[Congressional Record (Bound Edition), Volume 147 (2001), Part 18]
[House]
[Pages 24831-24848]
[From the U.S. Government Publishing Office, www.gpo.gov]



    GLOBAL ACCESS TO HIV/AIDS PREVENTION, AWARENESS, EDUCATION, AND 
                         TREATMENT ACT OF 2001

  Mr. HYDE. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 2069) to amend the Foreign Assistance Act of 1961 to 
authorize assistance to prevent, treat, and monitor HIV/AIDS in sub-
Saharan African and other developing countries, as amended.
  The Clerk read as follows:

                               H.R. 2069

       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 ``Global Access to HIV/AIDS 
     Prevention, Awareness, Education, and Treatment Act of 
     2001''.

     SEC. 2. FINDINGS; SENSE OF CONGRESS.

       (a) Findings.--Congress makes the following findings:
       (1) According to the Joint United Nations Programme on HIV/
     AIDS (UNAIDS) more than 58,000,000 people worldwide have 
     already been infected with HIV/AIDS, a fatal disease that is 
     devastating the health and economies in dozens of countries 
     in Africa and increasingly in Asia, the Caribbean region, and 
     Eastern Europe.
       (2) The HIV/AIDS pandemic has erased decades of progress in 
     improving the lives of families in the developing world and 
     has claimed 22,000,000 lives since its inception.
       (3) More than 17,000,000 individuals have died from HIV/
     AIDS in sub-Saharan Africa alone.
       (4) The HIV/AIDS pandemic in sub-Saharan Africa has grown 
     beyond an international public health issue to become a 
     humanitarian, national security, and developmental crisis.
       (5) The HIV/AIDS pandemic is striking hardest among women 
     and girls. According to UNAIDS, by the end of 2000, fifty-
     five percent of the HIV-positive population in sub-Saharan 
     Africa and 40 percent of such population in North Africa and 
     the Middle East were women, infected mainly through 
     heterosexual transmission. In Africa, 6 out of 7 children who 
     are HIV positive are girls.
       (6) An estimated 1,400,000 children under age 15 were 
     living with HIV/AIDS at the end of 2000, of which 1,100,000 
     were children living in sub-Saharan Africa. An estimated 
     500,000 children died of AIDS during 2000, of which 440,000 
     were children in sub-Saharan Africa. In addition there are an 
     estimated 13,200,000 children worldwide who have lost one or 
     both of their parents to HIV/AIDS, of which 12,100,000 are 
     children in sub-Saharan Africa.
       (7) Mother-to-child transmission is the largest source of 
     HIV infection in children under age 15 and the only source 
     for very young children. The total number of births to HIV-
     infected pregnant women each year in developing countries is 
     approximately 700,000.
       (8) Counseling and voluntary testing are critical services 
     to help infected women accept their HIV status and the risk 
     it poses to their unborn child. Mothers who are aware of 
     their status can make informed decisions about treatment, 
     replacement feeding, and future child-bearing.
       (9) Although the HIV/AIDS pandemic has impacted the sub-
     Saharan Africa disproportionately, HIV infection rates are 
     rising rapidly in India and other South Asian countries, 
     Brazil, Russia, Eastern European countries, and Caribbean 
     countries, and pose a serious threat to the security and 
     stability in those countries.
       (10) By 2010, it is estimated that approximately 40,000,000 
     children worldwide will have lost one or both of their 
     parents to HIV/AIDS.
       (11) In January 2000, the United States National 
     Intelligence Council estimates that

[[Page 24832]]

     this dramatic increase in AIDS orphans will contribute to 
     economic decay, social fragmentation, and political 
     destabilization in already volatile and strained societies. 
     Children without care or hope are often drawn into 
     prostitution, crime, substance abuse or child soldiery. The 
     Council also stated that, in addition to the reduction of 
     economic activity caused by HIV/AIDS to date, the disease 
     could reduce GDP by as much as 20 percent or more by 2010 in 
     some countries in sub-Saharan Africa.
       (12) The HIV/AIDS epidemic is not just a health crisis but 
     is directly linked to development problems, including chronic 
     poverty, food security and personal debt that are reflected 
     in the capacity of affected households, often headed by 
     elders or orphaned children, to meet basic needs. Similarly, 
     heavily-indebted countries are stripped of the resources 
     necessary to improve health care delivery systems and 
     infrastructure and to prevent, treat, and care for 
     individuals affected by HIV/AIDS.
       (13) On March 7, 2001, the United States Secretary of State 
     testified before Congress that the United States has an 
     obligation `` . . . if we believe in democracy and freedom, 
     to stop this catastrophe from destroying whole economies and 
     families and societies and cultures and nations''.
       (14) A continuing priority for responding to the HIV/AIDS 
     crisis should be to emphasize and encourage awareness, 
     education, and prevention, including prevention activities 
     that promote behavioral change, while recognizing that 
     behavioral change alone will not conquer this disease. In so 
     doing, priority and support should be given to building 
     capacity in the local public health sector through technical 
     assistance as well as through nongovernmental organizations, 
     including faith-based organizations where practicable.
       (15) Effective use should be made of existing health care 
     systems to provide treatment for individuals suffering from 
     HIV/AIDS.
       (16) Many countries in Africa facing health crises, 
     including high HIV/AIDS infection rates, already have well-
     developed and high functioning health care systems. 
     Additional resources to expand and improve capacity to 
     respond to these crises can easily be absorbed by the private 
     and public sectors, as well as by nongovernmental 
     organizations, community-based organizations, and faith-based 
     organizations currently engaged in combatting the crises.
       (17) An effective response to the HIV/AIDS pandemic must 
     also involve assistance to stimulate the development of sound 
     health care delivery systems and infrastructure in countries 
     in sub-Saharan Africa and other developing countries, 
     including assistance to increase the capacity and technical 
     skills of local public health professionals and other 
     personnel in such countries, and improved access to treatment 
     and care for those already infected with HIV/AIDS.
       (18) Access to effective treatment for HIV/AIDS is 
     determined by issues of price, health care delivery system 
     and infrastructure, and sustainable financing and such access 
     can be inhibited by the stigma and discrimination associated 
     with HIV/AIDS.
       (19) The HIV/AIDS crisis must be addressed by a robust, 
     multilateral approach such as the one envisioned by the 
     Congress in the Global AIDS and Tuberculosis Relief Act of 
     2000, which directed the United States Government to seek to 
     negotiate the creation of an international HIV/AIDS trust 
     fund involving the World Bank.
       (20) The Secretary General of the United Nations has called 
     for a global fund to halt and reverse the spread of HIV/AIDS 
     and other infectious diseases. The Secretary General has also 
     called for annual expenditures of $7,000,000,000 to 
     $10,000,000,000, financed by donor governments and private 
     contributors, for all efforts to combat the HIV/AIDS pandemic 
     and, equally important, called on leaders from developing 
     countries to give a much higher priority in their budgets to 
     development of comprehensive health systems.
       (21) The Administration has advocated a fiduciary role for 
     the World Bank in the Global Fund to Fight AIDS, 
     Tuberculosis, and Malaria and the Transitional Working Group 
     for that fund has decided to invite the World Bank to play 
     such a role.
       (22) An effective United States response to the HIV/AIDS 
     crisis must also focus on the development of HIV/AIDS 
     vaccines to prevent the spread of the disease as well as the 
     development of microbicides, effective diagnostics, and 
     simpler treatments.
       (23) The innovative capacity of the United States in the 
     commercial and public pharmaceutical research sectors is 
     among the foremost in the world, and the active participation 
     of both these sectors should be supported as it is critical 
     to combat the global HIV/AIDS pandemic.
       (24) Appropriate treatment of individuals with HIV/AIDS can 
     prolong the lives of such individuals, preserve their 
     families and prevent children from becoming orphans, and 
     increase productivity of such individuals by allowing them to 
     lead active lives and reduce the need for costly 
     hospitalization for treatment of opportunistic infections 
     caused by HIV.
       (25) United States nongovernmental organizations, including 
     faith-based organizations, with experience in healthcare and 
     HIV/AIDS counseling, have proven effective in combatting the 
     HIV/AIDS pandemic and can be a resource in assisting sub-
     Saharan African leaders of traditional, political, business, 
     and women and youth organizations in their efforts to provide 
     treatment and care for individuals infected with HIV/AIDS.
       (26) Most of the HIV infected poor of the developing world 
     die of deadly diseases such as tuberculosis and malaria. 
     Accordingly, effective HIV/AIDS treatment programs should 
     address the growing threat and spread of tuberculosis, 
     malaria, and other infectious diseases in the developing 
     world.
       (27) Law enforcement and military personnel of foreign 
     countries often have a high rate of prevalence of HIV/AIDS, 
     and therefore, in order to be effective, HIV/AIDS awareness, 
     prevention, and education programs must include education and 
     related services to such law enforcement and military 
     personnel.
       (28) Microenterprise development and other income 
     generation programs assist communities afflicted by the HIV/
     AIDS pandemic and increase the productive capacity of 
     communities and afflicted households. Microenterprise 
     programs are also an effective means to support the 
     productive activities of healthy family members caring for 
     the sick and orphaned. Such programs should give priority to 
     women infected with the AIDS virus or in HIV/AIDS affected 
     families, particularly women in high-risk categories.
       (29) The exploding global HIV/AIDS pandemic has created new 
     challenges for United States bilateral assistance programs 
     and will require a substantial increase in the capacity of 
     the United States Agency for International Development and 
     other agencies of the United States to manage and monitor 
     bilateral HIV/AIDS programs and resources. To meet this 
     challenge, the Agency will need to recruit and retain 
     appropriate technical expertise in the United States as well 
     as in foreign countries to help develop and implement HIV/
     AIDS strategies in concert with multilateral agencies, host 
     country governments, and nongovernmental organizations.
       (b) Sense of Congress.--It is the sense of Congress that--
       (1)(A) combatting the HIV/AIDS pandemic in countries in 
     sub-Saharan Africa and other developing countries should be a 
     global effort and include the financial support of all 
     developed countries and the cooperation of governments and 
     the private sector, including faith-based organizations; and
       (B) the United States should provide additional funds for 
     multilateral programs and efforts to combat HIV/AIDS and also 
     seek to leverage public and private resources to combat HIV/
     AIDS on a global basis through the Global Development 
     Alliance Initiative of the United States Agency for 
     International Development and other public and private 
     partnerships with an emphasis on HIV/AIDS awareness, 
     education, prevention, and treatment programs;
       (2)(A) in addition to HIV/AIDS awareness, education, and 
     prevention programs, the United States Government should make 
     its best efforts to support programs that safely make 
     available to public and private entities in countries in sub-
     Saharan Africa and other developing countries pharmaceuticals 
     and diagnostics for HIV/AIDS therapy in order--
       (i) to effectively and safely assist such countries in the 
     delivery of HIV/AIDS therapy pharmaceuticals through the 
     establishment of adequate health care delivery systems and 
     treatment monitoring programs; and
       (ii) to provide treatment for poor individuals with HIV/
     AIDS in such countries; and
       (B) in carrying out such programs, priority consideration 
     for participation should be given to countries in sub-Saharan 
     Africa;
       (3)(A) combatting the HIV/AIDS pandemic requires that 
     United States Government programs place a priority on the 
     vulnerable populations at greatest risk for contracting HIV;
       (B) these populations should be determined through 
     qualitative and quantitative assessments at the local level 
     by local government, nongovernmental organizations, people 
     living with HIV/AIDS, and other relevant sectors of civil 
     society; and
       (C) such assessments should be included in national HIV/
     AIDS strategies;
       (4) the United States should promote efforts to expand and 
     develop programs that support the growing number of children 
     orphaned by the HIV/AIDS pandemic;
       (5) in countries where the United States Government is 
     conducting HIV/AIDS awareness, prevention, and education 
     programs, such programs should include education and related 
     services to law enforcement and military personnel of foreign 
     countries to prevent and control HIV/AIDS, malaria, and 
     tuberculosis;
       (6) prevention and treatment for HIV/AIDS should be a 
     component of a comprehensive international effort to combat 
     deadly infectious diseases, including malaria and 
     tuberculosis, and opportunistic infections, that kill 
     millions annually in the developing world;
       (7) programs developed by the United States Agency for 
     International Development to address the HIV/AID pandemic 
     should preserve personal privacy and confidentiality, should 
     not include compulsory HIV/AIDS testing, and should not be 
     discriminatory;

[[Page 24833]]

       (8)(A) the United States Agency for International 
     Development should carry out HIV/AIDS awareness, prevention, 
     and treatment programs in conjunction with effective 
     international tuberculosis and malaria treatment programs and 
     with programs that address the relationship between HIV/AIDS 
     and a number of opportunistic diseases that include bacterial 
     diseases, fungal diseases, viral diseases and HIV-associated 
     malignancies, such as Kaposi sarcoma, lymphoma, and squamous 
     cell carcinoma; and
       (B) effective intervention against opportunistic diseases 
     requires not only the appropriate drug or other medication 
     for a given medical condition, but also the infrastructure 
     necessary to diagnose the condition, monitor the 
     intervention, and provide counseling services; and
       (9) the United States Agency for International Development 
     should expand and replicate successful microenterprise 
     programs in Uganda, Zambia, Zimbabwe, and other African 
     countries that provide poor families affected by HIV/AIDS 
     with the means to care for themselves, their children, and 
     orphans;
       (10) the United States Agency for International Development 
     should substantially increase and improve its capacity to 
     manage and monitor HIV/AIDS programs and resources;
       (11) the United States Agency for International Development 
     must recruit and retain appropriate technical expertise in 
     the United States as well as in foreign countries to help 
     develop and implement HIV/AIDS strategies in conjunction with 
     multilateral agencies, host country governments, and 
     nongovernmental organizations;
       (12) the United States Agency for International Development 
     must strengthen coordination and collaboration between the 
     technical experts in its central and regional bureaus and 
     foreign country missions in formulating country strategies 
     and implementing HIV/AIDS programs;
       (13) strong coordination among the various agencies of the 
     United States, including the Department of State, the United 
     States Agency for International Development, the Department 
     of Health and Human Services, including the Centers for 
     Disease Control and the National Institutes of Health, the 
     Department of the Treasury, the Department of Defense, and 
     other relevant Federal agencies must exist to ensure 
     effective and efficient use of financial and technical 
     resources within the United States Government; and
       (14) to help alleviate human suffering, and enhance the 
     dignity and quality of life for patients debilitated by HIV/
     AIDS, the United States should promote, both unilaterally and 
     through multilateral initiatives, the use of palliative and 
     hospice care, and provide financial and technical assistance 
     to palliative and hospice care programs, including programs 
     under which such care is provided by faith-based 
     organizations.

     SEC. 3. ASSISTANCE TO COMBAT HIV/AIDS.

       (a) Assistance.--Section 104(c) of the Foreign Assistance 
     Act of 1961 (22 U.S.C. 2151b(c)) is amended--
       (1) by striking paragraphs (4) through (6); and
       (2) by inserting after paragraph (3) the following:
       ``(4)(A) Congress recognizes that the alarming spread of 
     HIV/AIDS in countries in sub-Saharan Africa and other 
     developing countries is a major global health, national 
     security, and humanitarian crisis. Accordingly, the United 
     States and other developed countries should provide 
     assistance to countries in sub-Saharan Africa and other 
     developing countries to control this crisis through HIV/AIDS 
     prevention, treatment, monitoring, and related activities, 
     particularly activities focused on women and youth, including 
     mother-to-child transmission prevention strategies.
       ``(B)(i) The Administrator of the United States Agency for 
     International Development is authorized to provide assistance 
     to prevent, treat, and monitor HIV/AIDS, and carry out 
     related activities, in countries in sub-Saharan Africa and 
     other developing countries.
       ``(ii) It is the sense of Congress that the Administrator 
     should provide an appropriate level of assistance under 
     clause (i) through nongovernmental organizations in countries 
     in sub-Saharan Africa and other developing countries affected 
     by the HIV/AIDS pandemic.
       ``(iii) The Administrator shall coordinate the provision of 
     assistance under clause (i) with the provision of related 
     assistance by the Joint United Nations Programme on HIV/AIDS 
     (UNAIDS), the United Nations Children's Fund (UNICEF), the 
     World Health Organization (WHO), the United Nations 
     Development Programme (UNDP), other appropriate international 
     organizations, such as the World Bank and the relevant 
     regional multilateral development institutions, national, 
     state, and local governments of foreign countries, and other 
     appropriate governmental and nongovernmental organizations.
       ``(C) Assistance provided under subparagraph (B) shall, to 
     the maximum extent practicable, be used to carry out the 
     following activities:
       ``(i) Prevention of HIV/AIDS through activities including--
       ``(I) education, voluntary testing, and counseling 
     (including the incorporation of confidentiality protections 
     with respect to such testing and counseling), including 
     integration of such programs into women's and children's 
     health programs;
       ``(II) assistance to ensure a safe blood supply and to 
     provide post-exposure prophylaxis to victims of rape and 
     sexual assault; and
       ``(III) assistance through nongovernmental organizations, 
     including faith-based organizations, particularly those 
     organizations that utilize both professionals and volunteers 
     with appropriate skills and experience, to establish and 
     implement culturally appropriate HIV/AIDS education and 
     prevention programs.
       ``(ii) The treatment and care of individuals with HIV/AIDS, 
     including--
       ``(I) assistance to establish and implement programs to 
     strengthen and broaden indigenous health care delivery 
     systems and the capacity of such systems to deliver HIV/AIDS 
     pharmaceuticals and otherwise provide for the treatment of 
     individuals with HIV/AIDS, including clinical training for 
     indigenous organizations and health care providers;
       ``(II) assistance aimed at the prevention of transmission 
     of HIV/AIDS from mother to child, including medications to 
     prevent such transmission and access to infant formula and 
     other alternatives for infant feeding; and
       ``(III) assistance to strengthen and expand hospice and 
     palliative care programs to assist patients debilitated by 
     HIV/AIDS, their families, and the primary caregivers of such 
     patients, including programs that utilize faith-based 
     organizations.
       ``(iii) The monitoring of programs, projects, and 
     activities carried out pursuant to clauses (i) and (ii), 
     including--
       ``(I) monitoring to ensure that adequate controls are 
     established and implemented to provide HIV/AIDS 
     pharmaceuticals and other appropriate medicines to poor 
     individuals with HIV/AIDS; and
       ``(II) appropriate evaluation and surveillance activities.
       ``(iv) The conduct of related activities, including--
       ``(I) the care and support of children who are orphaned by 
     the HIV/AIDS pandemic, including services designed to care 
     for orphaned children in a family environment which rely on 
     extended family members;
       ``(II) improved infrastructure and institutional capacity 
     to develop and manage education, prevention, and treatment 
     programs, including the resources to collect and maintain 
     accurate HIV surveillance data to target programs and measure 
     the effectiveness of interventions;
       ``(III) vaccine research and development partnership 
     programs with specific plans of action to develop a safe, 
     effective, accessible, preventive HIV vaccine for use 
     throughout the world; and
       ``(IV) the development and expansion of financially-
     sustainable microfinance institutions and other income 
     generation programs that strengthen the economic and social 
     viability of communities afflicted by the HIV/AIDS pandemic, 
     including support for the savings and productive capacity of 
     affected poor households caring for orphans.
       ``(D)(i) Not later than January 31 of each calendar year, 
     the Administrator shall submit to Congress an annual report 
     on the implementation of this paragraph for the prior fiscal 
     year.
       ``(ii) Such report shall include--
       ``(I) a description of efforts made to implement the 
     policies set forth in this paragraph;
       ``(II) a description of the programs established pursuant 
     to this paragraph and section 4 of the Global Access to HIV/
     AIDS Prevention, Awareness, Education, and Treatment Act of 
     2001; and
       ``(III) a detailed assessment of the impact of programs 
     established pursuant to this paragraph, including the 
     effectiveness of such programs in reducing the spread of HIV 
     infection, particularly in women and girls, in reducing HIV 
     transmission from mother to child, in reducing mortality 
     rates from HIV/AIDS, and the progress toward improving health 
     care delivery systems and infrastructure to ensure increased 
     access to care and treatment.
       ``(iii) The Administrator shall consult with the Global 
     Health Advisory Board established under section 6 of the 
     Global Access to HIV/AIDS Prevention, Awareness, Education, 
     and Treatment Act of 2001 in the preparation of the report 
     under clause (i) and on other global health activities 
     carried out by the United States Agency for International 
     Development.
       ``(E)(i) There is authorized to be appropriated to the 
     President to carry out this paragraph $485,000,000 for fiscal 
     year 2002.
       ``(ii) Not more than six percent of the amount appropriated 
     pursuant to the authorization of appropriations under clause 
     (i) for fiscal year 2002, and not more than four percent of 
     the amount made available to carry out this paragraph for any 
     subsequent fiscal year, may be used for the administrative 
     expenses of the Agency in carrying out this paragraph.
       ``(iii) Amounts appropriated pursuant to the authorization 
     of appropriations under clause (i) are in addition to amounts 
     otherwise available for such purposes and are authorized to 
     remain available until expended.

