing substantial financial resources, technical
expertise, and training, particularly of health care personnel
and community workers and leaders;
(B) promoting vaccine and microbicide research and the
development of new treatment protocols in the public and
commercial pharmaceutical research sectors;
(C) making available pharmaceuticals and diagnostics for
HIV/AIDS therapy;
(D) encouraging governments and faith-based and community-
based organizations to adopt policies that treat HIV/AIDS as a
multisectoral public health problem affecting not only health
but other areas such as agriculture, education, the economy,
the family and society, and assisting them to develop and
implement programs corresponding to these needs;
(E) promoting healthy lifestyles, including abstinence,
delaying sexual debut, monogamy, marriage, faithfulness, use of
condoms, and avoiding substance abuse; and
(F) encouraging active involvement of the private sector,
including businesses, pharmaceutical and biotechnology
companies, the medical and scientific communities, charitable
foundations, private and voluntary organizations and
nongovernmental organizations, faith-based organizations,
community-based organizations, and other nonprofit entities.
(23) Prostitution and other sexual victimization are degrading
to women and children and it should be the policy of the United
States to eradicate such practices. The sex industry, the
trafficking of individuals into such industry, and sexual violence
are additional causes of and factors in the spread of the HIV/AIDS
epidemic. One in nine South Africans is living with AIDS, and
sexual assault is rampant, at a victimization rate of one in three
women. Meanwhile in Cambodia, as many as 40 percent of prostitutes
are infected with HIV and the country has the highest rate of
increase of HIV infection in all of Southeast Asia. Victims of
coercive sexual encounters do not get to make choices about their
sexual activities.
(24) Strong coordination must exist among the various agencies
of the United States to ensure effective and efficient use of
financial and technical resources within the United States
Government with respect to the provision of international HIV/AIDS
assistance.
(25) In his address to Congress on January 28, 2003, the
President announced the Administration's intention to embark on a
five-year emergency plan for AIDS relief, to confront HIV/AIDS with
the goals of preventing 7,000,000 new HIV/AIDS infections, treating
at least 2,000,000 people with life-extending drugs, and providing
humane care for millions of people suffering from HIV/AIDS, and for
children orphaned by HIV/AIDS.
(26) In this address to Congress, the President stated the
following: ``Today, on the continent of Africa, nearly 30,000,000
people have the AIDS virus--including 3,000,000 children under the
age of 15. There are whole countries in Africa where more than one-
third of the adult population carries the infection. More than
4,000,000 require immediate drug treatment. Yet across that
continent, only 50,000 AIDS victims--only 50,000--are receiving the
medicine they need.''.
(27) Furthermore, the President focused on care and treatment
of HIV/AIDS in his address to Congress, stating the following:
``Because the AIDS diagnosis is considered a death sentence, many
do not seek treatment. Almost all who do are turned away. A doctor
in rural South Africa describes his frustration. He says, `We have
no medicines. Many hospitals tell people, you've got AIDS, we can't
help you. Go home and die.' In an age of miraculous medicines, no
person should have to hear those words. AIDS can be prevented.
Anti-retroviral drugs can extend life for many years * * * Ladies
and gentlemen, seldom has history offered a greater opportunity to
do so much for so many.''.
(28) Finally, the President stated that ``[w]e have confronted,
and will continue to confront, HIV/AIDS in our own country'',
proposing now that the United States should lead the world in
sparing innocent people from a plague of nature, and asking
Congress ``to commit $15,000,000,000 over the next five years,
including nearly $10,000,000,000 in new money, to turn the tide
against AIDS in the most afflicted nations of Africa and the
Caribbean''.
SEC. 3. DEFINITIONS.
In this Act:
(1) AIDS.--The term ``AIDS'' means the acquired immune
deficiency syndrome.
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means the Committee on
Foreign Relations of the Senate and the Committee on International
Relations of the House of Representatives.
(3) Global fund.--The term ``Global Fund'' means the public-
private partnership known as the Global Fund to Fight AIDS,
Tuberculosis and Malaria established pursuant to Article 80 of the
Swiss Civil Code.
(4) HIV.--The term ``HIV'' means the human immunodeficiency
virus, the pathogen that causes AIDS.
(5) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to an
individual, an individual who is infected with HIV or living with
AIDS.
(6) Relevant executive branch agencies.--The term ``relevant
executive branch agencies'' means the Department of State, the
United States Agency for International Development, and any other
department or agency of the United States that participates in
international HIV/AIDS activities pursuant to the authorities of
such department or agency or the Foreign Assistance Act of 1961.
SEC. 4. PURPOSE.
The purpose of this Act is to strengthen United States leadership
and the effectiveness of the United States response to certain global
infectious diseases by--
(1) establishing a comprehensive, integrated five-year, global
strategy to fight HIV/AIDS that encompasses a plan for phased
expansion of critical programs and improved coordination among
relevant executive branch agencies and between the United States
and foreign governments and international organizations;
(2) providing increased resources for multilateral efforts to
fight HIV/AIDS;
(3) providing increased resources for United States bilateral
efforts, particularly for technical assistance and training, to
combat HIV/AIDS, tuberculosis, and malaria;
(4) encouraging the expansion of private sector efforts and
expanding public-private sector partnerships to combat HIV/AIDS;
and
(5) intensifying efforts to support the development of vaccines
and treatment for HIV/AIDS, tuberculosis, and malaria.
SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.
With respect to the reports required by this Act to be submitted by
the President, to ensure an efficient use of resources, the President
may, in his discretion and notwithstanding any other provision of this
Act, consolidate or combine any of these reports, except for the report
required by section 101 of this Act, so long as the required elements
of each report are addressed and reported within a 90-day period from
the original deadline date for submission of the report specified in
this Act. The President may also enter into contracts with
organizations with relevant expertise to develop, originate, or
contribute to any of the reports required by this Act to be submitted
by the President.
TITLE I--POLICY PLANNING AND COORDINATION
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL STRATEGY.
(a) Strategy.--The President shall establish a comprehensive,
integrated, five-year strategy to combat global HIV/AIDS that
strengthens the capacity of the United States to be an effective leader
of the international campaign against HIV/AIDS. Such strategy shall
maintain sufficient flexibility and remain responsive to the ever-
changing nature of the HIV/AIDS pandemic and shall--
(1) include specific objectives, multisectoral approaches, and
specific strategies to treat individuals infected with HIV/AIDS and
to prevent the further spread of HIV infections, with a particular
focus on the needs of families with children (including the
prevention of mother-to-child transmission), women, young people,
and children (such as unaccompanied minor children and orphans);
(2) as part of the strategy, implement a tiered approach to
direct delivery of care and treatment through a system based on
central facilities augmented by expanding circles of local delivery
of care and treatment through local systems and capacity;
(3) assign priorities for relevant executive branch agencies;
(4) provide that the reduction of HIV/AIDS behavioral risks
shall be a priority of all prevention efforts in terms of funding,
educational messages, and activities by promoting abstinence from
sexual activity and substance abuse, encouraging monogamy and
faithfulness, promoting the effective use of condoms, and
eradicating prostitution, the sex trade, rape, sexual assault and
sexual exploitation of women and children;
(5) improve coordination and reduce duplication among relevant
executive branch agencies, foreign governments, and international
organizations;
(6) project general levels of resources needed to achieve the
stated objectives;
(7) expand public-private partnerships and the leveraging of
resources;
(8) maximize United States capabilities in the areas of
technical assistance and training and research, including vaccine
research;
(9) establish priorities for the distribution of resources
based on factors such as the size and demographics of the
population with HIV/AIDS, tuberculosis, and malaria and the needs
of that population and the existing infrastructure or funding
levels that may exist to cure, treat, and prevent HIV/AIDS,
tuberculosis, and malaria; and
(10) include initiatives describing how the President will
maximize the leverage of private sector dollars in reduction and
treatment of HIV/AIDS, tuberculosis, and malaria.
(b) Report.--
(1) In general.--Not later than 270 days after the date of
enactment of this Act, the President shall submit to the
appropriate congressional committees a report setting forth the
strategy described in subsection (a).
(2) Report contents.--The report required by paragraph (1)
shall include a discussion of the elements described in paragraph
(3) and may include a discussion of additional elements relevant to
the strategy described in subsection (a). Such discussion may
include an explanation as to why a particular element described in
paragraph (3) is not relevant to such strategy.
(3) Report elements.--The elements referred to in paragraph (2)
are the following:
(A) The objectives, general and specific, of the strategy.
(B) A description of the criteria for determining success
of the strategy.
(C) A description of the manner in which the strategy will
address the fundamental elements of prevention and education,
care, and treatment (including increasing access to
pharmaceuticals and to vaccines), the promotion of abstinence,
monogamy, avoidance of substance abuse, and use of condoms,
research (including incentives for vaccine development and new
protocols), training of health care workers, the development of
health care infrastructure and delivery systems, and avoidance
of substance abuse.
(D) A description of the manner in which the strategy will
promote the development and implementation of national and
community-based multisectoral strategies and programs,
including those designed to enhance leadership capacity
particularly at the community level.
(E) A description of the specific strategies developed to
meet the unique needs of women, including the empowerment of
women in interpersonal situations, young people and children,
including those orphaned by HIV/AIDS and those who are victims
of the sex trade, rape, sexual abuse, assault, and
exploitation.
