[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;

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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;

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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

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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.

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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

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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):
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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.