IIB 

110TH CONGRESS 

2D SESSION H. R. 5501 

IN THE SENATE OF THE UNITED STATES 

APRIL 3, 2008 

Received; read twice and referred to the Committee on Foreign Relations 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 

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

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

4 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

5 Reauthorization Act of 2008’’. 

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

7 this Act is as follows: 

Sec. 1. Short title and table of contents. 

Sec. 2. Findings. 

Sec. 3. Definitions. 

Sec. 4. Purpose. 

TITLE I—POLICY PLANNING AND COORDINATION 

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

Sec. 102. HIV/AIDS Response Coordinator. 

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, 

AND PUBLIC-PRIVATE PARTNERSHIPS 

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

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

Malaria. 

Sec. 203. Voluntary contributions to international vaccine funds. 

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

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

TITLE III—BILATERAL EFFORTS 

Subtitle A—General Assistance and Programs 

Sec. 301. Assistance to combat HIV/AIDS. 

Sec. 302. Assistance to combat tuberculosis. 

Sec. 303. Assistance to combat malaria. 

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

Subtitle B—Assistance for Women, Children, and Families 

Sec. 311. Policy and requirements. 

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

HIV infection. 

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

Sec. 314. Clerical amendment. 

TITLE IV—AUTHORIZATION OF APPROPRIATIONS 

Sec. 401. Authorization of appropriations. 

Sec. 402. Sense of Congress. 


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Sec. 403. Allocation of funds. 

Sec. 404. Prohibition on taxation by foreign governments. 

TITLE V—SUSTAINABILITY AND STRENGTHENING OF HEALTH 

CARE SYSTEMS 

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

Sec. 502. Clerical amendment. 

1 SEC. 2. FINDINGS. 

2 Section 2 of the United States Leadership Against 

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

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

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

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

9 sub-Saharan Africa and the Caribbean, to the 

10 emerging epidemics of Eastern Europe, Central 

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

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

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

16 million are children under 15 who also account for 

17 460,000 of the newly-infected individuals. 

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

19 region most affected by the HIV/AIDS pandemic. 

20 More than 68 percent of adults and nearly 90 per21 cent of children with HIV/AIDS live in sub-Saharan 


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1 Africa, and more than 76 percent of AIDS deaths 

2 in 2007 occurred in sub-Saharan Africa. 

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

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

5 AIDS pandemic continues to affect virtually every 

6 world region. While prevalence rates are relatively 

7 low in Eastern Europe, Central Asia, South and 

8 Southeast Asia, and Latin America, without effective 

9 prevention strategies, HIV prevalence rates could 

10 rise quickly in these regions. 

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

12 2007 global estimates— 

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

14 22.5 million adults and children infected with 

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

16 million new HIV infections, a 5 percent preva17 lence rate, and 1.6 million deaths; 

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

19 were 4 million adults and children infected with 

20 HIV, up from 3.5 million in 2001, with 

21 340,000 new HIV infections, a 0.3 percent 

22 prevalence rate, and 270,000 deaths; 

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

24 adults and children infected with HIV, up from 

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1 tions, a 0.1 percent prevalence rate, and 32,000 

2 deaths; 

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

4 were 1.6 million adults and children infected 

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

6 150,000 new HIV infections, a 0.9 percent 

7 prevalence rate, and 55,000 deaths; and 

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

9 adults and children infected with HIV, up from 

10 190,000 in 2001, with 17,000 new HIV infec11 tions, a 1 percent prevalence rate, and 11,000 

12 deaths. 

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

14 individuals with HIV/AIDS and is responsible for up 

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

16 ‘‘(35) The wide extent of drug resistant tuber17 culosis, including both multi-drug resistant tuber18 culosis (MDR–TB) and extensively drug resistant 

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

20 pandemic in sub-Saharan Africa, has hampered both 

21 HIV/AIDS and tuberculosis treatment services. The 

22 World Health Organization (WHO) has declared the 

23 prevalence of tuberculosis to be at emergency levels 

24 in sub-Saharan Africa. 


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

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

3 which is highly preventable, kills more than 1 million 

4 individuals worldwide each year. Ninety percent of 

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

6 percent of malaria’s victims are children under the 

7 age of 5. Additionally, hunger and malnutrition kill 

8 another 6 million individuals worldwide each year. 

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

10 address the nutritional factors associated with the 

11 disease in order to be effective and sustainable. The 

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

14 by 2008. 

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

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

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

25 women ages 15 to 24. 


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

2 and economically more vulnerable to HIV infection. 

3 Gender disparities in the rate of HIV infection are 

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

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

7 who are more likely to be infected with HIV, 

8 and a lack of choice regarding when and whom 

9 to marry, leading to early marriages and high 

10 rates of child marriages with older men. About 

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

13 in Asia are married by age 18. 

14 ‘‘(B) Studies show that married women 

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

18 their partner’s faithfulness, or insist on condom 

19 use. Under these circumstances, women often 

20 run the risk of being infected by husbands or 

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

23 change is particularly important in societies in 

24 which this is a common practice. 


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1 ‘‘(C) Because young married women and 

2 girls are more likely to have unprotected sex 

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

6 HIV/AIDS through a husband’s infidelity or 

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

9 protective factor overall. 

10 ‘‘(D) Social and economic inequalities 

11 based largely on gender limit access for women 

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

15 women, a lack of independent economic means 

16 combines with socio-cultural practices to sustain 

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

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

22 ‘‘(E) A lack of educational opportunities 

23 for women and girls is linked to younger sexual 

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

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

4 rape, and sexual coercion within and outside 

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

8 women in various countries and settings have 

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

11 marriage. Women who are unable to protect 

12 themselves from such violence are often unable 

13 to protect themselves from being infected with 

14 HIV through forced sexual contact. 

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

16 continuing stigma and discrimination associated 

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

19 tested, disclosing their HIV status, accessing 

20 services to prevent mother-to-child transmission 

21 of HIV, or receiving treatment and counseling 

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

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


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

4 and legal services, limited access to information 

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

7 and trafficking, harmful or non-protective laws 

8 and policies, and exposure to risks associated 

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

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

14 reduce stigma and maximize coverage. 

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

16 female-controlled HIV prevention methods, such 

17 as the female condom, and lack of training on 

18 proper use of either male or female condoms. 

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

21 pregnancies and childbirth. 

22 ‘‘(L) An absence of functioning legal 

23 frameworks to protect women and girls and, 

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1 countable and effective enforcement of such 

2 frameworks. 

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

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

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

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

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

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

12 to help HIV-positive women safely deliver healthy 

13 babies and save women’s lives. 

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

16 of HIV worldwide and is responsible for 80 percent 

17 of new HIV infections in sub-Saharan Africa. 

18 ‘‘(44) Multiple randomized controlled trials 

19 have established that male circumcision reduces a 

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

21 more. Twelve acceptability studies have found that 

22 in regions of sub-Saharan Africa where circumcision 

23 is not traditionally practiced, a majority of men 

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1 fections not only in men but also in their female 

2 partners. 

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

4 in receiving services for HIV/AIDS. 

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

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

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

8 in particular need of services to protect themselves 

9 against sexually-transmitted infections, including 

10 HIV. 

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

14 reduction, and condoms. Providing comprehensive 

15 information about HIV, including delay of sexual 

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

17 Condoms’, and linking such information to health 

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

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

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

24 youth about the prevention and transmission of 

25 HIV. 


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

2 Commissioner for Refugees (UNHCR), HIV/AIDS 

3 prevalence rates among refugees are generally lower 

4 than the HIV/AIDS prevalence rates for their host 

5 communities, though perceptions run counter to this 

6 fact. However, peacekeeping operations that no 

7 longer deploy HIV/AIDS-positive troops still face 

8 vulnerabilities to sexual transmission of HIV with 

9 HIV-positive individuals in refugee camps. Host 

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

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

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

15 requires increased efforts to strengthen health care 

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

19 United States global HIV/AIDS assistance. 

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

21 health threat of modern times, it also poses the 

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

25 shoulder the burden of this disease. International 


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1 donors will have to play a critical role in providing 

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

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

6 States must include stronger coordination between 

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

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

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

15 Organization (WHO), the World Bank and the 

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

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

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

21 requires effective and transparent public finance 

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

24 revenues and donor funds aimed at combating HIV/ 

25 AIDS and other diseases. 


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

2 the shortage of health care personnel through loss of 

3 life and illness, unsafe working conditions, increased 

4 workloads for diminished staff, and resulting stress 

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

7 care and treatment for individuals with HIV/AIDS. 

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

11 and researchers is one of the leading obstacles to 

12 combating HIV/AIDS in sub-Saharan Africa. 

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

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

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

16 increasing at an alarming rate. According to the 

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

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

21 ‘‘(55) The United States Government continues 

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

23 AIDS and the unsurpassed partner with developing 

24 countries in their efforts to control this disease. 


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

2 through the United States Leadership Against HIV/ 

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

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

6 during 10 million pregnancies; provided 

7 antiretroviral prophylaxis for women during over 

8 827,300 pregnancies; prevented an estimated 

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

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

12 antiretroviral therapies for approximately 1.4 million 

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

14 Asia, and the Carribean; and provided counseling 

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

16 children in developing countries. 

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

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

22 who are taking control of the HIV/AIDS epidemics 

23 in their own countries.’’. 


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1 SEC. 3. DEFINITIONS. 

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

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

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

5 International Relations’’ and inserting ‘‘Committee on 

6 Foreign Affairs’’. 

7 SEC. 4. PURPOSE. 

8 Section 4 of the United States Leadership Against 

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

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

11 ‘‘SEC. 4. PURPOSE. 

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

16 preventable infectious diseases in developing countries 

17 by— 

18 ‘‘(1) establishing a comprehensive, integrated 

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

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

23 executive branch agencies and between the United 

24 States and foreign governments and international 

25 organizations; 


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1 ‘‘(2) providing increased resources for United 

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

4 treatment, and care (including nutritional support), 

5 technical assistance and training, the strengthening 

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

8 operations research; 

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

11 malaria; 

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

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

17 technologies and improved diagnostics treatment for 

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

19 TITLE I—POLICY PLANNING AND 

20 COORDINATION 

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

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

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

2 amended— 

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

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

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

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

9 behavioral risks shall be a priority of all prevention 

10 efforts in terms of funding, scientifically-accurate 

11 educational services, and activities by— 

12 ‘‘(A) designing prevention strategies and 

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

15 country and community, and reaching those 

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

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

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

21 monogamy, fidelity, and partner reduction; 

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

23 and female condoms; 

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1 ant couples (where one individual has HIV/ 

2 AIDS and the other individual does not have 

3 HIV/AIDS or whose status is unknown); 

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

5 risks of procuring sex commercially and about 

6 the need to end violent behavior toward women 

7 and girls; 

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

9 and voluntary male circumcision services; 

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

12 ‘‘(I) supporting advocacy for child and 

13 youth community-based protective social serv14 ices; 

15 ‘‘(J) eradicating trafficking in persons and 

16 creating alternatives to prostitution; 

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

19 rape, and sexual assault crimes with the goal of 

20 eliminating such crimes; 

21 ‘‘(L) promoting services demonstrated to 

22 be effective in reducing the transmission of HIV 

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


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1 ‘‘(M) promoting policies and programs to 

2 end the sexual exploitation of and violence 

3 against women and children; and 

4 ‘‘(N) promoting prevention and treatment 

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

6 (3) by redesignating paragraphs (5) through 

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

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

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

12 referral systems for nongovernmental organizations 

13 that implement multisectoral approaches, including 

14 faith-based and community-based organizations, 

15 for— 

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

19 ‘‘(B) child health services and development 

20 programs; 

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

22 services for injection drug users; 

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

24 testing in family planning and maternal health 


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1 programs supported by the United States Gov2 ernment; and 

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

4 victims of violence;’’; 

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

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

8 and 

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

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

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

15 amended— 

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

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

18 Global Leadership Against HIV/AIDS, Tuberculosis, 

19 and Malaria Reauthorization Act of 2008’’; and 

20 (2) in paragraph (3)— 

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

22 as follows: 

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

24 the strategy will address the following: 


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

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

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

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

9 individuals on antiretroviral therapies. 

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

11 debut, abstinence, monogamy, fidelity, and 

12 partner reduction. 

13 ‘‘(iii) The promotion of correct and 

14 consistent use of male and female condoms 

15 and other strategies and skills development 

16 to reduce the risk of HIV transmission. 

17 ‘‘(iv) Increasing voluntary access to 

18 safe male circumcision services. 

19 ‘‘(v) Life-skills training. 

20 ‘‘(vi) The provision of information and 

21 services to encourage young people to delay 

22 sexual debut and ensure access to HIV/ 

23 AIDS prevention information and services. 

24 ‘‘(vii) Prevention of sexual violence 

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1 ance for victims of violence who are at risk 

2 of HIV transmission. 

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

4 and treatment services for injection drug 

5 users. 

6 ‘‘(ix) Research, including incentives 

7 for HIV vaccine development and new pro8 tocols. 

9 ‘‘(x) Advocacy for community-based 

10 child and youth protective services. 

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

12 ‘‘(xii) The development of health care 

13 infrastructure and delivery systems. 

