[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1553 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 1553

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 6, 2007

  Mrs. Feinstein (for herself, Ms. Snowe, Mr. Leahy, Mr. Durbin, Mr. 
Lautenberg, Mrs. Clinton, Mr. Brown, Mr. Kerry, Mr. Dodd, Mrs. Murray, 
Mr. Feingold, and Mrs. Boxer) 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 Act of 2007''.

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) According to the Joint United Nations Programme on HIV/
        AIDS, young people between the ages of 15 and 24 years old are 
        ``the most threatened by AIDS'' and ``are at the centre of HIV 
        vulnerability''. Globally, young people between the ages of 10 
        and 24 years old account for \1/2\ of all new HIV cases each 
        year. About 7,000 young people in this cohort contract the 
        virus every day.
            (4) A recent review funded by the United States Agency for 
        International Development 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.
            (5) The United States Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.) 
        requires that at least \1/3\ of all prevention funds be 
        reserved for abstinence-until-marriage programs.
            (6) A congressionally mandated review by the Institute of 
        Medicine of the first 3 years of PEPFAR unequivocally 
        recommends greater flexibility in the global fight against 
        AIDS. The March 2007 Institute of Medicine report entitled 
        ``PEPFAR Implementation: Progress and Promise'' calls for 
        greater emphasis on prevention than the law currently allows 
        and says that ``removal of the abstinence-until-marriage'' 
        earmark, among other changes, ``could enhance the quality, 
        accountability, and flexibility'' of prevention efforts.
            (7) The Institute of Medicine report further found that the 
        abstinence-until-marriage earmark ``has greatly limited the 
        ability of Country Teams to develop and implement comprehensive 
        prevention programs that are well integrated with each other 
        and with counseling and testing, care and treatment programs 
        and that target those populations at greatest risk''.
            (8) The Institute of Medicine report also found that the 
        earmark has ``limited PEPFAR's ability to tailor its activities 
        in each country to the local epidemic and to coordinate with . 
        . . the countries' national plans''.
            (9) The Institute of Medicine report is in keeping with the 
        conclusions of a report issued in 2006 by the Government 
        Accountability Office. The GAO report, entitled ``Spending 
        Requirement Presents Challenges for Allocating Funding under 
        the President's Emergency Plan for AIDS Relief'', found 
        ``significant challenges'' associated with meeting the earmark 
        for abstinence-until-marriage programs.
            (10) The Government Accountability Office 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.
            (11) The Government Accountability Office 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.
            (12) The Government Accountability Office 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.
            (13) The Government Accountability Office 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.
            (14) The Government Accountability Office found that the 
        abstinence-until-marriage spending requirement made it 
        difficult for countries to fund medical and blood safety 
        activities.
            (15) The Government Accountability Office 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.
            (16) In addition, the Government Accountability Office 
        found that \2/3\ of focus country teams reported that the 
        policy for implementing PEPFAR's ABC model (defined as 
        ``Abstain, Be faithful, use Condoms'') is unclear and open to 
        varying interpretations, causing confusion about which groups 
        may be targeted and whether youth may receive the ABC message.
            (17) The Government Accountability Office 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.
            (18) Young people are our greatest hope for changing the 
        course of the AIDS epidemic. According to the World Health 
        Organization, ``[f]ocusing on young people is likely to be the 
        most effective approach to confronting the epidemic, 
        particularly in high prevalence countries''.

SEC. 3. ENSURING BALANCED FUNDING FOR HIV PREVENTION METHODS.

    (a) Sense of Congress on Abstinence-Until-Marriage Funding 
Requirement.--Section 402(b)(3) of the United States Leadership Against 
HIV/AIDS, Tuburculosis, 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''.
    (b) Elimination of Abstinence-Until-Marriage Funding Requirement.--
Section 403(a) of such Act (22 U.S.C. 7673(a)) is amended by striking 
the second sentence.
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