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Pub.L. 108-026 To extend the Temporary Extended Unemployment Compensation Act of 2002. <> ...
[[Page 117 STAT. 711]]
Public Law 108-25
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.>>
SECTION 1. <<NOTE: 22 USC 7601 note.>> SHORT TITLE; TABLE OF CONTENTS.
(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.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis
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
Sec. 315. Pilot program on family survival partnerships.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
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.
TITLE V--INTERNATIONAL FINANCIAL INSTITUTIONS
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
(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
(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
(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
(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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108th Congressional Public Laws Records and Documents
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