    [United States Statutes at Large, Volume 117, 108th Congress, 1st Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    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 Against 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.

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    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

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    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

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    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

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    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;

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    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

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    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

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    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;

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    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.

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    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,

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    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 722]]

    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 723]]

    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 724]]

    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 725]]

    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 726]]

    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 727]]

    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 728]]

    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 729]]

    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 730]]

    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 731]]

    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 732]]

    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 733]]

    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 734]]

    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 735]]

    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 736]]

    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 737]]

    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 738]]

    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 739]]

    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 740]]

    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 741]]

    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 742]]

    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 743]]

    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 744]]

    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 745]]

    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 746]]

    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 747]]

    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 748]]

    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 749]]

    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 750]]

    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.