H. R. 3519
One Hundred Sixth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday,
the twenty-fourth day of January, two thousand
An Act
To provide for negotiations for the creation of a trust fund to be administered
by the International Bank for Reconstruction and Development or the International
Development Association to combat the AIDS epidemic.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Global AIDS and Tuberculosis
Relief Act of 2000’’.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I—ASSISTANCE TO COUNTRIES WITH LARGE POPULATIONS HAVING
HIV/AIDS
Sec. 101. Short title.
Sec. 102. Definitions.
Sec. 103. Findings and purposes.
Subtitle A—United States Assistance
Sec. 111. Additional assistance authorities to combat HIV and AIDS.
Sec. 112. Voluntary contribution to Global Alliance for Vaccines and Immunizations
and International AIDS Vaccine Initiative.
Sec. 113. Coordinated donor strategy for support and education of orphans in sub-
Saharan Africa.
Sec. 114. African Crisis Response Initiative and HIV/AIDS training.
Subtitle B—World Bank AIDS Trust Fund
CHAPTER 1—ESTABLISHMENT OF THE FUND
Sec. 121. Establishment.
Sec. 122. Grant authorities.
Sec. 123. Administration.
Sec. 124. Advisory Board.
CHAPTER 2—REPORTS
Sec. 131. Reports to Congress.
CHAPTER 3—UNITED STATES FINANCIAL PARTICIPATION
Sec. 141. Authorization of appropriations.
Sec. 142. Certification requirement.
TITLE II—INTERNATIONAL TUBERCULOSIS CONTROL
Sec. 201. Short title.
Sec. 202. Findings.
Sec. 203. Assistance for tuberculosis prevention, treatment, control, and elimi-
nation.
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TITLE III—ADMINISTRATIVE AUTHORITIES
Sec. 301. Effective program oversight.
Sec. 302. Termination expenses.
TITLE I—ASSISTANCE TO COUNTRIES
WITH LARGE POPULATIONS HAVING
HIV/AIDS
SEC. 101. SHORT TITLE.
This title may be cited as the ‘‘Global AIDS Research and
Relief Act of 2000’’.
SEC. 102. DEFINITIONS.
In this title:
(1) AIDS.—The term ‘‘AIDS’’ means the acquired immune
deficiency syndrome.
(2) ASSOCIATION.—The term ‘‘Association’’ means the Inter-
national Development Association.
(3) BANK.—The term ‘‘Bank’’ or ‘‘World Bank’’ means the
International Bank for Reconstruction and Development.
(4) HIV.—The term ‘‘HIV’’ means the human immuno-
deficiency virus, the pathogen which 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.
SEC. 103. FINDINGS AND PURPOSES.
(a) FINDINGS.—Congress makes the following findings:
(1) According to the Surgeon General of the United States,
the epidemic of human immunodeficiency virus/acquired
immune deficiency syndrome (HIV/AIDS) will soon become the
worst epidemic of infectious disease in recorded history,
eclipsing both the bubonic plague of the 1300’s and the
influenza epidemic of 1918–1919 which killed more than
20,000,000 people worldwide.
(2) According to the Joint United Nations Programme on
HIV/AIDS (UNAIDS), more than 34,300,000 people in the world
today are living with HIV/AIDS, of which approximately 95
percent live in the developing world.
(3) UNAIDS data shows that among children age 14 and
under worldwide, more than 3,800,000 have died from AIDS,
more than 1,300,000 are living with the disease; and in 1
year alone—1999—an estimated 620,000 became infected, of
which over 90 percent were babies born to HIV-positive women.
(4) Although sub-Saharan Africa has only 10 percent of
the world’s population, it is home to more than 24,500,000—
roughly 70 percent—of the world’s HIV/AIDS cases.
(5) Worldwide, there have already been an estimated
18,800,000 deaths because of HIV/AIDS, of which more than
80 percent occurred in sub-Saharan Africa.
(6) The gap between rich and poor countries in terms
of transmission of HIV from mother to child has been
increasing. Moreover, AIDS threatens to reverse years of steady
progress of child survival in developing countries. UNAIDS
believes that by the year 2010, AIDS may have increased
H. R. 3519—3
mortality of children under 5 years of age by more than 100
percent in regions most affected by the virus.
(7) According to UNAIDS, by the end of 1999, 13,200,000
children have lost at least one parent to AIDS, including
12,100,000 children in sub-Saharan Africa, and are thus consid-
ered AIDS orphans.
