Order Code RS21181
Updated January 28, 2004
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. The Consolidated Appropriations (P.L. 108-199), which was signed
into law on January 23, 2004, would provide approximately $2.2 billion, including
bilateral HIV/AIDS programs and contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria. The bill would provide a total of approximately $2.4 billion
for fighting HIV/AIDS and other infectious diseases, particularly tuberculosis and
malaria. Most international HIV/AIDS funding is included in the Foreign Operations
Appropriations and the appropriations for the Departments of Labor, Health and Human
Services, and Education. 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 AIDS, tuberculosis, and malaria. Of this amount, up to $1
billion was authorized for the Global Fund in FY2004. The Administration had
requested $200 million for the Global Fund, while H.R. 2673 would provide $550
million (pre-rescission). 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). Table 1 summarizes requests and appropriations for
international HIV/AIDS activities through these and other appropriations bills.
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
FY2004 FY2004 FY2004 FY2004
Program
Actual
Actual.a
Request
House
Senate
Approp.l
1. Child Survival Assistance for
395.0
587.6
650.0
840.8b
500.0e,f
513.4
bilateral programs
2. Foreign Operations Appropriation
50.0
248.4
100.0
400.0b
250.0e,g
397.6
for the Global Fund
3. Other economic assistance
40.0
38.5
40.0
30.0b
50.0e
36.0m
4. State Department Global AIDS
Initiative (not including any
450.0 See text
739.0e,h
488.1
earmarked Global Fund contributions)
5. Foreign Military Financing
0
2.0
1.5
0
2.0e
0
6. Subtotal, Foreign Operations
485.0
876.5
1241.5
1270.8
1541.0
1435.1
Appropriations
7. CDC Global AIDS Program
143.8
182.6
293.8
242.6c
292.6i
291.9
8. CDC International Applied
11.0
11.0
11.0
11.0c,d
11.0i,d
11.0d
Prevention Research
9. NIH International Research
218.2
252.3
274.7
274.7c,d
274.7i,d
274.7d
10. Global Fund contribution from
125.0
99.3
100.0
100.0c
150.0i
149.1
NIH/HHS
11. DOL AIDS in the Workplace
8.5
9.9
0
10.0j
9.9
Initiative
12. Subtotal, Labor/HHS
506.5
555.1
679.5
628.3
738.3
736.6
Appropriations
13. DOD HIV/AIDS prevention
14.0
7.0
0
0
0
education with African armed forces
14. Section 416(b) Food Aid
25.0
24.8
0
25.0k
24.8
15. TOTAL
1,030.5
1,463.4
1,921.0
1,899.1
2,304.3
2,196.5
a. The programs in this column were funded by the FY2003 Omnibus Appropriations Legislation (H.J.Res.
2), except for Line 13, which is in P.L. 107-248, the Department of Defense (DOD) Appropriations.
b. House-passed version of H.R. 2800, Foreign Operations Appropriations, FY2004.
c. House-passed version of H.R. 2660, Departments of Labor, Health and Human Services, and Education
Appropriations, FY2004.
d. This amount is not specified in the legislation, but overall program funding appears sufficient.
e. Senate-passed version H.R. 2800 and the report (S.Rept. 108-106) accompanying S. 1426.
f. The bill itself specifies $500 million in Child Survival aid for HIV/AIDS, but S.Rept. 108-106 counts
$105 million in AIDS-related malaria and tuberculosis funding to reach a $605 million AIDS total.
g. Additional funding provided by Sec. 699k (“DeWine Amendment”) could have increased this amount.
h. Includes $150 million earmarked for International Mother and Child HIV Prevention Initiative. $250
million earmarked for the Global Fund is shown separately.
i. Senate-passed version of H.R. 2660. Includes an additional $60 million for mother-to-child transmission
prevention provided in Sec. 237.
j. S.Rept. 108-81, Report to Accompany S. 1356, the original Senate bill.
k. Senate-passed version of H.R. 2673, Agriculture Appropriations.
l. Consolidated Appropriations Act, 2004 (P.L. 108-199), adjusted for the .59% rescission imposed in
Division H, Sec. 168. The DOD Appropriations, referred to in line 13, passed separately.
m. Includes the AIDS-related portion of $53.5 million earmarked for AIDS, tuberculosis, and malaria in
Eastern Europe and the Baltic States, as well as unearmarked assistance through other programs.

---

CRS-3
Where possible, amounts reported in Table 1 for FY2003 and for the FY2004
Consolidated Appropriations (P.L. 108-199) have been adjusted for the rescissions
imposed at the end of each measure on specified budget authorities. The rescission for
FY2003 was .65%, and the proposed rescission for FY2004 is .59%. It is not clear how
or whether the rescissions affect the numbers recorded in italics, since these are 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 60% of its funding goes to fight
HIV/AIDS, while 23% goes toward malaria and 17% toward tuberculosis. Otherwise,
Table 1 does not include spending for other infectious diseases, including tuberculosis and
malaria, through the Child Survival and Health Programs Fund. For FY2003, the pre-
rescission amount for other infectious diseases was $155.5 million in FY2003, while $185
million is proposed for FY2004 under the Consolidated Appropriations.
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, 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). Line 2 refers to U.S. contributions to
the Global Fund to Fight AIDS, Tuberculosis, and Malaria through the Foreign
Operations Appropriations. 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 — that is, funds that would not have been spent if
spending had continued at the FY2002 rate. The Global AIDS Initiative (GAI) will be a
Department of State program, primarily focused, according to Administration 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 major AIDS
authorization signed into law in May 2003 (H.R. 1298/P.L. 108-25) established a
Coordinator for the Initiative and made the Coordinator responsible for administering all
international AIDS funds, which are to be deposited in a separate account at the Treasury.
The Senate-passed version of the FY2004 Foreign Operations Appropriations (H.R. 2800)
did not specifically mention the GAI under “Child Survival” or “Activities to Combat
HIV/AIDS,” but report language (S.Rept. 108-106) indicated that apart from the Global
Fund contribution routed through the GAI, $450 million would go to the GAI itself. An
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. The FY2004 Consolidated Appropriations states that assistance should be
provided for not fewer than 15 countries, at least one of which shall not be in Africa or the
Caribbean.

