H. R. 1298—30
malaria, the Director of the Centers for Disease Control and Preven-
tion, in coordination with the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally, the National
Institutes of Health, national and local government, and other
organizations, such as the World Health Organization and the
United Nations Children’s Fund, shall develop and implement effec-
tive strategies to improve injection safety, including eliminating
unnecessary injections, promoting sterile injection practices and
technologies, strengthening the procedures for proper needle and
syringe disposal, and improving the education and information pro-
vided to the public and to health professionals.’’.
SEC. 307. STUDY ON ILLEGAL DIVERSIONS OF PRESCRIPTION DRUGS.
Not later than 180 days after enactment of this Act, the Sec-
retary of Health and Human Services, in coordination with other
agencies, shall submit a report to the Congress that includes the
following:
(1) A thorough accounting of evidence indicating illegal
diversion into the United States of prescription drugs donated
or sold for humanitarian efforts, and an estimate of the extent
of such diversion.
(2) Recommendations to increase the administrative and
enforcement powers of the United States to identify, monitor,
and prevent the illegal diversion into the United States of
prescription drugs donated or sold for humanitarian efforts.
(3) Recommendations and guidelines to advise and provide
technical assistance to developing countries on how to imple-
ment a program that minimizes diversion into the United States
of prescription drugs donated or sold for humanitarian efforts.
Subtitle B—Assistance for Children and
Families
SEC. 311. FINDINGS.
Congress makes the following findings:
(1) Approximately 2,000 children around the world are
infected each day with HIV through mother-to-child trans-
mission. Transmission can occur during pregnancy, labor, and
delivery or through breast feeding. Over 90 percent of these
cases are in developing nations with little or no access to
public health facilities.
(2) Mother-to-child transmission is largely preventable with
the proper application of pharmaceuticals, therapies, and other
public health interventions.
(3) Certain antiretroviral drugs reduce mother-to-child
transmission by nearly 50 percent. Universal availability of
this drug could prevent up to 400,000 infections per year and
dramatically reduce the number of AIDS-related deaths.
(4) At the United Nations Special Session on HIV/AIDS
in June 2001, the United States committed to the specific
goals with respect to the prevention of mother-to-child trans-
mission, including the goals of reducing the proportion of
infants infected with HIV by 20 percent by the year 2005
and by 50 percent by the year 2010, as specified in the Declara-
tion of Commitment on HIV/AIDS adopted by the United
Nations General Assembly at the Special Session.
H. R. 1298—31
(5) Several United States Government agencies including
the United States Agency for International Development and
the Centers for Disease Control are already supporting pro-
grams to prevent mother-to-child transmission in resource-poor
nations and have the capacity to expand these programs rapidly
by working closely with foreign governments and nongovern-
mental organizations.
(6) Efforts to prevent mother-to-child transmission can pro-
vide the basis for a broader response that includes care and
treatment of mothers, fathers, and other family members who
are infected with HIV or living with AIDS.
(7) HIV/AIDS has devastated the lives of countless children
and families across the globe. Since the epidemic began, an
estimated 13,200,000 children under the age of 15 have been
orphaned by AIDS, that is they have lost their mother or
both parents to the disease. The Joint United Nations Program
on HIV/AIDS (UNAIDS) estimates that this number will double
by the year 2010.
(8) HIV/AIDS also targets young people between the ages
of 15 to 24, particularly young women, many of whom carry
the burden of caring for family members living with HIV/
AIDS. An estimated 10,300,000 young people are now living
with HIV/AIDS. One-half of all new infections are occurring
among this age group.
SEC. 312. POLICY AND REQUIREMENTS.
(a) POLICY.—The United States Government’s response to the
global HIV/AIDS pandemic should place high priority on the preven-
tion of mother-to-child transmission, the care and treatment of
family members and caregivers, and the care of children orphaned
by AIDS. To the maximum extent possible, the United States
Government should seek to leverage its funds by seeking matching
contributions from the private sector, other national governments,
and international organizations.