[[Page 24834]]

       ``(F) In this paragraph:
       ``(i) The term `HIV' means infection with the human 
     immunodeficiency virus.
       ``(ii) The term `AIDS' means acquired immune deficiency 
     syndrome.''.
       (b) Availability of Assistance Under Section 104(c).--
     Section 104(c) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b(c)) is amended--
       (1) by redesignating paragraph (7) as paragraph (5); and
       (2) by adding at the end the following:
       ``(6) Assistance made available under any paragraph of this 
     subsection, and assistance made available under chapter 4 of 
     part II of this Act to carry out the purposes of any 
     paragraph of this subsection, may be made available 
     notwithstanding any other provision of law.''.

     SEC. 4. ASSISTANCE FOR PROCUREMENT AND DISTRIBUTION OF HIV/
                   AIDS PHARMACEUTICALS AND RELATED MEDICINES.

       (a) Assistance.--The Administrator of the United States 
     Agency for International Development shall provide assistance 
     to countries in sub-Saharan Africa and other developing 
     countries for--
       (1) the procurement of HIV/AIDS pharmaceuticals, anti-viral 
     therapies, and other appropriate medicines; and
       (2) the distribution of such HIV/AIDS pharmaceuticals, 
     anti-viral therapies, and other appropriate medicines to 
     qualified national, regional, or local organizations for the 
     treatment of individuals with HIV/AIDS in accordance with 
     appropriate HIV/AIDS testing and monitoring requirements and 
     for the prevention of transmission of HIV/AIDS from mother to 
     child.
       (b) Additional Authority.--The authority contained in 
     section 104(c)(6) of the Foreign Assistance Act of 1961, as 
     amended by section 3(b) of this Act, shall apply to 
     assistance made available under subsection (a).
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to the President to carry out this section 
     $50,000,000 for fiscal year 2002.

     SEC. 5. INTERAGENCY TASK FORCE ON HIV/AIDS.

       (a) Establishment.--The President shall establish an 
     interagency task force (hereafter referred to as the ``task 
     force'') to ensure coordination of all Federal programs 
     related to the prevention, treatment, and monitoring of HIV/
     AIDS in foreign countries.
       (b) Duties.--The duties of the task force shall include--
       (1) reviewing all Federal programs related to the 
     prevention, treatment, and monitoring of HIV/AIDS in foreign 
     countries to ensure proper coordination and compatibility of 
     activities and policies of such programs;
       (2) exchanging information regarding design and impact of 
     such programs to ensure that the United States Government can 
     catalogue the best possible practices for HIV/AIDS 
     prevention, treatment, and monitoring and improve the 
     effectiveness of such programs in the countries in which they 
     operate; and
       (3) fostering discussions with United States and foreign 
     nongovernmental organizations to determine how United States 
     Government programs can be improved, including by engaging in 
     a dialogue with the Global Health Advisory Board established 
     under section 6 of this Act.
       (c) Membership.--
       (1) Composition.--The task force shall be composed of the 
     Secretary of State, the Administrator of the United States 
     Agency for International Development, the Secretary of Health 
     and Human Services, the Secretary of the Treasury, the 
     Director of the National Institutes of Health, the Director 
     of the Centers for Disease Control, the Secretary of Defense, 
     and the head of any other agency that the President 
     determines is appropriate.
       (2) Chairperson.--The Secretary of State shall serve as 
     chairperson of the task force.
       (d) Public Meetings.--At least once each calendar year, the 
     task force shall hold a public meeting in order to afford an 
     opportunity for any person to present views regarding the 
     activities of the United States Government with respect to 
     the prevention, treatment, and monitoring of HIV/AIDS in 
     foreign countries. The Secretary of State shall maintain a 
     record of each meeting and shall make the record available to 
     the public.
       (e) Availability of Funds.--Amounts made available for a 
     fiscal year pursuant to section 104(c)(4)(E)(ii) of the 
     Foreign Assistance Act of 1961, as amended by section 3(a) of 
     this Act, are authorized to be made available to carry out 
     this section for such fiscal year.

     SEC. 6. GLOBAL HEALTH ADVISORY BOARD.

       (a) Establishment.--There is established a permanent Global 
     Health Advisory Board (hereafter referred to as the 
     ``Board'') to assist the President and other Federal 
     officials, including the Secretary of State and the 
     Administrator of the United States Agency for International 
     Development, in the administration and implementation of 
     United States international health programs, particularly 
     programs relating to the prevention, treatment, and 
     monitoring of HIV/AIDS.
       (b) Duties.--
       (1) In general.--The Board shall serve as a liaison between 
     the United States Government and private and voluntary 
     organizations, other nongovernmental organizations, and 
     academic institutions in the United States that are active in 
     international health issues, particularly prevention, 
     treatment, and care with respect to HIV/AIDS and other 
     infectious diseases.
       (2) Specific activities.--In carrying out paragraph (1), 
     the Board--
       (A) shall provide advice to the United States Agency for 
     International Development and other Federal agencies on 
     health and management issues relating to foreign assistance 
     in which both the United States Government and private and 
     voluntary organizations participate;
       (B) shall provide advice on the formulation of basic 
     policy, procedures, and criteria for the review, selection, 
     and monitoring of project proposals for United States 
     Government international health programs and for the 
     establishment of transparency in the provision and 
     implementation of grants made under such programs;
       (C) shall provide advice on the establishment of evaluation 
     and monitoring programs to measure the effectiveness of 
     United States Government international health programs, 
     including standards and criteria to assess the extent to 
     which programs have met their goals and objectives and the 
     development of indicators to track progress of specific 
     initiatives;
       (D) shall review and evaluate the overall health strategy 
     for United States bilateral assistance for each country 
     receiving significant United States bilateral assistance in 
     the health sector;
       (E) shall recommend which developing countries could 
     benefit most from programs carried out under United States 
     Government international health programs; and
       (F) shall assess the impact and effectiveness of programs 
     carried out under section 104(c)(4) of the Foreign Assistance 
     Act of 1961, as amended by section 3(a) of this Act, in 
     meeting the objectives set out in the HIV/AIDS country 
     strategy established by the United States Agency for 
     International Development.
       (c) Membership.--
       (1) Composition.--The Board shall be composed of 12 
     members--
       (A)(i) all of whom shall have a substantial expertise and 
     background in international health research, policy, or 
     management, particularly in the area of prevention, 
     treatment, and care with respect to HIV/AIDS and other 
     infectious diseases; and
       (ii) of whom at least one member shall be an expert on 
     women's and children's health issues; and
       (B) of whom--
       (i) three members shall be individuals from academic 
     institutions;
       (ii) five members shall be individuals from nongovernmental 
     organizations active in international health programs, 
     particularly HIV/AIDS prevention, treatment and monitoring 
     programs in foreign countries, of which not more than two 
     members may be from faith-based organizations;
       (iii) two members shall be individuals from health policy 
     and advocacy institutes; and
       (iv) two members shall be individuals from private 
     foundations that make substantial contributions to global 
     health programs.
       (2) Appointment.--The individuals referred to in paragraph 
     (1) shall be appointed by the President, after consultation 
     with the chairman and ranking member of the Committee on 
     International Relations of the House of Representatives and 
     the Committee on Foreign Relations of the Senate.
       (3) Terms.--
       (A) In general.--Except as provided in subparagraph (B), 
     each member shall be appointed for a term of two years and no 
     member or organization shall serve on the Advisory Board for 
     more than two consecutive terms.
       (B) Terms of initial appointees.--As designated by the 
     President at the time of appointment, of the members first 
     appointed--
       (i) six members shall be appointed for a term of three 
     years; and
       (ii) six members, to the extent practicable equally divided 
     among the categories described in clauses (i) through (iv) of 
     paragraph (1)(B), shall be appointed for a term of two years.
       (4) Chairperson.--At the first meeting of the Board in each 
     calendar year, a majority of the members of the Commission 
     present and voting shall elect, from among the members of the 
     Board, an individual to serve as chairperson of the Board.
       (d) Travel Expenses.--Each member of the Board shall 
     receive travel expenses, including per diem in lieu of 
     subsistence, in accordance with applicable provisions under 
     subchapter I of chapter 57 of title 5, United States Code.
       (e) Availability of Funds.--Amounts made available for a 
     fiscal year pursuant to section 104(c)(4)(E)(ii) of the 
     Foreign Assistance Act of 1961, as amended by section 3(a) of 
     this Act, are authorized to be made available to carry out 
     this section for such fiscal year.

     SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR MULTILATERAL 
                   EFFORTS TO PREVENT, TREAT, AND MONITOR HIV/
                   AIDS.

       (a) Authorization.--There is authorized to be appropriated 
     to the President $750,000,000

[[Page 24835]]

     for fiscal year 2002 for United States contributions to a 
     global health fund negotiated by the United States consistent 
     with the general principles in the Global AIDS and 
     Tuberculosis Relief Act of 2000 and the initiative of the 
     Secretary General of the United Nations or other multilateral 
     efforts to prevent, treat, and monitor HIV/AIDS in countries 
     in sub-Saharan Africa and other developing countries, 
     including efforts to provide hospice and palliative care for 
     individuals with HIV/AIDS.
       (b) Characteristics of Global Health Fund.--It is the sense 
     of Congress that, consistent with the general principles 
     outlined in the Global AIDS and Tuberculosis Relief Act of 
     2000, United States contributions should be provided to a 
     global health fund under subsection (a) only if the fund--
       (1) is a public-private partnership that includes 
     participation of, and seeks contributions from, governments, 
     foundations, corporations, nongovernmental organizations, 
     organizations that are part of the United Nations system, and 
     other entities or individuals;
       (2) has the World Bank serving as the fiduciary agent of 
     the fund and in any other capacity deemed appropriate by the 
     international community;
       (3)(A) includes donors, recipient countries, civil society, 
     and other relevant parties in the governance of the fund; and
       (B) contains safeguards against conflicts of interest in 
     the governance of the fund by the individuals and entities 
     described in subparagraph (A);
       (4) supports targeted initiatives to address HIV/AIDS, 
     tuberculosis, and malaria through an integrated approach that 
     includes prevention interventions, care and treatment 
     programs, and infrastructure capacity-building;
       (5) permits strategic targeting of resources to address 
     needs not currently met by existing bilateral and 
     multilateral efforts and includes separate sub-accounts for 
     different activities allowing donors to designate funds for 
     specific categories of programs and activities;
       (6) reserves a minimum of 5 percent of its grant funds to 
     support scientific or medical research in connection with the 
     projects it funds in developing countries;
       (7) provides public disclosure with respect to--
       (A) the membership and official proceedings of the 
     mechanism established to manage and disburse amounts 
     contributed to the fund; and
       (B) grants and projects supported by the fund;
       (8) authorizes and enforces requirements for the periodic 
     financial and performance auditing of projects and makes 
     future funding conditional upon the results of such audits; 
     and
       (9) provides public disclosure of the findings of all 
     financial and performance audits of the fund.

     SEC. 8. DEFINITION.

       In this Act:
       (1) HIV.--The term ``HIV'' means infection with the human 
     immunodeficiency virus.
       (2) AIDS.--The term ``AIDS'' means acquired immune 
     deficiency syndrome.

     SEC. 9. EXTENSION OF TIME FOR GAO REPORT ON TRUST FUND 
                   EFFECTIVENESS.

       Section 131(b) of the Global AIDS and Tuberculosis Relief 
     Act of 2000 (22 U.S.C. 6831(b)) is amended by striking ``of 
     the enactment of this Act'' and inserting ``the Trust Fund is 
     established''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Illinois (Mr. Hyde).


                             General Leave

  Mr. HYDE. Madam Speaker, I ask unanimous consent that all Members may 
have 5 legislative days to revise and extend their remarks and include 
extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Illinois?
  There was no objection.
  Mr. HYDE. Madam Speaker, I yield myself such time as I may consume.
  (Mr. HYDE asked and was given permission to revise and extend his 
remarks.)
  Mr. HYDE. Madam Speaker, once again the United States has an 
opportunity, and the responsibility, to lead the world in confronting 
one of the most compelling humanitarian and moral challenges facing us 
today. I speak of the HIV/AIDS pandemic, a crisis unparalleled in 
modern times and one that threatens the entire world, embracing 
developed and developing countries alike.
  The statistics are chilling: over 22 million people have already died 
of AIDS throughout the world. More than 3 million died last year alone. 
That is over 8,000 deaths each day, or nearly one death every 6 
minutes. What is most alarming is that the number of infections and 
deaths is growing and the pandemic is quickly spreading from sub-
Saharan Africa to India, China and Russia. An incredible 36 million 
people are already infected with HIV; and 15,000 new infections occur 
every day.
  To illustrate the magnitude of the crisis, it is estimated that by 
the year 2010, over 80 million people may have died from AIDS. By 
comparison, that is more than all the military and civilian deaths 
resulting from World War II. If the disease is left unchecked, we have 
no idea what the statistics will be in 2015 or 2020, less than 20 years 
from today. The most dramatic increase in infection rates is in the 
developing world, where education, awareness and access to health care 
is most seriously lacking. As is too often the case, it is the children 
who suffer most. Millions are born HIV-infected even though mother-to-
child transmission is easily avoided if adequate training and health 
care is provided. To this is added a widespread mortality among 
parents: by the end of the decade, 40 million children are likely to be 
orphaned as a consequence of AIDS. The impact on developing societies, 
socially, politically and economically, is incalculable and threatens 
the stability of many countries and societies around the globe.
  Contrary to popular conceptions, the pandemic is not limited to 
Africa, where AIDS continues to sweep forward virtually unchecked. The 
disease has jumped to every continent. In Europe, last year Russia had 
the highest rate of increase of new cases of any country on the planet. 
That impoverished country's medical system is clearly unable to 
adequately cope with the challenge, ensuring that it will continue to 
spread. According to the National Intelligence Council, India is on the 
verge of a catastrophic AIDS epidemic. Closer to home, the Caribbean 
region has the second highest rate of HIV infections in the world.
  The most appropriate comparison of this ever-widening threat is with 
the 14th century, when the plague repeatedly swept through Europe, 
killing a quarter of that continent's population, leaving no country 
untouched, and decimating entire regions. This time, however, it is the 
entire world that is at risk. If the world is to have a chance of 
prevailing against this disease, the United States must take a leading 
role in the efforts to combat it. To do so, we must advance along many 
fronts, both bilateral and multilateral. The bill we consider today, 
H.R. 2069, addresses both the bilateral and multilateral pillars of our 
response to the AIDS crisis.
  H.R. 2069 builds upon existing efforts by authorizing the Agency for 
International Development to carry out a comprehensive program of HIV/
AIDS prevention, education and treatment at a level of $485 million 
during fiscal year 2002. Moreover, Madam Speaker, H.R. 2069 authorizes 
an additional $50 million pilot program to provide treatment for those 
infected with HIV/AIDS by helping the public and private sectors of 
developing countries procure HIV/AIDS pharmaceuticals and antiviral 
therapies.
  The novel bilateral treatment program that my bill authorizes is 
vitally important, for it gives hope to those already suffering from 
AIDS. By authorizing a pilot treatment program, we can work to extend 
the productive lives of those infected by the virus. This is not only 
the right thing to do, it has beneficial impact on treatment as well. 
Without some expectation of care, the poor have little reason to be 
tested for AIDS or to seek help. I am fully cognizant of the challenge 
posed by treatment programs in developing countries. However, it is my 
hope that successful treatment programs such as those carried out by 
the AIDS Healthcare Foundation will be replicated in developing 
countries. Madam Speaker, there simply is no option other than 
treatment if we are ever to stem the tide of this pandemic.
  Through our bilateral efforts, the United States will demonstrate its 
commitment to address all facets of the HIV/AIDS challenge and thereby 
challenge the entire developed world to emulate the example of the 
United States. It is also my hope that faith-

