I 

110TH CONGRESS 

2D SESSION H. R. 5237 

To amend the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

Act of 2003. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 6, 2008 

Mr. MCDERMOTT (for himself and Ms. GRANGER) introduced the following 

bill; which was referred to the Committee on Foreign Affairs 

A BILL 

To amend the U.S. Leadership Against HIV/AIDS, 

Tuberculosis, and Malaria Act of 2003. 

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 Pediatric HIV/ 

5 AIDS Prevention and Treatment Act’’. 

6 SEC. 2. FINDINGS. 

7 Section 2 of the United States Leadership Against 

8 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (26 

9 U.S.C. 7601) is amended— 


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1 (1) in paragraph (3), by adding at the end the 

2 following: 

3 ‘‘(D) In 2007, the rate at which children 

4 accessed treatment failed to keep pace with new pe5 diatric infections. While children account for almost 

6 16 percent of all new HIV infections, they make up 

7 only 9 percent of those receiving treatment under 

8 this Act.’’; 

9 (2) by amending paragraph (16) to read as fol10 lows: 

11 ‘‘(16) Basic interventions to prevent new HIV 

12 infections and to bring care and treatment to people 

13 living with AIDS, such as voluntary counseling and 

14 testing, are achieving meaningful results and are 

15 cost-effective. The challenge is to expand these inter16 ventions to a national basis in a coherent and sus17 tainable manner.’’; and 

18 (3) by amending paragraph (20) to read as fol19 lows: 

20 ‘‘(20) With no medical intervention, mothers in21 fected with HIV have a 25 to 30 percent chance of 

22 passing the virus to their babies during pregnancy 

23 and childbirth. A simple and effective intervention 

24 can significantly reduce mother to child transmission 

25 of HIV. A single dose of an anti-retroviral drug 


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1 given once to the mother at the onset of labor, and 

2 once to the baby during the first 3 days of life re3 duces transmission by approximately 50 percent. 

4 Other more complex drug regimens can further re5 duce transmission from mother-to-child. A dramatic 

6 expansion of access to prevention of mother-to-child 

7 transmission services is critical to preventing thou8 sands of new pediatric HIV infections.’’. 

9 SEC. 3. POLICY PLANNING AND COORDINATION. 

10 Section 101(b)(3) of the United States Leadership 

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

12 2003 (22 U.S.C. 7611(b)(3)) is amended by adding at the 

13 end the following: 

14 ‘‘(X) A description of the activities that 

15 will be conducted to achieve the targets de16 scribed in paragraphs (1) and (2) of section 

17 312(b).’’. 

18 SEC. 4. BILATERAL EFFORTS. 

19 (a) ASSISTANCE TO COMBAT HIV/AIDS.—Section 

20 104A of the Foreign Assistance Act of 1961 (22 U.S.C. 

21 2151b–2) is amended— 

22 (1) in subsection (d)(1)— 

23 (A) by amending subparagraph (E) to read 

24 as follows: 

25 ‘‘(E) assistance to— 


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1 ‘‘(i) achieve the target described in 

2 section 312(b)(1) of the United States 

3 Leadership Against HIV/AIDS, Tuber4 culosis, and Malaria Act of 2003; and 

5 ‘‘(ii) promote infant feeding options 

6 for HIV positive mothers that are con7 sistent with the most recent infant feeding 

8 recommendations and guidelines supported 

9 by the World Health Organization;’’; 

10 (B) in subparagraph (G), by striking 

11 ‘‘and’’ at the end; 

12 (C) in subparagraph (H), by striking the 

13 period at the end and inserting ‘‘; and’’; and 

14 (D) by adding at the end the following: 

15 ‘‘(I) assistance to achieve the target de16 scribed in section 312(b)(2) of the United 

17 States Leadership Against HIV/AIDS, Tuber18 culosis, and Malaria Act of 2003.’’; and 

19 (2) in subsection (e)(2)(C)— 

20 (A) in clause (iii), by striking ‘‘and’’ at the 

21 end; 

22 (B) in clause (iv), by striking the period at 

23 the end and inserting ‘‘; and’’; and 

24 (C) by adding at the end the following: 


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1 ‘‘(v) the number of HIV-infected chil2 dren currently receiving antiretroviral 

3 medications in each country under the 

4 United States Leadership Against HIV/ 

5 AIDS, Tuberculosis, and Malaria Act of 

6 2003.’’. 

