[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.