S 2845 PCS

To authorize additional assistance to countries with large populations having HIV/AIDS, to authorize assistance for tuberculosis prevention, treatment, control, and elimination, and for other purposes.

July 11, 2000

Mr. HELMS, from the Committee on Foreign Relations, reported the following original bill; which was read twice and placed on the calendar

To authorize additional assistance to countries with large populations having HIV/AIDS, to authorize assistance for tuberculosis prevention, treatment, control, and elimination, and for other purposes.

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 `Global AIDS and Tuberculosis Relief Act of 2000'.

TITLE I--ASSISTANCE TO COUNTRIES WITH LARGE POPULATIONS HAVING HIV/AIDS

SEC. 101. SHORT TITLE.

This title may be cited as the `Global AIDS Research and Relief Act of 2000'.

SEC. 102. DEFINITIONS.

In this title:

(1) AIDS- The term `AIDS' means the acquired immune deficiency syndrome.

(2) ASSOCIATION- The term `Association' means the International Development Association.

(3) BANK- The term `Bank' or `World Bank' means the International Bank for Reconstruction and Development.

(4) HIV- The term `HIV' means the human immunodeficiency virus.

(5) HIV/AIDS- The term `HIV/AIDS' means, with respect to an individual--

(A) an individual having HIV but not AIDS; or

(B) an individual having HIV and AIDS.

SEC. 103. FINDINGS AND PURPOSES.

(a) FINDINGS- Congress makes the following findings:

(1) According to statistics of the World Bank, more than 90 percent of all adults and children with HIV/AIDS live in the developing world--62 percent in sub-Saharan Africa, 24 percent in Asia, and 6.9 percent in Latin America and the Caribbean.

(2) According to UNAIDS, nearly 4,500,000 children under 15 years of age have been infected with HIV since the AIDS epidemic began. More than 3,000,000 have already died of AIDS. Children are becoming infected at about the rate of 1 child every minute, and the overwhelming majority of these children acquire the infection from their mothers.

(3) The gap between rich and poor countries in terms of transmission of HIV from mother to child has been increasing. Moreover, AIDS threatens to reverse years of steady progress of child survival in developing countries. UNAIDS believes that by the year 2010, AIDS may have increased mortality of children under 5 years of age by more than 100 percent in regions most affected by the virus.

(4) In Africa, the death toll from AIDS has reached 13,000,000, while 23,000,000 others live with the disease, and more than 10,000,000 children have been infected or orphaned by it.

(5) The World Bank, declaring AIDS not just a public health problem but the `foremost and fastest-growing threat to development' in Africa, has launched a new strategy for HIV/AIDS in Africa, declaring it a top priority for the World Bank on that continent.

(6) AIDS, like all diseases, knows no boundaries, and there is no certitude that the scale of the problem in one continent can be contained within that region.

(7) Accordingly, United States financial support for medical research, education, and disease containment as a global strategy has beneficial ramifications for millions of Americans and their families who are affected by this disease, and the entire population which is potentially susceptible.

(8) The discovery of a relatively simple and cheap means of interrupting the transmission of HIV from an infected mother to the unborn child--namely with nevirapine (NVP), which costs US$4 a tablet--has created a great opportunity for an unprecedented partnership between the United States Government and the governments of Asian, African and Latin American countries to combat mother-to-child transmission (also known as `vertical transmission') of HIV.

(9) According to UNAIDS, this strategy will decrease the proportion of orphans that are HIV-infected and decrease infant and child mortality rates in these developing regions.

(10) At current infection and growth rates for HIV/AIDS, the National Intelligence Council estimates that the number of AIDS orphans worldwide will increase dramatically, potentially increasing threefold or more in the next 10 years, contributing to economic decay, social fragmentation, and political destabilization in already volatile and strained societies. Children without care or hope are often drawn into prostitution, crime, substance abuse, or child soldiery.

(11) Donors must focus on adequate preparations for the explosion in the number of orphans and the burden they will place on families, communities, economies, and governments. Support structures and incentives for families, communities, and institutions which will provide care for children orphaned by HIV/AIDS, or for the children who are themselves infected by HIV/AIDS, will be essential.

(12) A mother-to-child antiretroviral drug strategy can be a force for social change, providing the opportunity and impetus needed to tackle often long-standing problems of inadequate services and the profound stigma associated with HIV-infection and the AIDS disease. Strengthening the health infrastructure to improve mother-and-child health, antenatal, delivery and postnatal services, and couples counseling generates enormous spillover effects toward combating the AIDS epidemic in developing regions.

