New United States Global HIV Prevention Strategy to Address the Needs of Women and Girls Act of 2004 - States that it shall be U.S. policy to: (1) pursue an HIV prevention strategy for each country for which the United States provides assistance to combat HIV/AIDS that emphasizes the needs of women and girls; and (2) support a variety of culturally appropriate HIV prevention programs for each country for which the United States provides HIV/AIDS assistance, and to ensure that unnecessary requirements on fund use are not imposed.
Directs the President to establish a comprehensive and culturally appropriate HIV prevention strategy for each country for which the United States provides assistance to combat HIV/AIDS. Requires each strategy to encompass health and HIV prevention education beyond the ABC model "Abstain, Be faithful, use Condoms" as a means to reduce HIV infections, particularly among women and girls.
Amends the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 to eliminate the "abstinence-until-marriage" reference with respect to the sense of Congress' HIV/AIDS funding allocation.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4792 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 4792
To require the President to establish a comprehensive, integrated, and
culturally appropriate HIV prevention strategy that emphasizes the
needs of women and girls for each country for which the United States
provides assistance to combat HIV/AIDS, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 9, 2004
Ms. Lee (for herself, Mr. Lantos, Mr. Wexler, Mr. Payne, Mr. McGovern,
Mr. Grijalva, Ms. Corrine Brown of Florida, Mr. Owens, Mr. Rush, Ms.
Waters, Ms. Norton, Mr. Conyers, Mr. Brown of Ohio, Mr. Bell, Mr.
McDermott, Mr. Crowley, Mr. Gutierrez, Ms. Carson of Indiana, Mr.
Pallone, Mr. Davis of Illinois, Mrs. Maloney, Mr. Delahunt, Mrs.
Christensen, Mr. Cummings, Mr. Doggett, Mr. Olver, Mr. Frank of
Massachusetts, Ms. Jackson-Lee of Texas, Mr. Waxman, Ms. Watson, Ms.
Kilpatrick, Ms. Eddie Bernice Johnson of Texas, Mr. Thompson of
Mississippi, Mr. Jackson of Illinois, Mr. Scott of Virginia, Mr. Scott
of Georgia, Mr. Lewis of Georgia, Mr. Clyburn, Ms. Millender-McDonald,
Mr. Bishop of Georgia, Ms. McCollum, Mr. Wynn, Mr. Kucinich, Mr.
Rangel, Ms. Solis, Mr. Dicks, Ms. Schakowsky, Mrs. McCarthy of New
York, Mr. Meeks of New York, Mr. Dingell, Mr. Berman, Ms. DeLauro, Mrs.
Jones of Ohio, Mr. Moran of Virginia, and Mr. Serrano) introduced the
following bill; which was referred to the Committee on International
Relations
_______________________________________________________________________
A BILL
To require the President to establish a comprehensive, integrated, and
culturally appropriate HIV prevention strategy that emphasizes the
needs of women and girls for each country for which the United States
provides assistance to combat HIV/AIDS, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``New United States Global HIV
Prevention Strategy to Address the Needs of Women and Girls Act of
2004''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Globally, the United Nations Joint Programme on HIV/
AIDS (UNAIDS) estimates that there are more than 40,000,000
people infected with HIV/AIDS, the vast majority of whom live
in the developing world. For a number of reasons, women and
girls are biologically, socially, and economically more
vulnerable to HIV infection, and today they represent more than
half of all individuals who are infected with HIV worldwide.
(2) In sub-Saharan Africa, women and girls make up 60
percent of those individuals infected with HIV. Data from
several countries in Africa indicate that women ages 15 to 24
are from two and a half to thirteen times more likely to be
infected with HIV as their male counterparts.
(3) Gender disparities in the rates of HIV infection are
the result of a number of factors, including--
(A) inadequate knowledge about how HIV is
transmitted;
(B) lack of access to basic HIV prevention and
reproductive health services;
(C) an inability to negotiate safer sex with
regular partners;
(D) social norms that prevent frank and open
discussions about sex;
(E) a lack of access to female-controlled HIV
prevention methods, such as the female condom and, when
available, microbicides; and
(F) social and economic inequalities based largely
on gender.
