108TH CONGRESS
1ST SESSION
H. R. 1298
AN ACT
To provide assistance to foreign countries to com-
bat HIV/AIDS, tuberculosis, and malaria, and
for other purposes.
108TH CONGRESS
1ST SESSION
H. R. 1298
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,
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 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.—
(1) IN
GENERAL.—Not later than 270 days
after the date of enactment of this Act, the Presi-
dent shall submit to the appropriate congressional
committees a report setting forth the strategy de-
scribed in subsection (a).
(2) REPORT CONTENTS.—The report required
by paragraph (1) shall include a discussion of the
elements described in paragraph (3) and may in-
clude a discussion of additional elements relevant to
the strategy described in subsection (a). Such dis-
cussion may include an explanation as to why a par-
ticular element described in paragraph (3) is not rel-
evant to such strategy.
(3) REPORT
ELEMENTS.—The elements re-
ferred to in paragraph (2) are the following:
(A) The objectives, general and specific, of
the strategy.
(B) A description of the criteria for deter-
mining success of the strategy.
(C) A description of the manner in which
the strategy will address the fundamental ele-
ments of prevention and education, care, and
treatment (including increasing access to phar-
maceuticals and to vaccines), the promotion of
abstinence, monogamy, avoidance of substance
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
notification—
(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.