[House Report 106-548]
[From the U.S. Government Publishing Office]



106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     106-548

======================================================================



 
              WORLD BANK AIDS MARSHALL PLAN TRUST FUND ACT

                                _______
                                

 March 28, 2000.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

   Mr. Leach, from the Committee on Banking and Financial Services, 
                        submitted the following

                              R E P O R T

                             together with

                    DISSENTING AND ADDITIONAL VIEWS

                        [To accompany H.R. 3519]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Banking and Financial Services, to whom 
was referred the bill (H.R. 3519) to provide for negotiations 
for the creation of a trust fund to be administered by the 
International Bank for Reconstruction and Development or the 
International Development Association to combat the AIDS 
epidemic, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.
    The amendment is as follows:
    Strike out all after the enacting clause and insert in lieu 
thereof the following:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``World Bank AIDS Marshall Plan Trust 
Fund Act''.

SEC. 2. FINDING AND PURPOSES.

    (a) Findings.--The Congress finds the following:
          (1) According to the Surgeon General of the United States, 
        the epidemic of human immunodeficiency virus/acquired immune 
        deficiency syndrome (HIV/AIDS) will soon become the worst 
        epidemic of infectious disease in recorded history, eclipsing 
        both the bubonic plague of the 1300's and the influenza 
        epidemic of 1918-1919 which killed more than 20,000,000 people 
        worldwide.
          (2) According to the Joint United Nations Programme on HIV/
        AIDS (UNAIDS), 33,600,000 people in the world today are living 
        with HIV/AIDS, of which approximately 95 percent live in the 
        developing world.
          (3) UNAIDS data shows that among children age 14 and under 
        worldwide, 3,600,000 have died from AIDS, 1,200,000, are living 
        with the disease; and in one year alone--1999--an estimated 
        570,000 became infected, of which over 90 percent were babies 
        born to HIV-positive women.
          (4) Although sub-Saharan Africa has only 10 percent of the 
        world's population, it is home to 23,300,000--roughly 70 
        percent--of the world's HIV/AIDS cases.
          (5) Worldwide, there have already been an estimated 
        16,300,000 deaths because of HIV/AIDS, of which 13,700,000--
        over 80 percent--occurred in Sub-Saharan Africa.
          (6) According to testimony by the Office of National AIDS 
        Policy, an entire generation of children in Africa is in 
        jeopardy, with one-fifth to one-third of all children in some 
        countries already orphaned and the figure estimated to rise to 
        40,000,000 by 2010.
          (7) the 1999 annual report by the United States Nations 
        Children's Fund (UNICEF) states ``[t]he number of orphans, 
        particularly in Africa, constitutes nothing less than an 
        emergency, requiring an emergency response'' and that ``finding 
        the resources needed to help stabilize the crisis and protect 
        children is a priority that requires urgent action from the 
        international community.''
          (8) A 1999 Bureau of the Census report states that the 
        average life expectancy in the Republic of Botswana, the 
        Republic of Zimbabwe, the Kingdom of Swaziland, the Republic of 
        Malawi, and the Republic of Zambia has decreased from 
        approximately age 65 to approximately age 40--the lowest life 
        expectancy in the world--due to high mortality rates from HIV/
        AIDS.
          (9) A January 2000 unclassified United States National 
        Intelligence Estimate (NIE) report on the global infectious 
        disease threat concluded that the economic costs of infectious 
        diseases--especially HIV/AIDS--are already significant and 
        could reduce GDP by as much as 20 percent or more by 2010 in 
        some sub-Saharan African nations.
          (10) According to the same NIE report, HIV prevalence among 
        militias in Angola and the Democratic Republic of the Congo are 
        estimated at 40 to 60 percent, and at 15 to 30 percent in 
        Tanzania.
          (11) The HIV/AIDS epidemic is of increasing concern in other 
        regions of the world with UNAIDS reporting, for example, that 
        there are 6 million cases in South and South-east Asia, that 
        the rate of HIV infection in the Caribbean is second only to 
        sub-Saharan Africa, and that HIV infections have doubled in 
        just two years in the former Soviet Union.
          (12) Despite the grim statistics on the spread of HIV/AIDS, 
        some developing nations--such as Uganda, Senegal, and 
        Thailand--have implemented prevention programs that have 
        substantially curbed the rate of HIV infection.
          (13) AIDS, like all diseases, knows no boundaries, and there 
        is no certitude that the scale of the problem in one continent 
        can be contained with that region.
          (14) According to a 1999 study prepared by UNAIDS and the 
        Francois-Xavier Bagnoud Center for Health and Human Rights at 
        the Harvard School of Public Health, HIV/AIDS is spreading 
        three times faster than funding available to control the 
        disease.
          (15) The United Nations Secretary General has stated ``[n]o 
        company and no government can take on the challenge of AIDS 
        along,'' and that what is needed is a new approach to public 
        health--combining all available resources, public and private, 
        local and global.''
          (16) The World Bank, declaring AIDS not just a public health 
        problem but ``the foremost and fastest-growing threat to 
        development'' in Africa, has launched a new strategy for HIV/
        AIDS in Africa, declaring it a top priority for the Bank on the 
        continent.
          (17) The World Bank estimates that for Africa along 
        $1,000,000,000 to $2,300,000,000 annually is needed for 
        prevention in contrast to the approximately $300,000,000 a year 
        in official assistance currently available for HIV/AIDS in 
        Africa.
          (18) Accordingly, United States financial support for medical 
        research, education, and disease containment as a global 
        strategy has beneficial ramifications for millions of Americans 
        and their families who are affected by this disease, and the 
        entire population which is potentially susceptible.
    (b) Purpose.--The purposes of this Act are to prevent the spread of 
HIV/AIDS and promote its eradication, prevent human suffering, and to 
mitigate the devastating impact of the disease on economic and human 
development, social stability, and security in the developing world, 
through the creation of a trust fund which is designed to--
          (1) work with governments, civil society, non-governmental 
        organizations, the Joint United Nations Program on HIV/AIDS 
        (UNAIDS), the International Partnership Against AIDS in Africa, 
        other international organizations, donor agencies, and the 
        private sector to intensify action against the HIV/AIDS 
        epidemic and to support essential field work in the most 
        affected countries to assist in the development of AIDS 
        vaccines; and
          (2) seek to leverage financial commitments by the United 
        States in order to mobilize additional resources from other 
        donors, the private sector, non-governmental organizations, and 
        recipient countries to combat the spread of HIV/AIDS.

 TITLE I--NEGOTIATIONS FOR THE CREATION OF A WORLD BANK AIDS TRUST FUND

SEC. 101. TRUST FUND TO ASSIST IN HIV/AIDS PREVENTION, CARE AND 
                    TREATMENT, AND ERADICATION.