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

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

17 and outreach efforts for men who have sex 

18 with men.’’; 

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

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

21 through faith-based and other nongovernmental 

22 organizations’’; 

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

25 family planning and maternal and child health 


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

3 women, including’’; 

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

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

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

9 ‘‘and men’s’’ after ‘‘women’s’’; 

10 (F) by redesignating subparagraphs (M) 

11 through (W) as subparagraphs (N) through 

12 (X); 

13 (G) by inserting after subparagraph (L) 

14 the following: 

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

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

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

23 striking ‘‘evaluating programs,’’ and inserting 

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


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

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

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

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

11 growth, and education’’; 

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

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

15 and’’ after ‘‘, including’’; 

16 (L) by redesignating subparagraphs (V) 

17 through (X) (as redesignated by subparagraph 

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

19 through (Y), respectively; 

20 (M) by inserting after subparagraph (U) 

21 (as redesignated by subparagraph (F) of this 

22 paragraph) the following: 

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

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


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

3 move toward global health program needs and 

4 toward targets established by the World Health 

5 Organization, while enabling health systems to 

6 expand coverage consistent with national and 

7 international targets and goals.’’; and 

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

10 this paragraph) and inserting the following: 

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

13 health programs, to prevent mother-to-child 

14 transmission of HIV, including the extent to 

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

18 methods of preventing HIV transmission and 

19 the extent to which HIV prevention methods 

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

21 care, and support programs. 

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

23 developed to maximize the capacity of health 

24 care providers, including faith-based and other 

25 nongovernmental organizations, and family 


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1 planning providers supported by the United 

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

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

7 for such providers. 

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

12 (c) STRATEGIC PLAN FOR PROGRAM MONITORING, 

13 OPERATIONS RESEARCH, AND IMPACT EVALUATION RE14 SEARCH.— 

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

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

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

19 strategic plan for program monitoring, operations 

20 research, and impact evaluation research of United 

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

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

24 developed under this subsection shall include— 


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1 (A) the amount of funding provided for 

2 program monitoring, operations research, and 

3 impact evaluation research under sections 

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

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

9 available through fiscal year 2009; 

10 (B) strategies to— 

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

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

15 (ii) establish the cost-effectiveness of 

16 program models; 

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

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

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

23 best practices in services provided under 

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


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1 (v) encourage and evaluate innovative 

2 service models and strategies to optimize 

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

5 States Government; 

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

10 (D) other information that the Coordinator 

11 determines to be necessary. 

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

14 disseminating, and promoting the use of program 

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

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

20 assistance, nongovernmental organizations involved 

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

23 (4) DEFINITIONS.—In this subsection— 

24 (A) the terms ‘‘program monitoring’’, ‘‘op25 erations research’’, and ‘‘impact evaluation reVerDate Aug 31 2005 00:33 Apr 05, 2008 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RFS H5501

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

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

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

5 (B) the term ‘‘relevant executive branch 

6 agencies’’ has the meaning given the term in 

7 section 3 of the United States Leadership 

8 Against HIV/AIDS, Tuberculosis, and Malaria 

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

10 SEC. 102. HIV/AIDS RESPONSE COORDINATOR. 

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

14 (1) in subparagraph (A)— 

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

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

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

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

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

23 (2) in subparagraph (B)(ii)— 

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

25 and inserting the following: 


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

3 that is comprised of, but not limited 

4 to, representatives from the United 

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

7 and Human Services (including the 

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

10 Health, and the Health Resources and 

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

13 Agriculture, the Millennium Challenge 

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

17 Activities to Combat Malaria Globally, 

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

20 interagency working group shall— 

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

23 toward HIV/AIDS prevention, 

24 treatment, and care objectives; 


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1 ‘‘(bb) participate in the 

2 process of identifying countries in 

3 need of increased assistance 

4 based on the epidemiology of 

5 HIV/AIDS in those countries; 

6 and 

7 ‘‘(cc) review policies that 

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

10 prevention, treatment, and care. 

11 ‘‘(V) Coordinating overall United 

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

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

17 institutions to achieve 

18 complementarity with other programs 

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

22 health care systems.’’; 

23 (B) by redesignating subclauses (VII) and 

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


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

2 following: 

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

7 on behalf of the individuals with HIV/ 

8 AIDS and those at particular risk of 

9 contracting HIV/AIDS. 

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

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

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

17 ‘‘(aa) maternal and child 

18 health care; 

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

21 and treatable infectious diseases, 

22 such as tuberculosis; 

23 ‘‘(cc) treatment and care 

24 services for injection drug users; 

25 and 


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1 ‘‘(dd) programs and services 

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

4 girls.’’; 

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

6 subparagraph (B) of this paragraph)— 

7 (i) by inserting ‘‘Vietnam, Antigua 

8 and Barbuda, the Bahamas, Barbados, 

9 Belize, Dominica, Grenada, Jamaica, 

10 Montserrat, Saint Kitts and Nevis, Saint 

11 Vincent and the Grenadines, Saint Lucia, 

12 Suriname, Trinidad and Tobago, the Do13 minican Republic, Malawi, Swaziland, Le14 sotho’’ after ‘‘Zambia,’’; 

15 (ii) by adding at the end before the 

16 period the following: ‘‘and other countries 

17 in which the United States is implementing 

18 HIV/AIDS programs’’; and 

19 (iii) by adding at the end the fol20 lowing: ‘‘In designating countries under 

21 this subclause, the President shall give pri22 ority to those countries in which there is a 

23 high prevalence of HIV/AIDS and coun24 tries with large populations that have a 

25 concentrated HIV/AIDS epidemic.’’; 


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

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

5 redesignated by subparagraph (B) and amended 

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

8 ‘‘(X) Working, in partnership with 

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

11 users, to establish, as a national priority, 

12 national HIV/AIDS prevention programs, 

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

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

17 use. 

18 ‘‘(XI) Working, in partnership with 

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

22 as a national priority, national prevention 

23 programs, including education, voluntary 

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


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

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

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

6 by striking ‘‘funds section’’ and inserting 

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

9 United States Leadership Against HIV/AIDS, 

10 Tuberculosis, and Malaria Act of 2003 for HIV/ 

11 AIDS assistance’’; and 

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

13 ‘‘(XIII) Publicizing updated drug 

14 pricing data to inform pharmaceutical 

15 procurement partners’ purchasing de16 cisions. 

17 ‘‘(XIV) Working in partnership 

18 with host countries in which the HIV/ 

19 AIDS epidemic is prevalent among 

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

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


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1 the transmission of HIV among men 

2 who have sex with men.’’. 

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

5 AND PUBLIC-PRIVATE PART6 NERSHIPS 

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

9 Section 201(a) of the United States Leadership 

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

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

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

13 diseases’’ and inserting ‘‘easily preventable and 

14 treatable infectious diseases’’; and 

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

16 diseases’’ and inserting ‘‘easily preventable and 

17 treatable infectious diseases’’. 

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

19 AIDS, TUBERCULOSIS AND MALARIA. 

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

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

23 amended— 

24 (1) by redesignating paragraphs (1) through 

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


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

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

6 this Act, extending United States efforts to a total 

7 of 136 countries around the world. 

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

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

10 tuberculosis, and malaria around the world and has 

11 grown into an organization that currently provides 

12 nearly a quarter of all international financing to 

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

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

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

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

21 States. 

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

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


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

3 resources and technical support. 

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

6 to its success.’’. 

7 (b) UNITED STATES FINANCIAL PARTICIPATION.— 

8 (1) AUTHORIZATION OF APPROPRIATIONS.— 

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

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

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

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

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

15 2010,’’; and 

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

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

18 2011 through 2013’’. 

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

20 section is amended— 

21 (A) in subparagraph (A)— 

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

23 years 2004 through 2008’’ and inserting 

24 ‘‘fiscal years 2009 through 2013’’; 


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

2 years 2004 through 2008’’ and inserting 

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

4 (iii) in clause (vi)— 

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

6 and inserting ‘‘For the purposes’’; 

7 (II) by striking ‘‘fiscal years 

8 2004 through 2008’’ and inserting 

9 ‘‘fiscal years 2009 through 2013’’; 

10 and 

11 (III) by striking ‘‘fiscal year 

12 2004’’ and inserting ‘‘fiscal year 

13 2009’’; 

14 (B) in subparagraph (B)(iv)— 

15 (i) by striking ‘‘fiscal years 2004 

16 through 2008’’ and inserting ‘‘fiscal years 

17 2009 through 2013’’; and 

18 (ii) by adding at the end before the 

19 period the following: ‘‘, unless such amount 

20 is made available for more than one fiscal 

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

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

25 first became available.’’; and 


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

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

4 (3) STATEMENT OF POLICY.—The following 

5 shall be the policy of the United States: 

6 (A) Support for the Global Fund to Fight 

7 AIDS, Tuberculosis and Malaria should be 

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

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

15 Fund Agents (LFAs), is undertaking a 

16 systematic assessment of the performance 

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

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

21 of performance data of Fund grants, which 

22 shall cover both Principal Recipients and 

23 sub-recipients. 

24 (ii) A well-staffed, independent Office 

25 of the Inspector General reports directly to 


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1 the Board and is responsible for regular, 

2 publicly published audits of both financial 

3 and programmatic and reporting aspects of 

4 the Fund, its grantees, and LFAs, includ5 ing both Principal Recipients and sub-re6 cipients. 

7 (iii) The Fund Secretariat has estab8 lished and is reporting publicly on stand9 ard indicators for all program areas. 

10 (iv) The Fund Secretariat has estab11 lished a database that tracks all subrecipi12 ents and the amounts of funds disbursed 

13 to each, as well as the distribution of re14 sources, by grant and Principal Recipient, 

15 for prevention, care, treatment, the pur16 chases of drugs and commodities, and 

17 other purposes. 

18 (v) The Fund Board has established a 

19 penalty to offset tariffs imposed by na20 tional governments on all goods and serv21 ices provided by the Fund. 

22 (vi) The Fund Board has successfully 

23 terminated its Administrative Services 

24 Agreement with the World Health Organi25 zation and completed the Fund SecretarVerDate Aug 31 2005 00:33 Apr 05, 2008 Jkt 069200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RFS H5501

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1 iat’s transition to a fully independent sta2 tus under the Headquarters Agreement the 

3 Fund has established with the Government 

4 of Switzerland. 

5 (B) Support for the Global Fund to Fight 

6 AIDS, Tuberculosis and Malaria should be 

7 based upon achievement of the following bench8 marks related to the founding principles of the 

9 Fund: 

10 (i) The Fund must maintain its status 

11 as a financing institution. 

12 (ii) The Fund must remain focused on 

13 programs directly related to HIV/AIDS, 

14 malaria, and tuberculosis. 

15 (iii) The Fund must maintain its 

16 Comprehensive Funding Policy, which re17 quires confirmed pledges to cover the full 

18 amount of new grants before the Board 

19 approves them. 

20 (iv) The Fund must maintain and 

21 make progress on sustaining its multisec22 toral approach, through Country Coordi23 nating Mechanisms (CCMs) and in the im24 plementation of grants, as reflected in per25 cent and resources allocated to different 


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1 sectors, including governments, civil soci2 ety, and faith- and community-based orga3 nizations. 

4 (4) SENSE OF CONGRESS.—Congress— 

5 (A) notes that section 625 of Public Law 

6 110–161 establishes a requirement to withhold 

7 20 percent of funds appropriated for the Global 

8 Fund if the Global Fund fails to meet certain 

9 benchmarks; and 

10 (B) will continue to review the implementa11 tion of the benchmarks to ensure accountability 

12 and transparency of the Global Fund. 

13 SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTER14 NATIONAL VACCINE FUNDS. 

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

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

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

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

19 (b) INTERNATIONAL AIDS VACCINE INITIATIVE.— 

20 Subsection (l) of such section is amended by striking ‘‘fis21 cal years 2004 through 2008’’ and inserting ‘‘fiscal years 

22 2009 through 2013’’. 

23 (c) MALARIA VACCINE DEVELOPMENT PROGRAMS.— 

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


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

2 years 2009 through 2013’’. 

3 (d) RESEARCH AND DEVELOPMENT OF A TUBER4 CULOSIS VACCINE.—Such section is further amended by 

5 adding at the end the following: 

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

7 this section, there are authorized to be appropriated to 

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

9 the fiscal years 2009 through 2013 to be available for 

10 United States contributions to research and development 

11 of a tuberculosis vaccine.’’. 

12 SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF 

13 MICROBICIDES TO PREVENT TRANSMISSION 

14 OF HIV AND OTHER DISEASES. 

15 (a) STATEMENT OF POLICY.—Congress recognizes 

16 the need and urgency to expand the range of interventions 

17 for preventing the transmission of human immuno18 deficiency virus (HIV), including nonvaccine prevention 

19 methods that can be controlled by women. 

20 (b) PROGRAM AUTHORIZED.—The Administrator of 

21 the United States Agency for International Development, 

22 in coordination with the Coordinator of United States 

23 Government Activities to Combat HIV/AIDS Globally, 

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1 mission of HIV after such microbicides are proven safe 

2 and effective. 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—Of the 

4 amounts authorized to be appropriated under section 401 

5 of the United States Leadership Against HIV/AIDS, Tu6 berculosis, and Malaria Act of 2003 (22 U.S.C. 7671) for 

7 HIV/AIDS assistance, there are authorized to be appro8 priated to the President such sums as may be necessary 

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

10 out this section. 

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

12 MALARIA BY STRENGTHENING HEALTH POLI13 CIES AND HEALTH SYSTEMS OF HOST COUN14 TRIES. 

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

16 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

17 Act of 2003 (22 U.S.C. 7621 et seq.) is amended by add18 ing at the end the following: 

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

20 AND MALARIA BY STRENGTHENING HEALTH 

21 POLICIES AND HEALTH SYSTEMS OF HOST 

22 COUNTRIES. 

23 ‘‘(a) FINDINGS.—Congress makes the following find24 ings: 


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

2 achieving universal access to HIV/AIDS treatment 

3 and prevention in developing countries is the lack of 

4 health infrastructure, particularly in sub-Saharan 

5 Africa. 

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

7 treatable and preventable infectious diseases could 

8 be treated concurrently and easily if health care de9 livery systems in developing countries were signifi10 cantly improved. 