(F) A description of the specific strategies developed to
encourage men to be responsible in their sexual behavior, child
rearing and to respect women including the reduction of sexual
violence and coercion.
(G) A description of the specific strategies developed to
increase women's access to employment opportunities, income,
productive resources, and microfinance programs.
(H) A description of the programs to be undertaken to
maximize United States contributions in the areas of technical
assistance, training (particularly of health care workers and
community-based leaders in affected sectors), and research,
including the promotion of research on vaccines and
microbicides.
(I) An identification of the relevant executive branch
agencies that will be involved and the assignment of priorities
to those agencies.
(J) A description of the role of each relevant executive
branch agency and the types of programs that the agency will be
undertaking.
(K) 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.
(L) 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.
(M) The level of resources that will be needed on an annual
basis and the manner in which those resources would generally
be allocated among the relevant executive branch agencies.
(N) A description of the mechanisms to be established for
monitoring and evaluating programs, promoting successful
models, and for terminating unsuccessful programs.
(O) 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.
(P) 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.
(Q) A description of the manner in which the United States
strategy for combating HIV/AIDS relates to and supports other
United States assistance strategies in developing countries.
(R) A description of the programs to be carried out under
the strategy that are specifically targeted at women and girls
to educate them about the spread of HIV/AIDS.
(S) A description of efforts being made to address the
unique needs of families with children with respect to HIV/
AIDS, including efforts to preserve the family unit.
(T) An analysis of the emigration of critically important
medical and public health personnel, including physicians,
nurses, and supervisors from sub-Saharan African countries that
are acutely impacted by HIV/AIDS, including a description of
the causes, effects, and the impact on the stability of health
infrastructures, as well as a summary of incentives and
programs that the United States could provide, in concert with
other private and public sector partners and international
organizations, to stabilize health institutions by encouraging
critical personnel to remain in their home countries.
(U) A description of the specific strategies developed to
promote sustainability of HIV/AIDS pharmaceuticals (including
antiretrovirals) and the effects of drug resistance on HIV/AIDS
patients.
(V) A description of the specific strategies to ensure that
the extraordinary benefit of HIV/AIDS pharmaceuticals
(especially antiretrovirals) are not diminished through the
illegal counterfeiting of pharmaceuticals and black market
sales of such pharmaceuticals.
(W) An analysis of the prevalence of Human Papilloma Virus
(HPV) in sub-Saharan Africa and the impact that condom usage
has upon the spread of HPV in sub-Saharan Africa.
(c) Study; Distribution of Resources.--
(1) Study.--Not later than 3 years after the date of the
enactment of this Act, the Institute of Medicine shall publish
findings comparing the success rates of the various programs and
methods used under the strategy described in subsection (a) to
reduce, prevent, and treat HIV/AIDS, tuberculosis, and malaria.
(2) Distribution of resources.--In prioritizing the
distribution of resources under the strategy described in
subsection (a), the President shall consider the findings published
by the Institute of Medicine under this subsection.
SEC. 102. HIV/AIDS RESPONSE COORDINATOR.
(a) Establishment of Position.--Section 1 of the State Department
Basic Authorities Act of 1956 (22 U.S.C. 265(a)) is amended--
(1) by redesignating subsection (f) as subsection (g); and
(2) by inserting after subsection (e) the following:
``(f) HIV/AIDS Response Coordinator.--
``(1) In general.--There shall be established within the
Department of State in the immediate office of the Secretary of
State a Coordinator of United States Government Activities to
Combat HIV/AIDS Globally, who shall be appointed by the President,
by and with the advice and consent of the Senate. The Coordinator
shall report directly to the Secretary.
``(2) Authorities and duties; definitions.--
``(A) Authorities.--The Coordinator, acting through such
nongovernmental organizations (including faith-based and
community-based organizations) and relevant executive branch
agencies as may be necessary and appropriate to effect the
purposes of this section, is authorized--
``(i) to operate internationally to carry out
prevention, care, treatment, support, capacity development,
and other activities for combatting HIV/AIDS;
``(ii) to transfer and allocate funds to relevant
executive branch agencies; and
``(iii) to provide grants to, and enter into contracts
with, nongovernmental organizations (including faith-based
and community-based organizations) to carry out the
purposes of section.
``(B) Duties.--
``(i) In general.--The Coordinator shall have primary
responsibility for the oversight and coordination of all
resources and international activities of the United States
Government to combat the HIV/AIDS pandemic, including all
programs, projects, and activities of the United States
Government relating to the HIV/AIDS pandemic under the
United States Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 or any amendment made by that Act.
``(ii) Specific duties.--The duties of the Coordinator
shall specifically include the following:
``(I) Ensuring program and policy coordination
among the relevant executive branch agencies and
nongovernmental organizations, including auditing,
monitoring, and evaluation of all such programs.
``(II) Ensuring that each relevant executive branch
agency undertakes programs primarily in those areas
where the agency has the greatest expertise, technical
capabilities, and potential for success.
``(III) Avoiding duplication of effort.
``(IV) Ensuring coordination of relevant executive
branch agency activities in the field.
``(V) Pursuing coordination with other countries
and international organizations.
``(VI) Resolving policy, program, and funding
disputes among the relevant executive branch agencies.
``(VII) Directly approving all activities of the
United States (including funding) relating to
combatting HIV/AIDS in each of Botswana, Cote d'Ivoire,
Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia,
Nigeria, Rwanda, South Africa, Tanzania, Uganda,
Zambia, and other countries designated by the
President, which other designated countries may include
those countries in which the United States is
implementing HIV/AIDS programs as of the date of the
enactment of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003.
``(VIII) Establishing due diligence criteria for
all recipients of funds section and all activities
subject to the coordination and appropriate monitoring,
evaluation, and audits carried out by the Coordinator
necessary to assess the measurable outcomes of such
activities.
``(C) Definitions.--In this paragraph:
``(i) AIDS.--The term `AIDS' means acquired immune
deficiency syndrome.
``(ii) HIV.--The term `HIV' means the human
immunodeficiency virus, the pathogen that causes AIDS.
``(iii) HIV/AIDS.--The term `HIV/AIDS' means, with
respect to an individual, an individual who is infected
with HIV or living with AIDS.
``(iv) Relevant executive branch agencies.--The term
`relevant executive branch agencies' means the Department
of State, the United States Agency for International
Development, the Department of Health and Human Services
(including the Public Health Service), and any other
department or agency of the United States that participates
in international HIV/AIDS activities pursuant to the
authorities of such department or agency or this Act.''.
(b) Resources.--Not later than 90 days after the date of enactment
of this Act, the President shall specify the necessary financial and
personnel resources, from funds appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
assistance, that shall be assigned to and under the direct control of
the Coordinator of United States Government Activities to Combat HIV/
AIDS Globally to establish and maintain the duties and supporting
activities assigned to the Coordinator by this Act and the amendments
made by this Act.
(c) Establishment of Separate Account.--There is established in the
general fund of the Treasury a separate account which shall be known as
the ``Activities to Combat HIV/AIDS Globally Fund'' and which shall be
administered by the Coordinator of United States Government Activities
to Combat HIV/AIDS Globally. There shall be deposited into the Fund all
amounts appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance, except for amounts
appropriated for United States contributions to the Global Fund.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.
(a) Findings.--Congress makes the following findings:
(1) Innovative partnerships between governments and
organizations in the private sector (including foundations,
universities, corporations, faith-based and community-based
organizations, and other nongovernmental organizations) have
proliferated in recent years, particularly in the area of health.
(2) Public-private sector partnerships multiply local and
international capacities to strengthen the delivery of health
services in developing countries and to accelerate research for
vaccines and other pharmaceutical products that are essential to
combat infectious diseases decimating the populations of these
countries.
(3) These partnerships maximize the unique capabilities of each
sector while combining financial and other resources, scientific
knowledge, and expertise toward common goals which neither the
public nor the private sector can achieve alone.
(4) Sustaining existing public-private partnerships and
building new ones are critical to the success of the international
community's efforts to combat HIV/AIDS and other infectious
diseases around the globe.
(b) Sense of Congress.--It is the sense of Congress that--
(1) the sustainment and promotion of public-private
partnerships should be a priority element of the strategy pursued
by the United States to combat the HIV/AIDS pandemic and other
global health crises; and
(2) the United States should systematically track the evolution
of these partnerships and work with others in the public and
private sector to profile and build upon those models that are most
effective.
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS
AND MALARIA.
(a) Findings.--The Congress finds as follows:
(1) The establishment of the Global Fund in January 2002 is
consistent with the general principles for an international AIDS
trust fund first outlined by the Congress in the Global AIDS and
Tuberculosis Relief Act of 2000 (Public Law 106-264).
(2) Section 2, Article 5 of the bylaws of the Global Fund
provides for the International Bank for Reconstruction and
Development to serve as the initial collection trustee for the
Global Fund.
(3) The trustee agreement signed between the Global Fund and
the International Bank for Reconstruction and Development narrows
the range of duties to include receiving and investing funds from
donors, disbursing the funds upon the instruction of the Global
Fund, reporting on trust fund resources to donors and the Global
Fund, and providing an annual external audit report to the Global
Fund.
(b) Authority for United States Participation.--
(1) United states participation.--The United States is hereby
authorized to participate in the Global Fund.
(2) Privileges and immunities.--The Global Fund shall be
considered a public international organization for purposes of
section 1 of the International Organizations Immunities Act (22
U.S.C. 288).
