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107th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    107-137

======================================================================



 
    GLOBAL ACCESS TO HIV/AIDS PREVENTION, AWARENESS, EDUCATION, AND 
                         TREATMENT ACT OF 2001

                                _______
                                

 July 12, 2001.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Hyde, from the Committee on International Relations, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2069]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on International Relations, to whom was 
referred the bill (H.R. 2069) to amend the Foreign Assistance 
Act of 1961 to authorize assistance to prevent, treat, and 
monitor HIV/AIDS in sub-Saharan African and other developing 
countries, having considered the same, reports favorably 
thereon with an amendment and recommends that the bill as 
amended do pass.

                           TABLE OF CONTENTS

                                                                   Page
The Amendment....................................................     2
Purpose and Summary..............................................     9
Background and Need for the Legislation..........................    10
Hearings.........................................................    12
Committee Consideration..........................................    12
Votes of the Committee...........................................    12
Committee Oversight Findings.....................................    12
New Budget Authority and Tax Expenditures........................    13
Congressional Budget Office Cost Estimate........................    13
Performance Goals and Objectives.................................    15
Constitutional Authority Statement...............................    15
Section-by-Section Analysis......................................    15
New Advisory Committees..........................................    21
Congressional Accountability Act.................................    21
Federal Mandates.................................................    21
Changes in Existing Law Made by the Bill, as Reported............    21

                             The Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Global Access to HIV/AIDS 
Prevention, Awareness, Education, and Treatment Act of 2001''.

SEC. 2. FINDINGS; SENSE OF CONGRESS.

    (a) Findings.--Congress makes the following findings:
            (1) According to the Joint United Nations Programme on HIV/
        AIDS (UNAIDS) more than 58,000,000 people worldwide have 
        already been infected with HIV/AIDS, a fatal disease that is 
        devastating the health and economies in dozens of countries in 
        Africa and increasingly in Asia, the Caribbean region, and 
        Eastern Europe.
            (2) The HIV/AIDS pandemic has erased decades of progress in 
        improving the lives of families in the developing world and has 
        claimed 22,000,000 lives since its inception.
            (3) More than 17,000,000 individuals have died from HIV/
        AIDS in sub-Saharan Africa alone.
            (4) The HIV/AIDS pandemic in sub-Saharan Africa has grown 
        beyond an international public health issue to become a 
        humanitarian, national security, and developmental crisis.
            (5) The HIV/AIDS pandemic is striking hardest among women 
        and girls. According to UNAIDS, by the end of 2000, fifty-five 
        percent of the HIV-positive population in sub-Saharan Africa 
        and 40 percent of such population in North Africa and the 
        Middle East were women, infected mainly through heterosexual 
        transmission. In Africa, 6 out of 7 children who are HIV 
        positive are girls.
            (6) An estimated 1,400,000 children under age 15 were 
        living with HIV/AIDS at the end of 2000, of which 1,100,000 
        were children living in sub-Saharan Africa. An estimated 
        500,000 children died of AIDS during 2000, of which 440,000 
        were children in sub-Saharan Africa. In addition there are an 
        estimated 13,200,000 children worldwide who have lost one or 
        both of their parents to HIV/AIDS, of which 12,100,000 are 
        children in sub-Saharan Africa.
            (7) Mother-to-child transmission is the largest source of 
        HIV infection in children under age 15 and the only source for 
        very young children. The total number of births to HIV-infected 
        pregnant women each year in developing countries is 
        approximately 700,000.
            (8) Counseling and voluntary testing are critical services 
        to help infected women accept their HIV status and the risk it 
        poses to their unborn child. Mothers who are aware of their 
        status can make informed decisions about treatment, replacement 
        feeding, and future child-bearing.
            (9) Although the HIV/AIDS pandemic has impacted the sub-
        Saharan Africa disproportionately, HIV infection rates are 
        rising rapidly in India and other South Asian countries, 
        Brazil, Russia, Eastern European countries, and Caribbean 
        countries, and pose a serious threat to the security and 
        stability in those countries.
            (10) By 2010, it is estimated that approximately 40,000,000 
        children worldwide will have lost one or both of their parents 
        to HIV/AIDS.
            (11) In January 2000, the United States National 
        Intelligence Council estimates that this dramatic increase in 
        AIDS orphans will contribute 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. The Council also stated that, in addition to 
        the reduction of economic activity caused by HIV/AIDS to date, 
        the disease could reduce GDP by as much as 20 percent or more 
        by 2010 in some countries in sub-Saharan Africa.
            (12) The HIV/AIDS epidemic is not just a health crisis but 
        is directly linked to development problems, including chronic 
        poverty, food security and personal debt that are reflected in 
        the capacity of affected households, often headed by elders or 
        orphaned children, to meet basic needs. Similarly, heavily-
        indebted countries are stripped of the resources necessary to 
        improve health care delivery systems and infrastructure and to 
        prevent, treat, and care for individuals affected by HIV/AIDS.
            (13) On March 7, 2001, the United States Secretary of State 
        testified before Congress that the United States has an 
        obligation `` . . . if we believe in democracy and freedom, to 
        stop this catastrophe from destroying whole economies and 
        families and societies and cultures and nations''.
            (14) A continuing priority for responding to the HIV/AIDS 
        crisis should be to emphasize and encourage awareness, 
        education, and prevention, including prevention activities that 
        promote behavioral change, while recognizing that behavioral 
        change alone will not conquer this disease. In so doing, 
        priority and support should be given to building capacity in 
        the local public health sector through technical assistance as 
        well as through nongovernmental organizations, including faith-
        based organizations where practicable.
            (15) Effective use should be made of existing health care 
        systems to provide treatment for individuals suffering from 
        HIV/AIDS.
            (16) Many countries in Africa facing health crises, 
        including high HIV/AIDS infection rates, already have well-
        developed and high functioning health care systems. Additional 
        resources to expand and improve capacity to respond to these 
        crises can easily be absorbed by the private and public 
        sectors, as well as by nongovernmental organizations, 
        community-based organizations, and faith-based organizations 
        currently engaged in combatting the crises.
            (17) An effective response to the HIV/AIDS pandemic must 
        also involve assistance to stimulate the development of sound 
        health care delivery systems and infrastructure in countries in 
        sub-Saharan Africa and other developing countries, including 
        assistance to increase the capacity and technical skills of 
        local public health professionals and other personnel in such 
        countries, and improved access to treatment and care for those 
        already infected with HIV/AIDS.
            (18) Access to effective treatment for HIV/AIDS is 
        determined by issues of price, health care delivery system and 
        infrastructure, and sustainable financing and such access can 
        be inhibited by the stigma and discrimination associated with 
        HIV/AIDS.
            (19) The HIV/AIDS crisis must be addressed by a robust, 
        multilateral approach. The Secretary General of the United 
        Nations has called for a global fund to halt and reverse the 
        spread of HIV/AIDS and other infectious diseases. The Secretary 
        General has also called for annual expenditures of 
        $7,000,000,000 to $10,000,000,000, financed by donor 
        governments and private contributors, for all efforts to combat 
        the HIV/AIDS pandemic and, equally important, called on leaders 
        from developing countries to give a much higher priority in 
        their budgets to development of comprehensive health systems.
            (20) An effective United States response to the HIV/AIDS 
        crisis must also focus on the development of HIV/AIDS vaccines 
        to prevent the spread of the disease as well as the development 
        of microbicides, effective diagnostics, and simpler treatments.
            (21) The innovative capacity of the United States in the 
        commercial and public pharmaceutical research sectors is among 
        the foremost in the world, and the active participation of both 
        these sectors should be supported as it is critical to combat 
        the global HIV/AIDS pandemic.
            (22) Appropriate treatment of individuals with HIV/AIDS can 
        prolong the lives of such individuals, preserve their families 
        and 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.
            (23) United States nongovernmental organizations, including 
        faith-based organizations, with experience in health care and 
        HIV/AIDS counseling, have proven effective in combatting the 
        HIV/AIDS pandemic and can be a resource in assisting sub-
        Saharan African leaders of traditional, political, business, 
        and women and youth organizations in their efforts to provide 
        treatment and care for individuals infected with HIV/AIDS.
            (24) Most of the HIV infected poor of the developing world 
        die of deadly diseases such as tuberculosis and malaria. 
        Accordingly, effective HIV/AIDS treatment programs should 
        address the growing threat and spread of tuberculosis, malaria, 
        and other infectious diseases in the developing world.
            (25) Law enforcement and military personnel of foreign 
        countries often have a high rate of prevalence of HIV/AIDS, and 
        therefore, in order to be effective, HIV/AIDS awareness, 
        prevention, and education programs must include education and 
        related services to such law enforcement and military 
        personnel.
            (26) Microenterprise development and other income 
        generation programs assist communities afflicted by the HIV/
        AIDS pandemic and increase the productive capacity of 
        communities and afflicted households. Microenterprise programs 
        are also an effective means to support the productive 
        activities of healthy family members caring for the sick and 
        orphaned. Such programs should give priority to women infected 
        with the AIDS virus or in HIV/AIDS affected families, 
        particularly women in high-risk categories.
            (27) The exploding global HIV/AIDS pandemic has created new 
        challenges for United States bilateral assistance programs and 
        will require a substantial increase in the capacity of the 
        United States Agency for International Development and other 
        agencies of the United States to manage and monitor bilateral 
        HIV/AIDS programs and resources. To meet this challenge, the 
        Agency will need to recruit and retain appropriate technical 
        expertise in the United States as well as in foreign countries 
        to help develop and implement HIV/AIDS strategies in concert 
        with multilateral agencies, host country governments, and 
        nongovernmental organizations.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1)(A) combatting the HIV/AIDS pandemic in countries in 
        sub-Saharan Africa and other developing countries should be a 
        global effort and include the financial support of all 
        developed countries and the cooperation of governments and the 
        private sector, including faith-based organizations; and
            (B) the United States should provide additional funds for 
        multilateral programs and efforts to combat HIV/AIDS and also 
        seek to leverage public and private resources to combat HIV/
        AIDS on a global basis through the Global Development Alliance 
        Initiative of the United States Agency for International 
        Development and other public and private partnerships with an 
        emphasis on HIV/AIDS awareness, education, prevention, and 
        treatment programs;
            (2)(A) in addition to HIV/AIDS awareness, education, and 
        prevention programs, the United States Government should make 
        its best efforts to support programs that safely make available 
        to public and private entities in countries in sub-Saharan 
        Africa and other developing countries pharmaceuticals and 
        diagnostics for HIV/AIDS therapy in order--
                    (i) to effectively and safely assist such countries 
                in the delivery of HIV/AIDS therapy pharmaceuticals 
                through the establishment of adequate health care 
                delivery systems and treatment monitoring programs; and
                    (ii) to provide treatment for poor individuals with 
                HIV/AIDS in such countries; and
            (B) in carrying out such programs, priority consideration 
        for participation should be given to countries in sub-Saharan 
        Africa;
            (3)(A) combatting the HIV/AIDS pandemic requires that 
        United States Government programs place a priority on the 
        vulnerable populations at greatest risk for contracting HIV;
            (B) these populations should be determined through 
        qualitative and quantitative assessments at the local level by 
        local government, nongovernmental organizations, people living 
        with HIV/AIDS, and other relevant sectors of civil society; and
            (C) such assessments should be included in national HIV/
        AIDS strategies;
            (4) the United States should promote efforts to expand and 
        develop programs that support the growing number of children 
        orphaned by the HIV/AIDS pandemic;
            (5) in countries where the United States Government is 
        conducting HIV/AIDS awareness, prevention, and education 
        programs, such programs should include education and related 
        services to law enforcement and military personnel of foreign 
        countries to prevent and control HIV/AIDS, malaria, and 
        tuberculosis;
            (6) prevention and treatment for HIV/AIDS should be a 
        component of a comprehensive international effort to combat 
        deadly infectious diseases, including malaria and tuberculosis, 
        and opportunistic infections, that kill millions annually in 
        the developing world;
            (7) programs developed by the United Stated Agency for 
        International Development to address the HIV/AID pandemic 
        should preserve personal privacy and confidentiality, should 
        not include compulsory HIV/AIDS testing, and should not be 
        discriminatory;
            (8)(A) the United States Agency for International 
        Development should carry out HIV/AIDS awareness, prevention, 
        and treatment programs in conjunction with effective 
        international tuberculosis and malaria treatment programs and 
        with programs that address the relationship between HIV/AIDS 
        and a number of opportunistic diseases that include bacterial 
        diseases, fungal diseases, viral diseases and HIV-associated 
        malignancies, such as Kaposi sarcoma, lymphoma, and squamous 
        cell carcinoma; and
            (B) effective intervention against opportunistic diseases 
        requires not only the appropriate drug or other medication for 
        a given medical condition, but also the infrastructure 
        necessary to diagnose the condition, monitor the intervention, 
        and provide counseling services; and
            (9) the United States Agency for International Development 
        should expand and replicate successful microenterprise programs 
        in Uganda, Zambia, Zimbabwe, and other African countries that 
        provide poor families affected by HIV/AIDS with the means to 
        care for themselves, their children, and orphans;
            (10) the United States Agency for International Development 
        should substantially increase and improve its capacity to 
        manage and monitor HIV/AIDS programs and resources;
            (11) the United States Agency for International Development 
        must recruit and retain appropriate technical expertise in the 
        United States as well as in foreign countries to help develop 
        and implement HIV/AIDS strategies in conjunction with 
        multilateral agencies, host country governments, and 
        nongovernmental organizations;
            (12) the United States Agency for International Development 
        must strengthen coordination and collaboration between the 
        technical experts in its central and regional bureaus and 
        foreign country missions in formulating country strategies and 
        implementing HIV/AIDS programs;
            (13) strong coordination among the various agencies of the 
        United States, including the Department of State, the United 
        States Agency for International Development, the Department of 
        Health and Human Services, including the Centers for Disease 
        Control and the National Institutes of Health, the Department 
        of the Treasury, the Department of Defense, and other relevant 
        Federal agencies must exist to ensure effective and efficient 
        use of financial and technical resources within the United 
        States Government; and
            (14) to help alleviate human suffering, and enhance the 
        dignity and quality of life for patients debilitated by HIV/
        AIDS, the United States should promote, both unilaterally and 
        through multilateral initiatives, the use of palliative and 
        hospice care, and provide financial and technical assistance to 
        palliative and hospice care programs, including programs under 
        which such care is provided by faith-based organizations.

