To amend the Foreign Assistance Act of 1961 to provide assistance for orphans and other vulnerable children in developing countries.

July 7, 2004

Mrs. BOXER (for herself, Mr. SMITH, Mr. CHAFEE, and Mr. FEINGOLD) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations

To amend the Foreign Assistance Act of 1961 to provide assistance for orphans and other vulnerable children in developing countries.

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 `Assistance for Orphans and Other Vulnerable Children in Developing Countries Act of 2004'.

SEC. 2. FINDINGS.

Congress finds the following:

(1)(A) According to estimates by the United Nations Children's Fund (UNICEF), there are more than 132,000,000 children in the world under the age of three.

(B) Of these children, 4,000,000 will die in their first month of life and another 7,000,000 will die each year before reaching the age of five. Thus an average of 30,000 children under the age of three die each day.

(2) According to a report developed by the United Nations Joint Programme on HIV/AIDS (UNAIDS), UNICEF, and the United States Agency for International Development, in 2001 there were more than 110,000,000 orphans living in sub-Saharan Africa, Asia, Latin America, and the Caribbean.

(3) Assessments carried out by the International Labor Organization (ILO) to investigate the situation of children who are working found that orphans are much more likely than non-orphans to be working in commercial agriculture, the domestic service industry, prostitution, as street vendors, or in industries that violate internationally recognized rights of children.

(4) Infants who are poor and malnourished are more likely to contract respiratory infections, diarrhea, measles, and other preventable diseases, and are less likely to receive needed health care.

(5) According to UNAIDS and UNICEF, by the end of 2001 there were an estimated 14,000,000 children under the age of 15 who had lost one or both parents to AIDS.

(6) As the number of HIV cases increases in sub-Saharan Africa and the Caribbean, as well as in Eastern Europe and Asia, the death rate from AIDS among adults in those regions is expected to increase. By 2010 the total number of children in those regions who will lose one or both parents to AIDS is expected to be approximately 30,000,000.

(7) One-third of children born from an HIV-infected mother develop HIV/AIDS. Few of these children have access to HIV/AIDS medications.

(8) Globally, more than 11,800,000 young people ages 15 to 24 were living with HIV/AIDS in 2001, and each day another 6,000 young people became infected with HIV. New estimates indicate that more than 70 percent of new HIV cases among this age group in sub-Saharan Africa are young women and girls.

(9) As their parents fall progressively sick from HIV/AIDS, children generally must take on an increasing number of responsibilities. Girls take responsibility for more household chores, often drop out of school, and care for their parents.

(10)(A) Without an adequate diet, individuals infected with HIV often die at an earlier age. Individuals with HIV become increasingly weak and fatigued, do not respond to drug treatment, and are prone to other illnesses such as malnutrition and tuberculosis (TB).

(B) Hunger can also cause previously HIV-negative people to engage in high-risk survival strategies that increase their chances of becoming infected with HIV.

(11) Extreme poverty and hunger coupled with the loss of one or both parents as a result of AIDS can force children from their families to a life on the streets, where the risk of HIV infection is extremely high.

(12)(A) A considerable number of United States and indigenous private voluntary organizations, including faith-based organizations, provide assistance to orphans and other vulnerable children in developing countries, especially children affected by HIV/AIDS.

(B) Many of these organizations have submitted applications for grants from the United States Agency for International Development in order to provide increased levels of assistance for orphans and other vulnerable children in developing countries but in most cases the Agency has not approved the applications.

(13)(A) Section 403(b) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108-25) establishes the requirement that for fiscal years 2006 through 2008, not less than 10 percent of amounts appropriated for HIV/AIDS assistance for each such fiscal year shall be expended for assistance for orphans and other vulnerable children affected by HIV/AIDS.

(B) Further, section 403(b) of Public Law 108-25 requires that at least 50 percent of such amounts shall be provided through non-profit, nongovernmental organizations, including faith-based organizations, that implement programs on the community level.

(14)(A) It is essential that the United States Government adopt a comprehensive approach for the provision of assistance to orphans and other vulnerable children in developing countries.

