[House Report 108-60]
[From the U.S. Government Publishing Office]



108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     108-60

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



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

                                _______
                                

 April 7, 2003.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Hyde, from the Committee on International Relations, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1298]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on International Relations, to whom was 
referred the bill (H.R. 1298) to provide assistance to foreign 
countries to combat HIV/AIDS, tuberculosis, and malaria, and 
for other purposes, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                           TABLE OF CONTENTS

                                                                   Page
The Amendment....................................................     1
Purpose and Summary..............................................    23
Background and Need for the Legislation..........................    24
Hearings.........................................................    27
Committee Consideration..........................................    27
Summary of Amendments............................................    28
Votes of the Committee...........................................    29
Committee Oversight Findings.....................................    31
New Budget Authority and Tax Expenditures........................    31
Congressional Budget Office Cost Estimate........................    31
Performance Goals and Objectives.................................    33
Constitutional Authority Statement...............................    33
Section-by-Section Analysis......................................    33
New Advisory Committees..........................................    37
Congressional Accountability Act.................................    37
Federal Mandates.................................................    37
Changes in Existing Law Made by the Bill, as Reported............    37

                             The Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

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

               TITLE I--POLICY PLANNING AND COORDINATION

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

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

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

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

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

            Subtitle B--Assistance for Children and Families

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

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

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

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) During the last 20 years, HIV/AIDS has assumed pandemic 
        proportions, spreading from the most severely affected regions, 
        sub-Saharan Africa and the Caribbean, to all corners of the 
        world, and leaving an unprecedented path of death and 
        devastation.
            (2) According to the Joint United Nations Programme on HIV/
        AIDS (UNAIDS), more than 65,000,000 individuals worldwide have 
        been infected with HIV since the epidemic began, more than 
        25,000,000 of these individuals have lost their lives to the 
        disease, and more than 14,000,000 children have been orphaned 
        by the disease. HIV/AIDS is the fourth-highest cause of death 
        in the world.
            (3)(A) At the end of 2002, an estimated 42,000,000 
        individuals were infected with HIV or living with AIDS, of 
        which more than 75 percent live in Africa or the Caribbean. Of 
        these individuals, more than 3,200,000 were children under the 
        age of fifteen and more than 19,200,000 were women.
            (B) Women are four times more vulnerable to infection than 
        are men and are becoming infected at increasingly high rates, 
        in part because many societies do not provide poor women and 
        young girls with the social, legal, and cultural protections 
        against high risk activities that expose them to HIV/AIDS.
            (C) Women and children who are refugees or are internally 
        displaced persons are especially vulnerable to sexual 
        exploitation and violence, thereby increasing the possibility 
        of HIV infection.
            (4) As the leading cause of death in sub-Saharan Africa, 
        AIDS has killed more than 19,400,000 individuals (more than 3 
        times the number of AIDS deaths in the rest of the world) and 
        will claim the lives of one-quarter of the population, mostly 
        adults, in the next decade.
            (5) An estimated 2,000,000 individuals in Latin America and 
        the Caribbean and another 7,100,000 individuals in Asia and the 
        Pacific region are infected with HIV or living with AIDS. 
        Infection rates are rising alarmingly in Eastern Europe 
        (especially in the Russian Federation), Central Asia, and 
        China.
            (6) HIV/AIDS threatens personal security by affecting the 
        health, lifespan, and productive capacity of the individual and 
        the social cohesion and economic well-being of the family.
            (7) HIV/AIDS undermines the economic security of a country 
        and individual businesses in that country by weakening the 
        productivity and longevity of the labor force across a broad 
        array of economic sectors and by reducing the potential for 
        economic growth over the long term.
            (8) HIV/AIDS destabilizes communities by striking at the 
        most mobile and educated members of society, many of whom are 
        responsible for security at the local level and governance at 
        the national and subnational levels as well as many teachers, 
        health care personnel, and other community workers vital to 
        community development and the effort to combat HIV/AIDS. In 
        some countries the overwhelming challenges of the HIV/AIDS 
        epidemic are accelerating the outward migration of critically 
        important health care professionals.
            (9) HIV/AIDS weakens the defenses of countries severely 
        affected by the HIV/AIDS crisis through high infection rates 
        among members of their military forces and voluntary 
        peacekeeping personnel. According to UNAIDS, in sub-Saharan 
        Africa, many military forces have infection rates as much as 
        five times that of the civilian population.
            (10) HIV/AIDS poses a serious security issue for the 
        international community by--
                    (A) increasing the potential for political 
                instability and economic devastation, particularly in 
                those countries and regions most severely affected by 
                the disease;
                    (B) decreasing the capacity to resolve conflicts 
                through the introduction of peacekeeping forces because 
                the environments into which these forces are introduced 
                pose a high risk for the spread of HIV/AIDS; and
                    (C) increasing the vulnerability of local 
                populations to HIV/AIDS in conflict zones from 
                peacekeeping troops with HIV infection rates 
                significantly higher than civilian populations.
            (11) The devastation wrought by the HIV/AIDS pandemic is 
        compounded by the prevalence of tuberculosis and malaria, 
        particularly in developing countries where the poorest and most 
        vulnerable members of society, including women, children, and 
        those individuals living with HIV/AIDS, become infected. 
        According to the World Health Organization (WHO), HIV/AIDS, 
        tuberculosis, and malaria accounted for more than 5,700,000 
        deaths in 2001 and caused debilitating illnesses in millions 
        more.
            (12) Together, HIV/AIDS, tuberculosis, malaria and related 
        diseases are undermining agricultural production throughout 
        Africa. According to the United Nations Food and Agricultural 
        Organization, 7,000,000 agricultural workers throughout 25 
        African countries have died from AIDS since 1985. Countries 
        with poorly developed agricultural systems, which already face 
        chronic food shortages, are the hardest hit, particularly in 
        sub-Saharan Africa, where high HIV prevalence rates are 
        compounding the risk of starvation for an estimated 14,400,000 
        people.
            (13) Tuberculosis is the cause of death for one out of 
        every three people with AIDS worldwide and is a highly 
        communicable disease. HIV infection is the leading threat to 
        tuberculosis control. Because HIV infection so severely weakens 
        the immune system, individuals with HIV and latent tuberculosis 
        infection have a 100 times greater risk of developing active 
        tuberculosis diseases thereby increasing the risk of spreading 
        tuberculosis to others. Tuberculosis, in turn, accelerates the 
        onset of AIDS in individuals infected with HIV.
            (14) Malaria, the most deadly of all tropical parasitic 
        diseases, has been undergoing a dramatic resurgence in recent 
        years due to increasing resistance of the malaria parasite to 
        inexpensive and effective drugs. At the same time, increasing 
        resistance of mosquitoes to standard insecticides makes control 
        of transmission difficult to achieve. The World Health 
        Organization estimates that between 300,000,000 and 500,000,000 
        new cases of malaria occur each year, and annual deaths from 
        the disease number between 2,000,000 and 3,000,000. Persons 
        infected with HIV are particularly vulnerable to the malaria 
        parasite. The spread of HIV infection contributes to the 
        difficulties of controlling resurgence of the drug resistant 
        malaria parasite.
            (15) HIV/AIDS is first and foremost a health problem. 
        Successful strategies to stem the spread of the HIV/AIDS 
        pandemic will require clinical medical interventions, the 
        strengthening of health care delivery systems and 
        infrastructure, and determined national leadership and 
        increased budgetary allocations for the health sector in 
        countries affected by the epidemic as well as measures to 
        address the social and behavioral causes of the problem and its 
        impact on families, communities, and societal sectors.
            (16) Basic interventions to prevent new HIV infections and 
        to bring care and treatment to people living with AIDS, such as 
        voluntary counseling and testing and mother-to-child 
        transmission programs, are achieving meaningful results and are 
        cost-effective. The challenge is to expand these interventions 
        from a pilot program basis to a national basis in a coherent 
        and sustainable manner.
            (17) Appropriate treatment of individuals with HIV/AIDS can 
        prolong the lives of such individuals, preserve their families, 
        prevent children from becoming orphans, and increase 
        productivity of such individuals by allowing them to lead 
        active lives and reduce the need for costly hospitalization for 
        treatment of opportunistic infections caused by HIV.
            (18) Nongovernmental organizations, including faith-based 
        organizations, with experience in health care and HIV/AIDS 
        counseling, have proven effective in combating the HIV/AIDS 
        pandemic and can be a resource in assisting indigenous 
        organizations in severely affected countries in their efforts 
        to provide treatment and care for individuals infected with 
        HIV/AIDS.
            (19) Faith-based organizations are making an important 
        contribution to HIV prevention and AIDS treatment programs 
        around the world. Successful HIV prevention programs in Uganda, 
        Jamaica, and elsewhere have included local churches and faith-
        based groups in efforts to promote behavior changes to prevent 
        HIV, to reduce stigma associated with HIV infection, to treat 
        those afflicted with the disease, and to care for orphans. The 
        Catholic Church alone currently cares for one in four people 
        being treated for AIDS worldwide. Faith-based organizations 
        possess infrastructure, experience, and knowledge that will be 
        needed to carry out these programs in the future and should be 
        an integral part of United States efforts.
            (20)(A) Uganda has experienced the most significant decline 
        in HIV rates of any country in Africa, including a decrease 
        among pregnant women from 20.6 percent in 1991 to 7.9 percent 
        in 2000.
            (B) Uganda made this remarkable turnaround because 
        President Yoweri Museveni spoke out early, breaking long-
        standing cultural taboos, and changed widespread perceptions 
        about the disease. His leadership stands as a model for ways 
        political leaders in Africa and other developing countries can 
        mobilize their nations, including civic organizations, 
        professional associations, religious institutions, business and 
        labor to combat HIV/AIDS.
            (C) Uganda's successful AIDS treatment and prevention 
        program is referred to as the ABC model: ``Abstain, Be 
        faithful, use Condoms'', in order of priority. Jamaica, Zambia, 
        Ethiopia and Senegal have also successfully used the ABC model. 
        Beginning in 1986, Uganda brought about a fundamental change in 
        sexual behavior by developing a low-cost program with the 
        message: ``Stop having multiple partners. Be faithful. 
        Teenagers, wait until you are married before you begin sex.''.
            (D) By 1995, 95 percent of Ugandans were reporting either 
        one or zero sexual partners in the past year, and the 
        proportion of sexually active youth declined significantly from 
        the late 1980s to the mid-1990s. The greatest percentage 
        decline in HIV infections and the greatest degree of behavioral 
        change occurred in those 15 to 19 years old. Uganda's success 
        shows that behavior change, through the use of the ABC model, 
        is a very successful way to prevent the spread of HIV.
            (21) The magnitude and scope of the HIV/AIDS crisis demands 
        a comprehensive, long-term, international response focused upon 
        addressing the causes, reducing the spread, and ameliorating 
        the consequences of the HIV/AIDS pandemic, including--
                    (A) prevention and education, care and treatment, 
                basic and applied research, and training of health care 
                workers, particularly at the community and provincial 
                levels, and other community workers and leaders needed 
                to cope with the range of consequences of the HIV/AIDS 
                crisis;
                    (B) development of health care infrastructure and 
                delivery systems through cooperative and coordinated 
                public efforts and public and private partnerships;
                    (C) development and implementation of national and 
                community-based multisector strategies that address the 
                impact of HIV/AIDS on the individual, family, 
                community, and nation and increase the participation of 
                at-risk populations in programs designed to encourage 
                behavioral and social change and reduce the stigma 
                associated with HIV/AIDS; and
                    (D) coordination of efforts between international 
                organizations such as the Global Fund to Fight AIDS, 
                Tuberculosis and Malaria, the Joint United Nations 
                Programme on HIV/AIDS (UNAIDS), the World Health 
                Organization (WHO), national governments, and private 
                sector organizations, including faith-based 
                organizations.
            (22) The United States has the capacity to lead and enhance 
        the effectiveness of the international community's response 
        by--
                    (A) providing substantial financial resources, 
                technical expertise, and training, particularly of 
                health care personnel and community workers and 
                leaders;
                    (B) promoting vaccine and microbicide research and 
                the development of new treatment protocols in the 
                public and commercial pharmaceutical research sectors;
                    (C) making available pharmaceuticals and 
                diagnostics for HIV/AIDS therapy;
                    (D) encouraging governments and faith-based and 
                community-based organizations to adopt policies that 
                treat HIV/AIDS as a multisectoral public health problem 
                affecting not only health but other areas such as 
                agriculture, education, the economy, the family and 
                society, and assisting them to develop and implement 
                programs corresponding to these needs;
                    (E) promoting healthy lifestyles, including 
                abstinence, delaying sexual debut, monogamy, marriage, 
                faithfulness, use of condoms, and avoiding substance 
                abuse; and
                    (F) encouraging active involvement of the private 
                sector, including businesses, pharmaceutical and 
                biotechnology companies, the medical and scientific 
                communities, charitable foundations, private and 
                voluntary organizations and nongovernmental 
                organizations, faith-based organizations, community-
                based organizations, and other nonprofit entities.
            (23) Prostitution and other sexual victimization are 
        degrading to women and children and it should be the policy of 
        the United States to eradicate such practices. The sex 
        industry, the trafficking of individuals into such industry, 
        and sexual violence are additional causes of and factors in the 
        spread of the HIV/AIDS epidemic. One in nine South Africans is 
        living with AIDS, and sexual assault is rampant, at a 
        victimization rate of one in three women. Meanwhile in 
        Cambodia, as many as 40 percent of prostitutes are infected 
        with HIV and the country has the highest rate of increase of 
        HIV infection in all of Southeast Asia. Victims of coercive 
        sexual encounters do not get to make choices about their sexual 
        activities.
            (24) Strong coordination must exist among the various 
        agencies of the United States to ensure effective and efficient 
        use of financial and technical resources within the United 
        States Government with respect to the provision of 
        international HIV/AIDS assistance.
            (25) In his address to Congress on January 28, 2003, the 
        President announced the Administration's intention to embark on 
        a five-year emergency plan for AIDS relief, to confront HIV/
        AIDS with the goals of preventing 7,000,000 new HIV/AIDS 
        infections, treating at least 2,000,000 people with life-
        extending drugs, and providing humane care for millions of 
        people suffering from HIV/AIDS, and for children orphaned by 
        HIV/AIDS.
            (26) In this address to Congress, the President stated the 
        following: ``Today, on the continent of Africa, nearly 
        30,000,000 people have the AIDS virus--including 3,000,000 
        children under the age of 15. There are whole countries in 
        Africa where more than one-third of the adult population 
        carries the infection. More than 4,000,000 require immediate 
        drug treatment. Yet across that continent, only 50,000 AIDS 
        victims--only 50,000--are receiving the medicine they need.''.
            (27) Furthermore, the President focused on care and 
        treatment of HIV/AIDS in his address to Congress, stating the 
        following: ``Because the AIDS diagnosis is considered a death 
        sentence, many do not seek treatment. Almost all who do are 
        turned away. A doctor in rural South Africa describes his 
        frustration. He says, `We have no medicines. Many hospitals 
        tell people, you've got AIDS, we can't help you. Go home and 
        die.' In an age of miraculous medicines, no person should have 
        to hear those words. AIDS can be prevented. Anti-retroviral 
        drugs can extend life for many years . . .  Ladies and 
        gentlemen, seldom has history offered a greater opportunity to 
        do so much for so many.''.
            (28) Finally, the President stated that ``[w]e have 
        confronted, and will continue to confront, HIV/AIDS in our own 
        country'', proposing now that the United States should lead the 
        world in sparing innocent people from a plague of nature, and 
        asking Congress ``to commit $15,000,000,000 over the next five 
        years, including nearly $10,000,000,000 in new money, to turn 
        the tide against AIDS in the most afflicted nations of Africa 
        and the Caribbean''.

