II 
Calendar No. 86
108TH CONGRESS 
1ST SESSION H. R. 1298
IN THE SENATE OF THE UNITED STATES 
MAY 5, 2003
Received and read the first time 
MAY 6, 2003
Read the second time and placed on the calendar 
AN ACT 
To provide assistance to foreign countries to combat HIV/
AIDS, tuberculosis, and malaria, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Definitions. 
Sec. 4. Purpose. 
Sec. 5. Authority to consolidate and combine reports. 
TITLE I—POLICY PLANNING AND COORDINATION 
Sec. 101. Development of a comprehensive, five-year, global strategy. 
Sec. 102. HIV/AIDS Response Coordinator. 
TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PARTNERSHIPS 
Sec. 201. Sense of Congress on public-private partnerships. 
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and 
Malaria. 
Sec. 203. Voluntary contributions to international vaccine funds. 
TITLE III—BILATERAL EFFORTS 
Subtitle A—General Assistance and Programs 
Sec. 301. Assistance to combat HIV/AIDS. 
Sec. 302. Assistance to combat tuberculosis. 
Sec. 303. Assistance to combat malaria. 
Sec. 304. Pilot program for the placement of health care professionals in over-
seas areas severely affected by HIV/AIDS, tuberculosis, and 
malaria. 
Sec. 305. Report on treatment activities by relevant executive branch agencies. 
Sec. 306. Strategies to improve injection safety. 
Sec. 307. Study on illegal diversions of prescription drugs. 
Subtitle B—Assistance for Children and Families 
Sec. 311. Findings. 
Sec. 312. Policy and requirements. 
Sec. 313. Annual reports on prevention of mother-to-child transmission of the 
HIV infection. 
Sec. 314. Pilot program of assistance for children and families affected by HIV/
AIDS. 
Sec. 315. Pilot program on family survival partnerships. 
TITLE IV—AUTHORIZATION OF APPROPRIATIONS
Sec. 401. Authorization of appropriations. 
Sec. 402. Sense of Congress. 
Sec. 403. Allocation of funds. 
Sec. 404. Assistance from the United States private sector to prevent and re-
duce HIV/AIDS in sub-Saharan Africa.
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) During the last 20 years, HIV/AIDS has 
assumed pandemic 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 devasta-
tion. 
(2) According to the Joint United Nations Pro-
gramme on HIV/AIDS (UNAIDS), more than 
65,000,000 individuals worldwide 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 individuals 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 
fifteen 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 soci-
eties 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 vul-
nerable to sexual exploitation and violence, thereby 
increasing the possibility of HIV infection. 
(4) As the leading cause of death in sub-Saha-
ran 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 in-
fected 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 capac-
ity of the individual and the social cohesion and eco-
nomic well-being of the family. 
(7) HIV/AIDS undermines the economic secu-
rity 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 secu-
rity at the local level and governance 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 over-
whelming challenges of the HIV/AIDS epidemic are 
accelerating the outward migration of critically im-
portant health care professionals. 
(9) HIV/AIDS weakens the defenses of coun-
tries severely affected by the HIV/AIDS crisis 
through high infection rates among members of their 
military forces and voluntary peacekeeping per-
sonnel. According to UNAIDS, in sub-Saharan Afri-
ca, 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 international community by—
(A) increasing the potential for political in-
stability and economic devastation, particularly
in those countries and regions most severely af-
fected by the disease; 
(B) decreasing the capacity to resolve con-
flicts 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 in-
fected. According to the World Health Organization
(WHO), HIV/AIDS, tuberculosis, and malaria ac-
counted for more than 5,700,000 deaths in 2001 
and caused debilitating illnesses in millions more. 
(12) Together, HIV/AIDS, tuberculosis, ma-
laria and related diseases are undermining agricul-
tural production throughout Africa. According to the 
United Nations Food and Agricultural Organization, 
7,000,000 agricultural workers throughout 25 Afri-
can countries have died from AIDS since 1985. 
Countries with poorly developed agricultural sys-
tems, 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 communicable disease. HIV infection is 
the leading threat to tuberculosis control. Because 
HIV infection so severely weakens the immune sys-
tem, individuals with HIV and latent tuberculosis in-
fection have a 100 times greater risk of developing 
active tuberculosis diseases thereby increasing the 
risk of spreading tuberculosis to others. Tuber-
culosis, in turn, accelerates the onset of AIDS in in-
dividuals infected with HIV. 