(8) At current infection and growth rates for HIV/AIDS,
the National Intelligence Council estimates that the number
of AIDS orphans worldwide will increase dramatically, poten-
tially increasing threefold or more in the next 10 years, contrib-
uting to economic decay, social fragmentation, and political
destabilization in already volatile and strained societies. Chil-
dren without care or hope are often drawn into prostitution,
crime, substance abuse, or child soldiery.
(9) Donors must focus on adequate preparations for the
explosion in the number of orphans and the burden they will
place on families, communities, economies, and governments.
Support structures and incentives for families, communities,
and institutions which will provide care for children orphaned
by HIV/AIDS, or for the children who are themselves afflicted
by HIV/AIDS, will be essential.
(10) The 1999 annual report by the United Nations Chil-
dren’s Fund (UNICEF) states ‘‘[t]he number of orphans, particu-
larly in Africa, constitutes nothing less than an emergency,
requiring an emergency response’’ and that ‘‘finding the
resources needed to help stabilize the crisis and protect children
is a priority that requires urgent action from the international
community.’’.
(11) The discovery of a relatively simple and inexpensive
means of interrupting the transmission of HIV from an infected
mother to the unborn child—namely with nevirapine (NVP),
which costs US$4 a tablet—has created a great opportunity
for an unprecedented partnership between the United States
Government and the governments of Asian, African and Latin
American countries to reduce mother-to-child transmission (also
known as ‘‘vertical transmission’’) of HIV.
(12) According to UNAIDS, if implemented this strategy
will decrease the proportion of orphans that are HIV-infected
and decrease infant and child mortality rates in these devel-
oping regions.
(13) A mother-to-child antiretroviral drug strategy can be
a force for social change, providing the opportunity and impetus
needed to address often long-standing problems of inadequate
services and the profound stigma associated with HIV-infection
and the AIDS disease. Strengthening the health infrastructure
to improve mother-and-child health, antenatal, delivery and
postnatal services, and couples counseling generates enormous
spillover effects toward combating the AIDS epidemic in devel-
oping regions.
(14) United States Census Bureau statistics show life
expectancy in sub-Saharan Africa falling to around 30 years
of age within a decade, the lowest in a century, and project
life expectancy in 2010 to be 29 years of age in Botswana,
30 years of age in Swaziland, 33 years of age in Namibia
and Zimbabwe, and 36 years of age in South Africa, Malawi,
and Rwanda, in contrast to a life expectancy of 70 years of
H. R. 3519—4
age in many of the countries without a high prevalence of
AIDS.
(15) A January 2000 United States National Intelligence
Estimate (NIE) report on the global infectious disease threat
concluded that the economic costs of infectious diseases—espe-
cially HIV/AIDS—are already significant and could reduce GDP
by as much as 20 percent or more by 2010 in some sub-
Saharan African nations.
(16) According to the same NIE report, HIV prevalence
among militias in Angola and the Democratic Republic of the
Congo are estimated at 40 to 60 percent, and at 15 to 30
percent in Tanzania.
(17) The HIV/AIDS epidemic is of increasing concern in
other regions of the world, with UNAIDS estimating that there
are more than 5,600,000 cases in South and South-east Asia,
that the rate of HIV infection in the Caribbean is second
only to sub-Saharan Africa, and that HIV infections have dou-
bled in just 2 years in the former Soviet Union.
(18) Despite the discouraging statistics on the spread of
HIV/AIDS, some developing nations—such as Uganda, Senegal,
and Thailand—have implemented prevention programs that
have substantially curbed the rate of HIV infection.
(19) AIDS, like all diseases, knows no national boundaries,
and there is no certitude that the scale of the problem in
one continent can be contained within that region.
(20) Accordingly, United States financial support for med-
ical research, education, and disease containment as a global
strategy has beneficial ramifications for millions of Americans
and their families who are affected by this disease, and the
entire population which is potentially susceptible.
(b) PURPOSES.—The purposes of this title are to—
(1) help prevent human suffering through the prevention,
diagnosis, and treatment of HIV/AIDS; and
(2) help ensure the viability of economic development, sta-
bility, and national security in the developing world by
advancing research to—
(A) understand the causes associated with HIV/AIDS
in developing countries; and
(B) assist in the development of an AIDS vaccine.
Subtitle A—United States Assistance
SEC. 111. ADDITIONAL ASSISTANCE AUTHORITIES TO COMBAT HIV AND
AIDS.