SEC. 3. DEFINITIONS.

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

SEC. 4. PURPOSE.

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

SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

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

               TITLE I--POLICY PLANNING AND COORDINATION

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

    (a) Strategy.--The President shall establish a comprehensive, 
integrated, five-year strategy to combat global HIV/AIDS that 
strengthens the capacity of the United States to be an effective leader 
of the international campaign against HIV/AIDS. Such strategy shall 
maintain sufficient flexibility and remain responsive to the ever-
changing nature of the HIV/AIDS pandemic and shall--
            (1) include specific objectives, multisectoral approaches, 
        and specific strategies to treat individuals infected with HIV/
        AIDS and to prevent the further spread of HIV infections, with 
        a particular focus on the needs of families with children 
        (including the prevention of mother-to-child transmission), 
        women, young people, and children (such as unaccompanied minor 
        children and orphans);
            (2) as part of the strategy, implement a tiered approach to 
        direct delivery of care and treatment through a system based on 
        central facilities augmented by expanding circles of local 
        delivery of care and treatment through local systems and 
        capacity;
            (3) assign priorities for relevant executive branch 
        agencies;
            (4) provide that the reduction of HIV/AIDS behavioral risks 
        shall be a priority of all prevention efforts in terms of 
        funding, educational messages, and activities by promoting 
        abstinence from sexual activity and substance abuse, 
        encouraging monogamy and faithfulness, promoting the effective 
        use of condoms, and eradicating prostitution, the sex trade, 
        rape, sexual assault and sexual exploitation of women and 
        children;
            (5) improve coordination among relevant executive branch 
        agencies, foreign governments, and international organizations;
            (6) project general levels of resources needed to achieve 
        the stated objectives;
            (7) expand public-private partnerships and the leveraging 
        of resources; and
            (8) maximize United States capabilities in the areas of 
        technical assistance and training and research, including 
        vaccine research.
    (b) Report.--
            (1) In general.--Not later than 270 days after the date of 
        enactment of this Act, the President shall submit to the 
        appropriate congressional committees a report setting forth the 
        strategy described in subsection (a).
            (2) Report contents.--The report required by paragraph (1) 
        shall include a discussion of the elements described in 
        paragraph (3) and may include a discussion of additional 
        elements relevant to the strategy described in subsection (a). 
        Such discussion may include an explanation as to why a 
        particular element described in paragraph (3) is not relevant 
        to such strategy.
            (3) Report elements.--The elements referred to in paragraph 
        (2) are the following:
                    (A) The objectives, general and specific, of the 
                strategy.
                    (B) A description of the criteria for determining 
                success of the strategy.
                    (C) A description of the manner in which the 
                strategy will address the fundamental elements of 
                prevention and education, care, and treatment 
                (including increasing access to pharmaceuticals and to 
                vaccines), the promotion of abstinence, monogamy, 
                avoidance of substance abuse, and use of condoms, 
                research (including incentives for vaccine development 
                and new protocols), training of health care workers, 
                the development of health care infrastructure and 
                delivery systems, and avoidance of substance abuse.
                    (D) A description of the manner in which the 
                strategy will promote the development and 
                implementation of national and community-based 
                multisectoral strategies and programs, including those 
                designed to enhance leadership capacity particularly at 
                the community level.
                    (E) A description of the specific strategies 
                developed to meet the unique needs of women, including 
                the empowerment of women in interpersonal situations, 
                young people and children, including those orphaned by 
                HIV/AIDS and those who are victims of the sex trade, 
                rape, sexual abuse, assault, and exploitation.
                    (F) A description of the programs to be undertaken 
                to maximize United States contributions in the areas of 
                technical assistance, training (particularly of health 
                care workers and community-based leaders in affected 
                sectors), and research, including the promotion of 
                research on vaccines and microbicides.
                    (G) An identification of the relevant executive 
                branch agencies that will be involved and the 
                assignment of priorities to those agencies.
                    (H) A description of the role of each relevant 
                executive branch agency and the types of programs that 
                the agency will be undertaking.
                    (I) A description of the mechanisms that will be 
                utilized to coordinate the efforts of the relevant 
                executive branch agencies, to avoid duplication of 
                efforts, to enhance on-site coordination efforts, and 
                to ensure that each agency undertakes programs 
                primarily in those areas where the agency has the 
                greatest expertise, technical capabilities, and 
                potential for success.
                    (J) A description of the mechanisms that will be 
                utilized to ensure greater coordination between the 
                United States and foreign governments and international 
                organizations including the Global Fund, UNAIDS, 
                international financial institutions, and private 
                sector organizations.
                    (K) The level of resources that will be needed on 
                an annual basis and the manner in which those resources 
                would generally be allocated among the relevant 
                executive branch agencies.
                    (L) A description of the mechanisms to be 
                established for monitoring and evaluating programs, 
                promoting successful models, and for terminating 
                unsuccessful programs.
                    (M) A description of the manner in which private, 
                nongovernmental entities will factor into the United 
                States Government-led effort and a description of the 
                type of partnerships that will be created to maximize 
                the capabilities of these private sector entities and 
                to leverage resources.
                    (N) A description of the ways in which United 
                States leadership will be used to enhance the overall 
                international response to the HIV/AIDS pandemic and 
                particularly to heighten the engagement of the member 
                states of the G-8 and to strengthen key financial and 
                coordination mechanisms such as the Global Fund and 
                UNAIDS.
                    (O) A description of the manner in which the United 
                States strategy for combating HIV/AIDS relates to and 
                supports other United States assistance strategies in 
                developing countries.
                    (P) A description of the programs to be carried out 
                under the strategy that are specifically targeted at 
                women and girls to educate them about the spread of 
                HIV/AIDS.
                    (Q) A description of efforts being made to address 
                the unique needs of families with children with respect 
                to HIV/AIDS, including efforts to preserve the family 
                unit.
                    (R) An analysis of the emigration of critically 
                important medical and public health personnel, 
                including physicians, nurses, and supervisors from sub-
                Saharan African countries that are acutely impacted by 
                HIV/AIDS, including a description of the causes, 
                effects, and the impact on the stability of health 
                infrastructures, as well as a summary of incentives and 
                programs that the United States could provide, in 
                concert with other private and public sector partners 
                and international organizations, to stabilize health 
                institutions by encouraging critical personnel to 
                remain in their home countries.
                    (S) A description of the specific strategies 
                developed to promote sustainability of HIV/AIDS 
                pharmaceuticals (including antiretrovirals) and the 
                effects of drug resistance on HIV/AIDS patients.
                    (T) A description of the specific strategies to 
                ensure that the extraordinary benefit of HIV/AIDS 
                pharmaceuticals (especially antiretrovirals) are not 
                diminished through the illegal counterfeiting of 
                pharmaceuticals and black market sales of such 
                pharmaceuticals.
                    (U) An analysis of the prevalence of Human 
                Papilloma Virus (HPV) in sub-Saharan Africa and the 
                impact that condom usage has upon the spread of HPV in 
                sub-Saharan Africa.

SEC. 102. HIV/AIDS RESPONSE COORDINATOR.

    (a) Establishment of Position.--Section 1 of the State Department 
Basic Authorities Act of 1956 (22 U.S.C. 265(a)) is amended--
            (1) by redesignating subsection (f) as subsection (g); and
            (2) by inserting after subsection (e) the following:
    ``(f) HIV/AIDS Response Coordinator.--
            ``(1) In general.--There shall be established within the 
        Department of State in the immediate office of the Secretary of 
        State a Coordinator of United States Government Activities to 
        Combat HIV/AIDS Globally, who shall be appointed by the 
        President, by and with the advice and consent of the Senate. 
        The Coordinator shall report directly to the Secretary.
            ``(2) Authorities and duties; definitions.--
                    ``(A) Authorities.--The Coordinator, acting through 
                such nongovernmental organizations (including faith-
                based and community-based organizations) and relevant 
                executive branch agencies as may be necessary and 
                appropriate to effect the purposes of this section, is 
                authorized--
                            ``(i) to operate internationally to carry 
                        out prevention, care, treatment, support, 
                        capacity development, and other activities for 
                        combatting HIV/AIDS;
                            ``(ii) to transfer and allocate funds to 
                        relevant executive branch agencies; and
                            ``(iii) to provide grants to, and enter 
                        into contracts with, nongovernmental 
                        organizations (including faith-based and 
                        community-based organizations) to carry out the 
                        purposes of section.
                    ``(B) Duties.--
                            ``(i) In general.--The Coordinator shall 
                        have primary responsibility for the oversight 
                        and coordination of all resources and 
                        international activities of the United States 
                        Government to combat the HIV/AIDS pandemic, 
                        including all programs, projects, and 
                        activities of the United States Government 
                        relating to the HIV/AIDS pandemic under the 
                        United States Leadership Against HIV/AIDS, 
                        Tuberculosis, and Malaria Act of 2003 or any 
                        amendment made by that Act.
                            ``(ii) Specific duties.--The duties of the 
                        Coordinator shall specifically include the 
                        following:
                                    ``(I) Ensuring program and policy 
                                coordination among the relevant 
                                executive branch agencies and 
                                nongovernmental organizations, 
                                including auditing, monitoring, and 
                                evaluation of all such programs.
                                    ``(II) Ensuring that each relevant 
                                executive branch agency undertakes 
                                programs primarily in those areas where 
                                the agency has the greatest expertise, 
                                technical capabilities, and potential 
                                for success.
                                    ``(III) Avoiding duplication of 
                                effort.
                                    ``(IV) Ensuring coordination of 
                                relevant executive branch agency 
                                activities in the field.
                                    ``(V) Pursuing coordination with 
                                other countries and international 
                                organizations.
                                    ``(VI) Resolving policy, program, 
                                and funding disputes among the relevant 
                                executive branch agencies.
                                    ``(VII) Directly approving all 
                                activities of the United States 
                                (including funding) relating to 
                                combatting HIV/AIDS in each of 
                                Botswana, Cote d'Ivoire, Ethiopia, 
                                Guyana, Haiti, Kenya, Mozambique, 
                                Namibia, Nigeria, Rwanda, South Africa, 
                                Tanzania, Uganda, Zambia, and other 
                                countries designated by the President, 
                                which other designated countries may 
                                include those countries in which the 
                                United States is implementing HIV/AIDS 
                                programs as of the date of the 
                                enactment of the United States 
                                Leadership Against HIV/AIDS, 
                                Tuberculosis, and Malaria Act of 2003.
                                    ``(VIII) Establishing due diligence 
                                criteria for all recipients of funds 
                                section and all activities subject to 
                                the coordination and appropriate 
                                monitoring, evaluation, and audits 
                                carried out by the Coordinator 
                                necessary to assess the measurable 
                                outcomes of such activities.
                    ``(C) Definitions.--In this paragraph:
                            ``(i) AIDS.--The term `AIDS' means acquired 
                        immune deficiency syndrome.
                            ``(ii) HIV.--The term `HIV' means the human 
                        immunodeficiency virus, the pathogen that 
                        causes AIDS.
                            ``(iii) HIV/AIDS.--The term `HIV/AIDS' 
                        means, with respect to an individual, an 
                        individual who is infected with HIV or living 
                        with AIDS.
                            ``(iv) Relevant executive branch 
                        agencies.--The term `relevant executive branch 
                        agencies' means the Department of State, the 
                        United States Agency for International 
                        Development, the Department of Health and Human 
                        Services (including the Public Health Service), 
                        and any other department or agency of the 
                        United States that participates in 
                        international HIV/AIDS activities pursuant to 
                        the authorities of such department or agency or 
                        this Act.''.
    (b) Resources.--Not later than 90 days after the date of enactment 
of this Act, the President shall specify the necessary financial and 
personnel resources, from funds appropriated pursuant to the 
authorization of appropriations under section 401 for HIV/AIDS 
assistance, that shall be assigned to and under the direct control of 
the Coordinator of United States Government Activities to Combat HIV/
AIDS Globally to establish and maintain the duties and supporting 
activities assigned to the Coordinator by this Act and the amendments 
made by this Act.
    (c) Establishment of Separate Account.--There is established in the 
general fund of the Treasury a separate account which shall be known as 
the ``Activities to Combat HIV/AIDS Globally Fund'' and which shall be 
administered by the Coordinator of United States Government Activities 
to Combat HIV/AIDS Globally. There shall be deposited into the Fund all 
amounts appropriated pursuant to the authorization of appropriations 
under section 401 for HIV/AIDS assistance, except for amounts 
appropriated for United States contributions to the Global Fund.