(14) Malaria, the most deadly of all tropical 
parasitic diseases, has been undergoing a dramatic 
resurgence in recent years due to increasing resist-
ance of the malaria parasite to inexpensive and ef-
fective drugs. At the same time, increasing resist-
ance of mosquitoes to standard insecticides makes 
control of transmission difficult to achieve. The 
World Health Organization 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 con-
tributes to the difficulties 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 pandemic will require clinical medical 
interventions, the strengthening of health care deliv-
ery systems and infrastructure, and determined na-
tional leadership and increased budgetary allocations 
for the health sector in countries affected by the epi-
demic 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 in-
fections 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-effec-
tive. 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 becom-
ing orphans, and increase productivity of such indi-
viduals by allowing them to lead active lives and re-
duce 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 effec-
tive in combating the HIV/AIDS pandemic and can 
be a resource in assisting indigenous organizations 
in severely affected countries in their efforts to pro-
vide 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 dis-
ease, 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 knowl-
edge 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 sig-
nificant decline in HIV rates of any country in Afri-
ca, 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 about the disease. His lead-
ership stands as a model for ways political leaders 
in Africa and other developing countries can mobi-
lize their nations, including civic organizations, pro-
fessional 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. Teenagers, wait until you are 
married before you begin sex.’’. 
(D) By 1995, 95 percent of Ugandans were re-
porting 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. Ugan-
da’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, includ-
ing—
(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 infrastruc-
ture 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 
populations in programs designed to encourage 
behavioral and social change and reduce the 
stigma associated with HIV/AIDS; and 
(D) coordination of efforts between inter-
national organizations such as the Global Fund
to Fight AIDS, Tuberculosis and Malaria, the 
Joint United Nations Programme on HIV/
AIDS (UNAIDS), the World Health Organiza-
tion (WHO), national governments, and private 
sector organizations, including faith-based orga-
nizations. 
(22) The United States has the capacity to lead 
and enhance the effectiveness of the international 
community’s response by—
(A) providing substantial financial re-
sources, technical expertise, and training, par-
ticularly of health care personnel and commu-
nity workers and leaders; 
(B) promoting vaccine and microbicide re-
search and the development of new treatment 
protocols in the public and commercial pharma-
ceutical research sectors; 
(C) making available pharmaceuticals and 
diagnostics for HIV/AIDS therapy; 
(D) encouraging governments and faith-
based and community-based organizations to 
adopt policies that treat HIV/AIDS as a multi-
sectoral public health problem affecting not only 
health but other areas such as agriculture, edu-
cation, the economy, the family and society, and
assisting them to develop and implement pro-
grams corresponding to these needs; 
(E) promoting healthy lifestyles, including 
abstinence, delaying sexual debut, monogamy, 
marriage, faithfulness, use of condoms, and 
avoiding substance abuse; and 
(F) encouraging active involvement of the 
private sector, including businesses, pharma-
ceutical and biotechnology companies, the med-
ical and scientific communities, charitable foun-
dations, private and voluntary organizations 
and nongovernmental organizations, faith-based 
organizations, community-based organizations, 
and other nonprofit entities. 
(23) Prostitution and other sexual victimization 
are degrading to women and children and it should 
be the policy of the United States to eradicate such 
practices. The sex industry, the trafficking of indi-
viduals into such industry, and sexual violence are 
additional causes of and factors in the spread of the 
HIV/AIDS epidemic. One in nine South Africans is 
living with AIDS, and sexual assault is rampant, at 
a victimization rate of one in three women. Mean-
while in Cambodia, as many as 40 percent of pros-
titutes are infected with HIV and the country has
the highest rate of increase of HIV infection in all 
of Southeast Asia. Victims of coercive sexual encoun-
ters do not get to make choices about their sexual 
activities. 
(24) Strong coordination must exist among the 
various agencies of the United States to ensure ef-
fective and efficient use of financial and technical re-
sources within the United States Government with 
respect to the provision of international HIV/AIDS 
assistance. 
(25) In his address to Congress on January 28, 
2003, the President announced the Administration’s 
intention to embark on a five-year emergency plan 
for AIDS relief, to confront HIV/AIDS with the 
goals of preventing 7,000,000 new HIV/AIDS infec-
tions, treating at least 2,000,000 people with life-ex-
tending drugs, and providing humane care for mil-
lions of people suffering from HIV/AIDS, and for 
children orphaned by HIV/AIDS. 
