‘‘TITLE V—ASSISTANCE FOR OR-
PHANS AND OTHER VULNER-
ABLE CHILDREN
‘‘SEC. 241. FINDINGS; DECLARATION OF POLICY.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) By 2010, HIV/AIDS will orphan more
than 25,000,000 children worldwide.
‘‘(2) Ongoing conflicts and civil wars in devel-
oping countries are adversely affecting children in
these countries, the vast majority of whom currently
do not receive humanitarian assistance or other sup-
port from the United States Government.
‘‘(3) The United States Government currently
administers assistance programs for orphans and
other vulnerable children in developing countries.
When requested by the Committee on International
Relations of the House of Representatives to provide
information on the overall number of orphans and
other vulnerable children receiving assistance from
the United States Agency for International Develop-
ment in fiscal year 2002, the Agency was only able
to report on its HIV/AIDS assistance program,
under which the Agency provided assistance to
462,000 such orphans and other vulnerable children.
‘‘(4) The United States Government should in-
crease its efforts to provide assistance for orphans
and other vulnerable children in developing coun-
tries, especially those children affected by HIV/AIDS
or conflict.
‘‘(5) The United States Agency for Inter-
national Development should establish improved ca-
pacity to deliver assistance to orphans and other vul-
nerable children in developing countries through
partnerships with private voluntary organizations,
including faith-based organizations.
‘‘(6) Further, the United States Agency for
International Development should be the primary
United States Government agency responsible for
identifying and assisting orphans and other vulner-
able children in developing countries.
‘‘(b) DECLARATION OF POLICY.—Congress, recog-
nizing that prompt and appropriate action by the United
States to assist orphans and other vulnerable children in
developing countries is an important expression of the hu-
manitarian concern and tradition of the people of the
United States, affirms the willingness of the United States
to assist such orphans and other vulnerable children—
‘‘(1) by providing assistance for the purpose of
improving the health, nutritional, shelter, edu-
cational, economic, and psychological status of or-
phans and other vulnerable children in such coun-
tries; and
‘‘(2) by providing humanitarian and protection
assistance to such orphans and other vulnerable chil-
dren affected by conflict or civil strife.
‘‘SEC. 242. ASSISTANCE TO PROVIDE BASIC CARE.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) The need for individuals and local organi-
zations in developing countries to assist households
headed by children is necessary due to the increase
in the number of such households. Millions of chil-
dren in these types of households lack basic care,
such as access to food and shelter.
‘‘(2) Although families and extended families
serve as the primary providers of care for these chil-
dren, when these family care networks break down,
and when communities are responsible for raising
orphans, these children are cared for in a rich and
nurturing environment and remain connected to the
traditions and rituals of families and the community.
‘‘(3) As the number of these children increases,
the ability of communities to provide basic care for
such children is limited. Assistance to support the
provision of such basic care is therefore necessary in
and of itself and also to facilitate the provision of
other types of assistance for such children under this
title.
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for programs in developing
countries to provide basic care for orphans and other
vulnerable children.
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used—
‘‘(A) to support individuals and local orga-
nizations, including teachers, social workers,
and representatives from religious institutions
and nongovernmental organizations, to mobilize
their own resources through the strengthening
of community care coalitions, networks, or sup-
port groups to provide basic care for orphans
and other vulnerable children, including day
care, food assistance, protection assistance, and
home visits;
‘‘(B) to increase the capacity of the com-
munity care groups described in subparagraph
(A) to meet on a regular basis to identify or-
phans and other vulnerable children and to fa-
cilitate the provision of services; and
‘‘(C) to ensure that the activities of com-
munity care groups described in subparagraph
(A) include appropriate monitoring and super-
vision components.
‘‘(3) DEFINITION.—In this subsection, the term
‘protection assistance’ means all appropriate meas-
ures to promote the physical and psychological secu-
rity of an individual, provide equal access to basic
services for the individual, and safeguard the legal
and human rights and dignity of the individual.
‘‘SEC. 243. ASSISTANCE TO PROVIDE TREATMENT TO OR-
PHANS AND OTHER VULNERABLE CHILDREN
WITH HIV/AIDS.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) Approximately 2,500,000 children under
the age of 15 worldwide have HIV/AIDS. Every day
another 2,000 children under the age of 15 are in-
fected with HIV.
