[Senate Report 107-206]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 482
107th Congress                                                   Report
                                 SENATE
 1st Session                                                    107-206

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



 
 UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                              ACT OF 2002

                                _______
                                

                  July 3, 2002.--Ordered to be printed

 Filed under the authority of the order of the Senate of June 26, 2002

                                _______
                                

          Mr. Biden, from the Committee on Foreign Relations,
                        submitted the following

                              R E P O R T

                         [To accompany S. 2525]

    The Committee on Foreign Relations, to which was referred 
the bill (S. 2525) to amend the Foreign Assistance Act of 1961 
to increase assistance for foreign countries seriously affected 
by HIV/AIDS, tuberculosis, and malaria, and for other purposes, 
having considered the same, reports favorably thereon and 
recommends that the bill do pass.


                                CONTENTS

                                                                   Page

  I. Purpose..........................................................1
 II. Major Provisions.................................................2
III. Funding Chart....................................................3
 IV. Background.......................................................3
  V. Committee Action.................................................5
 VI. Committee Comments...............................................5
VII. Section-by-Section Analysis......................................8
VIII.Cost Estimate...................................................16

 IX. Evaluation of Regulatory Impact.................................18
  X. Changes in Existing Law.........................................19

                               I. Purpose

    The purpose of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2002 is to strengthen 
U.S. leadership and the effectiveness of the U.S. response to 
the global spread of HIV/AIDS, tuberculosis (TB), and malaria 
by establishing a comprehensive, integrated 5-year global 
strategy to fight HIV/AIDS; providing increased resources for 
multilateral efforts to fight HIV/AIDS; providing increased 
resources for U.S. bilateral efforts to combat HIV/AIDS, TB, 
and malaria; encouraging the expansion of private sector 
efforts and expanding public-private partnerships to combat 
HIV/AIDS; and intensifying efforts to support the development 
of vaccines and treatment for HIV/AIDS, TB, and malaria.

                          II. Major Provisions

    The bill has five titles. Title I strengthens policy 
planning and coordination across the U.S. Government to combat 
the HIV/AIDS pandemic. A key provision of this title mandates 
the establishment of a comprehensive, integrated 5-year U.S. 
Government strategy to promote the goals and objectives of the 
June 2001 U.N. General Assembly Declaration of Commitment on 
HIV/AIDS and to strengthen the capacity of the United States to 
be an effective leader of the international campaign against 
AIDS.
    This title also requires the U.S. Agency for International 
Development (USAID) to develop a plan specifically designed to 
empower women to prevent the spread of HIV/AIDS, including the 
provision of currently available technologies. It also creates 
a new HIV/AIDS Response Coordinator in the Department of State.
    Title II authorizes funding for the Global Fund to Fight 
AIDS, Tuberculosis and Malaria and relevant public-private 
partnerships focused on vaccine research for these three 
diseases. The bill authorizes appropriations of $1 billion for 
the Global Fund in FY 03 and $1.2 billion in FY 04.
    Title III authorizes expanded debt relief for poor 
countries to provide resources to combat HIV/AIDS, TB, or 
malaria. The Secretary of the Treasury is authorized to 
conclude as soon as possible an agreement with the World Bank 
and other appropriate multilateral development institutions and 
donors to modify the Enhanced HIPC (Heavily Indebted Poor 
Countries) Initiative to achieve debt reduction for health 
programs.
    Title IV strengthens and expands U.S. bilateral efforts to 
respond to the health crises posed by AIDS, TB, and malaria. 
The Foreign Assistance Act of 1961 is amended to provide USAID 
with expanded and more detailed authorities with respect to the 
provision of assistance to combat each of these diseases. This 
title authorizes appropriations for USAID of $800 million in FY 
03 and $900 million in FY 04 for HIV/AIDS programs, $150 
million in FY 03 and $200 million in FY 04 for TB programs, and 
$70 million in FY 03 and $80 million in FY 04 for malaria 
programs.
    Title IV also establishes a new Health Care Provider 
Service and Training Program to enable American health care 
professionals to provide basic health care services and on-the-
ground training to African and other countries severely 
affected by HIV/AIDS, TB and Malaria, expands the Department of 
Defense's HIV/AIDS prevention assistance program to countries 
beyond sub-Saharan Africa and to international peacekeepers, 
and requires the submission of a comprehensive report on U.S. 
efforts to increase access to treatment for people living with 
HIV/AIDS.
    In recognition of the needs of children and families, Title 
IV requires that the 5-year U.S. Government strategy mandated 
by the bill meet or exceed the mother-to-child transmission 
(MTCT) prevention goals in the U.N. Declaration of Commitment 
on HIV/AIDS and include testing and treatment programs for HIV-
positive women and their family members and expanded programs 
for children orphaned by AIDS. The bill also creates a new 
assistance program for children and families to provide care 
and treatment to parents and/or caregivers infected with HIV.
    Title V sets forth a voluntary code of conduct for U.S. 
businesses operating in countries affected by the HIV/AIDS 
pandemic. This code includes best principles and practices for 
handling the challenges posed by HIV/AIDS in the workplace 
including discrimination and stigmatization, testing and 
confidentiality of HIV status, work tenure and separation, the 
development of HIV/AIDS policies and programs for the workplace 
and access to them, and availability of treatment.

                           III. Funding Chart


             U.S. LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA ACT OF 2002--Funding Levels
----------------------------------------------------------------------------------------------------------------
                                                                       FY02            FY03            FY04
                                                                 -----------------------------------------------
                                                                                    (under the      (under the
                                                                  (appropriated)       bill)           bill)
----------------------------------------------------------------------------------------------------------------
Global Fund to Fight HIV/AIDS, TB and Malaria...................         \1\$300    $1.0 billion    $1.2 billion
                                                                        million
USAID-Bilateral.................................................     435 million     800 million     900 million
  (Microbicide Research) \2\....................................    (15 million)    (20 million)    (24 million)
  (Pharmaceuticals) \2\.........................................         \3\ N/A   (100 million)   (120 million)
Vaccine Fund....................................................      53 million      60 million      70 million
International AIDS Vaccine Initiative...........................      10 million      12 million      15 million
Children's Program..............................................         \3\ N/A      15 million      30 million
Health Care Professionals Program...............................         \3\ N/A      10 million      20 million
DOD HIV/AIDS Expanded Program...................................      14 million      50 million      55 million
TB-USAID Programs...............................................      75 million     150 million     200 million
Malaria Vaccine Fund (PATH).....................................         \3\ N/A       5 million       6 million
Malaria-USAID Program...........................................      65 million      70 million      80 million
----------------------------------------------------------------------------------------------------------------
    Total in billions...........................................           $.952          $2.172          $2.576
----------------------------------------------------------------------------------------------------------------
\1\ Includes $100 million from FY01 Supplemental Appropriations bill.
\2\ Sub-authorization under USAID Bilateral Funding.
\3\N/A--Spending has not been previously authorized.

