In the Senate of the United States, 

July 16, 2008. 

Resolved, That the bill from the House of Representatives (H.R. 5501) entitled ‘‘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.’’, do pass with the following 

AMENDMENT: 

Strike all after the enacting clause and insert the 

following: 

1 SECTION 1. SHORT TITLE; 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; table of contents. 

Sec. 2. Findings. 

Sec. 3. Definitions. 

Sec. 4. Purpose. 

Sec. 5. Authority to consolidate and combine reports. 
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TITLE I—POLICY PLANNING AND COORDINATION 

Sec. 101. Development of an updated, comprehensive, 5-year, global strategy. 

Sec. 102. Interagency working group. 

Sec. 103. Sense of Congress. 

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND 

PUBLIC-PRIVATE PARTNERSHIPS 

Sec. 201. Voluntary contributions to international vaccine funds. 

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

Sec. 203. Research on methods for women to prevent transmission of HIV and 

other diseases. 

Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by strengthening 

health policies and health systems of partner countries. 

Sec. 205. Facilitating effective operations of the Centers for Disease Control. 

Sec. 206. Facilitating vaccine development. 

TITLE III—BILATERAL EFFORTS 

Subtitle A—General Assistance and Programs 

Sec. 301. Assistance to combat HIV/AIDS. 

Sec. 302. Assistance to combat tuberculosis. 

Sec. 303. Assistance to combat malaria. 

Sec. 304. Malaria Response Coordinator. 

Sec. 305. Amendment to Immigration and Nationality Act. 

Sec. 306. Clerical amendment. 

Sec. 307. Requirements. 

Sec. 308. Annual report on prevention of mother-to-child transmission of HIV. 

Sec. 309. Prevention of mother-to-child transmission expert panel. 

TITLE IV—FUNDING ALLOCATIONS 

Sec. 401. Authorization of appropriations. 

Sec. 402. Sense of Congress. 

Sec. 403. Allocation of funds. 

TITLE V—MISCELLANEOUS 

Sec. 501. Machine readable visa fees. 

TITLE VI—EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH 

Sec. 601. Emergency plan for Indian safety and health. 

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 following: 
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1 ‘‘(29) On May 27, 2003, the President signed 

2 this Act into law, launching the largest international 

3 public health program of its kind ever created. 

4 ‘‘(30) Between 2003 and 2008, the United States, 

5 through the President’s Emergency Plan for AIDS 

6 Relief (PEPFAR) and in conjunction with other bi7 lateral programs and the multilateral Global Fund 

8 has helped to— 

9 ‘‘(A) provide antiretroviral therapy for over 

10 1,900,000 people; 

11 ‘‘(B) ensure that over 150,000 infants, most 

12 of whom would have likely been infected with 

13 HIV during pregnancy or childbirth, were not 

14 infected; and 

15 ‘‘(C) provide palliative care and HIV pre16 vention assistance to millions of other people. 

17 ‘‘(31) While United States leadership in the bat18 tles against HIV/AIDS, tuberculosis, and malaria has 

19 had an enormous impact, these diseases continue to 

20 take a terrible toll on the human race. 

21 ‘‘(32) According to the 2007 AIDS Epidemic 

22 Update of the Joint United Nations Programme on 

23 HIV/AIDS (UNAIDS)— 

24 ‘‘(A) an estimated 2,100,000 people died of 

25 AIDS-related causes in 2007; and 
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1 ‘‘(B) an estimated 2,500,000 people were 

2 newly infected with HIV during that year. 

3 ‘‘(33) According to the World Health Organiza4 tion, malaria kills more than 1,000,000 people per 

5 year, 70 percent of whom are children under 5 years 

6 of age. 

7 ‘‘(34) According to the World Health Organization, 1 8 ⁄3 of the world’s population is infected with the 

9 tuberculosis bacterium, and tuberculosis is 1 of the 

10 greatest infectious causes of death of adults world11 wide, killing 1,600,000 people per year. 

12 ‘‘(35) Efforts to promote abstinence, fidelity, the 

13 correct and consistent use of condoms, the delay of 

14 sexual debut, and the reduction of concurrent sexual 

15 partners represent important elements of strategies to 

16 prevent the transmission of HIV/AIDS. 

17 ‘‘(36) According to UNAIDS— 

18 ‘‘(A) women and girls make up nearly 60 

19 percent of persons in sub-Saharan Africa who 

20 are HIV positive; 

21 ‘‘(B) women and girls are more biologically, 

22 economically, and socially vulnerable to HIV in23 fection; and 
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1 ‘‘(C) gender issues are critical components 

2 in the effort to prevent HIV/AIDS and to care 

3 for those affected by the disease. 

4 ‘‘(37) Children who have lost a parent to HIV/ 

5 AIDS, who are otherwise directly affected by the dis6 ease, or who live in areas of high HIV prevalence may 

7 be vulnerable to the disease or its socioeconomic ef8 fects. 

9 ‘‘(38) Lack of health capacity, including insuffi10 cient personnel and inadequate infrastructure, in sub11 Saharan Africa and other regions of the world is a 

12 critical barrier that limits the effectiveness of efforts 

13 to combat HIV/AIDS, tuberculosis, and malaria, and 

14 to achieve other global health goals. 

15 ‘‘(39) On March 30, 2007, the Institute of Medi16 cine of the National Academies released a report enti17 tled ‘PEPFAR Implementation: Progress and Prom18 ise’, which found that budget allocations setting per19 centage levels for spending on prevention, care, and 

20 treatment and for certain subsets of activities within 

21 the prevention category— 

22 ‘‘(A) have ‘adversely affected implementa23 tion of the U.S. Global AIDS Initiative’; 

24 ‘‘(B) have inhibited comprehensive, inte25 grated, evidence based approaches; 
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1 ‘‘(C) ‘have been counterproductive’; 

2 ‘‘(D) ‘may have been helpful initially in en3 suring a balance of attention to activities within 

4 the 4 categories of prevention, treatment, care, 

5 and orphans and vulnerable children’; 

6 ‘‘(E) ‘have also limited PEPFAR’s ability 

7 to tailor its activities in each country to the 

8 local epidemic and to coordinate with the level of 

9 activities in the countries’ national plans’; and 

10 ‘‘(F) should be removed by Congress and re11 placed with more appropriate mechanisms 

12 that— 

13 ‘‘(i) ‘ensure accountability for results 

14 from Country Teams to the U.S. Global 

15 AIDS Coordinator and to Congress’; and 

16 ‘‘(ii) ‘ensure that spending is directly 

17 linked to and commensurate with necessary 

18 efforts to achieve both country and overall 

19 performance targets for prevention, treat20 ment, care, and orphans and vulnerable 

21 children’. 

22 ‘‘(40) The United States Government has en23 dorsed the principles of harmonization in coordi24 nating efforts to combat HIV/AIDS commonly re25 ferred to as the ‘Three Ones’, which includes— 
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1 ‘‘(A) 1 agreed HIV/AIDS action framework 

2 that provides the basis for coordination of the 

3 work of all partners; 

4 ‘‘(B) 1 national HIV/AIDS coordinating 

5 authority, with a broadbased multisectoral man6 date; and 

7 ‘‘(C) 1 agreed HIV/AIDS country-level 

8 monitoring and evaluating system. 

9 ‘‘(41) In the Abuja Declaration on HIV/AIDS, 

10 Tuberculosis and Other Related Infectious Diseases, of 

11 April 26–27, 2001 (referred to in this Act as the 

12 ‘Abuja Declaration’), the Heads of State and Govern13 ment of the Organization of African Unity (OAU)— 

14 ‘‘(A) declared that they would ‘place the 

15 fight against HIV/AIDS at the forefront and as 

16 the highest priority issue in our respective na17 tional development plans’; 

18 ‘‘(B) committed ‘TO TAKE PERSONAL 

19 RESPONSIBILITY AND PROVIDE LEADER20 SHIP for the activities of the National AIDS 

21 Commissions/Councils’; 

22 ‘‘(C) resolved ‘to lead from the front the bat23 tle against HIV/AIDS, Tuberculosis and Other 

24 Related Infectious Diseases by personally ensur25 ing that such bodies were properly convened in 
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1 mobilizing our societies as a whole and pro2 viding focus for unified national policymaking 

3 and programme implementation, ensuring co4 ordination of all sectors at all levels with a gen5 der perspective and respect for human rights, 

6 particularly to ensure equal rights for people liv7 ing with HIV/AIDS’; and 

8 ‘‘(D) pledged ‘to set a target of allocating at 

9 least 15% of our annual budget to the improve10 ment of the health sector’.’’. 

11 SEC. 3. DEFINITIONS. 

12 Section 3 of the United States Leadership Against 

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

14 U.S.C. 7602) is amended— 

15 (1) in paragraph (2), by striking ‘‘Committee on 

16 International Relations’’ and inserting ‘‘Committee 

17 on Foreign Affairs of the House of Representatives, 

18 the Committee on Appropriations of the Senate, and 

19 the Committee on Appropriations’’; 

20 (2) by redesignating paragraph (6) as para21 graph (12); 

22 (3) by redesignating paragraphs (3) through (5), 

23 as paragraphs (4) through (6), respectively; 

24 (4) by inserting after paragraph (2) the fol25 lowing: 
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1 ‘‘(3) GLOBAL AIDS COORDINATOR.—The term 

2 ‘Global AIDS Coordinator’ means the Coordinator of 

3 United States Government Activities to Combat HIV/ 

4 AIDS Globally.’’; and 

5 (5) by inserting after paragraph (6), as redesig6 nated, the following: 

7 ‘‘(7) IMPACT EVALUATION RESEARCH.—The term 

8 ‘impact evaluation research’ means the application of 

9 research methods and statistical analysis to measure 

10 the extent to which change in a population-based out11 come can be attributed to program intervention in12 stead of other environmental factors. 

13 ‘‘(8) OPERATIONS RESEARCH.—The term ‘oper14 ations research’ means the application of social 

15 science research methods, statistical analysis, and 

16 other appropriate scientific methods to judge, com17 pare, and improve policies and program outcomes, 

18 from the earliest stages of defining and designing pro19 grams through their development and implementa20 tion, with the objective of the rapid dissemination of 

21 conclusions and concrete impact on programming. 

22 ‘‘(9) PARAPROFESSIONAL.—The term ‘para23 professional’ means an individual who is trained and 

24 employed as a health agent for the provision of basic 
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1 assistance in the identification, prevention, or treat2 ment of illness or disability. 

3 ‘‘(10) PARTNER GOVERNMENT.—The term ‘part4 ner government’ means a government with which the 

5 United States is working to provide assistance to 

6 combat HIV/AIDS, tuberculosis, or malaria on behalf 

7 of people living within the jurisdiction of such govern8 ment. 

9 ‘‘(11) PROGRAM MONITORING.—The term ‘pro10 gram monitoring’ means the collection, analysis, and 

11 use of routine program data to determine— 

12 ‘‘(A) how well a program is carried out; 

13 and 

14 ‘‘(B) how much the program costs.’’. 

15 SEC. 4. PURPOSE. 

16 Section 4 of the United States Leadership Against 

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

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

19 ‘‘SEC. 4. PURPOSE. 

20 ‘‘The purpose of this Act is to strengthen and enhance 

21 United States leadership and the effectiveness of the United 

22 States response to the HIV/AIDS, tuberculosis, and malaria 

23 pandemics and other related and preventable infectious dis24 eases as part of the overall United States health and devel25 opment agenda by— 
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1 ‘‘(1) establishing comprehensive, coordinated, 

2 and integrated 5-year, global strategies to combat 

3 HIV/AIDS, tuberculosis, and malaria by— 

4 ‘‘(A) building on progress and successes to 

5 date; 

6 ‘‘(B) improving harmonization of United 

7 States efforts with national strategies of partner 

8 governments and other public and private enti9 ties; and 

10 ‘‘(C) emphasizing capacity building initia11 tives in order to promote a transition toward 

12 greater sustainability through the support of 

13 country-driven efforts; 

14 ‘‘(2) providing increased resources for bilateral 

15 and multilateral efforts to fight HIV/AIDS, tuber16 culosis, and malaria as integrated components of 

17 United States development assistance; 

18 ‘‘(3) intensifying efforts to— 

19 ‘‘(A) prevent HIV infection; 

20 ‘‘(B) ensure the continued support for, and 

21 expanded access to, treatment and care pro22 grams; 

23 ‘‘(C) enhance the effectiveness of prevention, 

24 treatment, and care programs; and 
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1 ‘‘(D) address the particular vulnerabilities 

2 of girls and women; 

3 ‘‘(4) encouraging the expansion of private sector 

4 efforts and expanding public-private sector partner5 ships to combat HIV/AIDS, tuberculosis, and ma6 laria; 

7 ‘‘(5) reinforcing efforts to— 

8 ‘‘(A) develop safe and effective vaccines, 

9 microbicides, and other prevention and treat10 ment technologies; and 

11 ‘‘(B) improve diagnostics capabilities for 

12 HIV/AIDS, tuberculosis, and malaria; and 

13 ‘‘(6) helping partner countries to— 

14 ‘‘(A) strengthen health systems; 

15 ‘‘(B) expand health workforce; and 

16 ‘‘(C) address infrastructural weaknesses.’’. 

17 SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE RE18 PORTS. 

19 Section 5 of the United States Leadership Against 

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

21 U.S.C. 7604) is amended by inserting ‘‘, with the exception 

22 of the 5-year strategy’’ before the period at the end. 
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1 TITLE I—POLICY PLANNING AND 

2 COORDINATION 

3 SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHEN4 SIVE, 5-YEAR, GLOBAL STRATEGY. 

5 (a) STRATEGY.—Section 101(a) of the United States 

6 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

7 Act of 2003 (22 U.S.C. 7611(a)) is amended to read as fol8 lows: 

9 ‘‘(a) STRATEGY.—The President shall establish a com10 prehensive, integrated, 5-year strategy to expand and im11 prove efforts to combat global HIV/AIDS. This strategy 

12 shall— 

13 ‘‘(1) further strengthen the capability of the 

14 United States to be an effective leader of the inter15 national campaign against this disease and strength16 en the capacities of nations experiencing HIV/AIDS 

17 epidemics to combat this disease; 

18 ‘‘(2) maintain sufficient flexibility and remain 

19 responsive to— 

20 ‘‘(A) changes in the epidemic; 

21 ‘‘(B) challenges facing partner countries in 

22 developing and implementing an effective na23 tional response; and 
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1 ‘‘(C) evidence-based improvements and in2 novations in the prevention, care, and treatment 

3 of HIV/AIDS; 

4 ‘‘(3) situate United States efforts to combat HIV/ 

5 AIDS, tuberculosis, and malaria within the broader 

6 United States global health and development agenda, 

7 establishing a roadmap to link investments in specific 

8 disease programs to the broader goals of strengthening 

9 health systems and infrastructure and to integrate 

10 and coordinate HIV/AIDS, tuberculosis, or malaria 

11 programs with other health or development programs, 

12 as appropriate; 

13 ‘‘(4) provide a plan to— 

14 ‘‘(A) prevent 12,000,000 new HIV infections 

15 worldwide; 

16 ‘‘(B) support— 

17 ‘‘(i) the increase in the number of indi18 viduals with HIV/AIDS receiving 

19 antiretroviral treatment above the goal es20 tablished under section 402(a)(3) and in21 creased pursuant to paragraphs (1) through 

22 (3) of section 403(d); and 

23 ‘‘(ii) additional treatment through co24 ordinated multilateral efforts; 
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1 ‘‘(C) support care for 12,000,000 individ2 uals infected with or affected by HIV/AIDS, in3 cluding 5,000,000 orphans and vulnerable chil4 dren affected by HIV/AIDS, with an emphasis 

5 on promoting a comprehensive, coordinated sys6 tem of services to be integrated throughout the 

7 continuum of care; 

8 ‘‘(D) help partner countries in the effort to 

9 achieve goals of 80 percent access to counseling, 

10 testing, and treatment to prevent the trans11 mission of HIV from mother to child, empha12 sizing a continuum of care model; 

13 ‘‘(E) help partner countries to provide care 

14 and treatment services to children with HIV in 

15 proportion to their percentage within the HIV16 infected population in each country; 

17 ‘‘(F) promote preservice training for health 

18 professionals designed to strengthen the capacity 

19 of institutions to develop and implement policies 

20 for training health workers to combat HIV/ 

21 AIDS, tuberculosis, and malaria; 

22 ‘‘(G) equip teachers with skills needed for 

23 HIV/AIDS prevention and support for persons 

24 with, or affected by, HIV/AIDS; 
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1 ‘‘(H) provide and share best practices for 

2 combating HIV/AIDS with health professionals; 

3 ‘‘(I) promote pediatric HIV/AIDS training 

4 for physicians, nurses, and other health care 

5 workers, through public-private partnerships if 

6 possible, including through the designation, if 

7 appropriate, of centers of excellence for training 

8 in pediatric HIV/AIDS prevention, care, and 

9 treatment in partner countries; and 

10 ‘‘(J) help partner countries to train and 

11 support retention of health care professionals 

12 and paraprofessionals, with the target of train13 ing and retaining at least 140,000 new health 

14 care professionals and paraprofessionals with an 

15 emphasis on training and in country deploy16 ment of critically needed doctors and nurses and 

17 to strengthen capacities in developing countries, 

18 especially in sub-Saharan Africa, to deliver pri19 mary health care with the objective of helping 

20 countries achieve staffing levels of at least 2.3 

21 doctors, nurses, and midwives per 1,000 popu22 lation, as called for by the World Health Organi23 zation; 

24 ‘‘(5) include multisectoral approaches and spe25 cific strategies to treat individuals infected with HIV/ 
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1 AIDS and to prevent the further transmission of HIV 

2 infections, with a particular focus on the needs of 

3 families with children (including the prevention of 

4 mother-to-child transmission), women, young people, 

5 orphans, and vulnerable children; 

6 ‘‘(6) establish a timetable with annual global 

7 treatment targets with country-level benchmarks for 

8 antiretroviral treatment; 

9 ‘‘(7) expand the integration of timely and rel10 evant research within the prevention, care, and treat11 ment of HIV/AIDS; 

12 ‘‘(8) include a plan for program monitoring, op13 erations research, and impact evaluation and for the 

14 dissemination of a best practices report to highlight 

15 findings; 

16 ‘‘(9) support the in-country or intra-regional 

17 training, preferably through public-private partner18 ships, of scientific investigators, managers, and other 

19 staff who are capable of promoting the systematic up20 take of clinical research findings and other evidence21 based interventions into routine practice, with the 

22 goal of improving the quality, effectiveness, and local 

23 leadership of HIV/AIDS health care; 

24 ‘‘(10) expand and accelerate research on and de25 velopment of HIV/AIDS prevention methods for 
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1 women, including enhancing inter-agency collabora2 tion, staffing, and organizational infrastructure dedi3 cated to microbicide research; 

4 ‘‘(11) provide for consultation with local leaders 

5 and officials to develop prevention strategies and pro6 grams that are tailored to the unique needs of each 

