I 

108TH CONGRESS 

2D SESSION H. R. 4792 

To require the President to establish a comprehensive, integrated, and culturally appropriate HIV prevention strategy that emphasizes the needs 

of women and girls for each country for which the United States provides 

assistance to combat HIV/AIDS, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2004 

Ms. LEE (for herself, Mr. LANTOS, Mr. WEXLER, Mr. PAYNE, Mr. MCGOVERN, Mr. GRIJALVA, Ms. CORRINE BROWN of Florida, Mr. OWENS, Mr. 

RUSH, Ms. WATERS, Ms. NORTON, Mr. CONYERS, Mr. BROWN of Ohio, 

Mr. BELL, Mr. MCDERMOTT, Mr. CROWLEY, Mr. GUTIERREZ, Ms. CARSON of Indiana, Mr. PALLONE, Mr. DAVIS of Illinois, Mrs. MALONEY, Mr. 

DELAHUNT, Mrs. CHRISTENSEN, Mr. CUMMINGS, Mr. DOGGETT, Mr. 

OLVER, Mr. FRANK of Massachusetts, Ms. JACKSON-LEE of Texas, Mr. 

WAXMAN, Ms. WATSON, Ms. KILPATRICK, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. THOMPSON of Mississippi, Mr. JACKSON of Illinois, 

Mr. SCOTT of Virginia, Mr. SCOTT of Georgia, Mr. LEWIS of Georgia, 

Mr. CLYBURN, Ms. MILLENDER-MCDONALD, Mr. BISHOP of Georgia, 

Ms. MCCOLLUM, Mr. WYNN, Mr. KUCINICH, Mr. RANGEL, Ms. SOLIS, 

Mr. DICKS, Ms. SCHAKOWSKY, Mrs. MCCARTHY of New York, Mr. 

MEEKS of New York, Mr. DINGELL, Mr. BERMAN, Ms. DELAURO, Mrs. 

JONES of Ohio, Mr. MORAN of Virginia, and Mr. SERRANO) introduced 

the following bill; which was referred to the Committee on International 

Relations 

A BILL 

To require the President to establish a comprehensive, integrated, and culturally appropriate HIV prevention strategy that emphasizes the needs of women and girls for 

each country for which the United States provides assistance to combat HIV/AIDS, and for other purposes. 
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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 ‘‘New United States 

5 Global HIV Prevention Strategy to Address the Needs of 

6 Women and Girls Act of 2004’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) Globally, the United Nations Joint Pro10 gramme on HIV/AIDS (UNAIDS) estimates that 

11 there are more than 40,000,000 people infected with 

12 HIV/AIDS, the vast majority of whom live in the de13 veloping world. For a number of reasons, women 

14 and girls are biologically, socially, and economically 

15 more vulnerable to HIV infection, and today they 

16 represent more than half of all individuals who are 

17 infected with HIV worldwide. 

18 (2) In sub-Saharan Africa, women and girls 

19 make up 60 percent of those individuals infected 

20 with HIV. Data from several countries in Africa in21 dicate that women ages 15 to 24 are from two and 

22 a half to thirteen times more likely to be infected 

23 with HIV as their male counterparts. 
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1 (3) Gender disparities in the rates of HIV in2 fection are the result of a number of factors, includ3 ing— 

4 (A) inadequate knowledge about how HIV 

5 is transmitted; 

6 (B) lack of access to basic HIV prevention 

7 and reproductive health services; 

8 (C) an inability to negotiate safer sex with 

9 regular partners; 

10 (D) social norms that prevent frank and 

11 open discussions about sex; 

12 (E) a lack of access to female-controlled 

13 HIV prevention methods, such as the female 

14 condom and, when available, microbicides; and 

15 (F) social and economic inequalities based 

16 largely on gender. 

17 (4) Current HIV prevention programs designed 

18 to support the ABC model: ‘‘Abstain, Be faithful, 

19 use Condoms’’, are not always effective at address20 ing the central fact that women and girls are often 

21 powerless to abstain from sex, ensure their partner’s 

22 faithfulness, or to insist on condom use even within 

23 marriage, and especially in the case of early- or 

24 child-marriages. Women may also be coerced into 

25 unprotected sex and they often run the risk of being 
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1 infected by husbands or male partners in societies 

2 where it is common or accepted for men to have 

3 more than one partner. 

4 (5) Recognizing that current international HIV 

5 prevention and protection efforts are failing women 

6 and girls, UNAIDS officially launched the Global 

7 Coalition on Women and AIDS on February 2, 

8 2004, to focus on preventing new HIV infections 

9 among women and girls, promoting equal access to 

10 HIV care and treatment, increasing access to fe11 male-controlled prevention methods such as female 

12 condoms, accelerating microbicides research, pro13 tecting women’s property and inheritance rights, 

14 supporting ongoing efforts toward reaching universal 

15 primary education for girls, and reducing violence 

16 against women. 

