H. R. 1298—2
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 pan-
demic 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 world-
wide 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 individ-
uals 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 exploi-
tation 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
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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 criti-
cally 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 peace-
keeping 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 inter-
national 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 commu-
nicable disease. HIV infection is the leading threat to tuber-
culosis 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 dis-
eases, 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
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resistance of mosquitoes to standard insecticides makes control
of transmission difficult to achieve. The World Health Organiza-
tion 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 difficul-
ties 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 pan-
demic will require clinical medical interventions, the strength-
ening of health care delivery systems and infrastructure, and
determined national leadership and increased budgetary alloca-
tions 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 produc-
tivity 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 organiza-
tions 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 long-
standing cultural taboos, and changed widespread perceptions
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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, profes-
sional 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. Begin-
ning 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. Teen-
agers, 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 popu-
lations 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 Pro-
gramme 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 per-
sonnel 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;
H. R. 1298—40
(b) AVAILABILITY OF FUNDS.—Amounts appropriated pursuant
to subsection (a) are authorized to remain available until expended.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.