The House passed a $15 billion bill that would more than double U.S. contributions to the worldwide fight against AIDS.
Supporters, led by President Bush, said the money could bring relief to millions of people with AIDS and prevent the deadly disease from infecting millions more.
"It sends a message to the world that the United States will not sit idly by and allow AIDS to wreak havoc," said Rep. Barbara Lee, D-Calif.
The House passed the legislation by a 375-41 vote after lawmakers approved an amendment assuring that one-third of the money for AIDS prevention would go to sexual abstinence programs.
The president's conservative allies had insisted that abstinence get a prominent role in the AIDS effort.
The five-year spending plan is aimed specifically at sub-Saharan Africa, home to 30 million of the world's 42 million AIDS sufferers, and the Caribbean. The United States this year is spending about $1.2 billion on international AIDS efforts.
"Not since the bubonic plague swept across the world in the last millennium, killing more than 250 million people, has our world confronted such a horrible, unspeakable curse as we are now witnessing with the growing HIV/AIDS pandemic," said Rep. Henry Hyde, chairman of the House International Relations Committee.
"So much of what we do is really unimportant and trivial, but not today," said Hyde, R-Ill., chief sponsor of the measure with Rep. Tom Lantos, D-Calif.
Senate Majority Leader Bill Frist, R-Tenn., has pledged to act quickly on a Senate bill with the goal of getting legislation to the president by the end of the month.
Bush, in his State of the Union address in January, challenged Congress to come up with the significant increase in America's financial contribution to the fight against AIDS.
"We are doing probably the greatest thing that we have done since I have been in Congress," said Rep. Donald Payne, an eight-term Democrat from New Jersey.
DATA (Debt, AIDS, Trade, Africa), an advocacy group founded by the rock star Bono, said the bill would prevent 7 million new infections, provide care for 10 million HIV-infected individuals and AIDS orphans, and give antiretroviral therapy for 2 million.
But the bill also had its critics. Conservatives demanded stronger language to promote abstinence and monogamy as the best ways to prevent AIDS. They also sought language protecting religious groups that object to the distribution of condoms in their anti-AIDS programs.
The House approved, 220-197, an amendment by Rep. Joe Pitts, R-Pa., requiring that one-third of funds spent on prevention go to abstinence programs. "It's important that we not just send them money, but we send them values that work," said Rep. Mike Pence, R-Ind., a supporter of Pitts' proposal.
The legislation recommends that 20 percent of the aid for other countries go to prevention, with 55 percent for treatment programs, 15 percent for palliative care and 10 percent for orphans.
Prevention programs are modeled after the "ABC" approach that has achieved some success in Uganda. The model stresses "A" for abstinence, "B" for being faithful and "C" for condom use when appropriate.
The White House said in a statement that it supported language that would "prioritize the abstinence component of the ABC approach."
Critics contended that the Uganda model was successful because all three approaches were given equal importance. Uganda, while stressing abstinence and monogamy, has also been distributing 80 million condoms a year, Lantos said. "Countless lives will be lost if we fail to learn this lesson," he said.
Kate Carr, president of the Elizabeth Glaser Pediatric AIDS Foundation, said prevention programs are most effective "when they have the flexibility to match strategies to the specific needs of each community." Requiring that 33 percent go to abstinence was "compromising the effectiveness of the overall effort."
The House approved an amendment by Rep. Christopher Smith, R-N.J., to strengthen protections for religious groups. Smith and others noted that Catholic groups, which object to condom distribution, care for one-fourth of AIDS victims worldwide.
Conservatives balked at increased support for the recently established international Global Fund to Fight AIDS, Tuberculosis and Malaria, saying it lacked accountability and effectiveness.
The president asked for $200 million a year for the fund; the legislation allows, but does not require, the contribution of up to $1 billion to the fund in 2004. Hyde said his bill increases monitoring of the fund and limits the U.S. contribution to 33 percent of total donations.
The actual spending of money authorized by the bill must still be approved by the Appropriations committees responsible for annual budgets. Appropriators pointed out that Bush asked for only $1.7 billion for global AIDS in his 2004 budget proposal, and that it will not be easy to find the rest of the money.
American organizations that provide assistance and medications to poor and low-income HIV patients applaud the global measure, but are also calling for more help from the government.
A new report by The Henry J. Kaiser Foundation, The National Alliance of State and Territorial AIDS Directors and the AIDS Treatment Data Network suggests that state AIDS drug assistance programs are in danger of not being able to provide medications to all those who needs it.
Jennifer Kates, Director of HIV Policy for the Kaiser Family Foundation said, "These are the programs that provide medications to people with HIV who have no other coverage, or because they have limits in their coverage, or can't get their treatments anywhere else.
"One of the challenges of this program," she said, "because it's not an entitlement program, is that it's not necessarily the case that it's going to make enough funds available for everyone who needs them, and these are expensive drugs.
"Put on top of that, we're in the midst of a major fiscal crisis at the state level, so even states that have been generous in the past… are looking at cuts as well," Kates said.
Sixteen states have restrictions to their ADAP program because of a lack of funds, according to Kates. She said AIDS drugs cost patients about $10,000 to $12,000 a year.
By Jim Abrams