Order Code RS21181
Updated June 30, 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 FY2004 component of the President’s 5-year,
$15 billion 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
$348 million for the Global Fund in FY2003. On May 27, 2003, the President signed
into law H.R. 1298 (P.L. 108-25), the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003, authorizing $3 billion per year for FY2004
through FY2008 (a total of $15 billion) to fight the three diseases. Of this amount, up
to $1 billion is authorized for the Global Fund in FY2004. 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 for 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/P.L. 108-7), 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.
Congressional Research Service ˜ The Library of Congress

---

CRS-2
Table 1. U.S. International HIV/AIDS Programs
(Including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria)
($ millions)
FY2002
FY2003
FY2003
FY2004
Program
Actual
Request
Actual.a
Request
1. Child Survival Assistance for bilateral
395.0
600.0
587.6
650.0
programs
2. Child Survival Assistance for the Global
50.0
100.0
248.4
100.0
Fund
3. Other economic assistance
40.0
40.0
38.5
40.0
4. State Department Global AIDS Initiative
450.0
5. Foreign Military Financing
0
2.0
2.0
1.5
6. Subtotal, Foreign Operations
485.0
742.0
876.5
1241.5
Appropriations
7. CDC Global AIDS Program
143.8
243.8
182.6
293.8
8. CDC International Applied
11.0
11.0
11.0
11.0
Prevention Research
9. NIH International Research
218.2
252.3
252.3
274.7
10. DOD HIV/AIDS prevention
14.0
0
7.0b
education with African armed forces
11. DOL AIDS in the Workplace Initiative
8.5
0
9.9
12. Section 416(b) Food Aid
25.0
0
24.8
13. Global Fund contribution from NIH/HHS
125.0
100.0
99.3
100.0
14. Total
1030.5
1349.1
1463.4
1921.0
a. With the exception of line 10, the programs in this column were funded by the FY2003 Omnibus
Appropriations Legislation (H.J.Res. 2/H.Rept. 108-10).
b. P.L. 107-248, Department of Defense Appropriations for FY2003.
Table 1 summarizes requests and appropriations for international HIV/AIDS
activities in FY2003 and FY2004 and compares them with spending in FY2002. Where
possible, amounts reported for FY2003 have been adjusted for the .65% rescission
imposed by Title VI of Division N of the appropriations resolution report (H.Rept. 108-
10). However, it is not yet clear how or whether the rescission will affect the numbers
recorded in italics, since these were not specified in the appropriations legislation but are
part of larger programs. The figures in Table 1 include U.S. contributions to the Global
Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). The Fund reports that
approximately 65% of the funds to be disbursed will go to projects 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 (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, announced on June 19, 2002.
This initiative is to total $500 million, with $300 million requested in FY2004.

---

CRS-3
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. In accordance with the
President’s request, 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. The FY2004 request in line 1 is $50 million higher than the
FY2003 request in order to provide $150 million for the Mother and Child initiative in
the Foreign Operations appropriations.
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 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 will be a Department of
State program focused, according to current plans, on 12 African countries as well as
Haiti and Guyana.2 Objectives include prevention of 7 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 (H.Rept. 108-10), 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. 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
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 Some favor including additional countries. See CRS Report RS21166, AIDS in the Caribbean
and Central America.

---

CRS-4
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,
like the estimate in Table 1, 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, 2002, budget amendment with respect to
the International Mother and Child Prevention Initiative. The Omnibus Appropriations
provided somewhat less than requested and did not earmark an amount for the Mother and
Child initiative. In their report (H.Rept. 108-10), 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
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 Global AIDS in the
Workplace Initiative of the Department of Labor (line 11) in FY2002, but the executive

---

CRS-5
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, an amount that was reduced by the rescission. 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, $25
million be used to mitigate the effects of AIDS on communities overseas. As line 12 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,3 but the
Omnibus restores this funding. Funding has not been requested for FY2004.
U.S. Contributions to the Global Fund
Table 2. Appropriations for U.S. Contributions to the Global Fund
to Fight AIDS, Tuberculosis, and Malaria
($ millions)
FY2001
FY2002
FY2003
FY2003
FY2004
Actual
Actual
Request
Actual
Request
1. Child Survival Assistance for HIV/AIDS
100
40
100
248.375
100
2. Other infectious diseases
10
3. NIH
100
100
99.350
100
4. Remaining amount from USAID
5. Remaining amount from HHS
25
Total
100
175
200
347.725
200
a. H.R. 246.
b. S.Amdt. 1.
Table 2 provides detail on appropriations for contributions to the Global Fund to
Fight AIDS, Tuberculosis, and Malaria. To date, $623 million has been made available
for such contributions. Of this amount, $100 million was appropriated under the FY2001
Supplemental Appropriations Act (P.L. 107-20), $175 million was made available in
FY2002 funds from various sources, and another $348 million (rescission-adjusted) was
appropriated in the FY2003 Omnibus Appropriations.
Previously, the FY2002
contribution had been stated to be $200 million, but $25 million that was to come from
USAID was governed by “up to” language in the appropriations bill. Appropriators
ultimately decided that this amount should be devoted to other priorities.4 Line 1 refers
to the amounts to be directed to the Global Fund through Child Survival assistance. For
FY2003, line 1 shows that the Administration had requested $100 million through this
3 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.
4
For more information, see CRS Report RL31712, The Global Fund to Fight AIDS,
Tuberculosis, and Malaria: Background and Current Issues.

---

CRS-6
account, whereas the Omnibus eventually provided $248 million. For FY2004, the
Administration has again requested $100 million. Line 2 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 3 of Table 2. Under the FY2003
appropriation, $99 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.
Other Legislation
H.R. 1298, the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003, was signed into law (P.L. 108-25) by President Bush on May 27,
2003. This bill authorizes $3 billion per year from FY2004 through FY2008 (a total of
$15 billion) for international AIDS, tuberculosis, and malaria programs; and includes
provisions with respect to AIDS policy coordination, debt forgiveness, and other issues.
The bill states that of the amounts authorized, up to $1 billion is authorized as a
contribution to the Global Fund in FY2004, and such sums as may be necessary for the
Fund in FY2005-2008. (For more detail on the contents of H.R. 1298 and other bills, see
CRS Issue Brief IB10050, AIDS in Africa.) However, during floor debate in the House
on May 1, members of the House Appropriations Subcommittee on Foreign Operations
expressed concern that the amounts authorized for FY2004 exceeded the amounts that had
been budgeted. Chairman Jim Kolbe said the bill created “false expectations” with
respect to the Global Fund, and Ranking Member Nita Lowey warned of a $1.3 billion
“funding gap” that would be difficult to fill.5 In an April 29, 2003, Rose Garden address
praising the bill, President Bush reiterated that the Emergency Plan for AIDS Relief
would begin with $2 billion in FY2004 spending, reflecting the budget request.
5 Congressional Record, May 1, 2003, p. H3584.

---