HIV/AIDS International Programs: Appropriations, FY2003-FY2006

HIV/AIDS International Programs: Appropriations, FY2003-FY2006

Order Code RS21181
Updated January 3, 2006
CRS Report for Congress
Received through the CRS Web
HIV/AIDS International Programs:
Appropriations, FY2003-FY2006
Tiaji Salaam-Blyther
Analyst in Foreign Affairs
Foreign Affairs, Defense, and Trade Division
Summary
FY2006 Appropriations for Foreign Operations (P.L. 109-102), Labor/HHS/
Education (H.Rept. 109-300), Defense, and Agriculture (P.L. 109-97) provide more than
$3.4 billion for international HIV/AIDS, tuberculosis (TB), and malaria initiatives. The
largest portion of the funds is provided through P.L. 109-102, which directs more than
$2.8 billion to fighting the three diseases. The $550 million directed to the Global Fund
through FY2006 appropriations reflects the largest U.S. contribution to date, with $450
million in Foreign Operations Appropriations and an additional $100 million in
Labor/HHS/Education Appropriations. Final conference funding levels for AIDS, TB,
and malaria were $286 million more than the Administration requested, $230 million
more than the House requested, and nearly $121 million less than the Senate proposed.
U.S. International HIV/AIDS Programs
Most funding for international HIV/AIDS, TB, 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 funding for such
programs through these and other appropriations.1 Amounts reported in Table 1 for
FY2004 and FY2005 have been adjusted for the rescissions imposed in both years that
reduced final funding levels. Amounts for FY2006 do not include rescissions.
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)
FY2006
Program
FY2004 FY2005
Actual
Estimate Request House
Senate Enacted
1. Child Survival Assistance for HIV/AIDS
513.4
347.2
330.0
350.0
350.0
350.0
(not including Global Fund)
2. Child Survival Assistance for
155.0
168.6
109.0
170.0
205.0
180.0
Tuberculosis and Malaria
3. Child Survival Assistance for Global Fund
397.6
248.0
100.0
200.0
350.0
250.0
4. FY2004 Global Fund Carryover
-87.8a
87.8
—
—
—
—
5. Other bilateral assistance b
51.7
51.1
53.0
55.0
44.0
43.0
6. State Department Global HIV/AIDS
488.1
1,373.9 1,870.0 1,720.0 1,870.0
1,795.0
Initiative (GHAI)
7. GHAI for the Global Fund
100.0
200.0
150.0
200.0
8. Foreign Military Financing
1.5
2.0
2.0
—
2.0
2.0
9. Subtotal, Foreign Operations
1,519.5
2,278.6 2,564.0 2,695.0 2,971.0
2,820.0
Appropriations
10. CDC Global AIDS Program
273.9
123.8c
123.9
123.9
123.9
123.9
11. CDC Overseas Applied
11.0
11.0
11.0
11.0
11.0
11.0d
Prevention Research
12. CDC international TB and malaria
17.9
15.9
11.0
11.0
11.0
11.0e
13. NIH International Research
317.2
332.3
350.0
350.0
350.0
350.0d
14. Global Fund contribution NIH
149.1
99.2
100.0
0
100.0
100.0
15. DOL AIDS in the Workplace Initiative
9.9
2.0
—
—
—
—
16. Subtotal, Labor/HHS Appropriations
779.0
584.2
595.9
495.9
595.9
595.9
17. DOD HIV/AIDS prevention
4.2
7.5
—
—
—
5.3
education, primarily in Africa
18. Section 416(b) Food Aid
24.8
24.8
—
25.0
—
25.0
19. TOTAL
2,327.5
2,895.1 3,159.9 3,215.9 3,566.9
3,446.2
Sources: FY2006 House appropriations amounts are drawn from House-passed H.R. 3057 (Foreign Ops.),
H.R. 3010 (Labor/HHS), and H.R. 2744 (Agriculture). Senate amounts are from the Senate-passed version
of H.R. 3057 and S.Rept. 109-103 (Labor/HHS).
a. See section on Global Fund.
b. Includes funds for HIV/AIDS, TB, and malaria.
c. According to CDC, this apparent decrease compared to the previous year reflected 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 section on Labor/HHS appropriations.
d. Not earmarked, although funds could be provided at the Administration’s discretion.
e. Estimated amounts.
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. 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

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Global HIV/AIDS Initiative (GHAI). Thus, all U.S. AIDS funding in the focus countries
is under the direction of the Department of State 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
2 refers to Child Survival appropriations for international TB and malaria programs,
which are funded in part through “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 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 directed
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 amount reported in the
Senate bill for FY2006 included $100 million transferred from the Economic Support
Fund under Section 6118, added as a floor amendment during debate.

The fifth line in Table 1 indicates that other bilateral assistance is used to combat
AIDS, tuberculosis, and malaria. This assistance includes food aid,3 Economic Support
Fund aid (ESF), 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 on January 28, 2003. This five-year plan is
expected to 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 level. The State
Department’s GHAI is primarily focused on 12 African countries4 as well as Haiti,
Guyana, and Vietnam — though GHAI has provided small amounts of money for non-
focus countries. The United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (H.R. 1298/P.L. 108-25) established the office of the Global
HIV/AIDS Coordinator and made the Coordinator responsible for administering all global
HIV/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.
4 Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South
Africa, Tanzania, Uganda, and Zambia.

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program itself is referred to in line 17. Line 9 provides a subtotal for HIV/AIDS, TB, and
malaria programs funded through the Foreign Operations Appropriations.
The FY2005 Consolidated Appropriations bill set aside $30 million in Child
Survival AIDS funding for the development of microbicides, up from $22 million in
FY2004. The measure also provided $27 million from AIDS-designated Child Survival
funds for the International AIDS Vaccine Initiative (IAVI), compared with $26 million
in FY2004. The bill specified 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. For FY2006, appropriators directed $40
million to microbicides, $27 million to IAVI through Child Survival AIDS funding, and
$30 million to UNAIDS through GHAI funds.
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 was 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 part of the U.S. response to the global pandemic. Line 12 refers to
CDC research on international TB 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 did not request funding for the Global
AIDS in the Workplace Initiative of the Department of Labor (line 15). 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. Funding for the program was not requested in the
FY2006 Department of Defense Appropriations, as in previous years. However, Congress
provided $5.3 million for the program in FY2006.
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 provisions for it.
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

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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. It provided up to $150 million under
Foreign Operations and $150 million through the CDC. 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 provided under the
FY2005 Consolidated Appropriations was typically reported as $2.9 billion, an amount
that included the $87.8 million carried over from FY2004. According to the conference
report on the FY2005 Consolidated Appropriations (H.Rept. 108-792), the amount
provided for fighting AIDS alone, rather than the three diseases, was $1.96 billion in the
Foreign Operations portion of the bill. This reflected an assumption that the Global Fund
was 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 was approximately $580
million, making the AIDS-only total $2.5 billion.
According to the conference report of the FY2006 Foreign Operations
Appropriations (H.Rept. 109-265), Congress provided $2.42 billion for HIV/AIDS,
$150.9 million for tuberculosis, and $242.5 million for malaria. Of the total amount
provided for the three diseases, $450 million was set aside for the Global Fund.
Combining funding from FY2006 Labor/HHS/Education Appropriations ($595.9 million),
from FY2006 Agriculture Appropriations ($25 million), and from FY2006 Defense
Appropriations ($5.3 million) total funding for HIV/AIDS, TB, and malaria reached $3.45
billion in FY2006. 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 Global Fund contributions,
totalling more than contributions $2 billion ($2.066 billion) through FY2006. P.L. 109-
102 requires that 20% of Global Fund contributions be withheld until the Secretary of
State certifies to the Appropriations Committees that the Fund has undertaken a number
of steps to strengthen oversight and spending practices.5 The act allows the Secretary to
waive the requirement if she determines that a waiver is important to the national interest
of the United States. For further information, see CRS Report RL31712, The Global
Fund to Fight AIDS, Tuberculosis, and Malaria: Background and Current Issues.
5 The required steps are to: (1) establish clear progress indicators upon which to determine the
release of incremental disbursements; (2) release such incremental disbursements only if progress
is being made based on those indicators; and (3) provide support and oversight to country-level
entities, such as country coordinating mechanisms, principal recipients, and local Fund agents.

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Table 2. Funding for U.S. Contributions to the Global Fund
($ millions)
FY2006
FY2001 FY2002 FY2003 FY2004 FY2005
Actual Actual Actual Estimate Approp. Request House Senate Enacted
1. Foreign Operations
100
50.0
248.4
397.6
248.0
200.0 400.0 500.0
450.0
2. Labor/HHS
125.0
99.3
149.1
99.2
100.0
0 100.0
100.0
3. FY2004 Carryover
-87.8
87.8
TOTAL
100
175
347.7
458.9
435.0
300.0 400.0 600.0
550.0
Other Legislation
P.L. 108-25 authorizes $3 billion per year from FY2004 through FY2008 (a total of
$15 billion) for international AIDS, TB, 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 Global Fund
contribution for FY2004 and such sums as may be necessary for FY2005-2008. In a 2003
Rose Garden speech, President Bush stated that PEPFAR would begin with $2 billion in
FY2004, reiterating the Administration’s commitment to providing $15 billion over five
years while stating that the program needed to “ramp up.” Efforts to increase FY2004
funding for global HIV/AIDS, TB, and malaria 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. Officials see
the FY2006 $3.16 billion request in line with maintaining the $15 billion commitment.
On March 17, 2005, the Senate accepted an amendment by Senator Santorum and
Senator Durbin stating that the United States will need to contribute $500 million to the
Global Fund beyond the President’s $300 million request for a total of $800 million.
Under the one-third rule governing U.S. contributions to the Global Fund, this amount
could be expected to leverage $1.6 billion in contributions from other donors. This is the
amount others would have to contribute before the full $800 million could be paid in, and
would give the Global Fund a total budget of $2.4 billion. The Global Fund was saying
at the time that it needed $2.4 billion in 2006 to cover its existing grants, although it was
also seeking $1.1 billion to pay for new grants. S.Con.Res. 18, as amended, passed the
Senate on March 17. The conference version of the budget resolution (H.Con.Res. 95),
agreed to by the House and Senate on April 28, did not include the Santorum/Durbin
language. Instead, the conference report (H.Rept. 109-62) simply encouraged the
Appropriations Committees to donate the maximum allowed: one-third of total
contributions. In November 2005, the Global Fund estimated that it needed $1.8 billion
to fund existing grants. Under the one-third rule, this would mean a $600 million U.S.
contribution. The Fund is still seeking $1.1 billion for new grants in 2006.6 A one-third
share of the $2.9 billion total for new and existing grants would be $967 million.
6 Global Fund, “Global Fund Closes Funding Gap.” December 16, 2005.
[http://www.theglobalfund.org/en/media_center/press/pr_051216.asp]