110 HR 1713 IH: Protection Against Transmission of HIV
U.S. House of Representatives
2007-03-27
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the
Protection Against Transmission of HIV
for Women and Youth Act of 2007
.
2.Congress finds the following:
(1)Globally, the
United Nations Joint Program on AIDS (UNAIDS) estimates that at the end of 2006
there were more than 39,500,000 people infected with HIV/AIDS, the vast
majority of whom are living in the developing world.
(2)According to the
World Health Organization (WHO) unprotected heterosexual sex is now the single
most important factor in the spread of HIV infections worldwide, representing
80 percent of new infections in sub-Saharan Africa.
(3)According to
UNAIDS, women and adolescent girls account for about half of all HIV infections
worldwide. In sub-Saharan Africa, women and girls make up 60 percent of all
infections and 76 percent of infections among those aged 15–24.
(4)Women and girls
are biologically, socially, and economically more vulnerable to HIV infection.
Gender disparities in the rate of HIV infection are the result of a number of
factors, including the following:
(A)Cross generational
sex with older men who are more likely to be infected with HIV, and a lack of
choice regarding when and whom to marry, leading to early marriages and high
rates of child marriages with older men. About half of all adolescent females
in Africa and two-thirds of adolescent females in Asia are married by age
18.
(B)High rates of
infection within marriage. Research shows that married girls are more likely to
have unprotected sex and have far more frequent sex than their unmarried peers,
indicating that marriage cannot be considered a protective factor against HIV
infection.
(C)An inability to
negotiate safe sex in marriage or with regular partners. Studies show that
married women and married and unmarried adolescent females often are unable to
negotiate the frequency and timing of sexual intercourse, ensure their
partner’s faithfulness, or insist on condom use. Women 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.
(D)Social and
economic inequalities based largely on gender which limit access for women and
girls to education and employment opportunities and which prevent them from
asserting their inheritance and property rights. For many women, 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.
(E)A lack of
educational opportunities for women and girls which are 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.
(F)High rates of
gender-based violence, rape, and sexual coercion within and outside of
marriage. According to the WHO, between one-sixth and three-quarters of women
in various countries and settings have experienced some form of physical or
sexual violence since age 15.
(G)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.
(H)An increase in
commercial sex for survival, due to pervasive poverty, social dislocation, war
and internal conflicts, and other factors. According to UNAIDS, the
vulnerability of sex workers to HIV infection is heightened by stigmatization
and marginalization, limited economic options, limited access to health,
social, and legal services, limited access to information and prevention means,
gender-related differences and inequalities, sexual exploitation and
trafficking, harmful or nonprotective legislation and policies, and exposure to
risks associated with commercial sex such as violence, substance use, and
increased mobility.
(I)Lack of access to
basic HIV prevention information, education, and services, and lack of
coordination with existing reproductive health services to reduce stigma and
maximize coverage.
(J)Lack of access to
currently available female-controlled HIV prevention methods, such as the
female condom, and lack of training on proper use of either male or female
condoms.
(K)High rates of
other sexually transmitted infections, unintended pregnancy, and complications
during pregnancy and childbirth.
(L)An absence of
legal frameworks designed to protect the rights of women and girls and the lack
of accountable and effective enforcement of such frameworks, where they
exist.
(5)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.
(6)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 (Public Law
108–25; 22 U.S.C. 7611), does not adequately focus or provide sufficient
details on how the United States Government plans to address the factors that
lead to gender disparities in the rate of HIV infection in order to
successfully prevent HIV infection among both married and unmarried women and
girls.
3.Strategy to
prevent HIV infections among married and unmarried women and girls
(a)In order to meet the stated goal of preventing 7,000,000
new HIV infections worldwide, as announced by President George W. Bush in his
address to Congress on January 28, 2003, it shall be the policy of the United
States to pursue a global HIV prevention strategy that emphasizes the immediate
and ongoing needs of married and unmarried women and girls and addresses the
factors that lead to gender disparities in the rate of HIV infection.
