[House Report 108-80]
[From the U.S. Government Publishing Office]



108th Congress                                            Report
 1st Session                 HOUSE OF REPRESENTATIVES     108-80
======================================================================
 
PROVIDING FOR CONSIDERATION OF H.R. 1298, THE UNITED STATES LEADERSHIP 
        AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA ACT OF 2003

                                _______
                                

   April 30, 2003.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

   Mr. Lincoln Diaz-Balart of Florida, from the Committee on Rules, 
                        submitted the following

                              R E P O R T

                       [To accompany H. Res. 210]

    The Committee on Rules, having had under consideration 
House Resolution 210, by a nonrecord vote, report the same to 
the House with the recommendation that the resolution be 
adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 1289, the 
United States International Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003, under a structured rule. 
The rule provides one hour of general debate equally divided 
and controlled by the chairman and ranking minority member of 
the Committee on International Relations.
    The rule provides that the amendment in the nature of a 
substitute recommended by the Committee on International 
Relations now printed in the bill shall be considered as an 
original bill for the purpose of amendment and shall be 
considered as read.
    The rule makes in order only those amendments printed in 
this report. The rule provides that the amendments printed in 
this report shall be considered only in the order printed in 
this report, may be offered only by a Member designated in this 
report, shall be considered as read, shall be debatable for the 
time specified in this report equally divided and controlled by 
the proponent and an opponent, shall not be subject to 
amendment, and shall not be subject to a demand for a division 
of the question in the House or in the Committee of the Whole. 
The rule waives all points of order against the amendments 
printed in this report.
    The rule provides one motion to recommit with or without 
instructions.

           SUMMARY OF AMENDMENTS MADE IN ORDER UNDER THE RULE

    (Summaries derived from information provided by sponsors.)
    1. Tauzin/Brown (OH)--Establishes priorities for the 
distribution of resources based on factors such as the size and 
demographics of specific nations to ensure that the countries 
that need assistance the most receive it first. Commissions a 
report by the Institutes of Medicine that compares the success 
rates of various programs and methods used under the strategy 
set forth in H.R. 1298. Adds accountability measures to the 
funds authorized for the Global Fund. States that if at any 
point administrative expenses within the Global Fund exceed 10 
percent of total expenditures of the Fund for any 2-year 
period, the U.S. shall withhold an equal amount from its 
contribution the following year. Requires the HIV/AIDS 
Coordinator to make available to Congress information on the 
Global Fund, including all financial and accounting statements 
and reports provided to the Global Fund by organizations 
contracted to audit recipients of funds and project proposals 
submitted by applicants and grantees. Encourages the Centers 
for Disease Control, in coordination with the Global AIDS 
Coordinator, to develop and implement effective strategies to 
improve injection safety and improve the education and 
information provided to the public and to health professionals. 
Directs the Department of Health and Human Services to conduct 
a study on illegal importation into the U.S. of prescription 
drugs donated or sold for humanitarian efforts. (20 minutes)
    2. Crowley--Requires that the teaching of programs to 
combat HIV/AIDS should involve a curriculum targeted to men and 
boys emphasizing gender equality and respect for women and 
girls. (10 minutes)
    3. Biggert--Expresses the sense of Congress that the 
President should conduct an outreach campaign to inform the 
public of the existence of the Global Fund and encourage 
private contributions to the Global Fund by establishing and 
operating an Internet website and making public service 
announcements. (10 minutes)
    4. Stearns--Requires that for every dollar paid to any 
individual Global Fund staffer that is over the amount of the 
U.S. Vice President's salary, that there be a deduction of the 
same amount from the next year's appropriation to the Global 
Fund. All funds would continue to go to HIV/AIDS programs. The 
President may waive the provision for national security 
interests. (10 minutes)
    5. Ballance--Expresses the sense of Congress that African 
nations that object to U.S. food aid on non-scientific grounds 
should accept this food assistance to improve 
nutrition,particuarly for HIV/AIDS patients in those countries. 
Findings include discussion of food insecurity among HIV/AIDS infected 
individuals, the link between malnutrition and the accelerated 
deterioration of HIV/AIDS patients, as well as the diminished impact of 
HIV/AIDS drug therapy in malnourished individuals. Makes a technical 
change, removing an inaccurate reference to nevirapine. (10 minutes)
    6. Smith, Nick (MI)--Reconciles funding levels with the 
President's budget and the budget resolution. Authorizes $2 
billion in fiscal year 2004, as called for by the President's 
budget and the budget resolution. Increases the authorization 
by $500 million in each subsequent year until it reaches $4 
billion in fiscal year 2008. Total authorization of $15 billion 
over 5 years is maintained. (10 minutes)
    7. Millender-McDonald--Calls for a pilot program of 
assistance for children and families affected by HIV/AIDS that 
ensures the inheritance rights of women, particularly women in 
African countries. Requires that the Presidential report on the 
pilot program include a description of activities undertaken to 
carry out the pilot program. Calls for an authorization of 
appropriations to fund the pilot program. (10 minutes)
    8. McCollum--Ensures that orphans and vulnerable children 
affected by HIV/AIDS receive not less than 10 percent of the 
amounts appropriated for HIV/AIDS assistance for fiscal years 
2006 through 2008, of which not less than 50 percent of the 
funding shall be channeled through non-profit, non-governmental 
organizations, including faith-based organizations, that 
implement programs at the community level. (10 minutes)
    9. Jackson-Lee--Expresses the sense of Congress that U.S. 
agencies should encourage U.S. businesses and private groups to 
provide assistance to sub-Saharan African countries to reduce 
the incidence of HIV/AIDS. Funds and assistance should be 
coordinated through a privately funded HIV/AIDS Response Fund. 
(10 minutes)
    10. Smith, Chris (NJ)/Hyde/Stupak/Renzi--Clarification of 
the existing conscience protection language. Ensures that a 
qualified grantee is not disqualified from receiving HIV/AIDS 
funds because the grantee has a religious or moral objection to 
participating in some types of HIV/AIDS prevention or 
treatment. (20 minutes)
    11. Pitts/Hyde--Specifies that of the amount set aside for 
HIV/AIDS prevention in bilateral assistance, 33% should go to 
abstinence-until-marriage programs. (20 minutes)

