PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 711

Public Law 108–25

108th Congress

An Act

To provide assistance to foreign countries to combat HIV/AIDS, tuberculosis, and

malaria, and for other purposes.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘United States

Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of

2003’’.

(b) TABLE OF CONTENTS.—The table of contents for this Act

is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

Sec. 3. Definitions.

Sec. 4. Purpose.

Sec. 5. Authority to consolidate and combine reports.

TITLE I—POLICY PLANNING AND COORDINATION

Sec. 101. Development of a comprehensive, five-year, global strategy.

Sec. 102. HIV/AIDS Response Coordinator.

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLICPRIVATE PARTNERSHIPS

Sec. 201. Sense of Congress on public-private partnerships.

Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sec. 203. Voluntary contributions to international vaccine funds.

TITLE III—BILATERAL EFFORTS

Subtitle A—General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.

Sec. 302. Assistance to combat tuberculosis.

Sec. 303. Assistance to combat malaria.

Sec. 304. Pilot program for the placement of health care professionals in overseas

areas severely affected by HIV/AIDS, tuberculosis, and malaria.

Sec. 305. Report on treatment activities by relevant executive branch agencies.

Sec. 306. Strategies to improve injection safety.

Sec. 307. Study on illegal diversions of prescription drugs.

Subtitle B—Assistance for Children and Families

Sec. 311. Findings.

Sec. 312. Policy and requirements.

Sec. 313. Annual reports on prevention of mother-to-child transmission of the HIV

infection.

Sec. 314. Pilot program of assistance for children and families affected by HIV/

AIDS.

Sec. 315. Pilot program on family survival partnerships.

TITLE IV—AUTHORIZATION OF APPROPRIATIONS

Sec. 401. Authorization of appropriations.

22 USC 7601

note.

United States

Leadership

Aganist HIV/

AIDS,

Tuberculosis, and

Malaria Act of

2003.

May 27, 2003

[H.R. 1298]

117 STAT. 712 PUBLIC LAW 108–25—MAY 27, 2003

Sec. 402. Sense of Congress.

Sec. 403. Allocation of funds.

Sec. 404. Assistance from the United States private sector to prevent and reduce

HIV/AIDS in sub-Saharan Africa.

TITLE V—INTERNATIONAL FINANCIAL INSTITUTIONS

Sec. 501. Modification of the Enhanced HIPC Initiative.

Sec. 502. Report on expansion of debt relief to non-HIPC countries.

Sec. 503. Authorization of appropriations.

SEC. 2. FINDINGS.

Congress makes the following findings:

(1) During the last 20 years, HIV/AIDS has assumed pandemic proportions, spreading from the most severely affected

regions, sub-Saharan Africa and the Caribbean, to all corners

of the world, and leaving an unprecedented path of death

and devastation.

(2) According to the Joint United Nations Programme on

HIV/AIDS (UNAIDS), more than 65,000,000 individuals worldwide have been infected with HIV since the epidemic began,

more than 25,000,000 of these individuals have lost their lives

to the disease, and more than 14,000,000 children have been

orphaned by the disease. HIV/AIDS is the fourth-highest cause

of death in the world.

(3)(A) At the end of 2002, an estimated 42,000,000 individuals were infected with HIV or living with AIDS, of which

more than 75 percent live in Africa or the Caribbean. Of these

individuals, more than 3,200,000 were children under the age

of 15 and more than 19,200,000 were women.

(B) Women are four times more vulnerable to infection

than are men and are becoming infected at increasingly high

rates, in part because many societies do not provide poor women

and young girls with the social, legal, and cultural protections

against high risk activities that expose them to HIV/AIDS.

(C) Women and children who are refugees or are internally

displaced persons are especially vulnerable to sexual exploitation and violence, thereby increasing the possibility of HIV

infection.

(4) As the leading cause of death in sub-Saharan Africa,

AIDS has killed more than 19,400,000 individuals (more than

3 times the number of AIDS deaths in the rest of the world)

and will claim the lives of one-quarter of the population, mostly

adults, in the next decade.

(5) An estimated 2,000,000 individuals in Latin America

and the Caribbean and another 7,100,000 individuals in Asia

and the Pacific region are infected with HIV or living with

AIDS. Infection rates are rising alarmingly in Eastern Europe

(especially in the Russian Federation), Central Asia, and China.

(6) HIV/AIDS threatens personal security by affecting the

health, lifespan, and productive capacity of the individual and

the social cohesion and economic well-being of the family.

(7) HIV/AIDS undermines the economic security of a

country and individual businesses in that country by weakening

the productivity and longevity of the labor force across a broad

array of economic sectors and by reducing the potential for

economic growth over the long term.

(8) HIV/AIDS destabilizes communities by striking at the

most mobile and educated members of society, many of whom

are responsible for security at the local level and governance

26 USC 7601.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 713

at the national and subnational levels as well as many teachers,

health care personnel, and other community workers vital to

community development and the effort to combat HIV/AIDS.

In some countries the overwhelming challenges of the HIV/

AIDS epidemic are accelerating the outward migration of critically important health care professionals.

(9) HIV/AIDS weakens the defenses of countries severely

affected by the HIV/AIDS crisis through high infection rates

among members of their military forces and voluntary peacekeeping personnel. According to UNAIDS, in sub-Saharan

Africa, many military forces have infection rates as much as

five times that of the civilian population.

(10) HIV/AIDS poses a serious security issue for the international community by—

(A) increasing the potential for political instability and

economic devastation, particularly in those countries and

regions most severely affected by the disease;

(B) decreasing the capacity to resolve conflicts through

the introduction of peacekeeping forces because the

environments into which these forces are introduced pose

a high risk for the spread of HIV/AIDS; and

(C) increasing the vulnerability of local populations

to HIV/AIDS in conflict zones from peacekeeping troops

with HIV infection rates significantly higher than civilian

populations.

(11) The devastation wrought by the HIV/AIDS pandemic

is compounded by the prevalence of tuberculosis and malaria,

particularly in developing countries where the poorest and most

vulnerable members of society, including women, children, and

those individuals living with HIV/AIDS, become infected.

According to the World Health Organization (WHO), HIV/AIDS,

tuberculosis, and malaria accounted for more than 5,700,000

deaths in 2001 and caused debilitating illnesses in millions

more.

(12) Together, HIV/AIDS, tuberculosis, malaria and related

diseases are undermining agricultural production throughout

Africa. According to the United Nations Food and Agricultural

Organization, 7,000,000 agricultural workers throughout 25

African countries have died from AIDS since 1985. Countries

with poorly developed agricultural systems, which already face

chronic food shortages, are the hardest hit, particularly in

sub-Saharan Africa, where high HIV prevalence rates are

compounding the risk of starvation for an estimated 14,400,000

people.

(13) Tuberculosis is the cause of death for one out of every

three people with AIDS worldwide and is a highly communicable disease. HIV infection is the leading threat to tuberculosis control. Because HIV infection so severely weakens the

immune system, individuals with HIV and latent tuberculosis

infection have a 100 times greater risk of developing active

tuberculosis diseases thereby increasing the risk of spreading

tuberculosis to others. Tuberculosis, in turn, accelerates the

onset of AIDS in individuals infected with HIV.

(14) Malaria, the most deadly of all tropical parasitic diseases, has been undergoing a dramatic resurgence in recent

years due to increasing resistance of the malaria parasite to

inexpensive and effective drugs. At the same time, increasing

117 STAT. 714 PUBLIC LAW 108–25—MAY 27, 2003

resistance of mosquitoes to standard insecticides makes control

of transmission difficult to achieve. The World Health Organization estimates that between 300,000,000 and 500,000,000 new

cases of malaria occur each year, and annual deaths from

the disease number between 2,000,000 and 3,000,000. Persons

infected with HIV are particularly vulnerable to the malaria

parasite. The spread of HIV infection contributes to the difficulties of controlling resurgence of the drug resistant malaria

parasite.

(15) HIV/AIDS is first and foremost a health problem.

Successful strategies to stem the spread of the HIV/AIDS pandemic will require clinical medical interventions, the strengthening of health care delivery systems and infrastructure, and

determined national leadership and increased budgetary allocations for the health sector in countries affected by the epidemic

as well as measures to address the social and behavioral causes

of the problem and its impact on families, communities, and

societal sectors.

(16) Basic interventions to prevent new HIV infections

and to bring care and treatment to people living with AIDS,

such as voluntary counseling and testing and mother-to-child

transmission programs, are achieving meaningful results and

are cost-effective. The challenge is to expand these interventions

from a pilot program basis to a national basis in a coherent

and sustainable manner.

(17) Appropriate treatment of individuals with HIV/AIDS

can prolong the lives of such individuals, preserve their families,

prevent children from becoming orphans, and increase productivity of such individuals by allowing them to lead active lives

and reduce the need for costly hospitalization for treatment

of opportunistic infections caused by HIV.

(18) Nongovernmental organizations, including faith-based

organizations, with experience in health care and HIV/AIDS

counseling, have proven effective in combating the HIV/AIDS

pandemic and can be a resource in assisting indigenous

organizations in severely affected countries in their efforts to

provide treatment and care for individuals infected with HIV/

AIDS.

(19) Faith-based organizations are making an important

contribution to HIV prevention and AIDS treatment programs

around the world. Successful HIV prevention programs in

Uganda, Jamaica, and elsewhere have included local churches

and faith-based groups in efforts to promote behavior changes

to prevent HIV, to reduce stigma associated with HIV infection,

to treat those afflicted with the disease, and to care for orphans.

The Catholic Church alone currently cares for one in four

people being treated for AIDS worldwide. Faith-based organizations possess infrastructure, experience, and knowledge that

will be needed to carry out these programs in the future and

should be an integral part of United States efforts.

(20)(A) Uganda has experienced the most significant decline

in HIV rates of any country in Africa, including a decrease

among pregnant women from 20.6 percent in 1991 to 7.9 percent

in 2000.

(B) Uganda made this remarkable turnaround because

President Yoweri Museveni spoke out early, breaking longstanding cultural taboos, and changed widespread perceptions

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 715

about the disease. His leadership stands as a model for ways

political leaders in Africa and other developing countries can

mobilize their nations, including civic organizations, professional associations, religious institutions, business and labor

to combat HIV/AIDS.

(C) Uganda’s successful AIDS treatment and prevention

program is referred to as the ABC model: ‘‘Abstain, Be faithful,

use Condoms’’, in order of priority. Jamaica, Zambia, Ethiopia

and Senegal have also successfully used the ABC model. Beginning in 1986, Uganda brought about a fundamental change

in sexual behavior by developing a low-cost program with the

message: ‘‘Stop having multiple partners. Be faithful. Teenagers, wait until you are married before you begin sex.’’.

(D) By 1995, 95 percent of Ugandans were reporting either

one or zero sexual partners in the past year, and the proportion

of sexually active youth declined significantly from the late

1980s to the mid-1990s. The greatest percentage decline in

HIV infections and the greatest degree of behavioral change

occurred in those 15 to 19 years old. Uganda’s success shows

that behavior change, through the use of the ABC model, is

a very successful way to prevent the spread of HIV.

(21) The magnitude and scope of the HIV/AIDS crisis

demands a comprehensive, long-term, international response

focused upon addressing the causes, reducing the spread, and

ameliorating the consequences of the HIV/AIDS pandemic,

including—

(A) prevention and education, care and treatment, basic

and applied research, and training of health care workers,

particularly at the community and provincial levels, and

other community workers and leaders needed to cope with

the range of consequences of the HIV/AIDS crisis;

(B) development of health care infrastructure and

delivery systems through cooperative and coordinated

public efforts and public and private partnerships;

(C) development and implementation of national and

community-based multisector strategies that address the

impact of HIV/AIDS on the individual, family, community,

and nation and increase the participation of at-risk populations in programs designed to encourage behavioral and

social change and reduce the stigma associated with HIV/

AIDS; and

(D) coordination of efforts between international

organizations such as the Global Fund to Fight AIDS,

Tuberculosis and Malaria, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health

Organization (WHO), national governments, and private

sector organizations, including faith-based organizations.