17 (6) Violence against women, perpetuated by 

18 their intimate partners, is a major human rights and 

19 public health problem throughout the world and it is 

20 also a major contributing factor to the spread of 

21 HIV. According to the World Health Organization 

22 (WHO), one-fifth to one-third of women ages 15 to 

23 49 have experienced some form of physical abuse or 

24 sexual coercion in their lifetimes, the vast majority 

25 within marriage. 
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1 (7) Unfortunately, current HIV prevention pro2 grams do not place enough importance on respond3 ing to violence against women, changing the social 

4 norms that shape the attitudes and behaviors of men 

5 and boys toward women and girls, or using strate6 gies to promote effective communication among cou7 ples on matters of sex and reproduction. 

8 (8) The fear of domestic violence and the con9 tinuing stigma and discrimination associated with 

10 HIV/AIDS prevents many women from accessing in11 formation about HIV/AIDS, getting tested, dis12 closing their HIV status, accessing services to pre13 vent mother-to-child transmission, or receiving treat14 ment and counseling even when they already know 

15 they have been infected with HIV. 

16 (9) Economic and social disparities between 

17 men and women amplify the effects of stigma and 

18 discrimination, the fear of domestic violence, and 

19 other risks of HIV infection faced by women and 

20 girls. Unequal access to education, income, land, and 

21 other productive resources leaves many women and 

22 girls dependent on men for income, housing, suste23 nance and social security. 

24 (10) For women and girls, gender discrimina25 tion in the ownership and retention of property also 
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1 contributes to an increased risk of sexual abuse, ex2 ploitation, and HIV infection. As women’s property 

3 rights are violated on a massive scale by in-laws, rel4 atives, communities, and government officials, the 

5 impact on women and their dependents is cata6 strophic. Many women end up homeless or living in 

7 slums, begging for food and water, unable to afford 

8 health care or school fees for their children, and 

9 many women resort to working as commercial sex 

10 workers in order to make ends meet. 

11 (11) For many women, the combination of stig12 ma, violence, and a lack of independent economic 

13 means sustains their fear of abandonment, eviction, 

14 or ostracism from their homes and communities, and 

15 can leave many more of them trapped within rela16 tionships where they are vulnerable to HIV infec17 tion. 

18 (12) Women also face additional obstacles due 

19 to the pervasiveness of discriminatory legal frame20 works that fail to guarantee equal rights or equal 

21 protection before the law. In many cases, inequitable 

22 divorce and property laws make it difficult for 

23 women to leave abusive relationships, and in coun24 tries where laws against gender violence exist, insuf25 ficient resources, coupled with discriminatory prac-
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1 tices by police and courts and a lack of institutional 

2 support, leave women without access to adequate 

3 protection. 

4 (13) Recently, numerous studies have emerged 

5 indicating that early or child marriage cannot be 

6 considered a protective factor against HIV infection. 

7 These studies show that young women between the 

8 ages of 15–19 who are married are at significantly 

9 higher risk of contracting HIV/AIDS than single 

10 women of the same age, in some cases by as much 

11 as 10 percent. 

12 (14) There are several reasons that sexually ac13 tive unmarried girls are less vulnerable to HIV infec14 tion than married adolescent girls, including the fact 

15 that they tend to have sex less frequently, are more 

16 likely to have sex with those closer to their own age, 

17 and because they are more likely to use condoms 

18 during sex. The result is that in many countries 

19 today, most sexually transmitted HIV infections in 

20 females occur either inside marriage or in relation21 ships women believe to be monogamous. 

22 (15) Efforts to expand access to education for 

23 women and girls and to increase the age at which 

24 they marry are also critical to increasing the social 

25 and economic power of women, reducing the spread 
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1 of HIV, and to the attainment of overall health and 

2 development goals. For women and girls, education 

3 is linked to delayed intercourse, increased age-at4 marriage, delayed childbearing, increased child sur5 vival, improved nutrition, and reduced risk of HIV 

6 infection, among other positive outcomes. 

7 (16) Although attendance at school is consid8 ered a protective factor in preventing transmission 

9 of HIV, recent studies indicate that young women 

10 between the ages of 15–19 who are married and do 

11 not have children are less likely to be in school than 

12 single women of the same age who do not have chil13 dren. In some instances the difference is striking, as 

14 in the case of Nigeria, where 3 percent of young 

15 married women are in school, as compared to 70 

16 percent of young single women. 