(26) In this address to Congress, the President 
stated the following: ‘‘Today, on the continent of Af-
rica, nearly 30,000,000 people have the AIDS 
virus—including 3,000,000 children under the age of 
15. There are whole countries in Africa where more 
than one-third of the adult population carries the in-
fection. More than 4,000,000 require immediate 
drug treatment. Yet across that continent, only 
50,000 AIDS victims—only 50,000—are receiving 
the medicine they need.’’. 
(27) Furthermore, the President focused on 
care and treatment of HIV/AIDS in his address to 
Congress, stating the following: ‘‘Because the AIDS 
diagnosis is considered a death sentence, many do 
not seek treatment. Almost all who do are turned 
away. A doctor in rural South Africa describes his 
frustration. He says, ‘We have no medicines. Many 
hospitals tell people, you’ve got AIDS, we can’t help 
you. Go home and die.’ In an age of miraculous 
medicines, no person should have to hear those 
words. AIDS can be prevented. Anti-retroviral drugs 
can extend life for many years . . . Ladies and gen-
tlemen, seldom has history offered a greater oppor-
tunity to do so much for so many.’’. 
(28) Finally, the President stated that ‘‘[w]e 
have confronted, and will continue to confront, HIV/
AIDS in our own country’’, proposing now that the 
United States should lead the world in sparing inno-
cent people from a plague of nature, and asking 
Congress ‘‘to commit $15,000,000,000 over the next 
five years, including nearly $10,000,000,000 in new
money, to turn the tide against AIDS in the most 
afflicted nations of Africa and the Caribbean’’. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) AIDS.—The term ‘‘AIDS’’ means the ac-
quired immune deficiency syndrome. 
(2) APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES.—The term ‘‘appropriate congressional com-
mittees’’ means the Committee on Foreign Relations 
of the Senate and the Committee on International 
Relations of the House of Representatives. 
(3) GLOBAL FUND.—The term ‘‘Global Fund’’ 
means the public-private partnership known as the 
Global Fund to Fight AIDS, Tuberculosis and Ma-
laria established pursuant to Article 80 of the Swiss 
Civil Code. 
(4) HIV.—The term ‘‘HIV’’ means the human 
immunodeficiency virus, the pathogen that causes 
AIDS. 
(5) 
HIV/AIDS.—The 
term 
‘‘HIV/AIDS’’ 
means, with respect to an individual, an individual 
who is infected with HIV or living with AIDS. 
(6) RELEVANT
EXECUTIVE
BRANCH
AGEN-
CIES.—The term ‘‘relevant executive branch agen-
cies’’ means the Department of State, the United
States Agency for International Development, and 
any other department or agency of the United States 
that participates in international HIV/AIDS activi-
ties pursuant to the authorities of such department 
or agency or the Foreign Assistance Act of 1961. 
SEC. 4. PURPOSE. 
The purpose of this Act is to strengthen United 
States leadership and the effectiveness of the United 
States response to certain global infectious diseases by—
(1) establishing a comprehensive, integrated 
five-year, global strategy to fight HIV/AIDS that en-
compasses a plan for phased expansion of critical 
programs and improved coordination among relevant 
executive branch agencies and between the United 
States and foreign governments and international 
organizations; 
(2) providing increased resources for multilat-
eral efforts to fight HIV/AIDS; 
(3) providing increased resources for United 
States bilateral efforts, particularly for technical as-
sistance and training, to combat HIV/AIDS, tuber-
culosis, and malaria; 
(4) encouraging the expansion of private sector 
efforts and expanding public-private sector partner-
ships to combat HIV/AIDS; and
(5) intensifying efforts to support the develop-
ment of vaccines and treatment for HIV/AIDS, tu-
berculosis, and malaria. 
SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE RE-
PORTS. 
With respect to the reports required by this Act to 
be submitted by the President, to ensure an efficient use 
of resources, the President may, in his discretion and not-
withstanding any other provision of this Act, consolidate 
or combine any of these reports, except for the report re-
quired by section 101 of this Act, so long as the required 
elements of each report are addressed and reported within 
a 90-day period from the original deadline date for sub-
mission of the report specified in this Act. The President 
may also enter into contracts with organizations with rel-
evant expertise to develop, originate, or contribute to any 
of the reports required by this Act to be submitted by the 
President. 