(22) The United States has the capacity to lead and enhance

the effectiveness of the international community’s response by—

(A) providing substantial financial resources, technical

expertise, and training, particularly of health care personnel and community workers and leaders;

(B) promoting vaccine and microbicide research and

the development of new treatment protocols in the public

and commercial pharmaceutical research sectors;

(C) making available pharmaceuticals and diagnostics

for HIV/AIDS therapy;

117 STAT. 716 PUBLIC LAW 108–25—MAY 27, 2003

(D) encouraging governments and faith-based and

community-based organizations to adopt policies that treat

HIV/AIDS as a multisectoral public health problem

affecting not only health but other areas such as agriculture, education, the economy, the family and society,

and assisting them to develop and implement programs

corresponding to these needs;

(E) promoting healthy lifestyles, including abstinence,

delaying sexual debut, monogamy, marriage, faithfulness,

use of condoms, and avoiding substance abuse; and

(F) encouraging active involvement of the private

sector, including businesses, pharmaceutical and biotechnology companies, the medical and scientific communities, charitable foundations, private and voluntary

organizations and nongovernmental organizations, faithbased organizations, community-based organizations, and

other nonprofit entities.

(23) Prostitution and other sexual victimization are

degrading to women and children and it should be the policy

of the United States to eradicate such practices. The sex

industry, the trafficking of individuals into such industry, and

sexual violence are additional causes of and factors in the

spread of the HIV/AIDS epidemic. One in nine South Africans

is living with AIDS, and sexual assault is rampant, at a victimization rate of one in three women. Meanwhile in Cambodia,

as many as 40 percent of prostitutes are infected with HIV

and the country has the highest rate of increase of HIV infection

in all of Southeast Asia. Victims of coercive sexual encounters

do not get to make choices about their sexual activities.

(24) Strong coordination must exist among the various

agencies of the United States to ensure effective and efficient

use of financial and technical resources within the United

States Government with respect to the provision of international HIV/AIDS assistance.

(25) In his address to Congress on January 28, 2003, the

President announced the Administration’s intention to embark

on a five-year emergency plan for AIDS relief, to confront

HIV/AIDS with the goals of preventing 7,000,000 new HIV/

AIDS infections, treating at least 2,000,000 people with lifeextending drugs, and providing humane care for millions of

people suffering from HIV/AIDS, and for children orphaned

by HIV/AIDS.

(26) In this address to Congress, the President stated the

following: ‘‘Today, on the continent of Africa, nearly 30,000,000

people have the AIDS virus—including 3,000,000 children

under the age of 15. There are whole countries in Africa where

more than one-third of the adult population carries the infection. More than 4,000,000 require immediate drug treatment.

Yet across that continent, only 50,000 AIDS victims—only

50,000—are receiving the medicine they need.’’.

(27) Furthermore, the President focused on care and treatment of HIV/AIDS in his address to Congress, stating the

following: ‘‘Because the AIDS diagnosis is considered a death

sentence, many do not seek treatment. Almost all who do

are turned away. A doctor in rural South Africa describes

his frustration. He says, ‘We have no medicines. Many hospitals

tell people, you’ve got AIDS, we can’t help you. Go home and

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 717

die.’ In an age of miraculous medicines, no person should have

to hear those words. AIDS can be prevented. Anti-retroviral

drugs can extend life for many years * * * Ladies and gentlemen, seldom has history offered a greater opportunity to do

so much for so many.’’.

(28) Finally, the President stated that ‘‘[w]e have confronted, and will continue to confront, HIV/AIDS in our own

country’’, proposing now that the United States should lead

the world in sparing innocent people from a plague of nature,

and asking Congress ‘‘to commit $15,000,000,000 over the next

five years, including nearly $10,000,000,000 in new money,

to turn the tide against AIDS in the most afflicted nations

of Africa and the Caribbean’’.

SEC. 3. DEFINITIONS.

In this Act:

(1) AIDS.—The term ‘‘AIDS’’ means the acquired immune

deficiency syndrome.

(2) APPROPRIATE CONGRESSIONAL COMMITTEES.—The term

‘‘appropriate congressional committees’’ means the Committee

on Foreign Relations of the Senate and the Committee on

International Relations of the House of Representatives.

(3) GLOBAL FUND.—The term ‘‘Global Fund’’ means the

public-private partnership known as the Global Fund to Fight

AIDS, Tuberculosis and Malaria established pursuant to Article

80 of the Swiss Civil Code.

(4) HIV.—The term ‘‘HIV’’ means the human immunodeficiency virus, the pathogen that causes AIDS.

(5) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means, with respect

to an individual, an individual who is infected with HIV or

living with AIDS.

(6) RELEVANT EXECUTIVE BRANCH AGENCIES.—The term

‘‘relevant executive branch agencies’’ means the Department

of State, the United States Agency for International Development, and any other department or agency of the United States

that participates in international HIV/AIDS activities pursuant

to the authorities of such department or agency or the Foreign

Assistance Act of 1961.

SEC. 4. PURPOSE.

The purpose of this Act is to strengthen United States leadership and the effectiveness of the United States response to certain

global infectious diseases by—

(1) establishing a comprehensive, integrated five-year,

global strategy to fight HIV/AIDS that encompasses a plan

for phased expansion of critical programs and improved

coordination among relevant executive branch agencies and

between the United States and foreign governments and international organizations;

(2) providing increased resources for multilateral efforts

to fight HIV/AIDS;

(3) providing increased resources for United States bilateral

efforts, particularly for technical assistance and training, to

combat HIV/AIDS, tuberculosis, and malaria;

(4) encouraging the expansion of private sector efforts and

expanding public-private sector partnerships to combat HIV/

AIDS; and

22 USC 7603.

22 USC 7602.

117 STAT. 718 PUBLIC LAW 108–25—MAY 27, 2003

(5) intensifying efforts to support the development of vaccines and treatment for HIV/AIDS, tuberculosis, and malaria.

SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

With respect to the reports required by this Act to be submitted

by the President, to ensure an efficient use of resources, the President may, in his discretion and notwithstanding any other provision

of this Act, consolidate or combine any of these reports, except

for the report required by section 101 of this Act, so long as

the required elements of each report are addressed and reported

within a 90-day period from the original deadline date for submission of the report specified in this Act. The President may also

enter into contracts with organizations with relevant expertise to

develop, originate, or contribute to any of the reports required

by this Act to be submitted by the President.

TITLE I—POLICY PLANNING AND

COORDINATION

SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL

STRATEGY.

(a) STRATEGY.—The President shall establish a comprehensive,

integrated, five-year strategy to combat global HIV/AIDS that

strengthens the capacity of the United States to be an effective

leader of the international campaign against HIV/AIDS. Such

strategy shall maintain sufficient flexibility and remain responsive

to the ever-changing nature of the HIV/AIDS pandemic and shall—

(1) include specific objectives, multisectoral approaches, and

specific strategies to treat individuals infected with HIV/AIDS

and to prevent the further spread of HIV infections, with a

particular focus on the needs of families with children

(including the prevention of mother-to-child transmission),

women, young people, and children (such as unaccompanied

minor children and orphans);

(2) as part of the strategy, implement a tiered approach

to direct delivery of care and treatment through a system

based on central facilities augmented by expanding circles of

local delivery of care and treatment through local systems

and capacity;

(3) assign priorities for relevant executive branch agencies;

(4) provide that the reduction of HIV/AIDS behavioral risks

shall be a priority of all prevention efforts in terms of funding,

educational messages, and activities by promoting abstinence

from sexual activity and substance abuse, encouraging

monogamy and faithfulness, promoting the effective use of

condoms, and eradicating prostitution, the sex trade, rape,

sexual assault and sexual exploitation of women and children;

(5) improve coordination and reduce duplication among

relevant executive branch agencies, foreign governments, and

international organizations;

(6) project general levels of resources needed to achieve

the stated objectives;

(7) expand public-private partnerships and the leveraging

of resources;

President.

22 USC 7611.

Deadline.

22 USC 7604.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 719

(8) maximize United States capabilities in the areas of

technical assistance and training and research, including vaccine research;

(9) establish priorities for the distribution of resources

based on factors such as the size and demographics of the

population with HIV/AIDS, tuberculosis, and malaria and the

needs of that population and the existing infrastructure or

funding levels that may exist to cure, treat, and prevent HIV/

AIDS, tuberculosis, and malaria; and

(10) include initiatives describing how the President will

maximize the leverage of private sector dollars in reduction

and treatment of HIV/AIDS, tuberculosis, and malaria.

(b) REPORT.—

(1) IN GENERAL.—Not later than 270 days after the date

of enactment of this Act, the President shall submit to the

appropriate congressional committees a report setting forth

the strategy described in subsection (a).

(2) REPORT CONTENTS.—The report required by paragraph

(1) shall include a discussion of the elements described in

paragraph (3) and may include a discussion of additional elements relevant to the strategy described in subsection (a).

Such discussion may include an explanation as to why a particular element described in paragraph (3) is not relevant to

such strategy.

(3) REPORT ELEMENTS.—The elements referred to in paragraph (2) are the following:

(A) The objectives, general and specific, of the strategy.

(B) A description of the criteria for determining success

of the strategy.

(C) A description of the manner in which the strategy

will address the fundamental elements of prevention and

education, care, and treatment (including increasing access

to pharmaceuticals and to vaccines), the promotion of

abstinence, monogamy, avoidance of substance abuse, and

use of condoms, research (including incentives for vaccine

development and new protocols), training of health care

workers, the development of health care infrastructure and

delivery systems, and avoidance of substance abuse.

(D) A description of the manner in which the strategy

will promote the development and implementation of

national and community-based multisectoral strategies and

programs, including those designed to enhance leadership

capacity particularly at the community level.

(E) A description of the specific strategies developed

to meet the unique needs of women, including the empowerment of women in interpersonal situations, young people

and children, including those orphaned by HIV/AIDS and

those who are victims of the sex trade, rape, sexual abuse,

assault, and exploitation.

(F) A description of the specific strategies developed

to encourage men to be responsible in their sexual behavior,

child rearing and to respect women including the reduction

of sexual violence and coercion.

(G) A description of the specific strategies developed

to increase women’s access to employment opportunities,

income, productive resources, and microfinance programs.

Deadline.

President.

117 STAT. 720 PUBLIC LAW 108–25—MAY 27, 2003

(H) A description of the programs to be undertaken

to maximize United States contributions in the areas of

technical assistance, training (particularly of health care

workers and community-based leaders in affected sectors),

and research, including the promotion of research on vaccines and microbicides.

(I) An identification of the relevant executive branch

agencies that will be involved and the assignment of priorities to those agencies.

(J) A description of the role of each relevant executive

branch agency and the types of programs that the agency

will be undertaking.

(K) A description of the mechanisms that will be utilized to coordinate the efforts of the relevant executive

branch agencies, to avoid duplication of efforts, to enhance

on-site coordination efforts, and to ensure that each agency

undertakes programs primarily in those areas where the

agency has the greatest expertise, technical capabilities,

and potential for success.

(L) A description of the mechanisms that will be utilized to ensure greater coordination between the United

States and foreign governments and international organizations including the Global Fund, UNAIDS, international

financial institutions, and private sector organizations.

(M) The level of resources that will be needed on an

annual basis and the manner in which those resources

would generally be allocated among the relevant executive

branch agencies.

(N) A description of the mechanisms to be established

for monitoring and evaluating programs, promoting

successful models, and for terminating unsuccessful programs.

(O) A description of the manner in which private, nongovernmental entities will factor into the United States

Government-led effort and a description of the type of

partnerships that will be created to maximize the capabilities of these private sector entities and to leverage

resources.

(P) A description of the ways in which United States

leadership will be used to enhance the overall international

response to the HIV/AIDS pandemic and particularly to

heighten the engagement of the member states of the G–

8 and to strengthen key financial and coordination mechanisms such as the Global Fund and UNAIDS.

(Q) A description of the manner in which the United

States strategy for combating HIV/AIDS relates to and

supports other United States assistance strategies in developing countries.

(R) A description of the programs to be carried out

under the strategy that are specifically targeted at women

and girls to educate them about the spread of HIV/AIDS.

(S) A description of efforts being made to address the

unique needs of families with children with respect to

HIV/AIDS, including efforts to preserve the family unit.

(T) An analysis of the emigration of critically important

medical and public health personnel, including physicians,

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 721

nurses, and supervisors from sub-Saharan African countries that are acutely impacted by HIV/AIDS, including

a description of the causes, effects, and the impact on

the stability of health infrastructures, as well as a summary

of incentives and programs that the United States could

provide, in concert with other private and public sector

partners and international organizations, to stabilize health

institutions by encouraging critical personnel to remain

in their home countries.

