[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3656 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 3656

To provide additional assistance to combat HIV/AIDS among young people, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 13, 2006

  Mrs. Feinstein (for herself and Ms. Snowe) introduced the following 
  bill; which was read twice and referred to the Committee on Foreign 
                               Relations

_______________________________________________________________________

                                 A BILL


 
To provide additional assistance to combat HIV/AIDS among young people, 
                        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 ``HIV Prevention for Youth Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The President's Emergency Plan for AIDS Relief (in this 
        Act referred to as ``PEPFAR'') is an unprecedented effort to 
        combat the global AIDS epidemic, with $9,000,000,000 targeted 
        for initiatives in 15 focus countries.
            (2) The PEPFAR prevention goal is to avert 7,000,000 HIV 
        infections in the 15 focus countries--most in sub-Saharan 
        Africa where heterosexual intercourse is by far the predominant 
        mode of HIV transmission.
            (3) The PEPFAR strategy for prevention of sexual 
        transmission of HIV is shaped by 3 elements: the ABC model, 
        defined as ``Abstain, Be faithful, use Condoms'', the promotion 
        of ``abstinence-until-marriage'', and deference to local 
        prevention needs.
            (4) The United States Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Act of 2003 requires that at least 
        one-third of all prevention funds be reserved for abstinence-
        until-marriage programs. In implementing this requirement, the 
        U.S. Global AIDS Coordinator has required that 50 percent of 
        prevention funding be dedicated to sexual transmission 
        prevention activities. This requirement severely limits 
        countries from employing strategies for the prevention of 
        sexual transmission other than abstinence, because the other 
        sexual transmission prevention programs under PEPFAR (such as 
        the purchase of condoms and management of sexually transmitted 
        infections) cannot exceed one-sixth of the total prevention 
        funds.
            (5) The Government Accountability Office (GAO) issued a 
        report in April, 2006, ``Spending Requirement Presents 
        Challenges For Allocating Funding under the President's 
        Emergency Plan for AIDS Relief'', that found ``significant 
        challenges'' associated with meeting the earmark for 
        abstinence-until-marriage programs.
            (6) GAO found that a majority of country teams report that 
        fulfilling the requirement presents challenges to their ability 
        to respond to local epidemiology and cultural and social norms.
            (7) GAO found that, although some country teams may be 
        exempted from the abstinence-until-marriage spending 
        requirement, country teams that are not exempted have to spend 
        more than the 33 percent of prevention funds on abstinence-
        until-marriage activities--sometimes at the expense of other 
        programs.
            (8) Indeed, according to GAO, the proportion of HIV 
        prevention funds dedicated to ``other prevention'' activities 
        (i.e. the purchase and promotion of condoms, management of 
        sexually transmitted infections other than HIV, and messages or 
        programs to reduce injection drug use) declined from 23 percent 
        in fiscal year 2005 to 18 percent in fiscal year 2006 for 
        country teams that did not receive exemptions.
            (9) GAO found that, as a result of the abstinence-until-
        marriage spending requirement, some countries have had to 
        reduce planned funding for Prevention of Mother-to-Child 
        Transmission programs, thereby limiting services for pregnant 
        women and their children.
            (10) GAO found that the abstinence-until-marriage spending 
        requirement limited or reduced funding for programs directed to 
        high-risk groups, such as services for married discordant 
        couples, sexually active youth, and commercial sex workers.
            (11) GAO found that the abstinence-until-marriage spending 
        requirement made it difficult for countries to fund medical and 
        blood safety activities.
            (12) GAO found that, because of the abstinence-until-
        marriage spending requirement, some countries would likely have 
        to reduce funding for condom procurement and condom social 
        marketing.
            (13) In addition, GAO found that two-thirds of focus 
        country teams reported that the policy for implementing the ABC 
        model is unclear and open to varying interpretations, causing 
        confusion about which groups may be targeted and whether youth 
        may receive the ABC message.
            (14) GAO found that the ABC guidance does not clearly 
        delineate permissible C activities under the ABC model. Program 
        staff reported that they feel ``constrained'' by restrictions 
        on promoting or marketing condoms to youth. Other country teams 
        reported confusion about whether PEPFAR funds may be used for 
        broad condom social marketing, even to adults in a generalized 
        epidemic.
            (15) Each day, an estimated 13,400 people worldwide are 
        newly infected with HIV.
            (16) Sub-Saharan Africa is home to almost two-thirds of the 
        estimated 40,000,000 people currently living with HIV.
            (17) In many African countries, the epidemic has spread 
        among the general population. The HIV prevalence rate for the 
        general population is 8 percent across sub-Saharan Africa. 
        Among the United States focus countries in sub-Saharan Africa, 
        the HIV prevalence rate ranges from 4 percent in Uganda to 37 
        percent in Botswana.
            (18) According to the Joint United Nations Programme on 
        HIV/AIDS, young people between the ages of 15 and 24 are ``the 
        most threatened by AIDS'' and ``are at the centre of HIV 
        vulnerability''. Globally, this age group accounts for half of 
        all new HIV cases each year. More than 7,000 young people 
        contract the virus every day.
            (19) Most young people in sub-Saharan Africa have sex 
        before marriage during their adolescent years. In many 
        countries, at least half of all women have sex before age 20 
        and before marriage. Among young men, more than 70 percent have 
        premarital sex before age 20.
            (20) Many adolescents, who are sexually active and not yet 
        married, have inadequate information on how to protect 
        themselves against HIV. Fewer than half of young people in sub-
        Saharan Africa mention abstinence, monogamy, or condom use as a 
        way of avoiding HIV.
            (21) Young people who have sex are at greater risk of 
        acquiring HIV than adults, partly because of their lack of 
        knowledge. They are apt to change partners frequently, have 
        more than 1 partner in the same time period, or engage in 
        unprotected sex.
            (22) Coercion and sexual violence undercut the ability of 
        young people--women in particular--to prevent HIV and 
        contribute to the vulnerability to infection. In addition, 
        gender inequality makes it much more difficult for young women 
        to negotiate abstinence from sex or to insist that their 
        partners remain faithful or use condoms.
            (23) Marriage does not protect young women from HIV, even 
        when they are faithful to their husbands. In some settings, it 
        appears marriage actually increases a woman's HIV risk. In some 
        African countries, married women aged 15-19 have higher HIV 
        infection levels than nonmarried sexually active women of the 
        same age.
            (24) A recent USAID-funded review found that sex and HIV 
        education programs that encourage abstinence but also discuss 
        the use of condoms do not increase sexual activity as critics 
        of sex education have long alleged. Sex education can help 
        delay the initiation of intercourse, reduce the frequency of 
        sex and the number of sexual partners, and also increase condom 
        use.
            (25) Young people are our greatest hope for changing the 
        course of the AIDS epidemic. According to the World Health 
        Organization, ``Focusing on young people is likely to be the 
        most effective approach to confronting the epidemic, 
        particularly in high prevalence countries.''.

