IB 

Union Calendar No. 333 

110TH CONGRESS 

2D SESSION H. R. 5501 

[Report No. 110–546, Part I] 

To authorize appropriations for fiscal years 2009 through 2013 to provide 

assistance to foreign countries to combat HIV/AIDS, tuberculosis, and 

malaria, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 27, 2008 

Mr. BERMAN (for himself, Ms. ROS-LEHTINEN, Mr. PAYNE, Ms. LEE, Mr. 

WAXMAN, and Ms. JACKSON-LEE of Texas) introduced the following bill; 

which was referred to the Committee on Foreign Affairs, and in addition 

to the Committee on Financial Services, 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 

MARCH 10, 2008 

Reported from the Committee on Foreign Affairs 

MARCH 10, 2008 

Committee on Financial Services discharged; committed to the Committee of 

the Whole House on the State of the Union and ordered to be printed 

A BILL 

To authorize appropriations for fiscal years 2009 through 

2013 to provide assistance to foreign countries to combat 

HIV/AIDS, tuberculosis, and malaria, and for other purposes. 


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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 AND TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Tom Lantos and Henry J. Hyde United States Global 

6 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

7 Reauthorization Act of 2008’’. 

8 (b) TABLE OF CONTENTS.—The table of contents for 

9 this Act is as follows: 

Sec. 1. Short title and table of contents. 

Sec. 2. Findings. 

Sec. 3. Definitions. 

Sec. 4. Purpose. 

TITLE I—POLICY PLANNING AND COORDINATION 

Sec. 101. Development of a comprehensive, five-year, global strategy. 

Sec. 102. HIV/AIDS Response Coordinator. 

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, 

AND PUBLIC-PRIVATE PARTNERSHIPS 

Sec. 201. Sense of Congress on public-private partnerships. 

Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and 

Malaria. 

Sec. 203. Voluntary contributions to international vaccine funds. 

Sec. 204. Program to facilitate availability of microbicides to prevent transmission of HIV and other diseases. 

Sec. 205. Plan to combat HIV/AIDS, tuberculosis, and malaria by strengthening health policies and health systems of host countries. 

TITLE III—BILATERAL EFFORTS 

Subtitle A—General Assistance and Programs 

Sec. 301. Assistance to combat HIV/AIDS. 

Sec. 302. Assistance to combat tuberculosis. 

Sec. 303. Assistance to combat malaria. 

Sec. 304. Health care partnerships to combat HIV/AIDS. 

Subtitle B—Assistance for Women, Children, and Families 

Sec. 311. Policy and requirements. 

Sec. 312. Annual reports on prevention of mother-to-child transmission of the 

HIV infection. 

Sec. 313. Strategy to prevent HIV infections among women and youth. 

Sec. 314. Clerical amendment. 


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TITLE IV—AUTHORIZATION OF APPROPRIATIONS 

Sec. 401. Authorization of appropriations. 

Sec. 402. Sense of Congress. 

Sec. 403. Allocation of funds. 

Sec. 404. Prohibition on taxation by foreign governments. 

TITLE V—SUSTAINABILITY AND STRENGTHENING OF HEALTH 

CARE SYSTEMS 

Sec. 501. Sustainability and strengthening of health care systems. 

Sec. 502. Clerical amendment. 

1 SEC. 2. FINDINGS. 

2 Section 2 of the United States Leadership Against 

3 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 

4 U.S.C. 7601) is amended by adding at the end the fol5 lowing: 

6 ‘‘(29) The HIV/AIDS pandemic continues to 

7 pose a major threat to the health of the global com8 munity, from the most severely-affected regions of 

9 sub-Saharan Africa and the Caribbean, to the 

10 emerging epidemics of Eastern Europe, Central 

11 Asia, South and Southeast Asia, and Latin America. 

12 ‘‘(30) According to UNAIDS’ 2007 global esti13 mates, there are 33.2 million individuals with HIV/ 

14 AIDS worldwide, including 2.5 million people newly15 infected with HIV. Of those infected with HIV, 2.5 

16 million are children under 15 who also account for 

17 460,000 of the newly-infected individuals. 

18 ‘‘(31) Sub-Saharan Africa continues to be the 

19 region most affected by the HIV/AIDS pandemic. 

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1 cent of children with HIV/AIDS live in sub-Saharan 

2 Africa, and more than 76 percent of AIDS deaths 

3 in 2007 occurred in sub-Saharan Africa. 

4 ‘‘(32) Although sub-Saharan Africa carries the 

5 heaviest disease burden of HIV/AIDS, the HIV/ 

6 AIDS pandemic continues to affect virtually every 

7 world region. While prevalence rates are relatively 

8 low in Eastern Europe, Central Asia, South and 

9 Southeast Asia, and Latin America, without effective 

10 prevention strategies, HIV prevalence rates could 

11 rise quickly in these regions. 

12 ‘‘(33) By world region, according to UNAIDS’ 

13 2007 global estimates— 

14 ‘‘(A) in sub-Saharan Africa, there were 

15 22.5 million adults and children infected with 

16 HIV, up from 20.9 million in 2001, with 1.7 

17 million new HIV infections, a 5 percent preva18 lence rate, and 1.6 million deaths; 

19 ‘‘(B) in South and Southeast Asia, there 

20 were 4 million adults and children infected with 

21 HIV, up from 3.5 million in 2001, with 

22 340,000 new HIV infections, a 0.3 percent 

23 prevalence rate, and 270,000 deaths; 

24 ‘‘(C) in East Asia, there were 800,000 

25 adults and children infected with HIV, up from 


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1 420,000 in 2001, with 92,000 new HIV infec2 tions, a 0.1 percent prevalence rate, and 32,000 

3 deaths; 

4 ‘‘(D) in Eastern and Central Europe, there 

5 were 1.6 million adults and children infected 

6 with HIV, up from 630,000 in 2001, with 

7 150,000 new HIV infections, a 0.9 percent 

8 prevalence rate, and 55,000 deaths; and 

9 ‘‘(E) in the Caribbean, there were 230,000 

10 adults and children infected with HIV, up from 

11 190,000 in 2001, with 17,000 new HIV infec12 tions, a 1 percent prevalence rate, and 11,000 

13 deaths. 

14 ‘‘(34) Tuberculosis is the number one killer of 

15 individuals with HIV/AIDS and is responsible for up 

16 to one-half of HIV/AIDS deaths in Africa. 

17 ‘‘(35) The wide extent of drug resistant tuber18 culosis, including both multi-drug resistant tuber19 culosis (MDR–TB) and extensively drug resistant 

20 tuberculosis (XDR–TB), driven by the HIV/AIDS 

21 pandemic in sub-Saharan Africa, has hampered both 

22 HIV/AIDS and tuberculosis treatment services. The 

23 World Health Organization (WHO) has declared the 

24 prevalence of tuberculosis to be at emergency levels 

25 in sub-Saharan Africa. 


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1 ‘‘(36) Forty percent of the world’s population, 

2 mostly poor, live in malarial zones, and malaria, 

3 which is highly preventable, kills more than 1 million 

4 individuals worldwide each year. Ninety percent of 

5 malaria’s victims are in sub-Saharan Africa and 70 

6 percent of malaria’s victims are children under the 

7 age of 5. Additionally, hunger and malnutrition kill 

8 another 6 million individuals worldwide each year. 

9 ‘‘(37) Assistance to combat HIV/AIDS must 

10 address the nutritional factors associated with the 

11 disease in order to be effective and sustainable. The 

12 World Food Program estimates that 6.4 million indi13 viduals affected by HIV will need nutritional support 

14 by 2008. 

15 ‘‘(38) Women and girls continue to be vulner16 able to HIV, in large part, due to gender-based cul17 tural norms that leave many women and girls power18 less to negotiate social relationships. 

19 ‘‘(39) Women make up 50 percent of individ20 uals infected with HIV worldwide. In sub-Saharan 

21 Africa, where the HIV/AIDS epidemic is most se22 vere, women make up 57 percent of individuals in23 fected with HIV, and 75 percent of young people in24 fected with HIV in sub-Saharan Africa are young 

25 women ages 15 to 24. 


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1 ‘‘(40) Women and girls are biologically, socially, 

2 and economically more vulnerable to HIV infection. 

3 Gender disparities in the rate of HIV infection are 

4 the result of a number of factors, including the fol5 lowing: 

6 ‘‘(A) Cross-generational sex with older men 

7 who are more likely to be infected with HIV, 

8 and a lack of choice regarding when and whom 

9 to marry, leading to early marriages and high 

10 rates of child marriages with older men. About 

11 one-half of all adolescent females in sub-Saha12 ran Africa and two-thirds of adolescent females 

13 in Asia are married by age 18. 

14 ‘‘(B) Studies show that married women 

15 and married and unmarried girls often are un16 able or find it difficult to negotiate the fre17 quency and timing of sexual intercourse, ensure 

18 their partner’s faithfulness, or insist on condom 

19 use. Under these circumstances, women often 

20 run the risk of being infected by husbands or 

21 male partners in societies where men in rela22 tionships have more than one partner. Behavior 

23 change is particularly important in societies in 

24 which this is a common practice. 


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1 ‘‘(C) Because young married women and 

2 girls are more likely to have unprotected sex 

3 and have more frequent sex than their unmar4 ried peers, and women and girls who are faith5 ful to their spouses can be placed at risk of 

6 HIV/AIDS through a husband’s infidelity or 

7 prior infection, marriage is not always a guar8 antee against HIV infection, although it is a 

9 protective factor overall. 

10 ‘‘(D) Social and economic inequalities 

11 based largely on gender limit access for women 

12 and girls to education and employment opportu13 nities and prevent them from asserting their in14 heritance and property rights. For many 

15 women, a lack of independent economic means 

16 combines with socio-cultural practices to sustain 

17 and exacerbate their fear of abandonment, evic18 tion, or ostracism from their homes and com19 munities and can leave many more women 

20 trapped within relationships where they are vul21 nerable to HIV infection. 

22 ‘‘(E) A lack of educational opportunities 

23 for women and girls is linked to younger sexual 

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1 bearing, decreased child survival, worsening nu2 trition, and increased risk of HIV infection. 

3 ‘‘(F) High rates of gender-based violence, 

4 rape, and sexual coercion within and outside 

5 marriage contribute to high rates of HIV infec6 tion. According to the World Health Organiza7 tion, between one-sixth and three-quarters of 

8 women in various countries and settings have 

9 experienced some form of physical or sexual vio10 lence since the age of 15 within or outside of 

11 marriage. Women who are unable to protect 

12 themselves from such violence are often unable 

13 to protect themselves from being infected with 

14 HIV through forced sexual contact. 

15 ‘‘(G) Fear of domestic violence and the 

16 continuing stigma and discrimination associated 

17 with HIV/AIDS prevent many women from ac18 cessing information about HIV/AIDS, getting 

19 tested, disclosing their HIV status, accessing 

20 services to prevent mother-to-child transmission 

21 of HIV, or receiving treatment and counseling 

22 even when they already know they have been in23 fected with HIV. 

24 ‘‘(H) According to UNAIDS, the vulner25 ability of individuals involved in commercial sex 


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1 acts to HIV infection is heightened by stig2 matization and marginalization, limited eco3 nomic options, limited access to health, social, 

4 and legal services, limited access to information 

5 and prevention means, gender-related dif6 ferences and inequalities, sexual exploitation 

7 and trafficking, harmful or non-protective laws 

8 and policies, and exposure to risks associated 

9 with commercial sex acts, such as violence, sub10 stance abuse, and increased mobility. 

11 ‘‘(I) Lack of access to basic HIV preven12 tion information and education and lack of co13 ordination with existing primary health care to 

14 reduce stigma and maximize coverage. 

15 ‘‘(J) Lack of access to currently available 

16 female-controlled HIV prevention methods, such 

17 as the female condom, and lack of training on 

18 proper use of either male or female condoms. 

19 ‘‘(K) High rates of other sexually trans20 mitted infections and complications during 

21 pregnancies and childbirth. 

22 ‘‘(L) An absence of functioning legal 

23 frameworks to protect women and girls and, 

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1 countable and effective enforcement of such 

2 frameworks. 

3 ‘‘(41) In addition to vulnerabilities to HIV in4 fection, women in sub-Saharan Africa face a 1-in-13 

5 chance of dying in childbirth compared to a 1-in-16 

6 chance in least-developed countries worldwide, a 1- 

7 in-60 chance in developing countries, and a 1-in8 4,100 chance in developed countries. 

9 ‘‘(42) Due to these high maternal mortality 

10 rates and high HIV prevalence rates in certain coun11 tries, special attention is needed in these countries 

12 to help HIV-positive women safely deliver healthy 

13 babies and save women’s lives. 

14 ‘‘(43) Unprotected sex within or outside of mar15 riage is the single greatest factor in the transmission 

16 of HIV worldwide and is responsible for 80 percent 

17 of new HIV infections in sub-Saharan Africa. 

18 ‘‘(44) Multiple randomized controlled trials 

19 have established that male circumcision reduces a 

20 man’s risk of contracting HIV by 60 percent or 

21 more. Twelve acceptability studies have found that 

22 in regions of sub-Saharan Africa where circumcision 

23 is not traditionally practiced, a majority of men 

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1 fections not only in men but also in their female 

2 partners. 

3 ‘‘(45)(A) Youth also face particular challenges 

4 in receiving services for HIV/AIDS. 

5 ‘‘(B) Nearly one-half of all orphans who have 

6 lost one parent and two-thirds of those who have lost 

7 both parents are ages 12 to 17. These orphans are 

8 in particular need of services to protect themselves 

9 against sexually-transmitted infections, including 

10 HIV. 

11 ‘‘(C) Research indicates that many youth ben12 efit from full disclosure of medically accurate, age13 appropriate information about abstinence, partner 

14 reduction, and condoms. Providing comprehensive 

15 information about HIV, including delay of sexual 

16 debut and the ABC model: ‘Abstain, Be faithful, use 

17 Condoms’, and linking such information to health 

18 care can help improve awareness of safe sex prac19 tices and address the fact that only 1 in 3 young 

20 men and 1 in 5 young women ages 15 to 24 can cor21 rectly identify ways to prevent HIV infection. 

22 ‘‘(D) Surveys indicate that no country has suc23 ceeded in fully educating more than one-half of its 

24 youth about the prevention and transmission of 

25 HIV. 


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1 ‘‘(46) According to the United Nations High 

2 Commissioner for Refugees (UNHCR), HIV/AIDS 

3 prevalence rates among refugees are generally lower 

4 than the HIV/AIDS prevalence rates for their host 

5 communities, though perceptions run counter to this 

6 fact. However, peacekeeping operations that no 

7 longer deploy HIV/AIDS-positive troops still face 

8 vulnerabilities to sexual transmission of HIV with 

9 HIV-positive individuals in refugee camps. Host 

10 countries generally do not provide HIV/AIDS pre11 vention, treatment, and care services for refugees. 

12 ‘‘(47) Continuing progress to reach the millions 

13 of impoverished individuals who need voluntary test14 ing, counseling, treatment, and care for HIV/AIDS 

15 requires increased efforts to strengthen health care 

16 delivery systems and infrastructure, rebuild and ex17 pand the health care workforce, and strengthen al18 lied and support services in countries receiving 

19 United States global HIV/AIDS assistance. 

20 ‘‘(48) While HIV/AIDS poses the greatest 

21 health threat of modern times, it also poses the 

22 greatest development challenge for developing coun23 tries with fragile economies and weak public finan24 cial management systems that are ill equipped to 

25 shoulder the burden of this disease. International 


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1 donors will have to play a critical role in providing 

2 resources for HIV/AIDS programs far into the fu3 ture. 

4 ‘‘(49) The emerging partnerships between coun5 tries most affected by HIV/AIDS and the United 

6 States must include stronger coordination between 

7 HIV/AIDS programs and other United States for8 eign assistance programs, and stronger collaboration 

9 with other donors in the areas of economic develop10 ment and growth strategies. 

11 ‘‘(50) The future control of HIV/AIDS de12 mands coordination between international organiza13 tions such as the Global Fund to Fight AIDS, Tu14 berculosis and Malaria, UNAIDS, the World Health 

15 Organization (WHO), the World Bank and the 

16 International Monetary Fund (IMF), the inter17 national donor community, national governments, 

18 and private sector organizations, including commu19 nity and faith-based organizations. 

20 ‘‘(51) The future control of HIV/AIDS further 

21 requires effective and transparent public finance 

22 management systems in developing countries to ad23 vance the ability of such countries to manage public 

24 revenues and donor funds aimed at combating HIV/ 

25 AIDS and other diseases. 


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1 ‘‘(52) The HIV/AIDS pandemic contributes to 

2 the shortage of health care personnel through loss of 

3 life and illness, unsafe working conditions, increased 

4 workloads for diminished staff, and resulting stress 

5 and burnout, while the shortage of health care per6 sonnel undermines efforts to prevent and provide 

7 care and treatment for individuals with HIV/AIDS. 

8 ‘‘(53) The shortage of health care personnel, in9 cluding doctors, nurses, pharmacists, counselors, lab10 oratory staff, paraprofessionals, trained lay workers, 

11 and researchers is one of the leading obstacles to 

12 combating HIV/AIDS in sub-Saharan Africa. 

13 ‘‘(54) Since 2003, important progress has been 

14 made in combating HIV/AIDS, yet there is more to 

15 be done. The number of new HIV infections is still 

16 increasing at an alarming rate. According to the 

17 United States National Institute of Allergy and In18 fectious Diseases, globally, for every 1 individual put 

19 on antiretroviral therapy, 6 individuals are newly in20 fected with HIV. 

21 ‘‘(55) The United States Government continues 

22 to be the world’s leader in the fight against HIV/ 

23 AIDS and the unsurpassed partner with developing 

24 countries in their efforts to control this disease. 