[[Page 24836]]

based organizations such as Catholic Relief Services will play a very 
significant and meaningful role in advising USAID on the most effective 
approaches to combat the HIV/AIDS pandemic.
  In addition to our bilateral efforts, the President has already 
signaled our Nation's intention to lead the multilateral campaign by 
committing at least $200 million to combat HIV/AIDS through a global 
AIDS war chest that will be designed and implemented in the months to 
come.
  The Global Access to HIV/AIDS Prevention, Awareness, Education, and 
Treatment Act of 2001 also authorizes the President to contribute to 
multilateral efforts to combat HIV/AIDS at a level that the 
administration deems appropriate and at such time as a fund is 
established and criteria developed to ensure its sound management. 
America will contribute its fair share as we work to leverage 
additional funds for this effort from other developed countries.
  By providing the President with this flexibility, we can ensure that 
the contributions made by the United States will be adequate and also 
yield the commitments from other countries to make this effort a truly 
global war on AIDS.
  As with any problem, however, financial resources cannot serve as the 
sole answer, and the generosity of the American people must be well 
managed. We must provide resources at a pace at which these can be 
absorbed and used wisely. We must continue to encourage and support 
those faith-based organizations and churches that are on the front 
lines in the effort to educate the poor about HIV and AIDS and 
treatment and prevention. We must also insist that any program designed 
to combat the AIDS pandemic include abstinence as a core component.
  In closing, I wish to thank the many Members and staff who have 
contributed to the passage of this landmark legislation. I am 
especially grateful to the gentleman from California (Mr. Lantos) the 
committee's ranking member, and to the gentlewoman from California (Ms. 
Lee) for their leadership in crafting this legislation.
  I am also appreciative of the invaluable support of the gentleman 
from New York (Mr. Gilman), the committee's chairman emeritus; the 
gentleman from Nebraska (Mr. Bereuter); and the gentleman from Iowa 
(Mr. Leach). I am also very grateful for the generous support offered 
by the gentleman from Arizona (Mr. Kolbe). I also wish to thank Nisha 
Desai, David Abramowitz, Pearl Alice Marsh, and Michael Riggs of the 
Democratic staff for their many contributions and dedication to make 
this bill come to fruition.

                              {time}  1430

  My greatest appreciation, however, goes to Adolfo Franco, a member of 
my own staff, whose tireless work made this bill a reality. He is 
leaving the staff to go to a very important job with the 
administration, and he will be sorely missed.
  Madam Speaker, I wish to reiterate what I think is a consensus in 
Congress. Simply stated, the AIDS virus is one of the great moral 
challenges of our era. It is a scourge of unparalleled proportions in 
modern times. Every citizen has a stake in preventing what otherwise 
might well become the bubonic plague of the 21st century. We must do 
all that lies in our power to do if we are to meet this threat, first 
of all, by reaching out now to those most in need. It is not only the 
most sensible thing to do, it is the right thing to do for our 
children, our country and for the world.
  I urge all of my colleagues to vote for H.R. 2069.
  Madam Speaker, I reserve the balance of my time.
  Mr. LANTOS. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in strong support of this legislation.
  Madam Speaker, I first would like to commend my good friend, the 
distinguished chairman of the Committee on International Relations, for 
his leadership, his vision and his commitment to help combat the global 
HIV-AIDS crisis. The gentleman from Illinois (Mr. Hyde) has shown 
courage and integrity in tackling this issue, when he could have relied 
upon others to legislate on this front. Many do not see the global HIV-
AIDS crisis as a United States priority and question the need to spend 
significant U.S. funds toward preventing and treating this disease, but 
the gentleman from Illinois (Chairman Hyde) recognizes not only the 
severity of the epidemic, but our moral, humanitarian and national 
security interests in stemming the tide of the HIV-AIDS pandemic.
  I would also like to commend my colleague, the gentlewoman from 
California (Ms. Lee), for her unwavering leadership in the global fight 
against HIV-AIDS. She has played a critical role in setting this 
Congress on the right course on this human disaster and in fashioning 
this legislation.
  Madam Speaker, the bill reflects an extraordinary process of 
consultation that involves not only members of our committee, but 
advocacy groups, non-governmental organizations, the administration and 
the staff of the United Nations. The result is a landmark, bipartisan 
agreement that outlines both a policy framework and funding levels for 
U.S. bilateral and multilateral assistance to fight the global AIDS 
pandemic. I want to join the gentleman from Illinois (Chairman Hyde) in 
praising members of the Republican and Democratic staffs who played 
such a key role in bringing us to this point.
  Madam Speaker, the bill before us represents a broad consensus, and I 
urge all of my colleagues to support it. I truly believe that our 
legislation lays the foundation for a long-term commitment by the 
United States to eradicate this devastating disease.
  Our bill authorizes $535 million in bilateral U.S. assistance to 
education, prevention, treatment and care of HIV-AIDS and those highly 
infectious diseases associated with it. In addition, our bill commits 
$750 million towards a global health fund to coordinate both funding 
and comprehensive programs in the fight against this disease, to which 
governments the private sector, foundations and individual 
philanthropists will contribute.
  Madam Speaker, in this post-September 11 world, it is all too easy to 
lose sight of the HIV-AIDS crisis as we focus on the most pressing 
problem of global terrorism and the devastating conditions in 
Afghanistan, but it is precisely in this post-September 11 era that we 
must strive to maintain our commitment to HIV-AIDS and other crises of 
global magnitude. AIDS has devastated entire societies, and it is 
leaving in its wake a generation lost in despair. It is these children, 
raised without hope, who often provide fertile grounds for the 
terrorists and criminal networks to sow their evil seeds.
  As our Secretary of State, Colin Powell, said at the UN special 
session on AIDS, ``From this moment on, our response to AIDS must be no 
less comprehensive, no less relentless, and no less swift than the 
pandemic itself.''
  If we have learned anything through our terrible national tragedy, it 
is that the world's problems are our problems, and if we do not deal 
with these problems overseas, we will be dealing with them on our own 
doorstep.
  The resurgence of HIV-AIDS and tuberculosis in some parts of the 
United States is just one ominous indication of how the problems of the 
developing world can soon become our own problems if we do not act 
decisively. The new bilateral program authorized by our legislation 
will guarantee that the American people are directly engaged in 
providing education, prevention, treatment and care to those suffering 
in poor countries. It will improve the quality of the U.S. aid programs 
in the HIV-AIDS field and provide those who are suffering with AIDS 
opportunities to live better and more productive lives.
  Our proposed 1-year multilateral expenditure of $750 million is a 
major investment on our part toward a global effort to secure a better 
future for millions suffering from this deadly disease. It is a signal 
to the world, and particularly those suffering from this

[[Page 24837]]

disease, that the United States is a partner in the international 
battle against HIV-AIDS.
  Lastly, Madam Speaker, I want to tell schoolteachers, health workers, 
women and men, grandparents and orphans in poor countries suffering 
from the HIV-AIDS pandemic that we are fighting for and with them. Men, 
women and children in Africa, South Asia, Europe, the Western 
Hemisphere, are all affected, and we must all work together to find a 
solution. I urge my colleagues to support H.R. 2069.
  Madam Speaker, I reserve the balance of my time.
  Mr. HYDE. Madam Speaker, I am pleased to yield 4 minutes to the 
distinguished gentleman from Nebraska (Mr. Bereuter).
  Mr. BEREUTER. Madam Speaker, I rise in strong support of this 
legislation, and I thank the distinguished chairman for yielding me 
time. I want to thank him also for his leadership in introducing this 
legislation and for the effort to move it to the House floor so 
expeditiously. Also I would like to thank the distinguished ranking 
member of the House Committee on International Relations, the gentleman 
from California (Mr. Lantos) and the distinguished gentlewoman from 
California (Ms. Lee), among others mentioned by the gentleman from 
Illinois (Chairman Hyde), for their very positive efforts regarding 
H.R. 2069.
  I am pleased to be a member of the Committee on International 
Relations, but today I speak primarily as a chairman of a subcommittee 
of the Committee on Financial Services, the Subcommittee on 
International Monetary Policy and Trade. It is in that respect that I 
thank the gentleman from Illinois (Mr. Hyde), the chairman, and the 
gentleman from California (Mr. Lantos), and others, for working with 
the distinguished gentleman from Ohio (Chairman Oxley) and this Member 
by incorporating into H.R. 2069 language suggested by us to recognize 
the World Bank's fiduciary role for the Global Health Fund on HIV-AIDS.
  The statistics on HIV-AIDS are staggering, as we heard a few minutes 
ago. According to the joint United Nations Programme on HIV-AIDS, as of 
December 2001, an estimated 40 million people worldwide live with HIV-
AIDS, which includes an estimated 28.1 million people in Sub-Saharan 
Africa. Furthermore, in the year 2001 alone, there were an estimated 5 
million new HIV-AIDS infections worldwide, with 3.4 million of these 
cases being in Sub-Saharan Africa. In addition to Africa, HIV infection 
rates are also rising dramatically in India and the other South Asian 
countries, as well as Russia, the Eastern European countries, Brazil 
and the Caribbean countries.
  As the chairman of the Subcommittee on International Monetary Policy 
and Trade, this Member conducted a hearing on May 15, 2001, which 
focused on the activities in Africa of the International Monetary Fund, 
the World Bank, the African Development Bank and African Development 
Fund, including their efforts to combat HIV-AIDS. As a result of this 
hearing, which included testimony from the Joint United Nations 
Programme on HIV-AIDS, this Member introduced H.R. 2209. This 
legislation increases the authorization for the multilateral world AIDS 
trust for FY 2002 from $150 million to $200 million.
  The World Bank AIDS Trust Fund was established with American support 
through what became Public Law 106-264, primarily authored by the 
distinguished gentleman from Iowa (Mr. Leach). This law directed the 
United States Government to seek to negotiate the creation of an 
international HIV-AIDS trust fund which would be established within the 
World Bank.
  The Global Access to HIV-AIDS Prevention, Awareness, Treatment, and 
Education Act of 2001, this bill, provides both multilateral and 
bilateral authorization funding to help prevent, treat and monitor HIV-
AIDS. This dual approach is very important as the United States combats 
the global plague of HIV-AIDS with our neighbors and outer countries 
throughout the world.
  This Member would like to particularly emphasize the $750 million 
multilateral authorization for FY 2002 to the Global Health Fund to 
combat HIV-AIDS. This legislation, H.R. 2069, states that this Global 
Health Fund is consistent with the global AIDS and Tuberculosis Relief 
Act of 2000, which established the U.S. negotiations for the World Bank 
AIDS Trust Fund.
  The World Bank has the most extensive global infrastructure to 
provide the multilateral assistance needed to help prevent, treat and 
monitor HIV-AIDS. This Member fully supports the Bush administration's 
position to abdicate a fiduciary role for the World Bank in this Global 
Health Fund to fight HIV-AIDS. It should be noted that the Transitional 
Working Group, a multilateral institution for this Global Health Fund, 
has recently invited the World Bank to play that fiduciary role as a 
trustee for the fund.
  I urge support of this legislation. I think the two committees worked 
well together to merge the two bills together.
  Mr. LANTOS. Madam Speaker, I yield 4 minutes to the gentlewoman from 
California (Ms. Lee). No Member has worked harder and more diligently 
on this issue than my friend and colleague from California.
  Ms. LEE. Madam Speaker, I rise first to thank the gentleman from 
Illinois (Chairman Hyde), our ranking member, the gentleman from 
California (Mr. Lantos), the gentleman from Iowa (Mr. Leach), and also 
the gentleman from Nebraska (Mr. Bereuter), for their commitment and 
real diligence in working to develop H.R. 2069, legislation that will 
comprehensively fight the global AIDS, TB and malaria pandemics.
  This bipartisan legislation that we are considering today is 
important because it authorizes the desperately needed resources to 
address the multifaceted and multigenerational challenges presented by 
the global AIDS, TB and malaria pandemics.
  It has been over 20 years since the first AIDS diagnosis. Since then, 
HIV and AIDS has infected over 56 million people worldwide and has 
claimed over 25 million lives, including 4 million children. The events 
of September 11 have turned the world's attention appropriately on 
combatting international terrorism. However, we cannot forget the 
global will scourge of HIV and AIDS. It is a national security threat 
of staggering proportions. AIDS, like many diseases, knows no borders 
and discriminates against no one. Each day, AIDS, TB and malaria claim 
over 17,000 lives. So, just as we fight terrorism, we must also fight 
these diseases.
  According to UN, AIDS left unchecked, it is estimated that over 100 
million people will be infected worldwide by 2007.

                              {time}  1445

  AIDS is decimating the continent of Africa and leaving millions of 
orphans in its wake.
  Today, the number of orphans in Africa is the equivalent of the total 
population of children in America's public schools. Left unchecked, 
Africa will be home to more than 40 million orphans by 2010; and 
unfortunately, Africa is only the epicenter. We must not sacrifice this 
generation of children on the alter of indifference.
  The AIDS pandemic has cut life expectancy by 25 years in some 
countries. In Botswana, the population growth due to AIDS is negative. 
This means that there are more people dying from AIDS than there are 
being born. The AIDS, TB, and malaria pandemics constitute a crisis of 
biblical proportions in Africa and puts the very survival of the 
continent at stake. These pandemics are not only a humanitarian crisis, 
but they are potentially an economic, political, and social 
catastrophe. Therefore, it is important that we continue to beat the 
drum to raise awareness. Our efforts at home must reach far beyond our 
shores.
  When the House Committee on International Relations marked this bill 
up earlier this year, the gentleman from Illinois (Mr. Hyde), the 
chairman of the committee, the gentleman from California (Mr. Lantos), 
the gentleman from Iowa (Mr. Leach), and the gentleman from Nebraska 
(Mr. Bereuter) worked on this bill day and night to increase bilateral 
funding for AIDS, TB,

[[Page 24838]]

