II 

110TH CONGRESS 

1ST SESSION S. 1553 

To provide additional assistance to combat HIV/AIDS among young people, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 6, 2007 

Mrs. FEINSTEIN (for herself, Ms. SNOWE, Mr. LEAHY, Mr. DURBIN, Mr. LAUTENBERG, Mrs. CLINTON, Mr. BROWN, Mr. KERRY, Mr. DODD, Mrs. 

MURRAY, Mr. FEINGOLD, and Mrs. BOXER) introduced the following bill; 

which was read twice and referred to the Committee on Foreign Relations 

A BILL 

To provide additional assistance to combat HIV/AIDS among 

young people, 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 ‘‘HIV Prevention Act 

5 of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) The President’s Emergency Plan for AIDS 

9 Relief (in this Act referred to as ‘‘PEPFAR’’) is an 


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1 unprecedented effort to combat the global AIDS epi2 demic, with $9,000,000,000 targeted for initiatives 

3 in 15 focus countries. 

4 (2) The PEPFAR prevention goal is to avert 

5 7,000,000 HIV infections in the 15 focus coun6 tries—most in sub-Saharan Africa, where hetero7 sexual intercourse is by far the predominant mode of 

8 HIV transmission. 

9 (3) According to the Joint United Nations Pro10 gramme on HIV/AIDS, young people between the 

11 ages of 15 and 24 years old are ‘‘the most threat12 ened by AIDS’’ and ‘‘are at the centre of HIV vul13 nerability’’. Globally, young people between the ages 

of 10 and 24 years old account for 1 14 ⁄2 of all new 

15 HIV cases each year. About 7,000 young people in 

16 this cohort contract the virus every day. 

17 (4) A recent review funded by the United 

18 States Agency for International Development found 

19 that sex and HIV education programs that encour20 age abstinence but also discuss the use of condoms 

21 do not increase sexual activity as critics of sex edu22 cation have long alleged. Sex education can help 

23 delay the initiation of intercourse, reduce the fre24 quency of sex and the number of sexual partners, 

25 and also increase condom use. 


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1 (5) The United States Leadership Against HIV/ 

2 AIDS, Tuberculosis, and Malaria Act of 2003 (22 

U.S.C. 7601 et seq.) requires that at least 1 3 ⁄3 of all 

4 prevention funds be reserved for abstinence-until5 marriage programs. 

6 (6) A congressionally mandated review by the 

7 Institute of Medicine of the first 3 years of 

8 PEPFAR unequivocally recommends greater flexi9 bility in the global fight against AIDS. The March 

10 2007 Institute of Medicine report entitled 

11 ‘‘PEPFAR Implementation: Progress and Promise’’ 

12 calls for greater emphasis on prevention than the 

13 law currently allows and says that ‘‘removal of the 

14 abstinence-until-marriage’’ earmark, among other 

15 changes, ‘‘could enhance the quality, accountability, 

16 and flexibility’’ of prevention efforts. 

17 (7) The Institute of Medicine report further 

18 found that the abstinence-until-marriage earmark 

19 ‘‘has greatly limited the ability of Country Teams to 

20 develop and implement comprehensive prevention 

21 programs that are well integrated with each other 

22 and with counseling and testing, care and treatment 

23 programs and that target those populations at great24 est risk’’. 


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1 (8) The Institute of Medicine report also found 

2 that the earmark has ‘‘limited PEPFAR’s ability to 

3 tailor its activities in each country to the local epi4 demic and to coordinate with . . . the countries’ na5 tional plans’’. 

6 (9) The Institute of Medicine report is in keep7 ing with the conclusions of a report issued in 2006 

8 by the Government Accountability Office. The GAO 

9 report, entitled ‘‘Spending Requirement Presents 

10 Challenges for Allocating Funding under the Presi11 dent’s Emergency Plan for AIDS Relief’’, found 

12 ‘‘significant challenges’’ associated with meeting the 

13 earmark for abstinence-until-marriage programs. 

14 (10) The Government Accountability Office 

15 found that a majority of country teams report that 

16 fulfilling the requirement presents challenges to their 

17 ability to respond to local epidemiology and cultural 

18 and social norms. 

19 (11) The Government Accountability Office 

20 found that, although some country teams may be ex21 empted from the abstinence-until-marriage spending 

22 requirement, country teams that are not exempted 

23 have to spend more than the 33 percent of preven24 tion funds on abstinence-until-marriage activities— 

25 sometimes at the expense of other programs. 


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1 (12) The Government Accountability Office 

2 found that, as a result of the abstinence-until-mar3 riage spending requirement, some countries have had 

4 to reduce planned funding for Prevention of Mother5 to-Child Transmission programs, thereby limiting 

6 services for pregnant women and their children. 

7 (13) The Government Accountability Office 

8 found that the abstinence-until-marriage spending 

9 requirement limited or reduced funding for programs 

10 directed to high-risk groups, such as services for 

11 married discordant couples, sexually active youth, 

12 and commercial sex workers. 

13 (14) The Government Accountability Office 

14 found that the abstinence-until-marriage spending 

15 requirement made it difficult for countries to fund 

16 medical and blood safety activities. 

17 (15) The Government Accountability Office 

18 found that, because of the abstinence-until-marriage 

19 spending requirement, some countries would likely 

20 have to reduce funding for condom procurement and 

21 condom social marketing. 

22 (16) In addition, the Government Accountability Office found that 2 23 ⁄3 of focus country teams 

24 reported that the policy for implementing 

25 PEPFAR’s ABC model (defined as ‘‘Abstain, Be 


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1 faithful, use Condoms’’) is unclear and open to vary2 ing interpretations, causing confusion about which 

3 groups may be targeted and whether youth may re4 ceive the ABC message. 

5 (17) The Government Accountability Office 

6 found that the ABC guidance does not clearly delin7 eate permissible ‘‘C’’ activities under the ABC 

8 model. Program staff reported that they feel ‘‘con9 strained’’ by restrictions on promoting or marketing 

10 condoms to youth. Other country teams reported 

11 confusion about whether PEPFAR funds may be 

12 used for broad condom social marketing, even to 

13 adults in a generalized epidemic. 

14 (18) Young people are our greatest hope for 

15 changing the course of the AIDS epidemic. Accord16 ing to the World Health Organization, ‘‘[f]ocusing 

17 on young people is likely to be the most effective ap18 proach to confronting the epidemic, particularly in 

19 high prevalence countries’’. 

20 SEC. 3. ENSURING BALANCED FUNDING FOR HIV PREVEN21 TION METHODS. 

22 (a) SENSE OF CONGRESS ON ABSTINENCE-UNTIL23 MARRIAGE FUNDING REQUIREMENT.—Section 402(b)(3) 

24 of the United States Leadership Against HIV/AIDS, 

25 Tuburculosis, and Malaria Act of 2003 (22 U.S.C. 


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1 7672(b)(3)) is amended by striking ‘‘, of which such 

2 amount at least 33 percent should be expended for absti3 nence-until-marriage programs’’. 

4 (b) ELIMINATION OF ABSTINENCE-UNTIL-MARRIAGE

5 FUNDING REQUIREMENT.—Section 403(a) of such Act 

6 (22 U.S.C. 7673(a)) is amended by striking the second 

7 sentence. 

Æ 


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