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

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

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

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

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

SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.

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

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

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

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

    ``(a) Finding.--Congress recognizes that the alarming spread of 
HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, and other 
developing countries is a major global health, national security, 
development, and humanitarian crisis.
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to provide assistance for the prevention, 
treatment, and control of HIV/AIDS. The United States and other 
developed countries should provide assistance to countries in sub-
Saharan Africa, the Caribbean, and other countries and areas to control 
this crisis through HIV/AIDS prevention, treatment, monitoring, and 
related activities, particularly activities focused on women and youth, 
including strategies to protect women and prevent mother-to-child 
transmission of the HIV infection.
    ``(c) Authorization.--
            ``(1) In general.--Consistent with section 104(c), the 
        President is authorized to furnish assistance, on such terms 
        and conditions as the President may determine, for HIV/AIDS, 
        including to prevent, treat, and monitor HIV/AIDS, and carry 
        out related activities, in countries in sub-Saharan Africa, the 
        Caribbean, and other countries and areas.
            ``(2) Role of ngos.--It is the sense of Congress that the 
        President should provide an appropriate level of assistance 
        under paragraph (1) through nongovernmental organizations 
        (including faith-based and community-based organizations) in 
        countries in sub-Saharan Africa, the Caribbean, and other 
        countries and areas affected by the HIV/AIDS pandemic.
            ``(3) Coordination of assistance efforts.--The President 
        shall coordinate the provision of assistance under paragraph 
        (1) with the provision of related assistance by the Joint 
        United Nations Programme on HIV/AIDS (UNAIDS), the United 
        Nations Children's Fund (UNICEF), the World Health Organization 
        (WHO), the United Nations Development Programme (UNDP), the 
        Global Fund to Fight AIDS, Tuberculosis and Malaria and other 
        appropriate international organizations (such as the 
        International Bank for Reconstruction and Development), 
        relevant regional multilateral development institutions, 
        national, state, and local governments of foreign countries, 
        appropriate governmental and nongovernmental organizations, and 
        relevant executive branch agencies.
    ``(d) Activities Supported.--Assistance provided under subsection 
(c) shall, to the maximum extent practicable, be used to carry out the 
following activities:
            ``(1) Prevention.--Prevention of HIV/AIDS through 
        activities including--
                    ``(A) programs and efforts that are designed or 
                intended to impart knowledge with the exclusive purpose 
                of helping individuals avoid behaviors that place them 
                at risk of HIV infection, including integration of such 
                programs into health programs and the inclusion in 
                counseling programs of information on methods of 
                avoiding infection of HIV, including delaying sexual 
                debut, abstinence, fidelity and monogamy, reduction of 
                casual sexual partnering, and where appropriate, use of 
                condoms;
                    ``(B) assistance to establish and implement 
                culturally appropriate HIV/AIDS education and 
                prevention programs that focus on helping individuals 
                avoid infection of HIV/AIDS, implemented through 
                nongovernmental organizations, including faith-based 
                and community-based organizations, particularly those 
                organizations that utilize both professionals and 
                volunteers with appropriate skills, experience, and 
                community presence;
                    ``(C) assistance for the purpose of providing 
                voluntary testing and counseling (including the 
                incorporation of confidentiality protections with 
                respect to such testing and counseling);
                    ``(D) assistance for the purpose of preventing 
                mother-to-child transmission of the HIV infection, 
                including medications to prevent such transmission and 
                access to infant formula and other alternatives for 
                infant feeding;
                    ``(E) assistance to ensure a safe blood supply and 
                sterile medical equipment; and
                    ``(F) assistance to help avoid substance abuse and 
                intravenous drug use that can lead to HIV infection.
            ``(2) Treatment.--The treatment and care of individuals 
        with HIV/AIDS, including--
                    ``(A) assistance to establish and implement 
                programs to strengthen and broaden indigenous health 
                care delivery systems and the capacity of such systems 
                to deliver HIV/AIDS pharmaceuticals and otherwise 
                provide for the treatment of individuals with HIV/AIDS, 
                including clinical training for indigenous 
                organizations and health care providers;
                    ``(B) assistance to strengthen and expand hospice 
                and palliative care programs to assist patients 
                debilitated by HIV/AIDS, their families, and the 
                primary caregivers of such patients, including programs 
                that utilize faith-based and community-based 
                organizations; and
                    ``(C) assistance for the purpose of the care and 
                treatment of individuals with HIV/AIDS through the 
                provision of pharmaceuticals, including antiretrovirals 
                and other pharmaceuticals and therapies for the 
                treatment of opportunistic infections, nutritional 
                support, and other treatment modalities.
            ``(3) Preventative intervention education and 
        technologies.--(A) With particular emphasis on specific 
        populations that represent a particularly high risk of 
        contracting or spreading HIV/AIDS, including those exploited 
        through the sex trade, victims of rape and sexual assault, 
        individuals already infected with HIV/AIDS, and in cases of 
        occupational exposure of health care workers, assistance with 
        efforts to reduce the risk of HIV/AIDS infection including 
        post-exposure pharmaceutical prophylaxis, and necessary 
        pharmaceuticals and commodities, including test kits, condoms, 
        and, when proven effective, microbicides.
            ``(B) Bulk purchases of available test kits, condoms, and, 
        when proven effective, microbicides that are intended to reduce 
        the risk of HIV/AIDS transmission and for appropriate program 
        support for the introduction and distribution of these 
        commodities, as well as education and training on the use of 
        the technologies.
            ``(4) Monitoring.--The monitoring of programs, projects, 
        and activities carried out pursuant to paragraphs (1) through 
        (3), including--
                    ``(A) monitoring to ensure that adequate controls 
                are established and implemented to provide HIV/AIDS 
                pharmaceuticals and other appropriate medicines to poor 
                individuals with HIV/AIDS;
                    ``(B) appropriate evaluation and surveillance 
                activities;
                    ``(C) monitoring to ensure that appropriate 
                measures are being taken to maintain the sustainability 
                of HIV/AIDS pharmaceuticals (especially 
                antiretrovirals) and ensure that drug resistance is not 
                compromising the benefits of such pharmaceuticals; and
                    ``(D) monitoring to ensure appropriate law 
                enforcement officials are working to ensure that HIV/
                AIDS pharmaceuticals are not diminished through illegal 
                counterfeiting or black market sales of such 
                pharmaceuticals.
            ``(5) Pharmaceuticals.--
                    ``(A) Procurement.--The procurement of HIV/AIDS 
                pharmaceuticals, antiviral therapies, and other 
                appropriate medicines, including medicines to treat 
                opportunistic infections.
                    ``(B) Mechanisms for quality control and 
                sustainable supply.--Mechanisms to ensure that such 
                HIV/AIDS pharmaceuticals, antiretroviral therapies, and 
                other appropriate medicines are quality-controlled and 
                sustainably supplied.
                    ``(C) Distribution.--The distribution of such HIV/
                AIDS pharmaceuticals, antiviral therapies, and other 
                appropriate medicines (including medicines to treat 
                opportunistic infections) to qualified national, 
                regional, or local organizations for the treatment of 
                individuals with HIV/AIDS in accordance with 
                appropriate HIV/AIDS testing and monitoring 
                requirements and treatment protocols and for the 
                prevention of mother-to-child transmission of the HIV 
                infection.
            ``(6) Related activities.--The conduct of related 
        activities, including--
                    ``(A) the care and support of children who are 
                orphaned by the HIV/AIDS pandemic, including services 
                designed to care for orphaned children in a family 
                environment which rely on extended family members;
                    ``(B) improved infrastructure and institutional 
                capacity to develop and manage education, prevention, 
                and treatment programs, including training and the 
                resources to collect and maintain accurate HIV 
                surveillance data to target programs and measure the 
                effectiveness of interventions; and
                    ``(C) vaccine research and development partnership 
                programs with specific plans of action to develop a 
                safe, effective, accessible, preventive HIV vaccine for 
                use throughout the world.
            ``(7) Comprehensive hiv/aids public-private partnerships.--
        The establishment and operation of public-private partnership 
        entities within countries in sub-Saharan Africa, the Caribbean, 
        and other countries affected by the HIV/AIDS pandemic that are 
        dedicated to supporting the national strategy of such countries 
        regarding the prevention, treatment, and monitoring of HIV/
        AIDS. Each such public-private partnership should--
                    ``(A) support the development, implementation, and 
                management of comprehensive HIV/AIDS plans in support 
                of the national HIV/AIDS strategy;
                    ``(B) operate at all times in a manner that 
                emphasizes efficiency, accountability, and results-
                driven programs;
                    ``(C) engage both local and foreign development 
                partners and donors, including businesses, government 
                agencies, academic institutions, nongovernmental 
                organizations, foundations, multilateral development 
                agencies, and faith-based organizations, to assist the 
                country in coordinating and implementing HIV/AIDS 
                prevention, treatment, and monitoring programs in 
                accordance with its national HIV/AIDS strategy;
                    ``(D) provide technical assistance, consultant 
                services, financial planning, monitoring and 
                evaluation, and research in support of the national 
                HIV/AIDS strategy; and
                    ``(E) establish local human resource capacities for 
                the national HIV/AIDS strategy through the transfer of 
                medical, managerial, leadership, and technical skills.
    ``(e) Annual Report.--
            ``(1) In general.--Not later than January 31 of each year, 
        the President shall submit to the Committee on Foreign 
        Relations of the Senate and the Committee on International 
        Relations of the House of Representatives a report on the 
        implementation of this section for the prior fiscal year.
            ``(2) Report elements.--Each report shall include--
                    ``(A) a description of efforts made by each 
                relevant executive branch agency to implement the 
                policies set forth in this section, section 104B, and 
                section 104C;
                    ``(B) a description of the programs established 
                pursuant to such sections; and
                    ``(C) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                including--
                            ``(i)(I) the effectiveness of such programs 
                        in reducing the spread of the HIV infection, 
                        particularly in women and girls, in reducing 
                        mother-to-child transmission of the HIV 
                        infection, and in reducing mortality rates from 
                        HIV/AIDS; and
                            ``(II) the number of patients currently 
                        receiving treatment for AIDS in each country 
                        that receives assistance under this Act.
                            ``(ii) the progress made toward improving 
                        health care delivery systems (including the 
                        training of adequate numbers of staff) and 
                        infrastructure to ensure increased access to 
                        care and treatment;
                            ``(iii) with respect to tuberculosis, the 
                        increase in the number of people treated and 
                        the increase in number of tuberculosis patients 
                        cured through each program, project, or 
                        activity receiving United States foreign 
                        assistance for tuberculosis control purposes; 
                        and
                            ``(iv) with respect to malaria, the 
                        increase in the number of people treated and 
                        the increase in number of malaria patients 
                        cured through each program, project, or 
                        activity receiving United States foreign 
                        assistance for malaria control purposes.
    ``(f) Funding Limitation.--Of the funds made available to carry out 
this section in any fiscal year, not more than 7 percent may be used 
for the administrative expenses of the United States Agency for 
International Development in support of activities described in section 
104(c), this section, section 104B, and section 104C. Such amount shall 
be in addition to other amounts otherwise available for such purposes.
    ``(g) Definitions.--In this section:
            ``(1) AIDS.--The term `AIDS' means acquired immune 
        deficiency syndrome.
            ``(2) HIV.--The term `HIV' means the human immunodeficiency 
        virus, the pathogen that causes AIDS.
            ``(3) HIV/AIDS.--The term `HIV/AIDS' means, with respect to 
        an individual, an individual who is infected with HIV or living 
        with AIDS.
            ``(4) Relevant executive branch agencies.--The term 
        `relevant executive branch agencies' means the Department of 
        State, the United States Agency for International Development, 
        the Department of Health and Human Services (including its 
        agencies and offices), and any other department or agency of 
        the United States that participates in international HIV/AIDS 
        activities pursuant to the authorities of such department or 
        agency or this Act.''.
    (b) Authorization of Appropriations.--
            (1) In general.--In addition to funds available under 
        section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2151b(c)) for such purpose or under any other provision of that 
        Act, there are authorized to be appropriated to the President, 
        from amounts authorized to be appropriated under section 401, 
        such sums as may be necessary for each of the fiscal years 2004 
        through 2008 to carry out section 104A of the Foreign 
        Assistance Act of 1961, as added by subsection (a).
            (2) Availability of funds.--Amounts appropriated pursuant 
        to paragraph (1) are authorized to remain available until 
        expended.
            (3) Allocation of Funds.--Of the amount authorized to be 
        appropriated by paragraph (1) for the fiscal years 2004 through 
        2008, such sums as may be necessary are authorized to be 
        appropriated to carry out section 104A(d)(4) of the Foreign 
        Assistance Act of 1961 (as added by subsection (a)), relating 
        to the procurement and distribution of HIV/AIDS 
        pharmaceuticals.
    (c) Relationship to Assistance Programs to Enhance Nutrition.--In 
recognition of the fact that malnutrition may hasten the progression of 
HIV to AIDS and may exacerbate the decline among AIDS patients leading 
to a shorter life span, the Administrator of the United States Agency 
for International Development shall, as appropriate--
            (1) integrate nutrition programs with HIV/AIDS activities, 
        generally;
            (2) provide, as a component of an anti-retroviral therapy 
        program, support for food and nutrition to individuals infected 
        with and affected by HIV/AIDS; and
            (3) provide support for food and nutrition for children 
        affected by HIV/AIDS and to communities and households caring 
        for children affected by HIV/AIDS.
    (d) Eligibility for Assistance.--An organization that is otherwise 
eligible to receive assistance under section 104A of the Foreign 
Assistance Act of 1961 (as added by subsection (a)) or under any other 
provision of this Act (or any amendment made by this Act) to prevent, 
treat, or monitor HIV/AIDS shall not be required, as a condition of 
receiving the assistance, to endorse or utilize a multisectoral 
approach to combatting HIV/AIDS.
    (e) Limitation.--No funds made available to carry out this Act, or 
any amendment made by this Act, may be used to promote or advocate the 
legalization or practice of prostitution or sex trafficking. Nothing in 
the preceding sentence shall be construed to preclude the provision to 
individuals of palliative care, treatment, or post-exposure 
pharmaceutical prophylaxis, and necessary pharmaceuticals and 
commodities, including test kits, condoms, and, when proven effective, 
microbicides.
    (f) Limitation.--No funds made available to carry out this Act, or 
any amendment made by this Act, may be used to provide assistance to 
any group or organization that does not have a policy explicitly 
opposing prostitution and sex trafficking.

SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

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

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

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

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

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

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

    ``(a) Finding.--Congress finds that malaria kills more people 
annually than any other communicable disease except tuberculosis, that 
more than 90 percent of all malaria cases are in sub-Saharan Africa, 
and that children and women are particularly at risk. Congress 
recognizes that there are cost-effective tools to decrease the spread 
of malaria and that malaria is a curable disease if promptly diagnosed 
and adequately treated.
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to provide assistance for the prevention, 
control, and cure of malaria.
    ``(c) Authorization.--To carry out this section and consistent with 
section 104(c), the President is authorized to furnish assistance, on 
such terms and conditions as the President may determine, for the 
prevention, treatment, control, and elimination of malaria.
    ``(d) Coordination.--In carrying out this section, the President 
shall coordinate with the World Health Organization, the Global Fund to 
Fight AIDS, Tuberculosis, and Malaria, the Department of Health and 
Human Services (the Centers for Disease Control and Prevention and the 
National Institutes of Health), and other organizations with respect to 
the development and implementation of a comprehensive malaria control 
program.''.
    (b) Authorization of Appropriations.--
            (1) In general.--In addition to funds available under 
        section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2151b(c)) for such purpose or under any other provision of that 
        Act, there are authorized to be appropriated to the President, 
        from amounts authorized to be appropriated under section 401, 
        such sums as may be necessary for fiscal years 2004 through 
        2008 to carry out section 104C of the Foreign Assistance Act of 
        1961, as added by subsection (a), including for the development 
        of anti-malarial pharmaceuticals by the Medicines for Malaria 
        Venture.
            (2) Availability of funds.--Amounts appropriated pursuant 
        to paragraph (1) are authorized to remain available until 
        expended.
            (3) Transfer of prior year funds.--Unobligated balances of 
        funds made available for fiscal year 2001, 2002, or 2003 under 
        section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2151b(c) (as in effect immediately before the date of enactment 
        of this Act) and made available for the control of malaria 
        shall be transferred to, merged with, and made available for 
        the same purposes as funds made available for fiscal years 2004 
        through 2008 under paragraph (1).
    (c) Conforming Amendment.--Section 104(c) of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b(c)), as amended by section 301 of this 
Act, is further amended by adding after paragraph (3) the following:
    ``(4) Relationship to other laws.--Assistance made available under 
this subsection and sections 104A, 104B, and 104C, and assistance made 
available under chapter 4 of part II to carry out the purposes of this 
subsection and the provisions cited in this paragraph, may be made 
available notwithstanding any other provision of law that restricts 
assistance to foreign countries, except for the provisions of this 
subsection, the provisions of law cited in this paragraph, subsection 
(f), section 634A of this Act, and provisions of law that limit 
assistance to organizations that support or participate in a program of 
coercive abortion or involuntary sterilization included under the Child 
Survival and Health Programs Fund heading in the Consolidated 
Appropriations Resolution, 2003 (Public Law 108-7).''.

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

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

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

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

            Subtitle B--Assistance for Children and Families

SEC. 311. FINDINGS.

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

SEC. 312. POLICY AND REQUIREMENTS.

    (a) Policy.--The United States Government's response to the global 
HIV/AIDS pandemic should place high priority on the prevention of 
mother-to-child transmission, the care and treatment of family members 
and caregivers, and the care of children orphaned by AIDS. To the 
maximum extent possible, the United States Government should seek to 
leverage its funds by seeking matching contributions from the private 
sector, other national governments, and international organizations.
    (b) Requirements.--The 5-year United States Government strategy 
required by section 101 of this Act shall--
            (1) provide for meeting or exceeding the goal to reduce the 
        rate of mother-to-child transmission of HIV by 20 percent by 
        2005 and by 50 percent by 2010;
            (2) include programs to make available testing and 
        treatment to HIV-positive women and their family members, 
        including drug treatment and therapies to prevent mother-to-
        child transmission; and
            (3) expand programs designed to care for children orphaned 
        by AIDS.

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

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

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

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

SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.

    (a) Purpose.--The purpose of this section is to authorize the 
President to establish a program, through a public-private partnership, 
for the provision of medical care and support services to HIV positive 
parents and their children identified through existing programs to 
prevent mother-to-child transmission of HIV in countries with or at 
risk for severe HIV epidemic with particular attention to resource 
constrained countries.
    (b) Grants.--
            (1) In general.--The President is authorized to establish a 
        program for the award of grants to eligible administrative 
        organizations to enable such organizations to award subgrants 
        to eligible entities to expand activities to prevent the 
        mother-to-child transmission of HIV by providing medical care 
        and support services to HIV infected parents and their 
        children.
            (2) Use of funds.--Amounts provided under a grant awarded 
        under paragraph (1) shall be used--
                    (A) to award subgrants to eligible entities to 
                enable such entities to carry out activities described 
                in subsection (c);
                    (B) for administrative support and subgrant 
                management;
                    (C) for administrative data collection and 
                reporting concerning grant activities;
                    (D) for the monitoring and evaluation of grant 
                activities;
                    (E) for training and technical assistance for 
                subgrantees; and
                    (F) to promote sustainability.
    (c) Subgrants.--
            (1) In general.--An organization awarded a grant under 
        subsection (b) shall use amounts received under the grant to 
        award subgrants to eligible entities.
            (2) Eligibility.--To be eligible to receive a subgrant 
        under paragraph (1), an entity shall--
                    (A) be a local health organization, an 
                international organization, or a partnership of such 
                organizations; and
                    (B) demonstrate to the awarding organization that 
                such entity--
                            (i) is currently administering a proven 
                        intervention to prevent mother-to-child 
                        transmission of HIV in countries with or at 
                        risk for severe HIV epidemic with particular 
                        attention to resource constrained countries, as 
                        determined by the President;
                            (ii) has demonstrated support for the 
                        proposed program from relevant government 
                        entities; and
                            (iii) is able to provide HIV care, 
                        including antiretroviral treatment when 
                        medically indicated, to HIV positive women, 
                        men, and children with the support of the 
                        project funding.
            (3) Local health and international organizations.--For 
        purposes of paragraph (2)(A)--
                    (A) the term ``local health organization'' means a 
                public sector health system, nongovernmental 
                organization, institution of higher education, 
                community-based organization, or nonprofit health 
                system that provides directly, or has a clear link with 
                a provider for the indirect provision of, primary 
                health care services; and
                    (B) the term ``international organization'' means--
                            (i) a nonprofit international entity;
                            (ii) an international charitable 
                        institution;
                            (iii) a private voluntary international 
                        entity; or
                            (iv) a multilateral institution.
            (4) Priority requirement.--In awarding subgrants under this 
        subsection, the organization shall give priority to eligible 
        applicants that are currently administering a program of proven 
        intervention to HIV positive individuals to prevent mother-to-
        child transmission in countries with or at risk for severe HIV 
        epidemic with particular attention to resource constrained 
        countries, and who are currently administering a program to HIV 
        positive women, men, and children to provide life-long care in 
        family-centered care programs using non-Federal funds.
            (5) Selection of subgrant recipients.--In awarding 
        subgrants under this subsection, the organization should--
                    (A) consider applicants from a range of health care 
                settings, program approaches, and geographic locations; 
                and
                    (B) if appropriate, award not less than 1 grant to 
                an applicant to fund a national system of health care 
                delivery to HIV positive families.
            (6) Use of subgrant funds.--An eligible entity awarded a 
        subgrant under this subsection shall use subgrant funds to 
        expand activities to prevent mother-to-child transmission of 
        HIV by providing medical treatment and care and support 
        services to parents and their children, which may include--
                    (A) providing treatment and therapy, when medically 
                indicated, to HIV-infected women, their children, and 
                families;
                    (B) the hiring and training of local personnel, 
                including physicians, nurses, other health care 
                providers, counselors, social workers, outreach 
                personnel, laboratory technicians, data managers, and 
                administrative support personnel;
                    (C) paying laboratory costs, including costs 
                related to necessary equipment and diagnostic testing 
                and monitoring (including rapid testing), complete 
                blood counts, standard chemistries, and liver function 
                testing for infants, children, and parents, and costs 
                related to the purchase of necessary laboratory 
                equipment;
                    (D) purchasing pharmaceuticals for HIV-related 
                conditions, including antiretroviral therapies;
                    (E) funding support services, including adherence 
                and psychosocial support services;
                    (F) operational support activities; and
                    (G) conducting community outreach and capacity 
                building activities, including activities to raise the 
                awareness of individuals of the program carried out by 
                the subgrantee, other communications activities in 
                support of the program, local advisory board functions, 
                and transportation necessary to ensure program 
                participation.
    (d) Reports.--The President shall require that each organization 
awarded a grant under subsection (b)(1) to submit an annual report that 
includes--
            (1) the progress of programs funded under this section;
            (2) the benchmarks of success of programs funded under this 
        section; and
            (3) recommendations of how best to proceed with the 
        programs funded under this section upon the expiration of 
        funding under subsection (e).
    (e) Funding.--There are authorized to be appropriated to the 
President, from amounts authorized to be appropriated under section 
401, such sums as may be necessary for each of the fiscal years 2004 
through 2008 to carry out the program.
    (f) Limitation on Administrative Expenses.--An organization shall 
ensure that not more than 7 percent of the amount of a grant received 
under this section by the organization is used for administrative 
expenses.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

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

SEC. 402. SENSE OF CONGRESS.

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

SEC. 403. ALLOCATION OF FUNDS.

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

                          Purpose and Summary

    The United States Leadership Against HIV/AIDS Act of 2003 
(H.R. 1298), as ordered favorably reported out of the Committee 
on International Relations with an amendment in the nature of a 
substitute incorporating the 10 amendments adopted by the 
Committee, authorizes the expansion of United States efforts to 
fight HIV/AIDS in Africa, the Caribbean, and other countries in 
the developing world.
    Specifically, H.R. 1298 authorizes the provision of care 
and treatment to individuals and families affected by HIV/AIDS; 
promotes the preservation of the family unit so that fewer 
children will be orphaned by AIDS; promotes the ABC approach 
successfully employed in Uganda's fight against AIDS 
(``Abstinence, Be Faithful, Condoms''); endorses the work of 
non-governmental organizations (including faith-based and 
community-based organizations) which are essential partners in 
effective AIDS prevention; and provides increased emphasis on 
mother-to-child transmission activities, as well as support for 
the routine voluntary counseling and testing of pregnant women 
and access to treatment by women and children.
    H.R. 1298 authorizes a multisectoral approach to fighting 
AIDS, and endorses education, research, prevention, treatment 
and care of those infected with HIV and those individuals 
living with AIDS. H.R. 1298 is consistent with and endorses 
President Bush's $15 billion, 5-year strategy to arrest the 
spread of HIV, the virus that causes AIDS, and will provide the 
President with great flexibility to use the various agencies of 
the Federal Government to fight AIDS and assist those infected 
with the disease.
    H.R. 1298 authorizes a significant increase over existing 
levels of assistance, and over the course of the 5-year 
authorization (FY2004-FY2008) will result in an additional $10 
billion made available to fight AIDS worldwide. The bill 
creates accountability through the establishment of a position 
in the U.S. State Department of Coordinator for HIV/AIDS 
Assistance. H.R. 1298 will authorize the use of life-extending 
pharmaceuticals and the provision of other drugs to reduce 
mother-to-child transmission. The bill amends the Foreign 
Assistance Act of 1961 to update it with the President's 
proposal that emphasizes treatment and care of those 
individuals infected with HIV and living with AIDS. It endorses 
and supports United States financial participation in the 
Global Fund, authorizing up to $1 billion in FY2004 and such 
sums as may be necessary in 2005 through 2008. The legislation 
requires that the U.S. contribution be limited to one third of 
all contributions to the Fund in any given year in order to 
promote burden-sharing and the follow-through of pledges by 
other countries. The bill creates an oversight body within the 
Executive Branch that will carefully review all Global Fund 
applications in order to recommend coherence with U.S. policies 
and laws.
    H.R. 1298, as ordered favorably reported, plays a critical 
role in building capacity within affected countries to educate 
youth and society at large of the tremendous risk that AIDS 
creates to individual and public health, agricultural 
production, culture and society, the education sector, and 
national security. The legislation will assist in reducing the 
threat that AIDS presents to social stability and security, in 
particular on the African continent, in Asia, and closer to 
home, in the Caribbean.

