Protection Against Transmission of HIV for Women and Youth Act of 2006 - States that it shall be U.S. policy to: (1) pursue a global HIV prevention strategy that emphasizes the needs of married and unmarried women and girls and addresses the factors that lead to gender disparities in HIV infection rates; and (2) balance funding for HIV prevention methods.
Directs the President to: (1) formulate and submit to the appropriate congressional committees, and make available to the public, a comprehensive and culturally appropriate global HIV prevention strategy that addresses the HIV vulnerability of married and unmarried women and girls and seeks to reduce the factors that lead to gender disparities in HIV infection rates; (2) ensure that the United States coordinates its overall HIV/AIDS policy and programs with foreign governments, international organizations, other donor countries, and indigenous organizations; (3) provide clear guidance to U.S. field missions; and (4) implement a monitoring and evaluation system.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5674 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5674
To require the President and the Office of the Global AIDS Coordinator
to establish a comprehensive and integrated HIV prevention strategy to
address the vulnerabilities of women and girls in countries for which
the United States provides assistance to combat HIV/AIDS, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 22, 2006
Ms. Lee (for herself, Mr. Leach, Mr. Lantos, Mrs. Maloney, Ms. Corrine
Brown of Florida, Ms. Jackson-Lee of Texas, Mr. Jefferson, Mr. Payne,
Mr. Gutierrez, Ms. Norton, Mr. Honda, Ms. Schakowsky, Mr. McDermott,
Mr. Conyers, Mr. Waxman, Mr. Berman, Ms. Woolsey, Ms. Waters, Mr.
McGovern, Mr. Crowley, Mr. Brown of Ohio, Mrs. McCarthy, Mr. Wexler,
Mrs. Christensen, Mr. Meeks of New York, Ms. McCollum of Minnesota, Mr.
Capuano, Mr. Shays, Mr. Pallone, Mrs. Capps, Mr. Blumenauer, Ms.
McKinney, Mr. Owens, Mr. Cummings, Mr. Carnahan, Mr. Wynn, Ms. Solis,
Mr. Nadler, Mr. Davis of Illinois, Mr. Stark, Mr. Frank of
Massachusetts, Mr. Moran of Virginia, Mr. Scott of Virginia, Mr.
Clyburn, Mr. Delahunt, Ms. Kilpatrick of Michigan, Mr. Sanders, Ms.
Watson, Mr. Rush, Mr. Kucinich, Mr. Grijalva, Mr. Lewis of Georgia,
Mrs. Tauscher, Mr. Jackson of Illinois, Mr. Bishop of Georgia, Ms.
Carson, and Ms. Harman) introduced the following bill; which was
referred to the Committee on International Relations
_______________________________________________________________________
A BILL
To require the President and the Office of the Global AIDS Coordinator
to establish a comprehensive and integrated HIV prevention strategy to
address the vulnerabilities of women and girls in countries 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 ``Protection Against Transmission of
HIV for Women and Youth Act of 2006''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Globally, the United Nations Joint Program on AIDS
(UNAIDS) estimates that at the end of 2005 there were more than
38,600,000 people infected with HIV/AIDS, the vast majority of
whom are living in the developing world.
(2) According to the World Health Organization (WHO)
unprotected heterosexual sex is now the single most important
factor in the spread of HIV infections worldwide, representing
80 percent of new infections in sub-Saharan Africa.
(3) According to UNAIDS, women and adolescent girls account
for about half of all HIV infections worldwide. In sub-Saharan
Africa, women and girls make up 60 percent of all infections
and 76 percent of infections among those ages 15-24.
(4) Women and girls are biologically, socially, and
economically more vulnerable to HIV infection. Gender
disparities in the rate of HIV infection are the result of a
number of factors, including the following:
(A) Cross generational sex with older men who are
more likely to be infected with HIV, and a lack of
choice regarding when and whom to marry, leading to
early marriages and high rates of child marriages with
older men. About half of all adolescent females in
Africa and two-thirds of adolescent in Asia are married
by age 18.
(B) High rates of infection within marriage.
