II

Calendar No. 671

106TH CONGRESS

2D SESSION S. 2845

[Report No. 106–336]

To authorize additional assistance to countries with large populations having

HIV/AIDS, to authorize assistance for tuberculosis prevention, treatment,

control, and elimination, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 11, 2000

Mr. HELMS, from the Committee on Foreign Relations, reported the following

original bill; which was read twice and placed on the calendar

A BILL

To authorize additional assistance to countries with large

populations having HIV/AIDS, to authorize assistance

for tuberculosis prevention, treatment, control, and elimination, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Global AIDS and Tu5 berculosis Relief Act of 2000’’.
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1 TITLE I—ASSISTANCE TO COUN2 TRIES WITH LARGE POPU3 LATIONS HAVING HIV/AIDS

4 SEC. 101. SHORT TITLE.

5 This title may be cited as the ‘‘Global AIDS Research

6 and Relief Act of 2000’’.

7 SEC. 102. DEFINITIONS.

8 In this title:

9 (1) AIDS.—The term ‘‘AIDS’’ means the ac10 quired immune deficiency syndrome.

11 (2) ASSOCIATION.—The term ‘‘Association’’

12 means the International Development Association.

13 (3) BANK.—The term ‘‘Bank’’ or ‘‘World

14 Bank’’ means the International Bank for Recon15 struction and Development.

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

17 immunodeficiency virus.

18 (5) HIV/AIDS.—The term ‘‘HIV/AIDS’’

19 means, with respect to an individual—

20 (A) an individual having HIV but not

21 AIDS; or

22 (B) an individual having HIV and AIDS.

23 SEC. 103. FINDINGS AND PURPOSES.

24 (a) FINDINGS.—Congress makes the following find25 ings:
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1 (1) According to statistics of the World Bank,

2 more than 90 percent of all adults and children with

3 HIV/AIDS live in the developing world—62 percent

4 in sub-Saharan Africa, 24 percent in Asia, and 6.9

5 percent in Latin America and the Caribbean.

6 (2) According to UNAIDS, nearly 4,500,000

7 children under 15 years of age have been infected

8 with HIV since the AIDS epidemic began. More

9 than 3,000,000 have already died of AIDS. Children

10 are becoming infected at about the rate of 1 child

11 every minute, and the overwhelming majority of

12 these children acquire the infection from their moth13 ers.

14 (3) The gap between rich and poor countries in

15 terms of transmission of HIV from mother to child

16 has been increasing. Moreover, AIDS threatens to

17 reverse years of steady progress of child survival in

18 developing countries. UNAIDS believes that by the

19 year 2010, AIDS may have increased mortality of

20 children under 5 years of age by more than 100 per21 cent in regions most affected by the virus.

22 (4) In Africa, the death toll from AIDS has

23 reached 13,000,000, while 23,000,000 others live

24 with the disease, and more than 10,000,000 children

25 have been infected or orphaned by it.
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1 (5) The World Bank, declaring AIDS not just

2 a public health problem but the ‘‘foremost and fast3 est-growing threat to development’’ in Africa, has

4 launched a new strategy for HIV/AIDS in Africa,

5 declaring it a top priority for the World Bank on

6 that continent.

7 (6) AIDS, like all diseases, knows no bound8 aries, and there is no certitude that the scale of the

9 problem in one continent can be contained within

10 that region.

11 (7) Accordingly, United States financial support

12 for medical research, education, and disease contain13 ment as a global strategy has beneficial ramifica14 tions for millions of Americans and their families

15 who are affected by this disease, and the entire pop16 ulation which is potentially susceptible.

17 (8) The discovery of a relatively simple and

18 cheap means of interrupting the transmission of

19 HIV from an infected mother to the unborn child—

20 namely with nevirapine (NVP), which costs US$4 a

21 tablet—has created a great opportunity for an un22 precedented partnership between the United States

23 Government and the governments of Asian, African

24 and Latin American countries to combat mother-to-
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1 child transmission (also known as ‘‘vertical trans2 mission’’) of HIV.

3 (9) According to UNAIDS, this strategy will

4 decrease the proportion of orphans that are HIV-in5 fected and decrease infant and child mortality rates

6 in these developing regions.

7 (10) At current infection and growth rates for

8 HIV/AIDS, the National Intelligence Council esti9 mates that the number of AIDS orphans worldwide

10 will increase dramatically, potentially increasing

11 threefold or more in the next 10 years, contributing

12 to economic decay, social fragmentation, and polit13 ical destabilization in already volatile and strained

14 societies. Children without care or hope are often

15 drawn into prostitution, crime, substance abuse, or

16 child soldiery.