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

12 health care should be a priority in public spending 

13 in developing countries. 

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

15 of the United States Government— 

16 ‘‘(1) to invest appropriate resources authorized 

17 under this Act and the amendments made by this 

18 Act to carry out activities to strengthen HIV/AIDS 

19 health policies and health systems and provide work20 force training and capacity-building consistent with 

21 the goals and objectives of this Act and the amend22 ments made by this Act; and 

23 ‘‘(2) to support the development of a sound pol24 icy environment in host countries to increase the 

25 ability of such countries to maximize utilization of 


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1 health care resources from donor countries, deliver 

2 services to the people of such host countries in an 

3 effective and efficient manner, and reduce barriers 

4 that prevent recipients of services from achieving 

5 maximum benefit from such services. 

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

7 States Government Activities to Combat HIV/AIDS Glob8 ally, in collaboration with the Administrator of the United 

9 States Agency for International Development, shall de10 velop and implement a plan to combat HIV/AIDS by 

11 strengthening health policies and health systems of host 

12 countries as part of the United States Agency for Inter13 national Development’s ‘Health Systems 2020’ project. 

14 Recognizing that human and institutional capacity form 

15 the core of any health care system that can sustain the 

16 fight against HIV/AIDS, tuberculosis, and malaria, the 

17 plan shall include a strategy to encourage postsecondary 

18 educational institutions in host countries, particularly in 

19 Africa, in collaboration with United States postsecondary 

20 educational institutions, historically black colleges and 

21 universities, to develop such human and institutional ca22 pacity and in the process further build their capacity to 

23 sustain the fight against these diseases. 

24 ‘‘(d) ASSISTANCE TO IMPROVE PUBLIC FINANCE

25 MANAGEMENT SYSTEMS.— 


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

2 Treasury, acting through the head of the Office of 

3 Technical Assistance, is authorized to provide assist4 ance for advisors and host country finance, health, 

5 and other relevant ministries to improve the effec6 tiveness of public finance management systems in 

7 host countries to enable such countries to receive 

8 funding to carry out programs to combat HIV/ 

9 AIDS, tuberculosis, and malaria and to manage 

10 such programs. 

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

12 the amounts authorized to be appropriated under 

13 section 401 for HIV/AIDS assistance, there are au14 thorized to be appropriated to the Secretary of the 

15 Treasury such sums as may be necessary for each 

16 of the fiscal years 2009 through 2013 to carry out 

17 this subsection.’’. 

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

19 for the United States Leadership Against HIV/AIDS, Tu20 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

21 is amended by inserting after the item relating to section 

22 203 the following: 

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

health systems of host countries.’’. 


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1 TITLE III—BILATERAL EFFORTS 

2 Subtitle A—General Assistance and 

3 Programs 

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

5 (a) AMENDMENTS TO THE FOREIGN ASSISTANCE

6 ACT OF 1961.— 

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

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

9 2151b–2) is amended by inserting ‘‘, South and 

10 Southeast Asia, Central and Eastern Europe’’ after 

11 ‘‘the Caribbean’’. 

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

13 amended— 

14 (A) in the first sentence— 

15 (i) by striking ‘‘It is a major’’ and in16 serting the following: 

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

18 (ii) by striking ‘‘control’’ and insert19 ing ‘‘care’’; and 

20 (iii) by adding at the end before the 

21 period the following: ‘‘and to fulfill United 

22 States commitments to move toward the 

23 goal of universal access to prevention, 

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


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

2 ‘‘The United States and other developed coun3 tries should provide assistance for the preven4 tion, treatment, and care of HIV/AIDS to coun5 tries in sub-Saharan Africa, the Caribbean, 

6 South and Southeast Asia and Central and 

7 Eastern Europe, addressing both generalized 

8 epidemics and epidemics concentrated among 

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

10 (C) by further adding at the end the fol11 lowing: 

12 ‘‘(2) SPECIFIC POLICY.—It is therefore the pol13 icy of the United States, by 2013, to— 

14 ‘‘(A) prevent 12,000,000 new HIV infec15 tions worldwide; 

16 ‘‘(B) support treatment of at least 

17 3,000,000 individuals with HIV/AIDS with the 

18 goal of treating 450,000 children; 

19 ‘‘(C) provide care for 12,000,000 individ20 uals affected by HIV/AIDS, including 

21 5,000,000 orphans and vulnerable children in 

22 communities affected by HIV/AIDS, including 

23 orphans with HIV/AIDS; and 


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

2 care professionals and workers for HIV/AIDS 

3 prevention, treatment and care.’’. 

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

5 section is amended— 

6 (A) in paragraph (1)— 

7 (i) by inserting ‘‘, South and South8 east Asia, Central and Eastern Europe’’ 

9 after ‘‘the Caribbean’’; and 

10 (ii) by adding at the end before the 

11 period the following: ‘‘, and particularly 

12 with respect to refugee populations in such 

13 countries and areas’’; 

14 (B) in paragraph (2)— 

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

17 after ‘‘the Caribbean’’; and 

18 (ii) by adding at the end before the 

19 period the following: ‘‘, and particularly 

20 with respect to refugee populations in such 

21 countries and areas’’; 

22 (C) by redesignating paragraph (3) as 

23 paragraph (4); 

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

25 following: 


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

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

3 ‘‘(A) the President should provide an ap4 propriate level of assistance under paragraph 

5 (1) to help strengthen public health care deliv6 ery systems financed by host countries; and 

7 ‘‘(B) the President, acting through the Co8 ordinator of United States Government Activi9 ties to Combat HIV/AIDS Globally, should sup10 port the development of a policy framework in 

11 such host countries for the long-term sustain12 ability of HIV/AIDS prevention, treatment, and 

13 care programs, and for strengthening health 

14 care delivery systems and increasing health 

15 workforces through recruitment, training, and 

16 policies that allows the devolution of clinical re17 sponsibilities to increase the work force able to 

18 deliver prevention, treatment, and care services, 

19 as necessary, with clearly identified objectives 

20 and reporting strategies for such services.’’; 

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

22 subparagraph (C) of this paragraph), by strik23 ing ‘‘foreign countries’’ and inserting ‘‘host 

24 countries and donor countries’’; and 

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


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1 ‘‘(5) SENSE OF CONGRESS.— 

2 ‘‘(A) IN GENERAL.—It is the sense of Con3 gress that the Coordinator of United States 

4 Government Activities to Combat HIV/AIDS 

5 Globally and the heads of relevant executive 

6 branch agencies (as such term is defined in sec7 tion 3 of the United States Leadership Against 

8 HIV/AIDS, Tuberculosis, and Malaria Act of 

9 2003) should operate in a manner consistent 

10 with the ‘Three Ones’ goals of UNAIDS. 

11 ‘‘(B) ‘THREE ONES’ GOALS OF UNAIDS DE12 FINED.—In this paragraph, the term ‘‘ ‘Three 

13 Ones’’ goals of UNAIDS’ means— 

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

15 action framework that provides the basis 

16 for coordinating the work of all partners in 

17 host countries; 

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

19 AIDS coordinating authority, with a 

20 broad-based multisectoral mandate; and 

21 ‘‘(iii) the goal of one agreed country22 level data-collection, monitoring, and eval23 uation system.’’. 

24 (4) ACTIVITIES SUPPORTED.— 


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

2 such section is amended— 

3 (i) in subparagraph (A)— 

4 (I) by inserting ‘‘efforts by faith5 based and other nongovernmental or6 ganizations and’’ after ‘‘infection, in7 cluding’’; 

8 (II) by inserting ‘‘, including ac9 cess to such programs and efforts in 

10 family planning programs supported 

11 by the United States Government,’’ 

12 after ‘‘health programs’’; and 

13 (III) by inserting ‘‘male and fe14 male’’ before ‘‘condoms’’; 

15 (ii) in subparagraph (B)— 

16 (I) by inserting ‘‘relevant and’’ 

17 after ‘‘culturally’’; 

18 (II) by inserting ‘‘and programs’’ 

19 after ‘‘those organizations’’; and 

20 (III) by inserting ‘‘, level of sci21 entific and fact-based knowledge’’ 

22 after ‘‘experience’’; 

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

24 ‘‘and nonjudgmental approaches’’ after 

25 ‘‘protections’’; 


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1 (iv) by amending subparagraph (E) to 

2 read as follows: 

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

4 reaching 80 percent of pregnant women for pre5 vention and treatment of mother-to-child trans6 mission of HIV in countries in which the 

7 United States is implementing HIV/AIDS pro8 grams by 2013, as described in section 

9 312(b)(1) of the United States Leadership 

10 Against HIV/AIDS, Tuberculosis, and Malaria 

11 Act of 2003, and to promote infant feeding op12 tions that meet the criteria described in the 

13 World Health Organization’s Global Strategy 

14 for Infant and Young Child Feeding;’’; 

15 (v) in subparagraph (G)— 

16 (I) by adding at the end before 

17 the semicolon the following: ‘‘, includ18 ing education and services dem19 onstrated to be effective in reducing 

20 the transmission of HIV infection 

21 without increasing illicit drug use’’; 

22 and 

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


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

2 the period at the end and inserting ‘‘; 

3 and’’; and 

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

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

7 treatment, care, and support programs for pre8 vention of re-infection of individuals with HIV/ 

9 AIDS; 

10 ‘‘(ii) counseling to prevent sexual trans11 mission of HIV, including skill development for 

12 practicing abstinence, reducing the number of 

13 sexual partners, and providing information on 

14 correct and consistent use of male and female 

15 condoms; 

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

17 condoms; 

18 ‘‘(iv) diagnosis and treatment of other sex19 ually-transmitted infections; 

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

21 discrimination that impede HIV/AIDS preven22 tion efforts; and 

23 ‘‘(vi) assistance to facilitate widespread ac24 cess to microbicides for HIV prevention, as safe 

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1 ing financial and technical support for cul2 turally appropriate introductory programs, pro3 curement, distribution, logistics management, 

4 program delivery, acceptability studies, provider 

5 training, demand generation, and post-introduc6 tion monitoring; and 

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

8 targeted to reach and prevent the spread of 

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

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

11 such section is amended— 

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

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

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

15 the period at the end and inserting a semi16 colon; and 

17 (iii) by adding at the end the fol18 lowing: 

19 ‘‘(D) assistance specifically to address bar20 riers that might limit the start of and adher21 ence to treatment services, especially in rural 

22 areas, through such measures as mobile and de23 centralized distribution of treatment services, 

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1 come security programs, referrals to services for 

2 victims of violence, support groups for individ3 uals with HIV/AIDS, and efforts to combat 

4 stigma and discrimination against all such indi5 viduals; 

6 ‘‘(E) assistance to support comprehensive 

7 HIV/AIDS treatment (including free prophy8 laxis and treatment for common HIV/AIDS-re9 lated opportunistic infections) for at least one10 third of individuals with HIV/AIDS in the poor11 est countries worldwide who are in clinical need 

12 of antiretroviral treatment; and 

13 ‘‘(F) assistance to improve access to psy14 chosocial support systems and other necessary 

15 services for youth who are infected with HIV to 

16 ensure the start of and adherence to treatment 

17 services.’’. 

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

19 such section is amended— 

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

21 inserting the following: 

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

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

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


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1 (iii) by redesignating subparagraphs 

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

3 (iv), respectively; 

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

5 clause (iii) of this subparagraph), by strik6 ing ‘‘and’’ at the end; 

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

8 clause (iii) of this subparagraph), by strik9 ing the period at the end and inserting ‘‘; 

10 and’’; 

11 (vi) by adding at the end the fol12 lowing: 

13 ‘‘(v) carrying out and expanding pro14 gram monitoring, impact evaluation re15 search, and operations research (including 

16 research and evaluations of gender-respon17 sive interventions, disaggregated by age 

18 and sex, in order to identify and replicate 

19 effective models, develop gender indicators 

20 to measure both outcomes and impacts of 

21 interventions, especially interventions de22 signed to reduce gender inequalities, and 

23 collect lessons learned for dissemination 

24 among different countries) in order to— 


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1 ‘‘(I) improve the coverage, effi2 ciency, effectiveness, quality and ac3 cessibility of services provided under 

4 this section; 

5 ‘‘(II) establish the cost-effective6 ness of program models; 

7 ‘‘(III) assess the population-level 

8 impact of programs, projects, and ac9 tivities implemented; 

10 ‘‘(IV) ensure the transparency 

11 and accountability of services provided 

12 under this section; 

13 ‘‘(V) disseminate and promote 

14 the utilization of evaluation findings, 

15 lessons, and best practices in the im16 plementation of programs, projects, 

17 and activities supported under this 

18 section; and 

19 ‘‘(VI) encourage and evaluate in20 novative service models and strategies 

21 to optimize functionality of programs, 

22 projects, and activities.’’; and 

23 (vii) by further adding at the end the 

24 following: 


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1 ‘‘(B) DEFINITIONS.—For purposes of sub2 paragraph (A)(v)— 

3 ‘‘(i) the term ‘impact evaluation re4 search’ means the application of research 

5 methods and statistical analysis to meas6 ure the extent to which a change in a pop7 ulation-based outcome can be attributed to 

8 a program, project, or activity as opposed 

9 to other factors in the environment; 

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

11 means the collection, analysis, and use of 

12 routine data with respect to a program, 

13 project, or activity to determine how well 

14 the program, project, or activity is carried 

15 out and at what cost; and 

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

17 means the application of social science re18 search methods and statistical analysis to 

19 judge, compare, and improve policy out20 comes and outcomes of a program, project, 

21 or activity, from the earliest stages of de22 fining and designing the program, project, 

23 or activity through the development and 

24 implementation of the program, project, or 

25 activity.’’. 