‘‘(2) In 2002, approximately 2,500,000 children
were at risk for infection with HIV through mother-
to-child transmission, which includes transmission at
any point during pregnancy, labor, delivery, or
breastfeeding.
‘‘(3) To date, more than 4,000,000 children
worldwide are estimated to have died from AIDS,
primarily contracted through mother-to-child trans-
mission. Every year, approximately 700,000 babies
are infected with HIV, of which the majority are liv-
ing in Africa.
‘‘(4) In southern Africa HIV/AIDS is now the
leading cause of death among young children, ac-
counting for almost half of such deaths.
‘‘(5) Research has shown conclusively that initi-
ation in a timely manner of antiretroviral therapy
for infants or young children with HIV/AIDS can
preserve or restore their immune functions, promote
normal growth and development, and prolong life.
‘‘(6) Few international development programs
specifically target the treatment of children with
HIV/AIDS in developing countries. Reasons for this
include the perceived low priority of pediatric treat-
ment, a lack of pediatric health care professionals,
lack of expertise and experience in pediatric drug
dosing and monitoring, the perceived complexity of
pediatric treatment, and mistaken beliefs regarding
the risks and benefits of pediatric treatment.
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for the treatment of or-
phans and other vulnerable children with HIV/AIDS
in developing countries.
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used to carry
out the following activities:
‘‘(A) The treatment of orphans and other
vulnerable children with HIV/AIDS through the
provision of pharmaceuticals, including high-
quality, low-cost antiretrovirals and other thera-
pies, including generically manufactured phar-
maceuticals where appropriate.
‘‘(B)(i) The recruitment and training of in-
dividuals to provide the treatment described in
subparagraph (A), including the recruitment
and training of appropriate support personnel.
‘‘(ii) Such training should include appro-
priate methodologies relating to initial diag-
nosis, appropriate dosages of pharmaceuticals,
monitoring, medication adherence techniques,
treatment for any complications resulting from
such pharmaceuticals, and psychosocial support
for vulnerable children and their caregivers.
‘‘(C) Activities of medical laboratories re-
lating to the treatment described in subpara-
graph (A), including assistance for the purchase
of necessary equipment.
‘‘SEC. 244. ASSISTANCE TO PROVIDE PSYCHOSOCIAL SUP-
PORT TO ORPHANS AND OTHER VULNER-
ABLE CHILDREN AFFECTED BY HIV/AIDS.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) Many children who are orphaned as a re-
sult of AIDS blame themselves for the death of a
parent and many children are separated from sib-
lings, sometimes for life.
‘‘(2) The trauma that results from the loss of
a parent as a result of AIDS can trigger behavior
problems of aggression or emotional withdrawal and
negatively affect a child’s performance in school and
the child’s social relations.
‘‘(3) Children living in families affected by
HIV/AIDS are often stigmatized, teased, and ostra-
cized by peers.
‘‘(4) Children living in families affected by
HIV/AIDS who are most vulnerable are those chil-
dren in households headed by children. In these
households, trained community volunteers can play a
major role through home visits.
‘‘(5) In many African countries, religious lead-
ers are mobilizing individuals and local organizations
within the community to identify and respond to the
psychosocial needs of those children affected by
AIDS.
‘‘(b) ASSISTANCE.—The President is authorized to
provide assistance for programs in developing countries to
provide culturally appropriate mental health services and
psychosocial support for orphans and other vulnerable
children, and their caregivers.
‘‘SEC. 245. ASSISTANCE FOR SCHOOL FOOD PROGRAMS.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) In 2004, it is estimated that 125,000,000
children worldwide do not attend school, in part be-
cause of hunger and malnutrition, and the vast ma-
jority of these children are young girls.
‘‘(2) School food programs, including take-home
rations, in developing countries provide strong incen-
tives for parents to send their children to school and
ensure that they continue with their education.
School food programs may reduce short-term hun-
ger, improve cognitive functions, and enhance learn-
ing, behavior, and achievement.
‘‘(3) In 2004, more than 8,000,000 children in
sub-Saharan Africa are underweight compared to
1994. Malnutrition enhances the risk that orphans
and other vulnerable children will be at risk for ill-
ness and infections, especially if these children are
also infected with HIV.
‘‘(4) Healthy members of families affected by
HIV/AIDS in developing countries often leave the
workforce to care for those family members with
HIV/AIDS, which compounds the problem of access
to food for the family. Food consumption has been
shown to drop by as much as 40 percent in these
families.
