[Congressional Record (Bound Edition), Volume 149 (2003), Part 8]
[House]
[Pages 10250-10278]
[From the U.S. Government Publishing Office, www.gpo.gov]




 UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                              ACT OF 2003

  The SPEAKER pro tempore. Pursuant to House Resolution 210 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the State of the Union for the consideration of the bill, H.R. 1298.

[[Page 10251]]



                              {time}  1058


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 1298) to provide assistance to foreign countries to combat HIV/
AIDS, tuberculosis, and malaria, and for other purposes, with Mr. 
LaTourette in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered as having 
been read the first time.
  Under the rule, the gentleman from Illinois (Mr. Hyde) and the 
gentleman from California (Mr. Lantos) each will control 30 minutes.
  The Chair recognizes the gentleman from Illinois (Mr. Hyde).
  Mr. HYDE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, not since the bubonic plague swept across the world in 
the last millennium killing more than 250 million people has our world 
confronted such a horrible, unspeakable curse as we are now witnessing 
with the growing HIV/AIDS pandemic.
  In the very short time that we will spend today considering this 
legislation, thousands of people around the world will die of HIV/AIDS. 
The number of dead or dying is grotesquely high: 25 million already 
dead worldwide and growing at the rate of 8,500 every day, with the 
horror of entire villages populated only by orphans because the adults 
are dead or dying from AIDS.
  I do not mean to demean the work of this House, but so much of what 
we do is really unimportant and trivial; but not today. Today we have 
an opportunity, the opportunity to do something significant and of 
lasting importance. Today we have an obligation, the obligation to do 
something reflecting our commitment to human solidarity. We have a 
privilege today, the privilege of doing something truly compassionate.
  It is no exaggeration to compare the AIDS pandemic in Africa to the 
bubonic plague in medieval Europe. This plague took one-third of 
Europe's entire population, creating political chaos and set the course 
of civilization back for decades, perhaps centuries. AIDS in Africa is 
well on its way to doing something terribly similar, and similarly 
terrible. Tuesday's Wall Street Journal tells us 42 million people are 
infected with HIV/AIDS, 30 million in sub-Saharan Africa alone.

                              {time}  1100

  Today we need to consider H.R. 1298, the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. We would not 
be here today with this bill, that I think is an excellent one, without 
the sincere and heartfelt and invaluable assistance of the gentleman 
from California (Mr. Lantos), which makes this a truly bipartisan 
effort.
  This legislation authorizes the President's 5-year $15 billion 
emergency plan for treatment and prevention of AIDS in those countries 
already facing crisis. The legislation creates a more responsive, 
coordinated, and effective approach among the various agencies of the 
U.S. Government involved in this global fight. The legislation promotes 
an approach that provides funds for antiretroviral therapy for more 
than 2 million people living with HIV. It encourages a strategy that 
extends palliative care for people living with AIDS. It supports 
efforts to find vaccines for HIV/AIDS and malaria. It emphasizes the 
need to keep families together with particular focus on the assistance 
needs of children and young people with HIV. It endorses prevention 
programs that stress sexual abstinence and monogamy as a first line of 
defense against the spread of this disease and contributes to 
multilateral initiatives that leverage the funds of other donor 
nations.
  The HIV/AIDS pandemic is more than a humanitarian crisis. 
Increasingly, it is a threat to the security of the developed world. 
Left unchecked, this plague will further rip the fabric of developing 
societies, pushing fragile governments and economies to the point of 
collapse. So to those who suggest the U.S. has no stake in this 
pandemic, let me observe that the specter of failed states across the 
world certainly is our concern.
  Africa is a central concern. Today radical Islam is spreading in 
several African countries, especially Nigeria. This threatens to 
undercut democracy and make Nigeria a failed state. It is in our 
interest to counter this movement by doing what we can to build 
democracy and a growing economy in Nigeria and elsewhere. The spread of 
HIV/AIDS frustrates this important mission. We also have a strong 
interest in seeing the development of professional African militaries, 
militaries capable of maintaining stability in their country, but also 
capable of contributing to peacekeeping operations elsewhere in Africa. 
Yet an examination of the HIV/AIDS rates among the armed forces of key 
African countries, including Nigeria, South Africa, and Kenya, reveals 
infection rates between 30 and 40 percent. HIV/AIDS is a national 
security issue for those countries and for us.
  The President's proposal is based on America's deep conviction about 
the dignity of every human life, and these proposed remedies for the 
AIDS crisis in Africa recognize that human dignity. In adopting this 
proposal, we show the world that conviction and compassion go together 
as we demonstrate that compassion is not a sign of weakness but of 
strength. America does not have to take on the African AIDS crisis 
alone; but as is often the case, American leadership, political or 
financial, is necessary if our friends around the world are to bear 
their fair share of the burden. That is what the President's proposal 
does. It sets a pattern of American leadership that others we believe 
will follow.
  This bill is a compromise, a delicately arrived at, painstakingly 
negotiated compromise between various factions interested in this 
legislation; but it hangs together, and it works and it will advance 
the cause that we so desperately need to support. AIDS is a mortal 
challenge to our civilization. Let us today be animated by compassion 
and, yes, vision that always have defined what it means to be an 
American.
  Mr. Chairman, I reserve the balance of my time.
  Mr. LANTOS. Mr. Chairman, I yield myself such time as I may consume.
  I rise in strong support of this grand humanitarian legislation, and 
I urge all of my colleagues to make history today by securing its 
passage.
  Mr. Chairman, we could not have reached this day had it not been for 
the heroic efforts of the gentleman from Illinois (Mr. Hyde), my 
distinguished chairman and good friend. His leadership on this issue 
has been a true profile in courage, and I salute him. I also want to 
identify myself with his powerful and eloquent opening statement. Our 
colleagues on the Committee on International Relations, the gentlewoman 
from California (Ms. Lee) and the gentleman from Iowa (Mr. Leach) on 
the Republican side, have also been critically instrumental to our 
success thus far as have many other members of the committee. With the 
support of every single Democrat and most Republicans on the Committee 
on International Relations, we have crafted a bipartisan piece of 
legislation worthy of this body's support.
  Mr. Chairman, the $15 billion authorized in this legislation to 
combat HIV/AIDS, tuberculosis and malaria worldwide is an enormous sum 
by any measure. It is five times the amount we considered authorizing 
for this cause just last year. For those of us who have long called for 
a real commitment of resources to address the HIV/AIDS crisis, our day 
has arrived. As impressive as these amounts are, they are no more than 
the crisis demands. Every day AIDS claims the lives of thousands of 
innocent men, women, and, yes, children, old and young, sick and able-
bodied, destitute and affluent, unemployed and professional, African, 
Asian, and American. This disease, Mr. Chairman, does not discriminate. 
It targets us all; and in doing so, it ruins families, decimates 
communities, and fuels the violence and bloodshed that destroys whole 
nations. The political, economic, social, and humanitarian impact of 
this scourge cannot be contained to one region or to one population. It 
is a global human challenge that demands a global humanitarian response 
with the United States in the lead.

[[Page 10252]]

  The tragic history of this disease has shown that there are no silver 
bullets. We must use every means at our disposal to defeat it. All 
legislation builds to a significant extent upon Uganda's success in 
curbing the spread of AIDS through a combination of abstinence, 
monogamy, and condom use. In lending his support to this bill earlier 
this week, President Bush endorsed this three-pronged approach. In the 
President's words, preventing spread of HIV/AIDS requires a strategy 
emphasizing abstinence, marital fidelity, as well as condoms. Each 
element is crucial. Uganda's success in combating HIV/AIDS required not 
only abstinence and marital fidelity education programs but the 
distribution of nearly 80 million condoms per year. Countless lives 
will be lost if we fail to learn this lesson and undermine the balanced 
approach exquisitely negotiated and embodied in this bill.
  Mr. Chairman, in the his State of the Union address earlier this 
year, the President issued a challenge to Congress to join him in a new 
global campaign to combat HIV/AIDS. Today we take up the President's 
challenge and seek to fully fund this bold initiative. An overwhelming 
vote by the House of Representatives today to pass H.R. 1298 without 
crippling amendments will bring the President's vision, a vision most 
of us share, close to reality. The time for words has passed and the 
time for action has arrived in our struggle against HIV/AIDS. I urge my 
colleagues to join me today to pass this historic legislation.
  Mr. Chairman, I reserve the balance of my time.
  Mr. HYDE. Mr. Chairman, I yield 3 minutes to the distinguished 
gentleman from Iowa (Mr. Leach).
  Mr. LEACH. Mr. Chairman, I thank the gentleman for yielding me this 
time.
  Perspective is the most important and most difficult thing to apply 
to issues of the day. If one were to look at the 14th century, clearly 
the seminal event was the Bubonic plague in which some 20 million 
people died. Now, as many have died from AIDS as of the plague. Within 
a decade it will be a multiple of that figure. If sitting on the Moon, 
one might suggest that the most important public policy issue of our 
day is dealing with disease control, most particularly AIDS. In a very 
moral sense, it is probably the deepest philosophical issue of our 
time. Indeed, the global AIDS epidemic might be considered an epidemic 
of Biblical proportions.
  Everyone in this Congress understands that foreign assistance is 
controversial, but we are, after all, our brother's keeper and we must 
be concerned for the global family. We also have to be concerned for 
our own families. To the degree AIDS is not thwarted abroad, it 
threatens our own shores. As a Congress, obviously we have to be 
concerned with the allocation of the people's resources. This bill is a 
lot of money, but it is an extraordinarily sparse amount compared with 
the need; and I think of all the bills we are going to vote on in the 
near future, this is going to be the most justified financial expense 
the United States Congress has undertaken.
  In conclusion, let me just say we are all indebted to a lot of people 
from the outside, the President of the United States; the singer, Bono; 
and then our colleagues, the gentleman from California (Mr. Lantos), 
the gentlewoman from California (Ms. Lee), and from a distinct 
perspective the gentleman from Pennsylvania (Mr. Pitts) for raising 
concerns of America's faith-based community. But most of all I want to 
simply express my appreciation for the gentleman from Illinois (Mr. 
Hyde). This is the most important bill he has ever shepherded through 
Congress. It is going to be a seminal mark in his career, and we are 
all in his debt.
  Mr. LANTOS. Mr. Chairman, I yield myself such time as I may consume.
  Before yielding to our distinguished whip, let me also underscore the 
important contribution to the fight against HIV/AIDS of Bono who has 
worked with us on all aspects of this problem and whose leadership 
worldwide is deeply appreciated by all of us concerned with this issue.
  Mr. Chairman, I yield 3 minutes to the gentleman from Maryland (Mr. 
Hoyer), the distinguished Democratic whip, a leader on this and all 
issues in this body.
  Mr. HOYER. Mr. Chairman, I thank my friend for yielding me this time.
  I join the gentleman from Iowa (Mr. Leach) in congratulating the 
gentleman from Illinois (Mr. Hyde) and the gentleman from California 
(Mr. Lantos), ranking member, as well as the extraordinary work that 
has been done by the gentlewoman from California (Ms. Lee) as a Member 
of Congress and before she got to Congress.

                              {time}  1115

  Mr. Chairman, the great Dr. Martin Luther King, one of the world's 
great humanitarians, once said, ``We are caught in an inescapable 
network of mutuality tied in a single garment of destiny. Whatever 
affects one directly affects all indirectly.''
  Today, through this truly historic, bipartisan legislation 
authorizing $15 billion over the next 5 years for overseas care, 
treatment and prevention of AIDS, we recognize that our Nation has a 
moral obligation and a national security interest in combating the HIV/
AIDS pandemic, as well as malaria and tuberculosis.
  We ignore the world's increasing interdependence at our own peril, 
Mr. Chairman. And, frankly, while many of my colleagues have fought for 
many years to bring needed resources to bear on this problem, their 
call to arms has not, until now, been fully embraced.
  The source scourge of AIDS knows no borders. It does not 
discriminate. It targets every one of us, infecting some 42 million 
people around the world, two-thirds of them from Africa.
  As my good friend the gentleman from California (Mr. Lantos), who has 
worked with the gentleman from Illinois (Chairman Hyde) to bring this 
legislation to the floor today, stated in the markup of this bill, this 
health care crisis ruins families, communities and whole nations, 
fueling violence and bloodshed across borders. It cannot be contained 
in one region or in one population. And, thus, it is a global challenge 
that demands a global, humanitarian response with the United States in 
the lead.
  The ranking member, the gentleman from California (Mr. Lantos), the 
gentlewoman from California (Ms. Lee), and certainly the gentleman from 
Illinois (Chairman Hyde), deserve our congratulations, our thanks and 
admiration for their leadership in crafting this bill's balanced 
approach to treatment and prevention. It is a real commitment to 
addressing the HIV/AIDS crisis.
  I would hope that amendments to be offered later today that would 
upset this carefully crafted, balanced piece of legislation, that those 
amendments would be rejected. In particular, the Pitts amendment would 
upset the balanced HIV/AIDS prevention approach called for in the bill 
by requiring that one-third of the prevention funds be used solely for 
abstinence-only programs. Certainly we are supportive of abstinence, 
but not to wall it off for sole use resources.
  This historic legislation reflects our values, protects our 
interests, and extends, Mr. Chairman, a handle of hope to millions of 
vulnerable people across the world.
  We need not ask for whom the bell tolls; it tolls for us. This 
legislation is a response by us to reach out to save lives, to heal, 
and to make our Nation and our global community more secure.
  Mr. HYDE. Mr. Chairman, I am very pleased to yield 5 minutes to the 
distinguished gentleman from Florida (Mr. Weldon) who, as an original 
cosponsor of this legislation, has made an invaluable contribution.
  Mr. WELDON of Florida. Mr. Chairman, I rise today in strong support 
of this legislation, and I want to commend the chairman and ranking 
member for their open-mindedness in allowing me to be a part of this 
process.
  The bill before us today is a demonstration of the American people 
extending the hand of compassion and hope to millions of people 
suffering worldwide from AIDS.
  The level of commitment to end HIV/AIDS demonstrated in this bill 
before

[[Page 10253]]

us today is long overdue. Previous attempts to address the issue of 
global HIV/AIDS channeled millions of dollars into unaccountable 
multilateral efforts and programs that showed little effectiveness and 
did little to stem the death toll.
  H.R. 1298 reforms the status quo, ensures the most effective use of 
every dollar and puts new policies in place to help save lives. The 
bill sets a new course by focusing on real solutions, such as the model 
provided by Uganda.
  The bill requires financial accountability and opens doors to 
programs that have a history of doing much with little. H.R. 1298 
features a strong abstinence education component that has been proven 
to save lives by eliminating risky sexual behavior.
  This is a very important point.
  One of the key components of H.R. 1298 is a clear focus on prevention 
through education. The bill promotes primary prevention by funding 
activities that help individuals avoid HIV infection. Instead of just 
working towards reducing the prevalence of HIV/AIDS, this bill seeks to 
help young people adopt behaviors where the risk of HIV/AIDS can be 
eliminated. No longer do we just seek to manage the sure death of HIV 
infection. This bill empowers young people to participate in a future 
free from the behavioral risks of contracting HIV/AIDS.
  The bill distinguishes between true primary prevention efforts, such 
as abstinence education, from intervention activities that promote 
condoms under the guise of prevention. The bill distinguishes between 
prevention services that are appropriate for everyone and preventive 
intervention that helps a segment of the population engaging in risky 
behavior. As a physician who previously cared for AIDS patients, I know 
that encouraging this primary prevention approach will save lives, and 
save money.
  Another key component of the bill is bringing faith-based 
organizations into full participation with efforts to combat HIV/AIDS. 
Local churches and faith-based groups promote behavior change to 
prevent HIV, reduce the stigma associated with HIV infection, and treat 
those afflicted with the disease and care for orphans.
  The Catholic Church alone currently cares for one in four people 
being treated by HIV/AIDS worldwide. Mission organizations already 
possess much of the infrastructure, experience, knowledge and 
compassion necessary to combat AIDS. They also have a history of 
respecting the culture and values of indigenous communities and peoples 
so that lasting relationships and change can occur. And faith-based 
groups are doing this in the most remote areas with the greatest need.
  Up until now, resources that could have helped the efforts of 
churches and faith-based approaches have been soaked up by large 
international special interests. My missionary friends in Africa tell 
me about the many hats, T-shirts and conferences that UNAIDS provides 
to promote condoms and HIV/AIDS awareness. Unfortunately, few real 
resources are provided to help prevent HIV/AIDS infection.
  I am personally aware of faith-based organizations that have been in-
country for years, that have the support of the community, that have 
the support of the government and have brought people of different 
faiths together around strategies that are culturally and age-
appropriate, but yet have been refused resources through USAID and UN-
funded programs. Or they have been given a deal to promote condoms or 
get nothing.
  H.R. 1298 will open up new avenues to fund powerful faith-based 
efforts that save lives in the poorest and most remote places. I 
strongly encourage all of my colleagues on both sides of the aisle to 
support this legislation.
  Mr. Chairman, I am delighted to be an original cosponsor of the bill, 
and I again commend the chairman, the ranking member and their staff 
for crafting what I feel is a very, very good piece of legislation.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 5 minutes to my 
good friend, the distinguished gentlewoman from California (Ms. Lee), 
who has brought boundless energy and bold passion to this legislation. 
She has been the leader on our side on this entire matter.
  Ms. LEE. Mr. Chairman. Let me first thank our ranking member, the 
gentleman from California (Mr. Lantos), for those very kind and 
generous remarks, and let me thank the gentleman for his leadership in 
helping to ensure that our Democrats really saw the goal and understood 
our mission and helped to work to make sure that this was a bipartisan 
bill.
  I want to thank the gentleman from Illinois (Chairman Hyde) for his 
leadership, and for, again, I think, setting an example that on issues 
of common concern and where the survival of the human family is at 
stake, we all can come together and agree that we should work together.
  I also want to thank our staffs, especially Christos on my staff, and 
Pearl Alice, Peter and the entire committee staff, for their very 
diligent, competent and dedicated work.
  Mr. Chairman, today we really do stand at the crossroads in this 
global battle against HIV/AIDS. With an estimated 42 million 
individuals infected worldwide, the disease has already devastated the 
African continent, where 30 million people, 30 million, are currently 
living with AIDS and over 11 million children have been orphaned by 
this pandemic.
  Throughout Africa, AIDS has had a devastating impact, not only on 
health, but on education, agriculture, the economy, the military, on 
governments, as people at all levels of society have struggled to cope 
with this disease.
  Even now, the ongoing famine in Sub-Saharan Africa has been 
aggravated by the AIDS crisis. Food Insecurity and malnutrition have 
contributed to the spread of the virus, and both have sped up the onset 
of AIDS in HIV-infected individuals.
  The Caribbean, which is ranked as the second most affected region 
behind Africa, is also facing a devastating situation because of AIDS. 
In Haiti, where over 90 percent of all AIDS cases in the Caribbean are, 
Haiti has the unfortunate distinction of being the only country outside 
of Africa with an adult prevalence rate of over 6.5 percent.
  Despite the devastation that HIV and AIDS has caused within Africa 
and the Caribbean, the disease is truly a global killer. Even here at 
home, in my own district in Alameda County, we have been forced to 
declare a state of emergency to deal with the AIDS crisis. Now the 
disease is poised to run rampant through India, China and Russia, where 
a lack of information is contributing to the spread of the disease 
among poor and rural populations.
  So without a truly global effort to halt the spread of this disease, 
to provide care and treatment to those who are infected and affected by 
HIV and AIDS, we will all face a humanitarian disaster, the likes of 
which the world has never seen before.
  But there is hope. We have the know-how to stop the spread of HIV, 
and we have the drugs to prolong the lives of those infected with AIDS. 
The challenge is how we translate this know-how and these resources to 
people living in the developing world.
  Yet even in a country as poor as Haiti, there are already programs on 
the ground that are making a difference with minimal resources, like 
the Zanmi Lasante Clinic, run by Dr. Paul Farmer and the dedicated 
people at Partners in Health.
  And we also know from the indication of Uganda that when a country 
unites in the battle against AIDS, through the leadership, through its 
president, members of the government and civil society, and when 
everyone really engages in open dialogue about sex and AIDS, the need 
for abstinence, faithfulness and safe sex through the use of condoms, 
the HIV/AIDS rate can be reversed. In this case, it came down from 15 
percent in 1991 to 5 percent 10 years later. But it took all three 
strategies. No preference is given to one over the other.
  This bill we have before us today really recognizes these 
possibilities. But, more importantly, it sends a message to the world 
that the United States will not sit idly by and allow AIDS to wreak 
havoc on the human family.

[[Page 10254]]

  By committing $3 billion a year to fighting global HIV/AIDS and the 
two largest opportunistic infections that feed off of AIDS, 
tuberculosis and malaria, we will virtually double our global AIDS 
budget in the next year.
  Several years ago when we won a $40 million increase in global AIDS 
spending in 2000 under the leadership of our distinguished minority 
leader, the gentlewoman from California (Ms. Pelosi), we felt that that 
was a major victory and a major accomplishment. This legislation now 
puts those living with AIDS and those at greatest risk of getting 
infected ahead of ideological and political differences, and that is 
why the Pitts amendment does such a disservice to the bill and to those 
who desperately need our help. This bill attempts to create a 
comprehensive strategy to deal with the AIDS pandemic. Comprehensive.
  Finally, let me just say how important it is that this be new money. 
The President said that this was new money. We must make sure that this 
is new money. We face many challenges as this bill moves forward, but 
we hope that the President will receive the bill on his desk intact and 
sign it before Memorial Day, as he said he wanted to do.
  Mr. Chairman I want to thank again the chairman of our committee and 
the gentleman from California (Mr. Lantos) for their leadership, and 
once again hope that we can pass this bill intact, as it moved out of 
committee.
  Mr. HYDE. Mr. Chairman, I am pleased to yield 3 minutes to the 
learned gentleman from Wisconsin (Mr. Green).

                              {time}  1130

  Mr. GREEN of Wisconsin. Mr. Chairman, I thank the gentleman from 
Illinois (Mr. Hyde) for yielding me this time.
  During the course of the debate today, we will hear a lot of numbers, 
thousands and millions of percentiles. We will have a lot of 
platitudes. Platitudes are important, numbers are important; but they 
are just lines on a page.
  Let me give my colleagues an image that may help us put this all into 
perspective. Not so very long ago, I met a missionary who had served in 
the very area where I taught high school in Africa some 15 years ago, 
and I asked her what the changes were that she had seen over her time. 
I thought she would say to me, cell phones, electricity, running water, 
which we did not have; and she said, no, that is not it. She said, now 
as you walk down that mud path, you will stop and suddenly say to 
yourselves, my God, there are no adults here. There are children and 
there are grandparents, but there is an entire generation missing.
  Mr. Chairman, so many here are talking about why we must do this for 
the sake of the impoverished and the needy around the world, and it is 
true. I would also suggest we need to pass this legislation for our 
sake. Two reasons: number one, it makes us more human. Every one of the 
great faiths in this world calls upon its followers to care for their 
neighbor. I know my faith does. My faith requires me to take up issues 
like this. Secondly, it is a matter of national security. If we do not 
get our arms around this pandemic, this plague, entire regions of the 
world will be destabilized; and when they are destabilized, we will see 
openings for radicalism, and where radicalism grows, dangers emerge, 
dangers to us and our way of life.
  So yes, we must do this for the impoverished and the needy around the 
world, but we do this for us too. We are Americans. It is in our 
nature. It is the thing that we should do. This is important 
legislation. It is historic legislation. I commend the chairman. I 
agree with one of the previous speakers that this will be our most 
important legislation. It will save lives; it will shape history. I am 
proud to be part of this.
  Mr. LANTOS. Mr. Chairman, before yielding to our next speaker, I want 
to express my deep appreciation to several members of our staff. Pearl 
Alice Marsh, David Abramowitz, Peter Yeo, Bob King, and on the staff of 
the gentlewoman from California (Ms. Lee), Christos Tsentas. They have 
done an outstanding job in bringing this legislation to the floor.
  Mr. Chairman, I am delighted to yield 1 minute to my good friend, the 
gentleman from New York (Mr. Crowley), a distinguished member of the 
Committee on International Relations and a leader on this issue.
  Mr. CROWLEY. Mr. Chairman, I thank the gentleman from California (Mr. 
Lantos) for yielding me this time.
  I want to applaud the gentleman from Illinois (Chairman Hyde) for his 
work on this bill. I want to voice my strong support for the United 
States Leadership Against the HIV/AIDS, Malaria, and Tuberculosis Act 
of 2003. Make no mistake, this bill is a big step in the right 
direction. This bill means more help for those infected with HIV/AIDS. 
It means more hope and help for children who are dying from malaria. It 
means that fewer families will live in fear of tuberculosis.
  This bill is a true victory. But we must take the steps to ensure 
that what this bill stands for, protecting the health of individuals 
around the world, is also protected. And that is why we must see that 
this bill is not the end of the debate, but rather a step in the right 
direction.
  The prevention and treatment of these diseases requires funding; but, 
of course, it requires even more. It requires accurate information, 
cultural sensitivity, rapid response. It requires real dedication.
  Mr. Chairman, $15 billion over 5 years is real assistance for some of 
the world's most vulnerable, but only if it is allowed to be spent as 
those on the ground see fit. This bill can mean real hope for countless 
people around the world. I only hope that what this bill stands for 
survives as well.
  Mr. HYDE. Mr. Chairman, I am pleased to yield 3 minutes to the 
gentleman from Michigan (Mr. McCotter).
  Mr. McCOTTER. Mr. Chairman, one of our Nation's seminal principles 
holds that all human beings have a right to life, liberty, and the 
pursuit of happiness. Inherent in this principle, in this promise, 
rests the belief that to truly and fully live, every human heart needs 
hope.
  National borders neither define nor diminish this need. And today, 
millions of our fellow human beings throughout the world have no hope, 
for they suffer under the perceived certainty of an AIDS death 
sentence. For years they have done so with no hope for relief or 
reprieve until our Nation brought them this proposal's promising ray of 
hope.
  Due to this historic legislation, millions of ravaged bodies have 
hearts beating with hope. And thus, it is morally imperative that we 
pass this historic legislation, continue tending and kindling the sick 
and sufferings' faint rays of hope and, as Americans, reaffirm and 
retain our revolutionary role as a herald of hope for all humanity.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 1\1/2\ minutes to 
the distinguished gentleman from New Jersey (Mr. Payne), the ranking 
member of the Subcommittee on Africa of the Committee on International 
Relations, my good friend who has been one of the strongest leaders on 
this whole issue in the Congress.
  Mr. PAYNE. Mr. Chairman, let me express my strong support for this 
legislation and begin by commending the Bush administration for this 
initiative of 15 billion new dollars. I would like to also commend the 
gentleman from Illinois (Mr. Hyde), the chairman of the Committee on 
International Relations, for standing up to criticism primarily from 
his own friends. In spite of the criticism, the gentleman from Illinois 
showed that he still has the competitive drive that he had as an 
outstanding basketball player, that when the game got close, when it 
got tough, when it was needed, that last push, he stayed the course; 
and I would like to certainly commend him for that.
  We appreciate the work of the gentleman from California (Mr. Lantos) 
and the gentlewoman from California (Ms. Lee) and the gentleman from 
Iowa (Mr. Leach). We have all come together.
  But let me just say that I have seen the devastation with my own 
eyes. Over the 15 years that I have been in Congress, I have spent time 
during my first year visiting hostels and hospitals

