[House Report 107-137]
[From the U.S. Government Publishing Office]
107th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 107-137
======================================================================
GLOBAL ACCESS TO HIV/AIDS PREVENTION, AWARENESS, EDUCATION, AND
TREATMENT ACT OF 2001
_______
July 12, 2001.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Hyde, from the Committee on International Relations, submitted the
following
R E P O R T
[To accompany H.R. 2069]
[Including cost estimate of the Congressional Budget Office]
The Committee on International Relations, to whom was
referred the bill (H.R. 2069) to amend the Foreign Assistance
Act of 1961 to authorize assistance to prevent, treat, and
monitor HIV/AIDS in sub-Saharan African and other developing
countries, having considered the same, reports favorably
thereon with an amendment and recommends that the bill as
amended do pass.
TABLE OF CONTENTS
Page
The Amendment.................................................... 2
Purpose and Summary.............................................. 9
Background and Need for the Legislation.......................... 10
Hearings......................................................... 12
Committee Consideration.......................................... 12
Votes of the Committee........................................... 12
Committee Oversight Findings..................................... 12
New Budget Authority and Tax Expenditures........................ 13
Congressional Budget Office Cost Estimate........................ 13
Performance Goals and Objectives................................. 15
Constitutional Authority Statement............................... 15
Section-by-Section Analysis...................................... 15
New Advisory Committees.......................................... 21
Congressional Accountability Act................................. 21
Federal Mandates................................................. 21
Changes in Existing Law Made by the Bill, as Reported............ 21
The Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Global Access to HIV/AIDS
Prevention, Awareness, Education, and Treatment Act of 2001''.
SEC. 2. FINDINGS; SENSE OF CONGRESS.
(a) Findings.--Congress makes the following findings:
(1) According to the Joint United Nations Programme on HIV/
AIDS (UNAIDS) more than 58,000,000 people worldwide have
already been infected with HIV/AIDS, a fatal disease that is
devastating the health and economies in dozens of countries in
Africa and increasingly in Asia, the Caribbean region, and
Eastern Europe.
(2) The HIV/AIDS pandemic has erased decades of progress in
improving the lives of families in the developing world and has
claimed 22,000,000 lives since its inception.
(3) More than 17,000,000 individuals have died from HIV/
AIDS in sub-Saharan Africa alone.
(4) The HIV/AIDS pandemic in sub-Saharan Africa has grown
beyond an international public health issue to become a
humanitarian, national security, and developmental crisis.
(5) The HIV/AIDS pandemic is striking hardest among women
and girls. According to UNAIDS, by the end of 2000, fifty-five
percent of the HIV-positive population in sub-Saharan Africa
and 40 percent of such population in North Africa and the
Middle East were women, infected mainly through heterosexual
transmission. In Africa, 6 out of 7 children who are HIV
positive are girls.
(6) An estimated 1,400,000 children under age 15 were
living with HIV/AIDS at the end of 2000, of which 1,100,000
were children living in sub-Saharan Africa. An estimated
500,000 children died of AIDS during 2000, of which 440,000
were children in sub-Saharan Africa. In addition there are an
estimated 13,200,000 children worldwide who have lost one or
both of their parents to HIV/AIDS, of which 12,100,000 are
children in sub-Saharan Africa.
(7) Mother-to-child transmission is the largest source of
HIV infection in children under age 15 and the only source for
very young children. The total number of births to HIV-infected
pregnant women each year in developing countries is
approximately 700,000.
(8) Counseling and voluntary testing are critical services
to help infected women accept their HIV status and the risk it
poses to their unborn child. Mothers who are aware of their
status can make informed decisions about treatment, replacement
feeding, and future child-bearing.
(9) Although the HIV/AIDS pandemic has impacted the sub-
Saharan Africa disproportionately, HIV infection rates are
rising rapidly in India and other South Asian countries,
Brazil, Russia, Eastern European countries, and Caribbean
countries, and pose a serious threat to the security and
stability in those countries.
(10) By 2010, it is estimated that approximately 40,000,000
children worldwide will have lost one or both of their parents
to HIV/AIDS.
(11) In January 2000, the United States National
Intelligence Council estimates that this dramatic increase in
AIDS orphans will contribute to economic decay, social
fragmentation, and political destabilization in already
volatile and strained societies. Children without care or hope
are often drawn into prostitution, crime, substance abuse or
child soldiery. The Council also stated that, in addition to
the reduction of economic activity caused by HIV/AIDS to date,
the disease could reduce GDP by as much as 20 percent or more
by 2010 in some countries in sub-Saharan Africa.
(12) The HIV/AIDS epidemic is not just a health crisis but
is directly linked to development problems, including chronic
poverty, food security and personal debt that are reflected in
the capacity of affected households, often headed by elders or
orphaned children, to meet basic needs. Similarly, heavily-
indebted countries are stripped of the resources necessary to
improve health care delivery systems and infrastructure and to
prevent, treat, and care for individuals affected by HIV/AIDS.
(13) On March 7, 2001, the United States Secretary of State
testified before Congress that the United States has an
obligation `` . . . if we believe in democracy and freedom, to
stop this catastrophe from destroying whole economies and
families and societies and cultures and nations''.
(14) A continuing priority for responding to the HIV/AIDS
crisis should be to emphasize and encourage awareness,
education, and prevention, including prevention activities that
promote behavioral change, while recognizing that behavioral
change alone will not conquer this disease. In so doing,
priority and support should be given to building capacity in
the local public health sector through technical assistance as
well as through nongovernmental organizations, including faith-
based organizations where practicable.
(15) Effective use should be made of existing health care
systems to provide treatment for individuals suffering from
HIV/AIDS.
(16) Many countries in Africa facing health crises,
including high HIV/AIDS infection rates, already have well-
developed and high functioning health care systems. Additional
resources to expand and improve capacity to respond to these
crises can easily be absorbed by the private and public
sectors, as well as by nongovernmental organizations,
community-based organizations, and faith-based organizations
currently engaged in combatting the crises.
(17) An effective response to the HIV/AIDS pandemic must
also involve assistance to stimulate the development of sound
health care delivery systems and infrastructure in countries in
sub-Saharan Africa and other developing countries, including
assistance to increase the capacity and technical skills of
local public health professionals and other personnel in such
countries, and improved access to treatment and care for those
already infected with HIV/AIDS.
(18) Access to effective treatment for HIV/AIDS is
determined by issues of price, health care delivery system and
infrastructure, and sustainable financing and such access can
be inhibited by the stigma and discrimination associated with
HIV/AIDS.
(19) The HIV/AIDS crisis must be addressed by a robust,
multilateral approach. The Secretary General of the United
Nations has called for a global fund to halt and reverse the
spread of HIV/AIDS and other infectious diseases. The Secretary
General has also called for annual expenditures of
$7,000,000,000 to $10,000,000,000, financed by donor
governments and private contributors, for all efforts to combat
the HIV/AIDS pandemic and, equally important, called on leaders
from developing countries to give a much higher priority in
their budgets to development of comprehensive health systems.
(20) An effective United States response to the HIV/AIDS
crisis must also focus on the development of HIV/AIDS vaccines
to prevent the spread of the disease as well as the development
of microbicides, effective diagnostics, and simpler treatments.
(21) The innovative capacity of the United States in the
commercial and public pharmaceutical research sectors is among
the foremost in the world, and the active participation of both
these sectors should be supported as it is critical to combat
the global HIV/AIDS pandemic.
(22) Appropriate treatment of individuals with HIV/AIDS can
prolong the lives of such individuals, preserve their families
and prevent children from becoming orphans, and increase
productivity of such individuals by allowing them to lead
active lives and reduce the need for costly hospitalization for
treatment of opportunistic infections caused by HIV.
(23) United States nongovernmental organizations, including
faith-based organizations, with experience in health care and
HIV/AIDS counseling, have proven effective in combatting the
HIV/AIDS pandemic and can be a resource in assisting sub-
Saharan African leaders of traditional, political, business,
and women and youth organizations in their efforts to provide
treatment and care for individuals infected with HIV/AIDS.
(24) Most of the HIV infected poor of the developing world
die of deadly diseases such as tuberculosis and malaria.
Accordingly, effective HIV/AIDS treatment programs should
address the growing threat and spread of tuberculosis, malaria,
and other infectious diseases in the developing world.