(c) Reports to Congress.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for the duration of
the Global Fund, the President shall submit to the appropriate
congressional committees a report on the Global Fund, including
contributions pledged to, contributions (including donations from the
private sector) received by, and projects funded by the Global Fund,
and the mechanisms established for transparency and accountability in
the grant-making process.
(d) United States Financial Participation.--
(1) Authorization of appropriations.--In addition to any other
funds authorized to be appropriated for bilateral or multilateral
HIV/AIDS, tuberculosis, or malaria programs, of the amounts
authorized to be appropriated under section 401, there are
authorized to be appropriated to the President up to $1,000,000,000
for the period of fiscal year 2004 beginning on January 1, 2004,
and such sums as may be necessary for the fiscal years 2005-2008,
for contributions to the Global Fund.
(2) Availability of funds.--Amounts appropriated under
paragraph (1) are authorized to remain available until expended.
(3) Reprogramming of fiscal year 2001 funds.--Funds made
available for fiscal year 2001 under section 141 of the Global AIDS
and Tuberculosis Relief Act of 2000--
(A) are authorized to remain available until expended; and
(B) shall be transferred to, merged with, and made
available for the same purposes as, funds made available for
fiscal years 2004 through 2008 under paragraph (1).
(4) Limitation.--
(A)(i) At any time during fiscal years 2004 through 2008,
no United States contribution to the Global Fund may cause the
total amount of United States Government contributions to the
Global Fund to exceed 33 percent of the total amount of funds
contributed to the Global Fund from all sources. Contributions
to the Global Fund from the International Bank for
Reconstruction and Development and the International Monetary
Fund shall not be considered in determining compliance with
this paragraph.
(ii) If, at any time during any of the fiscal years 2004
through 2008, the President determines that the Global Fund has
provided assistance to a country, the government of which the
Secretary of State has determined, for purposes of section
6(j)(1) of the Export Administration Act of 1979 (50 U.S.C.
App. 2405(j)(1)), has repeatedly provided support for acts of
international terrorism, then the United States shall withhold
from its contribution for the next fiscal year an amount equal
to the amount expended by the Fund to the government of each
such country.
(iii) If at any time the President determines that the
expenses of the Governing, Administrative, and Advisory Bodies
(including the Partnership Forum, the Foundation Board, the
Secretariat, and the Technical Review Board) of the Global Fund
exceed 10 percent of the total expenditures of the Fund for any
2-year period, the United States shall withhold from its
contribution for the next fiscal year an amount equal the to
the average annual amount expended by the Fund for such 2-year
period for the expenses of the Governing, Administrative, and
Advisory Bodies in excess of 10 percent of the total
expenditures of the Fund.
(iv) The President may waive the application of clause
(iii) if the President determines that extraordinary
circumstances warrant such a waiver. No waiver under this
clause may be for any period that exceeds 1 year.
(v) If, at any time during any of the fiscal years 2004
through 2008, the President determines that the salary of any
individual employed by the Global Fund exceeds the salary of
the Vice President of the United States (as determined under
section 104 of title 3, United States Code) for that fiscal
year, then the United States shall withhold from its
contribution for the next fiscal year an amount equal to the
aggregate amount by which the salary of each such individual
exceeds the salary of the Vice President of the United States.
(B)(i) Any amount made available under this subsection that
is withheld by reason of subparagraph (A)(i) shall be
contributed to the Global Fund as soon as practicable, subject
to subparagraph (A)(i), after additional contributions to the
Global Fund are made from other sources.
(ii) Any amount made available under this subsection that
is withheld by reason of subparagraph (A)(iii) shall be
transferred to the Activities to Combat HIV/AIDS Globally Fund
and shall remain available under the same terms and conditions
as funds appropriated pursuant to the authorization of
appropriations under section 401 for HIV/AIDS assistance.
(iii) Any amount made available under this subsection that
is withheld by reason of clause (ii) or (iii) of subparagraph
(A) is authorized to be made available to carry out section
104A of the Foreign Assistance Act of 1961 (as added by section
301 of this Act). Amounts made available under the preceding
sentence are in addition to amounts appropriated pursuant to
the authorization of appropriations under section 401 of this
Act for HIV/AIDS assistance.
(C)(i) The President may suspend the application of
subparagraph (A) with respect to a fiscal year if the President
determines that an international health emergency threatens the
national security interests of the United States.
(ii) The President shall notify the Committee on
International Relations of the House of Representatives and the
Committee on Foreign Relations of the Senate not less than 5
days before making a determination under clause (i) with
respect to the application of subparagraph (A)(i) and shall
include in the notification--
(I) a justification as to why increased United States
Government contributions to the Global Fund is preferable
to increased United States assistance to combat HIV/AIDS,
tuberculosis, and malaria on a bilateral basis; and
(II) an explanation as to why other government donors
to the Global Fund are unable to provide adequate
contributions to the Fund.
(e) Interagency Technical Review Panel.--
(1) Establishment.--The Coordinator of United States Government
Activities to Combat HIV/AIDS Globally, established in section
1(f)(1) of the State Department Basic Authorities Act of 1956 (as
added by section 102(a) of this Act), shall establish in the
executive branch an interagency technical review panel.
(2) Duties.--The interagency technical review panel shall serve
as a ``shadow'' panel to the Global Fund by--
(A) periodically reviewing all proposals received by the
Global Fund; and
(B) providing guidance to the United States persons who are
representatives on the panels, committees, and boards of the
Global Fund, on the technical efficacy, suitability, and
appropriateness of the proposals, and ensuring that such
persons are fully informed of technical inadequacies or other
aspects of the proposals that are inconsistent with the
purposes of this or any other Act relating to the provision of
foreign assistance in the area of AIDS.
(3) Membership.--The interagency technical review panel shall
consist of qualified medical and development experts who are
officers or employees of the Department of Health and Human
Services, the Department of State, and the United States Agency for
International Development.
(4) Chair.--The Coordinator referred to in paragraph (1) shall
chair the interagency technical review panel.
(f) Monitoring by Comptroller General.--
(1) Monitoring.--The Comptroller General shall monitor and
evaluate projects funded by the Global Fund.
(2) Report.--The Comptroller General shall on a biennial basis
shall prepare and submit to the appropriate congressional
committees a report that contains the results of the monitoring and
evaluation described in paragraph (1) for the preceding 2-year
period.
(g) Provision of Information to Congress.--The Coordinator of
United States Government Activities to Combat HIV/AIDS Globally shall
make available to the Congress the following documents within 30 days
of a request by the Congress for such documents:
(1) All financial and accounting statements for the Global Fund
and the Activities to Combat HIV/AIDS Globally Fund, including
administrative and grantee statements.
(2) Reports provided to the Global Fund and the Activities to
Combat HIV/AIDS Globally Fund by organizations contracted to audit
recipients of funds.
(3) Project proposals submitted by applicants for funding from
the Global Fund and the Activities to Combat HIV/AIDS Globally
Fund, but which were not funded.
(4) Progress reports submitted to the Global Fund and the
Activities to Combat HIV/AIDS Globally Fund by grantees.
(h) Sense of the Congress Regarding Encouragement of Private
Contributions to the Global Fund.--It is the sense of the Congress that
the President should--
(1) conduct an outreach campaign that is designed to--
(A) inform the public of the existence of--
(i) the Global Fund; and
(ii) any entity that will accept private contributions
intended for use by the Global Fund; and
(B) encourage private contributions to the Global Fund; and
(2) encourage private contributions intended for use by the
Global Fund by--
(A) establishing and operating an Internet website, and
publishing information about the website; and
(B) making public service announcements on radio and
television.
SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.
(a) Vaccine Fund.--Section 302(k) of the Foreign Assistance Act of
1961 (22 U.S.C. 2222(k)) is amended--
(1) by striking ``$50,000,000 for each of the fiscal years 2001
and 2002'' and inserting ``such sums as may be necessary for each
of the fiscal years 2004 through 2008''; and
(2) by striking ``Global Alliance for Vaccines and
Immunizations'' and inserting ``Vaccine Fund''.
(b) International AIDS Vaccine Initiative.--Section 302(l) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2222(l)) is amended by
striking ``$10,000,000 for each of the fiscal years 2001 and 2002'' and
inserting ``such sums as may be necessary for each of the fiscal years
2004 through 2008''.
(c) Support for the Development of Malaria Vaccine.--Section 302 of
the Foreign Assistance Act of 1961 (22 U.S.C. 2222)) is amended by
adding at the end the following new subsection:
``(m) In addition to amounts otherwise available under this
section, there are authorized to be appropriated to the President such
sums as may be necessary for each of the fiscal years 2004 through 2008
to be available for United States contributions to malaria vaccine
development programs, including the Malaria Vaccine Initiative of the
Program for Appropriate Technologies in Health (PATH).''.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.)
is amended--
(1) in section 104(c) (22 U.S.C. 2151b(c)), by striking
paragraphs (4) through (7); and
(2) by inserting after section 104 the following new section:
``SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
``(a) Finding.--Congress recognizes that the alarming spread of
HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, and other
developing countries is a major global health, national security,
development, and humanitarian crisis.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to provide assistance for the prevention,
treatment, and control of HIV/AIDS. The United States and other
developed countries should provide assistance to countries in sub-
Saharan Africa, the Caribbean, and other countries and areas to control
this crisis through HIV/AIDS prevention, treatment, monitoring, and
related activities, particularly activities focused on women and youth,
including strategies to protect women and prevent mother-to-child
transmission of the HIV infection.