                             IV. Background

    In the twenty years since AIDS was first recognized as an 
international health problem, the numbers of those infected 
with the HIV virus and dying of AIDS has increased steadily and 
alarmingly. The epidemic, confined to sub-Saharan Africa for 
many years, is now worldwide. According to the Joint United 
Nations Programme on HIV/AIDS (UNAIDS) more than 60 million 
people have been infected with HIV since the epidemic began. 
AIDS has now become the fourth-highest cause of death globally, 
already claiming the lives of 22 million people. More than 
three-quarters of these deaths--more than 17 million--have been 
in sub-Saharan Africa, where AIDS is now the leading cause of 
death. Last year alone, AIDS killed 2.3 million African people. 
Experts project that the disease will eventually take the lives 
of one in four adults throughout that region. Because of AIDS, 
Botswana, Zimbabwe, and South Africa are already experiencing 
negative population growth, and life expectancy for children 
born in some parts of the continent has dropped to as low as 35 
years. Of the estimated 40 million people now living with HIV 
globally, 28.1 million are in sub-Saharan Africa. This number 
includes 3.4 million people who were infected last year alone.
    The Caribbean is now the second most affected region, with 
2.3% of adults infected with HIV. Eastern Europe, especially 
the Russian Federation, is experiencing the world's fastest-
growing epidemic, mainly from injection drug use. In Asia and 
the Pacific region, 7.1 million people are infected with HIV or 
living with AIDS. Although national prevalence rates in most 
countries throughout that region are relatively low, localized 
epidemics have broken out in many areas, and there is a serious 
threat of major outbreaks of the virus in China, India, and a 
number of other countries. A newly released U.N. study 
estimates that as many as 1.5 million Chinese contracted HIV 
last year and that China might have more HIV infections in the 
near future than any other country in the world.
    The AIDS crisis takes a severe toll on children and young 
people. Nearly one-third of the 40 million people currently 
living with HIV are between the ages of 15 and 24; one-half of 
all new infections occur in this age group. Mother-to-child 
transmission is responsible for the vast majority of infections 
among children under the age of 15. Without preventive 
measures, 30-40% of infants born to HIV-positive mothers 
contract the virus. Even those who are not infected in this 
manner can confront tremendous difficulties--more than 13 
million children under age 15 have already lost their mothers 
or both parents to AIDS, and this number is expected to more 
than double by the end of the decade. Children orphaned by AIDS 
are susceptible to extreme poverty, malnutrition, psychological 
distress, and a long list of other hardships. Many of these 
orphans turn to crime in order to survive.
    The AIDS pandemic strikes at the foundations of societies--
threatening family cohesion and productivity; undermining local 
and national economies; and weakening a broad range of 
institutions by taking the lives of educators, health care 
providers, police, military personnel, and civil servants. 
These forces cripple the potential for long-term economic 
development and jeopardize political and social stability and 
national security in sub-Saharan Africa, the most-severely 
affected region, and increasingly in all corners of the world. 
These ramifications of the AIDS crisis pose serious security 
concerns for the international community because they increase 
the potential for instability and failing states.
    The devastation wrought by the HIV/AIDS pandemic is 
compounded by the prevalence of two other infectious diseases--
tuberculosis and malaria--particularly in developing countries 
where the poorest and most vulnerable members of society, such 
as women, children and those living with HIV/AIDS, become 
infected. In the year 2001, HIV/AIDS, TB, and malaria claimed 
the lives of more than 5.7 million people and caused 
debilitating illnesses in millions more. Tuberculosis, a highly 
communicable disease, causes the death of one out of every 
three people with AIDS. HIV infection is the leading threat to 
TB control. Tuberculosis, in turn, accelerates the onset of 
AIDS in those infected with HIV.
    There is an alarming resurgence of malaria, the most deadly 
of all tropical parasitic diseases, because of increasing 
resistance of the malaria parasite to existing drug therapies 
and standard insecticides. The World Health Organization (WHO) 
estimates that between 2 and 3 million people die from malaria 
annually. Ninety percent of these deaths are in sub-Saharan 
Africa. Those infected with HIV are particularly vulnerable to 
malaria.
    The spread of the pandemic has led the international 
community to accelerate its response. In April 2001 the U.N. 
Secretary General, Kofi Annan, issued a call for action on HIV/
AIDS including the creation of a global fund to fight AIDS and 
other infectious diseases. At the end of the U.N. Special 
Session on HIV/AIDS, held in June 2001, the Secretary General 
announced the creation of the fund and welcomed pledges from 
donor nations and the private sector. The U.N. General Assembly 
concluded the session with the adoption of the Declaration of 
Commitment on HIV/AIDS. This Declaration set forth an 
international strategy for responding to the AIDS crisis 
including specific targets for reducing the rate of infection 
and death from HIV/AIDS.
    The Global Fund to Fight AIDS, Tuberculosis and Malaria is 
a public-private partnership with a board comprised of 
representatives of donor countries, developing countries, non-
governmental organizations, the private sector, relevant U.N. 
agencies, and those living with or affected by one of the three 
diseases. The Fund solicits proposals and funds those that are 
deemed by the Technical Review Committee to have a clear and 
demonstrable impact in the fight against AIDS, TB, and malaria. 
At the end of May 2002, the Fund had some $2 billion in pledges 
with $700 million available for disbursement in 2002. The 
United States has pledged $300 million to the Fund through FY 
02. The Bush Administration has requested $200 million for the 
Fund in its FY 03 budget.

                          V. Committee Action

    The committee held two days of hearings on the HIV/AIDS 
crisis and the United States Government response on February 13 
and 14, 2002. On June 13, by unanimous voice vote, the 
committee ordered reported favorably without amendment S. 2525, 
the ``United States Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Act of 2002,'' introduced by Senators Kerry and 
Frist with 12 cosponsors on May 15.

                         VI. Committee Comments

    The committee recognizes that the HIV/AIDS pandemic 
presents a serious moral and humanitarian crisis as well as one 
of the largest public health crises to date. While the rates of 
infection and incidence of death seem overwhelming, there is 
reason to believe that this crisis can be addressed 
effectively. Behavior can be changed through prevention and 
education programs, especially if those programs make treatment 
available to those individuals who already have AIDS. The 
transmission of the HIV virus from mother to child can be 
drastically reduced through the use of the drug nevirapine. 
More children can be prevented from becoming ``AIDS orphans,'' 
that is children who lose one or both parents to AIDS, if 
voluntary counseling, testing, and where necessary treatment is 
provided to the parents or caregivers through expansion of MTCT 
programs, commonly called ``MTCT plus.'' It is the intention of 
the committee that funding levels for programs for mother-to-
child transmission and treatment of family members and for 
programs for orphans shall continue to rise above current 
levels.
    HIV/AIDS is a global health crisis which must be addressed 
through the full range of medical responses including access to 
drugs, care and treatment for those who are ill, prevention 
programs for those not yet infected, and research to find a 
vaccine. Parallel responses must also be directed toward TB and 
malaria. However, the AIDS crisis is a multi-dimensional crisis 
with ramifications at the family, community, national and 
international level. Dimensions beyond the health sector must 
be recognized and factored into the response of the United 
States and others in the international community.
    The challenges posed by the AIDS pandemic demand a 
sustained response at international and bilateral levels. The 
Global Fund is a central element of the international response, 
mobilizing resources and moving governments in affected nations 
to draw up essential national strategies to combat the 
epidemic. However, a successful response requires intensified 
efforts on the part of all those in the campaign against AIDS: 
the United States and other donor nations, national governments 
in those countries severely affected, non-governmental 
organizations, local community organizations, charitable 
foundations, pharmaceutical companies, and others in the 
private sector. The committee recognizes the major challenge of 
developing as rapidly as possible the human and physical 
infrastructure required to undertake successful programs 
against AIDS. The committee believes that this problem must be 
addressed urgently by all parties.
    The committee believes that active participation and 
leadership of the United States are critical to the success of 
the international community's campaign against HIV/AIDS. The 
United States has much to bring to the effort: resources, 
technical expertise and training, scientific research and 
knowledge, and a host of interested and committed parties in 
the private sector. The bill approved by the committee, S. 
2525, will strengthen the capacity of the United States to 
undertake this leadership role and enhance the effectiveness of 
the U.S. bilateral response.
    In recognition of the critical need for resources, the bill 
authorizes substantial increases in appropriations for Fiscal 
Years 03 and 04 for U.S. contributions to the Global Fund and 
for bilateral programs administered by USAID for HIV/AIDS, TB, 
and malaria. The bill authorizes a total of $2.17 billion in FY 
03--approximately $1 billion more than the FY 02 appropriated 
level--and a total of $2.57 billion for FY 04.
    The bill brings coherence and rationality to the U.S. 
response by ensuring that the United States has a 5-year, 
comprehensive, and integrated government-wide strategy for 
addressing the global AIDS crisis and meeting the targets set 
by the international community in the Declaration of Commitment 
on HIV/AIDS. The strategy mandate reflects the committee's view 
that the U.S. response must address the fundamental elements of 
prevention and education; care and treatment including access 
to drug therapies; research for vaccines, new drug protocols, 
and technologies for women; training of health care workers and 
the strengthening of health care infrastructure and delivery 
systems.
    The committee believes that the formulation of an 
integrated strategy will reduce the duplication of efforts by 
the panoply of U.S. Government agencies now involved in the 
fight against global AIDS, including the Department of State, 
USAID, the Department of Health and Human Resources and 
agencies under its control, and the Department of Defense. It 
will also provide for greater coordination among these agencies 
and ensure that each agency undertakes programs primarily in 
those areas where it has the greatest expertise and experience. 
The committee also believes that the creation of a new post, an 
HIV/AIDS Response Coordinator in the Department of State, will 
improve inter-agency coordination.
    The bill expands and strengthens the legislative mandate 
for USAID to undertake the broad range of programs necessary to 
combat not only HIV/AIDS but also TB, and malaria. While the 
committee understands that funding limitations often force the 
agency to make difficult choices, the committee expects USAID 
to ensure that there is a fair balance between prevention and 
education programs, on the one hand, and care and treatment 
programs including programs that provide antiretrovirals and 
other necessary drug therapies, on the other.
    The committee realizes that a successful campaign to combat 
these three major infectious diseases will require not only 
increased resources but also sustained cooperation among the 
donor nations and between the donors and international 
organizations such as the Global Fund and UNAIDS and increased 
efforts on the part of the governments of countries acutely 
impacted. The bill seeks to enhance the capacity of these 
governments by authorizing expanded debt relief under the 
Enhanced HIPC Initiative as long as the resources are devoted 
to health and poverty reduction programs.
    Ultimately the ``cure'' for AIDS and other infectious 
diseases lies in the development of effective vaccines. The 
committee strongly supports ongoing efforts, such as those by 
the International AIDS Vaccine Initiative and the Malaria 
Vaccine Initiative, to develop vaccines. While efforts to 
produce a vaccine continue, it is essential that plans be made 
now to assure prompt access to vaccines once they are 
developed. Populations in resource-limited countries have 
typically waited a decade or longer to receive life-saving 
vaccines after they are licensed for use in industrialized 
nations. Similar delays have occurred with access to AIDS 
therapies. The committee understands that steps must be taken 
in advance of licensure of AIDS, malaria, and TB vaccines to 
ensure that these vaccines are rapidly available around the 
world. The public sector has an important role to play in 
providing resources to purchase vaccines for use in resource-
limited countries. Tax credits and other incentives may also be 
useful in promoting sale of priority vaccines for use in these 
countries. In addition, the public sector can significantly 
contribute to accelerated vaccine access by working with 
vaccine manufacturers to ensure a sufficient, affordable supply 
of vaccines for developing country markets and avoid shortages.
    The committee believes that resource-limited countries 
should have technical assistance available from developed 
country regulatory bodies, including the Food and Drug 
Administration, to assist with review of preclinical, clinical 
and manufacturing data. This assistance will facilitate local 
decision making about hosting clinical trials of particular 
products and expand each country's ability to assure the safety 
and consistency of new products.
    The committee regards assistance for vaccine research and 
development, and expanded access to vaccines once developed, as 
key components of the strategy mandated by the bill.