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1 ‘‘(56) By September 2007, the United States, 

2 through the United States Leadership Against HIV/ 

3 AIDS, Tuberculosis, and Malaria Act of 2003 (22 

4 U.S.C. 7601 et seq.), had provided services to pre5 vent mother-to-child-transmission of HIV to women 

6 during 10 million pregnancies; provided 

7 antiretroviral prophylaxis for women during over 

8 827,300 pregnancies; prevented an estimated 

9 157,240 HIV infections in infants; cared for over 

10 6.6 million individuals, including over 2.7 million or11 phans and vulnerable children; supported lifesaving 

12 antiretroviral therapies for approximately 1.4 million 

13 men, women, and children in sub-Saharan Africa, 

14 Asia, and the Carribean; and provided counseling 

15 and testing to over 33.7 million men, women, and 

16 children in developing countries. 

17 ‘‘(57) These numbers were achieved because of 

18 the commitment of substantial resources and sup19 port of the United States Government to our part20 ners on the front lines—the dedicated and com21 mitted women and men, communities, and nations 

22 who are taking control of the HIV/AIDS epidemics 

23 in their own countries.’’. 


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1 SEC. 3. DEFINITIONS. 

2 Section 3(2) of the United States Leadership Against 

3 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 

4 U.S.C. 7602(2)) is amended by striking ‘‘Committee on 

5 International Relations’’ and inserting ‘‘Committee on 

6 Foreign Affairs’’. 

7 SEC. 4. PURPOSE. 

8 Section 4 of the United States Leadership Against 

9 HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 

10 U.S.C. 7603) is amended to read as follows: 

11 ‘‘SEC. 4. PURPOSE. 

12 ‘‘The purpose of this Act is to strengthen and en13 hance United States global leadership and the effective14 ness of the United States response to the HIV/AIDS, tu15 berculosis, and malaria pandemics and other related and 

16 preventable infectious diseases in developing countries 

17 by— 

18 ‘‘(1) establishing a comprehensive, integrated 

19 five-year, global strategy to fight HIV/AIDS, tuber20 culosis, and malaria that encompasses a plan for 

21 continued expansion and coordination of critical pro22 grams and improved coordination among relevant 

23 executive branch agencies and between the United 

24 States and foreign governments and international 

25 organizations; 


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1 ‘‘(2) providing increased resources for United 

2 States bilateral efforts to combat HIV/AIDS, tuber3 culosis, and malaria, particularly for prevention, 

4 treatment, and care (including nutritional support), 

5 technical assistance and training, the strengthening 

6 of health care systems, health care workforce devel7 opment, monitoring and evaluations systems, and 

8 operations research; 

9 ‘‘(3) providing increased resources for multilat10 eral efforts to combat HIV/AIDS, tuberculosis, and 

11 malaria; 

12 ‘‘(4) encouraging the expansion of private sec13 tor efforts and expanding public-private sector part14 nerships to combat HIV/AIDS; and 

15 ‘‘(5) intensifying efforts to support the develop16 ment of vaccines, microbicides, and other prevention 

17 technologies and improved diagnostics treatment for 

18 HIV/AIDS, tuberculosis, and malaria.’’. 

19 TITLE I—POLICY PLANNING AND 

20 COORDINATION 

21 SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE22 YEAR, GLOBAL STRATEGY. 

23 (a) STRATEGY.—Subsection (a) of section 101 of the 

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1 culosis, and Malaria Act of 2003 (22 U.S.C. 7611) is 

2 amended— 

3 (1) in the first sentence of the matter preceding 

4 paragraph (1), by striking ‘‘to combat’’ and insert5 ing ‘‘to develop efforts further to combat’’; 

6 (2) by amending paragraph (4) to read as fol7 lows: 

8 ‘‘(4) provide that the reduction of HIV/AIDS 

9 behavioral risks shall be a priority of all prevention 

10 efforts in terms of funding, scientifically-accurate 

11 educational services, and activities by— 

12 ‘‘(A) designing prevention strategies and 

13 programs based on sound epidemiological evi14 dence, tailored to the unique needs of each 

15 country and community, and reaching those 

16 populations found to be most at risk for acquir17 ing HIV infection; 

18 ‘‘(B) promoting abstinence from sexual ac19 tivity and substance abuse; 

20 ‘‘(C) encouraging delay of sexual debut, 

21 monogamy, fidelity, and partner reduction; 

22 ‘‘(D) promoting the effective use of male 

23 and female condoms; 

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1 ant couples (where one individual has HIV/ 

2 AIDS and the other individual does not have 

3 HIV/AIDS or whose status is unknown); 

4 ‘‘(F) educating men and boys about the 

5 risks of procuring sex commercially and about 

6 the need to end violent behavior toward women 

7 and girls; 

8 ‘‘(G) promoting the rapid expansion of safe 

9 and voluntary male circumcision services; 

10 ‘‘(H) promoting life skills training and de11 velopment for children and youth; 

12 ‘‘(I) supporting advocacy for child and 

13 youth community-based protective social serv14 ices; 

15 ‘‘(J) eradicating trafficking in persons and 

16 creating alternatives to prostitution; 

17 ‘‘(K) promoting cooperation with law en18 forcement to prosecute offenders of trafficking, 

19 rape, and sexual assault crimes with the goal of 

20 eliminating such crimes; 

21 ‘‘(L) promoting services demonstrated to 

22 be effective in reducing the transmission of HIV 

23 infection among injection drug users without in24 creasing illicit drug use; 


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1 ‘‘(M) promoting policies and programs to 

2 end the sexual exploitation of and violence 

3 against women and children; and 

4 ‘‘(N) promoting prevention and treatment 

5 services for men who have sex with men;’’; 

6 (3) by redesignating paragraphs (5) through 

7 (10) as paragraphs (6) through (11), respectively; 

8 (4) by inserting after paragraph (4) (as amend9 ed by paragraph (2) of this subsection) the fol10 lowing: 

11 ‘‘(5) include specific plans for linkage to, and 

12 referral systems for nongovernmental organizations 

13 that implement multisectoral approaches, including 

14 faith-based and community-based organizations, 

15 for— 

16 ‘‘(A) nutrition and food support for indi17 viduals with HIV/AIDS and affected commu18 nities; 

19 ‘‘(B) child health services and development 

20 programs; 

21 ‘‘(C) HIV/AIDS prevention and treatment 

22 services for injection drug users; 

23 ‘‘(D) access to HIV/AIDS education and 

24 testing in family planning and maternal health 


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1 programs supported by the United States Gov2 ernment; and 

3 ‘‘(E) medical, social, and legal services for 

4 victims of violence;’’; 

5 (5) by redesignating paragraphs (10) and (11) 

6 (as redesignated by paragraph (3) of this sub7 section) as paragraphs (11) and (12), respectively; 

8 and 

9 (6) by inserting after paragraph (9) (as redesig10 nated by paragraph (3) of this subsection) the fol11 lowing: 

12 ‘‘(10) maximize host country capacities in train13 ing and research, particularly operations research;’’. 

14 (b) REPORT.—Subsection (b) of such section is 

15 amended— 

16 (1) in paragraph (1), by striking ‘‘this Act’’ and 

17 inserting ‘‘the Tom Lantos and Henry J. Hyde 

18 Global Leadership Against HIV/AIDS, Tuberculosis, 

19 and Malaria Reauthorization Act of 2008’’; and 

20 (2) in paragraph (3)— 

21 (A) by amending subparagraph (C) to read 

22 as follows: 

23 ‘‘(C) A description of the manner in which 

24 the strategy will address the following: 


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1 ‘‘(i) The fundamental elements of pre2 vention and education, care and treatment, 

3 including increasing access to pharma4 ceuticals, vaccines, and microbicides, as 

5 they become available, screening, prophy6 laxis, and treatment of major opportunistic 

7 infections, including tuberculosis, and in8 creasing access to nutrition and food for 

9 individuals on antiretroviral therapies. 

10 ‘‘(ii) The promotion of delay of sexual 

11 debut, abstinence, monogamy, fidelity, and 

12 partner reduction. 

13 ‘‘(iii) The promotion of correct and 

14 consistent use of male and female condoms 

15 and other strategies and skills development 

16 to reduce the risk of HIV transmission. 

17 ‘‘(iv) Increasing voluntary access to 

18 safe male circumcision services. 

19 ‘‘(v) Life-skills training. 

20 ‘‘(vi) The provision of information and 

21 services to encourage young people to delay 

22 sexual debut and ensure access to HIV/ 

23 AIDS prevention information and services. 

24 ‘‘(vii) Prevention of sexual violence 

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1 ance for victims of violence who are at risk 

2 of HIV transmission. 

3 ‘‘(viii) HIV/AIDS prevention, care, 

4 and treatment services for injection drug 

5 users. 

6 ‘‘(ix) Research, including incentives 

7 for HIV vaccine development and new pro8 tocols. 

9 ‘‘(x) Advocacy for community-based 

10 child and youth protective services. 

11 ‘‘(xi) Training of health care workers. 

12 ‘‘(xii) The development of health care 

13 infrastructure and delivery systems. 

14 ‘‘(xiii) Prevention efforts for sub15 stance abusers. 

16 ‘‘(xiv) Prevention, treatment, care, 

17 and outreach efforts for men who have sex 

18 with men.’’; 

19 (B) in subparagraph (D), by adding at the 

20 end before the period the following: ‘‘, including 

21 through faith-based and other nongovernmental 

22 organizations’’; 

23 (C) in subparagraph (E), by inserting ‘‘ac24 cess to HIV/AIDS education and testing in 

25 family planning and maternal and child health 


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1 programs supported by the United States Gov2 ernment and’’ after ‘‘the unique needs of 

3 women, including’’; 

4 (D) in subparagraph (F), by inserting 

5 ‘‘(including by accessing voluntary clinical cir6 cumcision services)’’ after ‘‘in their sexual be7 havior’’; 

8 (E) in subparagraph (G), by inserting 

9 ‘‘and men’s’’ after ‘‘women’s’’; 

10 (F) by redesignating subparagraphs (M) 

11 through (W) as subparagraphs (N) through 

12 (X); 

13 (G) by inserting after subparagraph (L) 

14 the following: 

15 ‘‘(M) A description of efforts to be under16 taken to strengthen the public finance manage17 ment systems of selected host countries to en18 sure transparent, efficient, and effective man19 agement of national and donor financial invest20 ments in health.’’; 

21 (H) in subparagraph (O) (as redesignated 

22 by subparagraph (F) of this paragraph), by 

23 striking ‘‘evaluating programs,’’ and inserting 

24 ‘‘evaluating programs to ensure medical accu25 racy, operations research,’’; 


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1 (I) in subparagraph (Q) (as redesignated 

2 by subparagraph (F) of this paragraph), by in3 serting ‘‘, strengthen national health care deliv4 ery systems, and increase national health work5 force capacities,’’ after ‘‘HIV/AIDS pandemic’’; 

6 (J) in subparagraph (R) (as redesignated 

7 by subparagraph (F) of this paragraph), by in8 serting at the end before the period the fol9 lowing: ‘‘, including strategies relating to agri10 cultural development, trade and economic 

11 growth, and education’’; 

12 (K) in subparagraph (T) (as redesignated 

13 by subparagraph (F) of this paragraph), by in14 serting ‘‘efforts of intergenerational caregivers 

15 and’’ after ‘‘, including’’; 

16 (L) by redesignating subparagraphs (V) 

17 through (X) (as redesignated by subparagraph 

18 (F) of this paragraph), as subparagraphs (W) 

19 through (Y), respectively; 

20 (M) by inserting after subparagraph (U) 

21 (as redesignated by subparagraph (F) of this 

22 paragraph) the following: 

23 ‘‘(V) A plan to strengthen and implement 

24 health care workforce strategies to enable coun25 tries to increase the supply and retention of all 


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1 cadres of trained professional and paraprofes2 sional health care workers by numbers that 

3 move toward global health program needs and 

4 toward targets established by the World Health 

5 Organization, while enabling health systems to 

6 expand coverage consistent with national and 

7 international targets and goals.’’; and 

8 (N) by striking subparagraph (Y) (as re9 designated by subparagraphs (F) and (L) of 

10 this paragraph) and inserting the following: 

11 ‘‘(Y) A description of the specific strate12 gies, developed in coordination with existing 

13 health programs, to prevent mother-to-child 

14 transmission of HIV, including the extent to 

15 which HIV-positive women and men in treat16 ment, care, and support programs and HIV17 negative women and men are counseled about 

18 methods of preventing HIV transmission and 

19 the extent to which HIV prevention methods 

20 are provided on-site or by referral in treatment, 

21 care, and support programs. 

22 ‘‘(Z) A description of the specific strategies 

23 developed to maximize the capacity of health 

24 care providers, including faith-based and other 

25 nongovernmental organizations, and family 


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1 planning providers supported by the United 

2 States Government to ensure access to nec3 essary and comprehensive information about re4 ducing sexual transmission of HIV among 

5 women, men, and young people, including strat6 egies to ensure HIV/AIDS prevention training 

7 for such providers. 

8 ‘‘(AA) A strategy to work with inter9 national and host country partners toward uni10 versal access to HIV/AIDS prevention, treat11 ment, and care programs.’’. 

12 (c) STRATEGIC PLAN FOR PROGRAM MONITORING, 

13 OPERATIONS RESEARCH, AND IMPACT EVALUATION RE14 SEARCH.— 

15 (1) IN GENERAL.—Not later than 1 year after 

16 the date of the enactment of this Act, the Coordi17 nator of United States Government Activities to 

18 Combat HIV/AIDS Globally shall develop a 5-year 

19 strategic plan for program monitoring, operations 

20 research, and impact evaluation research of United 

21 States HIV/AIDS, tuberculosis, and malaria pro22 grams. 

23 (2) ELEMENTS OF PLAN.—The strategic plan 

24 developed under this subsection shall include— 


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1 (A) the amount of funding provided for 

2 program monitoring, operations research, and 

3 impact evaluation research under sections 

4 104A, 104B, and 104C of the Foreign Assist5 ance Act of 1961 (22 U.S.C. 2151b–2, 2151b– 

6 3, and 2151b–4) and the United States Leader7 ship Against HIV/AIDS, Tuberculosis, and Ma8 laria Act of 2003 (22 U.S.C. 7601 et seq.) 

9 available through fiscal year 2009; 

10 (B) strategies to— 

11 (i) improve the efficiency, effective12 ness, quality, and accessibility of services 

13 provided under the provisions of law de14 scribed in subparagraph (A); 

15 (ii) establish the cost-effectiveness of 

16 program models; 

17 (iii) ensure the transparency and ac18 countability of services provided under the 

19 provisions of law described in subpara20 graph (A); 

21 (iv) disseminate and promote the utili22 zation of evaluation findings, lessons, and 

23 best practices in services provided under 

24 the provisions of law described in subpara25 graph (A); and 


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1 (v) encourage and evaluate innovative 

2 service models and strategies to optimize 

3 the delivery of care, treatment, and preven4 tion programs financed by the United 

5 States Government; 

6 (C) priorities for program monitoring, op7 erations research, and impact evaluation re8 search and a time line for completion of activi9 ties associated with such priorities; and 

10 (D) other information that the Coordinator 

11 determines to be necessary. 

12 (3) CONSULTATION.—In developing the stra13 tegic plan under this subsection and implementing, 

14 disseminating, and promoting the use of program 

15 monitoring, operations research, and impact evalua16 tion research, the Coordinator shall consult with rep17 resentatives of relevant executive branch agencies, 

18 other appropriate executive branch agencies, multi19 lateral institutions involved in providing HIV/AIDS 

20 assistance, nongovernmental organizations involved 

21 in implementing HIV/AIDS programs, and the gov22 ernments of host countries. 

23 (4) DEFINITIONS.—In this subsection— 

24 (A) the terms ‘‘program monitoring’’, ‘‘op25 erations research’’, and ‘‘impact evaluation reVerDate Aug 31 2005 04:22 Mar 11, 2008 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RH H5501

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1 search’’, have the meanings given such terms in 

2 section 104A(d)(4)(B) of the Foreign Assist3 ance Act of 1961 (as added by section 

4 301(a)(4)(C) of this Act); and 

5 (B) the term ‘‘relevant executive branch 

6 agencies’’ has the meaning given the term in 

7 section 3 of the United States Leadership 

8 Against HIV/AIDS, Tuberculosis, and Malaria 

9 Act of 2003 (22 U.S.C. 7602). 

10 SEC. 102. HIV/AIDS RESPONSE COORDINATOR. 

11 Section 1(f)(2) of the State Department Basic Au12 thorities Act of 1956 (22 U.S.C. 2651a(f)(2)) is amend13 ed— 

14 (1) in subparagraph (A)— 

15 (A) in the matter preceding clause (i), by 

16 inserting ‘‘, host country finance, health, and 

17 other relevant ministries’’ after ‘‘community18 based organizations)’’; and 

19 (B) in clause (iii), by inserting ‘‘and host 

20 country finance, health, and other relevant min21 istries’’ after ‘‘community-based organiza22 tions)’’; and 

23 (2) in subparagraph (B)(ii)— 

24 (A) by striking subclauses (IV) and (V) 

25 and inserting the following: 


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1 ‘‘(IV) Establishing an inter2 agency working group on HIV/AIDS 

3 that is comprised of, but not limited 

4 to, representatives from the United 

5 States Agency for International Devel6 opment, the Department of Health 

7 and Human Services (including the 

8 Centers for Disease Control and Pre9 vention, the National Institutes of 

10 Health, and the Health Resources and 

11 Services Administration), the Depart12 ment of Labor, the Department of 

13 Agriculture, the Millennium Challenge 

14 Corporation, the Department of De15 fense, and the Office of the Coordi16 nator of United States Government 

17 Activities to Combat Malaria Globally, 

18 for the purposes of coordination of ac19 tivities relating to HIV/AIDS. The 

20 interagency working group shall— 

21 ‘‘(aa) meet regularly to re22 view progress in host countries 

23 toward HIV/AIDS prevention, 

24 treatment, and care objectives; 


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1 ‘‘(bb) participate in the 

2 process of identifying countries in 

3 need of increased assistance 

4 based on the epidemiology of 

5 HIV/AIDS in those countries; 

6 and 

7 ‘‘(cc) review policies that 

8 may be obstacles to reaching ob9 jectives set forth for HIV/AIDS 

10 prevention, treatment, and care. 