(U) A description of the specific strategies developed

to promote sustainability of HIV/AIDS pharmaceuticals

(including antiretrovirals) and the effects of drug resistance

on HIV/AIDS patients.

(V) A description of the specific strategies to ensure

that the extraordinary benefit of HIV/AIDS pharmaceuticals (especially antiretrovirals) are not diminished

through the illegal counterfeiting of pharmaceuticals and

black market sales of such pharmaceuticals.

(W) An analysis of the prevalence of Human Papilloma

Virus (HPV) in sub-Saharan Africa and the impact that

condom usage has upon the spread of HPV in sub-Saharan

Africa.

(c) STUDY; DISTRIBUTION OF RESOURCES.—

(1) STUDY.—Not later than 3 years after the date of the

enactment of this Act, the Institute of Medicine shall publish

findings comparing the success rates of the various programs

and methods used under the strategy described in subsection

(a) to reduce, prevent, and treat HIV/AIDS, tuberculosis, and

malaria.

(2) DISTRIBUTION OF RESOURCES.—In prioritizing the distribution of resources under the strategy described in subsection

(a), the President shall consider the findings published by the

Institute of Medicine under this subsection.

SEC. 102. HIV/AIDS RESPONSE COORDINATOR.

(a) ESTABLISHMENT OF POSITION.—Section 1 of the State

Department Basic Authorities Act of 1956 (22 U.S.C. 265(a)) is

amended—

(1) by redesignating subsection (f) as subsection (g); and

(2) by inserting after subsection (e) the following:

‘‘(f) HIV/AIDS RESPONSE COORDINATOR.—

‘‘(1) IN GENERAL.—There shall be established within the

Department of State in the immediate office of the Secretary

of State a Coordinator of United States Government Activities

to Combat HIV/AIDS Globally, who shall be appointed by the

President, by and with the advice and consent of the Senate.

The Coordinator shall report directly to the Secretary.

‘‘(2) AUTHORITIES AND DUTIES; DEFINITIONS.—

‘‘(A) AUTHORITIES.—The Coordinator, acting through

such nongovernmental organizations (including faith-based

and community-based organizations) and relevant executive branch agencies as may be necessary and appropriate

to effect the purposes of this section, is authorized—

‘‘(i) to operate internationally to carry out prevention, care, treatment, support, capacity development,

and other activities for combatting HIV/AIDS;

President.

22 USC 2651a.

22 USC 7612.

President.

Deadline.

Publication.

117 STAT. 722 PUBLIC LAW 108–25—MAY 27, 2003

‘‘(ii) to transfer and allocate funds to relevant

executive branch agencies; and

‘‘(iii) to provide grants to, and enter into contracts

with, nongovernmental organizations (including faithbased and community-based organizations) to carry out

the purposes of section.

‘‘(B) DUTIES.— ‘‘(i) IN GENERAL.—The Coordinator shall have primary responsibility for the oversight and coordination

of all resources and international activities of the

United States Government to combat the HIV/AIDS

pandemic, including all programs, projects, and activities of the United States Government relating to the

HIV/AIDS pandemic under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act

of 2003 or any amendment made by that Act.

‘‘(ii) SPECIFIC DUTIES.—The duties of the Coordinator shall specifically include the following:

‘‘(I) Ensuring program and policy coordination

among the relevant executive branch agencies and

nongovernmental organizations, including

auditing, monitoring, and evaluation of all such

programs.

‘‘(II) Ensuring that each relevant executive

branch agency undertakes programs primarily in

those areas where the agency has the greatest

expertise, technical capabilities, and potential for

success.

‘‘(III) Avoiding duplication of effort.

‘‘(IV) Ensuring coordination of relevant executive branch agency activities in the field.

‘‘(V) Pursuing coordination with other countries and international organizations.

‘‘(VI) Resolving policy, program, and funding

disputes among the relevant executive branch

agencies.

‘‘(VII) Directly approving all activities of the

United States (including funding) relating to

combatting HIV/AIDS in each of Botswana, Cote

d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa,

Tanzania, Uganda, Zambia, and other countries

designated by the President, which other designated countries may include those countries in

which the United States is implementing HIV/

AIDS programs as of the date of the enactment

of the United States Leadership Against HIV/

AIDS, Tuberculosis, and Malaria Act of 2003.

‘‘(VIII) Establishing due diligence criteria for

all recipients of funds section and all activities

subject to the coordination and appropriate monitoring, evaluation, and audits carried out by the

Coordinator necessary to assess the measurable

outcomes of such activities.

‘‘(C) DEFINITIONS.—In this paragraph:

‘‘(i) AIDS.—The term ‘AIDS’ means acquired

immune deficiency syndrome.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 723

‘‘(ii) HIV.—The term ‘HIV’ means the human

immunodeficiency virus, the pathogen that causes

AIDS.

‘‘(iii) HIV/AIDS.—The term ‘HIV/AIDS’ means,

with respect to an individual, an individual who is

infected with HIV or living with AIDS.

‘‘(iv) RELEVANT EXECUTIVE BRANCH AGENCIES.—

The term ‘relevant executive branch agencies’ means

the Department of State, the United States Agency

for International Development, the Department of

Health and Human Services (including the Public

Health Service), and any other department or agency

of the United States that participates in international

HIV/AIDS activities pursuant to the authorities of such

department or agency or this Act.’’.

(b) RESOURCES.—Not later than 90 days after the date of enactment of this Act, the President shall specify the necessary financial

and personnel resources, from funds appropriated pursuant to the

authorization of appropriations under section 401 for HIV/AIDS

assistance, that shall be assigned to and under the direct control

of the Coordinator of United States Government Activities to Combat HIV/AIDS Globally to establish and maintain the duties and

supporting activities assigned to the Coordinator by this Act and

the amendments made by this Act.

(c) ESTABLISHMENT OF SEPARATE ACCOUNT.—There is established in the general fund of the Treasury a separate account

which shall be known as the ‘‘Activities to Combat HIV/AIDS Globally Fund’’ and which shall be administered by the Coordinator

of United States Government Activities to Combat HIV/AIDS Globally. There shall be deposited into the Fund all amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS assistance, except for amounts appropriated

for United States contributions to the Global Fund.

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE PARTNERSHIPS

SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.

(a) FINDINGS.—Congress makes the following findings:

(1) Innovative partnerships between governments and

organizations in the private sector (including foundations,

universities, corporations, faith-based and community-based

organizations, and other nongovernmental organizations) have

proliferated in recent years, particularly in the area of health.

(2) Public-private sector partnerships multiply local and

international capacities to strengthen the delivery of health

services in developing countries and to accelerate research for

vaccines and other pharmaceutical products that are essential

to combat infectious diseases decimating the populations of

these countries.

(3) These partnerships maximize the unique capabilities

of each sector while combining financial and other resources,

scientific knowledge, and expertise toward common goals which

neither the public nor the private sector can achieve alone.

22 USC 7621.

Deadline.

President.

117 STAT. 724 PUBLIC LAW 108–25—MAY 27, 2003

(4) Sustaining existing public-private partnerships and

building new ones are critical to the success of the international

community’s efforts to combat HIV/AIDS and other infectious

diseases around the globe.

(b) SENSE OF CONGRESS.—It is the sense of Congress that—

(1) the sustainment and promotion of public-private partnerships should be a priority element of the strategy pursued

by the United States to combat the HIV/AIDS pandemic and

other global health crises; and

(2) the United States should systematically track the evolution of these partnerships and work with others in the public

and private sector to profile and build upon those models that

are most effective.

SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS,

TUBERCULOSIS AND MALARIA.

(a) FINDINGS.—The Congress finds as follows:

(1) The establishment of the Global Fund in January 2002

is consistent with the general principles for an international

AIDS trust fund first outlined by the Congress in the Global

AIDS and Tuberculosis Relief Act of 2000 (Public Law 106–

264).

(2) Section 2, Article 5 of the bylaws of the Global Fund

provides for the International Bank for Reconstruction and

Development to serve as the initial collection trustee for the

Global Fund.

(3) The trustee agreement signed between the Global Fund

and the International Bank for Reconstruction and Development narrows the range of duties to include receiving and

investing funds from donors, disbursing the funds upon the

instruction of the Global Fund, reporting on trust fund

resources to donors and the Global Fund, and providing an

annual external audit report to the Global Fund.

(b) AUTHORITY FOR UNITED STATES PARTICIPATION.—

(1) UNITED STATES PARTICIPATION.—The United States is

hereby authorized to participate in the Global Fund.

(2) PRIVILEGES AND IMMUNITIES.—The Global Fund shall

be considered a public international organization for purposes

of section 1 of the International Organizations Immunities Act

(22 U.S.C. 288).

(c) REPORTS TO CONGRESS.—Not later than 1 year after the

date of the enactment of this Act, and annually thereafter for

the duration of the Global Fund, the President shall submit to

the appropriate congressional committees a report on the Global

Fund, including contributions pledged to, contributions (including

donations from the private sector) received by, and projects funded

by the Global Fund, and the mechanisms established for transparency and accountability in the grant-making process.

(d) UNITED STATES FINANCIAL PARTICIPATION.—

(1) AUTHORIZATION OF APPROPRIATIONS.—In addition to any

other funds authorized to be appropriated for bilateral or multilateral HIV/AIDS, tuberculosis, or malaria programs, of the

amounts authorized to be appropriated under section 401, there

are authorized to be appropriated to the President up to

$1,000,000,000 for the period of fiscal year 2004 beginning

on January 1, 2004, and such sums as may be necessary for

Deadline.

President.

22 USC 7622.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 725

the fiscal years 2005–2008, for contributions to the Global

Fund.

(2) AVAILABILITY OF FUNDS.—Amounts appropriated under

paragraph (1) are authorized to remain available until

expended.

(3) REPROGRAMMING OF FISCAL YEAR 2001 FUNDS.—Funds

made available for fiscal year 2001 under section 141 of the

Global AIDS and Tuberculosis Relief Act of 2000—

(A) are authorized to remain available until expended;

and

(B) shall be transferred to, merged with, and made

available for the same purposes as, funds made available

for fiscal years 2004 through 2008 under paragraph (1).

(4) LIMITATION.— (A)(i) At any time during fiscal years 2004 through

2008, no United States contribution to the Global Fund

may cause the total amount of United States Government

contributions to the Global Fund to exceed 33 percent

of the total amount of funds contributed to the Global

Fund from all sources. Contributions to the Global Fund

from the International Bank for Reconstruction and

Development and the International Monetary Fund shall

not be considered in determining compliance with this paragraph.

(ii) If, at any time during any of the fiscal years 2004

through 2008, the President determines that the Global

Fund has provided assistance to a country, the government

of which the Secretary of State has determined, for purposes of section 6(j)(1) of the Export Administration Act

of 1979 (50 U.S.C. App. 2405(j)(1)), has repeatedly provided

support for acts of international terrorism, then the United

States shall withhold from its contribution for the next

fiscal year an amount equal to the amount expended by

the Fund to the government of each such country.

(iii) If at any time the President determines that the

expenses of the Governing, Administrative, and Advisory

Bodies (including the Partnership Forum, the Foundation

Board, the Secretariat, and the Technical Review Board)

of the Global Fund exceed 10 percent of the total expenditures of the Fund for any 2-year period, the United States

shall withhold from its contribution for the next fiscal

year an amount equal the to the average annual amount

expended by the Fund for such 2-year period for the

expenses of the Governing, Administrative, and Advisory

Bodies in excess of 10 percent of the total expenditures

of the Fund.

(iv) The President may waive the application of clause

(iii) if the President determines that extraordinary circumstances warrant such a waiver. No waiver under this

clause may be for any period that exceeds 1 year.

(v) If, at any time during any of the fiscal years 2004

through 2008, the President determines that the salary

of any individual employed by the Global Fund exceeds

the salary of the Vice President of the United States (as

determined under section 104 of title 3, United States

Code) for that fiscal year, then the United States shall

withhold from its contribution for the next fiscal year an

117 STAT. 726 PUBLIC LAW 108–25—MAY 27, 2003

amount equal to the aggregate amount by which the salary

of each such individual exceeds the salary of the Vice

President of the United States.

(B)(i) Any amount made available under this subsection that is withheld by reason of subparagraph (A)(i)

shall be contributed to the Global Fund as soon as practicable, subject to subparagraph (A)(i), after additional contributions to the Global Fund are made from other sources.