(B) This comprehensive approach should ensure that important services, such as basic care, treatment for those children with HIV/AIDS, mental health and related services for those children affected by HIV/AIDS, school food programs, increased educational opportunities and employment training and related services, and the protection and promotion of inheritance rights, are made more accessible.

(C) This comprehensive approach should also ensure that government agencies and the private sector coordinate efforts to prevent and eliminate duplication of efforts and waste.

(15) As a result of the numerous United States Government programs under which assistance is specifically authorized or otherwise available for orphans and vulnerable children in developing countries, the United States Agency for International Development will be required to develop innovative methods for the conduct and monitoring of these programs, including through the collection, analysis, and reporting of information on the programs and the extent to which such programs provide assistance directly and indirectly to such children.

SEC. 3. PURPOSE.

The primary purpose of this Act, and the amendments made by this Act, is to provide assistance to orphans and other vulnerable children, especially such children affected by HIV/AIDS, and in particular, for such children in countries heavily affected by HIV/AIDS. To the maximum extent practicable, such assistance shall be provided for the direct benefit to such orphaned and vulnerable children.

SEC. 4. ASSISTANCE FOR ORPHANS AND OTHER VULNERABLE CHILDREN IN DEVELOPING COUNTRIES.

Title V of chapter 2 of part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2201) is amended to read as follows:

`TITLE V--ASSISTANCE FOR ORPHANS AND OTHER VULNERABLE CHILDREN

`SEC. 241. FINDINGS; DECLARATION OF POLICY.

`(a) Findings- Congress finds the following:

`(1) By 2010, HIV/AIDS will orphan more than 25,000,000 children worldwide.

`(2) Ongoing conflicts and civil wars in developing countries are adversely affecting children in these countries, the vast majority of whom currently do not receive humanitarian assistance or other support from the United States Government.

`(3) The United States Government currently administers assistance programs for orphans and other vulnerable children in developing countries. When requested by the Committee on International Relations of the House of Representatives to provide information on the overall number of orphans and other vulnerable children receiving assistance from the United States Agency for International Development in fiscal year 2002, the Agency was only able to report on its HIV/AIDS assistance program, under which the Agency provided assistance to 462,000 such orphans and other vulnerable children.

`(4) The United States Government should increase its efforts to provide assistance for orphans and other vulnerable children in developing countries, especially those children affected by HIV/AIDS or conflict.

`(5) The United States Agency for International Development should establish improved capacity to deliver assistance to orphans and other vulnerable children in developing countries through partnerships with private voluntary organizations, including faith-based organizations.

`(6) Further, the United States Agency for International Development should be the primary United States Government agency responsible for identifying and assisting orphans and other vulnerable children in developing countries.

`(b) Declaration of Policy- Congress, recognizing that prompt and appropriate action by the United States to assist orphans and other vulnerable children in developing countries is an important expression of the humanitarian concern and tradition of the people of the United States, affirms the willingness of the United States to assist such orphans and other vulnerable children--

`(1) by providing assistance for the purpose of improving the health, nutritional, shelter, educational, economic, and psychological status of orphans and other vulnerable children in such countries; and

`(2) by providing humanitarian and protection assistance to such orphans and other vulnerable children affected by conflict or civil strife.

`SEC. 242. ASSISTANCE TO PROVIDE BASIC CARE.

`(a) Findings- Congress finds the following:

`(1) The need for individuals and local organizations in developing countries to assist households headed by children is necessary due to the increase in the number of such households. Millions of children in these types of households lack basic care, such as access to food and shelter.

`(2) Although families and extended families serve as the primary providers of care for these children, when these family care networks break down, and when communities are responsible for raising orphans, these children are cared for in a rich and nurturing environment and remain connected to the traditions and rituals of families and the community.

`(3) As the number of these children increases, the ability of communities to provide basic care for such children is limited. Assistance to support the provision of such basic care is therefore necessary in and of itself and also to facilitate the provision of other types of assistance for such children under this title.