    The Secretary of the Treasury shall seek to enter into negotiations 
with the International Bank for Reconstruction and Development or the 
International Development Association, and with the member nations of 
such institutions and with other interested parties for the creation of 
a trust fund which would be authorized to solicit and accept 
contributions from governments, the private sector, and non-
governmental entities of all kinds and use the contributions to address 
the HIV/AIDS epidemic in countries eligible to borrow from such 
institutions, as follows:
          (1) Program objectives.--The trust fund would provide only 
        grants, including grants for technical assistance, to support 
        measures to build local capacity in national and local 
        government, civil society, and the private sector to lead and 
        implement effective and affordable HIV/AIDS prevention, 
        education, treatment and care services, and research and 
        development activities, including affordable drugs. In carrying 
        out this objective, the trust fund would coordinate its 
        activities with governments, civil society, nongovernmental 
        organizations, the Joint United Nations Program on HIV/AIDS 
        (UNAIDS), the International Partnership Against AIDS in Africa, 
        other international organizations, the private sector, and 
        donor agencies working to combat the HIV/AIDS crisis.
          (2) Priority.--In providing such grants, the trust fund would 
        give priority to countries that have the highest HIV/AIDS 
        prevalence rate or are at risk of having a high HIV/AIDS 
        prevalence, rate, and that have or agree to carry out a 
        national HIV/AIDS program which--
                  (A) has a government commitment at the highest level 
                and multiple partnerships with civil society and the 
                private sector;
                  (B) invests early in effective prevention efforts;
                  (C) requires cooperation and collaboration among many 
                different groups and sectors, including those who are 
                most affected by the epidemic, religious and community 
                leaders, nongovernmental organizations, researchers and 
                health professionals, and the private sector.
                  (D) is decentralized and uses participatory 
                approaches to bring prevention care programs to 
                national scale; and
                  (E) is characterized by community participation in 
                government policy-making as well as design and 
                implementation of the program, including implementation 
                of such programs by people living with HIV/AIDS, 
                nongovernmental organizations, civil society, and the 
                private sector.
          (3) Governance.--
                  (A) In general.--The trust fund would be administered 
                as a trust fund of the International Bank for 
                Reconstruction and Development. Subject to general 
                policy guidance from the President of the United States 
                and representatives of the other donors to the trust 
                fund, the Trustee would be responsible for managing the 
                day-to-day operations of the trust fund.
                  (B) Selection of projects and recipients.--In 
                consultation with the President and other donors to the 
                trust fund, the Trustee would establish criteria, that 
                have been agreed on by the donors, for the selection of 
                projects to receive support from the trust fund, 
                standards and criteria regarding qualifications of 
                recipients of such support, as well as such rules and 
                procedures as would be necessary for cost-effective 
                management of the trust fund. The trust fund would not 
                make grants for the purpose of project development 
                associated with bilateral or multilateral development 
                bank loans.
                  (C) Transparency of operations.--The Trustee shall 
                ensure full and prompt public disclosure of the 
                proposed objectives, financial organization, and 
                operations of the trust fund.
                  (D) Advisory board.--
                          (i) Appointment.--The President of the United 
                        States and representatives of other 
                        participating donors to the trust fund would 
                        establish an Advisory Board, and appoint to the 
                        Advisory Board renowned and distinguished 
                        international leaders who have demonstrated 
                        integrity and knowledge of issues relating to 
                        development, health care (especially HIV/AIDS), 
                        and Africa.
                          (ii) Duties.--The Advisory Board would, in 
                        consultation with other international experts 
                        in related fields (including scientists, 
                        researchers, and doctors), advise and provide 
                        guidance for the trust fund on the development 
                        and implementation of the projects receiving 
                        support from the trust fund. Once the Advisory 
                        Board is established the Secretary of the 
                        Treasury shall ensure that the Trustee provides 
                        the Advisory Board complete access to all 
                        information and documents of the trust fund 
                        necessary to the effective functioning of the 
                        Advisory Board.

            TITLE II--UNITED STATES FINANCIAL PARTICIPATION

SEC. 201. LIMITATIONS ON AUTHORIZATION OF APPROPRIATIONS.

    In addition to any other funds authorized to be appropriated for 
multilateral or bilateral programs related to AIDS or economic 
development, there are authorized to be appropriated to the Secretary 
of the Treasury $200,000.000 for each of fiscal years 2001 through 2005 
for payment to the trust fund established as a result of negotiations 
entered into pursuant to section 101.

                           TITLE III--REPORTS

SEC. 301. REPORTS TO THE CONGRESS.

    (a) Annual Reports.--Not later than 1 year after the date of the 
enactment of this Act, and annually thereafter for the duration of the 
trust fund established pursuant to section 101, the Secretary of the 
Treasury shall submit to the appropriate committees of the Congress a 
written report on the trust fund, the goals of the trust fund, the 
programs, projects, and activities, including any vaccination 
approaches, supported by the trust fund, and the effectiveness of such 
programs, projects, and activities in reducing the worldwide spread of 
AIDS.
    (b) Appropriate Committees Defined.--In subsection (a), the term 
``appropriate committees'' means the Committees on Appropriations, on 
International Relations, and on Banking and Financial Services of the 
House of Representatives and the Committees on Appropriations, on 
Foreign Relations, and on Banking, Housing, and Urban Affairs of the 
Senate.

                TITLE IV--HIV/AIDS PREVENTIONS AND CARE

SEC. 401. STRENGTHENING LOCAL CAPACITY IN SUB-SAHARAN AFRICA TO 
                    IMPLEMENT HIV/AIDS PREVENTION AND CARE PROGRAMS.

    Title XVI of the International Financial Institutions Act (22 
U.S.C. 262p-262p-7) is amended by adding at the end the following:

``SEC. 1625. STRENGTHENING LOCAL CAPACITY IN SUB-SAHARAN AFRICA TO 
                    IMPLEMENT HIV/AIDS PREVENTION AND CARE PROGRAMS.

    ``The Secretary of the Treasury shall instruct the United States 
Executive Director at the International Bank for Reconstruction and 
Development to use the voice and vote of the United States to encourage 
the Bank to work with Sub-saharan African countries to modify projects 
financed by the Bank and develop new projects to build local capacity 
to manage and implement programs for the prevention of human 
immunodeficiency virus (HIV) and acquired immune deficiency syndrome 
(AIDS) and the care of persons with HIV/AIDS, including through health 
care delivery mechanism which facilitate the distribution of affordable 
drugs for persons infected with HIV.''.