``(c) Authorization.--
``(1) In general.--Consistent with section 104(c), the
President is authorized to furnish assistance, on such terms and
conditions as the President may determine, for HIV/AIDS, including
to prevent, treat, and monitor HIV/AIDS, and carry out related
activities, in countries in sub-Saharan Africa, the Caribbean, and
other countries and areas.
``(2) Role of ngos.--It is the sense of Congress that the
President should provide an appropriate level of assistance under
paragraph (1) through nongovernmental organizations (including
faith-based and community-based organizations) in countries in sub-
Saharan Africa, the Caribbean, and other countries and areas
affected by the HIV/AIDS pandemic.
``(3) Coordination of assistance efforts.--The President shall
coordinate the provision of assistance under paragraph (1) with the
provision of related assistance by the Joint United Nations
Programme on HIV/AIDS (UNAIDS), the United Nations Children's Fund
(UNICEF), the World Health Organization (WHO), the United Nations
Development Programme (UNDP), the Global Fund to Fight AIDS,
Tuberculosis and Malaria and other appropriate international
organizations (such as the International Bank for Reconstruction
and Development), relevant regional multilateral development
institutions, national, state, and local governments of foreign
countries, appropriate governmental and nongovernmental
organizations, and relevant executive branch agencies.
``(d) Activities Supported.--Assistance provided under subsection
(c) shall, to the maximum extent practicable, be used to carry out the
following activities:
``(1) Prevention.--Prevention of HIV/AIDS through activities
including--
``(A) programs and efforts that are designed or intended to
impart knowledge with the exclusive purpose of helping
individuals avoid behaviors that place them at risk of HIV
infection, including integration of such programs into health
programs and the inclusion in counseling programs of
information on methods of avoiding infection of HIV, including
delaying sexual debut, abstinence, fidelity and monogamy,
reduction of casual sexual partnering, reducing sexual violence
and coercion, including child marriage, widow inheritance, and
polygamy, and where appropriate, use of condoms;
``(B) assistance to establish and implement culturally
appropriate HIV/AIDS education and prevention programs that
focus on helping individuals avoid infection of HIV/AIDS,
implemented through nongovernmental organizations, including
faith-based and community-based organizations, particularly
those organizations that utilize both professionals and
volunteers with appropriate skills, experience, and community
presence;
``(C) assistance for the purpose of encouraging men to be
responsible in their sexual behavior, child rearing, and to
respect women;
``(D) assistance for the purpose of providing voluntary
testing and counseling (including the incorporation of
confidentiality protections with respect to such testing and
counseling);
``(E) 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;
``(F) assistance to ensure a safe blood supply and sterile
medical equipment;
``(G) assistance to help avoid substance abuse and
intravenous drug use that can lead to HIV infection; and
(H) assistance for the purpose of increasing women's access
to employment opportunities, income, productive resources, and
microfinance programs, where appropriate.
``(2) Treatment.--The treatment and care of individuals with
HIV/AIDS, including--
``(A) assistance to establish and implement programs to
strengthen and broaden indigenous health care delivery systems
and the capacity of such systems to deliver HIV/AIDS
pharmaceuticals and otherwise provide for the treatment of
individuals with HIV/AIDS, including clinical training for
indigenous organizations and health care providers;
``(B) assistance to strengthen and expand hospice and
palliative care programs to assist patients debilitated by HIV/
AIDS, their families, and the primary caregivers of such
patients, including programs that utilize faith-based and
community-based organizations; and
``(C) assistance for the purpose of the care and treatment
of individuals with HIV/AIDS through the provision of
pharmaceuticals, including antiretrovirals and other
pharmaceuticals and therapies for the treatment of
opportunistic infections, nutritional support, and other
treatment modalities.
``(3) Preventative intervention education and technologies.--
(A) With particular emphasis on specific populations that represent
a particularly high risk of contracting or spreading HIV/AIDS,
including those exploited through the sex trade, victims of rape
and sexual assault, individuals already infected with HIV/AIDS, and
in cases of occupational exposure of health care workers,
assistance with efforts to reduce the risk of HIV/AIDS infection
including post-exposure pharmaceutical prophylaxis, and necessary
pharmaceuticals and commodities, including test kits, condoms, and,
when proven effective, microbicides.
``(B) Bulk purchases of available test kits, condoms, and, when
proven effective, microbicides that are intended to reduce the risk
of HIV/AIDStransmission and for appropriate program support for the
introduction and distribution of these commodities, as well as
education and training on the use of the technologies.
``(4) Monitoring.--The monitoring of programs, projects, and
activities carried out pursuant to paragraphs (1) through (3),
including--
``(A) monitoring to ensure that adequate controls are
established and implemented to provide HIV/AIDS pharmaceuticals
and other appropriate medicines to poor individuals with HIV/
AIDS;
``(B) appropriate evaluation and surveillance activities;
``(C) monitoring to ensure that appropriate measures are
being taken to maintain the sustainability of HIV/AIDS
pharmaceuticals (especially antiretrovirals) and ensure that
drug resistance is not compromising the benefits of such
pharmaceuticals; and
``(D) monitoring to ensure appropriate law enforcement
officials are working to ensure that HIV/AIDS pharmaceuticals
are not diminished through illegal counterfeiting or black
market sales of such pharmaceuticals.
``(5) Pharmaceuticals.--
``(A) Procurement.--The procurement of HIV/AIDS
pharmaceuticals, antiviral therapies, and other appropriate
medicines, including medicines to treat opportunistic
infections.
``(B) Mechanisms for quality control and sustainable
supply.--Mechanisms to ensure that such HIV/AIDS
pharmaceuticals, antiretroviral therapies, and other
appropriate medicines are quality-controlled and sustainably
supplied.
``(C) Distribution.--The distribution of such HIV/AIDS
pharmaceuticals, antiviral therapies, and other appropriate
medicines (including medicines to treat opportunistic
infections) to qualified national, regional, or local
organizations for the treatment of individuals with HIV/AIDS in
accordance with appropriate HIV/AIDS testing and monitoring
requirements and treatment protocols and for the prevention of
mother-to-child transmission of the HIV infection.
``(6) Related activities.--The conduct of related activities,
including--
``(A) the care and support of children who are orphaned by
the HIV/AIDS pandemic, including services designed to care for
orphaned children in a family environment which rely on
extended family members;
``(B) improved infrastructure and institutional capacity to
develop and manage education, prevention, and treatment
programs, including training and the resources to collect and
maintain accurate HIV surveillance data to target programs and
measure the effectiveness of interventions; and
``(C) vaccine research and development partnership programs
with specific plans of action to develop a safe, effective,
accessible, preventive HIV vaccine for use throughout the
world.
``(7) Comprehensive hiv/aids public-private partnerships.--The
establishment and operation of public-private partnership entities
within countries in sub-Saharan Africa, the Caribbean, and other
countries affected by the HIV/AIDS pandemic that are dedicated to
supporting the national strategy of such countries regarding the
prevention, treatment, and monitoring of HIV/AIDS. Each such
public-private partnership should--
``(A) support the development, implementation, and
management of comprehensive HIV/AIDS plans in support of the
national HIV/AIDS strategy;
``(B) operate at all times in a manner that emphasizes
efficiency, accountability, and results-driven programs;
``(C) engage both local and foreign development partners
and donors, including businesses, government agencies, academic
institutions, nongovernmental organizations, foundations,
multilateral development agencies, and faith-based
organizations, to assist the country in coordinating and
implementing HIV/AIDS prevention, treatment, and monitoring
programs in accordance with its national HIV/AIDS strategy;
``(D) provide technical assistance, consultant services,
financial planning, monitoring and evaluation, and research in
support of the national HIV/AIDS strategy; and
``(E) establish local human resource capacities for the
national HIV/AIDS strategy through the transfer of medical,
managerial, leadership, and technical skills.
``(e) Annual Report.--
``(1) In general.--Not later than January 31 of each year, the
President shall submit to the Committee on Foreign Relations of the
Senate and the Committee on International Relations of the House of
Representatives a report on the implementation of this section for
the prior fiscal year.
``(2) Report elements.--Each report shall include--
``(A) a description of efforts made by each relevant
executive branch agency to implement the policies set forth in
this section, section 104B, and section 104C;
``(B) a description of the programs established pursuant to
such sections; and
``(C) a detailed assessment of the impact of programs
established pursuant to such sections, including--
``(i)(I) the effectiveness of such programs in reducing
the spread of the HIV infection, particularly in women and
girls, in reducing mother-to-child transmission of the HIV
infection, and in reducing mortality rates from HIV/AIDS;
and
``(II) the number of patients currently receiving
treatment for AIDS in each country that receives assistance
under this Act.
``(ii) the progress made toward improving health care
delivery systems (including the training of adequate
numbers of staff) and infrastructure to ensure increased
access to care and treatment;
``(iii) with respect to tuberculosis, the increase in
the number of people treated and the increase in number of
tuberculosis patients cured through each program, project,
or activity receiving United States foreign assistance for
tuberculosis control purposes; and
``(iv) with respect to malaria, the increase in the
number of people treated and the increase in number of
malaria patients cured through each program, project, or
activity receiving United States foreign assistance for
malaria control purposes.