`(b) Assistance-

`(1) In general- The President is authorized to provide assistance for programs in developing countries to provide basic care for orphans and other vulnerable children.

`(2) Activities supported- Assistance provided under paragraph (1) should be used--

`(A) to support individuals and local organizations, including teachers, social workers, and representatives from religious institutions and nongovernmental organizations, to mobilize their own resources through the strengthening of community care coalitions, networks, or support groups to provide basic care for orphans and other vulnerable children, including day care, food assistance, protection assistance, and home visits;

`(B) to increase the capacity of the community care groups described in subparagraph (A) to meet on a regular basis to identify orphans and other vulnerable children and to facilitate the provision of services; and

`(C) to ensure that the activities of community care groups described in subparagraph (A) include appropriate monitoring and supervision components.

`(3) Definition- In this subsection, the term `protection assistance' means all appropriate measures to promote the physical and psychological security of an individual, provide equal access to basic services for the individual, and safeguard the legal and human rights and dignity of the individual.

`SEC. 243. ASSISTANCE TO PROVIDE TREATMENT TO ORPHANS AND OTHER VULNERABLE CHILDREN WITH HIV/AIDS.

`(a) Findings- Congress finds the following:

`(1) Approximately 2,500,000 children under the age of 15 worldwide have HIV/AIDS. Every day another 2,000 children under the age of 15 are infected with HIV.

`(2) In 2002, approximately 2,500,000 children were at risk for infection with HIV through mother-to-child transmission, which includes transmission at any point during pregnancy, labor, delivery, or breastfeeding.

`(3) To date, more than 4,000,000 children worldwide are estimated to have died from AIDS,

primarily contracted through mother-to-child transmission. Every year, approximately 700,000 babies are infected with HIV, of which the majority are living in Africa.

`(4) In southern Africa HIV/AIDS is now the leading cause of death among young children, accounting for almost half of such deaths.

`(5) Research has shown conclusively that initiation in a timely manner of antiretroviral therapy for infants or young children with HIV/AIDS can preserve or restore their immune functions, promote normal growth and development, and prolong life.

`(6) Few international development programs specifically target the treatment of children with HIV/AIDS in developing countries. Reasons for this include the perceived low priority of pediatric treatment, a lack of pediatric health care professionals, lack of expertise and experience in pediatric drug dosing and monitoring, the perceived complexity of pediatric treatment, and mistaken beliefs regarding the risks and benefits of pediatric treatment.

`(b) Assistance-

`(1) In general- The President is authorized to provide assistance for the treatment of orphans and other vulnerable children with HIV/AIDS in developing countries.

`(2) Activities supported- Assistance provided under paragraph (1) should be used to carry out the following activities:

`(A) The treatment of orphans and other vulnerable children with HIV/AIDS through the provision of pharmaceuticals, including high-quality, low-cost antiretrovirals and other therapies, including generically manufactured pharmaceuticals where appropriate.

`(B)(i) The recruitment and training of individuals to provide the treatment described in subparagraph (A), including the recruitment and training of appropriate support personnel.

`(ii) Such training should include appropriate methodologies relating to initial diagnosis, appropriate dosages of pharmaceuticals, monitoring, medication adherence techniques, treatment for any complications resulting from such pharmaceuticals, and psychosocial support for vulnerable children and their caregivers.

`(C) Activities of medical laboratories relating to the treatment described in subparagraph (A), including assistance for the purchase of necessary equipment.

`SEC. 244. ASSISTANCE TO PROVIDE PSYCHOSOCIAL SUPPORT TO ORPHANS AND OTHER VULNERABLE CHILDREN AFFECTED BY HIV/AIDS.

`(a) Findings- Congress finds the following:

`(1) Many children who are orphaned as a result of AIDS blame themselves for the death of a parent and many children are separated from siblings, sometimes for life.

`(2) The trauma that results from the loss of a parent as a result of AIDS can trigger behavior problems of aggression or emotional withdrawal and negatively affect a child's performance in school and the child's social relations.