(25) Law enforcement and military personnel of foreign
countries often have a high rate of prevalence of HIV/AIDS, and
therefore, in order to be effective, HIV/AIDS awareness,
prevention, and education programs must include education and
related services to such law enforcement and military
personnel.
(26) Microenterprise development and other income
generation programs assist communities afflicted by the HIV/
AIDS pandemic and increase the productive capacity of
communities and afflicted households. Microenterprise programs
are also an effective means to support the productive
activities of healthy family members caring for the sick and
orphaned. Such programs should give priority to women infected
with the AIDS virus or in HIV/AIDS affected families,
particularly women in high-risk categories.
(27) The exploding global HIV/AIDS pandemic has created new
challenges for United States bilateral assistance programs and
will require a substantial increase in the capacity of the
United States Agency for International Development and other
agencies of the United States to manage and monitor bilateral
HIV/AIDS programs and resources. To meet this challenge, the
Agency will need to recruit and retain appropriate technical
expertise in the United States as well as in foreign countries
to help develop and implement HIV/AIDS strategies in concert
with multilateral agencies, host country governments, and
nongovernmental organizations.
(b) Sense of Congress.--It is the sense of Congress that--
(1)(A) combatting the HIV/AIDS pandemic in countries in
sub-Saharan Africa and other developing countries should be a
global effort and include the financial support of all
developed countries and the cooperation of governments and the
private sector, including faith-based organizations; and
(B) the United States should provide additional funds for
multilateral programs and efforts to combat HIV/AIDS and also
seek to leverage public and private resources to combat HIV/
AIDS on a global basis through the Global Development Alliance
Initiative of the United States Agency for International
Development and other public and private partnerships with an
emphasis on HIV/AIDS awareness, education, prevention, and
treatment programs;
(2)(A) in addition to HIV/AIDS awareness, education, and
prevention programs, the United States Government should make
its best efforts to support programs that safely make available
to public and private entities in countries in sub-Saharan
Africa and other developing countries pharmaceuticals and
diagnostics for HIV/AIDS therapy in order--
(i) to effectively and safely assist such countries
in the delivery of HIV/AIDS therapy pharmaceuticals
through the establishment of adequate health care
delivery systems and treatment monitoring programs; and
(ii) to provide treatment for poor individuals with
HIV/AIDS in such countries; and
(B) in carrying out such programs, priority consideration
for participation should be given to countries in sub-Saharan
Africa;
(3)(A) combatting the HIV/AIDS pandemic requires that
United States Government programs place a priority on the
vulnerable populations at greatest risk for contracting HIV;
(B) these populations should be determined through
qualitative and quantitative assessments at the local level by
local government, nongovernmental organizations, people living
with HIV/AIDS, and other relevant sectors of civil society; and
(C) such assessments should be included in national HIV/
AIDS strategies;
(4) the United States should promote efforts to expand and
develop programs that support the growing number of children
orphaned by the HIV/AIDS pandemic;
(5) in countries where the United States Government is
conducting HIV/AIDS awareness, prevention, and education
programs, such programs should include education and related
services to law enforcement and military personnel of foreign
countries to prevent and control HIV/AIDS, malaria, and
tuberculosis;
(6) prevention and treatment for HIV/AIDS should be a
component of a comprehensive international effort to combat
deadly infectious diseases, including malaria and tuberculosis,
and opportunistic infections, that kill millions annually in
the developing world;
(7) programs developed by the United Stated Agency for
International Development to address the HIV/AID pandemic
should preserve personal privacy and confidentiality, should
not include compulsory HIV/AIDS testing, and should not be
discriminatory;
(8)(A) the United States Agency for International
Development should carry out HIV/AIDS awareness, prevention,
and treatment programs in conjunction with effective
international tuberculosis and malaria treatment programs and
with programs that address the relationship between HIV/AIDS
and a number of opportunistic diseases that include bacterial
diseases, fungal diseases, viral diseases and HIV-associated
malignancies, such as Kaposi sarcoma, lymphoma, and squamous
cell carcinoma; and
(B) effective intervention against opportunistic diseases
requires not only the appropriate drug or other medication for
a given medical condition, but also the infrastructure
necessary to diagnose the condition, monitor the intervention,
and provide counseling services; and
(9) the United States Agency for International Development
should expand and replicate successful microenterprise programs
in Uganda, Zambia, Zimbabwe, and other African countries that
provide poor families affected by HIV/AIDS with the means to
care for themselves, their children, and orphans;
(10) the United States Agency for International Development
should substantially increase and improve its capacity to
manage and monitor HIV/AIDS programs and resources;
(11) the United States Agency for International Development
must recruit and retain appropriate technical expertise in the
United States as well as in foreign countries to help develop
and implement HIV/AIDS strategies in conjunction with
multilateral agencies, host country governments, and
nongovernmental organizations;
(12) the United States Agency for International Development
must strengthen coordination and collaboration between the
technical experts in its central and regional bureaus and
foreign country missions in formulating country strategies and
implementing HIV/AIDS programs;
(13) strong coordination among the various agencies of the
United States, including the Department of State, the United
States Agency for International Development, the Department of
Health and Human Services, including the Centers for Disease
Control and the National Institutes of Health, the Department
of the Treasury, the Department of Defense, and other relevant
Federal agencies must exist to ensure effective and efficient
use of financial and technical resources within the United
States Government; and
(14) to help alleviate human suffering, and enhance the
dignity and quality of life for patients debilitated by HIV/
AIDS, the United States should promote, both unilaterally and
through multilateral initiatives, the use of palliative and
hospice care, and provide financial and technical assistance to
palliative and hospice care programs, including programs under
which such care is provided by faith-based organizations.
SEC. 3. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Assistance.--Section 104(c) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b(c)) is amended--
(1) by striking paragraphs (4) through (6); and
(2) by inserting after paragraph (3) the following:
``(4)(A) Congress recognizes that the alarming spread of HIV/AIDS
in countries in sub-Saharan Africa and other developing countries is a
major global health, national security, and humanitarian crisis.
Accordingly, the United States and other developed countries should
provide assistance to countries in sub-Saharan Africa and other
developing countries to control this crisis through HIV/AIDS
prevention, treatment, monitoring, and related activities, particularly
activities focused on women and youth, including mother-to-child
transmission prevention strategies.
``(B)(i) The Administrator of the United States Agency for
International Development is authorized to provide assistance to
prevent, treat, and monitor HIV/AIDS, and carry out related activities,
in countries in sub-Saharan Africa and other developing countries.
``(ii) It is the sense of Congress that the Administrator should
provide an appropriate level of assistance under clause (i) through
nongovernmental organizations in countries in sub-Saharan Africa and
other developing countries affected by the HIV/AIDS pandemic.
``(iii) The Administrator shall coordinate the provision of
assistance under clause (i) with the provision of related assistance by
the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United
Nations Children's Fund (UNICEF), the World Health Organization (WHO),
the United Nations Development Programme (UNDP), other appropriate
international organizations, national, state, and local governments of
foreign countries, and other appropriate governmental and
nongovernmental organizations.
``(C) Assistance provided under subparagraph (B) shall, to the
maximum extent practicable, be used to carry out the following
activities:
``(i) Prevention of HIV/AIDS through activities including--
``(I) education, voluntary testing, and counseling
(including the incorporation of confidentiality
protections with respect to such testing and
counseling), including integration of such programs
into women's and children's health programs; and
``(II) assistance through nongovernmental
organizations, including faith-based organizations,
particularly those organizations that utilize both
professionals and volunteers with appropriate skills
and experience, to establish and implement culturally
appropriate HIV/AIDS education and prevention programs.
``(ii) The treatment and care of individuals with HIV/AIDS,
including--
``(I) assistance to establish and implement
programs to strengthen and broaden indigenous health
care delivery systems and the capacity of such systems
to deliver HIV/AIDS pharmaceuticals and otherwise
provide for the treatment of individuals with HIV/AIDS,
including clinical training for indigenous
organizations and health care providers;
``(II) assistance aimed at the prevention of
transmission of HIV/AIDS from mother to child,
including medications to prevent such transmission; and
``(III) assistance to strengthen and expand hospice
and palliative care programs to assist patients
debilitated by HIV/AIDS, their families, and the
primary caregivers of such patients, including programs
that utilize faith-based organizations.
