107th Congress

Global HIV/AIDS, Tuberculosis, and Malaria

S. 1230 and S. 2525

Background

HIV/AIDS, tuberculosis (TB), and malaria continue to present significant problems for many developing nations, with millions of people of all ages affected. The impact of these diseases on the health and economic stability of affected countries serves as a reminder that industrialized countries must assist their global neighbors. A number of bills were introduced in the 107th Congress to focus attention and resources on these three global problems. Senator Bill Frist (R-TN) introduced S. 1230, the Global Leadership in Developing the Expanded Response (GLIDER) Act, to amend the Public Health Service Act to focus American efforts on HIV/AIDS, TB, and malaria in developing countries. Senator John F. Kerry (D-MA) introduced S. 2525, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002, to amend the Foreign Assistance Act of 1961 to increase assistance for foreign countries seriously affected by HIV/AIDS, TB, and malaria. These bills underscored congressional interest in the growing problem these diseases pose to families, communities, economies, and regional stability in the international arena.

Provisions of the Legislation/Impact on NIH

S. 1230-The GLIDER Act

In general, the provisions of S. 1230 would have authorized the Secretaries of Health and Human Services (HHS) and of State to establish and maintain effective partnerships with foreign governments, Federal agencies, multilateral entities, nongovernmental organizations (both faith-based and secular), universities, community-based organizations, and other national and international entities to 1) promote and expand primary prevention activities, 2) improve clinic-, community-, and home-based care and treatment, 3) provide assistance for capacity and infrastructure development, and 4) provide assistance to individuals affected by, but not infected with, HIV/AIDS, TB, and malaria, such as orphans and families.

Research provisions in Section 2812 of the bill would have authorized the Director of the National Institutes of Health (NIH), after obtaining the approval of the Secretary of HHS, to promote and expand primary prevention efforts related to HIV/AIDS, TB, and malaria through vaccine and microbicide research, and to carry out other activities deemed appropriate by the Secretary. Provisions specific to programs within the purview of the Centers for Disease Control and Prevention (CDC), Food and Drug Administration, Health Resources and Services Administration, and Agency for Healthcare Research and Quality were also included in this section. However, like those for NIH, all provisions would have authorized rather than mandated activities. The Secretary of HHS, in consultation with the Secretary of State, would have been required to prescribe appropriate procedures to ensure the coordination of activities under this section with other activities of the U.S. Government in each developing foreign country, under the leadership of the chief of the U.S. diplomatic mission. It is not clear whether this latter provision would have required approval by the chief prior to establishing projects in the respective country.

S. 2525-The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2002

Provisions of S. 2525 would have required the President to establish a comprehensive, integrated 5-year strategy to combat HIV/AIDS globally and strengthen U.S. capacity to effectively lead the international campaign. This strategy would have 1) included specific objectives, multisectoral approaches, and specific treatment and prevention approaches, with particular emphasis on women, children, and the young, 2) assigned priorities for relevant executive branch agencies, including NIH, 3) provided for improved coordination between relevant agencies, foreign governments, and international organizations, 4) projected general resource levels needed to achieve the objectives, and 5) expanded public-private partnerships. Although not stated in the bill, the practical effect of having priorities assigned to an agency like NIH would be that these priorities might be in conflict with scientific priorities and commitments already made by the affected agency.

In addition, the bill would have required the U.S. Agency for International Development to develop a comprehensive plan to empower women to prevent the spread of HIV/AIDS; ensure availability of affordable, effective, female-controlled preventive technologies; and provide for research to develop safe, effective, usable microbicides, relevant behavioral and social sciences research, and introductory studies of safe and effective microbicides in developing countries. S. 2525 would have established within the U.S. Department of State a Coordinator of U.S. Government Activities to Combat HIV/AIDS Globally, who would have had primary responsibility for the oversight and coordination of all Federal activities to combat the international HIV/AIDS pandemic.

The measure also would have provided for increased funding for the International AIDS Vaccine Initiative and the Malaria Vaccine Initiative of the Program for Appropriate Technologies in Health; assistance to prevent, treat, and monitor HIV/AIDS in sub-Saharan Africa and other countries; procurement of HIV/AIDS pharmaceuticals, antiviral therapies, and other appropriate medicines; and assistance to combat TB and malaria. The President would have been required to coordinate with the World Health Organization; Global Fund to Fight AIDS, Tuberculosis, and Malaria; U.S. Department of Health and Human Services, including NIH and CDC; and other organizations regarding the development and implementation of comprehensive TB and malaria control programs, respectively.

Status and Outlook

S. 1230 was introduced on July 24, 2001, and was referred to the Senate Foreign Relations Committee. There was no further action on this legislation during the 107th Congress.

S. 2525 was introduced on May 15, 2002, and was referred to the Senate Foreign Relations Committee. The measure, which has 17 cosponsors, was marked up on June 13 and ordered to be reported; the report was filed on July 3. On July 12, during Senate action on H.R. 2069, the Global Access to HIV/AIDS Prevention, Awareness, Education, and Treatment Act of 2001, provisions of S. 2525 were offered in an amendment and adopted. The amended H.R. 2069 was then passed by the Senate and returned to the House on July 15. There was no further action on this legislation during the 107th Congress.

For more information on this issue, see the articles entitled "Global Access to AIDS Treatment Act of 2001" and "Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment."