[108th Congress Public Law 25]
[From the U.S. Government Printing Office]


[DOCID: f:publ025.108]

[[Page 117 STAT. 711]]

Public Law 108-25
108th Congress

                                 An Act


 
     To provide assistance to foreign countries to combat HIV/AIDS, 
   tuberculosis, and malaria, and for other purposes. <<NOTE: May 27, 
                         2003 -  [H.R. 1298]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: United States 
Leadership Aganist HIV/AIDS, Tuberculosis, and Malaria Act of 2003.>> 

SECTION 1. <<NOTE: 22 USC 7601 note.>> 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.
Sec. 306. Strategies to improve injection safety.
Sec. 307. Study on illegal diversions of prescription drugs.

            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.

[[Page 117 STAT. 712]]

Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Assistance from the United States private sector to prevent 
           and reduce HIV/AIDS in sub-Saharan Africa.

              TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS

Sec. 501. Modification of the Enhanced HIPC Initiative.
Sec. 502. Report on expansion of debt relief to non-HIPC countries.
Sec. 503. Authorization of appropriations.

SEC. 2. <<NOTE: 26 USC 7601.>> 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 
        15 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

[[Page 117 STAT. 713]]

        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

[[Page 117 STAT. 714]]

        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

[[Page 117 STAT. 715]]

        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;

[[Page 117 STAT. 716]]

                    (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

[[Page 117 STAT. 717]]

        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. <<NOTE: 22 USC 7602.>> 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. <<NOTE: 22 USC 7603.>> 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

[[Page 117 STAT. 718]]

            (5) intensifying efforts to support the development of 
        vaccines and treatment for HIV/AIDS, tuberculosis, and malaria.

SEC. 5. <<NOTE: Deadline. 22 USC 7604.>> 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 <<NOTE: President. 22 USC 7611.>> 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 and reduce duplication 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;

[[Page 117 STAT. 719]]

            (8) maximize United States capabilities in the areas of 
        technical assistance and training and research, including 
        vaccine research;
            (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.

    (b) Report.--
            (1) In general.--Not <<NOTE: Deadline. President.>> 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 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 117 STAT. 720]]

                    (H) 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.
                    (I) An identification of the relevant executive 
                branch agencies that will be involved and the assignment 
                of priorities to those agencies.
                    (J) A description of the role of each relevant 
                executive branch agency and the types of programs that 
                the agency will be undertaking.
                    (K) 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.
                    (L) 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.
                    (M) 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.
                    (N) A description of the mechanisms to be 
                established for monitoring and evaluating programs, 
                promoting successful models, and for terminating 
                unsuccessful programs.
                    (O) 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.
                    (P) 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.
                    (Q) 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.
                    (R) 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.
                    (S) 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.
                    (T) An analysis of the emigration of critically 
                important medical and public health personnel, including 
                physicians,

[[Page 117 STAT. 721]]

                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.
                    (U) 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.
                    (V) 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.
                    (W) 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.

    (c) Study; Distribution of Resources.--
            (1) Study.--Not <<NOTE: Deadline. Publication.>> 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 <<NOTE: President.>> 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.

SEC. 102. <<NOTE: 22 USC 7612.>> HIV/AIDS RESPONSE COORDINATOR.

    (a) Establishment of Position.--Section 1 of the State Department 
Basic Authorities Act of <<NOTE: 22 USC 2651a.>> 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 <<NOTE: President.>> 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;

[[Page 117 STAT. 722]]

                          ``(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.

[[Page 117 STAT. 723]]

                          ``(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 <<NOTE: Deadline. President.>> 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. <<NOTE: 22 USC 7621.>> 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.

[[Page 117 STAT. 724]]

            (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. <<NOTE: 22 USC 7622.>> PARTICIPATION IN THE GLOBAL FUND TO 
            FIGHT AIDS, TUBERCULOSIS AND MALARIA.

    (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.

    (b) 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).

    (c) Reports to Congress.--Not <<NOTE: Deadline. President.>> 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.

    (d) 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 for the period of fiscal year 2004 beginning on 
        January 1, 2004, and such sums as may be necessary for

[[Page 117 STAT. 725]]

        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 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.
                    (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.
                    (v) 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

[[Page 117 STAT. 726]]

                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.
                    (B)(i) Any amount made available under this 
                subsection that is withheld by reason of subparagraph 
                (A)(i) shall be contributed to the Global Fund as soon 
                as practicable, subject to subparagraph (A)(i), after 
                additional contributions to the Global Fund are made 
                from other sources.
                    (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.
                    (iii) 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.
                    (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) <<NOTE: President. Notification. Deadline.>> 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.