[[Page 10255]]

where HIV and AIDS patients were dying, and it was a time when many 
people throughout the world were crying out for help. I was devastated 
because their voices were not being heard. People were dying all around 
us.
  Voltaire said, ``Nothing is as powerful as a dream whose time has 
come.'' The dream that we should really fight this devastating disease, 
the fact that people around the world are being devastated, not because 
of anything that is abnormal, but because of something that has just 
entered into this society. And so I hope that we will keep the 
legislation intact. I am proud to stand here and say that we are doing 
probably the greatest thing that we have done since I have been in the 
Congress, as has been mentioned earlier today.
  Mr. HYDE. Mr. Chairman, I am pleased to yield 3 minutes to the 
distinguished gentleman from Delaware (Mr. Castle).
  Mr. CASTLE. Mr. Chairman, I want to commend the administration as 
well, as a lot of others have spoken to today. The leadership of this 
House, and particularly the gentleman from Illinois (Chairman Hyde) and 
the ranking member, the gentleman from California (Mr. Lantos), two 
extraordinary Members who really care about issues such as this.
  This is important legislation that will dramatically increase the 
United States' participation and role in combating HIV and AIDS. The 
HIV/AIDS scourge is not only an international health threat killing 
millions and spreading each year, but it is also a major detriment to 
the economic security and well-being of our Nation and many countries 
around the world. As we have seen with the current SARS virus, economic 
partners as close as Canada have been seriously impacted in just a very 
short time period. While SARS is a new major health risk that experts 
are working to halt in recent weeks, we must not forget that HIV/AIDS 
is a killer disease that continues to plague the entire world.
  Specifically, the legislation before us today will authorize more 
than $15 billion for combating HIV/AIDS globally over the next 5 years. 
In President Bush's State of the Union address he called for an 
increase in the U.S. commitment to combat the global AIDS pandemic. I 
am pleased that today we are debating a holistic approach to combat 
such a destructive disease. The legislation creates a more responsive, 
coordinated, and effective approach among the various agencies of the 
United States Government involved in the war against HIV/AIDS and 
approves up to $1 billion for the Global Fund for AIDS, Tuberculosis, 
and Malaria for fiscal year 2004.
  I have seen firsthand the devastation that AIDS has had on the people 
of Africa, and I firmly believe that the United States and the rest of 
the developed world must act now to help end the suffering and hardship 
caused by this terrible disease.
  When I visited Zimbabwe, Nigeria, and South Africa several years ago, 
I saw the overwhelming impact that AIDS was having, not only on those 
adults afflicted with the disease, but also on thousands of orphans 
that the disease creates. In some countries, one-fifth to one-third of 
the children have already been orphaned by the disease. I am pleased 
that today's measure authorizes the President to establish pilot 
programs to create and treat orphans and young children.
  Through the work of my constituent, Jeff Busch, I have learned about 
and supported the work of the Safe Blood for Africa Corps. This small, 
not-for-profit company has the goal of safeguarding the blood supply in 
sub-Saharan Africa from infectious diseases such as HIV, Hepatitis B, 
and Hepatitis C.
  I have supported their efforts to fund a first-strike program of HIV/
AIDS prevention in sub-Saharan Africa that would immediately begin to 
save between 350,000 and 500,000 lives by utilizing rapid blood testing 
to provide for the transfusion of safe blood. The President has cited 
Uganda as the model country for putting together an effective plan to 
combat HIV/AIDS. Uganda has been very aggressive in their approach, and 
it is important to note that they first addressed the problem of 
cleaning the blood supply.
  In conclusion, the Bush administration has designated the war on HIV/
AIDS in developing countries a top priority, and I strongly believe 
that this important legislation will push this goal forward. Mr. 
Chairman, 40 million people are currently infected and 25 million have 
died of AIDS worldwide, including more than 3 million people last year 
alone. Now is the time for our Nation to step up and halt this most 
deadly disease.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 1 minute to my good 
friend, the gentleman from Pennsylvania (Mr. Hoeffel), a distinguished 
member of the Committee on International Relations and a strong leader 
on this and on so many other issues.
  Mr. HOEFFEL. Mr. Chairman, I rise in strong support of H.R. 1298. I 
want to salute the great work of the gentleman from Illinois (Chairman 
Hyde); the ranking member, the gentleman from California (Mr. Lantos); 
and President Bush for coming together to make this $15 billion 
commitment over 5 years to help curb the spread of AIDS around the 
world.
  One of the best parts of this bill is its balanced approach that 
treats equally importantly abstinence, marital fidelity, and the use of 
condoms to fight the spread of AIDS. I salute that balanced approach, 
and that is why it is so important to defeat the Pitts amendment and 
the Smith amendment. The Smith amendment would allow faith-based 
organizations that can be funded under this bill under the terms of the 
legislation to actively discourage the use of condoms. That makes no 
sense, and that destroys the balance that is currently in this 
legislation. The Pitts amendment would allow a particular amount of 
funding to go specifically and only for programs that only promote 
abstinence.
  Listen, abstinence works perfectly if it is used perfectly, but it is 
not. Not everybody abstains. We need to pass this bill as is. It is 
balanced and it is very good.
  Mr. HYDE. Mr. Chairman, I am pleased to yield 2 minutes to the 
gentleman from Iowa (Mr. King).
  Mr. KING of Iowa. Mr. Chairman, our Nation is greatly blessed. We 
have a responsibility to our fellow man. When rampaging machete mobs 
began massacring Rwandans, I believed then and I believe now that we 
should have deployed troops to save them.
  I agree with the principles expressed by President Bush in this very 
Chamber in his State of the Union speech when he said: ``We exercise 
power without conquest and we sacrifice for the liberty of strangers. 
Americans are a free people who know that freedom is a right of every 
person and the future of every nation. The liberty we prize is not 
America's gift to the world; it is God's gift to all humanity.''
  Now we face an AIDS crisis in Africa. It is severe. We have the 
unique opportunity to help save and extend the lives of Africans. 
However, we must ensure that our efforts to fight AIDS in Africa do not 
infringe upon their liberty, their freedom, and the right to life of 
unborn Africans.
  The travesty of family planning and population control funding being 
used to subsidize abortion providers and counseling is not new to 
Congress. In fact, in 1970, Congressman John Schmitz of California 
accurately predicted the consequences of providing funding without 
restrictions.

                              {time}  1145

  We know the results of that. He said on that day: ``The bill before 
us today . . . would commit the U.S. Government to the life prevention 
business at an initial cost of more than a quarter of a billion 
dollars.'' As we know, the rise in the cost of the program is under 
way, with no end in sight. Congressman Schmitz was right. In 1999, 
Planned Parenthood received $51 million. Effectively, we are 
subsidizing abortion services.
  Today we are poised to distribute AIDS assistance to those who are 
currently without hope in Africa. Hopefully, a large portion will go to 
proven abstinence, medical treatment, and as a last resort, condom 
distribution.
  However, none of the billions for relief in Africa should be used to 
fund

[[Page 10256]]

abortions. No United States taxpayer money should fund groups that 
provide abortion services or counseling. We will save lives by 
providing humanitarian AIDS relief to Africa. No lives are as innocent 
as those lives of babies taken by abortion.
  We must show compassion for Africans and ensure that the words of 
Congressman Schmitz when we committed the United States to the life 
prevention business do not come true with this excellent bill.
  Mr. LANTOS. Mr. Chairman, I am very pleased to yield 1 minute to my 
good friend and distinguished colleague, the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. I thank my colleague for yielding time to me, Mr. 
Chairman.
  Mr. Chairman, I rise in support of the bill and in opposition to the 
Pitts amendment. Devoting significant resources to the biggest health 
threat in the world, the global HIV/AIDS pandemic, is an excellent use 
of taxpayer dollars, as long as we focus on prevention efforts that 
work.
  For example, the people of Uganda have had great success controlling 
the spread of HIV/AIDS, and they did it with a comprehensive program 
that did stress abstinence and fidelity, but also emphasized the 
importance of using condoms.
  The Pitts amendment would move significant dollars away from that 
proven model by providing $5 billion to strictly abstinence-only 
programs. It will push aside proven comprehensive programs in favor of 
questionable models designed to appease a right-wing constituency.
  Let us not miss the opportunity to do good by misspending precious 
resources on abstinence-only programs. We should not condemn more 
people to death by AIDS by tying hands with ideology. I urge my 
colleagues to vote ``no'' on the Pitts amendment and strongly support 
H.R. 1298.
  Mr. HYDE. Mr. Chairman, I am pleased to yield 3 minutes to the 
distinguished gentleman from Arizona (Mr. Kolbe).
  Mr. KOLBE. Mr. Chairman, I thank the gentleman for yielding time to 
me.
  Mr. Chairman, I rise in my capacity as chairman of the Subcommittee 
on Foreign Operations, Export Financing and Related Programs on the 
Committee on Appropriations to discuss this bill, H.R. 1298. It is our 
subcommittee that will be called upon to fund this authorization.
  The legislation has three critical elements that are important to the 
issue of funding: first, the requirement for the President to establish 
within 9 months a comprehensive 5-year strategy to combat AIDS; second, 
within the Department of State the establishment of a new coordinator 
of U.S. activity to combat HIV/AIDS; and, third, providing statutory 
authority and sufficient authorization for additional United States 
contributions to the Global Fund to fight AIDS, tuberculosis, and 
malaria.
  There are many other provisions, some of which appear unnecessary to 
this Member, others of which are clearly contradictory; but I want to 
address these three core provisions in the time that I have available.
  I commend the gentleman from Illinois (Chairman Hyde) and the ranking 
member, the gentleman from California (Mr. Lantos), for their work in 
crafting legislation that could bring much-needed policy coherence and 
effective management to the outpouring of well-meaning but, frankly, 
scattershot Presidential and congressional initiatives designed to 
arrest the worldwide HIV/AIDS pandemic.
  I would ask the gentleman from Illinois (Chairman Hyde) and the 
members of the Committee on International Relations to take into 
consideration several of our subcommittee's concerns as they move this 
bill toward enactment.
  First, as the proposed 5-year strategy will not be in place, at the 
earliest, until midway through the next fiscal year, the funds 
appropriated for fiscal year 2004 will have to reflect the strategies 
and use the delivery systems now in place. For that reason, I would 
caution against legislating the Uganda model on a global basis or 
limiting increased funding to only 14 countries before that strategy is 
in place or Congress has had an opportunity to review it.
  Second, the legislation under consideration today proposes to turn 
the role of the AIDS coordinator into a de facto agency administrator. 
I have serious reservations about giving someone who was designated a 
coordinator within the State Department the authority to make grants, 
operate in foreign countries, or to, in effect, replace the Global 
Health Bureau of USAID or the Centers for Disease Control. Why are we 
creating an entire new Federal bureaucracy to administer the program 
when one already exists?
  I also object to the language which would allow the coordinator to 
transfer money from prior-year appropriations or to establish a new 
account in the Treasury for which no funds have been appropriated.
  Third, I welcome the flexibility to continue funding for the Global 
Fund at or above the current level of almost $350 million. But in all 
candor, the budget resolution does not permit fiscal 2004 funding 
anywhere near the $1 billion authorized by this legislation. Thus, we 
are only creating false expectations about what our Committee on 
Appropriations might be able to do this year.
  Mr. Chairman, having spent much time over many years on the critical 
issues addressed by this bill, I am really pleased to see that the 
Congress is grappling with HIV/AIDS as an international issue. The 
legislation before us today is a helpful start, but much work remains 
to be done if we are to have effective implementation of programs to 
combat HIV/AIDS around the world.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 1\1/2\ minutes to 
my good friend, the gentlewoman from New York (Mrs. Lowey), the 
distinguished ranking member of the Subcommittee on Foreign Operations, 
Export Financing and Related Programs.
  Mrs. LOWEY. Mr. Chairman, I rise today in support of this bill. I 
congratulate the gentleman from Illinois (Chairman Hyde) and the 
ranking member, the gentleman from California (Mr. Lantos), for their 
important work. I have always believed that dealing with the AIDS 
crisis is both a national security priority and a moral imperative for 
the United States. I am pleased to see that we are authorizing a 
significant infusion of resources and broad-based commitment.
  However, I caution my colleagues that despite strong administration 
and bipartisan congressional support for this bill, the $3 billion 
authorized for the upcoming fiscal year simply does not exist in the 
bill. The administration's request for 2004 for all global HIV/AIDS, 
tuberculosis, and malaria programs is about $1.7 billion, not $3 
billion. While my colleagues and I on the Committee on Appropriations 
will try to find the $1.3 billion necessary to fill the massive funding 
gap, it will be difficult in an already tight budget.
  I would urge the administration to request the funds necessary to 
fulfill the President's promise. I hope our Republican leadership will 
make sure we have the resources we need to fully fund this historic 
initiative.
  Mr. Chairman, we have before us today an opportunity to do a great 
deal of good in the world: to improve the lives of people living with 
AIDS, to help AIDS orphans survive and thrive, and to prevent millions 
of those who are most at risk from contracting this horrible virus. Our 
efforts will have massive implications for the stability and prosperity 
of whole communities, societies, and regions of the world, a tremendous 
privilege and an awesome burden.
  It is not every day that Members of Congress have the opportunity to 
jumpstart a process. So let us appropriate the money, let us fulfill 
the promise, and let us make sure we use it wisely and well.
  Mr. LANTOS. Mr. Chairman, I am very pleased to yield 1 minute to my 
good friend and distinguished colleague, the gentlewoman from Minnesota 
(Ms. McCollum), a member of the Committee on International Relations.
  Ms. McCOLLUM. Mr. Chairman, today, while Congress debates this bill,

[[Page 10257]]

every 15-year-old boy in Botswana is living with a 90 percent, a 90 
percent chance of dying from AIDS during his life. AIDS is destroying 
millions of lives, families, and entire nations in Africa. Congress 
should and must act now.
  America possesses the wealth, the knowledge, the leadership to 
partner with the people of Africa to save lives, offer dignity to the 
dying, and provide opportunity to orphans struggling for survival. Our 
fight against AIDS at home, in Africa, and around the world is both a 
strategic and humanitarian battle that reflects the greatest strengths 
and the absolute goodness of the American people.
  Standing together, let us pass this bill today and empower the people 
of Africa to use every means available and necessary to treat and stop 
the spread of AIDS. Today, the people of America and Africa stand 
together in our fight against AIDS. I thank the gentleman from Illinois 
(Mr. Hyde) and the gentleman from California (Mr. Lantos) for their 
work.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 1 minute to my good 
colleague, the gentlewoman from California (Ms. Waters), a 
distinguished Member of this body and a leader on this issue.
  Ms. WATERS. Mr. Chairman, I thank the gentleman from Illinois 
(Chairman Hyde) and the ranking member, the gentleman from California 
(Mr. Lantos), for their superb leadership on attacking the HIV/AIDS 
disaster in Africa.
  I take this moment to rise in strong support of H.R. 1298, and to 
thank my friends and colleagues for the many years of struggle and hard 
work that has brought us to this point of getting President Bush to 
support this effort.
  Thanks to all of the AIDS activists, the developmental activists. 
Thanks to the work of the gentlewoman from California (Ms. Pelosi) when 
she served on the Committee on Appropriations; and the gentlewoman from 
California (Ms. Lee) for the leadership she has provided; and the 
gentleman from New Jersey (Mr. Payne) and all the other Members of 
Congress.
  Thanks to President Bill Clinton for establishing the Global AIDS 
Fund we are putting the money in today. Thanks for the trip that he 
made to Africa, where we all had the opportunity to visit what was 
going on, the clinics in Uganda and other countries of Africa.
  It has been a lot of hard work. I am pleased and delighted that we 
are here today working in a bipartisan way to put money into this 
Global Fund, but it did not happen overnight. Again, I thank Members 
for all the years of work and struggle.
  Mr. LANTOS. Mr. Chairman, I am very pleased to yield 1\1/2\ minutes 
to my good friend and distinguished colleague, the gentleman from New 
York (Mr. Engel), a valued member of the Committee on International 
Relations.
  Mr. ENGEL. Mr. Chairman, I thank my friend for yielding time to me.
  I want to congratulate the gentleman from California (Mr. Lantos) and 
the gentleman from Illinois (Mr. Hyde) and the gentleman from Iowa (Mr. 
Leach) for their strong support and leadership on this bill. I 
particularly want to single out my colleague, the gentlewoman from 
California (Ms. Lee), who has led a good, long fight for so many years. 
This is truly something all of us can take pride in. The gentlewoman 
from California (Ms. Lee) has certainly led the way.
  Mr. Chairman, this is a bipartisan, middle-of-the-road bill, a good 
bill. We should allow no ideological fights in this bill. This is not a 
fight about abortion; it is a fight about saving lives. The Uganda 
approach, which has abstinence and marital fidelity and condoms, and we 
have to have condoms if we are going to fight this battle, is a very 
well-balanced approach.
  Let us look at AIDS. AIDS has killed over 20 million people since the 
epidemic began. Another 8,000 people die each day, with 68,000,000 
deaths predicted by 2020 unless the world takes action. Experts say a 
strong global response could prevent nearly two-thirds of those new 
infections, saving tens of millions of lives.
  What this bill does is respond to this crisis. It authorizes the bold 
initiative announced by President Bush. I want to say I was pleased to 
be in the White House 2 days ago with President Bush when he announced 
this initiative. This will provide $15 billion, including $10 billion 
in new money to fight HIV/AIDS in Africa and the Caribbean.
  The proposed bill will help prevent 7 million new infections, provide 
care and support for 10 million HIV-infected individuals and AIDS 
orphans, and offer antiretroviral therapy for 2 million of those in 
need.
  H.R. 1298 is only an authorization bill. We need to fight in the 
appropriations process for real resources to match the promises made in 
H.R. 1298.
  Mr. LANTOS. Mr. Chairman, I am delighted to yield 1 minute to my good 
friend, the gentlewoman from New York (Mrs. Maloney), a distinguished 
Member of this body.
  Mrs. MALONEY. Mr. Chairman, I thank the gentleman for yielding time 
to me, and for his leadership.
  I rise in strong support of the bill and in opposition to the Pitts 
amendment. We must remember that HIV/AIDS is preventable. That is why I 
support the ABC approach to prevention, which encourages a balanced 
approach to preventing the spread of HIV/AIDS.
  While we all believe that abstinence and fidelity are important 
methods of prevention, a full, balanced, and comprehensive range of 
options, including condoms, is a more responsible plan of attack; and 
attack is what we must do. We must attack this rampant epidemic with 
full force, full funding, and full freedom of information.
  I remember when then Ambassador Richard Holbrooke first brought the 
issue of HIV/AIDS as a national security crisis to the U.N. Security 
Council. We quickly learned that HIV/AIDS is not only a public health 
crisis; it is an economic crisis, an international security crisis, and 
a moral crisis.

                              {time}  1200

  In Africa the need and the will to combat the spread of AIDS is 
there. What is missing is the resources. That is what this bill brings 
in. No country should struggle to rise out of poverty while fighting a 
disease that can cut life expectancy by as much as 30 years.
  I strongly support this bill and commend the gentleman from Illinois 
(Mr. Hyde) and the gentleman from California (Mr. Lantos), the ranking 
member, and the gentlewoman from California (Ms. Lee) and the gentleman 
from Iowa (Mr. Leach) for their leadership.
  Mr. HYDE. Mr. Chairman, I yield 1 minute to the distinguished 
gentleman from Indiana (Mr. Pence) for the purposes of a colloquy.
  Mr. PENCE. Mr. Chairman, I want to thank the gentleman for his 
tireless efforts in crafting this HIV/AIDS relief bill.
  I have, as the gentleman knows personally, the utmost respect for him 
and for his distinguished career and leadership of this committee in 
particular. I appreciate him granting me this colloquy.
  Many of us have learned, Mr. Chairman, that there are a number of 
foreign countries that actually use abortion as a means of preventing 
mother to child transmission of HIV/AIDS. It is my hope that the 
distinguished chairman would today confirm that in carrying out this 
foreign assistance program, that it is the policy of the United States 
that abortion is not prevention of or treatment of mother to child 
transmission of HIV/AIDS.
  Mr. HYDE. Mr. Chairman, will the gentleman yield?
  Mr. PENCE. I yield to the gentleman from Illinois.
  Mr. HYDE. The gentleman is correct. Nothing this in this legislation 
should suggest that it is United States' policy that abortion is a 
proper and appropriate method for prevention of or treatment of mother 
to child transmission of HIV/AIDS.
  Mr. PENCE. Mr. Chairman, I thank the gentleman.
  Mr. LANTOS. Mr. Chairman, I yield 1 minute to my good friend, the 
gentleman from Ohio (Mr. Brown), a distinguished member of the 
Committee on International Relations, our ranking member on the 
Subcommittee on Health.

[[Page 10258]]


  Mr. BROWN of Ohio. Mr. Chairman, I thank the gentleman from 
California (Mr. Lantos) for his leadership.
  The Global Fund to fight AIDS, TB and malaria represents the best 
tool we have to provide relief on a scale that matters. Some of my 
colleagues want to eliminate the U.S. commitment to the Global Fund. 
They will say it is effective when it only began disbursing funds in 
the past year. They will say it is a blow to bureaucracy, when, in 
fact, it is a model of efficiency in coordination. They will say that 
evidence shows that it does not work, and then fail to produce any 
evidence.
  The Global Fund stresses accountability. Each proposal is reviewed by 
22 physicians and health experts from a variety of nations. Forty 
percent only of the applications are accepted. Only the best are 
approved. Each proposal is for 5 years. After 2 years a major audit of 
the program is done. If it is not effective funding is cut off.
  Both the House and the Senate supported its creation unanimously. It 
is transparent. The Global Funds Web site contains downloads of every 
single country's proposal that is approved.
  Fifty million people in the last 25 years have died of malaria, 
tuberculosis and AIDS, 50 million people. The Global Fund will help 
history's worst epidemic.
  Mr. LANTOS. Mr. Chairman, I yield 1 minute to my good friend, the 
gentleman from Massachusetts (Mr. Olver), a distinguished member of the 
Committee on Appropriations.
  Mr. OLVER. Mr. Chairman, I thank the gentleman for yielding me time.
  Mr. Chairman, H.R. 1298 is the best bill the full House has ever 
considered on the international HIV/AIDS crisis. This bill provides 
$1.7 billion in fiscal 2004 to the Global Fund to fight AIDS, 
tuberculosis, and malaria. Our support for the Global Fund demonstrates 
American commitment to the international fight against HIV/AIDS and is 
vital for gaining funds from other donor countries.
  In his State of the Union address President Bush announced his 5-year 
plan to fight HIV/AIDS but he only allotted $200 million each year to 
the Global Fund. This bill greatly increases the U.S. commitment to the 
Global Fund.
  As HIV/AIDS ravages Africa, the Caribbean and now explodes in Asia 
and the former Soviet Union, clearly no single nation has the ability 
to prevent the spread of AIDS or to adequately treat its victims. This 
international disease must be stopped with international and multi-
lateral action.
  Mr. Speaker, we must support this bill and the Global Fund to fight 
AIDS, TB, and malaria. It is the least we can do.
  Mr. LANTOS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, this is a historic moment in dealing with global 
humanitarian legislation. What we were doing today on a bipartisan 
basis will save the lives of tens of millions of innocent people across 
the globe. We are doing it on a bipartisan basis with the typical 
generosity and humanitarian instincts of the American people.
  This is legislation we must all be proud of. It should pass with an 
overwhelming majority. We are supportive of the legislation. We are 
grateful for the President's support and we fully anticipate that lives 
around the globe will be improved as a result of our efforts.
  Mr. Chairman, I yield back the balance of our time.
  Mr. HYDE. Mr. Chairman, I yield the balance of our time to the 
distinguished gentlewoman from Florida (Ms. Harris).
  Ms. HARRIS. Mr. Chairman, I thank the gentleman from Illinois (Mr. 
Hyde) for yielding me this time.
  Mr. Chairman, as our Nation confronts the threats of terrorism, 
tyranny, and weapons of mass destruction, we must not forget the 
ethical and practical imperative to fight nature's weapons of mass 
destruction which manifests themselves in the form of global epidemics, 
such as AIDS.
  President Bush and this Congress have demonstrated extraordinary 
courage and moral leadership in focussing our Nation's attention on 
this critical matter of national security. H.R. 1298, the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, implements 
the President's visionary proposal to combat AIDS and other infectious 
diseases in Africa as well as on a global scale. This legislation 
models programs that have experienced tremendous success throughout the 
world, most notably a program that has proven effective in Uganda.
  Such programs work with within existing cultural dynamics to combat 
the existing humanitarian crisis, while promoting the essential long-
term societal changes that will stop the spread of these dreadful 
diseases.
  As a freshmen Member of Congress, I am heartened to note the 
bipartisan support and the healthy debate that has accompanied our 
consideration of this vital legislation. The speed and effectiveness 
with which we have joined the fight against the global scourge of AIDS 
tuberculosis, and malaria shows the American people that we can indeed 
work together to make the world freer, safer, healthier and more just.
  I thank the gentleman from Illinois (Mr. Hyde) for his extraordinary 
vision and leadership in this momentous bill. I urge the passage of the 
legislation.
  Mr. LARSON of Connecticut. Mr. Chairman, I rise today in support of 
H.R. 1298, the United States Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Act of 2003. While much of our focus over the past two 
years has been on the eradication of terrorist threats from radical 
fringe groups and evil dictators, we must not forget the threat posed 
by a non-human terrorist: HIV/AIDS. More than 42 million people in the 
world are living with HIV/AIDS. Nearly 30 million of those people live 
on the continent of Africa and that includes 3 million children under 
the age of fifteen. As many of us in Congress have worked hard over the 
years to strengthen HIV/AIDS programs, I was particularly pleased to 
hear the President acknowledge this threat during his State of the 
Union address in January. Today Congress has a chance to address this 
global pandemic.
  Specifically, this bill would authorize $15 billion over five years 
to fight the HIV/AIDS pandemic, including up to $1 billion for the 
Global Fund to Combat HIV/AIDS, Tuberculosis, and Malaria in Fiscal 
Year 2004. It would also create a five-year comprehensive, integrated, 
global strategy to strength the U.S. capacity to respond to the HIV/
AIDS pandemic. Additionally, an HIV/AIDS Response Coordinator within 
the Department of State would be created to oversee this plan.
  I am particularly pleased by the bipartisan support that this 
legislation has garnered. I thank the gentleman from Illinois (Mr. 
Hyde) for introducing this bill and working with both sides of the 
aisle to bring to the floor today a bill that can be widely supported. 
Our goal should not be to impose our values on another culture, but to 
exhibit our values by showing care and compassion for our global 
neighbors. By supporting programs like the successful Ugandan ABC 
campaign (which says Abstain; if you can't abstain, Be Faithful; if you 
can't be faithful, use a Condom) we can effectively address this 
crisis.
  Again, I support this legislation and encourage my colleagues to join 
me. We have the opportunity today to make a commitment to improve the 
lives of millions of people and ease the suffering of an entire 
continent. However, the fight against HIV/AIDS is far from over and we 
must live up to the commitment we make today by fully funding these 
programs in the future.
  Mr. TOWNS. Mr. Chairman, I support the attempt in this bill to 
provide basic medical assistance to prevent and treat HIV/AIDS. To 
understand the importance of this assistance, we must get a firm grasp 
on the enormity of this problem. AIDS is truly a global killer. The 
virus respects no national boundaries, no religious affiliation, no 
race, no gender, and no age. In Sub-Sahara Africa, the region of the 
world most severely affected by HIV and AIDS, there are an estimated 
25.3 million persons infected with the virus. In 7 African countries, 
20 percent of the population is affected. In Botswana, it is estimated 
that 36 percent of the adult population is infected with HIV.
  Other regions of the world have equally alarming statistics. In Asia, 
the world's most populous continent, 3.5 million people are infected 
with HIV. Eastern Europe has the most rapid rate of growth in HIV 
infections. In 20 short months, the number of infected persons in the 
Russian Federation rose from 10,000 to 70,000. In Latin America, an 
estimated 1.9 million people are infected with HIV. In the Caribbean, 
HIV has impacted about 400,000 people.
  HIV and AIDS is the leading cause of death in Africa and the fourth 
leading cause of death worldwide. In the countries most affected in