17 (11) Donors must focus on adequate prepara18 tions for the explosion in the number of orphans and

19 the burden they will place on families, communities,

20 economies, and governments. Support structures and

21 incentives for families, communities, and institutions

22 which will provide care for children orphaned by

23 HIV/AIDS, or for the children who are themselves

24 infected by HIV/AIDS, will be essential.
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1 (12) A mother-to-child antiretroviral drug strat2 egy can be a force for social change, providing the

3 opportunity and impetus needed to tackle often long4 standing problems of inadequate services and the

5 profound stigma associated with HIV-infection and

6 the AIDS disease. Strengthening the health infra7 structure to improve mother-and-child health,

8 antenatal, delivery and postnatal services, and cou9 ples counseling generates enormous spillover effects

10 toward combating the AIDS epidemic in developing

11 regions.

12 (b) PURPOSES.—The purposes of this title are to—

13 (1) prevent human suffering; and

14 (2) ensure the viability of economic develop15 ment, stability, and national security in the devel16 oping world by advancing research to—

17 (A) understand the causes associated with

18 HIV/AIDS in developing countries; and

19 (B) assist in the development of an AIDS

20 vaccine.

21 SEC. 104. ADDITIONAL ASSISTANCE AUTHORITIES TO COM22 BAT HIV AND AIDS.

23 (a) ASSISTANCE FOR PREVENTION OF HIV/AIDS

24 AND VERTICAL TRANSMISSION.—Section 104(c) of the

25 Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) is
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1 amended by adding at the end the following new para2 graphs:

3 ‘‘(4)(A) Congress recognizes the growing inter4 national dilemma of children with the human immuno5 deficiency virus (HIV) and the merits of intervention pro6 grams aimed at this problem. Congress further recognizes

7 that mother-to-child transmission prevention strategies

8 can serve as a major force for change in developing re9 gions, and it is, therefore, a major objective of the foreign

10 assistance program to control the acquired immune defi11 ciency syndrome (AIDS) epidemic.

12 ‘‘(B) The agency primarily responsible for admin13 istering this part shall—

14 ‘‘(i) coordinate with UNAIDS, UNICEF,

15 WHO, local governments, and other organizations to

16 develop and implement effective strategies to prevent

17 vertical transmission of HIV; and

18 ‘‘(ii) coordinate with those organizations to in19 crease in scale intervention programs and introduce

20 voluntary counseling and testing, antiretroviral

21 drugs, replacement feeding, and other strategies.

22 ‘‘(5)(A) Congress expects the agency primarily re23 sponsible for administering this part to make the human

24 immunodeficiency virus (HIV) and the acquired immune

25 deficiency syndrome (AIDS) a priority in the foreign as-
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1 sistance program and to undertake a comprehensive, co2 ordinated effort to combat HIV and AIDS.

3 ‘‘(B) Assistance described in subparagraph (A) shall

4 include providing—

5 ‘‘(i) primary prevention and education;

6 ‘‘(ii) voluntary testing and counseling;

7 ‘‘(iii) medications to prevent the transmission of

8 HIV and AIDS from mother to child; and

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

10 ‘‘(6)(A) In addition to amounts otherwise available

11 for such purpose, there is authorized to be appropriated

12 to the President $300,000,000 for fiscal year 2001 to

13 carry out paragraphs (4) and (5).

14 ‘‘(B) Of the funds authorized to be appropriated

15 under subparagraph (A), not less than 65 percent is au16 thorized to be available through United States and foreign

17 nongovernmental organizations, including private and vol18 untary organizations, for-profit organizations, religious af19 filiated organizations, educational institutions, and re20 search facilities.

21 ‘‘(C)(i) Of the funds authorized to be appropriated

22 by subparagraph (A), not less than 20 percent is author23 ized to be available for programs as part of a multidonor

24 strategy to address the support and education of orphans

25 in sub-Saharan Africa, including AIDS orphans.
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1 ‘‘(ii) Assistance made available under this subpara2 graph may be made available notwithstanding any other

3 provision of law.

4 ‘‘(D) Of the funds authorized to be appropriated

5 under subparagraph (A), not less than 8.3 percent is au6 thorized to be available to carry out the prevention strate7 gies for vertical transmission referred to in paragraph

8 (4)(A).

9 ‘‘(E) Of the funds authorized to be appropriated by

10 subparagraph (A), not more than 7 percent may be used

11 for the administrative expenses of the agency primarily re12 sponsible for carrying out this part of this Act in support

13 of activities described in paragraphs (4) and (5).