‘‘(5)(A) Although a number of organizations
seek to meet the needs of children who are orphaned
or vulnerable as a result of HIV/AIDS, immediate
and extended families continue to be the primary
providers of care and support for these children, and
they need direct assistance urgently.
‘‘(B) According to a survey by the United
States Agency for International Development, or-
phans and other vulnerable children relied on rel-
atives for food support 74 percent of the time and
on friends for food support 19 percent of the time.
‘‘(b) ASSISTANCE.—
‘‘(1) IN GENERAL.—The President is author-
ized to provide assistance for school food programs
for orphans and vulnerable children in developing
countries, especially in such countries heavily af-
fected by HIV/AIDS.
‘‘(2) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (1) should be used to pur-
chase local or regional foodstuffs, where appropriate,
for school food programs.
‘‘SEC. 246. ASSISTANCE TO INCREASE EDUCATIONAL OP-
PORTUNITIES AND PROVIDE EMPLOYMENT
TRAINING.
‘‘(a) FINDINGS.—Congress finds the following:
‘‘(1) The lack of financial resources in families
affected by HIV/AIDS prevents many orphans and
other vulnerable children in developing countries
from attending school because of the requirement to
pay school fees and other costs of education.
‘‘(2) Such children, in particular young girls,
are often forced to miss school in order to serve as
caregivers to relatives with HIV/AIDS or assume
adult responsibilities for providing for the family.
Younger children who lose a parent also lose the op-
portunity to learn skills that they will need to sup-
port themselves as they grow older.
‘‘(3) According to the International Labor Or-
ganization (ILO), approximately 250,000,000 chil-
dren and adolescents ages 5 to 14 in developing
countries are working part-time and approximately
120,000,000 children and adolescents ages 5 to 14
in developing countries are working full-time.
‘‘(4) In many regions of Africa and other devel-
oping countries, non-formal education plays an im-
portant role to provide children who are unable to
attend school with the employment and related life
skills training such children need to survive.
‘‘(5) Many organizations in Africa, including
faith-based organizations, provide employment and
related life skills training for older children to better
prepare them to serve as caregivers for younger sib-
lings.
‘‘(6) Organizations that provide non-formal
education can assist the thousands of children in de-
veloping countries who are not currently being as-
sisted by families or communities and are struggling
to survive.
‘‘(b) ASSISTANCE.—
‘‘(1) EDUCATION ASSISTANCE.—The President
is authorized to provide assistance for programs in
developing countries to decrease barriers to public
primary school enrollment by eliminating school fees
and other costs of education, especially in developing
countries heavily affected by HIV/AIDS. Amounts
made available to carry out this paragraph—
‘‘(A) are authorized to be made available
to the President for assistance or contributions
to nongovernmental organizations and inter-
national organizations to achieve the purposes
of this paragraph; and
‘‘(B) shall not be used to pay school fees.
‘‘(2) EMPLOYMENT
TRAINING
ASSISTANCE.—
The President is authorized to provide assistance for
programs in developing countries to provide employ-
ment training and related services for orphans and
other vulnerable children who are of legal working
age, especially for programs in developing countries
heavily affected by HIV/AIDS.
‘‘SEC. 247. ASSISTANCE TO PROTECT AND PROMOTE INHER-
ITANCE RIGHTS.
‘‘(a) FINDING.—Congress finds that orphans and
other vulnerable children in developing countries, particu-
larly children who are orphaned as a result of AIDS, are
routinely denied their inheritance or encounter difficulties
in claiming the land and other property which they have
inherited.
‘‘(b) ASSISTANCE.—The President is authorized to
provide assistance in support of programs in developing
countries to protect and promote the inheritance rights of
orphans and other vulnerable children, particularly young
girls and children who are orphaned as a result of AIDS.
‘‘SEC. 248. ADMINISTRATION OF ASSISTANCE.
‘‘(a) OFFICE FOR ORPHANS AND OTHER VULNER-
ABLE CHILDREN.—
‘‘(1) ESTABLISHMENT.—There is established
within the United States Agency for International
Development an Office for Orphans and Other Vul-
nerable Children (hereafter in this title referred to
as the ‘Office’), which shall be headed by a Director
who shall be appointed by the Administrator of the
Agency.
‘‘(2) DUTIES.—The Office shall be responsible
for carrying out this title.