``(iii) The monitoring of programs, projects, and
activities carried out pursuant to clauses (i) and (ii),
including--
``(I) monitoring to ensure that adequate controls
are established and implemented to provide HIV/AIDS
pharmaceuticals and other appropriate medicines to poor
individuals with HIV/AIDS; and
``(II) appropriate evaluation and surveillance
activities.
``(iv) The conduct of related activities, including--
``(I) the care and support of children who are
orphaned by the HIV/AIDS pandemic, including services
designed to care for orphaned children in a family
environment which rely on extended family members;
``(II) improved infrastructure and institutional
capacity to develop and manage education, prevention,
and treatment programs, including the resources to
collect and maintain accurate HIV surveillance data to
target programs and measure the effectiveness of
interventions;
``(III) vaccine research and development
partnership programs with specific plans of action to
develop a safe, effective, accessible, preventive HIV
vaccine for use throughout the world; and
``(IV) the development and expansion of
financially-sustainable microfinance institutions and
other income generation programs that strengthen the
economic and social viability of communities afflicted
by the HIV/AIDS pandemic, including support for the
savings and productive capacity of affected poor
households caring for orphans.
``(D)(i) Not later than January 31 of each calendar year, the
Administrator shall submit to Congress an annual report on the
implementation of this paragraph for the prior fiscal year.
``(ii) Such report shall include--
``(I) a description of efforts made to implement the
policies set forth in this paragraph;
``(II) a description of the programs established pursuant
to this paragraph and section 4 of the Global Access to HIV/
AIDS Prevention, Awareness, Education, and Treatment Act of
2001; and
``(III) a detailed assessment of the impact of programs
established pursuant to this paragraph, including the
effectiveness of such programs in reducing the spread of HIV
infection, particularly in women and girls, in reducing HIV
transmission from mother to child, in reducing mortality rates
from HIV/AIDS, and the progress toward improving health care
delivery systems and infrastructure to ensure increased access
to care and treatment.
``(iii) The Administrator shall consult with the Global Health
Advisory Board established under section 6 of the Global Access to HIV/
AIDS Prevention, Awareness, Education, and Treatment Act of 2001 in the
preparation of the report under clause (i) and on other global health
activities carried out by the United States Agency for International
Development.
``(E)(i) There is authorized to be appropriated to the President to
carry out this paragraph $560,000,000 for fiscal year 2002.
``(ii) Not more than six percent of the amount appropriated
pursuant to the authorization of appropriations under clause (i) for
fiscal year 2002, and not more than four percent of the amount made
available to carry out this paragraph for any subsequent fiscal year,
may be used for the administrative expenses of the Agency in carrying
out this paragraph.
``(iii) Amounts appropriated pursuant to the authorization of
appropriations under clause (i) are in addition to amounts otherwise
available for such purposes and are authorized to remain available
until expended.
``(F) In this paragraph:
``(i) The term `HIV' means infection with the human
immunodeficiency virus.
``(ii) The term `AIDS' means acquired immune deficiency
syndrome.''.
(b) Availability of Assistance Under Section 104(c).--Section
104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) is
amended--
(1) by redesignating paragraph (7) as paragraph (5); and
(2) by adding at the end the following:
``(6) Assistance made available under any paragraph of this
subsection, and assistance made available under chapter 4 of part II of
this Act to carry out the purposes of any paragraph of this subsection,
may be made available notwithstanding any other provision of law.''.
SEC. 4. ASSISTANCE FOR PROCUREMENT AND DISTRIBUTION OF HIV/AIDS
PHARMACEUTICALS AND RELATED MEDICINES.
(a) Assistance.--The Administrator of the United States Agency for
International Development shall provide assistance to countries in sub-
Saharan Africa and other developing countries for--
(1) the procurement of HIV/AIDS pharmaceuticals, anti-viral
therapies, and other appropriate medicines; and
(2) the distribution of such HIV/AIDS pharmaceuticals,
anti-viral therapies, and other appropriate medicines to
qualified national, regional, or local organizations for the
treatment of individuals with HIV/AIDS in accordance with
appropriate HIV/AIDS testing and monitoring requirements and
for the prevention of transmission of HIV/AIDS from mother to
child.
(b) Additional Authority.--The authority contained in section
104(c)(6) of the Foreign Assistance Act of 1961, as amended by section
3(b) of this Act, shall apply to assistance made available under
subsection (a).
(c) Authorization of Appropriations.--There is authorized to be
appropriated to the President to carry out this section $50,000,000 for
fiscal year 2002.
SEC. 5. INTERAGENCY TASK FORCE ON HIV/AIDS.
(a) Establishment.--The President shall establish an interagency
task force (hereafter referred to as the ``task force'') to ensure
coordination of all Federal programs related to the prevention,
treatment, and monitoring of HIV/AIDS in foreign countries.
(b) Duties.--The duties of the task force shall include--
(1) reviewing all Federal programs related to the
prevention, treatment, and monitoring of HIV/AIDS in foreign
countries to ensure proper coordination and compatibility of
activities and policies of such programs;
(2) exchanging information regarding design and impact of
such programs to ensure that the United States Government can
catalogue the best possible practices for HIV/AIDS prevention,
treatment, and monitoring and improve the effectiveness of such
programs in the countries in which they operate; and
(3) fostering discussions with United States and foreign
nongovernmental organizations to determine how United States
Government programs can be improved, including by engaging in a
dialogue with the Global Health Advisory Board established
under section 6 of this Act.
(c) Membership.--
(1) Composition.--The task force shall be composed of the
Secretary of State, the Administrator of the United States
Agency for International Development, the Secretary of Heath
and Human Services, the Director of the National Institutes of
Health, the Director of the Centers for Disease Control, the
Secretary of Defense, and the head of any other agency that the
President determines is appropriate.
(2) Chairperson.--The Secretary of State shall serve as
chairperson of the task force.
(d) Public Meetings.--At least once each calendar year, the task
force shall hold a public meeting in order to afford an opportunity for
any person to present views regarding the activities of the United
States Government with respect to the prevention, treatment, and
monitoring of HIV/AIDS in foreign countries. The Secretary of State
shall maintain a record of each meeting and shall make the record
available to the public.
(e) Availability of Funds.--Amounts made available for a fiscal
year pursuant to section 104(c)(4)(E)(ii) of the Foreign Assistance Act
of 1961, as amended by section 3(a) of this Act, are authorized to be
made available to carry out this section for such fiscal year.
SEC. 6. GLOBAL HEALTH ADVISORY BOARD.
(a) Establishment.--There is established a permanent Global Health
Advisory Board (hereafter referred to as the ``Board'') to assist the
President and other Federal officials, including the Secretary of State
and the Administrator of the United States Agency for International
Development, in the administration and implementation of United States
international health programs, particularly programs relating to the
prevention, treatment, and monitoring of HIV/AIDS.
(b) Duties.--
(1) In general.--The Board shall serve as a liaison between
the United States Government and private and voluntary
organizations, other nongovernmental organizations, and
academic institutions in the United States that are active in
international health issues, particularly prevention,
treatment, and care with respect to HIV/AIDS and other
infectious diseases.
(2) Specific activities.--In carrying out paragraph (1),
the Board--
(A) shall provide advice to the United States
Agency for International Development and other Federal
agencies on health and management issues relating to
foreign assistance in which both the United States
Government and private and voluntary organizations
participate;
(B) shall provide advice on the formulation of
basic policy, procedures, and criteria for the review,
selection, and monitoring of project proposals for
United States Government international health programs
and for the establishment of transparency in the
provision and implementation of grants made under such
programs;
(C) shall provide advice on the establishment of
evaluation and monitoring programs to measure the
effectiveness of United States Government international
health programs, including standards and criteria to
assess the extent to which programs have met their
goals and objectives and the development of indicators
to track progress of specific initiatives;
(D) shall review and evaluate the overall health
strategy for United States bilateral assistance for
each country receiving significant United States
bilateral assistance in the health sector;
(E) shall recommend which developing countries
could benefit most from programs carried out under
United States Government international health programs;
and
(F) shall assess the impact and effectiveness of
programs carried out under section 104(c)(4) of the
Foreign Assistance Act of 1961, as amended by section
3(a) of this Act, in meeting the objectives set out in
the HIV/AIDS country strategy established by the United
States Agency for International Development.