7 (b) ASSISTANCE TO CHILDREN AND FAMILIES.— 

8 Subtitle B of Title III of the United States Leadership 

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

10 2003 (22 U.S.C. 7651 et seq.) is amended by striking sec11 tions 311 and 312 and inserting the following: 

12 ‘‘SEC. 311. FINDINGS. 

13 ‘‘Congress makes the following findings: 

14 ‘‘(1) Every day, approximately 1,100 children 

15 around the world are infected with HIV, the vast 

16 majority through mother-to-child transmission dur17 ing pregnancy, labor or delivery or soon after 

18 through breast-feeding. Approximately 90 percent of 

19 these infections occur in Africa. 

20 ‘‘(2) With no medical intervention, mothers in21 fected with HIV have a 25 to 30 percent chance of 

22 passing the virus to their babies during pregnancy 

23 and childbirth. A single dose of an anti-retroviral 

24 drug given once to the mother at the onset of labor, 


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1 and once to the baby during the first 3 days of life 

2 reduces transmission by approximately 50 percent. 

3 ‘‘(3) Providing the full range of interventions, 

4 as is the standard of care in the United States, 

5 could reduce the rate of mother-to-child transmission 

6 of HIV to as little as 2 percent. 

7 ‘‘(4) Global coverage of services to prevent 

8 transmission from mother-to-child remains unaccept9 ably low. The Joint United Nations Program on 

10 HIV/AIDS (UNAIDS) reports that fewer than 10 

11 percent of pregnant women with HIV in resource12 poor countries have access to prevention of mother13 to-child transmission services. 

14 ‘‘(5) Prevention of mother-to-child transmission 

15 programs provide health benefits for women and 

16 children beyond preventing the vertical transmission 

17 of HIV. They serve as an entry point for mothers 

18 to access treatment for their own HIV infection, al19 lowing them to stay healthy and to care for their 

20 children. Efforts to connect and integrate prevention 

21 of mother-to-child transmission and HIV care, treat22 ment and prevention programs are crucial to achiev23 ing improved outcomes for HIV-affected and HIV24 infected women and families. 


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1 ‘‘(6) Access to comprehensive HIV prevention 

2 services must be drastically scaled-up among preg3 nant women infected with HIV and pregnant women 

4 not infected with HIV to further protect themselves 

5 and their partners against the sexual transmission of 

6 HIV/AIDS. 

7 ‘‘(7) Preventing unintended pregnancy among 

8 HIV-infected women is recognized by the World 

9 Health Organization and the Office of the United 

10 States Global AIDS Coordinator to be an integral 

11 component of prevention of mother-to-child trans12 mission programs. To further reduce infection rates, 

13 women accessing prevention of mother-to-child 

14 transmission services must have access to a range of 

15 high-quality family planning and reproductive health 

16 care, so they can make informed decisions about fu17 ture pregnancies and contraception. 

18 ‘‘(8) In 2007, the rate at which children were 

19 accessing treatment failed to keep pace with new pe20 diatric infections. While children account for almost 

21 16 percent of all new HIV infections, they make up 

22 only 9 percent of those on treatment under this Act. 

23 ‘‘(9) Of the more than 2,500,000 people who 

24 were newly infected with HIV in 2007, more than 

25 420,000 were children. 


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1 ‘‘(10) Without proper care and treatment, half 

2 of newly HIV-infected children will die before they 

3 reach 2 years of age, and 75 percent will die before 

4 5 years of age. 

5 ‘‘(11) Because children are not just small 

6 adults, providing HIV care and treatment presents 

7 special challenges, including— 

8 ‘‘(A) limited access to reliable HIV testing 

9 for the youngest children; 

10 ‘‘(B) a shortage of providers trained in de11 livering pediatric care; 

12 ‘‘(C) weak linkages between services to 

13 prevent mother-to-child transmission and care 

14 and treatment programs; and 

15 ‘‘(D) the need for low-cost pediatric formu16 lations of HIV/AIDS medications. 

17 ‘‘SEC. 312. POLICY AND REQUIREMENTS. 

