Order Code RS21181
Updated July 18, 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 programs totaled
about $1.9 billion. Bills currently before the House would appropriate approximately
this amount, while bills before the Senate would appropriate just over $2 billion, if
approved. Most international HIV/AIDS funding is included in the Foreign Operations
Appropriations (S. 1426, House bill number not yet available) and the appropriations
for the Departments of Labor, Health and Human Services, and Education (S. 1426 and
H.R. 2660). 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. The Administration has requested $200 million for the Global Fund,
while House appropriations bills would provide $500 million and Senate bills $400
million. 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 (Labor/HHS).
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

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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 FY2004 FY2004
Program
Actual
Request
Actual.a
Request
House
Senate
1. Child Survival Assistance for
395.0
600.0
587.6
650.0
840.8c
605.0f
bilateral programs
2. Foreign Operations Appropriation
50.0
100.0
248.4
100.0
400.0c
250.0f
for the Global Fund
3. Other economic assistance
40.0
40.0
38.5
40.0
30.0c
50.0f
4. State Department Global AIDS
450.0
See text
450.0f
Initiative
5. Foreign Military Financing
0
2.0
2.0
1.5
?
2f
6. Subtotal, Foreign Operations
485.0
742.0
876.5
1241.5
1270.8
1357.0
Appropriations
7. CDC Global AIDS Program
143.8
243.8
182.6
293.8
242.6d
232.6g
8. CDC International Applied
11.0
11.0
11.0
11.0
11.0d,e
11.0g,e
Prevention Research
9. NIH International Research
218.2
252.3
252.3
274.7
274.7d,e
274.7g,e
10. Global Fund contribution from
125.0
100.0
99.3
100.0
100.0d
150.0g
NIH/HHS
11. DOL AIDS in the Workplace
8.5
0
9.9
0
10.0h
Initiative
12. Subtotal, Labor/HHS
506.5
607.1
555.1
679.5
628.3
678.3
Appropriations
13. DOD HIV/AIDS prevention
14.0
0
7.0b
0
0
education with African armed forces
14. Section 416(b) Food Aid
25.0
0
24.8
0
25.0i
15. TOTAL
1030.5
1349.1
1463.4
1921.0
1899.1
2060.3
a. With the exception of line 12, 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.
c. House Appropriations Committee markup version of the FY2004 Foreign Operations Appropriations.
d. H.R. 2660, Departments of Labor, Health and Human Services, and Education Appropriations, FY2004,
passed the House, July 10, 2003.
e. This amount is not specified in the legislation, but overall funding appears adequate to allow the request
to be met.
f. S. 1426, Foreign Operations, Export Financing, and Related Programs Appropriations Act, 2004,
reported in the Senate, July 17, 2004; and the accompanying report, S.Rept. 108-106.
g. S. 1356, Departments of Labor, Health and Human Services, and Education Appropriations Act, 2004,
reported in the Senate, June 26, 2003.
h. S.Rept. 108-81, Report to Accompany S. 1356.
i. S. 1427, Agriculture Appropriations, reported in the Senate, July 17, 2003.
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

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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.
HIV/AIDS in the Foreign Operations Appropriations. 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 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). The Foreign Operations bill reported in the Senate
(S. 1426) specifies that $500 million in Child Survival funds should be devoted to
HIV/AIDS, but the accompanying report (S.Rept. 108-106) counts an additional $105
million toward HIV/AIDS from malaria and tuberculosis programs related to combating
HIV/AIDS. Line 2 refers to U.S. contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria through the Foreign Operations Appropriations.
These
amounts have come from the Child Survival account, but S. 1426 would provide the
funds under a new heading, “Global AIDS Initiative.” (See below.) The third line in
Table 1 indicates that, apart from Child Survival Assistance funding, other economic
assistance is used to combat the AIDS epidemic. This 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, primarily focused, according to current plans, on 12 African countries as
well as Haiti and Guyana.2 Appropriations for the Initiative are slated to increase sharply
in future years under the Administration plan.
The FY2004 Foreign Operations
Appropriations reported in the House does not include a separate appropriation for the
Initiative, but places all funds in lines 1, 2, and 3 under the control of the Coordinator of
United States Government Activities to Combat HIV/AIDS Globally. This position, to
be at the State Department, was part of the President’s initiative and was formally
established by the major AIDS authorization signed into law on May 27, 2003 (H.R.
1298/P.L. 108-25). S. 1426 appropriates the Global Fund contribution and an additional
$450 million for the Global AIDS Initiative, giving the Initiative a total of $700 million.
Line 5 of Table 1 refers to Foreign Military Financing (FMF) to support a Military
Health Affairs program to complement the Department of Defense (DOD) program
offering HIV/AIDS prevention education to African armed forces. This amount would be
made available in FY2004 through language in the report accompanying S. 1426 (S.Rept.
108-106). However, the program is not mentioned in the House-reported Foreign
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 RL32001, AIDS in the Caribbean
and Central America.

