Order Code RS21181
Updated June 14, 2002
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
FY2003 Request and FY2002 Spending
Raymond W. Copson
Specialist in International Relations
Foreign Affairs, Defense, and Trade Division
Summary
Supplemental Appropriations legislation for FY2002, currently before Congress,
could increase spending for international HIV/AIDS programs by $200 million if finally
approved. The Administration’s FY2003 request for international HIV/AIDS spending
would boost funding for the bilateral programs of the U.S. Agency for International
Development but hold constant spending by the Centers for Disease Control and
Prevention of the Department of Health and Human Services. Funds have not been
requested for some international programs funded in FY2002, although $200 million has
been requested for a contribution to the Global Fund to Fight HIV/AIDS, Tuberculosis,
and Malaria – the same amount being provided in FY2002. For additional information,
see CRS Issue Brief IB10050, AIDS in Africa and CRS Report RS21114, HIV/AIDS:
Appropriations for Worldwide Programs in FY2001 and FY2002.
U.S. International HIV/AIDS Programs
During February and March 2002, the Bush Administration released information on
its FY2003 budget proposal for international HIV/AIDS programs. Table 1 summarizes
Administration requests for these programs and compares them with projected spending
in FY2002. The figures in Table 1 include U.S. contributions to the Global Fund to Fight
HIV/AIDS, Tuberculosis, and Malaria (Global Fund). The Fund announced its first grants
on April 25, 2002, and approximately 60% of the funds to be disbursed will go to projects
working in HIV/AIDS.
The first item in Table 1 is an “earmark” for HIV/AIDS programs in the Foreign
Operations Appropriations legislation. In FY2002, this earmark, which falls under the
Child Survival and Health Programs Fund of the Development Assistance program, is
Congressional Research Service ˜ The Library of Congress

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Table 1. U.S. International HIV/AIDS Programs
(Including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria)
($ millions)
Program
FY2002
FY2003
Projected
Request
1. Child Survival/Development Assistance, including part of the
435
600
Global Fund contribution (Table 2)
2. Other economic assistance
40
40
3. Foreign Military Financing
0
2
4. CDC Global AIDS Program
144
144
5. CDC International Applied Prevention Research
11
11
6. NIH International Research
188
222
7. DOD HIV/AIDS prevention education with African armed
14
0
forces
8. DOL AIDS in the Workplace Initiative
10
0
9. Section 416(b) Food Aid
25
0
10. Remaining Global Fund contribution (see Table 2)
160
100
Total
1,027
1,119
$435 million.1 The Administration is requesting, as part of its overall FY2003
Development Assistance request, that $600 million be provided for HIV/AIDS programs.
The largest part of the HIV/AIDS earmark goes toward the bilateral HIV/AIDS programs
of the U.S. Agency for International Development (USAID). In FY2002, however, $40
million from the earmark is being put toward the U.S. contribution to the Global Fund,
and this amount would rise to $100 million in FY2003. Moreover, in FY2002 the
earmark is funding an $18 million contribution to the United Nations Joint Program on
HIV/AIDS (UNAIDS), $15 million for microbicide research, and $10 million for the U.S.
contribution to the International AIDS Vaccine Initiative (IAVI).2 The same amount has
been requested for these programs in FY2003.
The second line in Table 1 indicates that apart from the HIV/AIDS Foreign
Operations earmark, $40 million in other economic assistance is being allocated to
HIV/AIDS programs in FY2002 and that the same amount has been requested for
FY2003. This other economic assistance used to fight HIV/AIDS includes food aid,3
1 H.R. 2506/P.L. 107-155, Title II.
2 The FY2002 Foreign Operations Appropriations required that $15 million of the HIV/AIDS
earmark be used to support the development of microbicides. The contribution to IAVI was
appropriated under the general Child Survival program, not specifically under the HIV/AIDS
earmark. The contribution to UNAIDS was not earmarked.
3 Such aid is in addition to the Section 416(b) food aid listed in Table 1. For a description of food
(continued...)

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Economic Support Fund aid, assistance for the former Soviet Union under the Freedom
Support Act (FSA), and Assistance for Eastern Europe and the Baltics (AEEB).
Line 3 in Table 1 indicates that the Administration is requesting $2 million in
Foreign Military Financing (FMF) for fighting HIV/AIDS in FY2003. This funding, if
approved, would support a new Military Health Affairs program to complement the
Department of Defense (DOD) program offering HIV/AIDS prevention education to
African armed forces. New funding for the education program itself (line 7) has not been
requested.4 Nor has funding been requested for the AIDS in the Workplace Initiative of
the Department of Labor (line 8), or for Section 416(b) food aid (line 9).5 For FY2002,
Congress has that directed $25 million be provided through the Section 416(b) program,
which provides for the donation of surplus food commodities, in order to mitigate the
effects of AIDS on communities overseas.6
Lines 4, 5, and 6 in Table 1 refer to international AIDS programs of the Department
of Health and Human Services (HHS). The Department’s Centers for Disease Control
and Prevention (CDC) has an appropriation of $143.8 million in FY2002 for its Global
AIDS Program (GAP). The same amount has been requested for FY 2003. The CDC is
also devoting $11 million to international applied prevention research in FY2002, and
again the same amount has been requested for FY2003. Meanwhile, as indicated in line
6, the National Institutes of Health (NIH) is conducting research with an international
dimension, focused primarily on the development of a vaccine for international markets.
Spending for this research would increase under the FY2003 request.