(ii) Any amount made available under this subsection

that is withheld by reason of subparagraph (A)(iii) shall

be transferred to the Activities to Combat HIV/AIDS Globally Fund and shall remain available under the same terms

and conditions as funds appropriated pursuant to the

authorization of appropriations under section 401 for HIV/

AIDS assistance.

(iii) Any amount made available under this subsection

that is withheld by reason of clause (ii) or (iii) of subparagraph (A) is authorized to be made available to carry out

section 104A of the Foreign Assistance Act of 1961 (as

added by section 301 of this Act). Amounts made available

under the preceding sentence are in addition to amounts

appropriated pursuant to the authorization of appropriations under section 401 of this Act for HIV/AIDS assistance.

(C)(i) The President may suspend the application of

subparagraph (A) with respect to a fiscal year if the President determines that an international health emergency

threatens the national security interests of the United

States.

(ii) The President shall notify the Committee on International Relations of the House of Representatives and

the Committee on Foreign Relations of the Senate not

less than 5 days before making a determination under

clause (i) with respect to the application of subparagraph

(A)(i) and shall include in the notification—

(I) a justification as to why increased United States

Government contributions to the Global Fund is preferable to increased United States assistance to combat

HIV/AIDS, tuberculosis, and malaria on a bilateral

basis; and

(II) an explanation as to why other government

donors to the Global Fund are unable to provide adequate contributions to the Fund.

(e) INTERAGENCY TECHNICAL REVIEW PANEL.—

(1) ESTABLISHMENT.—The Coordinator of United States

Government Activities to Combat HIV/AIDS Globally, established in section 1(f)(1) of the State Department Basic Authorities Act of 1956 (as added by section 102(a) of this Act), shall

establish in the executive branch an interagency technical

review panel.

(2) DUTIES.—The interagency technical review panel shall

serve as a ‘‘shadow’’ panel to the Global Fund by—

(A) periodically reviewing all proposals received by the

Global Fund; and

(B) providing guidance to the United States persons

who are representatives on the panels, committees, and

boards of the Global Fund, on the technical efficacy, suitability, and appropriateness of the proposals, and ensuring

President.

Notification.

Deadline.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 727

that such persons are fully informed of technical inadequacies or other aspects of the proposals that are inconsistent

with the purposes of this or any other Act relating to

the provision of foreign assistance in the area of AIDS.

(3) MEMBERSHIP.—The interagency technical review panel

shall consist of qualified medical and development experts who

are officers or employees of the Department of Health and

Human Services, the Department of State, and the United

States Agency for International Development.

(4) CHAIR.—The Coordinator referred to in paragraph (1)

shall chair the interagency technical review panel.

(f) MONITORING BY COMPTROLLER GENERAL.—

(1) MONITORING.—The Comptroller General shall monitor

and evaluate projects funded by the Global Fund.

(2) REPORT.—The Comptroller General shall on a biennial

basis shall prepare and submit to the appropriate congressional

committees a report that contains the results of the monitoring

and evaluation described in paragraph (1) for the preceding

2-year period.

(g) PROVISION OF INFORMATION TO CONGRESS.—The Coordinator

of United States Government Activities to Combat HIV/AIDS Globally shall make available to the Congress the following documents

within 30 days of a request by the Congress for such documents:

(1) All financial and accounting statements for the Global

Fund and the Activities to Combat HIV/AIDS Globally Fund,

including administrative and grantee statements.

(2) Reports provided to the Global Fund and the Activities

to Combat HIV/AIDS Globally Fund by organizations contracted

to audit recipients of funds.

(3) Project proposals submitted by applicants for funding

from the Global Fund and the Activities to Combat HIV/AIDS

Globally Fund, but which were not funded.

(4) Progress reports submitted to the Global Fund and

the Activities to Combat HIV/AIDS Globally Fund by grantees.

(h) SENSE OF THE CONGRESS REGARDING ENCOURAGEMENT OF

PRIVATE CONTRIBUTIONS TO THE GLOBAL FUND.—It is the sense

of the Congress that the President should—

(1) conduct an outreach campaign that is designed to—

(A) inform the public of the existence of—

(i) the Global Fund; and

(ii) any entity that will accept private contributions

intended for use by the Global Fund; and

(B) encourage private contributions to the Global Fund;

and

(2) encourage private contributions intended for use by

the Global Fund by—

(A) establishing and operating an Internet website,

and publishing information about the website; and

(B) making public service announcements on radio and

television.

SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE

FUNDS.

(a) VACCINE FUND.—Section 302(k) of the Foreign Assistance

Act of 1961 (22 U.S.C. 2222(k)) is amended—

Deadline.

117 STAT. 728 PUBLIC LAW 108–25—MAY 27, 2003

(1) by striking ‘‘$50,000,000 for each of the fiscal years

2001 and 2002’’ and inserting ‘‘such sums as may be necessary

for each of the fiscal years 2004 through 2008’’; and

(2) by striking ‘‘Global Alliance for Vaccines and Immunizations’’ and inserting ‘‘Vaccine Fund’’.

(b) INTERNATIONAL AIDS VACCINE INITIATIVE.—Section 302(l)

of the Foreign Assistance Act of 1961 (22 U.S.C. 2222(l)) is amended

by striking ‘‘$10,000,000 for each of the fiscal years 2001 and

2002’’ and inserting ‘‘such sums as may be necessary for each

of the fiscal years 2004 through 2008’’.

(c) SUPPORT FOR THE DEVELOPMENT OF MALARIA VACCINE.— Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222))

is amended by adding at the end the following new subsection:

‘‘(m) In addition to amounts otherwise available under this

section, there are authorized to be appropriated to the President

such sums as may be necessary for each of the fiscal years 2004

through 2008 to be available for United States contributions to

malaria vaccine development programs, including the Malaria Vaccine Initiative of the Program for Appropriate Technologies in

Health (PATH).’’.

TITLE III—BILATERAL EFFORTS

Subtitle A—General Assistance and

Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

(a) AMENDMENT OF THE FOREIGN ASSISTANCE ACT OF 1961.—

Chapter 1 of part I of the Foreign Assistance Act of 1961 (22

U.S.C. 2151 et seq.) is amended—

(1) in section 104(c) (22 U.S.C. 2151b(c)), by striking paragraphs (4) through (7); and

(2) by inserting after section 104 the following new section:

‘‘SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.

‘‘(a) FINDING.—Congress recognizes that the alarming spread

of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean,

and other developing countries is a major global health, national

security, development, and humanitarian crisis.

‘‘(b) POLICY.—It is a major objective of the foreign assistance

program of the United States to provide assistance for the prevention, treatment, and control of HIV/AIDS. The United States and

other developed countries should provide assistance to countries

in sub-Saharan Africa, the Caribbean, and other countries and

areas to control this crisis through HIV/AIDS prevention, treatment,

monitoring, and related activities, particularly activities focused

on women and youth, including strategies to protect women and

prevent mother-to-child transmission of the HIV infection.

‘‘(c) AUTHORIZATION.— ‘‘(1) IN GENERAL.—Consistent with section 104(c), the President is authorized to furnish assistance, on such terms and

conditions as the President may determine, for HIV/AIDS,

including to prevent, treat, and monitor HIV/AIDS, and carry

out related activities, in countries in sub-Saharan Africa, the

Caribbean, and other countries and areas.

22 USC

2151b–2.

22 USC 7631.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 729

‘‘(2) ROLE OF NGOS.—It is the sense of Congress that the

President should provide an appropriate level of assistance

under paragraph (1) through nongovernmental organizations

(including faith-based and community-based organizations) in

countries in sub-Saharan Africa, the Caribbean, and other countries and areas affected by the HIV/AIDS pandemic.

‘‘(3) COORDINATION OF ASSISTANCE EFFORTS.—The President

shall coordinate the provision of assistance under paragraph

(1) with the provision of related assistance by the Joint United

Nations Programme on HIV/AIDS (UNAIDS), the United

Nations Children’s Fund (UNICEF), the World Health

Organization (WHO), the United Nations Development Programme (UNDP), the Global Fund to Fight AIDS, Tuberculosis

and Malaria and other appropriate international organizations

(such as the International Bank for Reconstruction and

Development), relevant regional multilateral development

institutions, national, state, and local governments of foreign

countries, appropriate governmental and nongovernmental

organizations, and relevant executive branch agencies.

‘‘(d) ACTIVITIES SUPPORTED.—Assistance provided under subsection (c) shall, to the maximum extent practicable, be used to

carry out the following activities:

‘‘(1) PREVENTION.—Prevention of HIV/AIDS through activities including—

‘‘(A) programs and efforts that are designed or intended

to impart knowledge with the exclusive purpose of helping

individuals avoid behaviors that place them at risk of HIV

infection, including integration of such programs into

health programs and the inclusion in counseling programs

of information on methods of avoiding infection of HIV,

including delaying sexual debut, abstinence, fidelity and

monogamy, reduction of casual sexual partnering, reducing

sexual violence and coercion, including child marriage,

widow inheritance, and polygamy, and where appropriate,

use of condoms;

‘‘(B) assistance to establish and implement culturally

appropriate HIV/AIDS education and prevention programs

that focus on helping individuals avoid infection of HIV/

AIDS, implemented through nongovernmental organizations, including faith-based and community-based organizations, particularly those organizations that utilize both

professionals and volunteers with appropriate skills, experience, and community presence;

‘‘(C) assistance for the purpose of encouraging men

to be responsible in their sexual behavior, child rearing,

and to respect women;

‘‘(D) assistance for the purpose of providing voluntary

testing and counseling (including the incorporation of confidentiality protections with respect to such testing and

counseling);

‘‘(E) assistance for the purpose of preventing motherto-child transmission of the HIV infection, including medications to prevent such transmission and access to infant

formula and other alternatives for infant feeding;

‘‘(F) assistance to ensure a safe blood supply and sterile

medical equipment;

President.

117 STAT. 730 PUBLIC LAW 108–25—MAY 27, 2003

‘‘(G) assistance to help avoid substance abuse and

intravenous drug use that can lead to HIV infection; and

(H) assistance for the purpose of increasing women’s

access to employment opportunities, income, productive

resources, and microfinance programs, where appropriate.

‘‘(2) TREATMENT.—The treatment and care of individuals

with HIV/AIDS, including—

‘‘(A) assistance to establish and implement programs

to strengthen and broaden indigenous health care delivery

systems and the capacity of such systems to deliver HIV/

AIDS pharmaceuticals and otherwise provide for the treatment of individuals with HIV/AIDS, including clinical

training for indigenous organizations and health care providers;

‘‘(B) assistance to strengthen and expand hospice and

palliative care programs to assist patients debilitated by

HIV/AIDS, their families, and the primary caregivers of

such patients, including programs that utilize faith-based

and community-based organizations; and

‘‘(C) assistance for the purpose of the care and treatment of individuals with HIV/AIDS through the provision

of pharmaceuticals, including antiretrovirals and other

pharmaceuticals and therapies for the treatment of

opportunistic infections, nutritional support, and other

treatment modalities.

‘‘(3) PREVENTATIVE INTERVENTION EDUCATION AND TECHNOLOGIES.—(A) With particular emphasis on specific populations that represent a particularly high risk of contracting

or spreading HIV/AIDS, including those exploited through the

sex trade, victims of rape and sexual assault, individuals

already infected with HIV/AIDS, and in cases of occupational

exposure of health care workers, assistance with efforts to

reduce the risk of HIV/AIDS infection including post-exposure

pharmaceutical prophylaxis, and necessary pharmaceuticals

and commodities, including test kits, condoms, and, when

proven effective, microbicides.

‘‘(B) Bulk purchases of available test kits, condoms, and,

when proven effective, microbicides that are intended to reduce

the risk of HIV/AIDS transmission and for appropriate program

support for the introduction and distribution of these commodities, as well as education and training on the use of the

technologies.