                Background and Need for the Legislation

    The HIV/AIDS pandemic is a crisis that threatens the 
stability, economy and democratic institutions of many nations. 
The United States National Intelligence Council estimates that 
the disease could reduce Gross Domestic Product in some sub-
Saharan African countries by 20 percent or more by 2010. The 
U.S. Census Bureau estimates that the average human lifespan in 
certain nations will decrease well below the age of 40 by the 
end of the decade.
    AIDS is a disease that affects and afflicts women, men and 
children. Caused by a virus that is changing the face of 
families in Africa, Asia, Europe, and the Americas, AIDS 
creates orphans, breaks apart families, and erases the gains of 
development. AIDS is responsible for a catastrophic reduction 
in the life expectancy of tens of millions of people with whom 
we share this planet. Not a day goes by when Americans are not 
exposed to images of AIDS and its destructive impact.
    To date, 40 million people are infected and 25 million have 
died of AIDS worldwide, including more than 3 million last 
year. More than 8,600 persons die daily from complications and 
opportunistic infections brought on by this disease. 
Tragically, the number is growing, and by the end of this 
decade, AIDS may claim up to 80 million lives.
    The HIV/AIDS pandemic is more than a humanitarian crisis. 
Increasingly, it is a threat to the security of the developed 
world. Left unchecked, this plague will further rip the fabric 
of developing societies, pushing fragile governments and 
economies to the point of collapse. There can be no question 
that the spectre of failed states across the world most 
certainly threatens U.S. security interests, particularly at a 
time where unstable nations have proven fertile ground for the 
development of terrorist organizations.
    In this regard, Africa is a central concern. Today radical 
Islam is spreading in several African countries, especially 
Nigeria. This trend threatens to undercut democracy and make 
Nigeria a failed state. It is in American interests to counter 
this movement by doing what we can to help build democracy and 
a growing economy in Nigeria and elsewhere. The spread of HIV/
AIDS frustrates this most important mission. We also have a 
strong interest is seeing the development of professional 
African militaries; militaries capable of maintaining stability 
in their country, but also capable of contributing to 
peacekeeping operations elsewhere. Yet, an examination of the 
HIV/AIDS rates among the armed forces of key African countries, 
including Nigeria, South Africa and Kenya, reveals infection 
rates between 30 and 40 percent. Military and police forces in 
other countries with high HIV/AIDS prevalence rates are among 
the highest risk populations in the world. The increase in HIV-
infected military personnel is weakening the capacity of these 
forces to defend their nations and to serve as peacekeepers in 
crisis situations. High prevalence rates among police forces 
undermine their ability to maintain civil order. AIDS indeed 
presents a national security threat--a threat to the stability 
and viability of many nations in the developing world.
    Building on the bipartisan work accomplished in the 107th 
Congress, the Committee reports favorably an updated AIDS bill 
that focuses on treatment, prevention and care, and authorizes 
treatment for more than 2 million people.
    In the 107th Congress, the Committee on International 
Relations reported favorably H.R. 2069, introduced by Chairman 
Henry J. Hyde, the ``Global Access to HIV/AIDS Prevention, 
Awareness, Education and Treatment Act of 2001.'' That bill was 
passed by the House and sent to the Senate, which struck all 
after the enacting clause and inserted a new text and returned 
H.R. 2069 to the House as the ``United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002.'' The 
House and Senate were unable to reconcile the two versions of 
the bill, but both chambers agreed upon the need for expanded 
assistance to fight the HIV/AIDS pandemic. Both versions of the 
bill supported increases in funding for bilateral and 
multilateral approaches to fighting HIV/AIDS. Both bills 
stressed the urgency of the need for the President to develop a 
comprehensive strategy to expand U.S. assistance to encompass 
treatment of HIV/AIDS through the use of antiretroviral 
therapy.
    Chairman Hyde, accompanied by Ranking Member Lantos, 
Representative Weldon of Florida, Representative Lee and 
Representative Leach, introduced H.R. 1298 on March 17, 2003. 
The bill supports the President's plan to increase U.S. 
assistance for AIDS relief, and will create a more responsive, 
coordinated and effective approach among the various agencies 
of the U.S. Government involved in the global fight against 
HIV/AIDS. H.R. 1298 builds on the Chairman's bill, H.R. 2069, 
from the 107th Congress.
    H.R. 1298 includes important protections for accountability 
and transparency of the Global Fund. As reported, the 
legislation authorizes up to $1 billion for fiscal year 2004 
for contributions to the Global Fund, and such sums as may be 
necessary for the fiscal years 2005-2008. While the President's 
budget request is expected to be $200 million for each of the 
next 5 fiscal years for the Global Fund, in FY2003 the Congress 
appropriated nearly twice the amount requested by the 
President. The one billion dollar figure represents a carefully 
crafted compromise that builds bipartisan support for the bill 
while at the same time includes additional safeguards. United 
States financial support would be limited to 33 percent of the 
total amounts contributed by other donors. This means that in 
order for the U.S. to provide $350 million, other donors would 
have to actually contribute $700 million in the same year. This 
provision promotes better burden-sharing and follow-through for 
the donations of other countries. H.R. 1298 requires continual 
monitoring and evaluation of the Global Fund by the Comptroller 
General, and requires him to issue a report every 2 years on 
the Global Fund, including whether objectives are being met by 
projects supported by the Global Fund. The legislation creates 
a U.S. Government interagency technical review panel that will 
``shadow'' the work of the Global Fund's Technical Review 
Panel. This will ensure that all grant applications submitted 
to the Global Fund will undergo thorough review, and that 
concerns and questions about problematic proposals can be 
provided to U.S. persons who sit on the panels of the Global 
Fund.
    H.R. 1298 stresses the importance of behavior change 
(including the promotion of abstinence, faithfulness, the delay 
of ``sexual debut,'' and the effective use of condoms) as the 
foundation of efforts to fight AIDS. The legislation expands 
U.S. efforts at combating the HIV/AIDS pandemic in the 
developing world--in those countries already facing crisis of 
unprecedented proportions, and also in those countries with 
alarming recent increases in HIV prevalence.
    It encourages a strategy that extends palliative care for 
people living with AIDS and supports efforts to find vaccines 
for HIV/AIDS and malaria. H.R. 1298 emphasizes the need to keep 
families together, with particular focus on the assistance 
needs of children and young people with HIV and of orphans and 
other vulnerable children caused by the HIV/AIDS pandemic. The 
bill also contributes to multilateral initiatives that leverage 
the funds of others, and endorses wider application of the 
successful ``ABC'' approach that has reduced HIV prevalence in 
certain countries by acknowledging the importance of individual 
behavior change in fighting this disease.
    The legislation creates a position within the U.S. 
Department of State--a ``Coordinator of United States 
Government Activities to Combat HIV/AIDS Globally,'' who will 
be appointed by the President. The coordinator will ensure 
cohesion and unity of effort among the various agencies of the 
United States Government that contribute to our overall AIDS 
effort. H.R. 1298 updates the AIDS-related authorities in the 
Foreign Assistance Act--authorities for the President to 
support the widest variety of AIDS treatment and prevention 
programs overseas. The legislation endorses prevention programs 
that include the promotion of abstinence, faithfulness, the 
delay of ``sexual debut,'' and the effective use of condoms, 
and authorizes United States participation in the Global Fund 
to Fight AIDS, Tuberculosis and Malaria.
    Education is one of the most effective ways to combat HIV/
AIDS. Education systems provide a cost-effective infrastructure 
for delivering HIV/AIDS prevention messages and life skills 
training to two vital populations, particularly girls--those 
least likely to be infected (children ages 5 to 14) and those 
most vulnerable to infection (youths 15 to 24 years old)--but 
also to the broader population through the engagement of 
parents and community leaders in activities in and around 
schools.
    Funds designed for educational efforts can most effectively 
be used in conjunction with other efforts and institutions 
engaged in schools and educational institutions. Relevant 
education activities include developing and integrating HIV/
AIDS materials in the educational curriculum, training teachers 
in such curriculum, and strengthening the capabilities of 
schools so that they are better able to address health 
education needs.
    At the same time that education systems are vital to 
combating HIV/AIDS, they are also its victims. The disease is 
decimating teacher corps, undermining the quality of education, 
and straining already tight national education budgets as 
countries try to train replacements.
    The HIV/AIDS pandemic is also one of the great moral 
challenges of our era, and is a scourge of unparalleled 
proportions in modern times. Entire villages of orphans are 
being created because adults are dead or dying from this 
plague. The United States has an obligation to use its 
leadership and resources to stop this virus and the destruction 
it causes. The AIDS pandemic touches our national security, our 
civilization, and our humanity. We can and should leverage 
other countries to contribute to help prevent and fight the 
spread of HIV and furnish care, treatment and cure for those 
individuals infected with this terrible disease. Compromise 
must be at the heart and soul of this process. Certain groups 
and interests disagree with specific elements of H.R. 1298. 
While no piece of legislation will please all quarters, the 
Committee on International Relations has done its best to craft 
a compromise that demonstrates our common cause against AIDS. 
Members of the Committee may differ on approaches, but do agree 
on goals and objectives.
    As our Nation wages war in Iraq, the American people can 
and must fight on many fronts to protect our interests, promote 
our values, and provide hope to captive, destitute and 
vulnerable people across the globe.
    The United States Congress has waited too long to address 
the global HIV/AIDS crisis in a truly systematic and 
comprehensive way. This is one of the most ambitious pieces of 
legislation in the Committee's long history--$15 billion 
authorized in the United States Leadership Against HIV/AIDS, 
Tuberculosis and Malaria Act of 2003 is an enormous sum by any 
measure. It is five times the amount we considered for the 
cause in the 107th Congress through the Committee's 
consideration of H.R. 2069. As impressive as these amounts 
appear, they are no more than this crisis demands. Every day, 
AIDS claims the lives of innocent men and women, old and young, 
sick and able-bodied, destitute and affluent, unemployed and 
professional, African, Asian, American, atheist and faithful. 
This disease does not discriminate. It targets us all. In so 
doing, it ruins families, communities and whole nations; and it 
fuels violence and bloodshed across borders. The political, 
economic, social and health impacts of HIV/AIDS cannot be 
contained in one region or one population. It is a global human 
challenge that demands a global humanitarian response with the 
United States in the lead. H.R. 1298 is unprecedented 
legislation that will lead the way for increased U.S. 
engagement and leadership to contain the spread of the 
pandemic.

                                Hearings

    The Committee did not hold hearings on HIV/AIDS during the 
108th Congress prior to consideration of H.R. 1298.

                        Committee Consideration

    H.R. 1298 was introduced by Chairman Hyde on March 17, 
2003, and was referred to the Committee on International 
Relations. On April 2, 2003, the Committee met in open session, 
pursuant to notice, to consider the bill. A motion offered by 
Chairman Hyde to favorably report H.R. 1298 to the House of 
Representatives, as amended, was agreed to by a record vote of 
37 ayes to 8 noes, a quorum being present.

                         Summary of Amendments

    The Committee adopted several amendments. The first was 
offered by Chairman Hyde as an en bloc amendment (#1), and was 
approved by voice vote.
    Rep. Pitts (R-PA) offered an amendment (#2) to provide 
prioritized funding for programs promoting abstinence over 
those that focus on condom use. Rep. Lee (D-CA) offered a 
substitute amendment (#3) to the Pitts amendment. The Lee 
amendment requires the President's AIDS prevention strategy to 
prioritize behavioral risk reduction by promoting abstinence, 
encouraging monogamy and faithfulness, promoting the effective 
use of condoms, and eradicating prostitution, the sex trade, 
rape, sexual assault and the sexual exploitation of women and 
children. The Lee substitute amendment was approved by a record 
vote of 24 ayes to 20 nays [Record Vote #1]. The Pitts 
amendment, as amended by the Lee amendment, was agreed to by 
voice vote.
    The Committee approved by voice vote an amendment (#4) 
offered by Rep. Brown (D-OH), as amended by Chairman Hyde's 
amendment (#5), to Section 302 of the bill requiring the 
President to ensure that not less than 75 percent of 
tuberculosis funding should be spent on antituberculosis drugs, 
supplies, direct patient services, and training.
    The Committee approved by voice vote an amendment (#6) 
offered by Rep. Rohrabacher (R-CA) recommending that 10% of the 
funding be used to help orphans and vulnerable children 
affected by HIV/AIDS.
    The Committee approved by voice vote an amendment (#7) 
offered by Rep. Napolitano (D-CA) regarding awarding subgrants 
in a new pilot program on family survival partnerships--giving 
priority for consideration to groups that already provide 
mother-to-child HIV transmission prevention programs.
    The Committee defeated, by a record vote of 15 ayes to 25 
nays, an amendment (#8) offered by Rep. Smith (R-MI) that would 
have reduced the authorization levels in fiscal years 2004 and 
2005, and shifted such funds to fiscal years 2007 and 2008 
[Record Vote #2].
    The Committee approved by voice vote an amendment (#9) 
offered by Rep. Berman (D-CA) that would include, as eligible 
to receive funding, the public-private partnership ``Medicines 
for Malaria Venture'' for developing new anti-malarial 
medicines.
    The Committee approved by voice vote an amendment (#10) 
offered by Rep. Flake (R-AZ), as amended by the Lantos (#11) 
and Berman (#12) amendments, that would reduce the amount of 
Federal funding for the Global Fund by an amount equal to the 
amount provided by the Fund to governments on the State 
Department's terrorist list.
    The Committee approved by voice vote an amendment (#13) 
offered by Rep. McCollum (D-MN) that would make physician's 
assistants eligible to participate in a pilot program for the 
placement of health care professionals in countries severely 
affected by HIV/AIDS, TB and malaria.
    An amendment (#14) to add Malawi to the list of countries 
specifically listed to receive HIV/AIDS assistance was offered 
and withdrawn by Rep. McCollum.
    The Committee approved by unanimous consent an en bloc 
amendment (#15) with language by Rep. Harris (R-FL) to add the 
word ``abstinence'' to the list of other methods that should be 
promoted to reduce HIV/AIDS, and language by Rep. Davis (R-VA) 
that would require an analysis of Human Papilloma Virus (HPV) 
in sub-Saharan Africa and the impact that condom usage has upon 
the spread of HPV in sub-Saharan Africa.
    The Committee defeated, by a record vote of 21 ayes to 23 
noes [Record Vote #3], an amendment (#16) offered by Rep. Pitts 
which would have required the HIV/AIDS Coordinator to respect 
the views of faith-based organizations by not requiring such 
organizations to participate in any aspect of any assistance 
program if it violated their views as a matter of conscience.
    The Committee approved, by a record vote of 24 ayes to 22 
noes [Record Vote #5], an amendment (#17) offered by Rep. Smith 
(R-NJ) that would prohibit funds from going to any group or 
organization that does not have a policy ``explicitly opposing 
prostitution and sex trafficking.'' The Committee defeated, by 
a record vote of 21 ayes to 22 noes, an amendment (#18) offered 
by Rep. Lantos (D-CA) to the Smith amendment that would have 
provided exceptions to the prostitution policy [Record Vote 
#4].
    By a record vote of 37 ayes to 8 noes, the Committee 
favorably reported to the House H.R. 1298, as amended [Record 
Vote #6].
    By unanimous consent the Committee ordered H.R. 1298 
reported as a single amendment in the nature of a substitute 
incorporating the perfecting amendments adopted during markup.