and malaria and also to increase the U.S. contribution to our 
multilateral AIDS program. The program, under this bill's $750 million, 
includes a contribution to the Global AIDS Trust Fund, which the 
gentleman from Iowa (Mr. Leach) and I cosponsored last year. This was 
actually signed into law as the Global AIDS and TB Relief Act of 2000, 
which the gentleman from Nebraska (Mr. Bereuter) earlier referred to.
  So today, the House is sending a strong message that America can and 
must do more.
  Also, I want to state for the record that all HIV-infected persons 
have a basic right to vital medicines for prevention and treatment of 
AIDS and also must have access to drugs for treatment of opportunistic 
infections and to anti-retroviral agents. We have the knowledge and we 
have the technology to prevent the spread of AIDS. We have the 
necessary drugs that can substantially reduce the rate of mother-to-
child transmission and also prolong the lives of people who are 
infected.
  In addition to all of the barriers we face addressing this global 
crisis, basic health care infrastructure remains an issue. This bill 
addresses that also.
  So I just once again want to thank my colleagues, the gentleman from 
Illinois (Mr. Hyde), the chairman of the committee; the gentleman from 
California (Mr. Lantos), the ranking member; the gentleman from Iowa 
(Mr. Leach); and the gentleman from Nebraska (Mr. Bereuter) for their 
commitment, and also for our staffs' work. I want to thank the staff 
for diligently working on this. Our dedication and their dedication to 
the future of the human family will surely have a ripple effect.
  Mr. HYDE. Madam Speaker, I ask unanimous consent that each side be 
granted an additional 6 minutes for purposes of debate.
  The SPEAKER pro tempore (Mrs. Biggert). Is there objection to the 
request of the gentleman from Illinois?
  There was no objection.
  Mr. HYDE. Madam Speaker, I yield 3 minutes to the gentleman from 
Arizona (Mr. Kolbe).
  Mr. KOLBE. Madam Speaker, I thank the gentleman for yielding me this 
time.
  When I became chairman of the Subcommittee on Foreign Operations of 
the Committee on Appropriations, I said that one of my highest 
priorities was to fund the battle against HIV/AIDS that is becoming a 
pandemic globally. With that in mind, I want to thank the distinguished 
chairman of the Committee on International Relations for his leadership 
and his interest in fighting HIV and other infectious diseases. We 
share this as a priority, and I am very pleased to work with the 
chairman on this important matter.
  The authorization for bilateral assistance through the United States 
Agency for International Development is virtually identical to the 
amount recommended by the House and Senate conferees on the Foreign 
Operations, Export Financing, and Related Programs Appropriations Act 
for fiscal year 2002. We hope to file that conference report on the 
bill in the very near future. We completed the work on our conference 
in November and are awaiting a signal from the leadership to file that 
agreement.
  Having said that, however, I think it is important to tell the House 
and Members here that the $750 million authorization that is included 
in this bill for the multilateral assistance is unlikely to be funded 
in fiscal year 2002. The chairman indicated in his own remarks that he 
understood that that was going to be the case.
  Members need to know, should know, that the multilateral fund does 
not yet exist. It is a concept, and we are working on it; but its 
structure, its objectives, its voting methodology has not yet been 
determined and is not likely to occur until the middle of next year.
  Despite that, the Committee on Appropriations is in the process of 
providing a total of $250 million in three separate bills for the 
proposed global fund to fight HIV, tuberculosis, and malaria; and that 
is an amount that is $50 million greater than had been requested in the 
President's budget.
  Now, more funds are possible; but I do not want anybody to have 
unrealistic expectations for the FY 2002 budget. First, it is very 
important that this fund get created and that we begin to demonstrate 
success. That is not going to happen yet until at least well into this 
fiscal year. Until the Congress concurs with the proposed terms and 
conditions under which our initial $250 million could be used, it is 
not prudent, in my view, to leave the impression that there is another 
$500 million available or required at this time for the global fund.
  Madam Speaker, I support this bill, because we must continue to 
dedicate an increasing amount of resources to fight the global pandemic 
of HIV/AIDS, but I do not want my support for the bill to be viewed as 
an endorsement of the $750 million level authorized for the proposed 
global fund, at least not at this time. We have more work to do before 
we are going to be ready to spend any of the funds set aside for the 
global trust fund, much less an amount as large as $250 million. I know 
the chairman understands that.
  So this is a proactive, leading-the-way authorization, and I 
appreciate that. I do think that we can carry out the policies and 
provide for the ongoing and expanded bilateral programs. I thank the 
chairman for his leadership.
  Mr. LANTOS. Madam Speaker, I am delighted to yield 2 minutes to the 
gentlewoman from California (Ms. Pelosi), the incoming whip of the 
Democratic Party, my friend and neighbor in San Francisco, who has been 
a national leader in the fight against HIV/AIDS for years.
  Ms. PELOSI. Madam Speaker, I thank the gentleman for yielding me this 
time, and I thank him for his leadership on this issue. I commend the 
gentleman from Illinois (Mr. Hyde), the chairman of the committee; the 
gentleman from Nebraska (Mr. Bereuter), the gentleman from Iowa (Mr. 
Leach), and the gentlewoman from California (Ms. Lee) for their 
extraordinary leadership in bringing this bill to the floor. I know it 
was difficult, and I congratulate them in doing it.
  I am pleased to follow the gentleman from Arizona (Mr. Kolbe), my 
distinguished chairman on the Subcommittee on Foreign Operations, a 
longtime member on that committee. Following the lead of my own 
constituents, we put the first money for international AIDS into that 
bill several years ago. We could never get the attention that he is 
getting here today on this issue. I know how hard it is, and I commend 
him for it. We tried to get the attention of the G-7 to put AIDS on the 
agenda a dozen years ago in both Democratic and Republican 
administrations, and only recently have the ramifications of AIDS been 
recognized at that level.
  So it is with great enthusiasm that I commend all of my colleagues, 
and I rise in support of H.R. 2069.
  Madam Speaker, we must never forget that every single day, 8,000 
people die of AIDS; 8,000 people die every day of AIDS. Think of it. It 
is so staggering. It is unimaginable, almost. But we are concerned 
about every single one of them and about protecting every single child 
in the world and person in the world from contracting HIV and AIDS in 
the future.
  The United States must take the lead in the global effort to end the 
global AIDS pandemic and the havoc it is creating in the developing 
world. Halting this crisis can only happen with new resources, and the 
dramatic step that is being taken today is a very, very important and 
significant step forward.
  The social, economic, security, national security, and human rights 
cost of this crisis are devastating entire nations. Projections show 
that by 2010, South Africa's GDP will be 17 percent below where it 
would have been without AIDS, and the United Nations has estimated that 
AIDS could kill up to 26 percent of the workforce in Africa. India 
already has more infected people than Africa.
  Madam Speaker, I will submit my full statement for the Record 
because, again, the statistics are staggering. Madam Speaker, $750 
million is an excellent step forward. We need to do more.

[[Page 24839]]

  Experts are predicting that without significant prevention and 
treatment efforts the number of Indians living with HIV/AIDS could 
surpass the combined number of cases in all African countries within 
two decades.
  Developing countries will be unable to turn the tide on this epidemic 
if even the most basic health care is unavailable for most of their 
citizens. People must be educated about HIV and how to prevent its 
spread. Increased testing and counseling opportunities are desperately 
needed. Basic care and treatment that can be delivered in homes or 
makeshift clinics is essential. And the need for support for the 
growing number of children orphaned by AIDS looms large.
  We know that prevention and treatment work. Comprehensive prevention 
efforts have turned around HIV epidemics in Uganda and Thailand, and 
averted an epidemic in Senegal. In a small village in Haiti, community 
health workers have been trained to deliver high quality care, 
including the advanced medicines used to treat AIDS in our country. The 
provisions of H.R. 2069 will help impoverished countries expand and 
replicate effective programs, and strengthen the capacity of indigenous 
health care systems to deliver HIV/AIDS pharmaceuticals.
  Our investment in the fight against the global AIDS pandemic not only 
has a direct impact, but is also promises to leverage significant funds 
from other countries and multilateral institutions. Specifically, the 
$750 million authorized for multilateral assistance will demonstrate 
this country's dedication to the new United Nations Global Fund, and 
other international efforts. Fighting AIDS requires a real, sustained 
commitment, and the money we provide is a signal to other nations that 
we will do our part.
  The fight ahead of us against the global AIDS pandemic is a long one. 
We have no choice but to engage in the fight and to prevail. I urge my 
colleagues to support H.R. 2069.
  Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Maryland (Mrs. Morella).
  Mrs. MORELLA. Madam Speaker, I thank the gentleman for yielding me 
this time.
  I rise in strong support of H.R. 2069, the Global Access to HIV and 
AIDS Prevention Act, to authorize nearly $1.4 billion to combat HIV/
AIDS in sub-Saharan Africa and other developing countries.
  I certainly want to applaud the leadership of the gentleman from 
Illinois (Mr. Hyde) and the gentleman from California (Mr. Lantos) for 
their efforts in bringing this bill to the floor today. Because of 
their work and the work of so many of my friends and colleagues here in 
Congress, we are seeing a vast change in the global AIDS crisis in sub-
Saharan Africa and other parts of the world. What I am referring to is 
a rapidly changing and increased level of awareness and concern, not 
only about the horrific damage the virus is wreaking, but about the 
future costs, costs in cultural, political, and economic stability in 
Africa.
  New figures released on December 1, which was World AIDS Day, show 
that more than 40 million people are now living with the virus. The 
vast majority of them are in sub-Saharan Africa where the devastation 
is so acute it has become one of the main obstacles to development. I 
could go on with the various statistics. An estimated 24.5 million 
people in sub-Saharan Africa are infected with the HIV virus. That is 
71 percent of the world's total.
  What can we do? The United States is uniquely positioned to lead the 
world in the prevention and eradication of HIV and AIDS. This year's 
House-passed Foreign Operations Appropriations bill provides $474 
million for AIDS prevention and control. But we must also pass this 
bill, H.R. 2069, The Global Access to HIV and AIDS Prevention Act. It 
authorizes $560 million in bilateral assistance programs for the 
various AIDS treatment and prevention programs administered by USAID. 
It also authorizes $750 million in 2002 for the United States 
contributions to the Global AIDS Fund.
  So I would certainly say that this bill is good news. The bad news is 
it has taken so long.
  Mr. LANTOS. Madam Speaker, I am pleased to yield 2 minutes to the 
gentleman from Texas (Mr. Rodriguez), our distinguished colleague.
  Mr. RODRIGUEZ. Madam Speaker, I rise in support of the Global Access 
to HIV/AIDS Prevention Act, H.R. 2069. I would like to commend the 
gentlewoman from California (Ms. Lee). I want to thank her for her hard 
work and her dedication as well. I want to thank her specifically for 
when she first sent that letter for us to sign to get on board, and I 
was very pleased to see that. I also want to thank the gentleman from 
California (Mr. Lantos) for his efforts and the gentlewoman from 
California (Ms. Pelosi) and some of the other speakers that have been 
speaking on this issue, as well as the gentleman from Illinois (Mr. 
Hyde). I thank him for allowing us this opportunity to move forward on 
this issue.
  This year marks the 20th year of HIV/AIDS, and in that time the virus 
has taken the lives of more than 25 million people throughout the 
world. In claiming lives, the virus has destroyed families and 
communities. It has devastated economies and created instability. It 
has changed the very way we interact with our neighbors.
  The continued spread of the virus calls for a multilateral strategy 
in the struggle to reduce infections. Domestic and international 
efforts, prevention as well as treatment, as well as research and 
development and education, are critical. These are the parts of the 
equation that will help us change the outcome.
  We must remember that disease has no borders and especially 
infectious diseases. We cannot afford to ignore the plight of our 
neighbors, because sooner or later, it will come and knock on our door.
  By investing in the international efforts to eradicate this virus, we 
will be assuring and protecting Americans' health and prosperity. We 
will also show ourselves as a Nation committed to alleviating human 
sufferings everywhere else. It is the right thing to do for our 
neighbors and ourselves and for our constituents and for our children, 
for untreated and mistreated HIV/AIDS can hamper us all. For not 
treating appropriately, other types of strains can be created that will 
cause us more harm.

                              {time}  1500

  Madam Speaker, I urge my colleagues to support H.R. 2069, the Global 
Access to HIV/AIDS Prevention Awareness, Education, and Treatment Act 
of 2001.
  Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the 
distinguished gentleman from Florida, (Mr. Weldon).
  Mr. WELDON of Florida. Madam Speaker, I thank the gentleman for 
yielding time to me.
  Madam Speaker, I did my internship and residency in San Francisco in 
the early eighties when AIDS was ravaging the homosexual community in 
that city. Prior to coming here to the U.S. House, I practiced 
infectious diseases and primarily treated AIDS, so I have seen 
firsthand the devastation that this disease can cause. I certainly 
commend all those involved with working to bring this bill to the 
floor.
  I am particularly pleased that the chairman was willing to work with 
me to add language to emphasize the importance of a safe blood supply 
and the importance of prophylactic drugs for victims of rape and sexual 
assault; certainly, also, the language to emphasize access to infant 
formula and other alternatives for infant feeding.
  Many babies are born to HIV mothers and survive the birth process 
without contracting AIDS, to only go on, unfortunately, to contract the 
disease through the process of breast feeding.
  I do remain concerned, Madam Speaker, that the bill does not 
sufficiently stress abstinence. Abstinence programs have shown to be 
helpful in Uganda and Senegal; and abstinence, of course, is the only 
approach that actually guarantees that AIDS will not be spread.
  I have served in the past on the board of a faith-based group that 
has worked in Nigeria on abstinence-based education. I think the bill, 
as it moves through the conference process and gets signed by the 
President, should have some stronger language inserted to deal with the 
importance of abstinence.
  Also, I would like to see the makeup of the board, the advisory 
board, structured in such a way that faith-based

[[Page 24840]]

organizations will be guaranteed a place at the table. There are 
currently hundreds of faith-based organizations in Africa. As I said, I 
have worked with one of them firsthand. They need to be included in 
this process.
  Mr. LANTOS. Madam Speaker, I am pleased to yield 2 minutes to my good 
friend and my distinguished colleague, the gentlewoman from North 
Carolina (Mrs. Clayton).
  Mrs. CLAYTON. Madam Speaker, I thank the gentleman for yielding time 
to me.
  Madam Speaker, I rise in support of the Global to Access HIV/AIDS 
Prevention, Awareness, Education, and Treatment Act of 2001, H.R. 2069.
  I also want to commend the leadership on this bill, the gentleman 
from Illinois (Chairman Hyde) and the gentleman from California (Mr. 
Lantos), and all others involved in sponsoring this, the gentleman from 
Nebraska (Mr. Bereuter), the gentlewoman from California (Ms. Lee), and 
those who have been carrying this fight on and have been strong 
advocates for ridding the world of this disease.
  This legislation provides crucial funding for the prevention, 
treatment, and monitoring of AIDS in sub-Saharan Africa and other parts 
of the developing world, and an increased amount of assistance through 
education and treatment programs, as well as assistance and aid for the 
prevention and transmission of HIV/AIDS from mother to child.
  Madam Speaker, this legislation is essential to fighting the HIV/AIDS 
epidemic in many parts of the world, including that part of Africa. HIV 
is worldwide and actually knows no border, as we said earlier.
  Madam Speaker, I include for the Record information on the AIDS 
epidemic provided by the World Health Organization.
  The material referred to is as follows:

                  AIDS Epidemic Update--December 2001


                            Global overview

       Twenty years after the first clinical evidence of acquired 
     immunodeficiency syndrome was reported, AIDS has become the 
     most devastating disease humankind has ever faced. Since the 
     epidemic began, more than 60 million people have been 
     infected with the virus. HIV/AIDS is now the leading cause of 
     death in sub-Saharan Africa. Worldwide, it is the fourth-
     biggest killer.
       At the end of 2001, an estimated 40 million people globally 
     were living with HIV. In many parts of the developing world, 
     the majority of new infections occur in young adults, with 
     young women especially vulnerable. About one-third of those 
     currently living with HIV/AIDS are aged 15-24. Most of them 
     do not know they carry the virus. Many millions more know 
     nothing or too little about HIV to protect themselves against 
     it.
     Eastern Europe and Central Asia--still the fastest-growing 
         epidemic
       Eastern Europe--especially the Russian Federation--
     continues to experience the fastest-growing epidemic in the 
     world, with the number of new HIV infections rising steeply. 
     In 2001, there were an estimated 250,000 new infections in 
     this region, bringing to 1 million the number of people 
     living with HIV. Given the high levels of other sexually 
     transmitted infections, and the high rates of injecting drug 
     use among young people, the epidemic looks set to grow 
     considerably.
     Asia and the Pacific--narrowing windows of opportunity.
       In Asia and the Pacific, an estimated 7.1 million people 
     are now living with HIV/AIDS. The epidemic claimed the lives 
     of 435,000 people in the region in 2001. The apparently low 
     national prevalence rates in many countries in this region 
     are dangerously deceptive. They hide localized epidemics in 
     different areas, including some of the world's most populous 
     countries. There is a serious threat of major, generalized 
     epidemics. But, as Cambodia and Thailand have shown, prompt, 
     large-scale prevention programmes can hold the epidemic at 
     bay. In Cambodia, concerted efforts, driven by strong 
     political leadership and public commitment, lowered HIV 
     prevalence among pregnant women to 2.3 percent at the end of 
     2000--down by almost a third from 1997.
     Sub-Saharan Africa--the crisis grows
       AIDS killed 2.3 million African people in 2001. The 
     estimated 3.4 million new HIV infections in sub-Saharan 
     Africa in the past year mean that 28.1 million Africans now 
     live with the virus. Without adequate treatment and care, 
     most of them will not survive the next decade. Recent 
     antenatal clinic data show that several parts of southern 
     Africa have now joined Botswana with prevalence rates among 
     pregnant women exceeding 30 percent. In West Africa, at least 
     five countries are experiencing serious epidemics, with adult 
     HIV prevalence exceeding 5 percent. However, HIV prevalence 
     among adults continues to fall in Uganda, while there is 
     evidence that prevalence among young people (especially 
     women) is dropping in some parts of the continent.
     The Middle East and North Africa--slow but marked spread
       In the Middle East and North Africa, the number of people 
     living with HIV now totals 440,000. The epidemic's advance is 
     most marked in countries (such as Djibouti, Somalia and the 
     Sudan) that are already experiencing complex emergencies. 
     While HIV prevalence continues to be low in most countries in 
     the region, increasing numbers of HIV infections are being 
     detected in several countries, including the Islamic Republic 
     of Iran, the Libyan Arab Jamahiriya and Pakistan.
     High-income countries--resurgent epidemic threatens
       A larger epidemic also threatens to develop in the high-
     income countries, where over 75,000 people acquire HIV in 
     2001, bringing to 1.5 million the total number of people 
     living with HIV/AIDS. Recent advances in treatment and care 
     in these countries are not being consistently matched with 
     enough progress on the prevention front. New evidence of 
     rising HIV infection rates in North America, parts of Europe 
     and Australia is emerging. Unsafe sex, reflected in outbreaks 
     of sexually transmitted infections, and widespread injecting 
     drug use are propelling these epidemics, which, at the same 
     time, are shifting more towards deprived communities.
     Latin America and the Caribbean--diverse epidemics
       An estimated 1.8 million adults and children are living 
     with HIV in Latin America and the Caribbean--a region that is 
     experiencing diverse epidemics. With an average adult HIV 
     prevalence of approximately 2 percent, the Caribbean is the 
     second-most affected region in the world. But relatively low 
     national HIV prevalence rates in most South and Central 
     American countries mask the fact that the epidemic is already 
     firmly lodged among specific population groups. These 
     countries can avert more extensive epidemics by stepping up 
     their responses now.
     Stronger commitment
       Greater and more effective prevention, treatment and care 
     efforts need to be brought to bear. During the year 2001, the 
     resolve to do so became stronger than ever.
       History was made when the United Nations General Assembly 
     Special Session on HIV/AIDS in June 2001 set in place a 
     framework for national and international accountability in 
     the struggle against the epidemic. Each government pledged to 
     pursue a series of many benchmark targets relating to 
     prevention, care, support and treatment, impact alleviation, 
     and children orphaned and made vulnerable by HIV/AIDS, as 
     part of a comprehensive AIDS response. These targets include 
     the following: To reduce HIV infection among 15-24-year-olds 
     by 25 percent in the most affected countries by 2005 and, 
     globally, by 2010; by 2005, to reduce the proportion of 
     infants infected with HIV by 20 percent, and by 50 percent by 
     2010; by 2003, to develop national strategies to strengthen 
     health-care systems and address factors affecting the 
     provision of HIV-related drugs, including affordability and 
     pricing. Also, to urgently make every effort to provide the 
     highest attainable standard of treatment for HIV/AIDS, 
     including antiretroviral therapy in a careful and monitored 
     manner to reduce the risk of developing resistance; by 2003, 
     to develop and, by 2005, implement national strategies to 
     provide a supportive environment for orphans and children 
     infected and affected by HIV/AIDS; by 2003, to have in place 
     strategies that begin to address the factors that make 
     individuals particularly vulnerable to HIV infection, 
     including under-development, economic insecurity, poverty, 
     lack of empowerment of women, lack of education, social 
     exclusion, illiteracy, discrimination, lack of information 
     and/or commodities for self-protection, and all types of 
     sexual exploitation of women, girls and boys; and by 2003, to 
     develop multisectoral strategies to address the impact of the 
     HIV/AIDS epidemic at the individual, family, community and 
     national levels.
       Increasingly, other stakeholders, including nongovernmental 
     organizations and private companies worldwide, are making 
     clear their determination to boost those efforts.
       New resources are being marshalled to lift spending to the 
     necessary levels, which UNAIDS estimates at US$7-10 billion 
     per year in low- and middle-income countries. The global fund 
     called for by United Nations Secretary-General Kofi Annan has 
     attracted about US$1.5 billion in pledges. In addition, the 
     World Bank plans major new loans in 2002 and 2003 for HIV/
     AIDS, with a grant equivalency of over US$400 million per 
     year. All the while, more countries are boosting their 
     national budget allocations towards AIDS responses. Several 
     ``least developed countries'' have received, or are in line 
     for, debt relief that could help them increase their spending 
     on HIV/AIDS.
       More private companies are also stepping up their efforts. 
     Guiding some of their interventions is a new international 
     code of conduct on AIDS and the workplace, which was

