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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3117 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 3117

  To bring an end to the spread of HIV/AIDS in the United States and 
                           around the world.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 17, 2013

Ms. Lee of California introduced the following bill; which was referred 
 to the Committee on Foreign Affairs, and in addition to the Committee 
 on Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
  To bring an end to the spread of HIV/AIDS in the United States and 
                           around the world.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Ending the HIV/
AIDS Epidemic Act of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Statement of policy.
Sec. 3. Findings.
           TITLE I--GLOBAL HIV/AIDS-FREE GENERATION STRATEGY

Sec. 101. Global HIV/AIDS-Free Generation Strategy.
        TITLE II--USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS

Sec. 201. Support for operations research to improve program delivery, 
                            efficiency, impact, and effectiveness.
Sec. 202. Increasing coordination and integration of HIV/AIDS programs 
                            with development programs.
Sec. 203. Increasing program effectiveness and sustainability to 
                            achieve successful country ownership.
  TITLE III--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH 
                                  CARE

                     Subtitle A--General Provisions

Sec. 301. Support for laws and regulations that improve health outcomes 
                            and promote human rights.
Sec. 302. Intensifying efforts to establish effective programs for 
                            engaging key affected populations.
Sec. 303. Ensuring United States trade policy does not restrict access 
                            to affordable medicines.
     Subtitle B--Repeal of Certain Provisions of Public Law 108-25

Sec. 311. Repeal of ``conscience clause'' requirement for eligibility 
                            for assistance.
Sec. 312. Repeal of limitation on use of funds for assistance for sex 
                            workers.
Sec. 313. Repeal of reporting requirement on activities promoting 
                            abstinence and related activities.
Sec. 314. Effective date.
                         TITLE IV--DEFINITIONS

Sec. 401. Definitions.

SEC. 2. STATEMENT OF POLICY.

    It is the policy of the United States to achieve an AIDS-free 
generation, and to--
            (1) expand access to lifesaving antiretroviral therapy for 
        people living with HIV/AIDS and immediately link people to 
        continuous and coordinated high-quality care when they learn 
        they are infected with HIV;
            (2) expand targeted efforts to prevent HIV infection using 
        a combination of effective, evidence-based approaches, 
        including the elimination of new pediatric HIV infections 
        worldwide, routine HIV screening, and universal access to HIV 
        prevention tools in the communities where HIV/AIDS is most 
        heavily concentrated;
            (3) ensure laws, policies, and regulations do not impede 
        access to prevention, treatment, and care for people living 
        with HIV/AIDS or at risk for acquiring HIV;
            (4) accelerate research for more efficacious HIV prevention 
        and treatments tools, a cure, and a vaccine; and
            (5) respect the human rights and dignity of persons living 
        with HIV/AIDS.

SEC. 3. FINDINGS.

    The Congress makes the following findings:
            (1) An estimated 34,000,000 people around the world were 
        living with HIV at the end of 2010, up from 8,000,000 in 1990.
            (2) Developing countries continue to bear the brunt of the 
        HIV/AIDS epidemic, with sub-Saharan Africa accounting for 68 
        percent of all adults and children living with HIV/AIDS, 59 
        percent of whom are female.
            (3) Despite global efforts, 1,000 children around the world 
        still contract HIV each day, the majority through mother-to-
        child transmission of HIV.
            (4) HIV prevalence among young people aged 15 to 24 has 
        declined in many countries most impacted by HIV; nevertheless, 
        young people still account for 42 percent of all new infections 
        among individuals aged 15 and older.
            (5) A substantial number of HIV-positive women in HIV care 
        and treatment programs or prevention of mother-to-child 
        transmission (PMTCT) programs experience an unplanned 
        pregnancy.
            (6) Making contraceptive services more widely available 
        through HIV care, treatment, and PMTCT programs would make it 
        easier for women to coordinate their HIV-related care with 
        their pregnancy prevention goals, and at the same time, help 
        prevent mother-to-child HIV transmission.
            (7) In 2008, the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act was enacted into law, reauthorizing the 
        President's Emergency Plan for AIDS Relief (PEPFAR) and 
        continued United States participation and contributions to the 
        Global Fund to Fight AIDS, Tuberculosis and Malaria.
            (8) The United States President's Emergency Plan for AIDS 
        Relief (PEPFAR), which represents the largest commitment by any 
        nation to combat a single disease, has saved the lives of 
        millions of people around the world by establishing and 
        expanding the infrastructure necessary to deliver prevention, 
        care, and treatment services in low-resource settings.
            (9) Early detection and treatment of HIV can have 
        significant positive health effects. New research demonstrates 
        conclusively that treatment of individuals not only slows 
        disease progression, but can also reduce the risk of 
        transmission to other individuals by 96 percent.
            (10) In most countries HIV is a disease that discriminates, 
        disproportionately affecting society's most vulnerable. Even in 
        generalized epidemics in which a significant share of the wider 
        population is living with HIV/AIDS, people in vulnerable 
        communities often have considerably higher rates of HIV 
        infection.
            (11) Reaching men who have sex with men, transgender 
        people, people who inject drugs, sex workers, and other 
        vulnerable populations with effective HIV prevention and 
        treatment is critical to bringing the AIDS epidemic under 
        control.
            (12) In February 2013, the Institute of Medicine releases a 
        report evaluating PEPFAR and found that PEPFAR, which has 
        provided care and treatment for more than 5 million people, has 
        been ``globally transformative'', a ``lifeline'' that is 
        ``restoring hope''.