                    VII. Section-By-Section Analysis


Section 1. Short Title: Table of Contents

    This section entitles the Act as the ``United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2002.'' The Act is divided into five titles. The titles, with 
the sections each contains, are listed herein.

Sec. 2. Findings

    This section presents findings regarding the magnitude and 
scope of the global HIV/AIDS crisis, its impact at the family, 
community and national levels, and the type of response this 
crisis requires of the international community and the United 
States. Section 2 also contains findings on the impact of TB 
and malaria.

Sec. 3. Definitions

    This section defines the key terms used throughout the Act.

Sec. 4. Purpose

    This section states that the purpose of the Act is to 
strengthen U.S. leadership and the effectiveness of the U.S. 
response to the AIDS pandemic by establishing a comprehensive, 
integrated 5-year global strategy, providing increased 
resources for multilateral and bilateral efforts, encouraging 
the expansion of private sector efforts and public-private 
sector partnerships, and intensify efforts to support the 
development of vaccines and treatment for HIV/AIDS, TB, and 
malaria.

               TITLE I--POLICY PLANNING AND COORDINATION


Sec. 101. Development of a Comprehensive, Five-Year, Global Strategy

    This section mandates the President to establish a 
comprehensive, integrated 5-year strategy to combat global HIV/
AIDS that promotes the goals and objectives of the U.N. 
Declaration of Commitment on HIV/AIDS and strengthens the 
capacity of the United States to be a leader in the 
international campaign against HIV/AIDS. The strategy must 
address key issues including goals, strategies for vulnerable 
groups including treatment strategies, priorities for relevant 
executive branch agencies and improving coordination among them 
and at the international level, projected resource levels, 
expanding public private-sector partnerships, and maximizing 
United States capabilities in the areas of technical assistance 
and training and research including vaccine research. The 
President is required to submit a strategy report to Congress 
within 180 days of enactment of the bill. Specific elements to 
be included in the report are listed in this section.
    The committee views a 5-year strategy as essential to a 
successful U.S. Government response to the HIV/AIDS crisis and 
to effective American leadership on this issue. Many U.S. 
Government agencies administer worthy international AIDS 
programs, but often there is insufficient coordination and 
duplication of effort. A strategy that sets specific objectives 
and benchmarks for measuring success, addresses the full range 
of health issues including treatment of those infected with the 
HIV virus and the needs of vulnerable groups, treats AIDS as a 
multi-sectoral challenge, integrates the programs of U.S. 
Government agencies into a rational approach, and matches needs 
with resources will enable the United States to undertake a 
credible and responsible leadership role in the fight against 
AIDS.

Sec. 102. Comprehensive Plan to Empower Women to Prevent the Spread of 
        HIV/AIDS

    This section requires USAID to develop a comprehensive plan 
to empower women to protect themselves against the spread of 
HIV/AIDS and lists specific elements to be included in the plan 
including increased access to currently available technologies 
for women and microbicides when available. Section 102 mandates 
a report within 270 days of enactment of the Act, and every 
year for the next three years, on the programs and other 
activities undertaken under the plan.
    The committee recognizes that in many developing societies 
women lack control over sexual encounters and that women are 
biologically four times more vulnerable to HIV/AIDS infection 
than men. These same women, who represent 55% of the HIV 
infections in sub-Saharan Africa, are also the primary care 
givers to those infected with the disease.
    The purpose of this section is to ensure that women of all 
ages have access to education programs including health 
education and economic empowerment programs in order to reduce 
their vulnerability to HIV and/or to mitigate its impact. USAID 
is directed to devise a plan aimed at empowering women socially 
and economically to reduce their vulnerability to pressures 
which lead to unsafe sexual practices. The plan is to include 
ways to target refugee populations as well.
    As part of the plan, the Agency must increase women's 
access to micro-finance programs. In addition, the committee 
expects the Agency to make use of a variety of existing 
programs which increase women's access to regular paid 
employment, productive resources, and income.
    The plan must also include an expansion of education 
programs for men and boys which emphasize responsible sexual 
behavior, such as refraining from coercive sexual practices, 
delaying sexual debut, using safe sexual practices, and 
respecting the rights of women and girls. Programs such as 
these are important and necessary components of any strategy to 
empower women to protect themselves against HIV/AIDS.
    Access to microbicides and other female initiated 
prevention methods is an essential means of preventing 
infection and lowering the HIV/AIDS infection rate. The 
committee expects the Agency to ensure that its programs for 
women provide access to currently available technologies and 
others as they become available at an affordable price for 
women in developing countries.

Sec. 103. HIV/AIDS Response Coordinator

    Section 103 establishes the position of HIV/AIDS Response 
Coordinator, to be appointed by the President with the advice 
and consent of the Senate, in the Department of State. The 
Coordinator shall report directly to the Secretary of State and 
have ambassadorial rank. The Coordinator shall have primary 
responsibility for the oversight and coordination of all U.S. 
Government activities to combat the HIV/AIDS pandemic and for 
pursuing coordination with other countries and international 
organizations.
    The committee believes that coordination of executive 
branch agencies involved in the fight against HIV/AIDS is 
essential if the U.S. Government response is to be effective. 
The Coordinator is to ensure that U.S. Government programs are 
carried out in a coherent and structured manner and that there 
is communication between the agencies which contribute to 
efforts to fight the disease overseas. While it is not the 
committee's intent that the Coordinator manage or approve 
individual agency programs, the committee intends that the 
Coordinator make all final decisions regarding the resolution 
of disputes among various agencies as to program coordination, 
policy and funding.

Sec.104. Report on Reversing the Exodus of Critical Talent

    This section requires the President to submit a report to 
Congress within one year of the date of enactment analyzing the 
out migration of critically important medical and public health 
personnel from sub-Saharan African countries that are acutely 
impacted by HIV/AIDS. Included in the report must be a 
description of incentives and programs that the United States 
could provide to encourage critical personnel to remain and 
work in their home countries.

                 TITLE II--PUBLIC-PRIVATE PARTNERSHIPS


Sec. 201. Sense of Congress on Public-Private Partnerships

    This section presents findings on the importance of public-
private partnerships in addressing international health crises 
and expresses the sense of Congress that these partnerships 
should be a priority of the U.S. strategy to combat HIV/AIDS 
and other global infectious diseases.

Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis, 
        and Malaria

    This section provides the authority for the United States 
to participate in the Global Fund to Fight Aids, Tuberculosis 
and Malaria and authorizes appropriations of $1 billion for FY 
03 and $1.2 billion for FY 04 for contributions to the Fund. It 
also mandates an annual report on the activities of the Fund.
    The committee applauds the establishment of the Global 
Fund, which will serve as a focal point for the international 
community's campaign against the three major infectious global 
diseases--HIV/AIDS, TB, and malaria. The authorizations in this 
section reflect the committee's view that the provision of 
substantial resources to the Fund is and must be a key 
component of U.S. leadership. Demands on the Fund will no doubt 
grow as national HIV/AIDS strategies are developed and grant 
applications increase. The committee would support an increase 
in U.S. contributions to the Fund above the authorization 
levels provided in this section to address these demands.
    While the committee expects the United States to 
demonstrate strong support for the Fund and its work, the 
committee also believes that bilateral U.S. programs to combat 
AIDS, TB, and malaria should be strengthened and expanded. The 
committee does not want to see contributions for the Global 
Fund made at the expense of these bilateral programs. To the 
contrary, funding for these programs should increase because 
they are essential components of the U.S. response.