11 ‘‘(V) Coordinating overall United 

12 States HIV/AIDS policy and pro13 grams with efforts led by host coun14 tries and with the assistance provided 

15 by other relevant bilateral and multi16 lateral aid agencies and other donor 

17 institutions to achieve 

18 complementarity with other programs 

19 aimed at improving child and mater20 nal health, and food security, pro21 moting education, and strengthening 

22 health care systems.’’; 

23 (B) by redesignating subclauses (VII) and 

24 (VIII) as subclauses (IX) and (X), respectively; 


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1 (C) by inserting after subclause (VI) the 

2 following: 

3 ‘‘(VII) Holding annual consulta4 tions with host country nongovern5 mental organizations providing serv6 ices to improve health, and advocating 

7 on behalf of the individuals with HIV/ 

8 AIDS and those at particular risk of 

9 contracting HIV/AIDS. 

10 ‘‘(VIII) Ensuring, through inter11 agency and international coordination, 

12 that United States HIV/AIDS pro13 grams are coordinated with and com14 plementary to the delivery of related 

15 global health, food security, and edu16 cation services, including— 

17 ‘‘(aa) maternal and child 

18 health care; 

19 ‘‘(bb) services for other ne20 glected and easily preventable 

21 and treatable infectious diseases, 

22 such as tuberculosis; 

23 ‘‘(cc) treatment and care 

24 services for injection drug users; 

25 and 


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1 ‘‘(dd) programs and services 

2 to improve legal, social, and eco3 nomic status of women and 

4 girls.’’; 

5 (D) in subclause (IX) (as redesignated by 

6 subparagraph (B) of this paragraph)— 

7 (i) by inserting ‘‘Vietnam, Antigua 

8 and Barbuda, the Bahamas, Barbados, 

9 Belize, Dominica, Grenada, Jamaica, 

10 Montserrat, Saint Kitts and Nevis, Saint 

11 Vincent and the Grenadines, Saint Lucia, 

12 Suriname, Trinidad and Tobago, the Do13 minican Republic’’ after ‘‘Zambia,’’; 

14 (ii) by adding at the end before the 

15 period the following: ‘‘and other countries 

16 in which the United States is implementing 

17 HIV/AIDS programs’’; and 

18 (iii) by adding at the end the fol19 lowing: ‘‘In designating countries under 

20 this subclause, the President shall give pri21 ority to those countries in which there is a 

22 high prevalence of HIV/AIDS and coun23 tries with large populations that have a 

24 concentrated HIV/AIDS epidemic.’’; 


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1 (E) by redesignating subclause (X) (as re2 designated by subparagraph (B) of this para3 graph) as subclause (XII); 

4 (F) by inserting after subclause (IX) (as 

5 redesignated by subparagraph (B) and amended 

6 by subparagraph (D) of this paragraph) the fol7 lowing: 

8 ‘‘(X) Working, in partnership with 

9 host countries in which the HIV/AIDS epi10 demic is prevalent among injection drug 

11 users, to establish, as a national priority, 

12 national HIV/AIDS prevention programs, 

13 including education, and services dem14 onstrated to be effective in reducing the 

15 transmission of HIV infection among injec16 tion drug users without increasing drug 

17 use. 

18 ‘‘(XI) Working, in partnership with 

19 host countries in which the HIV/AIDS epi20 demic is prevalent among individuals in21 volved in commercial sex acts, to establish, 

22 as a national priority, national prevention 

23 programs, including education, voluntary 

24 testing, and counseling, and referral sys25 tems that link HIV/AIDS programs with 


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1 programs to eradicate trafficking in per2 sons and create alternatives to prostitu3 tion.’’; 

4 (G) in subclause (XII) (as redesignated by 

5 subparagraphs (B) and (E) of this paragraph), 

6 by striking ‘‘funds section’’ and inserting 

7 ‘‘funds appropriated pursuant to the authoriza8 tion of appropriations under section 401 of the 

9 United States Leadership Against HIV/AIDS, 

10 Tuberculosis, and Malaria Act of 2003 for HIV/ 

11 AIDS assistance’’; and 

12 (H) by adding at the end the following: 

13 ‘‘(XIII) Publicizing updated drug 

14 pricing data to inform pharmaceutical 

15 procurement partners’ purchasing de16 cisions. 

17 ‘‘(XIV) Working in partnership 

18 with host countries in which the HIV/ 

19 AIDS epidemic is prevalent among 

20 men who have sex with men, to estab21 lish, as a national priority, national 

22 HIV/AIDS prevention programs, in23 cluding education and services dem24 onstrated to be effective in reducing 


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1 the transmission of HIV among men 

2 who have sex with men.’’. 

3 TITLE II—SUPPORT FOR MULTI4 LATERAL FUNDS, PROGRAMS, 

5 AND PUBLIC-PRIVATE PART6 NERSHIPS 

7 SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PART8 NERSHIPS. 

9 Section 201(a) of the United States Leadership 

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

11 2003 (22 U.S.C. 7621(a)) is amended— 

12 (1) in paragraph (2), by striking ‘‘infectious 

13 diseases’’ and inserting ‘‘easily preventable and 

14 treatable infectious diseases’’; and 

15 (2) in paragraph (4), by striking ‘‘infectious 

16 diseases’’ and inserting ‘‘easily preventable and 

17 treatable infectious diseases’’. 

18 SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 

19 AIDS, TUBERCULOSIS AND MALARIA. 

20 (a) FINDINGS.—Subsection (a) of section 202 of the 

21 United States Leadership Against HIV/AIDS, Tuber22 culosis, and Malaria Act of 2003 (22 U.S.C. 7622) is 

23 amended— 

24 (1) by redesignating paragraphs (1) through 

25 (3) as paragraphs (7) through (9), respectively; and 


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1 (2) by inserting before paragraph (7) (as redes2 ignated by paragraph (1) of this subsection) the fol3 lowing: 

4 ‘‘(1) The Global Fund to Fight AIDS, Tuber5 culosis and Malaria is the multilateral component of 

6 this Act, extending United States efforts to a total 

7 of 136 countries around the world. 

8 ‘‘(2) Created in 2002, the Global Fund has 

9 played a leading role in the fight against HIV/AIDS, 

10 tuberculosis, and malaria around the world and has 

11 grown into an organization that currently provides 

12 nearly a quarter of all international financing to 

13 combat HIV/AIDS and two-thirds of all inter14 national financing to combat tuberculosis and ma15 laria. 

16 ‘‘(3) By 2010, it is estimated that the demand 

17 for funding by the Global Fund will grow in size to 

18 between $6 and $8 billion annually, requiring signifi19 cant contributions from donors around the world, in20 cluding at least $2 billion annually from the United 

21 States. 

22 ‘‘(4) The Global Fund is an innovative financ23 ing mechanism to combat HIV/AIDS, tuberculosis, 

24 and malaria, and has made progress in many areas. 


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1 ‘‘(5) The United States Government is the larg2 est supporter of the Global Fund, both in terms of 

3 resources and technical support. 

4 ‘‘(6) The United States made the initial con5 tribution to the Global Fund and is fully committed 

6 to its success.’’. 

7 (b) UNITED STATES FINANCIAL PARTICIPATION.— 

8 (1) AUTHORIZATION OF APPROPRIATIONS.— 

9 Subsection (d)(1) of such section is amended— 

10 (A) by striking ‘‘$1,000,000,000’’ and in11 serting ‘‘$2,000,000,000’’; 

12 (B) by striking ‘‘for the period of fiscal 

13 year 2004 beginning on January 1, 2004,’’ and 

14 inserting ‘‘for each of the fiscal years 2009 and 

15 2010,’’; and 

16 (C) by striking ‘‘the fiscal years 2005– 

17 2008’’ and inserting ‘‘each of the fiscal years 

18 2011 through 2013’’. 

19 (2) LIMITATION.—Subsection (d)(4) of such 

20 section is amended— 

21 (A) in subparagraph (A)— 

22 (i) in clause (i), by striking ‘‘fiscal 

23 years 2004 through 2008’’ and inserting 

24 ‘‘fiscal years 2009 through 2013’’; 


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1 (ii) in clause (ii), by striking ‘‘fiscal 

2 years 2004 through 2008’’ and inserting 

3 ‘‘fiscal years 2009 through 2013’’; and 

4 (iii) in clause (vi)— 

5 (I) by striking ‘‘for the purposes’’ 

6 and inserting ‘‘For the purposes’’; 

7 (II) by striking ‘‘fiscal years 

8 2004 through 2008’’ and inserting 

9 ‘‘fiscal years 2009 through 2013’’; 

10 and 

11 (III) by striking ‘‘fiscal year 

12 2004’’ and inserting ‘‘fiscal year 

13 2009’’; 

14 (B) in subparagraph (B)(iv)— 

15 (i) by striking ‘‘fiscal years 2004 

16 through 2008’’ and inserting ‘‘fiscal years 

17 2009 through 2013’’; and 

18 (ii) by adding at the end before the 

19 period the following: ‘‘, unless such amount 

20 is made available for more than one fiscal 

21 year, in which case such amount is author22 ized to be made available for such purposes 

23 after December 31 of the fiscal year fol24 lowing the fiscal year in which such funds 

25 first became available.’’; and 


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1 (C) in subparagraph (C)(ii) by striking 

2 ‘‘Committee on International Relations’’ and in3 serting ‘‘Committee on Foreign Affairs’’. 

4 (3) STATEMENT OF POLICY.—The following 

5 shall be the policy of the United States: 

6 (A) Support for the Global Fund to Fight 

7 AIDS, Tuberculosis and Malaria should be 

8 based upon achievement of the following bench9 marks related to transparency and account10 ability: 

11 (i) As recommended by the Govern12 ment Accountability Office, the Fund Sec13 retariat has established standardized ex14 pectations for the performance of Local 

15 Fund Agents (LFAs), is undertaking a 

16 systematic assessment of the performance 

17 of LFAs, and is making available for pub18 lic review, according to the Fund Board’s 

19 policies and practices on disclosure of in20 formation, a regular collection and analysis 

21 of performance data of Fund grants, which 

22 shall cover both Principal Recipients and 

23 sub-recipients. 

24 (ii) A well-staffed, independent Office 

25 of the Inspector General reports directly to 


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1 the Board and is responsible for regular, 

2 publicly published audits of both financial 

3 and programmatic and reporting aspects of 

4 the Fund, its grantees, and LFAs. 

5 (iii) The Fund Secretariat has estab6 lished and is reporting publicly on stand7 ard indicators for all program areas. 

8 (iv) The Fund Secretariat has estab9 lished a database that tracks all subrecipi10 ents and the amounts of funds disbursed 

11 to each, as well as the distribution of re12 sources, by grant and Principal Recipient, 

13 for prevention, care, treatment, the pur14 chases of drugs and commodities, and 

15 other purposes. 

16 (v) The Fund Board has established a 

17 penalty to offset tariffs imposed by na18 tional governments on all goods and serv19 ices provided by the Fund. 

20 (vi) The Fund Board has successfully 

21 terminated its Administrative Services 

22 Agreement with the World Health Organi23 zation and completed the Fund Secretar24 iat’s transition to a fully independent sta25 tus under the Headquarters Agreement the 


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1 Fund has established with the Government 

2 of Switzerland. 

3 (B) Support for the Global Fund to Fight 

4 AIDS, Tuberculosis and Malaria should be 

5 based upon achievement of the following bench6 marks related to the founding principles of the 

7 Fund: 

8 (i) The Fund must maintain its status 

9 as a financing institution. 

10 (ii) The Fund must remain focused on 

11 programs directly related to HIV/AIDS, 

12 malaria, and tuberculosis. 

13 (iii) The Fund must maintain its 

14 Comprehensive Funding Policy, which re15 quires confirmed pledges to cover the full 

16 amount of new grants before the Board 

17 approves them. 

18 (iv) The Fund must maintain and 

19 make progress on sustaining its multisec20 toral approach, through Country Coordi21 nating Mechanisms (CCMs) and in the im22 plementation of grants, as reflected in per23 cent and resources allocated to different 

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1 ety, and faith- and community-based orga2 nizations. 

3 (4) SENSE OF CONGRESS.—Congress— 

4 (A) notes that section 625 of Public Law 

5 110–161 establishes a requirement to withhold 

6 20 percent of funds appropriated for the Global 

7 Fund if the Global Fund fails to meet certain 

8 benchmarks; and 

9 (B) will continue to review the implementa10 tion of the benchmarks to ensure accountability 

11 and transparency of the Global Fund. 

12 SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTER13 NATIONAL VACCINE FUNDS. 

14 (a) VACCINE FUND.—Subsection (k) of section 302 

15 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 

16 is amended by striking ‘‘fiscal years 2004 through 2008’’ 

17 and inserting ‘‘fiscal years 2009 through 2013’’. 

18 (b) INTERNATIONAL AIDS VACCINE INITIATIVE.— 

19 Subsection (l) of such section is amended by striking ‘‘fis20 cal years 2004 through 2008’’ and inserting ‘‘fiscal years 

21 2009 through 2013’’. 

22 (c) MALARIA VACCINE DEVELOPMENT PROGRAMS.— 

23 Subsection (m) of such section is amended by striking 

24 ‘‘fiscal years 2004 through 2008’’ and inserting ‘‘fiscal 

25 years 2009 through 2013’’. 


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1 (d) RESEARCH AND DEVELOPMENT OF A TUBER2 CULOSIS VACCINE.—Such section is further amended by 

3 adding at the end the following: 

4 ‘‘(n) In addition to amounts otherwise available under 

5 this section, there are authorized to be appropriated to 

6 the President such sums as may be necessary for each of 

7 the fiscal years 2009 through 2013 to be available for 

8 United States contributions to research and development 

9 of a tuberculosis vaccine.’’. 

10 SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF 

11 MICROBICIDES TO PREVENT TRANSMISSION 

12 OF HIV AND OTHER DISEASES. 

13 (a) STATEMENT OF POLICY.—Congress recognizes 

14 the need and urgency to expand the range of interventions 

15 for preventing the transmission of human immuno16 deficiency virus (HIV), including nonvaccine prevention 

17 methods that can be controlled by women. 

18 (b) PROGRAM AUTHORIZED.—The Administrator of 

19 the United States Agency for International Development, 

20 in coordination with the Coordinator of United States 

21 Government Activities to Combat HIV/AIDS Globally, 

22 shall develop and implement a program to facilitate wide23 scale availability of microbicides that prevent the trans24 mission of HIV after such microbicides are proven safe 

25 and effective. 


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1 (c) AUTHORIZATION OF APPROPRIATIONS.—Of the 

2 amounts authorized to be appropriated under section 401 

3 of the United States Leadership Against HIV/AIDS, Tu4 berculosis, and Malaria Act of 2003 (22 U.S.C. 7671) for 

5 HIV/AIDS assistance, there are authorized to be appro6 priated to the President such sums as may be necessary 

7 for each of the fiscal years 2009 through 2013 to carry 

8 out this section. 

9 SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND 

10 MALARIA BY STRENGTHENING HEALTH POLI11 CIES AND HEALTH SYSTEMS OF HOST COUN12 TRIES. 

13 (a) IN GENERAL.—Title II of the United States 

14 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

15 Act of 2003 (22 U.S.C. 7621 et seq.) is amended by add16 ing at the end the following: 

17 ‘‘SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, 

18 AND MALARIA BY STRENGTHENING HEALTH 

19 POLICIES AND HEALTH SYSTEMS OF HOST 

20 COUNTRIES. 

21 ‘‘(a) FINDINGS.—Congress makes the following find22 ings: 

23 ‘‘(1) One of the most significant barriers to 

24 achieving universal access to HIV/AIDS treatment 

25 and prevention in developing countries is the lack of 


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1 health infrastructure, particularly in sub-Saharan 

2 Africa. 

3 ‘‘(2) In addition to HIV/AIDS programs, other 

4 treatable and preventable infectious diseases could 

5 be treated concurrently and easily if health care de6 livery systems in developing countries were signifi7 cantly improved. 

8 ‘‘(3) More public investment in basic primary 

9 health care should be a priority in public spending 

10 in developing countries. 

11 ‘‘(b) STATEMENT OF POLICY.—It shall be the policy 

12 of the United States Government— 

13 ‘‘(1) to invest appropriate resources authorized 

14 under this Act and the amendments made by this 

15 Act to carry out activities to strengthen HIV/AIDS 

16 health policies and health systems and provide work17 force training and capacity-building consistent with 

18 the goals and objectives of this Act and the amend19 ments made by this Act; and 

20 ‘‘(2) to support the development of a sound pol21 icy environment in host countries to increase the 

22 ability of such countries to maximize utilization of 

23 health care resources from donor countries, deliver 

24 services to the people of such host countries in an 

25 effective and efficient manner, and reduce barriers 


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1 that prevent recipients of services from achieving 

2 maximum benefit from such services. 

3 ‘‘(c) PLAN REQUIRED.—The Coordinator of United 

4 States Government Activities to Combat HIV/AIDS Glob5 ally, in collaboration with the Administrator of the United 

6 States Agency for International Development, shall de7 velop and implement a plan to combat HIV/AIDS by 

8 strengthening health policies and health systems of host 

9 countries as part of the United States Agency for Inter10 national Development’s ‘Health Systems 2020’ project. 