7 country and community and targeted particularly to8 ward those most at risk of acquiring HIV infection; 

9 ‘‘(12) make the reduction of HIV/AIDS behav10 ioral risks a priority of all prevention efforts by— 

11 ‘‘(A) promoting abstinence from sexual ac12 tivity and encouraging monogamy and faithful13 ness; 

14 ‘‘(B) encouraging the correct and consistent 

15 use of male and female condoms and increasing 

16 the availability of, and access to, these commod17 ities; 

18 ‘‘(C) promoting the delay of sexual debut 

19 and the reduction of multiple concurrent sexual 

20 partners; 

21 ‘‘(D) promoting education for discordant 

22 couples (where an individual is infected with 

23 HIV and the other individual is uninfected or 

24 whose status is unknown) about safer sex prac25 tices; 
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1 ‘‘(E) promoting voluntary counseling and 

2 testing, addiction therapy, and other prevention 

3 and treatment tools for illicit injection drug 

4 users and other substance abusers; 

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

6 risks of procuring sex commercially and about 

7 the need to end violent behavior toward women 

8 and girls; 

9 ‘‘(G) supporting partner country and com10 munity efforts to identify and address social, 

11 economic, or cultural factors, such as migration, 

12 urbanization, conflict, gender-based violence, lack 

13 of empowerment for women, and transportation 

14 patterns, which directly contribute to the trans15 mission of HIV; 

16 ‘‘(H) supporting comprehensive programs to 

17 promote alternative livelihoods, safety, and social 

18 reintegration strategies for commercial sex work19 ers and their families; 

20 ‘‘(I) promoting cooperation with law en21 forcement to prosecute offenders of trafficking, 

22 rape, and sexual assault crimes with the goal of 

23 eliminating such crimes; and 
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1 ‘‘(J) working to eliminate rape, gender2 based violence, sexual assault, and the sexual ex3 ploitation of women and children; 

4 ‘‘(13) include programs to reduce the trans5 mission of HIV, particularly addressing the height6 ened vulnerabilities of women and girls to HIV in 

7 many countries; and 

8 ‘‘(14) support other important means of pre9 venting or reducing the transmission of HIV, includ10 ing— 

11 ‘‘(A) medical male circumcision; 

12 ‘‘(B) the maintenance of a safe blood sup13 ply; 

14 ‘‘(C) promoting universal precautions in 

15 formal and informal health care settings; 

16 ‘‘(D) educating the public to recognize and 

17 to avoid risks to contract HIV through blood ex18 posures during formal and informal health care 

19 and cosmetic services; 

20 ‘‘(E) investigating suspected nosocomial in21 fections to identify and stop further nosocomial 

22 transmission; and 

23 ‘‘(F) other mechanisms to reduce the trans24 mission of HIV; 
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1 ‘‘(15) increase support for prevention of mother2 to-child transmission; 

3 ‘‘(16) build capacity within the public health 

4 sector of developing countries by improving health 

5 systems and public health infrastructure and devel6 oping indicators to measure changes in broader pub7 lic health sector capabilities; 

8 ‘‘(17) increase the coordination of HIV/AIDS 

9 programs with development programs; 

10 ‘‘(18) provide a framework for expanding or de11 veloping existing or new country or regional pro12 grams, including— 

13 ‘‘(A) drafting compacts or other agreements, 

14 as appropriate; 

15 ‘‘(B) establishing criteria and objectives for 

16 such compacts and agreements; and 

17 ‘‘(C) promoting sustainability; 

18 ‘‘(19) provide a plan for national and regional 

19 priorities for resource distribution and a global in20 vestment plan by region; 

21 ‘‘(20) provide a plan to address the immediate 

22 and ongoing needs of women and girls, which— 

23 ‘‘(A) addresses the vulnerabilities that con24 tribute to their elevated risk of infection; 
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1 ‘‘(B) includes specific goals and targets to 

2 address these factors; 

3 ‘‘(C) provides clear guidance to field mis4 sions to integrate gender across prevention, care, 

5 and treatment programs; 

6 ‘‘(D) sets forth gender-specific indicators to 

7 monitor progress on outcomes and impacts of 

8 gender programs; 

9 ‘‘(E) supports efforts in countries in which 

10 women or orphans lack inheritance rights and 

11 other fundamental protections to promote the 

12 passage, implementation, and enforcement of 

13 such laws; 

14 ‘‘(F) supports life skills training, especially 

15 among women and girls, with the goal of reduc16 ing vulnerabilities to HIV/AIDS; 

17 ‘‘(G) addresses and prevents gender-based 

18 violence; and 

19 ‘‘(H) addresses the posttraumatic and psy20 chosocial consequences and provides postexposure 

21 prophylaxis protecting against HIV infection to 

22 victims of gender-based violence and rape; 

23 ‘‘(21) provide a plan to— 
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1 ‘‘(A) determine the local factors that may 

2 put men and boys at elevated risk of contracting 

3 or transmitting HIV; 

4 ‘‘(B) address male norms and behaviors to 

5 reduce these risks, including by reducing alcohol 

6 abuse; 

7 ‘‘(C) promote responsible male behavior; 

8 and 

9 ‘‘(D) promote male participation and lead10 ership at the community level in efforts to pro11 mote HIV prevention, reduce stigma, promote 

12 participation in voluntary counseling and test13 ing, and provide care, treatment, and support 

14 for persons with HIV/AIDS; 

15 ‘‘(22) provide a plan to address the 

16 vulnerabilities and needs of orphans and children who 

17 are vulnerable to, or affected by, HIV/AIDS; 

18 ‘‘(23) encourage partner countries to develop 

19 health care curricula and promote access to training 

20 tailored to individuals receiving services through, or 

21 exiting from, existing programs geared to orphans 

22 and vulnerable children; 

23 ‘‘(24) provide a framework to work with inter24 national actors and partner countries toward uni25 versal access to HIV/AIDS prevention, treatment, and 
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1 care programs, recognizing that prevention is of par2 ticular importance; 

3 ‘‘(25) enhance the coordination of United States 

4 bilateral efforts to combat global HIV/AIDS with 

5 other major public and private entities; 

6 ‘‘(26) enhance the attention given to the national 

7 strategic HIV/AIDS plans of countries receiving 

8 United States assistance by— 

9 ‘‘(A) reviewing the planning and pro10 grammatic decisions associated with that assist11 ance; and 

12 ‘‘(B) helping to strengthen such national 

13 strategies, if necessary; 

14 ‘‘(27) support activities described in the Global 

15 Plan to Stop TB, including— 

16 ‘‘(A) expanding and enhancing the coverage 

17 of the Directly Observed Treatment Short-course 

18 (DOTS) in order to treat individuals infected 

19 with tuberculosis and HIV, including multi-drug 

20 resistant or extensively drug resistant tuber21 culosis; and 

22 ‘‘(B) improving coordination and integra23 tion of HIV/AIDS and tuberculosis program24 ming; 
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1 ‘‘(28) ensure coordination between the Global 

2 AIDS Coordinator and the Malaria Coordinator and 

3 address issues of comorbidity between HIV/AIDS and 

4 malaria; and 

5 ‘‘(29) include a longer term estimate of the pro6 jected resource needs, progress toward greater sustain7 ability and country ownership of HIV/AIDS pro8 grams, and the anticipated role of the United States 

9 in the global effort to combat HIV/AIDS during the 

10 10-year period beginning on October 1, 2013.’’. 

11 (b) REPORT.—Section 101(b) of such Act (22 U.S.C. 

12 7611(b)) is amended to read as follows: 

13 ‘‘(b) REPORT.— 

14 ‘‘(1) IN GENERAL.—Not later than October 1, 

15 2009, the President shall submit a report to the ap16 propriate congressional committees that sets forth the 

17 strategy described in subsection (a). 

18 ‘‘(2) CONTENTS.—The report required under 

19 paragraph (1) shall include a discussion of the fol20 lowing elements: 

21 ‘‘(A) The purpose, scope, methodology, and 

22 general and specific objectives of the strategy. 

23 ‘‘(B) The problems, risks, and threats to the 

24 successful pursuit of the strategy. 
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1 ‘‘(C) The desired goals, objectives, activities, 

2 and outcome-related performance measures of the 

3 strategy. 

4 ‘‘(D) A description of future costs and re5 sources needed to carry out the strategy. 

6 ‘‘(E) A delineation of United States Govern7 ment roles, responsibility, and coordination 

8 mechanisms of the strategy. 

9 ‘‘(F) A description of the strategy— 

10 ‘‘(i) to promote harmonization of 

11 United States assistance with that of other 

12 international, national, and private actors 

13 as elucidated in the ‘Three Ones’; and 

14 ‘‘(ii) to address existing challenges in 

15 harmonization and alignment. 

16 ‘‘(G) A description of the manner in which 

17 the strategy will— 

18 ‘‘(i) further the development and im19 plementation of the national multisectoral 

20 strategic HIV/AIDS frameworks of partner 

21 governments; and 

22 ‘‘(ii) enhance the centrality, effective23 ness, and sustainability of those national 

24 plans. 
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1 ‘‘(H) A description of how the strategy will 

2 seek to achieve the specific targets described in 

3 subsection (a) and other targets, as appropriate. 

4 ‘‘(I) A description of, and rationale for, the 

5 timetable for annual global treatment targets 

6 with country-level estimates of numbers of per7 sons in need of antiretroviral treatment, coun8 try-level benchmarks for United States support 

9 for assistance for antiretroviral treatment, and 

10 numbers of persons enrolled in antiretroviral 

11 treatment programs receiving United States sup12 port. If global benchmarks are not achieved with13 in the reporting period, the report shall include 

14 a description of steps being taken to ensure that 

15 global benchmarks will be achieved and a de16 tailed breakdown and justification of spending 

17 priorities in countries in which benchmarks are 

18 not being met, including a description of other 

19 donor or national support for antiretroviral 

20 treatment in the country, if appropriate. 

21 ‘‘(J) A description of how operations re22 search is addressed in the strategy and how such 

23 research can most effectively be integrated into 

24 care, treatment, and prevention activities in 

25 order to— 
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1 ‘‘(i) improve program quality and effi2 ciency; 

3 ‘‘(ii) ascertain cost effectiveness; 

4 ‘‘(iii) ensure transparency and ac5 countability; 

6 ‘‘(iv) assess population-based impact; 

7 ‘‘(v) disseminate findings and best 

8 practices; and 

9 ‘‘(vi) optimize delivery of services. 

10 ‘‘(K) An analysis of United States-assisted 

11 strategies to prevent the transmission of HIV/ 

12 AIDS, including methodologies to promote absti13 nence, monogamy, faithfulness, the correct and 

14 consistent use of male and female condoms, re15 ductions in concurrent sexual partners, and 

16 delay of sexual debut, and of intended moni17 toring and evaluation approaches to measure the 

18 effectiveness of prevention programs and ensure 

19 that they are targeted to appropriate audiences. 

20 ‘‘(L) Within the analysis required under 

21 subparagraph (K), an examination of additional 

22 planned means of preventing the transmission of 

23 HIV including medical male circumcision, 

24 maintenance of a safe blood supply, public edu25 cation about risks to acquire HIV infection from 
29 

•HR 5501 EAS 

1 blood exposures, promotion of universal pre2 cautions, investigation of suspected nosocomial 

3 infections and other tools. 

4 ‘‘(M) A description of efforts to assist part5 ner country and community to identify and ad6 dress social, economic, or cultural factors, such 

7 as migration, urbanization, conflict, gender8 based violence, lack of empowerment for women, 

9 and transportation patterns, which directly con10 tribute to the transmission of HIV. 

11 ‘‘(N) A description of the specific targets, 

12 goals, and strategies developed to address the 

13 needs and vulnerabilities of women and girls to 

14 HIV/AIDS, including— 

15 ‘‘(i) activities directed toward men and 

16 boys; 

17 ‘‘(ii) activities to enhance educational, 

18 microfinance, and livelihood opportunities 

19 for women and girls; 

20 ‘‘(iii) activities to promote and protect 

21 the legal empowerment of women, girls, and 

22 orphans and vulnerable children; 

23 ‘‘(iv) programs targeted toward gender24 based violence and sexual coercion; 
30 

•HR 5501 EAS 

1 ‘‘(v) strategies to meet the particular 

2 needs of adolescents; 

3 ‘‘(vi) assistance for victims of rape, 

4 sexual abuse, assault, exploitation, and traf5 ficking; and 

6 ‘‘(vii) programs to prevent alcohol 

7 abuse. 

8 ‘‘(O) A description of strategies to address 

9 male norms and behaviors that contribute to the 

10 transmission of HIV, to promote responsible 

11 male behavior, and to promote male participa12 tion and leadership in HIV/AIDS prevention, 

13 care, treatment, and voluntary counseling and 

14 testing. 

15 ‘‘(P) A description of strategies— 

16 ‘‘(i) to address the needs of orphans 

17 and vulnerable children, including an anal18 ysis of— 

19 ‘‘(I) factors contributing to chil20 dren’s vulnerability to HIV/AIDS; and 

21 ‘‘(II) vulnerabilities caused by the 

22 impact of HIV/AIDS on children and 

23 their families; and 

24 ‘‘(ii) in areas of higher HIV/AIDS 

25 prevalence, to promote a community-based 
31 

•HR 5501 EAS 

1 approach to vulnerability, maximizing com2 munity input into determining which chil3 dren participate. 

4 ‘‘(Q) A description of capacity-building ef5 forts undertaken by countries themselves, includ6 ing adherents of the Abuja Declaration and an 

7 assessment of the impact of International Mone8 tary Fund macroeconomic and fiscal policies on 

9 national and donor investments in health. 

10 ‘‘(R) A description of the strategy to— 

11 ‘‘(i) strengthen capacity building with12 in the public health sector; 

13 ‘‘(ii) improve health care in those 

14 countries; 

15 ‘‘(iii) help countries to develop and im16 plement national health workforce strate17 gies; 

18 ‘‘(iv) strive to achieve goals in train19 ing, retaining, and effectively deploying 

20 health staff; 

21 ‘‘(v) promote the use of codes of con22 duct for ethical recruiting practices for 

23 health care workers; and 

24 ‘‘(vi) increase the sustainability of 

25 health programs. 
32 

•HR 5501 EAS 

1 ‘‘(S) A description of the criteria for selec2 tion, objectives, methodology, and structure of 

3 compacts or other framework agreements with 

4 countries or regional organizations, including— 

5 ‘‘(i) the role of civil society; 

6 ‘‘(ii) the degree of transparency; 

7 ‘‘(iii) benchmarks for success of such 

8 compacts or agreements; and 

9 ‘‘(iv) the relationship between such 

10 compacts or agreements and the national 

11 HIV/AIDS and public health strategies and 

12 commitments of partner countries. 

13 ‘‘(T) A strategy to better coordinate HIV/ 

14 AIDS assistance with nutrition and food assist15 ance programs. 

16 ‘‘(U) A description of transnational or re17 gional initiatives to combat regionalized 

18 epidemics in highly affected areas such as the 

19 Caribbean. 

20 ‘‘(V) A description of planned resource dis21 tribution and global investment by region. 

22 ‘‘(W) A description of coordination efforts 

23 in order to better implement the Stop TB Strat24 egy and to address the problem of coinfection of 

25 HIV/AIDS and tuberculosis and of projected 
33 

•HR 5501 EAS 

1 challenges or barriers to successful implementa2 tion. 

3 ‘‘(X) A description of coordination efforts to 

4 address malaria and comorbidity with malaria 

5 and HIV/AIDS.’’. 

6 (c) STUDY.—Section 101(c) of such Act (22 U.S.C. 

7 7611(c)) is amended to read as follows: 

8 ‘‘(c) STUDY OF PROGRESS TOWARD ACHIEVEMENT OF

9 POLICY OBJECTIVES.— 

10 ‘‘(1) DESIGN AND BUDGET PLAN FOR DATA EVAL11 UATION.—The Global AIDS Coordinator shall enter 

12 into a contract with the Institute of Medicine of the 

13 National Academies that provides that not later than 

14 18 months after the date of the enactment of the Tom 

15 Lantos and Henry J. Hyde United States Global 

16 Leadership Against HIV/AIDS, Tuberculosis, and 

17 Malaria Reauthorization Act of 2008, the Institute, in 

18 consultation with the Global AIDS Coordinator and 

19 other relevant parties representing the public and pri20 vate sector, shall provide the Global AIDS Coordi21 nator with a design plan and budget for the evalua22 tion and collection of baseline and subsequent data to 

23 address the elements set forth in paragraph (2)(B). 

24 The Global AIDS Coordinator shall submit the budget 
34 

•HR 5501 EAS 

1 and design plan to the appropriate congressional 

2 committees. 

3 ‘‘(2) STUDY.— 

4 ‘‘(A) IN GENERAL.—Not later than 4 years 

5 after the date of the enactment of the Tom Lan6 tos and Henry J. Hyde United States Global 

7 Leadership Against HIV/AIDS, Tuberculosis, 

8 and Malaria Reauthorization Act of 2008, the 

9 Institute of Medicine of the National Academies 

10 shall publish a study that includes— 

11 ‘‘(i) an assessment of the performance 

12 of United States-assisted global HIV/AIDS 

13 programs; and 

14 ‘‘(ii) an evaluation of the impact on 

15 health of prevention, treatment, and care ef16 forts that are supported by United States 

17 funding, including multilateral and bilat18 eral programs involving joint operations. 

19 ‘‘(B) CONTENT.—The study conducted 

20 under this paragraph shall include— 

21 ‘‘(i) an assessment of progress toward 

22 prevention, treatment, and care targets; 

23 ‘‘(ii) an assessment of the effects on 

24 health systems, including on the financing 
35 

•HR 5501 EAS 

1 and management of health systems and the 

2 quality of service delivery and staffing; 

3 ‘‘(iii) an assessment of efforts to ad4 dress gender-specific aspects of HIV/AIDS, 

5 including gender related constraints to ac6 cessing services and addressing underlying 

7 social and economic vulnerabilities of 

8 women and men; 

9 ‘‘(iv) an evaluation of the impact of 

10 treatment and care programs on 5-year sur11 vival rates, drug adherence, and the emer12 gence of drug resistance; 

13 ‘‘(v) an evaluation of the impact of 

14 prevention programs on HIV incidence in 

15 relevant population groups; 

16 ‘‘(vi) an evaluation of the impact on 

17 child health and welfare of interventions au18 thorized under this Act on behalf of orphans 

19 and vulnerable children; 

20 ‘‘(vii) an evaluation of the impact of 

21 programs and activities authorized in this 

22 Act on child mortality; and 

23 ‘‘(viii) recommendations for improving 

24 the programs referred to in subparagraph 

25 (A)(i). 
36 

•HR 5501 EAS 

1 ‘‘(C) METHODOLOGIES.—Assessments and 

2 impact evaluations conducted under the study 

3 shall utilize sound statistical methods and tech4 niques for the behavioral sciences, including ran5 dom assignment methodologies as feasible. Quali6 tative data on process variables should be used 

7 for assessments and impact evaluations, wherever 

8 possible. 