[[Page 10259]]

Africa, life expectancy has declined by 10 years and the infant death 
rates have doubled.
  This disease has ravaged families. In the developing world, the loss 
of one parent can lead to a loss of income, the end of educational 
opportunities for children and an increase in child labor. The loss of 
both parents can be devastating. It has been estimated that by 2010 
there will be 40 million children in Africa who have been orphaned 
because of the AIDS virus. That is equivalent to every child living 
east of the Mississippi River in this country.
  I know this is a grim picture, but to paint a rosy scenario would be 
inappropriate. Compassion and concern are not enough. We must take 
concrete action, here and now. This epidemic can be stabilized and 
reversed. We must work effectively with leaders of the world to achieve 
these outcomes. Africa's tragedy can be reversed and a similar 
cataclysm can be avoided in other countries. This legislation is a good 
step forward in addressing this issue. But we must be prepared to take 
the next step and assist countries impacted by these diseases.
  Mr. SCHIFF. Mr. Chairman, I rise in support of this important 
legislation that will enable us to effectively combat the global 
scourges of HIV/AIDS, tuberculosis, and malaria. I am grateful for the 
bipartisan leadership of my colleagues who authored and were original 
co-sponsors of this bill especially Chairman Hyde, Ranking Member 
Lantos, Mr. Weldon, Ms. Lee, and Mr. Leach.
  This legislation enables the United States to take strong leadership 
role to ameliorate, and, we hope, ultimately to eradicate one of the 
most devastating diseases that man has ever encountered. We count the 
victims of HIV/AIDS in the tens and hundreds of millions, worldwide. It 
is a disease that affects men and women, adults and children. Its 
impact is most devastating on the poorest, those with the least 
capacity to deal with the ravages of this disease or to act effectively 
to prevent its spread. By affecting so many millions across societal 
cross-sections, this disease presents a humanitarian crisis of 
unprecedented magnitude. Furthermore, the HIV/AIDS pandemic is a 
potentially destabilizing force that presents a grave threat to 
international security.
  The African nations have been especially hard hit by the epidemic of 
HIV/AIDS and other diseases. Together, HIV/AIDS, tuberculosis, malaria, 
and related diseases are undermining agriculture production throughout 
Africa--aggravating disease with hunger.
  This bill will address these global problems by authorizing $15 
billion to combat HIV/AIDS, tuberculosis, and malaria, through a 
comprehensive five-year integrated strategy. This legislation will use 
these funds effectively by promoting inter-agency coordination, 
supporting the expansions of public/private partnerships, and using 
targeted programs that will especially benefit children and families 
affected by HIV/AIDS.
  Of course we must continue to work aggressively to combat the spread 
of this disease here in the United States and to continue our efforts 
to research a cure and to aid our own countrymen afflicted with this 
terrible illness.
  I am proud to be a co-sponsor of this vital legislation to attack one 
of the most significant threats to global health. I am pleased with the 
bill that the International Relations Committee passed, and I urge my 
colleagues to support his bill.
  Mr. PAUL. Mr. Chairman, as a physician I am particularly concerned 
about terrible diseases like AIDS. I have great sympathy for those--in 
increasing numbers--who suffer and die around the world. The question 
is not whether each and every one of us is concerned or would like to 
do something about this terrible problem. The question is whether yet 
another massive government foreign aid program will actually do 
anything at all to solve the problem. The United States has been 
sending billions and billions of dollars overseas for decades to do 
fine-sounding things like ``build democracy'' and ``fight drugs'' and 
``end poverty.'' Yet decades later we are told that in every category 
these things have actually gotten worse rather than better. Our money 
has disappeared into bank accounts of dictators and salaries for 
extremely well-paid consultants and U.S. Government employees. Yet we 
refuse to learn from these mistakes; we are about to make another 
multi-billion dollar mistake with this bill.
  Though I have not been in favor of Federal Government funding of 
healthcare, if this money is going to be spent why shouldn't it be 
spent in this country, on American citizens? One legitimate function of 
government is to protect its citizens and taxpayers. Yet thousands of 
Americans who have contracted this terrible disease find themselves 
without any healthcare at all. Thousands of these Americans, as they 
become ill, are no longer able to work and therefore lose their 
insurance coverage. Drugs to treat the disease become impossible to 
afford; those with disease end up along and in misery. I seriously 
wonder whether negative perceptions of those at risk in this country do 
not drive this push to send billions abroad rather than address the 
disease here at home. I believe that if this money is to be spend it 
should be spent on Americans, regardless of what some may think about 
those high-risk groups.
  Bills like the one we are considering today also force Americans to 
fund programs and organizations that many find morally objectionable, 
such as those that distribute condoms and perform abortion. While some 
amendments we are voting on today admirably seek to address some of 
these concerns, the fact remains that this bill even if amended 
unconstitutionally sends U.S. taxpayer money overseas and 
inappropriately engages in social engineering abroad. None of the 
amendments address the immorality of forcing Americans to fund 
organizations engaged in family planning, performing abortions, and 
distributing condoms. As Thomas Jefferson famously said, ``To compel a 
man to furnish funds for the propagation of ideas be disbelieves and 
abhors is sinful and tyrannical.'' That is why I have introduced H.R. 
1548, a bill to prohibit any Federal official from expending any 
Federal funds for any population control or population planning program 
or any family planning activity. What we are seeing today on the floor 
just underscores the need to pass H.R. 1548--to end this tyrannical and 
sinful practice of forcing Americans to pay for programs they believe 
to be immoral and evil.
  Mr. Chairman, at a time when the government is running record 
deficits, is engaged in an enormously expensive war in Iraq and 
Afghanistan and elsewhere, and is even cutting veterans benefits, I 
find it extremely irresponsible that we are discussing sending 
additional billions overseas in yet another dubious program. 
Additionally, I am greatly concerned that the billions we are 
contributing to the ``Global Fund'' will be going to organizations that 
support and perform abortions, prostitution, infanticide and other 
horrors. There is nothing in this bill to prevent this, only faith that 
the Coordinator will exercise good judgment in these matters. That is 
simply not sufficient. I strongly oppose this bill and urge my 
colleagues to do likewise.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I rise in support of H.R. 
1298, the ``United States Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Act of 2003.'' I also rise to applaud the efforts of Mr. 
Hyde, Mr. Lantos, Mr. Weldon, Ms. Lee, and Mr. Leach to get this bill 
on the floor so that the members of the House of Representatives can do 
our part to fight the spread of infectious diseases.
  I support H.R. 1298, because HIV/AIDS, tuberculosis, and malaria are 
killing men, women, and children in countries across the globe. And the 
United States, a country blessed with expert physicians, scientists, 
corporations, and governmental agencies should take the lead in 
worldwide efforts to combat the effects of these infectious diseases.
  H.R. 1298 contains many provisions that help in the battle to contain 
the spread of these diseases and to provide assistance to those 
suffering from HIV/AIDS, TB, and malaria. Among other provisions, H.R. 
1298 establishes a five-year global strategy to combat HIV/AIDS, TB, 
and malaria. It also supports voluntary contributions to the 
international vaccine funds, establishes pilot programs to place health 
care professionals in overseas areas and provide assistance for 
children and families affected by HIV/AIDS.
  I, along with several other members of the House of Representatives, 
have also proposed amendments to supplement the provisions already 
written into the bill. These provisions will also help combat the 
spread of HIV/AIDS, TB, and malaria.
  As the Chair of the Children's Caucus, I am particularly troubled by 
the pandemic of HIV/AIDS and the devastating impact this disease has 
had on children in Africa and worldwide. It has been over 20 years 
since AIDS was first diagnosed. Since then over 57 million people have 
been infected, 25 million people have perished, 4 million of which were 
children.
  According to a study by UNAIDS, if the AIDS epidemic in Africa is not 
controlled, AIDS related deaths will make 40 million children orphans 
by the year 2010. Presently, there are more children orphaned in Africa 
due to parental AIDS deaths than there are children in America's public 
school system. In Botswana, there are more deaths annually from AIDS 
than there are childbirths.
  I have had the opportunity to see for myself the devastating effect 
of HIV/AIDS, TB, and malaria on the citizens of African countries. I 
was a member of one of the first presidential missions to Africa. I 
have visited Zambia,

[[Page 10260]]

Uganda, and South Africa and seen the physical and emotional damage 
caused by infectious diseases. I have supported programs to change 
personal behaviors like the ABC Program which encourages youths to 
practice Abstinence, Be faithful, and use Condoms.
  Congressional trips to Africa and support of initiatives are positive 
steps in the fight against aids. However, we can do much more to 
provide funding, actively participate in developing programs, conduct 
studies, and disburse medicines to the victims of HIV/AIDS, 
tuberculosis, and malaria in sub-Saharan Africa.
  I reiterate my unwavering support for H.R. 1298. I encourage every 
member of the House of Representatives to also support H.R. 1298, as 
well as give serious consideration to the various amendments that have 
been offered to the bill. We must take swift and decisive action to 
prevent the further spread of infectious diseases. Each day that we 
delay the passage of H.R. 1298, thousands of people worldwide will die 
or be infected with HIV/AIDS, TB, and malaria. I commend Mr. Hyde, Mr. 
Lantos, Mr. Weldon, Ms. Lee, and Mr. Leach's efforts to prevent further 
infectious disease deaths. I support H.R. 1298, and I urge my 
colleagues to do the same.
  Mrs. CHRISTENSEN. Mr. Chairman, I rise today to urge for the passage 
of H.R. 1298, and I want to commend my colleagues Barbara Lee and Tom 
Lantos, as well as Chairman Hyde and the entire CBC for getting us to 
where we are today.
  The White House has also come a long way.
  And so I am pleased to support this bill, which now provides $1 
billion for the global Fund where it can be leveraged to greater levels 
of funding through contributions from other sources.
  Hopefully as we see its success, the U.S. will increase its 
contribution to the global Fund where I am convinced we can do the most 
good.
  This bill wisely builds on the program in Uganda, where the three 
pronged approach of abstinence, being faithful to one partner, and 
condom use has seen much success.
  This is a major victory, not for those of us who have urged this 
approach but for the people whose lives will be saved.
  Lastly, I am very pleased that the Caribbean is included, 
specifically Haiti and Guyana, but here too, I hope that we can see 
this funding expanded to other countries in the region, which also bear 
a heavy burden of HIV and AIDS.
  We have come a long way in these two years, and even since the 
announcement of the $15 billion in the President's State of the Union 
Address this year.
  Although we can still improve upon this effort, passage of H.R. 1298 
will mark a great step forward in responding to this strong moral 
imperative. We look forward to working with our colleagues and the 
White House to continue to match what will surely be growing need, and 
to do the same for the HIV and AIDS epidemic right here at home.
  Mr. NADLER. Mr. Chairman, I rise in strong support of H.R. 1298. This 
is an excellent bill that will save millions of lives throughout the 
world. It's an outstanding example of the kind of leadership the United 
States should be showing on public health issues, and I hope it's just 
the beginning of our work in this area.
  I'm particularly pleased that President Bush has stood up to the 
extremists in his party who wished to hijack this bill to push their 
ideological agenda. The radical right wing forces who oppose even the 
discussion as well as distribution of condoms as part of a balanced 
approach play a dangerous game with people's lives. Instead of allowing 
proven strategies to work, there are some who would rather watch a 
whole continent die than see condoms used. An abstinence-only approach 
is a death sentence for millions of people.
  As I said, however, I applaud President Bush for standing up to these 
extremists and supporting this balanced bill. When the Traditional 
Values Coalition and the Family Research Council are opposed to 
legislation, we must be doing something right.
  Mr. Chairman, for too long this nation has stood by and paid closer 
attention to our wallet than to the millions of people dying of AIDS 
throughout the world. Up until now, we've been unwilling to spend the 
money necessary to combat this terrible disease. But today, we are 
hopefully reversing this trend and beginning a new era of American 
leadership on this issue.
  We've seen incredible devastation throughout the world as a result of 
AIDS. Millions of children will grow up orphans and entire nations have 
been unable to sustain a healthy workforce, driving them even deeper 
into poverty. These are tragedies that we can help stop, but it takes 
money and political will. With this bill today, we take an important 
step in that direction.
  I urge my colleagues to support this legislation and to oppose any 
amendments that weaken it.
  Mr. HYDE. Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the rule, the committee amendment in the nature of a 
substitute printed in the bill shall be considered as an original bill 
for the purpose of amendment under the 5-minute rule and shall be 
considered read.
  The text of the committee amendment in the nature of a substitute is 
as follows:

                               H.R. 1298

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.

               TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.

TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis 
              and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Pilot program for the placement of health care professionals 
              in overseas areas severely affected by HIV/AIDS, 
              tuberculosis, and malaria.
Sec. 305. Report on treatment activities by relevant executive branch 
              agencies.

            Subtitle B--Assistance for Children and Families

Sec. 311. Findings.
Sec. 312. Policy and requirements.
Sec. 313. Annual reports on prevention of mother-to-child transmission 
              of the HIV infection.
Sec. 314. Pilot program of assistance for children and families 
              affected by HIV/AIDS.
Sec. 315. Pilot program on family survival partnerships.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) During the last 20 years, HIV/AIDS has assumed pandemic 
     proportions, spreading from the most severely affected 
     regions, sub-Saharan Africa and the Caribbean, to all corners 
     of the world, and leaving an unprecedented path of death and 
     devastation.
       (2) According to the Joint United Nations Programme on HIV/
     AIDS (UNAIDS), more than 65,000,000 individuals worldwide 
     have been infected with HIV since the epidemic began, more 
     than 25,000,000 of these individuals have lost their lives to 
     the disease, and more than 14,000,000 children have been 
     orphaned by the disease. HIV/AIDS is the fourth-highest cause 
     of death in the world.
       (3)(A) At the end of 2002, an estimated 42,000,000 
     individuals were infected with HIV or living with AIDS, of 
     which more than 75 percent live in Africa or the Caribbean. 
     Of these individuals, more than 3,200,000 were children under 
     the age of fifteen and more than 19,200,000 were women.
       (B) Women are four times more vulnerable to infection than 
     are men and are becoming infected at increasingly high rates, 
     in part because many societies do not provide poor women and 
     young girls with the social, legal, and cultural protections 
     against high risk activities that expose them to HIV/AIDS.
       (C) Women and children who are refugees or are internally 
     displaced persons are especially vulnerable to sexual 
     exploitation and violence, thereby increasing the possibility 
     of HIV infection.
       (4) As the leading cause of death in sub-Saharan Africa, 
     AIDS has killed more than 19,400,000 individuals (more than 3 
     times the number of AIDS deaths in the rest of the world) and 
     will claim the lives of one-quarter of the population, mostly 
     adults, in the next decade.
       (5) An estimated 2,000,000 individuals in Latin America and 
     the Caribbean and another

[[Page 10261]]

     7,100,000 individuals in Asia and the Pacific region are 
     infected with HIV or living with AIDS. Infection rates are 
     rising alarmingly in Eastern Europe (especially in the 
     Russian Federation), Central Asia, and China.
       (6) HIV/AIDS threatens personal security by affecting the 
     health, lifespan, and productive capacity of the individual 
     and the social cohesion and economic well-being of the 
     family.
       (7) HIV/AIDS undermines the economic security of a country 
     and individual businesses in that country by weakening the 
     productivity and longevity of the labor force across a broad 
     array of economic sectors and by reducing the potential for 
     economic growth over the long term.
       (8) HIV/AIDS destabilizes communities by striking at the 
     most mobile and educated members of society, many of whom are 
     responsible for security at the local level and governance at 
     the national and subnational levels as well as many teachers, 
     health care personnel, and other community workers vital to 
     community development and the effort to combat HIV/AIDS. In 
     some countries the overwhelming challenges of the HIV/AIDS 
     epidemic are accelerating the outward migration of critically 
     important health care professionals.
       (9) HIV/AIDS weakens the defenses of countries severely 
     affected by the HIV/AIDS crisis through high infection rates 
     among members of their military forces and voluntary 
     peacekeeping personnel. According to UNAIDS, in sub-Saharan 
     Africa, many military forces have infection rates as much as 
     five times that of the civilian population.
       (10) HIV/AIDS poses a serious security issue for the 
     international community by--
       (A) increasing the potential for political instability and 
     economic devastation, particularly in those countries and 
     regions most severely affected by the disease;
       (B) decreasing the capacity to resolve conflicts through 
     the introduction of peacekeeping forces because the 
     environments into which these forces are introduced pose a 
     high risk for the spread of HIV/AIDS; and
       (C) increasing the vulnerability of local populations to 
     HIV/AIDS in conflict zones from peacekeeping troops with HIV 
     infection rates significantly higher than civilian 
     populations.
       (11) The devastation wrought by the HIV/AIDS pandemic is 
     compounded by the prevalence of tuberculosis and malaria, 
     particularly in developing countries where the poorest and 
     most vulnerable members of society, including women, 
     children, and those individuals living with HIV/AIDS, become 
     infected. According to the World Health Organization (WHO), 
     HIV/AIDS, tuberculosis, and malaria accounted for more than 
     5,700,000 deaths in 2001 and caused debilitating illnesses in 
     millions more.
       (12) Together, HIV/AIDS, tuberculosis, malaria and related 
     diseases are undermining agricultural production throughout 
     Africa. According to the United Nations Food and Agricultural 
     Organization, 7,000,000 agricultural workers throughout 25 
     African countries have died from AIDS since 1985. Countries 
     with poorly developed agricultural systems, which already 
     face chronic food shortages, are the hardest hit, 
     particularly in sub-Saharan Africa, where high HIV prevalence 
     rates are compounding the risk of starvation for an estimated 
     14,400,000 people.
       (13) Tuberculosis is the cause of death for one out of 
     every three people with AIDS worldwide and is a highly 
     communicable disease. HIV infection is the leading threat to 
     tuberculosis control. Because HIV infection so severely 
     weakens the immune system, individuals with HIV and latent 
     tuberculosis infection have a 100 times greater risk of 
     developing active tuberculosis diseases thereby increasing 
     the risk of spreading tuberculosis to others. Tuberculosis, 
     in turn, accelerates the onset of AIDS in individuals 
     infected with HIV.
       (14) Malaria, the most deadly of all tropical parasitic 
     diseases, has been undergoing a dramatic resurgence in recent 
     years due to increasing resistance of the malaria parasite to 
     inexpensive and effective drugs. At the same time, increasing 
     resistance of mosquitoes to standard insecticides makes 
     control of transmission difficult to achieve. The World 
     Health Organization estimates that between 300,000,000 and 
     500,000,000 new cases of malaria occur each year, and annual 
     deaths from the disease number between 2,000,000 and 
     3,000,000. Persons infected with HIV are particularly 
     vulnerable to the malaria parasite. The spread of HIV 
     infection contributes to the difficulties of controlling 
     resurgence of the drug resistant malaria parasite.
       (15) HIV/AIDS is first and foremost a health problem. 
     Successful strategies to stem the spread of the HIV/AIDS 
     pandemic will require clinical medical interventions, the 
     strengthening of health care delivery systems and 
     infrastructure, and determined national leadership and 
     increased budgetary allocations for the health sector in 
     countries affected by the epidemic as well as measures to 
     address the social and behavioral causes of the problem and 
     its impact on families, communities, and societal sectors.
       (16) Basic interventions to prevent new HIV infections and 
     to bring care and treatment to people living with AIDS, such 
     as voluntary counseling and testing and mother-to-child 
     transmission programs, are achieving meaningful results and 
     are cost-effective. The challenge is to expand these 
     interventions from a pilot program basis to a national basis 
     in a coherent and sustainable manner.
       (17) Appropriate treatment of individuals with HIV/AIDS can 
     prolong the lives of such individuals, preserve their 
     families, 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.
       (18) Nongovernmental organizations, including faith-based 
     organizations, with experience in health care and HIV/AIDS 
     counseling, have proven effective in combating the HIV/AIDS 
     pandemic and can be a resource in assisting indigenous 
     organizations in severely affected countries in their efforts 
     to provide treatment and care for individuals infected with 
     HIV/AIDS.
       (19) Faith-based organizations are making an important 
     contribution to HIV prevention and AIDS treatment programs 
     around the world. Successful HIV prevention programs in 
     Uganda, Jamaica, and elsewhere have included local churches 
     and faith-based groups in efforts to promote behavior changes 
     to prevent HIV, to reduce stigma associated with HIV 
     infection, to treat those afflicted with the disease, and to 
     care for orphans. The Catholic Church alone currently cares 
     for one in four people being treated for AIDS worldwide. 
     Faith-based organizations possess infrastructure, experience, 
     and knowledge that will be needed to carry out these programs 
     in the future and should be an integral part of United States 
     efforts.
       (20)(A) Uganda has experienced the most significant decline 
     in HIV rates of any country in Africa, including a decrease 
     among pregnant women from 20.6 percent in 1991 to 7.9 percent 
     in 2000.
       (B) Uganda made this remarkable turnaround because 
     President Yoweri Museveni spoke out early, breaking long-
     standing cultural taboos, and changed widespread perceptions 
     about the disease. His leadership stands as a model for ways 
     political leaders in Africa and other developing countries 
     can mobilize their nations, including civic organizations, 
     professional associations, religious institutions, business 
     and labor to combat HIV/AIDS.
       (C) Uganda's successful AIDS treatment and prevention 
     program is referred to as the ABC model: ``Abstain, Be 
     faithful, use Condoms'', in order of priority. Jamaica, 
     Zambia, Ethiopia and Senegal have also successfully used the 
     ABC model. Beginning in 1986, Uganda brought about a 
     fundamental change in sexual behavior by developing a low-
     cost program with the message: ``Stop having multiple 
     partners. Be faithful. Teenagers, wait until you are married 
     before you begin sex.''.
       (D) By 1995, 95 percent of Ugandans were reporting either 
     one or zero sexual partners in the past year, and the 
     proportion of sexually active youth declined significantly 
     from the late 1980s to the mid-1990s. The greatest percentage 
     decline in HIV infections and the greatest degree of 
     behavioral change occurred in those 15 to 19 years old. 
     Uganda's success shows that behavior change, through the use 
     of the ABC model, is a very successful way to prevent the 
     spread of HIV.
       (21) The magnitude and scope of the HIV/AIDS crisis demands 
     a comprehensive, long-term, international response focused 
     upon addressing the causes, reducing the spread, and 
     ameliorating the consequences of the HIV/AIDS pandemic, 
     including--
       (A) prevention and education, care and treatment, basic and 
     applied research, and training of health care workers, 
     particularly at the community and provincial levels, and 
     other community workers and leaders needed to cope with the 
     range of consequences of the HIV/AIDS crisis;
       (B) development of health care infrastructure and delivery 
     systems through cooperative and coordinated public efforts 
     and public and private partnerships;
       (C) development and implementation of national and 
     community-based multisector strategies that address the 
     impact of HIV/AIDS on the individual, family, community, and 
     nation and increase the participation of at-risk populations 
     in programs designed to encourage behavioral and social 
     change and reduce the stigma associated with HIV/AIDS; and
       (D) coordination of efforts between international 
     organizations such as the Global Fund to Fight AIDS, 
     Tuberculosis and Malaria, the Joint United Nations Programme 
     on HIV/AIDS (UNAIDS), the World Health Organization (WHO), 
     national governments, and private sector organizations, 
     including faith-based organizations.
       (22) The United States has the capacity to lead and enhance 
     the effectiveness of the international community's response 
     by--
       (A) providing substantial financial resources, technical 
     expertise, and training, particularly of health care 
     personnel and community workers and leaders;
       (B) promoting vaccine and microbicide research and the 
     development of new treatment protocols in the public and 
     commercial pharmaceutical research sectors;
       (C) making available pharmaceuticals and diagnostics for 
     HIV/AIDS therapy;
       (D) encouraging governments and faith-based and community-
     based organizations to adopt policies that treat HIV/AIDS as 
     a multisectoral public health problem affecting not only 
     health but other areas such as agriculture, education, the 
     economy, the family and society, and assisting them to 
     develop and implement programs corresponding to these needs;
       (E) promoting healthy lifestyles, including abstinence, 
     delaying sexual debut, monogamy, marriage, faithfulness, use 
     of condoms, and avoiding substance abuse; and
       (F) encouraging active involvement of the private sector, 
     including businesses, pharmaceutical and biotechnology 
     companies, the medical and scientific communities, charitable 
     foundations, private and voluntary organizations