TITLE I—POLICY PLANNING AND 
COORDINATION 
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-
YEAR, GLOBAL STRATEGY. 
(a) STRATEGY.—The President shall establish a com-
prehensive, integrated, five-year strategy to combat global 
HIV/AIDS that strengthens the capacity of the United
States to be an effective leader of the international cam-
paign against HIV/AIDS. Such strategy shall maintain 
sufficient flexibility and remain responsive to the ever-
changing nature of the HIV/AIDS pandemic and shall—
(1) include specific objectives, multisectoral ap-
proaches, and specific strategies to treat individuals 
infected with HIV/AIDS and to prevent the further 
spread of HIV infections, with a particular focus on 
the needs of families with children (including the 
prevention of mother-to-child transmission), women, 
young people, and children (such as unaccompanied 
minor children and orphans); 
(2) as part of the strategy, implement a tiered 
approach to direct delivery of care and treatment 
through a system based on central facilities aug-
mented by expanding circles of local delivery of care 
and treatment through local systems and capacity; 
(3) assign priorities for relevant executive 
branch agencies; 
(4) provide that the reduction of HIV/AIDS be-
havioral risks shall be a priority of all prevention ef-
forts in terms of funding, educational messages, and 
activities by promoting abstinence from sexual activ-
ity and substance abuse, encouraging monogamy and 
faithfulness, promoting the effective use of condoms,
and eradicating prostitution, the sex trade, rape, 
sexual assault and sexual exploitation of women and 
children; 
(5) improve coordination and reduce duplication 
among relevant executive branch agencies, foreign 
governments, and international organizations; 
(6) project general levels of resources needed to 
achieve the stated objectives; 
(7) expand public-private partnerships and the 
leveraging of resources;
(8) maximize United States capabilities in the 
areas of technical assistance and training and re-
search, including vaccine research; 
(9) establish priorities for the distribution of re-
sources based on factors such as the size and demo-
graphics of the population with HIV/AIDS, tuber-
culosis, and malaria and the needs of that popu-
lation and the existing infrastructure or funding lev-
els that may exist to cure, treat, and prevent HIV/
AIDS, tuberculosis, and malaria; and 
(10) include initiatives describing how the 
President will maximize the leverage of private sec-
tor dollars in reduction and treatment of HIV/AIDS, 
tuberculosis, and malaria. 
(b) REPORT.—
abuse, and use of condoms, research (including 
incentives for vaccine development and new pro-
tocols), training of health care workers, the de-
velopment of health care infrastructure and de-
livery systems, and avoidance of substance 
abuse. 
(D) A description of the manner in which 
the strategy will promote the development and 
implementation of national and community-
based multisectoral strategies and programs, in-
cluding those designed to enhance leadership 
capacity particularly at the community level. 
(E) A description of the specific strategies 
developed to meet the unique needs of women, 
including the empowerment of women in inter-
personal situations, young people and children, 
including those orphaned by HIV/AIDS and 
those who are victims of the sex trade, rape, 
sexual abuse, assault, and exploitation. 
(F) a description of the specific strategies 
developed to encourage men to be responsible in 
their sexual behavior, child rearing and to re-
spect women including the reduction of sexual 
violence and coercion;
(G) a description of the specific strategies 
developed to increase women’s access to employ-
ment opportunities, income, productive re-
sources, and microfinance programs; 
(H) A description of the programs to be 
undertaken to maximize United States con-
tributions in the areas of technical assistance, 
training (particularly of health care workers 
and community-based leaders in affected sec-
tors), and research, including the promotion of 
research on vaccines and microbicides. 
(I) An identification of the relevant execu-
tive branch agencies that will be involved and 
the assignment of priorities to those agencies. 
(J) A description of the role of each rel-
evant executive branch agency and the types of 
programs that the agency will be undertaking. 
(K) A description of the mechanisms that 
will be utilized to coordinate the efforts of the 
relevant executive branch agencies, to avoid du-
plication of efforts, to enhance on-site coordina-
tion efforts, and to ensure that each agency un-
dertakes programs primarily in those areas 
where the agency has the greatest expertise, 
technical capabilities, and potential for success.