9 ‘‘(3) CONTRACT AUTHORITY.—The Institute of 

10 Medicine may enter into contracts or cooperative 

11 agreements or award grants to conduct the study 

12 under paragraph (2). 

13 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

14 There are authorized to be appropriated such sums as 

15 may be necessary to carry out the study under this 

16 subsection.’’. 

17 (d) REPORT.—Section 101 of such Act, as amended by 

18 this section, is further amended by adding at the end the 

19 following: 

20 ‘‘(d) COMPTROLLER GENERAL REPORT.— 

21 ‘‘(1) REPORT REQUIRED.—Not later than 3 

22 years after the date of the enactment of the Tom Lan23 tos and Henry J. Hyde United States Global Leader24 ship Against HIV/AIDS, Tuberculosis, and Malaria 

25 Reauthorization Act of 2008, the Comptroller General 
37 

•HR 5501 EAS 

1 of the United States shall submit a report on the glob2 al HIV/AIDS programs of the United States to the 

3 appropriate congressional committees. 

4 ‘‘(2) CONTENTS.—The report required under 

5 paragraph (1) shall include— 

6 ‘‘(A) a description and assessment of the 

7 monitoring and evaluation practices and policies 

8 in place for these programs; 

9 ‘‘(B) an assessment of coordination within 

10 Federal agencies involved in these programs, ex11 amining both internal coordination within these 

12 programs and integration with the larger global 

13 health and development agenda of the United 

14 States; 

15 ‘‘(C) an assessment of procurement policies 

16 and practices within these programs; 

17 ‘‘(D) an assessment of harmonization with 

18 national government HIV/AIDS and public 

19 health strategies as well as other international 

20 efforts; 

21 ‘‘(E) an assessment of the impact of global 

22 HIV/AIDS funding and programs on other 

23 United States global health programming; and 

24 ‘‘(F) recommendations for improving the 

25 global HIV/AIDS programs of the United States. 
38 

•HR 5501 EAS 

1 ‘‘(e) BEST PRACTICES REPORT.— 

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

3 the date of the enactment of the Tom Lantos and 

4 Henry J. Hyde United States Global Leadership 

5 Against HIV/AIDS, Tuberculosis, and Malaria Reau6 thorization Act of 2008, and annually thereafter, the 

7 Global AIDS Coordinator shall publish a best prac8 tices report that highlights the programs receiving fi9 nancial assistance from the United States that have 

10 the potential for replication or adaption, particularly 

11 at a low cost, across global AIDS programs, including 

12 those that focus on both generalized and localized 

13 epidemics. 

14 ‘‘(2) DISSEMINATION OF FINDINGS.— 

15 ‘‘(A) PUBLICATION ON INTERNET

16 WEBSITE.—The Global AIDS Coordinator shall 

17 disseminate the full findings of the annual best 

18 practices report on the Internet website of the Of19 fice of the Global AIDS Coordinator. 

20 ‘‘(B) DISSEMINATION GUIDANCE.—The 

21 Global AIDS Coordinator shall develop guidance 

22 to ensure timely submission and dissemination 

23 of significant information regarding best prac24 tices with respect to global AIDS programs. 

25 ‘‘(f) INSPECTORS GENERAL.— 
39 

•HR 5501 EAS 

1 ‘‘(1) OVERSIGHT PLAN.— 

2 ‘‘(A) DEVELOPMENT.—The Inspectors Gen3 eral of the Department of State and Broad4 casting Board of Governors, the Department of 

5 Health and Human Services, and the United 

6 States Agency for International Development 

7 shall jointly develop 5 coordinated annual plans 

8 for oversight activity in each of the fiscal years 

9 2009 through 2013, with regard to the programs 

10 authorized under this Act and sections 104A, 

11 104B, and 104C of the Foreign Assistance Act of 

12 1961 (22 U.S.C. 2151b–2, 2151b–3, and 2151b– 

13 4). 

14 ‘‘(B) CONTENTS.—The plans developed 

15 under subparagraph (A) shall include a schedule 

16 for financial audits, inspections, and perform17 ance reviews, as appropriate. 

18 ‘‘(C) DEADLINE.— 

19 ‘‘(i) INITIAL PLAN.—The first plan de20 veloped under subparagraph (A) shall be 

21 completed not later than the later of— 

22 ‘‘(I) September 1, 2008; or 

23 ‘‘(II) 60 days after the date of the 

24 enactment of the Tom Lantos and 

25 Henry J. Hyde United States Global 
40 

•HR 5501 EAS 

1 Leadership Against HIV/AIDS, Tuber2 culosis, and Malaria Reauthorization 

3 Act of 2008. 

4 ‘‘(ii) SUBSEQUENT PLANS.—Each of 

5 the last four plans developed under subpara6 graph (A) shall be completed not later than 

7 30 days before each of the fiscal years 2010 

8 through 2013, respectively. 

9 ‘‘(2) COORDINATION.—In order to avoid duplica10 tion and maximize efficiency, the Inspectors General 

11 described in paragraph (1) shall coordinate their ac12 tivities with— 

13 ‘‘(A) the Government Accountability Office; 

14 and 

15 ‘‘(B) the Inspectors General of the Depart16 ment of Commerce, the Department of Defense, 

17 the Department of Labor, and the Peace Corps, 

18 as appropriate, pursuant to the 2004 Memo19 randum of Agreement Coordinating Audit Cov20 erage of Programs and Activities Implementing 

21 the President’s Emergency Plan for AIDS Relief, 

22 or any successor agreement. 

23 ‘‘(3) FUNDING.—The Global AIDS Coordinator 

24 and the Coordinator of the United States Government 

25 Activities to Combat Malaria Globally shall make 
41 

•HR 5501 EAS 

1 available necessary funds not exceeding $15,000,000 

2 during the 5-year period beginning on October 1, 

3 2008 to the Inspectors General described in para4 graph (1) for the audits, inspections, and reviews de5 scribed in that paragraph.’’. 

6 (e) ANNUAL STUDY; MESSAGE.—Section 101 of such 

7 Act, as amended by this section, is further amended by add8 ing at the end the following: 

9 ‘‘(g) ANNUAL STUDY.— 

10 ‘‘(1) IN GENERAL.—Not later than September 30, 

11 2009, and annually thereafter through September 30, 

12 2013, the Global AIDS Coordinator shall complete a 

13 study of treatment providers that— 

14 ‘‘(A) represents a range of countries and 

15 service environments; 

16 ‘‘(B) estimates the per-patient cost of 

17 antiretroviral HIV/AIDS treatment and the care 

18 of people with HIV/AIDS not receiving 

19 antiretroviral treatment, including a comparison 

20 of the costs for equivalent services provided by 

21 programs not receiving assistance under this Act; 

22 ‘‘(C) estimates per-patient costs across the 

23 program and in specific categories of service pro24 viders, including— 

25 ‘‘(i) urban and rural providers; 
42 

•HR 5501 EAS 

1 ‘‘(ii) country-specific providers; and 

2 ‘‘(iii) other subcategories, as appro3 priate. 

4 ‘‘(2) PUBLICATION.—Not later than 90 days 

5 after the completion of each study under paragraph 

6 (1), the Global AIDS Coordinator shall make the re7 sults of such study available on a publicly accessible 

8 Web site. 

9 ‘‘(h) MESSAGE.—The Global AIDS Coordinator shall 

10 develop a message, to be prominently displayed by each pro11 gram receiving funds under this Act, that— 

12 ‘‘(1) demonstrates that the program is a commit13 ment by citizens of the United States to the global 

14 fight against HIV/AIDS, tuberculosis, and malaria; 

15 and 

16 ‘‘(2) enhances awareness by program recipients 

17 that the program is an effort on behalf of the citizens 

18 of the United States.’’. 

19 SEC. 102. INTERAGENCY WORKING GROUP. 

20 Section 1(f)(2) of the State Department Basic Authori21 ties Act of 1956 (22 U.S.C. 2651a(f)(2)) is amended— 

22 (1) in subparagraph (A), by inserting ‘‘, partner 

23 country finance, health, and other relevant min24 istries,’’ after ‘‘community based organizations)’’ each 

25 place it appears; 
43 

•HR 5501 EAS 

1 (2) in subparagraph (B)(ii)— 

2 (A) by striking subclauses (IV) and (V); 

3 (B) by inserting after subclause (III) the 

4 following: 

5 ‘‘(IV) Establishing an interagency 

6 working group on HIV/AIDS headed 

7 by the Global AIDS Coordinator and 

8 comprised of representatives from the 

9 United States Agency for International 

10 Development and the Department of 

11 Health and Human Services, for the 

12 purposes of coordination of activities 

13 relating to HIV/AIDS, including— 

14 ‘‘(aa) meeting regularly to 

15 review progress in partner coun16 tries toward HIV/AIDS preven17 tion, treatment, and care objec18 tives; 

19 ‘‘(bb) participating in the 

20 process of identifying countries to 

21 consider for increased assistance 

22 based on the epidemiology of HIV/ 

23 AIDS in those countries, includ24 ing clear evidence of a public 

25 health threat, as well as govern-
44 

•HR 5501 EAS 

1 ment commitment to address the 

2 HIV/AIDS problem, relative need, 

3 and coordination and joint plan4 ning with other significant actors; 

5 ‘‘(cc) assisting the Coordi6 nator in the evaluation, execution, 

7 and oversight of country oper8 ational plans; 

9 ‘‘(dd) reviewing policies that 

10 may be obstacles to reaching tar11 gets set forth for HIV/AIDS pre12 vention, treatment, and care; and 

13 ‘‘(ee) consulting with rep14 resentatives from additional rel15 evant agencies, including the Na16 tional Institutes of Health, the 

17 Health Resources and Services 

18 Administration, the Department 

19 of Labor, the Department of Agri20 culture, the Millennium Challenge 

21 Corporation, the Peace Corps, and 

22 the Department of Defense. 

23 ‘‘(V) Coordinating overall United 

24 States HIV/AIDS policy and pro25 grams, including ensuring the coordi-
45 

•HR 5501 EAS 

1 nation of relevant executive branch 

2 agency activities in the field, with ef3 forts led by partner countries, and 

4 with the assistance provided by other 

5 relevant bilateral and multilateral aid 

6 agencies and other donor institutions 

7 to promote harmonization with other 

8 programs aimed at preventing and 

9 treating HIV/AIDS and other health 

10 challenges, improving primary health, 

11 addressing food security, promoting 

12 education and development, and 

13 strengthening health care systems.’’; 

14 (C) by redesignating subclauses (VII) and 

15 VIII) as subclauses (IX) and (XII), respectively; 

16 (D) by inserting after subclause (VI) the fol17 lowing: 

18 ‘‘(VII) Holding annual consulta19 tions with nongovernmental organiza20 tions in partner countries that provide 

21 services to improve health, and advo22 cating on behalf of the individuals 

23 with HIV/AIDS and those at par24 ticular risk of contracting HIV/AIDS, 
46 

•HR 5501 EAS 

1 including organizations with members 

2 who are living with HIV/AIDS. 

3 ‘‘(VIII) Ensuring, through inter4 agency and international coordination, 

5 that HIV/AIDS programs of the 

6 United States are coordinated with, 

7 and complementary to, the delivery of 

8 related global health, food security, de9 velopment, and education.’’; 

10 (E) in subclause (IX), as redesignated by 

11 subparagraph (C)— 

12 (i) by inserting ‘‘Vietnam,’’ after 

13 ‘‘Uganda,’’; 

14 (ii) by inserting after ‘‘of 2003’’ the 

15 following: ‘‘and other countries in which the 

16 United States is implementing HIV/AIDS 

17 programs as part of its foreign assistance 

18 program’’; and 

19 (iii) by adding at the end the fol20 lowing: ‘‘In designating additional coun21 tries under this subparagraph, the President 

22 shall give priority to those countries in 

23 which there is a high prevalence of HIV or 

24 risk of significantly increasing incidence of 

25 HIV within the general population and in-
47 

•HR 5501 EAS 

1 adequate financial means within the coun2 try.’’; 

3 (F) by inserting after subclause (IX), as re4 designated by subparagraph (C), the following: 

5 ‘‘(X) Working with partner coun6 tries in which the HIV/AIDS epidemic 

7 is prevalent among injection drug 

8 users to establish, as a national pri9 ority, national HIV/AIDS prevention 

10 programs. 

11 ‘‘(XI) Working with partner coun12 tries in which the HIV/AIDS epidemic 

13 is prevalent among individuals in14 volved in commercial sex acts to estab15 lish, as a national priority, national 

16 prevention programs, including edu17 cation, voluntary testing, and coun18 seling, and referral systems that link 

19 HIV/AIDS programs with programs to 

20 eradicate trafficking in persons and 

21 support alternatives to prostitution.’’; 

22 (G) in subclause (XII), as redesignated by 

23 subparagraph (C), by striking ‘‘funds section’’ 

24 and inserting ‘‘funds appropriated for HIV/ 

25 AIDS assistance pursuant to the authorization of 
48 

•HR 5501 EAS 

1 appropriations under section 401 of the United 

2 States Leadership Against HIV/AIDS, Tuber3 culosis, and Malaria Act of 2003 (22 U.S.C. 

4 7671)’’; and 

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

6 ‘‘(XIII) Publicizing updated drug 

7 pricing data to inform the purchasing 

8 decisions of pharmaceutical procure9 ment partners.’’. 

10 SEC. 103. SENSE OF CONGRESS. 

11 Section 102 of the United States Leadership Against 

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

13 U.S.C. 7612) is amended by adding at the end the following: 

14 ‘‘(d) SENSE OF CONGRESS.—It is the sense of Congress 

15 that— 

16 ‘‘(1) full-time country level coordinators, pref17 erably with management experience, should head each 

18 HIV/AIDS country team for United States missions 

19 overseeing significant HIV/AIDS programs; 

20 ‘‘(2) foreign service nationals provide critically 

21 important services in the design and implementation 

22 of United States country-level HIV/AIDS programs 

23 and their skills and experience as public health pro24 fessionals should be recognized within hiring and 

25 compensation practices; and 
49 

•HR 5501 EAS 

1 ‘‘(3) staffing levels for United States country2 level HIV/AIDS teams should be adequately main3 tained to fulfill oversight and other obligations of the 

4 positions.’’. 

5 TITLE II—SUPPORT FOR MULTI6 LATERAL FUNDS, PROGRAMS, 

7 AND PUBLIC-PRIVATE PART8 NERSHIPS 

9 SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL 

10 VACCINE FUNDS. 

11 Section 302 of the Foreign Assistance Act of 1961 (22 

12 U.S.C. 2222) is amended— 

13 (1) by inserting after subsection (c) the fol14 lowing: 

15 ‘‘(d) TUBERCULOSIS VACCINE DEVELOPMENT PRO16 GRAMS.—In addition to amounts otherwise available under 

17 this section, there are authorized to be appropriated to the 

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

19 fiscal years 2009 through 2013, which shall be used for 

20 United States contributions to tuberculosis vaccine develop21 ment programs, which may include the Aeras Global TB 

22 Vaccine Foundation.’’; 

23 (2) in subsection (k)— 
50 

•HR 5501 EAS 

1 (A) by striking ‘‘fiscal years 2004 through 

2 2008’’ and inserting ‘‘fiscal years 2009 through 

3 2013’’; and 

4 (B) by striking ‘‘Vaccine Fund’’ and insert5 ing ‘‘GAVI Fund’’. 

6 (3) in subsection (l), by striking ‘‘fiscal years 

7 2004 through 2008’’ and inserting ‘‘fiscal years 2009 

8 through 2013’’; and 

9 (4) in subsection (m), by striking ‘‘fiscal years 

10 2004 through 2008’’ and inserting ‘‘fiscal years 2009 

11 through 2013’’. 

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

13 AIDS, TUBERCULOSIS AND MALARIA. 

14 (a) FINDINGS; SENSE OF CONGRESS.—Section 202(a) 

15 of the United States Leadership Against HIV/AIDS, Tuber16 culosis, and Malaria Act of 2003 (22 U.S.C. 7622(a)) is 

17 amended to read as follows: 

18 ‘‘(a) FINDINGS; SENSE OF CONGRESS.— 

19 ‘‘(1) FINDINGS.—Congress makes the following 

20 findings: 

21 ‘‘(A) The establishment of the Global Fund 

22 in January 2002 is consistent with the general 

23 principles for an international AIDS trust fund 

24 first outlined by Congress in the Global AIDS 
51 

•HR 5501 EAS 

1 and Tuberculosis Relief Act of 2000 (Public Law 

2 106–264). 

3 ‘‘(B) The Global Fund is an innovative fi4 nancing mechanism which— 

5 ‘‘(i) has made progress in many areas 

6 in combating HIV/AIDS, tuberculosis, and 

7 malaria; and 

8 ‘‘(ii) represents the multilateral compo9 nent of this Act, extending United States ef10 forts to more than 130 countries around the 

11 world. 

12 ‘‘(C) The Global Fund and United States 

13 bilateral assistance programs— 

14 ‘‘(i) are demonstrating increasingly ef15 fective coordination, with each possessing 

16 certain comparative advantages in the fight 

17 against HIV/AIDS, tuberculosis, and ma18 laria; and 

19 ‘‘(ii) often work most effectively in con20 cert with each other. 

21 ‘‘(D) The United States Government— 

22 ‘‘(i) is the largest supporter of the 

23 Global Fund in terms of resources and tech24 nical support; 
52 

•HR 5501 EAS 

1 ‘‘(ii) made the founding contribution 

2 to the Global Fund; and 

3 ‘‘(iii) is fully committed to the success 

4 of the Global Fund as a multilateral public5 private partnership. 