(4) Current HIV prevention programs designed to support the
ABC model: ``Abstain, Be faithful, use Condoms'', are not
always effective at addressing the central fact that women and
girls are often powerless to abstain from sex, ensure their
partner's faithfulness, or to insist on condom use even within
marriage, and especially in the case of early- or child-
marriages. Women may also be coerced into unprotected sex and
they often run the risk of being infected by husbands or male
partners in societies where it is common or accepted for men to
have more than one partner.
(5) Recognizing that current international HIV prevention
and protection efforts are failing women and girls, UNAIDS
officially launched the Global Coalition on Women and AIDS on
February 2, 2004, to focus on preventing new HIV infections
among women and girls, promoting equal access to HIV care and
treatment, increasing access to female-controlled prevention
methods such as female condoms, accelerating microbicides
research, protecting women's property and inheritance rights,
supporting ongoing efforts toward reaching universal primary
education for girls, and reducing violence against women.
(6) Violence against women, perpetuated by their intimate
partners, is a major human rights and public health problem
throughout the world and it is also a major contributing factor
to the spread of HIV. According to the World Health
Organization (WHO), one-fifth to one-third of women ages 15 to
49 have experienced some form of physical abuse or sexual
coercion in their lifetimes, the vast majority within marriage.
(7) Unfortunately, current HIV prevention programs do not
place enough importance on responding to violence against
women, changing the social norms that shape the attitudes and
behaviors of men and boys toward women and girls, or using
strategies to promote effective communication among couples on
matters of sex and reproduction.
(8) The fear of domestic violence and the continuing stigma
and discrimination associated with HIV/AIDS prevents many women
from accessing information about HIV/AIDS, getting tested,
disclosing their HIV status, accessing services to prevent
mother-to-child transmission, or receiving treatment and
counseling even when they already know they have been infected
with HIV.
(9) Economic and social disparities between men and women
amplify the effects of stigma and discrimination, the fear of
domestic violence, and other risks of HIV infection faced by
women and girls. Unequal access to education, income, land, and
other productive resources leaves many women and girls
dependent on men for income, housing, sustenance and social
security.
(10) For women and girls, gender discrimination in the
ownership and retention of property also contributes to an
increased risk of sexual abuse, exploitation, and HIV
infection. As women's property rights are violated on a massive
scale by in-laws, relatives, communities, and government
officials, the impact on women and their dependents is
catastrophic. Many women end up homeless or living in slums,
begging for food and water, unable to afford health care or
school fees for their children, and many women resort to
working as commercial sex workers in order to make ends meet.
(11) For many women, the combination of stigma, violence,
and a lack of independent economic means sustains their fear of
abandonment, eviction, or ostracism from their homes and
communities, and can leave many more of them trapped within
relationships where they are vulnerable to HIV infection.
(12) Women also face additional obstacles due to the
pervasiveness of discriminatory legal frameworks that fail to
guarantee equal rights or equal protection before the law. In
many cases, inequitable divorce and property laws make it
difficult for women to leave abusive relationships, and in
countries where laws against gender violence exist,
insufficient resources, coupled with discriminatory practices
by police and courts and a lack of institutional support, leave
women without access to adequate protection.
(13) Recently, numerous studies have emerged indicating
that early or child marriage cannot be considered a protective
factor against HIV infection. These studies show that young
women between the ages of 15-19 who are married are at
significantly higher risk of contracting HIV/AIDS than single
women of the same age, in some cases by as much as 10 percent.
(14) There are several reasons that sexually active
unmarried girls are less vulnerable to HIV infection than
married adolescent girls, including the fact that they tend to
have sex less frequently, are more likely to have sex with
those closer to their own age, and because they are more likely
to use condoms during sex. The result is that in many countries
today, most sexually transmitted HIV infections in females
occur either inside marriage or in relationships women believe
to be monogamous.
