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)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.
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 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)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)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)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 plansIn 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)
(1)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)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.
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
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)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)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.