Research shows that married girls are more likely to
have unprotected sex and have far more frequent sex
than their unmarried peers, indicating that marriage
cannot be considered a protective factor against HIV
infection.
(C) An inability to negotiate safe sex in marriage
or with regular partners. Studies show that married
women and married and unmarried adolescent females
often are unable to negotiate the frequency and timing
of sexual intercourse, ensure their partner's
faithfulness, or insist on condom use. Women 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.
(D) Social and economic inequalities based largely
on gender which limit access for women and girls to
education and employment opportunities and which
prevent them from asserting their inheritance and
property rights. For many women, 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.
(E) A lack of educational opportunities for women
and girls which are 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.
(F) High rates of gender-based violence, rape, and
sexual coercion within and outside of marriage.
According to the WHO, between one-sixth and three-
quarters of women in various countries and settings
have experienced some form of physical or sexual
violence since age 15.
(G) 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.
(H) An increase in commercial sex for survival, due
to pervasive poverty, social dislocation, war and
internal conflicts, and other factors. According to
UNAIDS, the vulnerability of sex workers to HIV
infection is heightened by stigmatization and
marginalization, limited economic options, limited
access to health, social, and legal services, limited
access to information and prevention means, gender-
related differences and inequalities, sexual
exploitation and trafficking, harmful or nonprotective
legislation and policies, and exposure to risks
associated with commercial sex such as violence,
substance use, and increased mobility.
(I) Lack of access to basic HIV prevention
information, education, and services, and lack of
coordination with existing reproductive health services
to reduce stigma and maximize coverage.
(J) Lack of access to currently available female-
controlled HIV prevention methods, such as the female
condom, and lack of training on proper use of either
male or female condoms.
(K) High rates of other sexually transmitted
infections, unintended pregnancy, and complications
during pregnancy and childbirth.
(L) An absence of legal frameworks designed to
protect the rights of women and girls and the lack of
accountable and effective enforcement of such
frameworks, where they exist.
(5) 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.
(6) 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 (Public Law 108-25; 22 U.S.C. 7611), does not adequately
focus or provide sufficient details on how the United States
Government plans to address the factors that lead to gender
disparities in the rate of HIV infection in order to
successfully prevent HIV infection among both married and
unmarried women and girls.
SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS AMONG MARRIED AND UNMARRIED
WOMEN AND GIRLS.
(a) Statement of Policy.--In order to meet the stated goal of
preventing 7,000,000 new HIV infections worldwide, as announced by
President George W. Bush in his address to Congress on January 28,
2003, it shall be the policy of the United States to pursue a global
HIV prevention strategy that emphasizes the immediate and ongoing needs
of married and unmarried women and girls and addresses the factors that
lead to gender disparities in the rate of HIV infection.
(b) Strategy.--Not later than 180 days after the date of the
enactment of this Act, the President shall formulate and submit to the
appropriate congressional committees, and make available to the public,
a comprehensive, integrated, and culturally appropriate global HIV
prevention strategy that addresses the vulnerabilities of married and
unmarried women and girls to HIV infection and seeks to reduce the
factors that lead to gender disparities in the rate of HIV infection.
The strategy shall encompass comprehensive health and HIV prevention
education at the individual and population level beyond the ABC model
(``Abstain, Be faithful, use Condoms'') as a means to reduce HIV
infections and shall include the following strategies:
(1) Empowering women and girls to avoid cross-generational
sex and to decide when and whom to marry in order to reduce the
incidence of early- or child-marriage.
(2) Dramatically increasing access to currently available
female-controlled prevention methods and including investments
in training to increase the effective and consistent use of
both male and female condoms.
(3) Accelerating the destigmatization of HIV/AIDS, as women
are generally at a disadvantage in combating stigma.
(4) Addressing gender based violence and rape against women
and girls.
(5) Promoting male attitudes and behavior that respect the
human rights of women and girls and that support and foster
gender equality.
(6) Supporting the development of micro-enterprise
initiatives, job training programs, and other such efforts to
assist women in developing and retaining independent economic
means.
(7) Supporting expanded educational opportunities for women
and girls.
(8) Protecting the property and inheritance rights of
women.
