Committee on International Relations
U.S. House of Representatives
Henry J. Hyde, Chairman

CONTACT: Sam Stratman, (202) 226-7875, May 1, 2003

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HR 1298, The United States Leadership Against HIV/AIDS,
Tuberculosis and Malaria Act of 2003
Introduced by U.S. Rep. Henry J. Hyde

The Hyde AIDS Act is an unprecedented bipartisan initiative that will lead the way for increased U.S. engagement and leadership to contain the spread of the pandemic, and ultimately to arrest AIDS as a threat to economic and national security.

AIDS threatens the political, social and economic stability of the world, a danger that grows with each passing year.
 
bulletDeath toll so far: 25 million worldwide; 3 million last year; 8,500/daily. It is estimated that by 2010, the death toll will be 80 million worldwide, including 40 million orphans.
bulletInfection rate: 15,000/daily; an estimated 36 million infected people worldwide.
bulletMortality rates are highest in sub-Saharan Africa, but the disease in spreading rapidly in Russia, which recorded the highest number of new AIDS cases in 2000. India, China and Russia are on the cusp of a potentially catastrophic epidemic and, closer to home, the Caribbean region has the second highest rate of HIV infections in the world.
bulletAIDS prevalence in sub-Saharan Africa threatens the stability of dozens of governments. Among African nations in which the U.S. has some degree of security ties - Nigeria, South Africa and Kenya - AIDS prevalence among military personnel is twice the average of infection rates in the general populations which vary between 20 and 30 percent. In Nigeria, Islamists are making important cultural and social inroads. Is a weakened Nigeria ready to defend itself against the kind of violent radicalism witnessed in November when dozens were killed in clashes between Islamists and police?
 
An aggressive response by the United States to the HIV/AIDS pandemic worldwide advances American security and foreign policy interests:
 
bulletStabilizes governments in the developing world that are combating the threat of a failed-state status.
bulletAlleviates dire economic and social conditions that permit the growth of anti-U.S. and anti-democratic radical movements in poor nations.

The Hyde HIV/AIDS Act --

bulletAuthorizes the President’s Emergency Plan for AIDS Relief announced in the State of the Union Address by authorizing $15 billion over the next five years ($3 billion a year, FY 2004-‘08) for HIV/AIDS care, treatment and prevention in those countries already facing crisis of unprecedented proportions, and also in those countries with alarming recent increases in HIV prevalence.
bulletCreates a more responsive, coordinated and effective approach among the various agencies of the U.S. Government involved in the global fight against HIV/AIDS.
bulletPromotes a multisectoral approach that:
 
bulletprovides funds for antiretroviral therapy for people living with HIV;
bulletencourages a strategy that extends palliative care for people living with AIDS;
bulletsupports efforts to find vaccines for HIV/AIDS and malaria;
bulletemphasizes the need to keep families together, with particular focus on the assistance needs of children and young people with HIV;
bulletcontributes to multilateral initiatives that leverage the funds of others;
bulletendorses wider application of the successful "ABC" approach that has reduced HIV prevalence in certain countries by stressing the importance of behavior change (including the promotion of abstinence, faithfulness and, when appropriate, the use of condoms) as the foundation of efforts to fight AIDS.
bulletPlays a critical role in building capacity within affected countries to educate youth and society at large about the tremendous risk of AIDS and its impact on agricultural production, the education sector, and national defense.
 
Includes important protections for accountability and transparency of the Global Fund:
 
bulletU.S. financial support would be limited to 33 percent of the total amounts contributed by other donors. (EXAMPLE: for the U.S. to provide $350 million, other donors would have to actually contribute $700 million in the same year.) This provision promotes better burden-sharing on the part of other governments in the developed world.
bulletRequires continual monitoring and evaluation of the Global Fund by the GAO. Requires a report every two years on the Global Fund, including whether objectives are being met by projects supported by the Global Fund. 
bulletCreates a U.S. Government interagency technical review panel that will "shadow" the work of the Global Fund’s Technical Review Panel. This will ensure that all grant applications submitted to the Global Fund will undergo thorough review, and that concerns and questions about problematic proposals can be provided to U.S. persons who sit on the panels of the Global Fund.

Section-by-Section Analysis

The United States Leadership
Against HIV/AIDS, Tuberculosis and Malaria Act of 2003
Introduced by U.S. Rep. Henry J. Hyde

    Section 1. Short Title. Section 1 contains a short title and table of contents.