Sec. 203. Voluntary Contributions to International Vaccine Funds

    This section authorizes appropriations for Fiscal Years 03 
and 04 for the Vaccine Fund, the International AIDS Vaccine 
Initiative (IAVI), and the Malaria Vaccine Initiative of the 
Program for Appropriate Technologies in Health (PATH). The 
Vaccine Fund is authorized at $60 million for FY 03 and $70 
million for FY 04. IAVI is authorized at $12 million for FY 03 
and $15 million for FY 04. The Malaria Vaccine Initiative is 
authorized at $5 million for FY 03 and $6 million for FY 04.
    It is the intention of the committee that the funding for 
the Malaria Vaccine Initiative be additional to the funding 
that USAID currently provides for existing malaria programs, 
including malaria vaccine programs.

                    TITLE III--MULTILATERAL EFFORTS


Sec. 301. Improvement of the Enhanced HIPC Initiative

    This section proposes deeper international debt 
cancellation to provide poor countries with financial resources 
necessary to respond to public health crises, promote human 
development, and reduce poverty. The Secretary of the Treasury 
is authorized and encouraged to engage in negotiations with 
other donor countries, the International Monetary Fund, the 
World Bank, and other international financial institutions to 
improve the operation of the Enhanced HIPC Initiative.
    Specifically, the debt of HIPC countries would be reduced 
to a more sustainable level as measured by two criteria: first, 
net present value of qualified debt not to exceed 150% of the 
annual value of exports, the standard in the current HIPC 
Initiative; and second, annual payments on qualified debt not 
to exceed 10%, or in the case of a country facing a public 
health crisis, 5% of internal revenues, an additional measure 
of a country's ability to repay external debt.
    In financing the objectives of this section, the 
international financial institutions shall give priority to 
using their own resources.
    An eligible poor country must ensure that the financial 
benefits of debt reduction are applied to combating major 
health crises like AIDS, poverty reduction, human development 
and to redress environmental degradation; to ensure that the 
financial benefits are in addition to current public health and 
poverty reduction programs; and to implement good government 
measures.

Sec 302. Reports on Implementation of Improvements to the Enhanced HIPC 
        Initiative

    This section requires the Secretary of the Treasury to 
report no later than 180 days after the date of enactment on 
progress toward an agreement to improve the operation of the 
Enhanced HIPC Initiative. In addition, one year after the 
submission of that report, the Secretary of the Treasury is 
required to report on the progress of countries to implement an 
improved HIPC program.

                      TITLE IV--BILATERAL EFFORTS


              SUBTITLE A--GENERAL ASSISTANCE AND PROGRAMS

Sec. 401. Assistance to Combat HIV/AIDS

    This section amends the Foreign Assistance Act of 1961 to 
strengthen and expand the authorities of USAID to furnish 
assistance to prevent, treat and monitor HIV/AIDS and to carry 
our related programs in sub-Saharan Africa and other countries 
and areas. Specific authorities include the provision of 
medications to prevent MTCT, assistance to ensure safe blood 
supplies, research on microbicides, bulk purchases of available 
prevention technologies for women, treatment of those infected 
with the HIV virus including the provision of antiretrovirals, 
and the purchase and distribution of HIV/AIDS pharmaceuticals.
    Section 401 authorizes appropriations of $800 million for 
FY 03 and $900 million for FY 04 for HIV/AIDS programs and 
activities administered by USAID. Reflecting the committee's 
view that care and treatment programs are fundamental elements 
of an effective response to the AIDS crisis, the bill 
authorizes $100 million of the funds authorized for FY 03 and 
$120 million of the funds authorized for FY 04 for the 
procurement and distribution of HIV/AIDS pharmaceuticals.
    Recognizing the urgent public health need to develop new 
HIV prevention options and the emerging scientific 
opportunities in the field, the committee is strongly 
supportive of USAID's microbicides research and development 
program, and urges USAID's Office of HIV/AIDS, in conjunction 
with other Agency offices and other appropriate executive 
branch agencies, to fully implement the Agency's comprehensive 
strategy to support the development of microbicides, and 
facilitate wide-scale introduction once these products are 
available. The bill authorizes $20 million for FY 03 and $24 
million for FY 04 for microbicide research, reflecting the 
committee's expectation that USAID will fully fund this 
program.

Sec 402. Assistance to Combat Tuberculosis

    This section amends the Foreign Assistance Act of 1961 to 
expand the authorities of USAID to provide assistance for the 
prevention, treatment, control and elimination of tuberculosis. 
Priority is to be given to activities that increase directly 
observed treatment shortcourse (DOTS) coverage, including 
funding for the Global Tuberculosis Drug Facility and the Stop 
Tuberculosis Partnership. This section authorizes $150 million 
for FY 03 and $200 million for FY 04 for TB programs.
    The committee intends that the increased resources 
authorized by this section be used to measurably increase the 
number of patients cured of TB through proven, effective DOTS 
treatment (and DOTS-plus treatment for multi-drug resistant 
TB). The committee expects USAID to devote a large majority of 
the funds to the provision of anti-TB drugs, commodities, 
direct patient services and health worker training to increase 
treatment coverage.
    Efforts to provide much needed drugs and patient services 
have been enhanced through the work of the Stop Tuberculosis 
Partnership, the Global Tuberculosis Drug Facility, and the 
Global Alliance for Tuberculosis Drug Development. The 
committee supports the activities of these organizations and 
encourages the Agency to expand support for each of them, 
including increased U.S. contributions to the Global 
Tuberculosis Drug Facility in order to provide high quality, 
very low-cost TB drugs and help fill the $53 million 
anticipated need for drugs through the Facility in 2003, and to 
the Stop Tuberculosis Partnership.

Sec 403. Assistance to Combat Malaria

    This section amends the Foreign Assistance Act of 1961 to 
add a new section specifically authorizing assistance for the 
prevention, treatment, control, and elimination of malaria. 
Section 403 also authorizes appropriations of $70 million for 
FY 03 and $80 million for FY 04 for bilateral programs to 
combat malaria.
    The committee believes that the resurgence of the malaria 
epidemic, particularly in sub-Saharan Africa and other 
developing countries, requires an expanded assistance effort by 
the United States. This effort should include not only 
assistance for malaria vaccine research, which is authorized in 
section 203 of the bill, but also support for entities engaging 
in anti-malarial drug research. Currently, drugs are the only 
intervention that can treat malaria, but drugs now available 
may not be effective in 5 to 10 years because the malaria 
parasite develops resistance to them. Given this situation, the 
development and bringing to market of new, affordable drugs is 
critical to control of the malaria epidemic. The Medicines for 
Malaria Venture (MMV), a public-private partnership founded by 
the World Health Organization, the World Bank, donor nations 
and various U.S. charitable foundations, is at the forefront of 
the effort to develop new malaria drugs. The committee urges 
USAID to support MMV's work, which holds the promise of closing 
the treatment gap and reversing the spread of malaria.

Sec. 404. Pilot Program for the Placement of Health Care Professionals 
        in Overseas Areas Severely Affected by HIV/AIDS, Tuberculosis, 
        and Malaria

    This section requires the President to establish a program 
to enable American health care professionals to serve in sub-
Saharan Africa and other areas severely affected by HIV/AIDS, 
tuberculosis, and malaria. Participants in the program must 
provide basic health care services, training to medical and 
other personnel in the area in which they are serving, and 
health care educational training to local residents. The 
President may offer financial incentives as necessary to 
encourage participation in the program. Section 404 authorizes 
appropriations of $10 million for the program for FY 03 and $20 
million for FY 04.

Sec 405. Department of Defense HIV/AIDS Prevention Assistance Program

    The Department of Defense currently has a program to 
provide prevention counseling and education for sub-Saharan 
African militaries. Section 405 mandates an expansion of that 
program to the militaries of other countries severely affected 
by the AIDS crisis and also to those serving in international 
peacekeeping operations. Section 405 authorizes appropriations 
of $50 million for FY 03 and $55 million for FY 04 for the 
expanded program.

Sec 406. Report on Treatment Activities by Relevant Executive Branch 
        Agencies

    This section mandates a report to Congress within 15 months 
after the date of enactment on the programs and activities of 
USAID, the Centers for Disease Control and Prevention (CDC), 
and other relevant executive branch agencies to bring treatment 
to individuals infected with the HIV virus or living with AIDS 
in foreign countries. Section 406 specifies elements to be 
included in the report, including efforts to treat 
opportunistic infections and to provide antiretrovirals.
    In the committee's view, treatment is fundamental to a 
successful strategy to combat AIDS. Access to treatment 
strengthens the impact of prevention, education and counseling 
programs and prolongs the lives of those living with HIV/AIDS.

