Order Code RS21181
Updated February 10, 2003
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
Appropriations, FY2002 - FY2004
Raymond W. Copson
Specialist in International Relations
Foreign Affairs, Defense, and Trade Division
Summary
The Administration’s FY2004 request for international HIV/AIDS spending
would commit $450 million to a new Global AIDS Initiative to be administered by the
Department of State. This is the principal component of the President’s Emergency Plan
for AIDS Relief, announced in the State of the Union Message on January 28, 2003.
The Administration is seeking $300 million for the President’s Mother and Child HIV
Prevention Initiative in FY2004, up from $200 million in the FY2003 request. The
request for a contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria
is $200 million, the same amount requested for FY2003. The Senate-passed omnibus
appropriations bill for FY2003 would provide $400 million for the Global Fund. For
additional information, see CRS Issue Brief IB10050, AIDS in Africa; CRS Report
RS21114, HIV/AIDS: Appropriations for Worldwide Programs in FY2001 and FY2002;
and CRS Report RS21340, The Global Fund to Fight AIDS, Tuberculosis, and Malaria:
Background and Current Issues.

U.S. International HIV/AIDS Programs
Most funding for international HIV/AIDS programs is included in appropriations
for Foreign Operations and the Departments of Health and Human Services, Labor, and
Education. Congressional action on these appropriations for FY2003 has yet to be
completed, but both were included in the FY2003 Omnibus Appropriations Resolution,
passed by the Senate January 23, 2003, as S.Amdt. 1 to H.J.Res. 2. The Administration
submitted its FY2004 budget proposal, including proposals for international HIV/AIDS
spending, on February 3, 2003.
Table 1 summarizes Administration requests for international HIV/AIDS activities
in FY2003 and FY2004 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 new Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global
Fund). The Fund reports that 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
Congressional Research Service ˜ The Library of Congress

CRS-2
Survival and Health Programs Fund Assistance and for the Global Aids Program of the
Centers for Disease Control and Prevention (CDC) of the Department of Health and
Human Services 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 International Mother and Child HIV Prevention Initiative.
HIV/AIDS in the Foreign Operations Appropriations. 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 funded by Title II of
the Foreign Operations Appropriations. 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. On January 22, 2003,
the Senate approved by voice vote an amendment to the Omnibus Appropriations
Resolution by Senator Richard Durbin that added $180 million to the amount set aside for
HIV/AIDS in the Child Survival program. Of this amount, $100 million was added to the
contribution to the Global Fund, and the amendment specified that of the remainder, $25
million could be transferred to the CDC. The Durbin amendment amounts are included
in lines 1 and 2.
The Senate bill for FY2003 states that up to $100 million in Child Survival AIDS
funds may be used to support the International Mother and Child HIV Prevention
Initiative. As noted above, this is the amount requested by the Administration. The
FY2004 request shown in line 1 is $50 million above the FY2003 request, reflecting the
Administration’s request for $150 million for the Initiative.
The third line in Table 1 indicates that apart from Child Survival/Development
Assistance funding, $40 million in other economic assistance was allocated to HIV/AIDS
programs in FY2002 and that the same amount has been requested for FY2003 and
FY2004. 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 Global AIDS Initiative, referred to in Line 4 of Table 1, is the major component
of the Emergency Plan for AIDS Relief, announced by President Bush in his State of the
Union message on January 28, 2003. This 5-year plan will total $15 billion and is to
include $10 billion in new funds. The Global AIDS Initiative, if approved by Congress,
will be a Department of State program focused on 12 African countries as well as Haiti
and Guyana. Objectives include prevention of seven million new infections, antiretroviral
drugs for 1 million HIV-infected people, and care for 10 million individuals, including
AIDS orphans. Appropriations for the Initiative are slated to increase sharply in future
years under the Administration plan.
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.

CRS-3
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
FY2003 FY2004
Projected
Request
House
Senate
Conf.
Request
1. Child Survival Assistance for
395.0
600.0
496.5a
621.5f
650.0
bilateral programs
2. Child Survival Assistance for the
40.0
100.0
250.0
300.0f
100.0
Global Fund
3. Other economic assistance
40.0
40.0
40.0
50.0g
40.0
4. State Department Global AIDS
450.0
Initiative
5. Foreign Military Financing
0
2.0
2
2
1.5
6. Subtotal, Foreign Operations
475.0
742.0
788.5
973.5
1241.5
Appropriations
7. CDC Global AIDS Program
143.8
243.8
183.8b
168.8f
293.8
8. CDC International Applied
11.0
11.0
11c
11.0c
11.0
Prevention Research
9. NIH International Research
218.2
252.3
252.3c
252.3 c
274.7
10. DOD HIV/AIDS prevention
14.0
0
10.0d
0
7.0h
education with African armed forces
11. DOL AIDS in the Workplace
8.5
0
10.0g
Initiative
12. Section 416(b) Food Aid
25.0
0
25.0f
13. Global Fund contribution from
160.0
100.0
100.0e
100.0f
100
NIH (and other sources in FY2002)
14. Total
1055.5
1349.1
1345.6
1540.6
1921.0
a. House amounts in the foreign policy budget are drawn from H.R. 5410, the Foreign Operations
Appropriations bill reported by the House Appropriations Committee in the 107th Congress.
b. H.R. 246, Departments of Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2003. Introduced in the House, January 8, 2003.
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. 5010, Department of Defense Appropriations, passed the House June 27, 2002. The program was
not mentioned in the Senate version of the bill.
e. H.R. 246.
f. S.Amdt. 1, Omnibus FY2003 Appropriations, to H.J.Res. 2, making further continuing appropriations.
g. Report to accompany S.Amdt. 1, appearing in the Congressional Record, January 15, 2003.
h. P.L. 107-248, see text.

