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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5501 Engrossed Amendment Senate (EAS)]

  
  
  
  
  
  
  
  
  
  

                  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:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

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

               TITLE I--POLICY PLANNING AND COORDINATION

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

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

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

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Malaria Response Coordinator.
Sec. 305. Amendment to Immigration and Nationality Act.
Sec. 306. Clerical amendment.
Sec. 307. Requirements.
Sec. 308. Annual report on prevention of mother-to-child transmission 
                            of HIV.
Sec. 309. Prevention of mother-to-child transmission expert panel.

                     TITLE IV--FUNDING ALLOCATIONS

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

                         TITLE V--MISCELLANEOUS

Sec. 501. Machine readable visa fees.

         TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

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

SEC. 2. FINDINGS.

    Section 2 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by 
adding at the end the following:
            ``(29) On May 27, 2003, the President signed this Act into 
        law, launching the largest international public health program 
        of its kind ever created.
            ``(30) Between 2003 and 2008, the United States, through 
        the President's Emergency Plan for AIDS Relief (PEPFAR) and in 
        conjunction with other bilateral programs and the multilateral 
        Global Fund has helped to--
                    ``(A) provide antiretroviral therapy for over 
                1,900,000 people;
                    ``(B) ensure that over 150,000 infants, most of 
                whom would have likely been infected with HIV during 
                pregnancy or childbirth, were not infected; and
                    ``(C) provide palliative care and HIV prevention 
                assistance to millions of other people.
            ``(31) While United States leadership in the battles 
        against HIV/AIDS, tuberculosis, and malaria has had an enormous 
        impact, these diseases continue to take a terrible toll on the 
        human race.
            ``(32) According to the 2007 AIDS Epidemic Update of the 
        Joint United Nations Programme on HIV/AIDS (UNAIDS)--
                    ``(A) an estimated 2,100,000 people died of AIDS-
                related causes in 2007; and
                    ``(B) an estimated 2,500,000 people were newly 
                infected with HIV during that year.
            ``(33) According to the World Health Organization, malaria 
        kills more than 1,000,000 people per year, 70 percent of whom 
        are children under 5 years of age.
            ``(34) According to the World Health Organization, \1/3\ of 
        the world's population is infected with the tuberculosis 
        bacterium, and tuberculosis is 1 of the greatest infectious 
        causes of death of adults worldwide, killing 1,600,000 people 
        per year.
            ``(35) Efforts to promote abstinence, fidelity, the correct 
        and consistent use of condoms, the delay of sexual debut, and 
        the reduction of concurrent sexual partners represent important 
        elements of strategies to prevent the transmission of HIV/AIDS.
            ``(36) According to UNAIDS--
                    ``(A) women and girls make up nearly 60 percent of 
                persons in sub-Saharan Africa who are HIV positive;
                    ``(B) women and girls are more biologically, 
                economically, and socially vulnerable to HIV infection; 
                and
                    ``(C) gender issues are critical components in the 
                effort to prevent HIV/AIDS and to care for those 
                affected by the disease.
            ``(37) Children who have lost a parent to HIV/AIDS, who are 
        otherwise directly affected by the disease, or who live in 
        areas of high HIV prevalence may be vulnerable to the disease 
        or its socioeconomic effects.
            ``(38) Lack of health capacity, including insufficient 
        personnel and inadequate infrastructure, in sub-Saharan Africa 
        and other regions of the world is a critical barrier that 
        limits the effectiveness of efforts to combat HIV/AIDS, 
        tuberculosis, and malaria, and to achieve other global health 
        goals.
            ``(39) On March 30, 2007, the Institute of Medicine of the 
        National Academies released a report entitled `PEPFAR 
        Implementation: Progress and Promise', which found that budget 
        allocations setting percentage levels for spending on 
        prevention, care, and treatment and for certain subsets of 
        activities within the prevention category--
                    ``(A) have `adversely affected implementation of 
                the U.S. Global AIDS Initiative';
                    ``(B) have inhibited comprehensive, integrated, 
                evidence based approaches;
                    ``(C) `have been counterproductive';
                    ``(D) `may have been helpful initially in ensuring 
                a balance of attention to activities within the 4 
                categories of prevention, treatment, care, and orphans 
                and vulnerable children';
                    ``(E) `have also limited PEPFAR's ability to tailor 
                its activities in each country to the local epidemic 
                and to coordinate with the level of activities in the 
                countries' national plans'; and
                    ``(F) should be removed by Congress and replaced 
                with more appropriate mechanisms that--
                            ``(i) `ensure accountability for results 
                        from Country Teams to the U.S. Global AIDS 
                        Coordinator and to Congress'; and
                            ``(ii) `ensure that spending is directly 
                        linked to and commensurate with necessary 
                        efforts to achieve both country and overall 
                        performance targets for prevention, treatment, 
                        care, and orphans and vulnerable children'.
            ``(40) The United States Government has endorsed the 
        principles of harmonization in coordinating efforts to combat 
        HIV/AIDS commonly referred to as the `Three Ones', which 
        includes--
                    ``(A) 1 agreed HIV/AIDS action framework that 
                provides the basis for coordination of the work of all 
                partners;
                    ``(B) 1 national HIV/AIDS coordinating authority, 
                with a broadbased multisectoral mandate; and
                    ``(C) 1 agreed HIV/AIDS country-level monitoring 
                and evaluating system.
            ``(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis 
        and Other Related Infectious Diseases, of April 26-27, 2001 
        (referred to in this Act as the `Abuja Declaration'), the Heads 
        of State and Government of the Organization of African Unity 
        (OAU)--
                    ``(A) declared that they would `place the fight 
                against HIV/AIDS at the forefront and as the highest 
                priority issue in our respective national development 
                plans';
                    ``(B) committed `TO TAKE PERSONAL RESPONSIBILITY 
                AND PROVIDE LEADERSHIP for the activities of the 
                National AIDS Commissions/Councils';
                    ``(C) resolved `to lead from the front the battle 
                against HIV/AIDS, Tuberculosis and Other Related 
                Infectious Diseases by personally ensuring that such 
                bodies were properly convened in mobilizing our 
                societies as a whole and providing focus for unified 
                national policymaking and programme implementation, 
                ensuring coordination of all sectors at all levels with 
                a gender perspective and respect for human rights, 
                particularly to ensure equal rights for people living 
                with HIV/AIDS'; and
                    ``(D) pledged `to set a target of allocating at 
                least 15% of our annual budget to the improvement of 
                the health sector'.''.