11 ‘‘(d) ASSISTANCE TO IMPROVE PUBLIC FINANCE

12 MANAGEMENT SYSTEMS.— 

13 ‘‘(1) IN GENERAL.—The Secretary of the 

14 Treasury, acting through the head of the Office of 

15 Technical Assistance, is authorized to provide assist16 ance for advisors and host country finance, health, 

17 and other relevant ministries to improve the effec18 tiveness of public finance management systems in 

19 host countries to enable such countries to receive 

20 funding to carry out programs to combat HIV/ 

21 AIDS, tuberculosis, and malaria and to manage 

22 such programs. 

23 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—Of 

24 the amounts authorized to be appropriated under 

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1 thorized to be appropriated to the Secretary of the 

2 Treasury such sums as may be necessary for each 

3 of the fiscal years 2009 through 2013 to carry out 

4 this subsection.’’. 

5 (b) CLERICAL AMENDMENT.—The table of contents 

6 for the United States Leadership Against HIV/AIDS, Tu7 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

8 is amended by inserting after the item relating to section 

9 203 the following: 

‘‘Sec. 204. Plan to combat HIV/AIDS by strengthening health policies and 

health systems of host countries.’’. 

10 TITLE III—BILATERAL EFFORTS 

11 Subtitle A—General Assistance and 

12 Programs 

13 SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS. 

14 (a) AMENDMENTS TO THE FOREIGN ASSISTANCE

15 ACT OF 1961.— 

16 (1) FINDING.—Subsection (a) of section 104A 

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

18 2151b–2) is amended by inserting ‘‘, South and 

19 Southeast Asia, Central and Eastern Europe’’ after 

20 ‘‘the Caribbean’’. 

21 (2) POLICY.—Subsection (b) of such section is 

22 amended— 

23 (A) in the first sentence— 


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1 (i) by striking ‘‘It is a major’’ and in2 serting the following: 

3 ‘‘(1) GENERAL POLICY.—It is a major’’; 

4 (ii) by striking ‘‘control’’ and insert5 ing ‘‘care’’; and 

6 (iii) by adding at the end before the 

7 period the following: ‘‘and to fulfill United 

8 States commitments to move toward the 

9 goal of universal access to prevention, 

10 treatment, and care of HIV/AIDS’’; 

11 (B) by adding at the end the following: 

12 ‘‘The United States and other developed coun13 tries should provide assistance for the preven14 tion, treatment, and care of HIV/AIDS to coun15 tries in sub-Saharan Africa, the Caribbean, 

16 South and Southeast Asia and Central and 

17 Eastern Europe, addressing both generalized 

18 epidemics and epidemics concentrated among 

19 populations at high risk of infection.’’; and 

20 (C) by further adding at the end the fol21 lowing: 

22 ‘‘(2) SPECIFIC POLICY.—It is therefore the pol23 icy of the United States, by 2013, to— 

24 ‘‘(A) prevent 12,000,000 new HIV infec25 tions worldwide; 


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1 ‘‘(B) support treatment of at least 

2 3,000,000 individuals with HIV/AIDS with the 

3 goal of treating 450,000 children; 

4 ‘‘(C) provide care for 12,000,000 individ5 uals affected by HIV/AIDS, including 

6 5,000,000 orphans and vulnerable children in 

7 communities affected by HIV/AIDS, including 

8 orphans with HIV/AIDS; and 

9 ‘‘(D) train at least 140,000 new health 

10 care professionals and workers for HIV/AIDS 

11 prevention, treatment and care.’’. 

12 (3) AUTHORIZATION.—Subsection (c) of such 

13 section is amended— 

14 (A) in paragraph (1)— 

15 (i) by inserting ‘‘, South and South16 east Asia, Central and Eastern Europe’’ 

17 after ‘‘the Caribbean’’; and 

18 (ii) by adding at the end before the 

19 period the following: ‘‘, and particularly 

20 with respect to refugee populations in such 

21 countries and areas’’; 

22 (B) in paragraph (2)— 

23 (i) by inserting ‘‘, South and South24 east Asia, Central and Eastern Europe’’ 

25 after ‘‘the Caribbean’’; and 


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1 (ii) by adding at the end before the 

2 period the following: ‘‘, and particularly 

3 with respect to refugee populations in such 

4 countries and areas’’; 

5 (C) by redesignating paragraph (3) as 

6 paragraph (4); 

7 (D) by inserting after paragraph (2) the 

8 following: 

9 ‘‘(3) ROLE OF PUBLIC HEALTH CARE DELIVERY

10 SYSTEMS.—It is the sense of Congress that— 

11 ‘‘(A) the President should provide an ap12 propriate level of assistance under paragraph 

13 (1) to help strengthen public health care deliv14 ery systems financed by host countries; and 

15 ‘‘(B) the President, acting through the Co16 ordinator of United States Government Activi17 ties to Combat HIV/AIDS Globally, should sup18 port the development of a policy framework in 

19 such host countries for the long-term sustain20 ability of HIV/AIDS prevention, treatment, and 

21 care programs, and for strengthening health 

22 care delivery systems and increasing health 

23 workforces through recruitment, training, and 

24 policies that allows the devolution of clinical re25 sponsibilities to increase the work force able to 


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1 deliver prevention, treatment, and care services, 

2 as necessary, with clearly identified objectives 

3 and reporting strategies for such services.’’; 

4 (E) in paragraph (4) (as redesignated by 

5 subparagraph (C) of this paragraph), by strik6 ing ‘‘foreign countries’’ and inserting ‘‘host 

7 countries and donor countries’’; and 

8 (F) by adding at the end the following: 

9 ‘‘(5) SENSE OF CONGRESS.— 

10 ‘‘(A) IN GENERAL.—It is the sense of Con11 gress that the Coordinator of United States 

12 Government Activities to Combat HIV/AIDS 

13 Globally and the heads of relevant executive 

14 branch agencies (as such term is defined in sec15 tion 3 of the United States Leadership Against 

16 HIV/AIDS, Tuberculosis, and Malaria Act of 

17 2003) should operate in a manner consistent 

18 with the ‘Three Ones’ goals of UNAIDS. 

19 ‘‘(B) ‘THREE ONES’ GOALS OF UNAIDS DE20 FINED.—In this paragraph, the term ‘‘ ‘Three 

21 Ones’’ goals of UNAIDS’ means— 

22 ‘‘(i) the goal of one agreed HIV/AIDS 

23 action framework that provides the basis 

24 for coordinating the work of all partners in 

25 host countries; 


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1 ‘‘(ii) the goal of one national HIV/ 

2 AIDS coordinating authority, with a 

3 broad-based multisectoral mandate; and 

4 ‘‘(iii) the goal of one agreed country5 level data-collection, monitoring, and eval6 uation system.’’. 

7 (4) ACTIVITIES SUPPORTED.— 

8 (A) PREVENTION.—Subsection (d)(1) of 

9 such section is amended— 

10 (i) in subparagraph (A)— 

11 (I) by inserting ‘‘efforts by faith12 based and other nongovernmental or13 ganizations and’’ after ‘‘infection, in14 cluding’’; 

15 (II) by inserting ‘‘, including ac16 cess to such programs and efforts in 

17 family planning programs supported 

18 by the United States Government,’’ 

19 after ‘‘health programs’’; and 

20 (III) by inserting ‘‘male and fe21 male’’ before ‘‘condoms’’; 

22 (ii) in subparagraph (B)— 

23 (I) by inserting ‘‘relevant and’’ 

24 after ‘‘culturally’’; 


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1 (II) by inserting ‘‘and programs’’ 

2 after ‘‘those organizations’’; and 

3 (III) by inserting ‘‘, level of sci4 entific and fact-based knowledge’’ 

5 after ‘‘experience’’; 

6 (iii) in subparagraph (D), by inserting 

7 ‘‘and nonjudgmental approaches’’ after 

8 ‘‘protections’’; 

9 (iv) by amending subparagraph (E) to 

10 read as follows: 

11 ‘‘(E) assistance to achieve the target of 

12 reaching 80 percent of pregnant women for pre13 vention and treatment of mother-to-child trans14 mission of HIV in countries in which the 

15 United States is implementing HIV/AIDS pro16 grams by 2013, as described in section 

17 312(b)(1) of the United States Leadership 

18 Against HIV/AIDS, Tuberculosis, and Malaria 

19 Act of 2003, and to promote infant feeding op20 tions that meet the criteria described in the 

21 World Health Organization’s Global Strategy 

22 for Infant and Young Child Feeding;’’; 

23 (v) in subparagraph (G)— 

24 (I) by adding at the end before 

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1 ing education and services dem2 onstrated to be effective in reducing 

3 the transmission of HIV infection 

4 without increasing illicit drug use’’; 

5 and 

6 (II) by striking ‘‘and’’ at the end; 

7 (vi) in subparagraph (H), by striking 

8 the period at the end and inserting ‘‘; 

9 and’’; and 

10 (vii) by adding at the end the fol11 lowing: 

12 ‘‘(I)(i) assistance for counseling, testing, 

13 treatment, care, and support programs for pre14 vention of re-infection of individuals with HIV/ 

15 AIDS; 

16 ‘‘(ii) counseling to prevent sexual trans17 mission of HIV, including skill development for 

18 practicing abstinence, reducing the number of 

19 sexual partners, and providing information on 

20 correct and consistent use of male and female 

21 condoms; 

22 ‘‘(iii) assistance to provide male and female 

23 condoms; 

24 ‘‘(iv) diagnosis and treatment of other sex25 ually-transmitted infections; 


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1 ‘‘(v) strategies to address the stigma and 

2 discrimination that impede HIV/AIDS preven3 tion efforts; and 

4 ‘‘(vi) assistance to facilitate widespread ac5 cess to microbicides for HIV prevention, as safe 

6 and effective products become available, includ7 ing financial and technical support for cul8 turally appropriate introductory programs, pro9 curement, distribution, logistics management, 

10 program delivery, acceptability studies, provider 

11 training, demand generation, and post-introduc12 tion monitoring; and 

13 ‘‘(J) assistance for HIV/AIDS education 

14 targeted to reach and prevent the spread of 

15 HIV among men who have sex with men.’’. 

16 (B) TREATMENT.—Subsection (d)(2) of 

17 such section is amended— 

18 (i) in subparagraph (B), by striking ‘‘; 

19 and’’ at the end and inserting a semicolon; 

20 (ii) in subparagraph (C), by striking 

21 the period at the end and inserting a semi22 colon; and 

23 (iii) by adding at the end the fol24 lowing: 


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1 ‘‘(D) assistance specifically to address bar2 riers that might limit the start of and adher3 ence to treatment services, especially in rural 

4 areas, through such measures as mobile and de5 centralized distribution of treatment services, 

6 and where feasible and necessary, direct link7 ages with nutrition and income security pro8 grams, referrals to services for victims of vio9 lence, support groups for individuals with HIV/ 

10 AIDS, and efforts to combat stigma and dis11 crimination against all such individuals; 

12 ‘‘(E) assistance to support comprehensive 

13 HIV/AIDS treatment (including free prophy14 laxis and treatment for common HIV/AIDS-re15 lated opportunistic infections) for at least one16 third of individuals with HIV/AIDS in the poor17 est countries worldwide who are in clinical need 

18 of antiretroviral treatment; and 

19 ‘‘(F) assistance to improve access to psy20 chosocial support systems and other necessary 

21 services for youth who are infected with HIV to 

22 ensure the start of and adherence to treatment 

23 services.’’. 

24 (C) MONITORING.—Subsection (d)(4) of 

25 such section is amended— 


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1 (i) by striking ‘‘The monitoring’’ and 

2 inserting the following: 

3 ‘‘(A) IN GENERAL.—The monitoring’’; 

4 (ii) by inserting ‘‘and paragraph (8)’’ 

5 after ‘‘paragraphs (1) through (3)’’; 

6 (iii) by redesignating subparagraphs 

7 (A) through (D) as clauses (i) through 

8 (iv), respectively; 

9 (iv) in clause (iii) (as redesignated by 

10 clause (iii) of this subparagraph), by strik11 ing ‘‘and’’ at the end; 

12 (v) in clause (iv) (as redesignated by 

13 clause (iii) of this subparagraph), by strik14 ing the period at the end and inserting ‘‘; 

15 and’’; 

16 (vi) by adding at the end the fol17 lowing: 

18 ‘‘(v) carrying out and expanding pro19 gram monitoring, impact evaluation re20 search, and operations research (including 

21 research and evaluations of gender-respon22 sive interventions, disaggregated by age 

23 and sex, in order to identify and replicate 

24 effective models, develop gender indicators 

25 to measure both outcomes and impacts of 


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1 interventions, especially interventions de2 signed to reduce gender inequalities, and 

3 collect lessons learned for dissemination 

4 among different countries) in order to— 

5 ‘‘(I) improve the coverage, effi6 ciency, effectiveness, quality and ac7 cessibility of services provided under 

8 this section; 

9 ‘‘(II) establish the cost-effective10 ness of program models; 

11 ‘‘(III) assess the population-level 

12 impact of programs, projects, and ac13 tivities implemented; 

14 ‘‘(IV) ensure the transparency 

15 and accountability of services provided 

16 under this section; 

17 ‘‘(V) disseminate and promote 

18 the utilization of evaluation findings, 

19 lessons, and best practices in the im20 plementation of programs, projects, 

21 and activities supported under this 

22 section; and 

23 ‘‘(VI) encourage and evaluate in24 novative service models and strategies 


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1 to optimize functionality of programs, 

2 projects, and activities.’’; and 

3 (vii) by further adding at the end the 

4 following: 

5 ‘‘(B) DEFINITIONS.—For purposes of sub6 paragraph (A)(v)— 

7 ‘‘(i) the term ‘impact evaluation re8 search’ means the application of research 

9 methods and statistical analysis to meas10 ure the extent to which a change in a pop11 ulation-based outcome can be attributed to 

12 a program, project, or activity as opposed 

13 to other factors in the environment; 

14 ‘‘(ii) the term ‘program monitoring’ 

15 means the collection, analysis, and use of 

16 routine data with respect to a program, 

17 project, or activity to determine how well 

18 the program, project, or activity is carried 

19 out and at what cost; and 

20 ‘‘(iii) the term ‘operations research’ 

21 means the application of social science re22 search methods and statistical analysis to 

23 judge, compare, and improve policy out24 comes and outcomes of a program, project, 

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1 fining and designing the program, project, 

2 or activity through the development and 

3 implementation of the program, project, or 

4 activity.’’. 

5 (D) PHARMACEUTICALS.—Subsection 

6 (d)(5) of such section is amended— 

7 (i) by redesignating subparagraph (C) 

8 as subparagraph (D); and 

9 (ii) by inserting after subparagraph 

10 (B) the following: 

11 ‘‘(C) MECHANISMS TO ENSURE COST-EF12 FECTIVE DRUG PURCHASING.—Mechanisms to 

13 ensure that pharmaceuticals, including 

14 antiretrovirals and medicines to treat opportun15 istic infections, are purchased at the lowest pos16 sible price at which such pharmaceuticals may 

17 be obtained in sufficient quantity on the world 

18 market.’’. 

19 (E) REFERRAL SYSTEMS AND COORDINA20 TION WITH OTHER ASSISTANCE PROGRAMS.— 

21 (i) FINDING.—The effectiveness of all 

22 HIV/AIDS prevention, treatment, and care 

23 programs and the survival of individuals 

24 with HIV/AIDS would be enhanced by en25 suring that such individuals are referred to 


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1 appropriate support programs, including 

2 education, income generation, HIV/AIDS 

3 support group and food and nutrition pro4 grams, and by providing assistance directly 

5 to such programs to the extent such pro6 grams would further the purposes of ex7 panding access to and the success of HIV/ 

8 AIDS prevention, treatment, and care. 

9 (ii) AMENDMENT.—Subsection (d) of 

10 such section is further amended by adding 

11 at the end the following: 

12 ‘‘(8) REFERRAL SYSTEMS AND COORDINATION

13 WITH OTHER ASSISTANCE PROGRAMS.— 

14 ‘‘(A) REFERRAL SYSTEMS.—Assistance to 

15 ensure that a continuum of care is available to 

16 individuals participating in HIV/AIDS preven17 tion, treatment, and care programs through the 

18 development of referral systems for such indi19 viduals to community-based programs that, 

20 where practicable, are co-located with such 

21 HIV/AIDS programs, and that provide support 

22 activities for such individuals, including HIV/ 

23 AIDS treatment adherence, HIV/AIDS support 

24 groups, food and nutrition support, maternal 

25 health services, substance abuse prevention and 


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1 treatment services, income-generation pro2 grams, legal services, and other program sup3 port. 

4 ‘‘(B) COORDINATION WITH OTHER ASSIST5 ANCE PROGRAMS.— 

6 ‘‘(i)(I) Assistance to integrate HIV/AIDS 

7 testing with testing for other easily detectable 

8 and treatable infectious diseases, such as ma9 laria, tuberculosis, and respiratory infections, 

10 and to provide treatment if possible or referral 

11 to appropriate treatment programs. 

12 ‘‘(II) Assistance to provide, whenever pos13 sible, as a component of HIV/AIDS prevention, 

14 treatment, and care services, and co-treatment 

15 of curable diseases, such as other sexually 

16 transmitted diseases. 

17 ‘‘(III) Assistance and other activities to en18 sure, through interagency and international co19 ordination, that United States global HIV/ 

20 AIDS programs are integrated and complemen21 tary to delivering related health services. 

22 ‘‘(ii) Assistance to support schools and re23 lated programs for children and youth that in24 crease the effectiveness of programs described 

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1 ture, teachers, and other support to such pro2 grams. 