                          purpose and summary

    The purpose of H.R. 3519, the World Bank AIDS Marshall Plan 
Trust Fund Act, as reported out of the Committee on Banking and 
Financial Services with an amendment, is to provide increased 
U.S. support for global efforts to combat HIV/AIDS (human 
immunodeficiency virus/acquired immune deficiency syndrome). As 
articulated in section 2(b) of the bill, the specific purposes 
of the bill are to prevent the spread of HIV/AIDS and promote 
its eradication, prevent human suffering, and mitigate its 
devastating effects on economic development and security, 
through a trust fund that would work with governmental and non-
governmental organizations and leverage a U.S. contribution to 
mobilize additional resources from other donors.
    Findings in Section 2(a) of the bill describe the stunning 
dimensions of the worldwide HIV/AIDS crisis, particularly its 
disproportionate impact on the nations of sub-Saharan Africa. 
The bill requires the Secretary of the Treasury to seek to 
enter into negotiations with the World Bank, its members, and 
other interested parties to create a trust fund to provide 
grants to HIV/AIDS affected countries to implement HIV/AIDS 
prevention, education, treatment and care, and research and 
development activities. Priority consideration would be given 
to countries with the highest HIV/AIDS infection rates (or at 
risk of such rates) and which are committed to national HIV/
AIDS programs. The fund would be administered by the World 
Bank, subject to guidance from the U.S. and other donors on 
project selection and cost-effective management of the fund. 
Full and prompt disclosure of the fund's financing and 
operations would also be required. An advisory board, 
consisting of international experts appointed by the U.S. and 
other donors, would provide guidance to the fund.
    The bill authorizes an annual U.S. contribution to the 
trust fund of $200 million for five years, FY 2001-2005, and 
requires annual reports on the activities of the fund and their 
effectiveness in stemming the global spread of HIV/AIDS.

                  background and need for legislation

    According to the U.S. Surgeon General, HIV/AIDS will soon 
become the worst epidemic of infectious disease in recorded 
history, eclipsing both the bubonic plague of the 1300's and 
the influenza epidemic of 1918-19 which killed more than 20 
million worldwide. Indeed, the global HIV/AIDS epidemic might 
fairly be described as a disease of Biblical proportion.
    Recent statistics in the ``AIDS epidemic update: December 
1999,'' prepared by the Joint United Nations Programme on HIV/
AIDS (UNAIDS), reveal that 16.3 million people have died from 
AIDS worldwide and 33.6 million people are living with the 
deadly disease.
    Among all regions of the world, sub-Saharan Africa has been 
hardest hit by the disease. Although it has only 10 percent of 
the world's population, it accounts for 80 percent of global 
AIDS deaths and nearly 70 percent of the world's current HIV/
AIDS cases. According to Dr. James Sherry of UNAIDS, these 
numbers have outpaced all projections. He cited 1991 
projections by the World Health Organization (WHO) that an 
estimated 9 million would be infected and 5 million dead from 
AIDS in Africa by 1999. Instead, current estimates are double 
to triple those numbers.
    Millions of children have died or been orphaned. Director 
Sandra Thurman of the White House Office of National AIDS 
Policy testified at the Committee's March 8, 2000, hearing 
that, ``In Africa, an entire generation of children is in 
jeopardy.'' She reported that in several sub-Saharan African 
countries, an estimated one-fifth to one-third of all children 
have already been orphaned by the disease and that the worst is 
yet to come. She cited projections that some 40 million 
children will lose one or both parents to AIDS within the next 
10 years. The United Nations Children's Fund (UNICEF), in its 
1999 annual report, called the number of orphans, particularly 
in Africa, ``nothing less than an emergency'' requiring 
``urgent action from the international community.'' Ms. Mary 
Fisher, founder and chair of the Family AIDS Network, testified 
at the hearing about her own visit to Africa, observing that:

          But what dominates the African landscape is orphans. 
        Acres of orphans--orphans raising orphans, because 
        there is no one else left to do it. Tough children take 
        to the streets. Weak children die of starvation. Many 
        just sit, docile and sick, a vast, human ocean of 
        orphans, mostly infected and doomed.