‘‘(4) MONITORING.—The monitoring of programs, projects,

and activities carried out pursuant to paragraphs (1) through

(3), including—

‘‘(A) monitoring to ensure that adequate controls are

established and implemented to provide HIV/AIDS pharmaceuticals and other appropriate medicines to poor individuals with HIV/AIDS;

‘‘(B) appropriate evaluation and surveillance activities;

‘‘(C) monitoring to ensure that appropriate measures

are being taken to maintain the sustainability of HIV/

AIDS pharmaceuticals (especially antiretrovirals) and

ensure that drug resistance is not compromising the benefits of such pharmaceuticals; and

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 731

‘‘(D) monitoring to ensure appropriate law enforcement

officials are working to ensure that HIV/AIDS pharmaceuticals are not diminished through illegal counterfeiting

or black market sales of such pharmaceuticals.

‘‘(5) PHARMACEUTICALS.— ‘‘(A) PROCUREMENT.—The procurement of HIV/AIDS

pharmaceuticals, antiviral therapies, and other appropriate

medicines, including medicines to treat opportunistic infections.

‘‘(B) MECHANISMS FOR QUALITY CONTROL AND SUSTAIN- ABLE SUPPLY.—Mechanisms to ensure that such HIV/AIDS

pharmaceuticals, antiretroviral therapies, and other appropriate medicines are quality-controlled and sustainably

supplied.

‘‘(C) DISTRIBUTION.—The distribution of such HIV/

AIDS pharmaceuticals, antiviral therapies, and other

appropriate medicines (including medicines to treat

opportunistic infections) to qualified national, regional, or

local organizations for the treatment of individuals with

HIV/AIDS in accordance with appropriate HIV/AIDS

testing and monitoring requirements and treatment protocols and for the prevention of mother-to-child transmission

of the HIV infection.

‘‘(6) RELATED ACTIVITIES.—The conduct of related activities,

including—

‘‘(A) the care and support of children who are orphaned

by the HIV/AIDS pandemic, including services designed

to care for orphaned children in a family environment

which rely on extended family members;

‘‘(B) improved infrastructure and institutional capacity

to develop and manage education, prevention, and treatment programs, including training and the resources to

collect and maintain accurate HIV surveillance data to

target programs and measure the effectiveness of interventions; and

‘‘(C) vaccine research and development partnership programs with specific plans of action to develop a safe, effective, accessible, preventive HIV vaccine for use throughout

the world.

‘‘(7) COMPREHENSIVE HIV/AIDS PUBLIC-PRIVATE PARTNERSHIPS.—The establishment and operation of public-private partnership entities within countries in sub-Saharan Africa, the

Caribbean, and other countries affected by the HIV/AIDS pandemic that are dedicated to supporting the national strategy

of such countries regarding the prevention, treatment, and

monitoring of HIV/AIDS. Each such public-private partnership

should—

‘‘(A) support the development, implementation, and

management of comprehensive HIV/AIDS plans in support

of the national HIV/AIDS strategy;

‘‘(B) operate at all times in a manner that emphasizes

efficiency, accountability, and results-driven programs;

‘‘(C) engage both local and foreign development partners and donors, including businesses, government agencies, academic institutions, nongovernmental organizations,

foundations, multilateral development agencies, and faithbased organizations, to assist the country in coordinating

117 STAT. 732 PUBLIC LAW 108–25—MAY 27, 2003

and implementing HIV/AIDS prevention, treatment, and

monitoring programs in accordance with its national HIV/

AIDS strategy;

‘‘(D) provide technical assistance, consultant services,

financial planning, monitoring and evaluation, and

research in support of the national HIV/AIDS strategy;

and

‘‘(E) establish local human resource capacities for the

national HIV/AIDS strategy through the transfer of medical, managerial, leadership, and technical skills.

‘‘(e) ANNUAL REPORT.— ‘‘(1) IN GENERAL.—Not later than January 31 of each year,

the President shall submit to the Committee on Foreign Relations of the Senate and the Committee on International Relations of the House of Representatives a report on the

implementation of this section for the prior fiscal year.

‘‘(2) REPORT ELEMENTS.—Each report shall include—

‘‘(A) a description of efforts made by each relevant

executive branch agency to implement the policies set forth

in this section, section 104B, and section 104C;

‘‘(B) a description of the programs established pursuant

to such sections; and

‘‘(C) a detailed assessment of the impact of programs

established pursuant to such sections, including—

‘‘(i)(I) the effectiveness of such programs in

reducing the spread of the HIV infection, particularly

in women and girls, in reducing mother-to-child transmission of the HIV infection, and in reducing mortality

rates from HIV/AIDS; and

‘‘(II) the number of patients currently receiving

treatment for AIDS in each country that receives

assistance under this Act.

‘‘(ii) the progress made toward improving health

care delivery systems (including the training of adequate numbers of staff) and infrastructure to ensure

increased access to care and treatment;

‘‘(iii) with respect to tuberculosis, the increase in

the number of people treated and the increase in

number of tuberculosis patients cured through each

program, project, or activity receiving United States

foreign assistance for tuberculosis control purposes;

and

‘‘(iv) with respect to malaria, the increase in the

number of people treated and the increase in number

of malaria patients cured through each program,

project, or activity receiving United States foreign

assistance for malaria control purposes.

‘‘(f) FUNDING LIMITATION.—Of the funds made available to carry

out this section in any fiscal year, not more than 7 percent may

be used for the administrative expenses of the United States Agency

for International Development in support of activities described

in section 104(c), this section, section 104B, and section 104C.

Such amount shall be in addition to other amounts otherwise available for such purposes.

‘‘(g) DEFINITIONS.—In this section:

‘‘(1) AIDS.—The term ‘AIDS’ means acquired immune deficiency syndrome.

Deadline.

President.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 733

‘‘(2) HIV.—The term ‘HIV’ means the human immunodeficiency virus, the pathogen that causes AIDS.

‘‘(3) HIV/AIDS.—The term ‘HIV/AIDS’ means, with respect

to an individual, an individual who is infected with HIV or

living with AIDS.

‘‘(4) RELEVANT EXECUTIVE BRANCH AGENCIES.—The term

‘relevant executive branch agencies’ means the Department

of State, the United States Agency for International Development, the Department of Health and Human Services (including

its agencies and offices), and any other department or agency

of the United States that participates in international HIV/

AIDS activities pursuant to the authorities of such department

or agency or this Act.’’.

(b) AUTHORIZATION OF APPROPRIATIONS.— (1) IN GENERAL.—In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.

2151b(c)) for such purpose or under any other provision of

that Act, there are authorized to be appropriated to the President, from amounts authorized to be appropriated under section

401, such sums as may be necessary for each of the fiscal

years 2004 through 2008 to carry out section 104A of the

Foreign Assistance Act of 1961, as added by subsection (a).

(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant to paragraph (1) are authorized to remain available until

expended.

(3) ALLOCATION OF FUNDS.—Of the amount authorized to

be appropriated by paragraph (1) for the fiscal years 2004

through 2008, such sums as may be necessary are authorized

to be appropriated to carry out section 104A(d)(4) of the Foreign

Assistance Act of 1961 (as added by subsection (a)), relating

to the procurement and distribution of HIV/AIDS pharmaceuticals.

(c) RELATIONSHIP TO ASSISTANCE PROGRAMS TO ENHANCE

NUTRITION.—In recognition of the fact that malnutrition may hasten

the progression of HIV to AIDS and may exacerbate the decline

among AIDS patients leading to a shorter life span, the Administrator of the United States Agency for International Development

shall, as appropriate—

(1) integrate nutrition programs with HIV/AIDS activities,

generally;

(2) provide, as a component of an anti-retroviral therapy

program, support for food and nutrition to individuals infected

with and affected by HIV/AIDS; and

(3) provide support for food and nutrition for children

affected by HIV/AIDS and to communities and households

caring for children affected by HIV/AIDS.

(d) ELIGIBILITY FOR ASSISTANCE.—An organization that is otherwise eligible to receive assistance under section 104A of the Foreign

Assistance Act of 1961 (as added by subsection (a)) or under any

other provision of this Act (or any amendment made by this Act)

to prevent, treat, or monitor HIV/AIDS shall not be required, as

a condition of receiving the assistance, to endorse or utilize a

multisectoral approach to combatting HIV/AIDS, or to endorse,

utilize, or participate in a prevention method or treatment program

to which the organization has a religious or moral objection.

(e) LIMITATION.—No funds made available to carry out this

Act, or any amendment made by this Act, may be used to promote

117 STAT. 734 PUBLIC LAW 108–25—MAY 27, 2003

or advocate the legalization or practice of prostitution or sex trafficking. Nothing in the preceding sentence shall be construed to

preclude the provision to individuals of palliative care, treatment,

or post-exposure pharmaceutical prophylaxis, and necessary

pharmaceuticals and commodities, including test kits, condoms, and,

when proven effective, microbicides.

(f) LIMITATION.—No funds made available to carry out this

Act, or any amendment made by this Act, may be used to provide

assistance to any group or organization that does not have a policy

explicitly opposing prostitution and sex trafficking.

(g) SENSE OF CONGRESS RELATING TO FOOD ASSISTANCE FOR

INDIVIDUALS LIVING WITH HIV/AIDS.—

(1) FINDINGS.—Congress finds the following:

(A) The United States provides more than 60 percent

of all food assistance worldwide.

(B) According to the United Nations World Food Program and other United Nations agencies, food insecurity

of individuals infected or living with HIV/AIDS is a major

problem in countries with large populations of such individuals, particularly in African countries.

(C) Although the United States is willing to provide

food assistance to these countries in need, a few of the

countries object to part or all of the assistance because

of fears of benign genetic modifications to the foods.

(D) Healthy and nutritious foods for individuals

infected or living with HIV/AIDS are an important complement to HIV/AIDS medicines for such individuals.

(E) Individuals infected with HIV have higher nutritional requirements than individuals who are not infected

with HIV, particularly with respect to the need for protein.

Also, there is evidence to suggest that the full benefit

of therapy to treat HIV/AIDS may not be achieved in

individuals who are malnourished, particularly in pregnant

and lactating women.

(2) SENSE OF CONGRESS.—It is therefore the sense of Congress that United States food assistance should be accepted

by countries with large populations of individuals infected or

living with HIV/AIDS, particularly African countries, in order

to help feed such individuals.

SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

(a) AMENDMENT OF THE FOREIGN ASSISTANCE ACT OF 1961.—

Chapter 1 of part I of the Foreign Assistance Act of 1961 (22

U.S.C. 2151 et seq.), as amended by section 301 of this Act, is

further amended by inserting after section 104A the following new

section:

‘‘SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

‘‘(a) FINDINGS.—Congress makes the following findings:

‘‘(1) Congress recognizes the growing international problem

of tuberculosis and the impact its continued existence has on

those countries that had previously largely controlled the disease.

‘‘(2) Congress further recognizes that the means exist to

control and treat tuberculosis through expanded use of the

DOTS (Directly Observed Treatment Short-course) treatment

strategy, including DOTS-Plus to address multi-drug resistant

22 USC

2151b–3.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 735

tuberculosis, and adequate investment in newly created mechanisms to increase access to treatment, including the Global

Tuberculosis Drug Facility established in 2001 pursuant to

the Amsterdam Declaration to Stop TB and the Global Alliance

for TB Drug Development.

‘‘(b) POLICY.—It is a major objective of the foreign assistance

program of the United States to control tuberculosis, including

the detection of at least 70 percent of the cases of infectious tuberculosis, and the cure of at least 85 percent of the cases detected,

not later than December 31, 2005, in those countries classified

by the World Health Organization as among the highest tuberculosis burden, and not later than December 31, 2010, in all countries in which the United States Agency for International Development has established development programs.

‘‘(c) AUTHORIZATION.—To carry out this section and consistent

with section 104(c), the President is authorized to furnish assistance, on such terms and conditions as the President may determine,

for the prevention, treatment, control, and elimination of tuberculosis.

‘‘(d) COORDINATION.—In carrying out this section, the President

shall coordinate with the World Health Organization, the Global

Fund to Fight AIDS, Tuberculosis, and Malaria, and other organizations with respect to the development and implementation of a

comprehensive tuberculosis control program.

‘‘(e) PRIORITY TO DOTS COVERAGE.—In furnishing assistance

under subsection (c), the President shall give priority to activities

that increase Directly Observed Treatment Short-course (DOTS)

coverage and treatment of multi-drug resistant tuberculosis where

needed using DOTS-Plus, including funding for the Global Tuberculosis Drug Facility, the Stop Tuberculosis Partnership, and the

Global Alliance for TB Drug Development. In order to meet the

requirement of the preceding sentence, the President should ensure

that not less than 75 percent of the amount made available to

carry out this section for a fiscal year should be expended for

antituberculosis drugs, supplies, direct patient services, and

training in diagnosis and treatment for Directly Observed Treatment Short-course (DOTS) coverage and treatment of multi-drug

resistant tuberculosis using DOTS-Plus, including substantially

increased funding for the Global Tuberculosis Drug Facility.