(c) Membership.--
(1) Composition.--The Board shall be composed of 12
members--
(A)(i) all of whom shall have a substantial
expertise and background in international health
research, policy, or management, particularly in the
area of prevention, treatment, and care with respect to
HIV/AIDS and other infectious diseases; and
(ii) of whom at least one member shall be an expert
on women's and children's health issues; and
(B) of whom--
(i) three members shall be individuals from
academic institutions;
(ii) five members shall be individuals from
nongovernmental organizations active in
international health programs, particularly
HIV/AIDS prevention, treatment and monitoring
programs in foreign countries, of which not
more than two members may be from faith-based
organizations;
(iii) two members shall be individuals from
health policy and advocacy institutes; and
(iv) two members shall be individuals from
private foundations that make substantial
contributions to global health programs.
(2) Appointment.--The individuals referred to in paragraph
(1) shall be appointed by the President, after consultation
with the chairman and ranking member of the Committee on
International Relations of the House of Representatives and the
Committee on Foreign Relations of the Senate.
(3) Terms.--
(A) In general.--Except as provided in subparagraph
(B), each member shall be appointed for a term of two
years and no member or organization shall serve on the
Advisory Board for more than two consecutive terms.
(B) Terms of initial appointees.--As designated by
the President at the time of appointment, of the
members first appointed--
(i) six members shall be appointed for a
term of three years; and
(ii) six members, to the extent practicable
equally divided among the categories described
in clauses (i) through (iv) of paragraph
(1)(B), shall be appointed for a term of two
years.
(4) Chairperson.--At the first meeting of the Board in each
calendar year, a majority of the members of the Commission
present and voting shall elect, from among the members of the
Board, an individual to serve as chairperson of the Board.
(d) Travel Expenses.--Each member of the Board shall receive travel
expenses, including per diem in lieu of subsistence, in accordance with
applicable provisions under subchapter I of chapter 57 of title 5,
United States Code.
(e) Availability of Funds.--Amounts made available for a fiscal
year pursuant to section 104(c)(4)(E)(ii) of the Foreign Assistance Act
of 1961, as amended by section 3(a) of this Act, are authorized to be
made available to carry out this section for such fiscal year.
SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR MULTILATERAL EFFORTS TO
PREVENT, TREAT, AND MONITOR HIV/AIDS.
(a) Authorization.--There is authorized to be appropriated to the
President $750,000,000 for fiscal year 2002 for United States
contributions to a global health fund or other multilateral efforts to
prevent, treat, and monitor HIV/AIDS in countries in sub-Saharan Africa
and other developing countries, including efforts to provide hospice
and palliative care for individuals with HIV/AIDS.
(b) Characteristics of Global Health Fund.--It is the sense of
Congress that United States contributions should be provided to a
global health fund under subsection (a) only if the fund--
(1) is a public-private partnership that includes
participation of, and seeks contributions from, governments,
foundations, corporations, nongovernmental organizations,
organizations that are part of the United Nations system, and
other entities or individuals;
(2)(A) includes donors, recipient countries, civil society,
and other relevant parties in the governance of the fund; and
(B) contains safeguards against conflicts of interest in
the governance of the fund by the individuals and entities
described in subparagraph (A);
(3) supports targeted initiatives to address HIV/AIDS,
tuberculosis, and malaria through an integrated approach that
includes prevention interventions, care and treatment programs,
and infrastructure capacity-building;
(4) permits strategic targeting of resources to address
needs not currently met by existing bilateral and multilateral
efforts and includes separate sub-accounts for different
activities allowing donors to designate funds for specific
categories of programs and activities;
(5) reserves a minimum of 5 percent of its grant funds to
support scientific or medical research in connection with the
projects it funds in developing countries;
(6) provides public disclosure with respect to--
(A) the membership and official proceedings of the
mechanism established to manage and disburse amounts
contributed to the fund; and
(B) grants and projects supported by the fund;
(7) authorizes and enforces requirements for the periodic
financial and performance auditing of projects and makes future
funding conditional upon the results of such audits; and
(8) provides public disclosure of the findings of all
financial and performance audits of the fund.
SEC. 8. DEFINITION.
In this Act:
(1) HIV.--The term ``HIV'' means infection with the human
immunodeficiency virus.
(2) AIDS.--The term ``AIDS'' means acquired immune
deficiency syndrome.
Purpose and Summary
H.R. 2069, the Global Access to HIV/AIDS Prevention,
Awareness, Education and Treatment Act of 2001, as reported out
of the Committee on International Relations with an amendment,
authorizes substantial bilateral and multilateral assistance to
combat the HIV/AIDS pandemic in countries in sub-Saharan Africa
and other developing countries. Specifically, the bill amends
provisions in the Foreign Assistance Act of 1961 that authorize
assistance to prevent, treat, and monitor HIV/AIDS. The bill
recognizes that the HIV/AIDS pandemic in sub-Saharan Africa is
more than an international public health issue, but also a
humanitarian, national security, and development crisis that
threatens the stability and economy of affected developing
countries. The threat is not confined to the region of sub-
Saharan Africa, but is increasing rapidly in Southeast Asia,
the Caribbean, and the Middle East.
The Secretary General of the United Nations has estimated
an annual need of $7 billion to $10 billion to adequately
respond to this global crisis. H.R. 2069 authorizes the
allocation of $560 million in bilateral assistance and $750
million in multilateral assistance for fiscal year 2002 to
control the HIV/AIDS crisis through prevention, treatment,
monitoring, and related activities, such as the care and
support of children orphaned by the disease, and improving
health care delivery systems and infrastructure in developing
countries. The bill also authorizes $50 million for the
procurement of HIV/AIDS pharmaceuticals, anti-viral therapies,
and other appropriate medicines, as well as the distribution of
such medicines to national, regional, or local organizations
for the treatment of individuals with HIV/AIDS.
The bill supports the development and upgrade of health
care delivery systems and infrastructure that includes
hospitals, clinics, laboratories, storage facilities, equipment
and capital to fund appropriate program efforts, and the
upgrade of related basic infrastructure (e.g., access to water,
power and transportation), needed to sustain the programs that
address HIV/AIDS. The bill supports the development of
effective delivery systems that include public and private
organizations with appropriately trained health care providers
and support personnel, and management systems. Effective
delivery systems can assure accessibility, accountability, and
the continuity of care needed to combat HIV/AIDS by
coordinating education, prevention, treatment, and palliative
and hospice care programs and monitoring and evaluation
programs.
The bill establishes an interagency task force to ensure
the coordination of all Federal programs related to the
prevention, treatment, and monitoring of HIV/AIDS in foreign
countries. This interagency task force is comprised of various
department heads, and will be chaired by the Secretary of
State. The bill also establishes a permanent Global Health
Advisory Board to serve as a liaison between the United States
Government and private and voluntary organizations, other non-
governmental organizations, and academic institutions active in
international health and infectious disease issues.
Background and Need for the Legislation
The HIV/AIDS pandemic is no longer simply a health issue,
but a humanitarian, national security developmental crisis that
threatens the stability, economy, and democratic institutions
of many nations. Recent statistics on the devastation of the
disease are staggering. Since its inception, 58 million
individuals have been infected with HIV/AIDS, and 22 million
have lost their lives to the disease--of whom 17 million are
from sub-Saharan Africa. The United States National
Intelligence Council estimates that the disease could reduce
Gross Domestic Product in some sub-Saharan African countries by
as much as 20 percent or more by 2010.
Sub-Saharan Africa has been the hardest hit region and has
been disproportionately affected by the disease. Though the
region has only 10 percent of the world's population, it
accounts for 70 percent of all HIV/AIDS cases and 80 percent of
all HIV/AIDS-related deaths. The infection rates in some
countries are numbing. Botswana has an estimated infection rate
at 36 percent, the highest in the world. The infection rate is
25 percent in Zimbabwe, and 20 percent in South Africa. Yet,
the threat is not confined to this region alone. HIV infection
rates are rising rapidly in India, Brazil, Russia, Eastern
Europe, South Asia, and the Caribbean.
Tragically women and children in developing societies are
the hardest hit by the disease. According to UNAIDS, by the end
of 2000, 55 percent of the HIV-positive population in sub-
Saharan Africa and 40 percent of such population in North
Africa and the Middle East, were women--infected mainly through
heterosexual transmission. In Africa, 6 out of 7 children who
are HIV-positive are girls. Over one million children under the
age of 15 are living with the disease and most of these victims
are from sub-Saharan Africa. Mother-to-child transmission is
the largest source of infection for these children.
