HR 4140 IH

To amend the Foreign Assistance Act of 1961 to authorize appropriations for HIV/AIDS prevention efforts.

March 30, 2000

Ms. MILLENDER-MCDONALD introduced the following bill; which was referred to the Committee on International Relations

To amend the Foreign Assistance Act of 1961 to authorize appropriations for HIV/AIDS prevention efforts.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `International HIV/AIDS Partnership Prevention Act of 2000'.

SEC. 2. FINDINGS.

The Congress makes the following findings:

(1)(A) AIDS is potentially the greatest health catastrophe to humankind since the indigenous communities of South and Central America were reduced from 110,000,000 to 4,500,000 in 15 years when conquered by the Spanish in the 1500s.

(B) More than 16,000,000 men, women and children have died of AIDS. More than 33,600,000 people are living with HIV, and nearly all of them will die of AIDS-related complications within the next 2 decades. UNAIDS estimated that there were 5,600,000 newly-infected people with HIV in 1999, including an estimated 2,300,000 women and approximately 570,000 children.

(C) AIDS has orphaned more than 11,000,000 children worldwide and UNICEF estimates that their number will reach 40,000,000 in the next decade.

(2) 95 percent of people worldwide living with HIV live in the world's poorest countries. With poor health systems, weak economies, poverty, and limited access to resources, the epidemic will grow even further over the next quarter century.

(3) It has been shown that HIV/AIDS does not strike women and men equally. Heterosexual women are 2 to 4 times more likely than their husbands or partners to become infected with HIV. Many HIV-infected women fear and experience domestic violence. Women's fertility also is impacted by this disease since once infected, a woman can be expected to bear 20 percent fewer children than she otherwise would. In cities throughout the world, voluntary and involuntary prostitution among women and girls further exposes them to HIV/AIDS and other sexually transmitted diseases.

(4) In 1999, the United Nations estimated that 570,000 children age 14 or younger became infected with HIV. More than 90 percent were babies born to HIV-positive women. Almost nine-tenths of these babies were born in sub-Saharan Africa.

(5) Sub-Saharan Africa continues to bear the brunt of HIV and AIDS, with approximately 75 percent of the global total of HIV-positive people. Most of these people will die in the next 10 years.

(6) As of December 1999, the Asian continent had about 6,500,000 people living with HIV. This is 5 times the number of people who have already died of AIDS in the region. According to UNAIDS, a rise of just 0.1 percent prevalence among adults in India would add over 500,000 people to the national total of adults living with HIV.

(7) The Russian Federation and other countries of the former Soviet Union had the world's greatest rate of increase in HIV infections in 1999 due primarily to intravenous drug use.

(8) According to United Nations estimates, at the end of December 1999 there were 1,300,000 adults and children living with HIV/AIDS in Latin America and 360,000 in the Caribbean basin. Mexico, our closest neighbor, had an estimated 180,000 new cases of HIV/AIDS at the end of 1999.

(9) Although statistics on HIV/AIDS prevalence rates in North Africa and the Middle East are not available, the insidious nature of the epidemic that traverses geographic, social, and economic boundaries put Middle Eastern populations at risk.

(10) AIDS and secondary infectious diseases like tuberculosis, are disproportionately draining national budgets and threatening development capacity. The AIDS crisis has reversed decades of economic and social development and threatens nascent democratic institutions.

(11) There are potential security implications in poor countries where the increase in HIV-infected military personnel is gradually weakening the capacity of militaries to defend their nations, maintain civil order, and deploy peacekeepers. Child soldiers and girl `wives', some also HIV-infected, are a by-product of a dwindling pool of adult recruits.

SEC. 3. STATEMENTS OF POLICY.

The Congress declares the following:

(1)(A) The Congress recognizes the threat that the global HIV/AIDS epidemic poses to international security, and the need for public and private commitments to provide equal access to HIV/AIDS education, prevention, testing, diagnosis, and treatment services in all regions of the world affected by the epidemic without regard to age, ancestry, color, disability, gender, national origin, race, religion, sexual orientation, or political status.