`(3) Children living in families affected by HIV/AIDS are often stigmatized, teased, and ostracized by peers.

`(4) Children living in families affected by HIV/AIDS who are most vulnerable are those children in households headed by children. In these households, trained community volunteers can play a major role through home visits.

`(5) In many African countries, religious leaders are mobilizing individuals and local organizations within the community to identify and respond to the psychosocial needs of those children affected by AIDS.

`(b) Assistance- The President is authorized to provide assistance for programs in developing countries to provide culturally appropriate mental health services and psychosocial support for orphans and other vulnerable children, and their caregivers.

`SEC. 245. ASSISTANCE FOR SCHOOL FOOD PROGRAMS.

`(a) Findings- Congress finds the following:

`(1) In 2004, it is estimated that 125,000,000 children worldwide do not attend school, in part because of hunger and malnutrition, and the vast majority of these children are young girls.

`(2) School food programs, including take-home rations, in developing countries provide strong incentives for parents to send their children to school and ensure that they continue with their education. School food programs may reduce short-term hunger, improve cognitive functions, and enhance learning, behavior, and achievement.

`(3) In 2004, more than 8,000,000 children in sub-Saharan Africa are underweight compared to 1994. Malnutrition enhances the risk that orphans and other vulnerable children will be at risk for illness and infections, especially if these children are also infected with HIV.

`(4) Healthy members of families affected by HIV/AIDS in developing countries often leave the workforce to care for those family members with HIV/AIDS, which compounds the problem of access to food for the family. Food consumption has been shown to drop by as much as 40 percent in these families.

`(5)(A) Although a number of organizations seek to meet the needs of children who are orphaned or vulnerable as a result of HIV/AIDS, immediate and extended families continue to be the primary providers of care and support for these children, and they need direct assistance urgently.

`(B) According to a survey by the United States Agency for International Development, orphans and other vulnerable children relied on relatives for food support 74 percent of the time and on friends for food support 19 percent of the time.

`(b) Assistance-

`(1) In general- The President is authorized to provide assistance for school food programs for orphans and vulnerable children in developing

countries, especially in such countries heavily affected by HIV/AIDS.

`(2) Activities supported- Assistance provided under paragraph (1) should be used to purchase local or regional foodstuffs, where appropriate, for school food programs.

`SEC. 246. ASSISTANCE TO INCREASE EDUCATIONAL OPPORTUNITIES AND PROVIDE EMPLOYMENT TRAINING.

`(a) Findings- Congress finds the following:

`(1) The lack of financial resources in families affected by HIV/AIDS prevents many orphans and other vulnerable children in developing countries from attending school because of the requirement to pay school fees and other costs of education.

`(2) Such children, in particular young girls, are often forced to miss school in order to serve as caregivers to relatives with HIV/AIDS or assume adult responsibilities for providing for the family. Younger children who lose a parent also lose the opportunity to learn skills that they will need to support themselves as they grow older.

`(3) According to the International Labor Organization (ILO), approximately 250,000,000 children and adolescents ages 5 to 14 in developing countries are working part-time and approximately 120,000,000 children and adolescents ages 5 to 14 in developing countries are working full-time.

`(4) In many regions of Africa and other developing countries, non-formal education plays an important role to provide children who are unable to attend school with the employment and related life skills training such children need to survive.

`(5) Many organizations in Africa, including faith-based organizations, provide employment and related life skills training for older children to better prepare them to serve as caregivers for younger siblings.

`(6) Organizations that provide non-formal education can assist the thousands of children in developing countries who are not currently being assisted by families or communities and are struggling to survive.

`(b) Assistance-

`(1) Education assistance- The President is authorized to provide assistance for programs in developing countries to decrease barriers to public primary school enrollment by eliminating school fees and other costs of education, especially in developing countries heavily affected by HIV/AIDS. Amounts made available to carry out this paragraph--

`(A) are authorized to be made available to the President for assistance or contributions to nongovernmental organizations and international organizations to achieve the purposes of this paragraph; and

`(B) shall not be used to pay school fees.