SEC. 3. ASSISTANCE TO COMBAT HIV/AIDS.

    (a) Assistance.--Section 104(c) of the Foreign Assistance Act of 
1961 (22 U.S.C. 2151b(c)) is amended--
            (1) by striking paragraphs (4) through (6); and
            (2) by inserting after paragraph (3) the following:
    ``(4)(A) Congress recognizes that the alarming spread of HIV/AIDS 
in countries in sub-Saharan Africa and other developing countries is a 
major global health, national security, and humanitarian crisis. 
Accordingly, the United States and other developed countries should 
provide assistance to countries in sub-Saharan Africa and other 
developing countries to control this crisis through HIV/AIDS 
prevention, treatment, monitoring, and related activities, particularly 
activities focused on women and youth, including mother-to-child 
transmission prevention strategies.
    ``(B)(i) The Administrator of the United States Agency for 
International Development is authorized to provide assistance to 
prevent, treat, and monitor HIV/AIDS, and carry out related activities, 
in countries in sub-Saharan Africa and other developing countries.
    ``(ii) It is the sense of Congress that the Administrator should 
provide an appropriate level of assistance under clause (i) through 
nongovernmental organizations in countries in sub-Saharan Africa and 
other developing countries affected by the HIV/AIDS pandemic.
    ``(iii) The Administrator shall coordinate the provision of 
assistance under clause (i) 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), other appropriate 
international organizations, national, state, and local governments of 
foreign countries, and other appropriate governmental and 
nongovernmental organizations.
    ``(C) Assistance provided under subparagraph (B) shall, to the 
maximum extent practicable, be used to carry out the following 
activities:
            ``(i) Prevention of HIV/AIDS through activities including--
                    ``(I) education, voluntary testing, and counseling 
                (including the incorporation of confidentiality 
                protections with respect to such testing and 
                counseling), including integration of such programs 
                into women's and children's health programs; and
                    ``(II) assistance through nongovernmental 
                organizations, including faith-based organizations, 
                particularly those organizations that utilize both 
                professionals and volunteers with appropriate skills 
                and experience, to establish and implement culturally 
                appropriate HIV/AIDS education and prevention programs.
            ``(ii) The treatment and care of individuals with HIV/AIDS, 
        including--
                    ``(I) 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;
                    ``(II) assistance aimed at the prevention of 
                transmission of HIV/AIDS from mother to child, 
                including medications to prevent such transmission; and
                    ``(III) 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 organizations.
            ``(iii) The monitoring of programs, projects, and 
        activities carried out pursuant to clauses (i) and (ii), 
        including--
                    ``(I) 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; and
                    ``(II) appropriate evaluation and surveillance 
                activities.
            ``(iv) The conduct of related activities, including--
                    ``(I) 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;
                    ``(II) 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;
                    ``(III) 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; and
                    ``(IV) the development and expansion of 
                financially-sustainable microfinance institutions and 
                other income generation programs that strengthen the 
                economic and social viability of communities afflicted 
                by the HIV/AIDS pandemic, including support for the 
                savings and productive capacity of affected poor 
                households caring for orphans.
    ``(D)(i) Not later than January 31 of each calendar year, the 
Administrator shall submit to Congress an annual report on the 
implementation of this paragraph for the prior fiscal year.
    ``(ii) Such report shall include--
            ``(I) a description of efforts made to implement the 
        policies set forth in this paragraph;
            ``(II) a description of the programs established pursuant 
        to this paragraph and section 4 of the Global Access to HIV/
        AIDS Prevention, Awareness, Education, and Treatment Act of 
        2001; and
            ``(III) a detailed assessment of the impact of programs 
        established pursuant to this paragraph, including the 
        effectiveness of such programs in reducing the spread of HIV 
        infection, particularly in women and girls, in reducing HIV 
        transmission from mother to child, in reducing mortality rates 
        from HIV/AIDS, and the progress toward improving health care 
        delivery systems and infrastructure to ensure increased access 
        to care and treatment.
    ``(iii) The Administrator shall consult with the Global Health 
Advisory Board established under section 6 of the Global Access to HIV/
AIDS Prevention, Awareness, Education, and Treatment Act of 2001 in the 
preparation of the report under clause (i) and on other global health 
activities carried out by the United States Agency for International 
Development.
    ``(E)(i) There is authorized to be appropriated to the President to 
carry out this paragraph $560,000,000 for fiscal year 2002.
    ``(ii) Not more than six percent of the amount appropriated 
pursuant to the authorization of appropriations under clause (i) for 
fiscal year 2002, and not more than four percent of the amount made 
available to carry out this paragraph for any subsequent fiscal year, 
may be used for the administrative expenses of the Agency in carrying 
out this paragraph.
    ``(iii) Amounts appropriated pursuant to the authorization of 
appropriations under clause (i) are in addition to amounts otherwise 
available for such purposes and are authorized to remain available 
until expended.
    ``(F) In this paragraph:
            ``(i) The term `HIV' means infection with the human 
        immunodeficiency virus.
            ``(ii) The term `AIDS' means acquired immune deficiency 
        syndrome.''.
    (b) Availability of Assistance Under Section 104(c).--Section 
104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) is 
amended--
            (1) by redesignating paragraph (7) as paragraph (5); and
            (2) by adding at the end the following:
    ``(6) Assistance made available under any paragraph of this 
subsection, and assistance made available under chapter 4 of part II of 
this Act to carry out the purposes of any paragraph of this subsection, 
may be made available notwithstanding any other provision of law.''.

SEC. 4. ASSISTANCE FOR PROCUREMENT AND DISTRIBUTION OF HIV/AIDS 
                    PHARMACEUTICALS AND RELATED MEDICINES.

    (a) Assistance.--The Administrator of the United States Agency for 
International Development shall provide assistance to countries in sub-
Saharan Africa and other developing countries for--
            (1) the procurement of HIV/AIDS pharmaceuticals, anti-viral 
        therapies, and other appropriate medicines; and
            (2) the distribution of such HIV/AIDS pharmaceuticals, 
        anti-viral therapies, and other appropriate medicines 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 
        for the prevention of transmission of HIV/AIDS from mother to 
        child.
    (b) Additional Authority.--The authority contained in section 
104(c)(6) of the Foreign Assistance Act of 1961, as amended by section 
3(b) of this Act, shall apply to assistance made available under 
subsection (a).
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to the President to carry out this section $50,000,000 for 
fiscal year 2002.

SEC. 5. INTERAGENCY TASK FORCE ON HIV/AIDS.

    (a) Establishment.--The President shall establish an interagency 
task force (hereafter referred to as the ``task force'') to ensure 
coordination of all Federal programs related to the prevention, 
treatment, and monitoring of HIV/AIDS in foreign countries.
    (b) Duties.--The duties of the task force shall include--
            (1) reviewing all Federal programs related to the 
        prevention, treatment, and monitoring of HIV/AIDS in foreign 
        countries to ensure proper coordination and compatibility of 
        activities and policies of such programs;
            (2) exchanging information regarding design and impact of 
        such programs to ensure that the United States Government can 
        catalogue the best possible practices for HIV/AIDS prevention, 
        treatment, and monitoring and improve the effectiveness of such 
        programs in the countries in which they operate; and
            (3) fostering discussions with United States and foreign 
        nongovernmental organizations to determine how United States 
        Government programs can be improved, including by engaging in a 
        dialogue with the Global Health Advisory Board established 
        under section 6 of this Act.
    (c) Membership.--
            (1) Composition.--The task force shall be composed of the 
        Secretary of State, the Administrator of the United States 
        Agency for International Development, the Secretary of Heath 
        and Human Services, the Director of the National Institutes of 
        Health, the Director of the Centers for Disease Control, the 
        Secretary of Defense, and the head of any other agency that the 
        President determines is appropriate.
            (2) Chairperson.--The Secretary of State shall serve as 
        chairperson of the task force.
    (d) Public Meetings.--At least once each calendar year, the task 
force shall hold a public meeting in order to afford an opportunity for 
any person to present views regarding the activities of the United 
States Government with respect to the prevention, treatment, and 
monitoring of HIV/AIDS in foreign countries. The Secretary of State 
shall maintain a record of each meeting and shall make the record 
available to the public.
    (e) Availability of Funds.--Amounts made available for a fiscal 
year pursuant to section 104(c)(4)(E)(ii) of the Foreign Assistance Act 
of 1961, as amended by section 3(a) of this Act, are authorized to be 
made available to carry out this section for such fiscal year.

SEC. 6. GLOBAL HEALTH ADVISORY BOARD.