3 ‘‘(iii) Assistance and other activities to 

4 provide access to HIV/AIDS prevention, treat5 ment, and care programs in family planning 

6 and maternal and child health programs sup7 ported by the United States Government. 

8 ‘‘(iv) Assistance to United States and host 

9 country nonprofit development organizations 

10 that directly support livelihood initiatives in 

11 HIV/AIDS-affected countries that provide op12 portunities for direct lending to microentre13 preneurs by United States citizens or opportu14 nities for United States citizens to purchase 

15 livestock and plants for families to provide nu16 trition and generate income for individual 

17 households and communities. 

18 ‘‘(v) Assistance to coordinate and provide 

19 linkages between HIV/AIDS prevention, treat20 ment, and care programs with efforts to im21 prove the economic and legal status of women 

22 and girls. 

23 ‘‘(vi) Technical assistance coordinated 

24 across implementing agencies, offered on a reg25 ular basis, and made available upon request, for 


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1 faith-based and community-based organizations, 

2 especially indigenous organizations and new 

3 partners who do not have extensive experience 

4 managing United States foreign assistance pro5 grams, including for training and logistical sup6 port to establish financial mechanisms to track 

7 program receipts and expenditures and data 

8 management systems to ensure data quality 

9 and strengthen reporting. 

10 ‘‘(vii) In accordance with the World Health 

11 Organization’s Interim Policy on TB/HIV Ac12 tivities (2004), assistance to individuals with or 

13 symptomatic of tuberculosis, and assistance to 

14 implement the following: 

15 ‘‘(I) Provide opt-out HIV/AIDS coun16 seling and testing and appropriate referral 

17 for treatment and care to individuals with 

18 or symptomatic of tuberculosis, and work 

19 with host countries to ensure that such in20 dividuals in host countries are provided 

21 such services. 

22 ‘‘(II) Ensure, in coordination with 

23 host countries, that individuals with HIV/ 

24 AIDS receive tuberculosis screening and 

25 other appropriate treatment. 


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1 ‘‘(III) Provide increased funding for 

2 HIV/AIDS and tuberculosis activities, by 

3 increasing total resources for such activi4 ties, including lab strengthening and infec5 tion control. 

6 ‘‘(IV) Improve the management and 

7 dissemination of knowledge gained from 

8 HIV/AIDS and tuberculosis activities to 

9 increase the replication of best practices.’’. 

10 (5) ANNUAL REPORT.—Subsection (e) of such 

11 section is amended— 

12 (A) in paragraph (1), by striking ‘‘Com13 mittee on International Relations’’ and insert14 ing ‘‘Committee on Foreign Affairs’’; 

15 (B) in paragraph (2)— 

16 (i) in subparagraph (B), by striking 

17 ‘‘and’’ at the end; 

18 (ii) in subparagraph (C)— 

19 (I) in the matter preceding clause 

20 (i), by striking ‘‘including’’ and insert21 ing ‘‘including—’’; 

22 (II) by striking clauses (i) and 

23 (ii) and inserting the following: 

24 ‘‘(i)(I) the effectiveness of such pro25 grams in reducing the transmission of 


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1 HIV, particularly in women and girls, in 

2 reducing mother-to-child transmission of 

3 HIV, including through drug treatment 

4 and therapies, either directly or by refer5 ral, and in reducing mortality rates from 

6 HIV/AIDS, including through drug treat7 ment, and addiction therapies; 

8 ‘‘(II) a description of strategies, goals, 

9 programs, and interventions to address the 

10 specific needs and vulnerabilities of young 

11 women and young men; the progress to12 ward expanding access among young 

13 women and young men to evidence-based, 

14 comprehensive HIV/AIDS health care serv15 ices and HIV prevention and sexuality and 

16 abstinence education programs at the indi17 vidual, community, and national levels; and 

18 clear targets for integrating adolescents 

19 who are orphans, including adolescents 

20 who are infected with HIV, into programs 

21 for orphans and vulnerable children; and 

22 ‘‘(III) the amount of United States 

23 funding provided under the authorities of 

24 this Act to procure drugs for HIV/AIDS 

25 programs in countries described in section 


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1 1(f)(2)(B)(IX) of the State Department 

2 Basic Authorities Act of 1956 (22 U.S.C. 

3 2651a(f)(2)(B)(VIII)), including a detailed 

4 description of anti-retroviral drugs pro5 cured, including— 

6 ‘‘(aa) the total amount expended 

7 for each generic and name brand 

8 drug; 

9 ‘‘(bb) the price paid per unit of 

10 each drug; and 

11 ‘‘(cc) the vendor from which each 

12 drug was purchased; and 

13 ‘‘(ii) the progress made toward im14 proving health care delivery systems (in15 cluding the training of adequate numbers 

16 of health care professionals) and infra17 structure to ensure increased access to 

18 care and treatment, including a description 

19 of progress toward— 

20 ‘‘(I)(aa) the training and reten21 tion of adequate numbers of health 

22 care professionals in order to meet a 

23 nationally-determined ratio of doctors, 

24 nurses, and midwives to patients, 

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1 thousand ratio established by the 

2 World Health Organization (WHO); 

3 ‘‘(bb) increases in the number of 

4 other health care professions, such as 

5 pharmacists and lab technicians, as 

6 necessary; and 

7 ‘‘(cc) the improvement of infra8 structure needed to ensure universal 

9 access to HIV/AIDS prevention, treat10 ment, and care by 2015; 

11 ‘‘(II) national health care work12 force strategy benchmarks, as re13 quired by section 202(d)(5)(B) of the 

14 United States Leadership Against 

15 HIV/AIDS, Tuberculosis, and Malaria 

16 Act of 2003, United States contribu17 tions to developing and implementing 

18 the benchmarks, and main challenges 

19 to implementing the benchmarks; 

20 ‘‘(III) ensuring, to the extent 

21 practicable, that health care workers 

22 providing services under this Act have 

23 safe working conditions and are re24 ceiving health care services, including 

25 services relating to HIV/AIDS; 


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1 ‘‘(IV) activities to strengthen 

2 health care systems in order to over3 come obstacles and barriers to the 

4 provision of HIV/AIDS, tuberculosis, 

5 and malaria services; 

6 ‘‘(V) improving integration and 

7 coordination of HIV/AIDS programs 

8 with related health care services and 

9 supporting the capacity of health care 

10 programs to refer individuals to com11 munity-based services; and 

12 ‘‘(VI) strengthening procurement 

13 and supply chain management sys14 tems of host countries;’’; 

15 (III) in clause (iii), by adding at 

16 the end before the semicolon the fol17 lowing: ‘‘, including the percentage of 

18 such United States foreign assistance 

19 provided for diagnosis and treatment 

20 of individuals with tuberculosis in 

21 countries with the highest burden of 

22 tuberculosis, as determined by the 

23 World Health Organization (WHO)’’; 

24 and 


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1 (IV) in clause (iv), by striking 

2 the period at the end and inserting a 

3 semicolon; and 

4 (iii) by adding at the end the fol5 lowing: 

6 ‘‘(D) a description of efforts to integrate 

7 HIV/AIDS and tuberculosis prevention, treat8 ment, and care programs, including— 

9 ‘‘(i) the number and percentage of 

10 HIV-infected individuals receiving HIV/ 

11 AIDS treatment or care services who are 

12 also receiving screening and subsequent 

13 treatment for tuberculosis; 

14 ‘‘(ii) the number and percentage of in15 dividuals with tuberculosis who are receiv16 ing HIV/AIDS counseling and testing, and 

17 appropriate referral to HIV/AIDS services; 

18 ‘‘(iii) the number and location of lab19 oratories with the capacity to perform tu20 berculosis culture tests and tuberculosis 

21 drug susceptibility tests; 

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1 berculosis (MDR–TB) and extensively drug 

2 resistant tuberculosis (XDR–TB); and 

3 ‘‘(v) the number of HIV-infected indi4 viduals suspected of having tuberculosis 

5 who are provided tuberculosis culture diag6 nosis or tuberculosis drug susceptibility 

7 testing; 

8 ‘‘(E) a description of coordination efforts 

9 with relevant executive branch agencies (as such 

10 term is defined in section 3 of the United 

11 States Leadership Against HIV/AIDS, Tuber12 culosis, and Malaria Act of 2003) and at the 

13 global level in the effort to link HIV/AIDS serv14 ices with non-HIV/AIDS services; 

15 ‘‘(F) a description of programs serving 

16 women and girls, including— 

17 ‘‘(i) a description of HIV/AIDS pre18 vention programs that address the 

19 vulnerabilities of girls and women to HIV/ 

20 AIDS; and 

21 ‘‘(ii) information on the number of in22 dividuals served by programs aimed at re23 ducing the vulnerabilities of women and 

24 girls to HIV/AIDS; 


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1 ‘‘(G) a description of the specific strategies 

2 funded to ensure the reduction of HIV infection 

3 among injection drug users, and the number of 

4 injection drug users, by country, reached by 

5 such strategies, including medication-assisted 

6 drug treatment for individuals with HIV or at 

7 risk of HIV, and HIV prevention programs 

8 demonstrated to be effective in reducing HIV 

9 transmission without increasing drug use; and 

10 ‘‘(H) a detailed description of monitoring, 

11 impact evaluation research, and operations re12 search of programs, projects, and activities car13 ried out pursuant to subsection (d)(4)(A)(v).’’; 

14 and 

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

16 ‘‘(3) PUBLIC AVAILABILITY.—The Coordinator 

17 of United States Government Activities to Combat 

18 HIV/AIDS Globally shall make publicly available on 

19 the Internet website of the Office of the Coordinator 

20 the information contained in paragraph (2)(H) of 

21 each report and, in addition, the individual evalua22 tions and other reports that were the basis of such 

23 information, including lessons learned and collected 

24 in such evaluations and reports.’’. 


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1 (b) AUTHORIZATION OF APPROPRIATIONS.—Sub2 section (b) of section 301 of the United States Leadership 

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

4 2003 (22 U.S.C. 7631) is amended— 

5 (1) in paragraph (1), by striking ‘‘fiscal years 

6 2004 through 2008’’ and inserting ‘‘fiscal years 

7 2009 through 2013’’; and 

8 (2) in paragraph (3), by striking ‘‘fiscal years 

9 2004 through 2008’’ and inserting ‘‘fiscal years 

10 2009 through 2013’’. 

11 (c) FOOD SECURITY AND NUTRITION SUPPORT.— 

12 Subsection (c) of such section is amended to read as fol13 lows: 

14 ‘‘(c) FOOD SECURITY AND NUTRITION SUPPORT.— 

15 ‘‘(1) FINDINGS.—Congress finds the following: 

16 ‘‘(A) The United States provides more 

17 than 60 percent of all food assistance world18 wide. 

19 ‘‘(B) According to the United Nations 

20 World Food Program and other United Nations 

21 agencies, food insecurity of individuals with 

22 HIV/AIDS is a major problem in countries with 

23 large populations of such individuals, particu24 larly in sub-Saharan African countries. 


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1 ‘‘(C) Individuals infected with HIV have 

2 higher nutritional requirements than individuals 

3 who are not infected with HIV, particularly 

4 with respect to the need for protein. Also, there 

5 is evidence to suggest that the full benefit of 

6 therapy to treat HIV/AIDS may not be 

7 achieved in individuals who are malnourished, 

8 particularly in pregnant and lactating women. 

9 ‘‘(2) SENSE OF CONGRESS.—It is the sense of 

10 Congress that— 

11 ‘‘(A) malnutrition, especially for individ12 uals with HIV/AIDS, is a clinical health issue 

13 with wider nutrition, health, and social implica14 tions for such individuals, their families, and 

15 their communities that must be addressed by 

16 United States HIV/AIDS prevention, treat17 ment, and care programs; 

18 ‘‘(B) food security and nutrition directly 

19 impact an individual’s vulnerability to HIV in20 fection, the progression of HIV to AIDS, an in21 dividual’s ability to begin an antiretroviral 

22 medication treatment regimen, the efficacy of 

23 an antiretroviral medication treatment regimen 

24 once an individual begins such a regimen, and 


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1 the ability of communities to effectively cope 

2 with the HIV/AIDS epidemic and its impacts; 

3 ‘‘(C) international guidelines established by 

4 the World Health Organization (WHO) should 

5 serve as the reference standard for HIV/AIDS 

6 food and nutrition activities supported by this 

7 Act and the amendments made by this Act; 

8 ‘‘(D) the Coordinator of United States 

9 Government Activities to Combat HIV/AIDS 

10 Globally and the Administrator of the United 

11 States Agency for International Development 

12 should make it a priority to work together and 

13 with other United States Government agencies, 

14 donors, and multilateral institutions to increase 

15 the integration of food and nutrition support 

16 and livelihood activities into HIV/AIDS preven17 tion, treatment, and care activities funded by 

18 the United States and other governments and 

19 organizations; 

20 ‘‘(E) for purposes of determining which in21 dividuals infected with HIV should be provided 

22 with nutrition and food support— 

23 ‘‘(i) children with moderate or severe 

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1 ards, shall be given priority for such nutri2 tion and food support; and 

3 ‘‘(ii) adults with a body mass index 

4 (BMI) of 18.5 or less, or at the prevailing 

5 WHO-approved measurement for BMI, 

6 should be considered ‘malnourished’ and 

7 should be given priority for such nutrition 

8 and food support; 

9 ‘‘(F) programs funded by the United 

10 States should include therapeutic and supple11 mentary feeding, food, and nutrition support 

12 and should include strong links to development 

13 programs that provide support for livelihoods; 

14 and 

15 ‘‘(G) the inability of individuals with HIV/ 

16 AIDS to access food for themselves or their 

17 families should not be allowed to impair or 

18 erode the therapeutic status of such individuals 

19 with respect to HIV/AIDS or related co20 morbidities. 

21 ‘‘(3) STATEMENT OF POLICY.—It is the policy 

22 of the United States to— 

23 ‘‘(A) address the food and nutrition needs 

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1 dividuals, including orphans and vulnerable 

2 children; 

3 ‘‘(B) fully integrate food and nutrition 

4 support into HIV/AIDS prevention, treatment, 

5 and care programs carried out under this Act 

6 and the amendments made by this Act; 

7 ‘‘(C) ensure, to the extent practicable, 

8 that— 

9 ‘‘(i) HIV/AIDS prevention, treatment, 

10 and care providers and health care workers 

11 are adequately trained so that such pro12 viders and workers can provide accurate 

13 and informed information regarding food 

14 and nutrition support to individuals en15 rolled in treatment and care programs and 

16 individuals affected by HIV/AIDS; and 

17 ‘‘(ii) individuals with HIV/AIDS who, 

18 with their households, are identified as 

19 food insecure are provided with adequate 

20 food and nutrition support; and 

21 ‘‘(D) effectively link food and nutrition 

22 support provided under this Act and the 

23 amendments made by this Act to individuals 

24 with HIV/AIDS, their households, and their 

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1 hood programs funded by the United States 

2 and other donors and multilateral agencies. 

3 ‘‘(4) INTEGRATION OF FOOD SECURITY AND

4 NUTRITION ACTIVITIES INTO HIV/AIDS PREVENTION, 

5 TREATMENT, AND CARE ACTIVITIES.— 

6 ‘‘(A) REQUIREMENTS RELATING TO GLOB7 AL AIDS COORDINATOR.—Consistent with the 

8 statement of policy described in paragraph (3), 

9 the Coordinator of United States Government 

10 Activities to Combat HIV/AIDS Globally 

11 shall— 

12 ‘‘(i) ensure, to the extent practicable, 

13 that— 

14 ‘‘(I) an assessment, using vali15 dated criteria, of the food security and 

16 nutritional status of each individual 

17 enrolled in antiretroviral medication 

18 treatment programs supported with 

19 funds authorized under this Act or 

20 any amendment made by this Act is 

21 carried out; and 

22 ‘‘(II) appropriate nutritional 

23 counseling is provided to each indi24 vidual described in subclause (I); 


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1 ‘‘(ii) coordinate with the Adminis2 trator of the United States Agency for 

3 International Development, the Secretary 

4 of Agriculture, and the heads of other rel5 evant executive branch agencies to— 

6 ‘‘(I) ensure, to the extent prac7 ticable, that, in communities in which 

8 a significant proportion of individuals 

9 with HIV/AIDS are in need of food 

10 and nutrition support, a status and 

11 needs assessment for such support 

12 employing validated criteria is con13 ducted and a plan to provide such 

14 support is developed and implemented; 

15 ‘‘(II) improve and enhance co16 ordination between food security and 

17 livelihood programs for individuals in18 fected with HIV in host countries and 

19 food security and livelihood programs 

20 that may already exist in such coun21 tries; 

22 ‘‘(III) establish effective linkages 

23 between the health and agricultural 

24 development and livelihoods sectors in 

25 order to enhance food security; and 


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1 ‘‘(IV) ensure, by providing in2 creased resources if necessary, effec3 tive coordination between activities 

4 authorized under this Act and the 

5 amendments made by this Act and ac6 tivities carried out under other provi7 sions of the Foreign Assistance Act of 

8 1961 when establishing new HIV/ 

9 AIDS treatment sites; 

10 ‘‘(iii) develop effective, validated indi11 cators that measure outcomes of nutrition 

12 and food security interventions carried out 

13 under this section and use such indicators 

14 to monitor and evaluate the effectiveness 

15 of such interventions; and 

16 ‘‘(iv) evaluate the role of and, to the 

17 extent appropriate, support and expand 

18 partnerships and linkages between United 

19 States postsecondary educational institu20 tions with postsecondary educational insti21 tutions in host countries in order to pro22 vide training and build indigenous human 

23 and institutional capacity and expertise to 

24 respond to HIV/AIDS, and to improve ca25 pacity to address nutrition, food security, 


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1 and livelihood needs of HIV/AIDS-affected 

2 and impoverished communities. 