SEC. 3. DEFINITIONS.

    Section 3 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is amended--
            (1) in paragraph (2), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs of the House of Representatives, the Committee on 
        Appropriations of the Senate, and the Committee on 
        Appropriations'';
            (2) by redesignating paragraph (6) as paragraph (12);
            (3) by redesignating paragraphs (3) through (5), as 
        paragraphs (4) through (6), respectively;
            (4) by inserting after paragraph (2) the following:
            ``(3) Global aids coordinator.--The term `Global AIDS 
        Coordinator' means the Coordinator of United States Government 
        Activities to Combat HIV/AIDS Globally.''; and
            (5) by inserting after paragraph (6), as redesignated, the 
        following:
            ``(7) Impact evaluation research.--The term `impact 
        evaluation research' means the application of research methods 
        and statistical analysis to measure the extent to which change 
        in a population-based outcome can be attributed to program 
        intervention instead of other environmental factors.
            ``(8) Operations research.--The term `operations research' 
        means the application of social science research methods, 
        statistical analysis, and other appropriate scientific methods 
        to judge, compare, and improve policies and program outcomes, 
        from the earliest stages of defining and designing programs 
        through their development and implementation, with the 
        objective of the rapid dissemination of conclusions and 
        concrete impact on programming.
            ``(9) Paraprofessional.--The term `paraprofessional' means 
        an individual who is trained and employed as a health agent for 
        the provision of basic assistance in the identification, 
        prevention, or treatment of illness or disability.
            ``(10) Partner government.--The term `partner government' 
        means a government with which the United States is working to 
        provide assistance to combat HIV/AIDS, tuberculosis, or malaria 
        on behalf of people living within the jurisdiction of such 
        government.
            ``(11) Program monitoring.--The term `program monitoring' 
        means the collection, analysis, and use of routine program data 
        to determine--
                    ``(A) how well a program is carried out; and
                    ``(B) how much the program costs.''.