    (a) Establishment.--There is established a permanent Global Health 
Advisory Board (hereafter referred to as the ``Board'') to assist the 
President and other Federal officials, including the Secretary of State 
and the Administrator of the United States Agency for International 
Development, in the administration and implementation of United States 
international health programs, particularly programs relating to the 
prevention, treatment, and monitoring of HIV/AIDS.
    (b) Duties.--
            (1) In general.--The Board shall serve as a liaison between 
        the United States Government and private and voluntary 
        organizations, other nongovernmental organizations, and 
        academic institutions in the United States that are active in 
        international health issues, particularly prevention, 
        treatment, and care with respect to HIV/AIDS and other 
        infectious diseases.
            (2) Specific activities.--In carrying out paragraph (1), 
        the Board--
                    (A) shall provide advice to the United States 
                Agency for International Development and other Federal 
                agencies on health and management issues relating to 
                foreign assistance in which both the United States 
                Government and private and voluntary organizations 
                participate;
                    (B) shall provide advice on the formulation of 
                basic policy, procedures, and criteria for the review, 
                selection, and monitoring of project proposals for 
                United States Government international health programs 
                and for the establishment of transparency in the 
                provision and implementation of grants made under such 
                programs;
                    (C) shall provide advice on the establishment of 
                evaluation and monitoring programs to measure the 
                effectiveness of United States Government international 
                health programs, including standards and criteria to 
                assess the extent to which programs have met their 
                goals and objectives and the development of indicators 
                to track progress of specific initiatives;
                    (D) shall review and evaluate the overall health 
                strategy for United States bilateral assistance for 
                each country receiving significant United States 
                bilateral assistance in the health sector;
                    (E) shall recommend which developing countries 
                could benefit most from programs carried out under 
                United States Government international health programs; 
                and
                    (F) shall assess the impact and effectiveness of 
                programs carried out under section 104(c)(4) of the 
                Foreign Assistance Act of 1961, as amended by section 
                3(a) of this Act, in meeting the objectives set out in 
                the HIV/AIDS country strategy established by the United 
                States Agency for International Development.
    (c) Membership.--
            (1) Composition.--The Board shall be composed of 12 
        members--
                    (A)(i) all of whom shall have a substantial 
                expertise and background in international health 
                research, policy, or management, particularly in the 
                area of prevention, treatment, and care with respect to 
                HIV/AIDS and other infectious diseases; and
                    (ii) of whom at least one member shall be an expert 
                on women's and children's health issues; and
                    (B) of whom--
                            (i) three members shall be individuals from 
                        academic institutions;
                            (ii) five members shall be individuals from 
                        nongovernmental organizations active in 
                        international health programs, particularly 
                        HIV/AIDS prevention, treatment and monitoring 
                        programs in foreign countries, of which not 
                        more than two members may be from faith-based 
                        organizations;
                            (iii) two members shall be individuals from 
                        health policy and advocacy institutes; and
                            (iv) two members shall be individuals from 
                        private foundations that make substantial 
                        contributions to global health programs.
            (2) Appointment.--The individuals referred to in paragraph 
        (1) shall be appointed by the President, after consultation 
        with the chairman and ranking member of the Committee on 
        International Relations of the House of Representatives and the 
        Committee on Foreign Relations of the Senate.
            (3) Terms.--
                    (A) In general.--Except as provided in subparagraph 
                (B), each member shall be appointed for a term of two 
                years and no member or organization shall serve on the 
                Advisory Board for more than two consecutive terms.
                    (B) Terms of initial appointees.--As designated by 
                the President at the time of appointment, of the 
                members first appointed--
                            (i) six members shall be appointed for a 
                        term of three years; and
                            (ii) six members, to the extent practicable 
                        equally divided among the categories described 
                        in clauses (i) through (iv) of paragraph 
                        (1)(B), shall be appointed for a term of two 
                        years.
            (4) Chairperson.--At the first meeting of the Board in each 
        calendar year, a majority of the members of the Commission 
        present and voting shall elect, from among the members of the 
        Board, an individual to serve as chairperson of the Board.
    (d) Travel Expenses.--Each member of the Board shall receive travel 
expenses, including per diem in lieu of subsistence, in accordance with 
applicable provisions under subchapter I of chapter 57 of title 5, 
United States Code.
    (e) Availability of Funds.--Amounts made available for a fiscal 
year pursuant to section 104(c)(4)(E)(ii) of the Foreign Assistance Act 
of 1961, as amended by section 3(a) of this Act, are authorized to be 
made available to carry out this section for such fiscal year.

SEC. 7. AUTHORIZATION OF APPROPRIATIONS FOR MULTILATERAL EFFORTS TO 
                    PREVENT, TREAT, AND MONITOR HIV/AIDS.

    (a) Authorization.--There is authorized to be appropriated to the 
President $750,000,000 for fiscal year 2002 for United States 
contributions to a global health fund or other multilateral efforts to 
prevent, treat, and monitor HIV/AIDS in countries in sub-Saharan Africa 
and other developing countries, including efforts to provide hospice 
and palliative care for individuals with HIV/AIDS.
    (b) Characteristics of Global Health Fund.--It is the sense of 
Congress that United States contributions should be provided to a 
global health fund under subsection (a) only if the fund--
            (1) is a public-private partnership that includes 
        participation of, and seeks contributions from, governments, 
        foundations, corporations, nongovernmental organizations, 
        organizations that are part of the United Nations system, and 
        other entities or individuals;
            (2)(A) includes donors, recipient countries, civil society, 
        and other relevant parties in the governance of the fund; and
            (B) contains safeguards against conflicts of interest in 
        the governance of the fund by the individuals and entities 
        described in subparagraph (A);
            (3) supports targeted initiatives to address HIV/AIDS, 
        tuberculosis, and malaria through an integrated approach that 
        includes prevention interventions, care and treatment programs, 
        and infrastructure capacity-building;
            (4) permits strategic targeting of resources to address 
        needs not currently met by existing bilateral and multilateral 
        efforts and includes separate sub-accounts for different 
        activities allowing donors to designate funds for specific 
        categories of programs and activities;
            (5) reserves a minimum of 5 percent of its grant funds to 
        support scientific or medical research in connection with the 
        projects it funds in developing countries;
            (6) provides public disclosure with respect to--
                    (A) the membership and official proceedings of the 
                mechanism established to manage and disburse amounts 
                contributed to the fund; and
                    (B) grants and projects supported by the fund;
            (7) authorizes and enforces requirements for the periodic 
        financial and performance auditing of projects and makes future 
        funding conditional upon the results of such audits; and
            (8) provides public disclosure of the findings of all 
        financial and performance audits of the fund.

SEC. 8. DEFINITION.

    In this Act:
            (1) HIV.--The term ``HIV'' means infection with the human 
        immunodeficiency virus.
            (2) AIDS.--The term ``AIDS'' means acquired immune 
        deficiency syndrome.

                          Purpose and Summary

    H.R. 2069, the Global Access to HIV/AIDS Prevention, 
Awareness, Education and Treatment Act of 2001, as reported out 
of the Committee on International Relations with an amendment, 
authorizes substantial bilateral and multilateral assistance to 
combat the HIV/AIDS pandemic in countries in sub-Saharan Africa 
and other developing countries. Specifically, the bill amends 
provisions in the Foreign Assistance Act of 1961 that authorize 
assistance to prevent, treat, and monitor HIV/AIDS. The bill 
recognizes that the HIV/AIDS pandemic in sub-Saharan Africa is 
more than an international public health issue, but also a 
humanitarian, national security, and development crisis that 
threatens the stability and economy of affected developing 
countries. The threat is not confined to the region of sub-
Saharan Africa, but is increasing rapidly in Southeast Asia, 
the Caribbean, and the Middle East.
    The Secretary General of the United Nations has estimated 
an annual need of $7 billion to $10 billion to adequately 
respond to this global crisis. H.R. 2069 authorizes the 
allocation of $560 million in bilateral assistance and $750 
million in multilateral assistance for fiscal year 2002 to 
control the HIV/AIDS crisis through prevention, treatment, 
monitoring, and related activities, such as the care and 
support of children orphaned by the disease, and improving 
health care delivery systems and infrastructure in developing 
countries. The bill also authorizes $50 million for the 
procurement of HIV/AIDS pharmaceuticals, anti-viral therapies, 
and other appropriate medicines, as well as the distribution of 
such medicines to national, regional, or local organizations 
for the treatment of individuals with HIV/AIDS.
    The bill supports the development and upgrade of health 
care delivery systems and infrastructure that includes 
hospitals, clinics, laboratories, storage facilities, equipment 
and capital to fund appropriate program efforts, and the 
upgrade of related basic infrastructure (e.g., access to water, 
power and transportation), needed to sustain the programs that 
address HIV/AIDS. The bill supports the development of 
effective delivery systems that include public and private 
organizations with appropriately trained health care providers 
and support personnel, and management systems. Effective 
delivery systems can assure accessibility, accountability, and 
the continuity of care needed to combat HIV/AIDS by 
coordinating education, prevention, treatment, and palliative 
and hospice care programs and monitoring and evaluation 
programs.
    The bill establishes an interagency task force to ensure 
the coordination of all Federal programs related to the 
prevention, treatment, and monitoring of HIV/AIDS in foreign 
countries. This interagency task force is comprised of various 
department heads, and will be chaired by the Secretary of 
State. The bill also establishes a permanent Global Health 
Advisory Board to serve as a liaison between the United States 
Government and private and voluntary organizations, other non-
governmental organizations, and academic institutions active in 
international health and infectious disease issues.