‘‘(f) DEFINITIONS.—In this section:

‘‘(1) DOTS.—The term ‘DOTS’ or ‘Directly Observed Treatment Short-course’ means the World Health Organization-recommended strategy for treating tuberculosis.

‘‘(2) DOTS-PLUS.—The term ‘DOTS-Plus’ means a comprehensive tuberculosis management strategy that is built upon

and works as a supplement to the standard DOTS strategy,

and which takes into account specific issues (such as use of

second line anti-tuberculosis drugs) that need to be addressed

in areas where there is high prevalence of multi-drug resistant

tuberculosis.

‘‘(3) GLOBAL ALLIANCE FOR TUBERCULOSIS DRUG DEVELOP- MENT.—The term ‘Global Alliance for Tuberculosis Drug

Development’ means the public-private partnership that brings

together leaders in health, science, philanthropy, and private

industry to devise new approaches to tuberculosis and to ensure

that new medications are available and affordable in high tuberculosis burden countries and other affected countries.

President.

President.

117 STAT. 736 PUBLIC LAW 108–25—MAY 27, 2003

‘‘(4) GLOBAL TUBERCULOSIS DRUG FACILITY.—The term

‘Global Tuberculosis Drug Facility (GDF)’ means the new initiative of the Stop Tuberculosis Partnership to increase access

to high-quality tuberculosis drugs to facilitate DOTS expansion.

‘‘(5) STOP TUBERCULOSIS PARTNERSHIP.—The term ‘Stop

Tuberculosis Partnership’ means the partnership of the World

Health Organization, donors including the United States, high

tuberculosis burden countries, multilateral agencies, and nongovernmental and technical agencies committed to short- and

long-term measures required to control and eventually eliminate tuberculosis as a public health problem in the world.’’.

(b) AUTHORIZATION OF APPROPRIATIONS.— (1) IN GENERAL.—In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.

2151b(c)) for such purpose or under any other provision of

that Act, there are authorized to be appropriated to the President, from amounts authorized to be appropriated under section

401, such sums as may be necessary for each of the fiscal

years 2004 through 2008 to carry out section 104B of the

Foreign Assistance Act of 1961, as added by subsection (a).

(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant to the authorization of appropriations under paragraph

(1) are authorized to remain available until expended.

(3) TRANSFER OF PRIOR YEAR FUNDS.—Unobligated balances

of funds made available for fiscal year 2001, 2002, or 2003

under section 104(c)(7) of the Foreign Assistance Act of 1961

(22 U.S.C. 2151b(c)(7) (as in effect immediately before the date

of enactment of this Act) shall be transferred to, merged with,

and made available for the same purposes as funds made

available for fiscal years 2004 through 2008 under paragraph

(1).

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

(a) AMENDMENT OF THE FOREIGN ASSISTANCE ACT OF 1961.—

Chapter 1 of part I of the Foreign Assistance Act of 1961 (22

U.S.C. 2151 et seq.), as amended by sections 301 and 302 of this

Act, is further amended by inserting after section 104B the following

new section:

‘‘SEC. 104C. ASSISTANCE TO COMBAT MALARIA.

‘‘(a) FINDING.—Congress finds that malaria kills more people

annually than any other communicable disease except tuberculosis,

that more than 90 percent of all malaria cases are in sub-Saharan

Africa, and that children and women are particularly at risk. Congress recognizes that there are cost-effective tools to decrease the

spread of malaria and that malaria is a curable disease if promptly

diagnosed and adequately treated.

‘‘(b) POLICY.—It is a major objective of the foreign assistance

program of the United States to provide assistance for the prevention, control, and cure of malaria.

‘‘(c) AUTHORIZATION.—To carry out this section and consistent

with section 104(c), the President is authorized to furnish assistance, on such terms and conditions as the President may determine,

for the prevention, treatment, control, and elimination of malaria.

‘‘(d) COORDINATION.—In carrying out this section, the President

shall coordinate with the World Health Organization, the Global

Fund to Fight AIDS, Tuberculosis, and Malaria, the Department

of Health and Human Services (the Centers for Disease Control

President.

22 USC

2151b–4.

22 USC 7632.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 737

and Prevention and the National Institutes of Health), and other

organizations with respect to the development and implementation

of a comprehensive malaria control program.’’.

(b) AUTHORIZATION OF APPROPRIATIONS.—

(1) IN GENERAL.—In addition to funds available under section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C.

2151b(c)) for such purpose or under any other provision of

that Act, there are authorized to be appropriated to the President, from amounts authorized to be appropriated under section

401, such sums as may be necessary for fiscal years 2004

through 2008 to carry out section 104C of the Foreign Assistance Act of 1961, as added by subsection (a), including for

the development of anti-malarial pharmaceuticals by the Medicines for Malaria Venture.

(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant to paragraph (1) are authorized to remain available until

expended.

(3) TRANSFER OF PRIOR YEAR FUNDS.—Unobligated balances

of funds made available for fiscal year 2001, 2002, or 2003

under section 104(c) of the Foreign Assistance Act of 1961

(22 U.S.C. 2151b(c) (as in effect immediately before the date

of enactment of this Act) and made available for the control

of malaria shall be transferred to, merged with, and made

available for the same purposes as funds made available for

fiscal years 2004 through 2008 under paragraph (1).

(c) CONFORMING AMENDMENT.—Section 104(c) of the Foreign

Assistance Act of 1961 (22 U.S.C. 2151b(c)), as amended by section

301 of this Act, is further amended by adding after paragraph

(3) the following:

‘‘(4) RELATIONSHIP TO OTHER LAWS.—Assistance made available

under this subsection and sections 104A, 104B, and 104C, and

assistance made available under chapter 4 of part II to carry

out the purposes of this subsection and the provisions cited in

this paragraph, may be made available notwithstanding any other

provision of law that restricts assistance to foreign countries, except

for the provisions of this subsection, the provisions of law cited

in this paragraph, subsection (f), section 634A of this Act, and

provisions of law that limit assistance to organizations that support

or participate in a program of coercive abortion or involuntary

sterilization included under the Child Survival and Health Programs Fund heading in the Consolidated Appropriations Resolution,

2003 (Public Law 108–7).’’.

SEC. 304. PILOT PROGRAM FOR THE PLACEMENT OF HEALTH CARE

PROFESSIONALS IN OVERSEAS AREAS SEVERELY

AFFECTED BY HIV/AIDS, TUBERCULOSIS, AND MALARIA.

(a) IN GENERAL.—The President should establish a program

to demonstrate the feasibility of facilitating the service of United

States health care professionals in those areas of sub-Saharan

Africa and other parts of the world severely affected by HIV/AIDS,

tuberculosis, and malaria.

(b) REQUIREMENTS.—Participants in the program shall—

(1) provide basic health care services for those infected

and affected by HIV/AIDS, tuberculosis, and malaria in the

area in which they are serving;

President.

22 USC 7634.

22 USC 7633.

117 STAT. 738 PUBLIC LAW 108–25—MAY 27, 2003

(2) provide on-the-job training to medical and other personnel in the area in which they are serving to strengthen

the basic health care system of the affected countries;

(3) provide health care educational training for residents

of the area in which they are serving;

(4) serve for a period of up to 3 years; and

(5) meet the eligibility requirements in subsection (d).

(c) ELIGIBILITY REQUIREMENTS.—To be eligible to participate

in the program, a candidate shall—

(1) be a national of the United States who is a trained

health care professional and who meets the educational and

licensure requirements necessary to be such a professional such

as a physician, nurse, physician assistant, nurse practitioner,

pharmacist, other type of health care professional, or other

individual determined to be appropriate by the President; or

(2) be a retired commissioned officer of the Public Health

Service Corps.

(d) RECRUITMENT.—The President shall ensure that information

on the program is widely distributed, including the distribution

of information to schools for health professionals, hospitals, clinics,

and nongovernmental organizations working in the areas of international health and aid.

(e) PLACEMENT OF PARTICIPANTS.—

(1) IN GENERAL.—To the maximum extent practicable,

participants in the program shall serve in the poorest areas

of the affected countries, where health care needs are likely

to be the greatest. The decision on the placement of a participant should be made in consultation with relevant officials

of the affected country at both the national and local level

as well as with local community leaders and organizations.

(2) COORDINATION.—Placement of participants in the program shall be coordinated with the United States Agency for

International Development in countries in which that Agency

is conducting HIV/AIDS, tuberculosis, or malaria programs.

Overall coordination of placement of participants in the program shall be made by the Coordinator of United States

Government Activities to Combat HIV/AIDS Globally (as

described in section 1(f) of the State Department Basic Authorities Act of 1956 (as added by section 102(a) of this Act)).

(f) INCENTIVES.—The President may offer such incentives as

the President determines to be necessary to encourage individuals

to participate in the program, such as partial payment of principal,

interest, and related expenses on government and commercial loans

for educational expenses relating to professional health training

and, where possible, deferment of repayments on such loans, the

provision of retirement benefits that would otherwise be jeopardized

by participation in the program, and other incentives.

(g) REPORT.—Not later than 18 months after the date of enactment of this Act, the President shall submit to the appropriate

congressional committees a report on steps taken to establish the

program, including—

(1) the process of recruitment, including the venues for

recruitment, the number of candidates recruited, the incentives

offered, if any, and the cost of those incentives;

(2) the process, including the criteria used, for the selection

of participants;

Deadline.

President.

President.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 739

(3) the number of participants placed, the countries in

which they were placed, and why those countries were selected;

and

(4) the potential for expansion of the program.

(h) AUTHORIZATION OF APPROPRIATIONS.—

(1) IN GENERAL.—In addition to amounts otherwise available for such purpose, there are authorized to be appropriated

to the President, from amounts authorized to be appropriated

under section 401, such sums as may be necessary for each

of the fiscal years 2004 through 2008 to carry out the program.

(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant to the authorization of appropriations under paragraph

(1) are authorized to remain available until expended.

SEC. 305. REPORT ON TREATMENT ACTIVITIES BY RELEVANT EXECUTIVE BRANCH AGENCIES.

(a) IN GENERAL.—Not later than 15 months after the date

of enactment of this Act, the President shall submit to appropriate

congressional committees a report on the programs and activities

of the relevant executive branch agencies that are directed to the

treatment of individuals in foreign countries infected with HIV

or living with AIDS.

(b) REPORT ELEMENTS.—The report shall include—

(1) a description of the activities of relevant executive

branch agencies with respect to—

(A) the treatment of opportunistic infections;

(B) the use of antiretrovirals;

(C) the status of research into successful treatment

protocols for individuals in the developing world;

(D) technical assistance and training of local health

care workers (in countries affected by the pandemic) to

administer antiretrovirals, manage side effects, and monitor patients’ viral loads and immune status;

(E) the status of strategies to promote sustainability

of HIV/AIDS pharmaceuticals (including antiretrovirals)

and the effects of drug resistance on HIV/AIDS patients;

and

(F) the status of appropriate law enforcement officials

working to ensure that HIV/AIDS pharmaceutical treatment is not diminished through illegal counterfeiting and

black market sales of such pharmaceuticals;

(2) information on existing pilot projects, including a discussion of why a given population was selected, the number of

people treated, the cost of treatment, the mechanisms established to ensure that treatment is being administered effectively

and safely, and plans for scaling up pilot projects (including

projected timelines and required resources); and

(3) an explanation of how those activities relate to efforts

to prevent the transmission of the HIV infection.

SEC. 306. STRATEGIES TO IMPROVE INJECTION SAFETY.

Section 307 of the Public Health Service Act (42 U.S.C. 242l)

is amended by adding at the end the following:

‘‘(d) In carrying out immunization programs and other programs

in developing countries for the prevention, treatment, and control

of infectious diseases, including HIV/AIDS, tuberculosis, and

President.

Deadline.

22 USC 7635.

117 STAT. 740 PUBLIC LAW 108–25—MAY 27, 2003

malaria, the Director of the Centers for Disease Control and Prevention, in coordination with the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, the National

Institutes of Health, national and local government, and other

organizations, such as the World Health Organization and the

United Nations Children’s Fund, shall develop and implement effective strategies to improve injection safety, including eliminating

unnecessary injections, promoting sterile injection practices and

technologies, strengthening the procedures for proper needle and

syringe disposal, and improving the education and information provided to the public and to health professionals.’’.