3 ‘‘(B) REQUIREMENTS RELATING TO USAID

4 ADMINISTRATOR.—Consistent with the state5 ment of policy described in paragraph (3), the 

6 Administrator of the United States Agency for 

7 International Development, in coordination with 

8 the Coordinator of United States Government 

9 Activities to Combat HIV/AIDS Globally and 

10 the Secretary of Agriculture, shall provide, to 

11 the extent practicable, as an essential compo12 nent of antiretroviral medication treatment pro13 grams supported with funds authorized under 

14 this Act and the amendments made by this Act, 

15 food and nutrition support to each individual 

16 with HIV/AIDS who is determined to need such 

17 support by the assessing health professional, 

18 based on a body mass index (BMI) of 18.5 or 

19 less, or at the prevailing WHO-approved meas20 urement for BMI, and the individual’s house21 hold, for a period of not less than 180 days, ei22 ther directly or through referral to an assist23 ance program or organization with demon24 strable ability to provide such support. 


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1 ‘‘(C) REPORT.—Not later than October 31, 

2 2010, and annually thereafter, the Coordinator 

3 of United States Government Activities to Com4 bat HIV/AIDS Globally, in consultation with 

5 the Administrator of the United States Agency 

6 for International Development, shall submit to 

7 the appropriate congressional committees a re8 port on the implementation of this subsection 

9 for the prior fiscal year. The report shall in10 clude a description of— 

11 ‘‘(i) the effectiveness of interventions 

12 carried out to improve the nutritional sta13 tus of individuals with HIV/AIDS; 

14 ‘‘(ii) the amount of funds provided for 

15 food and nutrition support for individuals 

16 with HIV/AIDS and affected individuals in 

17 the prior fiscal year and the projected 

18 amount of funds to be provided for such 

19 purpose for next fiscal year; and 

20 ‘‘(iii) a strategy for improving the 

21 linkage between assistance provided with 

22 funds authorized under this subsection and 

23 food security and livelihood programs 

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1 tivities funded by other donors and multi2 lateral organizations. 

3 ‘‘(D) AUTHORIZATION OF APPROPRIA4 TIONS.—Of the amounts authorized to be ap5 propriated under section 401 for HIV/AIDS as6 sistance, there are authorized to be appro7 priated to the President such sums as may be 

8 necessary for each of the fiscal years 2009 

9 through 2013 to carry out this subsection.’’. 

10 (d) ELIGIBILITY FOR ASSISTANCE.—Subsection (d) 

11 of such section is amended to read as follows: 

12 ‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organiza13 tion, including a faith-based organization, that is other14 wise eligible to receive assistance under section 104A of 

15 the Foreign Assistance Act of 1961 (as added by sub16 section (a)) or under any other provision of this Act (or 

17 any amendment made by this Act or the Tom Lantos and 

18 Henry J. Hyde Global Leadership Against HIV/AIDS, 

19 Tuberculosis, and Malaria Reauthorization Act of 2008) 

20 to prevent, treat, or monitor HIV/AIDS— 

21 ‘‘(1) shall not be required, as a condition of re22 ceiving the assistance, to endorse or utilize a multi23 sectoral approach to combating HIV/AIDS, or to en24 dorse, utilize, make a referral to, become integrated 

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1 tivity to which the organization has a religious or 

2 moral objection; and 

3 ‘‘(2) shall not be discriminated against in the 

4 solicitation or issuance of grants, contracts, or coop5 erative agreements under such provisions of law for 

6 refusing to do so.’’. 

7 (e) SENSE OF CONGRESS.—Such section is further 

8 amended by striking subsection (g). 

9 (f) REPORT.— 

10 (1) IN GENERAL.—Not later than 270 days 

11 after the date of the enactment of this Act, the Co12 ordinator of United States Government Activities to 

13 Combat HIV/AIDS Globally shall submit to the ap14 propriate congressional committees a report identi15 fying a target for the number of additional health 

16 professionals and workers needed in host countries 

17 to provide HIV/AIDS prevention, treatment, and 

18 care and the training needs of such health profes19 sionals and workers. The target should reflect avail20 able data and should identify the need for United 

21 States Government contributions to meet the target. 

22 (2) DEFINITION.—In this subsection, the term 

23 ‘‘appropriate congressional committees’’ has the 

24 meaning given the term in section 3 of the United 


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1 States Leadership Against HIV/AIDS, Tuberculosis, 

2 and Malaria Act of 2003 (22 U.S.C. 7602). 

3 SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 

4 (a) AMENDMENTS TO THE FOREIGN ASSISTANCE

5 ACT OF 1961.— 

6 (1) FINDINGS.—Subsection (a) of section 104B 

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

8 2151b–3) is amended by striking paragraphs (1) 

9 and (2) and inserting the following: 

10 ‘‘(1) Tuberculosis is one of the greatest infec11 tious causes of death of adults worldwide, killing 1.6 

12 million individuals per year—one person every 20 

13 seconds. 

14 ‘‘(2) Tuberculosis is the leading infectious cause 

15 of death among individuals who are infected with 

16 HIV due to their weakened immune systems, and it 

17 is estimated that one-third of such individuals have 

18 tuberculosis. Tuberculosis is also a leading killer of 

19 women of reproductive age. 

20 ‘‘(3) Driven by the HIV/AIDS pandemic, inci21 dence rates of tuberculosis in sub-Saharan Africa 

22 have more than doubled on average since 1990. The 

23 problem is so pervasive that in August 2005, African 

24 health ministers and the World Health Organization 


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1 (WHO) declared tuberculosis to be an emergency in 

2 sub-Saharan Africa. 

3 ‘‘(4)(A) The wide extent of drug resistance, in4 cluding both multi-drug resistant tuberculosis 

5 (MDR–TB) and extensively drug resistant tuber6 culosis (XDR–TB), represents both a critical chal7 lenge to the global control of tuberculosis and a seri8 ous worldwide public health threat. 

9 ‘‘(B) XDR–TB, which is a form of MDR–TB 

10 with additional resistance to multiple second-line 

11 anti-tuberculosis drugs, is associated with worst 

12 treatment outcomes of any form of tuberculosis. 

13 ‘‘(C) XDR–TB is converging with the HIV/ 

14 AIDS epidemic, undermining gains in HIV/AIDS 

15 prevention and treatment programs and requires ur16 gent interventions. 

17 ‘‘(D) Drug resistance surveillance reports have 

18 confirmed the serious scale and spread of tuber19 culosis, with XDR–TB strains confirmed on six con20 tinents. 

21 ‘‘(E) Demonstrating the lethality of XDR–TB, 

22 an initial outbreak in Tugela Ferry, South Africa, in 

23 2006 killed 52 of 53 patients with hundreds more 

24 cases reported since that time. 


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1 ‘‘(F) Of the world’s regions, sub-Saharan Afri2 ca, faces the greatest gap in capacity to prevent, 

3 treat, and care for individuals with XDR–TB.’’. 

4 (2) POLICY.—Subsection (b) of such section is 

5 amended to read as follows: 

6 ‘‘(b) POLICY.—It is a major objective of the foreign 

7 assistance program of the United States to control tuber8 culosis. In all countries in which the Government of the 

9 United States has established development programs, par10 ticularly in countries with the highest burden of tuber11 culosis and other countries with high rates of tuberculosis, 

12 the United States Government should prioritize the 

13 achievement of the following goals by not later than De14 cember 31, 2015: 

15 ‘‘(1) Reduce by one-half the tuberculosis death 

16 and disease burden from the 1990 baseline. 

17 ‘‘(2) Sustain or exceed the detection of at least 

18 70 percent of sputum smear-positive cases of tuber19 culosis and the cure of at least 85 percent of such 

20 cases detected.’’. 

21 (3) ACTIVITIES SUPPORTED.—Such section is 

22 further amended— 

23 (A) by redesignating subsections (d) 

24 through (f) as subsections (e) through (g); and 


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1 (B) by inserting after subsection (c) the 

2 following: 

3 ‘‘(d) ACTIVITIES SUPPORTED.—Assistance provided 

4 under subsection (c) shall, to the maximum extent prac5 ticable, be used to carry out the following activities: 

6 ‘‘(1) Provide diagnostic counseling and testing 

7 to individuals with HIV/AIDS for tuberculosis (in8 cluding a culture diagnosis to rule out multi-drug re9 sistant tuberculosis (MDR–TB) and extensively drug 

10 resistant tuberculosis (XDR–TB) and provide HIV/ 

11 AIDS voluntary counseling and testing to individuals 

12 with any form of tuberculosis. 

13 ‘‘(2) Provide tuberculosis treatment to individ14 uals receiving treatment and care for HIV/AIDS 

15 who have active tuberculosis and provide prophy16 lactic treatment to individuals with HIV/AIDS who 

17 also have a latent tuberculosis infection. 

18 ‘‘(3) Link individuals with both HIV/AIDS and 

19 tuberculosis to HIV/AIDS treatment and care serv20 ices, including antiretroviral therapy and 

21 cotrimoxazole therapy. 

22 ‘‘(4) Ensure that health care workers trained to 

23 diagnose, treat, and provide care for HIV/AIDS are 

24 also trained to diagnose, treat, and provide care for 

25 individuals with both HIV/AIDS and tuberculosis. 


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1 ‘‘(5) Ensure that individuals with active pul2 monary tuberculosis are provided a culture diag3 nosis, including drug susceptibility testing to rule 

4 out multi-drug resistant tuberculosis (MDR–TB) 

5 and extensively drug resistant tuberculosis (XDR– 

6 TB) in areas with high prevalence of tuberculosis 

7 drug resistance.’’. 

8 (4) PRIORITY TO STOP TB STRATEGY.—Sub9 section (f) of such section (as redesignated by para10 graph (3) of this subsection) is amended— 

11 (A) by amending the heading to read as 

12 follows: ‘‘PRIORITY TO STOP TB STRATEGY’’; 

13 (B) in the first sentence, by striking ‘‘In 

14 furnishing’’ and all that follows through ‘‘, in15 cluding funding’’ and inserting the following: 

16 ‘‘(1) PRIORITY.—In furnishing assistance under 

17 subsection (c), the President shall give priority to— 

18 ‘‘(A) activities described in the Stop TB 

19 Strategy, including expansion and enhancement 

20 of Directly Observed Treatment Short-course 

21 (DOTS) coverage, treatment for individuals in22 fected with both tuberculosis and HIV and 

23 treatment for individuals with multi-drug resist24 ant tuberculosis (MDR–TB), strengthening of 

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1 ards for Tuberculosis Care by all care pro2 viders, empowering individuals with tuber3 culosis, and enabling and promoting research to 

4 develop new diagnostics, drugs, and vaccines, 

5 and program-based operational research relat6 ing to tuberculosis; and 

7 ‘‘(B) funding’’; and 

8 (C) in the second sentence— 

9 (i) by striking ‘‘In order to’’ and all 

10 that follows through ‘‘not less than’’ and 

11 inserting the following: 

12 ‘‘(2) AVAILABILITY OF AMOUNTS.—In order to 

13 meet the requirements of paragraph (1), the Presi14 dent— 

15 ‘‘(A) shall ensure that not less than’’; 

16 (ii) by striking ‘‘for Directly Observed 

17 Treatment Short-course (DOTS) coverage 

18 and treatment of multi-drug resistant tu19 berculosis using DOTS–Plus,’’ and insert20 ing ‘‘to implement the Stop TB Strategy; 

21 and’’; and 

22 (iii) by striking ‘‘including’’ and all 

23 that follows and inserting the following: 

24 ‘‘(B) should ensure that not less than 

25 $15,000,000 of the amount made available to 


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1 carry out this section for a fiscal year is used 

2 to make a contribution to the Global Tuber3 culosis Drug Facility.’’. 

4 (5) ASSISTANCE FOR WHO AND THE STOP TU5 BERCULOSIS PARTNERSHIP.—Such section is further 

6 amended— 

7 (A) by redesignating subsection (g) (as re8 designated by paragraph (3) of this subsection) 

9 as subsection (h); and 

10 (B) by inserting after subsection (f) (as re11 designated by paragraph (4) and amended by 

12 paragraph (5) of this subsection) the following 

13 new subsection: 

14 ‘‘(g) ASSISTANCE FOR WHO AND THE STOP TUBER15 CULOSIS PARTNERSHIP.—In carrying out this section, the 

16 President, acting through the Administrator of the United 

17 States Agency for International Development, is author18 ized to provide increased resources to the World Health 

19 Organization (WHO) and the Stop Tuberculosis Partner20 ship to improve the capacity of countries with high rates 

21 of tuberculosis and other affected countries to implement 

22 the Stop TB Strategy and specific strategies related to 

23 addressing extensively drug resistant tuberculosis (XDR– 

24 TB).’’. 


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1 (6) DEFINITIONS.—Subsection (h) of such sec2 tion (as redesignated by paragraph (5)(A) of this 

3 subsection) is amended— 

4 (A) in paragraph (1), by adding at the end 

5 before the period the following: ‘‘, including low 

6 cost and effective diagnosis and evaluation of 

7 treatment regimes, vaccines, and monitoring of 

8 tuberculosis, as well as a reliable drug supply, 

9 and a management strategy for public health 

10 systems, with health system strengthening, pro11 motion of the use of the International Stand12 ards for Tuberculosis Care by all care pro13 viders, bacteriology under an external quality 

14 assessment framework, short-course chemo15 therapy, and sound reporting and recording sys16 tems’’; and 

17 (B) by adding after paragraph (5) the fol18 lowing new paragraph: 

19 ‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 

20 Strategy’ means the six-point strategy to reduce tu21 berculosis developed by the World Health Organiza22 tion. The strategy is described in the Global Plan to 

23 Stop TB 2007–2016: Actions for Life, a comprehen24 sive plan developed by the Stop Tuberculosis Part25 nership that sets out the actions necessary to 


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1 achieve the millennium development goal of cutting 

2 tuberculosis deaths and disease burden in half by 

3 2016.’’. 

4 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

5 302(b) of the United States Leadership Against HIV/ 

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

7 7632(b)) is amended— 

8 (1) in paragraph (1), by striking ‘‘such sums as 

9 may be necessary for each of the fiscal years 2004 

10 through 2008’’ and inserting ‘‘$4,000,000,000 for 

11 fiscal years 2009 through 2013’’; and 

12 (2) in paragraph (3), by striking ‘‘fiscal years 

13 2004 through 2008’’ and inserting ‘‘fiscal years 

14 2009 through 2013’’. 

15 SEC. 303. ASSISTANCE TO COMBAT MALARIA. 

16 (a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT

17 OF 1961.—Section 104C(b) of the Foreign Assistance Act 

18 of 1961 (22 U.S.C. 21516–4(b)) is amended by striking 

19 ‘‘control, and cure’’ and inserting ‘‘treatment, and care’’. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

21 303(b) of the United States Leadership Against HIV/ 

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

23 7633(b)) is amended— 

24 (1) in paragraph (1), by striking ‘‘such sums as 

25 may be necessary for fiscal years 2004 through 


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1 2008’’ and inserting ‘‘$5,000,000,000 for fiscal 

2 years 2009 through 2013’’; and 

3 (2) in paragraph (3), by striking ‘‘fiscal years 

4 2004 through 2008’’ and inserting ‘‘fiscal years 

5 2009 through 2013’’. 

6 (c) DEVELOPMENT OF A COMPREHENSIVE FIVE7 YEAR STRATEGY.—Section 303 of the United States 

8 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

9 Act of 2003 (22 U.S.C. 7633) is amended by adding at 

10 the end the following: 

11 ‘‘(d) DEVELOPMENT OF A COMPREHENSIVE FIVE12 YEAR STRATEGY.—The President shall establish a com13 prehensive, five-year strategy to combat global malaria 

14 that strengthens the capacity of the United States to be 

15 an effective leader of international efforts to reduce the 

16 global malaria disease burden. Such strategy shall main17 tain sufficient flexibility and remain responsive to the 

18 ever-changing nature of the global malaria challenge and 

19 shall— 

20 ‘‘(1) include specific objectives, multisectoral 

21 approaches and strategies to treat and provide care 

22 to individuals infected with malaria, to prevent the 

23 further spread of malaria; 


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1 ‘‘(2) describe how this strategy would con2 tribute to the United States’ overall global health 

3 and development goals; 

4 ‘‘(3) clearly explain how proposed activities to 

5 combat malaria will be coordinated with other 

6 United States global health activities, including the 

7 five-year global HIV/AIDS and tuberculosis strate8 gies developed pursuant to section 101 of this Act; 

9 ‘‘(4) expand public-private partnerships and 

10 leveraging of resources to combat malaria, including 

11 private sector resources; 

12 ‘‘(5) coordinate among relevant executive 

13 branch agencies providing assistance to combat ma14 laria in order to maximize human and financial re15 sources and reduce unnecessary duplication among 

16 such agencies and other donors; 

17 ‘‘(6) maximize United States capabilities in the 

18 areas of technical assistance, training, and research, 

19 including vaccine research, to combat malaria; and 

20 ‘‘(7) establish priorities and selection criteria 

21 for the distribution of resources to combat malaria 

22 based on factors such as the size and demographics 

23 of the population with malaria, the needs of that 

24 population, the host countries’ existing infrastruc25 ture, and the host countries’ ability to complement 


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1 United States efforts with strategies outlined in na2 tional malaria control plans. 

3 ‘‘(e) MALARIA RESPONSE COORDINATOR.— 

4 ‘‘(1) IN GENERAL.—There should be established 

5 within the United States Agency for International 

6 Development a Coordinator of United States Gov7 ernment Activities to Combat Malaria Globally, who 

8 should be appointed by the President. 

