II 

109TH CONGRESS 

2D SESSION S. 3656 

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

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 13, 2006 

Mrs. FEINSTEIN (for herself and Ms. SNOWE) 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 for 

5 Youth Act’’. 

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 

10 unprecedented effort to combat the global AIDS epiVerDate Aug 31 2005 05:26 Jul 15, 2006 Jkt 049200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3656.IS S3656

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1 demic, with $9,000,000,000 targeted for initiatives 

2 in 15 focus countries. 

3 (2) The PEPFAR prevention goal is to avert 

4 7,000,000 HIV infections in the 15 focus coun5 tries—most in sub-Saharan Africa where hetero6 sexual intercourse is by far the predominant mode of 

7 HIV transmission. 

8 (3) The PEPFAR strategy for prevention of 

9 sexual transmission of HIV is shaped by 3 elements: 

10 the ABC model, defined as ‘‘Abstain, Be faithful, 

11 use Condoms’’, the promotion of ‘‘abstinence-until12 marriage’’, and deference to local prevention needs. 

13 (4) The United States Leadership Against HIV/ 

14 AIDS, Tuberculosis, and Malaria Act of 2003 re15 quires that at least one-third of all prevention funds 

16 be reserved for abstinence-until-marriage programs. 

17 In implementing this requirement, the U.S. Global 

18 AIDS Coordinator has required that 50 percent of 

19 prevention funding be dedicated to sexual trans20 mission prevention activities. This requirement se21 verely limits countries from employing strategies for 

22 the prevention of sexual transmission other than ab23 stinence, because the other sexual transmission pre24 vention programs under PEPFAR (such as the pur25 chase of condoms and management of sexually 


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1 transmitted infections) cannot exceed one-sixth of 

2 the total prevention funds. 

3 (5) The Government Accountability Office 

4 (GAO) issued a report in April, 2006, ‘‘Spending 

5 Requirement Presents Challenges For Allocating 

6 Funding under the President’s Emergency Plan for 

7 AIDS Relief’’, that found ‘‘significant challenges’’ 

8 associated with meeting the earmark for abstinence9 until-marriage programs. 

10 (6) GAO found that a majority of country 

11 teams report that fulfilling the requirement presents 

12 challenges to their ability to respond to local epide13 miology and cultural and social norms. 

14 (7) GAO found that, although some country 

15 teams may be exempted from the abstinence-until16 marriage spending requirement, country teams that 

17 are not exempted have to spend more than the 33 

18 percent of prevention funds on abstinence-until-mar19 riage activities—sometimes at the expense of other 

20 programs. 

21 (8) Indeed, according to GAO, the proportion of 

22 HIV prevention funds dedicated to ‘‘other preven23 tion’’ activities (i.e. the purchase and promotion of 

24 condoms, management of sexually transmitted infec25 tions other than HIV, and messages or programs to 


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1 reduce injection drug use) declined from 23 percent 

2 in fiscal year 2005 to 18 percent in fiscal year 2006 

3 for country teams that did not receive exemptions. 

4 (9) GAO found that, as a result of the absti5 nence-until-marriage spending requirement, some 

6 countries have had to reduce planned funding for 

7 Prevention of Mother-to-Child Transmission pro8 grams, thereby limiting services for pregnant women 

9 and their children. 

10 (10) GAO found that the abstinence-until-mar11 riage spending requirement limited or reduced fund12 ing for programs directed to high-risk groups, such 

13 as services for married discordant couples, sexually 

14 active youth, and commercial sex workers. 

15 (11) GAO found that the abstinence-until-mar16 riage spending requirement made it difficult for 

17 countries to fund medical and blood safety activities. 

18 (12) GAO found that, because of the absti19 nence-until-marriage spending requirement, some 

20 countries would likely have to reduce funding for 

21 condom procurement and condom social marketing. 

22 (13) In addition, GAO found that two-thirds of 

23 focus country teams reported that the policy for im24 plementing the ABC model is unclear and open to 

25 varying interpretations, causing confusion about 


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1 which groups may be targeted and whether youth 

2 may receive the ABC message. 

3 (14) GAO found that the ABC guidance does 

4 not clearly delineate permissible C activities under 

5 the ABC model. Program staff reported that they 

6 feel ‘‘constrained’’ by restrictions on promoting or 

7 marketing condoms to youth. Other country teams 

8 reported confusion about whether PEPFAR funds 

9 may be used for broad condom social marketing, 

10 even to adults in a generalized epidemic. 

11 (15) Each day, an estimated 13,400 people 

12 worldwide are newly infected with HIV. 

13 (16) Sub-Saharan Africa is home to almost 

14 two-thirds of the estimated 40,000,000 people cur15 rently living with HIV. 

16 (17) In many African countries, the epidemic 

17 has spread among the general population. The HIV 

18 prevalence rate for the general population is 8 per19 cent across sub-Saharan Africa. Among the United 

20 States focus countries in sub-Saharan Africa, the 

21 HIV prevalence rate ranges from 4 percent in Ugan22 da to 37 percent in Botswana. 

23 (18) According to the Joint United Nations 

24 Programme on HIV/AIDS, young people between 

25 the ages of 15 and 24 are ‘‘the most threatened by 


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1 AIDS’’ and ‘‘are at the centre of HIV vulnerability’’. 