[[Page 24841]]

     ratified earlier this year by members of the International 
     Labour Organization (the new, eighth cosponsoring 
     organization of UNAIDS).
       The challenge now is to build on the new-found commitment 
     and convert it into sustained action--both in the countries 
     and regions already hard hit, and in those where the epidemic 
     began later but is gathering steam.
     Beyond complacency
       The diversity of HIV's spread worldwide is striking. But in 
     many regions of the world, the HIV/AIDS epidemic is still in 
     its early stages. While 16 sub-Saharan African countries 
     reported overall adult HIV prevalence of more than 10 percent 
     by the end of 1999, there remained 119 countries of the world 
     where adult HIV prevalence was less than 1 percent.
       Low national prevalence rates can, however, be very 
     misleading. They often disguise serious epidemics that are 
     initially concentrated in certain localities or among 
     specific population groups and that threaten to spill over 
     into the wider population.
       Nationwide prevalence in Myanmar, for instance, has been 
     put at 2 percent. Yet, national HIV rates as high as 60 
     percent are being registered among injecting drug users and 
     almost 40 percent among sex workers. Moreover, in vast 
     populous countries such as China, India and Indonesia (where 
     individual provinces or states often have more inhabitants 
     than most countries), national prevalence all but loses 
     meaning. The Indian states of Maharashtra, Andhra Pradesh and 
     Tamil Nadu (each with at least 55 million inhabitants), have 
     registered HIV prevalence rates of over 2 percent among 
     pregnant women in one or two sentinel sites and over 10 
     percent among sexually transmitted infection patients--rates 
     far higher than the national average of less than 1 percent. 
     In the absence of vigorous prevention efforts, there is 
     considerable scope for further HIV spread. Even HIV 
     prevalence rates as low as 1 percent or 2 percent across Asia 
     and the Pacific (which is home to about 60 percent of the 
     world's population) would cause the number of people living 
     with HIV/AIDS to soar.
       All countries have, at some point in their epidemic 
     histories, been low-prevalence countries. HIV prevalence 
     among pregnant women attending antenatal clinics in South 
     Africa was less than 1 percent in 1990 (almost a decade after 
     the first HIV diagnosis there in 1982). Yet, a decade later, 
     the country was experiencing one of the fastest growing 
     epidemics in the world, with prevalence among pregnant women 
     at 24.5 percent by the end of 2000.
       Low-prevalence settings present special challenges. At the 
     same time, they offer opportunities for averting large 
     numbers of future infections. Today, we are seeing rapidly 
     emerging epidemics in several countries that had previously 
     recorded relatively low rates of HIV infection--proof that 
     the epidemic can emerge quickly and unexpectedly, and that no 
     society is immune. In Indonesia, where recorded infection 
     rates were negligible until very recently (even among some 
     high-risk groups), there is new evidence of striking 
     increases in the infection rates of HIV. Prevalence has risen 
     significantly among female sex workers in three cities at 
     opposite ends of the Indonesian archipelago, with similar 
     increases also evident at other sites. Among women working in 
     massage parlours in the capital, Jakarta, HIV prevalence was 
     measured at 18 percent in 2000. Blood donor data now show a 
     tenfold rise in HIV prevalence since 1998.
       Elsewhere, longer-standing epidemics could be on the verge 
     of spreading more rapidly and widely. Nepal and Viet Nam, for 
     example, have registered marked increases in HIV infection in 
     recent years, while in China--home to a fifth of the world's 
     people--the virus seems to be moving into new groups of the 
     population.
       In other areas of the world, too, time is fast running out 
     if much larger AIDS epidemics are to be averted. For 
     instance, in the Russian Federation, only 523 HIV infections 
     had been diagnosed by 1991. A decade later, that number had 
     climbed to more than 129,000. In a country where injecting 
     drug use among young people is rife (and there are higher 
     levels of sexually transmitted infections in the wider 
     population), there is an urgent need for action to avoid an 
     even larger number of new infections.
     Prompt, focused prevention
       Countires that still have low levels of HIV infection 
     should avert the epidemic's potential spread, rather than 
     take comfort from current infection rates. The key to success 
     in low-prevalence settings where HIV is not yet at risk to 
     the wider population is to enable the most vulnerable groups 
     to adopt safer sexual and drug-injecting behaviour, interrupt 
     the virus's spread among and between those groups, and buy 
     time to bolster the wider population's ability to protect 
     itself against the virus.
       This means, first, determining which population groups are 
     at highest risk of infection and, second mustering the 
     political will to safeguard them against the epidemic. At the 
     same time, it is vital to defuse the stigma and blame so 
     often attached to vulnerable groups and to deepen the wider 
     public's knowledge and understanding of the epidemic.
       Young people are a priority on this front. Twenty years 
     into the epidemic, millions of young people know little, if 
     anything, about HIV/AIDS. According to UNICEF, over 50 
     percent of young people (aged 15-24) in more than a dozen 
     countries, including Bolivia, Botswana, Cote d'Ivoire, the 
     Dominican Republic, Ukraine, Uzbekistan and Viet Nam, have 
     never heard of AIDS or harbour serious misconceptions about 
     how HIV is transmitted. Providing young people with candid 
     information and life skills is a prerequisite for success in 
     any AIDS response.
     Reclaiming the future
       The impact of the AIDS epidemic is being increasingly felt 
     in many countries across the world. Southern Africa continues 
     to be the worst affected area, with adult prevalence rates 
     still rising in several countries. But elsewhere, also, in 
     countries often already burdened by huge socioeconomic 
     challenges, AIDS threatens human welfare, developmental 
     progress and social stability on an unprecedented scale.
       The AIDS epidemic has a profound impact on growth, income 
     and poverty. It is estimated that the annual per capita 
     growth in half the countries of sub-Saharan Africa is falling 
     by 0.5-1.2 percent as a direct result of AIDS. By 2010, per 
     capita GDP in some of the hardest hit countries may drop by 8 
     percent and per capita consumption may fall even farther. 
     Calculations show that heavily affected countries could lose 
     more than 20 percent of GDP by 2020. Companies of all types 
     face higher costs in training, insurance, benefits, 
     absenteeism and illness. A survey of 15 firms in Ethiopia has 
     shown that, over a five-year period, 53 percent of all 
     illnesses among staff were AIDS-related.
     Devastating cycles
       An index of existing social and economic injustices, the 
     epidemic is driving a ruthless cycle of impoverishment. 
     People at all income levels are vulnerable to the economic 
     impact of HIV/AIDS, but the poor suffer most acutely. One 
     quarter of households in Botswana, where adult HIV prevalence 
     is over 35 percent can expect to lose an income earner within 
     the next 10 years. A rapid increase in the number of very 
     poor and destitute families is anticipated. Per capita 
     household income for the poorest quarter of households is 
     expected to fall by 13 percent, while every income earner in 
     this category can expect to take on four more dependents as a 
     result of HIV/AIDS.
       In sub-Saharan Africa, the economic hardships of the past 
     two decades have left three-quarters of the continent's 
     people surviving on less than US $2 a day. The epidemic is 
     deepening their plight. Typically, this impoverished majority 
     has limited access to social and health services, especially 
     in countries where public services have been cut back and 
     where privatized services are unaffordable. In hard-hit 
     areas, households cope by cutting their food consumption and 
     other basic expenditures, and tend to sell assets in order to 
     cover the costs of health care and funerals.
       Studies in Rwanda have shown that households with a HIV/
     AIDS patient spend, on average, 20 times more on health care 
     annually than households without an AIDS patient. Only a 
     third of those households can manage to meet these extra 
     costs.
       According to a new United Nations Food and Agricultural 
     Organization (FAO) report, seven million farm workers have 
     died from AIDS-related causes since 1985 and 16 million more 
     are expected to die in the next 20 years. Agricultural 
     output--especially of staple products--cannot be sustained in 
     such circumstances. The prospect of widespread food shortages 
     and hunger is real. Some 20 percent of rural families in 
     Burkina Faso are estimated to have reduced their agricultural 
     work or even abandoned their farms because of AIDS. Rural 
     households in Thailand are seeing their agricultural output 
     shrink by half. In 15 percent of these instances, children 
     are removed from school to take care of ill family members 
     and to regain lost income. Almost everywhere, the extra 
     burdens of care and work are deflected onto women--especially 
     the young and the elderly.
       Families often remove girls from school to care for sick 
     relatives or assume other family responsibilities, 
     jeopardizing the girls' education and future prospects. In 
     Swaziland, school enrollment is reported to have fallen by 36 
     percent due to AIDS, with girls most affected. Enabling young 
     people--especially girls--to attend school and, hopefully, 
     complete their education, is essential. South Africa's and 
     Malawi's universal free primary education systems point the 
     way. Schemes to provide girls with second-chance schooling 
     are another option.
     Development and stability threatened
       Meanwhile, the epidemic is claiming huge numbers of 
     teachers, doctors, extension workers and other human 
     resources. In some countries, health-care systems are losing 
     up to a quarter of their personnel to the epidemic. In Malawi 
     and Zambia, for example, five-to-six-fold increases in health 
     worker illness and death rates have reduced personnel, 
     increasing stress levels and workload for the remaining 
     employees.
       Teachers and students are dying or leaving school, reducing 
     both the quality and efficiency of educational systems. In 
     1999 alone, an estimated 860,000 children lost their teachers 
     to AIDS in sub-Saharan Africa. In the Central African 
     Republic, AIDS was the

[[Page 24842]]

     cause of 85 percent of the 300 teacher deaths that occurred 
     in 2000. Already, by the late 1990s, the toll had forced the 
     closure of more than 100 educational establishments in that 
     country. In Guatemala, studies have shown that more than a 
     third of children orphaned by HIV/AIDS drop out of school. In 
     Zambia, teacher deaths caused by AIDS are equivalent to about 
     half the total number of new teachers the country manages to 
     train annually.
       Replacing skilled professionals is a top priority, 
     especially in low-income countries where governments depend 
     heavily on a small number of policy-makers and managers for 
     public management and core social services. In heavily 
     affected countries, losing such personnel reduces capacity, 
     while raising the costs of recruitment, training, benefits 
     and replacements. A successful response to AIDS requires that 
     essential public services, such as education, health, 
     security, justice and institutions of democratic governance, 
     be maintained. Each sector has to take account of HIV/AIDS in 
     its own development plans and introduce measures to sustain 
     public sector functions. Such actions might include fast-
     track training, as well as the recruitment of key civil 
     servants and the reallocation of budgets towards the most 
     essential services. Countries that explore innovative ways of 
     maintaining and rebuilding capacity in government will be 
     better equipped to contain the epidemic. Equally valuable are 
     labour and social legislation changes that boost people's 
     rights, more effective and equitable ways of delivering 
     social services, and more extensive programmes that benefit 
     those worst hit by the epidemic (especially women and 
     orphans).
     Coping with crisis
       In the worst-affected countries, steep drops in life 
     expectancies are beginning to occur, most drastically in sub-
     Saharan Africa, where four countries (Botswana, Malawi, 
     Mozambique and Swaziland) now have a life expectancy of less 
     than 40 years. Were it not for HIV/AIDS, average life 
     expectancy in sub-Saharan Africa would be approximately 62 
     years; instead, it is about 47 years. In South Africa, it is 
     estimated that average life expectancy is only 47 years, 
     instead of 66, if AIDS were not a factor. And, in Haiti, it 
     has dropped to 53 years (as opposed to 59). The number of 
     African children who had lost their mother or both parents to 
     the epidemic by the end of 2000--12.1 million--is forecast to 
     more than double over the next decade. These orphans are 
     especially vulnerable to the epidemic, and the impoverishment 
     and precariousness it brings.
       As more infants are born HIV-positive in badly affected 
     countries, child mortality rates are also rising. In the 
     Bahamas, it is estimated that some 60 percent of deaths among 
     children under the age of five are due to AIDS, while, in 
     Zimbabwe, the figure is 70 percent.
       Unequal access to affordable treatment and adequate health 
     services is one of the main factors accounting for 
     drastically different survival rates among those living with 
     HIV/AIDS in rich and poor countries and communities. Public 
     pressure and UN-sponsored engagements with pharmaceutical 
     corporations (through the Accelerating Access Initiative), 
     along with competition from generic drug manufacturers, has 
     helped drive antiretroviral drug prices down. But prices 
     remain too high for public-sector budgets in low-income 
     countries where, in addition, health infrastructures are too 
     frail to bring life-prolonging treatments to the millions who 
     need it.
       Backed by a strong social movement, Brazil's government has 
     shown that those barriers are not impregnable and that the 
     use of cheaper drugs can be an important element of a 
     successful response. Along with Brazil, countries such as 
     Argentina and Uruguay also guarantee HIV/AIDS patients free 
     antiretroviral drugs. In Africa, several governments are 
     launching programmes to provide similar drugs through their 
     public health system, albeit on a limited scale, at first.
       In all such cases, though, clearing the hurdle of high 
     prices is essential but not enough. Also indispensable are 
     functioning and affordable health systems. Massive 
     international support is needed to help countries meet that 
     challenge.


                    eastern europe and central asia

       HIV incidence is rising faster in this region than anywhere 
     else in the world. There were an estimated 250,000 new 
     infections in 2001, raising to 1 million the number of people 
     living with HIV.
       In the Russian Federation, the startling increase in HIV 
     infections of recent years is continuing, with new reported 
     diagnoses almost doubling annually since 1998. In 2001, more 
     than 40,000 new HIV-positive diagnoses were reported in the 
     first six months. The total number of HIV infections reported 
     since the epidemic began came to more than 129,000 in June 
     2001--up from the 10,993 reported for the end of 1998. The 
     actual number of people now living with HIV in the Russian 
     Federation is estimated to be many times higher than these 
     reported figures.
       At 1 percent, the adult HIV prevalence rate in Ukraine is 
     the highest in the region. While injecting drug use is 
     currently responsible for three-quarters of HIV infections in 
     Ukraine, the proportion of sexually transmitted HIV 
     infections is increasing. In Estonia, reported HIV infections 
     have soared from 12 in 1999 to 1,112 in the first nine months 
     of 2001. Outbreaks of HIV-related injecting drug use are also 
     being reported in several Central Asian republics, including 
     Kazakhstan and, most recently, Kyrgyzstan, Tajikistan and 
     Uzbekistan.
       Given the current evidence, a much larger and more 
     generalized epidemic is a real threat. However, the epidemic 
     is still at an early stage in the region and massive 
     prevention efforts could curtail its scale and extent. Such 
     efforts would require a comprehensive response to reduce 
     risky sexual and drug-injecting behaviour among young people, 
     and tackle the socioeconomic and other factors that promote 
     the spread of the virus.
       In the Russian Federation and other parts of the former 
     Soviet Union, the vast majority of reported HIV infections 
     are related to injecting drug use, which has become unusually 
     widespread among young people, especially young men. An 
     estimated 1 percent of the population of those countries is 
     injecting drugs. Given the high odds of transmission through 
     needle sharing, the fact that the young people are also 
     sexually active, and the high levels of sexually transmitted 
     infections in the wider population, a huge epidemic may be 
     imminent. As well, the male-female ratio among newly detected 
     HIV cases has narrowed from 4:1 to 2:1, indicating that young 
     women are increasingly at risk of HIV infection.
       Several factors are creating a fertile setting for the 
     epidemic; mass unemployment and economic insecurity beset 
     much of the region; social and cultural norms are being 
     increasingly liberalized; and public health services are 
     steadily disintegrating.
       Reported rates of other sexually transmitted infections are 
     very high and compound the odds of HIV being transmitted 
     through unprotected sex. The incidence of syphilis (the 
     reported number of infections in a given year) in the Russian 
     Federation in 2000 stood at 157 per 100,000 persons, compared 
     to 4.2 per 100,000 persons in 1987. Similar general trends 
     are visible in the Baltic States, Belarus, the Central Asian 
     republics, the Republic of Moldova, and Ukraine.
       Unprecedented numbers of young people are not completing 
     their secondary schooling. With jobs in short supply, many 
     are at special risk of joining groups of vulnerable 
     populations, by resorting to injecting drug use and (regular 
     or occasional) sex work. Among young people in the Russian 
     Federation, for instance, drug use is almost three times more 
     prevalent than it was five years ago. Drug use is steadily 
     becoming a more frequent feature of secondary school life in 
     many cities. Needle sharing is common practice among 
     injecting drug users--and a common cause of HIV transmission. 
     Surveys in some cities in the Russian Federation show that 
     most sex workers are 17-23 years old and that condom use in 
     the sex industry is erratic, at best.
       HIV risk is high among men who have sex with men, among 
     whom multiple partners and unprotected sex are widespread. 
     While laws penalizing homosexual activities with imprisonment 
     have been struck off the statute books in the Russian 
     Federation and in most (though not all) other countries of 
     the former Soviet Union, men who have sex with men remain 
     highly stigmatized socially. Currently, there are very few 
     examples of HIV prevention activities targeting this group.
       In south-eastern Europe, rates of sexually transmitted 
     infections and injecting drug use are also on the rise, 
     although still at considerably lower levels than elsewhere in 
     the region. Drug trafficking, along with the economic and 
     psychological aftermath of recent conflicts, are increasing 
     the likelihood that HIV epidemics will emerge in this region.
       In Central Europe, there is cause for tempered optimism. 
     There is little indication, at this stage, of a potential 
     rise in HIV infections. By mounting a strong national 
     response, the Polish Government has successfully curtailed 
     the epidemic among injecting drug users and prevented it from 
     gaining a foothold in the general population. Prevalence 
     remains low in countries such as the Czech Republic, Hungary 
     and Slovenia, where well-designed national HIV/AIDS 
     programmers are in operation.
       More than 150 HIV/AIDS prevention projects among injecting 
     drug users have been set up across the region in the past 
     five years, along with projects focusing on other vulnerable 
     populations such as prison inmates, sex workers and men who 
     have sex with men. Although comparatively few in number, many 
     of these projects are laying the foundations for larger, more 
     extensive prevention work.
       At the same time, there are signs of growing political 
     commitment in the region. Following the UN General Assembly 
     Special Session on HIV/AIDS, countries of the Commonwealth of 
     Independent States are developing a special declaration on 
     the epidemic and are preparing a regional work plan to guide 
     a coordinated response. In countries such as Bulgaria, 
     Romania, the Russian Federation and Ukraine, the budgets of 
     national AIDS programmes have increased substantially. The 
     strong partnerships being forged

[[Page 24843]]

     between the government, private sector and nongovernmental 
     organizations in Ukraine are setting a positive example for 
     the rest of the region. In June 2001, the President of 
     Ukraine declared 2002 the year of the fight against AIDS.
       Vigorous prevention efforts are needed to equip young 
     people with the knowledge and services (such as HIV/AIDS 
     information, condom promotion, life-skills training) they 
     need to protect themselves against the virus. Given that 
     young people (especially women) are bearing the brunt of the 
     economic transitions in the region, socioeconomic programmes 
     that can reduce the vulnerability of young men and women are 
     also vital.
       Special steps are needed to include HIV-related life-skills 
     education in school curricula and to extend peer education to 
     vulnerable young people who are in institutions or out of 
     school and employment. Much more comprehensive efforts are 
     needed to address the complex issues related to HIV and 
     injecting drug use among young people.


