[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4792 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 4792

To require the President to establish a comprehensive, integrated, and 
  culturally appropriate HIV prevention strategy that emphasizes the 
 needs of women and girls for each country for which the United States 
    provides assistance to combat HIV/AIDS, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 9, 2004

Ms. Lee (for herself, Mr. Lantos, Mr. Wexler, Mr. Payne, Mr. McGovern, 
 Mr. Grijalva, Ms. Corrine Brown of Florida, Mr. Owens, Mr. Rush, Ms. 
   Waters, Ms. Norton, Mr. Conyers, Mr. Brown of Ohio, Mr. Bell, Mr. 
   McDermott, Mr. Crowley, Mr. Gutierrez, Ms. Carson of Indiana, Mr. 
   Pallone, Mr. Davis of Illinois, Mrs. Maloney, Mr. Delahunt, Mrs. 
    Christensen, Mr. Cummings, Mr. Doggett, Mr. Olver, Mr. Frank of 
 Massachusetts, Ms. Jackson-Lee of Texas, Mr. Waxman, Ms. Watson, Ms. 
    Kilpatrick, Ms. Eddie Bernice Johnson of Texas, Mr. Thompson of 
Mississippi, Mr. Jackson of Illinois, Mr. Scott of Virginia, Mr. Scott 
of Georgia, Mr. Lewis of Georgia, Mr. Clyburn, Ms. Millender-McDonald, 
   Mr. Bishop of Georgia, Ms. McCollum, Mr. Wynn, Mr. Kucinich, Mr. 
  Rangel, Ms. Solis, Mr. Dicks, Ms. Schakowsky, Mrs. McCarthy of New 
York, Mr. Meeks of New York, Mr. Dingell, Mr. Berman, Ms. DeLauro, Mrs. 
 Jones of Ohio, Mr. Moran of Virginia, and Mr. Serrano) introduced the 
 following bill; which was referred to the Committee on International 
                               Relations