(b) PURPOSES- The purposes of this title are to--

(1) prevent human suffering; and

(2) ensure the viability of economic development, stability, and national security in the developing world by advancing research to--

(A) understand the causes associated with HIV/AIDS in developing countries; and

(B) assist in the development of an AIDS vaccine.

SEC. 104. ADDITIONAL ASSISTANCE AUTHORITIES TO COMBAT HIV AND AIDS.

(a) ASSISTANCE FOR PREVENTION OF HIV/AIDS AND VERTICAL TRANSMISSION- 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 new paragraphs:

`(4)(A) Congress recognizes the growing international dilemma of children with the human immunodeficiency virus (HIV) and the merits of intervention programs aimed at this problem. Congress further recognizes that mother-to-child transmission prevention strategies can serve as a major force for change in developing regions, and it is, therefore, a major objective of the foreign assistance program to control the acquired immune deficiency syndrome (AIDS) epidemic.

`(B) The agency primarily responsible for administering this part shall--

`(i) coordinate with UNAIDS, UNICEF, WHO, local governments, and other organizations to develop and implement effective strategies to prevent vertical transmission of HIV; and

`(ii) coordinate with those organizations to increase in scale intervention programs and introduce voluntary counseling and testing, antiretroviral drugs, replacement feeding, and other strategies.

`(5)(A) Congress expects the agency primarily responsible for administering this part to make the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) a priority in the foreign assistance program and to undertake a comprehensive, coordinated effort to combat HIV and AIDS.

`(B) Assistance described in subparagraph (A) shall include providing--

`(i) primary prevention and education;

`(ii) voluntary testing and counseling;

`(iii) medications to prevent the transmission of HIV and AIDS from mother to child; and

`(iv) care for those living with HIV or AIDS.

`(6)(A) In addition to amounts otherwise available for such purpose, there is authorized to be appropriated to the President $300,000,000 for fiscal year 2001 to carry out paragraphs (4) and (5).

`(B) Of the funds authorized to be appropriated under subparagraph (A), not less than 65 percent is authorized to be available through United States and foreign nongovernmental organizations, including private and voluntary organizations, for-profit organizations, religious affiliated organizations, educational institutions, and research facilities.

`(C)(i) Of the funds authorized to be appropriated by subparagraph (A), not less than 20 percent is authorized to be available for programs as part of a multidonor strategy to address the support and education of orphans in sub-Saharan Africa, including AIDS orphans.

`(ii) Assistance made available under this subparagraph may be made available notwithstanding any other provision of law.

`(D) Of the funds authorized to be appropriated under subparagraph (A), not less than 8.3 percent is authorized to be available to carry out the prevention strategies for vertical transmission referred to in paragraph (4)(A).

`(E) Of the funds authorized to be appropriated by subparagraph (A), not more than 7 percent may be used for the administrative expenses of the agency primarily responsible for carrying out this part of this Act in support of activities described in paragraphs (4) and (5).

`(F) Funds appropriated under this paragraph are authorized to remain available until expended.'.

(b) TRAINING AND TRAINING FACILITIES IN SUB-SAHARAN AFRICA- Section 496(i)(2) of the Foreign Assistance Act of 1961 (22 U.S.C. 2293(i)(2)) is amended by adding at the end the following new sentence: `In addition, providing training and training facilities, in sub-Saharan Africa, for doctors and other health care providers, notwithstanding any provision of law that restricts assistance to foreign countries.'.

SEC. 105. VOLUNTARY CONTRIBUTION TO GLOBAL ALLIANCE FOR VACCINES AND IMMUNIZATIONS AND INTERNATIONAL AIDS VACCINE INITIATIVE.

(a) AUTHORIZATION OF APPROPRIATIONS- Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) is amended by adding at the end the following new subsections:

`(j) In addition to amounts otherwise available under this section, there is authorized to be appropriated to the President $50,000,000 for fiscal year 2001 to be available only for United States contributions to the Global Alliance for Vaccines and Immunizations.

`(k) In addition to amounts otherwise available under this section, there is authorized to be appropriated to the President $10,000,000 for fiscal year 2001 to be available only for United States contributions to the International AIDS Vaccine Initiative.'.

(b) REPORT- At the close of fiscal year 2001, the President shall submit a report to the appropriate congressional committees on the effectiveness of the Global Alliance for Vaccines and Immunizations and the International AIDS Vaccine Initiative during that fiscal year in meeting the goals of--

(1) improving access to sustainable immunization services;

(2) expanding the use of all existing, safe, and cost-effective vaccines where they address a public health problem;

(3) accelerating the development and introduction of new vaccines and technologies;

(4) accelerating research and development efforts for vaccines needed primarily in developing countries; and

(5) making immunization coverage a centerpiece in international development efforts.