    Section 2. Findings. Section 2 articulates findings on the state of the HIV/AIDS pandemic in the developing world, including the latest statistics on the numbers infected and dead; the particular effect of AIDS on and the vulnerability of women and children; the effect of the AIDS crisis on the economic security of countries; its effect on society, labor, military readiness and peacekeeping; the relationship of HIV/AIDS to tuberculosis and malaria; the types of strategies appropriate for dealing with the pandemic; the importance of treatment and care of people living with AIDS; the role of NGOs and faith-based organizations in assisting those people living with AIDS; the positive track record of countries such as Uganda in confronting AIDS directly, resulting in significant progress through the adoption of strategies based on behavior change; the demand for a comprehensive, long-term international response, founded upon addressing the crisis, reducing the spread, and ameliorating the consequences of the pandemic; recognizing that prostitution, sex trafficking and sexual violence are additional causes and factors in the spread of HIV/AIDS; the need for strong coordination among the various agencies of the United States to ensure effective and efficient use of financial and technical resources with respect to the provision of international HIV/AIDS assistance; and findings summarizing and emphasizing the importance of the President’s support of greatly increased and expanded United States efforts to control the pandemic.

    Section 3. Definitions. Section 3 defines terms used throughout the bill.

    Section 4. Purpose. Section 4 articulates in general terms the purposes of the act: to establish a comprehensive, five-year strategy; to provide increased resources for bilateral and multilateral efforts to fight the pandemic; to encourage the expansion of private sector efforts and public-private partnerships; to intensify care and treatment for individuals with HIV/AIDS; and to develop vaccines for HIV/AIDS, tuberculosis, and malaria.

Section 5. Authority to consolidate and combine reports. Section 5 authorizes the President to consolidate the various reports required by the Act, and to enter into contracts for the purpose of developing, originating, or contributing to any of the required reports.

Title I – Policy Planning and Coordination

    Section 101. Development of a comprehensive, five-year global strategy. Section 101 requires the President to establish a comprehensive, integrated five-year strategy to combat HIV/AIDS globally, and articulates that the required elements of the strategy should: include objectives and approaches to treat those infected and prevent further spread of infections; improve coordination and assign priorities for relevant executive branch agencies; expand public-private partnerships; maximize U.S. capabilities in the areas of technical assistance, training, and research; and require a report on the strategy.

    Section 102. HIV/AIDS Response Coordinator. Section 102(a) creates the position of Coordinator of United States Government Activities to Combat HIV/AIDS Globally and enumerates the duties and responsibilities of that individual, generally and specifically. Section 102(b) requires the President to specify the necessary financial resources that shall be assigned to and under the direct control of the Coordinator. Section 102(c) establishes a separate account in the Treasury into which shall be deposited all amounts appropriated pursuant to the authorization of appropriations under section 401, except for amounts appropriated for U.S. contributions to the Global Fund.

Title II – Support for Multilateral Funds, Programs, and Public-Private Partnerships

    Section 201. Sense of Congress on public-private partnerships. Section 201 includes findings and a Sense of Congress supportive of public-private partnerships in strengthening the delivery of health services and accelerating research in the fight against HIV/AIDS.

    Section 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria. Section 202 authorizes U.S. financial participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), and requires an annual report on contributions pledged to, received by, and projects funded by the Global Fund, and the mechanisms established for transparency and accountability in the grant-making process. Authorizes up to $1,000,000,000 for Fiscal Year 2004, and such sums as may be necessary for FY2005-2008, available until expended, with the limitation that the U.S. contribution may not be more than 33 percent of the total amounts contributed to the Fund from all other sources. Requires the establishment of an interagency technical review panel that will analyze proposals received by the Global Fund and provide recommendations to U.S. representatives on the committees, panels and executive board of the Global Fund. Requires the GAO to monitor and evaluate projects and report to Congress every two years the results of the monitoring and evaluation.

    Section 203. Voluntary contributions to international vaccine funds. Section 203 authorizes such sums as may be necessary to be contributed by the United States Government to the "Vaccine Fund," the "International AIDS Vaccine Initiative (IAVI)," and malaria vaccine development programs such as the "Malaria Vaccine Initiative of the Program for Appropriate Technologies in Health."

