Order Code RS21181
Updated November 24, 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 conference version of the FY2005 Consolidated Appropriations (H.Rept. 108-
792/H.R. 4818) would provide $2.9 billion for international AIDS, tuberculosis, and
malaria programs â€” somewhat more than the Administrationâ€™s request of $2.8 billion.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria, would receive $434.9
million under the omnibus measure (compared with an Administration request of $200
million) after the .8% rescission imposed at the end of the bill is applied. This amount
includes $87.8 million that was appropriated for the Global Fund in FY2004 but not
provided due to provisions limiting the U.S. contribution to 33% of all contributions.
The legislation provides $1.37 billion for the bilateral Global AIDS Initiative,
headquartered at the Department of State, while the Administration had requested $1.45
billion. For additional information, see CRS Issue Brief IB10050, AIDS in Africa; 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, 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
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
[http://www.kff.org/hivaids/7110.cfm].
Congressional Research Service Ëœ The Library of Congress

CRS-2
Table 1. Appropriations for U.S. International HIV/AIDS,
Tuberculosis, and Malaria Programs
($ millions)
FY2005
Program
FY2003
FY2004
Actual
Estimate
Request
Housed
Senated
Conf.h
1. Child Survival Assistance for
587.6
513.4
500.0
330.0
350.0
347.2
HIV/AIDS (not including Global Fund)
2. Child Survival Assistance for
129.0
155.0
105.0
155.0
175.0
168.6
Tuberculosis and Malaria
248.0
397.6
3. Child Survival Assistance for the
(+87.8
248.4
(87.8 not
100.0
400.0
400.0
Global Fund
from
provided)b
FY2004)
4. Other economic assistance
38.5a
53.5c
40.0
53.5c
40.0
53.5c
5. State Department Global AIDS
488.1
1,450.0
1,260.0
1,450.0
1,373.9
Initiative
6. Foreign Military Financing
2.0
1.5
2.0
e
2.0
2.0
7. Subtotal, Foreign Operations
1,005.5
1,609.1
2,197.0
2,198.5
2,417.0
2,281.0
Appropriations
8. CDC Global AIDS Program
182.6
291.9
142.8
142.8
118.8
123.9
9. CDC International Applied
11.0
11.0
11.0
11.0f
11.0f
11.0f
Prevention Research
10. CDC international TB and malaria
15.8
17.9
15.9
15.9f
15.9f
15.9f
11. NIH International Research
278.6
323.5
355.0
355.0f
355.0f
355.0f
12. Global Fund contribution from
99.3
149.1
100.0
100.0
149.1
99.2
NIH/HHS
13. DOL AIDS in the Workplace
9.9
9.9
0
0
10.0
2.0
Initiative
14. Subtotal, Labor/HHS
597.2
803.3
624.7
624.7
659.8
607.0
Appropriations
15. DOD HIV/AIDS prevention
7.0
4.2
0
10.0
0
7.5i
education, primarily in Africa
16. Section 416(b) Food Aid
24.8
24.8
0
0
25.0g
24.8
17. TOTAL
1,634.5
2,441.4
2,821.7
2,833.2
3,101.8
2,920.3
a This amount is for AIDS only.
b. See text.
c. Includes AIDS, tuberculosis, and malaria. For FY2004 and 2005, the AIDS only amount is estimated at $36 million.
d. Foreign Operations data are from the original version of H.R. 4818, the Foreign Operations bill, which passed the
House, July 15, 2004; Senate version passed September 23. House Labor/HHS data are from H.R. 5006, which
passed the House, September 9, 2004. Senate Labor/HHS data are from S. 2810, reported (S.Rept. 108-345)
on September 15.
e. Not earmarked, although funds could have been provided at the Administrationâ€™s discretion.
f. Not earmarked, but overall appropriations appear sufficient to meet request.
g. S. 2803, Department of Agriculture Appropriations, reported (S.Rept. 108-340) September 14, 2004.
h. Except for line 15, these figures are from H.R. 4818, Consolidated Appropriations, FY2005, and the accompanying
conference report (H.Rept. 108-792). The .8% rescission in this bill (as amended by H.Con.Res. 528) has been
applied to program amounts specified in the legislation. The amounts in lines 4, 9, 10, and 11 were not
specified.
i. P.L. 108-287, Department of Defense Appropriations, not subject to the rescission.