                         Votes of the Committee

    Clause (3)(b) of rule XIII of the Rules of the House of 
Representatives requires that the results of each record vote 
on an amendment or motion to report, together with the names of 
those voting for or against, be printed in the Committee 
report.
Description of Amendment, Motion, Order, or Other Proposition:
    Vote #1 (11:34 a.m.): Lee substitute amendment (#3) [to 
Pitts amendment (#2)] regarding the approach to a reduction of 
HIV/AIDS behavioral risks.

        Voting yes: Leach, Houghton, Lantos, Berman, Ackerman, 
        Payne, Menendez, Brown, Sherman, Wexler, Engel, 
        Delahunt, Meeks, Lee, Crowley, Hoeffel, Blumenauer, 
        Berkley, Napolitano, Schiff, Watson, Smith (WA), 
        McCollum and Bell.

        Voting no: Hyde, Smith (NJ), Burton, Gallegly, 
        Ballenger, Rohrabacher, Royce, Chabot, Tancredo, Paul, 
        Smith (MI), Pitts, Flake, Davis, Green, Weller, Pence, 
        McCotter, Janklow and Harris.

Ayes 24. Noes 20.

    Vote #2 (1:42 p.m.): Smith (MI) amendment (#8) regarding 
gradual increases for the authorized funding for FY04-08.

        Voting yes: Bereuter, Ballenger, Rohrabacher, Royce, 
        Chabot, Houghton, Smith (MI), Pitts, Flake, Davis, 
        Green, Pence, McCotter, Janklow and Harris.

        Voting no: Hyde, Leach, King, Weller, Lantos, Berman, 
        Ackerman, Payne, Menendez, Brown, Wexler, Engel, 
        Delahunt, Meeks, Lee, Crowley, Hoeffel, Blumenauer, 
        Berkley, Napolitano, Schiff, Watson, Smith (WA), 
        McCollum and Bell.

Ayes 15. Noes 25.

    Vote #3 (3:25 p.m.): Pitts amendment (#16) regarding 
respecting the views of faith-based organizations when carrying 
out assistance relating to matters of conscience.

        Voting yes: Hyde, Leach, Bereuter, Smith (NJ), 
        Ballenger, Rohrabacher, Royce, King, Chabot, Tancredo, 
        Paul, Smith (MI), Pitts, Flake, Davis, Green, Weller, 
        Pence, McCotter, Janklow and Harris.

        Voting no: Houghton, Lantos, Berman, Ackerman, Payne, 
        Menendez, Brown, Sherman, Wexler, Engel, Delahunt, 
        Meeks, Lee, Crowley, Hoeffel, Blumenauer, Berkley, 
        Napolitano, Schiff, Watson, Smith (WA), McCollum and 
        Bell.

Ayes 21. Noes 23.

    Vote #4 (3:50 p.m.): Lantos amendment (#18) [to Smith (NJ) 
amendment (#17)] regarding funds to organizations that do not 
have a policy opposing sexual trafficking and prostitution--
adding exceptions to the policy.

        Voting yes: Leach, Lantos, Berman, Ackerman, Payne, 
        Menendez, Brown, Wexler, Engel, Delahunt, Meeks, Lee, 
        Crowley, Hoeffel, Blumenauer, Berkley, Napolitano, 
        Schiff, Watson, Smith (WA) and McCollum.

        Voting no: Hyde, Bereuter, Smith (NJ), Burton, 
        Gallegly, Ballenger, Rohrabacher, Royce, King, Chabot, 
        Houghton, Tancredo, Paul, Pitts, Flake, Davis, Green, 
        Weller, Pence, McCotter, Janklow and Harris.

Ayes 21. Noes 22.

    Vote #5 (4:00 p.m.): Smith (NJ) amendment (#17) providing 
that no funds may be made available to organizations that do 
not have a policy opposing sexual trafficking and prostitution.

        Voting yes: Hyde, Leach, Bereuter, Smith (NJ), Burton, 
        Gallegly, Ballenger, Rohrabacher, Royce, King, Chabot, 
        Houghton, Tancredo, Paul, Smith (MI), Pitts, Flake, 
        Davis, Green, Weller, Pence, McCotter, Janklow and 
        Harris.

        Voting no: Lantos, Berman, Ackerman, Payne, Menendez, 
        Brown, Sherman, Wexler, Engel, Delahunt, Meeks, Lee, 
        Crowley, Hoeffel, Blumenauer, Berkley, Napolitano, 
        Schiff, Watson, Smith (WA), McCollum and Bell.

Ayes 24. Noes 22.

    Vote #6 (4:04 p.m.): Report H.R. 1298, as amended, 
favorably to the House.

        Voting yes: Hyde, Leach, Bereuter, Smith (NJ), Burton, 
        Gallegly, Ballenger, Rohrabacher, Royce, King, 
        Houghton, Green, Weller, McCotter, Janklow, Harris, 
        Lantos, Berman, Ackerman, Payne, Menendez, Brown, 
        Sherman, Wexler, Engel, Delahunt, Meeks, Lee, Crowley, 
        Hoeffel, Berkley, Napolitano, Schiff, Watson, Smith 
        (WA), McCollum and Bell.

        Voting no: Chabot, Tancredo, Paul, Smith (MI), Pitts, 
        Flake, Davis, and Pence.

Ayes 37. Noes 8.

                      Committee Oversight Findings

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

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of House Rule XIII is inapplicable because 
this legislation does not provide new budgetary authority or 
increased tax expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R.1298, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, April 7, 2003.
Hon. Henry J. Hyde, Chairman,
Committee on International Relations,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1298, the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Joseph C. 
Whitehill, who can be reached at 226-2840.
            Sincerely,
                                       Douglas Holtz-Eakin.

Enclosure

cc:
        Honorable Tom Lantos,
        Ranking Member.

H.R. 1298--United States Leadership Against HIV/AIDS, Tuberculosis, and 
        Malaria Act of 2003.

                                SUMMARY

    H.R. 1298 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 
the appropriation of $3 billion a year over the 2004-2008 
period 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 H.R. 1298 would cost $568 million in 2004 and $11 
billion over the 2004-2008 period. The bill would not affect 
direct spending or receipts.
    H.R. 1298 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no significant costs on the budgets of state, 
local, or tribal governments.

                ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 1298 is shown in the 
following table. The costs of this legislation fall within 
budget functions 150 (international affairs) and 550 (health). 
For this estimate, CBO assumes that the bill will be enacted by 
September 30, 2003, that authorized amounts will be provided in 
annual appropriation acts near the start of each fiscal year, 
and that outlays will follow historical spending patterns.

                                     By fiscal year, in millions of dollars
----------------------------------------------------------------------------------------------------------------
                                                              2003     2004     2005     2006     2007     2008
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for                                1,639        0        0        0        0        0
International HIV/AIDS, Tuberculosis,
Malaria, and Vaccine Programs
  Budget Authority \1\
  Estimated Outlays                                             955    1,098      382      167       78       21

Proposed Changes                                                  0    3,000    3,000    3,000    3,000    3,000
  Authorization Level
  Estimated Outlays                                               0      568    2,107    2,606    2,817    2,924

Spending Under H.R. 1298                                      1,639    3,000    3,000    3,000    3,000    3,000
  Authorization Level \1\
  Estimated Outlays                                             955    1,666    2,489    2,773    2,895    2,945
----------------------------------------------------------------------------------------------------------------
\1\ The 2003 level is the amount appropriated for that year.

                           BASIS OF ESTIMATE

    H.R. 1298 would identify HIV/AIDS as being of particular 
concern to the United States and would require the President to 
develop a comprehensive strategy to combat it on a global 
basis. The bill would establish within the Department of State 
the position of Coordinator of U.S. Government Activities to 
Combat HIV/AIDS Globally with the responsibility to oversee and 
to coordinate U.S. programs with those of other countries and 
international organizations. The bill also would require 
numerous reports to the Congress, and it would permit a portion 
of the authorized amounts to be used for administrative 
expenses.
    The bill would give the Coordinator discretion to allocate 
funds to the various programs authorized. For the purpose of 
the estimate, CBO assumed that programs under the Public Health 
Services agencies would be funded at the amounts identified in 
the President's budget request for 2004 and that the additional 
amounts authorized by H.R. 1298, about $0.9 billion of the $3 
billion annual authorization, would be allocated by the 
Coordinator consistent with the plan to be developed by the 
President.

              INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    H.R. 1298 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would impose no significant 
costs on the budgets of state, local, or tribal governments.

                    Performance Goals and Objectives

    The goals and objectives of this legislation are to provide 
for the national security of the United States and other 
nations by increasing HIV/AIDS assistance to those countries 
most affected by the pandemic for the purpose of reducing the 
spread of the pandemic and its effects on the health of 
populations in the developing world.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in article I, section 8, clause 18 of the 
Constitution (relating to making all laws necessary and proper 
for carrying into execution powers vested by the Constitution 
in the Government of the United States).