(c) APPROPRIATE CONGRESSIONAL COMMITTEES DEFINED- In subsection (b), 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.

SEC. 106. MULTILATERAL LIFESAVING VACCINE PURCHASE FUND.

(a) NEGOTIATIONS- The President should enter into negotiations with officials of foreign governments and other interested parties for the establishment of an international vaccine purchase fund that would--

(1) accept contributions from governments of developed countries;

(2) use such contributions to purchase and distribute in developing countries vaccines for--

(A) malaria,

(B) tuberculosis,

(C) HIV, and

(D) any infectious disease (of a single etiology) which causes the deaths of over 1,000,000 people worldwide each year; and

(3) be a significant market incentive for private sector vaccine research.

(b) REPORT- Not later than 1 year after the date of enactment of this Act, and annually thereafter, the President shall submit a report to Congress on--

(1) the status of negotiations under subsection (a); and

(2) if such fund is established, any recommendations for further action.

SEC. 107. WORLD BANK TRUST FUND FOR AIDS PREVENTION AND ERADICATION.

(a) NEGOTIATIONS FOR THE CREATION OF A WORLD BANK TRUST FUND TO ASSIST IN AIDS PREVENTION AND ERADICATION- The Secretary of the Treasury shall enter into negotiations with the World Bank or the Association, with the member nations of such institutions, and with other interested parties for the creation of a trust fund, to be administered by the Bank or the Association, as appropriate, which would--

(1) accept contributions from governments, the private sector, and nongovernmental entities of all kinds; and

(2) use such contributions to address the AIDS epidemic in countries eligible to borrow from the Association.

(b) AUTHORIZATION OF APPROPRIATIONS- In addition to any other funds authorized to be appropriated for multilateral or bilateral programs related to AIDS, there is authorized to be appropriated to the President $100,000,000 for fiscal year 2001 for payment to the trust fund established as a result of the negotiations entered into pursuant to subsection (a).

(c) REPORT TO CONGRESS- Beginning 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of the Treasury shall submit to the Committees on Banking and Financial Services and on International Relations of the House of Representatives and the Committees on Banking, Housing, and Urban Affairs and on Foreign Relations of the Senate a written report on the trust fund established pursuant to subsection (a), the goals of the trust fund, the programs, projects, and activities, including any vaccination approaches, supported by the trust fund, and the effectiveness of such programs, projects, and activities in reducing the worldwide spread of AIDS.

SEC. 108. NEGOTIATIONS FOR THE CREATION OF A WORLD BANK TRUST FUND FOR EDUCATION OF ORPHANS IN SUB-SAHARAN AFRICA.

(a) NEGOTIATIONS- The Secretary of the Treasury shall enter into negotiations with the World Bank or the Association, with member nations of such institutions, and with other interested parties, for the creation of a trust fund which could accept contributions from governments, the private sector, and nongovernmental entities of all kinds, and use such contributions to provide support for or the establishment of programs which provide primary and secondary education for orphans in sub-Saharan Africa.

(b) AUTHORIZATION OF APPROPRIATIONS- In addition to funds otherwise available for the purposes of subsection (a), there is authorized to be appropriated to the President $50,000,000 for the fiscal year 2001 for payment to the trust fund established as a result of the negotiations entered into pursuant to subsection (a).

SEC. 109. COORDINATED DONOR STRATEGY FOR SUPPORT AND EDUCATION OF ORPHANS IN SUB-SAHARAN AFRICA.

Chapter 1 of part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amended by adding at the end the following new section:

`SEC. 131. COORDINATED DONOR STRATEGY FOR SUPPORT AND EDUCATION OF ORPHANS IN SUB-SAHARAN AFRICA.

`(a) STATEMENT OF POLICY- It is in the national interest of the United States to assist in mitigating the burden that will be placed on sub-Saharan African social, economic, and political institutions as these institutions struggle with the consequences of a dramatically increasing AIDS orphan population, many of whom are themselves infected by HIV/AIDS. Effectively addressing that burden and its consequences in sub-Saharan Africa will require a coordinated multidonor strategy.

`(b) DEVELOPMENT OF STRATEGY- The President shall coordinate the development of a multidonor strategy to provide for the support and education of AIDS orphans and the families, communities, and institutions most affected by the HIV/AIDS epidemic in sub-Saharan Africa.