(a) ASSISTANCE FOR PREVENTION OF HIV/AIDS AND VERTICAL
TRANSMISSION.—Section 104(c) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b(c)) is amended by adding at the end the
following new paragraphs:
‘‘(4)(A) Congress recognizes the growing international dilemma
of children with the human immunodeficiency virus (HIV) and
the merits of intervention programs aimed at this problem. Congress
further recognizes that mother-to-child transmission prevention
strategies can serve as a major force for change in developing
regions, and it is, therefore, a major objective of the foreign assist-
ance program to control the acquired immune deficiency syndrome
(AIDS) epidemic.
H. R. 3519—5
‘‘(B) The agency primarily responsible for administering this
part shall—
‘‘(i) coordinate with UNAIDS, UNICEF, WHO, national
and local governments, and other organizations to develop and
implement effective strategies to prevent vertical transmission
of HIV; and
‘‘(ii) coordinate with those organizations to increase inter-
vention programs and introduce voluntary counseling and
testing, antiretroviral drugs, replacement feeding, and other
strategies.
‘‘(5)(A) Congress expects the agency primarily responsible for
administering this part to make the human immunodeficiency virus
(HIV) and the acquired immune deficiency syndrome (AIDS) a
priority in the foreign assistance program and to undertake a com-
prehensive, coordinated effort to combat HIV and AIDS.
‘‘(B) Assistance described in subparagraph (A) shall include
help providing—
‘‘(i) primary prevention and education;
‘‘(ii) voluntary testing and counseling;
‘‘(iii) medications to prevent the transmission of HIV from
mother to child; and
‘‘(iv) care for those living with HIV or AIDS.
‘‘(6)(A) In addition to amounts otherwise available for such
purpose, there is authorized to be appropriated to the President
$300,000,000 for each of the fiscal years 2001 and 2002 to carry
out paragraphs (4) and (5).
‘‘(B) Of the funds authorized to be appropriated under subpara-
graph (A), not less than 65 percent is authorized to be available
through United States and foreign nongovernmental organizations,
including private and voluntary organizations, for-profit organiza-
tions, religious affiliated organizations, educational institutions, and
research facilities.
‘‘(C)(i) Of the funds authorized to be appropriated by subpara-
graph (A), not less than 20 percent is authorized to be available
for programs as part of a multidonor strategy to address the support
and education of orphans in sub-Saharan Africa, including AIDS
orphans.
‘‘(ii) Assistance made available under this subsection, and
assistance made available under chapter 4 of part II to carry
out the purposes of this subsection, may be made available notwith-
standing any other provision of law that restricts assistance to
foreign countries.
‘‘(D) Of the funds authorized to be appropriated under subpara-
graph (A), not less than 8.3 percent is authorized to be available
to carry out the prevention strategies for vertical transmission
referred to in paragraph (4)(A).
‘‘(E) Of the funds authorized to be appropriated by subpara-
graph (A), not more than 7 percent may be used for the administra-
tive expenses of the agency primarily responsible for carrying out
this part of this Act in support of activities described in paragraphs
(4) and (5).
‘‘(F) Funds appropriated under this paragraph are authorized
to remain available until expended.’’.
(b) TRAINING
AND
TRAINING
FACILITIES
IN
SUB-SAHARAN
AFRICA.—Section 496(i)(2) of the Foreign Assistance Act of 1961
(22 U.S.C. 2293(i)(2)) is amended by adding at the end the following
H. R. 3519—6
new sentence: ‘‘In addition, providing training and training facili-
ties, in sub-Saharan Africa, for doctors and other health care pro-
viders, notwithstanding any provision of law that restricts assist-
ance to foreign countries.’’.
SEC. 112. VOLUNTARY CONTRIBUTION TO GLOBAL ALLIANCE FOR VAC-
CINES AND IMMUNIZATIONS AND INTERNATIONAL AIDS
VACCINE INITIATIVE.
(a) AUTHORIZATION
OF APPROPRIATIONS.—Section 302 of the
Foreign Assistance Act of 1961 (22 U.S.C. 2222) is amended by
adding at the end the following new subsections:
‘‘(k) In addition to amounts otherwise available under this
section, there is authorized to be appropriated to the President
$50,000,000 for each of the fiscal years 2001 and 2002 to be avail-
able only for United States contributions to the Global Alliance
for Vaccines and Immunizations.