               Section-by-Section Analysis and Discussion

    Section 1. Short Title. Section 1 contains a short title 
and table of contents.
    Section 2. Findings. Section 2 articulates findings on the 
state of the HIV/AIDS pandemic in the developing world, 
including latest statistics on the numbers infected and dead; 
the particular effect of AIDS on, and the vulnerability of, 
women and children; the effect of the AIDS crisis on the 
economic security of countries; its effect on society, labor, 
military readiness and peacekeeping; the relationship of HIV/
AIDS to tuberculosis and malaria; the types of strategies 
appropriate for dealing with the pandemic; the importance of 
treatment and care of people living with AIDS; the role of NGOs 
and faith-based organizations in assisting those people living 
with AIDS; the positive track record of countries such as 
Uganda in facing AIDS directly, resulting in significant 
progress by adopting strategies based on behavior change; the 
demand for a comprehensive, long-term international response, 
founded upon addressing the crisis, reducing the spread, and 
ameliorating the consequence of the pandemic; that 
prostitution, sex trafficking and sexual violence are 
additional causes and factors in the spread of HIV/AIDS; the 
need for strong coordination among the various agencies of the 
United States to ensure effective and efficient use of 
financial and technical resources with respect to the provision 
of international HIV/AIDS assistance; and findings summarizing 
and emphasizing the importance of the President's support of 
greatly increased and expanded United States efforts to control 
the pandemic.
    Section 3. Definitions. Section 3 defines terms used 
throughout the bill.
    Section 4. Purpose. Section 4 articulates in general terms 
the purposes of the act: to establish a comprehensive, 5-year 
strategy; to provide increased resources for bilateral and 
multilateral efforts to fight the pandemic; to encourage the 
expansion of private sector efforts and public-private 
partnerships; and to intensify care and treatment for 
individuals with HIV/AIDS, and development of vaccines for HIV/
AIDS, tuberculosis, and malaria.
    Section 5. Authority to consolidate and combine reports. 
Section 5 authorizes the President to consolidate the various 
reports required by the act, and to enter into contracts for 
the purpose of developing, originating, or contributing to any 
of the required reports.
Title I--Policy Planning and Coordination
    Section 101. Development of a comprehensive, 5-year global 
strategy. Section 101 requires the President to: establish a 
comprehensive, integrated 5-year strategy to combat HIV/AIDS 
globally, and articulates that the required elements of the 
strategy should include objectives and approaches to treat 
those infected, and prevent further spread of infections; 
improve coordination and assign priorities for relevant 
executive branch agencies; expand public-private partnerships; 
maximize U.S. capabilities in the areas of technical 
assistance, training, and research; and report on the strategy 
not later than 270 days after the date of enactment of the law.
    Section 102. HIV/AIDS Response Coordinator. Section 102(a) 
creates the position of Coordinator of United States Government 
Activities to Combat HIV/AIDS Globally and enumerates the 
duties and responsibilities of that individual, generally and 
specifically. Section 102(b) requires the President to specify 
the necessary financial resources that shall be assigned to, 
and under the direct control of, the Coordinator. Section 
102(c) establishes a separate account in the Treasury into 
which shall be deposited all amounts appropriated pursuant to 
the authorization of appropriations under section 401, except 
for amounts appropriated for U.S. contributions to the Global 
Fund.
Title II--Support for Multilateral Funds, Programs, and Public-Private 
        Partnerships
    Section 201. Sense of Congress on public-private 
partnerships. Section 201 includes findings and a Sense of 
Congress supportive of public-private partnerships in 
strengthening the delivery of health services and accelerating 
research in the fight against HIV/AIDS.
    Section 202. Participation in the Global Fund to Fight 
AIDS, Tuberculosis and Malaria. Section 202 authorizes U.S. 
financial participation in the Global Fund to Fight AIDS, 
Tuberculosis and Malaria (the Global Fund), and requires an 
annual report on contributions pledged to, received by, and 
projects funded by the Global Fund, and the mechanisms 
established for transparency and accountability in the grant-
making process. It authorizes up to $1 billion for fiscal year 
2004, and such sums as may be necessary for FY2005-2008, 
available until expended, with the limitation that the U.S. 
contribution may not be more than 33 percent of the total 
amounts contributed to the Fund from all other sources, unless 
the President waives this requirement. It also requires the 
establishment of an interagency technical review panel that 
will analyze proposals received by the Global Fund and provide 
recommendations to U.S. representatives on the committees, 
panels and executive board of the Global Fund. It requires the 
GAO to monitor and evaluate projects and report to Congress 
every 2 years the results of the monitoring and evaluation.
    Section 203. Voluntary contributions to international 
vaccine funds. Section 203 authorizes such sums as may be 
necessary to be contributed by the United States Government to 
the ``Vaccine Fund,'' the ``International AIDS Vaccine 
Initiative (IAVI),'' and malaria vaccine development programs 
such as the ``Malaria Vaccine Initiative of the Program for 
Appropriate Technologies in Health.''
Title III--Bilateral Efforts
            Subtitle A--General Assistance and Programs
    Section 301. Assistance to combat HIV/AIDS. Section 301(a) 
amends and updates the Foreign Assistance Act (FAA) by 
inserting a new section, Section 104A--``Assistance to Combat 
HIV/AIDS.'' This new section: recognizes that the alarming 
spread of HIV/AIDS in developing countries is a major health, 
national security, development and humanitarian crisis; states 
that a major objective of the foreign assistance program of the 
United States is to provide assistance for the prevention, 
treatment and control of HIV/AIDS; authorizes the President to 
furnish assistance to prevent, treat and monitor HIV/AIDS, and 
carry out related activities in sub-Saharan Africa and other 
countries and areas; describes in general the types of 
assistance activities that shall be supported to the maximum 
extent practicable (prevention, treatment, prevention 
intervention education and technologies, monitoring, 
pharmaceuticals, and related activities); requires an annual 
report on the implementation of the new Section 104A; provides 
a limitation on administrative expenses for activities 
described in Section 104(c) and Sections104A, 104B, and 104C; 
and defines terms used in Section 104A. Section 301(b) 
authorizes the appropriation of such sums as may be necessary 
for FY2004-2008 to carry out the new Section 104A of the FAA as 
added by Section 301(a), and authorizes such sums to remain 
available until expended.
    In order to promote effective and efficient use of 
financial and technical resources with respect to the provision 
of U.S. HIV/AIDS assistance, the Committee expects that the 
Coordinator will establish in-country mechanisms under which 
all organizations receiving U.S. HIV/AIDS funds in a particular 
country will closely coordinate their activities to decrease 
overlap in programming and ensure maximum success for each 
program supported by U.S. funds.
    Section 302. Assistance to combat tuberculosis. Section 302 
amends the FAA by adding a new section, Section 104B, that 
authorizes assistance to combat tuberculosis, and authorizes 
the appropriation of such sums as may be necessary to carry out 
this new section of the FAA.
    Section 303. Assistance to combat malaria. Section 303 
amends the FAA by adding a new Section 104C that authorizes 
assistance to combat malaria, and authorizes the appropriation 
of such sums as may be necessary to carry out this new Section 
104C of the FAA.
    Section 304. Pilot program for the placement of health care 
professionals in overseas areas severely affected by HIV/AIDS, 
tuberculosis, and malaria. Section 304 authorizes the President 
to establish a pilot program for the placement of health care 
professionals in overseas areas severely affected by HIV/AIDS, 
tuberculosis and malaria, including foreign-born health care 
workers living permanently in the United States; and from the 
amounts authorized to be appropriated to the President under 
Section 401, authorizes the appropriation of such sums as may 
be necessary for FY2004-2008 to carry out the program.
    Section 305. Report on treatment activities by relevant 
executive branch agencies. Section 305 requires a report by the 
President on the programs and activities of relevant executive 
branch agencies that are directed to the treatment of 
individuals in foreign countries infected with HIV or living 
with AIDS.
            Subtitle B--Assistance for Children and Families
    Section 311. Findings. Section 311 includes findings on the 
effect of AIDS on children and families in foreign countries.
    Section 312. Policy and requirements. Section 312 states 
that the United States Government response to the pandemic 
should place a high priority on the prevention of mother-to-
child transmission, the care and treatment of family members, 
and the care of children orphaned by AIDS.
    Section 313. Annual reports on prevention of mother-to-
child transmission of the HIV infection. Section 313 requires 
an annual report on the activities of relevant executive branch 
agencies to assist in the prevention of mother-to-child 
transmission of HIV infection.
    Section 314. Pilot program of assistance for children and 
families affected by HIV/AIDS. Section 314 authorizes the 
President to establish a pilot program to demonstrate the 
feasibility of the provision of care and treatment to orphans 
and other children and young people affected by HIV/AIDS in 
foreign countries, and from the amounts authorized to be 
appropriated to the President under Section 401, authorizes the 
appropriation of such sums as may be necessary for FY2004-2008 
to carry out the program.
    Section 315. Pilot programs on family survival 
partnerships. Section 315 authorizes the President to establish 
a program, through a public-private partnership, for the 
provision of medical care and support services to HIV-positive 
parents and their children identified through existing programs 
to prevent mother-to-child transmission of HIV in countries 
with or at risk for severe HIV epidemic, with particular 
attention to resource-constrained countries, and from the 
amounts authorized to be appropriated to the President under 
Section 401, authorizes the appropriation of such sums as may 
be necessary for FY2004-2008 to carry out the program.
Title IV--Authorization of Appropriations.
    Section 401. Authorization of Appropriations. Section 401 
authorizes to be appropriated to the President to carry out the 
act and the amendments made by the act $3 billion for each of 
the fiscal years 2004 through 2008. Amounts are authorized to 
remain available until expended and the authorization of 
appropriations therein shall remain available until the 
appropriations are made.
    Section 402. Sense of Congress. Section 402(a) includes a 
sense of the Congress that an urgent priority of U.S. 
assistance programs to fight HIV/AIDS should be the rapid 
increase in distribution of antiretroviral treatment (ARV) so 
that by the end of FY2004, at least 500,000 individuals are 
receiving ARV; by the end of FY2005, at least 1,000,000 
individuals are receiving such treatment; and by the end of 
FY2006, at least 2,000,000 individuals are receiving treatment. 
Section 402(b) includes a sense of the Congress that of the 
amounts appropriated pursuant to the authorization of 
appropriations under Section 401 for HIV/AIDS assistance, an 
effective distribution of such funds would be 55 percent for 
treatment of individuals with HIV/AIDS, 15 percent for 
palliative care of individuals with HIV/AIDS, 20 percent for 
HIV/AIDS prevention, and 10 percent for orphans and vulnerable 
children.
    Section 403. Allocation of Funds. Section 403 requires that 
for fiscal years 2006 through 2008, not less than 55 percent of 
the amounts appropriated under Section 401 for HIV/AIDS 
assistance for each fiscal year shall be expended for 
therapeutic medical care of individuals infected with HIV, of 
which at least 75 percent should be expended for the purchase 
and distribution of ARV drugs and at least 25 percent should be 
expended for related care.

                        New Advisory Committees

    H.R. 1298 does not establish or authorize any new advisory 
committees.

                    Congressional Accountability Act

    H.R. 1298 does not apply to the legislative branch.

                            Federal Mandates

    H.R. 1298 imposes no Federal mandates.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

    SECTION 1 OF THE STATE DEPARTMENT BASIC AUTHORITIES ACT OF 1956

                ORGANIZATION OF THE DEPARTMENT OF STATE

    Section 1. (a) * * *

           *       *       *       *       *       *       *

    (f) HIV/AIDS Response Coordinator.--
            (1) In general.--There shall be established within 
        the Department of State in the immediate office of the 
        Secretary of State a Coordinator of United States 
        Government Activities to Combat HIV/AIDS Globally, who 
        shall be appointed by the President, by and with the 
        advice and consent of the Senate. The Coordinator shall 
        report directly to the Secretary.
            (2) Authorities and duties; definitions.--
                    (A) Authorities.--The Coordinator, acting 
                through such nongovernmental organizations 
                (including faith-based and community-based 
                organizations) and relevant executive branch 
                agencies as may be necessary and appropriate to 
                effect the purposes of this section, is 
                authorized--
                            (i) to operate internationally to 
                        carry out prevention, care, treatment, 
                        support, capacity development, and 
                        other activities for combatting HIV/
                        AIDS;
                            (ii) to transfer and allocate funds 
                        to relevant executive branch agencies; 
                        and
                            (iii) to provide grants to, and 
                        enter into contracts with, 
                        nongovernmental organizations 
                        (including faith-based and community-
                        based organizations) to carry out the 
                        purposes of section.
                    (B) Duties.--
                            (i) In general.--The Coordinator 
                        shall have primary responsibility for 
                        the oversight and coordination of all 
                        resources and international activities 
                        of the United States Government to 
                        combat the HIV/AIDS pandemic, including 
                        all programs, projects, and activities 
                        of the United States Government 
                        relating to the HIV/AIDS pandemic under 
                        the United States Leadership Against 
                        HIV/AIDS, Tuberculosis, and Malaria Act 
                        of 2003 or any amendment made by that 
                        Act.
                            (ii) Specific duties.--The duties 
                        of the Coordinator shall specifically 
                        include the following:
                                    (I) Ensuring program and 
                                policy coordination among the 
                                relevant executive branch 
                                agencies and nongovernmental 
                                organizations, including 
                                auditing, monitoring, and 
                                evaluation of all such 
                                programs.
                                    (II) Ensuring that each 
                                relevant executive branch 
                                agency undertakes programs 
                                primarily in those areas where 
                                the agency has the greatest 
                                expertise, technical 
                                capabilities, and potential for 
                                success.
                                    (III) Avoiding duplication 
                                of effort.
                                    (IV) Ensuring coordination 
                                of relevant executive branch 
                                agency activities in the field.
                                    (V) Pursuing coordination 
                                with other countries and 
                                international organizations.
                                    (VI) Resolving policy, 
                                program, and funding disputes 
                                among the relevant executive 
                                branch agencies.
                                    (VII) Directly approving 
                                all activities of the United 
                                States (including funding) 
                                relating to combatting HIV/AIDS 
                                in each of Botswana, Cote 
                                d'Ivoire, Ethiopia, Guyana, 
                                Haiti, Kenya, Mozambique, 
                                Namibia, Nigeria, Rwanda, South 
                                Africa, Tanzania, Uganda, 
                                Zambia, and other countries 
                                designated by the President, 
                                which other designated 
                                countries may include those 
                                countries in which the United 
                                States is implementing HIV/AIDS 
                                programs as of the date of the 
                                enactment of the United States 
                                Leadership Against HIV/AIDS, 
                                Tuberculosis, and Malaria Act 
                                of 2003.
                                    (VIII) Establishing due 
                                diligence criteria for all 
                                recipients of funds section and 
                                all activities subject to the 
                                coordination and appropriate 
                                monitoring, evaluation, and 
                                audits carried out by the 
                                Coordinator necessary to assess 
                                the measurable outcomes of such 
                                activities.
                    (C) Definitions.--In this paragraph:
                            (i) AIDS.--The term ``AIDS'' means 
                        acquired immune deficiency syndrome.
                            (ii) HIV.--The term ``HIV'' means 
                        the human immunodeficiency virus, the 
                        pathogen that causes AIDS.
                            (iii) HIV/AIDS.--The term ``HIV/
                        AIDS'' means, with respect to an 
                        individual, an individual who is 
                        infected with HIV or living with AIDS.
                            (iv) Relevant executive branch 
                        agencies.--The term ``relevant 
                        executive branch agencies'' means the 
                        Department of State, the United States 
                        Agency for International Development, 
                        the Department of Health and Human 
                        Services (including the Public Health 
                        Service), and any other department or 
                        agency of the United States that 
                        participates in international HIV/AIDS 
                        activities pursuant to the authorities 
                        of such department or agency or this 
                        Act.
    [(f)] (g) Qualifications of Certain Officers of the 
Department of State.--
            (1) * * *

           *       *       *       *       *       *       *

                              ----------                              


                     FOREIGN ASSISTANCE ACT OF 1961



           *       *       *       *       *       *       *
                                 PART I

Chapter 1--Policy; Development Assistance Authorizations 

           *       *       *       *       *       *       *


    Sec. 104. Population and Health.--(a) * * *

           *       *       *       *       *       *       *

    (c) Assistance for Health and Disease Prevention.--(1) * * 
*

           *       *       *       *       *       *       *

    [(4)(A) Congress recognizes the growing international 
dilemma of children with the human immunodeficiency virus (HIV) 
and the merits of intervention programs aimed at this problem. 
Congress further recognizes that mother-to-child transmission 
prevention strategies can serve as a major force for change in 
developing regions, and it is, therefore, a major objective of 
the foreign assistance program to control the acquired immune 
deficiency syndrome (AIDS) epidemic.
    [(B) The agency primarily responsible for administering 
this part shall--
            [(i) coordinate with UNAIDS, UNICEF, WHO, national 
        and local governments, and other organizations to 
        develop and implement effective strategies to prevent 
        vertical transmission of HIV; and
            [(ii) coordinate with those organizations to 
        increase intervention programs and introduce voluntary 
        counseling and testing, antiretroviral drugs, 
        replacement feeding, and other strategies.
    [(5)(A) Congress expects the agency primarily responsible 
for administering this part to make the human immunodeficiency 
virus (HIV) and the acquired immune deficiency syndrome (AIDS) 
a priority in the foreign assistance program and to undertake a 
comprehensive, coordinated effort to combat HIV and AIDS.
    [(B) Assistance described in subparagraph (A) shall include 
help providing--
            [(i) primary prevention and education;
            [(ii) voluntary testing and counseling;
            [(iii) medications to prevent the transmission of 
        HIV from mother to child; and
            [(iv) care for those living with HIV or AIDS.
    [(6)(A) In addition to amounts otherwise available for such 
purpose, there is authorized to be appropriated to the 
President $300,000,000 for each of the fiscal years 2001 and 
2002 to carry out paragraphs (4) and (5).
    [(B) Of the funds authorized to be appropriated under 
subparagraph (A), not less than 65 percent is authorized to be 
available through United States and foreign nongovernmental 
organizations, including private and voluntary organizations, 
for-profit organizations, religious affiliated organizations, 
educational institutions, and research facilities.
    [(C)(i) Of the funds authorized to be appropriated by 
subparagraph (A), not less than 20 percent is authorized to be 
available for programs as part of a multidonor strategy to 
address the support and education of orphans in sub-Saharan 
Africa, including AIDS orphans.
    [(ii) Assistance made available under this subsection, and 
assistance made available under chapter 4 of part II to carry 
out the purposes of this subsection, may be made available 
notwithstanding any other provision of law that restricts 
assistance to foreign countries.
    [(D) Of the funds authorized to be appropriated under 
subparagraph (A), not less than 8.3 percent is authorized to be 
available to carry out the prevention strategies for vertical 
transmission referred to in paragraph (4)(A).
    [(E) Of the funds authorized to be appropriated by 
subparagraph (A), not more than 7 percent may be used for the 
administrative expenses of the agency primarily responsible for 
carrying out this part of this Act in support of activities 
described in paragraphs (4) and (5).
    [(F) Funds appropriated under this paragraph are authorized 
to remain available until expended.
    [(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 the provisions cited in 
this paragraph, may be made available notwithstanding any other 
provision of law that restricts assistance to foreign 
countries, except for the provisions of this subsection, the 
provisions of law cited in this paragraph, subsection (f), 
section 634A of this Act, and provisions of law that limit 
assistance to organizations that support or participate in a 
program of coercive abortion or involuntary sterilization 
included under the Child Survival and Health Programs Fund 
heading in the Consolidated Appropriations Resolution, 2003 
(Public Law 108-7).

