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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5501 Enrolled Bill (ENR)]

        H.R.5501

                       One Hundred Tenth Congress

                                 of the

                        United States of America

                          AT THE SECOND SESSION

          Begun and held at the City of Washington on Thursday,
            the third day of January, two thousand and eight

                                 An Act

 
   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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.

                TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of an updated, comprehensive, 5-year, global 
          strategy.
Sec. 102. Interagency working group.
Sec. 103. Sense of Congress.

 TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

Sec. 201. Voluntary contributions to international vaccine funds.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis 
          and Malaria.
Sec. 203. Research on methods for women to prevent transmission of HIV 
          and other diseases.
Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by strengthening 
          health policies and health systems of partner countries.
Sec. 205. Facilitating effective operations of the Centers for Disease 
          Control.
Sec. 206. Facilitating vaccine development.

                      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. Malaria Response Coordinator.
Sec. 305. Amendment to Immigration and Nationality Act.
Sec. 306. Clerical amendment.
Sec. 307. Requirements.
Sec. 308. Annual report on prevention of mother-to-child transmission of 
          HIV.
Sec. 309. Prevention of mother-to-child transmission expert panel.

                      TITLE IV--FUNDING ALLOCATIONS

Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.

                         TITLE V--MISCELLANEOUS

Sec. 501. Machine readable visa fees.

          TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

Sec. 601. Emergency plan for Indian safety and health.
SEC. 2. FINDINGS.
    Section 2 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by 
adding at the end the following:
        ``(29) On May 27, 2003, the President signed this Act into law, 
    launching the largest international public health program of its 
    kind ever created.
        ``(30) Between 2003 and 2008, the United States, through the 
    President's Emergency Plan for AIDS Relief (PEPFAR) and in 
    conjunction with other bilateral programs and the multilateral 
    Global Fund has helped to--
            ``(A) provide antiretroviral therapy for over 1,900,000 
        people;
            ``(B) ensure that over 150,000 infants, most of whom would 
        have likely been infected with HIV during pregnancy or 
        childbirth, were not infected; and
            ``(C) provide palliative care and HIV prevention assistance 
        to millions of other people.
        ``(31) While United States leadership in the battles against 
    HIV/AIDS, tuberculosis, and malaria has had an enormous impact, 
    these diseases continue to take a terrible toll on the human race.
        ``(32) According to the 2007 AIDS Epidemic Update of the Joint 
    United Nations Programme on HIV/AIDS (UNAIDS)--
            ``(A) an estimated 2,100,000 people died of AIDS-related 
        causes in 2007; and
            ``(B) an estimated 2,500,000 people were newly infected 
        with HIV during that year.
        ``(33) According to the World Health Organization, malaria 
    kills more than 1,000,000 people per year, 70 percent of whom are 
    children under 5 years of age.
        ``(34) According to the World Health Organization, \1/3\ of the 
    world's population is infected with the tuberculosis bacterium, and 
    tuberculosis is 1 of the greatest infectious causes of death of 
    adults worldwide, killing 1,600,000 people per year.
        ``(35) Efforts to promote abstinence, fidelity, the correct and 
    consistent use of condoms, the delay of sexual debut, and the 
    reduction of concurrent sexual partners represent important 
    elements of strategies to prevent the transmission of HIV/AIDS.
        ``(36) According to UNAIDS--
            ``(A) women and girls make up nearly 60 percent of persons 
        in sub-Saharan Africa who are HIV positive;
            ``(B) women and girls are more biologically, economically, 
        and socially vulnerable to HIV infection; and
            ``(C) gender issues are critical components in the effort 
        to prevent HIV/AIDS and to care for those affected by the 
        disease.
        ``(37) Children who have lost a parent to HIV/AIDS, who are 
    otherwise directly affected by the disease, or who live in areas of 
    high HIV prevalence may be vulnerable to the disease or its 
    socioeconomic effects.
        ``(38) Lack of health capacity, including insufficient 
    personnel and inadequate infrastructure, in sub-Saharan Africa and 
    other regions of the world is a critical barrier that limits the 
    effectiveness of efforts to combat HIV/AIDS, tuberculosis, and 
    malaria, and to achieve other global health goals.
        ``(39) On March 30, 2007, the Institute of Medicine of the 
    National Academies released a report entitled `PEPFAR 
    Implementation: Progress and Promise', which found that budget 
    allocations setting percentage levels for spending on prevention, 
    care, and treatment and for certain subsets of activities within 
    the prevention category--
            ``(A) have `adversely affected implementation of the U.S. 
        Global AIDS Initiative';
            ``(B) have inhibited comprehensive, integrated, evidence 
        based approaches;
            ``(C) `have been counterproductive';
            ``(D) `may have been helpful initially in ensuring a 
        balance of attention to activities within the 4 categories of 
        prevention, treatment, care, and orphans and vulnerable 
        children';
            ``(E) `have also limited PEPFAR's ability to tailor its 
        activities in each country to the local epidemic and to 
        coordinate with the level of activities in the countries' 
        national plans'; and
            ``(F) should be removed by Congress and replaced with more 
        appropriate mechanisms that--
                ``(i) `ensure accountability for results from Country 
            Teams to the U.S. Global AIDS Coordinator and to Congress'; 
            and
                ``(ii) `ensure that spending is directly linked to and 
            commensurate with necessary efforts to achieve both country 
            and overall performance targets for prevention, treatment, 
            care, and orphans and vulnerable children'.
        ``(40) The United States Government has endorsed the principles 
    of harmonization in coordinating efforts to combat HIV/AIDS 
    commonly referred to as the `Three Ones', which includes--
            ``(A) 1 agreed HIV/AIDS action framework that provides the 
        basis for coordination of the work of all partners;
            ``(B) 1 national HIV/AIDS coordinating authority, with a 
        broadbased multisectoral mandate; and
            ``(C) 1 agreed HIV/AIDS country-level monitoring and 
        evaluating system.
        ``(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis and 
    Other Related Infectious Diseases, of April 26-27, 2001 (referred 
    to in this Act as the `Abuja Declaration'), the Heads of State and 
    Government of the Organization of African Unity (OAU)--
            ``(A) declared that they would `place the fight against 
        HIV/AIDS at the forefront and as the highest priority issue in 
        our respective national development plans';
            ``(B) committed `TO TAKE PERSONAL RESPONSIBILITY AND 
        PROVIDE LEADERSHIP for the activities of the National AIDS 
        Commissions/Councils';
            ``(C) resolved `to lead from the front the battle against 
        HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by 
        personally ensuring that such bodies were properly convened in 
        mobilizing our societies as a whole and providing focus for 
        unified national policymaking and programme implementation, 
        ensuring coordination of all sectors at all levels with a 
        gender perspective and respect for human rights, particularly 
        to ensure equal rights for people living with HIV/AIDS'; and
            ``(D) pledged `to set a target of allocating at least 15% 
        of our annual budget to the improvement of the health 
        sector'.''.
SEC. 3. DEFINITIONS.
    Section 3 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is amended--
        (1) in paragraph (2), by striking ``Committee on International 
    Relations'' and inserting ``Committee on Foreign Affairs of the 
    House of Representatives, the Committee on Appropriations of the 
    Senate, and the Committee on Appropriations'';
        (2) by redesignating paragraph (6) as paragraph (12);
        (3) by redesignating paragraphs (3) through (5), as paragraphs 
    (4) through (6), respectively;
        (4) by inserting after paragraph (2) the following:
        ``(3) Global aids coordinator.--The term `Global AIDS 
    Coordinator' means the Coordinator of United States Government 
    Activities to Combat HIV/AIDS Globally.''; and
        (5) by inserting after paragraph (6), as redesignated, the 
    following:
        ``(7) Impact evaluation research.--The term `impact evaluation 
    research' means the application of research methods and statistical 
    analysis to measure the extent to which change in a population-
    based outcome can be attributed to program intervention instead of 
    other environmental factors.
        ``(8) Operations research.--The term `operations research' 
    means the application of social science research methods, 
    statistical analysis, and other appropriate scientific methods to 
    judge, compare, and improve policies and program outcomes, from the 
    earliest stages of defining and designing programs through their 
    development and implementation, with the objective of the rapid 
    dissemination of conclusions and concrete impact on programming.
        ``(9) Paraprofessional.--The term `paraprofessional' means an 
    individual who is trained and employed as a health agent for the 
    provision of basic assistance in the identification, prevention, or 
    treatment of illness or disability.
        ``(10) Partner government.--The term `partner government' means 
    a government with which the United States is working to provide 
    assistance to combat HIV/AIDS, tuberculosis, or malaria on behalf 
    of people living within the jurisdiction of such government.
        ``(11) Program monitoring.--The term `program monitoring' means 
    the collection, analysis, and use of routine program data to 
    determine--
            ``(A) how well a program is carried out; and
            ``(B) how much the program costs.''.
SEC. 4. PURPOSE.
    Section 4 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7603) is amended to 
read as follows:
``SEC. 4. PURPOSE.
    ``The purpose of this Act is to strengthen and enhance United 
States leadership and the effectiveness of the United States response 
to the HIV/AIDS, tuberculosis, and malaria pandemics and other related 
and preventable infectious diseases as part of the overall United 
States health and development agenda by--
        ``(1) establishing comprehensive, coordinated, and integrated 
    5-year, global strategies to combat HIV/AIDS, tuberculosis, and 
    malaria by--
            ``(A) building on progress and successes to date;
            ``(B) improving harmonization of United States efforts with 
        national strategies of partner governments and other public and 
        private entities; and
            ``(C) emphasizing capacity building initiatives in order to 
        promote a transition toward greater sustainability through the 
        support of country-driven efforts;
        ``(2) providing increased resources for bilateral and 
    multilateral efforts to fight HIV/AIDS, tuberculosis, and malaria 
    as integrated components of United States development assistance;
        ``(3) intensifying efforts to--
            ``(A) prevent HIV infection;
            ``(B) ensure the continued support for, and expanded access 
        to, treatment and care programs;
            ``(C) enhance the effectiveness of prevention, treatment, 
        and care programs; and
            ``(D) address the particular vulnerabilities of girls and 
        women;
        ``(4) encouraging the expansion of private sector efforts and 
    expanding public-private sector partnerships to combat HIV/AIDS, 
    tuberculosis, and malaria;
        ``(5) reinforcing efforts to--
            ``(A) develop safe and effective vaccines, microbicides, 
        and other prevention and treatment technologies; and
            ``(B) improve diagnostics capabilities for HIV/AIDS, 
        tuberculosis, and malaria; and
        ``(6) helping partner countries to--
            ``(A) strengthen health systems;
            ``(B) expand health workforce; and
            ``(C) address infrastructural weaknesses.''.
SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.
    Section 5 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7604) is amended by 
inserting ``, with the exception of the 5-year strategy'' before the 
period at the end.