9 ‘‘(2) AUTHORITIES.—The Coordinator, acting 

10 through such nongovernmental organizations and 

11 relevant executive branch agencies as may be nec12 essary and appropriate to effect the purposes of sec13 tion 104C of the Foreign Assistance Act of 1961 (22 

14 U.S.C. 2151b–4), is authorized— 

15 ‘‘(A) to operate internationally to carry out 

16 prevention, treatment, care, support, capacity 

17 development of health systems, and other activi18 ties for combating malaria; 

19 ‘‘(B) to transfer and allocate funds to rel20 evant executive branch agencies; 

21 ‘‘(C) to provide grants to, and enter into 

22 contracts with, nongovernmental organizations 

23 to carry out the purposes of such section 104C; 

24 ‘‘(D) to enter into contracts and transfer 

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1 tions to carry out the purposes of such section 

2 104C; and 

3 ‘‘(E) to coordinate with a public-private 

4 partnership to discover and develop effective 

5 new antimalarial drugs, including drugs for 

6 multi-drug resistant malaria and malaria in 

7 pregnant women. 

8 ‘‘(3) DUTIES.— 

9 ‘‘(A) IN GENERAL.—The Coordinator shall 

10 have primary responsibility for the oversight 

11 and coordination of all resources and global 

12 United States government activities to combat 

13 malaria. 

14 ‘‘(B) SPECIFIC DUTIES.—The Coordinator 

15 shall— 

16 ‘‘(i) facilitate program and policy co17 ordination among relevant executive 

18 branch agencies and nongovernmental or19 ganizations, including auditing, monitoring 

20 and evaluation of such programs; 

21 ‘‘(ii) ensure that each relevant execu22 tive branch agency has sufficient resources 

23 to execute programs in areas in which the 

24 agency has the greatest expertise, technical 

25 capability, and potential for success; 


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1 ‘‘(iii) coordinate with the Office of the 

2 Coordinator of United States Government 

3 Activities to Combat HIV/AIDS Globally 

4 and equivalent managers of other relevant 

5 executive branch agencies that are imple6 menting global health programs to develop 

7 and implement program plans, country8 level interactions, and recipient administra9 tive requirements in countries in which 

10 more than one program operates; 

11 ‘‘(iv) coordinate relevant executive 

12 branch agency activities in the field, in13 cluding coordination of planning, imple14 mentation, and evaluation of malaria pro15 grams with HIV/AIDS programs in coun16 tries in which both programs are being 

17 carried out; 

18 ‘‘(v) pursue coordinate program im19 plementation with host governments, other 

20 donors, and the private sector; and 

21 ‘‘(vi) establish due diligence criteria 

22 for all recipients of funds appropriated 

23 pursuant to the authorizations of appro24 priations under section 401 for malaria as25 sistance. 


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1 ‘‘(f) ASSISTANCE TO WHO.—In carrying out this sec2 tion, the President is authorized to make a United States 

3 contribution to the Roll Back Malaria Partnership and the 

4 World Health Organization (WHO) to improve the capac5 ity of countries with high rates of malaria and other af6 fected countries to implement comprehensive malaria con7 trol programs. 

8 ‘‘(g) ANNUAL REPORT.— 

9 ‘‘(1) IN GENERAL.—Not later than 270 days 

10 after the date of the enactment of the Tom Lantos 

11 and Henry J. Hyde Global Leadership Against HIV/ 

12 AIDS, Tuberculosis, and Malaria Reauthorization 

13 Act of 2008, and annually thereafter, the President 

14 shall transmit to the appropriate congressional com15 mittees a report on United States assistance for the 

16 prevention, treatment, control, and elimination of 

17 malaria. 

18 ‘‘(2) MATTERS TO BE INCLUDED.—The report 

19 required under paragraph (1) shall include a de20 scription of— 

21 ‘‘(A) the countries and activities to which 

22 malaria assistance has been allocated; 

23 ‘‘(B) the number of people reached 

24 through malaria assistance programs; 


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1 ‘‘(C) the percentage and number of chil2 dren and mothers reached through malaria as3 sistance programs; 

4 ‘‘(D) research efforts to develop new tools 

5 to combat malaria, including drugs and vac6 cines; 

7 ‘‘(E) collaboration with the World Health 

8 Organization (WHO), the Global Fund to Fight 

9 AIDS, Tuberculosis and Malaria, other donor 

10 governments, and relevant executive branch 

11 agencies to combat malaria; 

12 ‘‘(F) quantified impact of United States 

13 assistance on childhood morbidity and mor14 tality; 

15 ‘‘(G) the number of children who received 

16 immunizations through malaria assistance pro17 grams; and 

18 ‘‘(H) the number of women receiving ante19 natal care through malaria assistance pro20 grams.’’. 

21 SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/ 

22 AIDS. 

23 (a) IN GENERAL.—Title III of the United States 

24 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 


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1 Act of 2003 (22 U.S.C. 7631 et seq.) is amended by strik2 ing section 304 and inserting the following: 

3 ‘‘SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/ 

4 AIDS. 

5 ‘‘(a) SENSE OF CONGRESS.—It is the sense of Con6 gress that the use of health care partnerships that link 

7 United States and host country health care institutions 

8 create opportunities for sharing of knowledge and exper9 tise among individuals with significant experience in 

10 health-related fields and build local capacity to combat 

11 HIV/AIDS and increase scientific understanding of the 

12 progression of HIV/AIDS and the HIV/AIDS epidemic. 

13 ‘‘(b) AUTHORITY TO FACILITATE HEALTH CARE

14 PARTNERSHIPS TO COMBAT HIV/AIDS.—The President, 

15 acting through the Coordinator of United States Govern16 ment Activities to Combat HIV/AIDS Globally, shall fa17 cilitate the development of health care partnerships de18 scribed in subsection (a) by– 

19 ‘‘(1) supporting short- and long-term institu20 tional partnerships, including partnerships that build 

21 capacity in ministries of health, central- and district22 level health agencies, medical facilities, health edu23 cation and training institutions, academic centers, 

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1 volved in prevention, treatment, and care of HIV/ 

2 AIDS; 

3 ‘‘(2) supporting the development of consultation 

4 services using appropriate technologies, including on5 line courses, DVDs, telecommunications services, 

6 and other technologies to eliminate the barriers that 

7 prevent host country professionals from accessing 

8 high quality health care services information, par9 ticularly providers located in rural areas; 

10 ‘‘(3) supporting the placements of highly quali11 fied individuals to strengthen human and organiza12 tional capacity through the use of health care profes13 sionals to facilitate skills transfer, building local ca14 pacity, and to expand rapidly the pool of providers, 

15 managers, and other health care staff delivering 

16 HIV/AID services in host countries; and 

17 ‘‘(4) meeting individual country needs and, 

18 where possible, insisting on the implementation of a 

19 national strategic plan, by providing training and 

20 mentoring to strengthen human and organizational 

21 capacity among local health care service organiza22 tions. 

23 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—Of the 

24 amounts authorized to be appropriated under section 401 

25 for HIV/AIDS assistance, there are authorized to be apVerDate Aug 31 2005 04:22 Mar 11, 2008 Jkt 069200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RH H5501

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1 propriated to the President such sums as may be nec2 essary for each of the fiscal years 2009 through 2013 to 

3 carry out this section.’’. 

4 (b) CLERICAL AMENDMENT.—The table of contents 

5 for the United States Leadership Against HIV/AIDS, Tu6 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

7 is amended by striking the item relating to section 304 

8 and inserting the following new item: 

‘‘Sec. 304. Health care partnerships to combat HIV/AIDS.’’. 

9 Subtitle B—Assistance for Women, 

10 Children, and Families 

11 SEC. 311. POLICY AND REQUIREMENTS. 

12 (a) POLICY.—Subsection (a) of section 312 of the 

13 United States Leadership Against HIV/AIDS, Tuber14 culosis, and Malaria Act of 2003 (22 U.S.C. 7652) is 

15 amended— 

16 (1) in the first sentence, by striking ‘‘The 

17 United States Government’s’’ and inserting the fol18 lowing: 

19 ‘‘(1) IN GENERAL.—The United States’’; and 

20 (2) by adding at the end the following: 

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

22 should work in collaboration with governments, do23 nors, the private sector, nongovernmental organiza24 tions, and other key stakeholders to carry out the 

25 policy described in paragraph (1).’’. 


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1 (b) REQUIREMENTS.—Subsection (b) of such section 

2 is amended to read as follows: 

3 ‘‘(b) REQUIREMENTS.—The 5-year United States 

4 strategy required by section 101 of this Act shall— 

5 ‘‘(1) establish a target for prevention and treat6 ment of mother-to-child transmission of HIV that by 

7 2013 will reach at least 80 percent of pregnant 

8 women in those countries most affected by HIV/ 

9 AIDS; 

10 ‘‘(2) establish a target requiring that by 2013 

11 up to 15 percent of individuals receiving care and up 

12 to 15 percent of individuals receiving treatment 

13 under this Act and the amendments made by this 

14 Act are children; 

15 ‘‘(3) integrate care and treatment with preven16 tion of mother-to-child transmission of HIV pro17 grams in order to improve outcomes for HIV-af18 fected women and families as soon as is feasible, 

19 consistent with the national government policies of 

20 countries in which programs under this Act are ad21 ministered, and including support for strategies to 

22 ensure successful follow-up and continuity of care; 

23 ‘‘(4) expand programs designed to care for chil24 dren orphaned by HIV/AIDS; 


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1 ‘‘(5) develop a timeline for expanding access to 

2 more effective regimes to prevent mother-to-child 

3 transmission of HIV, consistent with the national 

4 government policies of countries in which programs 

5 under this Act are administered and the goal of 

6 achieving universal use of such regimens as soon as 

7 possible; 

8 ‘‘(6) ensure that women receiving voluntary 

9 contraceptive counseling, services, or commodities in 

10 programs supported by the United States Govern11 ment have access to the full range of HIV/AIDS 

12 services; and 

13 ‘‘(7) ensure that women in prevention of moth14 er-to-child transmission of HIV programs are pro15 vided with appropriate maternal and child services, 

16 either directly or by referral.’’. 

17 SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER18 TO-CHILD TRANSMISSION OF THE HIV INFEC19 TION. 

20 Section 313(a) of the United States Leadership 

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

22 2003 (22 U.S.C. 7653(a)) is amended by striking ‘‘5 

23 years’’ and inserting ‘‘10 years’’. 


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1 SEC. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG 

2 WOMEN AND YOUTH. 

3 (a) IN GENERAL.—Title III of the United States 

4 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

5 Act of 2003 (22 U.S.C. 7631 et seq.) is amended by add6 ing at the end the following: 

7 ‘‘SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG 

8 WOMEN AND YOUTH. 

9 ‘‘(a) STATEMENT OF POLICY.—In order to meet the 

10 United States Government’s goal of preventing 

11 12,000,000 new HIV infections worldwide, it shall be the 

12 policy of the United States to pursue a global HIV/AIDS 

13 prevention strategy that emphasizes the immediate and 

14 ongoing needs of women and youth and addresses the fac15 tors that lead to gender disparities in the rate of HIV in16 fection. 

17 ‘‘(b) STRATEGY.— 

18 ‘‘(1) IN GENERAL.—The President shall formu19 late a comprehensive, integrated, and culturally-ap20 propriate global HIV/AIDS prevention strategy that, 

21 to the extent epidemiologically appropriate, address22 es the vulnerabilities of women and youth to HIV in23 fection and seeks to reduce the factors that lead to 

24 gender disparities in the rate of HIV infection. 

25 ‘‘(2) ELEMENTS.—The strategy required under 

26 paragraph (1) shall include specific goals and tarVerDate Aug 31 2005 04:22 Mar 11, 2008 Jkt 069200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RH H5501

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1 gets under the 5-year strategy outlined in section 

2 101 and shall include comprehensive HIV/AIDS pre3 vention education at the individual and national level 

4 including the ABC (‘Abstain, Be faithful, use 

5 Condoms’) model as a means to reduce HIV infec6 tions and shall include the following: 

7 ‘‘(A) Specific goals under the five-year 

8 strategy outlined in section 101. 

9 ‘‘(B) Empowering women and youth to 

10 avoid cross-generational sex and to decide when 

11 and whom to marry in order to reduce the inci12 dence of early or child marriage. 

13 ‘‘(C) Dramatically increasing access to cur14 rently available female-controlled prevention 

15 methods and including investments in training 

16 to increase the effective and consistent use of 

17 both male and female condoms. 

18 ‘‘(D) Accelerating the de-stigmatization of 

19 HIV/AIDS among women and youth as a major 

20 risk factor for the transmission of HIV. 

21 ‘‘(E) Addressing and preventing post-trau22 matic and psycho-social consequences and pro23 viding post-exposure prophylaxis to victims of 

24 gender-based violence and rape against women 

25 and youth through appropriate medical, social, 


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1 educational, and legal assistance and through 

2 prosecutions and legal penalties to address such 

3 violence. 

4 ‘‘(F) Promoting changes in male attitudes 

5 and behavior that respect the human rights of 

6 women and youth and that support and foster 

7 gender equality. 

8 ‘‘(G) Supporting the development of micro9 enterprise initiatives, job training programs, 

10 and other such efforts to assist women in devel11 oping and retaining independent economic 

12 means. 

13 ‘‘(H) Supporting universal basic education 

14 and expanded educational opportunities for 

15 women and youth. 

16 ‘‘(I) Protecting the property and inherit17 ance rights of women. 

18 ‘‘(J) Coordinating inclusion of HIV/AIDS 

19 prevention information and education services 

20 and programs for individuals with HIV/AIDS 

21 with existing health care services targeted to 

22 women and youth, such as ensuring access to 

23 HIV/AIDS education and testing in family 

24 planning programs supported by the United 

25 States Government and programs to reduce 


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1 mother-to-child transmission of HIV, and ex2 panding the reach of such HIV/AIDS health 

3 services. 

4 ‘‘(K) Promoting gender equality by sup5 porting the development of nongovernmental or6 ganizations, including faith-based and commu7 nity-based organizations, that support the needs 

8 of women and utilizing such organizations that 

9 are already empowering women and youth at 

10 the community level. 

11 ‘‘(L) Encouraging the creation and effec12 tive enforcement of legal frameworks that guar13 antee women equal rights and equal protection 

14 under the law. 

15 ‘‘(M) Encouraging the participation and 

16 involvement of women in drafting, coordinating, 

17 and implementing the national HIV/AIDS stra18 tegic plans of their countries. 

19 ‘‘(N) Responding to other economic and 

20 social factors that increase the vulnerability of 

21 women and youth to HIV infection. 

22 ‘‘(3) TRANSMISSION TO CONGRESS AND PUBLIC

23 AVAILABILITY.—Not later than 180 days after the 

24 date of the enactment of the Tom Lantos and Henry 

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1 berculosis, and Malaria Reauthorization Act of 

2 2008, the President shall transmit to the appro3 priate congressional committees and make available 

4 to the public the strategy required under paragraph 

5 (1). 

6 ‘‘(c) COORDINATION.—In formulating and imple7 menting the strategy required under subsection (b), the 

8 President shall ensure that the United States coordinates 

9 its overall HIV/AIDS policy and programs with the na10 tional governments of the countries for which the United 

11 States provides assistance to combat HIV/AIDS and, to 

12 the extent practicable, with international organizations, 

13 other donor countries, and indigenous organizations, in14 cluding faith-based and community-based organizations 

15 specifically for the purposes of ensuring gender equality 

16 and promoting respect of the human rights of women that 

17 impact their susceptibility to HIV/AIDS, improving wom18 en’s health, and expanding education for women and 

19 youth, and organizations, including faith-based and other 

20 nonprofit organizations, providing services to and advo21 cating on behalf of individuals with HIV/AIDS and indi22 viduals affected by HIV/AIDS. 

23 ‘‘(d) GUIDANCE.— 

24 ‘‘(1) IN GENERAL.—The President shall provide 

25 clear guidance to field missions of the United States 


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1 Government in countries for which the United States 

2 provides assistance to combat HIV/AIDS, based on 

3 the strategy required under subsection (b). 

4 ‘‘(2) TRANSMISSION TO CONGRESS AND PUBLIC

5 AVAILABILITY.—The President shall transmit to the 

6 appropriate congressional committees and make 

7 available to the public a description of the guidance 

8 required under paragraph (1). 

9 ‘‘(e) REPORT.— 

10 ‘‘(1) IN GENERAL.—Not later than 1 year after 

11 the date of the enactment of the Tom Lantos and 

12 Henry J. Hyde Global Leadership Against HIV/ 

13 AIDS, Tuberculosis, and Malaria Reauthorization 

14 Act of 2008, and annually thereafter as part of the 

15 annual report required under section 104A(e) of the 

16 Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 

17 2(e)), the President shall transmit to the appro18 priate congressional committees and make available 

19 to the public a report on the implementation of this 

20 section for the prior fiscal year. 

21 ‘‘(2) MATTERS TO BE INCLUDED.—The report 

22 required under paragraph (1) shall include the fol23 lowing: 


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1 ‘‘(A) A description of the prevention pro2 grams designed to address the vulnerabilities of 

3 women and youth to HIV/AIDS. 

4 ‘‘(B) A list of nongovernmental organiza5 tions in each country that receive assistance 

6 from the United States to carry out HIV pre7 vention activities, including the amount and the 

8 source of funding received.’’. 

9 (b) CLERICAL AMENDMENT.—The table of contents 

10 for the United States Leadership Against HIV/AIDS, Tu11 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

12 is amended by inserting after the item relating to section 

13 315 the following: 

‘‘Sec. 316. Strategy to prevent HIV infections among women and youth.’’. 