Title III– Bilateral Efforts

Subtitle A – General Assistance and Programs

    Section 301. Assistance to combat HIV/AIDS. Section 301(a) amends and updates the Foreign Assistance Act (FAA) by inserting a new section 104A -- "Assistance to Combat HIV/AIDS." This new section recognizes that the alarming spread of HIVAIDS in developing countries is a major health, national security, development and humanitarian crisis; states that a major objective of the foreign assistance program of the United States is to provide assistance for the prevention, treatment and control of HIV/AIDS; authorizes the President to furnish assistance to prevent, treat and monitor HIV/AIDS and carry out related activities in sub-Saharan Africa and other countries and areas; describes in general the types of assistance activities that shall be supported to the maximum extent practicable: prevention, treatment, intervention education and technologies, monitoring, pharmaceuticals, and related activities; requires an annual report on the implementation of the new Section 104A; provides a limitation on administrative expenses for activities described in Section 104(c) and Sections104A, 104B, and 104C; defines terms used in Section 104A. Section 301(b) authorizes the appropriation of such sums as may be necessary for FY2004-2008 to carry out the new Section 104A of the FAA as added by Section 301(a); authorizes such sums to remain available until expended.

    Section 302. Assistance to combat tuberculosis. Section 302 amends the FAA by adding a new Section 104B that authorizes assistance to combat tuberculosis, and authorizes the appropriation of such sums as may be necessary to carry out this new Section 104B of the FAA.

    Section 303. Assistance to combat malaria. Section 303 amends the FAA by adding a new Section 104C that authorizes assistance to combat malaria, and authorizes the appropriation of such sums as may be necessary to carry out this new Section 104C of the FAA.

    Section 304. Pilot program for the placement of health care professionals in overseas areas severely affected by HIV/AIDS, tuberculosis, and malaria. Section 304 authorizes the President to establish a pilot program for the placement of health care professionals in overseas areas severely affected by HIV/AIDS, tuberculosis and malaria; and from the amounts authorized to be appropriated to the President under Section 401, authorizes the appropriation of such sums as may be necessary for FY2004-2008 to carry out the program.

    Section 305. Report on treatment activities by relevant executive branch agencies. Section 305 requires a report on the programs and activities of relevant executive branch agencies that are directed toward the treatment of individuals in foreign countries infected with HIV or living with AIDS.

Subtitle B -- Assistance for Children and Families

    Section 311. Findings. Section 311 includes findings on the effect of AIDS on children and families in foreign countries.

    Section 312. Policy and requirements. Section 312 states that the United States Government’s response to the pandemic should place a high priority on the prevention of mother-to-child transmission, the care and treatment of family members, and the care of children orphaned by AIDS.

    Section 313. Annual reports on prevention of mother-to-child transmission of the HIV infection. Section 313 requires an annual report on the activities of relevant executive branch agencies to assist in the prevention of mother-to-child transmission of HIV infection.

    Section 314. Pilot program of assistance for children and families affected by HIV/AIDS. Section 314 authorizes the President to establish a pilot program to 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, and from the amounts authorized to be appropriated to the President under Section 401, authorizes the appropriation of such sums as may be necessary for FY2004-2008 to carry out the program.

    Section 315. Pilot programs on family survival partnerships. Section 315 authorizes the President to establish a program, through a public-private partnership, 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 countries with or at risk for a severe HIV epidemic, with particular attention to resource-constrained countries, and from the amounts authorized to be appropriated to the President under Section 401, authorizes the appropriation of such sums as may be necessary for FY2004-2008 to carry out the program.

Title IV – Authorization of Appropriations.

    Section 401. Authorization of Appropriations. Section 401 authorizes to be appropriated to the President to carry out the Act, and the amendments made by the Act, $3,000,000,000 for each of the fiscal years 2004 through 2008; amounts authorized to remain available until expended; and the authorization of appropriations therein shall remain available until the appropriations are made.

    Section 402. Sense of Congress. Section 402(a) includes a sense of the Congress that an urgent priority of U.S. assistance programs to fight HIV/AIDS should be the rapid increase in distribution of antiretroviral treatment (ARV) so that by the end of FY2004, at least 500,000 individuals are receiving ARV; by the end of FY2005, at least 1,000,000 individuals are receiving such treatment; and by the end of FY2006, at least 2,000,000 individuals are receiving treatment. Section 402(b) includes a sense of the Congress that of the amounts appropriated pursuant to the authorization of appropriations under Section 401 for HIV/AIDS assistance, an effective distribution of such funds would be 55 percent for treatment of individuals with HIV/AIDS, 15 percent for palliative care of individuals with HIV/AIDS, 20 percent for HIV/AIDS prevention, and 10 percent for orphans and vulnerable children.

    Section 403. Allocation of Funds. Section 403 requires that for fiscal years 2006 through 2008, not less than 55 percent of the amounts appropriated under Section 401 for HIV/AIDS assistance for each 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 ARV drugs and at least 25 percent should be expended for related care.

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