            SUBTITLE B--ASSISTANCE FOR CHILDREN AND FAMILIES

Sec . 411. Findings

    This section presents findings on the impact of the HIV/
AIDS crisis on children and efforts to reduce that impact.

Sec. 412. Policy and Requirements

    Section 412 states that the United States Government should 
place high priority on the prevention of mother-to-child 
transmission, the care and treatment of family members and care 
givers, and the care of children orphaned by AIDS. This section 
also requires that the United States meet or exceed the 
specific targets set by the Declaration of Commitment on HIV/
AIDS to reduce the rate of MTCT, include programs in the U.S. 
strategy to make testing and treatment available to HIV-
positive women and their families, and expand programs for 
children orphaned by AIDS.
    The committee believes that a strong emphasis on preventing 
MTCT is one of the most important steps that can be taken to 
stem the tide of the HIV/AIDS pandemic. At the United Nations 
Special Session on HIV/AIDS, the United States made a 
commitment to reduce global infections of infants in accordance 
with the targets agreed to in the Declaration of Commitment on 
HIV/AIDS, including a 20% reduction in the rate of infection of 
infants by 2005 and a 50% reduction by 2010. USAID and CDC have 
skills and experience in preventing MTCT abroad; both are 
specifically authorized to proceed with rapid scale-up of MTCT 
programs in resource poor nations, with an emphasis on meeting 
the targets set by the United Nations.
    Funding is not the only obstacle to preventing MTCT. USAID, 
working with other appropriate executive branch agencies, 
should support operational research aimed at improving the 
success of these programs by increasing the number of pregnant 
women who participate and the number of women and infants who 
receive a drug intervention to prevent HIV infection of the 
infant.
    Rapid expansion of MTCT activities by USAID and other U.S. 
Government agencies should include close cooperation with the 
governments of resource poor nations, non-governmental 
organizations, and international entities such as UNICEF, WHO, 
UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and 
Malaria. Nationwide scale up of MTCT prevention programs should 
focus on a select number of nations prepared to undertake this 
step.
    Efforts to prevent MTCT can serve as a basis to provide 
expanded care and treatment services to mothers and families 
living with HIV/ AIDS. The committee supports the expansion of 
MTCT to MTCT plus programs and urges USAID to expand the 
availability of care and treatment services for family members 
at MTCT prevention sites that are well established and ready to 
take the next step forward.
    While it is particularly important to have programs to 
prevent MTCT in sub-Saharan Africa, where in some nations more 
than one-third of pregnant mothers are HIV-positive, the 
committee believes that USAID, working with CDC, should begin 
to initiate MTCT prevention programs in other countries and 
regions where the HIV infection rates are growing.

Sec. 413. Annual Reports on the Prevention of Mother-to-Child 
        Transmission of the HIV Infection

    This section mandates a report, the first to be submitted 
within 270 days after the date of enactment and annually 
thereafter for the next eight years, on the activities of 
relevant U.S. Government agencies to assist in the prevention 
of mother-to-child transmission of the HIV infection. Section 
413 lists specific elements to be included in the report.

Sec. 414. Pilot Program of Assistance for Children and Families 
        Affected by HIV/AIDS

    This section directs the Administrator of USAID to 
establish a new program of assistance for the care and 
treatment of orphans and other children and young people 
affected by the global AIDS crisis. The program must build upon 
and be integrated into programs currently administered by the 
Agency for children affected by HIV/AIDS. It must also meet 
other requirements set forth by the section. Section 414 
authorizes appropriations of $15 million for FY 03 and $30 
million for FY 04 for the new program.

                      TITLE V--BUSINESS PRINCIPLES


Sec. 501. Principles for United States Firms Operating in Countries 
        Affected by the HIV/AIDS Pandemic

    This section presents findings on the impact of the HIV/
AIDS pandemic in the workplace and expresses the sense of 
Congress that U.S. firms operating in countries affected by the 
pandemic can make significant contributions to the U.S. 
response to the pandemic through the voluntary adoption of 
certain principles and practices.
    Section 501 lays out ten principles and practices dealing 
with a range of workplace issues including discrimination and 
stigmatization, compulsory HIV/AIDS testing, confidentiality, 
work tenure and separation policies, the development of HIV/
AIDS programs and policies for the workplace, and access to 
treatment.

                          VIII. Cost Estimate

                            United States Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 24, 2002.

Honorable Joseph R. Biden, Jr., Chairman
Committee on Foreign Relations,
United States Senate,
Washington, DC.

    Dear Mr. Chairman:

    The Congressional Budget Office has prepared the enclosed 
cost estimate for S. 2525, the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2002.
    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).

    Enclosure.

 S. 2525--United States Leadership Against HIV/AIDS, Tuberculosis, and 
                          Malaria Act of 2002


Summary

    S. 2525 would require the President to develop a 
comprehensive strategy for the prevention, treatment, and 
monitoring of acquired immune deficiency syndrome (AIDS) caused 
by the human immunodeficiency virus (HIV) and would authorize 
appropriations in 2003 and 2004 to fund those efforts. 
Specifically, the bill would authorize appropriations for 
contributions to the Global Fund to Fight AIDS, Tuberculosis, 
and Malaria and to various international vaccine funds. It 
would authorize funding for bilateral assistance programs to 
prevent, treat, and monitor HIV/AIDS, tuberculosis, and malaria 
and for assistance to the families and children of persons 
affected by those diseases. Assuming appropriation of the 
authorized amounts, CBO estimates implementing S. 2525 would 
cost $256 million in 2003 and almost $4.5 billion over the 
2003-2007 period. The bill would not affect direct spending or 
receipts; therefore, pay-as-you-go procedures would not apply.
    S. 2525 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on the budgets of state, local, or 
tribal governments.

Estimated cost to the Federal Government

    The estimated budgetary impact of S. 2525 is shown in Table 
1. The estimate assumes that the bill will be enacted by 
September 30, 2002, and the authorized amounts will be 
appropriated each year. The costs of this legislation fall 
within budget functions 150 (international affairs) and 050 
(defense).

                                      TABLE 1.--BUDGETARY IMPACT OF S. 2525
                                    [By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                        2002      2003      2004      2005      2006      2007
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law for HIV/AIDS and other
 Infectious Diseases:
  Budget Authority \1\..............................       785         0         0         0         0         0
  Estimated Outlays.................................       646       461       170        79        37        17

Proposed Changes:
  Authorization Level...............................         0     2,172     2,576         0         0         0
  Estimated Outlays.................................         0       256     1,478     1,789       655       303

Spending Under S. 2525 for HIV/AIDS and other
 Infectious Diseases:
  Authorization Level \1\...........................       735     2,172     2,576         0         0         0
  Estimated Outlays.................................       646       717     1,648     1,868       692       320

----------------------------------------------------------------------------------------------------------------
\1\ The 2002 level is the amount appropriated for that year.


Basis of Estimate

    S. 2525 would identify three diseases--HIV/AIDS, 
tuberculosis, and malaria--as being of particular concern to 
the United States and would require the President to develop a 
comprehensive strategy to combat these diseases on a global 
basis. It would establish the position of Coordinator of U.S. 
Government Activities to Combat HIV/AIDS with the 
responsibility to oversee and to coordinate U.S. programs with 
those of other countries and international organizations. The 
bill would require numerous reports to the Congress, and it 
would permit a portion of the authorized amounts to be used for 
administrative expenses.
    Table 2 shows the amounts specifically authorized by the 
bill. CBO estimates that spending for bilateral assistance 
programs and for contributions to the international vaccine 
funds will follow historical patterns for similar programs. The 
Global Fund to Fight AIDS, Tuberculosis, and Malaria is just 
starting operations, having approved its first grants in April 
2002. CBO estimates that disbursements to the fund will proceed 
relatively slowly with disbursements tied to the fund's 
payments to grant recipients to preclude the fund from building 
up idle cash balances.

              TABLE 2.--SPECIFIC AUTHORIZATIONS IN S. 2525
                [By fiscal year, in millions of dollars]
------------------------------------------------------------------------
                                                    2003         2004
------------------------------------------------------------------------
Contribution to the Gobal Fund to Fight Aids,        $1,000       $1,200
 Tuberculosis, and Malaria....................