‘‘(l) In addition to amounts otherwise available under this sec-
tion, there is authorized to be appropriated to the President
$10,000,000 for each of the fiscal years 2001 and 2002 to be avail-
able only for United States contributions to the International AIDS
Vaccine Initiative.’’.
(b) REPORT.—At the close of fiscal year 2001, the President
shall submit a report to the appropriate congressional committees
on the effectiveness of the Global Alliance for Vaccines and
Immunizations and the International AIDS Vaccine Initiative
during that fiscal year in meeting the goals of—
(1) improving access to sustainable immunization services;
(2) expanding the use of all existing, safe, and cost-effective
vaccines where they address a public health problem;
(3) accelerating the development and introduction of new
vaccines and technologies;
(4) accelerating research and development efforts for vac-
cines needed primarily in developing countries; and
(5) making immunization coverage a centerpiece in inter-
national development efforts.
(c) APPROPRIATE CONGRESSIONAL COMMITTEES DEFINED.—In
subsection (b), the term ‘‘appropriate congressional committees’’
means the Committee on Foreign Relations and the Committee
on Appropriations of the Senate and the Committee on International
Relations and the Committee on Appropriations of the House of
Representatives.
SEC. 113. COORDINATED DONOR STRATEGY FOR SUPPORT AND EDU-
CATION OF ORPHANS IN SUB-SAHARAN AFRICA.
(a) STATEMENT OF POLICY.—It is in the national interest of
the United States to assist in mitigating the burden that will
be placed on sub-Saharan African social, economic, and political
institutions as these institutions struggle with the consequences
of a dramatically increasing AIDS orphan population, many of
whom are themselves infected by HIV and living with AIDS. Effec-
tively addressing that burden and its consequences in sub-Saharan
Africa will require a coordinated multidonor strategy.
(b) DEVELOPMENT OF STRATEGY.—The President shall coordi-
nate the development of a multidonor strategy to provide for the
support and education of AIDS orphans and the families, commu-
nities, and institutions most affected by the HIV/AIDS epidemic
in sub-Saharan Africa.
H. R. 3519—7
(c) DEFINITION.—In this section, the term ‘‘HIV/AIDS’’ means,
with respect to an individual, an individual who is infected with
the human immunodeficiency virus (HIV), the pathogen that causes
the acquired immune deficiency virus (AIDS), or living with AIDS.
SEC. 114. AFRICAN CRISIS RESPONSE INITIATIVE AND HIV/AIDS
TRAINING.
(a) FINDINGS.—Congress finds that—
(1) the spread of HIV/AIDS constitutes a threat to security
in Africa;
(2) civil unrest and war may contribute to the spread
of the disease to different parts of the continent;
(3) the percentage of soldiers in African militaries who
are infected with HIV/AIDS is unknown, but estimates range
in some countries as high as 40 percent; and
(4) it is in the interests of the United States to assist
the countries of Africa in combating the spread of HIV/AIDS.
(b) EDUCATION ON THE PREVENTION OF THE SPREAD OF AIDS.—
In undertaking education and training programs for military
establishments in African countries, the United States shall ensure
that classroom training under the African Crisis Response Initiative
includes military-based education on the prevention of the spread
of AIDS.
Subtitle B—World Bank AIDS Trust Fund
CHAPTER 1—ESTABLISHMENT OF THE FUND
SEC. 121. ESTABLISHMENT.
(a) NEGOTIATIONS FOR ESTABLISHMENT OF TRUST FUND.—The
Secretary of the Treasury shall seek to enter into negotiations
with the World Bank or the Association, in consultation with the
Administrator of the United States Agency for International
Development and other United States Government agencies, and
with the member nations of the World Bank or the Association
and with other interested parties, for the establishment within
the World Bank of—
(1) the World Bank AIDS Trust Fund (in this subtitle
referred to as the ‘‘Trust Fund’’) in accordance with the provi-
sions of this chapter; and
(2) the Advisory Board to the Trust Fund in accordance
with section 124.
(b) PURPOSE.—The purpose of the Trust Fund should be to
use contributed funds to—
(1) assist in the prevention and eradication of HIV/AIDS
and the care and treatment of individuals infected with HIV/
AIDS; and
(2) provide support for the establishment of programs that
provide health care and primary and secondary education for
children orphaned by the HIV/AIDS epidemic.
(c) COMPOSITION.—
(1) IN GENERAL.—The Trust Fund should be governed by
a Board of Trustees, which should be composed of representa-
tives of the participating donor countries to the Trust Fund.
Individuals appointed to the Board should have demonstrated