(b) REQUIREMENTS.—The 5-year United States Government
strategy required by section 101 of this Act shall—
(1) provide for meeting or exceeding the goal to reduce
the rate of mother-to-child transmission of HIV by 20 percent
by 2005 and by 50 percent by 2010;
(2) include programs to make available testing and treat-
ment to HIV-positive women and their family members,
including drug treatment and therapies to prevent mother-
to-child transmission; and
(3) expand programs designed to care for children orphaned
by AIDS.
SEC. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION OF THE HIV INFECTION.
(a) IN GENERAL.—Not later than 1 year after the date of the
enactment of this Act, and annually thereafter for a period of
5 years, the President shall submit to appropriate congressional
committees a report on the activities of relevant executive branch
agencies during the reporting period to assist in the prevention
of mother-to-child transmission of the HIV infection.
(b) REPORT ELEMENTS.—Each report shall include—
(1) a statement of whether or not all relevant executive
branch agencies have met the goal described in section
312(b)(1); and
H. R. 1298—32
(2) a description of efforts made by the relevant executive
branch agencies to expand those activities, including—
(A) information on the number of sites supported for
the prevention of mother-to-child transmission of the HIV
infection;
(B) the specific activities supported;
(C) the number of women tested and counseled; and
(D) the number of women receiving preventative drug
therapies.
(c) REPORTING PERIOD DEFINED.—In this section, the term
‘‘reporting period’’ means, in the case of the initial report, the
period since the date of enactment of this Act and, in the case
of any subsequent report, the period since the date of submission
of the most recent report.
SEC. 314. PILOT PROGRAM OF ASSISTANCE FOR CHILDREN AND FAMI-
LIES AFFECTED BY HIV/AIDS.
(a) IN GENERAL.—The President, acting through the United
States Agency for International Development, should establish a
program of assistance that would demonstrate the feasibility of
the provision of care and treatment to orphans and other children
and young people affected by HIV/AIDS in foreign countries.
(b) PROGRAM REQUIREMENTS.—The program should—
(1) build upon and be integrated into programs adminis-
tered as of the date of enactment of this Act by the relevant
executive branch agencies for children affected by HIV/AIDS;
(2) work in conjunction with indigenous community-based
programs and activities, particularly those that offer proven
services for children;
(3) reduce the stigma of HIV/AIDS to encourage vulnerable
children infected with HIV or living with AIDS and their family
members and caregivers to avail themselves of voluntary coun-
seling and testing, and related programs, including treatments;
(4) ensure the importance of inheritance rights of women,
particularly women in African countries, due to the exponential
growth in the number of young widows, orphaned girls, and
grandmothers becoming heads of households as a result of
the HIV/AIDS pandemic;
(5) provide, in conjunction with other relevant executive
branch agencies, the range of services for the care and treat-
ment, including the provision of antiretrovirals and other nec-
essary pharmaceuticals, of children, parents, and caregivers
infected with HIV or living with AIDS;
(6) provide nutritional support and food security, and the
improvement of overall family health;
(7) work with parents, caregivers, and community-based
organizations to provide children with educational opportuni-
ties; and
(8) provide appropriate counseling and legal assistance for
the appointment of guardians and the handling of other issues
relating to the protection of children.
(c) REPORT.—Not later than 18 months after the date of enact-
ment of this Act, the President should submit a report on the
implementation of this section to the appropriate congressional
committees. Such report should include a description of activities
undertaken to carry out subsection (b)(4).
(d) AUTHORIZATION OF APPROPRIATIONS.—
H. R. 1298—33
(1) IN GENERAL.—In addition to amounts otherwise avail-
able for such purpose, there are authorized to be appropriated
to the President, from amounts authorized to be appropriated
under section 401, such sums as may be necessary for each
of the fiscal years 2004 through 2008 to carry out the program.
A significant percentage of the amount appropriated pursuant
to the authorization of appropriations under the preceding sen-
tence for a fiscal year should be made available to carry out
subsection (b)(4).
(2) AVAILABILITY OF FUNDS.—Amounts appropriated pursu-
ant to paragraph (1) are authorized to remain available until
expended.
SEC. 315. PILOT PROGRAM ON FAMILY SURVIVAL PARTNERSHIPS.