    (e) 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

[[Page 117 STAT. 727]]

                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.

    (f) 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.

    (g) Provision of Information to Congress.--
The <<NOTE: Deadline.>> 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.

    (h) 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.

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--

[[Page 117 STAT. 728]]

            (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. <<NOTE: 22 USC 7631.>> 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. <<NOTE: 22 USC 2151b-2.>> 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.

[[Page 117 STAT. 729]]

            ``(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 <<NOTE: President.>> 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, reducing sexual violence and 
                coercion, including child marriage, widow inheritance, 
                and polygamy, 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 encouraging men 
                to be responsible in their sexual behavior, child 
                rearing, and to respect women;
                    ``(D) assistance for the purpose of providing 
                voluntary testing and counseling (including the 
                incorporation of confidentiality protections with 
                respect to such testing and counseling);
                    ``(E) 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;
                    ``(F) assistance to ensure a safe blood supply and 
                sterile medical equipment;

[[Page 117 STAT. 730]]

                    ``(G) assistance to help avoid substance abuse and 
                intravenous drug use that can lead to HIV infection; and
                    (H) assistance for the purpose of increasing women's 
                access to employment opportunities, income, productive 
                resources, and microfinance programs, where appropriate.
            ``(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

[[Page 117 STAT. 731]]

                    ``(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

[[Page 117 STAT. 732]]

                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 <<NOTE: Deadline. President.>> 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.

[[Page 117 STAT. 733]]

            ``(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, or to endorse, utilize, or participate in a 
prevention method or treatment program to which the organization has a 
religious or moral objection.
    (e) Limitation.--No funds made available to carry out this Act, or 
any amendment made by this Act, may be used to promote

[[Page 117 STAT. 734]]

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.
    (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.

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. <<NOTE: 22 USC 2151b-3.>> 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

[[Page 117 STAT. 735]]

        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 <<NOTE: President.>> 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 <<NOTE: President.>> 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.

[[Page 117 STAT. 736]]

            ``(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 <<NOTE: 22 USC 7632.>> 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. <<NOTE: 22 USC 2151b-4.>> 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 <<NOTE: President.>> 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

[[Page 117 STAT. 737]]

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 <<NOTE: 22 USC 7633.>> 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. <<NOTE: 22 USC 7634.>> PILOT PROGRAM FOR THE PLACEMENT OF 
            HEALTH CARE PROFESSIONALS IN OVERSEAS AREAS SEVERELY 
            AFFECTED BY HIV/AIDS, TUBERCULOSIS, AND MALARIA.

    (a) In General.--The <<NOTE: President.>> 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;

[[Page 117 STAT. 738]]

            (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 3 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 <<NOTE: President.>> 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 <<NOTE: Deadline. President.>> 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;

[[Page 117 STAT. 739]]

            (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. <<NOTE: 22 USC 7635.>> REPORT ON TREATMENT ACTIVITIES BY 
            RELEVANT EXECUTIVE BRANCH AGENCIES.

    (a) In General.--Not <<NOTE: President. Deadline.>> 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.

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

[[Page 117 STAT. 740]]

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. <<NOTE: 22 USC 7636.>> STUDY ON ILLEGAL DIVERSIONS OF 
            PRESCRIPTION DRUGS.

    Not later than <<NOTE: Deadline. Reports.>> 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.

            Subtitle B--Assistance for Children and Families

SEC. 311. <<NOTE: 22 USC 7651.>> 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 90 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) Certain antiretroviral drugs reduce 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.

[[Page 117 STAT. 741]]

            (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. <<NOTE: 22 USC 7652.>> 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. <<NOTE: 22 USC 7653.>> ANNUAL REPORTS ON PREVENTION OF MOTHER-
            TO-CHILD TRANSMISSION OF THE HIV INFECTION.

    (a) In General.--Not <<NOTE: Deadline. President.>> later than 1 
year after the date of the enactment of this Act, and annually 
thereafter for a period of 5 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

[[Page 117 STAT. 742]]

            (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. <<NOTE: 22 USC 7654.>> PILOT PROGRAM OF ASSISTANCE FOR 
            CHILDREN AND FAMILIES AFFECTED BY HIV/AIDS.

    (a) In General.--The <<NOTE: President.>> 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) 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;
            (5) 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;
            (6) provide nutritional support and food security, and the 
        improvement of overall family health;
            (7) work with parents, caregivers, and community-based 
        organizations to provide children with educational 
        opportunities; and
            (8) 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 <<NOTE: Deadline. President.>> 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. Such report should include a description of 
activities undertaken to carry out subsection (b)(4).