(L) A description of the mechanisms that 
will be utilized to ensure greater coordination 
between the United States and foreign govern-
ments and international organizations including 
the Global Fund, UNAIDS, international finan-
cial institutions, and private sector organiza-
tions. 
(M) The level of resources that will be 
needed on an annual basis and the manner in 
which those resources would generally be allo-
cated among the relevant executive branch 
agencies. 
(N) A description of the mechanisms to be 
established for monitoring and evaluating pro-
grams, promoting successful models, and for 
terminating unsuccessful programs. 
(O) A description of the manner in which 
private, nongovernmental entities will factor 
into the United States Government-led effort 
and a description of the type of partnerships 
that will be created to maximize the capabilities 
of these private sector entities and to leverage 
resources. 
(P) A description of the ways in which 
United States leadership will be used to en-
hance the overall international response to the 
HIV/AIDS pandemic and particularly to height-
en the engagement of the member states of the 
G–8 and to strengthen key financial and coordi-
nation mechanisms such as the Global Fund 
and UNAIDS. 
(Q) A description of the manner in which 
the United States strategy for combating HIV/
AIDS relates to and supports other United 
States assistance strategies in developing coun-
tries. 
(R) A description of the programs to be 
carried out under the strategy that are specifi-
cally targeted at women and girls to educate 
them about the spread of HIV/AIDS. 
(S) A description of efforts being made to 
address the unique needs of families with chil-
dren with respect to HIV/AIDS, including ef-
forts to preserve the family unit. 
(T) An analysis of the emigration of criti-
cally important medical and public health per-
sonnel, including physicians, nurses, and super-
visors from sub-Saharan African countries that 
are acutely impacted by HIV/AIDS, including a 
description of the causes, effects, and the im-
pact on the stability of health infrastructures, 
as well as a summary of incentives and pro-
grams that the United States could provide, in 
concert with other private and public sector 
partners and international organizations, to sta-
bilize health institutions by encouraging critical 
personnel to remain in their home countries. 
(U) A description of the specific strategies 
developed to promote sustainability of HIV/
AIDS 
pharmaceuticals 
(including 
antiretrovirals) and the effects of drug resist-
ance on HIV/AIDS patients. 
(V) A description of the specific strategies 
to ensure that the extraordinary benefit of HIV/
AIDS 
pharmaceuticals 
(especially 
antiretrovirals) are not diminished through the 
illegal counterfeiting of pharmaceuticals and 
black market sales of such pharmaceuticals. 
(W) An analysis of the prevalence of 
Human Papilloma Virus (HPV) in sub-Saharan 
Africa and the impact that condom usage has 
upon the spread of HPV in sub-Saharan Africa. 
(c) STUDY; DISTRIBUTION OF RESOURCES.—
(1) STUDY.—Not later than 3 years after the 
date of the enactment of this Act, the Institute of
Medicine shall publish findings comparing the suc-
cess rates of the various programs and methods used 
under the strategy described in subsection (a) to re-
duce, prevent, and treat HIV/AIDS, tuberculosis, 
and malaria. 
(2) 
DISTRIBUTION
OF
RESOURCES.—In 
prioritizing the distribution of resources under the 
strategy described in subsection (a), the President 
shall consider the findings published by the Institute 
of Medicine under this subsection. 
SEC. 102. HIV/AIDS RESPONSE COORDINATOR. 
(a) ESTABLISHMENT OF POSITION.—Section 1 of the 
State Department Basic Authorities Act of 1956 (22 
U.S.C. 265(a)) is amended—
(1) by redesignating subsection (f) as sub-
section (g); and 
(2) by inserting after subsection (e) the fol-
lowing: 
‘‘(f) HIV/AIDS RESPONSE COORDINATOR.—
‘‘(1) IN GENERAL.—There shall be established 
within the Department of State in the immediate of-
fice of the Secretary of State a Coordinator of 
United States Government Activities to Combat 
HIV/AIDS Globally, who shall be appointed by the 
President, by and with the advice and consent of the
Senate. The Coordinator shall report directly to the 
Secretary. 
‘‘(2) 
AUTHORITIES
AND
DUTIES; 
DEFINI-
TIONS.—
‘‘(A) 
AUTHORITIES.—The 
Coordinator, 
acting through such nongovernmental organiza-
tions (including faith-based and community-
based organizations) and relevant executive 
branch agencies as may be necessary and ap-
propriate to effect the purposes of this section, 
is authorized—
‘‘(i) to operate internationally to carry 
out prevention, care, treatment, support, 
capacity development, and other activities 
for combatting HIV/AIDS; 
‘‘(ii) to transfer and allocate funds to 
relevant executive branch agencies; and 
‘‘(iii) to provide grants to, and enter 
into contracts with, nongovernmental orga-
nizations (including faith-based and com-
munity-based organizations) to carry out 
the purposes of section. 
