II 

113TH CONGRESS 

1ST SESSION S. 1545 

To extend authorities related to global HIV/AIDS and to promote oversight 

of United States programs. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 24, 2013 

Mr. MENENDEZ (for himself and Mr. CORKER) introduced the following bill; 

which was read twice and referred to the Committee on Foreign Relations 

A BILL 

To extend authorities related to global HIV/AIDS and to 

promote oversight of United States programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘PEPFAR Stewardship 

5 and Oversight Act of 2013’’. 

6 SEC. 2. INSPECTOR GENERAL OVERSIGHT. 

7 Section 101(f)(1) of the United States Leadership 

8 Against HIV/AIDS, Tuberculosis, and Malaria Act of 

9 2003 (22 U.S.C. 7611(f)(1)) is amended— 


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1 (1) in subparagraph (A), by striking ‘‘5 coordi2 nated annual plans for oversight activity in each of 

3 the fiscal years 2009 through 2013’’ and inserting 

4 ‘‘coordinated annual plans for oversight activity in 

5 each of the fiscal years 2009 through 2018’’; and 

6 (2) in subparagraph (C)— 

7 (A) in clause (ii)— 

8 (i) in the heading, by striking ‘‘SUB9 SEQUENT’’ and inserting ‘‘2010 THROUGH

10 2013’’; and 

11 (ii) by striking ‘‘the last four plans’’ 

12 and inserting ‘‘the plans for fiscal years 

13 2010 through 2013’’; and 

14 (B) by adding at the end the following new 

15 clause: 

16 ‘‘(iii) 2014 PLAN.—The plan devel17 oped under subparagraph (A) for fiscal 

18 year 2014 shall be completed not later 

19 than 60 days after the date of the enact20 ment of the PEPFAR Stewardship and 

21 Oversight Act of 2013. 

22 ‘‘(iv) SUBSEQUENT PLANS.—Each of 

23 the last four plans developed under sub24 paragraph (A) shall be completed not later 


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1 than 30 days before each of the fiscal 

2 years 2015 through 2018, respectively.’’. 

3 SEC. 3. ANNUAL TREATMENT STUDY. 

4 (a) ANNUAL STUDY; MESSAGE.—Section 101(g) of 

5 the United States Leadership Against HIV/AIDS, Tuber6 culosis, and Malaria Act of 2003 (22 U.S.C. 7611(g)) is 

7 amended— 

8 (1) in paragraph (1), by striking ‘‘through Sep9 tember 30, 2013’’ and inserting ‘‘through September 

10 30, 2019’’; 

11 (2) by redesignating paragraph (2) as para12 graph (3); 

13 (3) by inserting after paragraph (1) the fol14 lowing new paragraph: 

15 ‘‘(2) 2013 THROUGH 2018 STUDIES.—The stud16 ies required to be submitted by September 30, 2014, 

17 and annually thereafter through September 30, 

18 2018, shall include, in addition to the elements set 

19 forth under paragraph (1), the following elements: 

20 ‘‘(A) A plan for conducting cost studies of 

21 United States assistance under section 104A of 

22 the Foreign Assistance Act of 1961 (22 U.S.C. 

23 2151b–2) in partner countries, taking into ac24 count the goal for more systematic collection of 


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1 data, as well as the demands of such analysis 

2 on available human and fiscal resources. 

3 ‘‘(B) A comprehensive and harmonized ex4 penditure analysis by partner country, includ5 ing— 

6 ‘‘(i) an analysis of Global Fund and 

7 national partner spending and comparable 

8 data across United States, Global Fund, 

9 and national partner spending; or 

10 ‘‘(ii) where providing such comparable 

11 data is not currently practicable, an expla12 nation of why it is not currently prac13 ticable, and when it will be practicable.’’; 

14 and 

15 (4) by adding at the end the following new 

16 paragraph: 

17 ‘‘(4) PARTNER COUNTRY DEFINED.—In this 

18 subsection, the term ‘partner country’ means a coun19 try with a minimum United States Government in20 vestment of HIV/AIDS assistance of at least 

21 $5,000,000 annually.’’. 