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Amounts reported in Table 1 for FY2003, FY2004, and the FY2005 conference
version of the Consolidated Appropriations have been adjusted for the rescissions
imposed at the end of each measure on specified budget authorities.
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 Child Survival
appropriations for international tuberculosis and malaria programs, which are part of the
appropriation for â€œother infectious diseasesâ€ 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. In FY2004,
$87.8 million of the amount appropriated for the Global Fund was not provided due to
legislative provisions limiting the U.S. contribution to 33% of the amount contributed by
all donors.2 The FY2005 Consolidated Appropriations bill (H.R. 4818) directs that these
withheld funds be provided to the Global Fund in FY2005, subject, like the remainder of
the U.S. contribution, to the 33% proviso.

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,3 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 the Presidentâ€™s Emergency Plan for AIDS Relief (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 â€” that is, funds that
would not have been spent if spending had continued at the FY2002 level. The State
Departmentâ€™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. Line 7 provides a subtotal for HIV/AIDS,
tuberculosis, and malaria programs funded through the Foreign Operations
Appropriations.
2 These provisions are found in Sec. 202 of P.L. 108-25, the United States Leadership against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003, as amended by P.L. 108-199, the FY2004
Consolidated Appropriations.
3 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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The FY2005 Consolidated Appropriations bill sets aside $30 million in Child
Survival AIDS funding for the development of microbicides, up from $22 million in
FY2004. The omnibus measure would provide $27 million from AIDS-designated Child
Survival funds for the International AIDS Vaccine Initiative (IAVI), compared with $26
million in FY2004. The bill also specifies that $27 million should be contributed to the
United Nations Joint Program on HIV/AIDS (UNAIDS) from the Global AIDS Initiative,
while the amount specified for FY2004 was again $26 million.
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 dropped for 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 or FY2005, but some funding is provided in Consolidated Appropriations
legislation. 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 Departmentâ€™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, but was provided through appropriations. As
noted above, this program is using Foreign Military Financing funds for equipment
purchases.
Since FY2002, Congress has 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 (line 16).
In subsequent years, this assistance was not requested by the Administration, but Congress
has continued to make provision for it. The Administration did not include aid under this
provision in a table included in the State Departmentâ€™s February 23, 2004, report on the
Presidentâ€™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.
Mother and Child Transmission Initiative. The Presidentâ€™s International
Mother and Child HIV Prevention Initiative was announced on June 19, 2002. This
4 U.S. Department of State, The Presidentâ€™s Emergency Plan for AIDS Relief: U.S. Five-Year
Global HIV/AIDS Strategy, February 23, 2004.

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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. The Consolidated
Appropriations legislation currently before Congress does not specify particular amounts
for these programs.
Total Funding. Press and other accounts typically report that the FY2004
Consolidated Appropriations included $2.4 billion for international HIV/AIDS programs.
However, this figure is actually the pre-rescission amount for fighting HIV/AIDS,
tuberculosis, and malaria. The amount to be appropriated under the FY2005 Consolidated
Appropriations is reported as $2.9 billion, but some may argue that $2.8 billion is more
accurate since $87.8 million is a carryover from the FY2004 Global Fund appropriation.
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.
Global Fund. Table 2 summarizes appropriations for contributions to the
Global Fund to Fight AIDS, Tuberculosis, and Malaria. Appropriations total $1.17 billion
through FY2004. The amount available to the Fund through FY2005 would total $1.5
billion, including funds in the FY2005 Consolidated Appropriations and taking into
account the fact that $87.8 million was not provided in FY2004 due to the 33% proviso
(see above). For further information, see CRS Report RL31712, The Global Fund to
Fight AIDS, Tuberculosis, and Malaria: Background and Current Issues.
Table 2. Appropriations for U.S. Contributions to the Global Fund
($ millions)
FY2005
FY2001 FY2002 FY2003
FY2004
Actual
Actual
Actual
Estimate
Request
House
Senate
Conf.
1. Foreign Operations
100
50.0
248.4
397.6
100.0
400.0
400.0
248.0
(87.8 not
(+87.8
provided)
from
FY2004)
2. Labor/HHS
125.0
99.3
149.1
100.0
100.0
149.1
99.1
TOTAL
100
175
347.7
546.7
200.0
500.0
549.1
434.9

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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 â€œramp upâ€ 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 allowed nearly $500
million in additional spending beyond the Presidentâ€™s request of $2.8 billion. An
amendment by Senator DeWine, which was also accepted, permitted $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 might make it difficult for the Administration to meet its plans for international
HIV/AIDS spending. A conference agreement on the resolution was not reached.
The FY2005 Foreign Affairs Authorization Act (S. 2144), reported in the Senate on
March 8, 2004 (S.Rept. 108-248), would add $200 million to the Presidentâ€™s FY2005
international HIV/AIDS request, so that the total FY2005 authorization would be $3
billion.