_______________________________________________________________________

                                 A BILL


 
To require the President to establish a comprehensive, integrated, and 
  culturally appropriate HIV prevention strategy that emphasizes the 
 needs of women and girls for each country for which the United States 
    provides assistance to combat HIV/AIDS, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``New United States Global HIV 
Prevention Strategy to Address the Needs of Women and Girls Act of 
2004''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Globally, the United Nations Joint Programme on HIV/
        AIDS (UNAIDS) estimates that there are more than 40,000,000 
        people infected with HIV/AIDS, the vast majority of whom live 
        in the developing world. For a number of reasons, women and 
        girls are biologically, socially, and economically more 
        vulnerable to HIV infection, and today they represent more than 
        half of all individuals who are infected with HIV worldwide.
            (2) In sub-Saharan Africa, women and girls make up 60 
        percent of those individuals infected with HIV. Data from 
        several countries in Africa indicate that women ages 15 to 24 
        are from two and a half to thirteen times more likely to be 
        infected with HIV as their male counterparts.
            (3) Gender disparities in the rates of HIV infection are 
        the result of a number of factors, including--
                    (A) inadequate knowledge about how HIV is 
                transmitted;
                    (B) lack of access to basic HIV prevention and 
                reproductive health services;
                    (C) an inability to negotiate safer sex with 
                regular partners;
                    (D) social norms that prevent frank and open 
                discussions about sex;
                    (E) a lack of access to female-controlled HIV 
                prevention methods, such as the female condom and, when 
                available, microbicides; and
                    (F) social and economic inequalities based largely 
                on gender.
            (4) Current HIV prevention programs designed to support the 
        ABC model: ``Abstain, Be faithful, use Condoms'', are not 
        always effective at addressing the central fact that women and 
        girls are often powerless to abstain from sex, ensure their 
        partner's faithfulness, or to insist on condom use even within 
        marriage, and especially in the case of early- or child-
        marriages. Women may also be coerced into unprotected sex and 
        they often run the risk of being infected by husbands or male 
        partners in societies where it is common or accepted for men to 
        have more than one partner.
            (5) Recognizing that current international HIV prevention 
        and protection efforts are failing women and girls, UNAIDS 
        officially launched the Global Coalition on Women and AIDS on 
        February 2, 2004, to focus on preventing new HIV infections 
        among women and girls, promoting equal access to HIV care and 
        treatment, increasing access to female-controlled prevention 
        methods such as female condoms, accelerating microbicides 
        research, protecting women's property and inheritance rights, 
        supporting ongoing efforts toward reaching universal primary 
        education for girls, and reducing violence against women.
            (6) Violence against women, perpetuated by their intimate 
        partners, is a major human rights and public health problem 
        throughout the world and it is also a major contributing factor 
        to the spread of HIV. According to the World Health 
        Organization (WHO), one-fifth to one-third of women ages 15 to 
        49 have experienced some form of physical abuse or sexual 
        coercion in their lifetimes, the vast majority within marriage.
            (7) Unfortunately, current HIV prevention programs do not 
        place enough importance on responding to violence against 
        women, changing the social norms that shape the attitudes and 
        behaviors of men and boys toward women and girls, or using 
        strategies to promote effective communication among couples on 
        matters of sex and reproduction.
            (8) The fear of domestic violence and the continuing stigma 
        and discrimination associated with HIV/AIDS prevents many women 
        from accessing information about HIV/AIDS, getting tested, 
        disclosing their HIV status, accessing services to prevent 
        mother-to-child transmission, or receiving treatment and 
        counseling even when they already know they have been infected 
        with HIV.
            (9) Economic and social disparities between men and women 
        amplify the effects of stigma and discrimination, the fear of 
        domestic violence, and other risks of HIV infection faced by 
        women and girls. Unequal access to education, income, land, and 
        other productive resources leaves many women and girls 
        dependent on men for income, housing, sustenance and social 
        security.
            (10) For women and girls, gender discrimination in the 
        ownership and retention of property also contributes to an 
        increased risk of sexual abuse, exploitation, and HIV 
        infection. As women's property rights are violated on a massive 
        scale by in-laws, relatives, communities, and government 
        officials, the impact on women and their dependents is 
        catastrophic. Many women end up homeless or living in slums, 
        begging for food and water, unable to afford health care or 
        school fees for their children, and many women resort to 
        working as commercial sex workers in order to make ends meet.