17 (17) As a result of these studies, HIV preven18 tion programs that strictly focus on promoting absti19 nence-until-marriage and do not provide comprehen20 sive health and sexuality education fail to adequately 

21 address the true vulnerabilities faced by women, es22 pecially younger women, or to equip them properly 

23 with the full range of tools they need to protect 

24 themselves. 
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1 (18) A substantial body of evidence also exists 

2 to support the coordination of HIV prevention initia3 tives, including programs to prevent the trans4 mission of HIV from mother-to-child, with existing 

5 health care services, especially family planning and 

6 reproductive health programs, as the health and 

7 well-being of women and girls is improved when they 

8 have access to comprehensive care that is designed 

9 to address their needs. 

10 (19) Over the last forty years, the United 

11 States has made substantial investments in building 

12 basic health care services for mothers and children, 

13 including family planning and reproductive health 

14 care programs. In many cases these programs serve 

15 as a trusted source of health information and re16 sources to women, both for their own health and 

17 well-being, and that of their children. Frequently, 

18 these types of coordinated programs can also serve 

19 as a source of information and resources free from 

20 the stigma frequently associated with stand-alone 

21 HIV prevention programs. 

22 (20) The United States already works to coordi23 nate HIV prevention services with existing family 

24 planning and reproductive health care programs, as 

25 they represent a readily available platform upon 
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1 which to build new initiatives. Such efforts should 

2 continue as part of any global expansion of HIV pre3 vention services in order to produce an efficient and 

4 effective global health policy. 

5 (21) Efforts to increase women’s access to com6 prehensive prevention information and services, ad7 dress gender violence, increase women’s economic 

8 and social status, and foster equitable partnerships 

9 between women and men are all central to reducing 

10 the spread of HIV/AIDS worldwide and to enhanc11 ing the success of effective treatment and care pro12 grams supported by the United States. 

13 (22) The comprehensive, integrated, five-year 

14 strategy to combat global HIV/AIDS submitted to 

15 Congress on February 23, 2004, as required by sec16 tion 101 of the United States Leadership Against 

17 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

18 (22 U.S.C. 7611), does not adequately focus or pro19 vide sufficient details on United States Government 

20 strategies to prevent HIV infection among women 

21 and girls. 

22 SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS ON A 

23 COUNTRY-BY-COUNTRY BASIS. 

24 (a) STATEMENT OF POLICY.—In order to meet the 

25 stated goal of preventing 7,000,000 new HIV infections, 
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1 as announced by the President in his address to Congress 

2 on January 28, 2003, it shall be the policy of the United 

3 States to pursue an HIV prevention strategy for each 

4 country for which the United States provides assistance 

5 to combat HIV/AIDS that emphasizes the immediate and 

6 ongoing needs of women and girls in those countries. 

7 (b) STRATEGY.—Not later than 90 days after the 

8 date of the enactment of this Act, the President shall es9 tablish a comprehensive, integrated, and culturally appro10 priate HIV prevention strategy for each country for which 

11 the United States provides assistance to combat HIV/ 

12 AIDS. Each such strategy shall encompass comprehensive 

13 health and HIV prevention education beyond the ABC 

14 model: ‘‘Abstain, Be faithful, use Condoms’’, as a means 

15 to reduce HIV infections, particularly among women and 

16 girls, and which strengthens the capacity of the United 

17 States to be an effective leader of the international cam18 paign against HIV/AIDS. Each such strategy shall also 

19 include the following: 

20 (1) Increasing access to female-controlled pre21 vention methods, most immediately, access to female 

22 condoms, and including training to ensure effective 

23 and consistent use of such condoms. 
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1 (2) Accelerating destigmatization of HIV/AIDS, 

2 as women are generally at a disadvantage in com3 bating stigma. 

4 (3) Empowering women and girls to avoid 

5 cross-generational sex and reduce the incidence of 

6 early- or child-marriage. 

7 (4) Reducing violence against women. 

8 (5) Supporting the development of microenter9 prise programs and other such efforts to assist 

10 women in developing and retaining independent eco11 nomic means. 

12 (6) Promoting positive male behavior toward 

13 women and girls. 

14 (7) Supporting expanded educational opportuni15 ties for women and girls. 

16 (8) Protecting the property and inheritance 

17 rights of women. 

18 (9) Coordinating HIV prevention services with 

19 existing health care services, including programs in20 tended to reduce the transmission of HIV between 

21 mother-to-child, and family planning and reproduc22 tive health services. 

23 (10) Promoting gender equality by supporting 

24 the development of civil society organizations focused 

25 on the needs of women, and by encouraging the cre-
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1 ation and effective enforcement of legal frameworks 

2 that guarantee women equal rights and equal protec3 tion under the law. 