    U.S. Ambassador to the United Nations Richard C. Holbrooke 
described the findings of a December 1999 mission to Africa 
during which his delegation saw first hand, ``the terrible 
costs reaped by AIDS--from the thousands of orphans in Lusaka, 
Zambia who were forced to live in a bus depot, many of whom 
were already infected with HIV; to the six pregnant women in 
Windhoek Namibia, all of whom were infected with AIDS and who 
had to meet with our delegation secretly because of the 
stigmatization associated with the disease.''
    The Committee also heard compelling testimony from 
Ambassador Mary M. Kanya of Swaziland regarding the impact of 
HIV/AIDS on her country. Although Swaziland is the size of New 
Jersey and has just under a million people, it has an HIV 
infection rate of 22 percent. Eighty percent of in-patient beds 
in major hospitals are reportedly occupied by HIV/AIDS cases. 
And she warned that as children drop out of school to fend for 
dying parents or simply to fend for themselves, the number of 
street children will increase. The crisis in Swaziland led the 
King to declare HIV/AIDS a national disaster a year ago.
    Africa's disproportionately high incidence of HIV/AIDS may 
be due to several factors. The pervasive lack of basic health 
infrastructure--clinics, medical personnel, etc.--in many 
countries is stymieing efforts to provide HIV/AIDS testing, 
counseling, and treatment. A reluctance on the part of some 
national governments to openly address the issue--in part 
because of cultural taboos--is also a critical factor in the 
lack of national prevention programs.
    As staggering as the public health statistics are, experts 
increasingly note that the HIV/AIDS epidemic is no longer 
singularly a health issue; it has become a major issue for 
economic development. Assessments by World Bank officials call 
HIV/AIDS ``the foremost and fastest-growing threat to 
development'' in Africa. An unclassified January 2000 National 
Intelligence Estimate (NIE) report on the global infectious 
disease threat concluded that the economic costs of infectious 
diseases, particularly HIV/AIDS, are already significant and 
could reduce GDP by as much as 20 percent or more by 2010 in 
some sub-Saharan African nations. The economic cost of the 
disease is illustrated by two studies: a Namibian study which 
concluded that AIDS cost the country nearly 8% of GDP in 1996, 
and a study of Kenya which projected GDP in 2005 would be 14.5% 
lower than it would be without AIDS.
    According to Director Thurman, professionals--including 
civil servants, engineers, teachers, and others--have been 
particularly hard hit in sub-Saharan Africa. The impact of the 
disease on the working age population is also illustrated by 
data from a 1999 U.S. Census Bureau report, showing that 
average life expectancy in Botswana, Zimbabwe, Swaziland, 
Malawi, and Zambia has decreased from approximately age 65 to 
approximately age 40--the lowest life expectancy in the world.
    In terms of net global costs from AIDS, the NIE cites 
estimates by the Global AIDS Policy Coalition at Harvard 
University suggesting that by this year--2000--the cumulative 
direct and indirect costs of AIDS are likely to have exceeded 
$500 billion.
    HIV/AIDS poses a threat to global security as well. 
According to the January 2000 NIE, HIV/AIDS prevalence rates in 
selected sub-Saharan militaries range from 10-60 percent. For 
example, the prevalence rates in the militaries of Angola and 
the Democratic Republic of the Congo are estimated at 40 to 60 
percent, and in Tanzania at 15 to 30 percent. The disease can 
also affect security in less direct ways. Treasury 
Undersecretary Timothy F. Geithner told the committee in his 
testimony that the national economic distress and political 
instability accompanying significant human losses can undercut 
the world economy and regional stability. Ambassador Holbrooke 
also noted that HIV/AIDS is a security issue, pointing out that 
the UN Security Council for the first time in its history of 
4,086 meetings held a session January 10, 2000, to address a 
health issue as a security threat.
    The epidemic, as horrific as it is in sub-Saharan Africa, 
is far from confined to that region. The NIE cites UNAIDS 
epidemiologists who warn that Asia alone is likely to outstrip 
sub-Saharan Africa in the absolute number of HIV carriers by 
2010. Current UNAIDS estimates show some 6 million HIV/AIDS 
cases in South and Southeast Asia, a rate of HIV infection in 
the Caribbean second only to sub-Saharan Africa, and a doubling 
of HIV infections in just two years in the former Soviet Union.
    Clearly the United States has a strong national interest in 
combating the global HIV/AIDS crisis. Infectious diseases, like 
HIV/AIDS, know no borders. Although HIV/AIDS was first 
identified in the U.S. in 1983, scientists believe it 
originated in sub-Saharan Africa. The number of Americans 
travelling abroad--often to countries posing a high risk of 
infectious diseases of all kinds--has increased significantly. 
In fact, more than 57 million Americans traveled abroad in 
1998, more than double the number a decade earlier. Travel and 
commerce will remain key factors in the spread of infectious 
diseases like HIV/AIDS.
    Despite the grim statistics on the global HIV/AIDS 
epidemic, there is reason for hope. Several nations--including 
Uganda and Senegal in Africa and Thailand in Asia--have 
implemented national HIV/AIDS programs that have curtailed the 
incidence of infection in their own populations. Dr. James 
Sherry of UNAIDS told the Committee that, ``We are far from 
powerless against this epidemic. We have solid experience with 
what works . . .'' Another witness, Dr. Gary Slutkin, argued 
that the successes of Uganda could be replicated elsewhere. He 
testified that, ``There was nothing that was facilitated or 
supported in Uganda that could not have happened in the 
majority of the remaining countries currently overwhelmed by 
the AIDS epidemic.''
    In the area of mother-to-child transmission, Dr. Catherine 
Wilfert testified about a joint U.S./Uganda study of a 
promising new and affordable drug treatment--nevirapine--that 
could reduce mother to child transmission of HIV by 47 percent. 
Dr. Thomas Welty, a medical epidemiologist with the Cameroon 
Baptist Convention Health Board, submitted written testimony on 
a pilot study of the same drug in Cameroon. A study published 
in the March 1, 2000, issue of the Journal of the American 
Medical Association (JAMA) also demonstrates that avoidance of 
breast-feeding can significantly decrease the risk of mother-
to-child transmission of HIV/AIDS for infants not already 
infected before or during birth. The data on the above programs 
as well as other research suggests that effective programs 
worthy of consideration in curbing the risk of mother-to-child 
transmission include testing, counseling, treatment, and making 
feeding supplies available to HIV-infected mothers who choose 
not to continue breast-feeding.
    Broad multilateral planning efforts to combat HIV/AIDS in 
Africa are underway as well. UN agencies, African and other 
national governments, international donors and private 
organizations are nearing completion of an action plan for AIDS 
in Africa called, the ``International Partnership against HIV/
AIDS in Africa.''
    Despite these promising developments, resources to support 
these initiatives are not keeping pace. According to a 1999 
study prepared by UNAIDS and the Francois-Xavier Bagnoud Center 
for Health and Human Rights at the Harvard School of Public 
Health, HIV/AIDS is spreading three times faster than funding 
available to control it. The World Bank recently estimated that 
$1 billion to $2.3 billion is needed annually for prevention in 
Africa alone. That figure is far in excess of approximately 
$350 million that international donors are estimated to be 
providing for the region. While U.S. assistance has accounted 
for roughly half of that, significantly greater resources are 
needed.
    The legislation before the Committee--H.R. 3519--seeks to 
address the urgent need for global AIDS resources by leveraging 
a U.S. contribution of $200 million a year over the next five 
years to mobilize potentially more than a billion dollars a 
year from other governmental and private sector donors.
    In addition to its role as one of six co-sponsoring members 
of UNAIDS, along with UNICEF and the World Health Organization, 
the World Bank has launched its own strategy to combat HIV/AIDS 
in Africa, declaring it a top priority for the Bank in the 
region. Its role as an international financial institution and 
its commitment to combating HIV/AIDS make the Bank a logical 
vehicle for expanded multilateral financing.
    The trust fund approach, as proposed in H.R. 3519, has 
ample precedent at the World Bank and allows donors to target 
resources to specific problems. Such trust funds are highly 
flexible financial arrangements between the Bank and one or 
more donors under which the donor(s) entrust the Bank to 
administer funds for specific development-related activities. 
The objectives and policies of the trust fund are established 
by the donor(s). The trust fund policy objectives should, 
however, be in harmony with international development 
priorities and the Bank's country assistance strategies. The 
trust fund envisioned in the bill will ensure that the U.S. and 
other donors will be able to establish policies for the fund 
and its activities, and to require full transparency of all of 
its financing and operations.
    By utilizing the trust fund mechanism, the Committee is 
emphasizing a multilateral, burden-sharing approach to the 
global AIDS crisis. Using the World Bank also sends an 
important signal to affected countries. As Undersecretary 
Geithner said, ``Health issues are not usually considered the 
province of Finance Ministries, but they should be.'' As such, 
H.R. 3519 helps to underscore the necessity for this issue to 
be dealt with at the highest levels of government.