[[Page 10262]]

     and nongovernmental organizations, faith-based organizations, 
     community-based organizations, and other nonprofit entities.
       (23) Prostitution and other sexual victimization are 
     degrading to women and children and it should be the policy 
     of the United States to eradicate such practices. The sex 
     industry, the trafficking of individuals into such industry, 
     and sexual violence are additional causes of and factors in 
     the spread of the HIV/AIDS epidemic. One in nine South 
     Africans is living with AIDS, and sexual assault is rampant, 
     at a victimization rate of one in three women. Meanwhile in 
     Cambodia, as many as 40 percent of prostitutes are infected 
     with HIV and the country has the highest rate of increase of 
     HIV infection in all of Southeast Asia. Victims of coercive 
     sexual encounters do not get to make choices about their 
     sexual activities.
       (24) Strong coordination must exist among the various 
     agencies of the United States to ensure effective and 
     efficient use of financial and technical resources within the 
     United States Government with respect to the provision of 
     international HIV/AIDS assistance.
       (25) In his address to Congress on January 28, 2003, the 
     President announced the Administration's intention to embark 
     on a five-year emergency plan for AIDS relief, to confront 
     HIV/AIDS with the goals of preventing 7,000,000 new HIV/AIDS 
     infections, treating at least 2,000,000 people with life-
     extending drugs, and providing humane care for millions of 
     people suffering from HIV/AIDS, and for children orphaned by 
     HIV/AIDS.
       (26) In this address to Congress, the President stated the 
     following: ``Today, on the continent of Africa, nearly 
     30,000,000 people have the AIDS virus--including 3,000,000 
     children under the age of 15. There are whole countries in 
     Africa where more than one-third of the adult population 
     carries the infection. More than 4,000,000 require immediate 
     drug treatment. Yet across that continent, only 50,000 AIDS 
     victims--only 50,000--are receiving the medicine they 
     need.''.
       (27) Furthermore, the President focused on care and 
     treatment of HIV/AIDS in his address to Congress, stating the 
     following: ``Because the AIDS diagnosis is considered a death 
     sentence, many do not seek treatment. Almost all who do are 
     turned away. A doctor in rural South Africa describes his 
     frustration. He says, `We have no medicines. Many hospitals 
     tell people, you've got AIDS, we can't help you. Go home and 
     die.' In an age of miraculous medicines, no person should 
     have to hear those words. AIDS can be prevented. Anti-
     retroviral drugs can extend life for many years ... Ladies 
     and gentlemen, seldom has history offered a greater 
     opportunity to do so much for so many.''.
       (28) Finally, the President stated that ``[w]e have 
     confronted, and will continue to confront, HIV/AIDS in our 
     own country'', proposing now that the United States should 
     lead the world in sparing innocent people from a plague of 
     nature, and asking Congress ``to commit $15,000,000,000 over 
     the next five years, including nearly $10,000,000,000 in new 
     money, to turn the tide against AIDS in the most afflicted 
     nations of Africa and the Caribbean''.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) AIDS.--The term ``AIDS'' means the acquired immune 
     deficiency syndrome.
       (2) Appropriate congressional committees.--The term 
     ``appropriate congressional committees'' means the Committee 
     on Foreign Relations of the Senate and the Committee on 
     International Relations of the House of Representatives.
       (3) Global fund.--The term ``Global Fund'' means the 
     public-private partnership known as the Global Fund to Fight 
     AIDS, Tuberculosis and Malaria established pursuant to 
     Article 80 of the Swiss Civil Code.
       (4) HIV.--The term ``HIV'' means the human immunodeficiency 
     virus, the pathogen that causes AIDS.
       (5) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to 
     an individual, an individual who is infected with HIV or 
     living with AIDS.
       (6) Relevant executive branch agencies.--The term 
     ``relevant executive branch agencies'' means the Department 
     of State, the United States Agency for International 
     Development, and any other department or agency of the United 
     States that participates in international HIV/AIDS activities 
     pursuant to the authorities of such department or agency or 
     the Foreign Assistance Act of 1961.

     SEC. 4. PURPOSE.

       The purpose of this Act is to strengthen United States 
     leadership and the effectiveness of the United States 
     response to certain global infectious diseases by--
       (1) establishing a comprehensive, integrated five-year, 
     global strategy to fight HIV/AIDS that encompasses a plan for 
     phased expansion of critical programs and improved 
     coordination among relevant executive branch agencies and 
     between the United States and foreign governments and 
     international organizations;
       (2) providing increased resources for multilateral efforts 
     to fight HIV/AIDS;
       (3) providing increased resources for United States 
     bilateral efforts, particularly for technical assistance and 
     training, to combat HIV/AIDS, tuberculosis, and malaria;
       (4) encouraging the expansion of private sector efforts and 
     expanding public-private sector partnerships to combat HIV/
     AIDS; and
       (5) intensifying efforts to support the development of 
     vaccines and treatment for HIV/AIDS, tuberculosis, and 
     malaria.

     SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

       With respect to the reports required by this Act to be 
     submitted by the President, to ensure an efficient use of 
     resources, the President may, in his discretion and 
     notwithstanding any other provision of this Act, consolidate 
     or combine any of these reports, except for the report 
     required by section 101 of this Act, so long as the required 
     elements of each report are addressed and reported within a 
     90-day period from the original deadline date for submission 
     of the report specified in this Act. The President may also 
     enter into contracts with organizations with relevant 
     expertise to develop, originate, or contribute to any of the 
     reports required by this Act to be submitted by the 
     President.

               TITLE I--POLICY PLANNING AND COORDINATION

     SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL 
                   STRATEGY.

       (a) Strategy.--The President shall establish a 
     comprehensive, integrated, five-year strategy to combat 
     global HIV/AIDS that strengthens the capacity of the United 
     States to be an effective leader of the international 
     campaign against HIV/AIDS. Such strategy shall maintain 
     sufficient flexibility and remain responsive to the ever-
     changing nature of the HIV/AIDS pandemic and shall--
       (1) include specific objectives, multisectoral approaches, 
     and specific strategies to treat individuals infected with 
     HIV/AIDS and to prevent the further spread of HIV infections, 
     with a particular focus on the needs of families with 
     children (including the prevention of mother-to-child 
     transmission), women, young people, and children (such as 
     unaccompanied minor children and orphans);
       (2) as part of the strategy, implement a tiered approach to 
     direct delivery of care and treatment through a system based 
     on central facilities augmented by expanding circles of local 
     delivery of care and treatment through local systems and 
     capacity;
       (3) assign priorities for relevant executive branch 
     agencies;
       (4) provide that the reduction of HIV/AIDS behavioral risks 
     shall be a priority of all prevention efforts in terms of 
     funding, educational messages, and activities by promoting 
     abstinence from sexual activity and substance abuse, 
     encouraging monogamy and faithfulness, promoting the 
     effective use of condoms, and eradicating prostitution, the 
     sex trade, rape, sexual assault and sexual exploitation of 
     women and children;
       (5) improve coordination among relevant executive branch 
     agencies, foreign governments, and international 
     organizations;
       (6) project general levels of resources needed to achieve 
     the stated objectives;
       (7) expand public-private partnerships and the leveraging 
     of resources; and
       (8) maximize United States capabilities in the areas of 
     technical assistance and training and research, including 
     vaccine research.
       (b) Report.--
       (1) In general.--Not later than 270 days after the date of 
     enactment of this Act, the President shall submit to the 
     appropriate congressional committees a report setting forth 
     the strategy described in subsection (a).
       (2) Report contents.--The report required by paragraph (1) 
     shall include a discussion of the elements described in 
     paragraph (3) and may include a discussion of additional 
     elements relevant to the strategy described in subsection 
     (a). Such discussion may include an explanation as to why a 
     particular element described in paragraph (3) is not relevant 
     to such strategy.
       (3) Report elements.--The elements referred to in paragraph 
     (2) are the following:
       (A) The objectives, general and specific, of the strategy.
       (B) A description of the criteria for determining success 
     of the strategy.
       (C) A description of the manner in which the strategy will 
     address the fundamental elements of prevention and education, 
     care, and treatment (including increasing access to 
     pharmaceuticals and to vaccines), the promotion of 
     abstinence, monogamy, avoidance of substance abuse, and use 
     of condoms, research (including incentives for vaccine 
     development and new protocols), training of health care 
     workers, the development of health care infrastructure and 
     delivery systems, and avoidance of substance abuse.
       (D) A description of the manner in which the strategy will 
     promote the development and implementation of national and 
     community-based multisectoral strategies and programs, 
     including those designed to enhance leadership capacity 
     particularly at the community level.
       (E) A description of the specific strategies developed to 
     meet the unique needs of women, including the empowerment of 
     women in interpersonal situations, young people and children, 
     including those orphaned by HIV/AIDS and those who are 
     victims of the sex trade, rape, sexual abuse, assault, and 
     exploitation.
       (F) A description of the programs to be undertaken to 
     maximize United States contributions in the areas of 
     technical assistance, training (particularly of health care 
     workers and community-based leaders in affected sectors), and 
     research, including the promotion of research on vaccines and 
     microbicides.
       (G) An identification of the relevant executive branch 
     agencies that will be involved and the assignment of 
     priorities to those agencies.
       (H) A description of the role of each relevant executive 
     branch agency and the types of programs that the agency will 
     be undertaking.
       (I) A description of the mechanisms that will be utilized 
     to coordinate the efforts of the relevant executive branch 
     agencies, to avoid duplication of efforts, to enhance on-site 
     coordination efforts, and to ensure that each agency 
     undertakes programs primarily in those areas

[[Page 10263]]

     where the agency has the greatest expertise, technical 
     capabilities, and potential for success.
       (J) A description of the mechanisms that will be utilized 
     to ensure greater coordination between the United States and 
     foreign governments and international organizations including 
     the Global Fund, UNAIDS, international financial 
     institutions, and private sector organizations.
       (K) The level of resources that will be needed on an annual 
     basis and the manner in which those resources would generally 
     be allocated among the relevant executive branch agencies.
       (L) A description of the mechanisms to be established for 
     monitoring and evaluating programs, promoting successful 
     models, and for terminating unsuccessful programs.
       (M) A description of the manner in which private, 
     nongovernmental entities will factor into the United States 
     Government-led effort and a description of the type of 
     partnerships that will be created to maximize the 
     capabilities of these private sector entities and to leverage 
     resources.
       (N) A description of the ways in which United States 
     leadership will be used to enhance the overall international 
     response to the HIV/AIDS pandemic and particularly to 
     heighten the engagement of the member states of the G-8 and 
     to strengthen key financial and coordination mechanisms such 
     as the Global Fund and UNAIDS.
       (O) A description of the manner in which the United States 
     strategy for combating HIV/AIDS relates to and supports other 
     United States assistance strategies in developing countries.
       (P) A description of the programs to be carried out under 
     the strategy that are specifically targeted at women and 
     girls to educate them about the spread of HIV/AIDS.
       (Q) A description of efforts being made to address the 
     unique needs of families with children with respect to HIV/
     AIDS, including efforts to preserve the family unit.
       (R) An analysis of the emigration of critically important 
     medical and public health personnel, including physicians, 
     nurses, and supervisors from sub-Saharan African countries 
     that are acutely impacted by HIV/AIDS, including a 
     description of the causes, effects, and the impact on the 
     stability of health infrastructures, as well as a summary of 
     incentives and programs that the United States could provide, 
     in concert with other private and public sector partners and 
     international organizations, to stabilize health institutions 
     by encouraging critical personnel to remain in their home 
     countries.
       (S) A description of the specific strategies developed to 
     promote sustainability of HIV/AIDS pharmaceuticals (including 
     antiretrovirals) and the effects of drug resistance on HIV/
     AIDS patients.
       (T) A description of the specific strategies to ensure that 
     the extraordinary benefit of HIV/AIDS pharmaceuticals 
     (especially antiretrovirals) are not diminished through the 
     illegal counterfeiting of pharmaceuticals and black market 
     sales of such pharmaceuticals.
       (U) An analysis of the prevalence of Human Papilloma Virus 
     (HPV) in sub-Saharan Africa and the impact that condom usage 
     has upon the spread of HPV in sub-Saharan Africa.

     SEC. 102. HIV/AIDS RESPONSE COORDINATOR.

       (a) Establishment of Position.--Section 1 of the State 
     Department Basic Authorities Act of 1956 (22 U.S.C. 265(a)) 
     is amended--
       (1) by redesignating subsection (f) as subsection (g); and
       (2) by inserting after subsection (e) the following:
       ``(f) HIV/AIDS Response Coordinator.--
       ``(1) In general.--There shall be established within the 
     Department of State in the immediate office of the Secretary 
     of State a Coordinator of United States Government Activities 
     to Combat HIV/AIDS Globally, who shall be appointed by the 
     President, by and with the advice and consent of the Senate. 
     The Coordinator shall report directly to the Secretary.
       ``(2) Authorities and duties; definitions.--
       ``(A) Authorities.--The Coordinator, acting through such 
     nongovernmental organizations (including faith-based and 
     community-based organizations) and relevant executive branch 
     agencies as may be necessary and appropriate to effect the 
     purposes of this section, is authorized--
       ``(i) to operate internationally to carry out prevention, 
     care, treatment, support, capacity development, and other 
     activities for combatting HIV/AIDS;
       ``(ii) to transfer and allocate funds to relevant executive 
     branch agencies; and
       ``(iii) to provide grants to, and enter into contracts 
     with, nongovernmental organizations (including faith-based 
     and community-based organizations) to carry out the purposes 
     of section.
       ``(B) Duties.--
       ``(i) In general.--The Coordinator shall have primary 
     responsibility for the oversight and coordination of all 
     resources and international activities of the United States 
     Government to combat the HIV/AIDS pandemic, including all 
     programs, projects, and activities of the United States 
     Government relating to the HIV/AIDS pandemic under the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 or any amendment made by that Act.
       ``(ii) Specific duties.--The duties of the Coordinator 
     shall specifically include the following:

       ``(I) Ensuring program and policy coordination among the 
     relevant executive branch agencies and nongovernmental 
     organizations, including auditing, monitoring, and evaluation 
     of all such programs.
       ``(II) Ensuring that each relevant executive branch agency 
     undertakes programs primarily in those areas where the agency 
     has the greatest expertise, technical capabilities, and 
     potential for success.
       ``(III) Avoiding duplication of effort.
       ``(IV) Ensuring coordination of relevant executive branch 
     agency activities in the field.
       ``(V) Pursuing coordination with other countries and 
     international organizations.
       ``(VI) Resolving policy, program, and funding disputes 
     among the relevant executive branch agencies.
       ``(VII) Directly approving all activities of the United 
     States (including funding) relating to combatting HIV/AIDS in 
     each of Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, 
     Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, 
     Tanzania, Uganda, Zambia, and other countries designated by 
     the President, which other designated countries may include 
     those countries in which the United States is implementing 
     HIV/AIDS programs as of the date of the enactment of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003.
       ``(VIII) Establishing due diligence criteria for all 
     recipients of funds section and all activities subject to the 
     coordination and appropriate monitoring, evaluation, and 
     audits carried out by the Coordinator necessary to assess the 
     measurable outcomes of such activities.

       ``(C) Definitions.--In this paragraph:
       ``(i) AIDS.--The term `AIDS' means acquired immune 
     deficiency syndrome.
       ``(ii) HIV.--The term `HIV' means the human 
     immunodeficiency virus, the pathogen that causes AIDS.
       ``(iii) HIV/AIDS.--The term `HIV/AIDS' means, with respect 
     to an individual, an individual who is infected with HIV or 
     living with AIDS.
       ``(iv) Relevant executive branch agencies.--The term 
     `relevant executive branch agencies' means the Department of 
     State, the United States Agency for International 
     Development, the Department of Health and Human Services 
     (including the Public Health Service), and any other 
     department or agency of the United States that participates 
     in international HIV/AIDS activities pursuant to the 
     authorities of such department or agency or this Act.''.
       (b) Resources.--Not later than 90 days after the date of 
     enactment of this Act, the President shall specify the 
     necessary financial and personnel resources, from funds 
     appropriated pursuant to the authorization of appropriations 
     under section 401 for HIV/AIDS assistance, that shall be 
     assigned to and under the direct control of the Coordinator 
     of United States Government Activities to Combat HIV/AIDS 
     Globally to establish and maintain the duties and supporting 
     activities assigned to the Coordinator by this Act and the 
     amendments made by this Act.
       (c) Establishment of Separate Account.--There is 
     established in the general fund of the Treasury a separate 
     account which shall be known as the ``Activities to Combat 
     HIV/AIDS Globally Fund'' and which shall be administered by 
     the Coordinator of United States Government Activities to 
     Combat HIV/AIDS Globally. There shall be deposited into the 
     Fund all amounts appropriated pursuant to the authorization 
     of appropriations under section 401 for HIV/AIDS assistance, 
     except for amounts appropriated for United States 
     contributions to the Global Fund.

TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

     SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.

       (a) Findings.--Congress makes the following findings:
       (1) Innovative partnerships between governments and 
     organizations in the private sector (including foundations, 
     universities, corporations, faith-based and community-based 
     organizations, and other nongovernmental organizations) have 
     proliferated in recent years, particularly in the area of 
     health.
       (2) Public-private sector partnerships multiply local and 
     international capacities to strengthen the delivery of health 
     services in developing countries and to accelerate research 
     for vaccines and other pharmaceutical products that are 
     essential to combat infectious diseases decimating the 
     populations of these countries.
       (3) These partnerships maximize the unique capabilities of 
     each sector while combining financial and other resources, 
     scientific knowledge, and expertise toward common goals which 
     neither the public nor the private sector can achieve alone.
       (4) Sustaining existing public-private partnerships and 
     building new ones are critical to the success of the 
     international community's efforts to combat HIV/AIDS and 
     other infectious diseases around the globe.
       (b) Sense of Congress.--It is the sense of Congress that--
       (1) the sustainment and promotion of public-private 
     partnerships should be a priority element of the strategy 
     pursued by the United States to combat the HIV/AIDS pandemic 
     and other global health crises; and
       (2) the United States should systematically track the 
     evolution of these partnerships and work with others in the 
     public and private sector to profile and build upon those 
     models that are most effective.

     SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, 
                   TUBERCULOSIS AND MALARIA.

       (a) Authority for United States Participation.--
       (1) United states participation.--The United States is 
     hereby authorized to participate in the Global Fund.

[[Page 10264]]

       (2) Privileges and immunities.--The Global Fund shall be 
     considered a public international organization for purposes 
     of section 1 of the International Organizations Immunities 
     Act (22 U.S.C. 288).
       (b) Reports to Congress.--Not later than 1 year after the 
     date of the enactment of this Act, and annually thereafter 
     for the duration of the Global Fund, the President shall 
     submit to the appropriate congressional committees a report 
     on the Global Fund, including contributions pledged to, 
     contributions (including donations from the private sector) 
     received by, and projects funded by the Global Fund, and the 
     mechanisms established for transparency and accountability in 
     the grant-making process.
       (c) United States Financial Participation.--
       (1) Authorization of appropriations.--In addition to any 
     other funds authorized to be appropriated for bilateral or 
     multilateral HIV/AIDS, tuberculosis, or malaria programs, of 
     the amounts authorized to be appropriated under section 401, 
     there are authorized to be appropriated to the President up 
     to $1,000,000,000 in the fiscal year 2004, and such sums as 
     may be necessary for the fiscal years 2005-2008, for 
     contributions to the Global Fund.
       (2) Availability of funds.--Amounts appropriated under 
     paragraph (1) are authorized to remain available until 
     expended.
       (3) Reprogramming of fiscal year 2001 funds.--Funds made 
     available for fiscal year 2001 under section 141 of the 
     Global AIDS and Tuberculosis Relief Act of 2000--
       (A) are authorized to remain available until expended; and
       (B) shall be transferred to, merged with, and made 
     available for the same purposes as, funds made available for 
     fiscal years 2004 through 2008 under paragraph (1).
       (4) Limitation.--
       (A)(i) At any time during fiscal years 2004 through 2008, 
     no United States contribution to the Global Fund may cause 
     the total amount of United States Government contributions to 
     the Global Fund to exceed 33 percent of the total amount of 
     funds contributed to the Global Fund from all other sources. 
     Contributions to the Global Fund from the International Bank 
     for Reconstruction and Development and the International 
     Monetary Fund shall not be considered in determining 
     compliance with this paragraph.
       (ii) If, at any time during any of the fiscal years 2004 
     through 2008, the President determines that the Global Fund 
     has provided assistance to a country, the government of which 
     the Secretary of State has determined, for purposes of 
     section 6(j)(1) of the Export Administration Act of 1979 (50 
     U.S.C. App. 2405(j)(1)), has repeatedly provided support for 
     acts of international terrorism, then the United States shall 
     withhold from its contribution for the next fiscal year an 
     amount equal to the amount expended by the Fund to the 
     government of each such country.
       (B) Any amount made available under this subsection that is 
     withheld by reason of subparagraph (A) shall be contributed 
     to the Global Fund as soon as practicable, subject to 
     subparagraph (A), after additional contributions to the 
     Global Fund are made from other sources.
       (C)(i) The President may suspend the application of 
     subparagraph (A) with respect to a fiscal year if the 
     President determines that an international health emergency 
     threatens the national security interests of the United 
     States.
       (ii) The President shall notify the Committee on 
     International Relations of the House of Representatives and 
     the Committee on Foreign Relations of the Senate not less 
     than 5 days before making a determination under clause (i) 
     with respect to the application of subparagraph (A)(i) and 
     shall include in the notification--
       (I) a justification as to why increased United States 
     Government contributions to the Global Fund is preferable to 
     increased United States assistance to combat HIV/AIDS, 
     tuberculosis, and malaria on a bilateral basis; and
       (II) an explanation as to why other government donors to 
     the Global Fund are unable to provide adequate contributions 
     to the Fund.
       (d) Interagency Technical Review Panel.--
       (1) Establishment.--The Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally, 
     established in section 1(f)(1) of the State Department Basic 
     Authorities Act of 1956 (as added by section 102(a) of this 
     Act), shall establish in the executive branch an interagency 
     technical review panel.
       (2) Duties.--The interagency technical review panel shall 
     serve as a ``shadow'' panel to the Global Fund by--
       (A) periodically reviewing all proposals received by the 
     Global Fund; and
       (B) providing guidance to the United States persons who are 
     representatives on the panels, committees, and boards of the 
     Global Fund, on the technical efficacy, suitability, and 
     appropriateness of the proposals, and ensuring that such 
     persons are fully informed of technical inadequacies or other 
     aspects of the proposals that are inconsistent with the 
     purposes of this or any other Act relating to the provision 
     of foreign assistance in the area of AIDS.
       (3) Membership.--The interagency technical review panel 
     shall consist of qualified medical and development experts 
     who are officers or employees of the Department of Health and 
     Human Services, the Department of State, and the United 
     States Agency for International Development.
       (4) Chair.--The Coordinator referred to in paragraph (1) 
     shall chair the interagency technical review panel.
       (e) Monitoring by Comptroller General.--
       (1) Monitoring.--The Comptroller General shall monitor and 
     evaluate projects funded by the Global Fund.
       (2) Report.--The Comptroller General shall on a biennial 
     basis prepare and submit to the appropriate congressional 
     committees a report that contains the results of the 
     monitoring and evaluation described in paragraph (1) for the 
     preceding 2-year period.

     SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE 
                   FUNDS.

       (a) Vaccine Fund.--Section 302(k) of the Foreign Assistance 
     Act of 1961 (22 U.S.C. 2222(k)) is amended--
       (1) by striking ``$50,000,000 for each of the fiscal years 
     2001 and 2002'' and inserting ``such sums as may be necessary 
     for each of the fiscal years 2004 through 2008''; and
       (2) by striking ``Global Alliance for Vaccines and 
     Immunizations'' and inserting ``Vaccine Fund''.
       (b) International AIDS Vaccine Initiative.--Section 302(l) 
     of the Foreign Assistance Act of 1961 (22 U.S.C. 2222(l)) is 
     amended by striking ``$10,000,000 for each of the fiscal 
     years 2001 and 2002'' and inserting ``such sums as may be 
     necessary for each of the fiscal years 2004 through 2008''.
       (c) Support for the Development of Malaria Vaccine.--
     Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 
     2222)) is amended by adding at the end the following new 
     subsection:
       ``(m) In addition to amounts otherwise available under this 
     section, there are authorized to be appropriated to the 
     President such sums as may be necessary for each of the 
     fiscal years 2004 through 2008 to be available for United 
     States contributions to malaria vaccine development programs, 
     including the Malaria Vaccine Initiative of the Program for 
     Appropriate Technologies in Health (PATH).''.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

     SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

       (a) Amendment of the Foreign Assistance Act of 1961.--
     Chapter 1 of part I of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151 et seq.) is amended--
       (1) in section 104(c) (22 U.S.C. 2151b(c)), by striking 
     paragraphs (4) through (7); and
       (2) by inserting after section 104 the following new 
     section:

     ``SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.