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

7 Congress that— 

8 ‘‘(A) transparency and accountability are 

9 crucial to the long-term success and viability of 

10 the Global Fund; 

11 ‘‘(B) the Global Fund has made significant 

12 progress toward addressing concerns raised by 

13 the Government Accountability Office by— 

14 ‘‘(i) improving risk assessment and 

15 risk management capabilities; 

16 ‘‘(ii) providing clearer guidance for 

17 and oversight of Local Fund Agents; and 

18 ‘‘(iii) strengthening the Office of the 

19 Inspector General for the Global Fund; 

20 ‘‘(C) the provision of sufficient resources 

21 and authority to the Office of the Inspector Gen22 eral for the Global Fund to ensure that office has 

23 the staff and independence necessary to carry out 

24 its mandate will be a measure of the commit-
53 

•HR 5501 EAS 

1 ment of the Global Fund to transparency and 

2 accountability; 

3 ‘‘(D) regular, publicly published financial, 

4 programmatic, and reporting audits of the Fund, 

5 its grantees, and Local Fund Agents are also im6 portant benchmarks of transparency; 

7 ‘‘(E) the Global Fund should establish and 

8 maintain a system to track— 

9 ‘‘(i) the amount of funds disbursed to 

10 each subrecipient on the grant’s fiscal cycle; 

11 and 

12 ‘‘(ii) the distribution of resources, by 

13 grant and principal recipient, for preven14 tion, care, treatment, drug and commodity 

15 purchases, and other purposes; 

16 ‘‘(F) relevant national authorities in recipi17 ent countries should exempt from duties and 

18 taxes all products financed by Global Fund 

19 grants and procured by any principal recipient 

20 or subrecipient for the purpose of carrying out 

21 such grants; 

22 ‘‘(G) the Global Fund, UNAIDS, and the 

23 Global AIDS Coordinator should work together 

24 to standardize program indicators wherever pos25 sible; 
54 

•HR 5501 EAS 

1 ‘‘(H) for purposes of evaluating total 

2 amounts of funds contributed to the Global Fund 

3 under subsection (d)(4)(A)(i), the timetable for 

4 evaluations of contributions from sources other 

5 than the United States should take into account 

6 the fiscal calendars of other major contributors; 

7 and 

8 ‘‘(I) the Global Fund should not support ac9 tivities involving the ‘Affordable Medicines Facil10 ity-Malaria’ or similar entities pending compel11 ling evidence of success from pilot programs as 

12 evaluated by the Coordinator of United States 

13 Government Activities to Combat Malaria Glob14 ally.’’. 

15 (b) STATEMENT OF POLICY.—Section 202(b) of such 

16 Act is amended by adding at the end the following: 

17 ‘‘(3) STATEMENT OF POLICY.—The United States 

18 Government regards the imposition by recipient coun19 tries of taxes or tariffs on goods or services provided 

20 by the Global Fund, which are supported through 

21 public and private donations, including the substan22 tial contribution of the American people, as inappro23 priate and inconsistent with standards of good gov24 ernance. The Global AIDS Coordinator or other rep25 resentatives of the United States Government shall 
55 

•HR 5501 EAS 

1 work with the Global Fund to dissuade governments 

2 from imposing such duties, tariffs, or taxes.’’. 

3 (c) UNITED STATES FINANCIAL PARTICIPATION.—Sec4 tion 202(d) of such Act (22 U.S.C. 7622(d)) is amended— 

5 (1) in paragraph (1)— 

6 (A) by striking ‘‘$1,000,000,000 for the pe7 riod of fiscal year 2004 beginning on January 1, 

8 2004’’ and inserting ‘‘$2,000,000,000 for fiscal 

9 year 2009,’’; and 

10 (B) by striking ‘‘the fiscal years 2005– 

11 2008’’ and inserting ‘‘each of the fiscal years 

12 2010 through 2013’’; 

13 (2) in paragraph (4)— 

14 (A) in subparagraph (A)— 

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

16 years 2004 through 2008’’ and inserting 

17 ‘‘fiscal years 2009 through 2013’’; 

18 (ii) in clause (ii)— 

19 (I) by striking ‘‘during any of the 

20 fiscal years 2004 through 2008’’ and 

21 inserting ‘‘during any of the fiscal 

22 years 2009 through 2013’’; and 

23 (II) by adding at the end the fol24 lowing: ‘‘The President may waive the 

25 application of this clause with respect 
56 

•HR 5501 EAS 

1 to assistance for Sudan that is overseen 

2 by the Southern Country Coordinating 

3 Mechanism, including Southern 

4 Sudan, Southern Kordofan, Blue Nile 

5 State, and Abyei, if the President de6 termines that the national interest or 

7 humanitarian reasons justify such a 

8 waiver. The President shall publish 

9 each waiver of this clause in the Fed10 eral Register and, not later than 15 

11 days before the waiver takes effect, 

12 shall consult with the Committee on 

13 Foreign Relations of the Senate and 

14 the Committee on Foreign Affairs of 

15 the House of Representatives regarding 

16 the proposed waiver.’’; and 

17 (iii) in clause (vi)— 

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

19 and inserting ‘‘For the purposes’’; 

20 (II) by striking ‘‘fiscal years 2004 

21 through 2008’’ and inserting ‘‘fiscal 

22 years 2009 through 2013’’; and 

23 (III) by striking ‘‘prior to fiscal 

24 year 2004’’ and inserting ‘‘before fiscal 

25 year 2009’’; 
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1 (B) in subparagraph (B)(iv), by striking 

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

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

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

5 ‘‘Committee on International Relations’’ and in6 serting ‘‘Committee on Foreign Affairs’’; and 

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

8 ‘‘(5) WITHHOLDING FUNDS.—Notwithstanding 

9 any other provision of this Act, 20 percent of the 

10 amounts appropriated pursuant to this Act for a con11 tribution to support the Global Fund for each of the 

12 fiscal years 2010 through 2013 shall be withheld from 

13 obligation to the Global Fund until the Secretary of 

14 State certifies to the appropriate congressional com15 mittees that the Global Fund— 

16 ‘‘(A) has established an evaluation frame17 work for the performance of Local Fund Agents 

18 (referred to in this paragraph as ‘LFAs’); 

19 ‘‘(B) is undertaking a systematic assessment 

20 of the performance of LFAs; 

21 ‘‘(C) has adopted, and is implementing, a 

22 policy to publish on a publicly available Web 

23 site— 

24 ‘‘(i) grant performance reviews; 
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1 ‘‘(ii) all reports of the Inspector Gen2 eral of the Global Fund, in a manner that 

3 is consistent with the Policy for Disclosure 

4 of Reports of the Inspector General, ap5 proved at the 16th Meeting of the Board of 

6 the Global Fund; 

7 ‘‘(iii) decision points of the Board of 

8 the Global Fund; 

9 ‘‘(iv) reports from Board committees to 

10 the Board; and 

11 ‘‘(v) a regular collection and analysis 

12 of performance data and funding of grants 

13 of the Global Fund, which shall cover all 

14 principal recipients and all subrecipients; 

15 ‘‘(D) is maintaining an independent, well16 staffed Office of the Inspector General that— 

17 ‘‘(i) reports directly to the Board of the 

18 Global Fund; and 

19 ‘‘(ii) compiles regular, publicly pub20 lished audits of financial, programmatic, 

21 and reporting aspects of the Global Fund, 

22 its grantees, and LFAs; 

23 ‘‘(E) has established, and is reporting pub24 licly on, standard indicators for all program 

25 areas; 
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1 ‘‘(F) has established a methodology to track 

2 and is publicly reporting on— 

3 ‘‘(i) all subrecipients and the amount 

4 of funds disbursed to each subrecipient on 

5 the grant’s fiscal cycle; and 

6 ‘‘(ii) the distribution of resources, by 

7 grant and principal recipient, for preven8 tion, care, treatment, drugs and commod9 ities purchase, and other purposes; 

10 ‘‘(G) has established a policy on tariffs im11 posed by national governments on all goods and 

12 services financed by the Global Fund; 

13 ‘‘(H) through its Secretariat, has taken 

14 meaningful steps to prevent national authorities 

15 in recipient countries from imposing taxes or 

16 tariffs on goods or services provided by the Fund; 

17 ‘‘(I) is maintaining its status as a financ18 ing institution focused on programs directly re19 lated to HIV/AIDS, malaria, and tuberculosis; 

20 ‘‘(J) is maintaining and making progress 

21 on— 

22 ‘‘(i) sustaining its multisectoral ap23 proach, through country coordinating mech24 anisms; and 
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1 ‘‘(ii) the implementation of grants, as 

2 reflected in the proportion of resources allo3 cated to different sectors, including govern4 ments, civil society, and faith- and commu5 nity-based organizations; and 

6 ‘‘(K) has established procedures providing 

7 access by the Office of Inspector General of the 

8 Department of State and Broadcasting Board of 

9 Governors, as cognizant Inspector General, and 

10 the Inspector General of the Health and Human 

11 Services and the Inspector General of the United 

12 States Agency for International Development, to 

13 Global Fund financial data, and other informa14 tion relevant to United States contributions (as 

15 determined by the Inspector General in consulta16 tion with the Global AIDS Coordinator). 

17 ‘‘(6) SUMMARIES OF BOARD DECISIONS AND

18 UNITED STATES POSITIONS.—Following each meeting 

19 of the Board of the Global Fund, the Coordinator of 

20 United States Government Activities to Combat HIV/ 

21 AIDS Globally shall report on the public website of 

22 the Coordinator a summary of Board decisions and 

23 how the United States Government voted and its posi24 tions on such decisions.’’. 
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1 SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PRE2 VENT TRANSMISSION OF HIV AND OTHER DIS3 EASES. 

4 (a) SENSE OF CONGRESS.—Congress recognizes the 

5 need and urgency to expand the range of interventions for 

6 preventing the transmission of human immunodeficiency 

7 virus (HIV), including nonvaccine prevention methods that 

8 can be controlled by women. 

9 (b) NIH OFFICE OF AIDS RESEARCH.—Subpart 1 of 

10 part D of title XXIII of the Public Health Service Act (42 

11 U.S.C. 300cc–40 et seq.) is amended by inserting after sec12 tion 2351 the following: 

13 ‘‘SEC. 2351A. MICROBICIDE RESEARCH. 

14 ‘‘(a) FEDERAL STRATEGIC PLAN.—The Director of the 

15 Office shall— 

16 ‘‘(1) expedite the implementation of the Federal 

17 strategic plans required by section 403(a) of the Pub18 lic Health Service Act (42 U.S.C. 283(a)(5)) regard19 ing the conduct and support of research on, and de20 velopment of, a microbicide to prevent the trans21 mission of the human immunodeficiency virus; and 

22 ‘‘(2) review and, as appropriate, revise such plan 

23 to prioritize funding and activities relative to their 

24 scientific urgency and potential market readiness. 

25 ‘‘(b) COORDINATION.—In implementing, reviewing, 

26 and prioritizing elements of the plan described in subsection 
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•HR 5501 EAS 

1 (a), the Director of the Office shall consult, as appropriate, 

2 with— 

3 ‘‘(1) representatives of other Federal agencies in4 volved in microbicide research, including the Coordi5 nator of United States Government Activities to Com6 bat HIV/AIDS Globally, the Director of the Centers 

7 for Disease Control and Prevention, and the Adminis8 trator of the United States Agency for International 

9 Development; 

10 ‘‘(2) the microbicide research and development 

11 community; and 

12 ‘‘(3) health advocates.’’. 

13 (c) NATIONAL INSTITUTE OF ALLERGY AND INFEC14 TIOUS DISEASES.—Subpart 6 of part C of title IV of the 

15 Public Health Service Act (42 U.S.C. 285f et seq.) is amend16 ed by adding at the end the following: 

17 ‘‘SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT. 

18 ‘‘The Director of the Institute, acting through the head 

19 of the Division of AIDS, shall, consistent with the peer-re20 view process of the National Institutes of Health, carry out 

21 research on, and development of, safe and effective methods 

22 for use by women to prevent the transmission of the human 

23 immunodeficiency virus, which may include microbicides.’’. 
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1 (d) CDC.—Part B of title III of the Public Health 

2 Service Act (42 U.S.C. 243 et seq.) is amended by inserting 

3 after section 317S the following: 

4 ‘‘SEC. 317T. MICROBICIDE RESEARCH. 

5 ‘‘(a) IN GENERAL.—The Director of the Centers for 

6 Disease Control and Prevention is strongly encouraged to 

7 fully implement the Centers’ microbicide agenda to support 

8 research and development of microbicides for use to prevent 

9 the transmission of the human immunodeficiency virus. 

10 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated such sums as may be nec12 essary for each of fiscal years 2009 through 2013 to carry 

13 out this section.’’. 

14 (e) UNITED STATES AGENCY FOR INTERNATIONAL DE15 VELOPMENT.— 

16 (1) IN GENERAL.—The Administrator of the 

17 United States Agency for International Development, 

18 in coordination with the Coordinator of United States 

19 Government Activities to Combat HIV/AIDS Glob20 ally, may facilitate availability and accessibility of 

21 microbicides, provided that such pharmaceuticals are 

22 approved, tentatively approved, or otherwise author23 ized for use by— 

24 (A) the Food and Drug Administration; 
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•HR 5501 EAS 

1 (B) a stringent regulatory agency acceptable 

2 to the Secretary of Health and Human Services; 

3 or 

4 (C) a quality assurance mechanism accept5 able to the Secretary of Health and Human 

6 Services. 

7 (2) AUTHORIZATION OF APPROPRIATIONS.—Of 

8 the amounts authorized to be appropriated under sec9 tion 401 of the United States Leadership Against 

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

11 (22 U.S.C. 7671) for HIV/AIDS assistance, there are 

12 authorized to be appropriated to the President such 

13 sums as may be necessary for each of the fiscal years 

14 2009 through 2013 to carry out this subsection. 

15 SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MA16 LARIA BY STRENGTHENING HEALTH POLI17 CIES AND HEALTH SYSTEMS OF PARTNER 

18 COUNTRIES. 

19 (a) IN GENERAL.—Title II of the United States Lead20 ership Against HIV/AIDS, Tuberculosis, and Malaria Act 

21 of 2003 (22 U.S.C. 7621) is amended by adding at the end 

22 the following: 
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1 ‘‘SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MA2 LARIA BY STRENGTHENING HEALTH POLI3 CIES AND HEALTH SYSTEMS OF PARTNER 

4 COUNTRIES. 

5 ‘‘(a) STATEMENT OF POLICY.—It shall be the policy 

6 of the United States Government— 

7 ‘‘(1) to invest appropriate resources authorized 

8 under this Act— 

9 ‘‘(A) to carry out activities to strengthen 

10 HIV/AIDS, tuberculosis, and malaria health 

11 policies and health systems; and 

12 ‘‘(B) to provide workforce training and ca13 pacity-building consistent with the goals and ob14 jectives of this Act; and 

15 ‘‘(2) to support the development of a sound pol16 icy environment in partner countries to increase the 

17 ability of such countries— 

18 ‘‘(A) to maximize utilization of health care 

19 resources from donor countries; 

20 ‘‘(B) to increase national investments in 

21 health and education and maximize the effective22 ness of such investments; 

23 ‘‘(C) to improve national HIV/AIDS, tuber24 culosis, and malaria strategies; 

25 ‘‘(D) to deliver evidence-based services in an 

26 effective and efficient manner; and 
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1 ‘‘(E) to reduce barriers that prevent recipi2 ents of services from achieving maximum benefit 

3 from such services. 

4 ‘‘(b) ASSISTANCE TO IMPROVE PUBLIC FINANCE MAN5 AGEMENT SYSTEMS.— 

6 ‘‘(1) IN GENERAL.—Consistent with the author7 ity under section 129 of the Foreign Assistance Act of 

8 1961 (22 U.S.C. 2152), the Secretary of the Treasury, 

9 acting through the head of the Office of Technical As10 sistance, is authorized to provide assistance for advi11 sors and partner country finance, health, and other 

12 relevant ministries to improve the effectiveness of pub13 lic finance management systems in partner countries 

14 to enable such countries to receive funding to carry 

15 out programs to combat HIV/AIDS, tuberculosis, and 

16 malaria and to manage such programs. 

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

18 the amounts authorized to be appropriated under sec19 tion 401 for HIV/AIDS assistance, there are author20 ized to be appropriated to the Secretary of the Treas21 ury such sums as may be necessary for each of the fis22 cal years 2009 through 2013 to carry out this sub23 section. 

24 ‘‘(c) PLAN REQUIRED.—The Global AIDS Coordi25 nator, in collaboration with the Administrator of the 
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1 United States Agency for International Development 

2 (USAID), shall develop and implement a plan to combat 

3 HIV/AIDS by strengthening health policies and health sys4 tems of partner countries as part of USAID’s ‘Health Sys5 tems 2020’ project. Recognizing that human and institu6 tional capacity form the core of any health care system that 

7 can sustain the fight against HIV/AIDS, tuberculosis, and 

8 malaria, the plan shall include a strategy to encourage 

9 postsecondary educational institutions in partner countries, 

10 particularly in Africa, in collaboration with United States 

11 postsecondary educational institutions, including histori12 cally black colleges and universities, to develop such human 

13 and institutional capacity and in the process further build 

14 their capacity to sustain the fight against these diseases.’’. 

15 (b) CLERICAL AMENDMENT.—The table of contents for 

16 the United States Leadership Against HIV/AIDS, Tuber17 culosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) is 

18 amended by inserting after the item relating to section 203, 

19 as added by section 203 of this Act, the following: 

‘‘Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by strengthening 

health policies and health systems of partner countries.’’. 

20 SEC. 205. FACILITATING EFFECTIVE OPERATIONS OF THE 

21 CENTERS FOR DISEASE CONTROL. 

22 Section 307 of the Public Health Service Act (42 

23 U.S.C. 242l) is amended— 
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•HR 5501 EAS 

1 (1) by amending subsection (a) to read as fol2 lows: 

3 ‘‘(a) The Secretary may participate with other coun4 tries in cooperative endeavors in— 

5 ‘‘(1) biomedical research, health care technology, 

6 and the health services research and statistical anal7 ysis authorized under section 306 and title IX; and 

8 ‘‘(2) biomedical research, health care services, 

9 health care research, or other related activities in fur10 therance of the activities, objectives or goals author11 ized under the Tom Lantos and Henry J. Hyde 

12 United States Global Leadership Against HIV/AIDS, 

13 Tuberculosis, and Malaria Reauthorization Act of 

14 2008.’’; and 

15 (2) in subsection (b)— 

16 (A) in paragraph (7), by striking ‘‘and’’ 

17 after the semicolon at the end; 

18 (B) by striking ‘‘The Secretary may not, in 

19 the exercise of his authority under this section, 

20 provide financial assistance for the construction 

21 of any facility in any foreign country.’’ 

22 (C) in paragraph (8), by striking ‘‘for any 

23 purpose.’’ and inserting ‘‘for the purpose of any 

24 law administered by the Office of Personnel 

25 Management;’’; and 
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•HR 5501 EAS 

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

2 ‘‘(9) provide such funds by advance or reim3 bursement to the Secretary of State, as may be nec4 essary, to pay the costs of acquisition, lease, construc5 tion, alteration, equipping, furnishing or manage6 ment of facilities outside of the United States; and 

7 ‘‘(10) in consultation with the Secretary of 

8 State, through grant or cooperative agreement, make 

9 funds available to public or nonprofit private institu10 tions or agencies in foreign countries in which the 

11 Secretary is participating in activities described 

12 under subsection (a) to acquire, lease, construct, alter, 

13 or renovate facilities in those countries.’’. 

14 (3) in subsection (c)— 

15 (A) by striking ‘‘1990’’ and inserting 

16 ‘‘1980’’; and 

17 (B) by inserting or ‘‘or section 903 of the 

18 Foreign Service Act of 1980 (22 U.S.C. 4083)’’ 

19 after ‘‘Code’’. 