           *       *       *       *       *       *       *


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

    (a) Finding.--Congress recognizes that the alarming spread 
of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, 
and other developing countries is a major global health, 
national security, development, and humanitarian crisis.
    (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to provide assistance 
for the prevention, treatment, and control of HIV/AIDS. The 
United States and other developed countries should provide 
assistance to countries in sub-Saharan Africa, the Caribbean, 
and other countries and areas to control this crisis through 
HIV/AIDS prevention, treatment, monitoring, and related 
activities, particularly activities focused on women and youth, 
including strategies to protect women and prevent mother-to-
child transmission of the HIV infection.
    (c) Authorization.--
            (1) In general.--Consistent with section 104(c), 
        the President is authorized to furnish assistance, on 
        such terms and conditions as the President may 
        determine, for HIV/AIDS, including to prevent, treat, 
        and monitor HIV/AIDS, and carry out related activities, 
        in countries in sub-Saharan Africa, the Caribbean, and 
        other countries and areas.
            (2) Role of ngos.--It is the sense of Congress that 
        the President should provide an appropriate level of 
        assistance under paragraph (1) through nongovernmental 
        organizations (including faith-based and community-
        based organizations) in countries in sub-Saharan 
        Africa, the Caribbean, and other countries and areas 
        affected by the HIV/AIDS pandemic.
            (3) Coordination of assistance efforts.--The 
        President shall coordinate the provision of assistance 
        under paragraph (1) with the provision of related 
        assistance by the Joint United Nations Programme on 
        HIV/AIDS (UNAIDS), the United Nations Children's Fund 
        (UNICEF), the World Health Organization (WHO), the 
        United Nations Development Programme (UNDP), the Global 
        Fund to Fight AIDS, Tuberculosis and Malaria and other 
        appropriate international organizations (such as the 
        International Bank for Reconstruction and Development), 
        relevant regional multilateral development 
        institutions, national, state, and local governments of 
        foreign countries, appropriate governmental and 
        nongovernmental organizations, and relevant executive 
        branch agencies.
    (d) Activities Supported.--Assistance provided under 
subsection (c) shall, to the maximum extent practicable, be 
used to carry out the following activities:
            (1) Prevention.--Prevention of HIV/AIDS through 
        activities including--
                    (A) programs and efforts that are designed 
                or intended to impart knowledge with the 
                exclusive purpose of helping individuals avoid 
                behaviors that place them at risk of HIV 
                infection, including integration of such 
                programs into health programs and the inclusion 
                in counseling programs of information on 
                methods of avoiding infection of HIV, including 
                delaying sexual debut, abstinence, fidelity and 
                monogamy, reduction of casual sexual 
                partnering, and where appropriate, use of 
                condoms;
                    (B) assistance to establish and implement 
                culturally appropriate HIV/AIDS education and 
                prevention programs that focus on helping 
                individuals avoid infection of HIV/AIDS, 
                implemented through nongovernmental 
                organizations, including faith-based and 
                community-based organizations, particularly 
                those organizations that utilize both 
                professionals and volunteers with appropriate 
                skills, experience, and community presence;
                    (C) assistance for the purpose of providing 
                voluntary testing and counseling (including the 
                incorporation of confidentiality protections 
                with respect to such testing and counseling);
                    (D) assistance for the purpose of 
                preventing mother-to-child transmission of the 
                HIV infection, including medications to prevent 
                such transmission and access to infant formula 
                and other alternatives for infant feeding;
                    (E) assistance to ensure a safe blood 
                supply and sterile medical equipment; and
                    (F) assistance to help avoid substance 
                abuse and intravenous drug use that can lead to 
                HIV infection.
            (2) Treatment.--The treatment and care of 
        individuals with HIV/AIDS, including--
                    (A) assistance to establish and implement 
                programs to strengthen and broaden indigenous 
                health care delivery systems and the capacity 
                of such systems to deliver HIV/AIDS 
                pharmaceuticals and otherwise provide for the 
                treatment of individuals with HIV/AIDS, 
                including clinical training for indigenous 
                organizations and health care providers;
                    (B) assistance to strengthen and expand 
                hospice and palliative care programs to assist 
                patients debilitated by HIV/AIDS, their 
                families, and the primary caregivers of such 
                patients, including programs that utilize 
                faith-based and community-based organizations; 
                and
                    (C) assistance for the purpose of the care 
                and treatment of individuals with HIV/AIDS 
                through the provision of pharmaceuticals, 
                including antiretrovirals and other 
                pharmaceuticals and therapies for the treatment 
                of opportunistic infections, nutritional 
                support, and other treatment modalities.
            (3) Preventative intervention education and 
        technologies.--(A) With particular emphasis on specific 
        populations that represent a particularly high risk of 
        contracting or spreading HIV/AIDS, including those 
        exploited through the sex trade, victims of rape and 
        sexual assault, individuals already infected with HIV/
        AIDS, and in cases of occupational exposure of health 
        care workers, assistance with efforts to reduce the 
        risk of HIV/AIDS infection including post-exposure 
        pharmaceutical prophylaxis, and necessary 
        pharmaceuticals and commodities, including test kits, 
        condoms, and, when proven effective, microbicides.
            (B) Bulk purchases of available test kits, condoms, 
        and, when proven effective, microbicides that are 
        intended to reduce the risk of HIV/AIDS transmission 
        and for appropriate program support for the 
        introduction and distribution of these commodities, as 
        well as education and training on the use of the 
        technologies.
            (4) Monitoring.--The monitoring of programs, 
        projects, and activities carried out pursuant to 
        paragraphs (1) through (3), including--
                    (A) monitoring to ensure that adequate 
                controls are established and implemented to 
                provide HIV/AIDS pharmaceuticals and other 
                appropriate medicines to poor individuals with 
                HIV/AIDS;
                    (B) appropriate evaluation and surveillance 
                activities;
                    (C) monitoring to ensure that appropriate 
                measures are being taken to maintain the 
                sustainability of HIV/AIDS pharmaceuticals 
                (especially antiretrovirals) and ensure that 
                drug resistance is not compromising the 
                benefits of such pharmaceuticals; and
                    (D) monitoring to ensure appropriate law 
                enforcement officials are working to ensure 
                that HIV/AIDS pharmaceuticals are not 
                diminished through illegal counterfeiting or 
                black market sales of such pharmaceuticals.
            (5) Pharmaceuticals.--
                    (A) Procurement.--The procurement of HIV/
                AIDS pharmaceuticals, antiviral therapies, and 
                other appropriate medicines, including 
                medicines to treat opportunistic infections.
                    (B) Mechanisms for quality control and 
                sustainable supply.--Mechanisms to ensure that 
                such HIV/AIDS pharmaceuticals, antiretroviral 
                therapies, and other appropriate medicines are 
                quality-controlled and sustainably supplied.
                    (C) Distribution.--The distribution of such 
                HIV/AIDS pharmaceuticals, antiviral therapies, 
                and other appropriate medicines (including 
                medicines to treat opportunistic infections) to 
                qualified national, regional, or local 
                organizations for the treatment of individuals 
                with HIV/AIDS in accordance with appropriate 
                HIV/AIDS testing and monitoring requirements 
                and treatment protocols and for the prevention 
                of mother-to-child transmission of the HIV 
                infection.
            (6) Related activities.--The conduct of related 
        activities, including--
                    (A) the care and support of children who 
                are orphaned by the HIV/AIDS pandemic, 
                including services designed to care for 
                orphaned children in a family environment which 
                rely on extended family members;
                    (B) improved infrastructure and 
                institutional capacity to develop and manage 
                education, prevention, and treatment programs, 
                including training and the resources to collect 
                and maintain accurate HIV surveillance data to 
                target programs and measure the effectiveness 
                of interventions; and
                    (C) vaccine research and development 
                partnership programs with specific plans of 
                action to develop a safe, effective, 
                accessible, preventive HIV vaccine for use 
                throughout the world.
            (7) Comprehensive hiv/aids public-private 
        partnerships.--The establishment and operation of 
        public-private partnership entities within countries in 
        sub-Saharan Africa, the Caribbean, and other countries 
        affected by the HIV/AIDS pandemic that are dedicated to 
        supporting the national strategy of such countries 
        regarding the prevention, treatment, and monitoring of 
        HIV/AIDS. Each such public-private partnership should--
                    (A) support the development, 
                implementation, and management of comprehensive 
                HIV/AIDS plans in support of the national HIV/
                AIDS strategy;
                    (B) operate at all times in a manner that 
                emphasizes efficiency, accountability, and 
                results-driven programs;
                    (C) engage both local and foreign 
                development partners and donors, including 
                businesses, government agencies, academic 
                institutions, nongovernmental organizations, 
                foundations, multilateral development agencies, 
                and faith-based organizations, to assist the 
                country in coordinating and implementing HIV/
                AIDS prevention, treatment, and monitoring 
                programs in accordance with its national HIV/
                AIDS strategy;
                    (D) provide technical assistance, 
                consultant services, financial planning, 
                monitoring and evaluation, and research in 
                support of the national HIV/AIDS strategy; and
                    (E) establish local human resource 
                capacities for the national HIV/AIDS strategy 
                through the transfer of medical, managerial, 
                leadership, and technical skills.
    (e) Annual Report.--
            (1) In general.--Not later than January 31 of each 
        year, the President shall submit to the Committee on 
        Foreign Relations of the Senate and the Committee on 
        International Relations of the House of Representatives 
        a report on the implementation of this section for the 
        prior fiscal year.
            (2) Report elements.--Each report shall include--
                    (A) a description of efforts made by each 
                relevant executive branch agency to implement 
                the policies set forth in this section, section 
                104B, and section 104C;
                    (B) a description of the programs 
                established pursuant to such sections; and
                    (C) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                including--
                            (i)(I) the effectiveness of such 
                        programs in reducing the spread of the 
                        HIV infection, particularly in women 
                        and girls, in reducing mother-to-child 
                        transmission of the HIV infection, and 
                        in reducing mortality rates from HIV/
                        AIDS; and
                            (II) the number of patients 
                        currently receiving treatment for AIDS 
                        in each country that receives 
                        assistance under this Act.
                            (ii) the progress made toward 
                        improving health care delivery systems 
                        (including the training of adequate 
                        numbers of staff) and infrastructure to 
                        ensure increased access to care and 
                        treatment;
                            (iii) with respect to tuberculosis, 
                        the increase in the number of people 
                        treated and the increase in number of 
                        tuberculosis patients cured through 
                        each program, project, or activity 
                        receiving United States foreign 
                        assistance for tuberculosis control 
                        purposes; and
                            (iv) with respect to malaria, the 
                        increase in the number of people 
                        treated and the increase in number of 
                        malaria patients cured through each 
                        program, project, or activity receiving 
                        United States foreign assistance for 
                        malaria control purposes.
    (f) Funding Limitation.--Of the funds made available to 
carry out this section in any fiscal year, not more than 7 
percent may be used for the administrative expenses of the 
United States Agency for International Development in support 
of activities described in section 104(c), this section, 
section 104B, and section 104C. Such amount shall be in 
addition to other amounts otherwise available for such 
purposes.
    (g) Definitions.--In this section:
            (1) AIDS.--The term ``AIDS'' means acquired immune 
        deficiency syndrome.
            (2) HIV.--The term ``HIV'' means the human 
        immunodeficiency virus, the pathogen that causes AIDS.
            (3) HIV/AIDS.--The term ``HIV/AIDS'' means, with 
        respect to an individual, an individual who is infected 
        with HIV or living with AIDS.
            (4) Relevant executive branch agencies.--The term 
        ``relevant executive branch agencies'' means the 
        Department of State, the United States Agency for 
        International Development, the Department of Health and 
        Human Services (including its agencies and offices), 
        and any other department or agency of the United States 
        that participates in international HIV/AIDS activities 
        pursuant to the authorities of such department or 
        agency or this Act.

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

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

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.

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Chapter 3--International Organizations and Programs

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    Sec. 302. Authorization.--(a) * * *

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    (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] such sums as may be necessary for each of the fiscal 
years 2004 through 2008 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] such sums as may be necessary for each of the fiscal 
years 2004 through 2008 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 such sums as may be necessary for each of the fiscal 
years 2004 through 2008 to be available for United States 
contributions to malaria vaccine development programs, 
including the Malaria Vaccine Initiative of the Program for 
Appropriate Technologies in Health (PATH).

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