‘‘(B) DUTIES.—
‘‘(i) IN
GENERAL.—The Coordinator 
shall have primary responsibility for the
oversight and coordination of all resources 
and international activities of the United 
States Government to combat the HIV/
AIDS pandemic, including all programs, 
projects, and activities of the United 
States Government relating to the HIV/
AIDS pandemic under the United States 
Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 or any 
amendment made by that Act. 
‘‘(ii) SPECIFIC
DUTIES.—The duties 
of the Coordinator shall specifically include 
the following: 
‘‘(I) Ensuring program and pol-
icy coordination among the relevant 
executive branch agencies and non-
governmental organizations, including 
auditing, monitoring, and evaluation 
of all such programs. 
‘‘(II) Ensuring that each relevant 
executive branch agency undertakes 
programs primarily in those areas 
where the agency has the greatest ex-
pertise, technical capabilities, and po-
tential for success.
‘‘(III) Avoiding duplication of ef-
fort. 
‘‘(IV) Ensuring coordination of 
relevant executive branch agency ac-
tivities in the field. 
‘‘(V) Pursuing coordination with 
other countries and international or-
ganizations. 
‘‘(VI) Resolving policy, program, 
and funding disputes among the rel-
evant executive branch agencies. 
‘‘(VII) Directly approving all ac-
tivities of the United States (including 
funding) relating to combatting HIV/
AIDS in each of Botswana, Cote 
d’Ivoire, Ethiopia, Guyana, Haiti, 
Kenya, Mozambique, Namibia, Nige-
ria, Rwanda, South Africa, Tanzania, 
Uganda, Zambia, and other countries 
designated by the President, which 
other designated countries may in-
clude those countries in which the 
United States is implementing HIV/
AIDS programs as of the date of the 
enactment of the United States Lead-
ership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003. 
‘‘(VIII) Establishing due dili-
gence criteria for all recipients of 
funds section and all activities subject 
to the coordination and appropriate 
monitoring, evaluation, and audits 
carried out by the Coordinator nec-
essary to assess the measurable out-
comes of such activities. 
‘‘(C) DEFINITIONS.—In this paragraph: 
‘‘(i) AIDS.—The term ‘AIDS’ means 
acquired immune deficiency syndrome. 
‘‘(ii) HIV.—The term ‘HIV’ means 
the human immunodeficiency virus, the 
pathogen that causes AIDS. 
‘‘(iii) HIV/AIDS.—The term ‘HIV/
AIDS’ means, with respect to an indi-
vidual, an individual who is infected with 
HIV or living with AIDS. 
‘‘(iv) RELEVANT EXECUTIVE BRANCH 
AGENCIES.—The term ‘relevant executive 
branch agencies’ means the Department of 
State, the United States Agency for Inter-
national Development, the Department of
Health and Human Services (including the 
Public Health Service), and any other de-
partment or agency of the United States 
that participates in international HIV/
AIDS activities pursuant to the authorities 
of such department or agency or this 
Act.’’. 
(b) RESOURCES.—Not later than 90 days after the 
date of enactment of this Act, the President shall specify 
the necessary financial and personnel resources, from 
funds appropriated pursuant to the authorization of ap-
propriations under section 401 for HIV/AIDS assistance, 
that shall be assigned to and under the direct control of 
the Coordinator of United States Government Activities 
to Combat HIV/AIDS Globally to establish and maintain 
the duties and supporting activities assigned to the Coor-
dinator by this Act and the amendments made by this Act. 
(c) ESTABLISHMENT
OF SEPARATE ACCOUNT.—
There is established in the general fund of the Treasury 
a separate account which shall be known as the ‘‘Activities 
to Combat HIV/AIDS Globally Fund’’ and which shall be 
administered by the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally. There 
shall be deposited into the Fund all amounts appropriated 
pursuant to the authorization of appropriations under sec-
tion 401 for HIV/AIDS assistance, except for amounts ap-
propriated for United States contributions to the Global 
Fund. 
