Order Code RS21181
Updated February 23, 2005
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
Appropriations, FY2003-FY2006
Raymond W. Copson
Specialist in International Relations
Foreign Affairs, Defense, and Trade Division
Summary
On February 7, 2005, the Bush Administration requested $3.16 billion for
international HIV/aids, tuberculosis, and malaria programs in FY2006, a 9% increase
over the estimated amount to be provided in FY2005. The request included $2.564
billion to be appropriated through the Foreign Operations appropriations and $596
million through appropriations for the Departments of Labor and Health and Human
Services. The contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria
would be $300 million. 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 provided $2.9 billion for international AIDS, tuberculosis,
and malaria programs — somewhat more than the Administration’s request of $2.8
billion — including $435 million for the Global Fund. 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)
FY2003
FY2004
FY2005
FY2006
Program
Actual
Actual
Estimate
Request
1. Child Survival Assistance for HIV/AIDS (not
including Global Fund)
587.6
513.4
347.2
330.0
2. Child Survival Assistance for Tuberculosis and
129.0
155.0
168.6
109.0
Malaria
3. Child Survival Assistance for the Global Fund
248.4
397.6
248.0
100.0
4. FY2004 Global Fund Carryover
-87.8b
87.8
5. Other bilateral assistance
38.2a
51.7c
51.1c
53.0c
6. State Department Global HIV/AIDS Initiative (GHAI)
488.1
1,373.9
1,870.0
7. GHAI for the Global Fund
100.0
8. Foreign Military Financing
2.0
1.5
2.0
2.0
9. Subtotal, Foreign Operations Appropriations
1,005.2
1,519.5
2,278.6
2,564.0
10. CDC Global AIDS Program
182.6
273.9
123.8d
123.9
11. CDC Overseas Applied
11.0
11.0
11.0
11.0
Prevention Research
12. CDC international TB and malaria
15.8
17.9
15.9
11.0
13. NIH International Research
278.6
317.2
332.3
350.0
14. Global Fund contribution from NIH/HHS
99.3
149.1
99.2
100.0
15. DOL AIDS in the Workplace Initiative
9.9
9.9
2.0
16. Subtotal, Labor/HHS Appropriations
597.2
779.0
584.2
595.9
17. DOD HIV/AIDS prevention
7.0
4.2
7.5
education, primarily in Africa
18. Section 416(b) Food Aid
24.8
24.8
24.8
19. TOTAL
1,634.2
2,327.5
2,895.1
3,159.9
a This amount is for AIDS only.
b. See text.
c. Includes AIDS, TB, and malaria. The AIDS only amount is estimated at $39 million for FY2004 and
FY2005, and at $31 million in the FY2006 request.
d. According to CDC, this apparent decrease compared to the previous year 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 Global HIV/AIDS Initiative. The change in budget structure also
affects the FY2006 request. See text.
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.

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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. Under the
Administration’s FY2006 request, $170 million that would formerly have been requested
under Child Survival for programs in the 15 focus countries of the President’s Emergency
Plan for AIDS Relief (PEPFAR, see below) has been shifted to the State Department’s
Global HIV/AIDS Initiative (GHAI). Thus, all U.S. AIDS funding in the focus countries
is under the direction of the Department of State, under the request, except for a small
amount still coming through HHS programs. Congressional appropriators first made this
shift in dealing with the FY2005 appropriations in order “to simplify budget processes
and improve transparency.” (H.Rept. 108-599; see also the conference report, H.Rept.
108-792.)
Line 3 encompasses U.S. contributions to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria through the Child Survival Account. 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 legislation 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 State Department’s Global HIV/AIDS Initiative (GHAI), 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 GHAI 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. For the first time in FY2006, under the Administration’s
request, a portion of the U.S. contribution to the Global Fund is to come from GHAI, as
shown in line 7.
Line 8 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
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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program itself is referred to in line 17. Line 9 provides a subtotal for HIV/AIDS,
tuberculosis, and malaria programs funded through the Foreign Operations
Appropriations.
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 measure also provides $27 million from AIDS-designated Child Survival
funds for the International AIDS Vaccine Initiative (IAVI), compared with $26 million
in FY2004. The bill specifies that $27 million should be contributed to the United
Nations Joint Program on HIV/AIDS (UNAIDS) from the GHAI, while the amount
specified for FY2004 was again $26 million.
Labor/HHS Appropriations. Lines 10 through 16 in Table 1 refer to
international AIDS programs funded through the Labor/HHS Appropriations. The
Centers for Disease Control and Prevention (CDC) at HHS administers the Global AIDS
Program (GAP), which promotes prevention, care, and capacity building in AIDS-stricken
countries. Funding for GAP dropped for FY2005, as compared to FY2004, in part
because CDC adopted a new budget structure that removed overhead and indirect costs
from the request, which now solely reflects spending on the program itself. Moreover,
funding for mother to child transmission prevention programs has been shifted to the
Global HIV/AIDS Initiative at the Department of State (see below).
In addition to GAP, the CDC conducts AIDS prevention research overseas, referred
to in line 11, which is counted as part of the U.S. response to the international pandemic.
Line 12 refers to CDC research on international tuberculosis and malaria. According to
CDC, the apparent decrease in this program under the FY2006 request reflects the change
in the HHS budget structure noted above. Meanwhile, as indicated in line 13, 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 14 refers to contributions to the Global Fund channeled through the
National Institutes of Health (see Table 2). As in previous years, the Administration has
not requested funding for the Global AIDS in the Workplace Initiative of the Department
of Labor (line 15), although Congress has continued to fund the program through
appropriations. Line 16 provides a subtotal for international HIV/AIDS funding through
the Labor/HHS Appropriations.
Other Appropriations. Line 17 in Table 1 refers to the Defense Department’s
AIDS prevention education program, primarily with African militaries. New funding for
the education program itself has not been requested in the Department of Defense
Appropriations for FY2006, as in previous years. As noted above, Foreign Military
Financing funds have been requested for purchases of equipment used in the program.
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 18).
In subsequent years, this assistance was not requested by the Administration, but Congress
continued to make provision for it.

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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, funding for mother and child transmission
programs begun under the initiative were moved to the GHAI program at the Department
of State.
Total Funding. Press and other accounts typically reported that the FY2004
Consolidated Appropriations included $2.4 billion for international HIV/AIDS programs,
rather than the $2.3 billion reported in Table 1. However, the $2.4 billion figure was 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. Finally,
some amounts, such as NIH international research, were adjusted downward as final
spending information for the year became available. The amount to be provided under
the FY2005 Consolidated Appropriations is typically reported as $2.9 billion, an amount
that includes the $87.8 million carried over from FY2004. According to the conference
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 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 $2.5 billion. Additional U.S. funds go toward
fighting the AIDS pandemic through contributions to the World Bank Group, which has
its own HIV/AIDS programs.
Table 2. Funding for U.S. Contributions to the Global Fund
($ millions)
FY2001
FY2002
FY2003
FY2004
FY2005
FY2006
Actual
Actual
Actual
Estimate
Approp.
Request
1. Foreign Operations
100
50.0
248.4
397.6
248.0
200.0
2. Labor/HHS
125.0
99.3
149.1
99.2
100.0
3. FY2004 Carryover
-87.8
87.8
TOTAL
100
175
347.7
458.9
435.0
300.0
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 totals $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.

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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 argued that what they saw as a
pledge made in P.L. 108-25 was not being fulfilled. Others maintained that additional
resources could not be provided in view of competing priorities or argued 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.” Officials see the FY2006 request of $3.16 billion
as keeping the United States on track to meet the $15 billion commitment.

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