4 (c) COORDINATION.— 

5 (1) IN GENERAL.—In formulating each HIV 

6 prevention strategy pursuant to subsection (b), the 

7 President shall ensure that the United States coordi8 nates its overall HIV/AIDS policy and programs 

9 with the national government of the country involved 

10 and with other donor countries and organizations 

11 through the Three Ones Principles. Such coordina12 tion shall include proper consultation and dialogue 

13 with both indigenous and international nongovern14 mental organizations (including faith- and commu15 nity-based organizations) that work to combat HIV/ 

16 AIDS or that specifically work to address the needs 

17 of women and girls through comprehensive health 

18 care, education, or income-generating programs. 

19 (2) DEFINITION.—In paragraph (1), the term 

20 ‘‘Three Ones Principles’’ means the following three 

21 guiding principles which provide a framework for co22 ordinated action on HIV/AIDS at the country level, 

23 as developed by the United Nations Joint Pro24 gramme on HIV/AIDS (UNAIDS) and agreed to by 
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1 the United States and other donor countries and or2 ganizations on April 25, 2004: 

3 (A) One national HIV/AIDS action frame4 work that provides the basis for coordinating 

5 the work of the national government and all or6 ganizations in a country. 

7 (B) One national HIV/AIDS coordinating 

8 authority for the country, with a broad multi9 sector mandate. 

10 (C) One national HIV/AIDS monitoring 

11 and evaluation system for the country. 

12 (d) REPORT.—Not later than 180 days after the date 

13 of the enactment of this Act, the President shall transmit 

14 to the appropriate congressional committees and make 

15 available to the public a report that— 

16 (1) contains a description of each HIV preven17 tion strategy established pursuant to subsection (b) 

18 and a description of any ongoing United States-sup19 ported activities that relate to the elements of each 

20 such strategy as described in paragraphs (1) 

21 through (10) of subsection (b); and 

22 (2) includes a list of the nongovernmental orga23 nizations (including faith- and community-based or24 ganizations) in each country that carry out such ac25 tivities, the amount and the source of funding re-
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1 ceived, and the overall goals and implementation 

2 strategy of such activities 

3 SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METH4 ODS. 

5 (a) FINDING.—Congress finds that while in some 

6 cases abstinence programs may help to delay sexual debut 

7 among young people, when such programs are not com8 bined with comprehensive sexuality and life skills edu9 cation, these programs can leave young people who eventu10 ally do become sexually active without the appropriate 

11 knowledge to protect themselves from sexually-transmitted 

12 diseases such as HIV. 

13 (b) STATEMENT OF POLICY.—In carrying out the ac14 tivities required by the United States Leadership Against 

15 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 

16 U.S.C. 7601 et seq.; Public Law 108–25), and the amend17 ments made by that Act, it shall be the policy of the 

18 United States— 

19 (1) to provide flexibility to support a variety of 

20 culturally appropriate HIV prevention programs that 

21 are carried out in accordance with the HIV preven22 tion strategy for each country for which the United 

23 States provides assistance to combat HIV/AIDS, as 

24 established pursuant to section 3 of this Act; and 
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1 (2) to ensure that unnecessary requirements are 

2 not imposed with respect to how funds made avail3 able for such programs can be obligated and ex4 pended. 

5 (c) AMENDMENTS TO FUNDING PROVISIONS OF PUB6 LIC LAW 108–25.— 

7 (1) SENSE OF CONGRESS.—Section 402(b)(3) 

8 of the United States Leadership Against HIV/AIDS, 

9 Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 

10 7672(b)(3)) is amended by striking ‘‘, of which such 

11 amount at least 33 percent should be expended for 

12 abstinence-until-marriage programs’’. 

13 (2) ALLOCATION OF FUNDS.—Section 403(a) of 

14 such Act (22 U.S.C. 7673(a)) is amended by strik15 ing the second sentence. 

16 SEC. 5. DEFINITIONS. 

17 In this Act: 

18 (1) AIDS.—The term ‘‘AIDS’’ means the ac19 quired immune deficiency syndrome. 

20 (2) APPROPRIATE CONGRESSIONAL COMMIT21 TEES.—The term ‘‘appropriate congressional com22 mittees’’ means the Committee on International Re23 lations of the House of Representatives and the 

24 Committee on Foreign Relations of the Senate. 
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1 (3) HIV.—The term ‘‘HIV’’ means the human 

2 immunodeficiency virus, the pathogen that causes 

3 AIDS. 

4 (4) HIV/AIDS.—The term ‘‘HIV/AIDS’’ 

5 means, with respect to an individual, an individual 

6 who is infected with HIV or living with AIDS. 

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