            (11) For many women, the combination of stigma, violence, 
        and a lack of independent economic means sustains their fear of 
        abandonment, eviction, or ostracism from their homes and 
        communities, and can leave many more of them trapped within 
        relationships where they are vulnerable to HIV infection.
            (12) Women also face additional obstacles due to the 
        pervasiveness of discriminatory legal frameworks that fail to 
        guarantee equal rights or equal protection before the law. In 
        many cases, inequitable divorce and property laws make it 
        difficult for women to leave abusive relationships, and in 
        countries where laws against gender violence exist, 
        insufficient resources, coupled with discriminatory practices 
        by police and courts and a lack of institutional support, leave 
        women without access to adequate protection.
            (13) Recently, numerous studies have emerged indicating 
        that early or child marriage cannot be considered a protective 
        factor against HIV infection. These studies show that young 
        women between the ages of 15-19 who are married are at 
        significantly higher risk of contracting HIV/AIDS than single 
        women of the same age, in some cases by as much as 10 percent.
            (14) There are several reasons that sexually active 
        unmarried girls are less vulnerable to HIV infection than 
        married adolescent girls, including the fact that they tend to 
        have sex less frequently, are more likely to have sex with 
        those closer to their own age, and because they are more likely 
        to use condoms during sex. The result is that in many countries 
        today, most sexually transmitted HIV infections in females 
        occur either inside marriage or in relationships women believe 
        to be monogamous.
            (15) Efforts to expand access to education for women and 
        girls and to increase the age at which they marry are also 
        critical to increasing the social and economic power of women, 
        reducing the spread of HIV, and to the attainment of overall 
        health and development goals. For women and girls, education is 
        linked to delayed intercourse, increased age-at-marriage, 
        delayed childbearing, increased child survival, improved 
        nutrition, and reduced risk of HIV infection, among other 
        positive outcomes.
            (16) Although attendance at school is considered a 
        protective factor in preventing transmission of HIV, recent 
        studies indicate that young women between the ages of 15-19 who 
        are married and do not have children are less likely to be in 
        school than single women of the same age who do not have 
        children. In some instances the difference is striking, as in 
        the case of Nigeria, where 3 percent of young married women are 
        in school, as compared to 70 percent of young single women.
            (17) As a result of these studies, HIV prevention programs 
        that strictly focus on promoting abstinence-until-marriage and 
        do not provide comprehensive health and sexuality education 
        fail to adequately address the true vulnerabilities faced by 
        women, especially younger women, or to equip them properly with 
        the full range of tools they need to protect themselves.
            (18) A substantial body of evidence also exists to support 
        the coordination of HIV prevention initiatives, including 
        programs to prevent the transmission of HIV from mother-to-
        child, with existing health care services, especially family 
        planning and reproductive health programs, as the health and 
        well-being of women and girls is improved when they have access 
        to comprehensive care that is designed to address their needs.
            (19) Over the last forty years, the United States has made 
        substantial investments in building basic health care services 
        for mothers and children, including family planning and 
        reproductive health care programs. In many cases these programs 
        serve as a trusted source of health information and resources 
        to women, both for their own health and well-being, and that of 
        their children. Frequently, these types of coordinated programs 
        can also serve as a source of information and resources free 
        from the stigma frequently associated with stand-alone HIV 
        prevention programs.
            (20) The United States already works to coordinate HIV 
        prevention services with existing family planning and 
        reproductive health care programs, as they represent a readily 
        available platform upon which to build new initiatives. Such 
        efforts should continue as part of any global expansion of HIV 
        prevention services in order to produce an efficient and 
        effective global health policy.
            (21) Efforts to increase women's access to comprehensive 
        prevention information and services, address gender violence, 
        increase women's economic and social status, and foster 
        equitable partnerships between women and men are all central to 
        reducing the spread of HIV/AIDS worldwide and to enhancing the 
        success of effective treatment and care programs supported by 
        the United States.
            (22) The comprehensive, integrated, five-year strategy to 
        combat global HIV/AIDS submitted to Congress on February 23, 
        2004, as required by section 101 of the United States 
        Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
        2003 (22 U.S.C. 7611), does not adequately focus or provide 
        sufficient details on United States Government strategies to 
        prevent HIV infection among women and girls.

SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS ON A COUNTRY-BY-COUNTRY 
              BASIS.

    (a) Statement of Policy.--In order to meet the stated goal of 
preventing 7,000,000 new HIV infections, as announced by the President 
in his address to Congress on January 28, 2003, it shall be the policy 
of the United States to pursue an HIV prevention strategy for each 
country for which the United States provides assistance to combat HIV/
AIDS that emphasizes the immediate and ongoing needs of women and girls 
in those countries.
    (b) Strategy.--Not later than 90 days after the date of the 
enactment of this Act, the President shall establish a comprehensive, 
integrated, and culturally appropriate HIV prevention strategy for each 
country for which the United States provides assistance to combat HIV/
AIDS. Each such strategy shall encompass comprehensive health and HIV 
prevention education beyond the ABC model: ``Abstain, Be faithful, use 
Condoms'', as a means to reduce HIV infections, particularly among 
women and girls, and which strengthens the capacity of the United 
States to be an effective leader of the international campaign against 
HIV/AIDS. Each such strategy shall also include the following:
            (1) Increasing access to female-controlled prevention 
        methods, most immediately, access to female condoms, and 
        including training to ensure effective and consistent use of 
        such condoms.
            (2) Accelerating destigmatization of HIV/AIDS, as women are 
        generally at a disadvantage in combating stigma.
            (3) Empowering women and girls to avoid cross-generational 
        sex and reduce the incidence of early- or child-marriage.
            (4) Reducing violence against women.
            (5) Supporting the development of microenterprise programs 
        and other such efforts to assist women in developing and 
        retaining independent economic means.
            (6) Promoting positive male behavior toward women and 
        girls.
            (7) Supporting expanded educational opportunities for women 
        and girls.
            (8) Protecting the property and inheritance rights of 
        women.
            (9) Coordinating HIV prevention services with existing 
        health care services, including programs intended to reduce the 
        transmission of HIV between mother-to-child, and family 
        planning and reproductive health services.
            (10) Promoting gender equality by supporting the 
        development of civil society organizations focused on the needs 
        of women, and by encouraging the creation and effective 
        enforcement of legal frameworks that guarantee women equal 
        rights and equal protection under the law.
    (c) Coordination.--
            (1) In general.--In formulating each HIV prevention 
        strategy pursuant to subsection (b), the President shall ensure 
        that the United States coordinates its overall HIV/AIDS policy 
        and programs with the national government of the country 
        involved and with other donor countries and organizations 
        through the Three Ones Principles. Such coordination shall 
        include proper consultation and dialogue with both indigenous 
        and international nongovernmental organizations (including 
        faith- and community-based organizations) that work to combat 
        HIV/AIDS or that specifically work to address the needs of 
        women and girls through comprehensive health care, education, 
        or income-generating programs.
            (2) Definition.--In paragraph (1), the term ``Three Ones 
        Principles'' means the following three guiding principles which 
        provide a framework for coordinated action on HIV/AIDS at the 
        country level, as developed by the United Nations Joint 
        Programme on HIV/AIDS (UNAIDS) and agreed to by the United 
        States and other donor countries and organizations on April 25, 
        2004:
                    (A) One national HIV/AIDS action framework that 
                provides the basis for coordinating the work of the 
                national government and all organizations in a country.
                    (B) One national HIV/AIDS coordinating authority 
                for the country, with a broad multi-sector mandate.
                    (C) One national HIV/AIDS monitoring and evaluation 
                system for the country.
    (d) Report.--Not later than 180 days after the date of the 
enactment of this Act, the President shall transmit to the appropriate 
congressional committees and make available to the public a report 
that--
            (1) contains a description of each HIV prevention strategy 
        established pursuant to subsection (b) and a description of any 
        ongoing United States-supported activities that relate to the 
        elements of each such strategy as described in paragraphs (1) 
        through (10) of subsection (b); and
            (2) includes a list of the nongovernmental organizations 
        (including faith- and community-based organizations) in each 
        country that carry out such activities, the amount and the 
        source of funding received, and the overall goals and 
        implementation strategy of such activities

SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METHODS.

    (a) Finding.--Congress finds that while in some cases abstinence 
programs may help to delay sexual debut among young people, when such 
programs are not combined with comprehensive sexuality and life skills 
education, these programs can leave young people who eventually do 
become sexually active without the appropriate knowledge to protect 
themselves from sexually-transmitted diseases such as HIV.
    (b) Statement of Policy.--In carrying out the activities required 
by the United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7601 et seq.; Public Law 108-25), and 
the amendments made by that Act, it shall be the policy of the United 
States--
            (1) to provide flexibility to support a variety of 
        culturally appropriate HIV prevention programs that are carried 
        out in accordance with the HIV prevention strategy for each 
        country for which the United States provides assistance to 
        combat HIV/AIDS, as established pursuant to section 3 of this 
        Act; and
            (2) to ensure that unnecessary requirements are not imposed 
        with respect to how funds made available for such programs can 
        be obligated and expended.
    (c) Amendments to Funding Provisions of Public Law 108-25.--
            (1) Sense of congress.--Section 402(b)(3) of the United 
        States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Act of 2003 (22 U.S.C. 7672(b)(3)) is amended by striking ``, 
        of which such amount at least 33 percent should be expended for 
        abstinence-until-marriage programs''.
            (2) Allocation of funds.--Section 403(a) of such Act (22 
        U.S.C. 7673(a)) is amended by striking the second sentence.

SEC. 5. 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 
        International Relations of the House of Representatives and the 
        Committee on Foreign Relations of the Senate.
            (3) HIV.--The term ``HIV'' means the human immunodeficiency 
        virus, the pathogen that causes AIDS.
            (4) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to 
        an individual, an individual who is infected with HIV or living 
        with AIDS.
                                 <all>