                                hearings

    H.R. 3519, the World Bank AIDS Prevention Trust Fund Act, 
was introduced on January 24, 2000, by Chairman James A. Leach 
(R-IA), and has 25 cosponsors.
    On March 8, 2000, the Committee held a hearing on H.R. 
3519. Testifying at the hearing were: the Honorable John F. 
Kerry, United States Senator; the Honorable Amo Houghton, 
United States Representative; the Honorable Richard C. 
Holbrooke, United States Ambassador to the United Nations; the 
Honorable Sandra L. Thurman, Director of the White House Office 
of National AIDS Policy; the Honorable Timothy F. Geithner, 
Undersecretary, U.S. Department of Treasury; Ms. Mary Fisher, 
Founder and Chair of the Family AIDS Network; Ms. Mpule 
Kwelagobe, Miss Universe 1999; Her Excellency Mary M. Kanya, 
Ambassador from the Kingdom of Swaziland; Dr. James Sherry, 
Director of Program Development and Coordination at UNAIDS; Dr. 
Gary Slutkin, Professor of International Health at the 
University of Illinois School of Public Health and Formerly 
Chief of Prevention of the WHO Global Programme on AIDS; Dr. 
Catherine Wilfert, Scientific Director of the Elizabeth Glaser 
Pediatric AIDS Foundation; and former Member of Congress Ronald 
Dellums, President of Healthcare International Management 
Company and Chairman of the Constituency for Africa. Written 
testimony was provided by the Honorable Richard A. Gephardt, 
Minority Leader of the U.S. House of Representatives; Dr. 
Thomas K. Welty, Medical Epidemiologist, Cameroon Baptist 
Convention Health Board; Mr. Kenneth Weg, Vice Chairman of the 
Bristol-Myers Squibb Company; actor Danny Glover; and the Ford 
Motor Company.

                   committee consideration and votes

    On March 15, 2000, the full Committee met in open session 
to mark up H.R. 3519. The Committee called up a Manager's 
Amendment as original text for purposes of amendment. The 
Manager's Amendment, developed in close coordination with 
Ranking Member John LaFalce and Committee member Barbara Lee, 
herself the author of the AIDS Marshall Plan Fund for Africa 
Act (H.R. 2765), clarified that Trust Fund operations would be 
tightly coordinated with the Joint United Nations Program on 
HIV/AIDS (UNAIDS), the International Partnership Against AIDS 
in Africa, and other agencies and donors in order to maximize 
its catalytic impact; that the Trust Fund's purpose is to 
maximally leverage U.S. financial commitments in order to 
mobilize additional resources from other donors, the private 
sector, NGOS, and recipient countries; that the Trust Fund 
would only provide grant assistance, and not loans; that in 
providing grants, the trust fund would give priority to 
countries that have the highest HIV/AIDS prevalence rates, or 
are at risk of having a high HIV/AIDS prevalence rates, and 
that have shown a strong governmental commitment to combating 
HIV/AIDS, by developing partnerships with the private sector, 
communities, NGOS, and people infected or affected by HIV; that 
Trust Fund operations would be fully and promptly disclosed to 
the public; that the Trust Fund would receive advice from a 
distinguished international Advisory Board; and that 
accountability to Congress and the public would be strengthened 
by requiring annual reports on the trust fund, its goals, 
programs, projects, and activities, and the effectiveness of 
such activities in reducing the worldwide spread of AIDS.
    During the markup, several amendments were offered. Ms. 
Schakowsky offered an amendment to clarify that HIV/AIDS 
programs funded by grants should be ``affordable'' and that 
funds for research and development could include affordable 
drugs. The amendment was adopted on a voice vote.
    An amendment was offered by Ms. Waters to authorize the 
trust fund to provide technical assistance to grant recipients 
and to include in the ``priority'' provisions governments that 
may not yet have national HIV/AIDS programs but have agreed to 
implement such programs. The amendment was adopted by voice 
vote after agreement was reached that the technical assistance 
could be provided by way of grants for such purposes since the 
fund would be expected to have little staff.
    Another amendment was offered by Ms. Waters to double the 
authorization level for a U.S. contribution to the World Bank 
trust fund in Section 201 from $100 million a year for five 
years to $200 million a year for five years. Opponents 
indicated sympathy for Ms. Water's views but expressed concern 
that such a high level of spending might derail the bill and 
make it more difficult to bring it to the House Floor. The 
amendment was adopted by a vote of 13 to 12.
        YEAS                          NAYS
Mr. LaFalce                         Mr. Leach
Mr. Frank                           Mrs. Roukema
Ms. Waters                          Mr. Bereuter
Mrs. Maloney                        Mr. Lazio
Mr. Bentsen                         Mr. Royce
Mr. Maloney                         Mr. Metcalf
Mr. Sherman                         Mr. Barr
Mr. Meeks, G.                       Mrs. Kelly
Ms. Lee                             Dr. Paul
Ms. Schakowsky                      Mr. Sweeney
Mr. Moore                           Mrs. Biggert
Mrs. Jones                          Mr. Terry
Mr. Capuano

    An amendment offered by Mr. LaFalce and Ms. Waters to 
require the Secretary of the Treasury to direct the U.S. 
Executive Director to the World Bank to use his or her voice 
and vote to promote the availability of affordable HIV/AIDS 
drugs was also adopted by voice vote.
    The Manager's Amendment, as amended, was adopted by a voice 
vote. Subsequently, H.R. 3519, as amended, was ordered reported 
by a vote of 27-4.
        YEAS                          NAYS
Mr. Leach                           Mr. Metcalf
Mr. Bereuter                        Mr. Barr
Mr. Lazio                           Dr. Paul
Mr. King                            Mr. Riley
Mrs. Kelly
Mrs. Biggert
Mr. LaFalce
Mr. Frank
Ms. Waters
Mr. Sanders
Mrs. Maloney
Mr. Gutierrez
Ms. Velazquez
Mr. Watt
Mr. Ackerman
Mr. Bentsen
Mr. Maloney
Ms. Carson
Mr. Sherman
Mr. Sandlin
Mr. Meeks, G.
Ms. Lee
Mr. Inslee
Ms. Schakowsky
Mr. Moore
Mrs. Jones
Mr. Capuano

                      committee oversight findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

         committee on government reform and oversight findings

    In compliance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, no oversight findings have 
been submitted to the Committee by the Committee on Government 
Reform.

                        constitutional authority

    In compliance with clause 3(d)(1) of rule XIII of the Rules 
of the House of Representatives, the Constitutional Authority 
for Congress to enact this legislation is derived from Article 
I, section 8, clause 1 (relating to the general welfare of the 
United States): Article I, section 8, clause 3 (relating to 
Congressional power to regulate commerce); Article 1, section 
8, clause 5 (relating to the power ``to coin money'' and 
``regulate the value thereof''); Article I, section 8, clause 
18 (relating to making all laws necessary and proper for 
carrying into execution powers vested by the Constitution in 
the government of the United States).

               new budget authority and tax expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, please see the attached 
Congressional Budget Office cost estimate.

                      advisory committee statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                    congressional accountability act

    The reporting requirement under section 102(b)(3) of the 
Congressional Accountability Act (P.L. 104-1) is inapplicable 
because this legislation does not relate to terms and 
conditions of employment or access to public services or 
accommodations.

    congressional budget office cost estimate and unfunded mandates 
                                analysis

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 22, 2000.
Hon. James A. Leach,
Chairman, Committee on Banking and Financial Services, House of 
        Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3519, the World 
Bank AIDS Marshall Plan Trust Fund Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Joseph C. 
Whitehill.
            Sincerely,
                                          Barry B. Anderson
                                    (For Dan L. Crippen, Director).
    Enclosure.