Not only is HIV/AIDS directly devastating children, but it
is doing so indirectly as well. It is estimated that over 13
million children worldwide have lost one or both of their
parents to HIV/AIDS, and by 2010, it is estimated that this
number will rise to a staggering 40 million children. An
alarmingly high rate of orphaned children is leading to the
decay of many African societies. As a consequence of losing
their parents to HIV/AIDS, children are drawn into
prostitution, crime, substance abuse, and child soldiery.
Military and police forces in countries with high HIV/AIDS
prevalence rates are among the highest risk populations in the
world. There are national security implications where the
increase in HIV-infected military personnel is weakening their
capacity to defend their nations and deploy peacekeepers in
crisis situations. High prevalence rates among police forces
undermines their ability to maintain civil order. Any program
of HIV/AIDS prevention treatment and care must address this
population.
The Secretary General of the United Nations has called for
annual expenditures of $7 billion to $10 billion to combat the
disease. The United States has a strong national interest in
making a significant contribution to this global effort to
combat, and ultimately, eradicate the disease as it is
destroying economies on every continent and affecting trade and
productivity. The infection rate is inordinately high among
many military personnel, thus also potentially affecting global
security. Secretary of State Powell testified before the
Committee that the United States has an obligation ``. . . if
we believe in democracy and freedom, to stop this catastrophe
from destroying whole economies and families and societies and
cultures and nations.''
The need for drug treatment is clearly necessary from a
humanitarian perspective. However, the pilot program for drug
therapy recognizes that prevention and treatment are
inextricably intertwined. Without some expectation of hope that
they will receive treatment, individuals who do not have the
resources to pay for treatment have no reason to be tested for
AIDS or to seek help. Simply stated, without treatment, there
cannot be fully effective prevention.
H.R. 2069 will help combat the spread of HIV/AIDS by
providing funds for the prevention, treatment, and education of
the disease through a comprehensive bilateral and multilateral
strategy. The bill authorizes funds to improve orphan care,
encourage hospice and palliative care, strengthen existing
health care systems, and to procure medicines and anti-viral
therapies to treat the disease. The bill has received strong
bipartisan support, and also promotes the active participation
of private and public entities in the global war against HIV/
AIDS.
Hearings
The Committee held a hearing on AIDS entitled, ``The United
States' War on AIDS'' on June 7, 2001. Testimony was received
from: The Honorable Andrew Natsios, Administrator, U.S. Agency
for International Development; His Excellency Mamadou Mansour
Seck, Ambassador E. & P., Republic of Senegal; Mr. Stephen
Hayes, President, Corporate Council on Africa; Mr. Rupert
Schofield, Executive Director, Foundation for International
Community Assistance; Mr. Charles Dokmo, President and Chief
Executive Officer, Opportunities International-U.S.; and Paul
Zeitz, M.D., Co-Director, Global AIDS Alliance.
Committee Consideration
On June 27, 2001, the International Relations Committee
marked up the bill, H.R. 2069, pursuant to notice, in open
session. The Committee adopted an amendment in the nature of a
substitute, which was further amended by an amendment offered
by Representative Smith of New Jersey (adopted by voice vote)
relating to palliative care for persons afflicted by the
disease. The Committee agreed to a motion offered by Chairman
Hyde to favorably report the bill, as amended, to the House of
Representatives, by a vote of 32 to 4, a quorum being present.
Votes of the Committee
Clause (3)(b) of rule XIII of the Rules of the House of
Representatives requires that the results of each record vote
on an amendment or motion to report, together with the names of
those voting for or against, be printed in the committee
report.
Description of Amendment, Motion, Order, or Other
Proposition:
Vote 1 (12:06 p.m.) A motion to favorably report to the House H.R.
2069, as amended.
Voting yes: Hyde, Gilman, Leach, Bereuter, Christopher H.
Smith, Gallegly, Royce, Houghton, McHugh, Burr, Nick Smith,
Issa, Cantor, Jo Ann Davis, Lantos, Ackerman, Payne, Menendez,
Brown, Hilliard, Sherman, Wexler, Engel, Delahunt, Meeks, Lee,
Crowley, Hoeffel, Berkley, Napolitano, Schiff, and Watson.
Voting no: Ballenger, Paul, Flake, and Kerns.
Ayes 32. Nays 4.
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.
New Budget Authority and Tax Expenditures
Clause 3(c)(2) of House Rule XIII is inapplicable because
this legislation does not provide new budgetary authority or
increased tax expenditures.
Congressional Budget Office Cost Estimate
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, the Committee sets forth, with
respect to the bill, H.R. 2069, the following estimate and
comparison prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 5, 2001.
Hon. Henry J. Hyde, Chairman,
Committee on International Relations,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2069, the Global
Access to HIV/AIDS Prevention, Awareness, Education, and
Treatment Act of 2001.
If you wish further details on this estimate, we would be
pleased to provide them. The CBO staff contact is Joseph C.
Whitehill, who can be reached at 226-2840.
Sincerely,
Dan L. Crippen, Director.
Enclosure
cc:
Honorable Tom Lantos
Ranking Democratic Member
H.R. 2069--Global Access to HIV/AIDS Prevention, Awareness, Education,
and Treatment Act of 2001.
SUMMARY
H.R. 2069 would authorize programs for the prevention,
treatment, and monitoring of acquired immune deficiency
syndrome (AIDS) caused by the human immunodeficiency virus
(HIV) in sub-Saharan Africa and other developing countries.
Specifically, the bill would authorize appropriations for
bilateral assistance programs, for the purchase of medicines,
and for contributions to a global fund or other multilateral
efforts to prevent, treat, and monitor HIV/AIDS. It would
establish a Global Health Advisory Board to assist the
President and other federal officials in administering
international health programs and an interagency task force for
coordinating federal efforts related to fighting HIV/AIDS in
foreign countries. Assuming the appropriation of the authorized
amounts, CBO estimates implementing H.R. 2069 would cost $81
million in 2002 and $1.2 billion over the 2002-2006 period. The
bill would not affect direct spending or receipts; therefore,
pay-as-you-go procedures would not apply.
H.R. 2069 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. 2069 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
----------------------------------------------------------------------------------------------------------------
2001 2002 2003 2004 2005 2006
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for International
HIV/AIDS Programs
Budget Authority \1\ 340 0 0 0 0 0
Estimated Outlays 178 241 84 44 27 19
Proposed Changes
Authorization Level 0 1,360 0 0 0 0
Estimated Outlays 0 81 442 322 231 138
Spending Under H.R. 1646 for International HIV/AIDS
Programs
Authorization Level \1\ 340 1,360 0 0 0 0
Estimated Outlays 178 322 526 366 258 157
----------------------------------------------------------------------------------------------------------------
\1\ The 2001 level is the amount appropriated for that year.
BASIS OF ESTIMATE
H.R. 2069 would authorize the appropriation in 2002 of $560
million for bilateral assistance programs and associated
administrative expenses, $50 million for the purchase of
medicines, and $750 million for a contribution to a global fund
or other multilateral efforts to prevent, treat, and monitor
HIV/AIDS. The bill would limit spending for administrative
expenses from bilateral assistance to 6 percent of the amount
made available in 2002. CBO assumes that the authorized amounts
would be appropriated by October 1, 2001. CBO estimates outlays
for bilateral assistance, administrative expenses, and the
purchase of medicine would follow historical spending patterns
and total $66 million in 2002 and $560 million over the 2002-
2006 period.
Negotiations for the creation of a global HIV/AIDS fund are
just beginning. Until negotiations are complete, CBO has no
information on how this fund might operate. For the purpose of
this estimate, CBO assumed the following:
The schedule for beginning operation of the
fund in 2002 will experience delays.
Administration expenses would be paid out of
contributions with some start-up costs paid in 2002.
The contribution to the global fund would be
in the form of a letter-of-credit drawn upon as needed
for the timely disbursement of grants.
The typical grant would cover a number of
years with grant disbursements beginning in 2003 and
drawn over a 3- to 4-year period.
CBO estimates that outlays from the contribution to a
global HIV/AIDS fund would be $15 million in 2002 and $654
million over the 2002-2006 period, assuming appropriation of
the authorized amounts.
PAY-AS-YOU-GO CONSIDERATIONS:
None.
INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT
H.R. 2069 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 (226-2840)
Impact on State, Local, and Tribal Governments: Elyse Goldman
(225-3220)
Impact on the Private Sector: Lauren Marks (226-2940)
ESTIMATE APPROVED BY:
Peter H. Fontaine
Deputy Assistant Director for Budget Analysis
Performance Goals and Objectives
The goals and objectives of this legislation are to
decrease the rate of infection and alleviate human suffering in
sub-Saharan Africa and other developing countries caused by the
HIV/AIDS pandemic.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds the authority for
this legislation in article I, section 8, clause 18 of the
Constitution (relating to making all laws necessary and proper
for carrying into execution powers vested by the Constitution
in the government of the United States).
Section-by-Section Analysis and Discussion
Section 1. Short Title
Section 1 cites the act as the ``Global Access to HIV/AIDS
Prevention, Awareness, Education, and Treatment Act of 2001.''
Section 2. Findings; Sense of Congress.
Subsection (a) Findings. This subsection articulates
numerous Congressional findings of fact, including that more
than 58 million people worldwide have already been infected
with the HIV/AIDS disease and that the pandemic has claimed the
lives of over 22 million--17 million of whom were from sub-
Saharan Africa. In Africa, 6 out of 7 children who are HIV
positive are girls and 440,000 children out of an estimated
500,000 children who died as a consequence of AIDS in 2000 were
living in sub-Saharan Africa. An estimated 13.2 million
children worldwide have lost one or both of their parents to
HIV/AIDS, most of whom are children from sub-Saharan Africa.
Moreover, the largest source of HIV infection in children under
age 15 is mother-to-child transmission, and the total number of
births to HIV-infected pregnant women in developing countries
is approximately 700,000. With respect to HIV infection rates
in the military, the armed forces of Argola and the Democratic
Republic of Congo, for example, are estimated to be 40-60%, and
with respect to Nigeria, 10-20%. Awareness of HIV status
enables better decision-making for families. By 2010, 40
million children worldwide will have lost one or both of their
parents to HIV/AIDS, and the disease has dramatically increased
the number of orphans which will increase the instability in
already volatile regions in the world.
By 2010, the disease could reduce Gross Domestic Product by
as much as 20 percent or more in some sub-Saharan countries. It
is the view of the Committee that the HIV/AIDS pandemic is more
than a health crisis, and is directly related to developmental
problems. Moreover, the Secretary of State strongly feels the
United States has an obligation to stop the AIDS pandemic from
destroying economies, nations, and families throughout the
world and that it poses a threat to democracy and freedom. An
effective response to the HIV/AIDS pandemic must also involve
assistance to stimulate the development of sound health care
delivery systems and infrastructure. In addition, as called for
by the Secretary General of the United Nations, a global fund
should be established, and contributions by both governments
and private contributors will be required to combat the
pandemic. An effective HIV/AIDS treatment program should also
address the threat and spread of infectious diseases such as
tuberculosis and malaria, as most victims of AIDS die from
these diseases. In addition, microenterprise programs and other
income-generating programs assist communities and individuals
caring for the sick by increasing their productive activities
and incomes, and therefore should be expanded. It is the sense
of the Committee that the exploding growth of the HIV/AIDS
pandemic will require a substantial increase in the capacity of
the United States Agency for International Development (USAID)
and other agencies to carry out and monitor bilateral HIV/AIDS
programs.
In addition, microfinance programs and other income-
generating programs assist individuals infected with the HIV/
AIDS virus as well as communities and individuals caring for
the sick by increasing their productive activities and incomes,
and therefore should be expanded. There is growing consensus in
the international community regarding the relationship between
poverty and HIV/AIDS and other diseases. It is evident that the
poor, particularly women, are most affected of HIV/AIDS. The
Committee feels that microfinance programs and other income-
generation programs are a key to alleviating poverty and
mitigating the impact of HIV/AIDS on the most vulnerable
populations. Therefore, the Committee feels that these
microfinance programs should give priority to HIV affected
populations particularly those groups and individuals which are
at highest risk of being infected, including women.
Subsection (b) Sense of Congress. This subsection expresses
the sense of Congress regarding the U.S. bilateral and
multilateral efforts that are intended to guide the President's
efforts. This section provides that HIV/AIDS pandemic should be
fought through a global effort, and that the United States
should provide additional funds for multilateral-programs to
achieve this purpose. The United States should also support
programs that safely make available in developing countries
pharmaceuticals and diagnostics for HIV/AIDS anti-viral
therapies and treatment. Priority should be placed on
populations at greatest risk for contracting HIV. The United
States should also promote programs that support the growing
number of children orphaned by the HIV/AIDS pandemic. In
addition, HIV/AIDS awareness, prevention, and education
programs should include services for law enforcement and
military personnel--since they tend to be at high risk. USAID
programs should preserve privacy and confidentiality, and
should not include compulsory HIV/AIDS testing. The Committee
encourages strong coordination among the various agencies of
the United States carrying out international HIV/AIDS programs
to ensure the effective and efficient use of financial and
technical resources provided by the United States Government.
USAID should promote the use of and provide financial and
technical assistance to palliative and hospice care programs to
help alleviate human suffering and enhance the dignity and
quality of life for those afflicted with HIV/AIDS.
Section 3. Assistance to Combat HIV/AIDS
Section 3 amends section 104(c) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b(c) by striking paragraphs (4)
through (6) and by inserting a revised text strengthening and
refining the program. The revised provision states that
Congress recognizes HIV/AIDS as a major global health, national
security, and humanitarian crisis. Accordingly, the United
States should provide assistance to countries in sub-Saharan
Africa and other developing countries to control the HIV/AIDS
crisis through prevention, treatment, monitoring, and related
activities, with particular focus on women and youth, including
mother-to-child transmission interventions.
In providing HIV/AIDS assistance, priority should be given
to the most vulnerable populations. HIV/AIDS programs should
identify and take into account those factors that make
individuals or groups particularly vulnerable to HIV infection,
including poverty, lack of education, migration, social
exclusion, illiteracy, discrimination, lack of information or
commodities for self-protection. These programs should address
the gender dimension of the epidemic, specify the actions that
will be taken to address vulnerability and set targets for
their achievement.
U.S. government agency strategies should encourage the
development of national strategies, policies and programs,
through a participatory approach, to promote and protect the
health of those most vulnerable to, and at greatest risk of HIV
infection. Such populations should include, but not be limited
to children in especially difficult circumstances, women in low
income house holds, particularly pregnant women, intravenous
drug users and their sexual partners, persons confined in
institutions and prison populations, refugees and internally
displaced persons and people separated from their families due
to work or conflict;
U.S. government strategies and programs, should recognize
the importance of the family and take into consideration
cultural, religious and ethical factors, to reduce the
vulnerability of children and young people by: promoting access
of both girls and boys to primary and secondary education,
including on HIV/AIDS in curricula for adolescents; expanding
youth-friendly information and health services; strengthening
women's and children's health education programs; and involving
target groups in planning, implementing and evaluating HIV/AIDS
prevention and care programs
The revised section 104(c) provides that the Administrator
of USAID is authorized to carry out comprehensive HIV/AIDS
education, prevention, and treatment programs to combat and
monitor the HIV/AIDS pandemic. The provision directs that the
Administrator should provide an appropriate level of this
assistance through non-governmental organizations, including
faith-based organizations, and should coordinate the provision
of assistance with the provision of related assistance by other
appropriate international entities.
Under the revised paragraph (4), assistance provided
through this act shall be used to carry out:
(1) the prevention of HIV/AIDS, including education,
voluntary testing, and counseling;
(2) the treatment and care of individuals with HIV/
AIDS, including strengthening and broadening the
capacity of indigenous health care systems, assistance
aimed at mother-to-child transmission prevention, and
strengthening and expanding hospice and palliative care
programs;
(3) the monitoring of programs, projects, and
activities to ensure adequate controls and appropriate
evaluation and surveillance activities; and
(4) the conduct of related activities, including the
care of children orphaned by HIV/AIDS, improved
infrastructure, vaccine research, and the development
and expansion of microfinance institutions and other
income generation programs targetting assistance to
HIV/AIDS affected population, particularly those groups
and individuals who are at the highest risk of being
infected, including women.
Not later than January 31 of each calendar year, the
amended section 104(c)(4) requires the Administrator to submit
to Congress an annual report on the implementation of HIV/AIDS
programs during the prior fiscal year. The report shall include
a description of efforts made to implement the policies, a
description of the programs established, and a detailed
assessment of the impact of programs established pursuant to
this act. The Administrator must consult with the Global Health
Advisory Board authorized by this act in the preparation of
this report and on other global health activities. The
Committee expects this report to contain specific objective
measurements, such as evaluation of mortality and infection
rates, in countries where the U.S. is providing assistance.