                Background and Need for the Legislation

    The HIV/AIDS pandemic is no longer simply a health issue, 
but a humanitarian, national security developmental crisis that 
threatens the stability, economy, and democratic institutions 
of many nations. Recent statistics on the devastation of the 
disease are staggering. Since its inception, 58 million 
individuals have been infected with HIV/AIDS, and 22 million 
have lost their lives to the disease--of whom 17 million are 
from sub-Saharan Africa. The United States National 
Intelligence Council estimates that the disease could reduce 
Gross Domestic Product in some sub-Saharan African countries by 
as much as 20 percent or more by 2010.
    Sub-Saharan Africa has been the hardest hit region and has 
been disproportionately affected by the disease. Though the 
region has only 10 percent of the world's population, it 
accounts for 70 percent of all HIV/AIDS cases and 80 percent of 
all HIV/AIDS-related deaths. The infection rates in some 
countries are numbing. Botswana has an estimated infection rate 
at 36 percent, the highest in the world. The infection rate is 
25 percent in Zimbabwe, and 20 percent in South Africa. Yet, 
the threat is not confined to this region alone. HIV infection 
rates are rising rapidly in India, Brazil, Russia, Eastern 
Europe, South Asia, and the Caribbean.
    Tragically women and children in developing societies are 
the hardest hit by the disease. According to UNAIDS, by the end 
of 2000, 55 percent of the HIV-positive population in sub-
Saharan Africa and 40 percent of such population in North 
Africa and the Middle East, were women--infected mainly through 
heterosexual transmission. In Africa, 6 out of 7 children who 
are HIV-positive are girls. Over one million children under the 
age of 15 are living with the disease and most of these victims 
are from sub-Saharan Africa. Mother-to-child transmission is 
the largest source of infection for these children.
    Not only is HIV/AIDS directly devastating children, but it 
is doing so indirectly as well. It is estimated that over 13 
million children worldwide have lost one or both of their 
parents to HIV/AIDS, and by 2010, it is estimated that this 
number will rise to a staggering 40 million children. An 
alarmingly high rate of orphaned children is leading to the 
decay of many African societies. As a consequence of losing 
their parents to HIV/AIDS, children are drawn into 
prostitution, crime, substance abuse, and child soldiery.
    Military and police forces in countries with high HIV/AIDS 
prevalence rates are among the highest risk populations in the 
world. There are national security implications where the 
increase in HIV-infected military personnel is weakening their 
capacity to defend their nations and deploy peacekeepers in 
crisis situations. High prevalence rates among police forces 
undermines their ability to maintain civil order. Any program 
of HIV/AIDS prevention treatment and care must address this 
population.
    The Secretary General of the United Nations has called for 
annual expenditures of $7 billion to $10 billion to combat the 
disease. The United States has a strong national interest in 
making a significant contribution to this global effort to 
combat, and ultimately, eradicate the disease as it is 
destroying economies on every continent and affecting trade and 
productivity. The infection rate is inordinately high among 
many military personnel, thus also potentially affecting global 
security. Secretary of State Powell testified before the 
Committee that the United States has an obligation ``. . . if 
we believe in democracy and freedom, to stop this catastrophe 
from destroying whole economies and families and societies and 
cultures and nations.''
    The need for drug treatment is clearly necessary from a 
humanitarian perspective. However, the pilot program for drug 
therapy recognizes that prevention and treatment are 
inextricably intertwined. Without some expectation of hope that 
they will receive treatment, individuals who do not have the 
resources to pay for treatment have no reason to be tested for 
AIDS or to seek help. Simply stated, without treatment, there 
cannot be fully effective prevention.
    H.R. 2069 will help combat the spread of HIV/AIDS by 
providing funds for the prevention, treatment, and education of 
the disease through a comprehensive bilateral and multilateral 
strategy. The bill authorizes funds to improve orphan care, 
encourage hospice and palliative care, strengthen existing 
health care systems, and to procure medicines and anti-viral 
therapies to treat the disease. The bill has received strong 
bipartisan support, and also promotes the active participation 
of private and public entities in the global war against HIV/
AIDS.

                                Hearings

    The Committee held a hearing on AIDS entitled, ``The United 
States' War on AIDS'' on June 7, 2001. Testimony was received 
from: The Honorable Andrew Natsios, Administrator, U.S. Agency 
for International Development; His Excellency Mamadou Mansour 
Seck, Ambassador E. & P., Republic of Senegal; Mr. Stephen 
Hayes, President, Corporate Council on Africa; Mr. Rupert 
Schofield, Executive Director, Foundation for International 
Community Assistance; Mr. Charles Dokmo, President and Chief 
Executive Officer, Opportunities International-U.S.; and Paul 
Zeitz, M.D., Co-Director, Global AIDS Alliance.

                        Committee Consideration

    On June 27, 2001, the International Relations Committee 
marked up the bill, H.R. 2069, pursuant to notice, in open 
session. The Committee adopted an amendment in the nature of a 
substitute, which was further amended by an amendment offered 
by Representative Smith of New Jersey (adopted by voice vote) 
relating to palliative care for persons afflicted by the 
disease. The Committee agreed to a motion offered by Chairman 
Hyde to favorably report the bill, as amended, to the House of 
Representatives, by a vote of 32 to 4, a quorum being present.

                         Votes of the Committee

    Clause (3)(b) of rule XIII of the Rules of the House of 
Representatives requires that the results of each record vote 
on an amendment or motion to report, together with the names of 
those voting for or against, be printed in the committee 
report.
    Description of Amendment, Motion, Order, or Other 
Proposition:
Vote 1 (12:06 p.m.) A motion to favorably report to the House H.R. 
        2069, as amended.
    Voting yes: Hyde, Gilman, Leach, Bereuter, Christopher H. 
Smith, Gallegly, Royce, Houghton, McHugh, Burr, Nick Smith, 
Issa, Cantor, Jo Ann Davis, Lantos, Ackerman, Payne, Menendez, 
Brown, Hilliard, Sherman, Wexler, Engel, Delahunt, Meeks, Lee, 
Crowley, Hoeffel, Berkley, Napolitano, Schiff, and Watson.
    Voting no: Ballenger, Paul, Flake, and Kerns.
    Ayes 32. Nays 4.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of House Rule XIII is inapplicable because 
this legislation does not provide new budgetary authority or 
increased tax expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R. 2069, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, July 5, 2001.
Hon. Henry J. Hyde, Chairman,
Committee on International Relations,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2069, the Global 
Access to HIV/AIDS Prevention, Awareness, Education, and 
Treatment Act of 2001.
    If you wish further details on this estimate, we would be 
pleased to provide them. The CBO staff contact is Joseph C. 
Whitehill, who can be reached at 226-2840.
            Sincerely,
                                  Dan L. Crippen, Director.

Enclosure

cc:
        Honorable Tom Lantos
        Ranking Democratic Member
H.R. 2069--Global Access to HIV/AIDS Prevention, Awareness, Education, 
        and Treatment Act of 2001.

                                SUMMARY

    H.R. 2069 would authorize programs for the prevention, 
treatment, and monitoring of acquired immune deficiency 
syndrome (AIDS) caused by the human immunodeficiency virus 
(HIV) in sub-Saharan Africa and other developing countries. 
Specifically, the bill would authorize appropriations for 
bilateral assistance programs, for the purchase of medicines, 
and for contributions to a global fund or other multilateral 
efforts to prevent, treat, and monitor HIV/AIDS. It would 
establish a Global Health Advisory Board to assist the 
President and other federal officials in administering 
international health programs and an interagency task force for 
coordinating federal efforts related to fighting HIV/AIDS in 
foreign countries. Assuming the appropriation of the authorized 
amounts, CBO estimates implementing H.R. 2069 would cost $81 
million in 2002 and $1.2 billion over the 2002-2006 period. The 
bill would not affect direct spending or receipts; therefore, 
pay-as-you-go procedures would not apply.
    H.R. 2069 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.

                ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 2069 is shown in the 
following table. The costs of this legislation fall within 
budget function 150 (international affairs).

                                     By fiscal year, in millions of dollars
----------------------------------------------------------------------------------------------------------------
                                                              2001     2002     2003     2004     2005     2006
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law for International
HIV/AIDS Programs
  Budget Authority \1\                                          340        0        0        0        0        0
  Estimated Outlays                                             178      241       84       44       27       19

Proposed Changes
  Authorization Level                                             0    1,360        0        0        0        0
  Estimated Outlays                                               0       81      442      322      231      138

Spending Under H.R. 1646 for International HIV/AIDS
 Programs
  Authorization Level \1\                                       340    1,360        0        0        0        0
  Estimated Outlays                                             178      322      526      366      258      157
----------------------------------------------------------------------------------------------------------------
\1\ The 2001 level is the amount appropriated for that year.