SEC. 307. STUDY ON ILLEGAL DIVERSIONS OF PRESCRIPTION DRUGS.

Not later than 180 days after enactment of this Act, the Secretary of Health and Human Services, in coordination with other

agencies, shall submit a report to the Congress that includes the

following:

(1) A thorough accounting of evidence indicating illegal

diversion into the United States of prescription drugs donated

or sold for humanitarian efforts, and an estimate of the extent

of such diversion.

(2) Recommendations to increase the administrative and

enforcement powers of the United States to identify, monitor,

and prevent the illegal diversion into the United States of

prescription drugs donated or sold for humanitarian efforts.

(3) Recommendations and guidelines to advise and provide

technical assistance to developing countries on how to implement a program that minimizes diversion into the United States

of prescription drugs donated or sold for humanitarian efforts.

Subtitle B—Assistance for Children and

Families

SEC. 311. FINDINGS.

Congress makes the following findings:

(1) Approximately 2,000 children around the world are

infected each day with HIV through mother-to-child transmission. Transmission can occur during pregnancy, labor, and

delivery or through breast feeding. Over 90 percent of these

cases are in developing nations with little or no access to

public health facilities.

(2) Mother-to-child transmission is largely preventable with

the proper application of pharmaceuticals, therapies, and other

public health interventions.

(3) Certain antiretroviral drugs reduce mother-to-child

transmission by nearly 50 percent. Universal availability of

this drug could prevent up to 400,000 infections per year and

dramatically reduce the number of AIDS-related deaths.

(4) At the United Nations Special Session on HIV/AIDS

in June 2001, the United States committed to the specific

goals with respect to the prevention of mother-to-child transmission, including the goals of reducing the proportion of

infants infected with HIV by 20 percent by the year 2005

and by 50 percent by the year 2010, as specified in the Declaration of Commitment on HIV/AIDS adopted by the United

Nations General Assembly at the Special Session.

22 USC 7651.

Deadline.

Reports.

22 USC 7636.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 741

(5) Several United States Government agencies including

the United States Agency for International Development and

the Centers for Disease Control are already supporting programs to prevent mother-to-child transmission in resource-poor

nations and have the capacity to expand these programs rapidly

by working closely with foreign governments and nongovernmental organizations.

(6) Efforts to prevent mother-to-child transmission can provide the basis for a broader response that includes care and

treatment of mothers, fathers, and other family members who

are infected with HIV or living with AIDS.

(7) HIV/AIDS has devastated the lives of countless children

and families across the globe. Since the epidemic began, an

estimated 13,200,000 children under the age of 15 have been

orphaned by AIDS, that is they have lost their mother or

both parents to the disease. The Joint United Nations Program

on HIV/AIDS (UNAIDS) estimates that this number will double

by the year 2010.

(8) HIV/AIDS also targets young people between the ages

of 15 to 24, particularly young women, many of whom carry

the burden of caring for family members living with HIV/

AIDS. An estimated 10,300,000 young people are now living

with HIV/AIDS. One-half of all new infections are occurring

among this age group.

SEC. 312. POLICY AND REQUIREMENTS.

(a) POLICY.—The United States Government’s response to the

global HIV/AIDS pandemic should place high priority on the prevention of mother-to-child transmission, the care and treatment of

family members and caregivers, and the care of children orphaned

by AIDS. To the maximum extent possible, the United States

Government should seek to leverage its funds by seeking matching

contributions from the private sector, other national governments,

and international organizations.

(b) REQUIREMENTS.—The 5-year United States Government

strategy required by section 101 of this Act shall—

(1) provide for meeting or exceeding the goal to reduce

the rate of mother-to-child transmission of HIV by 20 percent

by 2005 and by 50 percent by 2010;

(2) include programs to make available testing and treatment to HIV-positive women and their family members,

including drug treatment and therapies to prevent motherto-child transmission; and

(3) expand programs designed to care for children orphaned

by AIDS.

SEC. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD

TRANSMISSION OF THE HIV INFECTION.

(a) IN GENERAL.—Not later than 1 year after the date of the

enactment of this Act, and annually thereafter for a period of

5 years, the President shall submit to appropriate congressional

committees a report on the activities of relevant executive branch

agencies during the reporting period to assist in the prevention

of mother-to-child transmission of the HIV infection.

(b) REPORT ELEMENTS.—Each report shall include—

(1) a statement of whether or not all relevant executive

branch agencies have met the goal described in section

312(b)(1); and

Deadline.

President.

22 USC 7653.

22 USC 7652.

117 STAT. 742 PUBLIC LAW 108–25—MAY 27, 2003

(2) a description of efforts made by the relevant executive

branch agencies to expand those activities, including—

(A) information on the number of sites supported for

the prevention of mother-to-child transmission of the HIV

infection;

(B) the specific activities supported;

(C) the number of women tested and counseled; and

(D) the number of women receiving preventative drug

therapies.

(c) REPORTING PERIOD DEFINED.—In this section, the term

‘‘reporting period’’ means, in the case of the initial report, the

period since the date of enactment of this Act and, in the case

of any subsequent report, the period since the date of submission

of the most recent report.

SEC. 314. PILOT PROGRAM OF ASSISTANCE FOR CHILDREN AND FAMILIES AFFECTED BY HIV/AIDS.

(a) IN GENERAL.—The President, acting through the United

States Agency for International Development, should establish a

program of assistance that would demonstrate the feasibility of

the provision of care and treatment to orphans and other children

and young people affected by HIV/AIDS in foreign countries.

(b) PROGRAM REQUIREMENTS.—The program should—

(1) build upon and be integrated into programs administered as of the date of enactment of this Act by the relevant

executive branch agencies for children affected by HIV/AIDS;

(2) work in conjunction with indigenous community-based

programs and activities, particularly those that offer proven

services for children;

(3) reduce the stigma of HIV/AIDS to encourage vulnerable

children infected with HIV or living with AIDS and their family

members and caregivers to avail themselves of voluntary counseling and testing, and related programs, including treatments;

(4) ensure the importance of inheritance rights of women,

particularly women in African countries, due to the exponential

growth in the number of young widows, orphaned girls, and

grandmothers becoming heads of households as a result of

the HIV/AIDS pandemic;

(5) provide, in conjunction with other relevant executive

branch agencies, the range of services for the care and treatment, including the provision of antiretrovirals and other necessary pharmaceuticals, of children, parents, and caregivers

infected with HIV or living with AIDS;

(6) provide nutritional support and food security, and the

improvement of overall family health;

(7) work with parents, caregivers, and community-based

organizations to provide children with educational opportunities; and

(8) provide appropriate counseling and legal assistance for

the appointment of guardians and the handling of other issues

relating to the protection of children.

(c) REPORT.—Not later than 18 months after the date of enactment of this Act, the President should submit a report on the

implementation of this section to the appropriate congressional

committees. Such report should include a description of activities

undertaken to carry out subsection (b)(4).

(d) AUTHORIZATION OF APPROPRIATIONS.—

Deadline.

President.

President.

22 USC 7654.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 743

(1) IN GENERAL.—In addition to amounts otherwise available for such purpose, there are authorized to be appropriated

to the President, from amounts authorized to be appropriated

under section 401, such sums as may be necessary for each

of the fiscal years 2004 through 2008 to carry out the program.

A significant percentage of the amount appropriated pursuant

to the authorization of appropriations under the preceding sentence for a fiscal year should be made available to carry out

subsection (b)(4).

(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant to paragraph (1) are authorized to remain available until

expended.

SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.

(a) PURPOSE.—The purpose of this section is to authorize the

President to establish a program, through a public-private partnership, for the provision of medical care and support services to

HIV positive parents and their children identified through existing

programs to prevent mother-to-child transmission of HIV in countries with or at risk for severe HIV epidemic with particular attention to resource constrained countries.

(b) GRANTS.—

(1) IN GENERAL.—The President is authorized to establish

a program for the award of grants to eligible administrative

organizations to enable such organizations to award subgrants

to eligible entities to expand activities to prevent the motherto-child transmission of HIV by providing medical care and

support services to HIV infected parents and their children.

(2) USE OF FUNDS.—Amounts provided under a grant

awarded under paragraph (1) shall be used—

(A) to award subgrants to eligible entities to enable

such entities to carry out activities described in subsection

(c);

(B) for administrative support and subgrant management;

(C) for administrative data collection and reporting

concerning grant activities;

(D) for the monitoring and evaluation of grant activities;

(E) for training and technical assistance for subgrantees; and

(F) to promote sustainability.

(c) SUBGRANTS.—

(1) IN GENERAL.—An organization awarded a grant under

subsection (b) shall use amounts received under the grant to

award subgrants to eligible entities.

(2) ELIGIBILITY.—To be eligible to receive a subgrant under

paragraph (1), an entity shall—

(A) be a local health organization, an international

organization, or a partnership of such organizations; and

(B) demonstrate to the awarding organization that such

entity—

(i) is currently administering a proven intervention

to prevent mother-to-child transmission of HIV in countries with or at risk for severe HIV epidemic with

particular attention to resource constrained countries,

as determined by the President;

President.

22 USC 7655.

117 STAT. 744 PUBLIC LAW 108–25—MAY 27, 2003

(ii) has demonstrated support for the proposed program from relevant government entities; and

(iii) is able to provide HIV care, including

antiretroviral treatment when medically indicated, to

HIV positive women, men, and children with the support of the project funding.

(3) LOCAL HEALTH AND INTERNATIONAL ORGANIZATIONS.—

For purposes of paragraph (2)(A)—

(A) the term ‘‘local health organization’’ means a public

sector health system, nongovernmental organization,

institution of higher education, community-based organization, or nonprofit health system that provides directly,

or has a clear link with a provider for the indirect provision

of, primary health care services; and

(B) the term ‘‘international organization’’ means—

(i) a nonprofit international entity;

(ii) an international charitable institution;

(iii) a private voluntary international entity; or

(iv) a multilateral institution.

(4) PRIORITY REQUIREMENT.—In awarding subgrants under

this subsection, the organization shall give priority to eligible

applicants that are currently administering a program of proven

intervention to HIV positive individuals to prevent motherto-child transmission in countries with or at risk for severe

HIV epidemic with particular attention to resource constrained

countries, and who are currently administering a program to

HIV positive women, men, and children to provide life-long

care in family-centered care programs using non-Federal funds.

(5) SELECTION OF SUBGRANT RECIPIENTS.—In awarding subgrants under this subsection, the organization should—

(A) consider applicants from a range of health care

settings, program approaches, and geographic locations;

and

(B) if appropriate, award not less than 1 grant to

an applicant to fund a national system of health care

delivery to HIV positive families.

(6) USE OF SUBGRANT FUNDS.—An eligible entity awarded

a subgrant under this subsection shall use subgrant funds

to expand activities to prevent mother-to-child transmission

of HIV by providing medical treatment and care and support

services to parents and their children, which may include—

(A) providing treatment and therapy, when medically

indicated, to HIV-infected women, their children, and families;

(B) the hiring and training of local personnel, including

physicians, nurses, other health care providers, counselors,

social workers, outreach personnel, laboratory technicians,

data managers, and administrative support personnel;

(C) paying laboratory costs, including costs related to

necessary equipment and diagnostic testing and monitoring

(including rapid testing), complete blood counts, standard

chemistries, and liver function testing for infants, children,

and parents, and costs related to the purchase of necessary

laboratory equipment;

(D) purchasing pharmaceuticals for HIV-related conditions, including antiretroviral therapies;

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 745

(E) funding support services, including adherence and

psychosocial support services;

(F) operational support activities; and

(G) conducting community outreach and capacity

building activities, including activities to raise the awareness of individuals of the program carried out by the subgrantee, other communications activities in support of the

program, local advisory board functions, and transportation

necessary to ensure program participation.

(d) REPORTS.—The President shall require that each organization awarded a grant under subsection (b)(1) to submit an annual

report that includes—

(1) the progress of programs funded under this section;

(2) the benchmarks of success of programs funded under

this section; and

(3) recommendations of how best to proceed with the programs funded under this section upon the expiration of funding

under subsection (e).