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1 SEC. 4. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 

2 AIDS, TUBERCULOSIS, AND MALARIA. 

3 (a) LIMITATION.—Section 202(d)(4) of the United 

4 States Leadership Against HIV/AIDS, Tuberculosis, and 

5 Malaria Act of 2003 (22 U.S.C. 7622(d)(4)) is amended— 

6 (1) in subparagraph (A)— 

7 (A) in clause (i), by striking ‘‘2013’’ and 

8 inserting ‘‘2018’’; 

9 (B) in clause (ii)— 

10 (i) by striking ‘‘2013’’ and inserting 

11 ‘‘2018’’; and 

12 (ii) by striking the last two sentences; 

13 and 

14 (C) in clause (vi), by striking ‘‘2013’’ and 

15 inserting ‘‘2018’’; and 

16 (2) in subparagraph (B)— 

17 (A) by striking ‘‘under this subsection’’ 

18 each place it appears; 

19 (B) in clause (ii), by striking ‘‘pursuant to 

20 the authorization of appropriations under sec21 tion 401’’ and inserting ‘‘to carry out section 

22 104A of the Foreign Assistance Act of 1961’’; 

23 and 

24 (C) in clause (iv), by striking ‘‘2013’’ and 

25 inserting ‘‘2018’’. 


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1 (b) WITHHOLDING FUNDS.—Section 202(d)(5) of the 

2 United States Leadership Against HIV/AIDS, Tuber3 culosis, and Malaria Act of 2003 (22 U.S.C. 7622(d)) is 

4 amended by— 

5 (1) in paragraph (5)— 

6 (A) by striking ‘‘2013’’ and inserting 

7 ‘‘2018’’; 

8 (B) in subparagraph (C)— 

9 (i) by inserting ‘‘in an open, machine 

10 readable format’’ after ‘‘site’’; 

11 (ii) by amending clause (v) to read as 

12 follows: 

13 ‘‘(v) a regular collection, analysis, and 

14 reporting of performance data and funding 

15 of grants of the Global Fund, which covers 

16 all principal recipients and all subrecipi17 ents on the fiscal cycle of each grant, and 

18 includes the distribution of resources, by 

19 grant and principal recipient and sub20 recipient, for prevention, care, treatment, 

21 drugs, and commodities purchase, and 

22 other purposes as practicable;’’; 

23 (C) in subparagraph (D)(ii), by inserting 

24 ‘‘, in an open, machine readable format,’’ after 

25 ‘‘audits’’; 


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1 (D) in subparagraph (E), by inserting ‘‘, 

2 in an open, machine readable format,’’ after 

3 ‘‘publicly’’; 

4 (E) in subparagraph (F)— 

5 (i) in clause (i), by striking ‘‘; and’’ 

6 and inserting a semicolon; and 

7 (ii) by striking clause (ii) and insert8 ing the following new clauses: 

9 ‘‘(ii) all principal recipients and sub10 recipients and the amount of funds dis11 bursed to each principal recipient and sub12 recipient on the fiscal cycle of the grant; 

13 ‘‘(iii) expenditure data— 

14 ‘‘(I) tracked by principal recipi15 ents and subrecipients by prevention, 

16 care, and treatment as practicable and 

17 reported in a format that allows com18 parison with other funding streams in 

19 each country; or 

20 ‘‘(II) if such expenditure data is 

21 not available, outlay or disbursement 

22 data, and an explanation of progress 

23 made toward providing such expendi24 ture data; and 


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1 ‘‘(iv) high-quality grant performance 

2 evaluations measuring inputs, outputs, and 

3 outcomes, as appropriate, with the goal of 

4 achieving outcome reporting;’’; and 

5 (F) by amending subparagraph (G) to read 

6 as follows: 

7 ‘‘(G) has published an annual report on a 

8 publicly available Web site in an open, machine 

9 readable format, that includes— 

10 ‘‘(i) a list of all countries imposing 

11 import duties and internal taxes on any 

12 goods or services financed by the Global 

13 Fund; 

14 ‘‘(ii) a description of the types of 

15 goods or services on which the import du16 ties and internal taxes are levied; 

17 ‘‘(iii) the total cost of the import du18 ties and internal taxes; 

19 ‘‘(iv) recovered import duties or inter20 nal taxes; and 

21 ‘‘(v) the status of country status22 agreements;’’. 


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1 SEC. 5. ANNUAL REPORT. 

2 Section 104A(f) of the Foreign Assistance Act of 

3 1961 (22 U.S.C. 2151b–2(f)) is amended to read as fol4 lows: 

5 ‘‘(f) ANNUAL REPORT.— 

6 ‘‘(1) IN GENERAL.—Not later than February 

7 15, 2014, and annually thereafter, the President 

8 shall submit to the Committee on Foreign Relations 

9 of the Senate and the Committee on Foreign Affairs 

10 of the House of Representatives a report in an open, 

11 machine readable format, on the implementation of 

12 this section for the prior fiscal year. 