(B) It is in the interest of the United States to provide leadership to foreign governments, international organizations, and the global private sector to counteract the negative effects of HIV/AIDS worldwide.

(2) The Congress further recognizes the inextricable link between the HIV/AIDS epidemic and political and economic development in the poorest countries of the world and the need for collaborative partnerships between traditional aid and development programs and HIV/AIDS program funding.

(3) A major purpose of this Act is to prevent the transmission of HIV/AIDS, to treat persons infected with HIV/AIDS, to assist persons affected by this disease, and to keep the economically active HIV-infected population viable. An individual with AIDS, provided that he or she receives all necessary treatment and care, can survive for many years, 3 or 4 times more than was previously possible.

(4)(A) While national coordination is required to address the epidemic, funding priorities will also seek more effective responses at the local level that build upon local government and civil society's capacity to help relieve the enormous suffering caused by HIV/AIDS and to prevent further spreading of the epidemic.

(B) Critical efforts to contain the epidemic must include primary prevention and psychological and social support programs, clinical and medical treatment, and programs that recognize the broader social and economic dimensions of the disease.

(5) Behavior alone will not conquer this disease. The world needs an affordable AIDS vaccine. Research toward a safe, effective, affordable, and accessible vaccine to prevent the onset of the disease is vital to our human survival. The best long-term hope for eradicating AIDS is through the development and widespread distribution of a preventive vaccine. Vaccines have been effective in helping to solve public health problems such as the smallpox epidemic, polio, influenza and hepatitis B. Significant advances in molecular biology and basic HIV research have led to the development of several promising strategies for designing safe and effective vaccines for the prevention of HIV/AIDS.

(6) Human rights is a primary basis for caring for individuals with HIV/AIDS and controlling the spread of this disease. A program will be eligible for funding under this Act only if the program does not engage in compulsory testing, is nondiscriminatory, and preserves privacy and confidentiality.

(7) The United States, through collaborative efforts in education, prevention, treatment, and vaccine research with highly impacted countries, can substantially reduce new HIV infections and provide a continuum of appropriate services and support for those individuals infected and affected by HIV/AIDS.

(8) The Congress recognizes the need for consultation and collaboration among the United States Government, the private sector, and nongovernmental organizations, and with their counterparts throughout the world, to further address the HIV/AIDS epidemic.

SEC. 4. AMENDMENT TO THE FOREIGN ASSISTANCE ACT OF 1961.

Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by adding at the end the following:

`(4)(A) The Congress declares that the United States Agency for International Development shall undertake a comprehensive, coordinated effort to combat HIV/AIDS and mitigate the epidemic's impact on sustainable development through effective partnerships with international organizations, donors, national and local governments, and nongovernmental organizations.

`(B)(i) In order to meet the requirement of subparagraph (A), the Administrator of the United States Agency for International Development (hereinafter in this paragraph referred to as the `Administrator') shall establish and carry out HIV/AIDS education, prevention, treatment, and research programs in foreign countries, including programs to build community capacity to slow the spread of the epidemic. Such programs and activities shall include strengthening existing programs and promoting innovate community-based programs.

`(ii) The Administrator shall take all appropriate steps to enhance cooperative efforts among foreign countries and to assist in fostering human rights with respect to the establishment and conduct of programs and initiatives described in clause (i).

`(C)(i) In carrying out the programs and initiatives described in subparagraph (B), the Administrator shall make grants to national governments, units of local government, and nongovernmental and multilateral organizations to initiate, develop, expand, or strengthen HIV/AIDS prevention and education programs.

`(ii) In determining eligibility for grants under clause (i), a nongovernmental or multilateral organization shall not be subject to requirements that are more restrictive than requirements applicable to a foreign government.

`(iii) A government or organization may receive a grant under clause (i) only if the government or organization, as the case may be, certifies that its laws, policies, and practices, as appropriate, do not punish or deny services to victims based on age, ancestry, color, disability, gender, national origin, race, religion, sexual orientation, and political status.