2 Globally, this age group accounts for half of all new 

3 HIV cases each year. More than 7,000 young people 

4 contract the virus every day. 

5 (19) Most young people in sub-Saharan Africa 

6 have sex before marriage during their adolescent 

7 years. In many countries, at least half of all women 

8 have sex before age 20 and before marriage. Among 

9 young men, more than 70 percent have premarital 

10 sex before age 20. 

11 (20) Many adolescents, who are sexually active 

12 and not yet married, have inadequate information on 

13 how to protect themselves against HIV. Fewer than 

14 half of young people in sub-Saharan Africa mention 

15 abstinence, monogamy, or condom use as a way of 

16 avoiding HIV. 

17 (21) Young people who have sex are at greater 

18 risk of acquiring HIV than adults, partly because of 

19 their lack of knowledge. They are apt to change 

20 partners frequently, have more than 1 partner in the 

21 same time period, or engage in unprotected sex. 

22 (22) Coercion and sexual violence undercut the 

23 ability of young people—women in particular—to 

24 prevent HIV and contribute to the vulnerability to 

25 infection. In addition, gender inequality makes it 


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1 much more difficult for young women to negotiate 

2 abstinence from sex or to insist that their partners 

3 remain faithful or use condoms. 

4 (23) Marriage does not protect young women 

5 from HIV, even when they are faithful to their hus6 bands. In some settings, it appears marriage actu7 ally increases a woman’s HIV risk. In some African 

8 countries, married women aged 15–19 have higher 

9 HIV infection levels than nonmarried sexually active 

10 women of the same age. 

11 (24) A recent USAID-funded review found that 

12 sex and HIV education programs that encourage ab13 stinence but also discuss the use of condoms do not 

14 increase sexual activity as critics of sex education 

15 have long alleged. Sex education can help delay the 

16 initiation of intercourse, reduce the frequency of sex 

17 and the number of sexual partners, and also increase 

18 condom use. 

19 (25) Young people are our greatest hope for 

20 changing the course of the AIDS epidemic. Accord21 ing to the World Health Organization, ‘‘Focusing on 

22 young people is likely to be the most effective ap23 proach to confronting the epidemic, particularly in 

24 high prevalence countries.’’. 


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1 SEC. 3. SENSE OF CONGRESS. 

2 It is the sense of Congress that sexually active young 

3 people, both unmarried and married, who live in a country 

4 where HIV infection is spreading through the general pop5 ulation, rather than being confined to specific populations, 

6 such as sex workers and their clients, injecting drug users, 

7 and men who have sex with men, and the rate of HIV 

8 infection among people between the ages of 15 and 49 ex9 ceeds 1 percent should be— 

10 (1) considered at high risk of contracting HIV 

11 infection; and 

12 (2) provided with the knowledge, skill-building 

13 programs, and tools to protect themselves from HIV 

14 infection, including— 

15 (A) medically accurate information on pub16 lic health benefits and failure rates of multiple 

17 strategies for eliminating or reducing the risks 

18 of contracting HIV and other sexually trans19 mitted infections; and 

20 (B) information about correct and con21 sistent use of condoms as well as abstinence 

22 and the importance of reducing casual sexual 

23 partnering. 


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1 SEC. 4. ALLOCATION OF FUNDS. 

2 Section 403 of the United States Leadership Against 

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

4 U.S.C. 7673) is amended— 

5 (1) in subsection (a), in the second sentence, by 

6 striking ‘‘HIV/AIDS prevention’’ and inserting ‘‘pre7 vention of the sexual transmission of HIV’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(c) ABSTINENCE-UNTIL-MARRIAGE PROGRAMS.— 

11 The term ‘abstinence-until-marriage programs’ means 

12 programs that place the highest priority on encouraging 

13 individuals who have not yet married to abstain from sex14 ual activity, which if practiced 100 percent correctly and 

15 consistently is the only certain way to protect against ex16 posure to HIV and other sexually transmitted infections. 

17 The programs include information on the health benefits 

18 of delayed sexual debut in reducing the transmission of 

19 HIV and may be used to support the wide range of ap20 proaches that promote skill-building strategies for prac21 ticing abstinence.’’. 

22 SEC. 5. ASSISTANCE TO YOUNG PEOPLE. 

23 Section 104A(d)(3) of the Foreign Assistance Act of 

24 1961 (22 U.S.C. 2151b–2(d)(3)) is amended— 

25 (1) in subparagraph (A), by inserting ‘‘sexually 

26 active young people, both unmarried and married, 


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1 who live in a country experiencing a generalized HIV 

2 epidemic,’’ after ‘‘infected with HIV/AIDS,’’; and 

3 (2) by adding at the end the following new sub4 paragraph: 

5 ‘‘(C) In subparagraph (A), the term ‘general6 ized epidemic’ means, with respect to a country, 

7 that— 

8 ‘‘(i) HIV infection is spreading through the 

9 general population of such country, rather than 

10 being confined to specific populations, such as 

11 sex workers and their clients, injecting drug 

12 users, and men who have sex with men; and 

13 ‘‘(ii) the rate of HIV infection among peo14 ple between the ages of 15 and 49 exceeds 1 

15 percent.’’. 

Æ 


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