(e) FUNDING.—There are authorized to be appropriated to the

President, from amounts authorized to be appropriated under section 401, such sums as may be necessary for each of the fiscal

years 2004 through 2008 to carry out the program.

(f) LIMITATION ON ADMINISTRATIVE EXPENSES.—An organization

shall ensure that not more than 7 percent of the amount of a

grant received under this section by the organization is used for

administrative expenses.

TITLE IV—AUTHORIZATION OF

APPROPRIATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

(a) IN GENERAL.—There are authorized to be appropriated to

the President to carry out this Act and the amendments made

by this Act $3,000,000,000 for each of the fiscal years 2004 through

2008.

(b) AVAILABILITY.—Amounts appropriated pursuant to the

authorization of appropriations in subsection (a) are authorized

to remain available until expended.

(c) AVAILABILITY OF AUTHORIZATIONS.—Authorizations of appropriations under subsection (a) shall remain available until the

appropriations are made.

SEC. 402. SENSE OF CONGRESS.

(a) INCREASE IN HIV/AIDS ANTIRETROVIRAL TREATMENT.—It

is a sense of the Congress that an urgent priority of United States

assistance programs to fight HIV/AIDS should be the rapid increase

in distribution of antiretroviral treatment so that—

(1) by the end of fiscal year 2004, at least 500,000 individuals with HIV/AIDS are receiving antiretroviral treatment

through United States assistance programs;

(2) by the end of fiscal year 2005, at least 1,000,000 such

individuals are receiving such treatment; and

(3) by the end of fiscal year 2006, at least 2,000,000 such

individuals are receiving such treatment.

(b) EFFECTIVE DISTRIBUTION OF HIV/AIDS FUNDS.—It is the

sense of Congress that, of the amounts appropriated pursuant to

22 USC 7672.

22 USC 7671.

117 STAT. 746 PUBLIC LAW 108–25—MAY 27, 2003

the authorization of appropriations under section 401 for HIV/

AIDS assistance, an effective distribution of such amounts would

be—

(1) 55 percent of such amounts for treatment of individuals

with HIV/AIDS;

(2) 15 percent of such amounts for palliative care of individuals with HIV/AIDS;

(3) 20 percent of such amounts for HIV/AIDS prevention

consistent with section 104A(d) of the Foreign Assistance Act

of 1961 (as added by section 301 of this Act), of which such

amount at least 33 percent should be expended for abstinenceuntil-marriage programs; and

(4) 10 percent of such amounts for orphans and vulnerable

children.

SEC. 403. ALLOCATION OF FUNDS.

(a) THERAPEUTIC MEDICAL CARE.—For fiscal years 2006 through

2008, not less than 55 percent of the amounts appropriated pursuant to the authorization of appropriations under section 401 for

HIV/AIDS assistance for each such fiscal year shall be expended

for therapeutic medical care of individuals infected with HIV, of

which such amount at least 75 percent should be expended for

the purchase and distribution of antiretroviral pharmaceuticals and

at least 25 percent should be expended for related care. For fiscal

years 2006 through 2008, not less than 33 percent of the amounts

appropriated pursuant to the authorization of appropriations under

section 401 for HIV/AIDS prevention consistent with section 104A(d)

of the Foreign Assistance Act of 1961 (as added by section 301

of this Act) for each such fiscal year shall be expended for

abstinence-until-marriage programs.

(b) ORPHANS AND VULNERABLE CHILDREN.—For fiscal years

2006 through 2008, not less than 10 percent of the amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS assistance for each such fiscal year shall

be expended for assistance for orphans and vulnerable children

affected by HIV/AIDS, of which such amount at least 50 percent

shall be provided through non-profit, nongovernmental organizations, including faith-based organizations, that implement programs

on the community level.

SEC. 404. ASSISTANCE FROM THE UNITED STATES PRIVATE SECTOR

TO PREVENT AND REDUCE HIV/AIDS IN SUB-SAHARAN

AFRICA.

It is the sense of Congress that United States businesses should

be encouraged to provide assistance to sub-Saharan African countries to prevent and reduce the incidence of HIV/AIDS in subSaharan Africa. In providing such assistance, United States

businesses should be encouraged to consider the establishment of

an HIV/AIDS Response Fund in order to provide for coordination

among such businesses in the collection and distribution of the

assistance to sub-Saharan African countries.

22 USC 7674.

22 USC 7673.

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 747

TITLE V—INTERNATIONAL FINANCIAL

INSTITUTIONS

SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

Title XVI of the International Financial Institutions Act (22

U.S.C. 262p–262p–7) is amended by adding at the end the following

new section:

‘‘SEC. 1625. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.

‘‘(a) AUTHORITY.— ‘‘(1) IN GENERAL.—The Secretary of the Treasury should

immediately commence efforts within the Paris Club of Official

Creditors, the International Bank for Reconstruction and

Development, the International Monetary Fund, and other

appropriate multilateral development institutions to modify the

Enhanced HIPC Initiative so that the amount of debt stock

reduction approved for a country eligible for debt relief under

the Enhanced HIPC Initiative shall be sufficient to reduce,

for each of the first 3 years after the date of enactment of

this section or the Decision Point, whichever is later—

‘‘(A) the net present value of the outstanding public

and publicly guaranteed debt of the country—

‘‘(i) as of the decision point if the country has

already reached its decision point; or

‘‘(ii) as of the date of enactment of this Act, if

the country has not reached its decision point,

to not more than 150 percent of the annual value of exports

of the country for the year preceding the Decision Point;

and

‘‘(B) the annual payments due on such public and

publicly guaranteed debt to not more than—

‘‘(i) 10 percent or, in the case of a country suffering

a public health crisis (as defined in subsection (e)),

not more than 5 percent, of the amount of the annual

current revenues received by the country from internal

resources; or

‘‘(ii) a percentage of the gross national product

of the country, or another benchmark, that will yield

a result substantially equivalent to that which would

be achieved through application of subparagraph (A).

‘‘(2) LIMITATION.—In financing the objectives of the

Enhanced HIPC Initiative, an international financial institution

shall give priority to using its own resources.

‘‘(b) RELATION TO POVERTY AND THE ENVIRONMENT.—Debt cancellation under the modifications to the Enhanced HIPC Initiative

described in subsection (a) should not be conditioned on any agreement by an impoverished country to implement or comply with

policies that deepen poverty or degrade the environment, including

any policy that—

‘‘(1) implements or extends user fees on primary education

or primary health care, including prevention and treatment

efforts for HIV/AIDS, tuberculosis, malaria, and infant, child,

and maternal well-being;

‘‘(2) provides for increased cost recovery from poor people

to finance basic public services such as education, health care,

clean water, or sanitation;

22 USC 262p–8.

117 STAT. 748 PUBLIC LAW 108–25—MAY 27, 2003

‘‘(3) reduces the country’s minimum wage to a level of less than $2 per day or undermines workers’ ability to exercise

effectively their internationally recognized worker rights, as

defined under section 526(e) of the Foreign Operations, Export

Financing and Related Programs Appropriations Act, 1995 (22

U.S.C. 262p–4p); or

‘‘(4) promotes unsustainable extraction of resources or

results in reduced budget support for environmental programs.

‘‘(c) CONDITIONS.—A country shall not be eligible for cancellation of debt under modifications to the Enhanced HIPC Initiative

described in subsection (a) if the government of the country—

‘‘(1) has an excessive level of military expenditures;

‘‘(2) has repeatedly provided support for acts of international terrorism, as determined by the Secretary of State

under section 6(j)(1) of the Export Administration Act of 1979

(50 U.S.C. App. 2405(j)(1)) or section 620A(a) of the Foreign

Assistance Act of 1961 (22 U.S.C. 2371(a));

‘‘(3) is failing to cooperate on international narcotics control

matters; or

‘‘(4) engages in a consistent pattern of gross violations

of internationally recognized human rights (including its military or other security forces).

‘‘(d) PROGRAMS TO COMBAT HIV/AIDS AND POVERTY.—A

country that is otherwise eligible to receive cancellation of debt

under the modifications to the Enhanced HIPC Initiative described

in subsection (a) may receive such cancellation only if the country

has agreed—

‘‘(1) to ensure that the financial benefits of debt cancellation

are applied to programs to combat HIV/AIDS and poverty,

in particular through concrete measures to improve basic services in health, education, nutrition, and other development

priorities, and to redress environmental degradation;

‘‘(2) to ensure that the financial benefits of debt cancellation

are in addition to the government’s total spending on poverty

reduction for the previous year or the average total of such

expenditures for the previous 3 years, whichever is greater;

‘‘(3) to implement transparent and participatory policymaking and budget procedures, good governance, and effective

anticorruption measures; and

‘‘(4) to broaden public participation and popular understanding of the principles and goals of poverty reduction.

‘‘(e) DEFINITIONS.—In this section:

‘‘(1) COUNTRY SUFFERING A PUBLIC HEALTH CRISIS.—The

term ‘country suffering a public health crisis’ means a country

in which the HIV/AIDS infection rate, as reported in the most

recent epidemiological data for that country compiled by the

Joint United Nations Program on HIV/AIDS, is at least 5

percent among women attending prenatal clinics or more than

20 percent among individuals in groups with high-risk behavior.

‘‘(2) DECISION POINT.—The term ‘Decision Point’ means the

date on which the executive boards of the International Bank

for Reconstruction and Development and the International

Monetary Fund review the debt sustainability analysis for a

country and determine that the country is eligible for debt

relief under the Enhanced HIPC Initiative.

‘‘(3) ENHANCED HIPC INITIATIVE.—The term ‘Enhanced

HIPC Initiative’ means the multilateral debt initiative for

PUBLIC LAW 108–25—MAY 27, 2003 117 STAT. 749

heavily indebted poor countries presented in the Report of

G–7 Finance Ministers on the Cologne Debt Initiative to the

Cologne Economic Summit, Cologne, June 18–20, 1999.’’.

SEC. 502. REPORT ON EXPANSION OF DEBT RELIEF TO NON-HIPC

COUNTRIES.

(a) IN GENERAL.—Not later than 90 days after the date of

enactment of this Act, the Secretary of the Treasury shall submit

to Congress a report on—

(1) the options and costs associated with the expansion

of debt relief provided by the Enhanced HIPC Initiative to

include poor countries that were not eligible for inclusion in

the Enhanced HIPC Initiative;

(2) options for burden-sharing among donor countries and

multilateral institutions of costs associated with the expansion

of debt relief; and

(3) options, in addition to debt relief, to ensure debt sustainability in poor countries, particularly in cases when the poor

country has suffered an external economic shock or a natural

disaster.

(b) SPECIFIC OPTIONS TO BE CONSIDERED.—Among the options

for the expansion of debt relief provided by the Enhanced HIPC

Initiative, consideration should be given to making eligible for that

relief poor countries for which outstanding public and publicly

guaranteed debt requires annual payments in excess of 10 percent

or, in the case of a country suffering a public health crisis (as

defined in section 1625(e) of the Financial Institutions Act, as

added by section 501 of this Act), not more than 5 percent, of

the amount of the annual current revenues received by the country

from internal resources.

(c) ENHANCED HIPC INITIATIVE DEFINED.—In this section, the

term ‘‘Enhanced HIPC Initiative’’ means the multilateral debt initiative for heavily indebted poor countries presented in the Report

of G–7 Finance Ministers on the Cologne Debt Initiative to the

Cologne Economic Summit, Cologne, June 18–20, 1999.

SEC. 503. AUTHORIZATION OF APPROPRIATIONS.

(a) IN GENERAL.—There are authorized to be appropriated to

the President such sums as may be necessary for the fiscal year

2004 and each fiscal year thereafter to carry out section 1625

of the International Financial Institutions Act, as added by section

501 of this Act.

22 USC 7682.

Deadline.

22 USC 7681.

117 STAT. 750 PUBLIC LAW 108–25—MAY 27, 2003

LEGISLATIVE HISTORY—H.R. 1298 (S. 1009):

HOUSE REPORTS: No. 108–60 (Comm. on International Relations).

CONGRESSIONAL RECORD, Vol. 149 (2003):

May 1, considered and passed House.

May 15, considered and passed Senate, amended.

May 21, House concurred in Senate amendments.

WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 39 (2003):

May 27, Presidential remarks.

Æ

(b) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant

to subsection (a) are authorized to remain available until expended.

Approved May 27, 2003.