The act authorizes $560 million to be appropriated for
fiscal year 2002 to carry out the purposes of this legislation.
Not more than 6 percent of this amount in fiscal year 2002, and
not more than 4 percent of the amount available for any
subsequent year, may be used for administrative expenses of
USAID, and amounts appropriated are authorized to remain
available until expended. While this represents a reduction
percentage-wise from current law, the Committee expects
increased funding for HIV/AIDS programs in the future and
therefore believe there will be economies of scale.
Assistance authorized by this act should be provided
primarily through non-governmental organizations, including
faith-based organizations, and should support innovative
approaches to combat the pandemic. As an example, the Committee
strongly encourages the USAID to support and replicate
programs, such as the Nyumbani Orphanage in Kenya, where young
orphans and the elderly who have lost their own children to
HIV/AIDS can be mutually supportive. The Nyumbani Orphanage is
an example of a ``village of hope'' for the victims of HIV/
AIDS, who are often helpless orphaned children and the elderly
who have lost adult children who traditionally care for them.
By supporting programs that bring these two generations
together, a semblance of family structure is preserved for the
victims of HIV/AIDS.
In addition, the Administrator of USAID is urged to
coordinate the provision of assistance with entities such as
the AIDS Healthcare Foundation, which demonstrate expertise in
building and operating infrastructure for the delivery of anti-
viral HIV medical care to the medically indigent, as well as
training of medical staff experienced in HIV medical care. Such
coordination should seek to develop replicable models for
expanded access to medical care appropriate to the local area.
Section 4. Assistance for Procurement and Distributorship of HIV/AIDS
Pharmaceuticals and Related Medicines.
This section authorizes the appropriation of $50 million
for the procurement of HIV/AIDS pharmaceuticals, anti-viral
therapies, and other appropriate medicines and for the
distribution of these pharmaceuticals to qualified national,
regional, or local organizations to treat individuals infected
with HIV/AIDS. The Committee strongly supports the development
of pilot treatment programs by USAID as treatment is an
integral part of any HIV/AIDS prevention strategy.
Section 5. Interagency Task Force on HIV/AIDS.
This section establishes an interagency task force to
ensure coordination of all Federal programs related to the
prevention, treatment, and monitoring of HIV/AIDS in foreign
countries. In order to ensure overall policy coherence and
sufficient programmatic coordination among the various agencies
of the U.S. government involved in global HIV/AIDS programs,
the Committee feels it is necessary to have a high-level
interagency task force on HIV/AIDS. This task force shall
review all Federal programs related to the prevention,
treatment, and monitoring of HIV/AIDS in foreign countries and
shall provide for the exchange of information regarding the
design and impact of such programs in order to catalogue the
best possible practices. In countries where there are multiple
agencies of the U.S. government implementing HIV/AIDS programs,
the task force shall ensure that there is coordination and
complementarity between the agencies. The task force shall also
endeavor to share information and coordinate programs and
policies of U.S. government agencies with other international
donors and with non-governmental organizations to facilitate an
international consensus and maximize the effectiveness of
programs to combat HIV/AIDS. The task force, chaired by the
Secretary of State, shall also include the Administrator of
USAID, the Secretary of Health and Human Services, the Director
of the National Institutes of Health, the Director of the
Centers for Disease Control, the Secretary of Defense, and the
head of any other agency that the President determines is
appropriate. At least once annually, the task force shall hold
a public meeting and the Secretary of State shall maintain a
record of each meeting on its activities, making the record
available to the public. The Committee believes that this
interagency cooperation will serve to better coordinate U.S.
efforts with international HIV/AIDS programs and strategies.
Amounts available under section 104(c)(4)(E)(ii) of the Foreign
Assistance Act of 1961, as amended by section 3(a) of this act,
are authorized to be made available to carry out this section
for such fiscal year.
Section 6. Global Health Advisory Board.
This section authorizes the establishment of a permanent
Global Health Advisory Board to assist the President and other
Federal officials in the administration and implementation of
United States international health programs, particularly those
relating to the prevention and treatment of HIV/AIDS. It is the
intent of this committee that the Global Health Advisory Board
serve as a bridge between USAID and the larger health and NGO
community. The Committee feels that in the planning and
implementation of its global health programs, the U.S. Agency
for International Development, and other agencies of the U.S.
government which carry out international health programs,
should take into account the experience and expertise of
private and voluntary organizations, non-governmental
institutions, faith-based organizations, and academic
institutions. The Board will provide advice and guidance to
USAID and other Federal agencies on the formulation of basic
policy, procedures, and criteria for the review, selection, and
monitoring of project proposals and for the establishment of
transparency in the provision and implementation of grants
awarded to combat HIV/AIDS and other global health programs.
The Board shall issue recommendations on which developing
countries could benefit the most from aforementioned programs
and assess the impact and effectiveness of programs carried out
under section 104(c)(4) of the Foreign Assistance Act of 1961,
as amended by section 3(a) of this Act.
This section authorizes the establishment of a board,
composed of 12 members, all with substantial expertise and
background in international health research, policy, or
management, particularly related to HIV/AIDS. At least one
member shall be an expert on women's and children's health
issues, three members shall be from academic institutions, five
members shall be from non-governmental institutions active in
international health, but no more than two from faith-based
organizations, and two members shall be from private
foundations that make substantial contributions to global
health issues. These members shall be appointed by the
President, after consultation with the Chairman and Ranking
Member of the Committee on International Relations of the House
of Representatives and the Chairman and Ranking Member of the
Committee on Foreign Relations of the Senate. The members shall
be appointed for a term of 2 years with no member or
organization serving for more than two consecutive terms. The
initial members shall be appointed in such a manner that no
more than six of the twelve members terms shall expire in any
subsequent year.
Members of the Board shall be authorized to receive travel
expenses and amounts made available under section
104(c)(4)(E)(ii) of the Foreign Assistance Act of 1961 to carry
out this section.
Section 7. Authorization of Appropriations for Multilateral efforts to
Prevent, Treat, and Monitor HIV/AIDS.
This section authorizes the appropriation of $750 million
for fiscal year 2002 for United States contributions to a
global health fund or other multilateral efforts to prevent,
treat, and monitor HIV/AIDS and other infectious diseases in
countries in sub-Saharan Africa and other developing countries.
While the Committee understands that the fight against HIV/
AIDS must be include all segments of the international
community including bilateral and multilateral efforts, private
and public sector contributions, non-governmental actors as
well as government commitments at the highest levels,
prevention efforts as well as treatment and care, the Committee
agrees that there must be a coordinated multilateral effort to
spear head this campaign if it is to be successful. The Global
Health Fund established by the United Nations Secretary General
seems to be the most likely vehicle for this multilateral
effort.
The Committee believes that these contributions should only
be provided if the global fund constitutes a public-private
partnership with donors and recipients involved in its
governance. In addition, the Committee believes that the fund
must contain safeguards against conflicts of interest in its
governance. Additionally, the fund should support targeted
initiatives to address HIV/AIDS, tuberculosis, and malaria
through an integrated approach that includes prevention
interventions, care and treatment programs, and infrastructure
capacity-building, and reserve a minimum of 5 percent of its
grant fund to support scientific or medical research.
New Advisory Committees
H.R. 2069 does not establish or authorize any new advisory
committees.
Congressional Accountability Act
H.R. 2069 does not apply to the legislative branch.
Federal Mandates
H.R. 2069 provides no Federal mandates.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
SECTION 104 OF THE FOREIGN ASSISTANCE ACT OF 1961
Sec. 104. Population and Health.--(a) * * *
* * * * * * *
(c) Assistance for Health and Disease Prevention.--(1) * *
*
* * * * * * *
[(4)(A) Congress recognizes the growing international
dilemma of children with the human immunodeficiency virus (HIV)
and the merits of intervention programs aimed at this problem.
Congress further recognizes that mother-to-child transmission
prevention strategies can serve as a major force for change in
developing regions, and it is, therefore, a major objective of
the foreign assistance program to control the acquired immune
deficiency syndrome (AIDS) epidemic.