20 SEC. 206. FACILITATING VACCINE DEVELOPMENT. 

21 (a) TECHNICAL ASSISTANCE FOR DEVELOPING COUN22 TRIES.—The Administrator of the United States Agency for 

23 International Development, utilizing public-private part24 ners, as appropriate, and working in coordination with 

25 other international development agencies, is authorized to 
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1 strengthen the capacity of developing countries’ govern2 mental institutions to— 

3 (1) collect evidence for informed decision-making 

4 and introduction of new vaccines, including potential 

5 HIV/AIDS, tuberculosis, and malaria vaccines, if 

6 such vaccines are determined to be safe and effective; 

7 (2) review protocols for clinical trials and im8 pact studies and improve the implementation of clin9 ical trials; and 

10 (3) ensure adequate supply chain and delivery 

11 systems. 

12 (b) ADVANCED MARKET COMMITMENTS.— 

13 (1) PURPOSE.—The purpose of this subsection is 

14 to improve global health by requiring the United 

15 States to participate in negotiations for advance mar16 ket commitments for the development of future vac17 cines, including potential vaccines for HIV/AIDS, tu18 berculosis, and malaria. 

19 (2) NEGOTIATION REQUIREMENT.—The Secretary 

20 of the Treasury shall enter into negotiations with the 

21 appropriate officials of the International Bank of Re22 construction and Development (World Bank) and the 

23 GAVI Alliance, the member nations of such entities, 

24 and other interested parties to establish advanced 

25 market commitments to purchase vaccines to combat 
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•HR 5501 EAS 

1 HIV/AIDS, tuberculosis, malaria, and other related 

2 infectious diseases. 

3 (3) REQUIREMENTS.—In negotiating the United 

4 States participation in programs for advanced mar5 ket commitments, the Secretary of the Treasury shall 

6 take into account whether programs for advance mar7 ket commitments include— 

8 (A) legally binding contracts for product 

9 purchase that include a fair market price for up 

10 to a maximum number of treatments, creating a 

11 strong market incentive; 

12 (B) clearly defined and transparent rules of 

13 program participation for qualified developers 

14 and suppliers of the product; 

15 (C) clearly defined requirements for eligible 

16 vaccines to ensure that they are safe and effective 

17 and can be delivered in developing country con18 texts; 

19 (D) dispute settlement mechanisms; and 

20 (E) sufficient flexibility to enable the con21 tracts to be adjusted in accord with new infor22 mation related to projected market size and other 

23 factors while still maintaining the purchase com24 mitment at a fair price. 
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1 (4) REPORT.—Not later than 1 year after the 

2 date of the enactment of this Act— 

3 (A) the Secretary of the Treasury shall sub4 mit a report to the appropriate congressional 

5 committees on the status of the United States ne6 gotiations to participate in programs for the ad7 vanced market commitments under this sub8 section; and 

9 (B) the President shall produce a com10 prehensive report, written by a study group of 

11 qualified professionals from relevant Federal 

12 agencies and initiatives, nongovernmental orga13 nizations, and industry representatives, that sets 

14 forth a coordinated strategy to accelerate devel15 opment of vaccines for infectious diseases, such 

16 as HIV/AIDS, malaria, and tuberculosis, which 

17 includes— 

18 (i) initiatives to create economic incen19 tives for the research, development, and 

20 manufacturing of vaccines for HIV/AIDS, 

21 tuberculosis, malaria, and other infectious 

22 diseases; 

23 (ii) an expansion of public-private 

24 partnerships and the leveraging of resources 
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•HR 5501 EAS 

1 from other countries and the private sector; 

2 and 

3 (iii) efforts to maximize United States 

4 capabilities to support clinical trials of vac5 cines in developing countries and to address 

6 the challenges of delivering vaccines in de7 veloping countries to minimize delays in ac8 cess once vaccines are available. 

9 TITLE III—BILATERAL EFFORTS 

10 Subtitle A—General Assistance and 

11 Programs 

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

13 (a) AMENDMENTS TO THE FOREIGN ASSISTANCE ACT

14 OF 1961.— 

15 (1) FINDING.—Section 104A(a) of the Foreign 

16 Assistance Act of 1961 (22 U.S.C. 2151b–2(a)) is 

17 amended by inserting ‘‘Central Asia, Eastern Europe, 

18 Latin America’’ after ‘‘Caribbean,’’. 

19 (2) POLICY.—Section 104A(b) of such Act is 

20 amended to read as follows: 

21 ‘‘(b) POLICY.— 

22 ‘‘(1) OBJECTIVES.—It is a major objective of the 

23 foreign assistance program of the United States to 

24 provide assistance for the prevention and treatment of 

25 HIV/AIDS and the care of those affected by the dis-
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1 ease. It is the policy objective of the United States, by 

2 2013, to— 

3 ‘‘(A) assist partner countries to— 

4 ‘‘(i) prevent 12,000,000 new HIV infec5 tions worldwide; 

6 ‘‘(ii) support— 

7 ‘‘(I) the increase in the number of 

8 individuals with HIV/AIDS receiving 

9 antiretroviral treatment above the goal 

10 established under section 402(a)(3) and 

11 increased pursuant to paragraphs (1) 

12 through (3) of section 403(d); and 

13 ‘‘(II) additional treatment 

14 through coordinated multilateral ef15 forts; 

16 ‘‘(iii) support care for 12,000,000 indi17 viduals infected with or affected by HIV/ 

18 AIDS, including 5,000,000 orphans and 

19 vulnerable children affected by HIV/AIDS, 

20 with an emphasis on promoting a com21 prehensive, coordinated system of services to 

22 be integrated throughout the continuum of 

23 care; 

24 ‘‘(iv) provide at least 80 percent of the 

25 target population with access to counseling, 
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•HR 5501 EAS 

1 testing, and treatment to prevent the trans2 mission of HIV from mother-to-child; 

3 ‘‘(v) provide care and treatment serv4 ices to children with HIV in proportion to 

5 their percentage within the HIV-infected 

6 population of a given partner country; and 

7 ‘‘(vi) train and support retention of 

8 health care professionals, paraprofessionals, 

9 and community health workers in HIV/ 

10 AIDS prevention, treatment, and care, with 

11 the target of providing such training to at 

12 least 140,000 new health care professionals 

13 and paraprofessionals with an emphasis on 

14 training and in country deployment of 

15 critically needed doctors and nurses; 

16 ‘‘(B) strengthen the capacity to deliver pri17 mary health care in developing countries, espe18 cially in sub-Saharan Africa; 

19 ‘‘(C) support and help countries in their ef20 forts to achieve staffing levels of at least 2.3 doc21 tors, nurses, and midwives per 1,000 population, 

22 as called for by the World Health Organization; 

23 and 

24 ‘‘(D) help partner countries to develop inde25 pendent, sustainable HIV/AIDS programs. 
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1 ‘‘(2) COORDINATED GLOBAL STRATEGY.—The 

2 United States and other countries with the sufficient 

3 capacity should provide assistance to countries in 

4 sub-Saharan Africa, the Caribbean, Central Asia, 

5 Eastern Europe, and Latin America, and other coun6 tries and regions confronting HIV/AIDS epidemics in 

7 a coordinated global strategy to help address general8 ized and concentrated epidemics through HIV/AIDS 

9 prevention, treatment, care, monitoring and evalua10 tion, and related activities. 

11 ‘‘(3) PRIORITIES.—The United States Govern12 ment’s response to the global HIV/AIDS pandemic 

13 and the Government’s efforts to help countries assume 

14 leadership of sustainable campaigns to combat their 

15 local epidemics should place high priority on— 

16 ‘‘(A) the prevention of the transmission of 

17 HIV; 

18 ‘‘(B) moving toward universal access to 

19 HIV/AIDS prevention counseling and services; 

20 ‘‘(C) the inclusion of cost sharing assur21 ances that meet the requirements under section 

22 110; and 

23 ‘‘(D) the inclusion of transition strategies to 

24 ensure sustainability of such programs and ac25 tivities, including health care systems, under 
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1 other international donor support, or budget 

2 support by respective foreign governments.’’. 

3 (b) AUTHORIZATION.—Section 104A(c) of such Act is 

4 amended— 

5 (1) in paragraph (1), by striking ‘‘and other 

6 countries and areas.’’ and inserting ‘‘Central Asia, 

7 Eastern Europe, Latin America, and other countries 

8 and areas, particularly with respect to refugee popu9 lations or those in postconflict settings in such coun10 tries and areas with significant or increasing HIV 

11 incidence rates.’’; 

12 (2) in paragraph (2), by striking ‘‘and other 

13 countries and areas affected by the HIV/AIDS pan14 demic’’ and inserting ‘‘Central Asia, Eastern Europe, 

15 Latin America, and other countries and areas affected 

16 by the HIV/AIDS pandemic, particularly with respect 

17 to refugee populations or those in post-conflict settings 

18 in such countries and areas with significant or in19 creasing HIV incidence rates.’’; and 

20 (3) in paragraph (3)— 

21 (A) by striking ‘‘foreign countries’’ and in22 serting ‘‘partner countries, other international 

23 actors,’’; and 
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•HR 5501 EAS 

1 (B) by inserting ‘‘within the framework of 

2 the principles of the Three Ones’’ before the pe3 riod at the end. 

4 (c) ACTIVITIES SUPPORTED.—Section 104A(d) of such 

5 Act is amended— 

6 (1) in paragraph (1)— 

7 (A) in subparagraph (A)— 

8 (i) by inserting ‘‘and multiple concur9 rent sexual partnering,’’ after ‘‘casual sex10 ual partnering’’; and 

11 (ii) by striking ‘‘condoms’’ and insert12 ing ‘‘male and female condoms’’; 

13 (B) in subparagraph (B)— 

14 (i) by striking ‘‘programs that’’ and 

15 inserting ‘‘programs that are designed with 

16 local input and’’; and 

17 (ii) by striking ‘‘those organizations’’ 

18 and inserting ‘‘those locally based organiza19 tions’’; 

20 (C) in subparagraph (D), by inserting ‘‘and 

21 promoting the use of provider-initiated or ‘opt22 out’ voluntary testing in accordance with World 

23 Health Organization guidelines’’ before the semi24 colon at the end; 
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1 (D) by redesignating subparagraphs (F), 

2 (G), and (H) as subparagraphs (H), (I), and 

3 (J), respectively; 

4 (E) by inserting after subparagraph (E) the 

5 following: 

6 ‘‘(F) assistance to— 

7 ‘‘(i) achieve the goal of reaching 80 

8 percent of pregnant women for prevention 

9 and treatment of mother-to-child trans10 mission of HIV in countries in which the 

11 United States is implementing HIV/AIDS 

12 programs by 2013; and 

13 ‘‘(ii) promote infant feeding options 

14 and treatment protocols that meet the most 

15 recent criteria established by the World 

16 Health Organization; 

17 ‘‘(G) medical male circumcision programs 

18 as part of national strategies to combat the 

19 transmission of HIV/AIDS;’’; 

20 (F) in subparagraph (I), as redesignated, 

21 by striking ‘‘and’’ at the end; and 

22 (G) by adding at the end the following: 

23 ‘‘(K) assistance for counseling, testing, 

24 treatment, care, and support programs, includ25 ing— 
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1 ‘‘(i) counseling and other services for 

2 the prevention of reinfection of individuals 

3 with HIV/AIDS; 

4 ‘‘(ii) counseling to prevent sexual 

5 transmission of HIV, including— 

6 ‘‘(I) life skills development for 

7 practicing abstinence and faithfulness; 

8 ‘‘(II) reducing the number of sex9 ual partners; 

10 ‘‘(III) delaying sexual debut; and 

11 ‘‘(IV) ensuring correct and con12 sistent use of condoms; 

13 ‘‘(iii) assistance to engage underlying 

14 vulnerabilities to HIV/AIDS, especially 

15 those of women and girls; 

16 ‘‘(iv) assistance for appropriate HIV/ 

17 AIDS education programs and training 

18 targeted to prevent the transmission of HIV 

19 among men who have sex with men; 

20 ‘‘(v) assistance to provide male and fe21 male condoms; 

22 ‘‘(vi) diagnosis and treatment of other 

23 sexually transmitted infections; 
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1 ‘‘(vii) strategies to address the stigma 

2 and discrimination that impede HIV/AIDS 

3 prevention efforts; and 

4 ‘‘(viii) assistance to facilitate wide5 spread access to microbicides for HIV pre6 vention, if safe and effective products be7 come available, including financial and 

8 technical support for culturally appropriate 

9 introductory programs, procurement, dis10 tribution, logistics management, program 

11 delivery, acceptability studies, provider 

12 training, demand generation, and 

13 postintroduction monitoring.’’; and 

14 (2) in paragraph (2)— 

15 (A) in subparagraph (B), by striking ‘‘and’’ 

16 at the end; 

17 (B) in subparagraph (C)— 

18 (i) by inserting ‘‘pain management,’’ 

19 after ‘‘opportunistic infections,’’; and 

20 (ii) by striking the period at the end 

21 and inserting a semicolon; and 

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

23 ‘‘(D) as part of care and treatment of HIV/ 

24 AIDS, assistance (including prophylaxis and 

25 treatment) for common HIV/AIDS-related oppor-
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1 tunistic infections for free or at a rate at which 

2 it is easily affordable to the individuals and pop3 ulations being served; 

4 ‘‘(E) as part of care and treatment of HIV/ 

5 AIDS, assistance or referral to available and 

6 adequately resourced service providers for nutri7 tional support, including counseling and where 

8 necessary the provision of commodities, for per9 sons meeting malnourishment criteria and their 

10 families;’’; 

11 (3) in paragraph (4)— 

12 (A) in subparagraph (C), by striking ‘‘and’’ 

13 at the end; 

14 (B) in subparagraph (D), by striking the 

15 period at the end and inserting a semicolon; and 

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

17 ‘‘(E) carrying out and expanding program 

18 monitoring, impact evaluation research and 

19 analysis, and operations research and dissemi20 nating data and findings through mechanisms to 

21 be developed by the Coordinator of United States 

22 Government Activities to Combat HIV/AIDS 

23 Globally, in coordination with the Director of the 

24 Centers for Disease Control, in order to— 
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1 ‘‘(i) improve accountability, increase 

2 transparency, and ensure the delivery of 

3 evidence-based services through the collec4 tion, evaluation, and analysis of data re5 garding gender-responsive interventions, 

6 disaggregated by age and sex; 

7 ‘‘(ii) identify and replicate effective 

8 models; and 

9 ‘‘(iii) develop gender indicators to 

10 measure outcomes and the impacts of inter11 ventions; and 

12 ‘‘(F) establishing appropriate systems to— 

13 ‘‘(i) gather epidemiological and social 

14 science data on HIV; and 

15 ‘‘(ii) evaluate the effectiveness of pre16 vention efforts among men who have sex 

17 with men, with due consideration to stigma 

18 and risks associated with disclosure.’’; 

19 (4) in paragraph (5)— 

20 (A) by redesignating subparagraph (C) as 

21 subparagraph (D); and 

22 (B) by inserting after subparagraph (B) the 

23 following: 

24 ‘‘(C) MECHANISM TO ENSURE COST-EFFEC25 TIVE DRUG PURCHASING.—Subject to subpara-
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1 graph (B), mechanisms to ensure that safe and 

2 effective pharmaceuticals, including 

3 antiretrovirals and medicines to treat opportun4 istic infections, are purchased at the lowest pos5 sible price at which such pharmaceuticals may 

6 be obtained in sufficient quantity on the world 

7 market, provided that such pharmaceuticals are 

8 approved, tentatively approved, or otherwise au9 thorized for use by— 

10 ‘‘(i) the Food and Drug Administra11 tion; 

12 ‘‘(ii) a stringent regulatory agency ac13 ceptable to the Secretary of Health and 

14 Human Services; or 

15 ‘‘(iii) a quality assurance mechanism 

16 acceptable to the Secretary of Health and 

17 Human Services.’’; 

18 (5) in paragraph (6)— 

19 (A) by amending the paragraph heading to 

20 read as follows: 

21 ‘‘(6) RELATED AND COORDINATED ACTIVITIES.— 

22 ’’; 

23 (B) in subparagraph (B), by striking ‘‘and’’ 

24 at the end; 
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1 (C) in subparagraph (C), by striking the 

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

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

4 ‘‘(D) coordinated or referred activities to— 

5 ‘‘(i) enhance the clinical impact of 

6 HIV/AIDS care and treatment; and 

7 ‘‘(ii) ameliorate the adverse social and 

8 economic costs often affecting AIDS-im9 pacted families and communities through 

10 the direct provision, as necessary, or 

11 through the referral, if possible, of support 

12 services, including— 

13 ‘‘(I) nutritional and food support; 

14 ‘‘(II) safe drinking water and 

15 adequate sanitation; 

16 ‘‘(III) nutritional counseling; 

17 ‘‘(IV) income-generating activities 

18 and livelihood initiatives; 

19 ‘‘(V) maternal and child health 

20 care; 

21 ‘‘(VI) primary health care; 

22 ‘‘(VII) the diagnosis and treat23 ment of other infectious or sexually 

24 transmitted diseases; 
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1 ‘‘(VIII) substance abuse and treat2 ment services; and 

3 ‘‘(IX) legal services; 

4 ‘‘(E) coordinated or referred activities to 

5 link programs addressing HIV/AIDS with pro6 grams addressing gender-based violence in areas 

7 of significant HIV prevalence to assist countries 

8 in the development and enforcement of women’s 

9 health, children’s health, and HIV/AIDS laws 

10 and policies that— 

11 ‘‘(i) prevent and respond to violence 

12 against women and girls; 

13 ‘‘(ii) promote the integration of screen14 ing and assessment for gender-based vio15 lence into HIV/AIDS programming; 

16 ‘‘(iii) promote appropriate HIV/AIDS 

17 counseling, testing, and treatment into gen18 der-based violence programs; and 

19 ‘‘(iv) assist governments to develop 

20 partnerships with civil society organiza21 tions to create networks for psychosocial, 

22 legal, economic, or other support services; 

23 ‘‘(F) coordinated or referred activities to— 
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1 ‘‘(i) address the frequent coinfection of 

2 HIV and tuberculosis, in accordance with 

3 World Health Organization guidelines; 

4 ‘‘(ii) promote provider-initiated or 

5 ‘opt-out’ HIV/AIDS counseling and testing 

6 and appropriate referral for treatment and 

7 care to individuals with tuberculosis or its 

8 symptoms, particularly in areas with sig9 nificant HIV prevalence; and 

10 ‘‘(iii) strengthen programs to ensure 

11 that individuals testing positive for HIV re12 ceive tuberculosis screening and to improve 

13 laboratory capacities, infection control, and 

14 adherence; and 

15 ‘‘(G) activities to— 

16 ‘‘(i) improve the effectiveness of na17 tional responses to HIV/AIDS; 

18 ‘‘(ii) strengthen overall health systems 

19 in high-prevalence countries, including sup20 port for workforce training, retention, and 

21 effective deployment, capacity building, lab22 oratory development, equipment mainte23 nance and repair, and public health and re24 lated public financial management systems 

25 and operations; and 
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1 ‘‘(iii) encourage fair and transparent 

2 procurement practices among partner coun3 tries; and 

4 ‘‘(iv) promote in-country or intra-re5 gional pediatric training for physicians 

6 and other health professionals, preferably 

7 through public-private partnerships involv8 ing colleges and universities, with the goal 

9 of increasing pediatric HIV workforce ca10 pacity.’’; and 

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

12 ‘‘(8) COMPACTS AND FRAMEWORK AGREE13 MENTS.—The development of compacts or framework 

14 agreements, tailored to local circumstances, with na15 tional governments or regional partnerships in coun16 tries with significant HIV/AIDS burdens to promote 

17 host government commitment to deeper integration of 

18 HIV/AIDS services into health systems, contribute to 

19 health systems overall, and enhance sustainability, in20 cluding— 

21 ‘‘(A) cost sharing assurances that meet the 

22 requirements under section 110; and 

23 ‘‘(B) transition strategies to ensure sustain24 ability of such programs and activities, includ25 ing health care systems, under other inter-
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1 national donor support, or budget support by re2 spective foreign governments.’’. 

