Order Code RS21181
Updated February 21, 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, while Congress made available $350 million for the Global Fund in
FY2003. 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 RL31712, 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. For FY2003, these appropriations were part of the conference version of the
Omnibus Appropriations Resolution (H.J.Res. 2), accepted by the House and Senate on
February 13, 2003 and signed into law by President Bush on February 20. The
Administration submitted its FY2004 budget proposal, including proposals for
international HIV/AIDS spending, on February 3, 2003.
Table 1 summarizes requests and appropriations for international HIV/AIDS
activities in FY2003 and FY2004 and compares them 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 Survival and Health Programs Fund Assistance
and for the Global Aids Program of the Centers for Disease Control and Prevention
Congressional Research Service ˜ The Library of Congress

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(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
sought to add $100 million to each program to fund the President’s International Mother
and Child HIV Prevention Initiative.
Table 1. U.S. International HIV/AIDS Programs
(Including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria)
($ millions)
FY2002
FY2003
FY2003
FY2003
FY2003 FY2004
Program
Projected
Request
House
Senate
Conf.h
Request
1. Child Survival Assistance for
395.0
600.0
496.5a
621.5f
591.5
650.0
bilateral programs
2. Child Survival Assistance for the
40.0
100.0
250.0
300.0f
250.0
100.0
Global Fund
3. Other economic assistance
40.0
40.0
40.0
50.0g
38.5
40.0
4. State Department Global AIDS
450.0
Initiative
5. Foreign Military Financing
0
2.0
2.0
2.0
2.0
1.5
6. Subtotal, Foreign Operations
475.0
742.0
788.5
973.5
882.0
1241.5
Appropriations
7. CDC Global AIDS Program
143.8
243.8
183.8b
168.8f
183.8
293.8
8. CDC International Applied
11.0
11.0
11c
11.0c
11.0
11.0
Prevention Research
9. NIH International Research
218.2
252.3
252.3c
252.3 c
252.3
274.7
10. DOD HIV/AIDS prevention
14.0
0
10.0d
0
7.0i
education with African armed forces
11. DOL AIDS in the Workplace
8.5
0
10.0g
10.0
Initiative
12. Section 416(b) Food Aid
25.0
0
25.0f
25.0
13. Global Fund contribution from
160.0
100.0
100.0e
100.0f
100.0
100.0
NIH (and other sources in FY2002)
14. Total
1055.5
1349.1
1345.6
1540.6
1471.1
1921.0
a. House amounts in the Foreign Operations Appropriations 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. With the exception of line 10, the data in this column are from the FY2003 Omnibus Appropriations
Legislation (H.J.Res. 2) and the accompanying report (H.Rept. 108-10).
i. P.L. 107-248, see text.

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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 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 FY2003 Omnibus Appropriations 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 Assistance
funding, $38.5 million in other economic assistance is allocated to international
HIV/AIDS programs in 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 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 2 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.
As indicated in line 5 of Table 1, the Administration requested $2 million in Foreign
Military Financing (FMF), also part of the Foreign Operations Appropriations, for
fighting HIV/AIDS in FY2003, and is seeking $1.5 million in FY2004. This funding is
to 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
Omnibus Appropriations measure, nor in the bill itself; but overall funding for FMF
appears sufficient to support the request.
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.

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Line 6 is a subtotal permitting a comparison of funding levels in the Foreign
Operations Appropriations under various bills and requests. The report accompanying the
conference version of the Omnibus Appropriations for FY2003 (H.Rept. 108-10)
calculates that not less than $800 million is provided to treat and prevent AIDS under the
Foreign Operations section of the measure. This estimate, somewhat lower than the
amount reported on line 6, takes into account the fact that a portion of the amount
appropriated for the Global Fund will be used to fight tuberculosis and malaria rather than
HIV/AIDS. The $800 million estimate also takes into account U.S. funds flowing to
HIV/AIDS programs through U.N. agencies, but not through the HIV/AIDS programs of
the World Bank Group.
In FY2002, $15 million of Child Survival funding for HIV/AIDS was earmarked for
microbicide research, while $18 million has been set aside for this purpose in FY2003.
The FY2002 appropriations specified that up to $10 million could be given as a
contribution to the International AIDS Vaccine Initiative (IAVI), while the FY2003
Omnibus would provide up to $10.5 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. Nor was the amount for UNAIDS specified in the FY2003 Omnibus,
although the report accompanying the House-reported version of the FY2003 Foreign
Operations appropriations (H.Rept. 107-663) urged a higher funding level for the
organization. The report on the Senate-passed version of the Omnibus Appropriations
expressed support for UNAIDS. (Congressional Record, January 15, 2003.) 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 Omnibus Appropriations
provided somewhat less than requested and did not earmark an amount for the Mother and
Child initiative. In their report, however, conferees agreed that, of the amount provided
to CDC for international HIV/AIDS, $40 million was for the initiative. The FY2004
request for the CDC would rise another $50 million over the FY2003 request, since the
request for the Mother and Child HIV Transmission Initiative through CDC is $150
million.
The CDC devoted $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, is to increase FY2003 and under the FY2004 request.
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

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requested for FY2003, but the conference version 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. 107-248) 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,
but the report on the Omnibus Appropriations states $10 million is included for the
initiative in the appropriation for the International Labor Affairs Bureau. No funds have
been 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. As line 12 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,2 but the
Omnibus restores this funding. Funding has not been requested for FY2004.
U.S. Contributions to the Global Fund
Table 2 provides detail on appropriations for contributions to the Global Fund to
Fight AIDS, Tuberculosis, and Malaria. To date, $650 million has been made available
for such contributions, as indicated in the unshaded columns of the table. Of this
amount, $100 million was appropriated under the FY2001 Supplemental Appropriations
Act (P.L. 107-20), $200 million was made available in FY2002 funds from various
sources, and another $350 million was appropriated in the FY2003 Omnibus
Appropriations.
Table 2. U.S. Contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria
($ millions)
FY2001 FY2002 FY2003 FY2003 FY2003 FY2003 FY2004
Actual
Actual
Request
House
Senate
Conf. Request
1. FY2001 Supplemental
100
2. Child Survival Assistance for
40
100
250
300
250
100
HIV/AIDS
3. Other infectious diseases
10
4. NIH
100
100
100a
100b
100
100
5. Remaining amount from USAID
25
6. Remaining amount from HHS
25
Total
100
200
200
350
400
350
200
a. H.R. 246.
b. Senate Amendment 1.
2 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.

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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 had requested $100 million through this account, whereas the Omnibus
eventually provided $250 million. For FY2004, the Administration has again requested
$100 million. 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 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
appropriation, $100 million is made available through NIAID. The Administration is
requesting $200 million for the Global Fund in FY2004, to be shared between the Child
Survival and NIAID accounts. 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.

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