           TITLE I--GLOBAL HIV/AIDS-FREE GENERATION STRATEGY

SEC. 101. GLOBAL HIV/AIDS-FREE GENERATION STRATEGY.

    (a) Strategy.--The President, acting through the Coordinator of 
United States Government Activities to Combat HIV/AIDS Globally, shall 
establish a comprehensive, integrated, 5-year strategy to expand and 
improve efforts to combat global HIV/AIDS, while promoting efficiency 
and maximizing results. The strategy shall be referred to as the 
``Global HIV/AIDS-Free Generation Strategy''.
    (b) Contents.--The strategy shall--
            (1) accelerate progress toward achieving the United States 
        goal of an AIDS-free generation;
            (2) establish a limited number of measurable targets to 
        accelerate reductions in HIV incidence and HIV/AIDS-related 
        morbidity and mortality;
            (3) strengthen existing and future compacts and framework 
        agreements authorized under section 104A(d)(8) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2151b-2(d)(8));
            (4) strengthen engagement with diplomatic efforts at all 
        levels of government to--
                    (A) continue to identify and promote linkages 
                between efforts to combat HIV/AIDS and other health 
                development issues and human rights issues;
                    (B) encourage and assist national governments to 
                pursue policies and legal frameworks that facilitate 
                and enable effective responses to HIV prevention, care, 
                and treatment services; and
                    (C) increase financial accountability; and
            (5) provide a plan to--
                    (A) support early diagnosis and initiation of HIV 
                treatment to achieve accelerated reductions of 
                incidence and morbidity;
                    (B) eliminate vertical transmission of HIV from 
                mother to child and support early diagnosis and 
                initiation of HIV treatment in infants and children;
                    (C) intensify efforts to expand access to 
                voluntarily medical male circumcision, male and female 
                condoms and other proven-effective HIV prevention 
                interventions, in combination with other evidence-based 
                modalities and structural interventions;
                    (D) reduce the risk of HIV infection and address 
                the HIV-related needs of sex workers, men who have sex 
                with men, transgender people, and people who inject 
                drugs;
                    (E) increase gender equity in HIV/AIDS programs and 
                services, including access to voluntary family planning 
                and reproductive health services and reducing violence 
                and coercion;
                    (F) expand partnership with implementers, 
                researchers, and academic organizations to improve the 
                science that guides the global response to HIV/AIDS;
                    (G) provide capacity development support to 
                increase meaningful engagement of civil society, 
                especially local indigenous organizations, that work in 
                the areas of human rights, women's and young people's 
                health and rights, and gay, lesbian, bisexual, and 
                transgender rights, in the development, implementation, 
                monitoring, and evaluation of United States-funded 
                programs;
                    (H) advance the efforts of developing countries to 
                develop health systems capable of managing their 
                epidemics, respond to broader health needs impacting 
                affected communities, and address new and emerging 
                health concerns; and
                    (I) defend, protect, and fulfill the human rights 
                of people living with HIV and those most at risk of HIV 
                infection.
    (c) Consultation.--In developing the strategy, the President, 
acting through the Coordinator of United States Government Activities 
to Combat HIV/AIDS Globally, shall consult with--
            (1) each executive branch agency administering United 
        States foreign assistance related to--
                    (A) improving global health;
                    (B) strengthening financial management systems; and
                    (C) monitoring and promoting human rights and 
                democracy;
            (2) personnel at United States embassies and country 
        missions involved in the administration of the types of United 
        States foreign assistance described in paragraph (1);
            (3) the appropriate congressional committees with 
        jurisdiction over the agencies described in paragraph (1);
            (4) civil society and nongovernmental organizations engaged 
        in improving health care and health outcomes in developing 
        countries, including indigenous community and faith-based 
        organizations;
            (5) international organizations engaged in improving health 
        care and health outcomes in developing countries and of which 
        the United States is a voting member, with which the United 
        States coordinates the delivery of foreign assistance, or to 
        which the United States contributes funding for the purpose of 
        providing such assistance;
            (6) academic organizations, private foundations, 
        businesses, and other organizations engaged in improving health 
        care and health outcomes in developing countries and not 
        receiving United States funding for such purposes;
            (7) other donor nations engaged in improving health care 
        and health outcomes in developing countries;
            (8) countries receiving health-related United States 
        foreign assistance;
            (9) any other global, regional, or subregional 
        organizations or partnerships engaged in improving health care 
        and health outcomes in developing countries; and
            (10) small, disadvantaged, and women-owned businesses and 
        United States minority-serving institutions, specifically 
        historically Black colleges and universities.
    (d) Report.--Not later than 1 year after the date of the enactment 
of this Act, the President shall submit to Congress a report that sets 
forth the strategy described in this section.