3 (d) COMPACTS AND FRAMEWORK AGREEMENTS.—Sec4 tion 104A of such Act is amended— 

5 (1) by redesignating subsections (e) through (g) 

6 as subsections (f) through (h); and 

7 (2) by inserting after subsection (d) the fol8 lowing: 

9 ‘‘(e) COMPACTS AND FRAMEWORK AGREEMENTS.— 

10 ‘‘(1) FINDINGS.—Congress makes the following 

11 findings: 

12 ‘‘(A) The congressionally mandated Insti13 tute of Medicine report entitled ‘PEPFAR Imple14 mentation: Progress and Promise’ states: ‘The 

15 next strategy [of the U.S. Global AIDS Initia16 tive] should squarely address the needs and chal17 lenges involved in supporting sustainable coun18 try HIV/AIDS programs, thereby transitioning 

19 from a focus on emergency relief.’. 

20 ‘‘(B) One mechanism to promote the transi21 tion from an emergency to a public health and 

22 development approach to HIV/AIDS is through 

23 compacts or framework agreements between the 

24 United States Government and each partici25 pating nation. 
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1 ‘‘(2) ELEMENTS.—Compacts on HIV/AIDS au2 thorized under subsection (d)(8) shall include the fol3 lowing elements: 

4 ‘‘(A) Compacts whose primary purpose is to 

5 provide direct services to combat HIV/AIDS are 

6 to be made between— 

7 ‘‘(i) the United States Government; 

8 and 

9 ‘‘(ii)(I) national or regional entities 

10 representing low-income countries served by 

11 an existing United States Agency for Inter12 national Development or Department of 

13 Health and Human Services presence or re14 gional platform; or 

15 ‘‘(II) countries or regions— 

16 ‘‘(aa) experiencing significantly 

17 high HIV prevalence or risk of signifi18 cantly increasing incidence within the 

19 general population; 

20 ‘‘(bb) served by an existing United 

21 States Agency for International Devel22 opment or Department of Health and 

23 Human Services presence or regional 

24 platform; and 
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1 ‘‘(cc) that have inadequate finan2 cial means within such country or re3 gion. 

4 ‘‘(B) Compacts whose primary purpose is to 

5 provide limited technical assistance to a country 

6 or region connected to services provided within 

7 the country or region— 

8 ‘‘(i) may be made with other countries 

9 or regional entities served by an existing 

10 United States Agency for International De11 velopment or Department of Health and 

12 Human Services presence or regional plat13 form; 

14 ‘‘(ii) shall require significant invest15 ments in HIV prevention, care, and treat16 ment services by the host country; 

17 ‘‘(iii) shall be time-limited in terms of 

18 United States contributions; and 

19 ‘‘(iv) shall be made only upon prior 

20 notification to Congress— 

21 ‘‘(I) justifying the need for such 

22 compacts; 

23 ‘‘(II) describing the expected in24 vestment by the country or regional en25 tity; and 
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1 ‘‘(III) describing the scope, na2 ture, expected total United States in3 vestment, and time frame of the lim4 ited technical assistance under the 

5 compact and its intended impact. 

6 ‘‘(C) Compacts shall include provisions to— 

7 ‘‘(i) promote local and national efforts 

8 to reduce stigma associated with HIV/ 

9 AIDS; and 

10 ‘‘(ii) work with and promote the role of 

11 civil society in combating HIV/AIDS. 

12 ‘‘(D) Compacts shall take into account the 

13 overall national health and development and na14 tional HIV/AIDS and public health strategies of 

15 each country. 

16 ‘‘(E) Compacts shall contain— 

17 ‘‘(i) consideration of the specific objec18 tives that the country and the United States 

19 expect to achieve during the term of a com20 pact; 

21 ‘‘(ii) consideration of the respective re22 sponsibilities of the country and the United 

23 States in the achievement of such objectives; 
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1 ‘‘(iii) consideration of regular bench2 marks to measure progress toward achieving 

3 such objectives; 

4 ‘‘(iv) an identification of the intended 

5 beneficiaries, disaggregated by gender and 

6 age, and including information on orphans 

7 and vulnerable children, to the maximum 

8 extent practicable; 

9 ‘‘(v) consideration of the methods by 

10 which the compact is intended to— 

11 ‘‘(I) address the factors that put 

12 women and girls at greater risk of 

13 HIV/AIDS; and 

14 ‘‘(II) strengthen elements such as 

15 the economic, educational, and social 

16 status of women, girls, orphans, and 

17 vulnerable children and the inheritance 

18 rights and safety of such individuals; 

19 ‘‘(vi) consideration of the methods by 

20 which the compact will— 

21 ‘‘(I) strengthen the health care ca22 pacity, including factors such as the 

23 training, retention, deployment, re24 cruitment, and utilization of health 

25 care workers; 
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1 ‘‘(II) improve supply chain man2 agement; and 

3 ‘‘(III) improve the health systems 

4 and infrastructure of the partner coun5 try, including the ability of compact 

6 participants to maintain and operate 

7 equipment transferred or purchased as 

8 part of the compact; 

9 ‘‘(vii) consideration of proposed mecha10 nisms to provide oversight; 

11 ‘‘(viii) consideration of the role of civil 

12 society in the development of a compact and 

13 the achievement of its objectives; 

14 ‘‘(ix) a description of the current and 

15 potential participation of other donors in 

16 the achievement of such objectives, as appro17 priate; and 

18 ‘‘(x) consideration of a plan to ensure 

19 appropriate fiscal accountability for the use 

20 of assistance. 

21 ‘‘(F) For regional compacts, priority shall 

22 be given to countries that are included in re23 gional funds and programs in existence as of the 

24 date of the enactment of the Tom Lantos and 

25 Henry J. Hyde United States Global Leadership 
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1 Against HIV/AIDS, Tuberculosis, and Malaria 

2 Reauthorization Act of 2008. 

3 ‘‘(G) Amounts made available for compacts 

4 described in subparagraphs (A) and (B) shall be 

5 subject to the inclusion of— 

6 ‘‘(i) cost sharing assurances that meet 

7 the requirements under section 110; and 

8 ‘‘(ii) transition strategies to ensure 

9 sustainability of such programs and activi10 ties, including health care systems, under 

11 other international donor support, and 

12 budget support by respective foreign govern13 ments. 

14 ‘‘(3) LOCAL INPUT.—In entering into a compact 

15 on HIV/AIDS authorized under subsection (d)(8), the 

16 Coordinator of United States Government Activities 

17 to Combat HIV/AIDS Globally shall seek to ensure 

18 that the government of a country— 

19 ‘‘(A) takes into account the local perspec20 tives of the rural and urban poor, including 

21 women, in each country; and 

22 ‘‘(B) consults with private and voluntary 

23 organizations, including faith-based organiza24 tions, the business community, and other donors 

25 in the country. 
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1 ‘‘(4) CONGRESSIONAL AND PUBLIC NOTIFICATION

2 AFTER ENTERING INTO A COMPACT.—Not later than 

3 10 days after entering into a compact authorized 

4 under subsection (d)(8), the Global AIDS Coordinator 

5 shall— 

6 ‘‘(A) submit a report containing a detailed 

7 summary of the compact and a copy of the text 

8 of the compact to— 

9 ‘‘(i) the Committee on Foreign Rela10 tions of the Senate; 

11 ‘‘(ii) the Committee on Appropriations 

12 of the Senate; 

13 ‘‘(iii) the Committee on Foreign Af14 fairs of the House of Representatives; and 

15 ‘‘(iv) the Committee on Appropriations 

16 of the House of Representatives; and 

17 ‘‘(B) publish such information in the Fed18 eral Register and on the Internet website of the 

19 Office of the Global AIDS Coordinator.’’. 

20 (e) ANNUAL REPORT.—Section 104A(f) of such Act, as 

21 redesignated, is amended— 

22 (1) in paragraph (1), by striking ‘‘Committee on 

23 International Relations’’ and inserting ‘‘Committee 

24 on Foreign Affairs’’; and 

25 (2) in paragraph (2)— 
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1 (A) in subparagraph (B), by striking ‘‘and’’ 

2 at the end; 

3 (B) by striking subparagraph (C) and in4 serting the following: 

5 ‘‘(C) a detailed breakdown of funding allo6 cations, by program and by country, for preven7 tion activities; and 

8 ‘‘(D) a detailed assessment of the impact of 

9 programs established pursuant to such sections, 

10 including— 

11 ‘‘(i)(I) the effectiveness of such pro12 grams in reducing— 

13 ‘‘(aa) the transmission of HIV, 

14 particularly in women and girls; 

15 ‘‘(bb) mother-to-child transmission 

16 of HIV, including through drug treat17 ment and therapies, either directly or 

18 by referral; and 

19 ‘‘(cc) mortality rates from HIV/ 

20 AIDS; 

21 ‘‘(II) the number of patients receiving 

22 treatment for AIDS in each country that re23 ceives assistance under this Act; 

24 ‘‘(III) an assessment of progress to25 wards the achievement of annual goals set 
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1 forth in the timetable required under the 5- 

2 year strategy established under section 101 

3 of the United States Leadership Against 

4 HIV/AIDS, Tuberculosis, and Malaria Act 

5 of 2003 and, if annual goals are not being 

6 met, the reasons for such failure; and 

7 ‘‘(IV) retention and attrition data for 

8 programs receiving United States assist9 ance, including mortality and loss to follow10 up rates, organized overall and by country; 

11 ‘‘(ii) the progress made toward— 

12 ‘‘(I) improving health care deliv13 ery systems (including the training of 

14 health care workers, including doctors, 

15 nurses, midwives, pharmacists, labora16 tory technicians, and compensated 

17 community health workers, and the use 

18 of codes of conduct for ethical recruit19 ing practices for health care workers); 

20 ‘‘(II) advancing safe working con21 ditions for health care workers; and 

22 ‘‘(III) improving infrastructure to 

23 promote progress toward universal ac24 cess to HIV/AIDS prevention, treat25 ment, and care by 2013; 
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1 ‘‘(iii) a description of coordination ef2 forts with relevant executive branch agencies 

3 to link HIV/AIDS clinical and social serv4 ices with non-HIV/AIDS services as part of 

5 the United States health and development 

6 agenda; 

7 ‘‘(iv) a detailed description of inte8 grated HIV/AIDS and food and nutrition 

9 programs and services, including— 

10 ‘‘(I) the amount spent on food and 

11 nutrition support; 

12 ‘‘(II) the types of activities sup13 ported; and 

14 ‘‘(III) an assessment of the effec15 tiveness of interventions carried out to 

16 improve the health status of persons 

17 with HIV/AIDS receiving food or nu18 tritional support; 

19 ‘‘(v) a description of efforts to improve 

20 harmonization, in terms of relevant execu21 tive branch agencies, coordination with 

22 other public and private entities, and co23 ordination with partner countries’ national 

24 strategic plans as called for in the ‘Three 

25 Ones’; 
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1 ‘‘(vi) a description of— 

2 ‘‘(I) the efforts of partner coun3 tries that were signatories to the Abuja 

4 Declaration on HIV/AIDS, Tuber5 culosis and Other Related Infectious 

6 Diseases to adhere to the goals of such 

7 Declaration in terms of investments in 

8 public health, including HIV/AIDS; 

9 and 

10 ‘‘(II) a description of the HIV/ 

11 AIDS investments of partner countries 

12 that were not signatories to such Dec13 laration; 

14 ‘‘(vii) a detailed description of any 

15 compacts or framework agreements reached 

16 or negotiated between the United States and 

17 any partner countries, including a descrip18 tion of the elements of compacts described in 

19 subsection (e); 

20 ‘‘(viii) a description of programs serv21 ing women and girls, including— 

22 ‘‘(I) HIV/AIDS prevention pro23 grams that address the vulnerabilities 

24 of girls and women to HIV/AIDS; 
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1 ‘‘(II) information on the number 

2 of individuals served by programs 

3 aimed at reducing the vulnerabilities 

4 of women and girls to HIV/AIDS and 

5 data on the types, objectives, and dura6 tion of programs to address these 

7 issues; 

8 ‘‘(III) information on programs to 

9 address the particular needs of adoles10 cent girls and young women; and 

11 ‘‘(IV) programs to prevent gender12 based violence or to assist victims of 

13 gender based violence as part of, or in 

14 coordination with, HIV/AIDS pro15 grams; 

16 ‘‘(ix) a description of strategies, goals, 

17 programs, and interventions to— 

18 ‘‘(I) address the needs and 

19 vulnerabilities of youth populations; 

20 ‘‘(II) expand access among young 

21 men and women to evidence-based 

22 HIV/AIDS health care services and 

23 HIV prevention programs, including 

24 abstinence education programs; and 
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1 ‘‘(III) expand community-based 

2 services to meet the needs of orphans 

3 and of children and adolescents affected 

4 by or vulnerable to HIV/AIDS without 

5 increasing stigmatization; 

6 ‘‘(x) a description of— 

7 ‘‘(I) the specific strategies funded 

8 to ensure the reduction of HIV infec9 tion among injection drug users; 

10 ‘‘(II) the number of injection drug 

11 users, by country, reached by such 

12 strategies; and 

13 ‘‘(III) medication-assisted drug 

14 treatment for individuals with HIV or 

15 at risk of HIV; 

16 ‘‘(xi) a detailed description of program 

17 monitoring, operations research, and im18 pact evaluation research, including— 

19 ‘‘(I) the amount of funding pro20 vided for each research type; 

21 ‘‘(II) an analysis of cost-effective22 ness models; and 

23 ‘‘(III) conclusions regarding the 

24 efficiency, effectiveness, and quality of 

25 services as derived from previous or 
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1 ongoing research and monitoring ef2 forts; 

3 ‘‘(xii) building capacity to identify, 

4 investigate, and stop nosocomial trans5 mission of infectious diseases, including 

6 HIV and tuberculosis; and 

7 ‘‘(xiii) a description of staffing levels 

8 of United States government HIV/AIDS 

9 teams in countries with significant HIV/ 

10 AIDS programs, including whether or not a 

11 full-time coordinator was on staff for the 

12 year.’’. 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

14 301(b) of the United States Leadership Against HIV/AIDS, 

15 Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631(b)) 

16 is amended— 

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

18 2004 through 2008’’ and inserting ‘‘fiscal years 2009 

19 through 2013’’; and 

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

21 2004 through 2008’’ and inserting ‘‘fiscal years 2009 

22 through 2013’’. 

23 (g) RELATIONSHIP TO ASSISTANCE PROGRAMS TO EN24 HANCE NUTRITION.—Section 301(c) of such Act is amended 

25 to read as follows: 
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1 ‘‘(c) FOOD AND NUTRITIONAL SUPPORT.— 

2 ‘‘(1) IN GENERAL.—As indicated in the report 

3 produced by the Institute of Medicine, entitled 

4 ‘PEPFAR Implementation: Progress and Promise’, 

5 inadequate caloric intake has been clearly identified 

6 as a principal reason for failure of clinical response 

7 to antiretroviral therapy. In recognition of the impact 

8 of malnutrition as a clinical health issue for many 

9 persons living with HIV/AIDS that is often associated 

10 with health and economic impacts on these individ11 uals and their families, the Global AIDS Coordinator 

12 and the Administrator of the United States Agency 

13 for International Development shall— 

14 ‘‘(A) follow World Health Organization 

15 guidelines for HIV/AIDS food and nutrition 

16 services; 

17 ‘‘(B) integrate nutrition programs with 

18 HIV/AIDS activities through effective linkages 

19 among the health, agricultural, and livelihood 

20 sectors and establish additional services in cir21 cumstances in which referrals are inadequate or 

22 impossible; 

23 ‘‘(C) provide, as a component of care and 

24 treatment programs for persons with HIV/AIDS, 

25 food and nutritional support to individuals in-
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1 fected with, and affected by, HIV/AIDS who meet 

2 established criteria for nutritional support (in3 cluding clinically malnourished children and 

4 adults, and pregnant and lactating women in 

5 programs in need of supplemental support), in6 cluding— 

7 ‘‘(i) anthropometric and dietary assess8 ment; 

9 ‘‘(ii) counseling; and 

10 ‘‘(iii) therapeutic and supplementary 

11 feeding; 

12 ‘‘(D) provide food and nutritional support 

13 for children affected by HIV/AIDS and to com14 munities and households caring for children af15 fected by HIV/AIDS; and 

16 ‘‘(E) in communities where HIV/AIDS and 

17 food insecurity are highly prevalent, support 

18 programs to address these often intersecting 

19 health problems through community-based assist20 ance programs, with an emphasis on sustainable 

21 approaches. 

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

23 the amounts authorized to be appropriated under sec24 tion 401, there are authorized to be appropriated to 

25 the President such sums as may be necessary for each 
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1 of the fiscal years 2009 through 2013 to carry out this 

2 subsection.’’. 

3 (h) ELIGIBILITY FOR ASSISTANCE.—Section 301(d) of 

4 such Act is amended to read as follows: 

5 ‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organization, 

6 including a faith-based organization, that is otherwise eligi7 ble to receive assistance under section 104A of the Foreign 

8 Assistance Act of 1961, under this Act, or under any 

9 amendment made by this Act or by the Tom Lantos and 

10 Henry J. Hyde United States Global Leadership Against 

11 HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act 

12 of 2008, for HIV/AIDS prevention, treatment, or care— 

13 ‘‘(1) shall not be required, as a condition of re14 ceiving such assistance— 

15 ‘‘(A) to endorse or utilize a multisectoral or 

16 comprehensive approach to combating HIV/ 

17 AIDS; or 

18 ‘‘(B) to endorse, utilize, make a referral to, 

19 become integrated with, or otherwise participate 

20 in any program or activity to which the organi21 zation has a religious or moral objection; and 

22 ‘‘(2) shall not be discriminated against in the so23 licitation or issuance of grants, contracts, or coopera24 tive agreements under such provisions of law for re-
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1 fusing to meet any requirement described in para2 graph (1).’’. 