               TITLE I--POLICY PLANNING AND COORDINATION

    SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 5-YEAR, GLOBAL 
      STRATEGY.
    (a) Strategy.--Section 101(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7611(a)) is amended to read as follows:
    ``(a) Strategy.--The President shall establish a comprehensive, 
integrated, 5-year strategy to expand and improve efforts to combat 
global HIV/AIDS. This strategy shall--
        ``(1) further strengthen the capability of the United States to 
    be an effective leader of the international campaign against this 
    disease and strengthen the capacities of nations experiencing HIV/
    AIDS epidemics to combat this disease;
        ``(2) maintain sufficient flexibility and remain responsive 
    to--
            ``(A) changes in the epidemic;
            ``(B) challenges facing partner countries in developing and 
        implementing an effective national response; and
            ``(C) evidence-based improvements and innovations in the 
        prevention, care, and treatment of HIV/AIDS;
        ``(3) situate United States efforts to combat HIV/AIDS, 
    tuberculosis, and malaria within the broader United States global 
    health and development agenda, establishing a roadmap to link 
    investments in specific disease programs to the broader goals of 
    strengthening health systems and infrastructure and to integrate 
    and coordinate HIV/AIDS, tuberculosis, or malaria programs with 
    other health or development programs, as appropriate;
        ``(4) provide a plan to--
            ``(A) prevent 12,000,000 new HIV infections worldwide;
            ``(B) support--
                ``(i) the increase in the number of individuals with 
            HIV/AIDS receiving antiretroviral treatment above the goal 
            established under section 402(a)(3) and increased pursuant 
            to paragraphs (1) through (3) of section 403(d); and
                ``(ii) additional treatment through coordinated 
            multilateral efforts;
            ``(C) support care for 12,000,000 individuals infected with 
        or affected by HIV/AIDS, including 5,000,000 orphans and 
        vulnerable children affected by HIV/AIDS, with an emphasis on 
        promoting a comprehensive, coordinated system of services to be 
        integrated throughout the continuum of care;
            ``(D) help partner countries in the effort to achieve goals 
        of 80 percent access to counseling, testing, and treatment to 
        prevent the transmission of HIV from mother to child, 
        emphasizing a continuum of care model;
            ``(E) help partner countries to provide care and treatment 
        services to children with HIV in proportion to their percentage 
        within the HIV-infected population in each country;
            ``(F) promote preservice training for health professionals 
        designed to strengthen the capacity of institutions to develop 
        and implement policies for training health workers to combat 
        HIV/AIDS, tuberculosis, and malaria;
            ``(G) equip teachers with skills needed for HIV/AIDS 
        prevention and support for persons with, or affected by, HIV/
        AIDS;
            ``(H) provide and share best practices for combating HIV/
        AIDS with health professionals;
            ``(I) promote pediatric HIV/AIDS training for physicians, 
        nurses, and other health care workers, through public-private 
        partnerships if possible, including through the designation, if 
        appropriate, of centers of excellence for training in pediatric 
        HIV/AIDS prevention, care, and treatment in partner countries; 
        and
            ``(J) help partner countries to train and support retention 
        of health care professionals and paraprofessionals, with the 
        target of training and retaining at least 140,000 new health 
        care professionals and paraprofessionals with an emphasis on 
        training and in country deployment of critically needed doctors 
        and nurses and to strengthen capacities in developing 
        countries, especially in sub-Saharan Africa, to deliver primary 
        health care with the objective of helping countries achieve 
        staffing levels of at least 2.3 doctors, nurses, and midwives 
        per 1,000 population, as called for by the World Health 
        Organization;
        ``(5) include multisectoral approaches and specific strategies 
    to treat individuals infected with HIV/AIDS and to prevent the 
    further transmission of HIV infections, with a particular focus on 
    the needs of families with children (including the prevention of 
    mother-to-child transmission), women, young people, orphans, and 
    vulnerable children;
        ``(6) establish a timetable with annual global treatment 
    targets with country-level benchmarks for antiretroviral treatment;
        ``(7) expand the integration of timely and relevant research 
    within the prevention, care, and treatment of HIV/AIDS;
        ``(8) include a plan for program monitoring, operations 
    research, and impact evaluation and for the dissemination of a best 
    practices report to highlight findings;
        ``(9) support the in-country or intra-regional training, 
    preferably through public-private partnerships, of scientific 
    investigators, managers, and other staff who are capable of 
    promoting the systematic uptake of clinical research findings and 
    other evidence-based interventions into routine practice, with the 
    goal of improving the quality, effectiveness, and local leadership 
    of HIV/AIDS health care;
        ``(10) expand and accelerate research on and development of 
    HIV/AIDS prevention methods for women, including enhancing inter-
    agency collaboration, staffing, and organizational infrastructure 
    dedicated to microbicide research;
        ``(11) provide for consultation with local leaders and 
    officials to develop prevention strategies and programs that are 
    tailored to the unique needs of each country and community and 
    targeted particularly toward those most at risk of acquiring HIV 
    infection;
        ``(12) make the reduction of HIV/AIDS behavioral risks a 
    priority of all prevention efforts by--
            ``(A) promoting abstinence from sexual activity and 
        encouraging monogamy and faithfulness;
            ``(B) encouraging the correct and consistent use of male 
        and female condoms and increasing the availability of, and 
        access to, these commodities;
            ``(C) promoting the delay of sexual debut and the reduction 
        of multiple concurrent sexual partners;
            ``(D) promoting education for discordant couples (where an 
        individual is infected with HIV and the other individual is 
        uninfected or whose status is unknown) about safer sex 
        practices;
            ``(E) promoting voluntary counseling and testing, addiction 
        therapy, and other prevention and treatment tools for illicit 
        injection drug users and other substance abusers;
            ``(F) educating men and boys about the risks of procuring 
        sex commercially and about the need to end violent behavior 
        toward women and girls;
            ``(G) supporting partner country and community efforts to 
        identify and address social, economic, or cultural factors, 
        such as migration, urbanization, conflict, gender-based 
        violence, lack of empowerment for women, and transportation 
        patterns, which directly contribute to the transmission of HIV;
            ``(H) supporting comprehensive programs to promote 
        alternative livelihoods, safety, and social reintegration 
        strategies for commercial sex workers and their families;
            ``(I) promoting cooperation with law enforcement to 
        prosecute offenders of trafficking, rape, and sexual assault 
        crimes with the goal of eliminating such crimes; and
            ``(J) working to eliminate rape, gender-based violence, 
        sexual assault, and the sexual exploitation of women and 
        children;
        ``(13) include programs to reduce the transmission of HIV, 
    particularly addressing the heightened vulnerabilities of women and 
    girls to HIV in many countries; and
        ``(14) support other important means of preventing or reducing 
    the transmission of HIV, including--
            ``(A) medical male circumcision;
            ``(B) the maintenance of a safe blood supply;
            ``(C) promoting universal precautions in formal and 
        informal health care settings;
            ``(D) educating the public to recognize and to avoid risks 
        to contract HIV through blood exposures during formal and 
        informal health care and cosmetic services;
            ``(E) investigating suspected nosocomial infections to 
        identify and stop further nosocomial transmission; and
            ``(F) other mechanisms to reduce the transmission of HIV;
        ``(15) increase support for prevention of mother-to-child 
    transmission;
        ``(16) build capacity within the public health sector of 
    developing countries by improving health systems and public health 
    infrastructure and developing indicators to measure changes in 
    broader public health sector capabilities;
        ``(17) increase the coordination of HIV/AIDS programs with 
    development programs;
        ``(18) provide a framework for expanding or developing existing 
    or new country or regional programs, including--
            ``(A) drafting compacts or other agreements, as 
        appropriate;
            ``(B) establishing criteria and objectives for such 
        compacts and agreements; and
            ``(C) promoting sustainability;
        ``(19) provide a plan for national and regional priorities for 
    resource distribution and a global investment plan by region;
        ``(20) provide a plan to address the immediate and ongoing 
    needs of women and girls, which--
            ``(A) addresses the vulnerabilities that contribute to 
        their elevated risk of infection;
            ``(B) includes specific goals and targets to address these 
        factors;
            ``(C) provides clear guidance to field missions to 
        integrate gender across prevention, care, and treatment 
        programs;
            ``(D) sets forth gender-specific indicators to monitor 
        progress on outcomes and impacts of gender programs;
            ``(E) supports efforts in countries in which women or 
        orphans lack inheritance rights and other fundamental 
        protections to promote the passage, implementation, and 
        enforcement of such laws;
            ``(F) supports life skills training, especially among women 
        and girls, with the goal of reducing vulnerabilities to HIV/
        AIDS;
            ``(G) addresses and prevents gender-based violence; and
            ``(H) addresses the posttraumatic and psychosocial 
        consequences and provides postexposure prophylaxis protecting 
        against HIV infection to victims of gender-based violence and 
        rape;
        ``(21) provide a plan to--
            ``(A) determine the local factors that may put men and boys 
        at elevated risk of contracting or transmitting HIV;
            ``(B) address male norms and behaviors to reduce these 
        risks, including by reducing alcohol abuse;
            ``(C) promote responsible male behavior; and
            ``(D) promote male participation and leadership at the 
        community level in efforts to promote HIV prevention, reduce 
        stigma, promote participation in voluntary counseling and 
        testing, and provide care, treatment, and support for persons 
        with HIV/AIDS;
        ``(22) provide a plan to address the vulnerabilities and needs 
    of orphans and children who are vulnerable to, or affected by, HIV/
    AIDS;
        ``(23) encourage partner countries to develop health care 
    curricula and promote access to training tailored to individuals 
    receiving services through, or exiting from, existing programs 
    geared to orphans and vulnerable children;
        ``(24) provide a framework to work with international actors 
    and partner countries toward universal access to HIV/AIDS 
    prevention, treatment, and care programs, recognizing that 
    prevention is of particular importance;
        ``(25) enhance the coordination of United States bilateral 
    efforts to combat global HIV/AIDS with other major public and 
    private entities;
        ``(26) enhance the attention given to the national strategic 
    HIV/AIDS plans of countries receiving United States assistance by--
            ``(A) reviewing the planning and programmatic decisions 
        associated with that assistance; and
            ``(B) helping to strengthen such national strategies, if 
        necessary;
        ``(27) support activities described in the Global Plan to Stop 
    TB, including--
            ``(A) expanding and enhancing the coverage of the Directly 
        Observed Treatment Short-course (DOTS) in order to treat 
        individuals infected with tuberculosis and HIV, including 
        multi-drug resistant or extensively drug resistant 
        tuberculosis; and
            ``(B) improving coordination and integration of HIV/AIDS 
        and tuberculosis programming;
        ``(28) ensure coordination between the Global AIDS Coordinator 
    and the Malaria Coordinator and address issues of comorbidity 
    between HIV/AIDS and malaria; and
        ``(29) include a longer term estimate of the projected resource 
    needs, progress toward greater sustainability and country ownership 
    of HIV/AIDS programs, and the anticipated role of the United States 
    in the global effort to combat HIV/AIDS during the 10-year period 
    beginning on October 1, 2013.''.
    (b) Report.--Section 101(b) of such Act (22 U.S.C. 7611(b)) is 
amended to read as follows:
    ``(b) Report.--
        ``(1) In general.--Not later than October 1, 2009, the 
    President shall submit a report to the appropriate congressional 
    committees that sets forth the strategy described in subsection 
    (a).
        ``(2) Contents.--The report required under paragraph (1) shall 
    include a discussion of the following elements:
            ``(A) The purpose, scope, methodology, and general and 
        specific objectives of the strategy.
            ``(B) The problems, risks, and threats to the successful 
        pursuit of the strategy.
            ``(C) The desired goals, objectives, activities, and 
        outcome-related performance measures of the strategy.
            ``(D) A description of future costs and resources needed to 
        carry out the strategy.
            ``(E) A delineation of United States Government roles, 
        responsibility, and coordination mechanisms of the strategy.
            ``(F) A description of the strategy--
                ``(i) to promote harmonization of United States 
            assistance with that of other international, national, and 
            private actors as elucidated in the `Three Ones'; and
                ``(ii) to address existing challenges in harmonization 
            and alignment.
            ``(G) A description of the manner in which the strategy 
        will--
                ``(i) further the development and implementation of the 
            national multisectoral strategic HIV/AIDS frameworks of 
            partner governments; and
                ``(ii) enhance the centrality, effectiveness, and 
            sustainability of those national plans.
            ``(H) A description of how the strategy will seek to 
        achieve the specific targets described in subsection (a) and 
        other targets, as appropriate.
            ``(I) A description of, and rationale for, the timetable 
        for annual global treatment targets with country-level 
        estimates of numbers of persons in need of antiretroviral 
        treatment, country-level benchmarks for United States support 
        for assistance for antiretroviral treatment, and numbers of 
        persons enrolled in antiretroviral treatment programs receiving 
        United States support. If global benchmarks are not achieved 
        within the reporting period, the report shall include a 
        description of steps being taken to ensure that global 
        benchmarks will be achieved and a detailed breakdown and 
        justification of spending priorities in countries in which 
        benchmarks are not being met, including a description of other 
        donor or national support for antiretroviral treatment in the 
        country, if appropriate.
            ``(J) A description of how operations research is addressed 
        in the strategy and how such research can most effectively be 
        integrated into care, treatment, and prevention activities in 
        order to--
                ``(i) improve program quality and efficiency;
                ``(ii) ascertain cost effectiveness;
                ``(iii) ensure transparency and accountability;
                ``(iv) assess population-based impact;
                ``(v) disseminate findings and best practices; and
                ``(vi) optimize delivery of services.
            ``(K) An analysis of United States-assisted strategies to 
        prevent the transmission of HIV/AIDS, including methodologies 
        to promote abstinence, monogamy, faithfulness, the correct and 
        consistent use of male and female condoms, reductions in 
        concurrent sexual partners, and delay of sexual debut, and of 
        intended monitoring and evaluation approaches to measure the 
        effectiveness of prevention programs and ensure that they are 
        targeted to appropriate audiences.
            ``(L) Within the analysis required under subparagraph (K), 
        an examination of additional planned means of preventing the 
        transmission of HIV including medical male circumcision, 
        maintenance of a safe blood supply, public education about 
        risks to acquire HIV infection from blood exposures, promotion 
        of universal precautions, investigation of suspected nosocomial 
        infections and other tools.
            ``(M) A description of efforts to assist partner country 
        and community to identify and address social, economic, or 
        cultural factors, such as migration, urbanization, conflict, 
        gender-based violence, lack of empowerment for women, and 
        transportation patterns, which directly contribute to the 
        transmission of HIV.
            ``(N) A description of the specific targets, goals, and 
        strategies developed to address the needs and vulnerabilities 
        of women and girls to HIV/AIDS, including--
                ``(i) activities directed toward men and boys;
                ``(ii) activities to enhance educational, microfinance, 
            and livelihood opportunities for women and girls;
                ``(iii) activities to promote and protect the legal 
            empowerment of women, girls, and orphans and vulnerable 
            children;
                ``(iv) programs targeted toward gender-based violence 
            and sexual coercion;
                ``(v) strategies to meet the particular needs of 
            adolescents;
                ``(vi) assistance for victims of rape, sexual abuse, 
            assault, exploitation, and trafficking; and
                ``(vii) programs to prevent alcohol abuse.
            ``(O) A description of strategies to address male norms and 
        behaviors that contribute to the transmission of HIV, to 
        promote responsible male behavior, and to promote male 
        participation and leadership in HIV/AIDS prevention, care, 
        treatment, and voluntary counseling and testing.
            ``(P) A description of strategies--
                ``(i) to address the needs of orphans and vulnerable 
            children, including an analysis of--

                    ``(I) factors contributing to children's 
                vulnerability to HIV/AIDS; and
                    ``(II) vulnerabilities caused by the impact of HIV/
                AIDS on children and their families; and

                ``(ii) in areas of higher HIV/AIDS prevalence, to 
            promote a community-based approach to vulnerability, 
            maximizing community input into determining which children 
            participate.
            ``(Q) A description of capacity-building efforts undertaken 
        by countries themselves, including adherents of the Abuja 
        Declaration and an assessment of the impact of International 
        Monetary Fund macroeconomic and fiscal policies on national and 
        donor investments in health.
            ``(R) A description of the strategy to--
                ``(i) strengthen capacity building within the public 
            health sector;
                ``(ii) improve health care in those countries;
                ``(iii) help countries to develop and implement 
            national health workforce strategies;
                ``(iv) strive to achieve goals in training, retaining, 
            and effectively deploying health staff;
                ``(v) promote the use of codes of conduct for ethical 
            recruiting practices for health care workers; and
                ``(vi) increase the sustainability of health programs.
            ``(S) A description of the criteria for selection, 
        objectives, methodology, and structure of compacts or other 
        framework agreements with countries or regional organizations, 
        including--
                ``(i) the role of civil society;
                ``(ii) the degree of transparency;
                ``(iii) benchmarks for success of such compacts or 
            agreements; and
                ``(iv) the relationship between such compacts or 
            agreements and the national HIV/AIDS and public health 
            strategies and commitments of partner countries.
            ``(T) A strategy to better coordinate HIV/AIDS assistance 
        with nutrition and food assistance programs.
            ``(U) A description of transnational or regional 
        initiatives to combat regionalized epidemics in highly affected 
        areas such as the Caribbean.
            ``(V) A description of planned resource distribution and 
        global investment by region.
            ``(W) A description of coordination efforts in order to 
        better implement the Stop TB Strategy and to address the 
        problem of coinfection of HIV/AIDS and tuberculosis and of 
        projected challenges or barriers to successful implementation.
            ``(X) A description of coordination efforts to address 
        malaria and comorbidity with malaria and HIV/AIDS.''.
    (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) is 
amended to read as follows:
    ``(c) Study of Progress Toward Achievement of Policy Objectives.--
        ``(1) Design and budget plan for data evaluation.--The Global 
    AIDS Coordinator shall enter into a contract with the Institute of 
    Medicine of the National Academies that provides that not later 
    than 18 months after the date of the enactment of the Tom Lantos 
    and Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
    Tuberculosis, and Malaria Reauthorization Act of 2008, the 
    Institute, in consultation with the Global AIDS Coordinator and 
    other relevant parties representing the public and private sector, 
    shall provide the Global AIDS Coordinator with a design plan and 
    budget for the evaluation and collection of baseline and subsequent 
    data to address the elements set forth in paragraph (2)(B). The 
    Global AIDS Coordinator shall submit the budget and design plan to 
    the appropriate congressional committees.
        ``(2) Study.--
            ``(A) In general.--Not later than 4 years after the date of 
        the enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, the Institute of Medicine of the 
        National Academies shall publish a study that includes--
                ``(i) an assessment of the performance of United 
            States-assisted global HIV/AIDS programs; and
                ``(ii) an evaluation of the impact on health of 
            prevention, treatment, and care efforts that are supported 
            by United States funding, including multilateral and 
            bilateral programs involving joint operations.
            ``(B) Content.--The study conducted under this paragraph 
        shall include--
                ``(i) an assessment of progress toward prevention, 
            treatment, and care targets;
                ``(ii) an assessment of the effects on health systems, 
            including on the financing and management of health systems 
            and the quality of service delivery and staffing;
                ``(iii) an assessment of efforts to address gender-
            specific aspects of HIV/AIDS, including gender related 
            constraints to accessing services and addressing underlying 
            social and economic vulnerabilities of women and men;
                ``(iv) an evaluation of the impact of treatment and 
            care programs on 5-year survival rates, drug adherence, and 
            the emergence of drug resistance;
                ``(v) an evaluation of the impact of prevention 
            programs on HIV incidence in relevant population groups;
                ``(vi) an evaluation of the impact on child health and 
            welfare of interventions authorized under this Act on 
            behalf of orphans and vulnerable children;
                ``(vii) an evaluation of the impact of programs and 
            activities authorized in this Act on child mortality; and
                ``(viii) recommendations for improving the programs 
            referred to in subparagraph (A)(i).
            ``(C) Methodologies.--Assessments and impact evaluations 
        conducted under the study shall utilize sound statistical 
        methods and techniques for the behavioral sciences, including 
        random assignment methodologies as feasible. Qualitative data 
        on process variables should be used for assessments and impact 
        evaluations, wherever possible.
        ``(3) Contract authority.--The Institute of Medicine may enter 
    into contracts or cooperative agreements or award grants to conduct 
    the study under paragraph (2).
        ``(4) Authorization of appropriations.--There are authorized to 
    be appropriated such sums as may be necessary to carry out the 
    study under this subsection.''.
    (d) Report.--Section 101 of such Act, as amended by this section, 
is further amended by adding at the end the following:
    ``(d) Comptroller General Report.--
        ``(1) Report required.--Not later than 3 years after the date 
    of the enactment of the Tom Lantos and Henry J. Hyde United States 
    Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
    Reauthorization Act of 2008, the Comptroller General of the United 
    States shall submit a report on the global HIV/AIDS programs of the 
    United States to the appropriate congressional committees.
        ``(2) Contents.--The report required under paragraph (1) shall 
    include--
            ``(A) a description and assessment of the monitoring and 
        evaluation practices and policies in place for these programs;
            ``(B) an assessment of coordination within Federal agencies 
        involved in these programs, examining both internal 
        coordination within these programs and integration with the 
        larger global health and development agenda of the United 
        States;
            ``(C) an assessment of procurement policies and practices 
        within these programs;
            ``(D) an assessment of harmonization with national 
        government HIV/AIDS and public health strategies as well as 
        other international efforts;
            ``(E) an assessment of the impact of global HIV/AIDS 
        funding and programs on other United States global health 
        programming; and
            ``(F) recommendations for improving the global HIV/AIDS 
        programs of the United States.
    ``(e) Best Practices Report.--
        ``(1) In general.--Not later than 1 year after the date of the 
    enactment of the Tom Lantos and Henry J. Hyde United States Global 
    Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
    Reauthorization Act of 2008, and annually thereafter, the Global 
    AIDS Coordinator shall publish a best practices report that 
    highlights the programs receiving financial assistance from the 
    United States that have the potential for replication or adaption, 
    particularly at a low cost, across global AIDS programs, including 
    those that focus on both generalized and localized epidemics.
        ``(2) Dissemination of findings.--
            ``(A) Publication on internet website.--The Global AIDS 
        Coordinator shall disseminate the full findings of the annual 
        best practices report on the Internet website of the Office of 
        the Global AIDS Coordinator.
            ``(B) Dissemination guidance.--The Global AIDS Coordinator 
        shall develop guidance to ensure timely submission and 
        dissemination of significant information regarding best 
        practices with respect to global AIDS programs.
    ``(f) Inspectors General.--
        ``(1) Oversight plan.--
            ``(A) Development.--The Inspectors General of the 
        Department of State and Broadcasting Board of Governors, the 
        Department of Health and Human Services, and the United States 
        Agency for International Development shall jointly develop 5 
        coordinated annual plans for oversight activity in each of the 
        fiscal years 2009 through 2013, with regard to the programs 
        authorized under this Act and sections 104A, 104B, and 104C of 
        the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2, 2151b-3, 
        and 2151b-4).
            ``(B) Contents.--The plans developed under subparagraph (A) 
        shall include a schedule for financial audits, inspections, and 
        performance reviews, as appropriate.
            ``(C) Deadline.--
                ``(i) Initial plan.--The first plan developed under 
            subparagraph (A) shall be completed not later than the 
            later of--