                    TEXT OF AMENDMENTS MADE IN ORDER

1. An Amendment To Be Offered by Representative Tauzin of Louisiana, or 
                 His Designee, Debatable for 20 Minutes

  Page 2, in the table of contents at section 1(b), after the 
item relating to section 305, insert the following:

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

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

SEC. 306. STRATEGIES TO IMPROVE INJECTION SAFETY.

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

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

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



2. An Amendment To Be Offered by Representative Crowley of New York, or 
                 His Designee, Debatable for 10 Minutes

  Page 22, after line 22, insert the following (and redesignate 
subsequent paragraphs accordingly):
                  (F) a description of the specific strategies 
                developed to encourage men to be responsible in 
                their sexual behavior, child rearing and to 
                respect women including the reduction of sexual 
                violence and coercion;
                  (G) a description of the specific strategies 
                developed to increase women's access to 
                employment opportunities, income, productive 
                resources, and microfinance programs;
  Page 43, line 10, after ``sexual partnering,'' insert 
``reducing sexual violence and coercion, including child 
marriage, widow inheritance, and polygamy,''.
  Page 43, after line 21, insert the following (and redesignate 
subsequent paragraphs accordingly):
                  (C) assistance for the purpose of encouraging 
                men to be responsible in their sexual behavior, 
                child rearing, and to respect women;
  Page 44, line 7, strike ``and'' at the end.
  Page 44, line 10, strike the period at the end and insert 
``and''.
  Page 44, after line 10, insert the following:
                  (G) assistance for the purpose of increasing 
                women's access to employment opportunities, 
                income, productive resources, and microfinance 
                programs, where appropriate.
                              ----------                                



3. An Amendment To Be Offered by Representative Biggert of Illinois, or 
                 Her Designee, Debatable for 10 Minutes

