Order Code RS21181
Updated September 24, 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 increase funding for U.S. international HIV/AIDS programs. In addition, a
budget amendment submitted by President Bush on September 3, 2002, would add $100
million in FY2003 spending for the U.S. Agency for International Development
(USAID) and $100 million for the Centers for Disease Control and Prevention (CDC)
to fund a mother and child HIV transmission prevention initiative. Funds have not been
requested for some international programs funded in FY2002, although $200 million
is being sought 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 House and Senate would provide additional resources for the Global
Fund, but less than requested for the bilateral programs of the CDC and USAID, taking
into account the September 3 budget amendment proposal. 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. 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.
In the FY2003 Request column, the amounts for Child Survival/Development Assistance
and for the CDC Global Aids Program include funds requested in a budget amendment
submitted by President Bush on September 3, 2002. The amendment would add $100
million to each program to fund the President’s Mother and Child Transmission Initiative.
Congressional Research Service ˜ The Library of Congress

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Lines 1 and 2 in Table 1 refer 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. 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, some of this funding is used
as part of the U.S. contribution to the Global Fund and for other purposes. Details on the
makeup of the Global Fund contribution are provided in Table 2.
The third 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,1
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 totals of lines 1, 2, and 3 are used to determine the overall amounts being
provided for international HIV/AIDS activities through the Foreign Operations
Appropriations. In FY2002, this amount is $435 million,2 while the Administration’s
FY2003 request totals $740 million – including the $100 million for USAID proposed in
the September 3 budget amendment. International HIV/AIDS spending under the FY2003
Foreign Operations Appropriations bill reported in the House (H.R. 5410) would total
$786.5 million, while $750 million would be provided under the bill reported in the
Senate (S. 2779).
In addition, as indicated in line 4 of Table 1, the Administration is requesting $2
million in Foreign Military Financing (FMF), also part of the Foreign Operations
Appropriations, 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 reports accompanying the FY2003 House
and Senate Foreign Operations Appropriations, nor in the bills themselves. However,
observers feel that overall FMF funding in these bills is sufficient to allow the program
to go forward.
In FY2002, $15 million of Child Survival funding 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). The foreign operations bill reported in the House would again provide
up to $10 million as a contribution to IAVI, while the Senate version would provide up
to $12 million. 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
1 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,
continually updated.
2 H.R. 2506/P.L. 107-155, Title II.

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for HIV/AIDS, although this amount was not specified in legislation. Foreign Operations
Appropriations bills reported in the House and Senate also do not specify an amount for
UNAIDS, although Senate report language (S.Rept. 107-219) expresses support for the
organization, and House report language (H.Rept. 107-663) urges increased UNAIDS
funding. The House bill also states that up to $100 million in Child Survival AIDS funds
may be used to support international mother and child HIV prevention activities.
Table 1. U.S. International HIV/AIDS Programs
(Including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria)
($ millions)
Program
FY2002
FY2003
FY2003
FY2003
Projected
Request
House
Senate
1. Child Survival/Development
395.0
600.0
496.5a
500.0g
Assistance for bilateral programs
2. Child Survival/Development
40.0
100.0
250.0a
200.0g
Assistance for the Global Fund
3. Other economic assistance
40.0
40.0
40b
50.0g
4. Foreign Military Financing
0
2.0
2c,a
2c,g
5. CDC Global AIDS Program
143.8
243.8
143.8d
168.8h
6. CDC International Applied
11.0
11.0
11c,d
11.0c,h
Prevention Research
7. NIH International Research
188.0
222.0
222.0d
222.0 h
8. DOD HIV/AIDS prevention
14.0
0
10.0e
0
education with African armed forces
9. DOL AIDS in the Workplace
8.5
0
–
10.0i
Initiative
10. Section 416(b) Food Aid
25.0
0
25.0f
25.0j
11. Remaining Global Fund
160.0
100.0
100.0d
100.0h
contribution (see Table 2)
Total
1025.3
1318.8
1300.3
1288.8
a H.R. 5410, Foreign Operations Appropriations, reported to the House (H.Rept.107-663) September 19,
2002.
b H.Rept. 107-663.
c 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.
d H.R. 5320, Labor, Health and Human Services, and Education Appropriations, referred to the House
Committee on Appropriations, September 4, 2002.
e 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.
f H.R. 5263, Agriculture Appropriations, as reported (H.Rept. 107-623) July 26, 2002.
g S. 2779, Foreign Operations Appropriations, as reported (S.Rept. 107-219), July 24, 2002.
h S. 2766, Appropriations for the Departments of Labor, Health and Human Services, and Education, as
reported (S.Rept. 107-216), July 22, 2002.
i S.Rept. 107-216.
j S. 2801, Agriculture Appropriations, as reported (S.Rept. 107-223), July 25, 2002.

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Lines 5, 6, and 7 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 had been requested for FY2003, but the request
has now been boosted by $100 million by the Administration’s September 3 budget
amendment. The Senate Appropriations legislation for HHS (S. 2766), as reported on
July 22, 2002, would provide $168.8 million, while the House bill (H.R. 5329), referred
to committee on September 4, would provide the $143.8 million originally requested.
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 7, the National Institutes of
Health (NIH) is also 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 8 in Table 1 refers to the Defense Department’s AIDS prevention education
program with African militaries. New funding for the education program itself has not
been requested for FY2003,3 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 9) 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 (S.Rept. 107-216), 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.4 As line 9 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,5 but Department
of Agriculture Appropriations bills reported in both the House and Senate would restore
this funding.
3 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.
4 This food aid was earmarked by Congress in the FY2002 Department of Agriculture
Appropriations (P.L. 107-76).
5 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.

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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 Approps., FY2001
100
–
–
–
–
2. Child Survival/Development
–
40
100
250
200
Assistance for HIV/AIDS
3. Other infectious diseases
–
10
–
–
–
4. NIAID (NIH)
–
25
100
100
100
5. NIH buildings and facilities
–
75
–
–
–
6. Remaining amount from USAID
–
25
–
–
–
7. Remaining amount from HHS
–
25
–
–
–
Total
100
200
200
350
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. For FY2003, line 2 shows
that the Administration has requested $100 million, whereas House and Senate bills
would provide considerably more. The $200 million in the Senate bill would be available
notwithstanding any other provision of law, while the House bill specifies that the
cumulative amount of U.S. contributions to the Fund not exceed amounts provided and
made available for the use of the Fund by other donors.
Line 3 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,”
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

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be made available within the NIAID account,6 and this amount is provided in the House
and Senate versions of the appropriations for the Departments of Labor, HHS, and
Education.
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 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. (On September 3, 2002, as noted above, the
President proposed that $200 million be added to the FY2003 budget to fund his mother
and child HIV transmission prevention initiative.) 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 made available (not just pledged) by other
donors (H.Rept. 107-593).
An authorization bill, H.R. 2069, which has cleared both the House and the Senate
in substantially different versions, would sharply increase international HIV/AIDS
funding if authorized 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, 2001, 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.
6 Budget of the United States Government, Fiscal Year 2003. Appendix, 976.

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