``(f) Funding Limitation.--Of the funds made available to carry out
this section in any fiscal year, not morethan 7 percent may be used for
the administrative expenses of the United States Agency for
International Development in support of activities described in section
104(c), this section, section 104B, and section 104C. Such amount shall
be in addition to other amounts otherwise available for such purposes.
``(g) Definitions.--In this section:
``(1) AIDS.--The term `AIDS' means acquired immune deficiency
syndrome.
``(2) HIV.--The term `HIV' means the human immunodeficiency
virus, the pathogen that causes AIDS.
``(3) HIV/AIDS.--The term `HIV/AIDS' means, with respect to an
individual, an individual who is infected with HIV or living with
AIDS.
``(4) Relevant executive branch agencies.--The term `relevant
executive branch agencies' means the Department of State, the
United States Agency for International Development, the Department
of Health and Human Services (including its agencies and offices),
and any other department or agency of the United States that
participates in international HIV/AIDS activities pursuant to the
authorities of such department or agency or this Act.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under section
104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c))
for such purpose or under any other provision of that Act, there
are authorized to be appropriated to the President, from amounts
authorized to be appropriated under section 401, such sums as may
be necessary for each of the fiscal years 2004 through 2008 to
carry out section 104A of the Foreign Assistance Act of 1961, as
added by subsection (a).
(2) Availability of funds.--Amounts appropriated pursuant to
paragraph (1) are authorized to remain available until expended.
(3) Allocation of Funds.--Of the amount authorized to be
appropriated by paragraph (1) for the fiscal years 2004 through
2008, such sums as may be necessary are authorized to be
appropriated to carry out section 104A(d)(4) of the Foreign
Assistance Act of 1961 (as added by subsection (a)), relating to
the procurement and distribution of HIV/AIDS pharmaceuticals.
(c) Relationship to Assistance Programs to Enhance Nutrition.--In
recognition of the fact that malnutrition may hasten the progression of
HIV to AIDS and may exacerbate the decline among AIDS patients leading
to a shorter life span, the Administrator of the United States Agency
for International Development shall, as appropriate--
(1) integrate nutrition programs with HIV/AIDS activities,
generally;
(2) provide, as a component of an anti-retroviral therapy
program, support for food and nutrition to individuals infected
with and affected by HIV/AIDS; and
(3) provide support for food and nutrition for children
affected by HIV/AIDS and to communities and households caring for
children affected by HIV/AIDS.
(d) Eligibility for Assistance.--An organization that is otherwise
eligible to receive assistance under section 104A of the Foreign
Assistance Act of 1961 (as added by subsection (a)) or under any other
provision of this Act (or any amendment made by this Act) to prevent,
treat, or monitor HIV/AIDS shall not be required, as a condition of
receiving the assistance, to endorse or utilize a multisectoral
approach to combatting HIV/AIDS, or to endorse, utilize, or participate
in a prevention method or treatment program to which the organization
has a religious or moral objection.
(e) Limitation.--No funds made available to carry out this Act, or
any amendment made by this Act, may be used to promote or advocate the
legalization or practice of prostitution or sex trafficking. Nothing in
the preceding sentence shall be construed to preclude the provision to
individuals of palliative care, treatment, or post-exposure
pharmaceutical prophylaxis, and necessary pharmaceuticals and
commodities, including test kits, condoms, and, when proven effective,
microbicides.
(f) Limitation.--No funds made available to carry out this Act, or
any amendment made by this Act, may be used to provide assistance to
any group or organization that does not have a policy explicitly
opposing prostitution and sex trafficking.
(g) Sense of Congress Relating to Food Assistance for Individuals
Living With HIV/AIDS.--
(1) Findings.--Congress finds the following:
(A) The United States provides more than 60 percent of all
food assistance worldwide.
(B) According to the United Nations World Food Program and
other United Nations agencies, food insecurity of individuals
infected or living with HIV/AIDS is a major problem in
countries with large populations of such individuals,
particularly in African countries.
(C) Although the United States is willing to provide food
assistance to these countries in need, a few of the countries
object to part or all of the assistance because of fears of
benign genetic modifications to the foods.
(D) Healthy and nutritious foods for individuals infected
or living with HIV/AIDS are an important complement to HIV/AIDS
medicines for such individuals.
(E) Individuals infected with HIV have higher nutritional
requirements than individuals who are not infected with HIV,
particularly with respect to the need for protein. Also, there
is evidence to suggest that the full benefit of therapy to
treat HIV/AIDS may not be achieved in individuals who are
malnourished, particularly in pregnant and lactating women.
(2) Sense of congress.--It is therefore the sense of Congress
that United States food assistance should be accepted by countries
with large populations of individuals infected or living with HIV/
AIDS, particularly African countries, in order to help feed such
individuals.
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.),
as amended by section 301 of this Act, is further amended by inserting
after section 104A the following new section:
``SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
``(a) Findings.--Congress makes the following findings:
``(1) Congress recognizes the growing international problem of
tuberculosis and the impact its continued existence has on those
countries that had previously largely controlled the disease.
``(2) Congress further recognizes that the means exist to
control and treat tuberculosis through expanded use of the DOTS
(Directly Observed Treatment Short-course) treatment strategy,
including DOTS-Plus to address multi-drug resistant tuberculosis,
and adequate investment in newly created mechanisms to increase
access to treatment, including the Global Tuberculosis Drug
Facility established in 2001 pursuant to the Amsterdam Declaration
to Stop TB and the Global Alliance for TB Drug Development.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to control tuberculosis, including the
detection of at least 70 percent of the cases of infectious
tuberculosis, and the cure of at least 85 percent of the cases
detected, not later than December 31, 2005, in those countries
classified by the World Health Organization as among the highest
tuberculosis burden, and not later than December 31, 2010, in all
countries in which the United States Agency for International
Development has established development programs.
``(c) Authorization.--To carry out this section and consistent with
section 104(c), the President is authorized to furnish assistance, on
such terms and conditions as the President may determine, for the
prevention, treatment, control, and elimination of tuberculosis.
``(d) Coordination.--In carrying out this section, the President
shall coordinate with the World Health Organization, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, and other organizations with
respect to the development and implementation of a comprehensive
tuberculosis control program.
``(e) Priority to DOTS Coverage.--In furnishing assistance under
subsection (c), the President shall give priority to activities that
increase Directly Observed Treatment Short-course (DOTS) coverage and
treatment of multi-drug resistant tuberculosis where needed using DOTS-
Plus, including funding for the Global Tuberculosis Drug Facility, the
Stop Tuberculosis Partnership, and the Global Alliance for TB Drug
Development. In order to meet the requirement of the preceding
sentence, the President should ensure that not less than 75 percent of
the amount made available to carry out this section for a fiscal year
should be expended for antituberculosis drugs, supplies, direct patient
services, and training in diagnosis and treatment for Directly Observed
Treatment Short-course (DOTS) coverage and treatment of multi-drug
resistant tuberculosis using DOTS-Plus, including substantially
increased funding for the Global Tuberculosis Drug Facility.
``(f) Definitions.--In this section:
``(1) DOTS.--The term `DOTS' or `Directly Observed Treatment
Short-course' means the World Health Organization-recommended
strategy for treating tuberculosis.
``(2) DOTS-plus.--The term `DOTS-Plus' means a comprehensive
tuberculosis management strategy that is built upon and works as a
supplement to the standard DOTS strategy, and which takes into
account specific issues (such as use of second line anti-
tuberculosis drugs) that need to be addressed in areas where there
is high prevalence of multi-drug resistant tuberculosis.
``(3) Global alliance for tuberculosis drug development.--The
term `Global Alliance for Tuberculosis Drug Development' means the
public-private partnership that brings together leaders in health,
science, philanthropy, and private industry to devise new
approaches to tuberculosis and to ensure that new medications are
available and affordable in high tuberculosis burden countries and
other affected countries.
``(4) Global tuberculosis drug facility.--The term `Global
Tuberculosis Drug Facility (GDF)' means the new initiative of the
Stop Tuberculosis Partnership to increase access to high-quality
tuberculosis drugs to facilitate DOTS expansion.
``(5) Stop tuberculosis partnership.--The term `Stop
Tuberculosis Partnership' means the partnership of the World Health
Organization, donors including the United States, high tuberculosis
burden countries, multilateral agencies, and nongovernmental and
technical agencies committed to short- and long-term measures
required to control and eventually eliminate tuberculosis as a
public health problem in the world.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under section
104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c))
for such purpose or under any other provision of that Act, there
are authorized to be appropriated to the President, from amounts
authorized to be appropriated under section 401, such sums as may
be necessary for each of the fiscal years 2004 through 2008 to
carry out section 104B of the Foreign Assistance Act of 1961, as
added by subsection (a).
(2) Availability of funds.--Amounts appropriated pursuant to
the authorization of appropriations under paragraph (1) are
authorized to remain available until expended.
(3) Transfer of prior year funds.--Unobligated balances of
funds made available for fiscal year 2001, 2002, or 2003 under
section 104(c)(7) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c)(7) (as in effect immediately before the date of enactment
of this Act) shall be transferred to, merged with, and made
available for the same purposes as funds made available for fiscal
years 2004 through 2008 under paragraph (1).
SEC. 303. ASSISTANCE TO COMBAT MALARIA.