(a) PURPOSE.—The purpose of this section is to authorize the
President to establish a program, through a public-private partner-
ship, for the provision of medical care and support services to
HIV positive parents and their children identified through existing
programs to prevent mother-to-child transmission of HIV in coun-
tries with or at risk for severe HIV epidemic with particular atten-
tion to resource constrained countries.
(b) GRANTS.—
(1) IN GENERAL.—The President is authorized to establish
a program for the award of grants to eligible administrative
organizations to enable such organizations to award subgrants
to eligible entities to expand activities to prevent the mother-
to-child transmission of HIV by providing medical care and
support services to HIV infected parents and their children.
(2) USE
OF
FUNDS.—Amounts provided under a grant
awarded under paragraph (1) shall be used—
(A) to award subgrants to eligible entities to enable
such entities to carry out activities described in subsection
(c);
(B) for administrative support and subgrant manage-
ment;
(C) for administrative data collection and reporting
concerning grant activities;
(D) for the monitoring and evaluation of grant activi-
ties;
(E) for training and technical assistance for sub-
grantees; and
(F) to promote sustainability.
(c) SUBGRANTS.—
(1) IN GENERAL.—An organization awarded a grant under
subsection (b) shall use amounts received under the grant to
award subgrants to eligible entities.
(2) ELIGIBILITY.—To be eligible to receive a subgrant under
paragraph (1), an entity shall—
(A) be a local health organization, an international
organization, or a partnership of such organizations; and
(B) demonstrate to the awarding organization that such
entity—
(i) is currently administering a proven intervention
to prevent mother-to-child transmission of HIV in coun-
tries with or at risk for severe HIV epidemic with
particular attention to resource constrained countries,
as determined by the President;
H. R. 1298—34
(ii) has demonstrated support for the proposed pro-
gram from relevant government entities; and
(iii) is able to provide HIV care, including
antiretroviral treatment when medically indicated, to
HIV positive women, men, and children with the sup-
port of the project funding.
(3) LOCAL HEALTH AND INTERNATIONAL ORGANIZATIONS.—
For purposes of paragraph (2)(A)—
(A) the term ‘‘local health organization’’ means a public
sector 
health 
system, 
nongovernmental 
organization,
institution of higher education, community-based organiza-
tion, or nonprofit health system that provides directly,
or has a clear link with a provider for the indirect provision
of, primary health care services; and
(B) the term ‘‘international organization’’ means—
(i) a nonprofit international entity;
(ii) an international charitable institution;
(iii) a private voluntary international entity; or
(iv) a multilateral institution.
(4) PRIORITY REQUIREMENT.—In awarding subgrants under
this subsection, the organization shall give priority to eligible
applicants that are currently administering a program of proven
intervention to HIV positive individuals to prevent mother-
to-child transmission in countries with or at risk for severe
HIV epidemic with particular attention to resource constrained
countries, and who are currently administering a program to
HIV positive women, men, and children to provide life-long
care in family-centered care programs using non-Federal funds.
(5) SELECTION OF SUBGRANT RECIPIENTS.—In awarding sub-
grants under this subsection, the organization should—
(A) consider applicants from a range of health care
settings, program approaches, and geographic locations;
and
(B) if appropriate, award not less than 1 grant to
an applicant to fund a national system of health care
delivery to HIV positive families.
(6) USE OF SUBGRANT FUNDS.—An eligible entity awarded
a subgrant under this subsection shall use subgrant funds
to expand activities to prevent mother-to-child transmission
of HIV by providing medical treatment and care and support
services to parents and their children, which may include—
(A) providing treatment and therapy, when medically
indicated, to HIV-infected women, their children, and fami-
lies;
(B) the hiring and training of local personnel, including
physicians, nurses, other health care providers, counselors,
social workers, outreach personnel, laboratory technicians,
data managers, and administrative support personnel;
(C) paying laboratory costs, including costs related to
necessary equipment and diagnostic testing and monitoring
(including rapid testing), complete blood counts, standard
chemistries, and liver function testing for infants, children,
and parents, and costs related to the purchase of necessary
laboratory equipment;
(D) purchasing pharmaceuticals for HIV-related condi-
tions, including antiretroviral therapies;
H. R. 1298—35
(E) funding support services, including adherence and
psychosocial support services;
(F) operational support activities; and
(G) conducting community outreach and capacity
building activities, including activities to raise the aware-
ness of individuals of the program carried out by the sub-
grantee, other communications activities in support of the
program, local advisory board functions, and transportation
necessary to ensure program participation.