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Operations Appropriations, nor in the accompanying report. It is possible that the
program could go forward with funds from the general FMF appropriation, although this
appropriation is less than the Administration requested under the House bill.
Line 6 is a subtotal permitting a comparison of funding levels in the Foreign
Operations Appropriations, although again it should be noted that part of the
appropriation for the Global Fund is used to fight tuberculosis and malaria rather than
HIV/AIDS.
On the other hand, additional U.S. funds go toward fighting the AIDS
epidemic through U.S. contributions to the World Bank Group, which has its own
HIV/AIDS programs.
In FY2003, $18 million of Child Survival funding for HIV/AIDS was earmarked for
microbicide research, and S. 1426 would set aside $22 million in FY2004. The FY2003
Omnibus would provide up to $10.5 million for the International AIDS Vaccine Initiative
(IAVI). S. 1426 would boost this amount to $18 million, while the House bill would
provide $15 million. The U.S. contribution to the United Nations Joint Program on
HIV/AIDS (UNAIDS), which was $18 million in FY2002, has also been taken from the
Child Survival HIV/AIDS appropriation, although the amount has not been specified in
legislation. The House-reported version of the FY2003 Foreign Operations
Appropriations (H.Rept. 107-663) urged a higher funding level for the organization, and
the report accompanying S. 1426 expresses support for UNAIDS.
Labor/HHS Appropriations. Lines 7 through 11 in Table 1 refer to international
AIDS programs funded through the Labor/HHS Appropriations. The Centers for Disease
Control and Prevention (CDC) at the Department of Health and Human Services receive
appropriations for the Global AIDS Program (GAP), which promotes prevention, care,
and capacity building in AIDS-stricken countries. In addition to GAP, CDC supports the
Mother and Child HIV Prevention Initiative (see below), included with the GAP program
in line 7, and international applied prevention research, referred to in line 8. Meanwhile,
as indicated in line 9, the National Institutes of Health (NIH) also conducts research with
an international dimension, focusing primarily on the development of a vaccine for
international markets. Spending for this research, which like the CDC research is not
earmarked, would increase under the FY2004 request. Line 10 refers to contributions to
the Global Fund channeled through the National Institutes of Health (see Table 2.)
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 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 that $10 million
(before accounting for the rescission) is included for the initiative in the appropriation for
the International Labor Affairs Bureau. No funds have been requested for FY2004, but
the program would be funded under the Senate-reported version of the Labor/HHS
Appropriations (S.Rept. 108-81, to accompany S. 1356). Line 12 provides a subtotal for
international HIV/AIDS funding through the Labor/HHS Appropriations.
Other Appropriations. Line 13 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

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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 and is not provided by either of the Defense
appropriations bills currently before Congress (H.R. 2658 and S. 1382).
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 14 of
Table 1 indicates, Section 416(b) food aid was not requested for FY2003,3 but was
restored by the Omnibus. Funding has not been requested for FY2004, but is included in
the Senate version of the Department of Agriculture Appropriations (S. 1427).
Mother and Child Transmission Initiative. The President’s International
Mother and Child HIV Prevention Initiative was announced on June 19, 2002. This
initiative, under Administration plans, is to total $500 million, with $200 million
requested in FY2003 and $300 million requested in FY2004, to be provided in equal
amounts from the Foreign Operations Appropriations and the Labor/HHS appropriations
for CDC international AIDS programs. The Omnibus Appropriations provided the $100
million requested through Foreign Operations in FY2003, but $40 million rather than
$100 million was provided through CDC (H.Rept. 108-10). S. 1356, the Labor/HHS
Appropriations reported in the Senate, provides up to $90 million through CDC for the
initiative in FY2004, as compared with the $150 million requested; while the House-
passed Labor/HHS Appropriations would provide $100 million. S. 1426 would fully fund
the requested Foreign Operations component of the initiative at $150 million. The House
Foreign Operations Appropriations bill does not specify an amount, but report language
expresses support for the program as part of a comprehensive approach to the epidemic.
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, $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
account, whereas the Omnibus eventually provided $248 million. For FY2004, the
Administration has again requested $100 million through this legislation as part of a $200
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.

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million request for the Global Fund, whereas bills before Congress provide higher
amounts.
Table 2. Appropriations for U.S. Contributions to the Global Fund
to Fight AIDS, Tuberculosis, and Malaria
($ millions)
FY2001 FY2002 FY2003 FY2003 FY2004 FY2004 FY2004
Actual
Actual
Request
Actual
Request
House
Senate
1. Foreign Operations
100
40
100 248.375
100
400
250
2. Child Survival Assistance for
10
other infections diseases
3. Labor/HHS through NIH
100
100
99.350
100
100
150
4. Remaining amount from USAID
5. Remaining amount from HHS
25
TOTAL
100
175
200 347.725
200
500
400
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. On July
16, 2003, during full committee markup of the House Foreign Operations Appropriations,
an amendment by Representative Lowey to add $1 billion for international AIDS
programs was not approved.
On July 10, 2003, the Senate approved an amendment (S.Amdt. 1174) to the State
Department authorization (S. 925) by Senator Jeff Bingaman stating the sense of
Congress that international AIDS programs should be funded at $3 billion in FY2004.
5 Congressional Record, May 1, 2003, p. H3584.

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