                    ``(I) September 1, 2008; or
                    ``(II) 60 days after the date of the enactment of 
                the Tom Lantos and Henry J. Hyde United States Global 
                Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
                Reauthorization Act of 2008.

                ``(ii) Subsequent plans.--Each of the last four plans 
            developed under subparagraph (A) shall be completed not 
            later than 30 days before each of the fiscal years 2010 
            through 2013, respectively.
        ``(2) Coordination.--In order to avoid duplication and maximize 
    efficiency, the Inspectors General described in paragraph (1) shall 
    coordinate their activities with--
            ``(A) the Government Accountability Office; and
            ``(B) the Inspectors General of the Department of Commerce, 
        the Department of Defense, the Department of Labor, and the 
        Peace Corps, as appropriate, pursuant to the 2004 Memorandum of 
        Agreement Coordinating Audit Coverage of Programs and 
        Activities Implementing the President's Emergency Plan for AIDS 
        Relief, or any successor agreement.
        ``(3) Funding.--The Global AIDS Coordinator and the Coordinator 
    of the United States Government Activities to Combat Malaria 
    Globally shall make available necessary funds not exceeding 
    $15,000,000 during the 5-year period beginning on October 1, 2008 
    to the Inspectors General described in paragraph (1) for the 
    audits, inspections, and reviews described in that paragraph.''.
    (e) Annual Study; Message.--Section 101 of such Act, as amended by 
this section, is further amended by adding at the end the following:
    ``(g) Annual Study.--
        ``(1) In general.--Not later than September 30, 2009, and 
    annually thereafter through September 30, 2013, the Global AIDS 
    Coordinator shall complete a study of treatment providers that--
            ``(A) represents a range of countries and service 
        environments;
            ``(B) estimates the per-patient cost of antiretroviral HIV/
        AIDS treatment and the care of people with HIV/AIDS not 
        receiving antiretroviral treatment, including a comparison of 
        the costs for equivalent services provided by programs not 
        receiving assistance under this Act;
            ``(C) estimates per-patient costs across the program and in 
        specific categories of service providers, including--
                ``(i) urban and rural providers;
                ``(ii) country-specific providers; and
                ``(iii) other subcategories, as appropriate.
        ``(2) Publication.--Not later than 90 days after the completion 
    of each study under paragraph (1), the Global AIDS Coordinator 
    shall make the results of such study available on a publicly 
    accessible Web site.
    ``(h) Message.--The Global AIDS Coordinator shall develop a 
message, to be prominently displayed by each program receiving funds 
under this Act, that--
        ``(1) demonstrates that the program is a commitment by citizens 
    of the United States to the global fight against HIV/AIDS, 
    tuberculosis, and malaria; and
        ``(2) enhances awareness by program recipients that the program 
    is an effort on behalf of the citizens of the United States.''.
    SEC. 102. INTERAGENCY WORKING GROUP.
    Section 1(f)(2) of the State Department Basic Authorities Act of 
1956 (22 U.S.C. 2651a(f)(2)) is amended--
        (1) in subparagraph (A), by inserting ``, partner country 
    finance, health, and other relevant ministries,'' after ``community 
    based organizations)'' each place it appears;
        (2) in subparagraph (B)(ii)--
            (A) by striking subclauses (IV) and (V);
            (B) by inserting after subclause (III) the following:

                    ``(IV) Establishing an interagency working group on 
                HIV/AIDS headed by the Global AIDS Coordinator and 
                comprised of representatives from the United States 
                Agency for International Development and the Department 
                of Health and Human Services, for the purposes of 
                coordination of activities relating to HIV/AIDS, 
                including--

                        ``(aa) meeting regularly to review progress in 
                    partner countries toward HIV/AIDS prevention, 
                    treatment, and care objectives;
                        ``(bb) participating in the process of 
                    identifying countries to consider for increased 
                    assistance based on the epidemiology of HIV/AIDS in 
                    those countries, including clear evidence of a 
                    public health threat, as well as government 
                    commitment to address the HIV/AIDS problem, 
                    relative need, and coordination and joint planning 
                    with other significant actors;
                        ``(cc) assisting the Coordinator in the 
                    evaluation, execution, and oversight of country 
                    operational plans;
                        ``(dd) reviewing policies that may be obstacles 
                    to reaching targets set forth for HIV/AIDS 
                    prevention, treatment, and care; and
                        ``(ee) consulting with representatives from 
                    additional relevant agencies, including the 
                    National Institutes of Health, the Health Resources 
                    and Services Administration, the Department of 
                    Labor, the Department of Agriculture, the 
                    Millennium Challenge Corporation, the Peace Corps, 
                    and the Department of Defense.

                    ``(V) Coordinating overall United States HIV/AIDS 
                policy and programs, including ensuring the 
                coordination of relevant executive branch agency 
                activities in the field, with efforts led by partner 
                countries, and with the assistance provided by other 
                relevant bilateral and multilateral aid agencies and 
                other donor institutions to promote harmonization with 
                other programs aimed at preventing and treating HIV/
                AIDS and other health challenges, improving primary 
                health, addressing food security, promoting education 
                and development, and strengthening health care 
                systems.'';

            (C) by redesignating subclauses (VII) and VIII) as 
        subclauses (IX) and (XII), respectively;
            (D) by inserting after subclause (VI) the following:

                    ``(VII) Holding annual consultations with 
                nongovernmental organizations in partner countries that 
                provide services to improve health, and advocating on 
                behalf of the individuals with HIV/AIDS and those at 
                particular risk of contracting HIV/AIDS, including 
                organizations with members who are living with HIV/
                AIDS.
                    ``(VIII) Ensuring, through interagency and 
                international coordination, that HIV/AIDS programs of 
                the United States are coordinated with, and 
                complementary to, the delivery of related global 
                health, food security, development, and education.'';

            (E) in subclause (IX), as redesignated by subparagraph 
        (C)--
                (i) by inserting ``Vietnam,'' after ``Uganda,'';
                (ii) by inserting after ``of 2003'' the following: 
            ``and other countries in which the United States is 
            implementing HIV/AIDS programs as part of its foreign 
            assistance program''; and
                (iii) by adding at the end the following: ``In 
            designating additional countries under this subparagraph, 
            the President shall give priority to those countries in 
            which there is a high prevalence of HIV or risk of 
            significantly increasing incidence of HIV within the 
            general population and inadequate financial means within 
            the country.'';
            (F) by inserting after subclause (IX), as redesignated by 
        subparagraph (C), the following:

                    ``(X) Working with partner countries in which the 
                HIV/AIDS epidemic is prevalent among injection drug 
                users to establish, as a national priority, national 
                HIV/AIDS prevention programs.
                    ``(XI) Working with partner countries in which the 
                HIV/AIDS epidemic is prevalent among individuals 
                involved in commercial sex acts to establish, as a 
                national priority, national prevention programs, 
                including education, voluntary testing, and counseling, 
                and referral systems that link HIV/AIDS programs with 
                programs to eradicate trafficking in persons and 
                support alternatives to prostitution.'';

            (G) in subclause (XII), as redesignated by subparagraph 
        (C), by striking ``funds section'' and inserting ``funds 
        appropriated for HIV/ AIDS assistance pursuant to the 
        authorization of appropriations under section 401 of the United 
        States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Act of 2003 (22 U.S.C. 7671)''; and
            (H) by adding at the end the following:

                    ``(XIII) Publicizing updated drug pricing data to 
                inform the purchasing decisions of pharmaceutical 
                procurement partners.''.

    SEC. 103. SENSE OF CONGRESS.
    Section 102 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) is amended by 
adding at the end the following:
    ``(d) Sense of Congress.--It is the sense of Congress that--
        ``(1) full-time country level coordinators, preferably with 
    management experience, should head each HIV/AIDS country team for 
    United States missions overseeing significant HIV/AIDS programs;
        ``(2) foreign service nationals provide critically important 
    services in the design and implementation of United States country-
    level HIV/AIDS programs and their skills and experience as public 
    health professionals should be recognized within hiring and 
    compensation practices; and
        ``(3) staffing levels for United States country-level HIV/AIDS 
    teams should be adequately maintained to fulfill oversight and 
    other obligations of the positions.''.

TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

    SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.
    Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 
is amended--
        (1) by inserting after subsection (c) the following:
    ``(d) Tuberculosis Vaccine Development Programs.--In addition to 
amounts otherwise available under this section, there are authorized to 
be appropriated to the President such sums as may be necessary for each 
of the fiscal years 2009 through 2013, which shall be used for United 
States contributions to tuberculosis vaccine development programs, 
which may include the Aeras Global TB Vaccine Foundation.'';
        (2) in subsection (k)--
            (A) by striking ``fiscal years 2004 through 2008'' and 
        inserting ``fiscal years 2009 through 2013''; and
            (B) by striking ``Vaccine Fund'' and inserting ``GAVI 
        Fund''.
        (3) in subsection (l), by striking ``fiscal years 2004 through 
    2008'' and inserting ``fiscal years 2009 through 2013''; and
        (4) in subsection (m), by striking ``fiscal years 2004 through 
    2008'' and inserting ``fiscal years 2009 through 2013''.
    SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, 
      TUBERCULOSIS AND MALARIA.
    (a) Findings; Sense of Congress.--Section 202(a) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7622(a)) is amended to read as follows:
    ``(a) Findings; Sense of Congress.--
        ``(1) Findings.--Congress makes the following findings:
            ``(A) The establishment of the Global Fund in January 2002 
        is consistent with the general principles for an international 
        AIDS trust fund first outlined by Congress in the Global AIDS 
        and Tuberculosis Relief Act of 2000 (Public Law 106-264).
            ``(B) The Global Fund is an innovative financing mechanism 
        which--
                ``(i) has made progress in many areas in combating HIV/
            AIDS, tuberculosis, and malaria; and
                ``(ii) represents the multilateral component of this 
            Act, extending United States efforts to more than 130 
            countries around the world.
            ``(C) The Global Fund and United States bilateral 
        assistance programs--
                ``(i) are demonstrating increasingly effective 
            coordination, with each possessing certain comparative 
            advantages in the fight against HIV/AIDS, tuberculosis, and 
            malaria; and
                ``(ii) often work most effectively in concert with each 
            other.
            ``(D) The United States Government--
                ``(i) is the largest supporter of the Global Fund in 
            terms of resources and technical support;
                ``(ii) made the founding contribution to the Global 
            Fund; and
                ``(iii) is fully committed to the success of the Global 
            Fund as a multilateral public-private partnership.
        ``(2) Sense of congress.--It is the sense of Congress that--
            ``(A) transparency and accountability are crucial to the 
        long-term success and viability of the Global Fund;
            ``(B) the Global Fund has made significant progress toward 
        addressing concerns raised by the Government Accountability 
        Office by--
                ``(i) improving risk assessment and risk management 
            capabilities;
                ``(ii) providing clearer guidance for and oversight of 
            Local Fund Agents; and
                ``(iii) strengthening the Office of the Inspector 
            General for the Global Fund;
            ``(C) the provision of sufficient resources and authority 
        to the Office of the Inspector General for the Global Fund to 
        ensure that office has the staff and independence necessary to 
        carry out its mandate will be a measure of the commitment of 
        the Global Fund to transparency and accountability;
            ``(D) regular, publicly published financial, programmatic, 
        and reporting audits of the Fund, its grantees, and Local Fund 
        Agents are also important benchmarks of transparency;
            ``(E) the Global Fund should establish and maintain a 
        system to track--
                ``(i) the amount of funds disbursed to each 
            subrecipient on the grant's fiscal cycle; and
                ``(ii) the distribution of resources, by grant and 
            principal recipient, for prevention, care, treatment, drug 
            and commodity purchases, and other purposes;
            ``(F) relevant national authorities in recipient countries 
        should exempt from duties and taxes all products financed by 
        Global Fund grants and procured by any principal recipient or 
        subrecipient for the purpose of carrying out such grants;
            ``(G) the Global Fund, UNAIDS, and the Global AIDS 
        Coordinator should work together to standardize program 
        indicators wherever possible;
            ``(H) for purposes of evaluating total amounts of funds 
        contributed to the Global Fund under subsection (d)(4)(A)(i), 
        the timetable for evaluations of contributions from sources 
        other than the United States should take into account the 
        fiscal calendars of other major contributors; and
            ``(I) the Global Fund should not support activities 
        involving the `Affordable Medicines Facility-Malaria' or 
        similar entities pending compelling evidence of success from 
        pilot programs as evaluated by the Coordinator of United States 
        Government Activities to Combat Malaria Globally.''.
    (b) Statement of Policy.--Section 202(b) of such Act is amended by 
adding at the end the following:
        ``(3) Statement of policy.--The United States Government 
    regards the imposition by recipient countries of taxes or tariffs 
    on goods or services provided by the Global Fund, which are 
    supported through public and private donations, including the 
    substantial contribution of the American people, as inappropriate 
    and inconsistent with standards of good governance. The Global AIDS 
    Coordinator or other representatives of the United States 
    Government shall work with the Global Fund to dissuade governments 
    from imposing such duties, tariffs, or taxes.''.
    (c) United States Financial Participation.--Section 202(d) of such 
Act (22 U.S.C. 7622(d)) is amended--
        (1) in paragraph (1)--
            (A) by striking ``$1,000,000,000 for the period of fiscal 
        year 2004 beginning on January 1, 2004'' and inserting 
        ``$2,000,000,000 for fiscal year 2009,''; and
            (B) by striking ``the fiscal years 2005-2008'' and 
        inserting ``each of the fiscal years 2010 through 2013'';
        (2) in paragraph (4)--
            (A) in subparagraph (A)--
                (i) in clause (i), by striking ``fiscal years 2004 
            through 2008'' and inserting ``fiscal years 2009 through 
            2013'';
                (ii) in clause (ii)--