(9) Coordinating HIV prevention information and education
services with existing health care services targeted to women
and girls, such as family planning, comprehensive reproductive
health services, and programs to reduce the transmission of HIV
between parents and children, and expanding the reach of such
health services.
(10) Promoting gender equality by supporting the
development of civil society organizations focused on the needs
of women and utilizing such organizations that are already
empowering women and girls at the community level.
(11) Encouraging the creation and effective enforcement of
legal frameworks that guarantee women equal rights and equal
protection under the law.
(12) Responding to other economic and social factors that
increase the vulnerability of women and girls to HIV infection.
(c) Coordination.--In formulating and implementing the global 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 governments of the countries for which
the United States provides assistance to combat HIV/AIDS and with
international organizations, other donor countries and indigenous
organizations, including specifically organizations focused on
expanding and enforcing women's rights, improving women's health, and
expanding education for women and girls, and organizations advocating
on behalf of individuals infected with and affected by HIV/AIDS.
(d) Guidance.--The President shall provide clear guidance to field
missions of the United States Government in countries for which the
United States provides assistance to combat HIV/AIDS, based on the
strategies specified under subsection (b), and shall submit to the
appropriate congressional committees and make available to the public
such guidance. Such guidance shall also include operational definitions
and a clear articulation of acceptable and prohibited activities
related to funding limitations for organizations working with
vulnerable and marginalized populations such as commercial sex workers,
in accordance with subsections (e) and (f) of section 301 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (Public Law 108-25; 22 U.S.C. 7631).
(e) Monitoring and Evaluation System.--
(1) In general.--The President shall develop and implement
a monitoring and evaluation system in order to measure the
effectiveness of United States assistance in preventing HIV
infection among women and girls and in addressing the factors
that lead to gender disparities in the rate of HIV infection.
(2) Requirements.--For each of the countries for which the
United States provides assistance to combat HIV/AIDS, and in
consultation with national governments, international
organizations, indigenous organizations, and other donor
countries, the monitoring and evaluation system under this
subsection shall--
(A) establish performance goals for such assistance
and express such goals in an objective and quantifiable
form, to the maximum extent practicable;
(B) establish performance indicators to be used in
measuring or assessing the achievement of the
performance goals established pursuant to subparagraph
(A);
(C) measure rates of HIV incidence and prevalence
among women and girls by age and marital status;
(D) measure rates of marriage for girls under the
age of 18;
(E) measure rates for children in school;
(F) measure access rates to primary health care,
including primary reproductive health and HIV
prevention programs, services, and technologies;
(G) measure utilization rates by married and
unmarried women of HIV prevention services and
commodities directly funded or supported by the United
States;
(H) measure rates of reported gender-based violence
and sexual coercion; and
(I) measure the prevalence of social norms and
beliefs supporting gender-based violence among women
and men, to the maximum extent practicable.
(3) Use of scientific surveys.--Where appropriate, the
President may utilize any existing scientific surveys to
augment the measurements required under subparagraphs (C)
through (I) of paragraph (2).
(f) Report.--Not later than one year after the date of the
enactment of this Act and annually thereafter as part of the annual
report required under section 104A(e) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b-2(e)) the President shall submit to the
appropriate congressional committees and make available to the public a
report on the implementation of this Act for the prior fiscal year. The
report shall include the following information:
(1) The results of the monitoring and evaluation system
required under subsection (e).
(2) A description of the prevention programs designed to
address the vulnerabilities to HIV/AIDS of married and
unmarried women and girls.
(3) A list of all nongovernmental organizations in each
country that receive assistance from the United States to carry
out HIV prevention activities, including the amount and the
source of funding received.
SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METHODS.
(a) Findings.--Congress finds the following:
(1) While effective evidence-based and measurable
strategies for delaying sexual debut are critical components of
comprehensive HIV prevention programs, current United States
funded HIV prevention programs based on the ABC model of
``Abstain, Be faithful, use Condoms'' are too narrow in scope
and do not respond to the specific vulnerabilities of women and
girls.