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1 (D) PHARMACEUTICALS.—Subsection 

2 (d)(5) of such section is amended— 

3 (i) by redesignating subparagraph (C) 

4 as subparagraph (D); and 

5 (ii) by inserting after subparagraph 

6 (B) the following: 

7 ‘‘(C) MECHANISMS TO ENSURE COST-EF8 FECTIVE DRUG PURCHASING.—Mechanisms to 

9 ensure that pharmaceuticals, including 

10 antiretrovirals and medicines to treat opportun11 istic infections, are purchased at the lowest pos12 sible price at which such pharmaceuticals may 

13 be obtained in sufficient quantity on the world 

14 market.’’. 

15 (E) REFERRAL SYSTEMS AND COORDINA16 TION WITH OTHER ASSISTANCE PROGRAMS.— 

17 (i) FINDING.—The effectiveness of all 

18 HIV/AIDS prevention, treatment, and care 

19 programs and the survival of individuals 

20 with HIV/AIDS would be enhanced by en21 suring that such individuals are referred to 

22 appropriate support programs, including 

23 education, income generation, HIV/AIDS 

24 support group and food and nutrition pro25 grams, and by providing assistance directly 


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1 to such programs to the extent such pro2 grams would further the purposes of ex3 panding access to and the success of HIV/ 

4 AIDS prevention, treatment, and care. 

5 (ii) AMENDMENT.—Subsection (d) of 

6 such section is further amended by adding 

7 at the end the following: 

8 ‘‘(8) REFERRAL SYSTEMS AND COORDINATION

9 WITH OTHER ASSISTANCE PROGRAMS.— 

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

11 ensure that a continuum of care is available to 

12 individuals participating in HIV/AIDS preven13 tion, treatment, and care programs through the 

14 development of referral systems for such indi15 viduals to community-based programs that, 

16 where practicable, are co-located with such 

17 HIV/AIDS programs, and that provide support 

18 activities for such individuals, including HIV/ 

19 AIDS treatment adherence, HIV/AIDS support 

20 groups, food and nutrition support, maternal 

21 health services, substance abuse prevention and 

22 treatment services, income-generation pro23 grams, legal services, and other program sup24 port. 


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1 ‘‘(B) COORDINATION WITH OTHER ASSIST2 ANCE PROGRAMS.— 

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

4 testing with testing for other easily detectable 

5 and treatable infectious diseases, such as ma6 laria, tuberculosis, and respiratory infections, 

7 and to provide treatment if possible or referral 

8 to appropriate treatment programs. 

9 ‘‘(II) Assistance to provide, whenever pos10 sible, as a component of HIV/AIDS prevention, 

11 treatment, and care services, and co-treatment 

12 of curable diseases, such as other sexually 

13 transmitted diseases. 

14 ‘‘(III) Assistance and other activities to en15 sure, through interagency and international co16 ordination, that United States global HIV/ 

17 AIDS programs are integrated and complemen18 tary to delivering related health services. 

19 ‘‘(ii) Assistance to support schools and re20 lated programs for children and youth that in21 crease the effectiveness of programs described 

22 in this subsection by providing the infrastruc23 ture, teachers, and other support to such pro24 grams. 


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1 ‘‘(iii) Assistance and other activities to 

2 provide access to HIV/AIDS prevention, treat3 ment, and care programs in family planning 

4 and maternal and child health programs sup5 ported by the United States Government. 

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

7 country nonprofit development organizations 

8 that directly support livelihood initiatives in 

9 HIV/AIDS-affected countries that provide op10 portunities for direct lending to microentre11 preneurs by United States citizens or opportu12 nities for United States citizens to purchase 

13 livestock and plants for families to provide nu14 trition and generate income for individual 

15 households and communities. 

16 ‘‘(v) Assistance to coordinate and provide 

17 linkages between HIV/AIDS prevention, treat18 ment, and care programs with efforts to im19 prove the economic and legal status of women 

20 and girls. 

21 ‘‘(vi) Technical assistance coordinated 

22 across implementing agencies, offered on a reg23 ular basis, and made available upon request, for 

24 faith-based and community-based organizations, 

25 especially indigenous organizations and new 


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1 partners who do not have extensive experience 

2 managing United States foreign assistance pro3 grams, including for training and logistical sup4 port to establish financial mechanisms to track 

5 program receipts and expenditures and data 

6 management systems to ensure data quality 

7 and strengthen reporting. 

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

9 Organization’s Interim Policy on TB/HIV Ac10 tivities (2004), assistance to individuals with or 

11 symptomatic of tuberculosis, and assistance to 

12 implement the following: 

13 ‘‘(I) Provide opt-out HIV/AIDS coun14 seling and testing and appropriate referral 

15 for treatment and care to individuals with 

16 or symptomatic of tuberculosis, and work 

17 with host countries to ensure that such in18 dividuals in host countries are provided 

19 such services. 

20 ‘‘(II) Ensure, in coordination with 

21 host countries, that individuals with HIV/ 

22 AIDS receive tuberculosis screening and 

23 other appropriate treatment. 

24 ‘‘(III) Provide increased funding for 

25 HIV/AIDS and tuberculosis activities, by 


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1 increasing total resources for such activi2 ties, including lab strengthening and infec3 tion control. 

4 ‘‘(IV) Improve the management and 

5 dissemination of knowledge gained from 

6 HIV/AIDS and tuberculosis activities to 

7 increase the replication of best practices.’’. 

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

9 section is amended— 

10 (A) in paragraph (1), by striking ‘‘Com11 mittee on International Relations’’ and insert12 ing ‘‘Committee on Foreign Affairs’’; 

13 (B) in paragraph (2)— 

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

15 ‘‘and’’ at the end; 

16 (ii) in subparagraph (C)— 

17 (I) in the matter preceding clause 

18 (i), by striking ‘‘including’’ and insert19 ing ‘‘including—’’; 

20 (II) by striking clauses (i) and 

21 (ii) and inserting the following: 

22 ‘‘(i)(I) the effectiveness of such pro23 grams in reducing the transmission of 

24 HIV, particularly in women and girls, in 

25 reducing mother-to-child transmission of 


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1 HIV, including through drug treatment 

2 and therapies, either directly or by refer3 ral, and in reducing mortality rates from 

4 HIV/AIDS, including through drug treat5 ment, and addiction therapies; 

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

7 programs, and interventions to address the 

8 specific needs and vulnerabilities of young 

9 women and young men; the progress to10 ward expanding access among young 

11 women and young men to evidence-based, 

12 comprehensive HIV/AIDS health care serv13 ices and HIV prevention and sexuality and 

14 abstinence education programs at the indi15 vidual, community, and national levels; and 

16 clear targets for integrating adolescents 

17 who are orphans, including adolescents 

18 who are infected with HIV, into programs 

19 for orphans and vulnerable children; and 

20 ‘‘(III) the amount of United States 

21 funding provided under the authorities of 

22 this Act to procure drugs for HIV/AIDS 

23 programs in countries described in section 

24 1(f)(2)(B)(IX) of the State Department 

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


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1 2651a(f)(2)(B)(VIII)), including a detailed 

2 description of anti-retroviral drugs pro3 cured, including— 

4 ‘‘(aa) the total amount expended 

5 for each generic and name brand 

6 drug; 

7 ‘‘(bb) the price paid per unit of 

8 each drug; and 

9 ‘‘(cc) the vendor from which each 

10 drug was purchased; and 

11 ‘‘(ii) the progress made toward im12 proving health care delivery systems (in13 cluding the training of adequate numbers 

14 of health care professionals) and infra15 structure to ensure increased access to 

16 care and treatment, including a description 

17 of progress toward— 

18 ‘‘(I)(aa) the training and reten19 tion of adequate numbers of health 

20 care professionals in order to meet a 

21 nationally-determined ratio of doctors, 

22 nurses, and midwives to patients, 

23 based on the target of the 2.3 per24 thousand ratio established by the 

25 World Health Organization (WHO); 


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1 ‘‘(bb) increases in the number of 

2 other health care professions, such as 

3 pharmacists and lab technicians, as 

4 necessary; and 

5 ‘‘(cc) the improvement of infra6 structure needed to ensure universal 

7 access to HIV/AIDS prevention, treat8 ment, and care by 2015; 

9 ‘‘(II) national health care work10 force strategy benchmarks, as re11 quired by section 202(d)(5)(B) of the 

12 United States Leadership Against 

13 HIV/AIDS, Tuberculosis, and Malaria 

14 Act of 2003, United States contribu15 tions to developing and implementing 

16 the benchmarks, and main challenges 

17 to implementing the benchmarks; 

18 ‘‘(III) ensuring, to the extent 

19 practicable, that health care workers 

20 providing services under this Act have 

21 safe working conditions and are re22 ceiving health care services, including 

23 services relating to HIV/AIDS; 

24 ‘‘(IV) activities to strengthen 

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1 come obstacles and barriers to the 

2 provision of HIV/AIDS, tuberculosis, 

3 and malaria services; 

4 ‘‘(V) improving integration and 

5 coordination of HIV/AIDS programs 

6 with related health care services and 

7 supporting the capacity of health care 

8 programs to refer individuals to com9 munity-based services; and 

10 ‘‘(VI) strengthening procurement 

11 and supply chain management sys12 tems of host countries;’’; 

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

14 the end before the semicolon the fol15 lowing: ‘‘, including the percentage of 

16 such United States foreign assistance 

17 provided for diagnosis and treatment 

18 of individuals with tuberculosis in 

19 countries with the highest burden of 

20 tuberculosis, as determined by the 

21 World Health Organization (WHO)’’; 

22 and 

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

24 the period at the end and inserting a 

25 semicolon; and 


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1 (iii) by adding at the end the fol2 lowing: 

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

4 HIV/AIDS and tuberculosis prevention, treat5 ment, and care programs, including— 

6 ‘‘(i) the number and percentage of 

7 HIV-infected individuals receiving HIV/ 

8 AIDS treatment or care services who are 

9 also receiving screening and subsequent 

10 treatment for tuberculosis; 

11 ‘‘(ii) the number and percentage of in12 dividuals with tuberculosis who are receiv13 ing HIV/AIDS counseling and testing, and 

14 appropriate referral to HIV/AIDS services; 

15 ‘‘(iii) the number and location of lab16 oratories with the capacity to perform tu17 berculosis culture tests and tuberculosis 

18 drug susceptibility tests; 

19 ‘‘(iv) the number and location of lab20 oratories with the capacity to perform ap21 propriate tests for multi-drug resistant tu22 berculosis (MDR–TB) and extensively drug 

23 resistant tuberculosis (XDR–TB); and 

24 ‘‘(v) the number of HIV-infected indi25 viduals suspected of having tuberculosis 


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1 who are provided tuberculosis culture diag2 nosis or tuberculosis drug susceptibility 

3 testing; 

4 ‘‘(E) a description of coordination efforts 

5 with relevant executive branch agencies (as such 

6 term is defined in section 3 of the United 

7 States Leadership Against HIV/AIDS, Tuber8 culosis, and Malaria Act of 2003) and at the 

9 global level in the effort to link HIV/AIDS serv10 ices with non-HIV/AIDS services; 

11 ‘‘(F) a description of programs serving 

12 women and girls, including— 

13 ‘‘(i) a description of HIV/AIDS pre14 vention programs that address the 

15 vulnerabilities of girls and women to HIV/ 

16 AIDS; and 

17 ‘‘(ii) information on the number of in18 dividuals served by programs aimed at re19 ducing the vulnerabilities of women and 

20 girls to HIV/AIDS; 

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

22 funded to ensure the reduction of HIV infection 

23 among injection drug users, and the number of 

24 injection drug users, by country, reached by 

25 such strategies, including medication-assisted 


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1 drug treatment for individuals with HIV or at 

2 risk of HIV, and HIV prevention programs 

3 demonstrated to be effective in reducing HIV 

4 transmission without increasing drug use; and 

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

6 impact evaluation research, and operations re7 search of programs, projects, and activities car8 ried out pursuant to subsection (d)(4)(A)(v).’’; 

9 and 

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

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

12 of United States Government Activities to Combat 

13 HIV/AIDS Globally shall make publicly available on 

14 the Internet website of the Office of the Coordinator 

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

16 each report and, in addition, the individual evalua17 tions and other reports that were the basis of such 

18 information, including lessons learned and collected 

19 in such evaluations and reports.’’. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—Sub21 section (b) of section 301 of the United States Leadership 

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

23 2003 (22 U.S.C. 7631) is amended— 


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

2 2004 through 2008’’ and inserting ‘‘fiscal years 

3 2009 through 2013’’; and 

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

5 2004 through 2008’’ and inserting ‘‘fiscal years 

6 2009 through 2013’’. 

7 (c) FOOD SECURITY AND NUTRITION SUPPORT.— 

8 Subsection (c) of such section is amended to read as fol9 lows: 

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

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

12 ‘‘(A) The United States provides more 

13 than 60 percent of all food assistance world14 wide. 

