I 

110TH CONGRESS 

1ST SESSION H. R. 4914 

To amend the United States Leadership Against HIV/AIDS, Tuberculosis, 

and Malaria Act of 2003 to provide for the integration of food security 

and nutrition activities into prevention, care, treatment, and support 

activities. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 19, 2007 

Mr. PAYNE (for himself, Ms. WATSON, Ms. WOOLSEY, Ms. JACKSON-LEE of 

Texas, and Mr. MILLER of North Carolina) introduced the following bill; 

which was referred to the Committee on Foreign Affairs 

A BILL 

To amend the United States Leadership Against HIV/AIDS, 

Tuberculosis, and Malaria Act of 2003 to provide for 

the integration of food security and nutrition activities 

into prevention, care, treatment, and support activities. 

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 ‘‘Global HIV/AIDS 

5 Food Security and Nutrition Support Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) The spread of HIV/AIDS is exacerbated by 

2 poverty, and economic and social vulnerability, 

3 disempowerment, and inequality. 

4 (2) Food insecurity has a direct detrimental im5 pact on prevention, care, and treatment of HIV/ 

6 AIDS. 

7 (3) Programming for HIV/AIDS must address 

8 the underlying factors that contribute to the spread 

9 of the disease in order to be effective and sustain10 able. 

11 (4) The World Food Program estimates that 

12 6,400,000 people affected by HIV will need nutri13 tional support by 2008. 

14 (5) The highest rates of HIV infections are in 

15 countries with significant rates of malnutrition, es16 pecially in sub-Saharan Africa. 

17 (6) People living with HIV/AIDS are less pro18 ductive due to illness, which contributes to food inse19 curity for such individuals and their households 

20 through loss of wages and/or decreased agricultural 

21 production. 

22 (7) People caring for HIV-infected persons are 

23 often less productive because of the demands of car24 ing for those persons, which in turn can lead to food 


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1 insecurity for the infected person and the entire 

2 household. 

3 (8) Adequate nutrition can extend the time that 

4 people infected with HIV are able to work and be 

5 productive. 

6 (9) Food insecurity is often cited by people liv7 ing with HIV/AIDS as their number one concern. 

8 SEC. 3. SENSE OF CONGRESS. 

9 It is the sense of Congress that— 

10 (1) malnutrition, especially for people living 

11 with and affected by HIV/AIDS, is a clinical health 

12 issue with wider nutrition, health, and social implica13 tions for HIV-infected individuals, their families, 

14 and communities that must be addressed by United 

15 States HIV/AIDS prevention, care, treatment, and 

16 support programs; 

17 (2) international guidelines established by the 

18 World Health Organization should serve as the ref19 erence standard for HIV/AIDS food and nutrition 

20 activities supported by the President’s Emergency 

21 Plan for AIDS Relief (PEPFAR); 

22 (3) the Coordinator of United States Govern23 ment Activities to Combat HIV/AIDS Globally (com24 monly known as the ‘‘Global AIDS Coordinator’’) 

25 should make it a priority to work with other United 


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1 States Government departments and agencies, do2 nors, and multilateral institutions to increase the in3 tegration of food and nutrition support and liveli4 hood activities into prevention, care, and treatment 

5 activities funded by the United States and other gov6 ernments and organizations; 

7 (4) for the purposes of determining which HIV8 infected individuals should be provided with nutri9 tion and food support, a patient with a body mass 

10 index of 18.5 or less should be considered ‘‘malnour11 ished’’ and should be given priority for nutrition and 

12 food support; 

13 (5) programs funded by the United States Gov14 ernment should include therapeutic and supple15 mentary feeding, food, and nutrition support and 

16 should include strong links to development programs 

17 that focus on support for livelihoods; and 

18 (6) the inability of HIV-infected individuals to 

19 access food for themselves or their families should 

20 not be allowed to impair or erode the therapeutic 

21 status of such individuals with respect to HIV or re22 lated comorbidities. 

23 SEC. 4. STATEMENT OF POLICY. 

24 It is the policy of the United States to— 


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1 (1) address the food and nutrition needs of 

2 HIV-infected and affected individuals, including or3 phans and vulnerable children; 

4 (2) fully integrate food and nutrition support 

5 into care, treatment, and support programs carried 

6 out under the United States Leadership Against 

7 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

8 (Public Law 108–25; 22 U.S.C. 7601 et seq.); 

9 (3) ensure that— 

10 (A) care, treatment, and support providers 

11 and healthcare workers are adequately trained 

12 such that they can provide accurate and in13 formed information regarding food and nutri14 tion support to patients enrolled in treatment 

15 and care programs and those affected by HIV; 

16 and 

17 (B) HIV-infected individuals identified as 

18 food insecure, as well as their households, are 

19 provided with adequate food and nutrition sup20 port; and 

21 (4) effectively link food and nutrition support to 

22 HIV-infected individuals and their households and 

23 communities provided under Public Law 108–25 to 

24 other food security and livelihood programs funded 


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1 by the United States Government and other donors 

2 and multilateral agencies. 

3 SEC. 5. INTEGRATION OF FOOD SECURITY AND NUTRITION 

4 ACTIVITIES INTO HIV/AIDS PREVENTION, 

5 CARE, TREATMENT, AND SUPPORT ACTIVI6 TIES. 

7 Section 301 of the United States Leadership Against 

8 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public 

9 Law 108–25; 22 U.S.C. 7631) is amended by striking sub10 section (c) and inserting the following: 

11 ‘‘(c) INTEGRATION OF FOOD SECURITY AND NUTRI12 TION ACTIVITIES INTO PREVENTION, CARE, TREATMENT, 

13 AND SUPPORT ACTIVITIES.— 

14 ‘‘(1) STATEMENT OF POLICY.—Congress de15 clares that food security and nutrition directly im16 pact a patient’s vulnerability to HIV infection, the 

17 progression of HIV to AIDS, a patient’s ability to 

18 begin an anti-retroviral medication treatment regi19 men, the efficacy of an anti-retroviral medication 

20 treatment regimen once a patient begins such a regi21 men, and the ability of communities to effectively 

22 cope with the HIV/AIDS epidemic and its impacts. 