  Page 33, after line 20, insert the following:
  (a) Findings.--The Congress finds as follows:
          (1) The establishment of the Global Fund in January 
        2002 is consistent with the general principles for an 
        international AIDS trust fund first outlined by the 
        Congress in the Global AIDS and Tuberculosis Relief Act 
        of 2000 (Public Law 106-264).
          (2) Section 2, Article 5 of the bylaws of the Global 
        Fund provides for the International Bank for 
        Reconstruction and Development to serve as the initial 
        collection trustee for the Global Fund.
          (3) The trustee agreement signed between the Global 
        Fund and the International Bank for Reconstruction and 
        Development narrows the range of duties to include 
        receiving and investing funds from donors, disbursing 
        the funds upon the instruction of the Global Fund, 
        reporting on trust fund resources to donors and the 
        Global Fund, and providing an annual external audit 
        report to the Global Fund.
  Page 33, line 20, strike ``(a)'' and insert ``(b)''.
  Page 34, line 5, strike ``(b)'' and insert ``(c)''.
  Page 34, line 14, strike ``(c)'' and insert ``(d)''.
  Page 37, line 18, strike ``(d)'' and insert ``(e)''.
  Page 38, line 25, strike ``(e)'' and insert ``(f)''.
  Page 39, after line 9, insert the following:
  (g) Sense of the Congress Regarding Encouragement of Private 
Contributions to the Global Fund.--It is the sense of the 
Congress that the President should--
          (1) conduct an outreach campaign that is designed 
        to--
                  (A) inform the public of the existence of--
                          (i) the Global Fund; and
                          (ii) any entity that will accept 
                        private contributions intended for use 
                        by the Global Fund; and
                  (B) encourage private contributions to the 
                Global Fund; and
          (2) encourage private contributions intended for use 
        by the Global Fund by--
                  (A) establishing and operating an Internet 
                website, and publishing information about the 
                website; and
                  (B) making public service announcements on 
                radio and television.
                              ----------                                



4. An Amendment To Be Offered by Representative Stearns of Florida, or 
                 His Designee, Debatable for 10 Minutes

  Page 36, after line 13, insert the following:
                  (iii) If, at any time during any of the 
                fiscal years 2004 through 2008, the President 
                determines that the salary of any individual 
                employed by the Global Fund exceeds the salary 
                of the Vice President of the United States (as 
                determined under section 104 of title 3, United 
                States Code) for that fiscal year, then the 
                United States shall withhold from its 
                contribution for the next fiscal year an amount 
                equal to the aggregate amount by which the 
                salary of each such individual exceeds the 
                salary of the Vice President of the United 
                States.
  Page 36, line 14, strike ``(B)'' and insert ``(B)(i)''.
  Page 36, beginning on each of lines 15 and 17, strike 
``subparagraph (A)'' and insert ``subparagraph (A)(i)''.
  Page 36, after line 19, insert the following:
                  (ii) Any amount made available under this 
                subsection that is withheld by reason of clause 
                (ii) or (iii) of subparagraph (A) is authorized 
                to be made available to carry out section 104A 
                of the Foreign Assistance Act of 1961 (as added 
                by section 301 of this Act). Amounts made 
                available under the preceding sentence are in 
                addition to amounts appropriated pursuant to 
                the authorization of appropriations under 
                section 401 of this Act for HIV/AIDS 
                assistance.
                              ----------                              


   5. An Amendment To Be Offered by Representative Ballance of North 
          Carolina, or His Designee, Debatable for 10 Minutes

  Page 55, after line 10, insert the following:
  (g) Sense of Congress Relating to Food Assistance for 
Individuals Living With HIV/AIDS.--
          (1) Findings.--Congress finds the following:
                  (A) The United States provides more than 60 
                percent of all food assistance worldwide.
                  (B) According to the United Nations World 
                Food Program and other United Nations agencies, 
                food insecurity of individuals infected or 
                living with HIV/AIDS is a major problem in 
                countries with large populations of such 
                individuals, particularly in African countries.
                  (C) Although the United States is willing to 
                provide food assistance to these countries in 
                need, a few of the countries object to part or 
                all of the assistance because of fears of 
                benign genetic modifications to the foods.
                  (D) Healthy and nutritious foods for 
                individuals infected or living with HIV/AIDS 
                are an important complement to HIV/AIDS 
                medicines for such individuals.
                  (E) Individuals infected with HIV have higher 
                nutritional requirements than individuals who 
                are not infected with HIV, particularly with 
                respect to the need for protein. Also, there is 
                evidence to suggest that the full benefit of 
                therapy to treat HIV/AIDS may not be achieved 
                in individuals who are malnourished, 
                particularly in pregnant and lactating women.
          (2) Sense of congress.--It is therefore the sense of 
        Congress that United States food assistance should be 
        accepted by countries with large populations of 
        individuals infected or living with HIV/AIDS, 
        particularly African countries, in order to help feed 
        such individuals.
  Page 69, line 19, strike ``The drug nevirapine reduces'' and 
insert ``Certain antiretroviral drugs reduce''.
                              ----------                              


