Order Code RS21181
Updated August 20, 2002
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
FY2002 Spending and FY2003 Outlook
Raymond W. Copson
Specialist in International Relations
Foreign Affairs, Defense, and Trade Division
Summary
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. Appropriations bills
reported in the Senate would provide approximately $170 million more for international
HIV/AIDS activities than the Administration’s request. 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
Appropriations bills to fund international HIV/AIDS programs are now moving
through the legislative process. Table 1 summarizes Administration requests for
international HIV/AIDS activities in FY2003 and compares them with funding levels in
House and Senate appropriations bills – and with spending in FY2002. House funding
for FY2003 is not totaled in Table 1 because bills that will fund major components of
global AIDS spending have not yet been reported. The figures in Table 1 include U.S.
contributions to the Global Fund to Fight 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.
Line 1 in Table 1 refers to HIV/AIDS funding through the Child Survival and Health
Programs Fund (formerly the Child Survival and Disease Programs Fund), which is part
of the Development Assistance program and funded by Title II of the Foreign Operations
Appropriations legislation. In FY2002, spending through the Child Survival program is
projected to be $435 million, the amount specified in the FY2002 Foreign Operations
Congressional Research Service ˜ The Library of Congress

---

CRS-2
Appropriations.1 The Administration’s FY2003 request does not include a Child Survival
program, but $600 million is being sought for international HIV/AIDS activities as part
of the overall Development Assistance request. The Foreign Operations Appropriations
bill reported in the Senate (S. 2779), which would restore a separate Child Survival
account, would provide $700 million for global HIV/AIDS, including $200 million for
the Global Fund.
Table 1. U.S. International HIV/AIDS Programs
(Including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria)
($ millions)
Program
FY2002
FY2003
FY2003
FY2003
Projected
Request
House
Senate
1. Child Survival/Development
435.0
600.0
–
700.0a
Assistance, including part of the
Global Fund contribution (Table 2)
2. Other economic assistance
40.0
40.0
–
50.0a
3. Foreign Military Financing
0
2.0
–
2.0 b
4. CDC Global AIDS Program
143.8
143.8
–
168.8c
5. CDC International Applied
11.0
11.0
–
11.0 b
Prevention Research
6. NIH International Research
188.0
222.0
–
222.0 b
7. DOD HIV/AIDS prevention
14.0
0
10.0d
0
education with African armed forces
8. DOL AIDS in the Workplace
8.5
0
–
10.0e
Initiative
9. Section 416(b) Food Aid
25.0
0
25.0f
25.0g
10. Remaining Global Fund
160.0
100.0
–
100.0c
contribution (see Table 2)
Total
1025.3
1118.8
–
1288.8
a S. 2779, Foreign Operations Appropriations, as reported (S.Rept. 107-219), July 24, 2002.
b Funding amounts recorded in italics are not specifically mentioned in appropriations bills or accompanying
reports. However, overall funding levels appear adequate to support the Administration’s request.
c S. 2766, Appropriations for the Departments of Labor, Health and Human Services, and Education, as
reported (S.Rept. 107-216), July 22, 2002.
d H.R. 5010, Department of Defense Appropriations, passed the House June 27, 2002. The program is not
mentioned in the Senate version of the bill, which passed on August 1.
e S.Rept. 107-216.
f H.R. 5263, Agriculture Appropriations, as reported (H.Rept. 107-623) July 26, 2002.
g S. 2801, Agriculture Appropriations, as reported (S.Rept. 107-223), July 25, 2002.
1 H.R. 2506/P.L. 107-155, Title II.

---

CRS-3
The largest part of Child Survival/Development Assistance HIV/AIDS spending goes
toward the bilateral HIV/AIDS programs of the U.S. Agency for International
Development (USAID). However, as indicated in Table 2, a portion of this funding is
used to make up the U.S. contribution to the Global Fund. Moreover, in FY2002, $15
million of the $450 million set aside for HIV/AIDS is earmarked for microbicide research,
and the same amount has been requested for FY2003. The Foreign Operations
Appropriations bill reported in the Senate would increase the amount for microbicide
development to $18 million.
The FY2002 appropriations legislation specified that up to $10 million could be
given as a contribution to the International AIDS Vaccine Initiative (IAVI) from general
Child Survival funds, not specifically from the $435 million designated for HIV/AIDS.
However, the executive branch, which is requesting the same amount for IAVI in
FY2003, decided to take the contribution from the AIDS funds. The foreign operations
bill reported in the Senate would provide up to $12 million as a contribution to IAVI, also
from the general Child Survival program, but the amount could again be taken from funds
specifically designated for HIV/AIDS.2 The U.S. contribution to the United Nations Joint
Program on HIV/AIDS (UNAIDS), which was $18 million in FY2002, is also being taken
from the $435 million for HIV/AIDS, although this amount was not specified in
legislation. S. 2779, the FY2003 appropriations bill reported in the Senate, also does not
specify an amount for UNAIDS, although report language expresses support for the
organization and its activities (S.Rept. 107-219).
The second line in Table 1 indicates that apart from Child Survival/Development
Assistance funding, $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
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). The
Appropriations bill reported in the Senate would provide $50 million for AIDS activities
through other economic assistance.
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. The FMF-funded program is not mentioned in the report
accompanying the FY2003 Senate Foreign Operations Appropriations, nor in the bill
itself. However, some observers feel that overall FMF funding in the Senate bill is
sufficient to allow the program to go forward.
2 The report on this bill (S.Rept. 107-219) states that it provides $750 million for international
HIV/AIDS activities, reflecting the amounts on lines 1 and 2 of Table 1, and not including an
additional amount for the IAVI contribution.
3 Such aid is in addition to the Section 416(b) food aid listed in Table 1. For a description of food
assistance programs, see CRS Issue Brief IB98006, Agricultural Export and Food Aid Programs,
continuously updated.