23 ‘‘(2) REQUIREMENTS.—Consistent with the 

24 statement of policy in paragraph (1), the Global 

25 AIDS Coordinator shall— 


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1 ‘‘(A) ensure that— 

2 ‘‘(i) an assessment, using validated 

3 criteria, of the food security and nutri4 tional status of each patient enrolled in 

5 anti-retroviral medication treatment pro6 grams supported with funds authorized 

7 under this Act or any amendment made by 

8 this Act is carried out; and 

9 ‘‘(ii) appropriate nutritional coun10 seling is provided to each patient described 

11 in clause (i); 

12 ‘‘(B) provide, as an essential component of 

13 anti-retroviral medication treatment programs 

14 supported with funds authorized under this Act 

15 or any amendment made by this Act, food and 

16 nutrition support to each HIV-infected indi17 vidual who is determined to need such support 

18 by the assessing health professional, and the in19 dividual’s household, for a period of not less 

20 than 180 days, either directly or through refer21 ral to an assistance program or organization 

22 with demonstrable ability to provide such sup23 port; 

24 ‘‘(C) coordinate with the Administrator of 

25 the United States Agency for International DeVerDate Aug 31 2005 02:29 Dec 27, 2007 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4914.IH H4914

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1 velopment, the Secretary of Agriculture, and 

2 heads of other relevant United States Govern3 ment departments and agencies to— 

4 ‘‘(i) ensure that, in communities in 

5 which a significant proportion of HIV-in6 fected individuals are in need of food and 

7 nutrition support, a status and needs as8 sessment for such support employing vali9 dated criteria is conducted and a plan to 

10 provide such support is developed and im11 plemented; 

12 ‘‘(ii) improve and enhance coordina13 tion between food security and livelihood 

14 programs for HIV-infected individuals in 

15 focus countries and food security and liveli16 hood programs that may already exist in 

17 those countries; 

18 ‘‘(iii) establish effective linkages be19 tween the health and agricultural develop20 ment and livelihoods sectors in order to en21 hance food security; and 

22 ‘‘(iv) ensure, by providing increased 

23 resources if necessary, effective coordina24 tion between activities authorized under 

25 this Act or any amendment made by this 


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1 Act and activities carried out under other 

2 provisions of the Foreign Assistance Act of 

3 1961 when establishing new HIV/AIDS 

4 treatment sites; 

5 ‘‘(D) develop effective, validated indicators 

6 which measure outcomes of nutrition and food 

7 security interventions carried out under this 

8 section and use such indicators to monitor and 

9 evaluate the effectiveness of such interventions; 

10 and 

11 ‘‘(E) support and expand partnerships and 

12 linkages between United States colleges and 

13 universities with colleges and universities in 

14 focus countries in order to provide training and 

15 build indigenous human and institutional capac16 ity and expertise to respond to HIV/AIDS, and 

17 to improve capacity to address nutrition, food 

18 security and livelihood needs of HIV/AIDS-af19 fected and impoverished communities. 

20 ‘‘(3) REPORT.—Not later than 180 days after 

21 the date of the enactment of the Global HIV/AIDS 

22 Food Security and Nutrition Support Act of 2007, 

23 and annually thereafter, the Global AIDS Coordi24 nator shall submit to Congress a report on the imVerDate Aug 31 2005 02:29 Dec 27, 2007 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4914.IH H4914

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1 plementation of this subsection for the prior fiscal 

2 year. The report shall include a description of— 

3 ‘‘(A) the indicators described in paragraph 

4 (2)(D) and a description of the effectiveness of 

5 interventions carried out to improve the nutri6 tional status of HIV-infected individuals; 

7 ‘‘(B) the amount of funds provided for 

8 food and nutrition support for HIV-infected 

9 and affected individuals in the prior fiscal year 

10 and the projected amount of funds to be pro11 vided for such purpose for next fiscal year; and 

12 ‘‘(C) a strategy for improving the linkage 

13 between assistance provided with funds author14 ized under this subsection and food security 

15 and livelihood programs under other provisions 

16 of law as well as activities funded by other do17 nors and multilateral organizations. 

18 ‘‘(4) DEFINITIONS.—In this subsection: 

19 ‘‘(A) FOCUS COUNTRIES.—The term ‘focus 

20 countries’ means countries described in section 

21 1(f)(2)(B)(ii)(VII) of the State Department 

22 Basic Authorities Act of 1956 (as added by sec23 tion 102(a) of this Act) and designated by the 

24 President pursuant to such section. 


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1 ‘‘(B) GLOBAL AIDS COORDINATOR.—The 

2 term ‘Global AIDS Coordinator’ means the Co3 ordinator of United States Government Activi4 ties to Combat HIV/AIDS Globally (as de5 scribed in section 1(f) of the State Department 

6 Basic Authorities Act of 1956 (as added by sec7 tion 102(a) of this Act)). 

8 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

9 To carry out this subsection, there are authorized to 

10 be appropriated to the Global AIDS Coordinator 

11 such sums as may be necessary for each of the fiscal 

12 years 2009 through 2014.’’ 

Æ 


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