Order Code RS21181
Updated December 30, 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
On December 8, 2004, President Bush signed into law (P.L. 108-447) the
conference version of the FY2005 Consolidated Appropriations (H.Rept. 108-792/H.R.
4818). The bill provides $2.9 billion for international AIDS, tuberculosis, and malaria
programs — somewhat more than the Administration’s request of $2.8 billion. The
Global Fund to Fight AIDS, Tuberculosis, and Malaria, would receive $435 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 ˜ The Library of Congress

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Table 1. Funding for U.S. International HIV/AIDS,
Tuberculosis, and Malaria Programs
($ millions)
FY2005
Program
FY2003
FY2004
Actual
Estimate
Request
Housee
Senatee
Finali
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
3. Child Survival Assistance for the
248.4
397.6
100.0
400.0
400.0
248.0
Global Fund
4. FY2004 Global Fund Carryover
-87.8b
87.8
5. Other bilateral assistance
38.2a
53.2c
40.0
53.5c
40.0
53.1c
6. State Department Global AIDS
488.1
1,450.0
1,260.0
1,450.0
1,373.9
Initiative (GAI)
7. Foreign Military Financing
2.0
1.5
2.0
f
2.0
2.0
8. Subtotal, Foreign Operations
1,005.2
1,521.0
2,197.0
2,198.5
2,417.0
2,280.6
Appropriations
9. CDC Global AIDS Program
182.6
291.9
142.8d
142.8
118.8
123.9
10. CDC International Applied
11.0
11.0
11.0d
11.0g
11.0g
11.0g
Prevention Research
11. CDC international TB and malaria
15.8
17.9
15.9
15.9g
15.9g
15.9g
12. NIH International Research
278.6
323.5
355.0
355.0g
355.0g
355.0g
13. Global Fund contribution from
99.3
149.1
100.0
100.0
149.1
99.2
NIH/HHS
14. DOL AIDS in the Workplace
9.9
9.9
0
0
10.0
2.0
Initiative
15. Subtotal, Labor/HHS
597.2
803.3
624.7
624.7
659.8
607.0
Appropriations
16. DOD HIV/AIDS prevention
7.0
4.2
0
10.0
0
7.5j
education, primarily in Africa
17. Section 416(b) Food Aid
24.8
24.8
0
0
25.0h
24.8
18. TOTAL
1,634.2
2,353.3
2,821.7
2,833.2
3,101.8
2,919.9
a This amount is for AIDS only.
b. See text.
c. Includes AIDS, TB, and malaria. Pre-rescission AIDS only amount is estimated at $36 million.
d. According to CDC, this request number reflects a change in budget structure that removed overhead and indirect
costs from the program. Moreover, mother and child prevention funds were shifted to the GAI. See text.
e. 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.
f. Not earmarked, although funds could have been provided at the Administration’s discretion.
g. Not earmarked, but overall appropriations appear sufficient to meet request.
h. S. 2803, Department of Agriculture Appropriations, reported (S.Rept. 108-340) September 14, 2004.
i. Except for line 16, these figures are from H.R. 4818/P.L. 108-447, 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 10, 11, and 12
were not specified.
j. 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 “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. In FY2004,
as shown in line 4, $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 fifth line in Table 1 indicates that, apart from Child Survival Assistance
funding, other bilateral 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 6 of Table 1, is the major
component of the President’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 — 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 7 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 16. Line 8 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 9 through 14 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, in part because funding for mother to child
transmission prevention programs has been shifted to the Global AIDS Initiative at the
Department of State (see below). Moreover, CDC adopted a new budget structure that
removed overhead and indirect costs from the request, which now solely reflects
spending on the program itself.
In addition to GAP, the CDC conducts international applied prevention research,
referred to in line 10, and supports efforts to counter malaria and tuberculosis
internationally. Meanwhile, as indicated in line 11, 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 13 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 14) in FY2004 or FY2005, but
some funding is provided in Consolidated Appropriations legislation. Funds have not
been requested for FY2005. Line 15 provides a subtotal for international HIV/AIDS
funding through the Labor/HHS Appropriations.
Other Appropriations. Line 16 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, 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 17).
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 Department’s February 23, 2004, report on the

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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.
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. 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. Moreover, as noted above, $87.8 million appropriated for the
Global Fund was not provided. The amount to be appropriated under the FY2005
Consolidated Appropriations is reported as $2.9 billion, including the $87.8 million
carried over from FY2004. According to the report on the FY2005 Consolidated
Appropriations (H.Rept. 108-792), the amount to be provided for fighting AIDS alone,
rather than the three diseases, is $1.96 million in the Foreign Operations portion of the
bill. This amount reflects an assumption that the Global Fund is providing about 56% of
its funds to fight HIV/AIDS. Using the same assumption, the AIDS-only amount in the
rest of the appropriations legislation is approximately $580 million, making the AIDS-
only total is $2.5 billion. Additional U.S. funds go toward fighting the AIDS pandemic
through contributions to the World Bank Group, which has its own HIV/AIDS programs.
Global Fund. Table 2 summarizes funding for contributions to the Global Fund
to Fight AIDS, Tuberculosis, and Malaria. Appropriations total approximately $1.1
billion through FY2004, taking into account the $87.8 million not provided in that year.
The amount available for the Fund through FY2005 would total $1.5 billion, including
funds in the FY2005 Consolidated Appropriations. For further information, see CRS
Report RL31712, The Global Fund to Fight AIDS, Tuberculosis, and Malaria:
Background and Current Issues.
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
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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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 $15 billion over five years but stated
that the program needed to “ramp up” first.
Table 2. Funding for U.S. Contributions to the Global Fund
($ millions)
FY2005
FY2001 FY2002 FY2003
FY2004
Actual
Actual
Actual
Estimate
Request
House
Senate
Final
1. Foreign Operations
100
50.0
248.4
397.6
100.0
400.0
400.0
248.0
2. Labor/HHS
125.0
99.3
149.1
100.0
100.0
149.1
99.2
3. FY2004 Carryover
-87.8
87.8
TOTAL
100
175
347.7
458.9
200.0
500.0
549.1
435.0
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 President’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 have added $200 million to the President’s
FY2005 international HIV/AIDS request, so that the total FY2005 authorization would
have been $3 billion.

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