(a) Amendment of the Foreign Assistance Act of 1961.--Chapter 1 of
part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.),
as amended by sections 301 and 302 of this Act, is further amended by
inserting after section 104B the following new section:
``SEC. 104C. ASSISTANCE TO COMBAT MALARIA.
``(a) Finding.--Congress finds that malaria kills more people
annually than any other communicable disease except tuberculosis, that
more than 90 percent of all malaria cases are in sub-Saharan Africa,
and that children and women are particularly at risk. Congress
recognizes that there are cost-effective tools to decrease the spread
of malaria and that malaria is a curable disease if promptly diagnosed
and adequately treated.
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to provide assistance for the prevention,
control, and cure of malaria.
``(c) Authorization.--To carry out this section and consistent with
section 104(c), the President is authorized to furnish assistance, on
such terms and conditions as the President may determine, for the
prevention, treatment, control, and elimination of malaria.
``(d) Coordination.--In carrying out this section, the President
shall coordinate with the World Health Organization, the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, the Department of Health and
Human Services (the Centers for Disease Control and Prevention and the
National Institutes of Health), and other organizations with respect to
the development and implementation of a comprehensive malaria control
program.''.
(b) Authorization of Appropriations.--
(1) In general.--In addition to funds available under section
104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c))
for such purpose or under any other provision of that Act, there
are authorized to be appropriated to the President, from amounts
authorized to be appropriated under section 401, suchsums as may be
necessary for fiscal years 2004 through 2008 to carry out section 104C
of the Foreign Assistance Act of 1961, as added by subsection (a),
including for the development of anti-malarial pharmaceuticals by the
Medicines for Malaria Venture.
(2) Availability of funds.--Amounts appropriated pursuant to
paragraph (1) are authorized to remain available until expended.
(3) Transfer of prior year funds.--Unobligated balances of
funds made available for fiscal year 2001, 2002, or 2003 under
section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b(c) (as in effect immediately before the date of enactment of
this Act) and made available for the control of malaria shall be
transferred to, merged with, and made available for the same
purposes as funds made available for fiscal years 2004 through 2008
under paragraph (1).
(c) Conforming Amendment.--Section 104(c) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b(c)), as amended by section 301 of this
Act, is further amended by adding after paragraph (3) the following:
``(4) Relationship to other laws.--Assistance made available under
this subsection and sections 104A, 104B, and 104C, and assistance made
available under chapter 4 of part II to carry out the purposes of this
subsection and the provisions cited in this paragraph, may be made
available notwithstanding any other provision of law that restricts
assistance to foreign countries, except for the provisions of this
subsection, the provisions of law cited in this paragraph, subsection
(f), section 634A of this Act, and provisions of law that limit
assistance to organizations that support or participate in a program of
coercive abortion or involuntary sterilization included under the Child
Survival and Health Programs Fund heading in the Consolidated
Appropriations Resolution, 2003 (Public Law 108-7).''.
SEC. 304. PILOT PROGRAM FOR THE PLACEMENT OF HEALTH CARE PROFESSIONALS
IN OVERSEAS AREAS SEVERELY AFFECTED BY HIV/AIDS,
TUBERCULOSIS, AND MALARIA.
(a) In General.--The President should establish a program to
demonstrate the feasibility of facilitating the service of United
States health care professionals in those areas of sub-Saharan Africa
and other parts of the world severely affected by HIV/AIDS,
tuberculosis, and malaria.
(b) Requirements.--Participants in the program shall--
(1) provide basic health care services for those infected and
affected by HIV/AIDS, tuberculosis, and malaria in the area in
which they are serving;
(2) provide on-the-job training to medical and other personnel
in the area in which they are serving to strengthen the basic
health care system of the affected countries;
(3) provide health care educational training for residents of
the area in which they are serving;
(4) serve for a period of up to 3 years; and
(5) meet the eligibility requirements in subsection (d).
(c) Eligibility Requirements.--To be eligible to participate in the
program, a candidate shall--
(1) be a national of the United States who is a trained health
care professional and who meets the educational and licensure
requirements necessary to be such a professional such as a
physician, nurse, physician assistant, nurse practitioner,
pharmacist, other type of health care professional, or other
individual determined to be appropriate by the President; or
(2) be a retired commissioned officer of the Public Health
Service Corps.
(d) Recruitment.--The President shall ensure that information on
the program is widely distributed, including the distribution of
information to schools for health professionals, hospitals, clinics,
and nongovernmental organizations working in the areas of international
health and aid.
(e) Placement of Participants.--
(1) In general.--To the maximum extent practicable,
participants in the program shall serve in the poorest areas of the
affected countries, where health care needs are likely to be the
greatest. The decision on the placement of a participant should be
made in consultation with relevant officials of the affected
country at both the national and local level as well as with local
community leaders and organizations.
(2) Coordination.--Placement of participants in the program
shall be coordinated with the United States Agency for
International Development in countries in which that Agency is
conducting HIV/AIDS, tuberculosis, or malaria programs. Overall
coordination of placement of participants in the program shall be
made by the Coordinator of United States Government Activities to
Combat HIV/AIDS Globally (as described in section 1(f) of the State
Department Basic Authorities Act of 1956 (as added by section
102(a) of this Act)).
(f) Incentives.--The President may offer such incentives as the
President determines to be necessary to encourage individuals to
participate in the program, such as partial payment of principal,
interest, and related expenses on government and commercial loans for
educational expenses relating to professional health training and,
where possible, deferment of repayments on such loans, the provision of
retirement benefits that would otherwise be jeopardized by
participation in the program, and other incentives.
(g) Report.--Not later than 18 months after the date of enactment
of this Act, the President shall submit to the appropriate
congressional committees a report on steps taken to establish the
program, including--
(1) the process of recruitment, including the venues for
recruitment, the number of candidates recruited, the incentives
offered, if any, and the cost of those incentives;
(2) the process, including the criteria used, for the selection
of participants;
(3) the number of participants placed, the countries in which
they were placed, and why those countries were selected; and
(4) the potential for expansion of the program.
(h) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available for
such purpose, there are authorized to be appropriated to the
President, from amounts authorized to be appropriated under section
401, such sums as may be necessary for each of the fiscal years
2004 through 2008 to carry out the program.
(2) Availability of funds.--Amounts appropriated pursuant to
the authorization of appropriations under paragraph (1) are
authorized to remain available until expended.
SEC. 305. REPORT ON TREATMENT ACTIVITIES BY RELEVANT EXECUTIVE BRANCH
AGENCIES.
(a) In General.--Not later than 15 months after the date of
enactment of this Act, the President shall submit to appropriate
congressional committees a report on the programs and activities of the
relevant executive branch agencies that are directed to the treatment
of individuals in foreign countries infected with HIV or living with
AIDS.
(b) Report Elements.--The report shall include--
(1) a description of the activities of relevant executive
branch agencies with respect to--
(A) the treatment of opportunistic infections;
(B) the use of antiretrovirals;
(C) the status of research into successful treatment
protocols for individuals in the developing world;
(D) technical assistance and training of local health care
workers (in countries affected by the pandemic) to administer
antiretrovirals, manage side effects, and monitor patients'
viral loads and immune status;
(E) the status of strategies to promote sustainability of
HIV/AIDS pharmaceuticals (including antiretrovirals) and the
effects of drug resistance on HIV/AIDS patients; and
(F) the status of appropriate law enforcement officials
working to ensure that HIV/AIDS pharmaceutical treatment is not
diminished through illegal counterfeiting and black market
sales of such pharmaceuticals;
(2) information on existing pilot projects, including a
discussion of why a given population was selected, the number of
people treated, the cost of treatment, the mechanisms established
to ensure that treatment is being administered effectively and
safely, and plans for scaling up pilot projects (including
projected timelines and required resources); and
(3) an explanation of how those activities relate to efforts to
prevent the transmission of the HIV infection.
SEC. 306. STRATEGIES TO IMPROVE INJECTION SAFETY.
Section 307 of the Public Health Service Act (42 U.S.C. 242l) is
amended by adding at the end the following:
``(d) In carrying out immunization programs and other programs in
developing countries for the prevention, treatment, and control of
infectious diseases, including HIV/AIDS, tuberculosis, and malaria, the
Director of the Centers for Disease Control and Prevention, in
coordination with the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally, the National Institutes of
Health, national and local government, and other organizations, such as
the World Health Organization and the United Nations Children's Fund,
shall develop and implement effective strategies to improve injection
safety, including eliminating unnecessary injections, promoting sterile
injection practices and technologies, strengthening the procedures for
proper needle and syringe disposal, and improving the education and
information provided to the public and to health professionals.''.
SEC. 307. STUDY ON ILLEGAL DIVERSIONS OF PRESCRIPTION DRUGS.
Not later than 180 days after enactment of this Act, the Secretary
of Health and Human Services, in coordination with other agencies,
shall submit a report to the Congress that includes the following:
(1) A thorough accounting of evidence indicating illegal
diversion into the United States of prescription drugs donated or
sold for humanitarian efforts, and an estimate of the extent of
such diversion.
(2) Recommendations to increase the administrative and
enforcement powers of the United States to identify, monitor, and
prevent the illegal diversion into the United States of
prescription drugs donated or sold for humanitarian efforts.
(3) Recommendations and guidelines to advise and provide
technical assistance to developing countries on how to implement a
program that minimizes diversion into the United States of
prescription drugs donated or sold for humanitarian efforts.