CRS-4
As indicated in line 5 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, and $1.5 million in FY2004. 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 Senate Omnibus Appropriations measure, nor in the bill itself; but
overall funding for FMF appears sufficient to support the request. Line 6 is a subtotal
permitting a comparison of funding levels in the Foreign Operations Appropriations under
various bills and requests.
In FY2002, $15 million of Child Survival funding for HIV/AIDS was earmarked for
microbicide research, and the same amount has been requested for FY2003. The Senate
Omnibus (S.Amdt. 1) would increase the amount for microbicide development to $18
million. The FY2002 appropriations specified that up to $10 million could be given as a
contribution to the International AIDS Vaccine Initiative (IAVI). The Senate Omnibus
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, was also taken
from the $435 million for HIV/AIDS, although this amount was not specified in
legislation. The FY2003 appropriations passed by the Senate does not specify an amount
for UNAIDS, although report language (Congressional Record, January 15, 2003)
expresses support for the organization. The FY2004 request does not specify amounts for
microbicide development, IAVI, or UNAIDS.
Other International HIV/AIDS Appropriations. Lines 7, 8, and 9 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) had 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 was boosted by $100
million by the Administration’s September 3 budget amendment with respect to the
International Mother and Child Transmission Initiative. The FY2004 request for the CDC
would rise another $50 million over the FY2003 request, since the request for the Mother
to Child Transmission Initiative is $150 million.
The Senate omnibus appropriations for HHS in FY2003 would provide $168.8
million for CDC international HIV/AIDS programs, but neither the bill nor the
accompanying report mention the President’s mother and child initiative in connection
with the CDC. An appropriations bill introduced in the House (H.R. 246) would fund the
CDC program at $183.8 million. The CDC is devoting $11 million to international
applied prevention research in FY2002 and expects to spend the same amount in FY2003
and FY2004. This spending is not earmarked. Meanwhile, as indicated in line 9, 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, which again is not earmarked, would increase under the
requests for FY2003 and FY2004.
Line 10 in Table 1 refers to the Defense Department’s AIDS prevention education
program with African militaries. New funding for the education program itself was not

CRS-5
requested for FY2003,2 but the conference version (“Conf.” in Table 1) of the
Department of Defense Appropriations bill (H.R. 5010) provided $7 million to remain
available until the end of FY2004. Action on H.R. 5010 was completed in the 107th
Congress, and the bill was signed into law (P.L. 1071-248) on October 23, 2002. New
funding has not been requested for FY2004.
Congress made available $10 million for the AIDS in the Workplace Initiative of
the Department of Labor (line 11) 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.
The report on the Senate Omnibus Appropriations recommends that $10 million be
provided, but solely for the purpose of assisting the International Labor Organization with
its workplace-based AIDS education and prevention programs. No funding is requested
for FY2004.
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.3 As line 12 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,4 but the Senate
Omnibus would restore this funding. Funding has not been requested for FY2004.
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).
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 Assistance. For FY2003, line 2 shows that the
Administration has requested $100 million, whereas the Senate omnibus would provide
$300 million, including the $100 million specified in Senator Durbin’s amendment. For
FY2004, the Administration has requested $100 million, the same amount as requested
for FY2003.
Line 3 of Table 2 shows that in FY2002, $10 million was taken from funds
designated in the Child Survival appropriations for fighting “other infectious diseases,”
principally tuberculosis and malaria. The FY2002 appropriations for the Department of
2 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.
3 This food aid was earmarked by Congress in the FY2002 Department of Agriculture
Appropriations (P.L. 107-76).
4 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.

CRS-6
Health and Human Services (P.L. 107-116) designated $100 million in FY2002 funds for
transfer 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 line
4 of Table 2. Under the FY2003 request, $100 million would be made available from
NIH, and this amount is provided in appropriations bills in both the House and Senate.
The same amount has been requested for FY2004.
Table 2. U.S. Contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria
($ millions)
FY2003 FY2003 FY2003 FY2003
FY2001 FY2002 Request House Senate Request
1. Supplemental Approps. FY2001
100
2. Child Survival Assistance for
40
100
250
300
100
HIV/AIDS
3. Other infectious diseases
10
4. NIH
100
100
100a
100b
100
5. Remaining amount from USAID
25
6. Remaining amount from HHS
25
Total
100
200
200
350
400
200
a. H.R. 246.
b. Senate Amendment 1.
Lines 5 and 6 of Table 2 indicate that the remaining $50 million of the FY2002
pledge to the Global Fund was 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.