    (d) Authorization of Appropriations.--

[[Page 117 STAT. 743]]

            (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. 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).
            (2) Availability of funds.--Amounts appropriated pursuant to 
        paragraph (1) are authorized to remain available until expended.

SEC. 315. <<NOTE: President. 22 USC 7655.>> 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;

[[Page 117 STAT. 744]]

                          (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;

[[Page 117 STAT. 745]]

                    (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. <<NOTE: 22 USC 7671.>> 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. <<NOTE: 22 USC 7672.>> 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

[[Page 117 STAT. 746]]

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), of which such amount 
        at least 33 percent should be expended for abstinence-until-
        marriage programs; and
            (4) 10 percent of such amounts for orphans and vulnerable 
        children.

SEC. 403. <<NOTE: 22 USC 7673.>> ALLOCATION OF FUNDS.

    (a) Therapeutic Medical Care.--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. 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.
    (b) Orphans and Vulnerable Children.--For fiscal years 2006 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.

SEC. 404. <<NOTE: 22 USC 7674.>> 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.

[[Page 117 STAT. 747]]

              TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS

SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

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

``SEC. 1625. <<NOTE: 22 USC 262p-8.>> MODIFICATION OF THE ENHANCED HIPC 
            INITIATIVE.

    ``(a) Authority.--
            ``(1) In general.--The Secretary of the Treasury should 
        immediately commence efforts within the Paris Club of Official 
        Creditors, the International Bank for Reconstruction and 
        Development, the International Monetary Fund, and other 
        appropriate multilateral development institutions to modify the 
        Enhanced HIPC Initiative so that the amount of debt stock 
        reduction approved for a country eligible for debt relief under 
        the Enhanced HIPC Initiative shall be sufficient to reduce, for 
        each of the first 3 years after the date of enactment of this 
        section or the Decision Point, whichever is later--
                    ``(A) the net present value of the outstanding 
                public and publicly guaranteed debt of the country--
                          ``(i) as of the decision point if the country 
                      has already reached its decision point; or
                          ``(ii) as of the date of enactment of this 
                      Act, if the country has not reached its decision 
                      point,
                to not more than 150 percent of the annual value of 
                exports of the country for the year preceding the 
                Decision Point; and
                    ``(B) the annual payments due on such public and 
                publicly guaranteed debt to not more than--
                          ``(i) 10 percent or, in the case of a country 
                      suffering a public health crisis (as defined in 
                      subsection (e)), not more than 5 percent, of the 
                      amount of the annual current revenues received by 
                      the country from internal resources; or
                          ``(ii) a percentage of the gross national 
                      product of the country, or another benchmark, that 
                      will yield a result substantially equivalent to 
                      that which would be achieved through application 
                      of subparagraph (A).
            ``(2) Limitation.--In financing the objectives of the 
        Enhanced HIPC Initiative, an international financial institution 
        shall give priority to using its own resources.

    ``(b) Relation to Poverty and the Environment.--Debt cancellation 
under the modifications to the Enhanced HIPC Initiative described in 
subsection (a) should not be conditioned on any agreement by an 
impoverished country to implement or comply with policies that deepen 
poverty or degrade the environment, including any policy that--
            ``(1) implements or extends user fees on primary education 
        or primary health care, including prevention and treatment 
        efforts for HIV/AIDS, tuberculosis, malaria, and infant, child, 
        and maternal well-being;
            ``(2) provides for increased cost recovery from poor people 
        to finance basic public services such as education, health care, 
        clean water, or sanitation;

[[Page 117 STAT. 748]]

            ``(3) reduces the country's minimum wage to a level of less 
        than $2 per day or undermines workers' ability to exercise 
        effectively their internationally recognized worker rights, as 
        defined under section 526(e) of the Foreign Operations, Export 
        Financing and Related Programs Appropriations Act, 1995 (22 
        U.S.C. 262p-4p); or
            ``(4) promotes unsustainable extraction of resources or 
        results in reduced budget support for environmental programs.

    ``(c) Conditions.--A country shall not be eligible for cancellation 
of debt under modifications to the Enhanced HIPC Initiative described in 
subsection (a) if the government of the country--
            ``(1) has an excessive level of military expenditures;
            ``(2) has repeatedly provided support for acts of 
        international terrorism, as determined by the Secretary of State 
        under section 6(j)(1) of the Export Administration Act of 1979 
        (50 U.S.C. App. 2405(j)(1)) or section 620A(a) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2371(a));
            ``(3) is failing to cooperate on international narcotics 
        control matters; or
            ``(4) engages in a consistent pattern of gross violations of 
        internationally recognized human rights (including its military 
        or other security forces).