H.R. 3519--World Bank AIDS Marshall Plan Trust Fund Act

    Summary: H.R. 3519 would authorize the Secretary of the 
Treasury to negotiate with the World Bank and other donor 
countries to create a new trust fund within the bank. The trust 
fund would provide grants to countries eligible to borrow from 
the bank to help them deal with the HIV/AIDS epidemic. The bill 
would authorize the appropriation of $200 million a year over 
the 2001-2005 period for contributions to the fund. Based on 
experience with other facilities administered by the bank, CBO 
estimates that appropriation of the authorized amounts would 
result in additional outlays of $338 million over the next five 
years. Because H.R. 3519 would not affect direct spending or 
receipts, pay-as-you-go procedures would not apply.
    H.R. 3519 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 3519 is shown in the following table. 
The costs of this legislation fall within budget function 150 
(international affairs).

----------------------------------------------------------------------------------------------------------------
                                                                By fiscal year, in millions of dollars
                                                     -----------------------------------------------------------
                                                        2000      2001      2002      2003      2004      2005
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPRORPIATION

Authorization level.................................         0       200       200       200       200       200
Estimated outlays...................................         0         0        12        62       112       152
----------------------------------------------------------------------------------------------------------------

    For purposes of this estimate, CBO assumes the enactment of 
H.R. 3519 and subsequent appropriation of the authorized 
amounts. Based on experience with other facilities operated by 
multilateral development banks, CBO estimates that it will take 
the bank and donor community more than one year to organize the 
operations of the trust fund and to begin making grants. CBO 
assumes that project selection and subsequent grants would 
augment lending by the bank, thus limiting administrative 
overhead. We also assume that the appropriated amounts would be 
provided to the trust fund as a letter of credit that would be 
drawn upon as needed to finance the grants, thus spreading 
outlays over a number of years. Using those assumptions, CBO 
estimates that approximately one-third of the authorized 
amounts would be disbursed over the next five years. CBO also 
estimates that the costs of negotiations and reporting 
requirements would be negligible.
    Pay-as-you-go considerations: None.
    Intergovernmental and private-sector impact: H.R. 3519 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Estimate prepared by: Federal costs: Joseph C. Whitehill; 
impact on State, local, and tribal governments: Leo Lex; impact 
on the private sector: Patrice Gordon.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                      SECTION-BY-SECTION ANALYSIS

Section 1. Short title

    This section cites the short title of the bill as the 
``World Bank AIDS Marshall Plan Trust Fund Act''.

Section 2. Findings and purposes

    Subsection (a) of this section articulates several 
Congressional findings of fact including that the HIV/AIDS 
epidemic will soon become the worst epidemic in recorded 
history; that 33.6 million people are living with AIDS, of 
which 95 percent are in the developing world; that 3.6 million 
children 14 and under have died of AIDS and that 1.2 million 
are living with it; that sub-Saharan Africa which has only 10 
percent of the world's population has had more than 80 percent 
of AIDS deaths and has nearly 70 percent of current cases; that 
an entire generation of children in Africa is in jeopardy with 
nearly 40 million expected to be orphaned by 2010; that UNICEF 
has declared the number of orphans in Africa an emergency; that 
the U.S. Census Bureau is reporting significant declines in 
life expectancy in several African nations; that a recent 
National Intelligence Estimate says the economic costs of 
infectious diseases, especially HIV/AIDS, could cut GDP by as 
much as 20 percent in some sub-Saharan nations by 2010; that 
HIV infection rates in certain African nations are 15 to 60 
percent; that the epidemic is threatening other regions 
including Asia, the Caribbean, and the former Soviet Union; 
that some countries have effectively implemented HIV/AIDS 
programs; that AIDS has no boundaries; that the disease is 
spreading three times faster than funding to control it; that 
the UN Secretary General says the problem cannot be handled by 
any one country; that the World Bank says HIV/AIDS is the 
fastest growing threat to economic development in Africa and 
that $1 billion to $2.3 billion is needed annually for 
prevention in that region alone; and U.S. support for HIV/AIDS 
research, education, and containment will have benefits for 
American and their families who are affected by or susceptible 
to this disease.
    Subsection (b) declares the purposes of the Act to prevent 
the spread of HIV/AIDS and promote its eradication, to prevent 
human suffering, and to mitigate the disease's impact on 
development, stability, and security in the developing world 
through the creation of a trust fund to: (1) work with 
governments at all levels and the private sector to intensify 
action against the disease and to support field work in 
affected countries to help develop AIDS vaccines; and (2) 
leverage U.S. contributions in order to mobilize additional 
resources from other governmental and private sector donors.

 Title I. Negotiations for the Creation of a World Bank Aids Trust Fund


Section 101. Trust fund to assist in HIV/AIDS prevention, care and 
        treatment, and eradication

    Section 101 requires the Secretary of the Treasury to seek 
to enter into negotiations with the World Bank, its members, 
and other interested parties, to create a trust fund which 
would be authorized to solicit and accept contributions from 
governments, the private sector, and non-governmental entities. 
Trust fund proceeds would be used to address the HIV/AIDS 
epidemic in affected countries by providing grants for local 
capacity building to implement effective HIV/AIDS prevention, 
education, treatment and care, and reserve and development 
activities. The trust fund is to coordinate its activities with 
other governments, international organizations, and private 
sector groups. Funding priority is to be given to nations with 
the highest HIV infection rates (or at risk of having high 
rates) and which have (or are committed to having) national 
HIV/AIDS programs characterized by top level government 
commitment and multiple partnerships with those affected by the 
disease, religious and community leaders, health professionals, 
and other entities.
    The trust fund is to be administered by the World Bank, as 
``trustee,'' subject to policy guidance from the United States 
and other donors. The trustee, in consultation with the 
President and other donors, will establish criteria regarding 
selection of projects, qualifications of recipients, and rules 
for cost-effective management. Grants are not be extended for 
the purpose of project development associated with bilateral or 
multilateral development bank loans. The trustee is to ensure 
full and prompt public disclosure of the finances and 
operations of the trust fund.
    The President of the United States and representatives of 
other donors to the trust fund are to establish an advisory 
board of international experts to provide guidance to the trust 
fund on projects to be supported.

            Title II. United States Financial Participation


Section 201. Limitations on authorization of appropriations

    This section provides that in addition to other funds 
authorized for AIDS or economic development programs, there are 
authorized to be appropriated $200 million each year for five 
years (fiscal years 2001 to 2005) for payment to the trust 
fund.

                           Title III. Reports


Section 3. Reports to the Congress

    The Secretary of the Treasury is required to submit annual 
reports to appropriate committees of Congress on the trust 
fund, its goals, programs, projects, and activities, including 
any vaccination approaches, and the effectiveness of such 
programs in reducing the worldwide spread of AIDS.

                 Title IV. HIV/AIDS Prevention and Care


Section 401. Strengthening local capacity in sub-Saharan Africa to 
        implement HIV/AIDS prevention and care programs.