14 SEC. 314. CLERICAL AMENDMENT. 

15 The table of contents for the United States Leader16 ship Against HIV/AIDS, Tuberculosis, and Malaria Act 

17 of 2003 (22 U.S.C. 7601 note) is amended by striking 

18 the item relating to subtitle B of title III and inserting 

19 the following: 

‘‘Subtitle B—Assistance for Women, Children, and Families’’. 


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1 TITLE IV—AUTHORIZATION OF 

2 APPROPRIATIONS 

3 SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 

4 Section 401(a) of the United States Leadership 

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

6 2003 (22 U.S.C. 7671(a)) is amended— 

7 (1) by striking ‘‘$3,000,000,000’’ and inserting 

8 ‘‘$10,000,000,000’’; and 

9 (2) by striking ‘‘fiscal years 2004 through 

10 2008’’ and inserting ‘‘fiscal years 2009 through 

11 2013’’. 

12 SEC. 402. SENSE OF CONGRESS. 

13 Section 402(b) of the United States Leadership 

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

15 2003 (22 U.S.C. 7672) is amended— 

16 (1) by striking paragraph (1); 

17 (2) by redesignating paragraphs (2) through 

18 (4) as paragraphs (1) through (3), respectively; and 

19 (3) in paragraph (2) (as redesignated by para20 graph (2) of this section), by striking ‘‘, of which’’ 

21 and all that follows through ‘‘programs’’. 

22 SEC. 403. ALLOCATION OF FUNDS. 

23 (a) HIV/AIDS PREVENTION ACTIVITIES.—Sub24 section (a) of section 403 of the United States Leadership 


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

2 2003 (22 U.S.C. 7673) is amended to read as follows: 

3 ‘‘(a) HIV/AIDS PREVENTION ACTIVITIES.— 

4 ‘‘(1) IN GENERAL.—For each of the fiscal years 

5 2009 through 2013, not less than 20 percent of the 

6 amounts appropriated pursuant to the authorization 

7 of appropriations under section 401 for HIV/AIDS 

8 assistance for each such fiscal year shall be ex9 pended for HIV/AIDS prevention activities con10 sistent with section 104A(d) of the Foreign Assist11 ance Act of 1961. 

12 ‘‘(2) BALANCED FUNDING REQUIREMENT.—(A) 

13 The Coordinator of United States Government Ac14 tivities to Combat HIV/AIDS Globally shall provide 

15 balanced funding for prevention activities for sexual 

16 transmission of HIV/AIDS and shall ensure that be17 havioral change programs, including abstinence, 

18 delay of sexual debut, monogamy, fidelity and part19 ner reduction, are implemented and funded in a 

20 meaningful and equitable way in the strategy for 

21 each host country based on objective epidemiological 

22 evidence as to the source of infections and in con23 sultation with the government of each host county 

24 involved in HIV/AIDS prevention activities. 


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1 ‘‘(B) In fulfilling the requirement under sub2 paragraph (A), the Coordinator shall establish a 

3 HIV sexual transmission prevention strategy gov4 erning the expenditure of funds authorized by the 

5 Act used to prevent the sexual transmission of HIV 

6 in any host country with a generalized epidemic. In 

7 each such host country, if this strategy provides less 

8 than 50 percent of such funds for behavioral change 

9 programs, including abstinence, delay of sexual 

10 debut, monogamy, fidelity, and partner reduction, 

11 the Coordinator shall, within 30 days of the issuance 

12 of this strategy, report to the appropriate congres13 sional committees on the justification for this deci14 sion. 

15 ‘‘(C) Programs and activities that implement or 

16 purchase new prevention technologies or modalities 

17 such as medical male circumcision, pre-exposure pro18 phylaxis, or microbicides and programs and activities 

19 that provide counseling and testing for HIV or pre20 vent mother-to-child prevention of HIV shall not be 

21 included in determining compliance with this para22 graph. 

23 ‘‘(3) REPORT.—Not later than 1 year after the 

24 date of the enactment of the Tom Lantos and Henry 

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1 berculosis, and Malaria Reauthorization Act of 

2 2008, and annually thereafter as part of the annual 

3 report required under section 104A(e) of the For4 eign Assistance Act of 1961 (22 U.S.C. 2151b– 

5 2(e)), the President shall transmit to the appro6 priate congressional committees and make available 

7 to the public a report on the implementation of 

8 paragraph (2) for the prior fiscal year.’’. 

9 (b) ORPHANS AND VULNERABLE CHILDREN.—Sub10 section (b) of such section is amended by striking ‘‘fiscal 

11 years 2006 through 2008’’ and inserting ‘‘fiscal years 

12 2009 through 2013’’. 

13 SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOV14 ERNMENTS. 

15 (a) PROHIBITION ON TAXATION.—None of the funds 

16 appropriated pursuant to the authorization of appropria17 tions under section 401 of the United States Leadership 

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

19 2003 (22 U.S.C. 7671) may be made available to provide 

20 assistance for a foreign country under a new bilateral 

21 agreement governing the terms and conditions under 

22 which such assistance is to be provided unless such agree23 ment includes a provision stating that assistance provided 

24 by the United States shall be exempt from taxation, or 

25 reimbursed, by the foreign government, and the Secretary 


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1 of State shall expeditiously seek to negotiate amendments 

2 to existing bilateral agreements, as necessary, to conform 

3 with this requirement. 

4 (b) DE MINIMUS EXCEPTION.—Foreign taxes of a de 

5 minimus nature shall not be subject to the provisions of 

6 subsection (a). 

7 (c) REPROGRAMMING OF FUNDS.—Funds withheld 

8 from obligation for each country or entity pursuant to sub9 section (a) shall be reprogrammed for assistance to coun10 tries which do not assess taxes on United States assistance 

11 or which have an effective arrangement that is providing 

12 substantial reimbursement of such taxes. 

13 (d) DETERMINATIONS.— 

14 (1) IN GENERAL.—The provisions of this sec15 tion shall not apply to any country or entity the Sec16 retary of State determines— 

17 (A) does not assess taxes on United States 

18 assistance or which has an effective arrange19 ment that is providing substantial reimburse20 ment of such taxes; or 

21 (B) the foreign policy interests of the 

22 United States outweigh the policy of this sec23 tion to ensure that United States assistance is 

24 not subject to taxation. 


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1 (2) CONSULTATION.—The Secretary of State 

2 shall consult with the Committees on Foreign Af3 fairs and Appropriations at least 15 days prior to 

4 exercising the authority of this subsection with re5 gard to any country or entity. 

6 (e) IMPLEMENTATION.—The Secretary of State shall 

7 issue rules, regulations, or policy guidance, as appropriate, 

8 to implement the prohibition against the taxation of assist9 ance contained in this section. 

10 (f) DEFINITIONS.—As used in this section— 

11 (1) the terms ‘‘taxes’’ and ‘‘taxation’’ refer to 

12 value added taxes and customs duties imposed on 

13 commodities financed with United States assistance 

14 for programs for which funds are authorized by this 

15 Act; and 

16 (2) the term ‘‘bilateral agreement’’ refers to a 

17 framework bilateral agreement between the Govern18 ment of the United States and the government of 

19 the country receiving assistance that describes the 

20 privileges and immunities applicable to United 

21 States foreign assistance for such country generally, 

22 or an individual agreement between the Government 

23 of the United States and such government that de24 scribes, among other things, the treatment for tax 


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1 purposes that will be accorded the United States as2 sistance provided under that agreement. 

3 TITLE V—SUSTAINABILITY AND 

4 STRENGTHENING OF HEALTH 

5 CARE SYSTEMS 

6 SEC. 501. SUSTAINABILITY AND STRENGTHENING OF 

7 HEALTH CARE SYSTEMS. 

8 The United States Leadership Against HIV/AIDS, 

9 Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 

10 et seq.) is amended by adding at the end the following: 

11 ‘‘TITLE VI—SUSTAINABILITY AND 

12 STRENGTHENING OF HEALTH 

13 CARE SYSTEMS 

14 ‘‘SEC. 601. FINDINGS. 

15 ‘‘Congress makes the following findings: 

16 ‘‘(1) The shortage of health personnel, includ17 ing doctors, nurses, pharmacists, counselors, labora18 tory staff, and paraprofessionals, is one of the lead19 ing obstacles to fighting HIV/AIDS in sub-Saharan 

20 Africa. 

21 ‘‘(2) The HIV/AIDS pandemic aggravates the 

22 shortage of health workers through loss of life and 

23 illness among medical staff, unsafe working condi24 tions for medical personnel, and increased workloads 

25 for diminished staff, while the shortage of health 


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1 personnel undermines efforts to prevent and provide 

2 care and treatment for individuals with HIV/AIDS. 

3 ‘‘(3) Failure to address the shortage of health 

4 care professionals and paraprofessionals, and the 

5 factors forcing such individuals to leave sub-Saharan 

6 Africa, will undermine the objectives of United 

7 States development policy and will subvert opportu8 nities to achieve internationally-recognized goals for 

9 the prevention, treatment, and care of HIV/AIDS 

10 and other diseases, the reduction of child and mater11 nal mortality, and for economic growth and develop12 ment in sub-Saharan Africa. 

13 ‘‘SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES 

14 AND OTHER POLICIES. 

15 ‘‘(a) NATIONAL HEALTH WORKFORCE STRATE16 GIES.— 

17 ‘‘(1) STATEMENT OF POLICY.—It shall be the 

18 policy of the United States Government to support 

19 countries receiving United States assistance to com20 bat HIV/AIDS, tuberculosis, and malaria, and other 

21 health programs in developing, strengthening, and 

22 implementing 5-year health workforce strategies. 

23 ‘‘(2) TECHNICAL AND FINANCIAL ASSIST24 ANCE.—The Administrator of the United States 

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1 tion with the Coordinator of United States Govern2 ment Activities to Combat HIV/AIDS Globally, is 

3 authorized to provide technical and financial assist4 ance to countries described in paragraph (1) to en5 able such countries, in conjunction with other fund6 ing sources, to develop, strengthen, and implement 

7 health workforce strategies. 

8 ‘‘(3) ACTIVITIES SUPPORTED.—Assistance pro9 vided under paragraph (2) shall, to the maximum 

10 extent practicable, be used to carry out the fol11 lowing: 

12 ‘‘(A) Activities to promote an inclusive 

13 process that includes nongovernmental organi14 zations and individuals with HIV/AIDS in de15 veloping health workforce strategies. 

16 ‘‘(B) Activities to achieve and sustain a 

17 health workforce sufficient in numbers, skill, 

18 and capacity to meet United States and host19 country international health commitments, in20 cluding the Millennium Development Goals and 

21 universal access to HIV/AIDS prevention, treat22 ment, and care. In particular, such health work23 force strategies should include plans for 

24 progress toward achieving the minimum ratio of 

25 health professionals required to achieve these 


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1 goals by 2015, estimated by the World Health 

2 Organization to require at least 2.3 doctors, 

3 nurses, and midwives per 1,000 population, and 

4 additional health workers such as pharmacists 

5 and lab technicians. 

6 ‘‘(C) Activities to ensure that health work7 force strategies are aimed at creating appro8 priate distribution of health workers and 

9 prioritizing activities required to ensure rural, 

10 marginalized, and other underserved popu11 lations are able to access skilled and equipped 

12 health workers. 

13 ‘‘(D) Activities to expand the capacity of 

14 public and private medical, nursing, pharma15 ceutical, and other health training institutions. 

16 ‘‘(b) POSITIVE BROADER HEALTH IMPACT.—It shall 

17 be the policy of the United States to ensure to expand 

18 the capacity of the health workforce engaged in HIV/AIDS 

19 programming in ways that contribute to, and do not de20 tract from, the capacity of countries to meet other health 

21 needs, particularly child survival and maternal health. 

22 ‘‘(c) SAFETY FOR HEALTH WORKERS.—It is the 

23 sense of Congress that the United States should ensure 

24 that all health workers participating in programs that re25 ceive assistance under this Act and the amendments made 


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1 by this Act have the proper training to create safe and 

2 sanitary working conditions in accordance with universal 

3 precautions and other forms of infection prevention and 

4 control. 

5 ‘‘(d) HEALTH CARE FOR HEALTH WORKERS.—The 

6 Coordinator of United States Government Activities to 

7 Combat HIV/AIDS Globally shall ensure that comprehen8 sive and confidential health services shall be provided to 

9 all health workers participating in programs that receive 

10 assistance under this Act and the amendments made by 

11 this Act, including— 

12 ‘‘(1) testing and counseling for all such employ13 ees; 

14 ‘‘(2) providing HIV/AIDS treatment to HIV15 positive employees; and 

16 ‘‘(3) taking measures to reduce HIV-related 

17 stigma in the workplace. 

18 ‘‘(e) TRAINING AND COMPENSATION FINANCE.— 

19 Where the Coordinator determines such financial support 

20 is essential to fulfill the purposes of this Act, the Coordi21 nator shall finance training and provide compensation or 

22 other benefits for health workers in order to enhance re23 cruitment and retention of such workers. 


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1 ‘‘SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM 

2 LIMITS SOUGHT BY INTERNATIONAL FINAN3 CIAL INSTITUTIONS. 

4 ‘‘(a) COORDINATION WITHIN THE UNITED STATES

5 GOVERNMENT.—The Coordinator of United States Gov6 ernment Activities to Combat HIV/AIDS Globally shall 

7 work with the Secretary of the Treasury to reform Inter8 national Monetary Fund macroeconomic and fiscal policies 

9 that result in limitations on national and donor invest10 ments in health. 

11 ‘‘(b) POSITION OF THE UNITED STATES AT THE

12 IMF.—The Secretary of the Treasury shall instruct the 

13 United States Executive Director at the International 

14 Monetary Fund to use the voice, vote, and influence of 

15 the United States to oppose any loan, project, agreement, 

16 memorandum, instrument, plan, or other program of the 

17 International Monetary Fund that does not exempt in18 creased government spending on health care from national 

19 budget caps or restraints, hiring or wage bill ceilings, or 

20 other limits sought by any international financial institu21 tion. 

22 ‘‘SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REG23 ISTRATION, AND SUPPLY CHAIN MANAGE24 MENT SYSTEMS. 

25 ‘‘(a) IN GENERAL.—The Coordinator of United 

26 States Government Activities to Combat AIDS Globally 


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1 shall work with the Partnership for Supply Chain Manage2 ment Systems, host countries, and nongovernmental orga3 nizations to develop effective, reliable host country-owned 

4 and operated public-sector procurement and supply chain 

5 management systems, including regional distribution, with 

6 ongoing technical assistance and sustained support to en7 sure the function of such systems, as well as the function 

8 of existing non-public sector supply chains, including those 

9 operated by faith-based and other humanitarian organiza10 tions that procure and distribute medical supplies. 

11 ‘‘(b) AVAILABILITY OF EQUIPMENT AND SUP12 PLIES.—The public-sector procurement and supply chain 

13 management systems developed pursuant to subsection (a) 

14 should ensure that adequate laboratory equipment and 

15 supplies commonly needed to fight HIV/AIDS, including 

16 diagnostic tests for CD4 and viral load counts, x-ray ma17 chines, mobile and facility-based rapid HIV test kits and 

18 other necessary assays, reagents and basic supplies such 

19 as sterile syringes and gloves, are available and distributed 

20 in a manner that is accessible to urban and rural popu21 lations. 

22 ‘‘(c) DRUG REGISTRATION.—The Coordinator shall 

23 work with host country partners and development partners 

24 to support efficient and effective drug approval and regVerDate Aug 31 2005 04:22 Mar 11, 2008 Jkt 069200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RH H5501

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1 istration systems that allow expeditious access to safe and 

2 effective drugs, including antiretroviral drugs. 

3 ‘‘(d) REPORT.—The Coordinator shall submit to the 

4 appropriate congressional committees an annual report on 

5 the implementation of this section, including progress to6 ward specific benchmarks established by the Partnership 

7 for Supply Chain Management Systems, and the projec8 tion of when host countries can fully sustain their own 

9 procurement and supply chain management and distribu10 tion systems at a scale necessary for national primary 

11 health needs. 

12 ‘‘SEC. 605. AUTHORIZATION OF APPROPRIATIONS. 

13 ‘‘(a) IN GENERAL.—Of the amounts authorized to be 

14 appropriated under section 401 for HIV/AIDS assistance, 

15 there are authorized to be appropriated to the President 

16 such sums as may be necessary for each of the fiscal years 

17 2009 through 2013 to carry out this title. 

18 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu19 ant to the authorization of appropriations under sub20 section (a) are authorized to remain available until ex21 pended.’’. 

22 SEC. 502. CLERICAL AMENDMENT. 

23 The table of contents for the United States Leader24 ship Against HIV/AIDS, Tuberculosis, and Malaria Act 


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1 of 2003 (22 U.S.C. 7601 note) is amended by inserting 

2 after the items relating to title V the following: 

‘‘TITLE VI—SUSTAINABILITY AND STRENGTHENING OF HEALTH 

CARE SYSTEMS 

‘‘Sec. 601. Findings. 

‘‘Sec. 602. National health workforce strategies and other policies. 

‘‘Sec. 603. Exemption of investments in health from limits sought by international financial institutions. 

‘‘Sec. 604. Public-sector procurement, drug registration, and supply chain management systems. 

‘‘Sec. 605. Authorization of appropriations.’’. 


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Union Calendar No. 333 

110TH CONGRESS 

2D SESSION H. R. 5501 

[Report No. 110

–546, Part I] 

A BILL 

To authorize appropriations for fiscal years 2009 

malaria, and for other purposes. countries to combat HIV/AIDS, tuberculosis, and through 2013 to provide assistance to foreign 

MARCH 10, 2008 

Committee on Financial Services discharged; committed 

the Union and ordered to be printed to the Committee of the Whole House on the State of 


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