       ``(a) Finding.--Congress recognizes that the alarming 
     spread of HIV/AIDS in countries in sub-Saharan Africa, the 
     Caribbean, and other developing countries is a major global 
     health, national security, development, and humanitarian 
     crisis.
       ``(b) Policy.--It is a major objective of the foreign 
     assistance program of the United States to provide assistance 
     for the prevention, treatment, and control of HIV/AIDS. The 
     United States and other developed countries should provide 
     assistance to countries in sub-Saharan Africa, the Caribbean, 
     and other countries and areas to control this crisis through 
     HIV/AIDS prevention, treatment, monitoring, and related 
     activities, particularly activities focused on women and 
     youth, including strategies to protect women and prevent 
     mother-to-child transmission of the HIV infection.
       ``(c) Authorization.--
       ``(1) In general.--Consistent with section 104(c), the 
     President is authorized to furnish assistance, on such terms 
     and conditions as the President may determine, for HIV/AIDS, 
     including to prevent, treat, and monitor HIV/AIDS, and carry 
     out related activities, in countries in sub-Saharan Africa, 
     the Caribbean, and other countries and areas.
       ``(2) Role of ngos.--It is the sense of Congress that the 
     President should provide an appropriate level of assistance 
     under paragraph (1) through nongovernmental organizations 
     (including faith-based and community-based organizations) in 
     countries in sub-Saharan Africa, the Caribbean, and other 
     countries and areas affected by the HIV/AIDS pandemic.
       ``(3) Coordination of assistance efforts.--The President 
     shall coordinate the provision of assistance under paragraph 
     (1) 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), the Global Fund to Fight AIDS, Tuberculosis and 
     Malaria and other appropriate international organizations 
     (such as the International Bank for Reconstruction and 
     Development), relevant regional multilateral development 
     institutions, national, state, and local governments of 
     foreign countries, appropriate governmental and 
     nongovernmental organizations, and relevant executive branch 
     agencies.
       ``(d) Activities Supported.--Assistance provided under 
     subsection (c) shall, to the maximum extent practicable, be 
     used to carry out the following activities:
       ``(1) Prevention.--Prevention of HIV/AIDS through 
     activities including--
       ``(A) programs and efforts that are designed or intended to 
     impart knowledge with the exclusive purpose of helping 
     individuals avoid behaviors that place them at risk of HIV 
     infection, including integration of such programs into health 
     programs and the inclusion in counseling programs of 
     information on methods of avoiding infection of HIV, 
     including delaying sexual debut, abstinence, fidelity and 
     monogamy, reduction of casual sexual partnering, and where 
     appropriate, use of condoms;
       ``(B) assistance to establish and implement culturally 
     appropriate HIV/AIDS education and

[[Page 10265]]

     prevention programs that focus on helping individuals avoid 
     infection of HIV/AIDS, implemented through nongovernmental 
     organizations, including faith-based and community-based 
     organizations, particularly those organizations that utilize 
     both professionals and volunteers with appropriate skills, 
     experience, and community presence;
       ``(C) assistance for the purpose of providing voluntary 
     testing and counseling (including the incorporation of 
     confidentiality protections with respect to such testing and 
     counseling);
       ``(D) assistance for the purpose of preventing mother-to-
     child transmission of the HIV infection, including 
     medications to prevent such transmission and access to infant 
     formula and other alternatives for infant feeding;
       ``(E) assistance to ensure a safe blood supply and sterile 
     medical equipment; and
       ``(F) assistance to help avoid substance abuse and 
     intravenous drug use that can lead to HIV infection.
       ``(2) Treatment.--The treatment and care of individuals 
     with HIV/AIDS, including--
       ``(A) 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;
       ``(B) 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 and 
     community-based organizations; and
       ``(C) assistance for the purpose of the care and treatment 
     of individuals with HIV/AIDS through the provision of 
     pharmaceuticals, including antiretrovirals and other 
     pharmaceuticals and therapies for the treatment of 
     opportunistic infections, nutritional support, and other 
     treatment modalities.
       ``(3) Preventative intervention education and 
     technologies.--(A) With particular emphasis on specific 
     populations that represent a particularly high risk of 
     contracting or spreading HIV/AIDS, including those exploited 
     through the sex trade, victims of rape and sexual assault, 
     individuals already infected with HIV/AIDS, and in cases of 
     occupational exposure of health care workers, assistance with 
     efforts to reduce the risk of HIV/AIDS infection including 
     post-exposure pharmaceutical prophylaxis, and necessary 
     pharmaceuticals and commodities, including test kits, 
     condoms, and, when proven effective, microbicides.
       ``(B) Bulk purchases of available test kits, condoms, and, 
     when proven effective, microbicides that are intended to 
     reduce the risk of HIV/AIDS transmission and for appropriate 
     program support for the introduction and distribution of 
     these commodities, as well as education and training on the 
     use of the technologies.
       ``(4) Monitoring.--The monitoring of programs, projects, 
     and activities carried out pursuant to paragraphs (1) through 
     (3), including--
       ``(A) 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;
       ``(B) appropriate evaluation and surveillance activities;
       ``(C) monitoring to ensure that appropriate measures are 
     being taken to maintain the sustainability of HIV/AIDS 
     pharmaceuticals (especially antiretrovirals) and ensure that 
     drug resistance is not compromising the benefits of such 
     pharmaceuticals; and
       ``(D) monitoring to ensure appropriate law enforcement 
     officials are working to ensure that HIV/AIDS pharmaceuticals 
     are not diminished through illegal counterfeiting or black 
     market sales of such pharmaceuticals.
       ``(5) Pharmaceuticals.--
       ``(A) Procurement.--The procurement of HIV/AIDS 
     pharmaceuticals, antiviral therapies, and other appropriate 
     medicines, including medicines to treat opportunistic 
     infections.
       ``(B) Mechanisms for quality control and sustainable 
     supply.--Mechanisms to ensure that such HIV/AIDS 
     pharmaceuticals, antiretroviral therapies, and other 
     appropriate medicines are quality-controlled and sustainably 
     supplied.
       ``(C) Distribution.--The distribution of such HIV/AIDS 
     pharmaceuticals, antiviral therapies, and other appropriate 
     medicines (including medicines to treat opportunistic 
     infections) 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 treatment protocols and for the 
     prevention of mother-to-child transmission of the HIV 
     infection.
       ``(6) Related activities.--The conduct of related 
     activities, including--
       ``(A) 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;
       ``(B) improved infrastructure and institutional capacity to 
     develop and manage education, prevention, and treatment 
     programs, including training and the resources to collect and 
     maintain accurate HIV surveillance data to target programs 
     and measure the effectiveness of interventions; and
       ``(C) 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.
       ``(7) Comprehensive hiv/aids public-private partnerships.--
     The establishment and operation of public-private partnership 
     entities within countries in sub-Saharan Africa, the 
     Caribbean, and other countries affected by the HIV/AIDS 
     pandemic that are dedicated to supporting the national 
     strategy of such countries regarding the prevention, 
     treatment, and monitoring of HIV/AIDS. Each such public-
     private partnership should--
       ``(A) support the development, implementation, and 
     management of comprehensive HIV/AIDS plans in support of the 
     national HIV/AIDS strategy;
       ``(B) operate at all times in a manner that emphasizes 
     efficiency, accountability, and results-driven programs;
       ``(C) engage both local and foreign development partners 
     and donors, including businesses, government agencies, 
     academic institutions, nongovernmental organizations, 
     foundations, multilateral development agencies, and faith-
     based organizations, to assist the country in coordinating 
     and implementing HIV/AIDS prevention, treatment, and 
     monitoring programs in accordance with its national HIV/AIDS 
     strategy;
       ``(D) provide technical assistance, consultant services, 
     financial planning, monitoring and evaluation, and research 
     in support of the national HIV/AIDS strategy; and
       ``(E) establish local human resource capacities for the 
     national HIV/AIDS strategy through the transfer of medical, 
     managerial, leadership, and technical skills.
       ``(e) Annual Report.--
       ``(1) In general.--Not later than January 31 of each year, 
     the President shall submit to the Committee on Foreign 
     Relations of the Senate and the Committee on International 
     Relations of the House of Representatives a report on the 
     implementation of this section for the prior fiscal year.
       ``(2) Report elements.--Each report shall include--
       ``(A) a description of efforts made by each relevant 
     executive branch agency to implement the policies set forth 
     in this section, section 104B, and section 104C;
       ``(B) a description of the programs established pursuant to 
     such sections; and
       ``(C) a detailed assessment of the impact of programs 
     established pursuant to such sections, including--
       ``(i)(I) the effectiveness of such programs in reducing the 
     spread of the HIV infection, particularly in women and girls, 
     in reducing mother-to-child transmission of the HIV 
     infection, and in reducing mortality rates from HIV/AIDS; and
       ``(II) the number of patients currently receiving treatment 
     for AIDS in each country that receives assistance under this 
     Act.
       ``(ii) the progress made toward improving health care 
     delivery systems (including the training of adequate numbers 
     of staff) and infrastructure to ensure increased access to 
     care and treatment;
       ``(iii) with respect to tuberculosis, the increase in the 
     number of people treated and the increase in number of 
     tuberculosis patients cured through each program, project, or 
     activity receiving United States foreign assistance for 
     tuberculosis control purposes; and
       ``(iv) with respect to malaria, the increase in the number 
     of people treated and the increase in number of malaria 
     patients cured through each program, project, or activity 
     receiving United States foreign assistance for malaria 
     control purposes.
       ``(f) Funding Limitation.--Of the funds made available to 
     carry out this section in any fiscal year, not more than 7 
     percent may be used for the administrative expenses of the 
     United States Agency for International Development in support 
     of activities described in section 104(c), this section, 
     section 104B, and section 104C. Such amount shall be in 
     addition to other amounts otherwise available for such 
     purposes.
       ``(g) Definitions.--In this section:
       ``(1) AIDS.--The term `AIDS' means acquired immune 
     deficiency syndrome.
       ``(2) HIV.--The term `HIV' means the human immunodeficiency 
     virus, the pathogen that causes AIDS.
       ``(3) HIV/AIDS.--The term `HIV/AIDS' means, with respect to 
     an individual, an individual who is infected with HIV or 
     living with AIDS.
       ``(4) Relevant executive branch agencies.--The term 
     `relevant executive branch agencies' means the Department of 
     State, the United States Agency for International 
     Development, the Department of Health and Human Services 
     (including its agencies and offices), and any other 
     department or agency of the United States that participates 
     in international HIV/AIDS activities pursuant to the 
     authorities of such department or agency or this Act.''.
       (b) Authorization of Appropriations.--
       (1) In general.--In addition to funds available under 
     section 104(c) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b(c)) for such purpose or under any other 
     provision of that Act, there are authorized to be 
     appropriated to the President, from amounts authorized to be 
     appropriated under section 401, such sums as may be necessary 
     for each of the fiscal years 2004 through 2008 to carry out 
     section 104A of the Foreign Assistance Act of 1961, as added 
     by subsection (a).
       (2) Availability of funds.--Amounts appropriated pursuant 
     to paragraph (1) are authorized to remain available until 
     expended.
       (3) Allocation of Funds.--Of the amount authorized to be 
     appropriated by paragraph (1) for the fiscal years 2004 
     through 2008, such sums as may be necessary are authorized to 
     be appropriated to carry out section 104A(d)(4) of the

[[Page 10266]]

     Foreign Assistance Act of 1961 (as added by subsection (a)), 
     relating to the procurement and distribution of HIV/AIDS 
     pharmaceuticals.
       (c) Relationship to Assistance Programs to Enhance 
     Nutrition.--In recognition of the fact that malnutrition may 
     hasten the progression of HIV to AIDS and may exacerbate the 
     decline among AIDS patients leading to a shorter life span, 
     the Administrator of the United States Agency for 
     International Development shall, as appropriate--
       (1) integrate nutrition programs with HIV/AIDS activities, 
     generally;
       (2) provide, as a component of an anti-retroviral therapy 
     program, support for food and nutrition to individuals 
     infected with and affected by HIV/AIDS; and
       (3) provide support for food and nutrition for children 
     affected by HIV/AIDS and to communities and households caring 
     for children affected by HIV/AIDS.
       (d) Eligibility for Assistance.--An organization that is 
     otherwise eligible to receive assistance under section 104A 
     of the Foreign Assistance Act of 1961 (as added by subsection 
     (a)) or under any other provision of this Act (or any 
     amendment made by this Act) to prevent, treat, or monitor 
     HIV/AIDS shall not be required, as a condition of receiving 
     the assistance, to endorse or utilize a multisectoral 
     approach to combatting HIV/AIDS.
       (e) Limitation.--No funds made available to carry out this 
     Act, or any amendment made by this Act, may be used to 
     promote or advocate the legalization or practice of 
     prostitution or sex trafficking. Nothing in the preceding 
     sentence shall be construed to preclude the provision to 
     individuals of palliative care, treatment, or post-exposure 
     pharmaceutical prophylaxis, and necessary pharmaceuticals and 
     commodities, including test kits, condoms, and, when proven 
     effective, microbicides.
       (f) Limitation.--No funds made available to carry out this 
     Act, or any amendment made by this Act, may be used to 
     provide assistance to any group or organization that does not 
     have a policy explicitly opposing prostitution and sex 
     trafficking.

     SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

       (a) Amendment of the Foreign Assistance Act of 1961.--
     Chapter 1 of part I of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151 et seq.), as amended by section 301 of this Act, 
     is further amended by inserting after section 104A the 
     following new section:

     ``SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

       ``(a) Findings.--Congress makes the following findings:
       ``(1) Congress recognizes the growing international problem 
     of tuberculosis and the impact its continued existence has on 
     those countries that had previously largely controlled the 
     disease.
       ``(2) Congress further recognizes that the means exist to 
     control and treat tuberculosis through expanded use of the 
     DOTS (Directly Observed Treatment Short-course) treatment 
     strategy, including DOTS-Plus to address multi-drug resistant 
     tuberculosis, and adequate investment in newly created 
     mechanisms to increase access to treatment, including the 
     Global Tuberculosis Drug Facility established in 2001 
     pursuant to the Amsterdam Declaration to Stop TB and the 
     Global Alliance for TB Drug Development.
       ``(b) Policy.--It is a major objective of the foreign 
     assistance program of the United States to control 
     tuberculosis, including the detection of at least 70 percent 
     of the cases of infectious tuberculosis, and the cure of at 
     least 85 percent of the cases detected, not later than 
     December 31, 2005, in those countries classified by the World 
     Health Organization as among the highest tuberculosis burden, 
     and not later than December 31, 2010, in all countries in 
     which the United States Agency for International Development 
     has established development programs.
       ``(c) Authorization.--To carry out this section and 
     consistent with section 104(c), the President is authorized 
     to furnish assistance, on such terms and conditions as the 
     President may determine, for the prevention, treatment, 
     control, and elimination of tuberculosis.
       ``(d) Coordination.--In carrying out this section, the 
     President shall coordinate with the World Health 
     Organization, the Global Fund to Fight AIDS, Tuberculosis, 
     and Malaria, and other organizations with respect to the 
     development and implementation of a comprehensive 
     tuberculosis control program.
       ``(e) Priority to DOTS Coverage.--In furnishing assistance 
     under subsection (c), the President shall give priority to 
     activities that increase Directly Observed Treatment Short-
     course (DOTS) coverage and treatment of multi-drug resistant 
     tuberculosis where needed using DOTS-Plus, including funding 
     for the Global Tuberculosis Drug Facility, the Stop 
     Tuberculosis Partnership, and the Global Alliance for TB Drug 
     Development. In order to meet the requirement of the 
     preceding sentence, the President should ensure that not less 
     than 75 percent of the amount made available to carry out 
     this section for a fiscal year should be expended for 
     antituberculosis drugs, supplies, direct patient services, 
     and training in diagnosis and treatment for Directly Observed 
     Treatment Short-course (DOTS) coverage and treatment of 
     multi-drug resistant tuberculosis using DOTS-Plus, including 
     substantially increased funding for the Global Tuberculosis 
     Drug Facility.
       ``(f) Definitions.--In this section:
       ``(1) DOTS.--The term `DOTS' or `Directly Observed 
     Treatment Short-course' means the World Health Organization-
     recommended strategy for treating tuberculosis.
       ``(2) DOTS-plus.--The term `DOTS-Plus' means a 
     comprehensive tuberculosis management strategy that is built 
     upon and works as a supplement to the standard DOTS strategy, 
     and which takes into account specific issues (such as use of 
     second line anti-tuberculosis drugs) that need to be 
     addressed in areas where there is high prevalence of multi-
     drug resistant tuberculosis.
       ``(3) Global alliance for tuberculosis drug development.--
     The term `Global Alliance for Tuberculosis Drug Development' 
     means the public-private partnership that brings together 
     leaders in health, science, philanthropy, and private 
     industry to devise new approaches to tuberculosis and to 
     ensure that new medications are available and affordable in 
     high tuberculosis burden countries and other affected 
     countries.
       ``(4) Global tuberculosis drug facility.--The term `Global 
     Tuberculosis Drug Facility (GDF)' means the new initiative of 
     the Stop Tuberculosis Partnership to increase access to high-
     quality tuberculosis drugs to facilitate DOTS expansion.
       ``(5) Stop tuberculosis partnership.--The term `Stop 
     Tuberculosis Partnership' means the partnership of the World 
     Health Organization, donors including the United States, high 
     tuberculosis burden countries, multilateral agencies, and 
     nongovernmental and technical agencies committed to short- 
     and long-term measures required to control and eventually 
     eliminate tuberculosis as a public health problem in the 
     world.''.
       (b) Authorization of Appropriations.--
       (1) In general.--In addition to funds available under 
     section 104(c) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b(c)) for such purpose or under any other 
     provision of that Act, there are authorized to be 
     appropriated to the President, from amounts authorized to be 
     appropriated under section 401, such sums as may be necessary 
     for each of the fiscal years 2004 through 2008 to carry out 
     section 104B of the Foreign Assistance Act of 1961, as added 
     by subsection (a).
       (2) Availability of funds.--Amounts appropriated pursuant 
     to the authorization of appropriations under paragraph (1) 
     are authorized to remain available until expended.
       (3) Transfer of prior year funds.--Unobligated balances of 
     funds made available for fiscal year 2001, 2002, or 2003 
     under section 104(c)(7) of the Foreign Assistance Act of 1961 
     (22 U.S.C. 2151b(c)(7) (as in effect immediately before the 
     date of enactment of this Act) shall be transferred to, 
     merged with, and made available for the same purposes as 
     funds made available for fiscal years 2004 through 2008 under 
     paragraph (1).

     SEC. 303. ASSISTANCE TO COMBAT MALARIA.

       (a) Amendment of the Foreign Assistance Act of 1961.--
     Chapter 1 of part I of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151 et seq.), as amended by sections 301 and 302 of 
     this Act, is further amended by inserting after section 104B 
     the following new section:

     ``SEC. 104C. ASSISTANCE TO COMBAT MALARIA.

       ``(a) Finding.--Congress finds that malaria kills more 
     people annually than any other communicable disease except 
     tuberculosis, that more than 90 percent of all malaria cases 
     are in sub-Saharan Africa, and that children and women are 
     particularly at risk. Congress recognizes that there are 
     cost-effective tools to decrease the spread of malaria and 
     that malaria is a curable disease if promptly diagnosed and 
     adequately treated.
       ``(b) Policy.--It is a major objective of the foreign 
     assistance program of the United States to provide assistance 
     for the prevention, control, and cure of malaria.
       ``(c) Authorization.--To carry out this section and 
     consistent with section 104(c), the President is authorized 
     to furnish assistance, on such terms and conditions as the 
     President may determine, for the prevention, treatment, 
     control, and elimination of malaria.
       ``(d) Coordination.--In carrying out this section, the 
     President shall coordinate with the World Health 
     Organization, the Global Fund to Fight AIDS, Tuberculosis, 
     and Malaria, the Department of Health and Human Services (the 
     Centers for Disease Control and Prevention and the National 
     Institutes of Health), and other organizations with respect 
     to the development and implementation of a comprehensive 
     malaria control program.''.
       (b) Authorization of Appropriations.--
       (1) In general.--In addition to funds available under 
     section 104(c) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b(c)) for such purpose or under any other 
     provision of that Act, there are authorized to be 
     appropriated to the President, from amounts authorized to be 
     appropriated under section 401, such sums as may be necessary 
     for fiscal years 2004 through 2008 to carry out section 104C 
     of the Foreign Assistance Act of 1961, as added by subsection 
     (a), including for the development of anti-malarial 
     pharmaceuticals by the Medicines for Malaria Venture.
       (2) Availability of funds.--Amounts appropriated pursuant 
     to paragraph (1) are authorized to remain available until 
     expended.
       (3) Transfer of prior year funds.--Unobligated balances of 
     funds made available for fiscal year 2001, 2002, or 2003 
     under section 104(c) of the Foreign Assistance Act of 1961 
     (22 U.S.C. 2151b(c) (as in effect immediately before the date 
     of enactment of this Act) and made available for the control 
     of malaria shall be transferred to, merged with, and made 
     available for the same

[[Page 10267]]

     purposes as funds made available for fiscal years 2004 
     through 2008 under paragraph (1).
       (c) Conforming Amendment.--Section 104(c) of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 2151b(c)), as amended by 
     section 301 of this Act, is further amended by adding after 
     paragraph (3) the following:
       ``(4) Relationship to other laws.--Assistance made 
     available under this subsection and sections 104A, 104B, and 
     104C, and assistance made available under chapter 4 of part 
     II to carry out the purposes of this subsection and the 
     provisions cited in this paragraph, may be made available 
     notwithstanding any other provision of law that restricts 
     assistance to foreign countries, except for the provisions of 
     this subsection, the provisions of law cited in this 
     paragraph, subsection (f), section 634A of this Act, and 
     provisions of law that limit assistance to organizations that 
     support or participate in a program of coercive abortion or 
     involuntary sterilization included under the Child Survival 
     and Health Programs Fund heading in the Consolidated 
     Appropriations Resolution, 2003 (Public Law 108-7).''.

     SEC. 304. PILOT PROGRAM FOR THE PLACEMENT OF HEALTH CARE 
                   PROFESSIONALS IN OVERSEAS AREAS SEVERELY 
                   AFFECTED BY HIV/AIDS, TUBERCULOSIS, AND 
                   MALARIA.

       (a) In General.--The President should establish a program 
     to demonstrate the feasibility of facilitating the service of 
     United States health care professionals in those areas of 
     sub-Saharan Africa and other parts of the world severely 
     affected by HIV/AIDS, tuberculosis, and malaria.
       (b) Requirements.--Participants in the program shall--
       (1) provide basic health care services for those infected 
     and affected by HIV/AIDS, tuberculosis, and malaria in the 
     area in which they are serving;
       (2) provide on-the-job training to medical and other 
     personnel in the area in which they are serving to strengthen 
     the basic health care system of the affected countries;
       (3) provide health care educational training for residents 
     of the area in which they are serving;
       (4) serve for a period of up to three years; and
       (5) meet the eligibility requirements in subsection (d).
       (c) Eligibility Requirements.--To be eligible to 
     participate in the program, a candidate shall--
       (1) be a national of the United States who is a trained 
     health care professional and who meets the educational and 
     licensure requirements necessary to be such a professional 
     such as a physician, nurse, physician assistant, nurse 
     practitioner, pharmacist, other type of health care 
     professional, or other individual determined to be 
     appropriate by the President; or
       (2) be a retired commissioned officer of the Public Health 
     Service Corps.
       (d) Recruitment.--The President shall ensure that 
     information on the program is widely distributed, including 
     the distribution of information to schools for health 
     professionals, hospitals, clinics, and nongovernmental 
     organizations working in the areas of international health 
     and aid.
       (e) Placement of Participants.--
       (1) In general.--To the maximum extent practicable, 
     participants in the program shall serve in the poorest areas 
     of the affected countries, where health care needs are likely 
     to be the greatest. The decision on the placement of a 
     participant should be made in consultation with relevant 
     officials of the affected country at both the national and 
     local level as well as with local community leaders and 
     organizations.
       (2) Coordination.--Placement of participants in the program 
     shall be coordinated with the United States Agency for 
     International Development in countries in which that Agency 
     is conducting HIV/AIDS, tuberculosis, or malaria programs. 
     Overall coordination of placement of participants in the 
     program shall be made by the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally (as 
     described in section 1(f) of the State Department Basic 
     Authorities Act of 1956 (as added by section 102(a) of this 
     Act)).
       (f) Incentives.--The President may offer such incentives as 
     the President determines to be necessary to encourage 
     individuals to participate in the program, such as partial 
     payment of principal, interest, and related expenses on 
     government and commercial loans for educational expenses 
     relating to professional health training and, where possible, 
     deferment of repayments on such loans, the provision of 
     retirement benefits that would otherwise be jeopardized by 
     participation in the program, and other incentives.
       (g) Report.--Not later than 18 months after the date of 
     enactment of this Act, the President shall submit to the 
     appropriate congressional committees a report on steps taken 
     to establish the program, including--
       (1) the process of recruitment, including the venues for 
     recruitment, the number of candidates recruited, the 
     incentives offered, if any, and the cost of those incentives;
       (2) the process, including the criteria used, for the 
     selection of participants;
       (3) the number of participants placed, the countries in 
     which they were placed, and why those countries were 
     selected; and
       (4) the potential for expansion of the program.
       (h) Authorization of Appropriations.--
       (1) In general.--In addition to amounts otherwise available 
     for such purpose, there are authorized to be appropriated to 
     the President, from amounts authorized to be appropriated 
     under section 401, such sums as may be necessary for each of 
     the fiscal years 2004 through 2008 to carry out the program.
       (2) Availability of funds.--Amounts appropriated pursuant 
     to the authorization of appropriations under paragraph (1) 
     are authorized to remain available until expended.

     SEC. 305. REPORT ON TREATMENT ACTIVITIES BY RELEVANT 
                   EXECUTIVE BRANCH AGENCIES.