                    (I) by striking ``during any of the fiscal years 
                2004 through 2008'' and inserting ``during any of the 
                fiscal years 2009 through 2013''; and
                    (II) by adding at the end the following: ``The 
                President may waive the application of this clause with 
                respect to assistance for Sudan that is overseen by the 
                Southern Country Coordinating Mechanism, including 
                Southern Sudan, Southern Kordofan, Blue Nile State, and 
                Abyei, if the President determines that the national 
                interest or humanitarian reasons justify such a waiver. 
                The President shall publish each waiver of this clause 
                in the Federal Register and, not later than 15 days 
                before the waiver takes effect, shall consult with the 
                Committee on Foreign Relations of the Senate and the 
                Committee on Foreign Affairs of the House of 
                Representatives regarding the proposed waiver.''; and

                (iii) in clause (vi)--

                    (I) by striking ``for the purposes'' and inserting 
                ``For the purposes'';
                    (II) by striking ``fiscal years 2004 through 2008'' 
                and inserting ``fiscal years 2009 through 2013''; and
                    (III) by striking ``prior to fiscal year 2004'' and 
                inserting ``before fiscal year 2009'';

            (B) in subparagraph (B)(iv), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
            (C) in subparagraph (C)(ii), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs''; and
        (3) by adding at the end the following:
        ``(5) Withholding funds.--Notwithstanding any other provision 
    of this Act, 20 percent of the amounts appropriated pursuant to 
    this Act for a contribution to support the Global Fund for each of 
    the fiscal years 2010 through 2013 shall be withheld from 
    obligation to the Global Fund until the Secretary of State 
    certifies to the appropriate congressional committees that the 
    Global Fund--
            ``(A) has established an evaluation framework for the 
        performance of Local Fund Agents (referred to in this paragraph 
        as `LFAs');
            ``(B) is undertaking a systematic assessment of the 
        performance of LFAs;
            ``(C) has adopted, and is implementing, a policy to publish 
        on a publicly available Web site--
                ``(i) grant performance reviews;
                ``(ii) all reports of the Inspector General of the 
            Global Fund, in a manner that is consistent with the Policy 
            for Disclosure of Reports of the Inspector General, 
            approved at the 16th Meeting of the Board of the Global 
            Fund;
                ``(iii) decision points of the Board of the Global 
            Fund;
                ``(iv) reports from Board committees to the Board; and
                ``(v) a regular collection and analysis of performance 
            data and funding of grants of the Global Fund, which shall 
            cover all principal recipients and all subrecipients;
            ``(D) is maintaining an independent, well-staffed Office of 
        the Inspector General that--
                ``(i) reports directly to the Board of the Global Fund; 
            and
                ``(ii) compiles regular, publicly published audits of 
            financial, programmatic, and reporting aspects of the 
            Global Fund, its grantees, and LFAs;
            ``(E) has established, and is reporting publicly on, 
        standard indicators for all program areas;
            ``(F) has established a methodology to track and is 
        publicly reporting on--
                ``(i) all subrecipients and the amount of funds 
            disbursed to each subrecipient on the grant's fiscal cycle; 
            and
                ``(ii) the distribution of resources, by grant and 
            principal recipient, for prevention, care, treatment, drugs 
            and commodities purchase, and other purposes;
            ``(G) has established a policy on tariffs imposed by 
        national governments on all goods and services financed by the 
        Global Fund;
            ``(H) through its Secretariat, has taken meaningful steps 
        to prevent national authorities in recipient countries from 
        imposing taxes or tariffs on goods or services provided by the 
        Fund;
            ``(I) is maintaining its status as a financing institution 
        focused on programs directly related to HIV/AIDS, malaria, and 
        tuberculosis;
            ``(J) is maintaining and making progress on--
                ``(i) sustaining its multisectoral approach, through 
            country coordinating mechanisms; and
                ``(ii) the implementation of grants, as reflected in 
            the proportion of resources allocated to different sectors, 
            including governments, civil society, and faith- and 
            community-based organizations; and
            ``(K) has established procedures providing access by the 
        Office of Inspector General of the Department of State and 
        Broadcasting Board of Governors, as cognizant Inspector 
        General, and the Inspector General of the Health and Human 
        Services and the Inspector General of the United States Agency 
        for International Development, to Global Fund financial data, 
        and other information relevant to United States contributions 
        (as determined by the Inspector General in consultation with 
        the Global AIDS Coordinator).
        ``(6) Summaries of board decisions and united states 
    positions.--Following each meeting of the Board of the Global Fund, 
    the Coordinator of United States Government Activities to Combat 
    HIV/AIDS Globally shall report on the public website of the 
    Coordinator a summary of Board decisions and how the United States 
    Government voted and its positions on such decisions.''.
    SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PREVENT TRANSMISSION OF 
      HIV AND OTHER DISEASES.
    (a) Sense of Congress.--Congress recognizes the need and urgency to 
expand the range of interventions for preventing the transmission of 
human immunodeficiency virus (HIV), including nonvaccine prevention 
methods that can be controlled by women.
    (b) NIH Office of AIDS Research.--Subpart 1 of part D of title 
XXIII of the Public Health Service Act (42 U.S.C. 300cc-40 et seq.) is 
amended by inserting after section 2351 the following:
``SEC. 2351A. MICROBICIDE RESEARCH.
    ``(a) Federal Strategic Plan.--The Director of the Office shall--
        ``(1) expedite the implementation of the Federal strategic 
    plans required by section 403(a) of the Public Health Service Act 
    (42 U.S.C. 283(a)(5)) regarding the conduct and support of research 
    on, and development of, a microbicide to prevent the transmission 
    of the human immunodeficiency virus; and
        ``(2) review and, as appropriate, revise such plan to 
    prioritize funding and activities relative to their scientific 
    urgency and potential market readiness.
    ``(b) Coordination.--In implementing, reviewing, and prioritizing 
elements of the plan described in subsection (a), the Director of the 
Office shall consult, as appropriate, with--
        ``(1) representatives of other Federal agencies involved in 
    microbicide research, including the Coordinator of United States 
    Government Activities to Combat HIV/AIDS Globally, the Director of 
    the Centers for Disease Control and Prevention, and the 
    Administrator of the United States Agency for International 
    Development;
        ``(2) the microbicide research and development community; and
        ``(3) health advocates.''.
    (c) National Institute of Allergy and Infectious Diseases.--Subpart 
6 of part C of title IV of the Public Health Service Act (42 U.S.C. 
285f et seq.) is amended by adding at the end the following:
``SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT.
    ``The Director of the Institute, acting through the head of the 
Division of AIDS, shall, consistent with the peer-review process of the 
National Institutes of Health, carry out research on, and development 
of, safe and effective methods for use by women to prevent the 
transmission of the human immunodeficiency virus, which may include 
microbicides.''.
    (d) CDC.--Part B of title III of the Public Health Service Act (42 
U.S.C. 243 et seq.) is amended by inserting after section 317S the 
following:
``SEC. 317T. MICROBICIDE RESEARCH.
    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention is strongly encouraged to fully implement the Centers' 
microbicide agenda to support research and development of microbicides 
for use to prevent the transmission of the human immunodeficiency 
virus.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2009 through 2013 to carry out this section.''.
    (e) United States Agency for International Development.--
        (1) In general.--The Administrator of the United States Agency 
    for International Development, in coordination with the Coordinator 
    of United States Government Activities to Combat HIV/AIDS Globally, 
    may facilitate availability and accessibility of microbicides, 
    provided that such pharmaceuticals are approved, tentatively 
    approved, or otherwise authorized for use by--
            (A) the Food and Drug Administration;
            (B) a stringent regulatory agency acceptable to the 
        Secretary of Health and Human Services; or
            (C) a quality assurance mechanism acceptable to the 
        Secretary of Health and Human Services.
        (2) Authorization of appropriations.--Of the amounts authorized 
    to be appropriated under section 401 of the United States 
    Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 
    (22 U.S.C. 7671) for HIV/AIDS assistance, there are authorized to 
    be appropriated to the President such sums as may be necessary for 
    each of the fiscal years 2009 through 2013 to carry out this 
    subsection.
    SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
      STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF PARTNER 
      COUNTRIES.
    (a) In General.--Title II of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621) is 
amended by adding at the end the following:
    ``SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
      STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF PARTNER 
      COUNTRIES.
    ``(a) Statement of Policy.--It shall be the policy of the United 
States Government--
        ``(1) to invest appropriate resources authorized under this 
    Act--
            ``(A) to carry out activities to strengthen HIV/AIDS, 
        tuberculosis, and malaria health policies and health systems; 
        and
            ``(B) to provide workforce training and capacity-building 
        consistent with the goals and objectives of this Act; and
        ``(2) to support the development of a sound policy environment 
    in partner countries to increase the ability of such countries--
            ``(A) to maximize utilization of health care resources from 
        donor countries;
            ``(B) to increase national investments in health and 
        education and maximize the effectiveness of such investments;
            ``(C) to improve national HIV/AIDS, tuberculosis, and 
        malaria strategies;
            ``(D) to deliver evidence-based services in an effective 
        and efficient manner; and
            ``(E) to reduce barriers that prevent recipients of 
        services from achieving maximum benefit from such services.
    ``(b) Assistance To Improve Public Finance Management Systems.--
        ``(1) In general.--Consistent with the authority under section 
    129 of the Foreign Assistance Act of 1961 (22 U.S.C. 2152), the 
    Secretary of the Treasury, acting through the head of the Office of 
    Technical Assistance, is authorized to provide assistance for 
    advisors and partner country finance, health, and other relevant 
    ministries to improve the effectiveness of public finance 
    management systems in partner countries to enable such countries to 
    receive funding to carry out programs to combat HIV/AIDS, 
    tuberculosis, and malaria and to manage such programs.
        ``(2) Authorization of appropriations.--Of the amounts 
    authorized to be appropriated under section 401 for HIV/AIDS 
    assistance, there are authorized to be appropriated to the 
    Secretary of the Treasury such sums as may be necessary for each of 
    the fiscal years 2009 through 2013 to carry out this subsection.
    ``(c) Plan Required.--The Global AIDS Coordinator, in collaboration 
with the Administrator of the United States Agency for International 
Development (USAID), shall develop and implement a plan to combat HIV/
AIDS by strengthening health policies and health systems of partner 
countries as part of USAID's `Health Systems 2020' project. Recognizing 
that human and institutional capacity form the core of any health care 
system that can sustain the fight against HIV/AIDS, tuberculosis, and 
malaria, the plan shall include a strategy to encourage postsecondary 
educational institutions in partner countries, particularly in Africa, 
in collaboration with United States postsecondary educational 
institutions, including historically black colleges and universities, 
to develop such human and institutional capacity and in the process 
further build their capacity to sustain the fight against these 
diseases.''.
    (b) Clerical Amendment.--The table of contents for the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7601 note) is amended by inserting after the item 
relating to section 203, as added by section 203 of this Act, the 
following:

``Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
          strengthening health policies and health systems of partner 
          countries.''.
    SEC. 205. FACILITATING EFFECTIVE OPERATIONS OF THE CENTERS FOR 
      DISEASE CONTROL.
    Section 307 of the Public Health Service Act (42 U.S.C. 242l) is 
amended--
        (1) by amending subsection (a) to read as follows:
    ``(a) The Secretary may participate with other countries in 
cooperative endeavors in--
        ``(1) biomedical research, health care technology, and the 
    health services research and statistical analysis authorized under 
    section 306 and title IX; and
        ``(2) biomedical research, health care services, health care 
    research, or other related activities in furtherance of the 
    activities, objectives or goals authorized under the Tom Lantos and 
    Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
    Tuberculosis, and Malaria Reauthorization Act of 2008.''; and
        (2) in subsection (b)--
            (A) in paragraph (7), by striking ``and'' after the 
        semicolon at the end;
            (B) by striking ``The Secretary may not, in the exercise of 
        his authority under this section, provide financial assistance 
        for the construction of any facility in any foreign country.''
            (C) in paragraph (8), by striking ``for any purpose.'' and 
        inserting ``for the purpose of any law administered by the 
        Office of Personnel Management;''; and
            (D) by adding at the end the following:
        ``(9) provide such funds by advance or reimbursement to the 
    Secretary of State, as may be necessary, to pay the costs of 
    acquisition, lease, construction, alteration, equipping, furnishing 
    or management of facilities outside of the United States; and
        ``(10) in consultation with the Secretary of State, through 
    grant or cooperative agreement, make funds available to public or 
    nonprofit private institutions or agencies in foreign countries in 
    which the Secretary is participating in activities described under 
    subsection (a) to acquire, lease, construct, alter, or renovate 
    facilities in those countries.''.
        (3) in subsection (c)--
            (A) by striking ``1990'' and inserting ``1980''; and
            (B) by inserting or ``or section 903 of the Foreign Service 
        Act of 1980 (22 U.S.C. 4083)'' after ``Code''.
    SEC. 206. FACILITATING VACCINE DEVELOPMENT.
    (a) Technical Assistance for Developing Countries.--The 
Administrator of the United States Agency for International 
Development, utilizing public-private partners, as appropriate, and 
working in coordination with other international development agencies, 
is authorized to strengthen the capacity of developing countries' 
governmental institutions to--
        (1) collect evidence for informed decision-making and 
    introduction of new vaccines, including potential HIV/AIDS, 
    tuberculosis, and malaria vaccines, if such vaccines are determined 
    to be safe and effective;
        (2) review protocols for clinical trials and impact studies and 
    improve the implementation of clinical trials; and
        (3) ensure adequate supply chain and delivery systems.
    (b) Advanced Market Commitments.--
        (1) Purpose.--The purpose of this subsection is to improve 
    global health by requiring the United States to participate in 
    negotiations for advance market commitments for the development of 
    future vaccines, including potential vaccines for HIV/AIDS, 
    tuberculosis, and malaria.
        (2) Negotiation requirement.--The Secretary of the Treasury 
    shall enter into negotiations with the appropriate officials of the 
    International Bank of Reconstruction and Development (World Bank) 
    and the GAVI Alliance, the member nations of such entities, and 
    other interested parties to establish advanced market commitments 
    to purchase vaccines to combat HIV/AIDS, tuberculosis, malaria, and 
    other related infectious diseases.
        (3) Requirements.--In negotiating the United States 
    participation in programs for advanced market commitments, the 
    Secretary of the Treasury shall take into account whether programs 
    for advance market commitments include--
            (A) legally binding contracts for product purchase that 
        include a fair market price for up to a maximum number of 
        treatments, creating a strong market incentive;
            (B) clearly defined and transparent rules of program 
        participation for qualified developers and suppliers of the 
        product;
            (C) clearly defined requirements for eligible vaccines to 
        ensure that they are safe and effective and can be delivered in 
        developing country contexts;
            (D) dispute settlement mechanisms; and
            (E) sufficient flexibility to enable the contracts to be 
        adjusted in accord with new information related to projected 
        market size and other factors while still maintaining the 
        purchase commitment at a fair price.
        (4) Report.--Not later than 1 year after the date of the 
    enactment of this Act--
            (A) the Secretary of the Treasury shall submit a report to 
        the appropriate congressional committees on the status of the 
        United States negotiations to participate in programs for the 
        advanced market commitments under this subsection; and
            (B) the President shall produce a comprehensive report, 
        written by a study group of qualified professionals from 
        relevant Federal agencies and initiatives, nongovernmental 
        organizations, and industry representatives, that sets forth a 
        coordinated strategy to accelerate development of vaccines for 
        infectious diseases, such as HIV/AIDS, malaria, and 
        tuberculosis, which includes--
                (i) initiatives to create economic incentives for the 
            research, development, and manufacturing of vaccines for 
            HIV/AIDS, tuberculosis, malaria, and other infectious 
            diseases;
                (ii) an expansion of public-private partnerships and 
            the leveraging of resources from other countries and the 
            private sector; and
                (iii) efforts to maximize United States capabilities to 
            support clinical trials of vaccines in developing countries 
            and to address the challenges of delivering vaccines in 
            developing countries to minimize delays in access once 
            vaccines are available.