Contributions to International Vaccine Funds:
  Global Alliance for Vaccines and                       60           70
   Immunizations..............................
  AIDS Vaccine Initiatives....................           12           15
  Malaria Vaccine Initiative..................            5            6

Bilateral Assistance Programs:
  Assistance to Combat HIV/AIDS...............          800          900
  Assistance to Combat Tuberculosis...........          150          200
  Assistance to Combat Malaria................           70           80
  Department of Defense HIV/AIDS Prevention              50           55
   Assistance.................................
  Pilot Program to Place Health Professionals            10           20
   Overseas...................................
  Pilot Programs to Assist Children and                  15           30
   Families...................................
------------------------------------------------------------------------

    Total Authorization Level.................       $2,172       $2,576
------------------------------------------------------------------------


    Title III would urge the Secretary of the Treasury to 
negotiate an agreement with other bilateral and multilateral 
creditors to provide debt relief to highly indebted poor 
countries (HIPC) on terms more generous than the enhanced HIPC 
initiative agreed to in 1999. The cost of this more generous 
debt relief would be borne by other creditors because current 
law only authorizes the United States to cancel its bilateral 
debt to HIPC countries. The bill would not authorize funds for 
any United States' contribution to multilateral, creditors for 
the cost of debt reduction that the U.S. government would be 
asking them to bear. CBO has no basis for estimating whether or 
not such negotiations would be successfully concluded.

Pay-as-you-go considerations

    None.

Intergovernmental and private-sector impact

    S. 2525 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would impose no costs on the 
budgets of state, local, or tribal governments.

Estimate prepared by

    Federal Costs: Joseph C. Whitehill. Impact on state, local, 
and tribal governments: Greg Waring. Impact on the private 
sector: Paige Piper/Bach.

Estimate approved by

    Peter H. Fontaine, Deputy Assistant Director for Budget 
Analysis.

                  IX. Evaluation of Regulatory Impact

    In accordance with rule XXVI, paragraph 11(b) of the 
Standing Rules of the Senate, the committee has concluded that 
there is no regulatory impact from this legislation.

                       X. Changes in Existing Law

    In compliance with Rule XXVI, paragraph 12 of the Standing 
Rules of the Senate, 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 
italic, existing law in which no change is proposed is shown in 
roman):

                     Foreign Assistance Act of 1961


                                 Part I


      CHAPTER 1--POLICY; DEVELOPMENT ASSISTANCE AUTHORIZATIONS

           *       *       *       *       *       *       *


SEC. 104.--POPULATION AND HEALTH.

           *       *       *       *       *       *       *


  (c) Assistance for Health and Disease Prevention.--(1) In 
order to contribute to improvements in the health of the 
greatest number of poor people in developing countries, the 
President is authorized to furnish assistance, on such terms 
and conditions as he may determine, for health programs. 
Assistance under this subsection shall be used primarily for 
basic integrated health services, safe water and sanitation, 
disease prevention and control, and related health planning and 
research. The assistance shall emphasize self-sustaining 
community-based health programs by means such as training of 
health auxiliary and other appropriate personnel, support for 
the establishment and evaluation of projects that can be 
replicated on a broader scale, measures to improve management 
of health programs, and other services and suppliers to support 
health and disease prevention programs.
  (2) (A) In carrying out the purposes of this subsection, the 
President shall promote, encourage, and undertake activities 
designed to deal directly with the special health needs of 
children and mothers. Such activities should utilize simple, 
available technologies which can significantly reduce childhood 
mortality, such as improved and expanded immunization programs, 
oral rehydration to combat diarrhoeal diseases, and education 
programs aimed at improving nutrition and sanitation and at 
promoting child spacing. In carrying out this paragraph, 
guidance shall be sought from knowledgeable health 
professionals from outside the agency primarily responsible for 
administering this part. In addition to government-to-
government programs, activities pursuant to this paragraph 
should include support for appropriate activities of the types 
described in this paragraph which are carried out by 
international organizations (which may include international 
organizations receiving funds under chapter 3 of this part) and 
by private and voluntary organizations, and should include 
encouragement to other donors to support such types of 
activities.
  (B) In addition to amounts otherwise available for such 
purpose, there are authorized to be appropriated to the 
President $25,000,000 for fiscal year 1986 and $75,000,000 for 
fiscal year 1987 for use in carrying out this paragraph. 
Amounts appropriated under this subparagraph are authorized to 
remain available until expended.
  (C) Appropriations pursuant to subparagraph (B) may be 
referred to as the ``Child Survival Fund.''
  (3) The Congress recognizes that the promotion of primary 
health care is a major objective of the foreign assistance 
program. The Congress further recognizes that simple, 
relatively low-cost means already exist to reduce incidence of 
communicable diseases among children, mothers, and infants. The 
promotion of vaccines for immunization, and salts for oral 
rehydration, therefore, is an essential feature of the health 
assistance program. To this end, the Congress expects the 
agency primarily responsible for administering this part to set 
as a goal the protection of not less than 80 percent of all 
children, in those countries in which such agency has 
established development programs, from immunizable diseases by 
January 1, 1991. Of the aggregate amounts made available for 
fiscal year 1987 to carry out paragraph (2) of this subsection 
(relating to the Child Survival Fund) and to carry out 
subsection (c) (relating to development assistance for health), 
$50,000,000 shall be used to carry out this paragraph.
  [(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.
  [(7) (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) to coordinate with the World Health 
        Organization, the Centers for Disease Control, the 
        National Institutes of Health, and other organizations 
        toward the development and implementation of a 
        comprehensive tuberculosis control program; and
          [(ii) to set as a goal the detection of at least 70 
        percent of the cases of infectious tuberculosis, and 
        the cure of at least 85 percent of the cases detected, 
        in those countries in which the agency has established 
        development programs, by December 31, 2010.
  [(B) There is authorized to be appropriated to the President, 
$60,000,000 for each of the fiscal years 2001 and 2002 to be 
used to carry out this paragraph. Funds appropriated under this 
subparagraph are authorized to remain available until 
expended.]
          (4) Relationship to other laws.--Assistance made 
        available under this subsection and sections 104A, 
        104B, and 104C, and assistance made available under 
        chapter 4 of part II to carry out the purposes of this 
        subsection and such other sections of this Act, may be 
        made available in accordance with this subsection and 
        such other provisions of this Act notwithstanding any 
        other provision of law.
  (d) Integration of Assistance Programs.--

