Order Code RS21181
Updated September 20, 2004
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
Appropriations, FY2003-FY2005
Raymond W. Copson
Specialist in International Relations
Foreign Affairs, Defense, and Trade Division
Summary
The Administration’s FY2005 request for international HIV/AIDS, tuberculosis,
and malaria programs totals about $2.8 billion, as compared with $2.4 billion
appropriated for FY2004. The FY2005 request includes a large increase for the bilateral
Global AIDS Initiative, headquartered at the Department of State, while the request for
the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) is $200
million, compared with $546.7 million appropriated in FY2004. The Foreign
Operations Appropriations bill that passed the House on July 15, 2004, would provide
slightly more than the Administration’s request overall and includes $400 million as the
Foreign Operations component of the Global Fund contribution. The version of the
Labor/Health and Human Services Appropriation (H.R. 5006), passed by the House on
September 9, would provide the $100 million requested for the Global Fund in that bill
and meet the Administration’s request for other international disease programs. In the
Senate, S. 2812, as reported on September 16, provides $2.42 billion, $220 million
higher than the request. Combined with $660 million approved in the Senate-reported
Labor/HHS bill (S. 2810) and two other appropriation measures, Senate bills
recommend $3.1 billion in total HIV/AIDS, tuberculosis, and malaria funding for
FY2005. For additional information, see CRS Issue Brief IB10050, AIDS in Africa.
U.S. International HIV/AIDS Programs
Most funding for international HIV/AIDS, tuberculosis, and malaria 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
appropriations for such programs through these and other appropriations bills.1 Amounts
1 For earlier years, see CRS Report RS21114, HIV/AIDS: Appropriations for Worldwide
Programs in FY2001 and FY2002; and Kaiser Family Foundation, Policy Brief: U.S. Government
Funding for Global HIV/AIDS Through FY2005, prepared by Jennifer Kates and Todd Summers
(continued...)
Congressional Research Service ˜ The Library of Congress

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reported in Table 1 for FY2003 (H.J.Res. 2) 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. These rescissions applied to all program
amounts specified in the legislation. 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.
Table 1. Appropriations for U.S. International HIV/AIDS,
Tuberculosis, and Malaria Programs
($ millions)
FY2003
FY2004
FY2005
Program
Actual
Estimate
Request
Housec
Senatec
Final
1. Child Survival Assistance for
587.6
513.4
500.0
330.0
350.0
HIV/AIDS (not including Global Fund)
2. Child Survival Assistance for
129.0
155.0
105.0
155.0
175.0
Tuberculosis and Malaria
3. Child Survival Assistance for the
248.4
397.6
100.0
400.0
400.0
Global Fund
4. Other economic assistance
38.5a
53.5b
40.0
53.5b
40.0
5. State Department Global AIDS
488.1
1,450.0
1,260.0
1450.0
Initiative
6. Foreign Military Financing
2.0
1.5
2.0
?
2.0
7. Subtotal, Foreign Operations
1,005.5
1,609.1
2,197.0
2,198.5
2417.0
Appropriations
8. CDC Global AIDS Program
182.6
291.9
142.8
142.8
118.8
9. CDC International Applied
11.0
11.0
11.0
11.0
11.0d
Prevention Research
10. CDC international TB and malaria
15.0
15.0
15.0
15.0
15.0d
11. NIH International Research
278.6
323.5
355.0
355.0
355.0d
12. Global Fund contribution from
99.3
149.1
100.0
100.0
149.1
NIH/HHS
13. DOL AIDS in the Workplace
9.9
9.9
0
0
10.0
Initiative
14. Subtotal, Labor/HHS
596.8
800.4
623.8
623.8
660.0
Appropriations
15. DOD HIV/AIDS prevention
7.0
4.2
0
10.0
0
7.5e
education, primarily in Africa
16. Section 416(b) Food Aid
24.8
24.8
0
0
25.0
17. TOTAL
1,634.1
2,438.5
2,820.8
2832.3
3102.0
a. This amount is for AIDS only.
b. Includes AIDS, tuberculosis, and malaria. For FY2004 and 2005, the AIDS only amount is $36 million.
1 (...continued)
[http://www.kff.org/hivaids/7110.cfm].