                      TITLE III--BILATERAL EFFORTS
              Subtitle A--General Assistance and Programs

    SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
    (a) Amendments to the Foreign Assistance Act of 1961.--
        (1) Finding.--Section 104A(a) of the Foreign Assistance Act of 
    1961 (22 U.S.C. 2151b-2(a)) is amended by inserting ``Central Asia, 
    Eastern Europe, Latin America'' after ``Caribbean,''.
        (2) Policy.--Section 104A(b) of such Act is amended to read as 
    follows:
    ``(b) Policy.--
        ``(1) Objectives.--It is a major objective of the foreign 
    assistance program of the United States to provide assistance for 
    the prevention and treatment of HIV/AIDS and the care of those 
    affected by the disease. It is the policy objective of the United 
    States, by 2013, to--
            ``(A) assist partner countries to--
                ``(i) prevent 12,000,000 new HIV infections worldwide;
                ``(ii) support--

                    ``(I) the increase in the number of individuals 
                with HIV/AIDS receiving antiretroviral treatment above 
                the goal established under section 402(a)(3) and 
                increased pursuant to paragraphs (1) through (3) of 
                section 403(d); and
                    ``(II) additional treatment through coordinated 
                multilateral efforts;

                ``(iii) support care for 12,000,000 individuals 
            infected with or affected by HIV/AIDS, including 5,000,000 
            orphans and vulnerable children affected by HIV/AIDS, with 
            an emphasis on promoting a comprehensive, coordinated 
            system of services to be integrated throughout the 
            continuum of care;
                ``(iv) provide at least 80 percent of the target 
            population with access to counseling, testing, and 
            treatment to prevent the transmission of HIV from mother-
            to-child;
                ``(v) provide care and treatment services to children 
            with HIV in proportion to their percentage within the HIV-
            infected population of a given partner country; and
                ``(vi) train and support retention of health care 
            professionals, paraprofessionals, and community health 
            workers in HIV/AIDS prevention, treatment, and care, with 
            the target of providing such training to at least 140,000 
            new health care professionals and paraprofessionals with an 
            emphasis on training and in country deployment of 
            critically needed doctors and nurses;
            ``(B) strengthen the capacity to deliver primary health 
        care in developing countries, especially in sub-Saharan Africa;
            ``(C) support and help countries in their efforts to 
        achieve staffing levels of at least 2.3 doctors, nurses, and 
        midwives per 1,000 population, as called for by the World 
        Health Organization; and
            ``(D) help partner countries to develop independent, 
        sustainable HIV/AIDS programs.
        ``(2) Coordinated global strategy.--The United States and other 
    countries with the sufficient capacity should provide assistance to 
    countries in sub-Saharan Africa, the Caribbean, Central Asia, 
    Eastern Europe, and Latin America, and other countries and regions 
    confronting HIV/AIDS epidemics in a coordinated global strategy to 
    help address generalized and concentrated epidemics through HIV/
    AIDS prevention, treatment, care, monitoring and evaluation, and 
    related activities.
        ``(3) Priorities.--The United States Government's response to 
    the global HIV/AIDS pandemic and the Government's efforts to help 
    countries assume leadership of sustainable campaigns to combat 
    their local epidemics should place high priority on--
            ``(A) the prevention of the transmission of HIV;
            ``(B) moving toward universal access to HIV/AIDS prevention 
        counseling and services;
            ``(C) the inclusion of cost sharing assurances that meet 
        the requirements under section 110; and
            ``(D) the inclusion of transition strategies to ensure 
        sustainability of such programs and activities, including 
        health care systems, under other international donor support, 
        or budget support by respective foreign governments.''.
    (b) Authorization.--Section 104A(c) of such Act is amended--
        (1) in paragraph (1), by striking ``and other countries and 
    areas.'' and inserting ``Central Asia, Eastern Europe, Latin 
    America, and other countries and areas, particularly with respect 
    to refugee populations or those in postconflict settings in such 
    countries and areas with significant or increasing HIV incidence 
    rates.'';
        (2) in paragraph (2), by striking ``and other countries and 
    areas affected by the HIV/AIDS pandemic'' and inserting ``Central 
    Asia, Eastern Europe, Latin America, and other countries and areas 
    affected by the HIV/AIDS pandemic, particularly with respect to 
    refugee populations or those in post-conflict settings in such 
    countries and areas with significant or increasing HIV incidence 
    rates.''; and
        (3) in paragraph (3)--
            (A) by striking ``foreign countries'' and inserting 
        ``partner countries, other international actors,''; and
            (B) by inserting ``within the framework of the principles 
        of the Three Ones'' before the period at the end.
    (c) Activities Supported.--Section 104A(d) of such Act is amended--
        (1) in paragraph (1)--
            (A) in subparagraph (A)--
                (i) by inserting ``and multiple concurrent sexual 
            partnering,'' after ``casual sexual partnering''; and
                (ii) by striking ``condoms'' and inserting ``male and 
            female condoms'';
            (B) in subparagraph (B)--
                (i) by striking ``programs that'' and inserting 
            ``programs that are designed with local input and''; and
                (ii) by striking ``those organizations'' and inserting 
            ``those locally based organizations'';
            (C) in subparagraph (D), by inserting ``and promoting the 
        use of provider-initiated or `opt-out' voluntary testing in 
        accordance with World Health Organization guidelines'' before 
        the semicolon at the end;
            (D) by redesignating subparagraphs (F), (G), and (H) as 
        subparagraphs (H), (I), and (J), respectively;
            (E) by inserting after subparagraph (E) the following:
            ``(F) assistance to--
                ``(i) achieve the goal of reaching 80 percent of 
            pregnant women for prevention and treatment of mother-to-
            child transmission of HIV in countries in which the United 
            States is implementing HIV/AIDS programs by 2013; and
                ``(ii) promote infant feeding options and treatment 
            protocols that meet the most recent criteria established by 
            the World Health Organization;
            ``(G) medical male circumcision programs as part of 
        national strategies to combat the transmission of HIV/AIDS;'';
            (F) in subparagraph (I), as redesignated, by striking 
        ``and'' at the end; and
            (G) by adding at the end the following:
            ``(K) assistance for counseling, testing, treatment, care, 
        and support programs, including--
                ``(i) counseling and other services for the prevention 
            of reinfection of individuals with HIV/AIDS;
                ``(ii) counseling to prevent sexual transmission of 
            HIV, including--

                    ``(I) life skills development for practicing 
                abstinence and faithfulness;
                    ``(II) reducing the number of sexual partners;
                    ``(III) delaying sexual debut; and
                    ``(IV) ensuring correct and consistent use of 
                condoms;

                ``(iii) assistance to engage underlying vulnerabilities 
            to HIV/AIDS, especially those of women and girls;
                ``(iv) assistance for appropriate HIV/AIDS education 
            programs and training targeted to prevent the transmission 
            of HIV among men who have sex with men;
                ``(v) assistance to provide male and female condoms;
                ``(vi) diagnosis and treatment of other sexually 
            transmitted infections;
                ``(vii) strategies to address the stigma and 
            discrimination that impede HIV/AIDS prevention efforts; and
                ``(viii) assistance to facilitate widespread access to 
            microbicides for HIV prevention, if safe and effective 
            products become available, including financial and 
            technical support for culturally appropriate introductory 
            programs, procurement, distribution, logistics management, 
            program delivery, acceptability studies, provider training, 
            demand generation, and postintroduction monitoring.''; and
        (2) in paragraph (2)--
            (A) in subparagraph (B), by striking ``and'' at the end;
            (B) in subparagraph (C)--
                (i) by inserting ``pain management,'' after 
            ``opportunistic infections,''; and
                (ii) by striking the period at the end and inserting a 
            semicolon; and
            (C) by adding at the end the following:
            ``(D) as part of care and treatment of HIV/AIDS, assistance 
        (including prophylaxis and treatment) for common HIV/AIDS-
        related opportunistic infections for free or at a rate at which 
        it is easily affordable to the individuals and populations 
        being served;
            ``(E) as part of care and treatment of HIV/AIDS, assistance 
        or referral to available and adequately resourced service 
        providers for nutritional support, including counseling and 
        where necessary the provision of commodities, for persons 
        meeting malnourishment criteria and their families;'';
        (3) in paragraph (4)--
            (A) in subparagraph (C), by striking ``and'' at the end;
            (B) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (C) by adding at the end the following:
            ``(E) carrying out and expanding program monitoring, impact 
        evaluation research and analysis, and operations research and 
        disseminating data and findings through mechanisms to be 
        developed by the Coordinator of United States Government 
        Activities to Combat HIV/AIDS Globally, in coordination with 
        the Director of the Centers for Disease Control, in order to--
                ``(i) improve accountability, increase transparency, 
            and ensure the delivery of evidence-based services through 
            the collection, evaluation, and analysis of data regarding 
            gender-responsive interventions, disaggregated by age and 
            sex;
                ``(ii) identify and replicate effective models; and
                ``(iii) develop gender indicators to measure outcomes 
            and the impacts of interventions; and
            ``(F) establishing appropriate systems to--
                ``(i) gather epidemiological and social science data on 
            HIV; and
                ``(ii) evaluate the effectiveness of prevention efforts 
            among men who have sex with men, with due consideration to 
            stigma and risks associated with disclosure.'';
        (4) in paragraph (5)--
            (A) by redesignating subparagraph (C) as subparagraph (D); 
        and
            (B) by inserting after subparagraph (B) the following:
            ``(C) Mechanism to ensure cost-effective drug purchasing.--
        Subject to subparagraph (B), mechanisms to ensure that safe and 
        effective pharmaceuticals, including antiretrovirals and 
        medicines to treat opportunistic infections, are purchased at 
        the lowest possible price at which such pharmaceuticals may be 
        obtained in sufficient quantity on the world market, provided 
        that such pharmaceuticals are approved, tentatively approved, 
        or otherwise authorized for use by--
                ``(i) the Food and Drug Administration;
                ``(ii) a stringent regulatory agency acceptable to the 
            Secretary of Health and Human Services; or
                ``(iii) a quality assurance mechanism acceptable to the 
            Secretary of Health and Human Services.'';
        (5) in paragraph (6)--
            (A) by amending the paragraph heading to read as follows:
        ``(6) Related and coordinated activities.--'';
            (B) in subparagraph (B), by striking ``and'' at the end;
            (C) in subparagraph (C), by striking the period at the end 
        and inserting ``; and''; and
            (D) by adding at the end the following:
            ``(D) coordinated or referred activities to--
                ``(i) enhance the clinical impact of HIV/AIDS care and 
            treatment; and
                ``(ii) ameliorate the adverse social and economic costs 
            often affecting AIDS-impacted families and communities 
            through the direct provision, as necessary, or through the 
            referral, if possible, of support services, including--

                    ``(I) nutritional and food support;
                    ``(II) safe drinking water and adequate sanitation;
                    ``(III) nutritional counseling;
                    ``(IV) income-generating activities and livelihood 
                initiatives;
                    ``(V) maternal and child health care;
                    ``(VI) primary health care;
                    ``(VII) the diagnosis and treatment of other 
                infectious or sexually transmitted diseases;
                    ``(VIII) substance abuse and treatment services; 
                and
                    ``(IX) legal services;

            ``(E) coordinated or referred activities to link programs 
        addressing HIV/AIDS with programs addressing gender-based 
        violence in areas of significant HIV prevalence to assist 
        countries in the development and enforcement of women's health, 
        children's health, and HIV/AIDS laws and policies that--
                ``(i) prevent and respond to violence against women and 
            girls;
                ``(ii) promote the integration of screening and 
            assessment for gender-based violence into HIV/AIDS 
            programming;
                ``(iii) promote appropriate HIV/AIDS counseling, 
            testing, and treatment into gender-based violence programs; 
            and
                ``(iv) assist governments to develop partnerships with 
            civil society organizations to create networks for 
            psychosocial, legal, economic, or other support services;
            ``(F) coordinated or referred activities to--
                ``(i) address the frequent coinfection of HIV and 
            tuberculosis, in accordance with World Health Organization 
            guidelines;
                ``(ii) promote provider-initiated or `opt-out' HIV/AIDS 
            counseling and testing and appropriate referral for 
            treatment and care to individuals with tuberculosis or its 
            symptoms, particularly in areas with significant HIV 
            prevalence; and
                ``(iii) strengthen programs to ensure that individuals 
            testing positive for HIV receive tuberculosis screening and 
            to improve laboratory capacities, infection control, and 
            adherence; and
            ``(G) activities to--
                ``(i) improve the effectiveness of national responses 
            to HIV/AIDS;
                ``(ii) strengthen overall health systems in high-
            prevalence countries, including support for workforce 
            training, retention, and effective deployment, capacity 
            building, laboratory development, equipment maintenance and 
            repair, and public health and related public financial 
            management systems and operations; and
                ``(iii) encourage fair and transparent procurement 
            practices among partner countries; and
                ``(iv) promote in-country or intra-regional pediatric 
            training for physicians and other health professionals, 
            preferably through public-private partnerships involving 
            colleges and universities, with the goal of increasing 
            pediatric HIV workforce capacity.''; and
        (6) by adding at the end the following:
        ``(8) Compacts and framework agreements.--The development of 
    compacts or framework agreements, tailored to local circumstances, 
    with national governments or regional partnerships in countries 
    with significant HIV/AIDS burdens to promote host government 
    commitment to deeper integration of HIV/AIDS services into health 
    systems, contribute to health systems overall, and enhance 
    sustainability, including--
            ``(A) cost sharing assurances that meet the requirements 
        under section 110; and
            ``(B) transition strategies to ensure sustainability of 
        such programs and activities, including health care systems, 
        under other international donor support, or budget support by 
        respective foreign governments.''.
    (d) Compacts and Framework Agreements.--Section 104A of such Act is 
amended--
        (1) by redesignating subsections (e) through (g) as subsections 
    (f) through (h); and
        (2) by inserting after subsection (d) the following:
    ``(e) Compacts and Framework Agreements.--
        ``(1) Findings.--Congress makes the following findings:
            ``(A) The congressionally mandated Institute of Medicine 
        report entitled `PEPFAR Implementation: Progress and Promise' 
        states: `The next strategy [of the U.S. Global AIDS Initiative] 
        should squarely address the needs and challenges involved in 
        supporting sustainable country HIV/AIDS programs, thereby 
        transitioning from a focus on emergency relief.'.
            ``(B) One mechanism to promote the transition from an 
        emergency to a public health and development approach to HIV/
        AIDS is through compacts or framework agreements between the 
        United States Government and each participating nation.
        ``(2) Elements.--Compacts on HIV/AIDS authorized under 
    subsection (d)(8) shall include the following elements:
            ``(A) Compacts whose primary purpose is to provide direct 
        services to combat HIV/AIDS are to be made between--
                ``(i) the United States Government; and
                ``(ii)(I) national or regional entities representing 
            low-income countries served by an existing United States 
            Agency for International Development or Department of 
            Health and Human Services presence or regional platform; or
                ``(II) countries or regions--

                    ``(aa) experiencing significantly high HIV 
                prevalence or risk of significantly increasing 
                incidence within the general population;
                    ``(bb) served by an existing United States Agency 
                for International Development or Department of Health 
                and Human Services presence or regional platform; and
                    ``(cc) that have inadequate financial means within 
                such country or region.