15 ‘‘(B) According to the United Nations 

16 World Food Program and other United Nations 

17 agencies, food insecurity of individuals with 

18 HIV/AIDS is a major problem in countries with 

19 large populations of such individuals, particu20 larly in sub-Saharan African countries. 

21 ‘‘(C) Individuals infected with HIV have 

22 higher nutritional requirements than individuals 

23 who are not infected with HIV, particularly 

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

25 is evidence to suggest that the full benefit of 


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1 therapy to treat HIV/AIDS may not be 

2 achieved in individuals who are malnourished, 

3 particularly in pregnant and lactating women. 

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

5 Congress that— 

6 ‘‘(A) malnutrition, especially for individ7 uals with HIV/AIDS, is a clinical health issue 

8 with wider nutrition, health, and social implica9 tions for such individuals, their families, and 

10 their communities that must be addressed by 

11 United States HIV/AIDS prevention, treat12 ment, and care programs; 

13 ‘‘(B) food security and nutrition directly 

14 impact an individual’s vulnerability to HIV in15 fection, the progression of HIV to AIDS, an in16 dividual’s ability to begin an antiretroviral 

17 medication treatment regimen, the efficacy of 

18 an antiretroviral medication treatment regimen 

19 once an individual begins such a regimen, and 

20 the ability of communities to effectively cope 

21 with the HIV/AIDS epidemic and its impacts; 

22 ‘‘(C) international guidelines established by 

23 the World Health Organization (WHO) should 

24 serve as the reference standard for HIV/AIDS 


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1 food and nutrition activities supported by this 

2 Act and the amendments made by this Act; 

3 ‘‘(D) the Coordinator of United States 

4 Government Activities to Combat HIV/AIDS 

5 Globally and the Administrator of the United 

6 States Agency for International Development 

7 should make it a priority to work together and 

8 with other United States Government agencies, 

9 donors, and multilateral institutions to increase 

10 the integration of food and nutrition support 

11 and livelihood activities into HIV/AIDS preven12 tion, treatment, and care activities funded by 

13 the United States and other governments and 

14 organizations; 

15 ‘‘(E) for purposes of determining which in16 dividuals infected with HIV should be provided 

17 with nutrition and food support— 

18 ‘‘(i) children with moderate or severe 

19 malnutrition, according to WHO stand20 ards, shall be given priority for such nutri21 tion and food support; and 

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

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

24 WHO-approved measurement for BMI, 

25 should be considered ‘malnourished’ and 


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1 should be given priority for such nutrition 

2 and food support; 

3 ‘‘(F) programs funded by the United 

4 States should include therapeutic and supple5 mentary feeding, food, and nutrition support 

6 and should include strong links to development 

7 programs that provide support for livelihoods; 

8 and 

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

10 AIDS to access food for themselves or their 

11 families should not be allowed to impair or 

12 erode the therapeutic status of such individuals 

13 with respect to HIV/AIDS or related co14 morbidities. 

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

16 of the United States to— 

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

18 of individuals with HIV/AIDS and affected in19 dividuals, including orphans and vulnerable 

20 children; 

21 ‘‘(B) fully integrate food and nutrition 

22 support into HIV/AIDS prevention, treatment, 

23 and care programs carried out under this Act 

24 and the amendments made by this Act; 


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

2 that— 

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

4 and care providers and health care workers 

5 are adequately trained so that such pro6 viders and workers can provide accurate 

7 and informed information regarding food 

8 and nutrition support to individuals en9 rolled in treatment and care programs and 

10 individuals affected by HIV/AIDS; and 

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

12 with their households, are identified as 

13 food insecure are provided with adequate 

14 food and nutrition support; and 

15 ‘‘(D) effectively link food and nutrition 

16 support provided under this Act and the 

17 amendments made by this Act to individuals 

18 with HIV/AIDS, their households, and their 

19 communities, to other food security and liveli20 hood programs funded by the United States 

21 and other donors and multilateral agencies. 

22 ‘‘(4) INTEGRATION OF FOOD SECURITY AND

23 NUTRITION ACTIVITIES INTO HIV/AIDS PREVENTION, 

24 TREATMENT, AND CARE ACTIVITIES.— 


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1 ‘‘(A) REQUIREMENTS RELATING TO GLOB2 AL AIDS COORDINATOR.—Consistent with the 

3 statement of policy described in paragraph (3), 

4 the Coordinator of United States Government 

5 Activities to Combat HIV/AIDS Globally 

6 shall— 

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

8 that— 

9 ‘‘(I) an assessment, using vali10 dated criteria, of the food security and 

11 nutritional status of each individual 

12 enrolled in antiretroviral medication 

13 treatment programs supported with 

14 funds authorized under this Act or 

15 any amendment made by this Act is 

16 carried out; and 

17 ‘‘(II) appropriate nutritional 

18 counseling is provided to each indi19 vidual described in subclause (I); 

20 ‘‘(ii) coordinate with the Adminis21 trator of the United States Agency for 

22 International Development, the Secretary 

23 of Agriculture, and the heads of other rel24 evant executive branch agencies to— 


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1 ‘‘(I) ensure, to the extent prac2 ticable, that, in communities in which 

3 a significant proportion of individuals 

4 with HIV/AIDS are in need of food 

5 and nutrition support, a status and 

6 needs assessment for such support 

7 employing validated criteria is con8 ducted and a plan to provide such 

9 support is developed and implemented; 

10 ‘‘(II) improve and enhance co11 ordination between food security and 

12 livelihood programs for individuals in13 fected with HIV in host countries and 

14 food security and livelihood programs 

15 that may already exist in such coun16 tries; 

17 ‘‘(III) establish effective linkages 

18 between the health and agricultural 

19 development and livelihoods sectors in 

20 order to enhance food security; and 

21 ‘‘(IV) ensure, by providing in22 creased resources if necessary, effec23 tive coordination between activities 

24 authorized under this Act and the 

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1 tivities carried out under other provi2 sions of the Foreign Assistance Act of 

3 1961 when establishing new HIV/ 

4 AIDS treatment sites; 

5 ‘‘(iii) develop effective, validated indi6 cators that measure outcomes of nutrition 

7 and food security interventions carried out 

8 under this section and use such indicators 

9 to monitor and evaluate the effectiveness 

10 of such interventions; and 

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

12 extent appropriate, support and expand 

13 partnerships and linkages between United 

14 States postsecondary educational institu15 tions with postsecondary educational insti16 tutions in host countries in order to pro17 vide training and build indigenous human 

18 and institutional capacity and expertise to 

19 respond to HIV/AIDS, and to improve ca20 pacity to address nutrition, food security, 

21 and livelihood needs of HIV/AIDS-affected 

22 and impoverished communities. 

23 ‘‘(B) REQUIREMENTS RELATING TO USAID

24 ADMINISTRATOR.—Consistent with the state25 ment of policy described in paragraph (3), the 


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1 Administrator of the United States Agency for 

2 International Development, in coordination with 

3 the Coordinator of United States Government 

4 Activities to Combat HIV/AIDS Globally and 

5 the Secretary of Agriculture, shall provide, to 

6 the extent practicable, as an essential compo7 nent of antiretroviral medication treatment pro8 grams supported with funds authorized under 

9 this Act and the amendments made by this Act, 

10 food and nutrition support to each individual 

11 with HIV/AIDS who is determined to need such 

12 support by the assessing health professional, 

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

14 less, or at the prevailing WHO-approved meas15 urement for BMI, and the individual’s house16 hold, for a period of not less than 180 days, ei17 ther directly or through referral to an assist18 ance program or organization with demon19 strable ability to provide such support. 

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

21 2010, and annually thereafter, the Coordinator 

22 of United States Government Activities to Com23 bat HIV/AIDS Globally, in consultation with 

24 the Administrator of the United States Agency 

25 for International Development, shall submit to 


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1 the appropriate congressional committees a re2 port on the implementation of this subsection 

3 for the prior fiscal year. The report shall in4 clude a description of— 

5 ‘‘(i) the effectiveness of interventions 

6 carried out to improve the nutritional sta7 tus of individuals with HIV/AIDS; 

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

9 food and nutrition support for individuals 

10 with HIV/AIDS and affected individuals in 

11 the prior fiscal year and the projected 

12 amount of funds to be provided for such 

13 purpose for next fiscal year; and 

14 ‘‘(iii) a strategy for improving the 

15 linkage between assistance provided with 

16 funds authorized under this subsection and 

17 food security and livelihood programs 

18 under other provisions of law as well as ac19 tivities funded by other donors and multi20 lateral organizations. 

21 ‘‘(D) AUTHORIZATION OF APPROPRIA22 TIONS.—Of the amounts authorized to be ap23 propriated under section 401 for HIV/AIDS as24 sistance, there are authorized to be appro25 priated to the President such sums as may be 


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1 necessary for each of the fiscal years 2009 

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

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

4 of such section is amended to read as follows: 

5 ‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organiza6 tion, including a faith-based organization, that is other7 wise eligible to receive assistance under section 104A of 

8 the Foreign Assistance Act of 1961 (as added by sub9 section (a)) or under any other provision of this Act (or 

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

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

12 Tuberculosis, and Malaria Reauthorization Act of 2008) 

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

14 ‘‘(1) shall not be required, as a condition of re15 ceiving the assistance, to endorse or utilize a multi16 sectoral approach to combating HIV/AIDS, or to en17 dorse, utilize, make a referral to, become integrated 

18 with or otherwise participate in any program or ac19 tivity to which the organization has a religious or 

20 moral objection; and 

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

22 solicitation or issuance of grants, contracts, or coop23 erative agreements under such provisions of law for 

24 refusing to do so.’’. 


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

2 amended by striking subsection (g). 

3 (f) REPORT.— 

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

5 after the date of the enactment of this Act, the Co6 ordinator of United States Government Activities to 

7 Combat HIV/AIDS Globally shall submit to the ap8 propriate congressional committees a report identi9 fying a target for the number of additional health 

10 professionals and workers needed in host countries 

11 to provide HIV/AIDS prevention, treatment, and 

12 care and the training needs of such health profes13 sionals and workers. The target should reflect avail14 able data and should identify the need for United 

15 States Government contributions to meet the target. 

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

17 ‘‘appropriate congressional committees’’ has the 

18 meaning given the term in section 3 of the United 

19 States Leadership Against HIV/AIDS, Tuberculosis, 

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

21 SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 

22 (a) AMENDMENTS TO THE FOREIGN ASSISTANCE

23 ACT OF 1961.— 

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

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


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

2 and (2) and inserting the following: 

3 ‘‘(1) Tuberculosis is one of the greatest infec4 tious causes of death of adults worldwide, killing 1.6 

5 million individuals per year—one person every 20 

6 seconds. 

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

8 of death among individuals who are infected with 

9 HIV due to their weakened immune systems, and it 

10 is estimated that one-third of such individuals have 

11 tuberculosis. Tuberculosis is also a leading killer of 

12 women of reproductive age. 

13 ‘‘(3) Driven by the HIV/AIDS pandemic, inci14 dence rates of tuberculosis in sub-Saharan Africa 

15 have more than doubled on average since 1990. The 

16 problem is so pervasive that in August 2005, African 

17 health ministers and the World Health Organization 

18 (WHO) declared tuberculosis to be an emergency in 

19 sub-Saharan Africa. 

20 ‘‘(4)(A) The wide extent of drug resistance, in21 cluding both multi-drug resistant tuberculosis 

22 (MDR–TB) and extensively drug resistant tuber23 culosis (XDR–TB), represents both a critical chal24 lenge to the global control of tuberculosis and a seri25 ous worldwide public health threat. 


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

2 with additional resistance to multiple second-line 

3 anti-tuberculosis drugs, is associated with worst 

4 treatment outcomes of any form of tuberculosis. 

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

6 AIDS epidemic, undermining gains in HIV/AIDS 

7 prevention and treatment programs and requires ur8 gent interventions. 

9 ‘‘(D) Drug resistance surveillance reports have 

10 confirmed the serious scale and spread of tuber11 culosis, with XDR–TB strains confirmed on six con12 tinents. 

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

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

15 2006 killed 52 of 53 patients with hundreds more 

16 cases reported since that time. 

17 ‘‘(F) Of the world’s regions, sub-Saharan Afri18 ca, faces the greatest gap in capacity to prevent, 

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

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

21 amended to read as follows: 

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

23 assistance program of the United States to control tuber24 culosis. In all countries in which the Government of the 

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1 ticularly in countries with the highest burden of tuber2 culosis and other countries with high rates of tuberculosis, 

3 the United States Government should prioritize the 

4 achievement of the following goals by not later than De5 cember 31, 2015: 

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

7 and disease burden from the 1990 baseline. 

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

9 70 percent of sputum smear-positive cases of tuber10 culosis and the cure of at least 85 percent of such 

11 cases detected.’’. 

12 (3) ACTIVITIES SUPPORTED.—Such section is 

13 further amended— 

14 (A) by redesignating subsections (d) 

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

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

17 following: 

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

19 under subsection (c) shall, to the maximum extent prac20 ticable, be used to carry out the following activities: 

21 ‘‘(1) Provide diagnostic counseling and testing 

22 to individuals with HIV/AIDS for tuberculosis (in23 cluding a culture diagnosis to rule out multi-drug re24 sistant tuberculosis (MDR–TB) and extensively drug 

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


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1 AIDS voluntary counseling and testing to individuals 

2 with any form of tuberculosis. 