---

CRS-4
additional $289 million was designated for the GAI through an amendment to H.R. 2800
by Senator DeWine, adopted on October 30, 2003. These funds could have been used for
additional contributions to the Global Fund (Sec. 699K). The House-passed version of
H.R. 2800 did not include a specific Global AIDS Initiative heading either, but provided
not more than $50 million for grants and contracts to be made by the Coordinator. The
FY2004 Consolidated Appropriations provides funding under a specific “Global
HIV/AIDS Initiative” heading.
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
available in FY2004 according to language in the Senate report (S.Rept. 108-106)
accompanying the Foreign Operations Appropriations. However, the program is not
mentioned in the House-reported Foreign Operations Appropriations, nor in the
Consolidated Appropriations. 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. The report on the FY2004 Consolidated Appropriations makes
a calculation accounting for this and estimates that there is $1.2835 billion strictly for
HIV/AIDS under Foreign Operations. (Congressional Record, November 25, 2003,
H12532). 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 the Consolidated Appropriations would set aside $22 million
in FY2004. The FY2003 Omnibus provides up to $10.5 million for the International
AIDS Vaccine Initiative (IAVI), while the Consolidated Appropriations would boost this
amount to not less than $26 million in FY2004. The U.S. contribution to the United
Nations Joint Program on HIV/AIDS (UNAIDS), which was $18 million in FY2003, has
been taken from the Child Survival HIV/AIDS appropriation, although the amount has
not been earmarked. The Consolidated Appropriations, however, earmarks $26 million
for UNAIDS in FY2004. The bill also earmarks $75 million for injection safety and
blood safety programs, and states that $15 million may be apportioned directly to the
Peace Corps for AIDS, tuberculosis, and malaria programs.
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). The
Administration did not request funding for the Global AIDS in the Workplace Initiative
of the Department of Labor (line 11) in FY2004, but the report on the FY2004

---

CRS-5
Consolidated Appropriations include $10 million (pre-rescission). 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
FY2003 Department of Defense Appropriations bill (P.L. 107-248) provided $7 million
to remain available until the end of FY2004. New funding has not been requested for
FY2004 and is not provided in the Defense Appropriations (P.L. 108-87). 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 was not requested for FY2004, but is included in the Department of Agriculture
portion of the Consolidated Appropriations.
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 the CDC (H.Rept. 108-10). The Consolidated
Appropriations for FY2004 fully funds the request by providing up to $150 million under
Foreign Operations and $150 million through the Centers for Disease Control.
Total Funding. Press and other accounts typically report that the FY2004
Consolidated Appropriations includes $2.4 billion for international HIV/AIDS programs.
However, this figure is actually the pre-rescission amount for fighting HIV/AIDS and
other infectious diseases, particularly tuberculosis and malaria. Some other calculations
attempt to reach a “pure” HIV/AIDS appropriations amount by counting only 60% of the
appropriation for the Global Fund, reflecting the proportion the Global Fund spends just
on HIV/AIDS. This approach would yield an HIV/AIDS appropriation of approximately
$2 billion. The FY2004 conference report total in line 15 of Table 1 is a post-rescission
amount including HIV/AIDS appropriations and the full appropriation for the Global
Fund — but not other funding for international malaria and tuberculosis programs.
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. Line 1 refers to the amounts to be
3 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.

---

CRS-6
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 $200 million request for the
Global Fund, whereas bills before Congress provide higher amounts.
Table 2. Appropriations for U.S. Contributions to the Global Fund
to Fight AIDS, Tuberculosis, and Malaria
($ millions)
FY2001 FY2002 FY2003 FY2004 FY2004 FY2004 FY2004
Actual
Actual
Actual
Request
House
Senate
Approp.
1. Foreign Operations
100
40 248.375
100
400
250a
397.6
2. Child Survival Assistance for
10
other infections diseases
3. Labor/HHS through NIH
100
99.350
100
100
150
149.1
4. Remaining amount from HHS
25
TOTAL
100
175 347.725
200
500
400
546.7
a. Additional funding provided by Sec. 699k (“DeWine Amendment”) could have increased this amount.
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, 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 (Congressional Record, p. H354). 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, and efforts to increase appropriations
for FY2004 international HIV/AIDS, tuberculosis, and malaria appropriations to $3
billion have not succeeded. As a result, many AIDS activists and others have argued that
what they see as a pledge made in H.R. 1298 is not being fulfilled. Others maintain that
additional resources cannot be provided in view of competing priorities or argue that
added funds could not be spent effectively in FY2004 since the Global AIDS Initiative,
the major vehicle for increased spending, is just getting underway. In a press conference
on July 30, 2003, President Bush reiterated that the Administration remained committed
to providing $15 billion over 5 years but stated that the program needed to “ramp up”
before it could absorb additional resources.

---