18 ‘‘(a) POLICY.— 

19 ‘‘(1) IN GENERAL.—The United States Govern20 ment’s response to the global HIV/AIDS pandemic 

21 should place high priority on— 

22 ‘‘(A) the prevention of mother-to-child 

23 transmission of HIV/AIDS; and 


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1 ‘‘(B) the care and treatment of all children 

2 affected by HIV/AIDS, including children or3 phaned by AIDS. 

4 ‘‘(2) COLLABORATION.—The United States 

5 Government should work in collaboration with for6 eign governments, donors, the private sector, non7 governmental organizations, and other key stake8 holders. 

9 ‘‘(b) REQUIREMENTS.—The comprehensive, 5-year, 

10 global strategy required under section 101 shall— 

11 ‘‘(1) establish a target for prevention of moth12 er-to-child transmission efforts that by 2013, in 

13 those countries most affected by HIV— 

14 ‘‘(A) 80 percent of pregnant women receive 

15 HIV counseling and testing; and 

16 ‘‘(B) all of the pregnant women receiving 

17 HIV counseling and testing who test positive 

18 for HIV receive anti-retroviral medications for 

19 prevention of mother-to-child transmission of 

20 HIV; 

21 ‘‘(2) establish a target requiring that by 2013, 

22 children account for at least 15 percent of those re23 ceiving treatment under this Act; 

24 ‘‘(3) integrate prevention, care, and treatment 

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1 grams, as soon as feasible and consistent with the 

2 national government policies of the foreign countries 

3 in which programs under this Act are administered, 

4 to improve outcomes for HIV-affected women and 

5 families and to promote follow-up and continuity of 

6 care; 

7 ‘‘(4) expand programs designed to care for chil8 dren orphaned by AIDS; and 

9 ‘‘(5) develop a time line for expanding access to 

10 more effective mother-to-child transmission preven11 tion regimens, consistent with the national govern12 ment policies of the foreign countries in which pro13 grams under this Act are administered and the goal 

14 of moving towards universal use of such regimens as 

15 rapidly as possible. 

16 ‘‘(c) APPLICATION OF REQUIREMENTS.—All strategic 

17 planning documents and bilateral funding agreements de18 veloped under the authority of the Office of the United 

19 States Global AIDS Coordinator, including country oper20 ating plans and any subsequent mechanisms through 

21 which funding under this Act is obligated, shall be con22 sistent with, and in furtherance of, the requirements under 

23 subsection (b). 

24 ‘‘(d) PREVENTION OF MOTHER-TO-CHILD TRANS25 MISSION EXPERT PANEL.— 


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1 ‘‘(1) ESTABLISHMENT.—The Coordinator of 

2 United States Government Activities to Combat 

3 HIV/AIDS Globally (referred to in this section as 

4 the ‘Coordinator’) shall establish a panel of experts 

5 to be known as the Prevention of Mother to Child 

6 Transmission Panel (referred to in this section as 

7 the ‘Panel’) to— 

8 ‘‘(A) provide an objective review of activi9 ties to prevent mother-to-child transmission of 

10 HIV that receive financial assistance under this 

11 Act; and 

12 ‘‘(B) provide recommendations to the Co13 ordinator and to the appropriate committees of 

14 Congress for scale-up of mother-to-child trans15 mission prevention services under this Act in 

16 order to achieve the target established in sub17 section (b)(1). 

18 ‘‘(2) MEMBERSHIP.—The Panel shall be con19 vened and chaired by the Coordinator, who shall 

20 serve as a nonvoting member. The Panel shall con21 sist of not more than 15 members (excluding the Co22 ordinator), to be appointed by the Coordinator not 

23 later than 60 days after the date of the enactment 

24 of this Act, including— 


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1 ‘‘(A) 2 members from the Department of 

2 Health and Human Services with expertise re3 lating to the prevention of mother-to-child 

4 transmission activities; 

5 ‘‘(B) 2 members from the United States 

6 Agency for International Development with ex7 pertise relating to the prevention of mother-to8 child transmission activities; 

9 ‘‘(C) 2 representatives from among health 

10 ministers of national governments of foreign 

11 countries in which programs under this Act are 

12 administered; 

13 ‘‘(D) 3 members representing organiza14 tions implementing prevention of mother-to15 child transmission activities under this Act; 