TITLE II—SUPPORT FOR MULTI-
LATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PART-
NERSHIPS 
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PART-
NERSHIPS. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Innovative partnerships between govern-
ments and organizations in the private sector (in-
cluding foundations, universities, corporations, faith-
based and community-based organizations, and other 
nongovernmental organizations) have proliferated in 
recent years, particularly in the area of health. 
(2) Public-private sector partnerships multiply 
local and international capacities to strengthen the 
delivery of health services in developing countries 
and to accelerate research for vaccines and other 
pharmaceutical products that are essential to combat 
infectious diseases decimating the populations of 
these countries.
(3) These partnerships maximize the unique ca-
pabilities of each sector while combining financial 
and other resources, scientific knowledge, and exper-
tise toward common goals which neither the public 
nor the private sector can achieve alone. 
(4) Sustaining existing public-private partner-
ships and building new ones are critical to the suc-
cess of the international community’s efforts to com-
bat HIV/AIDS and other infectious diseases around 
the globe. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that—
(1) the sustainment and promotion of public-
private partnerships should be a priority element of 
the strategy pursued by the United States to combat 
the HIV/AIDS pandemic and other global health cri-
ses; and 
(2) the United States should systematically 
track the evolution of these partnerships and work 
with others in the public and private sector to profile 
and build upon those models that are most effective. 
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 
AIDS, TUBERCULOSIS AND MALARIA.
(a) FINDINGS.—The Congress finds as follows:
(1) The establishment of the Global Fund in 
January 2002 is consistent with the general prin-
ciples for an international AIDS trust fund first out-
lined by the Congress in the Global AIDS and Tu-
berculosis Relief Act of 2000 (Public Law 106–264). 
(2) Section 2, Article 5 of the bylaws of the 
Global Fund provides for the International Bank for 
Reconstruction and Development to serve as the ini-
tial collection trustee for the Global Fund. 
(3) The trustee agreement signed between the 
Global Fund and the International Bank for Recon-
struction and Development narrows the range of du-
ties to include receiving and investing funds from 
donors, disbursing the funds upon the instruction of 
the Global Fund, reporting on trust fund resources 
to donors and the Global Fund, and providing an 
annual external audit report to the Global Fund. 
(b) AUTHORITY FOR UNITED STATES PARTICIPA-
TION.—
(1) 
UNITED
STATES
PARTICIPATION.—The 
United States is hereby authorized to participate in 
the Global Fund.
(2) PRIVILEGES AND IMMUNITIES.—The Global 
Fund shall be considered a public international orga-
nization for purposes of section 1 of the Inter-
national Organizations Immunities Act (22 U.S.C. 
288). 
(c) REPORTS TO CONGRESS.—Not later than 1 year 
after the date of the enactment of this Act, and annually 
thereafter for the duration of the Global Fund, the Presi-
dent shall submit to the appropriate congressional com-
mittees a report on the Global Fund, including contribu-
tions pledged to, contributions (including donations from 
the private sector) received by, and projects funded by the 
Global Fund, and the mechanisms established for trans-
parency and accountability in the grant-making process. 
(d) UNITED STATES FINANCIAL PARTICIPATION.—
(1) AUTHORIZATION OF APPROPRIATIONS.—In 
addition to any other funds authorized to be appro-
priated for bilateral or multilateral HIV/AIDS, tu-
berculosis, or malaria programs, of the amounts au-
thorized to be appropriated under section 401, there 
are authorized to be appropriated to the President 
up to $1,000,000,000 for the period of fiscal year 
2004 beginning on January 1, 2004, and such sums 
as may be necessary for the fiscal years 2005–2008, 
for contributions to the Global Fund. 
(2) AVAILABILITY OF FUNDS.—Amounts appro-
priated under paragraph (1) are authorized to re-
main available until expended.
(3) REPROGRAMMING
OF
FISCAL
YEAR
2001 
FUNDS.—Funds made available for fiscal year 2001 
under section 141 of the Global AIDS and Tuber-
culosis Relief Act of 2000—
(A) are authorized to remain available 
until expended; and 
(B) shall be transferred to, merged with, 
and made available for the same purposes as, 
funds made available for fiscal years 2004 
through 2008 under paragraph (1). 