6. An Amendment To Be Offered by Representative Nick Smith of Michigan, 
               or His Designee, Debatable for 10 Minutes

  Page 81, beginning on line 22, strike ``$3,000,000,000 for 
each of the fiscal years 2004 through 2008'' and insert 
``$2,000,000,000 for fiscal year 2004, $2,500,000,000 for 
fiscal year 2005, $3,000,000,000 for fiscal year 2006, 
$3,500,000,000 for fiscal year 2007, and $4,000,000,000 for 
fiscal year 2008''.
                              ----------                              


 7. An Amendment To Be Offered by Representative Millender-McDonald of 
         California, or Her Designee, Debatable for 10 Minutes

  Page 74, after line 10, insert the following (and redesignate 
subsequent paragraphs accordingly):
          (4) ensure the importance of inheritance rights of 
        women, particularly women in African countries, due to 
        the exponential growth in the number of young widows, 
        orphaned girls, and grandmothers becoming heads of 
        households as a result of the HIV/AIDS pandemic;
  Page 75, line 4, add at the end the following new sentence: 
``Such report should include a description of activities 
undertaken to carry out subsection (b)(4).''.
  Page 75, line 11, add at the end the following new sentence: 
``A significant percentage of the amount appropriated pursuant 
to the authorization of appropriations under the preceding 
sentence for a fiscal year should be made available to carry 
out subsection (b)(4).''.
                              ----------                              


8. An Amendment To Be Offered by Representative McCollum of Minnesota, 
               or Her Designee, Debatable for 10 Minutes

  Page 83, line 14, strike ``For'' and insert ``(a) Therapeutic 
Medical Care.--For''.
  Page 83, after line 22, add the following new subsection:
  (b) Orphans and Vulnerable Children.--For fiscal years 2004 
through 2008, not less than 10 percent of the amounts 
appropriated pursuant to the authorization of appropriations 
under section 401 for HIV/AIDS assistance for each such fiscal 
year shall be expended for assistance for orphans and 
vulnerable children affected by HIV/AIDS, of which such amount 
at least 50 percent shall be provided through non-profit, 
nongovernmental organizations, including faith-based 
organizations, that implement programs on the community level.
                              ----------                              


 9. An Amendment To Be Offered by Representative Jackson-Lee of Texas, 
               or Her Designee, Debatable for 10 Minutes

  At the end of the bill, add the following (and conform the 
table of contents accordingly):

SEC. 404. ASSISTANCE FROM THE UNITED STATES PRIVATE SECTOR TO PREVENT 
                    AND REDUCE HIV/AIDS IN SUB-SAHARAN AFRICA.

  It is the sense of Congress that United States businesses 
should be encouraged to provide assistance to sub-Saharan 
African countries to prevent and reduce the incidence of HIV/
AIDS in sub-Saharan Africa. In providing such assistance, 
United States businesses should be encouraged to consider the 
establishment of an HIV/AIDS Response Fund in order to provide 
for coordination among such businesses in the collection and 
distribution of the assistance to sub-Saharan African 
countries.
                              ----------                              


  10. An Amendment To Be Offered by Representative Chris Smith of New 
           Jersey, or His Designee, Debatable for 20 Minutes

  Page 54, line 21, insert before the period the following: ``, 
or to endorse, utilize, or participate in a prevention method 
or treatment program to which the organization has a religious 
or moral objection''.
                              ----------                              


11. An Amendment To Be Offered by Representative Pitts of Pennsylvania, 
               or His Designee, Debatable for 20 Minutes

  Page 83, line 10, insert before the semicolon the following: 
``, of which such amount at least 33 percent should be expended 
for abstinence-until-marriage programs''.
  Page 83, line 22, add at the end the following new sentence: 
``For fiscal years 2006 through 2008, not less than 33 percent 
of the amounts appropriated pursuant to the authorization of 
appropriations under section 401 for HIV/AIDS prevention 
consistent with section 104A(d) of the Foreign Assistance Act 
of 1961 (as added by section 301 of this Act) for each such 
fiscal year shall be expended for abstinence-until-marriage 
programs.''.

                                
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