       (a) In General.--Not later than 15 months after the date of 
     enactment of this Act, the President shall submit to 
     appropriate congressional committees a report on the programs 
     and activities of the relevant executive branch agencies that 
     are directed to the treatment of individuals in foreign 
     countries infected with HIV or living with AIDS.
       (b) Report Elements.--The report shall include--
       (1) a description of the activities of relevant executive 
     branch agencies with respect to--
       (A) the treatment of opportunistic infections;
       (B) the use of antiretrovirals;
       (C) the status of research into successful treatment 
     protocols for individuals in the developing world;
       (D) technical assistance and training of local health care 
     workers (in countries affected by the pandemic) to administer 
     antiretrovirals, manage side effects, and monitor patients' 
     viral loads and immune status;
       (E) the status of strategies to promote sustainability of 
     HIV/AIDS pharmaceuticals (including antiretrovirals) and the 
     effects of drug resistance on HIV/AIDS patients; and
       (F) the status of appropriate law enforcement officials 
     working to ensure that HIV/AIDS pharmaceutical treatment is 
     not diminished through illegal counterfeiting and black 
     market sales of such pharmaceuticals;
       (2) information on existing pilot projects, including a 
     discussion of why a given population was selected, the number 
     of people treated, the cost of treatment, the mechanisms 
     established to ensure that treatment is being administered 
     effectively and safely, and plans for scaling up pilot 
     projects (including projected timelines and required 
     resources); and
       (3) an explanation of how those activities relate to 
     efforts to prevent the transmission of the HIV infection.

            Subtitle B--Assistance for Children and Families

     SEC. 311. FINDINGS.

       Congress makes the following findings:
       (1) Approximately 2,000 children around the world are 
     infected each day with HIV through mother-to-child 
     transmission. Transmission can occur during pregnancy, labor, 
     and delivery or through breast feeding. Over ninety percent 
     of these cases are in developing nations with little or no 
     access to public health facilities.
       (2) Mother-to-child transmission is largely preventable 
     with the proper application of pharmaceuticals, therapies, 
     and other public health interventions.
       (3) The drug nevirapine reduces mother-to-child 
     transmission by nearly 50 percent. Universal availability of 
     this drug could prevent up to 400,000 infections per year and 
     dramatically reduce the number of AIDS-related deaths.
       (4) At the United Nations Special Session on HIV/AIDS in 
     June 2001, the United States committed to the specific goals 
     with respect to the prevention of mother-to-child 
     transmission, including the goals of reducing the proportion 
     of infants infected with HIV by 20 percent by the year 2005 
     and by 50 percent by the year 2010, as specified in the 
     Declaration of Commitment on HIV/AIDS adopted by the United 
     Nations General Assembly at the Special Session.
       (5) Several United States Government agencies including the 
     United States Agency for International Development and the 
     Centers for Disease Control are already supporting programs 
     to prevent mother-to-child transmission in resource-poor 
     nations and have the capacity to expand these programs 
     rapidly by working closely with foreign governments and 
     nongovernmental organizations.
       (6) Efforts to prevent mother-to-child transmission can 
     provide the basis for a broader response that includes care 
     and treatment of mothers, fathers, and other family members 
     who are infected with HIV or living with AIDS.
       (7) HIV/AIDS has devastated the lives of countless children 
     and families across the globe. Since the epidemic began, an 
     estimated 13,200,000 children under the age of 15 have been 
     orphaned by AIDS, that is they have lost their mother or both 
     parents to the disease. The Joint United Nations Program on 
     HIV/AIDS (UNAIDS) estimates that this number will double by 
     the year 2010.
       (8) HIV/AIDS also targets young people between the ages of 
     15 to 24, particularly young women, many of whom carry the 
     burden of caring for family members living with HIV/AIDS. An 
     estimated 10,300,000 young people are now living with HIV/
     AIDS. One-half of all new infections are occurring among this 
     age group.

     SEC. 312. POLICY AND REQUIREMENTS.

       (a) Policy.--The United States Government's response to the 
     global HIV/AIDS pandemic should place high priority on the 
     prevention of mother-to-child transmission, the care and 
     treatment of family members and caregivers, and the care of 
     children orphaned by AIDS. To the maximum extent possible, 
     the United States Government should seek to leverage its 
     funds by seeking matching contributions from the private 
     sector, other national governments, and international 
     organizations.
       (b) Requirements.--The 5-year United States Government 
     strategy required by section 101 of this Act shall--

[[Page 10268]]

       (1) provide for meeting or exceeding the goal to reduce the 
     rate of mother-to-child transmission of HIV by 20 percent by 
     2005 and by 50 percent by 2010;
       (2) include programs to make available testing and 
     treatment to HIV-positive women and their family members, 
     including drug treatment and therapies to prevent mother-to-
     child transmission; and
       (3) expand programs designed to care for children orphaned 
     by AIDS.

     SEC. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD 
                   TRANSMISSION OF THE HIV INFECTION.

       (a) In General.--Not later than one year after the date of 
     the enactment of this Act, and annually thereafter for a 
     period of five years, the President shall submit to 
     appropriate congressional committees a report on the 
     activities of relevant executive branch agencies during the 
     reporting period to assist in the prevention of mother-to-
     child transmission of the HIV infection.
       (b) Report Elements.--Each report shall include--
       (1) a statement of whether or not all relevant executive 
     branch agencies have met the goal described in section 
     312(b)(1); and
       (2) a description of efforts made by the relevant executive 
     branch agencies to expand those activities, including--
       (A) information on the number of sites supported for the 
     prevention of mother-to-child transmission of the HIV 
     infection;
       (B) the specific activities supported;
       (C) the number of women tested and counseled; and
       (D) the number of women receiving preventative drug 
     therapies.
       (c) Reporting Period Defined.--In this section, the term 
     ``reporting period'' means, in the case of the initial 
     report, the period since the date of enactment of this Act 
     and, in the case of any subsequent report, the period since 
     the date of submission of the most recent report.

     SEC. 314. PILOT PROGRAM OF ASSISTANCE FOR CHILDREN AND 
                   FAMILIES AFFECTED BY HIV/AIDS.

       (a) In General.--The President, acting through the United 
     States Agency for International Development, should establish 
     a program of assistance that would demonstrate the 
     feasibility of the provision of care and treatment to orphans 
     and other children and young people affected by HIV/AIDS in 
     foreign countries.
       (b) Program Requirements.--The program should--
       (1) build upon and be integrated into programs administered 
     as of the date of enactment of this Act by the relevant 
     executive branch agencies for children affected by HIV/AIDS;
       (2) work in conjunction with indigenous community-based 
     programs and activities, particularly those that offer proven 
     services for children;
       (3) reduce the stigma of HIV/AIDS to encourage vulnerable 
     children infected with HIV or living with AIDS and their 
     family members and caregivers to avail themselves of 
     voluntary counseling and testing, and related programs, 
     including treatments;
       (4) provide, in conjunction with other relevant executive 
     branch agencies, the range of services for the care and 
     treatment, including the provision of antiretrovirals and 
     other necessary pharmaceuticals, of children, parents, and 
     caregivers infected with HIV or living with AIDS;
       (5) provide nutritional support and food security, and the 
     improvement of overall family health;
       (6) work with parents, caregivers, and community-based 
     organizations to provide children with educational 
     opportunities; and
       (7) provide appropriate counseling and legal assistance for 
     the appointment of guardians and the handling of other issues 
     relating to the protection of children.
       (c) Report.--Not later than 18 months after the date of 
     enactment of this Act, the President should submit a report 
     on the implementation of this section to the appropriate 
     congressional committees.
       (d) Authorization of Appropriations.--
       (1) In general.--In addition to amounts otherwise available 
     for such purpose, there are authorized to be appropriated to 
     the President, from amounts authorized to be appropriated 
     under section 401, such sums as may be necessary for each of 
     the fiscal years 2004 through 2008 to carry out the program.
       (2) Availability of funds.--Amounts appropriated pursuant 
     to paragraph (1) are authorized to remain available until 
     expended.

     SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.

       (a) Purpose.--The purpose of this section is to authorize 
     the President to establish a program, through a public-
     private partnership, for the provision of medical care and 
     support services to HIV positive parents and their children 
     identified through existing programs to prevent mother-to-
     child transmission of HIV in countries with or at risk for 
     severe HIV epidemic with particular attention to resource 
     constrained countries.
       (b) Grants.--
       (1) In general.--The President is authorized to establish a 
     program for the award of grants to eligible administrative 
     organizations to enable such organizations to award subgrants 
     to eligible entities to expand activities to prevent the 
     mother-to-child transmission of HIV by providing medical care 
     and support services to HIV infected parents and their 
     children.
       (2) Use of funds.--Amounts provided under a grant awarded 
     under paragraph (1) shall be used--
       (A) to award subgrants to eligible entities to enable such 
     entities to carry out activities described in subsection (c);
       (B) for administrative support and subgrant management;
       (C) for administrative data collection and reporting 
     concerning grant activities;
       (D) for the monitoring and evaluation of grant activities;
       (E) for training and technical assistance for subgrantees; 
     and
       (F) to promote sustainability.
       (c) Subgrants.--
       (1) In general.--An organization awarded a grant under 
     subsection (b) shall use amounts received under the grant to 
     award subgrants to eligible entities.
       (2) Eligibility.--To be eligible to receive a subgrant 
     under paragraph (1), an entity shall--
       (A) be a local health organization, an international 
     organization, or a partnership of such organizations; and
       (B) demonstrate to the awarding organization that such 
     entity--
       (i) is currently administering a proven intervention to 
     prevent mother-to-child transmission of HIV in countries with 
     or at risk for severe HIV epidemic with particular attention 
     to resource constrained countries, as determined by the 
     President;
       (ii) has demonstrated support for the proposed program from 
     relevant government entities; and
       (iii) is able to provide HIV care, including antiretroviral 
     treatment when medically indicated, to HIV positive women, 
     men, and children with the support of the project funding.
       (3) Local health and international organizations.--For 
     purposes of paragraph (2)(A)--
       (A) the term ``local health organization'' means a public 
     sector health system, nongovernmental organization, 
     institution of higher education, community-based 
     organization, or nonprofit health system that provides 
     directly, or has a clear link with a provider for the 
     indirect provision of, primary health care services; and
       (B) the term ``international organization'' means--
       (i) a nonprofit international entity;
       (ii) an international charitable institution;
       (iii) a private voluntary international entity; or
       (iv) a multilateral institution.
       (4) Priority requirement.--In awarding subgrants under this 
     subsection, the organization shall give priority to eligible 
     applicants that are currently administering a program of 
     proven intervention to HIV positive individuals to prevent 
     mother-to-child transmission in countries with or at risk for 
     severe HIV epidemic with particular attention to resource 
     constrained countries, and who are currently administering a 
     program to HIV positive women, men, and children to provide 
     life-long care in family-centered care programs using non-
     Federal funds.
       (5) Selection of subgrant recipients.--In awarding 
     subgrants under this subsection, the organization should--
       (A) consider applicants from a range of health care 
     settings, program approaches, and geographic locations; and
       (B) if appropriate, award not less than 1 grant to an 
     applicant to fund a national system of health care delivery 
     to HIV positive families.
       (6) Use of subgrant funds.--An eligible entity awarded a 
     subgrant under this subsection shall use subgrant funds to 
     expand activities to prevent mother-to-child transmission of 
     HIV by providing medical treatment and care and support 
     services to parents and their children, which may include--
       (A) providing treatment and therapy, when medically 
     indicated, to HIV-infected women, their children, and 
     families;
       (B) the hiring and training of local personnel, including 
     physicians, nurses, other health care providers, counselors, 
     social workers, outreach personnel, laboratory technicians, 
     data managers, and administrative support personnel;
       (C) paying laboratory costs, including costs related to 
     necessary equipment and diagnostic testing and monitoring 
     (including rapid testing), complete blood counts, standard 
     chemistries, and liver function testing for infants, 
     children, and parents, and costs related to the purchase of 
     necessary laboratory equipment;
       (D) purchasing pharmaceuticals for HIV-related conditions, 
     including antiretroviral therapies;
       (E) funding support services, including adherence and 
     psychosocial support services;
       (F) operational support activities; and
       (G) conducting community outreach and capacity building 
     activities, including activities to raise the awareness of 
     individuals of the program carried out by the subgrantee, 
     other communications activities in support of the program, 
     local advisory board functions, and transportation necessary 
     to ensure program participation.
       (d) Reports.--The President shall require that each 
     organization awarded a grant under subsection (b)(1) to 
     submit an annual report that includes--
       (1) the progress of programs funded under this section;
       (2) the benchmarks of success of programs funded under this 
     section; and
       (3) recommendations of how best to proceed with the 
     programs funded under this section upon the expiration of 
     funding under subsection (e).
       (e) Funding.--There are authorized to be appropriated to 
     the President, from amounts authorized to be appropriated 
     under section 401, such sums as may be necessary for each of 
     the fiscal years 2004 through 2008 to carry out the program.

[[Page 10269]]

       (f) Limitation on Administrative Expenses.--An organization 
     shall ensure that not more than 7 percent of the amount of a 
     grant received under this section by the organization is used 
     for administrative expenses.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

     SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the President to carry out this Act and the amendments made 
     by this Act $3,000,000,000 for each of the fiscal years 2004 
     through 2008.
       (b) Availability.--Amounts appropriated pursuant to the 
     authorization of appropriations in subsection (a) are 
     authorized to remain available until expended.
       (c) Availability of Authorizations.--Authorizations of 
     appropriations under subsection (a) shall remain available 
     until the appropriations are made.

     SEC. 402. SENSE OF CONGRESS.

       (a) Increase in HIV/AIDS Antiretroviral Treatment.--It is a 
     sense of the Congress that an urgent priority of United 
     States assistance programs to fight HIV/AIDS should be the 
     rapid increase in distribution of antiretroviral treatment so 
     that--
       (1) by the end of fiscal year 2004, at least 500,000 
     individuals with HIV/AIDS are receiving antiretroviral 
     treatment through United States assistance programs;
       (2) by the end of fiscal year 2005, at least 1,000,000 such 
     individuals are receiving such treatment; and
       (3) by the end of fiscal year 2006, at least 2,000,000 such 
     individuals are receiving such treatment.
       (b) Effective Distribution of HIV/AIDS Funds.--It is the 
     sense of Congress that, of the amounts appropriated pursuant 
     to the authorization of appropriations under section 401 for 
     HIV/AIDS assistance, an effective distribution of such 
     amounts would be--
       (1) 55 percent of such amounts for treatment of individuals 
     with HIV/AIDS;
       (2) 15 percent of such amounts for palliative care of 
     individuals with HIV/AIDS;
       (3) 20 percent of such amounts for HIV/AIDS prevention 
     consistent with section 104A(d) of the Foreign Assistance Act 
     of 1961 (as added by section 301 of this Act); and
       (4) 10 percent of such amounts for orphans and vulnerable 
     children.

     SEC. 403. ALLOCATION OF FUNDS.

       For fiscal years 2006 through 2008, not less than 55 
     percent of the amounts appropriated pursuant to the 
     authorization of appropriations under section 401 for HIV/
     AIDS assistance for each such fiscal year shall be expended 
     for therapeutic medical care of individuals infected with 
     HIV, of which such amount at least 75 percent should be 
     expended for the purchase and distribution of antiretroviral 
     pharmaceuticals and at least 25 percent should be expended 
     for related care.

  The CHAIRMAN. No amendment to the committee amendment is in order 
except those printed in House Report 108-80. Each amendment may be 
offered only in the order printed in the report, by a Member designated 
in the report, shall be considered read, shall be debatable for the 
time specified in the report, equally divided and controlled by the 
proponent and an opponent, shall not be subject to amendment, and shall 
not be subject to a demand for division of the question.
  It is now in order to consider amendment No. 1 printed in House 
Report 108-80.


                 Amendment No. 1 Offered by Mr. Tauzin

  Mr. TAUZIN. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Mr. Tauzin:
       Page 2, in the table of contents at section 1(b), after the 
     item relating to section 305, insert the following:

Sec. 306. Strategies to improve injection safety.
Sec. 307. Study on illegal diversions of prescription drugs.

       Page 20, line 19, insert ``and reduce duplication'' after 
     ``improve coordination''.
       Page 20, line 25, strike ``resources; and'' and insert 
     ``resources;''.
       Page 21, line 3, strike ``research.'' and insert 
     ``research;''.
       Page 21, after line 3, insert the following:
       (9) establish priorities for the distribution of resources 
     based on factors such as the size and demographics of the 
     population with HIV/AIDS, tuberculosis, and malaria and the 
     needs of that population and the existing infrastructure or 
     funding levels that may exist to cure, treat, and prevent 
     HIV/AIDS, tuberculosis, and malaria; and
       (10) include initiatives describing how the President will 
     maximize the leverage of private sector dollars in reduction 
     and treatment of HIV/AIDS, tuberculosis, and malaria.
       Page 26, after line 13, insert the following:
       (c) Study; Distribution of Resources.--
       (1) Study.--Not later than 3 years after the date of the 
     enactment of this Act, the Institute of Medicine shall 
     publish findings comparing the success rates of the various 
     programs and methods used under the strategy described in 
     subsection (a) to reduce, prevent, and treat HIV/AIDS, 
     tuberculosis, and malaria.
       (2) Distribution of resources.--In prioritizing the 
     distribution of resources under the strategy described in 
     subsection (a), the President shall consider the findings 
     published by the Institute of Medicine under this subsection.
       Page 34, line 21, strike ``in the fiscal year 2004'' and 
     insert ``for the period of fiscal year 2004 beginning on 
     January 1, 2004''.
       Page 36, after line 13, insert the following:
       (iii) If at any time the President determines that the 
     expenses of the Governing, Administrative, and Advisory 
     Bodies (including the Partnership Forum, the Foundation 
     Board, the Secretariat, and the Technical Review Board) of 
     the Global Fund exceed 10 percent of the total expenditures 
     of the Fund for any 2-year period, the United States shall 
     withhold from its contribution for the next fiscal year an 
     amount equal the to the average annual amount expended by the 
     Fund for such 2-year period for the expenses of the 
     Governing, Administrative, and Advisory Bodies in excess of 
     10 percent of the total expenditures of the Fund.
       (iv) The President may waive the application of clause 
     (iii) if the President determines that extraordinary 
     circumstances warrant such a waiver. No waiver under this 
     clause may be for any period that exceeds 1 year.
       Page 36, line 14, strike ``(B) Any amount made available 
     under this subsection that is withheld by reason of 
     subparagraph (A)'' and insert ``(B)(i) Any amount made 
     available under this subsection that is withheld by reason of 
     subparagraph (A)(i)''.
       Page 36, after line 19, insert the following:
       (ii) Any amount made available under this subsection that 
     is withheld by reason of subparagraph (A)(iii) shall be 
     transferred to the Activities to Combat HIV/AIDS Globally 
     Fund and shall remain available under the same terms and 
     conditions as funds appropriated pursuant to the 
     authorization of appropriations under section 401 for HIV/
     AIDS assistance.
       Page 39, after line 9, insert the following:
       (f) Provision of Information to Congress.--The Coordinator 
     of United States Government Activities to Combat HIV/AIDS 
     Globally shall make available to the Congress the following 
     documents within 30 days of a request by the Congress for 
     such documents:
       (1) All financial and accounting statements for the Global 
     Fund and the Activities to Combat HIV/AIDS Globally Fund, 
     including administrative and grantee statements.
       (2) Reports provided to the Global Fund and the Activities 
     to Combat HIV/AIDS Globally Fund by organizations contracted 
     to audit recipients of funds.
       (3) Project proposals submitted by applicants for funding 
     from the Global Fund and the Activities to Combat HIV/AIDS 
     Globally Fund, but which were not funded.
       (4) Progress reports submitted to the Global Fund and the 
     Activities to Combat HIV/AIDS Globally Fund by grantees.
       Page 69, after line 3, insert the following:

     SEC. 306. STRATEGIES TO IMPROVE INJECTION SAFETY.

       Section 307 of the Public Health Service Act (42 U.S.C. 
     242l) is amended by adding at the end the following:
       ``(d) In carrying out immunization programs and other 
     programs in developing countries for the prevention, 
     treatment, and control of infectious diseases, including HIV/
     AIDS, tuberculosis, and malaria, the Director of the Centers 
     for Disease Control and Prevention, in coordination with the 
     Coordinator of United States Government Activities to Combat 
     HIV/AIDS Globally, the National Institutes of Health, 
     national and local government, and other organizations, such 
     as the World Health Organization and the United Nations 
     Children's Fund, shall develop and implement effective 
     strategies to improve injection safety, including eliminating 
     unnecessary injections, promoting sterile injection practices 
     and technologies, strengthening the procedures for proper 
     needle and syringe disposal, and improving the education and 
     information provided to the public and to health 
     professionals.''.

     SEC. 307. STUDY ON ILLEGAL DIVERSIONS OF PRESCRIPTION DRUGS.

       Not later than 180 days after enactment of this Act, the 
     Secretary of Health and Human Services, in coordination with 
     other agencies, shall submit a report to the Congress that 
     includes the following:
       (1) A thorough accounting of evidence indicating illegal 
     diversion into the United States of prescription drugs 
     donated or sold for humanitarian efforts, and an estimate of 
     the extent of such diversion.
       (2) Recommendations to increase the administrative and 
     enforcement powers of the United States to identify, monitor, 
     and prevent the illegal diversion into the United States of 
     prescription drugs donated or sold for humanitarian efforts.
       (3) Recommendations and guidelines to advise and provide 
     technical assistance to developing countries on how to 
     implement a program that minimizes diversion into the United 
     States of prescription drugs donated or sold for humanitarian 
     efforts.

  The CHAIRMAN. Pursuant to House Resolution 210 the gentleman from 
Louisiana (Mr. Tauzin) and a Member opposed each will control 10 
minutes.

[[Page 10270]]

  Does the gentleman from California (Mr. Lantos) claim the time in 
opposition?
  Mr. LANTOS. Mr. Chairman, I rise to claim the time in opposition.
  The CHAIRMAN. Is there objection to the request of the gentleman from 
California?
  There was no objection.
  The CHAIRMAN. The Chair recognizes the gentleman from Louisiana (Mr. 
Tauzin).
  Mr. TAUZIN. Mr. Chairman, I yield myself 3 minutes.
  Mr. Chairman, I rise today to urge all Members of the House to 
support the passage of the Tauzin-Brown amendment to H.R. 1298, the 
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003. I want to commend my colleague from the Committee on 
Energy and Commerce, the gentleman from Ohio (Mr. Brown) for his 
assistance and support and advocacy of this amendment.
  First, the Tauzin-Brown amendment strengthens H.R. 1298 by adding 
additional accountability measures to ensure that our fight against 
HIV/AIDS and TB and malaria has a greater chance of success. That is 
what we all want.
  Our amendment establishes priorities to be followed by the global 
AIDS coordinator for the distribution of resources based on factors 
such as size and demographics of specific nations to ensure that the 
countries who need assistance the most receive it first.
  Next, our amendment utilizes an independent third party to examine 
the success of strategies implemented by the global AIDS coordinator. 
The Institutes of Medicine, the IOM, will be responsible for examining 
the achievements of the programs funded by the global AIDS coordinator 
and then comparing the success rates of various methods that have been 
used by the coordinator.
  Second, the Tauzin-Brown amendment also strengthens the existing 
authority and the accountability measures in H.R. 1298. Our amendment 
specifically states that if at any point administrative expenses within 
the Global Fund exceed 10 percent of total expenditures of the fund for 
any 2-year period, then the U.S. will withhold an equal amount from its 
contribution the following year. This is to ensure that this fund does 
not get gobbled up in bureaucrats and administrative expenses. We 
believe this is fair and, at the same time, will ensure that the Global 
Fund remains fiscally responsible to its purpose. That is, getting 
dollars in to actually combat AIDS, malaria, and tuberculosis in the 
world.
  These two accountability measures represent provisions ensure our 
approach to this problem is not only morally responsible, it is 
fiscally responsible as well.
  Finally, the amendment requires that the HIV/AIDS coordinator make 
available to Congress basic information on the Global Fund. 
Specifically, the coordinator is required to submit to Congress a 
detailed report outlining all financial and accounting statements, 
copies of the reports provided to the Global Fund by organizations 
contracted to audit recipients, and project proposals submitted by 
applicants and grantees. In the past we have had great difficulty 
getting this information from the Global Fund. We are confident the 
coordinator will do a wonderful job in delivering this information to 
Congress. I urge my colleagues to support the Tauzin-Brown amendment.
  Mr. Chairman, I reserve the balance of my time.
  Mr. LANTOS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I want to thank my good friend from Louisiana (Mr. 
Tauzin) and my good friend from Ohio (Mr. Brown) for their thoughtful 
contribution to our legislation. Their amendment includes a number of 
complex initiatives, many of which reflect improvements to the bill. 
For example, I believe that the amendment's efforts to explicitly 
prioritize U.S. programs authorized by this Act to countries based on 
the size and demographics of the HIV/AIDS populations and the needs of 
those populations is a wise measure.
  I am concerned about several other provisions in the amendment. For 
example, the limitation on administrative expenditures of the Global 
Fund is well meaning, but when the fund may be going through a massive 
expansion of operations, there may be a need for some significant 
investments to make sure that the Global Fund can properly administer 
its programs.
  I was pleased that the sponsors added a waiver, and I believe that 
the President should consider the actual operations of the fund as he 
applies this provision.
  Finally, Mr. Chairman, I remain concerned regarding the provision 
requiring numerous reports to be provided to Congress within 30 days of 
the request. I am uncertain whether any Member could make this request 
or whether it must be a relevant committee or by resolution. Moreover, 
my experience with international organizations is that some of the 
documents may be considered confidential, such as unfunded proposals, 
and it may not be possible to get these documents within the time frame 
provided in the amendments. Nevertheless, Mr. Chairman, I am prepared 
to accept the amendment, and I look forward to working with the 
sponsors to clarify and further refine these provisions.
  Mr. Chairman, I ask unanimous consent to yield the balance of my time 
to my friend, the gentleman from Ohio (Mr. Brown) for the purposes of 
controlling time.
  The CHAIRMAN. Is there objection to the request of the gentleman from 
California?
  There was no objection.
  Mr. BROWN of Ohio. Mr. Chairman, I yield myself 5 minutes.
  Mr. Chairman, I rise in support of the Tauzin-Brown amendment. I 
thank the gentleman from Louisiana (Mr. Tauzin) for his good faith and 
bipartisan work in drafting this amendment, especially his staff, 
Patrick Ronan, for his hard work and others on his staff.
  The Committee on Energy and Commerce has jurisdiction over agencies 
that play a pivotal role in successful efforts to reduce the spread of 
HIV/AIDS, TB, and malaria in our country and worldwide. Some of the 
world's most promising research and best treatment on these diseases 
are carried out by agencies within the Department of Health and Human 
Services. CDC provides technical and scientific support for 
international agencies like USAID as well as national infectious 
disease programs in developing countries, in addition to the work that 
NIH and other agencies do.
  Secretary Thompson is the newly appointed chairman of the Global Fund 
to fight AIDS, TB, and malaria, the best tool this world has to fight 
three diseases that kill 6 million people every year. The success of 
this bipartisan Global AIDS Initiative depends on collaboration of the 
world's most important and best resources. One of the reasons why the 
Global Fund is such a critical component of the U.S. Global AIDS 
Initiative and a crucial part of the bill we are considering today, is 
it recognizes the need to fight tuberculosis, a lesser known infectious 
disease that has been around longer and kills 2 million people a year, 
including 1,100 people every day in the country of India.