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c. House Foreign Operations data are from H.R. 4818, which passed the House, July 15, 2004. House Labor/HHS data
are from H.R. 5006, which passed the House, September 9, 2004. Senate Foreign Operations data are from S. 2812,
which was reported on Sept. 16. Senate Labor/HHS data are from S. 2810, reported on Sept. 15.
d. Estimates based on total amounts provided in the Senate Labor/HHS appropriation.
e. P.L. 108-287, Department of Defense 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). The House version of the FY2005
Foreign Operations Appropriations (H.R. 4818) would move $170 million in funding for
USAID programs in the 15 focus countries of the President’s Emergency Plan for AIDS
Relief (PEPFAR, see below) to the Global AIDS Initiative at the State Department.
According to the report accompanying the bill (H.Rept. 108-599), this shift should not
affect implementation of the programs. Line 2 refers to Child Survival appropriations for
international tuberculosis and malaria programs, which are part of the appropriation for
“other infectious diseases” in the appropriations legislation. Line 3 encompasses U.S.
contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria through the
Foreign Operations Appropriations. The fourth line in Table 1 indicates that, apart from
Child Survival Assistance funding, other economic assistance is used to combat AIDS,
tuberculosis, and malaria. This assistance includes food aid,2 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 (GAI), referred to in Line 5 of Table 1, is the major
component of PEPFAR, announced by President Bush in his State of the Union message
on January 28, 2003. This five-year plan totals $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 level. The State Department’s GAI is primarily focused on 12 African
countries as well as Haiti, Guyana, and Vietnam. The United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (H.R. 1298/P.L.108-25) established
the office of Coordinator for the Initiative and made the Coordinator responsible for
administering all international AIDS funds.
Line 6 of Table 1 refers to Foreign Military Financing (FMF) for equipment
purchases to support a Military Health Affairs program under the Department of Defense
(DOD) offering HIV/AIDS prevention education, primarily to African armed forces. The
program itself is referred to in line 15. The FY2005 Foreign Operations Appropriations
reported in the House does not specifically mention the FMF program, although it could
be supported by general FMF funds. Line 7 provides a subtotal for HIV/AIDS and Other
Infectious Diseases programs funded through the Foreign Operations Appropriations.
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
2 Such aid is in addition to the Section 416(b) food aid listed in Table 1. For a description of
food aid programs, see CRS Issue Brief IB98006, Agricultural Export and Food Aid Programs.

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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 appropriation 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 8 through 13 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
administers the Global AIDS Program (GAP), which promotes prevention, care, and
capacity building in AIDS-stricken countries. The request for GAP has dropped in
FY2005, as compared to the FY2004 appropriation, because funding for mother to child
transmission prevention programs has been shifted to the Global AIDS Initiative at the
Department of State (see below). In addition to GAP, the CDC conducts international
applied prevention research, referred to in line 9, and supports efforts to counter malaria
and tuberculosis internationally. Meanwhile, as indicated in line 10, the National
Institutes of Health (NIH) also conducts research with an international dimension,
focusing primarily on the development of a vaccine for international markets.
Appropriations for the CDC and NIH research programs are not specifically earmarked
in legislation. Line 12 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 13) in
FY2004, but the report on the FY2004 Consolidated Appropriations included $10 million
(pre-rescission). Funds have not been requested for FY2005. Line 14 provides a subtotal
for international HIV/AIDS funding through the Labor/HHS Appropriations.
Other Appropriations. Line 15 in Table 1 refers to the Defense Department’s
AIDS prevention education program, primarily with African militaries. As in previous
years, new funding for the education program itself was not requested in the Department
of Defense Appropriations for FY2005. As noted above, this program is using Foreign
Military Financing funds for equipment purchases.
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. In subsequent
years, this assistance was not requested by the Administration but was provided through
legislation. Section 416(b) food aid has again not been requested for FY2005.3 The
Administration did not include aid through this provision in a table included in the State
Department’s February 23, 2004, report on the President’s Emergency Plan for AIDS
relief.4 Hence, the FY2003 and FY2004 totals in that table are approximately $25 million
less than those in Table 1.
3 Budget of the United States Government, Fiscal Year 2003. Appendix, 197.
4 U.S. Department of State, The President’s Emergency Plan for AIDS Relief: U.S. Five-Year
Global HIV/AIDS Strategy, February 23, 2004.