`(iv) In making grants under clause (i), the Administrator shall provide technical assistance, evaluation, and

data collection with respect to the programs established and carried out from amounts provided under such grants.

`(D) Amounts provided under a grant under subparagraph (C)(i) shall be used for activities such as--

`(i) national and community-level AIDS primary prevention and education programs among sexually vulnerable groups and the general population;

`(ii) voluntary testing and counseling services (with or without testing) that address the needs of susceptible client groups, for example, women, couples, care givers, children (particularly orphans and those living with HIV/AIDS), youth, intravenous drug users, and sex-workers;

`(iii) effective and economical treatment solutions including new medications to prevent the transmission of HIV/AIDS from mother to child;

`(iv) care services for those living with HIV/AIDS that also promote and maintain the emotional well-being of all care-givers providing support to persons living with HIV/AIDS;

`(v) improved infrastructure and institutional capacity to develop and manage education, prevention, and treatment programs including the resources to collect and maintain accurate HIV surveillance data to target programs and measure the effectiveness of interventions;

`(vi) sustained education, prevention, and treatment programs for military personnel;

`(vii) city-to-city collaborative exchanges between United States municipal HIV/AIDS programs and cities in highly impacted countries in order--

`(I) to share experiences and build local capacity to respond to the disease;

`(II) to stimulate environments where global partnerships can develop new problem-solving strategies, with emphasis on prevention and education; and

`(III) to foster opportunities for local economic development and mutual trade;

`(viii) collaboration with multilateral and binational programs that have similar goals;

`(ix) 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;

`(x) microbicide research, such as research to develop new preventive technologies and products, such as sexually-transmitted diseases and HIV diagnostic tools; and

`(xi) evaluation programs that will include participatory self-evaluation methodology to analyze issues of program effectiveness and short term impact on specific populations designed to generate high quality and useful data to inform further research.

`(E) In providing assistance under this paragraph, the Administrator shall give priority to those foreign countries with the highest incidence of HIV/AIDS cases.

`(F)(i) The Administrator is authorized to establish HIV/AIDS Technical Support Centers (in this paragraph referred to as `Centers') in any country mission of the United States Agency for International Development, as determined to be appropriate by the Administrator, in order to provide technical assistance to recipients of assistance under this paragraph.

`(ii) The duties of a Center shall be the following:

`(I) Provide short-term technical and related advisory services with respect to assistance provided under this paragraph, including financial and managerial support (such as assistance relating to general accounting principles and other bookkeeping principles).

`(II) Provide services relating to monitoring and reporting requirements with respect assistance provided under this paragraph.

`(III) Provide access to comprehensive and reliable information on HIV/AIDS treatment, policy, research, prevention, statistics, and epidemiology, including such information provided in electronic format.

`(IV) Support community-based HIV/AIDS research activities that--

`(aa) document best practices among HIV/AIDS programs;

`(bb) demonstrate prevention, treatment, and delivery strategies; and

`(cc) address issues of culture, religion, and sexuality within the relevant socio-national context.

`(V) Establish facilities, in conjunction with a local private financial institution or other local financial intermediary, to encourage, accept, and administer private gifts of real or personal property, or any income therefrom, or other interest therein, for the benefit of, or in support of, programs funded by assistance under this paragraph.

`(G)(i) In addition to amounts otherwise available for such purposes, there are authorized to be appropriated to the Administrator to carry out this paragraph $150,000,000 for fiscal year 2001, $175,000,000 for fiscal year 2002, $200,000,000 for fiscal year 2003, $225,000,000 for fiscal year 2004, and $250,000,000 for fiscal year 2005.

`(ii) $10,000,0000 made available each fiscal year under clause (i) shall be used for vaccine research development partnerships to accelerate the development of globally accessible AIDS vaccines.

`(iii) Not more than 8 percent of amounts made available each fiscal year under clause (i) may be used for administrative expenses of the United States Agency for International Development for carrying out this paragraph.

`(iv) Funds appropriated pursuant to the authorization of appropriations under clause (i) are authorized to remain available until expended.'.

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