`(2) Employment training assistance- The President is authorized to provide assistance for programs in developing countries to provide employment training and related services for orphans and other vulnerable children who are of legal working age, especially for programs in developing countries heavily affected by HIV/AIDS.

`SEC. 247. ASSISTANCE TO PROTECT AND PROMOTE INHERITANCE RIGHTS.

`(a) Finding- Congress finds that orphans and other vulnerable children in developing countries, particularly children who are orphaned as a result of AIDS, are routinely denied their inheritance or encounter difficulties in claiming the land and other property which they have inherited.

`(b) Assistance- The President is authorized to provide assistance in support of programs in developing countries to protect and promote the inheritance rights of orphans and other vulnerable children, particularly young girls and children who are orphaned as a result of AIDS.

`SEC. 248. ADMINISTRATION OF ASSISTANCE.

`(a) Office for Orphans and Other Vulnerable Children-

`(1) Establishment- There is established within the United States Agency for International Development an Office for Orphans and Other Vulnerable Children (hereafter in this title referred to as the `Office'), which shall be headed by a Director who shall be appointed by the Administrator of the Agency.

`(2) Duties- The Office shall be responsible for carrying out this title.

`(b) Approval of Applications- Subject to the requirements of subsection (e), the Director of the Office shall be responsible for reviewing or approving all applications submitted to the United States Agency for International Development for assistance under this title, including applications submitted to field missions of the Agency.

`(c) Priority- In providing assistance under this title, priority should be given to assistance for developing countries in which the rate of HIV infection, as reported

in the most recent epidemiological data for that country compiled by the United Nations Joint Programme on HIV/AIDS (UNAIDS), is at least 5 percent among women attending prenatal clinics or more than 15 percent among individuals in groups with high-risk behavior.

`(d) Form of Assistance- Assistance under this title shall be provided in the form of--

`(1) grants, cooperative agreements, or contracts;

`(2) contributions to international organizations; or

`(3) assistance to the governments of developing countries.

`(e) Coordination- The provision of assistance under this title for children who are orphaned as a result of HIV/AIDS, or are children with HIV/AIDS, shall be undertaken in accordance with section 104A of this Act and assistance relating to HIV/AIDS authorized under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108-25), including section 102 of such Act concerning the coordination of HIV/AIDS programs.

`(f) Other Assistance-

`(1) Review or approval of other usaid assistance- The Director of the Office shall be responsible for reviewing or approving--

`(A) each component of the annual plan of a mission, bureau, or other office of the United States Agency for International Development as the component relates to assistance for orphans or other vulnerable children in developing countries; and

`(B) each program, project, or activity relating to such assistance.

`(2) Coordination of all u.s. government assistance- The Director of the Office shall be responsible for ensuring coordination of all United States Government programs to provide assistance for orphans and other vulnerable children in developing countries.

`SEC. 249. MONITORING SYSTEM.

`(a) Establishment- In order to maximize the sustainable development impact of assistance authorized under this title, the President shall establish a monitoring system that meets the requirements of subsection (b).

`(b) Requirements- The requirements referred to in subsection (a) are the following:

`(1) The monitoring system establishes performance goals for the assistance and expresses such goals in an objective and quantifiable form, to the extent feasible.

`(2) The monitoring system establishes performance indicators to be used in measuring or assessing the achievement of the performance goals described in paragraph (1).

`(3) The monitoring system provides a basis for recommendations for adjustments to the assistance to enhance the impact of the assistance.

`SEC. 250. REPORT.

`(a) Report- Not later than December 31, 2005, and each December 31 thereafter, the President shall transmit to Congress a report that contains a detailed description of the implementation of this title for the previous fiscal year.

`(b) Contents- The report shall contain the following information:

`(1) For each grant, cooperative agreement, contract, contribution, or other form of assistance awarded or entered into under this title--

`(A) the amount of the grant, cooperative agreement, contract, contribution, or other form of assistance, the name of each recipient and each developing country with respect to which projects or activities under the grant, cooperative agreement, contract, contribution, or other form of assistance were carried out, and the approximate number of orphans and other vulnerable children who received direct or indirect assistance under the projects or activities; and

`(B) the results of the monitoring system with respect to the grant, cooperative agreement, contract, contribution, or other form of assistance.