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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, was 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 FY2003 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 funded the request by providing up to $150 million
under Foreign Operations and $150 million through the Centers for Disease Control and
Prevention. Under the FY2005 request, mother and child transmission programs begun
under the initiative will continue, but responsibility for these programs is being moved
to the Global AIDS Initiative office at the Department of State.
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,
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 $1.9 billion. For FY2005, a
total of $2.8 billion has been requested for HIV/AIDS, tuberculosis, and malaria, while
HIV/AIDS funding alone would total about $2.6 billion. Additional U.S. funds go toward
fighting the AIDS pandemic through U.S. contributions to the World Bank Group, which
has its own HIV/AIDS programs. As noted above, executive branch reporting on AIDS
spending is not including assistance available through the Department of Agriculture
appropriations. Hence, executive branch spending totals are about $25 million less than
those reported in Table 1.
Table 2 provides detail on appropriations for contributions to the Global Fund to
Fight AIDS, Tuberculosis, and Malaria. Appropriations total $1.17 billion through
FY2004. Whether the full amount appropriated for FY2004 can be contributed to the
Global Fund is uncertain due to a requirement that the United States contribute no more
than one-third of the amount paid in by others. For further information, see CRS Report
RL31712, The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Background and
Current Issues.
Table 2. Appropriations for U.S. Contributions to the Global Fund
($ millions)
FY2005
FY2001
FY2002
FY2003
FY2004
Actual
Actual
Actual
Estimate
Request
House
Senate
1. Foreign Operations
100
50.0
248.4
397.6
100.0
400.0a
400.0c
2. Labor/HHS
125.0
99.3
149.1
100.0
100.0b
149.1d
TOTAL
100
175
347.7
546.7
200.0
500.0
549.1
a. H.R. 4818, passed the House, July 15, 2004.
b. H.R. 5006, passed the House, September 9, 2004.
c. S. 2812, reported by the Senate Appropriations Committee, September 16, 2004.
d. S. 2810, reported by the Senate Appropriations Committee, September 15, 2004.

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Other Legislation
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
legislation 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. 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 did not
succeed. 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 until absorptive capacity in the recipient countries is
expanded. In a press conference on July 30, 2003, President Bush reiterated that the
Administration remained committed to providing $15 billion over five years but stated
that the program needed to “ramp up” first.
On March 12, 2004, the Senate, in acting on its version of the FY2005 budget
resolution (S.Con.Res. 95), passed amendments to allow more spending in the
International Affairs account than requested by the Administration. According to
observers, an amendment by Senators Lugar, Feinstein, and Durbin would allow nearly
$500 million in additional spending beyond the President’s request of $2.8 billion. An
amendment by Senator DeWine, which was also accepted, would permit $330 million in
additional spending under the Child Survival account. On March 25, the House passed
its own version of the budget resolution (H.Con.Res. 393), reducing overall spending for
international affairs by $4 billion from the requested amount. Analysts observed that this
reduction could make it difficult for the Administration to meet its plans for international
HIV/AIDS spending. A conference agreement on the resolution has not yet been reached.
The FY2005 Foreign Affairs Authorization Act (S. 2144) reported in the Senate
(S.Rept. 108-248) would add $200 million to the President’s FY2005 international
HIV/AIDS request, so that the total FY2005 authorization would be $3 billion.

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