3 ‘‘(2) Provide tuberculosis treatment to individ4 uals receiving treatment and care for HIV/AIDS 

5 who have active tuberculosis and provide prophy6 lactic treatment to individuals with HIV/AIDS who 

7 also have a latent tuberculosis infection. 

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

9 tuberculosis to HIV/AIDS treatment and care serv10 ices, including antiretroviral therapy and 

11 cotrimoxazole therapy. 

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

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

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

15 individuals with both HIV/AIDS and tuberculosis. 

16 ‘‘(5) Ensure that individuals with active pul17 monary tuberculosis are provided a culture diag18 nosis, including drug susceptibility testing to rule 

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

20 and extensively drug resistant tuberculosis (XDR– 

21 TB) in areas with high prevalence of tuberculosis 

22 drug resistance.’’. 

23 (4) PRIORITY TO STOP TB STRATEGY.—Sub24 section (f) of such section (as redesignated by para25 graph (3) of this subsection) is amended— 


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1 (A) by amending the heading to read as 

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

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

4 furnishing’’ and all that follows through ‘‘, in5 cluding funding’’ and inserting the following: 

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

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

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

9 Strategy, including expansion and enhancement 

10 of Directly Observed Treatment Short-course 

11 (DOTS) coverage, treatment for individuals in12 fected with both tuberculosis and HIV and 

13 treatment for individuals with multi-drug resist14 ant tuberculosis (MDR–TB), strengthening of 

15 health systems, use of the International Stand16 ards for Tuberculosis Care by all care pro17 viders, empowering individuals with tuber18 culosis, and enabling and promoting research to 

19 develop new diagnostics, drugs, and vaccines, 

20 and program-based operational research relat21 ing to tuberculosis; and 

22 ‘‘(B) funding’’; and 

23 (C) in the second sentence— 


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

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

3 inserting the following: 

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

5 meet the requirements of paragraph (1), the Presi6 dent— 

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

8 (ii) by striking ‘‘for Directly Observed 

9 Treatment Short-course (DOTS) coverage 

10 and treatment of multi-drug resistant tu11 berculosis using DOTS–Plus,’’ and insert12 ing ‘‘to implement the Stop TB Strategy; 

13 and’’; and 

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

15 that follows and inserting the following: 

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

17 $15,000,000 of the amount made available to 

18 carry out this section for a fiscal year is used 

19 to make a contribution to the Global Tuber20 culosis Drug Facility.’’. 

21 (5) ASSISTANCE FOR WHO AND THE STOP TU22 BERCULOSIS PARTNERSHIP.—Such section is further 

23 amended— 


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1 (A) by redesignating subsection (g) (as re2 designated by paragraph (3) of this subsection) 

3 as subsection (h); and 

4 (B) by inserting after subsection (f) (as re5 designated by paragraph (4) and amended by 

6 paragraph (5) of this subsection) the following 

7 new subsection: 

8 ‘‘(g) ASSISTANCE FOR WHO AND THE STOP TUBER9 CULOSIS PARTNERSHIP.—In carrying out this section, the 

10 President, acting through the Administrator of the United 

11 States Agency for International Development, is author12 ized to provide increased resources to the World Health 

13 Organization (WHO) and the Stop Tuberculosis Partner14 ship to improve the capacity of countries with high rates 

15 of tuberculosis and other affected countries to implement 

16 the Stop TB Strategy and specific strategies related to 

17 addressing extensively drug resistant tuberculosis (XDR– 

18 TB).’’. 

19 (6) DEFINITIONS.—Subsection (h) of such sec20 tion (as redesignated by paragraph (5)(A) of this 

21 subsection) is amended— 

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

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

24 cost and effective diagnosis and evaluation of 

25 treatment regimes, vaccines, and monitoring of 


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1 tuberculosis, as well as a reliable drug supply, 

2 and a management strategy for public health 

3 systems, with health system strengthening, pro4 motion of the use of the International Stand5 ards for Tuberculosis Care by all care pro6 viders, bacteriology under an external quality 

7 assessment framework, short-course chemo8 therapy, and sound reporting and recording sys9 tems’’; and 

10 (B) by adding after paragraph (5) the fol11 lowing new paragraph: 

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

13 Strategy’ means the six-point strategy to reduce tu14 berculosis developed by the World Health Organiza15 tion. The strategy is described in the Global Plan to 

16 Stop TB 2007–2016: Actions for Life, a comprehen17 sive plan developed by the Stop Tuberculosis Part18 nership that sets out the actions necessary to 

19 achieve the millennium development goal of cutting 

20 tuberculosis deaths and disease burden in half by 

21 2016.’’. 

22 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

23 302(b) of the United States Leadership Against HIV/ 

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

25 7632(b)) is amended— 


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

2 may be necessary for each of the fiscal years 2004 

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

4 fiscal years 2009 through 2013’’; and 

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

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

7 2009 through 2013’’. 

8 SEC. 303. ASSISTANCE TO COMBAT MALARIA. 

9 (a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT

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

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

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

13 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

14 303(b) of the United States Leadership Against HIV/ 

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

16 7633(b)) is amended— 

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

18 may be necessary for fiscal years 2004 through 

19 2008’’ and inserting ‘‘$5,000,000,000 for fiscal 

20 years 2009 through 2013’’; and 

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

22 2004 through 2008’’ and inserting ‘‘fiscal years 

23 2009 through 2013’’. 

24 (c) DEVELOPMENT OF A COMPREHENSIVE FIVE25 YEAR STRATEGY.—Section 303 of the United States 


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1 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

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

3 the end the following: 

4 ‘‘(d) DEVELOPMENT OF A COMPREHENSIVE FIVE5 YEAR STRATEGY.—The President shall establish a com6 prehensive, five-year strategy to combat global malaria 

7 that strengthens the capacity of the United States to be 

8 an effective leader of international efforts to reduce the 

9 global malaria disease burden. Such strategy shall main10 tain sufficient flexibility and remain responsive to the 

11 ever-changing nature of the global malaria challenge and 

12 shall— 

13 ‘‘(1) include specific objectives, multisectoral 

14 approaches and strategies to treat and provide care 

15 to individuals infected with malaria, to prevent the 

16 further spread of malaria; 

17 ‘‘(2) describe how this strategy would con18 tribute to the United States’ overall global health 

19 and development goals; 

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

21 combat malaria will be coordinated with other 

22 United States global health activities, including the 

23 five-year global HIV/AIDS and tuberculosis strate24 gies developed pursuant to section 101 of this Act; 


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

2 leveraging of resources to combat malaria, including 

3 private sector resources; 

4 ‘‘(5) coordinate among relevant executive 

5 branch agencies providing assistance to combat ma6 laria in order to maximize human and financial re7 sources and reduce unnecessary duplication among 

8 such agencies and other donors; 

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

10 areas of technical assistance, training, and research, 

11 including vaccine research, to combat malaria; and 

12 ‘‘(7) establish priorities and selection criteria 

13 for the distribution of resources to combat malaria 

14 based on factors such as the size and demographics 

15 of the population with malaria, the needs of that 

16 population, the host countries’ existing infrastruc17 ture, and the host countries’ ability to complement 

18 United States efforts with strategies outlined in na19 tional malaria control plans. 

20 ‘‘(e) MALARIA RESPONSE COORDINATOR.— 

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

22 within the United States Agency for International 

23 Development a Coordinator of United States Gov24 ernment Activities to Combat Malaria Globally, who 

25 should be appointed by the President. 


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

2 through such nongovernmental organizations and 

3 relevant executive branch agencies as may be nec4 essary and appropriate to effect the purposes of sec5 tion 104C of the Foreign Assistance Act of 1961 (22 

6 U.S.C. 2151b–4), is authorized— 

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

8 prevention, treatment, care, support, capacity 

9 development of health systems, and other activi10 ties for combating malaria; 

11 ‘‘(B) to transfer and allocate funds to rel12 evant executive branch agencies; 

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

14 contracts with, nongovernmental organizations 

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

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

17 and allocate funds to international organiza18 tions to carry out the purposes of such section 

19 104C; and 

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

21 partnership to discover and develop effective 

22 new antimalarial drugs, including drugs for 

23 multi-drug resistant malaria and malaria in 

24 pregnant women. 

25 ‘‘(3) DUTIES.— 


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

2 have primary responsibility for the oversight 

3 and coordination of all resources and global 

4 United States government activities to combat 

5 malaria. 

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

7 shall— 

8 ‘‘(i) facilitate program and policy co9 ordination among relevant executive 

10 branch agencies and nongovernmental or11 ganizations, including auditing, monitoring 

12 and evaluation of such programs; 

13 ‘‘(ii) ensure that each relevant execu14 tive branch agency has sufficient resources 

15 to execute programs in areas in which the 

16 agency has the greatest expertise, technical 

17 capability, and potential for success; 

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

19 Coordinator of United States Government 

20 Activities to Combat HIV/AIDS Globally 

21 and equivalent managers of other relevant 

22 executive branch agencies that are imple23 menting global health programs to develop 

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1 tive requirements in countries in which 

2 more than one program operates; 

3 ‘‘(iv) coordinate relevant executive 

4 branch agency activities in the field, in5 cluding coordination of planning, imple6 mentation, and evaluation of malaria pro7 grams with HIV/AIDS programs in coun8 tries in which both programs are being 

9 carried out; 

10 ‘‘(v) pursue coordinate program im11 plementation with host governments, other 

12 donors, and the private sector; and 

13 ‘‘(vi) establish due diligence criteria 

14 for all recipients of funds appropriated 

15 pursuant to the authorizations of appro16 priations under section 401 for malaria as17 sistance. 

18 ‘‘(f) ASSISTANCE TO WHO.—In carrying out this sec19 tion, the President is authorized to make a United States 

20 contribution to the Roll Back Malaria Partnership and the 

21 World Health Organization (WHO) to improve the capac22 ity of countries with high rates of malaria and other af23 fected countries to implement comprehensive malaria con24 trol programs. 

25 ‘‘(g) ANNUAL REPORT.— 


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

2 after the date of the enactment of the Tom Lantos 

3 and Henry J. Hyde Global Leadership Against HIV/ 

4 AIDS, Tuberculosis, and Malaria Reauthorization 

5 Act of 2008, and annually thereafter, the President 

6 shall transmit to the appropriate congressional com7 mittees a report on United States assistance for the 

8 prevention, treatment, control, and elimination of 

9 malaria. 

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

11 required under paragraph (1) shall include a de12 scription of— 

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

14 malaria assistance has been allocated; 

15 ‘‘(B) the number of people reached 

16 through malaria assistance programs; 

17 ‘‘(C) the percentage and number of chil18 dren and mothers reached through malaria as19 sistance programs; 

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

21 to combat malaria, including drugs and vac22 cines; 

23 ‘‘(E) collaboration with the World Health 

24 Organization (WHO), the Global Fund to Fight 

25 AIDS, Tuberculosis and Malaria, other donor 


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1 governments, and relevant executive branch 

2 agencies to combat malaria; 

3 ‘‘(F) quantified impact of United States 

4 assistance on childhood morbidity and mor5 tality; 

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

7 immunizations through malaria assistance pro8 grams; and 

9 ‘‘(H) the number of women receiving ante10 natal care through malaria assistance pro11 grams.’’. 

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

13 AIDS. 

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

15 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

16 Act of 2003 (22 U.S.C. 7631 et seq.) is amended by strik17 ing section 304 and inserting the following: 

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

19 AIDS. 

20 ‘‘(a) SENSE OF CONGRESS.—It is the sense of Con21 gress that the use of health care partnerships that link 

22 United States and host country health care institutions 

23 create opportunities for sharing of knowledge and exper24 tise among individuals with significant experience in 

25 health-related fields and build local capacity to combat 


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1 HIV/AIDS and increase scientific understanding of the 

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

3 ‘‘(b) AUTHORITY TO FACILITATE HEALTH CARE

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

5 acting through the Coordinator of United States Govern6 ment Activities to Combat HIV/AIDS Globally, shall fa7 cilitate the development of health care partnerships de8 scribed in subsection (a) by— 

9 ‘‘(1) supporting short- and long-term institu10 tional partnerships, including partnerships that build 

11 human and institutional capacity in ministries of 

12 health, central- and district-level health agencies, 

13 medical facilities, health education and training in14 stitutions, academic centers, and faith- and commu15 nity-based organizations involved in prevention, 

16 treatment, and care of HIV/AIDS; 

17 ‘‘(2) supporting the development of consultation 

18 services using appropriate technologies, including on19 line courses, DVDs, telecommunications services, 

20 partnerships, and other technologies to eliminate the 

21 barriers that prevent host country professionals from 

22 accessing high quality health care services informa23 tion, particularly providers located in rural areas; 

24 ‘‘(3) supporting the placements of highly quali25 fied individuals to strengthen human and organizaVerDate Aug 31 2005 00:33 Apr 05, 2008 Jkt 069200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RFS H5501

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1 tional capacity through the use of health care profes2 sionals to facilitate skills transfer, building local ca3 pacity, and to expand rapidly the pool of providers, 

4 managers, and other health care staff delivering 

5 HIV/AID services in host countries; and 

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

7 where possible, insisting on the implementation of a 

8 national strategic plan, by providing training and 

9 mentoring to strengthen human and organizational 

10 capacity among local health care service organiza11 tions. 

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

13 amounts authorized to be appropriated under section 401 

14 for HIV/AIDS assistance, there are authorized to be ap15 propriated to the President such sums as may be nec16 essary for each of the fiscal years 2009 through 2013 to 

17 carry out this section.’’. 