`(c) DEFINITION- In this section, the term `HIV/AIDS' means, with respect to an individual, an individual who is infected with--

`(1) the human immunodeficiency virus (HIV); or

`(2) HIV and the acquired immune deficiency virus (AIDS).'.

SEC. 110. AFRICAN CRISIS RESPONSE INITIATIVE AND HIV/AIDS TRAINING.

(a) FINDINGS- Congress finds that--

(1) the spread of AIDS constitutes a threat to security in Africa;

(2) civil unrest and war may contribute to the spread of the disease to different parts of the continent;

(3) the percentage of soldiers in African militaries who are infected with HIV/AIDS is unknown, but estimates range in some countries as high as 40 percent; and

(4) it is in the interests of the United States to assist the countries of Africa in combating the spread of HIV/AIDS.

(b) EDUCATION ON THE PREVENTION OF THE SPREAD OF AIDS- In undertaking education and training programs for military establishments of in African countries, the United States shall ensure that classroom training under the African Crisis Response Initiative includes military-based education on the prevention of the spread of AIDS.

TITLE II--INTERNATIONAL TUBERCULOSIS CONTROL

SEC. 201. SHORT TITLE.

This title may be cited as the `International Tuberculosis Control Act of 2000'.

SEC. 202. FINDINGS.

Congress makes the following findings:

(1) Since the development of antibiotics in the 1950s, tuberculosis has been largely controlled in the United States and the Western World.

(2) Due to societal factors, including growing urban decay, inadequate health care systems, persistent poverty, overcrowding, and malnutrition, as well as medical factors, including the HIV/AIDS epidemic and the emergence of multi-drug resistant strains of tuberculosis, tuberculosis has again become a leading and growing cause of adult deaths in the developing world.

(3) According to the World Health Organization--

(A) in 1998, about 1,860,000 people worldwide died of tuberculosis-related illnesses;

(B) one-third of the world's total population is infected with tuberculosis; and

(C) tuberculosis is the world's leading killer of women between 15 and 44 years old and is a leading cause of children becoming orphans.

(4) Because of the ease of transmission of tuberculosis, its international persistence and growth pose a direct public health threat to those nations that had previously largely controlled the disease. This is complicated in the United States by the growth of the homeless population, the rate of incarceration, international travel, immigration, and HIV/AIDS.

(5) With nearly 40 percent of the tuberculosis cases in the United States attributable to foreign-born persons, tuberculosis will never be controlled in the United States until it is controlled abroad.

(6) The means exist to control tuberculosis through screening, diagnosis, treatment, patient compliance, monitoring, and ongoing review of outcomes.

(7) Efforts to control tuberculosis are complicated by several barriers, including--

(A) the labor intensive and lengthy process involved in screening, detecting, and treating the disease;

(B) a lack of funding, trained personnel, and medicine in virtually every nation with a high rate of the disease;

(C) the unique circumstances in each country, which requires the development and implementation of country-specific programs; and

(D) the risk of having a bad tuberculosis program, which is worse than having no tuberculosis program because it would significantly increase the risk of the development of more widespread drug-resistant strains of the disease.

(8) Eliminating the barriers to the international control of tuberculosis through a well-structured, comprehensive, and coordinated worldwide effort would be a significant step in dealing with the increasing public health problem posed by the disease.

SEC. 203. ASSISTANCE FOR TUBERCULOSIS PREVENTION, TREATMENT, CONTROL, AND ELIMINATION.

Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)), as amended by section 103(a) of this Act, is further amended by adding at the end the following:

`(7)(A) Congress recognizes the growing international problem of tuberculosis and the impact its continued existence has on those nations that had previously largely controlled the disease. Congress further recognizes that the means exist to control and treat tuberculosis, and that it is therefore a major objective of the foreign assistance program to control the disease. To this end, Congress expects the agency primarily responsible for administering this part--

`(i) to coordinate with the World Health Organization, the Centers for Disease Control, the National Institutes of Health, and other organizations toward the development and implementation of a comprehensive tuberculosis control program; and

`(ii) to set as a goal 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, in those countries in which the agency has established development programs, by December 31, 2010.

`(B) There is authorized to be appropriated to the President, $60,000,000 for fiscal year 2001 to be used to carry out this paragraph. Funds appropriated under this subparagraph are authorized to remain available until expended.'.

Calendar No. 671

To authorize additional assistance to countries with large populations having HIV/AIDS, to authorize assistance for tuberculosis prevention, treatment, control, and elimination, and for other purposes.

July 11, 2000

END