14 ‘‘(F) Funds appropriated under this paragraph are

15 authorized to remain available until expended.’’.

16 (b) TRAINING AND TRAINING FACILITIES IN SUB-SA17 HARAN AFRICA.—Section 496(i)(2) of the Foreign Assist18 ance Act of 1961 (22 U.S.C. 2293(i)(2)) is amended by

19 adding at the end the following new sentence: ‘‘In addi20 tion, providing training and training facilities, in sub-Sa21 haran Africa, for doctors and other health care providers,

22 notwithstanding any provision of law that restricts assist23 ance to foreign countries.’’.
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1 SEC. 105. VOLUNTARY CONTRIBUTION TO GLOBAL ALLI2 ANCE FOR VACCINES AND IMMUNIZATIONS

3 AND INTERNATIONAL AIDS VACCINE INITIA4 TIVE.

5 (a) AUTHORIZATION OF APPROPRIATIONS.—Section

6 302 of the Foreign Assistance Act of 1961 (22 U.S.C.

7 2222) is amended by adding at the end the following new

8 subsections:

9 ‘‘(j) In addition to amounts otherwise available under

10 this section, there is authorized to be appropriated to the

11 President $50,000,000 for fiscal year 2001 to be available

12 only for United States contributions to the Global Alliance

13 for Vaccines and Immunizations.

14 ‘‘(k) In addition to amounts otherwise available under

15 this section, there is authorized to be appropriated to the

16 President $10,000,000 for fiscal year 2001 to be available

17 only for United States contributions to the International

18 AIDS Vaccine Initiative.’’.

19 (b) REPORT.—At the close of fiscal year 2001, the

20 President shall submit a report to the appropriate con21 gressional committees on the effectiveness of the Global

22 Alliance for Vaccines and Immunizations and the Inter23 national AIDS Vaccine Initiative during that fiscal year

24 in meeting the goals of—

25 (1) improving access to sustainable immuniza26 tion services;
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1 (2) expanding the use of all existing, safe, and

2 cost-effective vaccines where they address a public

3 health problem;

4 (3) accelerating the development and introduc5 tion of new vaccines and technologies;

6 (4) accelerating research and development ef7 forts for vaccines needed primarily in developing

8 countries; and

9 (5) making immunization coverage a center10 piece in international development efforts.

11 (c) APPROPRIATE CONGRESSIONAL COMMITTEES DE12 FINED.—In subsection (b), the term ‘‘appropriate congres13 sional committees’’ means the Committee on Foreign Re14 lations of the Senate and the Committee on International

15 Relations of the House of Representatives.

16 SEC. 106. MULTILATERAL LIFESAVING VACCINE PURCHASE

17 FUND.

18 (a) NEGOTIATIONS.—The President should enter into

19 negotiations with officials of foreign governments and

20 other interested parties for the establishment of an inter21 national vaccine purchase fund that would—

22 (1) accept contributions from governments of

23 developed countries;

24 (2) use such contributions to purchase and dis25 tribute in developing countries vaccines for—
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1 (A) malaria,

2 (B) tuberculosis,

3 (C) HIV, and

4 (D) any infectious disease (of a single eti5 ology) which causes the deaths of over

6 1,000,000 people worldwide each year; and

7 (3) be a significant market incentive for private

8 sector vaccine research.

9 (b) REPORT.—Not later than 1 year after the date

10 of enactment of this Act, and annually thereafter, the

11 President shall submit a report to Congress on—

12 (1) the status of negotiations under subsection

13 (a); and

14 (2) if such fund is established, any rec15 ommendations for further action.

16 SEC. 107. WORLD BANK TRUST FUND FOR AIDS PREVEN17 TION AND ERADICATION.

18 (a) NEGOTIATIONS FOR THE CREATION OF A WORLD

19 BANK TRUST FUND TO ASSIST IN AIDS PREVENTION

20 AND ERADICATION.—The Secretary of the Treasury shall

21 enter into negotiations with the World Bank or the Asso22 ciation, with the member nations of such institutions, and

23 with other interested parties for the creation of a trust

24 fund, to be administered by the Bank or the Association,

25 as appropriate, which would—
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1 (1) accept contributions from governments, the

2 private sector, and nongovernmental entities of all

3 kinds; and

4 (2) use such contributions to address the AIDS

5 epidemic in countries eligible to borrow from the As6 sociation.