                           BASIS OF ESTIMATE

    H.R. 2069 would authorize the appropriation in 2002 of $560 
million for bilateral assistance programs and associated 
administrative expenses, $50 million for the purchase of 
medicines, and $750 million for a contribution to a global fund 
or other multilateral efforts to prevent, treat, and monitor 
HIV/AIDS. The bill would limit spending for administrative 
expenses from bilateral assistance to 6 percent of the amount 
made available in 2002. CBO assumes that the authorized amounts 
would be appropriated by October 1, 2001. CBO estimates outlays 
for bilateral assistance, administrative expenses, and the 
purchase of medicine would follow historical spending patterns 
and total $66 million in 2002 and $560 million over the 2002-
2006 period.
    Negotiations for the creation of a global HIV/AIDS fund are 
just beginning. Until negotiations are complete, CBO has no 
information on how this fund might operate. For the purpose of 
this estimate, CBO assumed the following:
         The schedule for beginning operation of the 
        fund in 2002 will experience delays.
         Administration expenses would be paid out of 
        contributions with some start-up costs paid in 2002.
         The contribution to the global fund would be 
        in the form of a letter-of-credit drawn upon as needed 
        for the timely disbursement of grants.
         The typical grant would cover a number of 
        years with grant disbursements beginning in 2003 and 
        drawn over a 3- to 4-year period.
    CBO estimates that outlays from the contribution to a 
global HIV/AIDS fund would be $15 million in 2002 and $654 
million over the 2002-2006 period, assuming appropriation of 
the authorized amounts.

                     PAY-AS-YOU-GO CONSIDERATIONS:

    None.

              INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    H.R. 2069 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments.

                         ESTIMATE PREPARED BY:

Federal Costs: Joseph C. Whitehill (226-2840)
Impact on State, Local, and Tribal Governments: Elyse Goldman 
        (225-3220)
Impact on the Private Sector: Lauren Marks (226-2940)

                         ESTIMATE APPROVED BY:

Peter H. Fontaine
Deputy Assistant Director for Budget Analysis

                    Performance Goals and Objectives

    The goals and objectives of this legislation are to 
decrease the rate of infection and alleviate human suffering in 
sub-Saharan Africa and other developing countries caused by the 
HIV/AIDS pandemic.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in article I, section 8, clause 18 of the 
Constitution (relating to making all laws necessary and proper 
for carrying into execution powers vested by the Constitution 
in the government of the United States).