‘‘(b) APPROVAL OF APPLICATIONS.—Subject to the
requirements of subsection (e), the Director of the Office
shall be responsible for reviewing or approving all applica-
tions submitted to the United States Agency for Inter-
national Development for assistance under this title, in-
cluding applications submitted to field missions of the
Agency.
‘‘(c) PRIORITY.—In providing assistance under this
title, priority should be given to assistance for developing
countries in which the rate of HIV infection, as reported
in the most recent epidemiological data for that country
compiled by the United Nations Joint Programme on
HIV/AIDS (UNAIDS), is at least 5 percent among women
attending prenatal clinics or more than 15 percent among
individuals in groups with high-risk behavior.
‘‘(d) FORM OF ASSISTANCE.—Assistance under this
title shall be provided in the form of—
‘‘(1) grants, cooperative agreements, or con-
tracts;
‘‘(2) contributions to international organiza-
tions; or
‘‘(3) assistance to the governments of devel-
oping countries.
‘‘(e) COORDINATION.—The provision of assistance
under this title for children who are orphaned as a result
of HIV/AIDS, or are children with HIV/AIDS, shall be
undertaken in accordance with section 104A of this Act
and assistance relating to HIV/AIDS authorized under the
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (Public Law 108–25),
including section 102 of such Act concerning the coordina-
tion of HIV/AIDS programs.
‘‘(f) OTHER ASSISTANCE.—
‘‘(1) REVIEW OR APPROVAL OF OTHER USAID
ASSISTANCE.—The Director of the Office shall be re-
sponsible for reviewing or approving—
‘‘(A) each component of the annual plan of
a mission, bureau, or other office of the United
States Agency for International Development as
the component relates to assistance for orphans
or other vulnerable children in developing coun-
tries; and
‘‘(B) each program, project, or activity re-
lating to such assistance.
‘‘(2) COORDINATION OF ALL U.S. GOVERNMENT
ASSISTANCE.—The Director of the Office shall be re-
sponsible for ensuring coordination of all United
States Government programs to provide assistance
for orphans and other vulnerable children in devel-
oping countries.
‘‘SEC. 249. MONITORING SYSTEM.
‘‘(a) ESTABLISHMENT.—In order to maximize the
sustainable development impact of assistance authorized
under this title, the President shall establish a monitoring
system that meets the requirements of subsection (b).
‘‘(b) REQUIREMENTS.—The requirements referred to
in subsection (a) are the following:
‘‘(1) The monitoring system establishes per-
formance goals for the assistance and expresses such
goals in an objective and quantifiable form, to the
extent feasible.
‘‘(2) The monitoring system establishes per-
formance indicators to be used in measuring or as-
sessing the achievement of the performance goals de-
scribed in paragraph (1).
‘‘(3) The monitoring system provides a basis for
recommendations for adjustments to the assistance
to enhance the impact of the assistance.
‘‘SEC. 250. REPORT.
‘‘(a) REPORT.—Not later than December 31, 2005,
and each December 31 thereafter, the President shall
transmit to Congress a report that contains a detailed de-
scription of the implementation of this title for the pre-
vious fiscal year.
‘‘(b) CONTENTS.—The report shall contain the fol-
lowing information:
‘‘(1) For each grant, cooperative agreement,
contract, contribution, or other form of assistance
awarded or entered into under this title—
‘‘(A) the amount of the grant, cooperative
agreement, contract, contribution, or other form
of assistance, the name of each recipient and
each developing country with respect to which
projects or activities under the grant, coopera-
tive agreement, contract, contribution, or other
form of assistance were carried out, and the ap-
proximate number of orphans and other vulner-
able children who received direct or indirect as-
sistance under the projects or activities; and
‘‘(B) the results of the monitoring system
with respect to the grant, cooperative agree-
ment, contract, contribution, or other form of
assistance.
‘‘(2) For each grant, cooperative agreement,
contract, contribution, or other form of assistance
awarded or entered into under any provision of law
other than this title for assistance for orphans and
other vulnerable children in developing countries, the
information described in paragraph (1)(A).
‘‘(3) Of the total amounts of assistance made
available in each such fiscal year for orphans and
other vulnerable children, the percentage of assist-
ance provided in support of orphans or other vulner-
able children affected by HIV/AIDS.
‘‘(4) Any other appropriate information relating
to the needs of orphans and other vulnerable chil-
dren in developing countries that could be addressed
through the provision of assistance under this title
or under any other provision of law.