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

19 for the United States Leadership Against HIV/AIDS, Tu20 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

21 is amended by striking the item relating to section 304 

22 and inserting the following new item: 

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


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1 Subtitle B—Assistance for Women, 

2 Children, and Families 

3 SEC. 311. POLICY AND REQUIREMENTS. 

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

5 United States Leadership Against HIV/AIDS, Tuber6 culosis, and Malaria Act of 2003 (22 U.S.C. 7652) is 

7 amended— 

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

9 United States Government’s’’ and inserting the fol10 lowing: 

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

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

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

14 should work in collaboration with governments, do15 nors, the private sector, nongovernmental organiza16 tions, and other key stakeholders to carry out the 

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

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

19 is amended to read as follows: 

20 ‘‘(b) REQUIREMENTS.—The 5-year United States 

21 strategy required by section 101 of this Act shall— 

22 ‘‘(1) establish a target for prevention and treat23 ment of mother-to-child transmission of HIV that by 

24 2013 will reach at least 80 percent of pregnant 


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1 women in those countries most affected by HIV/ 

2 AIDS; 

3 ‘‘(2) establish a target requiring that by 2013 

4 up to 15 percent of individuals receiving care and up 

5 to 15 percent of individuals receiving treatment 

6 under this Act and the amendments made by this 

7 Act are children; 

8 ‘‘(3) integrate care and treatment with preven9 tion of mother-to-child transmission of HIV pro10 grams in order to improve outcomes for HIV-af11 fected women and families as soon as is feasible, 

12 consistent with the national government policies of 

13 countries in which programs under this Act are ad14 ministered, and including support for strategies to 

15 ensure successful follow-up and continuity of care; 

16 ‘‘(4) expand programs designed to care for chil17 dren orphaned by HIV/AIDS; 

18 ‘‘(5) develop a timeline for expanding access to 

19 more effective regimes to prevent mother-to-child 

20 transmission of HIV, consistent with the national 

21 government policies of countries in which programs 

22 under this Act are administered and the goal of 

23 achieving universal use of such regimens as soon as 

24 possible; 


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1 ‘‘(6) ensure that women receiving voluntary 

2 contraceptive counseling, services, or commodities in 

3 programs supported by the United States Govern4 ment have access to the full range of HIV/AIDS 

5 services; and 

6 ‘‘(7) ensure that women in prevention of moth7 er-to-child transmission of HIV programs are pro8 vided with appropriate maternal and child services, 

9 either directly or by referral.’’. 

10 SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER11 TO-CHILD TRANSMISSION OF THE HIV INFEC12 TION. 

13 Section 313(a) of the United States Leadership 

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

15 2003 (22 U.S.C. 7653(a)) is amended by striking ‘‘5 

16 years’’ and inserting ‘‘10 years’’. 

17 SEC. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG 

18 WOMEN AND YOUTH. 

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

20 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

21 Act of 2003 (22 U.S.C. 7631 et seq.) is amended by add22 ing at the end the following: 


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1 ‘‘SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG 

2 WOMEN AND YOUTH. 

3 ‘‘(a) STATEMENT OF POLICY.—In order to meet the 

4 United States Government’s goal of preventing 

5 12,000,000 new HIV infections worldwide, it shall be the 

6 policy of the United States to pursue a global HIV/AIDS 

7 prevention strategy that emphasizes the immediate and 

8 ongoing needs of women and youth and addresses the fac9 tors that lead to gender disparities in the rate of HIV in10 fection. 

11 ‘‘(b) STRATEGY.— 

12 ‘‘(1) IN GENERAL.—The President shall formu13 late a comprehensive, integrated, and culturally-ap14 propriate global HIV/AIDS prevention strategy that, 

15 to the extent epidemiologically appropriate, address16 es the vulnerabilities of women and youth to HIV in17 fection and seeks to reduce the factors that lead to 

18 gender disparities in the rate of HIV infection. 

19 ‘‘(2) ELEMENTS.—The strategy required under 

20 paragraph (1) shall include specific goals and tar21 gets under the 5-year strategy outlined in section 

22 101 and shall include comprehensive HIV/AIDS pre23 vention education at the individual and national level 

24 including the ABC (‘Abstain, Be faithful, use 

25 Condoms’) model as a means to reduce HIV infec26 tions and shall include the following: 


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1 ‘‘(A) Specific goals under the five-year 

2 strategy outlined in section 101. 

3 ‘‘(B) Empowering women and youth to 

4 avoid cross-generational sex and to decide when 

5 and whom to marry in order to reduce the inci6 dence of early or child marriage. 

7 ‘‘(C) Dramatically increasing access to cur8 rently available female-controlled prevention 

9 methods and including investments in training 

10 to increase the effective and consistent use of 

11 both male and female condoms. 

12 ‘‘(D) Accelerating the de-stigmatization of 

13 HIV/AIDS among women and youth as a major 

14 risk factor for the transmission of HIV. 

15 ‘‘(E) Addressing and preventing post-trau16 matic and psycho-social consequences and pro17 viding post-exposure prophylaxis to victims of 

18 gender-based violence and rape against women 

19 and youth through appropriate medical, social, 

20 educational, and legal assistance and through 

21 prosecutions and legal penalties to address such 

22 violence. 

23 ‘‘(F) Promoting changes in male attitudes 

24 and behavior that respect the human rights of 


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1 women and youth and that support and foster 

2 gender equality. 

3 ‘‘(G) Supporting the development of micro4 enterprise initiatives, job training programs, 

5 and other such efforts to assist women in devel6 oping and retaining independent economic 

7 means. 

8 ‘‘(H) Supporting universal basic education 

9 and expanded educational opportunities for 

10 women and youth. 

11 ‘‘(I) Protecting the property and inherit12 ance rights of women. 

13 ‘‘(J) Coordinating inclusion of HIV/AIDS 

14 prevention information and education services 

15 and programs for individuals with HIV/AIDS 

16 with existing health care services targeted to 

17 women and youth, such as ensuring access to 

18 HIV/AIDS education and testing in family 

19 planning programs supported by the United 

20 States Government and programs to reduce 

21 mother-to-child transmission of HIV, and ex22 panding the reach of such HIV/AIDS health 

23 services. 

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1 ganizations, including faith-based and commu2 nity-based organizations, that support the needs 

3 of women and utilizing such organizations that 

4 are already empowering women and youth at 

5 the community level. 

6 ‘‘(L) Encouraging the creation and effec7 tive enforcement of legal frameworks that guar8 antee women equal rights and equal protection 

9 under the law. 

10 ‘‘(M) Encouraging the participation and 

11 involvement of women in drafting, coordinating, 

12 and implementing the national HIV/AIDS stra13 tegic plans of their countries. 

14 ‘‘(N) Responding to other economic and 

15 social factors that increase the vulnerability of 

16 women and youth to HIV infection. 

17 ‘‘(3) TRANSMISSION TO CONGRESS AND PUBLIC

18 AVAILABILITY.—Not later than 180 days after the 

19 date of the enactment of the Tom Lantos and Henry 

20 J. Hyde Global Leadership Against HIV/AIDS, Tu21 berculosis, and Malaria Reauthorization Act of 

22 2008, the President shall transmit to the appro23 priate congressional committees and make available 

24 to the public the strategy required under paragraph 

25 (1). 


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1 ‘‘(c) COORDINATION.—In formulating and imple2 menting the strategy required under subsection (b), the 

3 President shall ensure that the United States coordinates 

4 its overall HIV/AIDS policy and programs with the na5 tional governments of the countries for which the United 

6 States provides assistance to combat HIV/AIDS and, to 

7 the extent practicable, with international organizations, 

8 other donor countries, and indigenous organizations, in9 cluding faith-based and community-based organizations 

10 specifically for the purposes of ensuring gender equality 

11 and promoting respect of the human rights of women that 

12 impact their susceptibility to HIV/AIDS, improving wom13 en’s health, and expanding education for women and 

14 youth, and organizations, including faith-based and other 

15 nonprofit organizations, providing services to and advo16 cating on behalf of individuals with HIV/AIDS and indi17 viduals affected by HIV/AIDS. 

18 ‘‘(d) GUIDANCE.— 

19 ‘‘(1) IN GENERAL.—The President shall provide 

20 clear guidance to field missions of the United States 

21 Government in countries for which the United States 

22 provides assistance to combat HIV/AIDS, based on 

23 the strategy required under subsection (b). 

24 ‘‘(2) TRANSMISSION TO CONGRESS AND PUBLIC

25 AVAILABILITY.—The President shall transmit to the 


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1 appropriate congressional committees and make 

2 available to the public a description of the guidance 

3 required under paragraph (1). 

4 ‘‘(e) REPORT.— 

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

6 the date of the enactment of the Tom Lantos and 

7 Henry J. Hyde Global Leadership Against HIV/ 

8 AIDS, Tuberculosis, and Malaria Reauthorization 

9 Act of 2008, and annually thereafter as part of the 

10 annual report required under section 104A(e) of the 

11 Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 

12 2(e)), the President shall transmit to the appro13 priate congressional committees and make available 

14 to the public a report on the implementation of this 

15 section for the prior fiscal year. 

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

17 required under paragraph (1) shall include the fol18 lowing: 

19 ‘‘(A) A description of the prevention pro20 grams designed to address the vulnerabilities of 

21 women and youth to HIV/AIDS. 

22 ‘‘(B) A list of nongovernmental organiza23 tions in each country that receive assistance 

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1 vention activities, including the amount and the 

2 source of funding received.’’. 

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

4 for the United States Leadership Against HIV/AIDS, Tu5 berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 

6 is amended by inserting after the item relating to section 

7 315 the following: 

‘‘Sec. 316. Strategy to prevent HIV infections among women and youth.’’. 

8 SEC. 314. CLERICAL AMENDMENT. 

9 The table of contents for the United States Leader10 ship Against HIV/AIDS, Tuberculosis, and Malaria Act 

11 of 2003 (22 U.S.C. 7601 note) is amended by striking 

12 the item relating to subtitle B of title III and inserting 

13 the following: 

‘‘Subtitle B—Assistance for Women, Children, and Families’’. 

14 TITLE IV—AUTHORIZATION OF 

15 APPROPRIATIONS 

16 SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 

17 Section 401(a) of the United States Leadership 

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

19 2003 (22 U.S.C. 7671(a)) is amended— 

20 (1) by striking ‘‘$3,000,000,000’’ and inserting 

21 ‘‘$10,000,000,000’’; and 

22 (2) by striking ‘‘fiscal years 2004 through 

23 2008’’ and inserting ‘‘fiscal years 2009 through 

24 2013’’. 


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1 SEC. 402. SENSE OF CONGRESS. 

2 Section 402(b) of the United States Leadership 

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

4 2003 (22 U.S.C. 7672) is amended— 

5 (1) by striking paragraph (1); 

6 (2) by redesignating paragraphs (2) through 

7 (4) as paragraphs (1) through (3), respectively; and 

8 (3) in paragraph (2) (as redesignated by para9 graph (2) of this section), by striking ‘‘, of which’’ 

10 and all that follows through ‘‘programs’’. 

11 SEC. 403. ALLOCATION OF FUNDS. 

12 (a) HIV/AIDS PREVENTION ACTIVITIES.—Sub13 section (a) of section 403 of the United States Leadership 

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

15 2003 (22 U.S.C. 7673) is amended to read as follows: 

16 ‘‘(a) HIV/AIDS PREVENTION ACTIVITIES.— 

17 ‘‘(1) IN GENERAL.—For each of the fiscal years 

18 2009 through 2013, not less than 20 percent of the 

19 amounts appropriated pursuant to the authorization 

20 of appropriations under section 401 for HIV/AIDS 

21 assistance for each such fiscal year shall be ex22 pended for HIV/AIDS prevention activities con23 sistent with section 104A(d) of the Foreign Assist24 ance Act of 1961. 

25 ‘‘(2) BALANCED FUNDING REQUIREMENT.—(A) 

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1 tivities to Combat HIV/AIDS Globally shall provide 

2 balanced funding for prevention activities for sexual 

3 transmission of HIV/AIDS and shall ensure that be4 havioral change programs, including abstinence, 

5 delay of sexual debut, monogamy, fidelity and part6 ner reduction, are implemented and funded in a 

7 meaningful and equitable way in the strategy for 

8 each host country based on objective epidemiological 

9 evidence as to the source of infections and in con10 sultation with the government of each host county 

11 involved in HIV/AIDS prevention activities. 

12 ‘‘(B) In fulfilling the requirement under sub13 paragraph (A), the Coordinator shall establish a 

14 HIV sexual transmission prevention strategy gov15 erning the expenditure of funds authorized by the 

16 Act used to prevent the sexual transmission of HIV 

17 in any host country with a generalized epidemic. In 

18 each such host country, if this strategy provides less 

19 than 50 percent of such funds for behavioral change 

20 programs, including abstinence, delay of sexual 

21 debut, monogamy, fidelity, and partner reduction, 

22 the Coordinator shall, within 30 days of the issuance 

23 of this strategy, report to the appropriate congres24 sional committees on the justification for this deci25 sion. 


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1 ‘‘(C) Programs and activities that implement or 

2 purchase new prevention technologies or modalities 

3 such as medical male circumcision, pre-exposure pro4 phylaxis, or microbicides and programs and activities 

5 that provide counseling and testing for HIV or pre6 vent mother-to-child prevention of HIV shall not be 

7 included in determining compliance with this para8 graph. 