(b)Not
later than 180 days after the date of the enactment of this Act, the President
shall formulate and submit to the appropriate congressional committees, and
make available to the public, a comprehensive, integrated, and culturally
relevant global HIV prevention strategy that addresses the vulnerabilities of
married and unmarried women and girls to HIV infection and seeks to reduce the
factors that lead to gender disparities in the rate of HIV infection. The
strategy shall encompass comprehensive health and HIV prevention education at
the individual and population level beyond the ABC model (Abstain, Be
faithful, use Condoms
) as a means to reduce HIV infections and shall
include the following strategies:
(1)Empowering women
and girls to avoid cross-generational sex and to decide when and whom to marry
in order to reduce the incidence of early- or child-marriage.
(2)Dramatically
increasing access to currently available female-controlled prevention methods
and including investments in training to increase the effective and consistent
use of both male and female condoms.
(3)Accelerating the
destigmatization of HIV/AIDS, as women are generally at a disadvantage in
combating stigma.
(4)Addressing and
preventing the consequences of gender based violence and rape against women and
girls.
(5)Promoting male
attitudes and behavior that respect the human rights of women and girls and
that support and foster gender equality.
(6)Supporting the
development of micro-enterprise initiatives, job training programs, and other
such efforts to assist women in developing and retaining independent economic
means.
(7)Supporting
expanded educational opportunities for women and girls.
(8)Protecting the
property and inheritance rights of women.
(9)Coordinating HIV
prevention information and education services and programs for people living
with HIV/AIDS with existing health care services targeted to women and girls,
such as family planning, comprehensive reproductive health services, and
programs to reduce the transmission of HIV between parents and children, and
expanding the reach of such health services.
(10)Promoting gender
equality by supporting the development of civil society organizations focused
on the needs of women and utilizing such organizations that are already
empowering women and girls at the community level.
(11)Encouraging the
creation and effective enforcement of legal frameworks that guarantee women
equal rights and equal protection under the law.
(12)Encouraging the participation and
involvement of women in drafting, coordinating, and implementing the national
HIV/AIDS strategic plans of their countries.
(13)Responding to
other economic and social factors that increase the vulnerability of women and
girls to HIV infection.
(c)In
formulating and implementing the global 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 governments of the
countries for which the United States provides assistance to combat HIV/AIDS
and with international organizations, other donor countries, and indigenous
organizations, including, specifically, organizations focused on or providing
services to expanding and enforcing women’s rights, improving women’s health,
and expanding education for women and girls, and organizations providing
services to and advocating on behalf of individuals living with and affected by
HIV/AIDS.
(d)The President shall provide clear guidance
to field missions of the United States Government in countries for which the
United States provides assistance to combat HIV/AIDS, based on the strategies
specified under subsection (b), and shall submit to the appropriate
congressional committees and make available to the public such guidance.
(e)Not later than one year after the date of
the enactment of this Act and annually thereafter as part of the annual report
required under section 104A(e) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b–2(e)), the President shall submit to the appropriate congressional
committees and make available to the public a report on the implementation of
this Act for the prior fiscal year. The report shall include the following
information:
(1)A description of the prevention programs
designed to address the vulnerabilities to HIV/AIDS of married and unmarried
women and girls.
(2)A list of all nongovernmental organizations
in each country that receive assistance from the United States to carry out HIV
prevention activities, including the amount and the source of funding
received.
4.Balancing funding
for HIV prevention methods
(a)Congress
finds the following:
(1)While effective
evidence-based and measurable strategies for delaying sexual debut are critical
components of comprehensive HIV prevention programs, current United States
funded HIV prevention programs based on the ABC model of Abstain, Be
faithful, use Condoms
are too narrow in scope and do not respond to the
specific vulnerabilities of women and girls.
(2)In
order to maximize the impact of United States foreign assistance to combat
HIV/AIDS, all sexually active persons in each country must be equipped with all
the skills and tools necessary to avoid infection, including information and
training on delay of sexual debut and the practice of safer sex, whether sexual
activity begins within or outside of marriage.