               Section-by-Section Analysis and Discussion

Section 1. Short Title
    Section 1 cites the act as the ``Global Access to HIV/AIDS 
Prevention, Awareness, Education, and Treatment Act of 2001.''
Section 2. Findings; Sense of Congress.
    Subsection (a) Findings. This subsection articulates 
numerous Congressional findings of fact, including that more 
than 58 million people worldwide have already been infected 
with the HIV/AIDS disease and that the pandemic has claimed the 
lives of over 22 million--17 million of whom were from sub-
Saharan Africa. In Africa, 6 out of 7 children who are HIV 
positive are girls and 440,000 children out of an estimated 
500,000 children who died as a consequence of AIDS in 2000 were 
living in sub-Saharan Africa. An estimated 13.2 million 
children worldwide have lost one or both of their parents to 
HIV/AIDS, most of whom are children from sub-Saharan Africa. 
Moreover, the largest source of HIV infection in children under 
age 15 is mother-to-child transmission, and the total number of 
births to HIV-infected pregnant women in developing countries 
is approximately 700,000. With respect to HIV infection rates 
in the military, the armed forces of Argola and the Democratic 
Republic of Congo, for example, are estimated to be 40-60%, and 
with respect to Nigeria, 10-20%. Awareness of HIV status 
enables better decision-making for families. By 2010, 40 
million children worldwide will have lost one or both of their 
parents to HIV/AIDS, and the disease has dramatically increased 
the number of orphans which will increase the instability in 
already volatile regions in the world.
    By 2010, the disease could reduce Gross Domestic Product by 
as much as 20 percent or more in some sub-Saharan countries. It 
is the view of the Committee that the HIV/AIDS pandemic is more 
than a health crisis, and is directly related to developmental 
problems. Moreover, the Secretary of State strongly feels the 
United States has an obligation to stop the AIDS pandemic from 
destroying economies, nations, and families throughout the 
world and that it poses a threat to democracy and freedom. An 
effective response to the HIV/AIDS pandemic must also involve 
assistance to stimulate the development of sound health care 
delivery systems and infrastructure. In addition, as called for 
by the Secretary General of the United Nations, a global fund 
should be established, and contributions by both governments 
and private contributors will be required to combat the 
pandemic. An effective HIV/AIDS treatment program should also 
address the threat and spread of infectious diseases such as 
tuberculosis and malaria, as most victims of AIDS die from 
these diseases. In addition, microenterprise programs and other 
income-generating programs assist communities and individuals 
caring for the sick by increasing their productive activities 
and incomes, and therefore should be expanded. It is the sense 
of the Committee that the exploding growth of the HIV/AIDS 
pandemic will require a substantial increase in the capacity of 
the United States Agency for International Development (USAID) 
and other agencies to carry out and monitor bilateral HIV/AIDS 
programs.
    In addition, microfinance programs and other income-
generating programs assist individuals infected with the HIV/
AIDS virus as well as communities and individuals caring for 
the sick by increasing their productive activities and incomes, 
and therefore should be expanded. There is growing consensus in 
the international community regarding the relationship between 
poverty and HIV/AIDS and other diseases. It is evident that the 
poor, particularly women, are most affected of HIV/AIDS. The 
Committee feels that microfinance programs and other income-
generation programs are a key to alleviating poverty and 
mitigating the impact of HIV/AIDS on the most vulnerable 
populations. Therefore, the Committee feels that these 
microfinance programs should give priority to HIV affected 
populations particularly those groups and individuals which are 
at highest risk of being infected, including women.
    Subsection (b) Sense of Congress. This subsection expresses 
the sense of Congress regarding the U.S. bilateral and 
multilateral efforts that are intended to guide the President's 
efforts. This section provides that HIV/AIDS pandemic should be 
fought through a global effort, and that the United States 
should provide additional funds for multilateral-programs to 
achieve this purpose. The United States should also support 
programs that safely make available in developing countries 
pharmaceuticals and diagnostics for HIV/AIDS anti-viral 
therapies and treatment. Priority should be placed on 
populations at greatest risk for contracting HIV. The United 
States should also promote programs that support the growing 
number of children orphaned by the HIV/AIDS pandemic. In 
addition, HIV/AIDS awareness, prevention, and education 
programs should include services for law enforcement and 
military personnel--since they tend to be at high risk. USAID 
programs should preserve privacy and confidentiality, and 
should not include compulsory HIV/AIDS testing. The Committee 
encourages strong coordination among the various agencies of 
the United States carrying out international HIV/AIDS programs 
to ensure the effective and efficient use of financial and 
technical resources provided by the United States Government. 
USAID should promote the use of and provide financial and 
technical assistance to palliative and hospice care programs to 
help alleviate human suffering and enhance the dignity and 
quality of life for those afflicted with HIV/AIDS.
Section 3. Assistance to Combat HIV/AIDS
    Section 3 amends section 104(c) of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b(c) by striking paragraphs (4) 
through (6) and by inserting a revised text strengthening and 
refining the program. The revised provision states that 
Congress recognizes HIV/AIDS as a major global health, national 
security, and humanitarian crisis. Accordingly, the United 
States should provide assistance to countries in sub-Saharan 
Africa and other developing countries to control the HIV/AIDS 
crisis through prevention, treatment, monitoring, and related 
activities, with particular focus on women and youth, including 
mother-to-child transmission interventions.
    In providing HIV/AIDS assistance, priority should be given 
to the most vulnerable populations. HIV/AIDS programs should 
identify and take into account those factors that make 
individuals or groups particularly vulnerable to HIV infection, 
including poverty, lack of education, migration, social 
exclusion, illiteracy, discrimination, lack of information or 
commodities for self-protection. These programs should address 
the gender dimension of the epidemic, specify the actions that 
will be taken to address vulnerability and set targets for 
their achievement.
    U.S. government agency strategies should encourage the 
development of national strategies, policies and programs, 
through a participatory approach, to promote and protect the 
health of those most vulnerable to, and at greatest risk of HIV 
infection. Such populations should include, but not be limited 
to children in especially difficult circumstances, women in low 
income house holds, particularly pregnant women, intravenous 
drug users and their sexual partners, persons confined in 
institutions and prison populations, refugees and internally 
displaced persons and people separated from their families due 
to work or conflict;
    U.S. government strategies and programs, should recognize 
the importance of the family and take into consideration 
cultural, religious and ethical factors, to reduce the 
vulnerability of children and young people by: promoting access 
of both girls and boys to primary and secondary education, 
including on HIV/AIDS in curricula for adolescents; expanding 
youth-friendly information and health services; strengthening 
women's and children's health education programs; and involving 
target groups in planning, implementing and evaluating HIV/AIDS 
prevention and care programs
    The revised section 104(c) provides that the Administrator 
of USAID is authorized to carry out comprehensive HIV/AIDS 
education, prevention, and treatment programs to combat and 
monitor the HIV/AIDS pandemic. The provision directs that the 
Administrator should provide an appropriate level of this 
assistance through non-governmental organizations, including 
faith-based organizations, and should coordinate the provision 
of assistance with the provision of related assistance by other 
appropriate international entities.
    Under the revised paragraph (4), assistance provided 
through this act shall be used to carry out:
          (1) the prevention of HIV/AIDS, including education, 
        voluntary testing, and counseling;
          (2) the treatment and care of individuals with HIV/
        AIDS, including strengthening and broadening the 
        capacity of indigenous health care systems, assistance 
        aimed at mother-to-child transmission prevention, and 
        strengthening and expanding hospice and palliative care 
        programs;
          (3) the monitoring of programs, projects, and 
        activities to ensure adequate controls and appropriate 
        evaluation and surveillance activities; and
          (4) the conduct of related activities, including the 
        care of children orphaned by HIV/AIDS, improved 
        infrastructure, vaccine research, and the development 
        and expansion of microfinance institutions and other 
        income generation programs targetting assistance to 
        HIV/AIDS affected population, particularly those groups 
        and individuals who are at the highest risk of being 
        infected, including women.
    Not later than January 31 of each calendar year, the 
amended section 104(c)(4) requires the Administrator to submit 