(15) Efforts to expand access to education for women and
girls and to increase the age at which they marry are also
critical to increasing the social and economic power of women,
reducing the spread of HIV, and to the attainment of overall
health and development goals. For women and girls, education is
linked to delayed intercourse, increased age-at-marriage,
delayed childbearing, increased child survival, improved
nutrition, and reduced risk of HIV infection, among other
positive outcomes.
(16) Although attendance at school is considered a
protective factor in preventing transmission of HIV, recent
studies indicate that young women between the ages of 15-19 who
are married and do not have children are less likely to be in
school than single women of the same age who do not have
children. In some instances the difference is striking, as in
the case of Nigeria, where 3 percent of young married women are
in school, as compared to 70 percent of young single women.
(17) As a result of these studies, HIV prevention programs
that strictly focus on promoting abstinence-until-marriage and
do not provide comprehensive health and sexuality education
fail to adequately address the true vulnerabilities faced by
women, especially younger women, or to equip them properly with
the full range of tools they need to protect themselves.
(18) A substantial body of evidence also exists to support
the coordination of HIV prevention initiatives, including
programs to prevent the transmission of HIV from mother-to-
child, with existing health care services, especially family
planning and reproductive health programs, as the health and
well-being of women and girls is improved when they have access
to comprehensive care that is designed to address their needs.
(19) Over the last forty years, the United States has made
substantial investments in building basic health care services
for mothers and children, including family planning and
reproductive health care programs. In many cases these programs
serve as a trusted source of health information and resources
to women, both for their own health and well-being, and that of
their children. Frequently, these types of coordinated programs
can also serve as a source of information and resources free
from the stigma frequently associated with stand-alone HIV
prevention programs.
(20) The United States already works to coordinate HIV
prevention services with existing family planning and
reproductive health care programs, as they represent a readily
available platform upon which to build new initiatives. Such
efforts should continue as part of any global expansion of HIV
prevention services in order to produce an efficient and
effective global health policy.
(21) Efforts to increase women's access to comprehensive
prevention information and services, address gender violence,
increase women's economic and social status, and foster
equitable partnerships between women and men are all central to
reducing the spread of HIV/AIDS worldwide and to enhancing the
success of effective treatment and care programs supported by
the United States.
(22) The comprehensive, integrated, five-year strategy to
combat global HIV/AIDS submitted to Congress on February 23,
2004, as required by section 101 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7611), does not adequately focus or provide
sufficient details on United States Government strategies to
prevent HIV infection among women and girls.
SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS ON A COUNTRY-BY-COUNTRY
BASIS.
(a) Statement of Policy.--In order to meet the stated goal of
preventing 7,000,000 new HIV infections, as announced by the President
in his address to Congress on January 28, 2003, it shall be the policy
of the United States to pursue an HIV prevention strategy for each
country for which the United States provides assistance to combat HIV/
AIDS that emphasizes the immediate and ongoing needs of women and girls
in those countries.
(b) Strategy.--Not later than 90 days after the date of the
enactment of this Act, the President shall establish a comprehensive,
integrated, and culturally appropriate HIV prevention strategy for each
country for which the United States provides assistance to combat HIV/
AIDS. Each such strategy shall encompass comprehensive health and HIV
prevention education beyond the ABC model: ``Abstain, Be faithful, use
Condoms'', as a means to reduce HIV infections, particularly among
women and girls, and which strengthens the capacity of the United
States to be an effective leader of the international campaign against
HIV/AIDS. Each such strategy shall also include the following:
(1) Increasing access to female-controlled prevention
methods, most immediately, access to female condoms, and
including training to ensure effective and consistent use of
such condoms.
(2) Accelerating destigmatization of HIV/AIDS, as women are
generally at a disadvantage in combating stigma.
(3) Empowering women and girls to avoid cross-generational
sex and reduce the incidence of early- or child-marriage.
(4) Reducing violence against women.
(5) Supporting the development of microenterprise programs
and other such efforts to assist women in developing and
retaining independent economic means.
(6) Promoting positive male behavior toward women and
girls.
(7) Supporting expanded educational opportunities for women
and girls.