                          ASIA AND THE PACIFIC

       HIV/AIDS was late coming to Asia. Until the late 1980s, no 
     country in the region had experienced a major epidemic and, 
     in 1999, only Cambodia, Myanmar and Thailand had documented 
     significant nationwide epidemics. This situation is now 
     rapidly changing. In 2001, 1.07 million adults and children 
     were newly infected with HIV in Asia and the Pacific, 
     bringing to 7.1 million the total number of people living 
     with HIV/AIDS in this region. Of particular concern are the 
     marked increases registered in some of the world's most 
     heavily populated countries.
       Surveillance data on China's huge population are sketchy, 
     but the country's health ministry estimates that about 
     600,000 Chinese were living with HIV/AIDS in 2000. Given the 
     recently observed rises in reported HIV infections and 
     infection rates in many sub-populations in several parts of 
     the country, the total number of people living with HIV/AIDS 
     in China could well have exceeded one million by late 2001. 
     Reported HIV infections rose by 67.4 percent in the first six 
     months of 2001, compared with the previous year, according to 
     the country's ministry of health. Increasing evidence has 
     emerged of serious epidemics in Henan Province in central 
     China, where many tens of thousands (and possibly more) of 
     rural villages have become infected since the early 1990s by 
     selling their blood to collecting centres that did not follow 
     basic blood donation safety procedures.
       HIV levels in specific groups are known to be rising in 
     several other areas. Seven Chinese provinces were 
     experiencing serious labor HIV epidemics in 2001, with 
     prevalence higher than 70 percent among injecting drug users 
     in a number of areas, such as Yili Prefecture in Xinjiang and 
     Ruili Country in Yunnan. Another nine provinces are possibly 
     on the brink of HIV epidemics among injecting drug users 
     because of very high rates of needle sharing. There are also 
     signs of heterosexually transmitted HIV epidemics in at least 
     three provinces (Yunnan, Guangxi and Guangdong), with HIV 
     rates reaching 4.6 percent (up from 1.6 percent in 1999) in 
     Yunnan and 10.7 percent in Guangxi (up from 6 percent) among 
     sentinel sex worker populations in 2000.
       Vast and populous India faces similar challenges. At the 
     end of 2000, the national adult HIV prevalence rate was under 
     1 percent, yet this meant that an estimated 3.86 million 
     Indians were living with HIV/AIDS--more than in any other 
     country besides South Africa. Indeed, median HIV prevalence 
     among women attending antenatal clinics was higher than 2 
     percent in Andhra Pradesh and exceeded 1 percent in five 
     other states (Karnataka, Maharashtra, Manipur, Nagaland and 
     Tamil Nadu) and in several major cities (including Bangalore, 
     Chennai, Hyderabad and Mumbai). India's epidemic is also 
     strikingly diverse, both among and within states.
       Indonesia--the world's fourth-most populous country--offers 
     an example of how suddenly a HIV/AIDS epidemic can emerge. 
     After more than a decade of negligible rates of HIV, the 
     country is now seeing infection rates increase rapidly among 
     injecting drug users and sex workers, in some places, along 
     with an exponential rise in infection among blood donors (an 
     indication of HIV spread in the population at large). HIV 
     infection in injection drug users was not considered worth 
     measuring until 1999/2000, when it had already reached 15 
     percent. Within another year, 40 percent of injectors in 
     treatment in Jakarta were already infected. In Bogor, in West 
     Java Province, 25 percent of injecting drug users tested were 
     HIV-infected, while among drug-using prisoners tested in 
     Bali, prevalence was 53 percent.
       Behaviours that bring the highest risk of infection in Asia 
     and the Pacific are unprotected sex between clients and sex 
     workers, needle sharing and unprotected sex between men. But 
     infections do not remain confined to those with higher-risk 
     behaviour. Many countries have been major epidemics grow out 
     of initially relatively contained rates of infection in these 
     populations. Northern Thailand's epidemic in the late 1980's 
     and early 1990s was primed in this way. Over 10 percent of 
     young men became infected before strong national and local 
     prevention efforts, including the ``100 percent programme'', 
     reduced high-risk behaviour, encouraged safer sex and lowered 
     HIV prevalence.
       Commercial sex provides the virus with considerable scope 
     for growth. The limited national behavioural data collected 
     in the region to date show that, over the past decade, the 
     percentage of surveyed adult men who reported having visited 
     a sex worker in a given year ranged from 5 percent in some 
     countries to 20 percent in others. India and Viet Nam are 
     countries where levels of infection among clients and sex 
     workers are rising. In Ho Chi Minh City, the percentage of 
     sex workers with HIV has risen sharply since 1998, reaching 
     more than 20 percent by 2000.
       Few countries are acting vigorously enough to protect sex 
     workers and clients from the HIV virus. Yet, it is from the 
     comparatively small pool of sex workers first infected by 
     their clients that HIV steadily enters the larger pool of 
     still-uninfected clients who eventually transmit the virus to 
     their wives and partners. Although recent behaviour 
     surveillance surveys show that, in 11 out of 15 Asian 
     countries and Indian states, over two-thirds of sex workers 
     report using a condom with their last client, the need to 
     boost condom use remains. In Bangladesh, Indonesia, Nepal and 
     the Philippines, for instance, fewer than half of sex workers 
     report using condoms with every client.
       Sharing injecting equipment is a very efficient way of 
     spreading HIV, making prevention programmes among injecting 
     drug user populations another top priority. Upwards of 50 
     percent of injecting drug users have acquired the virus in 
     Myanmar, Nepal, Thailand, China's Yunnan Province and Manipur 
     in India. Recent surveys show that a third of injecting drug 
     users in Viet Nam said they recently shared needles with 
     other users, while 55 percent of male injecting drug users in 
     northern Bangladesh and 75 percent in the central region 
     report sharing injecting equipment at least once in the week 
     prior to being questioned.
       Extensive harm reduction programmes can and do work. By the 
     1980s, Australia had prevented a major epidemic from 
     occurring among injecting drug users and, quite likely, from 
     spreading beyond them. Such examples are being followed by 
     several other countries, but in an isolated fashion. The 
     SHAKTI Project in Dhaka, Bangladesh, offers injecting drug 
     users needle exchange, safer injecting options and safer sex 
     education, as well as condoms. IKHLAS, in the Malaysian 
     capital of Kuala Lumpur, provides peer support services, but 
     the estimated 5000 injecting drug users reached are only a 
     fraction of the country's drug-injecting population.
       The need to expand such programmes nationally is patent is 
     these concentrated epidemics are to be brought under control 
     before they spill into the wider population. Many injecting 
     drug users are sexually active young men. Many have steady 
     partners; others buy sex. The overlap between injecting drug 
     use and buying sex is striking. In some Vietnamese cities, 17 
     percent of male injecting drug users reported having recently 
     bought unprotected sex. Between half and three-quarters of 
     male injecting drug users in several cities of Bangladesh 
     have reported buying sex from women during the past year, 
     with fewer than one-quarter of them saying they had used a 
     condom the last time they paid for sex. There also is 
     increasing evidence of female sex workers taking up injecting 
     drug use in Viet Nam.
       Some self-identified ``gay'' communities exist throughout 
     the region but, in most of Asia, many additional categories 
     of men engage in same-sex intercourse. Many men who prefer 
     sex with men also have sex with women. Indeed, many marry and 
     raise families. This creates a huge potential for men who 
     have unprotected sex with men to act as ``bridges'' for the 
     virus in the wider population. In Cambodia, for instance, 
     some 40 percent of men who have sex with men reported also 
     having had sex with women in the month prior to being 
     surveyed.
       At the same time, there is ample evidence that early, 
     large-scale and focused prevention programmes, which include 
     efforts directed at both those with higher-risk behavior and 
     the broader population, can keep infection rates lower in 
     specific groups and reduce the risk of extensive HIV spread 
     among the wider population. Cambodia's prevention measures, 
     which began in earnest in 1994-95, saw high-risk behavior 
     among men fall and condom use rise consistently in the late 
     1990s. As a consequence, HIV prevalence among pregnant women 
     declined from 3.2 percent in 1997 to 2.3 percent at the end 
     of 2000, suggesting that the country is beginning to bring 
     its epidemic under control.
       Thailand's well-funded, politically-supported and 
     comprehensive prevention programmes, which accelerated in the 
     early 1990s have trimmed annual new HIV infections to about 
     30,000, from a high of 140,000 a decade ago. Although an 
     estimated 700,000 Thais are living with HIV today, Thailand's 
     prevention efforts probably averted millions of HIV 
     infections. Nonetheless, one-in-60 Thais in this country of 
     62 million people is infected with HIV, and AIDS has become 
     the leading cause of death, despite the country's prevention 
     successes. There are indications that transmission between 
     spouses is now responsible for more than half of new 
     infections--a reminder that mainly targeting

[[Page 24844]]

     high-risk groups is inadequate, and that countries need to 
     carefully track patterns of HIV spread and adapt their 
     responses accordingly. Furthermore, ongoing high rates of HIV 
     infection through needle sharing in Thailand highlight the 
     need to sustain prevention efforts as the epidemic evolves.
       In large parts of Asia and the Pacific, prevention 
     programmes are poorly funded and resourced. Typically, small 
     projects are scattered across countries and do not acquire 
     the scale or coherence that is needed to halt the epidemic's 
     spread. Because many high-risk practices are frowned upon and 
     even criminalized, there are serious political hurdles to 
     prevention.


                           SUB-SAHARAN AFRICA

       Sub-Saharan Africa remains the region most severely 
     affected by HIV/AIDS. Approximately 3.4 million new 
     infections occurred in 2001, bringing to 28.1 million the 
     total number of people living with HIV/AIDS in this region.
       The region is experiencing diverse epidemics in terms of 
     scale and maturity. HIV prevalence rates have risen to 
     alarming levels in parts of southern Africa, where the most 
     recent antenatal clinic data reveal levels of more than 30 
     percent in several areas. In Swaziland, HIV prevalence among 
     pregnant women attending antenatal clinics in 2000 ranged 
     from 32.3 percent in urban areas to 34.5 percent in rural 
     areas; in Botswana, the corresponding figures were 43.9 
     percent and 35.5 percent. In South Africa's KwaZulu-Natal 
     Province, the figure stood at 36.2 percent in 2000.
       At least 10 percent of those aged 15-49 are infected in 16 
     African countries, including several in southern Africa, 
     where at least 20 percent are infected. Countries across the 
     region are expanding and upgrading their responses. But the 
     high prevalence rates mean that even exceptional success on 
     the prevention front will now only gradually reduce the human 
     toll. It is estimated that 2.3 million Africans died of AIDS 
     in 2001.
       This notwithstanding, in some of the most heavily affected 
     countries there is growing evidence that prevention efforts 
     are bearing fruit. One new study in Zambia shows urban men 
     and women reporting less sexual activity, fewer multiple 
     partners and more consistent use of condoms. This is in line 
     with earlier indications that HIV prevalence is declining 
     among urban residents in Zambia, especially among young women 
     aged 15-24.
       According to the South African Ministry of Health, HIV 
     prevalence among pregnant women attending antenatal clinics 
     reached 24.5 percent in 2000. About one-in-nine South 
     Africans (or 4.7 million people) are living with HIV/AIDS. 
     Yet, there are possibly heartening signs that positive trends 
     might be increasingly taking hold among adolescents, for whom 
     prevalence rates have dropped slightly since 1998. Large-
     scale information campaigns and condom distribution 
     programmes appear to be bearing fruit. In South Africa, for 
     instance, free male condom distribution rose from 6 million 
     in 1994 to 198 million five years later. In recent surveys, 
     approximately 55 percent of sexually active teenage girls 
     reported that they always use a condom during sex. But these 
     developments are accompanied by a troubling rise in 
     prevalence among South Africans aged 20-34, highlighting the 
     need for greater prevention efforts targeted at older age 
     groups, and tailored to their realities and concerns.
       Progress is also being made on the treatment and care 
     front. In the southern African region, relatively prosperous 
     Botswana has become the first country to begin providing 
     antiretroviral drugs through its public health system, thanks 
     to a bigger health budget and drug price reductions 
     negotiated with pharmaceutical companies.
       Within the context of a public/private partnership between 
     five research-and-development pharmaceutical companies and 
     five United Nations agencies, there is increasing access to 
     antiretroviral therapy in Africa. As of the end of 2001, more 
     than 10 African countries were providing antiretroviral 
     therapy to people living with HIV/AIDS.
       In five West African countries--Burkina Faso, Cameroon, 
     Cote d'Ivoire, Nigeria and Togo--national adult prevalence 
     rates already passed the 5 percent mark in 2000. Countries 
     such as Nigeria are boosting their spending on HIV/AIDS and 
     extending their responses nationwide. This year, Nigeria 
     launched a US $240-million HIV/AIDS Emergency Action Plan. 
     Determined prevention efforts in Senegal continue to bear 
     fruit, thanks to the prompt political support for its 
     programmes.
       On the eastern side of the continent, the downward arc in 
     prevalence rates continues in Uganda--the first African 
     country to have subdued a major HIV/AIDS epidemic. HIV 
     prevalence in pregnant women in urban areas has fallen for 
     eight years in a row, from a high of 29.5 percent in 1992 to 
     11.25 percent in 2000. Focusing heavily on information, 
     education and communication, and decentralized programmes 
     that reach down to village level, Uganda's efforts have also 
     boosted condom use across the country. In the Masindi and 
     Pallisa districts, for instance, condom use with casual 
     partners in 1997--2000 rose from 42 percent and 31 percent, 
     respectively, to 51 percent and 53 percent. In the capital, 
     Kampala, almost 98 percent of sex workers surveyed in 2000 
     said they had used a condom the last time they had sex.
       But despite such success, huge challenges remain. New 
     infections continue to occur at a high rate. Most people with 
     HIV do not have access to antiretroviral therapy. Already, by 
     the end of 1999, 1.7 million children had lost a mother or 
     both parents to the disease. Providing them with food, 
     housing and education will test the resources and resolve of 
     the country for many years to come.
       Uganda's experience underlines the fact that even a rampant 
     HIV/AIDS epidemic can be brought under control. The axis of 
     any effective response is a prevention strategy that draws on 
     the explicit and strong commitment of leaders at all levels, 
     that is built on community mobilization, and that extends 
     into every area of the country.
       Although they are exceptionally vulnerable to the epidemic, 
     millions of young African women are dangerously ignorant 
     about HIV/AIDS. According to UNICEF, more than 70 percent of 
     adolescent girls (aged 15-19) in Somalia and more than 40 
     percent in Guinea Bissau and Sierra Leone, for instance, have 
     never heard of AIDS. In countries such as Kenya and the 
     United Republic of Tanzania, more than 40 percent of 
     adolescent girls harbor serious misconceptions about how the 
     virus is transmitted. One of the targets fixed at the UN 
     General Assembly Special Session on HIV/AIDS in June 2001 was 
     to ensure that at least 90 percent of young men and women 
     should, by 2005, have the information, education and services 
     they need to defend themselves against HIV infection. As in 
     other regions of the world, most countries in sub-Saharan 
     Africa are a considerable way from fulfilling that pledge.
       The vast majority of Africans living with HIV do not know 
     they have acquired the virus. One study has found that 50 
     percent of adult Tanzanian women know where they could be 
     tested for HIV, yet only 6 percent have been tested. In 
     Zimbabwe, only 11 percent of adult women have been tested for 
     the virus. Moreover, many people who agree to be tested 
     prefer not to return and discover the outcome of those tests. 
     However, other obstacles remain. A study in Abidjan, Cote 
     d'Ivoire, shows that 80 percent of pregnant women who agree 
     to undergo a HIV test return to collect their results. But of 
     those who discover they are living with the virus, fewer than 
     50 percent return to receive drug treatment for the 
     prevention of mother-to-child transmission of the virus.
       More than half of the women who know they have acquired 
     HIV, and who were surveyed by Kenya's Population Council this 
     year, said they had not disclosed their HIV status to their 
     partners because they feared it would expose them to violence 
     or abandonment. Not only are voluntary counselling and 
     testing services in short supply across the region, but 
     stigma and discrimination continue to discourage people from 
     discovering their HIV status.
       Accumulating over the past year have been many encouraging 
     developments. Thirty-one countries in the region have now 
     completed a national HIV/AIDS strategic plan and another 12 
     are developing such a plan. Several regional initiatives to 
     roll back the epidemic are under way. Some, such as those 
     grouping countries in the Great Lakes region, the Lake Chad 
     Basin and West Africa, are concentrating their efforts on 
     reducing the vulnerability of refugee and other mobile 
     populations. The political commitment to turn the tide of 
     AIDS appears stronger than ever. Gatherings such as the 200 
     African Development Forum meeting last December, and the 
     Organization of African Unity Summit HIV/AIDS, Tuberculosis 
     and Other Related Infectious Diseases in April 2001, appear 
     to be cementing that resolve. At the latter meeting, Heads of 
     State agreed to devote at least 15 percent of their 
     countries' annual budgets to improving health sectors. Fewer 
     than five countries had reached that level in 2000.
       AIDS has become the biggest threat to the continent's 
     development and its quest to bring about an African 
     Renaissance. Most governments in sub-Saharan Africa depend on 
     a small number of highly skilled personnel in important areas 
     of public management and core social services. Badly affected 
     countries are losing many of these valuable civil servants to 
     AIDS. Essential services are being depleted at the same time 
     as state institutions and resources come under greater strain 
     and traditional safety nets disintegrate. In some countries, 
     health-care systems are losing up to a quarter of their 
     personnel to the epidemic. People at all income levels are 
     vulnerable to these repercussions, but those living in 
     poverty are hit hardest. Meanwhile, the ability of the state 
     to ensure law and order is being compromised, as the epidemic 
     disrupts institutions such as the courts and the police. The 
     risks of social unrest and even socio-political instability 
     should not be underestimated.


                    the middle east and north africa

       In the countries of the Middle East and North Africa, the 
     visible trend is also towards increasing HIV infection rates, 
     though still at very low levels. Existing surveillance 
     systems remain inadequate, but it is estimated that 80,000 
     people acquired the virus in 2001, bringing to 440,000 the 
     number of people living with HIV/AIDS. The need for early, 
     effective prevention is becoming manifest throughout this 
     region.