3 SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 

4 (a) POLICY.—Section 104B(b) of the Foreign Assist5 ance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended to read 

6 as follows: 

7 ‘‘(b) POLICY.—It is a major objective of the foreign as8 sistance program of the United States to control tuber9 culosis. In all countries in which the Government of the 

10 United States has established development programs, par11 ticularly in countries with the highest burden of tuber12 culosis and other countries with high rates of tuberculosis, 

13 the United States should support the objectives of the Global 

14 Plan to Stop TB, including through achievement of the fol15 lowing goals: 

16 ‘‘(1) Reduce by half the tuberculosis death and 

17 disease burden from the 1990 baseline. 

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

19 70 percent of sputum smear-positive cases of tuber20 culosis and the successful treatment of at least 85 per21 cent of the cases detected in countries with established 

22 United States Agency for International Development 

23 tuberculosis programs. 

24 ‘‘(3) In support of the Global Plan to Stop TB, 

25 the President shall establish a comprehensive, 5-year 
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1 United States strategy to expand and improve United 

2 States efforts to combat tuberculosis globally, includ3 ing a plan to support— 

4 ‘‘(A) the successful treatment of 4,500,000 

5 new sputum smear tuberculosis patients under 

6 DOTS programs by 2013, primarily through di7 rect support for needed services, commodities, 

8 health workers, and training, and additional 

9 treatment through coordinated multilateral ef10 forts; and 

11 ‘‘(B) the diagnosis and treatment of 90,000 

12 new multiple drug resistant tuberculosis cases by 

13 2013, and additional treatment through coordi14 nated multilateral efforts.’’. 

15 (b) PRIORITY TO STOP TB STRATEGY.—Section 

16 104B(e) of such Act is amended to read as follows: 

17 ‘‘(e) PRIORITY TO STOP TB STRATEGY.—In fur18 nishing assistance under subsection (c), the President shall 

19 give priority to— 

20 ‘‘(1) direct services described in the Stop TB 

21 Strategy, including expansion and enhancement of 

22 Directly Observed Treatment Short-course (DOTS) 

23 coverage, rapid testing, treatment for individuals in24 fected with both tuberculosis and HIV, and treatment 

25 for individuals with multi-drug resistant tuberculosis 
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1 (MDR–TB), strengthening of health systems, use of 

2 the International Standards for Tuberculosis Care by 

3 all providers, empowering individuals with tuber4 culosis, and enabling and promoting research to de5 velop new diagnostics, drugs, and vaccines, and pro6 gram-based operational research relating to tuber7 culosis; and 

8 ‘‘(2) funding for the Global Tuberculosis Drug 

9 Facility, the Stop Tuberculosis Partnership, and the 

10 Global Alliance for TB Drug Development.’’. 

11 (c) ASSISTANCE FOR THE WORLD HEALTH ORGANIZA12 TION AND THE STOP TUBERCULOSIS PARTNERSHIP.—Sec13 tion 104B of such Act is amended— 

14 (1) by redesignating subsection (f) as subsection 

15 (h); and 

16 (2) by inserting after subsection (e) the following: 

17 ‘‘(f) ASSISTANCE FOR THE WORLD HEALTH ORGANI18 ZATION AND THE STOP TUBERCULOSIS PARTNERSHIP.—In 

19 carrying out this section, the President, acting through the 

20 Administrator of the United States Agency for Inter21 national Development, is authorized to provide increased 

22 resources to the World Health Organization and the Stop 

23 Tuberculosis Partnership to improve the capacity of coun24 tries with high rates of tuberculosis and other affected coun25 tries to implement the Stop TB Strategy and specific strate-
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1 gies related to addressing multiple drug resistant tuber2 culosis (MDR–TB) and extensively drug resistant tuber3 culosis (XDR–TB).’’. 

4 (d) ANNUAL REPORT.—Section 104B of such Act is 

5 amended by inserting after subsection (f), as added by sub6 section (c) of this section, the following: 

7 ‘‘(g) ANNUAL REPORT.—The President shall submit an 

8 annual report to Congress that describes the impact of 

9 United States foreign assistance on efforts to control tuber10 culosis, including— 

11 ‘‘(1) the number of tuberculosis cases diagnosed 

12 and the number of cases cured in countries receiving 

13 United States bilateral foreign assistance for tuber14 culosis control purposes; 

15 ‘‘(2) a description of activities supported with 

16 United States tuberculosis resources in each country, 

17 including a description of how those activities specifi18 cally contribute to increasing the number of people di19 agnosed and treated for tuberculosis; 

20 ‘‘(3) in each country receiving bilateral United 

21 States foreign assistance for tuberculosis control pur22 poses, the percentage provided for direct tuberculosis 

23 services in countries receiving United States bilateral 

24 foreign assistance for tuberculosis control purposes; 
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1 ‘‘(4) a description of research efforts and clinical 

2 trials to develop new tools to combat tuberculosis, in3 cluding diagnostics, drugs, and vaccines supported by 

4 United States bilateral assistance; 

5 ‘‘(5) the number of persons who have been diag6 nosed and started treatment for multidrug-resistant 

7 tuberculosis in countries receiving United States bi8 lateral foreign assistance for tuberculosis control pro9 grams; 

10 ‘‘(6) a description of the collaboration and co11 ordination of United States anti-tuberculosis efforts 

12 with the World Health Organization, the Global 

13 Fund, and other major public and private entities 

14 within the Stop TB Strategy; 

15 ‘‘(7) the constraints on implementation of pro16 grams posed by health workforce shortages and capac17 ities; 

18 ‘‘(8) the number of people trained in tuberculosis 

19 control; and 

20 ‘‘(9) a breakdown of expenditures for direct pa21 tient tuberculosis services, drugs and other commod22 ities, drug management, training in diagnosis and 

23 treatment, health systems strengthening, research, and 

24 support costs.’’. 
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1 (e) DEFINITIONS.—Section 104B(h) of such Act, as re2 designated by subsection (c), is amended— 

3 (1) in paragraph (1), by striking the period at 

4 the end and inserting the following: ‘‘including— 

5 ‘‘(A) low-cost and effective diagnosis, treat6 ment, and monitoring of tuberculosis; 

7 ‘‘(B) a reliable drug supply; 

8 ‘‘(C) a management strategy for public 

9 health systems; 

10 ‘‘(D) health system strengthening; 

11 ‘‘(E) promotion of the use of the Inter12 national Standards for Tuberculosis Care by all 

13 care providers; 

14 ‘‘(F) bacteriology under an external quality 

15 assessment framework; 

16 ‘‘(G) short-course chemotherapy; and 

17 ‘‘(H) sound reporting and recording sys18 tems.’’; and 

19 (2) by redesignating paragraph (5) as para20 graph (6); and 

21 (3) by inserting after paragraph (4) the fol22 lowing: 

23 ‘‘(5) STOP TB STRATEGY.—The term ‘Stop TB 

24 Strategy’ means the 6-point strategy to reduce tuber25 culosis developed by the World Health Organization, 
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1 which is described in the Global Plan to Stop TB 

2 2006–2015: Actions for Life, a comprehensive plan 

3 developed by the Stop TB Partnership that sets out 

4 the actions necessary to achieve the millennium devel5 opment goal of cutting tuberculosis deaths and disease 

6 burden in half by 2015.’’. 

7 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

8 302 (b) of the United States Leadership Against HIV/AIDS, 

9 Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7632(b)) 

10 is amended— 

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

12 may be necessary for each of the fiscal years 2004 

13 through 2008’’ and inserting ‘‘a total of 

14 $4,000,000,000 for the 5-year period beginning on Oc15 tober 1, 2008.’’; and 

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

17 2004 through 2008’’ and inserting ‘‘fiscal years 2009 

18 through 2013.’’. 

19 SEC. 303. ASSISTANCE TO COMBAT MALARIA. 

20 (a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT

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

22 of 1961 (22 U.S.C. 2151–4(b)) is amended by inserting 

23 ‘‘treatment,’’ after ‘‘control,’’. 

24 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

25 303 of the United States Leadership Against HIV/AIDS, 
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1 Tuberculosis, and Malaria Act of 2003, and Malaria Act 

2 of 2003 (22 U.S.C. 7633) is amended— 

3 (1) in subsection (b)— 

4 (A) in paragraph (1), by striking ‘‘such 

5 sums as may be necessary for fiscal years 2004 

6 through 2008’’ and inserting ‘‘$5,000,000,000 

7 during the 5-year period beginning on October 1, 

8 2008’’; and 

9 (B) in paragraph (3), by striking ‘‘fiscal 

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

11 years 2009 through 2013’’; and 

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

13 ‘‘(c) STATEMENT OF POLICY.—Providing assistance 

14 for the prevention, control, treatment, and the ultimate 

15 eradication of malaria is— 

16 ‘‘(1) a major objective of the foreign assistance 

17 program of the United States; and 

18 ‘‘(2) 1 component of a comprehensive United 

19 States global health strategy to reduce disease burdens 

20 and strengthen communities around the world. 

21 ‘‘(d) DEVELOPMENT OF A COMPREHENSIVE 5-YEAR

22 STRATEGY.—The President shall establish a comprehensive, 

23 5-year strategy to combat global malaria that— 
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1 ‘‘(1) strengthens the capacity of the United 

2 States to be an effective leader of international efforts 

3 to reduce malaria burden; 

4 ‘‘(2) maintains sufficient flexibility and remains 

5 responsive to the ever-changing nature of the global 

6 malaria challenge; 

7 ‘‘(3) includes specific objectives and multisectoral 

8 approaches and strategies to reduce the prevalence, 

9 mortality, incidence, and spread of malaria; 

10 ‘‘(4) describes how this strategy would contribute 

11 to the United States’ overall global health and devel12 opment goals; 

13 ‘‘(5) clearly explains how outlined activities will 

14 interact with other United States Government global 

15 health activities, including the 5-year global AIDS 

16 strategy required under this Act; 

17 ‘‘(6) expands public-private partnerships and le18 verage of resources; 

19 ‘‘(7) coordinates among relevant Federal agencies 

20 to maximize human and financial resources and to 

21 reduce duplication among these agencies, foreign gov22 ernments, and international organizations; 

23 ‘‘(8) coordinates with other international enti24 ties, including the Global Fund; 
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1 ‘‘(9) maximizes United States capabilities in the 

2 areas of technical assistance and training and re3 search, including vaccine research; and 

4 ‘‘(10) establishes priorities and selection criteria 

5 for the distribution of resources based on factors such 

6 as— 

7 ‘‘(A) the size and demographics of the popu8 lation with malaria; 

9 ‘‘(B) the needs of that population; 

10 ‘‘(C) the country’s existing infrastructure; 

11 and 

12 ‘‘(D) the ability to closely coordinate United 

13 States Government efforts with national malaria 

14 control plans of partner countries.’’. 

15 SEC. 304. MALARIA RESPONSE COORDINATOR. 

16 Section 304 of the United States Leadership Against 

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

18 U.S.C. 7634) is amended to read as follows: 

19 ‘‘SEC. 304. MALARIA RESPONSE COORDINATOR. 

20 ‘‘(a) IN GENERAL.—There is established within the 

21 United States Agency for International Development a Co22 ordinator of United States Government Activities to Com23 bat Malaria Globally (referred to in this section as the ‘Ma24 laria Coordinator’), who shall be appointed by the Presi25 dent. 
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1 ‘‘(b) AUTHORITIES.—The Malaria Coordinator, acting 

2 through nongovernmental organizations (including faith3 based and community-based organizations), partner coun4 try finance, health, and other relevant ministries, and rel5 evant executive branch agencies as may be necessary and 

6 appropriate to carry out this section, is authorized to— 

7 ‘‘(1) operate internationally to carry out preven8 tion, care, treatment, support, capacity development, 

9 and other activities to reduce the prevalence, mor10 tality, and incidence of malaria; 

11 ‘‘(2) provide grants to, and enter into contracts 

12 and cooperative agreements with, nongovernmental 

13 organizations (including faith-based organizations) to 

14 carry out this section; and 

15 ‘‘(3) transfer and allocate executive branch agen16 cy funds that have been appropriated for the purposes 

17 described in paragraphs (1) and (2). 

18 ‘‘(c) DUTIES.— 

19 ‘‘(1) IN GENERAL.—The Malaria Coordinator 

20 has primary responsibility for the oversight and co21 ordination of all resources and international activi22 ties of the United States Government relating to ef23 forts to combat malaria. 

24 ‘‘(2) SPECIFIC DUTIES.—The Malaria Coordi25 nator shall— 
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1 ‘‘(A) facilitate program and policy coordi2 nation of antimalarial efforts among relevant ex3 ecutive branch agencies and nongovernmental or4 ganizations by auditing, monitoring, and evalu5 ating such programs; 

6 ‘‘(B) ensure that each relevant executive 

7 branch agency undertakes antimalarial pro8 grams primarily in those areas in which the 

9 agency has the greatest expertise, technical capa10 bility, and potential for success; 

11 ‘‘(C) coordinate relevant executive branch 

12 agency activities in the field of malaria preven13 tion and treatment; 

14 ‘‘(D) coordinate planning, implementation, 

15 and evaluation with the Global AIDS Coordi16 nator in countries in which both programs have 

17 a significant presence; 

18 ‘‘(E) coordinate with national governments, 

19 international agencies, civil society, and the pri20 vate sector; and 

21 ‘‘(F) establish due diligence criteria for all 

22 recipients of funds appropriated by the Federal 

23 Government for malaria assistance. 

24 ‘‘(d) ASSISTANCE FOR THE WORLD HEALTH ORGANI25 ZATION.—In carrying out this section, the President may 
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1 provide financial assistance to the Roll Back Malaria Part2 nership of the World Health Organization to improve the 

3 capacity of countries with high rates of malaria and other 

4 affected countries to implement comprehensive malaria con5 trol programs. 

6 ‘‘(e) COORDINATION OF ASSISTANCE EFFORTS.—In 

7 carrying out this section and in accordance with section 

8 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 

9 2151b–4), the Malaria Coordinator shall coordinate the pro10 vision of assistance by working with— 

11 ‘‘(1) relevant executive branch agencies, includ12 ing— 

13 ‘‘(A) the Department of State (including the 

14 Office of the Global AIDS Coordinator); 

15 ‘‘(B) the Department of Health and Human 

16 Services; 

17 ‘‘(C) the Department of Defense; and 

18 ‘‘(D) the Office of the United States Trade 

19 Representative; 

20 ‘‘(2) relevant multilateral institutions, includ21 ing— 

22 ‘‘(A) the World Health Organization; 

23 ‘‘(B) the United Nations Children’s Fund; 

24 ‘‘(C) the United Nations Development Pro25 gramme; 
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1 ‘‘(D) the Global Fund; 

2 ‘‘(E) the World Bank; and 

3 ‘‘(F) the Roll Back Malaria Partnership; 

4 ‘‘(3) program delivery and efforts to lift barriers 

5 that would impede effective and comprehensive ma6 laria control programs; and 

7 ‘‘(4) partner or recipient country governments 

8 and national entities including universities and civil 

9 society organizations (including faith- and commu10 nity-based organizations). 

11 ‘‘(f) RESEARCH.—To carry out this section, the Ma12 laria Coordinator, in accordance with section 104C of the 

13 Foreign Assistance Act of 1961 (22 U.S.C. 1151d–4), shall 

14 ensure that operations and implementation research con15 ducted under this Act will closely complement the clinical 

16 and program research being undertaken by the National In17 stitutes of Health. The Centers for Disease Control and Pre18 vention should advise the Malaria Coordinator on priorities 

19 for operations and implementation research and should be 

20 a key implementer of this research. 

21 ‘‘(g) MONITORING.—To ensure that adequate malaria 

22 controls are established and implemented, the Centers for 

23 Disease Control and Prevention should advise the Malaria 

24 Coordinator on monitoring, surveillance, and evaluation 

25 activities and be a key implementer of such activities under 
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1 this Act. Such activities shall complement, rather than du2 plicate, the work of the World Health Organization. 

3 ‘‘(h) ANNUAL REPORT.— 

4 ‘‘(1) SUBMISSION.—Not later than 1 year after 

5 the date of the enactment of the Tom Lantos and 

6 Henry J. Hyde United States Global Leadership 

7 Against HIV/AIDS, Tuberculosis, and Malaria Reau8 thorization Act of 2008, and annually thereafter, the 

9 President shall submit a report to the appropriate 

10 congressional committees that describes United States 

11 assistance for the prevention, treatment, control, and 

12 elimination of malaria. 

13 ‘‘(2) CONTENTS.—The report required under 

14 paragraph (1) shall describe— 

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

16 malaria resources have been allocated; 

17 ‘‘(B) the number of people reached through 

18 malaria assistance programs, including data on 

19 children and pregnant women; 

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

21 combat malaria, including drugs and vaccines; 

22 ‘‘(D) the collaboration and coordination of 

23 United States antimalarial efforts with the 

24 World Health Organization, the Global Fund, 
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1 the World Bank, other donor governments, major 

2 private efforts, and relevant executive agencies; 

3 ‘‘(E) the coordination of United States anti4 malarial efforts with the national malarial strat5 egies of other donor or partner governments and 

6 major private initiatives; 

7 ‘‘(F) the estimated impact of United States 

8 assistance on childhood mortality and morbidity 

9 from malaria; 

10 ‘‘(G) the coordination of antimalarial ef11 forts with broader health and development pro12 grams; and 

13 ‘‘(H) the constraints on implementation of 

14 programs posed by health workforce shortages or 

15 capacities; and 

16 ‘‘(I) the number of personnel trained as 

17 health workers and the training levels achieved.’’. 

18 SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY 

19 ACT. 

20 Section 212(a)(1)(A)(i) of the Immigration and Na21 tionality Act (8 U.S.C. 1182(a)(1)(A)(i)) is amended by 

22 striking ‘‘, which shall include infection with the etiologic 

23 agent for acquired immune deficiency syndrome,’’ and in24 serting a semicolon. 
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1 SEC. 306. CLERICAL AMENDMENT. 

2 Title III of the United States Leadership Against HIV/ 

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

4 7631 et seq.) is amended by striking the heading for subtitle 

5 B and inserting the following: 

6 ‘‘Subtitle B—Assistance for Women, 

7 Children, and Families’’. 

8 SEC. 307. REQUIREMENTS. 

9 Section 312(b) of the United States Leadership 

10 Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

11 (22 U.S.C. 7652(b)) is amended by striking paragraphs (1), 

12 (2), and (3) and inserting the following: 

13 ‘‘(1) establish a target for the prevention and 

14 treatment of mother-to-child transmission of HIV 

15 that, by 2013, will reach at least 80 percent of preg16 nant women in those countries most affected by HIV/ 

17 AIDS in which the United States has HIV/AIDS pro18 grams; 

19 ‘‘(2) establish a target that, by 2013, the propor20 tion of children receiving care and treatment under 

21 this Act is proportionate to their numbers within the 

22 population of HIV infected individuals in each coun23 try; 

24 ‘‘(3) integrate care and treatment with preven25 tion of mother-to-child transmission of HIV programs 

26 to improve outcomes for HIV-affected women and 
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1 families as soon as is feasible and support strategies 

2 that promote successful follow-up and continuity of 

3 care of mother and child; 

4 ‘‘(4) expand programs designed to care for chil5 dren orphaned by, affected by, or vulnerable to HIV/ 

6 AIDS; 

7 ‘‘(5) ensure that women in prevention of mother8 to-child transmission of HIV programs are provided 

9 with, or referred to, appropriate maternal and child 

10 services; and 

11 ‘‘(6) develop a timeline for expanding access to 

12 more effective regimes to prevent mother-to-child 

13 transmission of HIV, consistent with the national 

14 policies of countries in which programs are adminis15 tered under this Act and the goal of achieving uni16 versal use of such regimes as soon as possible.’’. 