            ``(B) Compacts whose primary purpose is to provide limited 
        technical assistance to a country or region connected to 
        services provided within the country or region--
                ``(i) may be made with other countries or regional 
            entities served by an existing United States Agency for 
            International Development or Department of Health and Human 
            Services presence or regional platform;
                ``(ii) shall require significant investments in HIV 
            prevention, care, and treatment services by the host 
            country;
                ``(iii) shall be time-limited in terms of United States 
            contributions; and
                ``(iv) shall be made only upon prior notification to 
            Congress--

                    ``(I) justifying the need for such compacts;
                    ``(II) describing the expected investment by the 
                country or regional entity; and
                    ``(III) describing the scope, nature, expected 
                total United States investment, and time frame of the 
                limited technical assistance under the compact and its 
                intended impact.

            ``(C) Compacts shall include provisions to--
                ``(i) promote local and national efforts to reduce 
            stigma associated with HIV/AIDS; and
                ``(ii) work with and promote the role of civil society 
            in combating HIV/AIDS.
            ``(D) Compacts shall take into account the overall national 
        health and development and national HIV/AIDS and public health 
        strategies of each country.
            ``(E) Compacts shall contain--
                ``(i) consideration of the specific objectives that the 
            country and the United States expect to achieve during the 
            term of a compact;
                ``(ii) consideration of the respective responsibilities 
            of the country and the United States in the achievement of 
            such objectives;
                ``(iii) consideration of regular benchmarks to measure 
            progress toward achieving such objectives;
                ``(iv) an identification of the intended beneficiaries, 
            disaggregated by gender and age, and including information 
            on orphans and vulnerable children, to the maximum extent 
            practicable;
                ``(v) consideration of the methods by which the compact 
            is intended to--

                    ``(I) address the factors that put women and girls 
                at greater risk of HIV/AIDS; and
                    ``(II) strengthen elements such as the economic, 
                educational, and social status of women, girls, 
                orphans, and vulnerable children and the inheritance 
                rights and safety of such individuals;

                ``(vi) consideration of the methods by which the 
            compact will--

                    ``(I) strengthen the health care capacity, 
                including factors such as the training, retention, 
                deployment, recruitment, and utilization of health care 
                workers;
                    ``(II) improve supply chain management; and
                    ``(III) improve the health systems and 
                infrastructure of the partner country, including the 
                ability of compact participants to maintain and operate 
                equipment transferred or purchased as part of the 
                compact;

                ``(vii) consideration of proposed mechanisms to provide 
            oversight;
                ``(viii) consideration of the role of civil society in 
            the development of a compact and the achievement of its 
            objectives;
                ``(ix) a description of the current and potential 
            participation of other donors in the achievement of such 
            objectives, as appropriate; and
                ``(x) consideration of a plan to ensure appropriate 
            fiscal accountability for the use of assistance.
            ``(F) For regional compacts, priority shall be given to 
        countries that are included in regional funds and programs in 
        existence as of the date of the enactment of the Tom Lantos and 
        Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Reauthorization Act of 2008.
            ``(G) Amounts made available for compacts described in 
        subparagraphs (A) and (B) shall be subject to the inclusion 
        of--
                ``(i) cost sharing assurances that meet the 
            requirements under section 110; and
                ``(ii) transition strategies to ensure sustainability 
            of such programs and activities, including health care 
            systems, under other international donor support, and 
            budget support by respective foreign governments.
        ``(3) Local input.--In entering into a compact on HIV/AIDS 
    authorized under subsection (d)(8), the Coordinator of United 
    States Government Activities to Combat HIV/AIDS Globally shall seek 
    to ensure that the government of a country--
            ``(A) takes into account the local perspectives of the 
        rural and urban poor, including women, in each country; and
            ``(B) consults with private and voluntary organizations, 
        including faith-based organizations, the business community, 
        and other donors in the country.
        ``(4) Congressional and public notification after entering into 
    a compact.--Not later than 10 days after entering into a compact 
    authorized under subsection (d)(8), the Global AIDS Coordinator 
    shall--
            ``(A) submit a report containing a detailed summary of the 
        compact and a copy of the text of the compact to--
                ``(i) the Committee on Foreign Relations of the Senate;
                ``(ii) the Committee on Appropriations of the Senate;
                ``(iii) the Committee on Foreign Affairs of the House 
            of Representatives; and
                ``(iv) the Committee on Appropriations of the House of 
            Representatives; and
            ``(B) publish such information in the Federal Register and 
        on the Internet website of the Office of the Global AIDS 
        Coordinator.''.
    (e) Annual Report.--Section 104A(f) of such Act, as redesignated, 
is amended--
        (1) in paragraph (1), by striking ``Committee on International 
    Relations'' and inserting ``Committee on Foreign Affairs''; and
        (2) in paragraph (2)--
            (A) in subparagraph (B), by striking ``and'' at the end;
            (B) by striking subparagraph (C) and inserting the 
        following:
            ``(C) a detailed breakdown of funding allocations, by 
        program and by country, for prevention activities; and
            ``(D) a detailed assessment of the impact of programs 
        established pursuant to such sections, including--
                ``(i)(I) the effectiveness of such programs in 
            reducing--

                    ``(aa) the transmission of HIV, particularly in 
                women and girls;
                    ``(bb) mother-to-child transmission of HIV, 
                including through drug treatment and therapies, either 
                directly or by referral; and
                    ``(cc) mortality rates from HIV/AIDS;

                ``(II) the number of patients receiving treatment for 
            AIDS in each country that receives assistance under this 
            Act;
                ``(III) an assessment of progress towards the 
            achievement of annual goals set forth in the timetable 
            required under the 5-year strategy established under 
            section 101 of the United States Leadership Against HIV/
            AIDS, Tuberculosis, and Malaria Act of 2003 and, if annual 
            goals are not being met, the reasons for such failure; and
                ``(IV) retention and attrition data for programs 
            receiving United States assistance, including mortality and 
            loss to follow-up rates, organized overall and by country;
                ``(ii) the progress made toward--

                    ``(I) improving health care delivery systems 
                (including the training of health care workers, 
                including doctors, nurses, midwives, pharmacists, 
                laboratory technicians, and compensated community 
                health workers, and the use of codes of conduct for 
                ethical recruiting practices for health care workers);
                    ``(II) advancing safe working conditions for health 
                care workers; and
                    ``(III) improving infrastructure to promote 
                progress toward universal access to HIV/AIDS 
                prevention, treatment, and care by 2013;

                ``(iii) a description of coordination efforts with 
            relevant executive branch agencies to link HIV/AIDS 
            clinical and social services with non-HIV/AIDS services as 
            part of the United States health and development agenda;
                ``(iv) a detailed description of integrated HIV/AIDS 
            and food and nutrition programs and services, including--

                    ``(I) the amount spent on food and nutrition 
                support;
                    ``(II) the types of activities supported; and
                    ``(III) an assessment of the effectiveness of 
                interventions carried out to improve the health status 
                of persons with HIV/AIDS receiving food or nutritional 
                support;

                ``(v) a description of efforts to improve 
            harmonization, in terms of relevant executive branch 
            agencies, coordination with other public and private 
            entities, and coordination with partner countries' national 
            strategic plans as called for in the `Three Ones';
                ``(vi) a description of--

                    ``(I) the efforts of partner countries that were 
                signatories to the Abuja Declaration on HIV/AIDS, 
                Tuberculosis and Other Related Infectious Diseases to 
                adhere to the goals of such Declaration in terms of 
                investments in public health, including HIV/AIDS; and
                    ``(II) a description of the HIV/AIDS investments of 
                partner countries that were not signatories to such 
                Declaration;

                ``(vii) a detailed description of any compacts or 
            framework agreements reached or negotiated between the 
            United States and any partner countries, including a 
            description of the elements of compacts described in 
            subsection (e);
                ``(viii) a description of programs serving women and 
            girls, including--

                    ``(I) HIV/AIDS prevention programs that address the 
                vulnerabilities of girls and women to HIV/AIDS;
                    ``(II) information on the number of individuals 
                served by programs aimed at reducing the 
                vulnerabilities of women and girls to HIV/AIDS and data 
                on the types, objectives, and duration of programs to 
                address these issues;
                    ``(III) information on programs to address the 
                particular needs of adolescent girls and young women; 
                and
                    ``(IV) programs to prevent gender-based violence or 
                to assist victims of gender based violence as part of, 
                or in coordination with, HIV/AIDS programs;

                ``(ix) a description of strategies, goals, programs, 
            and interventions to--

                    ``(I) address the needs and vulnerabilities of 
                youth populations;
                    ``(II) expand access among young men and women to 
                evidence-based HIV/AIDS health care services and HIV 
                prevention programs, including abstinence education 
                programs; and
                    ``(III) expand community-based services to meet the 
                needs of orphans and of children and adolescents 
                affected by or vulnerable to HIV/AIDS without 
                increasing stigmatization;

                ``(x) a description of--

                    ``(I) the specific strategies funded to ensure the 
                reduction of HIV infection among injection drug users;
                    ``(II) the number of injection drug users, by 
                country, reached by such strategies; and
                    ``(III) medication-assisted drug treatment for 
                individuals with HIV or at risk of HIV;

                ``(xi) a detailed description of program monitoring, 
            operations research, and impact evaluation research, 
            including--

                    ``(I) the amount of funding provided for each 
                research type;
                    ``(II) an analysis of cost-effectiveness models; 
                and
                    ``(III) conclusions regarding the efficiency, 
                effectiveness, and quality of services as derived from 
                previous or ongoing research and monitoring efforts;