‘‘SEC. 251. AUTHORIZATION OF APPROPRIATIONS; ADDI-
TIONAL PROVISIONS.
‘‘(a) AUTHORIZATION OF APPROPRIATION.—
‘‘(1) IN
GENERAL.—Of the amounts made
available to carry out the provisions of law described
in paragraph (2), there are authorized to be appro-
priated to the President to carry out this title such
sums as may be necessary for each of the fiscal
years 2005 and 2006.
‘‘(2) PROVISIONS OF LAW.—The provisions of
law referred to in paragraph (1) are the following:
‘‘(A) 
The 
United 
States 
Leadership
Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (Public Law 108–25) and the
amendments made by that Act.
‘‘(B) Any other provision of law under
which assistance is authorized for orphans and
other vulnerable children in developing coun-
tries.
‘‘(b) ADDITIONAL PROVISIONS.—
‘‘(1) 
AVAILABILITY.—Amounts 
appropriated
pursuant to the authorization of appropriations
under subsection (a) are authorized to remain avail-
able until expended and are in addition to amounts
otherwise available for such purposes.
‘‘(2) MINIMUM FUNDING REQUIREMENT.—Not
less than 60 percent of amounts appropriated pursu-
ant to the authorization of appropriations under
subsection (a) for a fiscal year (other than amounts
made available for assistance to eliminate school fees
and other costs of education pursuant to section
246) shall be provided through United States or in-
digenous private voluntary organizations that imple-
ment programs on the community level. Amounts
provided by for-profit entities to not-for-profit enti-
ties from assistance under this title shall not be con-
sidered for purposes of satisfying the requirement of
this paragraph.
‘‘(3) ASSISTANCE
UNDER
OTHER
PROVISIONS
OF LAW.—
‘‘(A) IN GENERAL.—Notwithstanding any
other provision of law, amounts made available
for assistance for orphans or other vulnerable
children in developing countries under any pro-
vision of law other than this title may be pro-
vided to further the purposes of this title.
‘‘(B) REPORT.—To the extent assistance
described in subparagraph (A) is provided in
accordance with such subparagraph, the Presi-
dent shall include, as part of the report re-
quired under section 250, a detailed description
of such assistance and, to the extent applicable,
the 
information 
required 
by 
subsection
(b)(1)(A) of such section with respect to such
assistance.
‘‘(4) ADMINISTRATIVE
EXPENSES.—Notwith-
standing any other provision of law, amounts made
available for assistance for orphans or other vulner-
able children in developing countries under this title,
or under any provision of law other than this title,
may be made available for administrative expenses
incurred in carrying out this title for a fiscal year
in an amount not to exceed 7 percent of amounts
made available for such fiscal year for such purpose
under this title, or under such other provision of
law, as the case may be.
‘‘SEC. 252. DEFINITIONS.
‘‘In this title:
‘‘(1) AIDS.—The term ‘AIDS’ has the meaning
given the term in section 104A(g)(1) of this Act.
‘‘(2) CHILDREN.—The term ‘children’ means
persons who have not attained the age of 18.
‘‘(3) HIV.—The term ‘HIV’ has the meaning
given the term in section 104A(g)(2) of this Act.
‘‘(4) HIV/AIDS.—The term ‘HIV/AIDS’ has
the meaning given the term in section 104A(g)(3) of
this Act.
‘‘(5) ORPHAN.—The term ‘orphan’ means a
child deprived by death of one or both parents.
‘‘(6) PSYCHOSOCIAL SUPPORT.—The term ‘psy-
chosocial support’ includes care that addresses the
ongoing psychological and social problems that affect
individuals, their partners, families, and caregivers
in order to alleviate suffering, strengthen social ties
and integration, provide emotional support, and pro-
mote coping strategies.
‘‘(7) VULNERABLE CHILDREN.—The term ‘vul-
nerable children’ includes children who are ne-
glected, destitute, abandoned, homeless, disabled,
suffering from malnutrition, are sexually exploited or
abused, or are displaced or otherwise adversely af-
fected by armed conflict.’’.
Passed the House of Representatives June 14, 2004.
Attest:
Clerk.
108TH CONGRESS
2D SESSION
H. R. 4061
AN ACT
To amend the Foreign Assistance Act of 1961 to
provide assistance for orphans and other vulner-
able children in developing countries.