Subtitle B--Assistance for Children and Families
SEC. 311. FINDINGS.
Congress makes the following findings:
(1) Approximately 2,000 children around the world are infected
each day with HIV through mother-to-child transmission.
Transmission can occur during pregnancy, labor, and delivery or
through breast feeding. Over 90 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) Certain antiretroviral drugs reduce mother-to-child
transmission by nearly 50 percent. Universal availability of this
drug could prevent up to 400,000 infections per year and
dramatically reduce the number of AIDS-related deaths.
(4) At the United Nations Special Session on HIV/AIDS in June
2001, the United States committed to the specific goals with
respect to the prevention of mother-to-child transmission,
including the goals of reducing the proportion of infants infected
with HIV by 20 percent by the year 2005 and by 50 percent by the
year 2010, as specified in the Declaration of Commitment on HIV/
AIDS adopted by the United Nations General Assembly at the Special
Session.
(5) Several United States Government agencies including the
United States Agency for International Development and the Centers
for Disease Control are already supporting programs to prevent
mother-to-child transmission in resource-poor nations and have the
capacity to expand these programs rapidly by working closely with
foreign governments and nongovernmental organizations.
(6) Efforts to prevent mother-to-child transmission can provide
the basis for a broader response that includes care and treatment
of mothers, fathers, and other family members who are infected with
HIV or living with AIDS.
(7) HIV/AIDS has devastated the lives of countless children and
families across the globe. Since the epidemic began, an estimated
13,200,000 children under the age of 15 have been orphaned by AIDS,
that is they have lost their mother or both parents to the disease.
The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates
that this number will double by the year 2010.
(8) HIV/AIDS also targets young people between the ages of 15
to 24, particularly young women, many of whom carry the burden of
caring for family members living with HIV/AIDS. An estimated
10,300,000 young people are now living with HIV/AIDS. One-half of
all new infections are occurring among this age group.
SEC. 312. POLICY AND REQUIREMENTS.
(a) Policy.--The United States Government's response to the global
HIV/AIDS pandemic should place high priority on the prevention of
mother-to-child transmission, the care and treatment of family members
and caregivers, and the care of children orphaned by AIDS. To the
maximum extent possible, the United States Government should seek to
leverage its funds by seeking matching contributions from the private
sector, other national governments, and international organizations.
(b) Requirements.--The 5-year United States Government strategy
required by section 101 of this Act shall--
(1) provide for meeting or exceeding the goal to reduce the
rate of mother-to-child transmission of HIV by 20 percent by 2005
and by 50 percent by 2010;
(2) include programs to make available testing and treatment to
HIV-positive women and their family members, including drug
treatment and therapies to prevent mother-to-child transmission;
and
(3) expand programs designed to care for children orphaned by
AIDS.
SEC. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
OF THE HIV INFECTION.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, and annually thereafter for a period of 5 years,
the President shall submit to appropriate congressional committees a
report on the activities of relevant executive branch agencies during
the reporting period to assist in the prevention of mother-to-child
transmission of the HIV infection.
(b) Report Elements.--Each report shall include--
(1) a statement of whether or not all relevant executive branch
agencies have met the goal described in section 312(b)(1); and
(2) a description of efforts made by the relevant executive
branch agencies to expand those activities, including--
(A) information on the number of sites supported for the
prevention of mother-to-child transmission of the HIV
infection;
(B) the specific activities supported;
(C) the number of women tested and counseled; and
(D) the number of women receiving preventative drug
therapies.
(c) Reporting Period Defined.--In this section, the term
``reporting period'' means, in the case of the initial report, the
period since the date of enactment of this Act and, in the case of any
subsequent report, the period since the date of submission of the most
recent report.
SEC. 314. PILOT PROGRAM OF ASSISTANCE FOR CHILDREN AND FAMILIES
AFFECTED BY HIV/AIDS.
(a) In General.--The President, acting through the United States
Agency for International Development, should establish a program of
assistance that would demonstrate the feasibility of the provision of
care and treatment to orphans and other children and young people
affected by HIV/AIDS in foreign countries.
(b) Program Requirements.--The program should--
(1) build upon and be integrated into programs administered as
of the date of enactment of this Act by the relevant executive
branch agencies for children affected by HIV/AIDS;
(2) work in conjunction with indigenous community-based
programs and activities, particularly those that offer proven
services for children;
(3) reduce the stigma of HIV/AIDS to encourage vulnerable
children infected with HIV or living with AIDS and their family
members and caregivers to avail themselves of voluntary counseling
and testing, and related programs, including treatments;
(4) ensure the importance of inheritance rights of women,
particularly women in African countries, due to the exponential
growth in the number of young widows, orphaned girls, and
grandmothers becoming heads of households as a result of the HIV/
AIDS pandemic;
(5) 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;
(6) provide nutritional support and food security, and the
improvement of overall family health;
(7) work with parents, caregivers, and community-based
organizations to provide children with educational opportunities;
and
(8) provide appropriate counseling and legal assistance for the
appointment of guardians and the handling of other issues relating
to the protection of children.
(c) Report.--Not later than 18 months after the date of enactment
of this Act, the President should submit a report on the implementation
of this section to the appropriate congressional committees. Such
report should include a description of activities undertaken to carry
out subsection (b)(4).
(d) Authorization of Appropriations.--
(1) In general.--In addition to amounts otherwise available for
such purpose, there are authorized to be appropriated to the
President, from amounts authorized to be appropriated under section
401, such sums as may be necessary for each of the fiscal years
2004 through 2008 to carry out the program. A significant
percentage of the amount appropriated pursuant to the authorization
of appropriations under the preceding sentence for a fiscal year
should be made available to carry out subsection (b)(4).
(2) Availability of funds.--Amounts appropriated pursuant to
paragraph (1) are authorized to remain available until expended.
SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.
(a) Purpose.--The purpose of this section is to authorize the
President to establish a program, through a public-private partnership,
for the provision of medical care and support services to HIV positive
parents and their children identified through existing programs to
prevent mother-to-child transmission of HIV in countries with or at
risk for severe HIV epidemic with particular attention to resource
constrained countries.
(b) Grants.--
(1) In general.--The President is authorized to establish a
program for the award of grants to eligible administrative
organizations to enable such organizations to award subgrants to
eligible entities to expand activities to prevent the mother-to-
child transmission of HIV by providing medical care and support
services to HIV infected parents and their children.
(2) Use of funds.--Amounts provided under a grant awarded under
paragraph (1) shall be used--
(A) to award subgrants to eligible entities to enable such
entities to carry out activities described in subsection (c);
(B) for administrative support and subgrant management;
(C) for administrative data collection and reporting
concerning grant activities;
(D) for the monitoring and evaluation of grant activities;
(E) for training and technical assistance for subgrantees;
and
(F) to promote sustainability.
(c) Subgrants.--
(1) In general.--An organization awarded a grant under
subsection (b) shall use amounts received under the grant to award
subgrants to eligible entities.
(2) Eligibility.--To be eligible to receive a subgrant under
paragraph (1), an entity shall--
(A) be a local health organization, an international
organization, or a partnership of such organizations; and
(B) demonstrate to the awarding organization that such
entity--
(i) is currently administering a proven intervention to
prevent mother-to-child transmission of HIV in countries
with or at risk for severe HIV epidemic with particular
attention to resource constrained countries, as determined
by the President;
(ii) has demonstrated support for the proposed program
from relevant government entities; and
(iii) is able to provide HIV care, including
antiretroviral treatment when medically indicated, to HIV
positive women, men, and children with the support of the
project funding.
(3) Local health and international organizations.--For purposes
of paragraph (2)(A)--
(A) the term ``local health organization'' means a public
sector health system, nongovernmental organization, institution
of higher education, community-based organization, or nonprofit
health system that provides directly, or has a clear link with
a provider for the indirect provision of, primary health care
services; and
(B) the term ``international organization'' means--
(i) a nonprofit international entity;
(ii) an international charitable institution;
(iii) a private voluntary international entity; or
(iv) a multilateral institution.
(4) Priority requirement.--In awarding subgrants under this
subsection, the organization shall give priority to eligible
applicants that are currently administering a program of proven
intervention to HIV positive individuals to prevent mother-to-child
transmission in countries with or at risk for severe HIV epidemic
with particular attention to resource constrained countries, and
who are currently administering a program to HIV positive women,
men, and children to provide life-long care in family-centered care
programs using non-Federal funds.
(5) Selection of subgrant recipients.--In awarding subgrants
under this subsection, the organization should--
(A) consider applicants from a range of health care
settings, program approaches, and geographic locations; and
(B) if appropriate, award not less than 1 grant to an
applicant to fund a national system of health care delivery to
HIV positive families.
(6) Use of subgrant funds.--An eligible entity awarded a
subgrant under this subsection shall use subgrant funds to expand
activities to prevent mother-to-child transmission of HIV by
providing medical treatment and care and support services to
parents and their children, which may include--
(A) providing treatment and therapy, when medically
indicated, to HIV-infected women, their children, and families;
(B) the hiring and training of local personnel, including
physicians, nurses, other health care providers, counselors,
social workers, outreach personnel, laboratory technicians,
data managers, and administrative support personnel;
(C) paying laboratory costs, including costs related to
necessary equipment and diagnostic testing and monitoring
(including rapid testing), complete blood counts, standard
chemistries, and liver function testing for infants, children,
and parents, and costs related to the purchase of necessary
laboratory equipment;
(D) purchasing pharmaceuticals for HIV-related conditions,
including antiretroviral therapies;
(E) funding support services, including adherence and
psychosocial support services;
(F) operational support activities; and
(G) conducting community outreach and capacity building
activities, including activities to raise the awareness of
individuals of the program carried out by the subgrantee, other
communications activities in support of the program, local
advisory board functions, and transportation necessary to
ensure program participation.