        TITLE II--USING FUNDS STRATEGICALLY TO MAXIMIZE RESULTS

SEC. 201. SUPPORT FOR OPERATIONS RESEARCH TO IMPROVE PROGRAM DELIVERY, 
              EFFICIENCY, IMPACT, AND EFFECTIVENESS.

    (a) Sense of Congress.--It is the sense of the Congress that there 
is a need and urgency to expand the range of interventions for 
preventing the transmission of HIV, including behavioral prevention 
research, operations research to optimize combination HIV prevention, 
and research on medical technology to prevent HIV infection, including 
microbicides, cost-effective female condoms, Pre-Exposure Prophylaxis 
(PrEP), multipurpose technologies for the prevention of HIV and 
unintended pregnancy, and vaccines.
    (b) Statement of Policy.--It should be the policy of the United 
States to ensure that efforts to combat HIV/AIDS globally should 
expand, intensify, and coordinate operations research to improve the 
quality, delivery, and impact of programming, including with respect 
to--
            (1) services appropriate for men who have sex with men, 
        transgender people, people who inject drugs, and sex workers;
            (2) structural interventions to remove barriers that 
        inhibit effective implementation of HIV/AIDS-related foreign 
        assistance, including the analysis of laws and policies that 
        have a negative health impact and put individuals at increased 
        risk of HIV infection;
            (3) scalable combination of prevention and treatment 
        approaches to HIV/AIDS;
            (4) prevention and management of co-morbidities such as 
        tuberculosis, malaria, and viral hepatitis; and
            (5) identification and follow up of HIV-positive infants 
        and children in resource-limited settings to increase the 
        proportion of children accessing HIV treatment and care 
        services.

SEC. 202. INCREASING COORDINATION AND INTEGRATION OF HIV/AIDS PROGRAMS 
              WITH DEVELOPMENT PROGRAMS.

    (a) Statement of Policy.--It should be the policy of the United 
States to ensure that efforts to combat HIV/AIDS globally should 
maximize efficiencies and the integration of services and programs to 
achieve reduction in HIV transmission rates and the burden of HIV-
related morbidity and mortality, by means that include--
            (1) ensuring that women and adolescent girls with HIV or 
        who are at risk of HIV infection and who do not wish to become 
        pregnant have access to voluntary contraceptive services, 
        including a range of contraceptive options, and voluntary 
        counseling to plan families, either directly or through 
        meaningful referrals to existing United States Agency for 
        International Development or local family planning programs 
        that provide counseling and a range of contraceptive options;
            (2) integrating tuberculosis interventions with HIV 
        services, including case-finding and tuberculosis treatment, 
        expanding tuberculosis preventive therapy, and reducing other 
        opportunistic infections that accompany HIV/AIDS;
            (3) ensuring young people with HIV are provided with 
        confidential and affordable access to youth-friendly 
        comprehensive sexual and reproductive health services and 
        supplies, including male and female condoms for the prevention 
        of pregnancy and sexually transmitted diseases, as relevant; 
        and
            (4) working to promote and protect the human rights of 
        people living with HIV, including men who have sex with men, 
        transgender people, people who inject drugs, sex workers, and 
        other vulnerable populations, including indigenous people, 
        migrants, internally displaced people, young people, 
        incarcerated populations, and people with disabilities.
    (b) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of State shall submit to the 
appropriate congressional committees a report describing the 
utilization of efficiencies in the delivery of HIV/AIDS treatment 
services within and between United States-funded bilateral and 
multilateral programs and partner countries, including to the extent 
that such gains in efficiencies are being exhausted.