(d) REPORTS.—The President shall require that each organiza-
tion awarded a grant under subsection (b)(1) to submit an annual
report that includes—
(1) the progress of programs funded under this section;
(2) the benchmarks of success of programs funded under
this section; and
(3) recommendations of how best to proceed with the pro-
grams funded under this section upon the expiration of funding
under subsection (e).
(e) FUNDING.—There are authorized to be appropriated to the
President, from amounts authorized to be appropriated under sec-
tion 401, such sums as may be necessary for each of the fiscal
years 2004 through 2008 to carry out the program.
(f) LIMITATION ON ADMINISTRATIVE EXPENSES.—An organization
shall ensure that not more than 7 percent of the amount of a
grant received under this section by the organization is used for
administrative expenses.
TITLE IV—AUTHORIZATION OF
APPROPRIATIONS
SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appropriated to
the President to carry out this Act and the amendments made
by this Act $3,000,000,000 for each of the fiscal years 2004 through
2008.
(b) AVAILABILITY.—Amounts appropriated pursuant to the
authorization of appropriations in subsection (a) are authorized
to remain available until expended.
(c) AVAILABILITY OF AUTHORIZATIONS.—Authorizations of appro-
priations under subsection (a) shall remain available until the
appropriations are made.
SEC. 402. SENSE OF CONGRESS.
(a) INCREASE IN HIV/AIDS ANTIRETROVIRAL TREATMENT.—It
is a sense of the Congress that an urgent priority of United States
assistance programs to fight HIV/AIDS should be the rapid increase
in distribution of antiretroviral treatment so that—
(1) by the end of fiscal year 2004, at least 500,000 individ-
uals with HIV/AIDS are receiving antiretroviral treatment
through United States assistance programs;
(2) by the end of fiscal year 2005, at least 1,000,000 such
individuals are receiving such treatment; and
(3) by the end of fiscal year 2006, at least 2,000,000 such
individuals are receiving such treatment.
(b) EFFECTIVE DISTRIBUTION OF HIV/AIDS FUNDS.—It is the
sense of Congress that, of the amounts appropriated pursuant to
H. R. 1298—36
the authorization of appropriations under section 401 for HIV/
AIDS assistance, an effective distribution of such amounts would
be—
(1) 55 percent of such amounts for treatment of individuals
with HIV/AIDS;
(2) 15 percent of such amounts for palliative care of individ-
uals with HIV/AIDS;
(3) 20 percent of such amounts for HIV/AIDS prevention
consistent with section 104A(d) of the Foreign Assistance Act
of 1961 (as added by section 301 of this Act), of which such
amount at least 33 percent should be expended for abstinence-
until-marriage programs; and
(4) 10 percent of such amounts for orphans and vulnerable
children.
SEC. 403. ALLOCATION OF FUNDS.
(a) THERAPEUTIC MEDICAL CARE.—For fiscal years 2006 through
2008, not less than 55 percent of the amounts appropriated pursu-
ant to the authorization of appropriations under section 401 for
HIV/AIDS assistance for each such fiscal year shall be expended
for therapeutic medical care of individuals infected with HIV, of
which such amount at least 75 percent should be expended for
the purchase and distribution of antiretroviral pharmaceuticals and
at least 25 percent should be expended for related care. For fiscal
years 2006 through 2008, not less than 33 percent of the amounts
appropriated pursuant to the authorization of appropriations under
section 401 for HIV/AIDS prevention consistent with section 104A(d)
of the Foreign Assistance Act of 1961 (as added by section 301
of this Act) for each such fiscal year shall be expended for
abstinence-until-marriage programs.
(b) ORPHANS
AND VULNERABLE CHILDREN.—For fiscal years
2006 through 2008, not less than 10 percent of the amounts appro-
priated pursuant to the authorization of appropriations under sec-
tion 401 for HIV/AIDS assistance for each such fiscal year shall
be expended for assistance for orphans and vulnerable children
affected by HIV/AIDS, of which such amount at least 50 percent
shall be provided through non-profit, nongovernmental organiza-
tions, including faith-based organizations, that implement programs
on the community level.