           *       *       *       *       *       *       *


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

  (a) Finding.--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.
  (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to provide assistance 
for the prevention, treatment, and control of HIV/AIDS. The 
United States and other developed countries should provide 
assistance to countries in sub-Saharan Africa and other 
countries and areas to control this crisis through HIV/AIDS 
prevention, treatment, monitoring, and related activities, 
particularly activities focused on women and youth, including 
strategies to prevent mother-to-child transmission of the HIV 
infection.
  (c) Authorization.--
          (1) In general.--Consistent with section 104(c), the 
        President is authorized to furnish assistance, on such 
        terms and conditions as the President may determine, to 
        prevent, treat, and monitor HIV/AIDS, and carry out 
        related activities, in countries in sub-Saharan Africa 
        and other countries and areas.
          (2) Role of ngos.--It is the sense of Congress that 
        the President should provide an appropriate level of 
        assistance under paragraph (1) through nongovernmental 
        organizations in countries in sub-Saharan Africa and 
        other countries and areas affected by the HIV/AIDS 
        pandemic.
          (3) Coordination of assistance efforts.--The 
        President shall coordinate the provision of assistance 
        under paragraph (1) with the provision of related 
        assistance by the Joint United Nations Programme on 
        HIV/AIDS (UNAIDS), the United Nations Children's Fund 
        (UNICEF), the World Health Organization (WHO), the 
        United Nations Development Programme (UNDP), the Global 
        Fund to Fight AIDS, Tuberculosis and Malaria and other 
        appropriate international organizations (such as the 
        International Bank for Reconstruction and Development), 
        relevant regional multilateral development 
        institutions, national, state, and local governments of 
        foreign countries, appropriate governmental and 
        nongovernmental organizations, and relevant Executive 
        branch agencies.
  (d) Activities Supported.--Assistance provided under 
subsection (c) shall, to the maximum extent practicable, be 
used to carry out the following activities:
          (1) Prevention.--Prevention of HIV/AIDS through 
        activities including--
                  (A) education, voluntary testing, and 
                counseling (including the incorporation of 
                confidentiality protections with respect to 
                such testing and counseling), including 
                integration of such programs into health 
                programs and the inclusion in counseling 
                programs of information on methods of 
                preventing transmission of the HIV infection, 
                including delaying sexual debut, abstinence, 
                reduction of casual sexual partnering, and, 
                where appropriate, the use of condoms;
                  (B) assistance for the purpose of preventing 
                mother-to-child transmission of the HIV 
                infection, including medications to prevent 
                such transmission and access to infant formula 
                and other alternatives for infant feeding;
                  (C) assistance to ensure a safe blood supply, 
                to provide--
                          (i) post-exposure prophylaxis to 
                        victims of rape and sexual assault and 
                        in cases of occupational exposure of 
                        health care workers; and
                          (ii) necessary commodities, including 
                        test kits, pharmaceuticals, and 
                        condoms;
                  (D) 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;
                  (E) research on microbicides which prevent 
                the spread of HIV/AIDS; and
                  (F) bulk purchases of available prevention 
                technologies for women and for appropriate 
                program support for the introduction and 
                distribution of these technologies, as well as 
                education and training on the use of the 
                technologies.
          (2) Treatment.--The treatment and care of individuals 
        with HIV/AIDS, including--
                  (A) assistance to establish and implement 
                programs to strengthen and broaden indigenous 
                health care delivery systems and the capacity 
                of such systems to deliver HIV/AIDS 
                pharmaceuticals and otherwise provide for the 
                treatment of individuals with HIV/AIDS, 
                including clinical training for indigenous 
                organizations and health care providers;
                  (B) assistance to strengthen and expand 
                hospice and palliative care programs to assist 
                patients debilitated by HIV/AIDS, their 
                families, and the primary caregivers of such 
                patients, including programs that utilize 
                faith-based and community-based organizations; 
                and
                  (C) assistance for the purpose of the care 
                and treatment of individuals with HIV/AIDS 
                through the provision of pharmaceuticals, 
                including antiretrovirals and other 
                pharmaceuticals and therapies for the treatment 
                of opportunistic infections, nutritional 
                support, and other treatment modalities.
          (3) Monitoring.--The monitoring of programs, 
        projects, and activities carried out pursuant to 
        paragraphs (1) and (2), including--
                  (A) monitoring to ensure that adequate 
                controls are established and implemented to 
                provide HIV/AIDS pharmaceuticals and other 
                appropriate medicines to poor individuals with 
                HIV/AIDS; and
                  (B) appropriate evaluation and surveillance 
                activities.
          (4) Pharmaceuticals.--
                  (A) Procurement.--The procurement of HIV/AIDS 
                pharmaceuticals, antiviral therapies, and other 
                appropriate medicines, including medicines to 
                treat opportunistic infections.
                  (B) Mechanisms for quality control and 
                sustainable supply.--Mechanisms to ensure that 
                such HIV/AIDS pharmaceuticals, antiretroviral 
                therapies, and other appropriate medicines are 
                quality-controlled and sustainably supplied.
                  (C) Distribution.--The distribution of such 
                HIV/AIDS pharmaceuticals, antiviral therapies, 
                and other appropriate medicines (including 
                medicines to treat opportunistic infections) to 
                qualified national, regional, or local 
                organizations for the treatment of individuals 
                with HIV/AIDS in accordance with appropriate 
                HIV/AIDS testing and monitoring requirements 
                and treatment protocols and for the prevention 
                of mother-to-child transmission of the HIV 
                infection.
          (5) Related activities.--The conduct of related 
        activities, including--
                  (A) the care and support of children who are 
                orphaned by the HIV/AIDS pandemic, including 
                services designed to care for orphaned children 
                in a family environment which rely on extended 
                family members;
                  (B) improved infrastructure and institutional 
                capacity to develop and manage education, 
                prevention, and treatment programs, including 
                training and the resources to collect and 
                maintain accurate HIV surveillance data to 
                target programs and measure the effectiveness 
                of interventions;
                  (C) vaccine research and development 
                partnership programs with specific plans of 
                action to develop a safe, effective, 
                accessible, preventive HIV vaccine for use 
                throughout the world; and
                  (D) 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.
  (e) Annual Report.--
          (1) In general.--Not later than January 31 of each 
        year, the President shall submit to the Committee on 
        Foreign Relations of the Senate and the Committee on 
        International Relations of the House of Representatives 
        a report on the implementation of this section for the 
        prior fiscal year.
          (2) Report elements.--Each report shall include--
                  (A) a description of efforts made to 
                implement the policies set forth in this 
                section;
                  (B) a description of the programs established 
                pursuant to this section; and
                  (C) a detailed assessment of the impact of 
                programs established pursuant to this section, 
                including--
                          (i) the effectiveness of such 
                        programs in reducing the spread of the 
                        HIV infection, particularly in women 
                        and girls, in reducing mother-to-child 
                        transmission of the HIV infection, and 
                        in reducing mortality rates from HIV/
                        AIDS; and
                          (ii) the progress made toward 
                        improving health care delivery systems 
                        (including the training of adequate 
                        numbers of staff) and infrastructure to 
                        ensure increased access to care and 
                        treatment.
  (f) Funding Limitation.--Of the funds made available to carry 
out this section in any fiscal year, not more than 7 percent 
may be used for the administrative expenses of the United 
States Agency for International Development in support of 
activities described in this section. Such amount shall be in 
addition to other amounts otherwise available for such 
purposes.
  (g) Definitions.--In this section:
          (1) AIDS.--The term ``AIDS'' means acquired immune 
        deficiency syndrome.
          (2) HIV.--The term ``HIV'' means the human 
        immunodeficiency virus, the pathogen that causes AIDS.
          (3) HIV/AIDS.--The term ``HIV/AIDS'' means, with 
        respect to an individual, an individual who is infected 
        with HIV or living with AIDS.

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

  (a) Findings.--Congress makes the following findings:
          (1) Congress recognizes the growing international 
        problem of tuberculosis and the impact its continued 
        existence has on those countries that had previously 
        largely controlled the disease.
          (2) Congress further recognizes that the means exist 
        to control and treat tuberculosis through expanded use 
        of the DOTS (Directly Observed Treatment Short-course) 
        treatment strategy and adequate investment in newly 
        created mechanisms to increase access to treatment, 
        including the Global Tuberculosis Drug Facility 
        established in 2001 pursuant to the Amsterdam 
        Declaration to Stop TB.
  (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to control 
tuberculosis, including the detection of at least 70 percent of 
the cases of infectious tuberculosis, and the cure of at least 
85 percent of the cases detected, not later than December 31, 
2005, in those countries classified by the World Health 
Organization as among the highest tuberculosis burden, and not 
later than December 31, 2010, in all countries in which the 
United States Agency for International Development has 
established development programs.
  (c) Authorization.--To carry out this section and consistent 
with section 104(c), the President is authorized to furnish 
assistance, on such terms and conditions as the President may 
determine, for the prevention, treatment, control, and 
elimination of tuberculosis.
  (d) Coordination.--In carrying out this section, the 
President shall coordinate with the World Health Organization, 
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the 
Department of Health and Human Services (including the Centers 
for Disease Control and Prevention and the National Institutes 
of Health), and other organizations with respect to the 
development and implementation of a comprehensive tuberculosis 
control program.
  (e) Annual Report.--Not later than January 31 of each year, 
the President shall submit a report to the Committee on Foreign 
Relations of the Senate and the Committee on International 
Relations of the House of Representatives specifying the 
increases in the number of people treated and the increases in 
number of tuberculosis patients cured through each program, 
project, or activity receiving United States foreign assistance 
for tuberculosis control purposes.
  (f) Priority to DOTS Coverage.--In furnishing assistance 
under subsection (c), the President shall give priority to 
activities that increase directly observed treatment 
shortcourse (DOTS) coverage, including funding for the Global 
Tuberculosis Drug Facility and the Stop Tuberculosis 
Partnership.
  (g) Definitions.--In this section:
          (1) DOTS.--The term ``DOTS'' or ``Directly Observed 
        Treatment Short-course'' means the World Health 
        Organization-recommended strategy for treating 
        tuberculosis.
          (2) Global tuberculosis drug facility.--The term 
        ``Global Tuberculosis Drug Facility (GDF)'' means the 
        new initiative of the Stop Tuberculosis Partnership to 
        increase access to high-quality tuberculosis drugs to 
        facilitate DOTS expansion.
          (3) Stop tuberculosis partnership.--The term ``Stop 
        Tuberculosis Partnership'' means the partnership of the 
        World Health Organization, donors including the United 
        States, high tuberculosis burden countries, 
        multilateral agencies, and nongovernmental and 
        technical agencies committed to short- and long-term 
        measures required to control and eventually eliminate 
        tuberculosis as a public health problem in the world.

SEC. 104C. ASSISTANCE TO COMBAT MALARIA.

  (a) Finding.--Congress finds that malaria kills more people 
annually than any other communicable disease except 
tuberculosis, that more than 90 percent of all malaria cases 
are in sub-Saharan Africa, and that children and women are 
particularly at risk. Congress recognizes that there are cost-
effective tools to decrease the spread of malaria and that 
malaria is a curable disease if promptly diagnosed and 
adequately treated.
  (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to provide assistance 
for the prevention, control, and cure of malaria.
  (c) Authorization.--To carry out this section and consistent 
with section 104(c), the President is authorized to furnish 
assistance, on such terms and conditions as the President may 
determine, for the prevention, treatment, control, and 
elimination of malaria.
  (d) Coordination.--In carrying out this section, the 
President shall coordinate with the World Health Organization, 
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the 
Department of Health and Human Services (the Centers for 
Disease Control and Prevention and the National Institutes of 
Health), and other organizations with respect to the 
development and implementation of a comprehensive malaria 
control program.
  (e) Annual Report.--Not later than January 31 of each year, 
the President shall submit a report to the Committee on Foreign 
Relations of the Senate and the Committee on International 
Relations of the House of Representatives specifying the 
increases in the number of people treated and the increases in 
number of malaria patients cured through each program, project, 
or activity receiving United States foreign assistance for 
malaria control purposes.