[[Page 24845]]

       Unfortunately, factors driving the epidemic are still too 
     seldom systematically analysed in most countries in the 
     region. As a result, HIV/AIDS responses are rarely based on a 
     clear understanding of infection patterns or knowledge of 
     particular high-risk groups.
       Based on current knowledge, however, factors putting people 
     at risk are varied, though sexual intercourse remains the 
     dominant route of transmission. A local study in Algeria has 
     revealed prevalence rates of 1 percent among pregnant women. 
     Outbreaks now appear to be occurring elsewhere, including in 
     the Libyan Arab Jamahiriya, where all but a fraction of the 
     570 new HIV infections reported in 2000 were among drug 
     users. Djibouti and the Sudan are facing growing epidemics 
     that are being driven by combinations of socioeconomic 
     disparities, large-scale population mobility and political 
     instability.
       The rate of HIV infection is increasing significantly in 
     other vulnerable groups. Among prisoners in the Islamic 
     Republic of Iran, rates of HIV infection have risen from 1.37 
     percent in 1999 to 2.28 percent in 2000. Besides the Sudan 
     and the Republic of Yemen, all countries in the region have 
     reported HIV transmission through injecting drug use. Unless 
     addressed promptly through harm reduction and other 
     prevention approaches, the epidemic among these 
     subpopulations of injecting drug users could grow 
     dramatically and spread into the wider population.
       There are also signs that the double disease burden of HIV 
     and tuberculosis is growing in some countries. Rates of HIV 
     infection among tuberculosis patients are rising and, by mid-
     2001, stood at 8 percent in the Sudan, 4.8 percent in Oman, 
     4.2 percent in the Islamic Republic of Iran and 2.1 percent 
     in Pakistan.
       At the same time, the political will to mount a more potent 
     response to the epidemic is visible in several countries, 
     some of which are introducing innovative approaches. Examples 
     include the mobilization of nongovernmental organizations 
     around prevention programmes in Lebanon, and harm reduction 
     work among injecting drug users in the Islamic Republic of 
     Iran.


                         HIGH-INCOME COUNTRIES

       Unless averted with renewed and more effective prevention 
     efforts, resurgent epidemics will continue to threaten high-
     income countries, where over 75,000 people became infected 
     with HIV in 2001.
       In Australia, Canada, the United States of America (USA) 
     and countries of Western Europe, a pronounced rise in unsafe 
     sex is triggering higher rates of sexually transmitted 
     infections and, in some cases, higher levels of HIV incidence 
     among men who have sex with men. The prospect of rebounding 
     HIV/AIDS epidemics looms as a result of widespread public 
     complacency and stalled, sometimes inappropriate, prevention 
     efforts that do not reflect changes in the epidemic. In 
     Japan, meanwhile, HIV infections are also on the rise.
       The rise in new HIV infections among men who have sex with 
     men is striking. In Vancouver, Canada, HIV incidence among 
     young men who have sex with men rose from an average of 0.6 
     percent in 1995-1999 to 3.7 percent in 2000. In London, 
     United Kingdom, reported HIV infections among gay men are 
     also on the rise. In Madrid, reported HIV infections rose 
     almost twofold (from 1.16 percent to 2.16 percent in 1996-
     2000, whereas, in San Francisco, it rose from 1.1 percent in 
     1997 to 1.7 percent in 2000 and appears to be rising still, 
     according to recent studies. Among gay men who inject drugs 
     in that city, the infection rate climbed from 2 percent in 
     1997 to 4.6 percent in 2000.
       Rising incidence of other sexually transmitted infections 
     among men who have sex with men (in Amsterdam, Sydney, London 
     and southern California, for instance) confirms that more 
     widespread risk-taking is eclipsing the safer-sex ethic 
     promoted so effectively for much of the 1980s and 1990s. 
     Similar trends are being detected among the heterosexual 
     populations of some countries, especially among young people. 
     Diagnoses of gonorrhea and syphilis among men and women have 
     hit their highest levels for 13 years in England and Wales, 
     for instance.
       Part of the explanation could lie in the visibly life-
     saving effects of antiretroviral therapy, introduced in high-
     income countries in 1996. Deaths attributed to HIV in the 
     USA, for instance, fell by a remarkable 42 percent in 1996-
     97, since the decline has levelled off. However, this wide 
     access to antiretroviral therapy has encouraged 
     misperceptions that there is now a cure for AIDS and that 
     unprotected sex poses a less daunting risk. High-risk 
     behaviour is increasing, as a result.
       Prevention efforts, as well as treatment and care 
     strategies, have to contend with other, significant shifts in 
     the epidemic, such as its slow but apparently inexorable 
     shift towards other vulnerable populations. At play appears 
     to be an overlap of racial discrimination with income, health 
     and other inequalities. In high-income countries there is 
     evidence that HIV is moving into poorer and more deprived 
     communities, with women at particular risk of infection. 
     Young adults belonging to ethnic minorities (including men 
     who have sex with men) face considerably greater risks of 
     infection than they did five years ago in the USA. African-
     Americans, for instance, make up only 12 percent of the 
     population of the USA, but constituted 47 percent of AIDS 
     cases reported there in 2000. As elsewhere in the world, 
     young disadvantaged women (especially African-American and 
     Hispanic women) in the USA are being infected with HIV at 
     higher rates and at younger ages than their male 
     counterparts.
       In the USA, men having sex with men is still the main mode 
     of transmission (accounting for some 53 percent of new HIV 
     infections in 2000), but almost one-third of new HIV-positive 
     diagnoses were among women in 2000. In this latter group, an 
     overlap of injecting drug use and heterosexual intercourse 
     appears to be driving the epidemic. Indeed, injecting drug 
     use has become a more prominent route of HIV infection in the 
     USA, where an estimated 30 percent of new reported AIDS cases 
     are related to this mode of transmission. In Canada, women 
     now represent 24 percent of new HIV infections, compared to 
     8.5 percent in 1995.
       The HIV epidemic in western and central Europe is the 
     result of a multitude of epidemics that differ in terms of 
     their timing, their scale and the populations they affect. 
     Portugal faces a serious epidemic among injecting drug users. 
     Of the 3733 new HIV infections reported there in 2000, more 
     than half were caused by injecting drug use and just under a 
     third occurred via heterosexual intercourse. Reports of new 
     HIV infections also indicate that sex between men is an 
     important transmission route in several countries, including 
     Germany, Greece and the United Kingdom. Unfortunately, HIV 
     reporting data are uneven in several of the more affected 
     countries, including some of those believed to be most 
     affected by the epidemic among injecting drug users.
       In Japan, the number of HIV infections detected in men who 
     have sex with men has risen sharply in recent years, with 
     male-male sex now accounting for more than twice as many 
     infections in men as heterosexual sex. This is a major 
     departure from past patterns: until two years ago, the number 
     of new infections reported in both groups was roughly equal.
       There are also signs that the sexual behavior of youth in 
     Japan could be changing significantly and putting this group 
     at greater risk of HIV infection. Higher rates of Chlamydia 
     among females and gonorrhoea infections among males, as well 
     as a doubling of the number of induced abortions among 
     teenage women in the past five years, suggest increased rates 
     of unprotected sexual intercourse. Behavioral data, 
     meanwhile, show low condom use, both in the general 
     population and among sex workers.


                    LATIN AMERICA AND THE CARIBBEAN

       Major differences in epidemic levels and patterns of HIV 
     transmission are evident in Latin America and the Caribbean, 
     where an estimated 1.8 million adults and children are living 
     with HIV--including the 190,000 people who acquired the virus 
     in the past year. Some 1.4 million people are living with 
     HIV/AIDS in Latin America and 420,000 in the Caribbean.
       In Central America and the Caribbean, HIV is mainly 
     heterosexually transmitted, with unsafe sex and frequent 
     partner exchange among young people high among the factors 
     driving the epidemic. Other powerful dynamics are abetting 
     the spread of HIV, notably the combination of socioeconomic 
     pressures and high population mobility (including tourism).
       The Caribbean is the second-most affected region in the 
     world, with adult HIV prevalence rates only exceeded by those 
     of sub-Saharan Africa. In several Caribbean countries, HIV/
     AIDS has become a leading cause of death. Worst affected are 
     Haiti and the Bahamas, where adult HIV prevalence rates are 
     above 4 percent. But the epidemic is by no means concentrated 
     only in the Caribbean.
       Along with Barbados and the Dominican Republic, several 
     Central American and Caribbean countries had adult HIV 
     prevalence rates of at least 1 percent at the end of 1999, 
     including Belize, Guyana, Honduras, Panama and Suriname. By 
     contrast, prevalence is lowest in Bolivia, Ecuador and other 
     Andean countries. Almost three-quarters of AIDS cases 
     reported in Central America are the result of sex between men 
     and women. On some Caribbean islands, the phenomenon of young 
     women having sex with older men is especially prominent, and 
     is reflected in the fact that the HIV rate among girls aged 
     15-19 is up to five times that of boys in the same age group. 
     Research among sex workers in Guyana's capital, Georgetown, 
     has found that 46 percent of surveyed sex workers were living 
     with HIV/AIDS, that more than one-third of them never used a 
     condom with their clients, and that almost three-quarters did 
     not use condoms with their regular partners. The probability 
     of the virus passing into the wider population is therefore 
     high.
       In Costa Rica, Mexico, Nicaragua and parts of the Andean 
     region, sex between men is the more prominent route of HIV 
     transmission. Recent studies among men who have sex with men 
     in Mexico have shown that just over 14 percent were HIV-
     positive. Prevalence rates among heterosexual sex workers and 
     sexually transmitted infection patients in Mexico, meanwhile, 
     appear still to be low. Injecting drug use is a main route of 
     HIV transmission in Argentina, Chile and Uruguay, and also 
     plays a major role in Brazil.

[[Page 24846]]

     Patterns of transmission can also differ markedly within 
     countries--a reminder that universal national programmes are 
     inappropriate. In Colombia's highlands, for instance, 
     unprotected sex between men accounts for most HIV infections, 
     while, on the coast, heterosexual intercourse is the main 
     route of transmission.
       Countries' commitment to stem the epidemic and limit its 
     effects has grown markedly. Several countries have launched 
     or are developing government programmes to distribute 
     antiretroviral drugs to HIV/AIDS patients. But there are wide 
     disparities in the quality and scope of different countries' 
     antiretroviral treatment programmes. The wide access to 
     treatment that people living with HIV/AIDS have in countries 
     such as Argentina, Brazil and Uruguay is not yet matched in 
     most other countries of the Americas. Up to recently, Central 
     America experienced a large gap in access to treatment. Now, 
     however, countries such as Costa Rica and Panama are 
     providing treatment access. Caribbean countries are currently 
     developing a regional strategy to speed up and expand access 
     to treatment and care for people living with HIV/AIDS. 
     Countries such as Barbados and Trinidad and Tobago are 
     preparing to implement new national programmes.
       In Brazil, a substantial decline in HIV prevalence among 
     injecting drug users has been observed recently in several 
     large metropolitan areas. This suggests that HIV/AIDS 
     prevention and harm reduction programmes in those cities have 
     made possible safer injection habits among these populations. 
     Brazil's prevention efforts are being balanced with an 
     extensive treatment and care programme that guarantees state-
     funded antiretroviral therapy for those living with HIV/AIDS. 
     The number of people living with the virus in Brazil has 
     reached about 600,000, according to the country's Health 
     Ministry--up from 540,000 in 1999. An estimated 105,000 
     Brazilians are receiving antiretrovial drugs through the 
     public health system.
       A new political resolve is also apparent in several 
     regional initiatives. Launched in February 2001, the Pan-
     Caribbean Partnership against HIV/AIDS, for instance, links 
     the resources of governments and the international community 
     with those of civil society to boost national and regional 
     responses. It is being coordinated by the Caribbean Community 
     Secretariat (CARICOM). On the basis of the Nassau Declaration 
     issued in July 2001, as follow-up to the UN General Assembly 
     Special Session on HIV/AIDS, Caribbean Heads of Government 
     are also devising ways to support each other's national HIV/
     AIDS programmes and jointly negotiate affordable prices for 
     antiretrovial drugs.
       Meanwhile, protecting vulnerable populations on the move is 
     now the focus of a regional initiative in Central America. 
     Argentina, Chile, Paraguay and Uruguay are collaborating in 
     harm-reduction schemes for injecting drugs users. National 
     AIDS programmes have also joined a collaborative scheme to 
     share technical assistance throughout Latin America and the 
     Caribbean. Known as the Horizontal Technical Cooperation 
     Group, it brings together more than 20 countries of the 
     region.


              explanatory note about unaids/who estimates

       The UNAIDS/WHO estimates in this document are based on the 
     most recent available data on the spread of HIV in countries 
     around the world. They are provisional. UNAIDS and WHO, 
     together with experts from national AIDS programmes and 
     research institutions, regularly review and update the 
     estimates as improved knowledge about the epidemic becomes 
     available, while also drawing on advances made in the methods 
     for deriving estimates.
       The estimates and data provided in the graphs and tables 
     are given in rounded numbers. However, unrounded numbers were 
     used in the calculation of rates and regional totals, so 
     there may be small discrepancies between the global totals 
     and the sum of the regional figures.
       In 2001, new software was developed to model the course of 
     HIV/AIDS around the world and to further enhance the quality 
     of estimates of HIV/AIDS prevalence and impact. As a result, 
     this year's estimates incorporate, in particular, new 
     knowledge and assumptions about survival times for adults and 
     children living with HIV/AIDS. Because of this, some of the 
     new estimates cannot be compared directly with estimates from 
     previous years.
       UNAIDS and WHO will continue to work with countries, 
     partner organizations and experts to improve data collection. 
     These efforts will ensure that the best possible estimates 
     are available to assist governments, nongovernmental 
     organizations and others in gauging the status of the 
     epidemic and monitoring the effectiveness of their 
     considerable prevention and care efforts.