16 ‘‘(E) 2 health care researchers with exper17 tise relating to global HIV/AIDS activities; and 

18 ‘‘(F) representatives from among patient 

19 advocate groups, health care professionals, per20 sons living with HIV/AIDS, and non-govern21 mental organizations with expertise relating to 

22 the prevention of mother-to-child transmission 

23 activities, giving priority to individuals in for24 eign countries in which programs under this 

25 Act are administered. 


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1 ‘‘(3) DUTIES OF PANEL.—The Panel shall— 

2 ‘‘(A) review activities receiving financial 

3 assistance under this Act to prevent mother-to4 child transmission of HIV and assess the effec5 tiveness of current activities in reaching the 

6 target described in subsection (b)(1); 

7 ‘‘(B) review scientific evidence related to 

8 the provision of mother-to-child transmission 

9 prevention services, including programmatic 

10 data and data from clinical trials; 

11 ‘‘(C) review and assess ways in which the 

12 Office of the United States Global AIDS Coor13 dinator and programs funded under this Act 

14 collaborate with international and multilateral 

15 entities on efforts to prevent mother-to-child 

16 transmission of HIV in affected countries; 

17 ‘‘(D) identify barriers and challenges to in18 creasing access to mother-to-child transmission 

19 prevention services and evaluate potential mech20 anisms to alleviate those barriers and chal21 lenges; 

22 ‘‘(E) identify the extent to which stigma 

23 has hindered pregnant women from obtaining 

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1 sults, and provide recommendations to address 

2 such stigma and its effects; 

3 ‘‘(F) identify opportunities to improve link4 ages between mother-to-child transmission pre5 vention services and care and treatment pro6 grams; 

7 ‘‘(G) evaluate the adequacy of financial as8 sistance provided under this Act for mother-to9 child transmission of HIV prevention services; 

10 and 

11 ‘‘(H) recommend levels of financial assist12 ance and specific activities to facilitate reaching 

13 the target described in subsection (b)(1). 

14 ‘‘(4) REPORT.— 

15 ‘‘(A) IN GENERAL.—Not later than 14 

16 months after the date of the enactment of this 

17 Act, the Panel shall submit a report containing 

18 a detailed statement of the recommendations, 

19 findings, and conclusions of the Panel to the 

20 appropriate congressional committees. 

21 ‘‘(B) AVAILABILITY.—The report sub22 mitted under subparagraph (A) shall be made 

23 available to the public. 

24 ‘‘(C) CONSIDERATION BY COORDINATOR.— 

25 The Coordinator shall— 


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1 ‘‘(i) consider any recommendations 

2 contained in the report submitted under 

3 subparagraph (A); and 

4 ‘‘(ii) include in the annual report re5 quired under section 104A(e) of the For6 eign Assistance Act of 1961 (22 U.S.C. 

7 2151b–2(e)) a description of the activities 

8 conducted in response to the recommenda9 tions made by the Panel and an expla10 nation of any recommendations not imple11 mented at the time of the report. 

12 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated to the 

14 Panel such sums as may be necessary for each of 

15 the fiscal years 2009 through 2011 to carry out this 

16 section. 

17 ‘‘(6) TERMINATION.—The Panel shall terminate 

18 on the date that is 60 days after the date on which 

19 the Panel submits the report to Congress under 

20 paragraph (4).’’. 

21 (c) ANNUAL REPORT ELEMENTS.—Section 313(b)(2) 

22 of the United States Leadership Against HIV/AIDS, Tu23 berculosis, and Malaria Act of 2003 (22 U.S.C. 

24 7653(b)(2)) is amended— 


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1 (1) in subparagraph (C), by striking ‘‘and’’ at 

2 the end; 

3 (2) in subparagraph (D), by striking the period 

4 at the end and inserting a semicolon; and 

5 (3) by adding at the end the following: 

6 ‘‘(E) coordination and collaboration with 

7 governments, donors, the private sector, non8 governmental organizations, and other key 

9 stakeholders to achieve the target described in 

10 section 312(b)(1); and 

11 ‘‘(F) the number of women offered and re12 ceiving the 4 components of a comprehensive 

13 strategy to prevent mother-to-child transmission 

14 of HIV, as recommended by the World Health 

15 Organization.’’. 

Æ 


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