    This section amends the International Financial 
Institutions Act to require the Secretary of the Treasury to 
instruct the U.S. Executive Director at the World Bank to use 
the voice and vote of the United States to encourage the Bank 
to work with sub-Saharan African countries to modify existing 
Bank projects and develop new projects to build local capacity 
to manage and implement HIV/AIDS prevention and care programs, 
including through health care delivery mechanisms which 
facilitate the distribution of affordable drugs.
    The Committee notes that the availability of affordable 
drugs--even drugs which have been donated free-of-charge--will 
be of little utility to those suffering from HIV/AIDS if the 
health systems and infrastructure necessary to distribute and 
administer such medications is lacking. For example, according 
to experts, in order for antiretroviral drug therapies to be 
used effectively against HIV/AIDS in Africa, there must be 
functioning health systems, trained health professionals, 
access to testing and early diagnosis, counseling on adherence 
to the medication's regime, and regular monitoring. According 
to the International Federation of Pharmaceutical Manufacturers 
Associations, inappropriate use of powerful anti-retroviral 
drugs ``can and has resulted in strains of HIV developing which 
are resistant to all known treatments, making our search for a 
cure even more difficult.''

                            DISSENTING VIEWS

    While the AIDS epidemic is a real problem and should be 
addressed, we are concerned that the approach in this bill will 
make a bad situation worse. HR 3519, the World Bank AIDS 
Prevention Trust Fund Act, duplicates existing programs, is 
costly, will very likely be counter-productive and comes at a 
most inopportune time.
    The bill would establish a World Bank program to duplicate 
the efforts of existing bilateral and multilateral programs 
through the US Agency for International Development and the 
United Nations, for example. USAID has had an AIDS program for 
Africa since 1986. The United States appropriates $200 million 
a year for AIDS-related foreign aid (of which $104 million goes 
for programs in Africa). In addition, the United States funds 
United Nations programs that spend hundreds of millions of 
dollars annually. All money diverted to fund a new, duplicative 
bureaucracy is money that could have been used for AIDS 
prevention or treatment programs.
    The new program will prove to be very costly. The $2 
billion appropriation over the next five years spends the 
budget surplus that is needed to shore up the Social Security 
Trust Fund and return some of the hard-earned money back to the 
taxpayers.
    Despite the best intentions of the supporters of the 
legislation, the World Bank AIDS Prevention Trust Fund will 
most likely only exacerbate the problem: Because aid money is 
fungible, it pays for foreign and civil wars and feeds 
corruption. HIV infection rates are high among soldiers in 
Africa who are a common route of transmission. In addition, the 
World Bank lent Russia $100 million, part of a package of more 
than $750 million, despite the Chechen military crisis; replied 
Grigory Yavlinsky, leader of a liberal reformist party, ``It's 
senseless to give money to Russia until corruption has been 
reduced'' (Financial Times, Dec. 29, 1999).
    The World Bank aided the Sharif government in Pakistan in a 
partisan investigation of corruption of the regime's political 
enemies. The Bank recently set up a $50 million ``leveraged 
insurance facility for trade and investment'' program in 
Kazakhstan to compensate foreign companies that suffer lost 
revenues as a result of corruption, legal changes or political 
instability. The program mirrors one in the former Soviet bloc 
where World Bank and IMF funds are well known to feed the 
corruption that it now aims to ``insure'' against and 
investigate.
    Aid money stifles local movements toward democracy and 
better domestic government by channeling money through existing 
(often well-entrenched) governments that created the policies 
conducive to the poverty and lack of education that facilitated 
the spread of AIDS. The success or failure of AIDS prevention 
depends on local will as the success in Senegal demonstrates. 
According to James Wolfensohn, president of the World Bank, 
Latin America is no better off now after two decades of IMF/
World Bank reforms: the gap between rich and poor was the worst 
in the world, 80% of the region's 30 million indigenous live in 
poverty, and 40 million more people live below the poverty line 
now than 20 years ago (Financial Times Feb 4, 2000). There is 
no reason to believe that the World Bank's record preventing 
AIDS will be any more successful than its poverty reduction 
programs.
    The Congressionally-mandated International Financial 
Institution Advisory Commission recently issued its report 
mapping out a blueprint of substantive, constructive reforms 
for the Bretton Woods institutions. Ideally, Congress would 
pass HR 1147, the Bretton Woods Sunset Act, in order to force a 
badly needed debate about the role of the Bretton Woods 
institutions.
    One member of the commission, Adam Lerrick, formerly head 
of product development at Credit Suisse First Boston, outlined 
a critique of the World Bank in a December 1999 Euromoney 
article, ``Has the World Bank Lost its way?'' In the article, 
he points out that only eleven countries (including the 
Communist regime in China, the kleptocracy in Russia, the 
world's longest-serving one-party ``democracy'' Mexico, and the 
brutal Suharto dictatorship in Indonesia) received 70% of World 
Bank resources between 1993 and 1999 with 145 other nations 
fighting for the remaining 30%. Those privileged eleven had 
ready access to private capital: World Bank resources amounted 
to only one percent and private sector resources 99% of 
resources received over the same period. ``The Bank's own 
research shows that flows under these [current lending] 
conditions are not beneficial and may even be counter-
productive,'' he explained.
    For the reasons outlined above, we believe that the World 
Bank is not the preferred institution to address successfully 
the AIDS prevention question and that any funding for World 
Bank AIDS prevention programs should result from a re-
orientation of its existing resources.

                                   Ron Paul.
                                   Bob Barr.