  HIV/AIDS accounts for 70 percent of all cases of AIDS worldwide. 
Since its inception, more than 58 million individuals have been 
infected with HIV/AIDS, while 22 million have lost their lives, 17 
million alone in sub-Saharan Africa. It is clearly the leading cause of 
death in sub-Saharan Africa. Further, 90 percent of the world's orphans 
reside in this region.
  Given the loss of life AIDS has caused, the destruction of entire 
communities, and the long-term impact of economic growth, we must step 
up our efforts to fight this devastating disease. I have worked with 
the officials in Botswana who are struggling to combat the impact of 
HIV on their young adults, their most productive sector of their 
community. Therefore, we must do all we can.
  I want to commend all involved and ask that we not only pass this 
bill, but do other things to fight this global pandemic.
  Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the 
distinguished gentleman from Iowa (Mr. Leach).
  Mr. LEACH. Madam Speaker, I thank the gentleman for yielding time to 
me.
  Let me first express my appreciation for the leadership of the 
gentleman from Illinois (Chairman Hyde), the gentleman from California 
(Mr. Lantos), the gentleman from Nebraska (Mr. Bereuter), and of course 
the gentlewoman from California (Ms. Lee) on this issue.
  There should be no doubt that the United States confronts two wars 
simultaneously. One is the war on terrorism, waged with the scourge of 
biological weapons. The other is war on the devastating disease that is 
pandemic in so many poor parts of the world.
  Einstein once said that splitting the atom has changed everything 
save our mode of thinking. Atom-splitting produced the potential for 
great good through nuclear energy, and the potential for great harm 
through weapons of mass destruction.
  Now, the splitting of genes has come to symbolize an even greater 
change: the biological discoveries that promise to enrich and lengthen 
life on the one hand, and the possibility of biological weapons on the 
other that jeopardize life itself on the planet.
  What we must be about is constraining the forces of evil and 
expanding the forces of life. We cannot win the war that terrorism has 
brought to our shore without waging with equal vigor the war on disease 
everywhere that it exists.
  Mr. LANTOS. Madam Speaker, I am very pleased to yield 2 minutes to my 
dear friend and distinguished colleague, the gentlewoman from 
California (Ms. Watson), who served our Nation with great distinction 
as a United States ambassador.
  Ms. WATSON of California. Madam Speaker, we have already heard the 
figures of the number of Africans infected with HIV and AIDS. They are 
staggering, but deserve to be repeated once again: sub-Saharan Africa 
has only 10 percent of the world's population, but accounts for 70 
percent of all HIV/AIDS cases and 80 percent of all HIV/AIDS-related 
deaths. The infection rate in some African nations now exceeds 30 
percent; and in a few countries, it is approaching 40 percent of the 
total population.
  Finally, the United States National Intelligence Council estimates 
that the disease could reduce the gross domestic product in some sub-
Saharan Africa countries by as much as 20 percent or more by 2010. The 
social and economic consequences of this disease are not like any other 
public health threat that the world has faced in modern times. 
Important and hard-won economic gains made by African nations could be 
wiped out in less than a decade. Moreover, social dislocation caused by 
the high rates of death among HIV-infected mothers and fathers is 
already straining the outer bounds of fragile African nation states.
  H.R. 2069, and I commend the sponsors, authorizes additional spending 
levels in excess of $1 billion for bilateral and multilateral HIV/AIDS 
assistance to African nations that is more in keeping with our 
international assistance obligations.
  Madam Speaker, the HIV/AIDS pandemic in Africa not only presents us 
with a profoundly humanitarian, economic, and social dilemma, it also, 
in the very near term, if more is not done, may challenge the very 
notion of law-based nation states.
  I support this legislation, and I would urge everyone else to do so.

[[Page 24847]]


  Mr. HYDE. Madam Speaker, I am pleased to yield 2 minutes to the 
distinguished gentleman from New Jersey (Mr. Smith).
  Mr. SMITH of New Jersey. Madam Speaker, I thank my good friend for 
yielding time to me.
  Madam Speaker, I rise in strong support of H.R. 2069 and believe the 
gentleman from Illinois (Chairman Hyde) deserves special recognition 
and thanks for his persistence on behalf of all who are weak and 
vulnerable, including AIDS victims.
  As my colleagues know, and has been said on the floor today, the 
scourge of AIDS around the globe has reached catastrophic proportions, 
particularly in sub-Saharan Africa. A December report by U.N. AIDS 
indicated that nearly 25.3 million adults and children are infected 
with the HIV virus in sub-Saharan Africa. To put this in perspective, 
this region has about 10 percent of the world's population, but more 
than 70 percent of the HIV/AIDS patients.
  Madam Speaker, among the most tragic of the victims are the children 
who contact HIV via vertical transmission, from mother to child, during 
or shortly after childbirth. Some estimates place the number of 
vertical transmission cases at 600,000 babies annually in Africa. Madam 
Speaker, vertical transmission is specifically addressed in this bill. 
In an age where we already have proven drug regimens and methods to 
prevent mother-to-child transmission, and we have had them for sometime 
now, Madam Speaker, it is outrageous that so many children around the 
world are still contracting HIV/AIDS in this manner. This could be 
stopped, and this bill goes a long way to doing so.
  I would also point out to my colleagues that during markup I offered 
an amendment in the area of hospice and palliative care. Madam Speaker, 
unfortunately, today, when people, particularly in Africa, get AIDS, 
they are treated as lepers, like we had in Biblical times: People go 
nowhere near them, even when they are family members.
  Thankfully, there is an effort under way in Africa and elsewhere to 
reach out to these people so they can die in dignity, and hopefully 
with the least amount of pain as is humanly possible. In South Africa, 
the Catholic Church and Catholic Relief Services and others are doing 
incredible jobs of networking, of bringing the news that you can take 
care of an AIDS patient in your home without the fear of contamination 
yourself. There are methods and procedures that need to be followed; 
and thankfully, that word is getting out.
  Madam Speaker, this legislation does address that and will target 
some resources in that direction.
  Madam Speaker, this is a great bill. I hope Members will support it, 
and congratulations to the gentleman from Illinois (Chairman Hyde).
  Mr. LANTOS. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, again I want to thank the gentleman from Illinois 
(Chairman Hyde) for his extraordinary leadership. I want to thank all 
my colleagues and staff for working on this landmark legislation, and I 
urge all of my colleagues to support it.
  Madam Speaker, I yield back the balance of my time.
  Mr. HYDE. Madam Speaker, I yield myself the balance of my time.
  Madam Speaker, we got an awful lot done in this committee because of 
the great cooperation of the gentleman from California (Mr. Lantos) and 
his staff; and I deeply appreciate it, particularly on this bill.
  Mr. GILMAN. Madam Speaker, I rise in strong support for H.R. 2069, 
The Global Access to HIV/AIDS Prevention, Awareness, Education, and 
Treatment Act of 2001.
  More than 58 million people worldwide are infected with HIV/AIDS 
making it more than just a humanitarian issue . . . it has become a 
national security, and developmental crisis. It is reported that ninety 
five percent of the world's HIV-infected people live in developing 
countries. Right next door, infection rates are rising rapidly in Haiti 
and the Caribbean, where an estimated 5 percent of the population has 
AIDS or is HIV-infected.
  Madam Speaker, our nation has only begun to properly tackle AIDS and 
HIV infection in our nation. Our friends and neighbors in lesser 
developed nations are breaking under the pressure of the destruction 
that this terrible disease has brought to bear on them. H.R. 2069 helps 
to alleviate some of the suffering and will help to strengthen the 
social structures that are crumbling under the weight of the burden of 
carrying for so many.
  Secretary Powell said it well when he stated that the United States 
has an obligation to do more ``if we believe in democracy and freedom 
(then we must work) to stop this catastrophe from destroying whole 
economies and families and societies and cultures and nations.''
  Accordingly, Madam Speaker, I urge my colleagues to support H.R. 
2069.
  Ms. SCHAKOWSKY. Madam Speaker, I rise in strong support of H.R. 2069, 
The Global Access to HIV/AIDS Prevention Act of 2001. I want to commend 
and thank the distinguished Chairman (Mr. Hyde) and Ranking Member (Mr. 
Lantos) of the International Relations Committee, the authors of this 
important legislation for their efforts and for their leadership. I 
also want to commend the gentlewoman from California (Ms. Lee) for her 
continuing leadership and commitment on this critical issue. The bill 
we have before us today is another step in the right direction for the 
global struggle against HIV/AIDS.
  H.R. 2069 authorizes a total of $1.3 billion for the prevention, 
treatment, and monitoring of acquired immune deficiency syndrome (AIDS) 
in sub-Saharan Africa and other developing countries. The bill 
authorizes $560 million in bilateral assistance for various AIDS 
treatment/prevention programs administered by the U.S. Agency for 
International Development (AID), and it authorizes a $750 million U.S. 
commitment to multilateral efforts to fight the pandemic. The bill also 
authorizes $50 million for AIDS drug procurement.
  Funds in this measure will be used to cover many of the needs created 
by HIV/AIDS. The bill is directed toward prevention, education, testing 
and counseling, including strengthening and broadening the capacity of 
indigenous health care systems. The bill also includes assistance aimed 
at mother-to-child transmission prevention, and strengthening and 
expanding hospice and palliative care programs, as well as care for 
children orphaned by HIV/AIDS, improved infrastructure, and vaccine 
research. Finally, H.R. 2069 includes funds for income generation 
programs targeting assistance to HIV/AIDS affected populations, 
particularly those groups and individuals who are at the highest risk 
of being infected, including women.
  I am particularly pleased that this body has recognized the 
importance of providing end of life care for those that are losing 
their struggle with AIDS and that we have acknowledged the particular 
plight that AIDS means for women and children.
  We have all heard some of the staggering statistics about AIDS. 
However, I believe that at least some of them need to be repeated time 
and again until necessary results are achieved.
  Since the HIV-AIDS pandemic began, it has claimed over 22 million 
lives. Over 17 million men, women and children have died due to AIDS in 
sub-Saharan Africa alone. Over 40 million people are infected with the 
HIV virus today. Over 25 million of them live in sub-Saharan Africa. By 
2010, approximately 40 million children worldwide will have lost one or 
both of their parents to HIV-AIDS.
  Each day AIDS kills more than 7,000 people in sub-Saharan Africa 
alone, and the pandemic continues to escalate in the Caribbean, Asia, 
Russia and elsewhere with more than 8,000 people around the world 
perishing from AIDS each day. This human catastrophe is unlike anything 
the world has known.
  While an encouraging symbol of progress, awareness, and compromise, 
the funding set forth by this bill alone will not be enough. In order 
to satisfy the demands posed by the AIDS pandemic, it has been 
estimated that sub-Saharan Africa will need as much as $15 billion a 
year.
  I want to take this opportunity to include for the Record a 
compelling article from the December 6 New York Times. The article goes 
a long way toward dispelling the myth that robust drug treatment 
programs cannot be implemented in poor developing nations. I agree with 
the article that what we can learn from the example of Haiti is that, 
``if we do not treat the millions of Africans dying of AIDS, it is 
because we have chosen not to, not because we can't.'' Indeed, we can 
and should help Africans and all of those struggling against the 
scourge of AIDS. The virus knows no bounds and failing to attack it 
with every resource at our disposal would not only be morally 
reprehensible, it will leave this nation more vulnerable to perhaps the 
greatest threat we have ever faced.
  Again, I commend all of those who helped to bring this important 
measure to the floor

[[Page 24848]]

and urge all members to vote in support of H.R. 2069.

                            Learn From Haiti

                           (By Howard Hiatt)

       Of the 28 million people in Africa with AIDS, no more than 
     25,000 have access to medications. Officials of both Western 
     nations and some affected countries--like South Africa, which 
     has millions in immediate need of treatment--have said that 
     poor countries have too few clinics and doctors and that 
     their populations are too poorly educated to allow treatment 
     of all infected people. This contention has become familiar 
     in the debate over international financing to treat H.I.V.
       But it is a misconception. At a health center in Haiti, a 
     country at the very bottom of the economic heap, H.I.V. 
     infections are controlled as effectively as in America. And 
     the success at this health center, sponsored by Partners in 
     Health, a non-profit charity affiliated with Harvard Medical 
     School, could be replicated all over the world if the wealthy 
     nations chose to provide the financing. The barrier to the 
     use of AIDS drugs for all H.I.V. patients is not some 
     physical or educational impossibility; it is lack of will.
       The center is in Cange, an impoverished village of small 
     houses with corrugated roofs and dirt floors. There and 
     nearby, care is delivered with skill and personal attention 
     comparable to that in American teaching hospitals.
       The compound was begun in 1983 by Paul Farmer, a physician 
     and anthropologist now at Harvard Medical School, and the 
     Rev. Fritz Lafontant, a Haitian Episcopal priest. Working 
     with Dr. Farmer and Jim Yong Kim, another American physician-
     anthropologist, are Haitian doctors and nurses and about 200 
     community health workers, who make this model of health care 
     succeed.
       About 1,400 of the patients have H.I.V.; of these, 100 of 
     the sickest receive the advanced medicines used to treat AIDS 
     in the United States and now function normally. Their care is 
     supervised by the local health workers, who are trained at 
     the clinic. The health center's operations are financed by 
     donations, and the doctors will treat another 100 desperately 
     ill patients with the AIDS drugs if they can persuade drug 
     companies to donate them.
       Partners in Health also applies the principles used in 
     Cange at a center in Peru and one in Mexico. In each case, 
     training community health workers allows the development of a 
     system that can offer sustained treatment for people ill with 
     hard-to-cure diseases. The center in Lima has cured more than 
     80 percent of patients with drug-resistant tuberculosis--
     something many tuberculosis experts and even the World Health 
     Organization had thought impossible.
       What these doctors do to treat H.I.V. infection is a small 
     effort against a huge worldwide problem. But they have shown 
     that if we do not treat the millions of Africans who are 
     dying of AIDS, it is because we have chosen not to, not 
     because we can't.
  Mrs. CHRISTENSEN. Madam Speaker, I rise in support of H.R. 2069, the 
Global Access to HIV/AIDS Prevention, Awareness, Education and 
Treatment Act of 2001 and I commend my colleagues Chairman Hyde, 
Ranking Member Lantos and my friend Congresswoman Barbara Lee for their 
work in bringing this bill to the floor today.
  Madam Speaker, H.R. 2069 is badly needed, and my only regret is that 
we didn't pass it sooner. Just 10 days ago we celebrated World Aids Day 
to call attention to the global scourge of HIV/AIDS which has, to date, 
claimed an estimated four million children world wide and the news gets 
worse, every day. Everyday AIDS kills more than 7,000 people in sub-
Saharan Africa. The AIDS pandemic continues to escalate in the 
Caribbean, Asia, and Russia and according to today's New York Times; 
the Chinese central government is taking steps to address its growing 
AIDS problem. This pandemic is now projected to infect over 100 million 
people with a deadly incurable virus by 2007.
  We must realize that we are no longer a world where any one country, 
or even one neighborhood can labor under the impression that they are 
isolated. The devastation and the disruptive effects of the HIV/AIDS 
pandemic may be at its very worse in far away, exotic lands but the 
dire effects will ripple until they reach our shores.
  The Global Access to HIV/AIDS Prevention, Awareness, Education and 
Treatment Act of 2001 is a step in the right direction in this regard, 
because it urges the United States and other developed countries to 
provide assistance to sub-Saharan Africa and other developing 
countries, with respect to activities supported in connection with 
health programs, to control the HIV/AIDS pandemic through HIV/AIDS 
prevention, treatment, monitoring and related activities, particularly 
focused on women and youth--including mother-to-child transmission 
prevention strategies.
  I urge my colleagues to support this important and badly need bill.
  Ms. JACKSON-LEE of Texas. Madam Speaker, I rise in strong support of 
H.R. 2069, the Global Access to HIV/AIDS Prevention, Awareness, 
Education and Treatment Act of 2001. This bill authorizes assistance to 
combat the HIV/AIDS pandemic in countries in sub-Saharan Africa and 
other developing countries. This pandemic is more than an international 
public health issue, but also a humanitarian, national security, and 
development crisis.
  Sub-Saharan Africa has been the hardest hit region and has been 
disproportionately affected by the deadly disease. Only 10 percent of 
the world's population live south of the Sahara, but the region is home 
to two-thirds of the world's HIV-positive suffering people, accounting 
for more than 80 percent of all AIDS deaths. In fact, Botswana has an 
estimated infection rate of 36 percent the highest in the world. 
Zimbabwe's infection rate is 25 percent, and South Africa's infection 
rate is 20 percent.
  Today, forty million people around the world live with and suffer 
from HIV/AIDS. Twenty-eight million of them live in the Sub-Saharan 
African region alone. On the continent of Africa, there are an 
estimated 11,000 new infections per day, and by the end of this year, 
approximately 2.3 million Africans will have died from HIV infection.
  AIDS does not discriminate against color, and regrettably, it does 
not discriminate against age. In Africa, 3.8 million children under the 
age of 15 have died since the beginning of the epidemic 20 years ago. 
Throughout Africa, 6 out of 7 children who are HIV positive are little 
girls. Many children are also being orphaned by HIV; losing their 
mothers or both parents to AIDS. So far, the AIDS pandemic has left 
behind 13 million orphans, of whom 9 percent currently live in Africa. 
By 2010, if we do nothing, an estimated 40 million children will be 
orphaned by this tragic disease. These numbers will lead to the 
absolute decay of many African societies. As a consequence to losing 
their parents, children are drawn into prostitution, crime, substance 
abuse, and child soldiery, and to the kind of destitution unbelievable 
to most Americans.
  Madam Speaker, I traveled to the South African region in 1999 and in 
July of this year, and what I witnessed was unbelievable! It was a 
life-altering event to see and meet with the people infected by this 
deadly virus. But what affected me the most was witnessing the 
thousands of orphaned children whose parents had died from AIDS.
  On November 28, the Global Health Alliance released a report entitled 
``Pay Now or Pay More Later: An Independent Report on the Response to 
the Global HIV/AIDS Pandemic''. The following day, the African 
Ambassadors Group and International AIDS Trust sponsored a briefing on 
Refocusing and Reaffirming our Commitment to AIDS''. This is clearly a 
global issue and it is everyone's problem. The key to fighting this 
virus must involve a comprehensive approach that includes prevention, 
education, and support of a health care infrastructure. H.R. 2069 
prescribes such an approach. H.R. 2069 also authorizes funds to improve 
orphan care, encourage hospice and palliative care, strengthen existing 
health care systems, and to procure medicines and anti-viral therapies 
to treat the disease. HIV prevention efforts must take into account 
social and economic factors, such as poverty, underemployment, and poor 
access to health care, all of which disproportionately affects African 
societies.
  As Members of Congress, we must continue to fight the struggle and 
persist in obtaining increased funding for the global AIDS response. 
This is one of the great challenges of our time and of this generation. 
H.R. 2069 gives us the tools to help overcome this challenge and I urge 
my colleagues to support this legislation.
  Mr. HYDE. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mrs. Biggert). The question is on the motion 
offered by the gentleman from Illinois (Mr. Hyde) that the House 
suspend the rules and pass the bill, H.R. 2069, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  The title was amended so as to read:
  ``A bill to amend the Foreign Assistance Act of 1961 and the Global 
    AIDS and Tuberculosis Relief Act of 2000 to authorize assistance to 
    prevent, treat, and monitor HIV/AIDS in sub-Saharan African and 
    other developing countries.''.

  A motion to reconsider was laid on the table.




                          ____________________