7 (b) AUTHORIZATION OF APPROPRIATIONS.—In addi8 tion to any other funds authorized to be appropriated for

9 multilateral or bilateral programs related to AIDS, there

10 is authorized to be appropriated to the President

11 $100,000,000 for fiscal year 2001 for payment to the

12 trust fund established as a result of the negotiations en13 tered into pursuant to subsection (a).

14 (c) REPORT TO CONGRESS.—Beginning 1 year after

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

16 the Secretary of the Treasury shall submit to the Commit17 tees on Banking and Financial Services and on Inter18 national Relations of the House of Representatives and

19 the Committees on Banking, Housing, and Urban Affairs

20 and on Foreign Relations of the Senate a written report

21 on the trust fund established pursuant to subsection (a),

22 the goals of the trust fund, the programs, projects, and

23 activities, including any vaccination approaches, supported

24 by the trust fund, and the effectiveness of such programs,
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1 projects, and activities in reducing the worldwide spread

2 of AIDS.

3 SEC. 108. NEGOTIATIONS FOR THE CREATION OF A WORLD

4 BANK TRUST FUND FOR EDUCATION OF OR5 PHANS IN SUB-SAHARAN AFRICA.

6 (a) NEGOTIATIONS.—The Secretary of the Treasury

7 shall enter into negotiations with the World Bank or the

8 Association, with member nations of such institutions, and

9 with other interested parties, for the creation of a trust

10 fund which could accept contributions from governments,

11 the private sector, and nongovernmental entities of all

12 kinds, and use such contributions to provide support for

13 or the establishment of programs which provide primary

14 and secondary education for orphans in sub-Saharan

15 Africa.

16 (b) AUTHORIZATION OF APPROPRIATIONS.—In addi17 tion to funds otherwise available for the purposes of sub18 section (a), there is authorized to be appropriated to the

19 President $50,000,000 for the fiscal year 2001 for pay20 ment to the trust fund established as a result of the nego21 tiations entered into pursuant to subsection (a).
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1 SEC. 109. COORDINATED DONOR STRATEGY FOR SUPPORT

2 AND EDUCATION OF ORPHANS IN SUB-SAHA3 RAN AFRICA.

4 Chapter 1 of part I of the Foreign Assistance Act

5 of 1961 (22 U.S.C. 2151 et seq.) is amended by adding

6 at the end the following new section:

7 ‘‘SEC. 131. COORDINATED DONOR STRATEGY FOR SUPPORT

8 AND EDUCATION OF ORPHANS IN SUB-SAHA9 RAN AFRICA.

10 ‘‘(a) STATEMENT OF POLICY.—It is in the national

11 interest of the United States to assist in mitigating the

12 burden that will be placed on sub-Saharan African social,

13 economic, and political institutions as these institutions

14 struggle with the consequences of a dramatically increas15 ing AIDS orphan population, many of whom are them16 selves infected by HIV/AIDS. Effectively addressing that

17 burden and its consequences in sub-Saharan Africa will

18 require a coordinated multidonor strategy.

19 ‘‘(b) DEVELOPMENT OF STRATEGY.—The President

20 shall coordinate the development of a multidonor strategy

21 to provide for the support and education of AIDS orphans

22 and the families, communities, and institutions most af23 fected by the HIV/AIDS epidemic in sub-Saharan Africa.

24 ‘‘(c) DEFINITION.—In this section, the term ‘HIV/

25 AIDS’ means, with respect to an individual, an individual

26 who is infected with—
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1 ‘‘(1) the human immunodeficiency virus (HIV);

2 or

3 ‘‘(2) HIV and the acquired immune deficiency

4 virus (AIDS).’’.

5 SEC. 110. AFRICAN CRISIS RESPONSE INITIATIVE AND HIV/

6 AIDS TRAINING.

7 (a) FINDINGS.—Congress finds that—

8 (1) the spread of AIDS constitutes a threat to

9 security in Africa;

10 (2) civil unrest and war may contribute to the

11 spread of the disease to different parts of the con12 tinent;

13 (3) the percentage of soldiers in African mili14 taries who are infected with HIV/AIDS is unknown,

15 but estimates range in some countries as high as 40

16 percent; and

17 (4) it is in the interests of the United States to

18 assist the countries of Africa in combating the

19 spread of HIV/AIDS.

20 (b) EDUCATION ON THE PREVENTION OF THE

21 SPREAD OF AIDS.—In undertaking education and train22 ing programs for military establishments of in African

23 countries, the United States shall ensure that classroom

24 training under the African Crisis Response Initiative in-
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1 cludes military-based education on the prevention of the

2 spread of AIDS.