9 ‘‘(3) REPORT.—Not later than 1 year after the 

10 date of the enactment of the Tom Lantos and Henry 

11 J. Hyde Global Leadership Against HIV/AIDS, Tu12 berculosis, and Malaria Reauthorization Act of 

13 2008, and annually thereafter as part of the annual 

14 report required under section 104A(e) of the For15 eign Assistance Act of 1961 (22 U.S.C. 2151b– 

16 2(e)), the President shall transmit to the appro17 priate congressional committees and make available 

18 to the public a report on the implementation of 

19 paragraph (2) for the prior fiscal year.’’. 

20 (b) ORPHANS AND VULNERABLE CHILDREN.—Sub21 section (b) of such section is amended by striking ‘‘fiscal 

22 years 2006 through 2008’’ and inserting ‘‘fiscal years 

23 2009 through 2013’’. 


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1 SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOV2 ERNMENTS. 

3 (a) PROHIBITION ON TAXATION.—None of the funds 

4 appropriated pursuant to the authorization of appropria5 tions under section 401 of the United States Leadership 

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

7 2003 (22 U.S.C. 7671) may be made available to provide 

8 assistance for a foreign country under a new bilateral 

9 agreement governing the terms and conditions under 

10 which such assistance is to be provided unless such agree11 ment includes a provision stating that assistance provided 

12 by the United States shall be exempt from taxation, or 

13 reimbursed, by the foreign government, and the Secretary 

14 of State shall expeditiously seek to negotiate amendments 

15 to existing bilateral agreements, as necessary, to conform 

16 with this requirement. 

17 (b) DE MINIMUS EXCEPTION.—Foreign taxes of a de 

18 minimus nature shall not be subject to the provisions of 

19 subsection (a). 

20 (c) REPROGRAMMING OF FUNDS.—Funds withheld 

21 from obligation for each country or entity pursuant to sub22 section (a) shall be reprogrammed for assistance to coun23 tries which do not assess taxes on United States assistance 

24 or which have an effective arrangement that is providing 

25 substantial reimbursement of such taxes. 

26 (d) DETERMINATIONS.— 


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1 (1) IN GENERAL.—The provisions of this sec2 tion shall not apply to any country or entity the Sec3 retary of State determines— 

4 (A) does not assess taxes on United States 

5 assistance or which has an effective arrange6 ment that is providing substantial reimburse7 ment of such taxes; or 

8 (B) the foreign policy interests of the 

9 United States outweigh the policy of this sec10 tion to ensure that United States assistance is 

11 not subject to taxation. 

12 (2) CONSULTATION.—The Secretary of State 

13 shall consult with the Committees on Foreign Af14 fairs and Appropriations at least 15 days prior to 

15 exercising the authority of this subsection with re16 gard to any country or entity. 

17 (e) IMPLEMENTATION.—The Secretary of State shall 

18 issue rules, regulations, or policy guidance, as appropriate, 

19 to implement the prohibition against the taxation of assist20 ance contained in this section. 

21 (f) DEFINITIONS.—As used in this section— 

22 (1) the terms ‘‘taxes’’ and ‘‘taxation’’ refer to 

23 value added taxes and customs duties imposed on 

24 commodities financed with United States assistance 


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1 for programs for which funds are authorized by this 

2 Act; and 

3 (2) the term ‘‘bilateral agreement’’ refers to a 

4 framework bilateral agreement between the Govern5 ment of the United States and the government of 

6 the country receiving assistance that describes the 

7 privileges and immunities applicable to United 

8 States foreign assistance for such country generally, 

9 or an individual agreement between the Government 

10 of the United States and such government that de11 scribes, among other things, the treatment for tax 

12 purposes that will be accorded the United States as13 sistance provided under that agreement. 

14 TITLE V—SUSTAINABILITY AND 

15 STRENGTHENING OF HEALTH 

16 CARE SYSTEMS 

17 SEC. 501. SUSTAINABILITY AND STRENGTHENING OF 

18 HEALTH CARE SYSTEMS. 

19 The United States Leadership Against HIV/AIDS, 

20 Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 

21 et seq.) is amended by adding at the end the following: 


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1 ‘‘TITLE VI—SUSTAINABILITY AND 

2 STRENGTHENING OF HEALTH 

3 CARE SYSTEMS 

4 ‘‘SEC. 601. FINDINGS. 

5 ‘‘Congress makes the following findings: 

6 ‘‘(1) The shortage of health personnel, includ7 ing doctors, nurses, pharmacists, counselors, labora8 tory staff, and paraprofessionals, is one of the lead9 ing obstacles to fighting HIV/AIDS in sub-Saharan 

10 Africa. 

11 ‘‘(2) The HIV/AIDS pandemic aggravates the 

12 shortage of health workers through loss of life and 

13 illness among medical staff, unsafe working condi14 tions for medical personnel, and increased workloads 

15 for diminished staff, while the shortage of health 

16 personnel undermines efforts to prevent and provide 

17 care and treatment for individuals with HIV/AIDS. 

18 ‘‘(3) Failure to address the shortage of health 

19 care professionals and paraprofessionals, and the 

20 factors forcing such individuals to leave sub-Saharan 

21 Africa, will undermine the objectives of United 

22 States development policy and will subvert opportu23 nities to achieve internationally-recognized goals for 

24 the prevention, treatment, and care of HIV/AIDS 

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1 nal mortality, and for economic growth and develop2 ment in sub-Saharan Africa. 

3 ‘‘SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES 

4 AND OTHER POLICIES. 

5 ‘‘(a) NATIONAL HEALTH WORKFORCE STRATE6 GIES.— 

7 ‘‘(1) STATEMENT OF POLICY.—It shall be the 

8 policy of the United States Government to support 

9 countries receiving United States assistance to com10 bat HIV/AIDS, tuberculosis, and malaria, and other 

11 health programs in developing, strengthening, and 

12 implementing 5-year health workforce strategies. 

13 ‘‘(2) TECHNICAL AND FINANCIAL ASSIST14 ANCE.—The Administrator of the United States 

15 Agency for International Development, in coordina16 tion with the Coordinator of United States Govern17 ment Activities to Combat HIV/AIDS Globally, is 

18 authorized to provide technical and financial assist19 ance to countries described in paragraph (1) to en20 able such countries, in conjunction with other fund21 ing sources, to develop, strengthen, and implement 

22 health workforce strategies. 

23 ‘‘(3) ACTIVITIES SUPPORTED.—Assistance pro24 vided under paragraph (2) shall, to the maximum 


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1 extent practicable, be used to carry out the fol2 lowing: 

3 ‘‘(A) Activities to promote an inclusive 

4 process that includes nongovernmental organi5 zations and individuals with HIV/AIDS in de6 veloping health workforce strategies. 

7 ‘‘(B) Activities to achieve and sustain a 

8 health workforce sufficient in numbers, skill, 

9 and capacity to meet United States and host10 country international health commitments, in11 cluding the Millennium Development Goals and 

12 universal access to HIV/AIDS prevention, treat13 ment, and care. In particular, such health work14 force strategies should include plans for 

15 progress toward achieving the minimum ratio of 

16 health professionals required to achieve these 

17 goals by 2015, estimated by the World Health 

18 Organization to require at least 2.3 doctors, 

19 nurses, and midwives per 1,000 population, and 

20 additional health workers such as pharmacists 

21 and lab technicians. 

22 ‘‘(C) Activities to ensure that health work23 force strategies are aimed at creating appro24 priate distribution of health workers and 

25 prioritizing activities required to ensure rural, 


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1 marginalized, and other underserved popu2 lations are able to access skilled and equipped 

3 health workers. 

4 ‘‘(D) Activities to expand the capacity of 

5 public and private medical, nursing, pharma6 ceutical, and other health training institutions. 

7 ‘‘(b) POSITIVE BROADER HEALTH IMPACT.—It shall 

8 be the policy of the United States to ensure to expand 

9 the capacity of the health workforce engaged in HIV/AIDS 

10 programming in ways that contribute to, and do not de11 tract from, the capacity of countries to meet other health 

12 needs, particularly child survival and maternal health. 

13 ‘‘(c) SAFETY FOR HEALTH WORKERS.—It is the 

14 sense of Congress that the United States should ensure 

15 that all health workers participating in programs that re16 ceive assistance under this Act and the amendments made 

17 by this Act have the proper training to create safe and 

18 sanitary working conditions in accordance with universal 

19 precautions and other forms of infection prevention and 

20 control. 

21 ‘‘(d) HEALTH CARE FOR HEALTH WORKERS.—The 

22 Coordinator of United States Government Activities to 

23 Combat HIV/AIDS Globally shall ensure that comprehen24 sive and confidential health services shall be provided to 

25 all health workers participating in programs that receive 


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1 assistance under this Act and the amendments made by 

2 this Act, including— 

3 ‘‘(1) testing and counseling for all such employ4 ees; 

5 ‘‘(2) providing HIV/AIDS treatment to HIV6 positive employees; and 

7 ‘‘(3) taking measures to reduce HIV-related 

8 stigma in the workplace. 

9 ‘‘(e) TRAINING AND COMPENSATION FINANCE.— 

10 Where the Coordinator determines such financial support 

11 is essential to fulfill the purposes of this Act, the Coordi12 nator shall finance training and provide compensation or 

13 other benefits for health workers in order to enhance re14 cruitment and retention of such workers. 

15 ‘‘SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM 

16 LIMITS SOUGHT BY INTERNATIONAL FINAN17 CIAL INSTITUTIONS. 

18 ‘‘(a) COORDINATION WITHIN THE UNITED STATES

19 GOVERNMENT.—The Coordinator of United States Gov20 ernment Activities to Combat HIV/AIDS Globally shall 

21 work with the Secretary of the Treasury to reform Inter22 national Monetary Fund macroeconomic and fiscal policies 

23 that result in limitations on national and donor invest24 ments in health. 


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1 ‘‘(b) POSITION OF THE UNITED STATES AT THE

2 IMF.—The Secretary of the Treasury shall instruct the 

3 United States Executive Director at the International 

4 Monetary Fund to use the voice, vote, and influence of 

5 the United States to oppose any loan, project, agreement, 

6 memorandum, instrument, plan, or other program of the 

7 International Monetary Fund that does not exempt in8 creased government spending on health care from national 

9 budget caps or restraints, hiring or wage bill ceilings, or 

10 other limits sought by any international financial institu11 tion. 

12 ‘‘SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REG13 ISTRATION, AND SUPPLY CHAIN MANAGE14 MENT SYSTEMS. 

15 ‘‘(a) IN GENERAL.—The Coordinator of United 

16 States Government Activities to Combat AIDS Globally 

17 shall work with the Partnership for Supply Chain Manage18 ment Systems, host countries, and nongovernmental orga19 nizations to develop effective, reliable host country-owned 

20 and operated public-sector procurement and supply chain 

21 management systems, including regional distribution, with 

22 ongoing technical assistance and sustained support to en23 sure the function of such systems, as well as the function 

24 of existing non-public sector supply chains, including those 


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1 operated by faith-based and other humanitarian organiza2 tions that procure and distribute medical supplies. 

3 ‘‘(b) AVAILABILITY OF EQUIPMENT AND SUP4 PLIES.—The public-sector procurement and supply chain 

5 management systems developed pursuant to subsection (a) 

6 should ensure that adequate laboratory equipment and 

7 supplies commonly needed to fight HIV/AIDS, including 

8 diagnostic tests for CD4 and viral load counts, x-ray ma9 chines, mobile and facility-based rapid HIV test kits and 

10 other necessary assays, reagents and basic supplies such 

11 as sterile syringes and gloves, are available and distributed 

12 in a manner that is accessible to urban and rural popu13 lations. 

14 ‘‘(c) DRUG REGISTRATION.—The Coordinator shall 

15 work with host country partners and development partners 

16 to support efficient and effective drug approval and reg17 istration systems that allow expeditious access to safe and 

18 effective drugs, including antiretroviral drugs. 

19 ‘‘(d) REPORT.—The Coordinator shall submit to the 

20 appropriate congressional committees an annual report on 

21 the implementation of this section, including progress to22 ward specific benchmarks established by the Partnership 

23 for Supply Chain Management Systems, and the projec24 tion of when host countries can fully sustain their own 

25 procurement and supply chain management and distribuVerDate Aug 31 2005 00:33 Apr 05, 2008 Jkt 069200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H5501.RFS H5501

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1 tion systems at a scale necessary for national primary 

2 health needs. 

3 ‘‘SEC. 605. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘(a) IN GENERAL.—Of the amounts authorized to be 

5 appropriated under section 401 for HIV/AIDS assistance, 

6 there are authorized to be appropriated to the President 

7 such sums as may be necessary for each of the fiscal years 

8 2009 through 2013 to carry out this title. 

9 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu10 ant to the authorization of appropriations under sub11 section (a) are authorized to remain available until ex12 pended.’’. 

13 SEC. 502. CLERICAL AMENDMENT. 

14 The table of contents for the United States Leader15 ship Against HIV/AIDS, Tuberculosis, and Malaria Act 

16 of 2003 (22 U.S.C. 7601 note) is amended by inserting 

17 after the items relating to title V the following: 

‘‘TITLE VI—SUSTAINABILITY AND STRENGTHENING OF HEALTH 

CARE SYSTEMS 

‘‘Sec. 601. Findings. 

‘‘Sec. 602. National health workforce strategies and other policies. 

‘‘Sec. 603. Exemption of investments in health from limits sought by international financial institutions. 


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‘‘Sec. 604. Public-sector procurement, drug registration, and supply chain management systems. 

‘‘Sec. 605. Authorization of appropriations.’’. 

Passed the House of Representatives April 2, 2008. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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