SEC. 3. SENSE OF CONGRESS.

    It is the sense of Congress that sexually active young people, both 
unmarried and married, who live in a country where HIV infection is 
spreading through the general population, rather than being confined to 
specific populations, such as sex workers and their clients, injecting 
drug users, and men who have sex with men, and the rate of HIV 
infection among people between the ages of 15 and 49 exceeds 1 percent 
should be--
            (1) considered at high risk of contracting HIV infection; 
        and
            (2) provided with the knowledge, skill-building programs, 
        and tools to protect themselves from HIV infection, including--
                    (A) medically accurate information on public health 
                benefits and failure rates of multiple strategies for 
                eliminating or reducing the risks of contracting HIV 
                and other sexually transmitted infections; and
                    (B) information about correct and consistent use of 
                condoms as well as abstinence and the importance of 
                reducing casual sexual partnering.

SEC. 4. ALLOCATION OF FUNDS.

    Section 403 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is amended--
            (1) in subsection (a), in the second sentence, by striking 
        ``HIV/AIDS prevention'' and inserting ``prevention of the 
        sexual transmission of HIV''; and
            (2) by adding at the end the following new subsection:
    ``(c) Abstinence-Until-Marriage Programs.--The term `abstinence-
until-marriage programs' means programs that place the highest priority 
on encouraging individuals who have not yet married to abstain from 
sexual activity, which if practiced 100 percent correctly and 
consistently is the only certain way to protect against exposure to HIV 
and other sexually transmitted infections. The programs include 
information on the health benefits of delayed sexual debut in reducing 
the transmission of HIV and may be used to support the wide range of 
approaches that promote skill-building strategies for practicing 
abstinence.''.

SEC. 5. ASSISTANCE TO YOUNG PEOPLE.

    Section 104A(d)(3) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b-2(d)(3)) is amended--
            (1) in subparagraph (A), by inserting ``sexually active 
        young people, both unmarried and married, who live in a country 
        experiencing a generalized HIV epidemic,'' after ``infected 
        with HIV/AIDS,''; and
            (2) by adding at the end the following new subparagraph:
            ``(C) In subparagraph (A), the term `generalized epidemic' 
        means, with respect to a country, that--
                    ``(i) HIV infection is spreading through the 
                general population of such country, rather than being 
                confined to specific populations, such as sex workers 
                and their clients, injecting drug users, and men who 
                have sex with men; and
                    ``(ii) the rate of HIV infection among people 
                between the ages of 15 and 49 exceeds 1 percent.''.
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