                            ADDITIONAL VIEWS

    It is important to note that AIDS is a global issue. What 
happens overseas always affects what happens in the U.S. It is 
in America's national interest to ensure that we do all we can 
to assist all countries in addressing HIV/AIDS, not only 
because of the potential for a tremendous loss of life, but for 
economic, political and security reasons.
    Globally, about 2.6 million people worldwide will die of 
AIDS this year, the most of any year since the epidemic began, 
according to a report by the United Nations AIDS program. About 
16.3 million people have already died of AIDS since 1981. In 
addition, about 5.6 million new infections with the human 
immunodeficiency virus (HIV) will occur this year, raising the 
number of people currently living with the disease to about 
33.6 million, with more than 23 million of those individuals 
being in sub-Saharan Africa. More than 1.3 million individuals 
living with HIV and AIDS are in Latin America and some 360,000 
are in the Caribbean. It is estimated that some 920,000 
individuals living with HIV and AIDS are in North America.
    Some 300,000 American are infected with HIV and do not know 
it since they have never been tested for HIV infection. Sadly, 
my own city of San Antonio has experienced over 3,704 cases of 
people with AIDS. 53% of these people have died. This means 
that over 1,950 people in San Antonio have died from this 
disease. Of the reported cases of AIDS in San Antonio, 48% are 
in the Hispanic community, 39% are White and 11% are Black. The 
majority of San Antonio's population is of Hispanic origin and 
maintains close ties to Mexico and other countries in Central 
and South America. Many return to visit, to work and live, and 
then return to the United States. Many of my constituents are 
very interested in reuniting with their families, bring family 
members to the U.S. to visit or become U.S. citizens.
    AIDS has affected Hispanics in San Antonio more than in 
most other communities around the country. One thing we can all 
do is to continue to educate our friends and relatives about 
AIDS, not only as to its causes but also on its impact on our 
local, national and global community. We can also push for 
increased funds for research and treatment of this deadly 
disease.
    Our efforts targeting African Americans here in the United 
States, and our efforts to address AIDS in Africa and elsewhere 
are to be commended and expanded. We must do more for those 
most in need, and we must do more to prevent HIV from becoming 
a problem in those areas where it has not yet established 
itself. To do any less is to allow a disease that we can 
prevent. And we must begin now to look at how we address AIDS 
in Latin America so that we can prevent it from becoming the 
next epicenter of the epidemic. Public health practices have 
shown that it is must more effective to prevent an illness than 
to treat an illness. Clearly, what we do now in our efforts to 
address HIV will affect the quality of our lives tomorrow.
    We must fight the complacency that is threatening our 
efforts to address HIV and AIDS in the U.S. and worldwide. Yes, 
new drug combination therapies have prolonged the lives of many 
Americans who have access to them, who can afford them, and who 
can tolerate them. Unfortunately, not all have access or can 
afford them. Imagine how difficult it will be for those in 
countries outside the U.S. whose average health care 
expenditures are less than a few hundred dollars a year to pay 
for drugs which can cost up to $14,000 a year in the United 
States. Unfortunately, many of our leaders are still afraid to 
discuss HIV/AIDS in public. This silence is also evident in 
many Latin American countries where AIDS is just starting to 
take hold. This silence only leads to continued denial that 
AIDS is affecting Latinos, and it will only lead to additional 
infections and deaths. By not publicly discussing HIV/AIDS, we 
send a message to our community that AIDS is not an issue of 
concern to us or that it is taboo. The number of cases, new 
infections, and deaths in our community have shown that our 
silence has been deadly.
    The Congressional Hispanic Caucus, of which I am a member, 
is proud of its role in securing additional funding and in 
providing leadership in this area. But we have a long way to 
go. We need the Hispanic community, especially our Hispanic 
leaders both here in the U.S. and in other countries, to expand 
their efforts. The Congressional Hispanic Caucus believes that 
health issues that disproportionately affect Latinos must be 
addressed openly and publicly. The Caucus understands the 
importance of public leadership in addressing HIV/AIDS as a 
means to educate the public of the impact that HIV/AIDS is 
having on the Latino community both here and internationally.
    I submit these comments to honor those from the Hispanic 
and other communities who have lost their lives to this dreaded 
disease and to remind the House, the country and the world that 
AIDS is indeed threatening the lives of a wide variety of 
people.

                                               Charles A. Gonzalez.

                            ADDITIONAL VIEWS

    I am pleased with the leadership and commitment 
demonstrated by both Chairman Leach and Ranking Member LaFalce 
have shown in addressing the AIDS crisis in Africa. I believe 
that the diligence of the hearing and mark up on H.R. 3519, the 
World Bank AIDS Prevention Trust Fund Act, represents the 
necessary response to the urgency of the AIDS crisis in Africa. 
The World Bank AIDS Marshall Plan Trust Fund Act represents the 
most effective, bipartisan strategy possible to push this issue 
to the national forefront.
    As we work to establish partnerships and relationships with 
African countries, whether as healthcare experts, business 
people, activists or policy makers, it is imperative that we 
unite to focus both attention and resources on the global 
emergency of HIV/AIDS, which wreaks havoc in developing 
countries, most tragically in Sub-Saharan Africa.
    Because the AIDS virus is insidious in nature, and 
prevention demands a multi-faceted approach, I have advocated 
for policies that will aggressively fight HIV/AIDS both 
domestically and internationally.
    Last April, I participated in a Presidential Delegation to 
Southern Africa to examine the growing crisis of African 
Children orphaned by AIDS. These children now total 7.8 million 
and are estimated to reach 40 million by 2010. The 1999 UNICEF 
report states that ``the number of orphans, particularly in 
Africa, constitutes nothing less than an emergency, requiring 
an emergency response from the international community.''
    The orphan crisis alone, reinforces our moral imperative to 
address this pandemic. HIV/AIDS in Africa has created an 
economic crisis, crippling Africa's workforce in many areas and 
creating even greater economic instability where poverty is 
ever-present. For example, some companies are now hiring two 
employees for each skilled job, assuming that one will die from 
AIDS. Successful and sustainable economic partnerships with 
African nations cannot be created, these include initiatives 
that are vital to many businesses in the Bay Area.
    HIV/AIDS also poses serious national security concerns not 
only to the continent of Africa, but the worldwide. Perhaps the 
most stunning example is the National Intelligence Estimate 
which indicates that militias in Angola and the Democratic 
Republic of the Congo show HIV prevalence rates of 40-60%.
    The United States must take the lead in developing an 
immediate and sustained response to this crisis in Africa and 
globally. The World Bank AIDS Marshall Plan Trust Fund Act 
should serve as a replicable model for addressing this crisis 
on a local, national or regional level.
    Despite the grim statistics on the spread of HIV/AIDS, we 
know that countries like Uganda, Senegal and Thailand have 
implemented prevention programs that have substantially curbed 
the rate of infection. AIDS experts have identified strategies 
that would make a difference in regions where AIDS cases 
continue to escalate.
    So, our message is clear: today we must press forward with 
our commitment to fight the war against HIV/AIDS and to stem 
the tide of death.
    AIDS, like all diseases, knows no boundaries. There is no 
guarantee that the scale of the problem in one continent can be 
contained within that region.
    It is estimated that 6000 people die of AIDS each day in 
Africa. Since I introduced the AIDS Marshall Plan last August, 
nearly 1.3 million people have died.
    Everyday, evidence that justifies our actions mounts. 
Evidence showing how we can marshal our support and resources 
to help fight this war, save lives and prevent the spread of 
HIV becomes clearer.
    The question has arisen, why Africa, why now? As it is most 
simply put, the house is burning down and there are people who 
are alive still inside. We have to get them out by any means 
necessary. In this time of unprecedented surpluses, I believe 
that we have the capacity and we should provide even more 
support to fight AIDS in Africa and throughout the world. 
Congress must pass legislation to address the AIDS pandemic in 
Africa.
    I commend the Chairman and Ranking Member for their 
leadership and challenge my colleagues to join in this historic 
and monumental effort.
    Thank you.
                                                       Barbara Lee.

                                