---

CRS-4
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, but the Senate
Appropriations legislation for HHS (S. 2766), as reported, would boost this amount by
$25 million. The CDC is also devoting $11 million to international applied prevention
research in FY2002 and expects to spend the same amount in FY2003. This spending
is not earmarked in legislation. 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.
Line 7 in Table 1 refers to the Defense Department’s AIDS prevention education
program with African militaries. New funding for the education program itself (line 7)
has not been requested for FY2003,4 although the $14 million appropriated for FY2002
remains available until the end of FY2003. The House version of the Defense
Appropriations bill (H.R. 5010), which passed on June 27, includes $10 million for the
program to remain available until the end of FY2004. The Senate version of the Defense
Appropriations, passed on August 1, does not include new funds for the program.
Congress made available $10 million for the AIDS in the Workplace Initiative of
the Department of Labor (line 8) in FY2002, but the executive branch decided that $1.5
million of this would be used for other programs of the Department’s International Labor
Affairs Bureau. The Administration did not request funding for the program in FY2003.
However, the report on the Senate version of the appropriations bill for the Departments
of Labor, Health and Human Services, and Education (H.Rept. 107-216 to accompany
S. 2766), recommends that $10 million be provided, but solely for the purpose of funding
workplace-based AIDS education and prevention programs of the International Labor
Organization.
For FY2002, Congress directed that of any aid provided through the Section 416(b)
food aid program, which provides for the donation of surplus food commodities, $25
million be used to mitigate the effects of AIDS on communities overseas.5 As line 9 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,6 but Department
of Agriculture Appropriations bills reported in both the House and Senate would restore
this funding.
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 This food aid was earmarked by Congress in the FY2002 Department of Agriculture
Appropriations (P.L. 107-76).
6 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.

---

CRS-5
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 to Fight AIDS, Tuberculosis, and
Malaria. Of this amount, $100 million was appropriated under the FY2001 Supplemental
Appropriations Act (P.L. 107-20), $200 million had been made available in FY2002
funds, and another $200 million was pledged in requested FY2003 funds. Table 2
provides further information on how Administration pledges to the Global Fund are
expected to be met.
Table 2. U.S. Contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria
($ millions)
FY2001
FY2002
FY2003
FY2003
FY2003
Request
House
Senate
1. Supplemental
100
–
–
–
–
Appropriations, FY2001
2. Child Survival/Development
–
40
100
–
–
Assistance for HIV/AIDS
3. Child Survival, general
–
–
–
200
4. Other economic assistance
–
10
–
–
–
5. NIAID (NIH)
–
25
100
–
100
6. NIH buildings and facilities
–
75
–
–
–
7. Remaining amount from
–
25
–
–
–
USAID
8. Remaining amount from
–
25
–
–
–
HHS
Total
100
200
200
–
300
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 funds designated for
HIV/AIDS through Child Survival/Development Assistance in FY2002. For FY2003,
line 2 shows that the Administration requested $100 million from the $600 it seeks to
have designated for HIV/AIDS, whereas the Foreign Operations Appropriations bill
reported in the Senate specifies that $200 be provided from general Child Survival funds
and not from the $500 million specifically designated for HIV/AIDS. The $200 million
for the Global Fund would be available notwithstanding any other provision of law under
the bill.
Line 4 of Table 2 shows that in FY2002, $10 million will also be taken from funds
designated in the Child Survival appropriations for fighting “other infectious diseases,”

---

CRS-6
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 5 and 6 of Table 2. Under the FY2003 request, $100 million would
be appropriated within the NIAID account,7 and this amount is provided in the Senate
version of the appropriations for the Departments of Labor, HHS, and Education.
Lines 7 and 8 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 and Other Legislation
The conference version of the FY2002 Supplemental Appropriations measure (P.L.
107-206) would have provided $200 million in additional Child Survival funds for
international HIV/AIDS activities. Of this amount, $100 million would have been for an
additional contribution to the Global Fund. However, appropriation of the AIDS funds,
with other funds, was contingent on a presidential designation that they were needed as
an emergency requirement; and on August 13, 2002, President Bush announced that he
would not make such a designation. The President added that he would seek funds for his
mother and child transmission prevention initiative, launched on June 19, 2002, through
amendments to the FY2003 budget. The supplemental requires that cumulative U.S.
funds provided to the Global Fund from the Child Survival account by December 31,
2002, not exceed the amount provided (not just pledged) by other donors (H.Rept. 107-
593).
An authorization bill, H.R. 2069, has cleared both the House and the Senate and
would substantially increase international HIV/AIDS funding if targeted spending levels
were met. For example, the House version, the Global Access to HIV/AIDS Prevention,
Awareness, and Treatment Act, which passed on December 11, 2002, authorizes $750
million for the Global Fund or other multilateral HIV/AIDS efforts in FY2002. The
Senate version, passed on July 12, 2002, authorizes $1 billion for the Fund in FY2003 and
$1.2 billion in FY2004. For information on this and other authorizing bills, see the
Legislation section of CRS Issue Brief IB10050, AIDS in Africa.
7 Budget of the United States Government, Fiscal Year 2003. Appendix, 976.

---