(4) LIMITATION.—
(A)(i) At any time during fiscal years 2004 
through 2008, no United States contribution to 
the Global Fund may cause the total amount of 
United States Government contributions to the 
Global Fund to exceed 33 percent of the total 
amount of funds contributed to the Global 
Fund from all other sources. Contributions to 
the Global Fund from the International Bank 
for Reconstruction and Development and the 
International Monetary Fund shall not be con-
sidered in determining compliance with this 
paragraph. 
(ii) If, at any time during any of the fiscal 
years 2004 through 2008, the President deter-
mines that the Global Fund has provided assist-
ance to a country, the government of which the 
Secretary of State has determined, for purposes 
of section 6(j)(1) of the Export Administration 
Act of 1979 (50 U.S.C. App. 2405(j)(1)), has 
repeatedly provided support for acts of inter-
national terrorism, then the United States shall 
withhold from its contribution for the next fis-
cal year an amount equal to the amount ex-
pended by the Fund to the government of each 
such country. 
(iii) If at any time the President deter-
mines that the expenses of the Governing, Ad-
ministrative, and Advisory Bodies (including 
the Partnership Forum, the Foundation Board, 
the Secretariat, and the Technical Review 
Board) of the Global Fund exceed 10 percent of 
the total expenditures of the Fund for any 2-
year period, the United States shall withhold 
from its contribution for the next fiscal year an 
amount equal the to the average annual amount 
expended by the Fund for such 2-year period 
for the expenses of the Governing, Administra-
tive, and Advisory Bodies in excess of 10 per-
cent of the total expenditures of the Fund.
(iv) The President may waive the applica-
tion of clause (iii) if the President determines 
that extraordinary circumstances warrant such 
a waiver. No waiver under this clause may be 
for any period that exceeds 1 year. 
(v) If, at any time during any of the fiscal 
years 2004 through 2008, the President deter-
mines that the salary of any individual em-
ployed by the Global Fund exceeds the salary of 
the Vice President of the United States (as de-
termined under section 104 of title 3, United 
States Code) for that fiscal year, then the 
United States shall withhold from its contribu-
tion for the next fiscal year an amount equal to 
the aggregate amount by which the salary of 
each such individual exceeds the salary of the 
Vice President of the United States. 
(B)(i) Any amount made available under 
this subsection that is withheld by reason of 
subparagraph (A)(i) shall be contributed to the 
Global Fund as soon as practicable, subject to 
subparagraph (A)(i), after additional contribu-
tions to the Global Fund are made from other 
sources.
(ii) Any amount made available under this 
subsection that is withheld by reason of sub-
paragraph (A)(iii) shall be transferred to the 
Activities to Combat HIV/AIDS Globally Fund 
and shall remain available under the same 
terms and conditions as funds appropriated 
pursuant to the authorization of appropriations 
under section 401 for HIV/AIDS assistance. 
(iii) Any amount made available under this 
subsection that is withheld by reason of clause 
(ii) or (iii) of subparagraph (A) is authorized to 
be made available to carry out section 104A of 
the Foreign Assistance Act of 1961 (as added 
by section 301 of this Act). Amounts made 
available under the preceding sentence are in 
addition to amounts appropriated pursuant to 
the authorization of appropriations under sec-
tion 401 of this Act for HIV/AIDS assistance. 
(C)(i) The President may suspend the ap-
plication of subparagraph (A) with respect to a 
fiscal year if the President determines that an 
international health emergency threatens the 
national security interests of the United States. 
(ii) The President shall notify the Com-
mittee on International Relations of the House
of Representatives and the Committee on For-
eign Relations of the Senate not less than 5 
days before making a determination under 
clause (i) with respect to the application of sub-
paragraph (A)(i) and shall include in the notifi-
cation—
(I) a justification as to why increased 
United States Government contributions to 
the Global Fund is preferable to increased 
United States assistance to combat HIV/
AIDS, tuberculosis, and malaria on a bilat-
eral basis; and 
(II) an explanation as to why other 
government donors to the Global Fund are 
unable to provide adequate contributions to 
the Fund. 
(e) INTERAGENCY TECHNICAL REVIEW PANEL.—
(1) ESTABLISHMENT.—The Coordinator of 
United States Government Activities to Combat 
HIV/AIDS Globally, established in section 1(f)(1) of 
the State Department Basic Authorities Act of 1956 
(as added by section 102(a) of this Act), shall estab-
lish in the executive branch an interagency technical 
review panel.