[(B) The agency primarily responsible for administering
this part shall--
[(i) coordinate with UNAIDS, UNICEF, WHO, national
and local governments, and other organizations to
develop and implement effective strategies to prevent
vertical transmission of HIV; and
[(ii) coordinate with those organizations to
increase intervention programs and introduce voluntary
counseling and testing, antiretroviral drugs,
replacement feeding, and other strategies.
[(5)(A) Congress expects the agency primarily responsible
for administering this part to make the human immunodeficiency
virus (HIV) and the acquired immune deficiency syndrome (AIDS)
a priority in the foreign assistance program and to undertake a
comprehensive, coordinated effort to combat HIV and AIDS.
[(B) Assistance described in subparagraph (A) shall include
help providing--
[(i) primary prevention and education;
[(ii) voluntary testing and counseling;
[(iii) medications to prevent the transmission of
HIV from mother to child; and
[(iv) care for those living with HIV or AIDS.
[(6)(A) In addition to amounts otherwise available for such
purpose, there is authorized to be appropriated to the
President $300,000,000 for each of the fiscal years 2001 and
2002 to carry out paragraphs (4) and (5).
[(B) Of the funds authorized to be appropriated under
subparagraph (A), not less than 65 percent is authorized to be
available through United States and foreign nongovernmental
organizations, including private and voluntary organizations,
for-profit organizations, religious affiliated organizations,
educational institutions, and research facilities.
[(C)(i) Of the funds authorized to be appropriated by
subparagraph (A), not less than 20 percent is authorized to be
available for programs as part of a multidonor strategy to
address the support and education of orphans in sub-Saharan
Africa, including AIDS orphans.
[(ii) Assistance made available under this subsection, and
assistance made available under chapter 4 of part II to carry
out the purposes of this subsection, may be made available
notwithstanding any other provision of law that restricts
assistance to foreign countries.
[(D) Of the funds authorized to be appropriated under
subparagraph (A), not less than 8.3 percent is authorized to be
available to carry out the prevention strategies for vertical
transmission referred to in paragraph (4)(A).
[(E) Of the funds authorized to be appropriated by
subparagraph (A), not more than 7 percent may be used for the
administrative expenses of the agency primarily responsible for
carrying out this part of this Act in support of activities
described in paragraphs (4) and (5).
[(F) Funds appropriated under this paragraph are authorized
to remain available until expended.]
(4)(A) Congress recognizes that the alarming spread of HIV/
AIDS in countries in sub-Saharan Africa and other developing
countries is a major global health, national security, and
humanitarian crisis. Accordingly, the United States and other
developed countries should provide assistance to countries in
sub-Saharan Africa and other developing countries to control
this crisis through HIV/AIDS prevention, treatment, monitoring,
and related activities, particularly activities focused on
women and youth, including mother-to-child transmission
prevention strategies.
(B)(i) The Administrator of the United States Agency for
International Development is authorized to provide assistance
to prevent, treat, and monitor HIV/AIDS, and carry out related
activities, in countries in sub-Saharan Africa and other
developing countries.
(ii) It is the sense of Congress that the Administrator
should provide an appropriate level of assistance under clause
(i) through nongovernmental organizations in countries in sub-
Saharan Africa and other developing countries affected by the
HIV/AIDS pandemic.
(iii) The Administrator shall coordinate the provision of
assistance under clause (i) with the provision of related
assistance by the Joint United Nations Programme on HIV/AIDS
(UNAIDS), the United Nations Children's Fund (UNICEF), the
World Health Organization (WHO), the United Nations Development
Programme (UNDP), other appropriate international
organizations, national, state, and local governments of
foreign countries, and other appropriate governmental and
nongovernmental organizations.
(C) Assistance provided under subparagraph (B) shall, to
the maximum extent practicable, be used to carry out the
following activities:
(i) Prevention of HIV/AIDS through activities
including--
(I) education, voluntary testing, and
counseling (including the incorporation of
confidentiality protections with respect to
such testing and counseling), including
integration of such programs into women's and
children's health programs; and
(II) assistance through nongovernmental
organizations, including faith-based
organizations, particularly those organizations
that utilize both professionals and volunteers
with appropriate skills and experience, to
establish and implement culturally appropriate
HIV/AIDS education and prevention programs.
(ii) The treatment and care of individuals with
HIV/AIDS, including--
(I) assistance to establish and implement
programs to strengthen and broaden indigenous
health care delivery systems and the capacity
of such systems to deliver HIV/AIDS
pharmaceuticals and otherwise provide for the
treatment of individuals with HIV/AIDS,
including clinical training for indigenous
organizations and health care providers;
(II) assistance aimed at the prevention of
transmission of HIV/AIDS from mother to child,
including medications to prevent such
transmission; and
(III) assistance to strengthen and expand
hospice and palliative care programs to assist
patients debilitated by HIV/AIDS, their
families, and the primary caregivers of such
patients, including programs that utilize
faith-based organizations.
(iii) The monitoring of programs, projects, and
activities carried out pursuant to clauses (i) and
(ii), including--
(I) monitoring to ensure that adequate
controls are established and implemented to
provide HIV/AIDS pharmaceuticals and other
appropriate medicines to poor individuals with
HIV/AIDS; and
(II) appropriate evaluation and
surveillance activities.
(iv) The conduct of related activities, including--
(I) the care and support of children who
are orphaned by the HIV/AIDS pandemic,
including services designed to care for
orphaned children in a family environment which
rely on extended family members;
(II) improved infrastructure and
institutional capacity to develop and manage
education, prevention, and treatment programs,
including the resources to collect and maintain
accurate HIV surveillance data to target
programs and measure the effectiveness of
interventions;
(III) vaccine research and development
partnership programs with specific plans of
action to develop a safe, effective,
accessible, preventive HIV vaccine for use
throughout the world; and
(IV) the development and expansion of
financially-sustainable microfinance
institutions and other income generation
programs that strengthen the economic and
social viability of communities afflicted by
the HIV/AIDS pandemic, including support for
the savings and productive capacity of affected
poor households caring for orphans.
(D)(i) Not later than January 31 of each calendar year, the
Administrator shall submit to Congress an annual report on the
implementation of this paragraph for the prior fiscal year.
(ii) Such report shall include--
(I) a description of efforts made to implement the
policies set forth in this paragraph;
(II) a description of the programs established
pursuant to this paragraph and section 4 of the Global
Access to HIV/AIDS Prevention, Awareness, Education,
and Treatment Act of 2001; and
(III) a detailed assessment of the impact of
programs established pursuant to this paragraph,
including the effectiveness of such programs in
reducing the spread of HIV infection, particularly in
women and girls, in reducing HIV transmission from
mother to child, in reducing mortality rates from HIV/
AIDS, and the progress toward improving health care
delivery systems and infrastructure to ensure increased
access to care and treatment.
(iii) The Administrator shall consult with the Global
Health Advisory Board established under section 6 of the Global
Access to HIV/AIDS Prevention, Awareness, Education, and
Treatment Act of 2001 in the preparation of the report under
clause (i) and on other global health activities carried out by
the United States Agency for International Development.
(E)(i) There is authorized to be appropriated to the
President to carry out this paragraph $560,000,000 for fiscal
year 2002.
(ii) Not more than six percent of the amount appropriated
pursuant to the authorization of appropriations under clause
(i) for fiscal year 2002, and not more than four percent of the
amount made available to carry out this paragraph for any
subsequent fiscal year, may be used for the administrative
expenses of the Agency in carrying out this paragraph.
(iii) Amounts appropriated pursuant to the authorization of
appropriations under clause (i) are in addition to amounts
otherwise available for such purposes and are authorized to
remain available until expended.
(F) In this paragraph:
(i) The term ``HIV'' means infection with the human
immunodeficiency virus.
(ii) The term ``AIDS'' means acquired immune
deficiency syndrome.
[(7)] (5)(A) Congress recognizes the growing international
problem of tuberculosis and the impact its continued existence
has on those nations that had previously largely controlled the
disease. Congress further recognizes that the means exist to
control and treat tuberculosis, and that it is therefore a
major objective of the foreign assistance program to control
the disease. To this end, Congress expects the agency primarily
responsible for administering this part--
(i) * * *
* * * * * * *
(6) Assistance made available under any paragraph of this
subsection, and assistance made available under chapter 4 of
part II of this Act to carry out the purposes of any paragraph
of this subsection, may be made available notwithstanding any
other provision of law.
* * * * * * *