17 SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER18 TO-CHILD TRANSMISSION OF HIV. 

19 Section 313(a) of the United States Leadership 

20 Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

21 (22 U.S.C. 7653(a)) is amended by striking ‘‘5 years’’ and 

22 inserting ‘‘10 years’’. 
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1 SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANS2 MISSION EXPERT PANEL. 

3 Section 312 of the United States Leadership Against 

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

5 U.S.C. 7652) is amended by adding at the end the following: 

6 ‘‘(c) PREVENTION OF MOTHER-TO-CHILD TRANS7 MISSION EXPERT PANEL.— 

8 ‘‘(1) ESTABLISHMENT.—The Global AIDS Coor9 dinator shall establish a panel of experts to be known 

10 as the Prevention of Mother-to-Child Transmission 

11 Panel (referred to in this subsection as the ‘Panel’) 

12 to— 

13 ‘‘(A) provide an objective review of activi14 ties to prevent mother-to-child transmission of 

15 HIV; and 

16 ‘‘(B) provide recommendations to the Global 

17 AIDS Coordinator and to the appropriate con18 gressional committees for scale-up of mother-to19 child transmission prevention services under this 

20 Act in order to achieve the target established in 

21 subsection (b)(1). 

22 ‘‘(2) MEMBERSHIP.—The Panel shall be con23 vened and chaired by the Global AIDS Coordinator, 

24 who shall serve as a nonvoting member. The Panel 

25 shall consist of not more than 15 members (excluding 

26 the Global AIDS Coordinator), to be appointed by the 
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1 Global AIDS Coordinator not later than 1 year after 

2 the date of the enactment of this Act, including— 

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

4 Health and Human Services with expertise re5 lating to the prevention of mother-to-child trans6 mission activities; 

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

8 Agency for International Development with ex9 pertise relating to the prevention of mother-to10 child transmission activities; 

11 ‘‘(C) 2 representatives from among health 

12 ministers of national governments of foreign 

13 countries in which programs under this Act are 

14 administered; 

15 ‘‘(D) 3 members representing organizations 

16 implementing prevention of mother-to-child 

17 transmission activities under this Act; 

18 ‘‘(E) 2 health care researchers with expertise 

19 relating to global HIV/AIDS activities; and 

20 ‘‘(F) representatives from among patient 

21 advocate groups, health care professionals, per22 sons living with HIV/AIDS, and non-govern23 mental organizations with expertise relating to 

24 the prevention of mother-to-child transmission 

25 activities, giving priority to individuals in for-
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1 eign countries in which programs under this Act 

2 are administered. 

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

4 ‘‘(A) assess the effectiveness of current ac5 tivities in reaching the target described in sub6 section (b)(1); 

7 ‘‘(B) review scientific evidence related to the 

8 provision of mother-to-child transmission preven9 tion services, including programmatic data and 

10 data from clinical trials; 

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

12 Office of the United States Global AIDS Coordi13 nator collaborates with international and multi14 lateral entities on efforts to prevent mother-to15 child transmission of HIV in affected countries; 

16 ‘‘(D) identify barriers and challenges to in17 creasing access to mother-to-child transmission 

18 prevention services and evaluate potential mech19 anisms to alleviate those barriers and challenges; 

20 ‘‘(E) identify the extent to which stigma has 

21 hindered pregnant women from obtaining HIV 

22 counseling and testing or returning for results, 

23 and provide recommendations to address such 

24 stigma and its effects; 
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1 ‘‘(F) identify opportunities to improve link2 ages between mother-to-child transmission pre3 vention services and care and treatment pro4 grams; and 

5 ‘‘(G) recommend specific activities to facili6 tate reaching the target described in subsection 

7 (b)(1). 

8 ‘‘(4) REPORT.— 

9 ‘‘(A) IN GENERAL.—Not later than 1 year 

10 after the date on which the Panel is first con11 vened, the Panel shall submit a report con12 taining a detailed statement of the recommenda13 tions, findings, and conclusions of the Panel to 

14 the appropriate congressional committees. 

15 ‘‘(B) AVAILABILITY.—The report submitted 

16 under subparagraph (A) shall be made available 

17 to the public. 

18 ‘‘(C) CONSIDERATION BY COORDINATOR.— 

19 The Coordinator shall— 

20 ‘‘(i) consider any recommendations 

21 contained in the report submitted under 

22 subparagraph (A); and 

23 ‘‘(ii) include in the annual report re24 quired under section 104A(f) of the Foreign 

25 Assistance Act of 1961 a description of the 
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1 activities conducted in response to the rec2 ommendations made by the Panel and an 

3 explanation of any recommendations not 

4 implemented at the time of the report. 

5 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

6 There are authorized to be appropriated to the Panel 

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

8 years 2009 through 2011 to carry out this section. 

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

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

11 the Panel submits the report to the appropriate con12 gressional committees under paragraph (4).’’. 

13 TITLE IV—FUNDING 

14 ALLOCATIONS 

15 SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 

16 (a) IN GENERAL.—Section 401(a) of the United States 

17 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

18 Act of 2003 (22 U.S.C. 7671(a)) is amended by striking 

19 ‘‘$3,000,000,000 for each of the fiscal years 2004 through 

20 2008’’ and inserting ‘‘$48,000,000,000 for the 5-year period 

21 beginning on October 1, 2008’’. 

22 (b) SENSE OF CONGRESS.—It is the sense of the Con23 gress that the appropriations authorized under section 

24 401(a) of the United States Leadership Against HIV/AIDS, 

25 Tuberculosis, and Malaria Act of 2003, as amended by sub-
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1 section (a), should be allocated among fiscal years 2009 

2 through 2013 in a manner that allows for the appropria3 tions to be gradually increased in a manner that is con4 sistent with program requirements, absorptive capacity, 

5 and priorities set forth in such Act, as amended by this 

6 Act. 

7 SEC. 402. SENSE OF CONGRESS. 

8 Section 402(b) of the United States Leadership 

9 Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

10 (22 U.S.C. 7672(b)) is amended by striking ‘‘an effective 

11 distribution of such amounts would be’’ and all that follows 

12 through ‘‘10 percent of such amounts’’ and inserting ‘‘10 

13 percent should be used’’. 

14 SEC. 403. ALLOCATION OF FUNDS. 

15 Section 403 of the United States Leadership Against 

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

17 U.S.C. 7673) is amended— 

18 (1) by amending subsection (a) to read as fol19 lows: 

20 ‘‘(a) BALANCED FUNDING REQUIREMENT.— 

21 ‘‘(1) IN GENERAL.—The Global AIDS Coordi22 nator shall— 

23 ‘‘(A) provide balanced funding for preven24 tion activities for sexual transmission of HIV/ 

25 AIDS; and 
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1 ‘‘(B) ensure that activities promoting absti2 nence, delay of sexual debut, monogamy, fidelity, 

3 and partner reduction are implemented and 

4 funded in a meaningful and equitable way in the 

5 strategy for each host country based on objective 

6 epidemiological evidence as to the source of infec7 tions and in consultation with the government of 

8 each host county involved in HIV/AIDS preven9 tion activities. 

10 ‘‘(2) PREVENTION STRATEGY.— 

11 ‘‘(A) ESTABLISHMENT.—In carrying out 

12 paragraph (1), the Global AIDS Coordinator 

13 shall establish an HIV sexual transmission pre14 vention strategy governing the expenditure of 

15 funds authorized under this Act to prevent the 

16 sexual transmission of HIV in any host country 

17 with a generalized epidemic. 

18 ‘‘(B) REPORT.—In each host country de19 scribed in subparagraph (A), if the strategy es20 tablished under subparagraph (A) provides less 

21 than 50 percent of the funds described in sub22 paragraph (A) for activities promoting absti23 nence, delay of sexual debut, monogamy, fidelity, 

24 and partner reduction, the Global AIDS Coordi25 nator shall, not later than 30 days after the 
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1 issuance of this strategy, report to the appro2 priate congressional committees on the justifica3 tion for this decision. 

4 ‘‘(3) EXCLUSION.—Programs and activities that 

5 implement or purchase new prevention technologies or 

6 modalities, such as medical male circumcision, public 

7 education about risks to acquire HIV infection from 

8 blood exposures, promoting universal precautions, in9 vestigating suspected nosocomial infections, pre-expo10 sure pharmaceutical prophylaxis to prevent trans11 mission of HIV, or microbicides and programs and 

12 activities that provide counseling and testing for HIV 

13 or prevent mother-to-child prevention of HIV, shall 

14 not be included in determining compliance with 

15 paragraph (2). 

16 ‘‘(4) REPORT.—Not later than 1 year after the 

17 date of the enactment of the Tom Lantos and Henry 

18 J. Hyde United States Global Leadership Against 

19 HIV/AIDS, Tuberculosis, and Malaria Reauthoriza20 tion Act of 2008, and annually thereafter as part of 

21 the annual report required under section 104A(e) of 

22 the Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 

23 2(e)), the President shall— 

24 ‘‘(A) submit a report on the implementation 

25 of paragraph (2) for the most recently concluded 
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1 fiscal year to the appropriate congressional com2 mittees; and 

3 ‘‘(B) make the report described in subpara4 graph (A) available to the public.’’; 

5 (2) in subsection (b)— 

6 (A) by striking ‘‘fiscal years 2006 through 

7 2008’’ and inserting ‘‘fiscal years 2009 through 

8 2013’’; and 

9 (B) by striking ‘‘vulnerable children affected 

10 by’’ and inserting ‘‘other children affected by, or 

11 vulnerable to,’’; and 

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

13 ‘‘(c) FUNDING ALLOCATION.—For each of the fiscal 

14 years 2009 through 2013, more than half of the amounts 

15 appropriated for bilateral global HIV/AIDS assistance pur16 suant to section 401 shall be expended for— 

17 ‘‘(1) antiretroviral treatment for HIV/AIDS; 

18 ‘‘(2) clinical monitoring of HIV-seropositive peo19 ple not in need of antiretroviral treatment; 

20 ‘‘(3) care for associated opportunistic infections; 

21 ‘‘(4) nutrition and food support for people living 

22 with HIV/AIDS; and 

23 ‘‘(5) other essential HIV/AIDS-related medical 

24 care for people living with HIV/AIDS. 
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1 ‘‘(d) TREATMENT, PREVENTION, AND CARE GOALS.— 

2 For each of the fiscal years 2009 through 2013— 

3 ‘‘(1) the treatment goal under section 402(a)(3) 

4 shall be increased above 2,000,000 by at least the per5 centage increase in the amount appropriated for bi6 lateral global HIV/AIDS assistance for such fiscal 

7 year compared with fiscal year 2008; 

8 ‘‘(2) any increase in the treatment goal under 

9 section 402(a)(3) above the percentage increase in the 

10 amount appropriated for bilateral global HIV/AIDS 

11 assistance for such fiscal year compared with fiscal 

12 year 2008 shall be based on long-term requirements, 

13 epidemiological evidence, the share of treatment needs 

14 being met by partner governments and other sources 

15 of treatment funding, and other appropriate factors; 

16 ‘‘(3) the treatment goal under section 402(a)(3) 

17 shall be increased above the number calculated under 

18 paragraph (1) by the same percentage that the aver19 age United States Government cost per patient of pro20 viding treatment in countries receiving bilateral HIV/ 

21 AIDS assistance has decreased compared with fiscal 

22 year 2008; and 

23 ‘‘(4) the prevention and care goals established in 

24 clauses (i) and (iv) of section 104A(b)(1)(A) of the 

25 Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 
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1 2(b)(1)(A)) shall be increased consistent with epide2 miological evidence and available resources.’’. 

3 TITLE V—MISCELLANEOUS 

4 SEC. 501. MACHINE READABLE VISA FEES. 

5 (a) FEE INCREASE.—Notwithstanding any other pro6 vision of law— 

7 (1) not later than October 1, 2010, the Secretary 

8 of State shall increase by $1 the fee or surcharge au9 thorized under section 140(a) of the Foreign Relations 

10 Authorization Act, Fiscal Years 1994 and 1995 (Pub11 lic Law 103–236; 8 U.S.C. 1351 note) for processing 

12 machine readable nonimmigrant visas and machine 

13 readable combined border crossing identification 

14 cards and nonimmigrant visas; and 

15 (2) not later than October 1, 2013, the Secretary 

16 shall increase the fee or surcharge described in para17 graph (1) by an additional $1. 

18 (b) DEPOSIT OF AMOUNTS.—Notwithstanding section 

19 140(a)(2) of the Foreign Relations Authorization Act, Fis20 cal Years 1994 and 1995 (Public Law 103–236; 8 U.S.C. 

21 1351 note), fees collected under the authority of subsection 

22 (a) shall be deposited in the Treasury. 
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1 TITLE VI—EMERGENCY PLAN 

2 FOR INDIAN SAFETY AND 

3 HEALTH 

4 SEC. 601. EMERGENCY PLAN FOR INDIAN SAFETY AND 

5 HEALTH. 

6 (a) ESTABLISHMENT OF FUND.—There is established 

7 in the Treasury of the United States a fund, to be known 

8 as the ‘‘Emergency Fund for Indian Safety and Health’’ 

9 (referred to in this section as the ‘‘Fund’’), consisting of 

10 such amounts as are appropriated to the Fund under sub11 section (b). 

12 (b) TRANSFERS TO FUND.— 

13 (1) IN GENERAL.—There is authorized to be ap14 propriated to the Fund, out of funds of the Treasury 

15 not otherwise appropriated, $2,000,000,000 for the 5- 

16 year period beginning on October 1, 2008. 

17 (2) AVAILABILITY OF AMOUNTS.—Amounts de18 posited in the Fund under this section shall— 

19 (A) be made available without further ap20 propriation; 

21 (B) be in addition to amounts made avail22 able under any other provision of law; and 

23 (C) remain available until expended. 

24 (c) EXPENDITURES FROM FUND.—On request by the 

25 Attorney General, the Secretary of the Interior, or the Sec-
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1 retary of Health and Human Services, the Secretary of the 

2 Treasury shall transfer from the Fund to the Attorney Gen3 eral, the Secretary of the Interior, or the Secretary of Health 

4 and Human Services, as appropriate, such amounts as the 

5 Attorney General, the Secretary of the Interior, or the Sec6 retary of Health and Human Services determines to be nec7 essary to carry out the emergency plan under subsection 

8 (f). 

9 (d) TRANSFERS OF AMOUNTS.— 

10 (1) IN GENERAL.—The amounts required to be 

11 transferred to the Fund under this section shall be 

12 transferred at least monthly from the general fund of 

13 the Treasury to the Fund on the basis of estimates 

14 made by the Secretary of the Treasury. 

15 (2) ADJUSTMENTS.—Proper adjustment shall be 

16 made in amounts subsequently transferred to the ex17 tent prior estimates were in excess of or less than the 

18 amounts required to be transferred. 

19 (e) REMAINING AMOUNTS.—Any amounts remaining 

20 in the Fund on September 30 of an applicable fiscal year 

21 may be used by the Attorney General, the Secretary of the 

22 Interior, or the Secretary of Health and Human Services 

23 to carry out the emergency plan under subsection (f) for 

24 any subsequent fiscal year. 
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1 (f) EMERGENCY PLAN.—Not later than 1 year after the 

2 date of enactment of this Act, the Attorney General, the Sec3 retary of the Interior, and the Secretary of Health and 

4 Human Services, in consultation with Indian tribes (as de5 fined in section 4 of the Indian Self-Determination and 

6 Education Assistance Act (25 U.S.C. 450b)), shall jointly 

7 establish an emergency plan that addresses law enforcement, 

8 water, and health care needs of Indian tribes under which, 

9 for each of fiscal years 2010 through 2019, of amounts in 

10 the Fund— 

11 (1) the Attorney General shall use— 

12 (A) 18.5 percent for the construction, reha13 bilitation, and replacement of Federal Indian de14 tention facilities; 

15 (B) 1.5 percent to investigate and prosecute 

16 crimes in Indian country (as defined in section 

17 1151 of title 18, United States Code); 

18 (C) 1.5 percent for use by the Office of Jus19 tice Programs for Indian and Alaska Native pro20 grams; and 

21 (D) 0.5 percent to provide assistance to— 

22 (i) parties to cross-deputization or 

23 other cooperative agreements between State 

24 or local governments and Indian tribes (as 

25 defined in section 102 of the Federally Rec-
139 

•HR 5501 EAS 

1 ognized Indian Tribe List Act of 1994 (25 

2 U.S.C. 479a)) carrying out law enforcement 

3 activities in Indian country; and 

4 (ii) the State of Alaska (including po5 litical subdivisions of that State) for car6 rying out the Village Public Safety Officer 

7 Program and law enforcement activities on 

8 Alaska Native land (as defined in section 3 

9 of Public Law 103–399 (25 U.S.C. 3902)); 

10 (2) the Secretary of the Interior shall— 

11 (A) deposit 15.5 percent in the public safety 

12 and justice account of the Bureau of Indian Af13 fairs for use by the Office of Justice Services of 

14 the Bureau in providing law enforcement or de15 tention services, directly or through contracts or 

16 compacts with Indian tribes under the Indian 

17 Self-Determination and Education Assistance 

18 Act (25 U.S.C. 450 et seq.); and 

19 (B) use 50 percent to implement require20 ments of Indian water settlement agreements 

21 that are approved by Congress (or the legislation 

22 to implement such an agreement) under which 

23 the United States shall plan, design, rehabilitate, 

24 or construct, or provide financial assistance for 

25 the planning, design, rehabilitation, or construc-
140 

•HR 5501 EAS 

1 tion of, water supply or delivery infrastructure 

2 that will serve an Indian tribe (as defined in 

3 section 4 of the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450b)); and 

5 (3) the Secretary of Health and Human Serv6 ices, acting through the Director of the Indian Health 

7 Service, shall use 12.5 percent to provide, directly or 

8 through contracts or compacts with Indian tribes 

9 under the Indian Self-Determination and Education 

10 Assistance Act (25 U.S.C. 450 et seq.)— 

11 (A) contract health services; 

12 (B) construction, rehabilitation, and re13 placement of Indian health facilities; and 

14 (C) domestic and community sanitation fa15 cilities serving members of Indian tribes (as de16 fined in section 4 of the Indian Self-Determina17 tion and Education Assistance Act (25 U.S.C. 

18 450b)) pursuant to section 7 of the Act of August 

19 5, 1954 (42 U.S.C. 2004a). 

Attest: 

Secretary. 

110TH CONGRESS 

2D SESSION H.R. 5501 

AMENDMENT