3 TITLE II—INTERNATIONAL

4 TUBERCULOSIS CONTROL

5 SEC. 201. SHORT TITLE.

6 This title may be cited as the ‘‘International Tuber7 culosis Control Act of 2000’’.

8 SEC. 202. FINDINGS.

9 Congress makes the following findings:

10 (1) Since the development of antibiotics in the

11 1950s, tuberculosis has been largely controlled in the

12 United States and the Western World.

13 (2) Due to societal factors, including growing

14 urban decay, inadequate health care systems, per15 sistent poverty, overcrowding, and malnutrition, as

16 well as medical factors, including the HIV/AIDS epi17 demic and the emergence of multi-drug resistant

18 strains of tuberculosis, tuberculosis has again be19 come a leading and growing cause of adult deaths in

20 the developing world.

21 (3) According to the World Health

22 Organization—

23 (A) in 1998, about 1,860,000 people

24 worldwide died of tuberculosis-related illnesses;
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1 (B) one-third of the world’s total popu2 lation is infected with tuberculosis; and

3 (C) tuberculosis is the world’s leading kill4 er of women between 15 and 44 years old and

5 is a leading cause of children becoming or6 phans.

7 (4) Because of the ease of transmission of tu8 berculosis, its international persistence and growth

9 pose a direct public health threat to those nations

10 that had previously largely controlled the disease.

11 This is complicated in the United States by the

12 growth of the homeless population, the rate of incar13 ceration, international travel, immigration, and HIV/

14 AIDS.

15 (5) With nearly 40 percent of the tuberculosis

16 cases in the United States attributable to foreign17 born persons, tuberculosis will never be controlled in

18 the United States until it is controlled abroad.

19 (6) The means exist to control tuberculosis

20 through screening, diagnosis, treatment, patient

21 compliance, monitoring, and ongoing review of out22 comes.

23 (7) Efforts to control tuberculosis are com24 plicated by several barriers, including—
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1 (A) the labor intensive and lengthy process

2 involved in screening, detecting, and treating

3 the disease;

4 (B) a lack of funding, trained personnel,

5 and medicine in virtually every nation with a

6 high rate of the disease;

7 (C) the unique circumstances in each coun8 try, which requires the development and imple9 mentation of country-specific programs; and

10 (D) the risk of having a bad tuberculosis

11 program, which is worse than having no tuber12 culosis program because it would significantly

13 increase the risk of the development of more

14 widespread drug-resistant strains of the disease.

15 (8) Eliminating the barriers to the international

16 control of tuberculosis through a well-structured,

17 comprehensive, and coordinated worldwide effort

18 would be a significant step in dealing with the in19 creasing public health problem posed by the disease.

20 SEC. 203. ASSISTANCE FOR TUBERCULOSIS PREVENTION,

21 TREATMENT, CONTROL, AND ELIMINATION.

22 Section 104(c) of the Foreign Assistance Act of 1961

23 (22 U.S.C. 2151b(c)), as amended by section 103(a) of

24 this Act, is further amended by adding at the end the fol25 lowing:
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1 ‘‘(7)(A) Congress recognizes the growing inter2 national problem of tuberculosis and the impact its contin3 ued existence has on those nations that had previously

4 largely controlled the disease. Congress further recognizes

5 that the means exist to control and treat tuberculosis, and

6 that it is therefore a major objective of the foreign assist7 ance program to control the disease. To this end, Congress

8 expects the agency primarily responsible for administering

9 this part—

10 ‘‘(i) to coordinate with the World Health Orga11 nization, the Centers for Disease Control, the Na12 tional Institutes of Health, and other organizations

13 toward the development and implementation of a

14 comprehensive tuberculosis control program; and

15 ‘‘(ii) to set as a goal the detection of at least

16 70 percent of the cases of infectious tuberculosis,

17 and the cure of at least 85 percent of the cases de18 tected, in those countries in which the agency has

19 established development programs, by December 31,

20 2010.

21 ‘‘(B) There is authorized to be appropriated to the

22 President, $60,000,000 for fiscal year 2001 to be used to

23 carry out this paragraph. Funds appropriated under this

24 subparagraph are authorized to remain available until ex25 pended.’’.

Calendar No. 671

106TH CONGRESS

2D SESSION H. R. 2845

[Report No. 106–336]

A BILL

To authorize additional assistance to countries with

large populations having HIV/AIDS, to authorizeassistance for tuberculosis prevention, treatment,control, and elimination, and for other purposes.

JULY 11, 2000

Read twice and placed on the calendar