SEC. 404. ASSISTANCE FROM THE UNITED STATES PRIVATE SECTOR
TO PREVENT AND REDUCE HIV/AIDS IN SUB-SAHARAN
AFRICA.
It is the sense of Congress that United States businesses should
be encouraged to provide assistance to sub-Saharan African coun-
tries to prevent and reduce the incidence of HIV/AIDS in sub-
Saharan Africa. In providing such assistance, United States
businesses should be encouraged to consider the establishment of
an HIV/AIDS Response Fund in order to provide for coordination
among such businesses in the collection and distribution of the
assistance to sub-Saharan African countries.
H. R. 1298—37
TITLE V—INTERNATIONAL FINANCIAL
INSTITUTIONS
SEC. 501. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.
Title XVI of the International Financial Institutions Act (22
U.S.C. 262p–262p–7) is amended by adding at the end the following
new section:
‘‘SEC. 1625. MODIFICATION OF THE ENHANCED HIPC INITIATIVE.
‘‘(a) AUTHORITY.—
‘‘(1) IN GENERAL.—The Secretary of the Treasury should
immediately commence efforts within the Paris Club of Official
Creditors, the International Bank for Reconstruction and
Development, the International Monetary Fund, and other
appropriate multilateral development institutions to modify the
Enhanced HIPC Initiative so that the amount of debt stock
reduction approved for a country eligible for debt relief under
the Enhanced HIPC Initiative shall be sufficient to reduce,
for each of the first 3 years after the date of enactment of
this section or the Decision Point, whichever is later—
‘‘(A) the net present value of the outstanding public
and publicly guaranteed debt of the country—
‘‘(i) as of the decision point if the country has
already reached its decision point; or
‘‘(ii) as of the date of enactment of this Act, if
the country has not reached its decision point,
to not more than 150 percent of the annual value of exports
of the country for the year preceding the Decision Point;
and
‘‘(B) the annual payments due on such public and
publicly guaranteed debt to not more than—
‘‘(i) 10 percent or, in the case of a country suffering
a public health crisis (as defined in subsection (e)),
not more than 5 percent, of the amount of the annual
current revenues received by the country from internal
resources; or
‘‘(ii) a percentage of the gross national product
of the country, or another benchmark, that will yield
a result substantially equivalent to that which would
be achieved through application of subparagraph (A).
‘‘(2) LIMITATION.—In financing the objectives of the
Enhanced HIPC Initiative, an international financial institution
shall give priority to using its own resources.
‘‘(b) RELATION TO POVERTY AND THE ENVIRONMENT.—Debt can-
cellation under the modifications to the Enhanced HIPC Initiative
described in subsection (a) should not be conditioned on any agree-
ment by an impoverished country to implement or comply with
policies that deepen poverty or degrade the environment, including
any policy that—
‘‘(1) implements or extends user fees on primary education
or primary health care, including prevention and treatment
efforts for HIV/AIDS, tuberculosis, malaria, and infant, child,
and maternal well-being;
‘‘(2) provides for increased cost recovery from poor people
to finance basic public services such as education, health care,
clean water, or sanitation;
H. R. 1298—38
‘‘(3) reduces the country’s minimum wage to a level of
less than $2 per day or undermines workers’ ability to exercise
effectively their internationally recognized worker rights, as
defined under section 526(e) of the Foreign Operations, Export
Financing and Related Programs Appropriations Act, 1995 (22
U.S.C. 262p–4p); or
‘‘(4) promotes unsustainable extraction of resources or
results in reduced budget support for environmental programs.
‘‘(c) CONDITIONS.—A country shall not be eligible for cancella-
tion of debt under modifications to the Enhanced HIPC Initiative
described in subsection (a) if the government of the country—
‘‘(1) has an excessive level of military expenditures;
‘‘(2) has repeatedly provided support for acts of inter-
national terrorism, as determined by the Secretary of State
under section 6(j)(1) of the Export Administration Act of 1979
(50 U.S.C. App. 2405(j)(1)) or section 620A(a) of the Foreign
Assistance Act of 1961 (22 U.S.C. 2371(a));
‘‘(3) is failing to cooperate on international narcotics control
matters; or
‘‘(4) engages in a consistent pattern of gross violations
of internationally recognized human rights (including its mili-
tary or other security forces).