                ``(xii) building capacity to identify, investigate, and 
            stop nosocomial transmission of infectious diseases, 
            including HIV and tuberculosis; and
                ``(xiii) a description of staffing levels of United 
            States government HIV/AIDS teams in countries with 
            significant HIV/AIDS programs, including whether or not a 
            full-time coordinator was on staff for the year.''.
    (f) Authorization of Appropriations.--Section 301(b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7631(b)) is amended--
        (1) in paragraph (1), by striking ``fiscal years 2004 through 
    2008'' and inserting ``fiscal years 2009 through 2013''; and
        (2) in paragraph (3), by striking ``fiscal years 2004 through 
    2008'' and inserting ``fiscal years 2009 through 2013''.
    (g) Relationship To Assistance Programs To Enhance Nutrition.--
Section 301(c) of such Act is amended to read as follows:
    ``(c) Food and Nutritional Support.--
        ``(1) In general.--As indicated in the report produced by the 
    Institute of Medicine, entitled `PEPFAR Implementation: Progress 
    and Promise', inadequate caloric intake has been clearly identified 
    as a principal reason for failure of clinical response to 
    antiretroviral therapy. In recognition of the impact of 
    malnutrition as a clinical health issue for many persons living 
    with HIV/AIDS that is often associated with health and economic 
    impacts on these individuals and their families, the Global AIDS 
    Coordinator and the Administrator of the United States Agency for 
    International Development shall--
            ``(A) follow World Health Organization guidelines for HIV/
        AIDS food and nutrition services;
            ``(B) integrate nutrition programs with HIV/AIDS activities 
        through effective linkages among the health, agricultural, and 
        livelihood sectors and establish additional services in 
        circumstances in which referrals are inadequate or impossible;
            ``(C) provide, as a component of care and treatment 
        programs for persons with HIV/AIDS, food and nutritional 
        support to individuals infected with, and affected by, HIV/AIDS 
        who meet established criteria for nutritional support 
        (including clinically malnourished children and adults, and 
        pregnant and lactating women in programs in need of 
        supplemental support), including--
                ``(i) anthropometric and dietary assessment;
                ``(ii) counseling; and
                ``(iii) therapeutic and supplementary feeding;
            ``(D) provide food and nutritional support for children 
        affected by HIV/AIDS and to communities and households caring 
        for children affected by HIV/AIDS; and
            ``(E) in communities where HIV/AIDS and food insecurity are 
        highly prevalent, support programs to address these often 
        intersecting health problems through community-based assistance 
        programs, with an emphasis on sustainable approaches.
        ``(2) Authorization of appropriations.--Of the amounts 
    authorized to be appropriated under section 401, there are 
    authorized to be appropriated to the President such sums as may be 
    necessary for each of the fiscal years 2009 through 2013 to carry 
    out this subsection.''.
    (h) Eligibility for Assistance.--Section 301(d) of such Act is 
amended to read as follows:
    ``(d) Eligibility for Assistance.--An organization, including a 
faith-based organization, that is otherwise eligible to receive 
assistance under section 104A of the Foreign Assistance Act of 1961, 
under this Act, or under any amendment made by this Act or by the Tom 
Lantos and Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, for HIV/
AIDS prevention, treatment, or care--
        ``(1) shall not be required, as a condition of receiving such 
    assistance--
            ``(A) to endorse or utilize a multisectoral or 
        comprehensive approach to combating HIV/AIDS; or
            ``(B) to endorse, utilize, make a referral to, become 
        integrated with, or otherwise participate in any program or 
        activity to which the organization has a religious or moral 
        objection; and
        ``(2) shall not be discriminated against in the solicitation or 
    issuance of grants, contracts, or cooperative agreements under such 
    provisions of law for refusing to meet any requirement described in 
    paragraph (1).''.
    SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
    (a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest burden 
of tuberculosis and other countries with high rates of tuberculosis, 
the United States should support the objectives of the Global Plan to 
Stop TB, including through achievement of the following goals:
        ``(1) Reduce by half the tuberculosis death and disease burden 
    from the 1990 baseline.
        ``(2) Sustain or exceed the detection of at least 70 percent of 
    sputum smear-positive cases of tuberculosis and the successful 
    treatment of at least 85 percent of the cases detected in countries 
    with established United States Agency for International Development 
    tuberculosis programs.
        ``(3) In support of the Global Plan to Stop TB, the President 
    shall establish a comprehensive, 5-year United States strategy to 
    expand and improve United States efforts to combat tuberculosis 
    globally, including a plan to support--
            ``(A) the successful treatment of 4,500,000 new sputum 
        smear tuberculosis patients under DOTS programs by 2013, 
        primarily through direct support for needed services, 
        commodities, health workers, and training, and additional 
        treatment through coordinated multilateral efforts; and
            ``(B) the diagnosis and treatment of 90,000 new multiple 
        drug resistant tuberculosis cases by 2013, and additional 
        treatment through coordinated multilateral efforts.''.
    (b) Priority To Stop TB Strategy.--Section 104B(e) of such Act is 
amended to read as follows:
    ``(e) Priority To Stop TB Strategy.--In furnishing assistance under 
subsection (c), the President shall give priority to--
        ``(1) direct services described in the Stop TB Strategy, 
    including expansion and enhancement of Directly Observed Treatment 
    Short-course (DOTS) coverage, rapid testing, treatment for 
    individuals infected with both tuberculosis and HIV, and treatment 
    for individuals with multi-drug resistant tuberculosis (MDR-TB), 
    strengthening of health systems, use of the International Standards 
    for Tuberculosis Care by all providers, empowering individuals with 
    tuberculosis, and enabling and promoting research to develop new 
    diagnostics, drugs, and vaccines, and program-based operational 
    research relating to tuberculosis; and
        ``(2) funding for the Global Tuberculosis Drug Facility, the 
    Stop Tuberculosis Partnership, and the Global Alliance for TB Drug 
    Development.''.
    (c) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--Section 104B of such Act is amended--
        (1) by redesignating subsection (f) as subsection (h); and
        (2) by inserting after subsection (e) the following:
    ``(f) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--In carrying out this section, the President, 
acting through the Administrator of the United States Agency for 
International Development, is authorized to provide increased resources 
to the World Health Organization and the Stop Tuberculosis Partnership 
to improve the capacity of countries with high rates of tuberculosis 
and other affected countries to implement the Stop TB Strategy and 
specific strategies related to addressing multiple drug resistant 
tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-
TB).''.
    (d) Annual Report.--Section 104B of such Act is amended by 
inserting after subsection (f), as added by subsection (c) of this 
section, the following:
    ``(g) Annual Report.--The President shall submit an annual report 
to Congress that describes the impact of United States foreign 
assistance on efforts to control tuberculosis, including--
        ``(1) the number of tuberculosis cases diagnosed and the number 
    of cases cured in countries receiving United States bilateral 
    foreign assistance for tuberculosis control purposes;
        ``(2) a description of activities supported with United States 
    tuberculosis resources in each country, including a description of 
    how those activities specifically contribute to increasing the 
    number of people diagnosed and treated for tuberculosis;
        ``(3) in each country receiving bilateral United States foreign 
    assistance for tuberculosis control purposes, the percentage 
    provided for direct tuberculosis services in countries receiving 
    United States bilateral foreign assistance for tuberculosis control 
    purposes;
        ``(4) a description of research efforts and clinical trials to 
    develop new tools to combat tuberculosis, including diagnostics, 
    drugs, and vaccines supported by United States bilateral 
    assistance;
        ``(5) the number of persons who have been diagnosed and started 
    treatment for multidrug-resistant tuberculosis in countries 
    receiving United States bilateral foreign assistance for 
    tuberculosis control programs;
        ``(6) a description of the collaboration and coordination of 
    United States anti-tuberculosis efforts with the World Health 
    Organization, the Global Fund, and other major public and private 
    entities within the Stop TB Strategy;
        ``(7) the constraints on implementation of programs posed by 
    health workforce shortages and capacities;
        ``(8) the number of people trained in tuberculosis control; and
        ``(9) a breakdown of expenditures for direct patient 
    tuberculosis services, drugs and other commodities, drug 
    management, training in diagnosis and treatment, health systems 
    strengthening, research, and support costs.''.
    (e) Definitions.--Section 104B(h) of such Act, as redesignated by 
subsection (c), is amended--
        (1) in paragraph (1), by striking the period at the end and 
    inserting the following: ``including--
            ``(A) low-cost and effective diagnosis, treatment, and 
        monitoring of tuberculosis;
            ``(B) a reliable drug supply;
            ``(C) a management strategy for public health systems;
            ``(D) health system strengthening;
            ``(E) promotion of the use of the International Standards 
        for Tuberculosis Care by all care providers;
            ``(F) bacteriology under an external quality assessment 
        framework;
            ``(G) short-course chemotherapy; and
            ``(H) sound reporting and recording systems.''; and
        (2) by redesignating paragraph (5) as paragraph (6); and
        (3) by inserting after paragraph (4) the following:
        ``(5) Stop tb strategy.--The term `Stop TB Strategy' means the 
    6-point strategy to reduce tuberculosis developed by the World 
    Health Organization, which is described in the Global Plan to Stop 
    TB 2006-2015: Actions for Life, a comprehensive plan developed by 
    the Stop TB Partnership that sets out the actions necessary to 
    achieve the millennium development goal of cutting tuberculosis 
    deaths and disease burden in half by 2015.''.
    (f) Authorization of Appropriations.--Section 302 (b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7632(b)) is amended--
        (1) in paragraph (1), by striking ``such sums as may be 
    necessary for each of the fiscal years 2004 through 2008'' and 
    inserting ``a total of $4,000,000,000 for the 5-year period 
    beginning on October 1, 2008.''; and
        (2) in paragraph (3), by striking ``fiscal years 2004 through 
    2008'' and inserting ``fiscal years 2009 through 2013.''.
    SEC. 303. ASSISTANCE TO COMBAT MALARIA.
    (a) Amendment to the Foreign Assistance Act of 1961.--Section 
104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-4(b)) is 
amended by inserting ``treatment,'' after ``control,''.
    (b) Authorization of Appropriations.--Section 303 of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
        (1) in subsection (b)--
            (A) in paragraph (1), by striking ``such sums as may be 
        necessary for fiscal years 2004 through 2008'' and inserting 
        ``$5,000,000,000 during the 5-year period beginning on October 
        1, 2008''; and
            (B) in paragraph (3), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
        (2) by adding at the end the following:
    ``(c) Statement of Policy.--Providing assistance for the 
prevention, control, treatment, and the ultimate eradication of malaria 
is--
        ``(1) a major objective of the foreign assistance program of 
    the United States; and
        ``(2) 1 component of a comprehensive United States global 
    health strategy to reduce disease burdens and strengthen 
    communities around the world.
    ``(d) Development of a Comprehensive 5-Year Strategy.--The 
President shall establish a comprehensive, 5-year strategy to combat 
global malaria that--
        ``(1) strengthens the capacity of the United States to be an 
    effective leader of international efforts to reduce malaria burden;
        ``(2) maintains sufficient flexibility and remains responsive 
    to the ever-changing nature of the global malaria challenge;
        ``(3) includes specific objectives and multisectoral approaches 
    and strategies to reduce the prevalence, mortality, incidence, and 
    spread of malaria;
        ``(4) describes how this strategy would contribute to the 
    United States' overall global health and development goals;
        ``(5) clearly explains how outlined activities will interact 
    with other United States Government global health activities, 
    including the 5-year global AIDS strategy required under this Act;
        ``(6) expands public-private partnerships and leverage of 
    resources;
        ``(7) coordinates among relevant Federal agencies to maximize 
    human and financial resources and to reduce duplication among these 
    agencies, foreign governments, and international organizations;
        ``(8) coordinates with other international entities, including 
    the Global Fund;
        ``(9) maximizes United States capabilities in the areas of 
    technical assistance and training and research, including vaccine 
    research; and
        ``(10) establishes priorities and selection criteria for the 
    distribution of resources based on factors such as--
            ``(A) the size and demographics of the population with 
        malaria;
            ``(B) the needs of that population;
            ``(C) the country's existing infrastructure; and
            ``(D) the ability to closely coordinate United States 
        Government efforts with national malaria control plans of 
        partner countries.''.
    SEC. 304. MALARIA RESPONSE COORDINATOR.
    Section 304 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended to 
read as follows:
    ``SEC. 304. MALARIA RESPONSE COORDINATOR.
    ``(a) In General.--There is established within the United States 
Agency for International Development a Coordinator of United States 
Government Activities to Combat Malaria Globally (referred to in this 
section as the `Malaria Coordinator'), who shall be appointed by the 
President.
    ``(b) Authorities.--The Malaria Coordinator, acting through 
nongovernmental organizations (including faith-based and community-
based organizations), partner country finance, health, and other 
relevant ministries, and relevant executive branch agencies as may be 
necessary and appropriate to carry out this section, is authorized to--
        ``(1) operate internationally to carry out prevention, care, 
    treatment, support, capacity development, and other activities to 
    reduce the prevalence, mortality, and incidence of malaria;
        ``(2) provide grants to, and enter into contracts and 
    cooperative agreements with, nongovernmental organizations 
    (including faith-based organizations) to carry out this section; 
    and
        ``(3) transfer and allocate executive branch agency funds that 
    have been appropriated for the purposes described in paragraphs (1) 
    and (2).
    ``(c) Duties.--
        ``(1) In general.--The Malaria Coordinator has primary 
    responsibility for the oversight and coordination of all resources 
    and international activities of the United States Government 
    relating to efforts to combat malaria.
        ``(2) Specific duties.--The Malaria Coordinator shall--
            ``(A) facilitate program and policy coordination of 
        antimalarial efforts among relevant executive branch agencies 
        and nongovernmental organizations by auditing, monitoring, and 
        evaluating such programs;
            ``(B) ensure that each relevant executive branch agency 
        undertakes antimalarial programs primarily in those areas in 
        which the agency has the greatest expertise, technical 
        capability, and potential for success;
            ``(C) coordinate relevant executive branch agency 
        activities in the field of malaria prevention and treatment;
            ``(D) coordinate planning, implementation, and evaluation 
        with the Global AIDS Coordinator in countries in which both 
        programs have a significant presence;
            ``(E) coordinate with national governments, international 
        agencies, civil society, and the private sector; and
            ``(F) establish due diligence criteria for all recipients 
        of funds appropriated by the Federal Government for malaria 
        assistance.
    ``(d) Assistance for the World Health Organization.--In carrying 
out this section, the President may provide financial assistance to the 
Roll Back Malaria Partnership of the World Health Organization to 
improve the capacity of countries with high rates of malaria and other 
affected countries to implement comprehensive malaria control programs.
    ``(e) Coordination of Assistance Efforts.--In carrying out this 
section and in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator shall 
coordinate the provision of assistance by working with--
        ``(1) relevant executive branch agencies, including--
            ``(A) the Department of State (including the Office of the 
        Global AIDS Coordinator);
            ``(B) the Department of Health and Human Services;
            ``(C) the Department of Defense; and
            ``(D) the Office of the United States Trade Representative;
        ``(2) relevant multilateral institutions, including--
            ``(A) the World Health Organization;
            ``(B) the United Nations Children's Fund;
            ``(C) the United Nations Development Programme;
            ``(D) the Global Fund;
            ``(E) the World Bank; and
            ``(F) the Roll Back Malaria Partnership;
        ``(3) program delivery and efforts to lift barriers that would 
    impede effective and comprehensive malaria control programs; and
        ``(4) partner or recipient country governments and national 
    entities including universities and civil society organizations 
    (including faith- and community-based organizations).
    ``(f) Research.--To carry out this section, the Malaria 
Coordinator, in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 1151d-4), shall ensure that operations and 
implementation research conducted under this Act will closely 
complement the clinical and program research being undertaken by the 
National Institutes of Health. The Centers for Disease Control and 
Prevention should advise the Malaria Coordinator on priorities for 
operations and implementation research and should be a key implementer 
of this research.
    ``(g) Monitoring.--To ensure that adequate malaria controls are 
established and implemented, the Centers for Disease Control and 
Prevention should advise the Malaria Coordinator on monitoring, 
surveillance, and evaluation activities and be a key implementer of 
such activities under this Act. Such activities shall complement, 
rather than duplicate, the work of the World Health Organization.
    ``(h) Annual Report.--
        ``(1) Submission.--Not later than 1 year after the date of the 
    enactment of the Tom Lantos and Henry J. Hyde United States Global 
    Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
    Reauthorization Act of 2008, and annually thereafter, the President 
    shall submit a report to the appropriate congressional committees 
    that describes United States assistance for the prevention, 
    treatment, control, and elimination of malaria.
        ``(2) Contents.--The report required under paragraph (1) shall 
    describe--
            ``(A) the countries and activities to which malaria 
        resources have been allocated;
            ``(B) the number of people reached through malaria 
        assistance programs, including data on children and pregnant 
        women;
            ``(C) research efforts to develop new tools to combat 
        malaria, including drugs and vaccines;
            ``(D) the collaboration and coordination of United States 
        antimalarial efforts with the World Health Organization, the 
        Global Fund, the World Bank, other donor governments, major 
        private efforts, and relevant executive agencies;
            ``(E) the coordination of United States antimalarial 
        efforts with the national malarial strategies of other donor or 
        partner governments and major private initiatives;
            ``(F) the estimated impact of United States assistance on 
        childhood mortality and morbidity from malaria;
            ``(G) the coordination of antimalarial efforts with broader 
        health and development programs; and
            ``(H) the constraints on implementation of programs posed 
        by health workforce shortages or capacities; and
            ``(I) the number of personnel trained as health workers and 
        the training levels achieved.''.
    SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.
    Section 212(a)(1)(A)(i) of the Immigration and Nationality Act (8 
U.S.C. 1182(a)(1)(A)(i)) is amended by striking ``, which shall include 
infection with the etiologic agent for acquired immune deficiency 
syndrome,'' and inserting a semicolon.
    SEC. 306. CLERICAL AMENDMENT.
    Title III of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is 
amended by striking the heading for subtitle B and inserting the 
following:

     ``Subtitle B--Assistance for Women, Children, and Families''.