13 ‘‘(2) REPORT ELEMENTS.—Each report sub14 mitted after February 15, 2014, shall include the 

15 following: 

16 ‘‘(A) A description based on internationally 

17 available data, and where practicable high-qual18 ity country-based data, of the total global bur19 den and need for HIV/AIDS prevention, treat20 ment, and care, including— 

21 ‘‘(i) estimates by partner country of 

22 the global burden and need; and 

23 ‘‘(ii) HIV incidence, prevalence, and 

24 AIDS deaths for the reporting period. 


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1 ‘‘(B) Reporting on annual targets across 

2 prevention, treatment, and care interventions in 

3 partner countries, including— 

4 ‘‘(i) a description of how those targets 

5 are designed to— 

6 ‘‘(I) ensure that the annual in7 crease in new patients on 

8 antiretroviral treatment exceeds the 

9 number of annual new HIV infections; 

10 ‘‘(II) reduce the number of new 

11 HIV infections below the number of 

12 deaths among persons infected with 

13 HIV; and 

14 ‘‘(III) achieve an AIDS-free gen15 eration; 

16 ‘‘(ii) national targets across preven17 tion, treatment, and care that are— 

18 ‘‘(I) established by partner coun19 tries; or 

20 ‘‘(II) where such national partner 

21 country-developed targets are unavail22 able, a description of progress towards 

23 developing national partner country 

24 targets; and 


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1 ‘‘(iii) bilateral programmatic targets 

2 across prevention, treatment, and care, in3 cluding— 

4 ‘‘(I) the number of adults and 

5 children to be directly supported on 

6 HIV treatment under United States7 funded programs; 

8 ‘‘(II) the number of adults and 

9 children to be otherwise supported on 

10 HIV treatment under United States11 funded programs; and 

12 ‘‘(III) other programmatic tar13 gets for activities directly and other14 wise supported by United States-fund15 ed programs. 

16 ‘‘(C) A description, by country, of HIV/ 

17 AIDS funding from all sources, including fund18 ing levels from partner countries, other donors, 

19 and the private sector, as practicable. 

20 ‘‘(D) A description of how United States21 funded programs, in conjunction with the Glob22 al Fund, other donors, and partner countries, 

23 together set targets, measure progress, and 

24 achieve positive outcomes in partner countries. 


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1 ‘‘(E) An annual assessment of outcome in2 dicator development, dissemination, and per3 formance for programs supported under this 

4 section, including ongoing corrective actions to 

5 improve reporting. 

6 ‘‘(F) A description and explanation of 

7 changes in related guidance or policies related 

8 to implementation of programs supported under 

9 this section. 

10 ‘‘(G) An assessment and quantification of 

11 progress over the reporting period toward 

12 achieving the targets set forth in subparagraph 

13 (B), including— 

14 ‘‘(i) the number, by country, of per15 sons on HIV treatment, including specifi16 cally— 

17 ‘‘(I) the number of adults and 

18 children on HIV treatment directly 

19 supported by United States-funded 

20 programs; and 

21 ‘‘(II) the number of adults and 

22 children on HIV treatment otherwise 

23 supported by United States-funded 

24 programs; 


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1 ‘‘(ii) HIV treatment coverage rates by 

2 country; 

3 ‘‘(iii) the net increase in persons on 

4 HIV treatment by country; 

5 ‘‘(iv) new infections of HIV by coun6 try; 

7 ‘‘(v) the number of HIV infections 

8 averted; 

9 ‘‘(vi) antiretroviral treatment program 

10 retention rates by country, including— 

11 ‘‘(I) performance against annual 

12 targets for program retention; and 

13 ‘‘(II) the retention rate of per14 sons on HIV treatment directly sup15 ported by United States-funded pro16 grams; and 

17 ‘‘(vii) a description of supportive care, 

18 including management of co-morbidities. 

19 ‘‘(H) A description of national and United 

20 States-funded HIV/AIDS prevention programs 

21 and policies, including— 

22 ‘‘(i) an assessment by country of 

23 progress towards targets set forth in sub24 paragraph (B), with a detailed description 

25 of the metrics used to assess— 


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1 ‘‘(I) programs to prevent mother 

2 to child transmission of HIV/AIDS, 

3 including coverage rates; 

4 ‘‘(II) programs to provide or pro5 mote voluntary medical male circumci6 sion, including coverage rates; 

7 ‘‘(III) programs for behavior8 change; and 

9 ‘‘(IV) other programmatic activi10 ties to prevent the transmission of 

11 HIV; 

12 ‘‘(ii) antiretroviral treatment as pre13 vention; and 

14 ‘‘(iii) a description of any new pre15 ventative interventions or methodologies. 