SEC. 203. INCREASING PROGRAM EFFECTIVENESS AND SUSTAINABILITY TO 
              ACHIEVE SUCCESSFUL COUNTRY OWNERSHIP.

    (a) Statement of Policy.--It should be the policy of the United 
States to ensure that efforts to combat HIV/AIDS globally should help 
developing countries significantly decrease the burden of HIV, 
strengthen and improve their health systems, help build country 
ownership, and increase financial accountability to ensure 
sustainability and equitable access to health services, including by--
            (1) assisting developing countries create, strengthen, and 
        implement their own evidence-based national HIV/AIDS 
        strategies, by means that include--
                    (A) supporting early diagnosis and initiation of 
                HIV and tuberculosis treatment to achieve accelerated 
                reductions of incidence and morbidity;
                    (B) eliminating the vertical transmission of HIV 
                from mother to child and supporting early diagnosis and 
                initiation of HIV treatment in infants and children;
                    (C) intensifying efforts to expand access to 
                voluntary medical male circumcision, male and female 
                condoms, harm reduction services, and other proven-
                effective HIV prevention interventions, in combination 
                with other evidence-based modalities, including 
                structural interventions;
                    (D) intensifying efforts to eliminate HIV 
                infections among populations that are often at greatest 
                risk, including sex workers, men who have sex with men, 
                transgender individuals, and people who inject drugs, 
                and addressing the HIV-related needs, including access 
                to ART, of those already infected;
                    (E) ensuring young people are provided with 
                comprehensive knowledge, skill-building programs, in 
                and out of school, to make informed and responsible 
                decisions for their sexual health, and are provided 
                with confidential and affordable access to youth-
                friendly comprehensive sexual and reproductive health 
                services and supplies, including male and female 
                condoms;
                    (F) ensuring women with HIV or who are at risk of 
                HIV infection and who do not wish to become pregnant 
                have access to voluntary contraceptive services and 
                commodities, and women who desire pregnancy have access 
                to family planning counseling and maternal health 
                services free of judgment and discrimination; and
                    (G) encouraging policy changes to eliminate 
                discriminatory and stigmatizing polices that stand in 
                the way of access to health services by marginalized 
                and poor populations including punitive laws against 
                HIV exposure and potential transmission, sex work, 
                same-sex behavior, drug use, and gender expression;
            (2) supporting meaningful community involvement and 
        participation, inclusive of poor, vulnerable, or marginalized 
        populations and their representative indigenous and civil 
        society organizations, in decisionmaking related to national 
        HIV/AIDS strategies and the delivery of health services, 
        including in decisions related to the adoption of health 
        policies and the total amount and distribution of health 
        funding;
            (3) assisting countries to coordinate, regulate, and 
        harmonize the delivery of health services provided by the 
        United States and nongovernmental organizations, including 
        community and faith-based organizations, private foundations, 
        international organizations, and other donors, and to 
        coordinate or integrate such services with the health system to 
        the maximum extent practicable;
            (4) using, to the maximum extent practicable, local and 
        regional entities for the provision of technical assistance, 
        and where the capacity of such entities is insufficient, 
        supporting capacity building to enable such entities to provide 
        such assistance;
            (5) strengthening procurement and supply chain logistics to 
        help prevent drug and commodity stock outs, including male and 
        female condom shortages, and to help ensure the eventual 
        provision of microbicides for HIV prevention; and
            (6) providing technical assistance and support to national 
        ministries of health, or their equivalents, and other relevant 
        ministries in overseeing the health systems of their countries 
        and monitoring and evaluating the effectiveness of such systems 
        in reducing mortality and improving health outcomes, including 
        preparing for the provision of HIV/AIDS, voluntary family 
        planning, non-communicable diseases, and reproductive health 
        services in emergency situations.
    (b) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of State shall submit to the 
appropriate congressional committees a report identifying benchmarks 
that are directly relevant to significantly decreasing the burden of 
the epidemic in each country receiving HIV-related foreign assistance 
and provide context for helping countries and civil society to build 
country ownership.

  TITLE III--ADDRESSING LEGAL AND POLICY BARRIERS TO ACCESSING HEALTH 
                                  CARE

                     Subtitle A--General Provisions

SEC. 301. SUPPORT FOR LAWS AND REGULATIONS THAT IMPROVE HEALTH OUTCOMES 
              AND PROMOTE HUMAN RIGHTS.