    SEC. 307. REQUIREMENTS.
    Section 312(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is amended by 
striking paragraphs (1), (2), and (3) and inserting the following:
        ``(1) establish a target for the prevention and treatment of 
    mother-to-child transmission of HIV that, by 2013, will reach at 
    least 80 percent of pregnant women in those countries most affected 
    by HIV/AIDS in which the United States has HIV/AIDS programs;
        ``(2) establish a target that, by 2013, the proportion of 
    children receiving care and treatment under this Act is 
    proportionate to their numbers within the population of HIV 
    infected individuals in each country;
        ``(3) integrate care and treatment with prevention of mother-
    to-child transmission of HIV programs to improve outcomes for HIV-
    affected women and families as soon as is feasible and support 
    strategies that promote successful follow-up and continuity of care 
    of mother and child;
        ``(4) expand programs designed to care for children orphaned 
    by, affected by, or vulnerable to HIV/AIDS;
        ``(5) ensure that women in prevention of mother-to-child 
    transmission of HIV programs are provided with, or referred to, 
    appropriate maternal and child services; and
        ``(6) develop a timeline for expanding access to more effective 
    regimes to prevent mother-to-child transmission of HIV, consistent 
    with the national policies of countries in which programs are 
    administered under this Act and the goal of achieving universal use 
    of such regimes as soon as possible.''.
    SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD 
      TRANSMISSION OF HIV.
    Section 313(a) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) is amended by 
striking ``5 years'' and inserting ``10 years''.
    SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT PANEL.
    Section 312 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) is amended by 
adding at the end the following:
    ``(c) Prevention of Mother-to-Child Transmission Expert Panel.--
        ``(1) Establishment.--The Global AIDS Coordinator shall 
    establish a panel of experts to be known as the Prevention of 
    Mother-to-Child Transmission Panel (referred to in this subsection 
    as the `Panel') to--
            ``(A) provide an objective review of activities to prevent 
        mother-to-child transmission of HIV; and
            ``(B) provide recommendations to the Global AIDS 
        Coordinator and to the appropriate congressional committees for 
        scale-up of mother-to-child transmission prevention services 
        under this Act in order to achieve the target established in 
        subsection (b)(1).
        ``(2) Membership.--The Panel shall be convened and chaired by 
    the Global AIDS Coordinator, who shall serve as a nonvoting member. 
    The Panel shall consist of not more than 15 members (excluding the 
    Global AIDS Coordinator), to be appointed by the Global AIDS 
    Coordinator not later than 1 year after the date of the enactment 
    of this Act, including--
            ``(A) 2 members from the Department of Health and Human 
        Services with expertise relating to the prevention of mother-
        to-child transmission activities;
            ``(B) 2 members from the United States Agency for 
        International Development with expertise relating to the 
        prevention of mother-to-child transmission activities;
            ``(C) 2 representatives from among health ministers of 
        national governments of foreign countries in which programs 
        under this Act are administered;
            ``(D) 3 members representing organizations implementing 
        prevention of mother-to-child transmission activities under 
        this Act;
            ``(E) 2 health care researchers with expertise relating to 
        global HIV/AIDS activities; and
            ``(F) representatives from among patient advocate groups, 
        health care professionals, persons living with HIV/AIDS, and 
        non-governmental organizations with expertise relating to the 
        prevention of mother-to-child transmission activities, giving 
        priority to individuals in foreign countries in which programs 
        under this Act are administered.
        ``(3) Duties of panel.--The Panel shall--
            ``(A) assess the effectiveness of current activities in 
        reaching the target described in subsection (b)(1);
            ``(B) review scientific evidence related to the provision 
        of mother-to-child transmission prevention services, including 
        programmatic data and data from clinical trials;
            ``(C) review and assess ways in which the Office of the 
        United States Global AIDS Coordinator collaborates with 
        international and multilateral entities on efforts to prevent 
        mother-to-child transmission of HIV in affected countries;
            ``(D) identify barriers and challenges to increasing access 
        to mother-to-child transmission prevention services and 
        evaluate potential mechanisms to alleviate those barriers and 
        challenges;
            ``(E) identify the extent to which stigma has hindered 
        pregnant women from obtaining HIV counseling and testing or 
        returning for results, and provide recommendations to address 
        such stigma and its effects;
            ``(F) identify opportunities to improve linkages between 
        mother-to-child transmission prevention services and care and 
        treatment programs; and
            ``(G) recommend specific activities to facilitate reaching 
        the target described in subsection (b)(1).
        ``(4) Report.--
            ``(A) In general.--Not later than 1 year after the date on 
        which the Panel is first convened, the Panel shall submit a 
        report containing a detailed statement of the recommendations, 
        findings, and conclusions of the Panel to the appropriate 
        congressional committees.
            ``(B) Availability.--The report submitted under 
        subparagraph (A) shall be made available to the public.
            ``(C) Consideration by coordinator.--The Coordinator 
        shall--
                ``(i) consider any recommendations contained in the 
            report submitted under subparagraph (A); and
                ``(ii) include in the annual report required under 
            section 104A(f) of the Foreign Assistance Act of 1961 a 
            description of the activities conducted in response to the 
            recommendations made by the Panel and an explanation of any 
            recommendations not implemented at the time of the report.
        ``(5) Authorization of appropriations.--There are authorized to 
    be appropriated to the Panel such sums as may be necessary for each 
    of the fiscal years 2009 through 2011 to carry out this section.
        ``(6) Termination.--The Panel shall terminate on the date that 
    is 60 days after the date on which the Panel submits the report to 
    the appropriate congressional committees under paragraph (4).''.

                     TITLE IV--FUNDING ALLOCATIONS

    SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
    (a) In General.--Section 401(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7671(a)) is amended by striking ``$3,000,000,000 for each of the fiscal 
years 2004 through 2008'' and inserting ``$48,000,000,000 for the 5-
year period beginning on October 1, 2008''.
    (b) Sense of Congress.--It is the sense of the Congress that the 
appropriations authorized under section 401(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, as 
amended by subsection (a), should be allocated among fiscal years 2009 
through 2013 in a manner that allows for the appropriations to be 
gradually increased in a manner that is consistent with program 
requirements, absorptive capacity, and priorities set forth in such 
Act, as amended by this Act.
    SEC. 402. SENSE OF CONGRESS.
    Section 402(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) is amended by 
striking ``an effective distribution of such amounts would be'' and all 
that follows through ``10 percent of such amounts'' and inserting ``10 
percent should be used''.
    SEC. 403. ALLOCATION OF FUNDS.
    Section 403 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is amended--
        (1) by amending subsection (a) to read as follows:
    ``(a) Balanced Funding Requirement.--
        ``(1) In general.--The Global AIDS Coordinator shall--
            ``(A) provide balanced funding for prevention activities 
        for sexual transmission of HIV/AIDS; and
            ``(B) ensure that activities promoting abstinence, delay of 
        sexual debut, monogamy, fidelity, and partner reduction are 
        implemented and funded in a meaningful and equitable way in the 
        strategy for each host country based on objective 
        epidemiological evidence as to the source of infections and in 
        consultation with the government of each host county involved 
        in HIV/AIDS prevention activities.
        ``(2) Prevention strategy.--
            ``(A) Establishment.--In carrying out paragraph (1), the 
        Global AIDS Coordinator shall establish an HIV sexual 
        transmission prevention strategy governing the expenditure of 
        funds authorized under this Act to prevent the sexual 
        transmission of HIV in any host country with a generalized 
        epidemic.
            ``(B) Report.--In each host country described in 
        subparagraph (A), if the strategy established under 
        subparagraph (A) provides less than 50 percent of the funds 
        described in subparagraph (A) for activities promoting 
        abstinence, delay of sexual debut, monogamy, fidelity, and 
        partner reduction, the Global AIDS Coordinator shall, not later 
        than 30 days after the issuance of this strategy, report to the 
        appropriate congressional committees on the justification for 
        this decision.
        ``(3) Exclusion.--Programs and activities that implement or 
    purchase new prevention technologies or modalities, such as medical 
    male circumcision, public education about risks to acquire HIV 
    infection from blood exposures, promoting universal precautions, 
    investigating suspected nosocomial infections, pre-exposure 
    pharmaceutical prophylaxis to prevent transmission of HIV, or 
    microbicides and programs and activities that provide counseling 
    and testing for HIV or prevent mother-to-child prevention of HIV, 
    shall not be included in determining compliance with paragraph (2).
        ``(4) Report.--Not later than 1 year after the date of the 
    enactment of the Tom Lantos and Henry J. Hyde United States Global 
    Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
    Reauthorization Act of 2008, and annually thereafter as part of the 
    annual report required under section 104A(e) of the Foreign 
    Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the President 
    shall--
            ``(A) submit a report on the implementation of paragraph 
        (2) for the most recently concluded fiscal year to the 
        appropriate congressional committees; and
            ``(B) make the report described in subparagraph (A) 
        available to the public.'';
        (2) in subsection (b)--
            (A) by striking ``fiscal years 2006 through 2008'' and 
        inserting ``fiscal years 2009 through 2013''; and
            (B) by striking ``vulnerable children affected by'' and 
        inserting ``other children affected by, or vulnerable to,''; 
        and
        (3) by adding at the end the following:
    ``(c) Funding Allocation.--For each of the fiscal years 2009 
through 2013, more than half of the amounts appropriated for bilateral 
global HIV/AIDS assistance pursuant to section 401 shall be expended 
for--
        ``(1) antiretroviral treatment for HIV/AIDS;
        ``(2) clinical monitoring of HIV-seropositive people not in 
    need of antiretroviral treatment;
        ``(3) care for associated opportunistic infections;
        ``(4) nutrition and food support for people living with HIV/
    AIDS; and
        ``(5) other essential HIV/AIDS-related medical care for people 
    living with HIV/AIDS.
    ``(d) Treatment, Prevention, and Care Goals.--For each of the 
fiscal years 2009 through 2013--
        ``(1) the treatment goal under section 402(a)(3) shall be 
    increased above 2,000,000 by at least the percentage increase in 
    the amount appropriated for bilateral global HIV/AIDS assistance 
    for such fiscal year compared with fiscal year 2008;
        ``(2) any increase in the treatment goal under section 
    402(a)(3) above the percentage increase in the amount appropriated 
    for bilateral global HIV/AIDS assistance for such fiscal year 
    compared with fiscal year 2008 shall be based on long-term 
    requirements, epidemiological evidence, the share of treatment 
    needs being met by partner governments and other sources of 
    treatment funding, and other appropriate factors;
        ``(3) the treatment goal under section 402(a)(3) shall be 
    increased above the number calculated under paragraph (1) by the 
    same percentage that the average United States Government cost per 
    patient of providing treatment in countries receiving bilateral 
    HIV/AIDS assistance has decreased compared with fiscal year 2008; 
    and
        ``(4) the prevention and care goals established in clauses (i) 
    and (iv) of section 104A(b)(1)(A) of the Foreign Assistance Act of 
    1961 (22 U.S.C. 2151b-2(b)(1)(A)) shall be increased consistent 
    with epidemiological evidence and available resources.''.

                         TITLE V--MISCELLANEOUS

    SEC. 501. MACHINE READABLE VISA FEES.
    (a) Fee Increase.--Notwithstanding any other provision of law--
        (1) not later than October 1, 2010, the Secretary of State 
    shall increase by $1 the fee or surcharge authorized under section 
    140(a) of the Foreign Relations Authorization Act, Fiscal Years 
    1994 and 1995 (Public Law 103-236; 8 U.S.C. 1351 note) for 
    processing machine readable nonimmigrant visas and machine readable 
    combined border crossing identification cards and nonimmigrant 
    visas; and
        (2) not later than October 1, 2013, the Secretary shall 
    increase the fee or surcharge described in paragraph (1) by an 
    additional $1.
    (b) Deposit of Amounts.--Notwithstanding section 140(a)(2) of the 
Foreign Relations Authorization Act, Fiscal Years 1994 and 1995 (Public 
Law 103-236; 8 U.S.C. 1351 note), fees collected under the authority of 
subsection (a) shall be deposited in the Treasury.

         TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

    SEC. 601. EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH.
    (a) Establishment of Fund.--There is established in the Treasury of 
the United States a fund, to be known as the ``Emergency Fund for 
Indian Safety and Health'' (referred to in this section as the 
``Fund''), consisting of such amounts as are appropriated to the Fund 
under subsection (b).
    (b) Transfers to Fund.--
        (1) In general.--There is authorized to be appropriated to the 
    Fund, out of funds of the Treasury not otherwise appropriated, 
    $2,000,000,000 for the 5-year period beginning on October 1, 2008.
        (2) Availability of amounts.--Amounts deposited in the Fund 
    under this section shall--
            (A) be made available without further appropriation;
            (B) be in addition to amounts made available under any 
        other provision of law; and
            (C) remain available until expended.
    (c) Expenditures From Fund.--On request by the Attorney General, 
the Secretary of the Interior, or the Secretary of Health and Human 
Services, the Secretary of the Treasury shall transfer from the Fund to 
the Attorney General, the Secretary of the Interior, or the Secretary 
of Health and Human Services, as appropriate, such amounts as the 
Attorney General, the Secretary of the Interior, or the Secretary of 
Health and Human Services determines to be necessary to carry out the 
emergency plan under subsection (f).
    (d) Transfers of Amounts.--
        (1) In general.--The amounts required to be transferred to the 
    Fund under this section shall be transferred at least monthly from 
    the general fund of the Treasury to the Fund on the basis of 
    estimates made by the Secretary of the Treasury.
        (2) Adjustments.--Proper adjustment shall be made in amounts 
    subsequently transferred to the extent prior estimates were in 
    excess of or less than the amounts required to be transferred.
    (e) Remaining Amounts.--Any amounts remaining in the Fund on 
September 30 of an applicable fiscal year may be used by the Attorney 
General, the Secretary of the Interior, or the Secretary of Health and 
Human Services to carry out the emergency plan under subsection (f) for 
any subsequent fiscal year.
    (f) Emergency Plan.--Not later than 1 year after the date of 
enactment of this Act, the Attorney General, the Secretary of the 
Interior, and the Secretary of Health and Human Services, in 
consultation with Indian tribes (as defined in section 4 of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450b)), 
shall jointly establish an emergency plan that addresses law 
enforcement, water, and health care needs of Indian tribes under which, 
for each of fiscal years 2010 through 2019, of amounts in the Fund--
        (1) the Attorney General shall use--
            (A) 18.5 percent for the construction, rehabilitation, and 
        replacement of Federal Indian detention facilities;
            (B) 1.5 percent to investigate and prosecute crimes in 
        Indian country (as defined in section 1151 of title 18, United 
        States Code);
            (C) 1.5 percent for use by the Office of Justice Programs 
        for Indian and Alaska Native programs; and
            (D) 0.5 percent to provide assistance to--
                (i) parties to cross-deputization or other cooperative 
            agreements between State or local governments and Indian 
            tribes (as defined in section 102 of the Federally 
            Recognized Indian Tribe List Act of 1994 (25 U.S.C. 479a)) 
            carrying out law enforcement activities in Indian country; 
            and
                (ii) the State of Alaska (including political 
            subdivisions of that State) for carrying out the Village 
            Public Safety Officer Program and law enforcement 
            activities on Alaska Native land (as defined in section 3 
            of Public Law 103-399 (25 U.S.C. 3902));
        (2) the Secretary of the Interior shall--
            (A) deposit 15.5 percent in the public safety and justice 
        account of the Bureau of Indian Affairs for use by the Office 
        of Justice Services of the Bureau in providing law enforcement 
        or detention services, directly or through contracts or 
        compacts with Indian tribes under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.); and
            (B) use 50 percent to implement requirements of Indian 
        water settlement agreements that are approved by Congress (or 
        the legislation to implement such an agreement) under which the 
        United States shall plan, design, rehabilitate, or construct, 
        or provide financial assistance for the planning, design, 
        rehabilitation, or construction of, water supply or delivery 
        infrastructure that will serve an Indian tribe (as defined in 
        section 4 of the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450b)); and
        (3) the Secretary of Health and Human Services, acting through 
    the Director of the Indian Health Service, shall use 12.5 percent 
    to provide, directly or through contracts or compacts with Indian 
    tribes under the Indian Self-Determination and Education Assistance 
    Act (25 U.S.C. 450 et seq.)--
            (A) contract health services;
            (B) construction, rehabilitation, and replacement of Indian 
        health facilities; and
            (C) domestic and community sanitation facilities serving 
        members of Indian tribes (as defined in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        450b)) pursuant to section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a).

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```