(2) In order to maximize the impact of United States
foreign assistance to combat HIV/AIDS, all sexually active
persons in each country must be equipped with all the skills
and tools necessary to avoid infection, including information
and training on delay of sexual debut and the practice of safer
sex, whether sexual activity begins within or outside of
marriage.
(3) Under section 403(a) of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public
Law 108-25; 22 U.S.C. 7673), 33 percent of all United States
foreign assistance provided for preventing the spread of HIV
must be spent on abstinence-until-marriage programs. Based on
operational guidance to field missions of the United States
Government, in order to meet this requirement, 50 percent of
all United States foreign assistance provided for preventing
the spread of HIV at the country level must be spent on
prevention of sexual transmission and 66 percent of all such
funding for sexual transmission must be spent on the Abstinence
and Be faithful components of the ABC model.
(4) A recent report by the Government Accountability Office
(Global Health: Spending Requirement Presents Challenges for
Allocating Prevention Funding under the President's Emergency
Plan for AIDS Relief, GAO-06-395, April 4, 2006) found the
following:
(A) Because it requires country teams to segregate
the Abstinence and Be faithful components of the ABC
model from funding for ``other prevention'', the
abstinence-until-marriage spending requirement can
undermine the teams' ability to design and implement
programs that integrate the components of the ABC
model, one of the guiding principles of the President's
Emergency Plan for AIDS Relief (PEPFAR) sexual
transmission prevention strategy. Eight of the 15 focus
country teams indicated that segregating the Abstinence
and Be faithful components of the ABC model from
``other prevention'' funding compromised the
integration of their programs. Examples of the problems
they cited include the following:
(i) Segregating program funding compromises
the integration of ABC activities, especially
for at-risk groups that need comprehensive
messages.
(ii) Segregating program funding limits
some country teams' ability to shift program
focuses to meet changing prevention needs.
(B) A large majority of the 20 PEPFAR country teams
required to meet the abstinence-until-marriage spending
requirement or obtain exemptions reported that the
requirement presented challenges to their efforts to
respond to local prevention needs. Seventeen of these
teams reported, either through documents submitted to
Office of the Global AIDS Coordinator (OGAC) or through
structured interviews, that meeting the spending
requirement, including OGAC's 50 percent and 66 percent
policies implementing it, challenged their ability to
develop interventions that are responsive to local
epidemiology and social norms.
(C) Between September 2005 and January 2006, ten of
these teams submitted documents to OGAC requesting
exemption from the spending requirement as it was
defined in OGAC's August 2005 guidance. These documents
highlight various challenges that the country teams
associated with meeting the spending requirement,
including the following:
(i) Reduced spending for Prevention of
Mother to Child Transmission (PMTCT).
(ii) Limited funding to deliver appropriate
prevention messaging to high-risk groups.
(iii) Lack of responsiveness to cultural
and social norms.
(iv) Cuts in medical and blood safety
activities.
(v) Elimination of care programs.
(D) In addition, seven teams that did not submit
documents requesting exemption from the spending
requirement (they did not meet OGAC's proposed criteria
for requesting exemptions) identified, in structured
interviews, specific program constraints related to
meeting the abstinence-until-marriage spending
requirement. These constraints included the following:
(i) Difficulty reaching certain populations
with comprehensive ABC messages.
(ii) Limited or reduced funding for
programs targeted at high-risk groups.
(iii) Reduced funding for PMTCT services.
(iv) Difficulty funding programs for condom
procurement and condom social marketing.
(b) Statement of Policy.--In carrying out the activities required
by the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (Public Law 108-25; 22 U.S.C. 7601 et seq.) and the
amendments made by that Act, it shall be the policy of the United
States--
(1) to provide flexibility to support the implementation of
culturally appropriate HIV prevention programs that are carried
out in accordance with the global HIV prevention strategy
established pursuant to section 3 of this Act;
(2) to ensure that onerous requirements are not imposed
with respect to how funds made available for such programs can
be obligated and expended; and
(3) to prevent the unnecessary reduction in funding for
effective HIV programs in order to meet such onerous
requirements.
(c) Amendments to Funding Provisions of United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.--
(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
Referred to the House Committee on International Relations.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line