to Congress an annual report on the implementation of HIV/AIDS 
programs during the prior fiscal year. The report shall include 
a description of efforts made to implement the policies, a 
description of the programs established, and a detailed 
assessment of the impact of programs established pursuant to 
this act. The Administrator must consult with the Global Health 
Advisory Board authorized by this act in the preparation of 
this report and on other global health activities. The 
Committee expects this report to contain specific objective 
measurements, such as evaluation of mortality and infection 
rates, in countries where the U.S. is providing assistance.
    The act authorizes $560 million to be appropriated for 
fiscal year 2002 to carry out the purposes of this legislation. 
Not more than 6 percent of this amount in fiscal year 2002, and 
not more than 4 percent of the amount available for any 
subsequent year, may be used for administrative expenses of 
USAID, and amounts appropriated are authorized to remain 
available until expended. While this represents a reduction 
percentage-wise from current law, the Committee expects 
increased funding for HIV/AIDS programs in the future and 
therefore believe there will be economies of scale.
    Assistance authorized by this act should be provided 
primarily through non-governmental organizations, including 
faith-based organizations, and should support innovative 
approaches to combat the pandemic. As an example, the Committee 
strongly encourages the USAID to support and replicate 
programs, such as the Nyumbani Orphanage in Kenya, where young 
orphans and the elderly who have lost their own children to 
HIV/AIDS can be mutually supportive. The Nyumbani Orphanage is 
an example of a ``village of hope'' for the victims of HIV/
AIDS, who are often helpless orphaned children and the elderly 
who have lost adult children who traditionally care for them. 
By supporting programs that bring these two generations 
together, a semblance of family structure is preserved for the 
victims of HIV/AIDS.
    In addition, the Administrator of USAID is urged to 
coordinate the provision of assistance with entities such as 
the AIDS Healthcare Foundation, which demonstrate expertise in 
building and operating infrastructure for the delivery of anti-
viral HIV medical care to the medically indigent, as well as 
training of medical staff experienced in HIV medical care. Such 
coordination should seek to develop replicable models for 
expanded access to medical care appropriate to the local area.
Section 4. Assistance for Procurement and Distributorship of HIV/AIDS 
        Pharmaceuticals and Related Medicines.
    This section authorizes the appropriation of $50 million 
for the procurement of HIV/AIDS pharmaceuticals, anti-viral 
therapies, and other appropriate medicines and for the 
distribution of these pharmaceuticals to qualified national, 
regional, or local organizations to treat individuals infected 
with HIV/AIDS. The Committee strongly supports the development 
of pilot treatment programs by USAID as treatment is an 
integral part of any HIV/AIDS prevention strategy.
Section 5. Interagency Task Force on HIV/AIDS.
    This section establishes an interagency task force to 
ensure coordination of all Federal programs related to the 
prevention, treatment, and monitoring of HIV/AIDS in foreign 
countries. In order to ensure overall policy coherence and 
sufficient programmatic coordination among the various agencies 
of the U.S. government involved in global HIV/AIDS programs, 
the Committee feels it is necessary to have a high-level 
interagency task force on HIV/AIDS. This task force shall 
review all Federal programs related to the prevention, 
treatment, and monitoring of HIV/AIDS in foreign countries and 
shall provide for the exchange of information regarding the 
design and impact of such programs in order to catalogue the 
best possible practices. In countries where there are multiple 
agencies of the U.S. government implementing HIV/AIDS programs, 
the task force shall ensure that there is coordination and 
complementarity between the agencies. The task force shall also 
endeavor to share information and coordinate programs and 
policies of U.S. government agencies with other international 
donors and with non-governmental organizations to facilitate an 
international consensus and maximize the effectiveness of 
programs to combat HIV/AIDS. The task force, chaired by the 
Secretary of State, shall also include the Administrator of 
USAID, the Secretary of Health and Human Services, the Director 
of the National Institutes of Health, the Director of the 
Centers for Disease Control, the Secretary of Defense, and the 
head of any other agency that the President determines is 
appropriate. At least once annually, the task force shall hold 
a public meeting and the Secretary of State shall maintain a 
record of each meeting on its activities, making the record 
available to the public. The Committee believes that this 
interagency cooperation will serve to better coordinate U.S. 
efforts with international HIV/AIDS programs and strategies. 
Amounts available under section 104(c)(4)(E)(ii) of the Foreign 
Assistance Act of 1961, as amended by section 3(a) of this act, 
are authorized to be made available to carry out this section 
for such fiscal year.
Section 6. Global Health Advisory Board.
    This section authorizes the establishment of a permanent 
Global Health Advisory Board to assist the President and other 
Federal officials in the administration and implementation of 
United States international health programs, particularly those 
relating to the prevention and treatment of HIV/AIDS. It is the 
intent of this committee that the Global Health Advisory Board 
serve as a bridge between USAID and the larger health and NGO 
community. The Committee feels that in the planning and 
implementation of its global health programs, the U.S. Agency 
for International Development, and other agencies of the U.S. 
government which carry out international health programs, 
should take into account the experience and expertise of 
private and voluntary organizations, non-governmental 
institutions, faith-based organizations, and academic 
institutions. The Board will provide advice and guidance to 
USAID and other Federal agencies on the formulation of basic 
policy, procedures, and criteria for the review, selection, and 
monitoring of project proposals and for the establishment of 
transparency in the provision and implementation of grants 
awarded to combat HIV/AIDS and other global health programs. 
The Board shall issue recommendations on which developing 
countries could benefit the most from aforementioned programs 
and assess the impact and effectiveness of programs carried out 
under section 104(c)(4) of the Foreign Assistance Act of 1961, 
as amended by section 3(a) of this Act.
    This section authorizes the establishment of a board, 
composed of 12 members, all with substantial expertise and 
background in international health research, policy, or 
management, particularly related to HIV/AIDS. At least one 
member shall be an expert on women's and children's health 
issues, three members shall be from academic institutions, five 
members shall be from non-governmental institutions active in 
international health, but no more than two from faith-based 
organizations, and two members shall be from private 
foundations that make substantial contributions to global 
health issues. These members shall be appointed by the 
President, after consultation with the Chairman and Ranking 
Member of the Committee on International Relations of the House 
of Representatives and the Chairman and Ranking Member of the 
Committee on Foreign Relations of the Senate. The members shall 
be appointed for a term of 2 years with no member or 
organization serving for more than two consecutive terms. The 
initial members shall be appointed in such a manner that no 
more than six of the twelve members terms shall expire in any 
subsequent year.
    Members of the Board shall be authorized to receive travel 
expenses and amounts made available under section 
104(c)(4)(E)(ii) of the Foreign Assistance Act of 1961 to carry 
out this section.
Section 7. Authorization of Appropriations for Multilateral efforts to 
        Prevent, Treat, and Monitor HIV/AIDS.
    This section authorizes the appropriation of $750 million 
for fiscal year 2002 for United States contributions to a 
global health fund or other multilateral efforts to prevent, 
treat, and monitor HIV/AIDS and other infectious diseases in 
countries in sub-Saharan Africa and other developing countries.
    While the Committee understands that the fight against HIV/
AIDS must be include all segments of the international 
community including bilateral and multilateral efforts, private 
and public sector contributions, non-governmental actors as 
well as government commitments at the highest levels, 
prevention efforts as well as treatment and care, the Committee 
agrees that there must be a coordinated multilateral effort to 
spear head this campaign if it is to be successful. The Global 
Health Fund established by the United Nations Secretary General 
seems to be the most likely vehicle for this multilateral 
effort.
    The Committee believes that these contributions should only 
be provided if the global fund constitutes a public-private 
partnership with donors and recipients involved in its 
governance. In addition, the Committee believes that the fund 
must contain safeguards against conflicts of interest in its 
governance. Additionally, the fund should support targeted 
initiatives to address HIV/AIDS, tuberculosis, and malaria 
through an integrated approach that includes prevention 
interventions, care and treatment programs, and infrastructure 
capacity-building, and reserve a minimum of 5 percent of its 
grant fund to support scientific or medical research.

                        New Advisory Committees

    H.R. 2069 does not establish or authorize any new advisory 
committees.

                    Congressional Accountability Act

    H.R. 2069 does not apply to the legislative branch.

                            Federal Mandates

    H.R. 2069 provides no Federal mandates.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

           SECTION 104 OF THE FOREIGN ASSISTANCE ACT OF 1961

    Sec. 104. Population and Health.--(a) * * *

           *       *       *       *       *       *       *

    (c) Assistance for Health and Disease Prevention.--(1) * * 
*

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    [(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, national 
        and 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 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 
help providing--
            [(i) primary prevention and education;
            [(ii) voluntary testing and counseling;
            [(iii) medications to prevent the transmission of 
        HIV 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 each of the fiscal years 2001 and 
2002 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 subsection, and 
assistance made available under chapter 4 of part II to carry 
out the purposes of this subsection, may be made available 
notwithstanding any other provision of law that restricts 
assistance to foreign countries.
    [(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.]
    (4)(A) Congress recognizes that the alarming spread of HIV/
AIDS in countries in sub-Saharan Africa and other developing 
countries is a major global health, national security, and 
humanitarian crisis. Accordingly, the United States and other 
developed countries should provide assistance to countries in 
sub-Saharan Africa and other developing countries to control 
this crisis through HIV/AIDS prevention, treatment, monitoring, 
and related activities, particularly activities focused on 
women and youth, including mother-to-child transmission 
prevention strategies.
    (B)(i) The Administrator of the United States Agency for 
International Development is authorized to provide assistance 
to prevent, treat, and monitor HIV/AIDS, and carry out related 
activities, in countries in sub-Saharan Africa and other 
developing countries.
    (ii) It is the sense of Congress that the Administrator 
should provide an appropriate level of assistance under clause 
(i) through nongovernmental organizations in countries in sub-
Saharan Africa and other developing countries affected by the 
HIV/AIDS pandemic.
    (iii) The Administrator shall coordinate the provision of 
assistance under clause (i) 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), other appropriate international 
organizations, national, state, and local governments of 
foreign countries, and other appropriate governmental and 
nongovernmental organizations.
    (C) Assistance provided under subparagraph (B) shall, to 
the maximum extent practicable, be used to carry out the 
following activities:
            (i) Prevention of HIV/AIDS through activities 
        including--
                    (I) education, voluntary testing, and 
                counseling (including the incorporation of 
                confidentiality protections with respect to 
                such testing and counseling), including 
                integration of such programs into women's and 
                children's health programs; and
                    (II) assistance through nongovernmental 
                organizations, including faith-based 
                organizations, particularly those organizations 
                that utilize both professionals and volunteers 
                with appropriate skills and experience, to 
                establish and implement culturally appropriate 
                HIV/AIDS education and prevention programs.
            (ii) The treatment and care of individuals with 
        HIV/AIDS, including--
                    (I) 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;
                    (II) assistance aimed at the prevention of 
                transmission of HIV/AIDS from mother to child, 
                including medications to prevent such 
                transmission; and
                    (III) 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 organizations.
            (iii) The monitoring of programs, projects, and 
        activities carried out pursuant to clauses (i) and 
        (ii), including--
                    (I) 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; and
                    (II) appropriate evaluation and 
                surveillance activities.
            (iv) The conduct of related activities, including--
                    (I) 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;
                    (II) 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;
                    (III) 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; and
                    (IV) the development and expansion of 
                financially-sustainable microfinance 
                institutions and other income generation 
                programs that strengthen the economic and 
                social viability of communities afflicted by 
                the HIV/AIDS pandemic, including support for 
                the savings and productive capacity of affected 
                poor households caring for orphans.
    (D)(i) Not later than January 31 of each calendar year, the 
Administrator shall submit to Congress an annual report on the 
implementation of this paragraph for the prior fiscal year.
    (ii) Such report shall include--
            (I) a description of efforts made to implement the 
        policies set forth in this paragraph;
            (II) a description of the programs established 
        pursuant to this paragraph and section 4 of the Global 
        Access to HIV/AIDS Prevention, Awareness, Education, 
        and Treatment Act of 2001; and
            (III) a detailed assessment of the impact of 
        programs established pursuant to this paragraph, 
        including the effectiveness of such programs in 
        reducing the spread of HIV infection, particularly in 
        women and girls, in reducing HIV transmission from 
        mother to child, in reducing mortality rates from HIV/
        AIDS, and the progress toward improving health care 
        delivery systems and infrastructure to ensure increased 
        access to care and treatment.
    (iii) The Administrator shall consult with the Global 
Health Advisory Board established under section 6 of the Global 
Access to HIV/AIDS Prevention, Awareness, Education, and 
Treatment Act of 2001 in the preparation of the report under 
clause (i) and on other global health activities carried out by 
the United States Agency for International Development.
    (E)(i) There is authorized to be appropriated to the 
President to carry out this paragraph $560,000,000 for fiscal 
year 2002.
    (ii) Not more than six percent of the amount appropriated 
pursuant to the authorization of appropriations under clause 
(i) for fiscal year 2002, and not more than four percent of the 
amount made available to carry out this paragraph for any 
subsequent fiscal year, may be used for the administrative 
expenses of the Agency in carrying out this paragraph.
    (iii) Amounts appropriated pursuant to the authorization of 
appropriations under clause (i) are in addition to amounts 
otherwise available for such purposes and are authorized to 
remain available until expended.
    (F) In this paragraph:
            (i) The term ``HIV'' means infection with the human 
        immunodeficiency virus.
            (ii) The term ``AIDS'' means acquired immune 
        deficiency syndrome.
    [(7)] (5)(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) * * *

           *       *       *       *       *       *       *

    (6) Assistance made available under any paragraph of this 
subsection, and assistance made available under chapter 4 of 
part II of this Act to carry out the purposes of any paragraph 
of this subsection, may be made available notwithstanding any 
other provision of law.

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