`(2) For each grant, cooperative agreement, contract, contribution, or other form of assistance awarded or entered into under any provision of law other than this title for assistance for orphans and other vulnerable children in developing countries, the information described in paragraph (1)(A).

`(3) Of the total amounts of assistance made available in each such fiscal year for orphans and other vulnerable children, the percentage of assistance provided in support of orphans or other vulnerable children affected by HIV/AIDS.

`(4) Any other appropriate information relating to the needs of orphans and other vulnerable children in developing countries that could be addressed

through the provision of assistance under this title or under any other provision of law.

`SEC. 251. AUTHORIZATION OF APPROPRIATIONS; ADDITIONAL PROVISIONS.

`(a) Authorization of Appropriation-

`(1) In general- Of the amounts made available to carry out the provisions of law described in paragraph (2), there are authorized to be appropriated to the President to carry out this title such sums as may be necessary for each of the fiscal years 2005 and 2006.

`(2) Provisions of law- The provisions of law referred to in paragraph (1) are the following:

`(A) The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108-25) and the amendments made by that Act.

`(B) Any other provision of law under which assistance is authorized for orphans and other vulnerable children in developing countries.

`(b) Additional Provisions-

`(1) Availability- Amounts appropriated pursuant to the authorization of appropriations under subsection (a) are authorized to remain available until expended and are in addition to amounts otherwise available for such purposes.

`(2) Minimum funding requirement- Not less than 60 percent of amounts appropriated pursuant to the authorization of appropriations under subsection (a) for a fiscal year (other than amounts made available for assistance to eliminate school fees and other costs of education pursuant to section 246) shall be provided through United States or indigenous private voluntary organizations that implement programs on the community level. Amounts provided by for-profit entities to not-for-profit entities from assistance under this title shall not be considered for purposes of satisfying the requirement of this paragraph.

`(3) Assistance under other provisions of law-

`(A) IN GENERAL- Notwithstanding any other provision of law, amounts made available for assistance for orphans or other vulnerable children in developing countries under any provision of law other than this title may be provided to further the purposes of this title.

`(B) Report- To the extent assistance described in subparagraph (A) is provided in accordance with such subparagraph, the President shall include, as part of the report required under section 250, a detailed description of such assistance and, to the extent applicable, the information required by subsection (b)(1)(A) of such section with respect to such assistance.

`(4) ADMINISTRATIVE EXPENSES- Notwithstanding any other provision of law, amounts made available for assistance for orphans or other vulnerable children in developing countries under this title, or under any provision of law other than this title, may be made available for administrative expenses incurred in carrying out this title for a fiscal year in an amount not to exceed 7 percent of amounts made available for such fiscal year for such purpose under this title, or under such other provision of law, as the case may be.

`SEC. 252. DEFINITIONS.

`In this title:

`(1) AIDS- The term `AIDS' has the meaning given the term in section 104A(g)(1) of this Act.

`(2) Children- The term `children' means persons who have not attained the age of 18.

`(3) HIV- The term `HIV' has the meaning given the term in section 104A(g)(2) of this Act.

`(4) HIV/AIDS- The term `HIV/AIDS' has the meaning given the term in section 104A(g)(3) of this Act.

`(5) Orphan- The term `orphan' means a child deprived by death of one or both parents.

`(6) PSYCHOSOCIAL SUPPORT- The term `psychosocial support' includes care that addresses the ongoing psychological and social problems that affect individuals, their partners, families, and caregivers in order to alleviate suffering, strengthen social ties and integration, provide emotional support, and promote coping strategies.

`(7) Vulnerable children- The term `vulnerable children' includes children who are neglected, destitute, abandoned, homeless, disabled, suffering from malnutrition, are sexually exploited or abused, or are displaced or otherwise adversely affected by armed conflict.'.

END