[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2415 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 2415

To require the President and the Office of the Global AIDS Coordinator 
to establish a comprehensive and integrated HIV prevention strategy to 
 address the vulnerabilities of women and girls in countries for which 
the United States provides assistance to combat HIV/AIDS, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 5, 2007

 Mr. Reid (for Mrs. Clinton) introduced the following bill; which was 
     read twice and referred to the Committee on Foreign Relations

_______________________________________________________________________

                                 A BILL


 
To require the President and the Office of the Global AIDS Coordinator 
to establish a comprehensive and integrated HIV prevention strategy to 
 address the vulnerabilities of women and girls in countries 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 ``Protection Against Transmission of 
HIV for Women and Youth Act of 2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The United Nations Joint Program on AIDS (referred to 
        in this Act as ``UNAIDS'') estimates that more than 33,000,000 
        people were infected with HIV/AIDS at the end of 2007, the vast 
        majority of whom are living in the developing world.
            (2) According to the World Health Organization, unprotected 
        heterosexual sex is a major factor in the spread of HIV 
        infections worldwide.
            (3) According to UNAIDS, women and adolescent girls account 
        for about 50 percent of all HIV infections worldwide. In sub-
        Saharan Africa, women and girls make up about 60 percent of all 
        infections and 76 percent of infections among those who are 
        between 15 and 24 years of age.
            (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--
                    (A) cross generational sex with older men who are 
                more likely to be infected with HIV, a lack of choice 
                regarding when and whom to marry, leading to early 
                marriages and high rates of child marriages with older 
                men, and the fact, according to UNICEF, that about 42 
                percent of all adolescent females in Africa and about 
                48 percent of adolescent females in South Asia are 
                married by age 18;
                    (B) high rates of infection within marriage because 
                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, the fact 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, and the fact that women often run 
                the risk of being infected by husbands or male partners 
                in societies in which it is common or accepted for men 
                to have more than 1 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, including, 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, since access to 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;
                    (F) high rates of gender-based violence, rape, and 
                sexual coercion within and outside of marriage, 
                including, according to the World Health Organization, 
                between \1/6\ and \3/4\ 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, including, 
                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; and
                    (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, 5-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. The March 2007 Institute of Medicine 
        report, entitled ``PEPFAR Implementation: Progress and 
        Promise'', affirms that additional programming is required to 
        address the factors that put women and girls at risk of 
        contracting HIV.

SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS AMONG MARRIED AND UNMARRIED 
              WOMEN AND GIRLS.

    (a) Statement of Policy.--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 is 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) Strategy.--Not later than 180 days after the date of the 
enactment of this Act, the President shall formulate, 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 all people, including 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) Coordination.--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--
            (1) 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
            (2) organizations providing services to, and advocating on 
        behalf of, individuals living with and affected by HIV/AIDS.
    (d) Guidance.--The President shall--
            (1) 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
            (2) submit the guidance described in paragraph (1) to the 
        appropriate congressional committees and make the guidance 
        available to the public.
    (e) Country Operational Plans.--In formulating and implementing the 
global HIV prevention strategy required under subsection (b), the 
President, acting through the Office of the Global AIDS Coordinator and 
field missions of the Federal Government in countries for which the 
United States provides assistance to combat HIV/AIDS, shall consult 
with appropriate local and national organizations regarding the 
vulnerability of women and girls at risk of, or living or affected by, 
HIV and AIDS as part of the development of country operational plans.
    (f) Report.--
            (1) In general.--Not later than 1 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--
                    (A) submit a report on the implementation of this 
                Act during the prior fiscal year to the appropriate 
                congressional committees; and
                    (B) make the report described in paragraph (1) 
                available to the public.
            (2) Contents.--The report prepared under paragraph (1) 
        shall include--
                    (A) a description of the prevention programs 
                designed to address the vulnerabilities to HIV/AIDS of 
                married and unmarried women and youth; and
                    (B) 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.

SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METHODS.

    (a) Findings.--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 circumstances that put women and 
        girls at risk of contracting HIV.
            (2) In order to maximize the impact of United States 
        foreign assistance to combat HIV/AIDS, all sexually active 
        persons in each country should 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, entitled 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, 1 of the guiding principles of the President's 
                Emergency Plan for AIDS Relief 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 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 (referred to 
                in this section as ``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, 10 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.
                            (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, 7 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, including 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 services to 
                        prevent mother to child transmission.
                            (iv) Difficulty funding programs for condom 
                        procurement and condom social marketing.
    (b) Statement of Policy.--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 is 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;
            (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) 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 
        Foreign Affairs 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.
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