(8) Protecting the property and inheritance rights of
women.
(9) Coordinating HIV prevention services with existing
health care services, including programs intended to reduce the
transmission of HIV between mother-to-child, and family
planning and reproductive health services.
(10) Promoting gender equality by supporting the
development of civil society organizations focused on the needs
of women, and by encouraging the creation and effective
enforcement of legal frameworks that guarantee women equal
rights and equal protection under the law.
(c) Coordination.--
(1) In general.--In formulating each HIV prevention
strategy pursuant to subsection (b), the President shall ensure
that the United States coordinates its overall HIV/AIDS policy
and programs with the national government of the country
involved and with other donor countries and organizations
through the Three Ones Principles. Such coordination shall
include proper consultation and dialogue with both indigenous
and international nongovernmental organizations (including
faith- and community-based organizations) that work to combat
HIV/AIDS or that specifically work to address the needs of
women and girls through comprehensive health care, education,
or income-generating programs.
(2) Definition.--In paragraph (1), the term ``Three Ones
Principles'' means the following three guiding principles which
provide a framework for coordinated action on HIV/AIDS at the
country level, as developed by the United Nations Joint
Programme on HIV/AIDS (UNAIDS) and agreed to by the United
States and other donor countries and organizations on April 25,
2004:
(A) One national HIV/AIDS action framework that
provides the basis for coordinating the work of the
national government and all organizations in a country.
(B) One national HIV/AIDS coordinating authority
for the country, with a broad multi-sector mandate.
(C) One national HIV/AIDS monitoring and evaluation
system for the country.
(d) Report.--Not later than 180 days after the date of the
enactment of this Act, the President shall transmit to the appropriate
congressional committees and make available to the public a report
that--
(1) contains a description of each HIV prevention strategy
established pursuant to subsection (b) and a description of any
ongoing United States-supported activities that relate to the
elements of each such strategy as described in paragraphs (1)
through (10) of subsection (b); and
(2) includes a list of the nongovernmental organizations
(including faith- and community-based organizations) in each
country that carry out such activities, the amount and the
source of funding received, and the overall goals and
implementation strategy of such activities
SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METHODS.
(a) Finding.--Congress finds that while in some cases abstinence
programs may help to delay sexual debut among young people, when such
programs are not combined with comprehensive sexuality and life skills
education, these programs can leave young people who eventually do
become sexually active without the appropriate knowledge to protect
themselves from sexually-transmitted diseases such as HIV.
(b) Statement of Policy.--In carrying out the activities required
by the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 et seq.; Public Law 108-25), and
the amendments made by that Act, it shall be the policy of the United
States--
(1) to provide flexibility to support a variety of
culturally appropriate HIV prevention programs that are carried
out in accordance with the HIV prevention strategy for each
country for which the United States provides assistance to
combat HIV/AIDS, as established pursuant to section 3 of this
Act; and
(2) to ensure that unnecessary requirements are not imposed
with respect to how funds made available for such programs can
be obligated and expended.
(c) Amendments to Funding Provisions of Public Law 108-25.--
(1) Sense of congress.--Section 402(b)(3) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7672(b)(3)) is amended by striking ``,
of which such amount at least 33 percent should be expended for
abstinence-until-marriage programs''.
(2) Allocation of funds.--Section 403(a) of such Act (22
U.S.C. 7673(a)) is amended by striking the second sentence.
SEC. 5. DEFINITIONS.
In this Act:
(1) AIDS.--The term ``AIDS'' means the acquired immune
deficiency syndrome.
(2) Appropriate congressional committees.--The term
``appropriate congressional committees'' means the Committee on
International Relations of the House of Representatives and the
Committee on Foreign Relations of the Senate.
(3) HIV.--The term ``HIV'' means the human immunodeficiency
virus, the pathogen that causes AIDS.
(4) HIV/AIDS.--The term ``HIV/AIDS'' means, with respect to
an individual, an individual who is infected with HIV or living
with AIDS.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1342)
Referred to the House Committee on International Relations.
Sponsor introductory remarks on measure. (CR H6539-6540)
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