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[[Page 117 STAT. 711]]

Public Law 108-25
108th Congress

                                 An Act

     To provide assistance to foreign countries to combat HIV/AIDS, 
   tuberculosis, and malaria, and for other purposes. <<NOTE: May 27, 
                         2003 -  [H.R. 1298]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: United States 
Leadership Aganist HIV/AIDS, Tuberculosis, and Malaria Act of 2003.>> 


    (a) Short Title.--This Act may be cited as the ``United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003''.
    (b) Table of Contents.--The table of contents for this Act is as 

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.


Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.


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 overseas areas severely affected by HIV/AIDS, 
           tuberculosis, and malaria.
Sec. 305. Report on treatment activities by relevant executive branch 
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.


Sec. 401. Authorization of appropriations.

[[Page 117 STAT. 712]]

Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Assistance from the United States private sector to prevent 
           and reduce HIV/AIDS in sub-Saharan Africa.


Sec. 501. Modification of the Enhanced HIPC Initiative.
Sec. 502. Report on expansion of debt relief to non-HIPC countries.
Sec. 503. Authorization of appropriations.

SEC. 2. <<NOTE: 26 USC 7601.>> 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 
            (2) According to the Joint United Nations Programme 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 
        15 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 societies 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 vulnerable to sexual 
        exploitation and violence, thereby increasing the possibility of 
        HIV infection.
            (4) As the leading cause of death in sub-Saharan 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 infected 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 capacity of the individual and 
        the social cohesion and economic well-being of the family.
            (7) HIV/AIDS undermines the economic security 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 security at the local level and governance

[[Page 117 STAT. 713]]

        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 overwhelming challenges of the HIV/AIDS epidemic 
        are accelerating the outward migration of critically important 
        health care professionals.
            (9) HIV/AIDS weakens the defenses of countries severely 
        affected by the HIV/AIDS crisis through high infection rates 
        among members of their military forces and voluntary 
        peacekeeping personnel. According to UNAIDS, in sub-Saharan 
        Africa, 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 
                instability and economic devastation, particularly in 
                those countries and regions most severely affected by 
                the disease;
                    (B) decreasing the capacity to resolve conflicts 
                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 infected. 
        According to the World Health Organization (WHO), HIV/AIDS, 
        tuberculosis, and malaria accounted for more than 5,700,000 
        deaths in 2001 and caused debilitating illnesses in millions 
            (12) Together, HIV/AIDS, tuberculosis, malaria and related 
        diseases are undermining agricultural production throughout 
        Africa. According to the United Nations Food and Agricultural 
        Organization, 7,000,000 agricultural workers throughout 25 
        African countries have died from AIDS since 1985. Countries with 
        poorly developed agricultural systems, 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 
            (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 
        system, individuals with HIV and latent tuberculosis infection 
        have a 100 times greater risk of developing active tuberculosis 
        diseases thereby increasing the risk of spreading tuberculosis 
        to others. Tuberculosis, in turn, accelerates the onset of AIDS 
        in individuals 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 resistance of the malaria parasite to 
        inexpensive and effective drugs. At the same time, increasing

[[Page 117 STAT. 714]]

        resistance 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 contributes 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 delivery systems and 
        infrastructure, and determined national leadership and increased 
        budgetary allocations for the health sector in countries 
        affected by the epidemic 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 infections 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-effective. 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 becoming orphans, and increase 
        productivity of such individuals by allowing them to lead active 
        lives and reduce 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 effective in combating the HIV/AIDS 
        pandemic and can be a resource in assisting indigenous 
        organizations in severely affected countries in their efforts to 
        provide treatment and care for individuals infected with HIV/
            (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 disease, and to care for orphans. The 
        Catholic Church alone currently cares for one in four people 
        being treated for AIDS worldwide. Faith-based organizations 
        possess infrastructure, experience, and knowledge 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 significant decline 
        in HIV rates of any country in Africa, including a decrease 
        among pregnant women from 20.6 percent in 1991 to 7.9 percent in 
            (B) Uganda made this remarkable turnaround because President 
        Yoweri Museveni spoke out early, breaking long-standing cultural 
        taboos, and changed widespread perceptions

[[Page 117 STAT. 715]]

        about the disease. His leadership stands as a model for ways 
        political leaders in Africa and other developing countries can 
        mobilize their nations, including civic organizations, 
        professional 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. Beginning 
        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 reporting 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. Uganda'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 
                    (B) development of health care infrastructure 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 

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