                              {time}  1215

  TB infects one-third of the world's population. Two million people 
carry the TB bacteria, and it is the leading killer of young women and 
people with HIV worldwide.
  HIV and TB form a lethal combination, each speeding the other's 
progress. HIV promotes rapid progression of primary TB infection to 
active disease. It is the most powerful known risk factor for 
reactivation of latent TB infection to active disease. Most HIV 
patients, in fact, will actually die of TB before they succumb to AIDS. 
The intersection of AIDS and TB is like the perfect storm.
  The Global Fund is a public-private partnership which draws 
contributions from governments, from private corporations, from faith-
based organizations and foundations. The Global Fund has shown signs 
that it works. Government entities, in coordination with nongovernment 
organizations, submit 5-year plans. Each plan is unique to each 
country, not a one-size-fits-all that comes from Washington or Geneva 
or any other country. The

[[Page 10271]]

Global Fund recognizes cultural differences. What works in Christian 
Uruguay may not work the same in Muslim Bangladesh.
  No overriding, international political agenda is attached to the 
Global Fund's assistance. No litmus test, only a judgment by the Global 
Fund, in collaboration with local citizens and health workers of what 
works best for each country. The Global Fund demands results, 
quantifiable results. The money supports activities, including access 
to health care services, purchasing of drugs, training of personnel, 
and training of community workers. If a country fails or an NGO fails 
to show results within 2 years, the money is cut off.
  About 60 percent of the Global Fund's money goes to HIV/AIDS, about 
20 to TB, about 20 to malaria. Fighting these diseases together, which 
the Global Fund does, is a cost-effective approach. For example, the 
infrastructure created in the treatment of TB, having health workers in 
place who sit with patients every day for about 6 months, has been 
proven, that infrastructure, to help in the treatment of HIV/AIDS, of 
malaria and other public health issues.
  If we can fully commit to the Global Fund, and fully commit means at 
least $1 billion every year, 2 million patients will be treated for TB, 
a half million AIDS orphans will receive support, and 16 million new 
malaria nets will be distributed over the next few years.
  Access to these lifesaving treatments means children will not be 
pulled out of school to work or to care for a sick parent. It means an 
HIV-positive father in the developing world has a few more years of 
life to provide for his family. It means children with TB, otherwise 
facing a virtual death sentence, will live.
  What AIDS and TB experts know, but policymakers consistently 
underestimate, is that preventing and treating HIV/AIDS without 
preventing and treating TB is a virtual death sentence for the 
developing world. If HIV does not kill you, TB might or malaria might. 
The Global Fund is the best tool in the world to address all three of 
these infectious diseases together.
  Our investment in the Global Fund, rather than a unilateral or 
bilateral U.S.-waged effort, will help leverage support from other 
countries. Funneling U.S. dollars through U.S. programs alone will do 
nothing to promote a united global front against these killers. If we 
put in money to the Global Fund, so will other nations and so will 
major philanthropists.
  In a short time, the Global Fund has shown it is capable of 
tremendous progress. In just two rounds of grants, the fund has 
approved 160 proposals in 94 low- income countries. With significant 
U.S. funding the fund will continue to support countries committed to 
addressing the epidemic killing their people. Without U.S. leadership, 
it will be a fund in name only. AIDS, TB, and malaria would remain a 
virtual death sentence in the developing world.
  Mr. Chairman, I reserve the balance of my time.
  Mr. TAUZIN. Mr. Chairman, I am honored to yield 1 minute to the 
distinguished gentleman from Illinois (Mr. Hyde), the chairman of the 
Committee on International Relations.
  Mr. HYDE. Mr. Chairman, I am pleased to say we are very pleased with 
this amendment. We are happy to accept it. It adds to the bill, and so 
I will not repeat what the other people have already said in outlining 
its terms. But it is a good amendment, and we hope everyone accepts it.
  Mr. TAUZIN. Mr. Chairman, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Chairman, I yield 2\1/2\ minutes to the 
gentlewoman from California (Ms. Lee).
  Ms. LEE. Mr. Chairman, I thank the gentleman from Ohio (Mr. Brown) 
for yielding me this time and for his leadership. Also I want to thank 
the gentleman from Louisiana (Mr. Tauzin) for this amendment, and with 
the cautions which our ranking member laid out, I rise in support of 
this amendment.
  I would like to just briefly mention the history and our debate here 
in Congress with regard to the background of this Global Fund. The idea 
for the Global Fund really started back somewhere around 1998 and 1999, 
when my friend and former colleague, Congressman Ron Dellums, had the 
vision and the foresight for an AIDS Marshall Plan in Africa. Refined 
under the leadership of our good friend, the gentleman from Iowa (Mr. 
Leach), who was then Chair of the Committee on Banking and Financial 
Services, we introduced the World Bank AIDS Trust Fund, and this fund 
became the basis for the Global Fund. This fund was signed into law in, 
I believe it was August of 2000, under the Global AIDS and Tuberculosis 
Relief Act of 2000, signed by President Bill Clinton.
  I cite this history because I think it is important for us to 
remember how important this fund is and that we fully debated this 
fund, and on a bipartisan basis voted it out and it was signed into 
law. So I think this amendment really strengthens the fund and its 
accountability.
  The United Nations, in I believe it was June 2001, picked up the idea 
of the fund, and Secretary General Kofi Annan made an impassioned plea 
for the creation of a Global Fund to fight AIDS, TB, and malaria, which 
again moved forward the World Bank AIDS Trust Fund, in terms of the 
foundation, the parameters and the guidelines. So this fund was 
established in 2002 and really has made significant strides in over 
just a year of operation. Not only has it created a novel approach to 
grant-making and approval-processing, but it has also made really a 
very determined commitment to maintain as lean an operation as possible 
in order to focus its activities on getting money out to those in need.
  The current system that the fund has set up provides several layers 
of accountability. On a country level, the proposals are gathered and 
voted upon by an advisory body that represent government, civil 
society, the private sector, faith-based groups, and nongovernmental 
organizations. Proposals that are submitted to the Global Fund then 
undergo a technical review from an independent body composed of leading 
global health experts. And now our own Secretary of Health and Human 
Services Tommy Thompson is leading this effort.
  So I believe this amendment will help further strengthen the Global 
Fund system of accountability, and I encourage Members to vote for its 
inclusion. And also, with regard to the comments of the gentleman from 
California (Mr. Lantos), I hope we can move forward, as he has so 
eloquently outlined, and fix what he thinks needs to be fixed in it.
  Mr. TAUZIN. Mr. Chairman, I yield 2 minutes to the gentleman from the 
great State of Michigan (Mr. Upton), the distinguished chairman of the 
Subcommittee on Telecommunications and the Internet.
  Mr. UPTON. Mr. Chairman, I rise for many reasons in support of this 
amendment. One of the main reasons that I rise in support of this 
amendment is because of language that I was able to get inserted as 
part of it, and I thank my chairman, the gentleman from Louisiana (Mr. 
Tauzin), and the gentleman from Ohio (Mr. Brown) for accepting this 
language so we did not need a separate amendment but make this as part 
of a comprehensive amendment.
  Part of this amendment reads, the language I was able to insert, says 
this: ``In carrying out immunization programs and other programs in 
developing countries for the prevention, treatment, and control of 
infectious diseases, including HIV/AIDS, TB, and malaria, the director 
of the CDC and Prevention, in coordination with the coordinator of the 
U.S. Government to combat AIDS globally, the National Institutes of 
Health, national and local government, and other organizations such as 
the World Health Organization, and the United Nations Children's Fund, 
shall development and implement effective strategies to improve 
injection safety, including eliminating unnecessary injections.''
  Now, why is this important? A couple of years ago I participated in a 
bipartisan lunch here in the Capitol, and they talked about many 
villages in Africa that are really led by children because there are no 
more adults there.

[[Page 10272]]

It became quite clear that for many of these injections they used 
syringes that were used over and over and over again. As a consequence, 
if one person had HIV/AIDS in that community, they all got it. They all 
died. They all got this terrible disease.
  In fact, we know from data provided by the Safe Injection Global 
Network, an organization affiliated with the WHO, that unsafe injection 
practices in developing countries cause 8 to 16 million hepatitis B 
infections, 2 to almost 5 million Hepatitis C infections, and the 
original 1976 Ebola epidemic in Zaire was traced to the reuse of three 
syringes.
  This language that was included will prevent that. I look forward to 
its adoption, and I again compliment the gentleman from Louisiana (Mr. 
Tauzin) and the gentleman from Ohio (Mr. Brown) for including the 
language.
  Mr. BROWN of Ohio. Mr. Chairman, I thank the gentleman from Michigan 
(Mr. Upton) for his comments, and I yield the balance of my time to the 
gentleman from Minnesota (Mr. Gutknecht).
  The CHAIRMAN. The gentleman from Minnesota (Mr. Gutknecht) is 
recognized for 30 seconds.
  Mr. GUTKNECHT. Mr. Chairman, with 30 seconds, I will be very brief.
  Mr. Chairman, there is a term ``illegal diversion'' used twice in 
section 307. I just want to make clear that the authors have the intent 
to keep us from reimporting drugs that are being donated for AIDS in 
central Africa; that this will not be used to block what we may do in 
the future in terms of allowing Americans to have access to drugs from 
other countries.
  Mr. TAUZIN. Mr. Chairman, will the gentleman yield?
  Mr. GUTKNECHT. I yield to the gentleman from Louisiana.
  Mr. TAUZIN. Mr. Chairman, the intent of the language is to study the 
question of the illegal diversion of drugs for improper purposes, that 
is, for resale and that sort of thing. We describe the purposes within 
that amendment. So the gentleman is accurate in his statement.
  Mr. Chairman, I yield myself such time as I may consume.
  I simply wanted to thank the gentleman from Ohio (Mr. Brown) and the 
members of the Committee on Energy and Commerce who worked on this 
amendment, as I said, to help coordinate the fine work done by the 
chairman and the gentleman from California (Mr. Lantos) on this 
underlying bill. This is an excellent piece of legislation. I hope we 
have improved it.
  I will commit to the gentleman from California (Mr. Lantos) that we 
will continue to work with him to clarify the concerns he has. We do 
not want to create those problems. We are simply trying to add more 
accountability, not less; and more clarity, less confusion.
  Finally, let me point out to the gentleman from Ohio (Mr. Brown) that 
it has obviously come to our committee's attention that a great deal of 
work is going on domestically by a number of pharmaceutical companies 
in testing, et cetera, in attempts to find some sort of vaccine to 
combat HIV/AIDS and some of these other diseases, particularly HIV/
AIDS. And when and if that discovery is made, as we all hope it is, we 
will be back on the floor with legislation to establish some sort of 
national framework for us to utilize that scientific breakthrough, when 
and if it does occur, in a way that humanely administers that kind of a 
hope and expectation of cure and prevention to all Americans without 
regard to the Americans' capabilities or financial capabilities to take 
advantage of it.
  We will have to think that through, how do we make sure everybody 
gets to take advantage of those scientific breakthroughs when they 
occur. We have done some preliminary work on it; and I invite my 
colleague from Ohio, and others, to stay in touch with us as we move 
forward. As we see these breakthroughs coming, we will want to talk 
with the gentleman and others on the committee to see if we cannot 
advance legislation to make sure that every American has the advantage 
of those breakthroughs when they occur.
  Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
  Mr. TAUZIN. I yield to the gentleman from Ohio.
  Mr. BROWN of Ohio. Mr. Chairman, I appreciate the efforts of the 
gentleman from Louisiana (Mr. Tauzin) and appreciate his offer. And I 
think the work we are doing with the gentleman from Illinois (Mr. 
Hyde), the gentleman from Louisiana (Mr. Tauzin), the gentleman from 
California (Mr. Lantos), the gentlewoman from California (Ms. Lee), and 
the gentleman from Iowa (Mr. Leach) today is outstanding, especially 
because with the Global Fund and with all of these efforts we can 
address all of these diseases, encourage philanthropists and other 
governments to contribute and make a difference in people's lives.
  Mr. TAUZIN. Mr. Chairman, I yield such time as he may consume to the 
gentleman from Texas (Mr. Green).
  Mr. GREEN of Texas. Mr. Chairman, I thank the chairman and the 
ranking member on our subcommittee, and I rise in support of the 
legislation.
  Mr. Chairman, I rise today in support of H.R. 1298, the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.
  The global devastation caused by these three diseases cannot be 
understood. The HIV/AIDS pandemic has killed more than 25 million of 
the 65 million individuals affected by this disease worldwide.
  More than 14 million children have been orphaned because of this 
awful disease.
  Tuberculosis, the leading killer of individuals with HIV/AIDS, is an 
equally serious threat. An estimated 2 billion persons--one third of 
the world's population--are infected with the bacteria that cause TB, 
and approximately 2 million persons die each year from TB.
  This isn't just a problem overseas--after years of decline in the 
United States, the number of reported TB cases increased 20 percent 
during 1985-1992.
  It is particularly problematic in my home State of Texas. According 
to the Centers for Disease Control and Prevention, we rank 5th in the 
country in TB case rates.
  With approximately 264 million persons crossing the United States-
Mexico border northbound annually, and 23 percent of all U.S. foreign-
born tuberculosis, TB, patients in the United States originating from 
Mexico, the implications are clear--we have to act on a global level if 
we are going to win the battle against this killer.
  That is why I am pleased to support H.R. 1298, important legislation 
which will provide $3 billion annually for global AIDS, TB and malaria 
in 2004-2008.
  The legislation provides up to $1 billion specifically for the Global 
Fund to Fight AIDS, TB and Malaria in 2004--a key multilateral 
mechanism for expanding prevention and treatment.
  This bill also allows the U.S. share of total contributions to the 
Global Fund of up to 33 percent, which solidifies our commitment to 
eradicating these diseases worldwide.
  This legislation is carefully crafted, bipartisan, and will be truly 
effective in our efforts to combat HIV/AIDS, Tuberculosis and Malaria.
  I urge my colleagues to support this bill, and oppose any efforts to 
weaken or amend it.
  Mr. TAUZIN. Mr. Chairman, I yield myself such time as I may consume, 
and let me again offer my sincere thanks to the chairman and to the 
gentleman from California (Mr. Lantos) for accepting this legislation 
and urge adoption of it.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. All time on this amendment has expired. The question is 
on the amendment offered by the gentleman from Louisiana (Mr. Tauzin).
  The amendment was agreed to.
  The CHAIRMAN. It is now in order to consider amendment No. 2 printed 
in House Report 108-80.


                 Amendment No. 2 Offered by Mr. Crowley

  Mr. CROWLEY. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 offered by Mr. Crowley:
       Page 22, after line 22, insert the following (and 
     redesignate subsequent paragraphs accordingly):
       (F) a description of the specific strategies developed to 
     encourage men to be responsible in their sexual behavior, 
     child rearing and to respect women including the reduction of 
     sexual violence and coercion;
       (G) a description of the specific strategies developed to 
     increase women's access to employment opportunities, income, 
     productive resources, and microfinance programs;

[[Page 10273]]

       Page 43, line 10, after ``sexual partnering,'' insert 
     ``reducing sexual violence and coercion, including child 
     marriage, widow inheritance, and polygamy,''.
       Page 43, after line 21, insert the following (and 
     redesignate subsequent paragraphs accordingly):
       (C) assistance for the purpose of encouraging men to be 
     responsible in their sexual behavior, child rearing, and to 
     respect women;
       Page 44, line 7, strike ``and'' at the end.
       Page 44, line 10, strike the period at the end and insert 
     ``and''.
       Page 44, after line 10, insert the following:
       (G) assistance for the purpose of increasing women's access 
     to employment opportunities, income, productive resources, 
     and microfinance programs, where appropriate.

  The CHAIRMAN. Pursuant to House Resolution 210, the gentleman from 
New York (Mr. Crowley) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from New York (Mr. Crowley).
  Mr. CROWLEY. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, I rise in support of my amendment on preventing women's 
vulnerability. The social empowerment of women and girls is critical to 
reducing the spread of HIV worldwide. Today, heterosexual sex is the 
primary factor in HIV transmission worldwide.

                              {time}  1230

  Women and girls now make up more than 50 percent of those infected 
with HIV worldwide and more than 58 percent of those in sub-Saharan 
Africa. Women and girls often are not able to control when and with 
whom they have sex, or to influence the behavior of their partners. In 
fact, each year millions of monogamous married women are infected by 
their husbands or their partners.
  Irrefutable evidence now links a range of discriminatory practices 
that violate the fundamental human rights of women and girls and lead 
to high rates of HIV infection. These include, but are not limited to, 
sexual violence and coercion, child marriage, widow inheritance in 
which male relatives of the deceased gain sexual access to the widow, 
polygamy, and the practice in which men engage in sex with virgins as a 
``cure'' for HIV/AIDS.
  During a visit to Malawi, I personally saw some of the horrific 
realities confronting women and girls today. I know many of us have 
heard the awful stories of babies raped in South Africa to cure 
themselves of AIDS. U.S. programs must work at every level to change 
the beliefs that support these life-threatening traditions and 
behaviors.
  My amendment would begin to address this appalling problem and 
require a curriculum of gender equity in HIV/AIDS training, so that 
adolescent boys and men learn to respect women and not just view them 
as sex partners.
  While men and boys learn about HIV/AIDS prevention, including 
abstinence, being faithful and using condoms, ABC as it is called, they 
also learn what we call the big R, respect, respect for girls and women 
as their co-equals.
  This is a great bill. My amendment can make it better by adding this 
curriculum to HIV/AIDS prevention education programs under the Global 
Fund. I urge passage of the Crowley amendment.
  Mr. LANTOS. Mr. Chairman, will the gentleman yield?
  Mr. CROWLEY. I yield to the gentleman from California.
  Mr. LANTOS. Mr. Chairman, I strongly support this amendment 
introduced by the gentleman from New York (Mr. Crowley).
  There is no question that the HIV/AIDS pandemic is disproportionately 
affecting women and compounding the egregious inequalities poor women 
live with all over the world. It is absolutely necessary that we deal 
with both genders if we are to reduce the impact of this disease on 
women's life and offer them opportunities to live with respect and 
dignity, free from sexual violence and coercion.
  The Crowley amendment requires that we include in the 5-year strategy 
a plan to make sure that men take responsibility for their sexual 
behavior and that they do respect women. It will also increase 
opportunities for women seeking access to employment. I urge Members to 
support this amendment.
  Mr. CROWLEY. Mr. Chairman, I reserve the balance of my time.
  Mr. HYDE. Mr. Chairman, I claim the time in opposition; however, I do 
not oppose the amendment.
  The CHAIRMAN pro tempore (Mr. Sweeney). Without objection, the 
gentleman from Illinois (Mr. Hyde) is recognized for 5 minutes.
  There was no objection.
  Mr. HYDE. Mr. Chairman, I yield myself such time as I may consume.
  This is a good amendment, a thoughtful amendment. It adds to the 
bill, so we are pleased to accept this amendment.
  Mr. Chairman, I yield back the balance of my time.
  Mr. CROWLEY. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from New York (Mrs. Lowey).
  Mrs. LOWEY. Mr. Chairman, I rise in strong support of the Crowley 
amendment, and I commend my colleague for his leadership on this 
important issue.
  The amendment addresses one of the core issues driving HIV/AIDS 
infection rates in the hardest hit countries: The disproportionate 
vulnerability of women to contracting HIV.
  The facts speak for themselves, women and adolescent girls make up 
more than 50 percent of those infected with HIV worldwide, more than 58 
percent of those infected in sub-Saharan Africa. The reasons for this 
are clear, gender violence and sexual coercion make it difficult, and 
even impossible, for women to say no to sex with an infected person. 
Widespread poverty has turned many younger women to having sex with 
older men in return for the food and shelter their families cannot 
provide. Poverty, as well, is a factor in the prevalence of early 
marriage, subjecting adolescent girls to marriages with unfaithful 
partners who often bring HIV home.
  The Crowley amendment would provide a solution requiring U.S. 
programs to prevent HIV/AIDS to work toward empowering women to 
negotiate their sexual activity, and working with men to understand and 
respect women's rights. I urge adoption of this amendment.
  Mr. CROWLEY. Mr. Chairman, I yield 1 minute to the gentlewoman from 
California (Ms. Lee).
  Ms. LEE. Mr. Chairman, I thank the gentleman from New York (Mr. 
Crowley) for yielding me this time, and thank the gentleman for this 
amendment. It is very important to this bill. I thank the gentleman 
from Illinois (Chairman Hyde) for accepting the amendment.
  The empowerment of women is critical in developing an AIDS strategy 
that is effective. In many parts of the developing world, women are 
still treated as second-class citizens. They lack basic protections of 
civil rights laws in their own country, and oftentimes are left at a 
disadvantage when it comes to accessing resources, owning land and in 
their general relationships to men.
  The Crowley amendment would fix this by encouraging men to develop a 
healthy relationship that treats women with respect. That is so 
important as we address this pandemic. In addition, it supports the 
development of specific strategies to increase women's access to 
employment, land and financial resources like microfinance programs 
that, in many instances, have encouraged women to set up their own 
small businesses and avoid having to turn to a life of prostitution in 
order to make ends meet.
  I urge Members to thank the gentleman from New York (Mr. Crowley) for 
his wisdom in moving forward with this amendment. I thank the gentleman 
from Illinois (Mr. Hyde) for accepting this very important amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from New York (Mr. Crowley).
  The amendment was agreed to.
  The CHAIRMAN pro tempore. It is now in order to consider amendment 
No. 3 printed in House Report 108-80.


                amendment no. 3 offered by mrs. biggert

  Mrs. BIGGERT. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:


[[Page 10274]]

       Amendment No. 3 offered by Mrs. Biggert:
       Page 33, after line 20, insert the following:
       (a) Findings.--The Congress finds as follows:
       (1) The establishment of the Global Fund in January 2002 is 
     consistent with the general principles for an international 
     AIDS trust fund first outlined by the Congress in the Global 
     AIDS and Tuberculosis Relief Act of 2000 (Public Law 106-
     264).
       (2) Section 2, Article 5 of the bylaws of the Global Fund 
     provides for the International Bank for Reconstruction and 
     Development to serve as the initial collection trustee for 
     the Global Fund.
       (3) The trustee agreement signed between the Global Fund 
     and the International Bank for Reconstruction and Development 
     narrows the range of duties to include receiving and 
     investing funds from donors, disbursing the funds upon the 
     instruction of the Global Fund, reporting on trust fund 
     resources to donors and the Global Fund, and providing an 
     annual external audit report to the Global Fund.
       Page 33, line 20, strike ``(a)'' and insert ``(b)''.
       Page 34, line 5, strike ``(b)'' and insert ``(c)''.
       Page 34, line 14, strike ``(c)'' and insert ``(d)''.
       Page 37, line 18, strike ``(d)'' and insert ``(e)''.
       Page 38, line 25, strike ``(e)'' and insert ``(f)''.
       Page 39, after line 9, insert the following:
       (g) Sense of the Congress Regarding Encouragement of 
     Private Contributions to the Global Fund.--It is the sense of 
     the Congress that the President should--
       (1) conduct an outreach campaign that is designed to--
       (A) inform the public of the existence of--
       (i) the Global Fund; and
       (ii) any entity that will accept private contributions 
     intended for use by the Global Fund; and
       (B) encourage private contributions to the Global Fund; and
       (2) encourage private contributions intended for use by the 
     Global Fund by--
       (A) establishing and operating an Internet website, and 
     publishing information about the website; and
       (B) making public service announcements on radio and 
     television.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 210, the 
gentlewoman from Illinois (Mrs. Biggert) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentlewoman from Illinois (Mrs. Biggert).
  Mrs. BIGGERT. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, first of all, let me thank the gentleman from Illinois 
(Mr. Hyde) for all of his work on this necessary initiative. I also 
applaud the bipartisan manner in which he and the ranking member, the 
gentleman from California (Mr. Lantos), have completed this difficult 
task.
  In addition, the gentleman from Iowa (Mr. Leach) and the gentlewoman 
from California (Ms. Lee) should be commended for the groundwork that 
they laid with their previous efforts in creating a World Bank/AIDS 
Trust Fund.
  This amendment does two things: First, it states that the World Bank, 
or the IBID, the International Bank for Reconstruction and Development, 
is the trustee for contributions made by sovereign nations. This makes 
the underlying bill consistent with both the charter of the Global Fund 
and with legislation previously passed and signed into law concerning 
the global fight against HIV/AIDS. This amendment in no way restricts 
the movement of the trustee role to any other financial institution if 
the board of the Global Fund deems it necessary some time down the 
road.
  Second, it expresses the sense of Congress that we wish to encourage 
individuals and private entities to make contributions to the Global 
Fund. The President, in his State of the Union address, specifically 
requested that $1 billion of emergency relief for AIDS go towards the 
Global AIDS Fund over a 5-year period. The Hyde bill has authorized $1 
billion in the first year alone and more money to be authorized in 
subsequent years, if necessary.
  While we all agree that government contributions on a multilateral 
level should be the main source of funding for the Global Fund, we also 
must agree that individual and private entity donations should not be 
discounted, discouraged, or dismissed. They should be encouraged. 
Governments alone cannot concur this enemy. There is so much more that 
individual citizens and charitable foundations can and will do if we 
give them the avenue, the information and the opportunity.
  To illustrate my point, we are all aware of the $100 million 
contribution made by two very well known and generous Americans from 
the Bill and Melissa Gates Foundation. This single contribution from an 
American-based foundation is roughly half the amount that was pledged 
by the governments of Italy and Japan combined to this Global Fund.
  The amendment seeks to encourage and enable other foundations and 
generous individuals, even those who might be thinking more in the 
neighborhood of a $10 or $100 contribution to contribute to the Global 
AIDS Fund to combat the HIV/AIDS pandemic. These funds promote 
expansion of public-private partnerships.
  Mr. HYDE. Mr. Chairman, will the gentlewoman yield?
  Mrs. BIGGERT. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, we certainly accept the amendment. It is an 
excellent addition to the bill, and congratulate the gentlewoman from 
Illinois (Mrs. Biggert).
  Mr. LANTOS. Mr. Chairman, will the gentlewoman yield?
  Mrs. BIGGERT. I yield to the gentleman from California.
  Mr. LANTOS. Mr. Chairman, we are in complete agreement with the 
gentlewoman on the value of the Global Fund and on the importance of 
private contributions to the fund. Contributions from the Gates 
Foundation and others significantly enhance the functioning of the 
fund, and we agree that the President should do even more to encourage 
private donations here.
  I am not aware of any objections to the gentlewoman's amendment on 
this side of the aisle. We would be pleased to accept it. I commend the 
gentlewoman from Illinois (Mrs. Biggert) for her important initiative.
  Ms. LEE. Mr. Chairman, will the gentlewoman yield?
  Mrs. BIGGERT. I yield to the gentlewoman from California.
  Ms. LEE. Mr. Chairman, I want to thank the gentlewoman from Illinois 
(Mrs. Biggert) for this amendment. I think it strengthens the bill. It 
strengthens the fund.
  One point I would like to make about the Global Fund which has been 
mentioned is the leveraging ability of the fund. $1 billion could 
leverage up to $4 to $5 billion. It has been estimated that $9 to $10 
billion is needed just to begin to scratch the surface on this 
pandemic. The importance of the fund cannot be overstated, and I thank 
the gentlewoman for this amendment. Now that Secretary Tommy Thompson 
is chair of the executive board, both sides should feel confident that 
he will move forward. And once we insist that our side put $1 billion 
in, at least we know that should lead to $4 to $5 billion immediately. 
I offer my support of the amendment.
  Mrs. BIGGERT. Mr. Chairman, I thank the gentlewoman from California 
(Ms. Lee) and thank the chairman and the ranking member for their 
support of this amendment. I urge its passage.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN pro tempore. The question is on amendment offered by the 
gentlewoman from Illinois (Mrs. Biggert).
  The amendment was agreed to.
  The CHAIRMAN pro tempore. It is now in order to consider amendment 
No. 4 printed in House Report 108-80.