(3)Under section
403(a) of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (Public Law 108–25; 22 U.S.C. 7673), 33 percent of all
United States foreign assistance provided for preventing the spread of HIV must
be spent on abstinence-until-marriage programs. Based on operational guidance
to field missions of the United States Government, in order to meet this
requirement, 50 percent of all United States foreign assistance provided for
preventing the spread of HIV at the country level must be spent on prevention
of sexual transmission and 66 percent of all such funding for sexual
transmission must be spent on the Abstinence and Be faithful components of the
ABC model.
(4)A
recent report by the Government Accountability Office (Global Health: Spending
Requirement Presents Challenges for Allocating Prevention Funding under the
President’s Emergency Plan for AIDS Relief, GAO–06–395, April 4, 2006) found
the following:
(A)Because it requires
country teams to segregate the Abstinence and Be faithful components of the ABC
model from funding for other prevention
, the
abstinence-until-marriage spending requirement can undermine the team’s ability
to design and implement programs that integrate the components of the ABC
model, one of the guiding principles of the President’s Emergency Plan for AIDS
Relief (PEPFAR) sexual transmission prevention strategy. Eight of the 15 focus
country teams indicated that segregating the Abstinence and Be faithful
components of the ABC model from other prevention
funding
compromised the integration of their programs. Examples of the problems they
cited include the following:
(i)Segregating
program funding compromises the integration of ABC activities, especially for
at-risk groups that need comprehensive messages.
(ii)Segregating
program funding limits some country teams’ ability to shift program focuses to
meet changing prevention needs.
(B)A large majority
of the 20 PEPFAR country teams required to meet the abstinence-until-marriage
spending requirement or obtain exemptions reported that the requirement
presented challenges to their efforts to respond to local prevention needs.
Seventeen of these teams reported, either through documents submitted to the
Office of the Global AIDS Coordinator (OGAC) or through structured interviews,
that meeting the spending requirement, including OGAC’s 50 percent and 66
percent policies implementing it, challenged their ability to develop
interventions that are responsive to local epidemiology and social
norms.
(C)Between September
2005 and January 2006, ten of these teams submitted documents to OGAC
requesting exemption from the spending requirement as it was defined in OGAC’s
August 2005 guidance. These documents highlight various challenges that the
country teams associated with meeting the spending requirement, including the
following:
(i)Reduced spending
for Prevention of Mother to Child Transmission (PMTCT).
(ii)Limited funding
to deliver appropriate prevention messaging to high-risk groups.
(iii)Lack of
responsiveness to cultural and social norms.
(iv)Cuts in medical
and blood safety activities.
(v)Elimination of
care programs.
(D)In addition, seven
teams that did not submit documents requesting exemption from the spending
requirement (they did not meet OGAC’s proposed criteria for requesting
exemptions) identified, in structured interviews, specific program constraints
related to meeting the abstinence-until-marriage spending requirement. These
constraints included the following:
(i)Difficulty
reaching certain populations with comprehensive ABC messages.
(ii)Limited or
reduced funding for programs targeted at high-risk groups.
(iii)Reduced funding
for PMTCT services.
(iv)Difficulty
funding programs for condom procurement and condom social marketing.
(b)In carrying out the activities required by the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(Public Law 108–25; 22 U.S.C. 7601 et seq.) and the amendments made by that
Act, it shall be the policy of the United States—
(1)to provide
flexibility to support the implementation of culturally relevant HIV prevention
programs that are carried out in accordance with the global HIV prevention
strategy established pursuant to section 3 of this Act;
(2)to ensure that
onerous requirements are not imposed with respect to how funds made available
for such programs can be obligated and expended; and
(3)to prevent the
unnecessary reduction in funding for effective HIV programs in order to meet
any such onerous requirements.
(c)Amendments to
funding provisions of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003
(1)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)Section 403(a) of such Act (22 U.S.C. 7673(a)) is amended
by striking the second sentence.
5.In this Act:
(1)The
term AIDS
means the acquired immune deficiency syndrome.
(2)Appropriate
congressional committeesThe term appropriate
congressional committees
means the Committee on Foreign Affairs of the
House of Representatives and the Committee on Foreign Relations of the
Senate.
(3)The
term HIV
means the human immunodeficiency virus, the pathogen
that causes AIDS.
(4)The
term HIV/AIDS
means, with respect to an individual, an
individual who is infected with HIV or living with AIDS.