U.S. Contributions to the Global Fund
On February 13, 2002, Secretary of Health and Human Services Tommy Thompson
testified before the Senate Foreign Relations Committee that to date, the United States
had pledged a total of $500 million to the Global Fund. Of this amount, $100 million was
appropriated under the FY2001 Supplemental Appropriations Act (P.L. 107-20), $200
million has been made available in FY2002 funds, and another $200 million has been
pledged in requested FY2003 funds. Table 2 provides further information on how U.S.
contributions to the Global Fund are expected to be met.
Line 1 of Table 2 refers to the amount appropriated in the FY2001 supplemental,
while line 2 indicates the amounts, already noted, to be taken from the HIV/AIDS earmark
3 (...continued)
assistance programs, see CRS Issue Brief IB98006, Agricultural Export and Food Aid Programs,
continuously updated.
4 Executive Office of the President, Office of Management and Budget, Budget of the United
States Government, Fiscal Year 2003. Appendix, 273. According to the Budget, “additional
authorizing legislation” is required for this program.
5 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.
6 This food aid was earmarked by Congress in the FY2002 Department of Agriculture
Appropriations (P.L. 107-76).

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Table 2. U.S. Contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria
($ millions)
Source
FY2001
FY2002
FY2003
projected
request
1. Supplemental Appropriations, FY2001
100
2. HIV/AIDS earmark
40
100
3. Other infections diseases earmark
10
4. NIAID (NIH)
25
100
5. NIH buildings and facilities
75
6. Remaining amount from USAID
25
7. Remaining amount from HHS
25
Total
100
200
200
of the Foreign Operations Appropriations. Line 3 shows that in FY2002, $10 million will
also be taken from funds earmarked in the Child Survival appropriations for fighting
“other infectious diseases,” principally tuberculosis and malaria. As provided for in the
FY2002 appropriations for the Department of Health and Human Services (P.L. 107-116),
$100 million in FY2002 funds will be transferred to the Global Fund from the National
Institute of Allergy and Infectious Diseases (NIAID) of NIH and from the NIH buildings
and facilities account, as indicated in lines 4 and 5 of Table 2. Under the FY2003 request,
$100 million would be appropriated within the NIAID account.7
Lines 6 and 7 of Table 2 indicate that the remaining $50 million of the FY2002
pledge to the Global Fund will be shared equally by USAID and HHS. The Foreign
Operations Appropriations for FY2002 had provided that in addition to the $50 million
for the Global Fund under the Child Survival program, up to $50 million could be taken
for the Fund from bilateral economic assistance funds appropriated for FY2002 and for
previous years. However, as a result of discussions between USAID and HHS, it was
decided that each agency would contribute $25 million to complete the pledge.
FY2002 Supplemental Appropriations. The House version of the FY2002
Supplemental Appropriations (H.R. 4775), which passed the House on May 24, 2002,
would appropriate an additional $200 million8 under the Child Survival and Health
Programs Fund for emergency expenses related to combating AIDS, tuberculosis, and
malaria. A House Appropriations Committee press release on the bill stated that these
funds are “intended to challenge other wealthy nations to meet and exceed the United
7 Budget of the United States Government, Fiscal Year 2003. Appendix, 976.
8 An effort to increase this amount to $500 million during markup in the House Appropriations
Committee did not succeed. Bill Ghent, “Democrats and Republicans Battle Over $29 Billion
Supplemental,” National Journal News Service, May 9, 2002.

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States’ pacesetting efforts to bring these infectious diseases under control,”9 but they are
not specifically designated as a contribution to the Global Fund. However, the legislation
does specify that U.S. contributions to the Global Fund shall not exceed 40% of
contributions by all donors.10
The Senate version of the Supplemental Appropriations (S. 2551), as reported on
May 22, 2002, provided an additional $100 million for HIV/AIDS, tuberculosis, and
malaria programs under the Child Survival Fund. The bill stated that these funds “may
be made available” to the Global Fund. On June 6, 2002, an amendment by Senator
Richard Durbin to increase the amount to $500 million failed when a motion to overturn
a point of order was rejected. However, an amendment by Senator Bill Frist to increase
the amount to $200 million was approved. In addition, the amendment requires that
special emphasis be placed on mother to child transmission prevention, and that U.S.
contributions to the Global Fund be limited to the amount contributed by other donors.
Authorization bills currently before Congress would support increased spending for
the Global Fund. For example, The Global Access to HIV/AIDS Prevention, Awareness,
Education, and Treatment Act of 2001 (H.R. 2069), would authorize $750 million for the
Fund or other multilateral efforts in FY2002 to prevent and treat HIV/AIDS. This bill
passed the House on December 11, 2001. The United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2002 (S. 2525), introduced by Senator John
Kerry and others on May 15, 2002, would authorize $1 billion for the Fund in FY2003
and $1.2 billion in FY2004. This bill was ordered to be reported on June 13. On May 27,
2002, however, Treasury Secretary Paul O’Neill, speaking at a press conference in South
Africa while on a tour with Irish rock star Bono, said that before increasing support for
the Global Fund “we need to understand ... what we are doing with what we have got.”11
9 “Full Committee Reports FY2002 Emergency Supplemental,” press release dated May 15, 2002.
10 According to a table at the Global Fund web site, pledges to the Fund total $2.1 billion, so that
the U.S. pledge of $500 million represents about 24% . A $200 million increase would bring the
U.S. share to 33%. The Fund does not provide information at its website on actual disbursements
by donors to the Fund. See [http://www.globalfundatm.org].
11 Paul Blaustein, “Mothers with AIDS Move O’Neill to Back More Money for Treatment,”
Washington Post, May 25, 2002.

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