                 Amendment No. 4 Offered by Mr. Stearns

  Mr. STEARNS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 4 offered by Mr. Stearns:
       Page 36, after line 13, insert the following:
       (iii) If, at any time during any of the fiscal years 2004 
     through 2008, the President determines that the salary of any 
     individual employed by the Global Fund exceeds the salary of 
     the Vice President of the United States (as determined under 
     section 104 of title 3, United States Code) for that fiscal 
     year, then the United States shall withhold from its 
     contribution for the next fiscal year an amount equal to the 
     aggregate amount by which the salary of each such individual 
     exceeds the salary of the Vice President of the United 
     States.

[[Page 10275]]

       Page 36, line 14, strike ``(B)'' and insert ``(B)(i)''.
       Page 36, beginning on each of lines 15 and 17, strike 
     ``subparagraph (A)'' and insert ``subparagraph (A)(i)''.
       Page 36, after line 19, insert the following:
       (ii) Any amount made available under this subsection that 
     is withheld by reason of clause (ii) or (iii) of subparagraph 
     (A) is authorized to be made available to carry out section 
     104A of the Foreign Assistance Act of 1961 (as added by 
     section 301 of this Act). Amounts made available under the 
     preceding sentence are in addition to amounts appropriated 
     pursuant to the authorization of appropriations under section 
     401 of this Act for HIV/AIDS assistance.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 210, the 
gentleman from Florida (Mr. Stearns) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Stearns).
  Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I appreciate the opportunity to offer this simple 
amendment. It will ensure that the money that the United States spends, 
which is taxpayers' money, to address the AIDS crisis will be spent 
treating patients rather than spent in bureaucratic, administrative 
costs.
  It requires that at the Global Fund, individual salaries may not 
exceed the salary of the Vice President of the United States. The 
criteria that I came up with, being the Vice President's salary, is 
because in the Homeland Security Act, we specified that no Federal 
employee may earn a salary in excess of the vice presidential salary. 
So that is the criteria I used. I think it is pretty simple, and back 
in our districts, $192,000 is a lot of money.
  Given that the Global Fund's mission is to help people dying from 
AIDS and prevent others from getting and eventually dying from AIDS, it 
would seem reasonable that administrative costs should be held to a 
minimum so that every dollar that taxpayers spend overseas will move to 
the patients and to the people who need it. As long as the U.S. 
Government is the largest single contributor to the fund, it is 
appropriate that we place this modest restriction on the salaries. We 
do it for our Federal employees here in the United States, why not do 
it in the Global Fund. With hundreds of millions of dollars at risk, it 
is the responsibility of all of us to ensure that dollars are spent 
wisely. Mr. Chairman, I think the amendment is pretty simple. I could 
point out a lot more.
  Mr. HYDE. Mr. Chairman, will the gentleman yield?
  Mr. STEARNS. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, we are prepared to accept the amendment.
  Mr. STEARNS. Mr. Chairman, I thank the gentleman.
  Mr. LANTOS. Mr. Chairman, will the gentleman yield?
  Mr. STEARNS. I yield to the gentleman from California.
  Mr. LANTOS. Mr. Chairman, we expect the Global Fund to recruit and 
hire the most competent and competitive international experts to manage 
this very complex organization.

                              {time}  1245

  I feel strongly that exorbitant executive salaries would only go to 
undermine the credibility of the organization. There are lots of 
skeptics who oppose the Global Fund and wish it to fail. These 
naysayers are looking for any means to discredit the work of the Global 
Fund. It is very important that the Global Fund salaries should be 
realistic and competitive and attract the most competent professionals 
in the world, but they should not be set at levels that would undermine 
the credibility of the good work that we hope to accomplish.
  I urge my colleagues to support my friend's amendment.
  Mr. Chairman, I yield back the balance of my time.
  Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
  I just will conclude by saying we all want this bill to save lives. 
That is why we are here. But I think we must have some kind of strict 
accountability with this organization sanctioned by the world to meet 
this dire need, and I thank the gentleman from California (Mr. Lantos) 
and the gentleman from Illinois (Mr. Hyde), distinguished chairman and 
ranking member. I appreciate their support. We must have confidence 
that these organizations are using American taxpayers' dollars wisely.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN pro tempore (Mr. Sweeney). The question is on the 
amendment offered by the gentleman from Florida (Mr. Stearns).
  The question was taken; and the Chairman pro tempore announced that 
the ayes appeared to have it.
  Mr. STEARNS. Mr. Chairman, I demand a recorded vote.
  The CHAIRMAN pro tempore. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from Florida (Mr. 
Stearns) will be postponed.
  It is now in order to consider amendment No. 5 printed in House 
Report 108-80.


                amendment no. 5 offered by mr. ballance

  Mr. BALLANCE. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 5 offered by Mr. Ballance:
       Page 55, after line 10, insert the following:
       (g) Sense of Congress Relating to Food Assistance for 
     Individuals Living With HIV/AIDS.--
       (1) Findings.--Congress finds the following:
       (A) The United States provides more than 60 percent of all 
     food assistance worldwide.
       (B) According to the United Nations World Food Program and 
     other United Nations agencies, food insecurity of individuals 
     infected or living with HIV/AIDS is a major problem in 
     countries with large populations of such individuals, 
     particularly in African countries.
       (C) Although the United States is willing to provide food 
     assistance to these countries in need, a few of the countries 
     object to part or all of the assistance because of fears of 
     benign genetic modifications to the foods.
       (D) Healthy and nutritious foods for individuals infected 
     or living with HIV/AIDS are an important complement to HIV/
     AIDS medicines for such individuals.
       (E) Individuals infected with HIV have higher nutritional 
     requirements than individuals who are not infected with HIV, 
     particularly with respect to the need for protein. Also, 
     there is evidence to suggest that the full benefit of therapy 
     to treat HIV/AIDS may not be achieved in individuals who are 
     malnourished, particularly in pregnant and lactating women.
       (2) Sense of congress.--It is therefore the sense of 
     Congress that United States food assistance should be 
     accepted by countries with large populations of individuals 
     infected or living with HIV/AIDS, particularly African 
     countries, in order to help feed such individuals.

       Page 69, line 19, strike ``The drug nevirapine reduces'' 
     and insert ``Certain antiretroviral drugs reduce''.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 210, the 
gentleman from North Carolina (Mr. Ballance) and a Member opposed each 
will control 5 minutes.
  The Chair recognizes the gentleman from North Carolina (Mr. 
Ballance).
  Mr. BALLANCE. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, I am thankful for this opportunity to offer this 
amendment to the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003. I would like to commend the 
efforts of my friends and colleagues on both sides of the aisle. I 
thank the gentleman from Illinois (Chairman Hyde) and the gentleman 
from California (Mr. Lantos), ranking member, for their leadership; but 
I also want to take a moment to point my finger at the honorable 
gentlewoman from California (Ms. Lee), our good friend and long-time 
leader in this effort who has stood tall on this issue for so many 
years, and I would like to take the opportunity to commend our 
President for getting involved in this issue.
  I have been in this Congress now for about 4 months, and there have 
not been many issues that have touched me. This one has. So I have come 
today to add my voice on behalf of a growing problem compounding the 
HIV/AIDS crisis in many African nations. America stands ready to help 
provide food assistance to our brothers and sisters in Africa suffering 
from this devastating disease, HIV/AIDS. We already provide more than 
60 percent of all food

[[Page 10276]]

aid around the world, and yet some parts of the world question the 
quality of our foods on the basis of unscientific concerns. Thus it is 
that some nations object to our food aid; and one I would point out, 
Zambia, has completely rejected our help.
  Mr. Chairman, I am concerned that America may not be doing enough to 
educate foreign countries about genetically modified foods. Many poor 
nations lack infrastructure to determine if food is safe. With images 
on television of epidemics like Mad Cow Disease, many African leaders 
are very hesitant to go on the findings of food safety inspections and 
research services of another nation.
  With many countries in Africa dealing with HIV/AIDS, their leaders 
are hesitant to introduce any item into the food supply that they 
suspect might further complicate health problems. Without adequate 
information, it is no wonder many of these countries have come to 
different conclusions about food products they allow into their 
country.
  Mr. Chairman, if we asked most HIV/AIDS victims in Africa what they 
need most, I would venture to say that they will tell us that they need 
food. More than any medication, providing proper nutrition to regions 
without adequate food can prolong lives. The most at risk in this 
debilitating crisis are women and children. The links between 
malnutrition and AIDS deaths is undeniable. Malnutrition accelerates 
the progression from HIV to AIDS and leaves those with HIV/AIDS 
vulnerable to opportunistic infections that often are fatal.
  The devastation that this disease causes in Africa, the hundreds of 
thousands of orphans, the decimated communities and the economic damage 
can be alleviated with a combined program of medical aid and good 
nutrition.
  Food is much less expensive than antiretroviral drugs, and good 
nutrition can prolong the lives of AIDS victims for many years and 
sometimes decades. According to the recently published Demographic 
Health Survey and the 2000 Census of Population and Housing by the 
United Nations, children born between 1970 and 1975 in Zambia could 
expect to live 47.2 years. That same study now has shown that their 
life expectancy has decreased to 40.5 years.
  Unfounded fears should not hold up food aid. This amendment I believe 
will go a long way to alleviate those concerns, and I would urge my 
colleagues to adopt this amendment.
  Mr. LANTOS. Mr. Chairman, will the gentleman yield?
  Mr. BALLANCE. I yield to the gentleman from California.
  Mr. LANTOS. Mr. Chairman, I strongly support the amendment introduced 
by the gentleman from North Carolina (Mr. Ballance), and I want to 
commend him for his initiative. We think this is a significant 
improvement to the underlying bill. We have no objections, and we 
strongly support it.
  Mr. HYDE. Mr. Chairman, will the gentleman yield?
  Mr. BALLANCE. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, I am delighted to associate myself with the 
remarks of the distinguished gentleman from California (Mr. Lantos). 
This is an excellent amendment, and I urge all our colleagues to 
support it.
  Mr. BALLANCE. Mr. Chairman, reclaiming my time, one other thing I 
wanted to say which was not in my prepared remarks was we grow a lot of 
corn in North Carolina.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from North Carolina (Mr. Ballance).
  The amendment was agreed to.
  The CHAIRMAN pro tempore. It is now in order to consider amendment 
No. 6 printed in House Report 108-80.
  It is now in order to consider amendment No. 7 printed in House 
report 108-80.


                 Amendment No. 7 Offered by Mr. Lantos

  Mr. LANTOS. Mr. Chairman, I offer an amendment as the designee of the 
gentlewoman from California (Ms. Millender-McDonald).
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 7 offered by Mr. Lantos:
       Page 74, after line 10, insert the following (and 
     redesignate subsequent paragraphs accordingly):
       (4) ensure the importance of inheritance rights of women, 
     particularly women in African countries, due to the 
     exponential growth in the number of young widows, orphaned 
     girls, and grandmothers becoming heads of households as a 
     result of the HIV/AIDS pandemic;
       Page 75, line 4, add at the end the following new sentence: 
     ``Such report should include a description of activities 
     undertaken to carry out subsection (b)(4).''.
       Page 75, line 11, add at the end the following new 
     sentence: ``A significant percentage of the amount 
     appropriated pursuant to the authorization of appropriations 
     under the preceding sentence for a fiscal year should be made 
     available to carry out subsection (b)(4).''.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 210, the 
gentleman from California (Mr. Lantos) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from California (Mr. Lantos).
  Mr. LANTOS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, the amendment offered by the gentlewoman from 
California (Ms. Millender-McDonald), my good friend and colleague, 
deals with a very important issue. The HIV/AIDS pandemic has had a 
frightening impact on women, particularly in Africa where 55 percent of 
all HIV/AIDS victims are women. Unequal inheritance rights all over the 
world, but particularly in Africa, favor men over women. Poor women are 
abandoned because of their HIV/AIDS status, widowed by the premature 
death of a husband, or left as orphans by the death of parents. Left 
with nothing but their desperation, these women and girls are exploited 
by sex traffickers, pimps, and abusive employers.
  Mr. Chairman, it is crucial that programs funded by this emergency 
program include the promotion and protection of women's inheritance 
rights, but we should not stop there. Women's equal rights across the 
board are absolutely essential to overcoming the poverty that underpins 
the seeming hopelessness of this disease.
  Mr. Chairman, I urge all of my colleagues to support this amendment.
  Mr. HYDE. Mr. Chairman, will the gentleman yield?
  Mr. LANTOS. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, I thank the gentleman for yielding. I am 
pleased to say that the majority accepts the amendment. It is an 
excellent addition to what I think is an excellent bill. So we are 
pleased to accept it.
  Ms. MILLENDER-McDONALD. Mr. Chairman, I want to take this time to 
thank Chairman Hyde and Ranking Member Lantos for being the driving 
force behind such an important bill, H.R. 1298, United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. 
This bill embodies true leadership on the part of the United States, 
dramatically increasing the U.S. participation in addressing the 
pandemic that is ravaging whole regions and millions upon millions of 
people. This unprecedented bill acknowledges our moral responsibility 
to address the pandemic that has already resulted in the deaths of 
millions. I am so proud to be a part of this legislation, this 
distinguished body and this country.
  The bill as reported out of the International Relations Committee 
contains a provision of mine included in the Committee markup which my 
good friend, Congresswoman Napolitano, offered for me as a member of 
that Committee. While much attention is being paid to preventing 
mother-to-child transmission (MTCT) of HIV/AIDS, we must turn to 
addressing the needs and rights of that child to grow up with parents, 
so that millions more are not orphaned before he or she can even walk. 
My language gives priority preference for federal funds to groups that 
are currently administering a program with non-federal funds to: 
prevent mother-to-child transmission; and provide life-long care and 
treatment in family-centered programs so that children do not grow up 
as orphans.
  This would benefit programs such as the MTCT-Plus Initiative, which 
is supported by United Nations Secretary General Kofi Annan and the 
First Ladies of Africa, and which has $50 million in funding from 
several private philanthropic foundations including the Bill and

[[Page 10277]]

Melinda Gates, the William and Flora Hewlett, the Robert Wood Johnson 
and other foundations. Such family-survival programs are critical to 
address the issues of millions of children orphaned by HIV/AIDS on a 
scale unrivaled in history. In sub-Saharan Africa, family and societal 
structures are breaking down because of the deaths of a generation of 
parents. The number of children in the developing world who have been 
orphaned by the AIDS pandemic will nearly double from 13.4 million to 
25.4 million by the end of this decade. Today, 5.5 million children in 
Africa have lost both parents and in most cases, at least one of them 
to AIDS, and that number will rise to 7.9 million by 2010. Older women 
are also profoundly affected since the responsibility for caring for 
and supporting grandchildren orphaned by AIDS infected parents often 
falls on the shoulders of the elderly.
  Thank you again, Chairman Hyde and Ranking Member Lantos, for 
agreeing to include my amendment in the bill as reported, and to 
Congresswoman Napolitano for agreeing to offer my amendment during the 
Committee markup.
  Mr. Chairman, my amendment today concerns Section 314 which calls for 
a pilot program of assistance for children and families affected by 
HIV/AIDS. My amendment requires that pilot program to ensure the 
importance of inheritance rights of women, particularly women in 
African countries are included in this program. The relationship of the 
denial of inheritance rights for women, increased HIV/AIDS infection in 
women and the resulting exponential growth in the numbers of young 
widows, orphaned girls, and grandmothers becoming heads of households 
needs to be further studied and documented. My amendment does just 
that.
  My amendment is necessary because a majority of those infected by 
HIV/AIDS in Africa are women of all classes, ethnic groups, and levels 
of education. Women with AIDS are condemned to an early death when 
their homes, lands, and other property are taken. They not only lose 
assets they could use for medical care, but also the shelter they need 
to endure this disease.
  The failure to ensure equal property and inheritance rights upon 
separation or divorce discourages women from leaving violent marriages. 
HIV risk is especially high for women in situations of domestic 
violence, which often involves coercive sex, diminished ability to 
negotiate with partners for safer sex, and impede women from seeking 
health information and treatment.
  In some places, widows are forced to undergo sexual practices such as 
``wife inheritance'' or ritual ``cleansing'' in order to keep their 
property. ``Wife inheritance'' occurs when a male relative of the dead 
husband takes over the widow as a wife, often in a polygamous 
environment. ``Cleansing'' usually involves sex with a social outcast 
who is paid by the dead husband's family, supposedly to cleanse the 
women of her dead husband's evil spirits. In both of these rituals, 
safe sex is seldom practiced and often forced. Such women are at 
increased risk of contracting and spreading HIV.
  For example, there are areas in Kenya where the wife inheritance and 
cleansing practices have created an alarmingly high rate of HIV/AIDS 
infection. Fully 22 percent of the population between ages 15 and 49 in 
the Nyanza province are infected, and 35 percent of ante-natal women in 
one district within that province are infected. Girls and young women 
in the Nyanza province are infected at six times the rate of their male 
counterparts.
  The underlying bill calls for the President to report on this pilot 
program, as described under Section 314(c). My amendment calls for that 
report to include in it a description of activities undertaken to 
ensure that the inheritance rights of women as just described are part 
of this program.
  Finally, in the last Congress, Rep. Eva Clayton and I introduced H. 
Con. Res. 421, recognizing the importance of inheritance rights of 
women in Africa, and its relationship to the HIV/AIDS pandemic. I have 
also chaired two briefings on this issue. Our resolution was very 
strongly supported by this body. It had 90 original cosponsors with 
bipartisan support. My amendment today to the underlying bill includes 
the crux of H. Con. Res. 421.
  Thank you so much and I hope you support my amendment to H.R. 1298.
  Mr. LANTOS. Mr. Chairman, we have no further requests for time, and 
we yield back the balance of our time.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from California (Mr. Lantos).
  The amendment was agreed to.

                              {time}  1300

  The CHAIRMAN pro tempore (Mr. Sweeney). It is now in order to 
consider Amendment No. 8 printed in House Report 108-80, as modified by 
the order of the House of earlier today.


                Amendment No. 8 Offered by Ms. McCollum

  Ms. McCOLLUM. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 8 offered by Ms. McCollum:
       Page 83, line 14, strike ``For'' and insert ``(a) 
     Therapeutic Medical Care.--For''.
       Page 83, after line 22, add the following new subsection:
       (b) Orphans and Vulnerable Children.--For fiscal years 2006 
     through 2008, not less than 10 percent of the amounts 
     appropriated pursuant to the authorization of appropriations 
     under section 401 for HIV/AIDS assistance for each such 
     fiscal year shall be expended for assistance for orphans and 
     vulnerable children affected by HIV/AIDS, of which such 
     amount at least 50 percent shall be provided through non-
     profit, nongovernmental organizations, including faith-based 
     organizations, that implement programs on the community 
     level.

  The CHAIRMAN pro tempore. Pursuant to House Resolution 210, the 
gentlewoman from Minnesota (Ms. McCollum) and a Member opposed each 
will control 5 minutes.
  The Chair recognizes the gentlewoman from Minnesota (Ms. McCollum).
  Ms. McCOLLUM. Mr. Chairman, I yield myself of such time as I may 
consume.
  Mr. Chairman, I want to begin by thanking once again the gentleman 
from Illinois (Chairman Hyde) and the ranking member, the gentleman 
from California (Mr. Lantos), for their hard work on this critical 
legislation. President Bush should also be congratulated for his 
leadership on this important legislation. This bill is a huge step 
forward in our global leadership to respond to the AIDS pandemic.
  The gentleman from Illinois (Chairman Hyde) and the gentleman from 
California (Mr. Lantos) have recognized AIDS orphans and vulnerable 
children and have included them in this historic bill expressing the 
sense of Congress that they receive a portion of funding. Nonetheless, 
I believe we can and we must do more to ensure that some of our 
planet's most vulnerable children are protected.
  The amendment I am offering today would ensure that 10 percent of the 
appropriated funds in this bill be expended for HIV/AIDS assistance for 
millions of orphans and vulnerable children affected by AIDS.
  As we prepare to authorize this groundbreaking legislation, I urge my 
colleagues to join me in committing this funding for children who are 
being left behind to survive on their own as a result of the AIDS 
pandemic.
  This funding will go far in providing the most basic health, 
education and economic needs to millions of children throughout the 
work of community and faith-based groups, as well as NGOs and host 
country governments.
  Today there are more than 12 million children, 12 million children in 
Africa, that have lost one or both parents to HIV/AIDS. By the year 
2005, there will be more than 20 million AIDS orphans around the world.
  Children in Africa are suffering the loss of parents, extended family 
members, teachers, health care providers and peers. Every community 
affected by AIDS is being robbed of a generation of adults in their 
most productive years, leaving behind children to be raised by 
relatives, left on their own in households headed by other children, 
or, even worse, to be totally left alone to forage in rural villages 
and on the streets of cities across the continent of Africa.
  The scope and complexity of the challenges facing children affected 
by AIDS cannot be overstated. Children become responsible for their own 
survival while providing care for dying parents. They are forced to 
abandon school and face the stigma and isolation far too frequently 
associated with AIDS. Tragically, orphan children who are the most 
vulnerable are often forced into labor, sexual exploitation, and the 
hopelessness of a life of mere survival.
  This amendment can help transform the future of communities filled 
with AIDS orphans by committing to reinvest into communities that have 
faith-

[[Page 10278]]

based organizations and other groups that are committed to working with 
orphans. We are ensuring by doing this that an entire generation of 
children in Africa will not be lost.
  We have the responsibility today to make a firm commitment to ensure 
that the resources in this bill go to provide the most basic needs of 
every child; food, shelter, safety, medicine, education, and, most 
importantly of all, hope for the future.
  I urge my colleagues to join me today in supporting the millions of 
children orphaned by AIDS. I respectfully ask my colleagues to support 
this amendment and to make a strong commitment to the millions of AIDS 
orphans and vulnerable children who desperately need our help today.
  Mr. HYDE. Mr. Chairman, will the gentlewoman yield?
  Ms. McCOLLUM. I yield to the gentleman from Illinois.
  Mr. HYDE. Mr. Chairman, the children and orphans who are affected by 
this scourge could have no better champion than the gentlewoman from 
Minnesota, and we are very pleased to accept her excellent amendment.
  Mr. LANTOS. Mr. Chairman, will the gentlewoman yield?
  Ms. McCOLLUM. I yield to the gentleman from California.
  Mr. LANTOS. Mr. Chairman, I want to congratulate and commend my 
friend from Minnesota for offering this most important amendment, which 
dramatically improves the underlying bill. On this side we are proud 
and pleased to accept her amendment.
  Ms. McCOLLUM. Mr. Chairman, reclaiming my time, I am very honored to 
have this amendment accepted, and I thank both my mentors for their 
help in preparing this amendment.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentlewoman from Minnesota (Ms. McCollum).
  The amendment was agreed to.
  Mr. HYDE. Mr. Chairman, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Green of Wisconsin) having assumed the chair, Mr. Sweeney, Chairman pro 
tempore of the Committee of the Whole House on the State of the Union, 
reported that that Committee, having had under consideration the bill 
(H.R. 1298) to provide assistance to foreign countries to combat HIV/
AIDS, tuberculosis, and malaria, and for other purposes, had come to no 
resolution thereon.

                          ____________________