16 ‘‘(I) A description of the goals, scope, and 

17 measurement of program efforts aimed at 

18 women and girls. 

19 ‘‘(J) A description of the goals, scope, and 

20 measurement of program efforts aimed at or21 phans, vulnerable children, and youth. 

22 ‘‘(K) A description of the indicators and 

23 milestones used to assess effective, strategic, 

24 and appropriately timed country ownership, in25 cluding— 


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1 ‘‘(i) an explanation of the metrics 

2 used to determine whether the pace of any 

3 transition to such ownership is appropriate 

4 for that country, given that country’s level 

5 of readiness for such transition; 

6 ‘‘(ii) an analysis of governmental and 

7 local nongovernmental capacity to sustain 

8 positive outcomes; 

9 ‘‘(iii) a description of measures taken 

10 to improve partner country capacity to sus11 tain positive outcomes where needed; and 

12 ‘‘(iv) for countries undergoing a tran13 sition to greater country ownership, a de14 scription of strategies to assess and miti15 gate programmatic and financial risk and 

16 to ensure continued quality of care for es17 sential services. 

18 ‘‘(L) A description, globally and by coun19 try, of specific efforts to achieve and incentivize 

20 greater programmatic and cost effectiveness, in21 cluding— 

22 ‘‘(i) progress toward establishing com23 mon economic metrics across prevention, 

24 care and treatment with partner counties 

25 and the Global Fund; 


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1 ‘‘(ii) average costs, by country and by 

2 core intervention; 

3 ‘‘(iii) expenditure reporting in all pro4 gram areas, supplemented with targeted 

5 analyses of the cost-effectiveness of specific 

6 interventions; and 

7 ‘‘(iv) import duties and internal taxes 

8 imposed on program commodities and serv9 ices, by country. 

10 ‘‘(M) A description of partnership frame11 work agreements with countries, and regions 

12 where applicable, including— 

13 ‘‘(i) the objectives and structure of 

14 partnership framework agreements with 

15 countries, including— 

16 ‘‘(I) how these agreements are 

17 aligned with national HIV/AIDS plans 

18 and public health strategies and com19 mitments of such countries; and 

20 ‘‘(II) how these agreements in21 corporate a role for civil society; and 

22 ‘‘(ii) a description of what has been 

23 learned in advancing partnership frame24 work agreements with countries, and re25 gions as applicable, in terms of improved 


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1 coordination and collaboration, definition 

2 of clear roles and responsibilities of partici3 pants and signers, and implications for 

4 how to further strengthen these agree5 ments with mutually accountable measures 

6 of progress. 

7 ‘‘(N) A description of efforts and activities 

8 to engage new partners, including faith-based, 

9 community-based, and United States minority10 serving institutions. 

11 ‘‘(O) A definition and description of the 

12 differentiation between directly and otherwise 

13 supported activities, including specific efforts to 

14 clarify programmatic attribution and contribu15 tion, as well as timelines for dissemination and 

16 implementation. 

17 ‘‘(3) PARTNER COUNTRY DEFINED.—In this 

18 subsection, the term ‘partner country’ means a coun19 try with a minimum United States Government in20 vestment of HIV/AIDS assistance of at least 

21 $5,000,000 annually.’’. 

22 SEC. 6. ALLOCATION OF FUNDING. 

23 (a) ORPHANS AND VULNERABLE CHILDREN.—Sec24 tion 403(b) of the United States Leadership Against HIV/ 


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1 AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 

2 7673(b)) is amended— 

3 (1) by striking ‘‘2013’’ and inserting ‘‘2018’’; 

4 and 

5 (2) by striking ‘‘amounts appropriated pursuant 

6 to the authorization of appropriations under section 

7 401’’ and inserting ‘‘amounts appropriated or other8 wise made available to carry out the provisions of 

9 section 104A of the Foreign Assistance Act of 1961 

10 (22 U.S.C. 2151b–2)’’. 

11 (b) FUNDING ALLOCATION.—Section 403(c) of the 

12 United States Leadership Against HIV/AIDS, Tuber13 culosis, and Malaria Act of 2003 (22 U.S.C. 7673(c)) is 

14 amended— 

15 (1) by striking ‘‘2013’’ and inserting ‘‘2018’’; 

16 and 

17 (2) by striking ‘‘amounts appropriated for bilat18 eral global HIV/AIDS assistance pursuant to section 

19 401’’ and inserting ‘‘amounts appropriated or other20 wise made available to carry out the provisions of 

21 section 104A of the Foreign Assistance Act of 1961 

22 (22 U.S.C. 2151b–2)’’. 

Æ 


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