‘‘(d) PROGRAMS
TO
COMBAT
HIV/AIDS 
AND
POVERTY.—A
country that is otherwise eligible to receive cancellation of debt
under the modifications to the Enhanced HIPC Initiative described
in subsection (a) may receive such cancellation only if the country
has agreed—
‘‘(1) to ensure that the financial benefits of debt cancellation
are applied to programs to combat HIV/AIDS and poverty,
in particular through concrete measures to improve basic serv-
ices in health, education, nutrition, and other development
priorities, and to redress environmental degradation;
‘‘(2) to ensure that the financial benefits of debt cancellation
are in addition to the government’s total spending on poverty
reduction for the previous year or the average total of such
expenditures for the previous 3 years, whichever is greater;
‘‘(3) to implement transparent and participatory policy-
making and budget procedures, good governance, and effective
anticorruption measures; and
‘‘(4) to broaden public participation and popular under-
standing of the principles and goals of poverty reduction.
‘‘(e) DEFINITIONS.—In this section:
‘‘(1) COUNTRY SUFFERING A PUBLIC HEALTH CRISIS.—The
term ‘country suffering a public health crisis’ means a country
in which the HIV/AIDS infection rate, as reported in the most
recent epidemiological data for that country compiled by the
Joint United Nations Program on HIV/AIDS, is at least 5
percent among women attending prenatal clinics or more than
20 percent among individuals in groups with high-risk behavior.
‘‘(2) DECISION POINT.—The term ‘Decision Point’ means the
date on which the executive boards of the International Bank
for Reconstruction and Development and the International
Monetary Fund review the debt sustainability analysis for a
country and determine that the country is eligible for debt
relief under the Enhanced HIPC Initiative.
‘‘(3) ENHANCED
HIPC
INITIATIVE.—The term ‘Enhanced
HIPC Initiative’ means the multilateral debt initiative for
H. R. 1298—39
heavily indebted poor countries presented in the Report of
G–7 Finance Ministers on the Cologne Debt Initiative to the
Cologne Economic Summit, Cologne, June 18–20, 1999.’’.
SEC. 502. REPORT ON EXPANSION OF DEBT RELIEF TO NON-HIPC
COUNTRIES.
(a) IN GENERAL.—Not later than 90 days after the date of
enactment of this Act, the Secretary of the Treasury shall submit
to Congress a report on—
(1) the options and costs associated with the expansion
of debt relief provided by the Enhanced HIPC Initiative to
include poor countries that were not eligible for inclusion in
the Enhanced HIPC Initiative;
(2) options for burden-sharing among donor countries and
multilateral institutions of costs associated with the expansion
of debt relief; and
(3) options, in addition to debt relief, to ensure debt sustain-
ability in poor countries, particularly in cases when the poor
country has suffered an external economic shock or a natural
disaster.
(b) SPECIFIC OPTIONS TO BE CONSIDERED.—Among the options
for the expansion of debt relief provided by the Enhanced HIPC
Initiative, consideration should be given to making eligible for that
relief poor countries for which outstanding public and publicly
guaranteed debt requires annual payments in excess of 10 percent
or, in the case of a country suffering a public health crisis (as
defined in section 1625(e) of the Financial Institutions Act, as
added by section 501 of this Act), not more than 5 percent, of
the amount of the annual current revenues received by the country
from internal resources.
(c) ENHANCED HIPC INITIATIVE DEFINED.—In this section, the
term ‘‘Enhanced HIPC Initiative’’ means the multilateral debt initia-
tive for heavily indebted poor countries presented in the Report
of G–7 Finance Ministers on the Cologne Debt Initiative to the
Cologne Economic Summit, Cologne, June 18–20, 1999.
SEC. 503. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appropriated to
the President such sums as may be necessary for the fiscal year
2004 and each fiscal year thereafter to carry out section 1625
of the International Financial Institutions Act, as added by section
501 of this Act.