    ``(d) Programs To Combat HIV/AIDS and Poverty.--A country that is 
otherwise eligible to receive cancellation of debt under the 
modifications to the Enhanced HIPC Initiative described in subsection 
(a) may receive such cancellation only if the country has agreed--
            ``(1) to ensure that the financial benefits of debt 
        cancellation are applied to programs to combat HIV/AIDS and 
        poverty, in particular through concrete measures to improve 
        basic services in health, education, nutrition, and other 
        development priorities, and to redress environmental 
        degradation;
            ``(2) to ensure that the financial benefits of debt 
        cancellation are in addition to the government's total spending 
        on poverty reduction for the previous year or the average total 
        of such expenditures for the previous 3 years, whichever is 
        greater;
            ``(3) to implement transparent and participatory 
        policymaking and budget procedures, good governance, and 
        effective anticorruption measures; and
            ``(4) to broaden public participation and popular 
        understanding of the principles and goals of poverty reduction.

    ``(e) Definitions.--In this section:
            ``(1) Country suffering a public health crisis.--The term 
        `country suffering a public health crisis' means a country in 
        which the HIV/AIDS infection rate, as reported in the most 
        recent epidemiological data for that country compiled by the 
        Joint United Nations Program on HIV/AIDS, is at least 5 percent 
        among women attending prenatal clinics or more than 20 percent 
        among individuals in groups with high-risk behavior.
            ``(2) Decision point.--The term `Decision Point' means the 
        date on which the executive boards of the International Bank for 
        Reconstruction and Development and the International Monetary 
        Fund review the debt sustainability analysis for a country and 
        determine that the country is eligible for debt relief under the 
        Enhanced HIPC Initiative.
            ``(3) Enhanced hipc initiative.--The term `Enhanced HIPC 
        Initiative' means the multilateral debt initiative for

[[Page 117 STAT. 749]]

        heavily indebted poor countries presented in the Report of G-7 
        Finance Ministers on the Cologne Debt Initiative to the Cologne 
        Economic Summit, Cologne, June 18-20, 1999.''.

SEC. 502. <<NOTE: 22 USC 7681.>> REPORT ON EXPANSION OF DEBT RELIEF TO 
            NON-HIPC COUNTRIES.

    (a) In General.--Not <<NOTE: Deadline.>> later than 90 days after 
the date of enactment of this Act, the Secretary of the Treasury shall 
submit to Congress a report on--
            (1) the options and costs associated with the expansion of 
        debt relief provided by the Enhanced HIPC Initiative to include 
        poor countries that were not eligible for inclusion in the 
        Enhanced HIPC Initiative;
            (2) options for burden-sharing among donor countries and 
        multilateral institutions of costs associated with the expansion 
        of debt relief; and
            (3) options, in addition to debt relief, to ensure debt 
        sustainability in poor countries, particularly in cases when the 
        poor country has suffered an external economic shock or a 
        natural disaster.

    (b) Specific Options To Be Considered.--Among the options for the 
expansion of debt relief provided by the Enhanced HIPC Initiative, 
consideration should be given to making eligible for that relief poor 
countries for which outstanding public and publicly guaranteed debt 
requires annual payments in excess of 10 percent or, in the case of a 
country suffering a public health crisis (as defined in section 1625(e) 
of the Financial Institutions Act, as added by section 501 of this Act), 
not more than 5 percent, of the amount of the annual current revenues 
received by the country from internal resources.
    (c) Enhanced HIPC Initiative Defined.--In this section, the term 
``Enhanced HIPC Initiative'' means the multilateral debt initiative for 
heavily indebted poor countries presented in the Report of G-7 Finance 
Ministers on the Cologne Debt Initiative to the Cologne Economic Summit, 
Cologne, June 18-20, 1999.

SEC. 503. <<NOTE: 22 USC 7682.>> AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
President such sums as may be necessary for the fiscal year 2004 and 
each fiscal year thereafter to carry out section 1625 of the 
International Financial Institutions Act, as added by section 501 of 
this Act.

[[Page 117 STAT. 750]]

    (b) Availability of Funds.--Amounts appropriated pursuant to 
subsection (a) are authorized to remain available until expended.

    Approved May 27, 2003.

LEGISLATIVE HISTORY--H.R. 1298 (S. 1009):
---------------------------------------------------------------------------

HOUSE REPORTS: No. 108-60 (Comm. on International Relations).
CONGRESSIONAL RECORD, Vol. 149 (2003):
            May 1, considered and passed House.
            May 15, considered and passed Senate, amended.
            May 21, House concurred in Senate amendments.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 39 (2003):
            May 27, Presidential remarks.

                                  <all>