    It should be the policy of the United States to ensure that United 
States foreign assistance should encourage and assist national 
governments of developing countries to pursue policies and legal 
frameworks that improve health outcomes, including policies and legal 
frameworks that--
            (1) are medically accurate and evidence-based and adhere to 
        the latest global public health standards for prevention, 
        treatment, and care;
            (2) promote and improve the status of women and youth, 
        ensuring their ability to access and use health services 
        without fear or risk of gender-based violence, reprisal, 
        discrimination, stigmatization, arrest, or other mistreatment;
            (3) work to remove criminalization of, stigmatization of, 
        and discrimination against poor, vulnerable, or marginalized 
        populations and enact laws and policies to promote and protect 
        the rights of such populations;
            (4) avoid, to the maximum extent possible, reliance on 
        criminal laws and sanctions to address health issues;
            (5) incorporate relevant policy guidance that addresses 
        structural barriers to accessing health care; and
            (6) prioritize the creation of a legal, political, and 
        social environment that enables access to health services by 
        all members of the population.

SEC. 302. INTENSIFYING EFFORTS TO ESTABLISH EFFECTIVE PROGRAMS FOR 
              ENGAGING KEY AFFECTED POPULATIONS.

    It should be the policy of the United States to ensure that efforts 
to combat HIV/AIDS globally should intensify efforts to establish 
effective programs for engaging men who have sex with men, transgender 
people, people who inject drugs, and sex workers in HIV prevention, 
care, and treatment initiatives, by means that include--
            (1) ensuring those eligible for treatment receive 
        antiretroviral treatment;
            (2) providing sterile syringes, education, and outreach and 
        treatment for drug dependence for injecting drug users through 
        a comprehensive package of services;
            (3) providing sexual health services, male and female 
        condoms, and other HIV prevention services to sex workers, 
        their clients, and partners; and
            (4) defending human rights and inherent dignity by 
        addressing laws and practices that prevent people from 
        accessing services and providing legal and social services to 
        individuals and communities to facilitate access to services 
        and to reduce violence, stigma, and discrimination.

SEC. 303. ENSURING UNITED STATES TRADE POLICY DOES NOT RESTRICT ACCESS 
              TO AFFORDABLE MEDICINES.

    In administering title III of the Trade Act of 1974 (19 U.S.C. 2411 
et seq.), the United States Government shall not seek, through 
negotiation or otherwise, the revocation or revision of any 
intellectual property law or policy of a low- or middle-income country 
that regulates HIV and opportunistic infection pharmaceuticals or 
medical technologies if the law or policy of the country--
            (1) promotes access to affordable HIV and opportunistic 
        infection pharmaceuticals or medical technologies for affected 
        populations in that country; and
            (2) provides intellectual property protection consistent 
        with the Agreement on Trade-Related Aspects of Intellectual 
        Property Rights referred to in section 101(d)(15) of the 
        Uruguay Round Agreements Act (19 U.S.C. 3511(d)(15)).

     Subtitle B--Repeal of Certain Provisions of Public Law 108-25

SEC. 311. REPEAL OF ``CONSCIENCE CLAUSE'' REQUIREMENT FOR ELIGIBILITY 
              FOR ASSISTANCE.

    Section 301 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631) is amended by 
striking subsection (d).

SEC. 312. REPEAL OF LIMITATION ON USE OF FUNDS FOR ASSISTANCE FOR SEX 
              WORKERS.

    Section 301 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631), as amended by 
section 311 of this Act, is further amended by striking subsections (e) 
and (f).

SEC. 313. REPEAL OF REPORTING REQUIREMENT ON ACTIVITIES PROMOTING 
              ABSTINENCE AND RELATED ACTIVITIES.

    Section 403(a)(2) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673(a)(2)) is 
amended--
            (1) by striking ``(2) Prevention strategy.--'' and all that 
        follows through ``In carrying out paragraph (1)'' and inserting 
        ``(2) Prevention strategy.--In carrying out paragraph (1)''; 
        and
            (2) by striking subparagraph (B).

SEC. 314. EFFECTIVE DATE.

    This subtitle and the amendments made by this subtitle--
            (1) take effect on the date of the enactment of this Act; 
        and
            (2) apply with respect to funds made available to carry out 
        the United States Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Act of 2003 or any amendment made by that Act on or 
        after such date of enactment.

                         TITLE IV--DEFINITIONS

SEC. 401. DEFINITIONS.

    In this Act:
            (1) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committee on Foreign Affairs and the 
                Committee on Appropriations of the House of 
                Representatives; and
                    (B) the Committee on Foreign Relations and the 
                Committee on Appropriations of the Senate.
            (2) AIDS.--The term ``AIDS'' means the acquired immune 
        deficiency syndrome.
            (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.
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