           *       *       *       *       *       *       *


SEC. 302. AUTHORIZATION.--

           *       *       *       *       *       *       *


  (k) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the 
President [$50,000,000 for each of the fiscal years 2001 and 
2002] $60,000,000 for the fiscal year 2003 and $70,000,000 for 
the fiscal year 2004 to be available only for United States 
contributions to the [Global Alliance for Vaccines and 
Immunizations] Vaccine Fund.
  (l) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the 
President [$10,000,000 for each of the fiscal years 2001 and 
2002] $12,000,000 for the fiscal year 2003 and $15,000,000 for 
the fiscal year 2004 to be available only for United States 
contributions to the International AIDS Vaccine Initiative.
  (m) In addition to amounts otherwise available under this 
section, there are authorized to be appropriated to the 
President $5,000,000 for the fiscal year 2003 and $6,000,000 
for the fiscal year 2004 to be available only for United States 
contributions to the Malaria Vaccine Initiative of the Program 
for Appropriate Technologies in Health (PATH).

             State Department Basic Authorities Act of 1956


                  TITLE 1--BASIC AUTHORITIES GENERALLY


                ORGANIZATION OF THE DEPARTMENT OF STATE

  Section 1. (a) Secretary of State.--

           *       *       *       *       *       *       *

  (f) HIV/AIDS Response Coordinator.--
          (1) In general.--There shall be within the Department 
        of State a Coordinator of United States Government 
        Activities to Combat HIV/AIDS Globally, who shall be 
        appointed by the President, by and with the advice and 
        consent of the Senate. The Coordinator shall report 
        directly to the Secretary of State and shall have the 
        rank and status of ambassador.
          (2) Duties.--(A) The Coordinator shall have primary 
        responsibility for the oversight and coordination of 
        all activities of the United States Government to 
        combat the international HIV/AIDS pandemic, including 
        all programs, projects, and activities of the United 
        States Government under this Act or any amendment made 
        by this Act.
          (B) The duties of the Coordinator shall specifically 
        include the following:
                  (i) Ensuring program and policy coordination 
                among the relevant Executive branch agencies.
                  (ii) Ensuring that each relevant Executive 
                branch agency undertakes programs primarily in 
                those areas where the agency has the greatest 
                expertise, technical capabilities, and 
                potential for success.
                  (iii) Avoiding duplication of effort.
                  (iv) Enhancing onsite coordination.
                  (v) Pursuing coordination with other 
                countries and international organizations.
                  (vi) Resolving policy, program, and funding 
                disputes among the relevant Executive branch 
                agencies.

               International Financial Institutions Act

           *       *       *       *       *       *       *



                       TITLE XVI--HUMAN WELFARE

           *       *       *       *       *       *       *



SEC. 1624. REFORM OF THE ENHANCED STRUCTUAL ADJUSTMENT FACILITY

           *       *       *       *       *       *       *


SEC. 1625. IMPROVEMENT OF THE ENHANCED HIPC INITIATIVE.

  (a) Authority.--In order to ensure that the Enhanced HIPC 
Initiative achieves the objective of substantially increasing 
resources available for human development and poverty reduction 
in heavily indebted poor countries, the Secretary of the 
Treasury is authorized and requested to conclude as soon as 
possible an agreement within the Paris Club of Official 
Creditors, as well as the International Bank for Reconstruction 
and Development (World Bank), the International Monetary Fund, 
and other appropriate multilateral development institutions to 
accomplish the modifications in the Enhanced HIPC Initiative 
described in subsection (b).
  (b) Agreement.--The agreement referred to in subsection (a) 
is an agreement that provides the following:
          (1) Level of exports and revenues.--
                  (A) In general.--The amount of debt stock 
                reduction approved for a country eligible for 
                debt relief under the Enhanced HIPC Initiative 
                shall be sufficient to reduce, for at least 
                each of the first 3 years after the Decision 
                Point--
                          (i) the net present value of the 
                        outstanding public and publicly 
                        guaranteed debt of the country to not 
                        more than 150 percent of the annual 
                        value of exports of the country for the 
                        year preceding the Decision Point; and
                          (ii) the annual payments due on such 
                        public and publicly guaranteed debt to 
                        not more than 10 percent or, in the 
                        case of a country suffering a public 
                        health crisis (as defined in subsection 
                        (c)), not more than 5 percent, of the 
                        amount of the annual current revenues 
                        received by the country from internal 
                        sources.
                  (B) Limitation.--In financing the objectives 
                of the Enhanced HIPC Initiative, an 
                international financial institution shall give 
                priority to using its own resources.
          (2) Relation to poverty and the environment.--The 
        debt cancellation under the Enhanced HIPC Initiative 
        shall not be conditioned on any agreement by an 
        impoverished country to implement or comply with 
        policies that deepen poverty or degrade the 
        environment, including any policy that--
                  (A) implements or extends user fees on 
                primary education or primary health care, 
                including prevention and treatment efforts for 
                HIV/AIDS, tuberculosis, malaria, and infant, 
                child, and maternal well-being;
                  (B) provides for increased cost recovery from 
                poor people to finance basic public services 
                such as education, health care, clean water, or 
                sanitation;
                  (C) reduces the country's minimum wage to a 
                level of less than $2 per day or undermines 
                workers' ability to exercise effectively their 
                internationally recognized worker rights, as 
                defined under section 526(e) of the Foreign 
                Operations, Export Financing and Related 
                Programs Appropriations Act, 1995 (22 U.S.C. 
                262p-4p); or
                  (D) promotes unsustainable extraction of 
                resources or results in reduced budget support 
                for environmental programs.
          (3) Foreign government policies.--A country shall not 
        be eligible for cancellation of debt under the Enhanced 
        HIPC Initiative if the government of the country--
                  (A) has repeatedly provided support for acts 
                of international terrorism, as determined by 
                the Secretary of State under section 6(j)(1) of 
                the Export Administration Act of 1979 (50 
                U.S.C. App. 2405(j)(1)) or section 620A(a) of 
                the Foreign Assistance Act of 1961 (22 U.S.C. 
                2371(a)); and
                  (B) engages in a consistent pattern of gross 
                violations of internationally recognized human 
                rights (including its military or other 
                security forces).
          (4) Programs to combat hiv/aids, tuberculosis, and 
        malaria.--A country that is otherwise eligible to 
        receive cancellation of debt under the Enhanced HIPC 
        Initiative may receive such cancellation only if the 
        country has agreed--
                  (A) in the case of a country suffering a 
                public health crisis (as defined in subsection 
                (c)), to ensure that, where practicable, 10 to 
                20 percent of the financial benefits of debt 
                cancellation are applied to programs to combat 
                HIV/AIDS, tuberculosis, and malaria in that 
                country;
                  (B) to ensure that the financial benefits of 
                debt cancellation are applied to programs to 
                combat poverty (in particular through concrete 
                measures to improve basic services in 
                education, nutrition, and health), and to 
                redress environmental degradation;
                  (C) to ensure that the financial benefits of 
                debt cancellation are in addition to the 
                government's total spending on programs to 
                combat HIV/AIDS and poverty reduction for the 
                previous year or the average total of such 
                expenditures for the previous 3 years, 
                whichever is greater;
                  (D) to implement transparent and 
                participatory policymaking and budget 
                procedures, good governance, and effective 
                anticorruption measures; and
                  (E) to broaden public participation and 
                popular understanding of the principles and 
                goals of poverty reduction.
  (c) Definitions.--In this section:
          (1) Country suffering a public health crisis.--The 
        term ``country suffering a public health crisis'' 
        means--
                  (A) a country in which HIV/AIDS, 
                tuberculosis, or malaria is causing significant 
                family, community, or societal disruption; and
                  (B) a country that has rapidly rising rates 
                of incidence of at least one of such diseases 
                that is likely to lead to conditions described 
                in subparagraph (A).
          (2) Decision point.--The term ``Decision Point'' 
        means the date on which the executive boards of the 
        World Bank and the International Monetary Fund review 
        the debt sustainability analysis for a country and 
        determine that the country is eligible for debt relief 
        under the Enhanced HIPC Initiative.
          (3) Enhanced hipc initiative.--The term ``Enhanced 
        HIPC Initiative'' means the multilateral debt 
        initiative for heavily indebted poor countries 
        presented in the Report of G-7 Finance Ministers on the 
        Cologne Debt Initiative to the Cologne Economic Summit, 
        Cologne, June 18-20, 1999.

                                  
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