(d) Reports.--The President shall require that each organization
awarded a grant under subsection (b)(1) to submit an annual report that
includes--
(1) the progress of programs funded under this section;
(2) the benchmarks of success of programs funded under this
section; and
(3) recommendations of how best to proceed with the programs
funded under this section upon the expiration of funding under
subsection (e).
(e) Funding.--There are authorized to be appropriated to the
President, from amounts authorized to be appropriated under section
401, such sums as may be necessary for each of the fiscal years 2004
through 2008 to carry out the program.
(f) Limitation on Administrative Expenses.--An organization shall
ensure that not more than 7 percent of the amount of a grant received
under this section by the organization is used for administrative
expenses.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
President to carry out this Act and the amendments made by this Act
$3,000,000,000 for each of the fiscal years 2004 through 2008.
(b) Availability.--Amounts appropriated pursuant to the
authorization of appropriations in subsection (a) are authorized to
remain available until expended.
(c) Availability of Authorizations.--Authorizations of
appropriations under subsection (a) shall remain available until the
appropriations are made.
SEC. 402. SENSE OF CONGRESS.
(a) Increase in HIV/AIDS Antiretroviral Treatment.--It is a sense
of the Congress that an urgent priority of United States assistance
programs to fight HIV/AIDS should be the rapid increase in distribution
of antiretroviral treatment so that--
(1) by the end of fiscal year 2004, at least 500,000
individuals with HIV/AIDS are receiving antiretroviral treatment
through United States assistance programs;
(2) by the end of fiscal year 2005, at least 1,000,000 such
individuals are receiving such treatment; and
(3) by the end of fiscal year 2006, at least 2,000,000 such
individuals are receiving such treatment.
(b) Effective Distribution of HIV/AIDS Funds.--It is the sense of
Congress that, of the amounts appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
assistance, an effective distribution of such amounts would be--
(1) 55 percent of such amounts for treatment of individuals
with HIV/AIDS;
(2) 15 percent of such amounts for palliative care of
individuals with HIV/AIDS;
(3) 20 percent of such amounts for HIV/AIDS prevention
consistent with section 104A(d) of the Foreign Assistance Act of
1961 (as added by section 301 of this Act), of which such amount at
least 33 percent should be expended for abstinence-until-marriage
programs; and
(4) 10 percent of such amounts for orphans and vulnerable
children.
SEC. 403. ALLOCATION OF FUNDS.
(a) Therapeutic Medical Care.--For fiscal years 2006 through 2008,
not less than 55 percent of the amounts appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
assistance for each such fiscal year shall be expended for therapeutic
medical care of individuals infected with HIV, of which such amount at
least 75 percent should be expended for the purchase and distribution
of antiretroviral pharmaceuticals and at least 25 percent should be
expended for related care. For fiscal years 2006 through 2008, not less
than 33 percent of the amounts appropriated pursuant to the
authorization of appropriations under section 401 for HIV/AIDS
prevention consistent with section 104A(d) of the Foreign Assistance
Act of 1961 (as added by section 301 of this Act) for each such fiscal
year shall be expended for abstinence-until-marriage programs.
(b) Orphans and Vulnerable Children.--For fiscal years 2006 through
2008, not less than 10 percent of the amounts appropriated pursuant to
the authorization of appropriations under section 401 for HIV/AIDS
assistance for each such fiscal year shall be expended for assistance
for orphans and vulnerable children affected by HIV/AIDS, of which such
amount at least 50 percent shall be provided through non-profit,
nongovernmental organizations, including faith-based organizations,
that implement programs on the community level.
SEC. 404. ASSISTANCE FROM THE UNITED STATES PRIVATE SECTOR TO PREVENT
AND REDUCE HIV/AIDS IN SUB-SAHARAN AFRICA.
It is the sense of Congress that United States businesses should be
encouraged to provide assistance to sub-Saharan African countries to
prevent and reduce the incidence of HIV/AIDS in sub-Saharan Africa. In
providing such assistance, United States businesses should be
encouraged to consider the establishment of an HIV/AIDS Response Fund
in order to provide for coordination among such businesses in the
collection and distribution of the assistance to sub-Saharan African
countries.
TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS
SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.
Title XVI of the International Financial Institutions Act (22
U.S.C. 262p-262p-7) is amended by adding at the end the following new
section:
``SEC. 1625. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.
``(a) Authority.--
``(1) In general.--The Secretary of the Treasury should
immediately commence efforts within the Paris Club of Official
Creditors, the International Bank for Reconstruction and
Development, the International Monetary Fund, and other appropriate
multilateral development institutions to modify the Enhanced HIPC
Initiative so that 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 each of the first 3
years after the date of enactment of this section or the Decision
Point, whichever is later--
``(A) the net present value of the outstanding public and
publicly guaranteed debt of the country--
``(i) as of the decision point if the country has
already reached its decision point; or
``(ii) as of the date of enactment of this Act, if the
country has not reached its decision point,
to not more than 150 percent of the annual value of exports of
the country for the year preceding the Decision Point; and
``(B) the annual payments due on such public and publicly
guaranteed debt to not more than--
``(i) 10 percent or, in the case of a country suffering
a public health crisis (as defined in subsection (e)), not
more than 5 percent, of the amount of the annual current
revenues received by the country from internal resources;
or
``(ii) a percentage of the gross national product of
the country, or another benchmark, that will yield a result
substantially equivalent to that which would be achieved
through application of subparagraph (A).
``(2) Limitation.--In financing the objectives of the Enhanced
HIPC Initiative, an international financial institution shall give
priority to using its own resources.
``(b) Relation to Poverty and the Environment.--Debt cancellation
under the modifications to the Enhanced HIPC Initiative described in
subsection (a) should 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--
``(1) 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;
``(2) provides for increased cost recovery from poor people to
finance basic public services such as education, health care, clean
water, or sanitation;
``(3) 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
``(4) promotes unsustainable extraction of resources or results
in reduced budget support for environmental programs.
``(c) Conditions.--A country shall not be eligible for cancellation
of debt under modifications to the Enhanced HIPC Initiative described
in subsection (a) if the government of the country--
``(1) has an excessive level of military expenditures;
``(2) 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));
``(3) is failing to cooperate on international narcotics
control matters; or
``(4) engages in a consistent pattern of gross violations of
internationally recognized human rights (including its military or
other security forces).
``(d) Programs To Combat HIV/AIDS and Poverty.--A country that is
otherwise eligible to receive cancellation of debt under the
modifications to the Enhanced HIPC Initiative described in subsection
(a) may receive such cancellation only if the country has agreed--
``(1) to ensure that the financial benefits of debt
cancellation are applied to programs to combat HIV/AIDS and
poverty, in particular through concrete measures to improve basic
services in health, education, nutrition, and other development
priorities, and to redress environmental degradation;
``(2) to ensure that the financial benefits of debt
cancellation are in addition to the government's total spending on
poverty reduction for the previous year or the average total of
such expenditures for the previous 3 years, whichever is greater;
``(3) to implement transparent and participatory policymaking
and budget procedures, good governance, and effective
anticorruption measures; and
``(4) to broaden public participation and popular understanding
of the principles and goals of poverty reduction.
``(e) Definitions.--In this section:
``(1) Country suffering a public health crisis.--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.
``(2) Decision point.--The term `Decision Point' means the date
on which the executive boards of the International Bank for
Reconstruction and Development 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. 502. REPORT ON EXPANSION OF DEBT RELIEF TO NON-HIPC COUNTRIES.
(a) In General.--Not later than 90 days after the date of enactment
of this Act, the Secretary of the Treasury shall submit to Congress a
report on--
(1) the options and costs associated with the expansion of debt
relief provided by the Enhanced HIPC Initiative to include poor
countries that were not eligible for inclusion in the Enhanced HIPC
Initiative;
(2) options for burden-sharing among donor countries and
multilateral institutions of costs associated with the expansion of
debt relief; and
(3) options, in addition to debt relief, to ensure debt
sustainability in poor countries, particularly in cases when the
poor country has suffered an external economic shock or a natural
disaster.
(b) Specific Options To Be Considered.--Among the options for the
expansion of debt relief provided by the Enhanced HIPC Initiative,
consideration should be given to making eligible for that relief poor
countries for which outstanding public and publicly guaranteed debt
requires annual payments in excess of 10 percent or, in the case of a
country suffering a public health crisis (as defined in section 1625(e)
of the Financial Institutions Act, as added by section 501 of this
Act), not more than 5 percent, of the amount of the annual current
revenues received by the country from internal resources.
(c) Enhanced HIPC Initiative Defined.--In this section, 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. 503. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
President such sums as may be necessary for the fiscal year 2004 and
each fiscal year thereafter to carry out section 1625 of the
International Financial Institutions Act, as added by section 501 of
this Act.
(b) Availability of Funds.--Amounts appropriated pursuant to
subsection (a) are authorized to remain available until expended.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.