SEC. 4. PURPOSE.

    Section 4 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7603) is amended to 
read as follows:

``SEC. 4. PURPOSE.

    ``The purpose of this Act is to strengthen and enhance United 
States leadership and the effectiveness of the United States response 
to the HIV/AIDS, tuberculosis, and malaria pandemics and other related 
and preventable infectious diseases as part of the overall United 
States health and development agenda by--
            ``(1) establishing comprehensive, coordinated, and 
        integrated 5-year, global strategies to combat HIV/AIDS, 
        tuberculosis, and malaria by--
                    ``(A) building on progress and successes to date;
                    ``(B) improving harmonization of United States 
                efforts with national strategies of partner governments 
                and other public and private entities; and
                    ``(C) emphasizing capacity building initiatives in 
                order to promote a transition toward greater 
                sustainability through the support of country-driven 
                efforts;
            ``(2) providing increased resources for bilateral and 
        multilateral efforts to fight HIV/AIDS, tuberculosis, and 
        malaria as integrated components of United States development 
        assistance;
            ``(3) intensifying efforts to--
                    ``(A) prevent HIV infection;
                    ``(B) ensure the continued support for, and 
                expanded access to, treatment and care programs;
                    ``(C) enhance the effectiveness of prevention, 
                treatment, and care programs; and
                    ``(D) address the particular vulnerabilities of 
                girls and women;
            ``(4) encouraging the expansion of private sector efforts 
        and expanding public-private sector partnerships to combat HIV/
        AIDS, tuberculosis, and malaria;
            ``(5) reinforcing efforts to--
                    ``(A) develop safe and effective vaccines, 
                microbicides, and other prevention and treatment 
                technologies; and
                    ``(B) improve diagnostics capabilities for HIV/
                AIDS, tuberculosis, and malaria; and
            ``(6) helping partner countries to--
                    ``(A) strengthen health systems;
                    ``(B) expand health workforce; and
                    ``(C) address infrastructural weaknesses.''.

SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

    Section 5 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7604) is amended by 
inserting ``, with the exception of the 5-year strategy'' before the 
period at the end.

               TITLE I--POLICY PLANNING AND COORDINATION

SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 5-YEAR, GLOBAL 
              STRATEGY.

    (a) Strategy.--Section 101(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7611(a)) is amended to read as follows:
    ``(a) Strategy.--The President shall establish a comprehensive, 
integrated, 5-year strategy to expand and improve efforts to combat 
global HIV/AIDS. This strategy shall--
            ``(1) further strengthen the capability of the United 
        States to be an effective leader of the international campaign 
        against this disease and strengthen the capacities of nations 
        experiencing HIV/AIDS epidemics to combat this disease;
            ``(2) maintain sufficient flexibility and remain responsive 
        to--
                    ``(A) changes in the epidemic;
                    ``(B) challenges facing partner countries in 
                developing and implementing an effective national 
                response; and
                    ``(C) evidence-based improvements and innovations 
                in the prevention, care, and treatment of HIV/AIDS;
            ``(3) situate United States efforts to combat HIV/AIDS, 
        tuberculosis, and malaria within the broader United States 
        global health and development agenda, establishing a roadmap to 
        link investments in specific disease programs to the broader 
        goals of strengthening health systems and infrastructure and to 
        integrate and coordinate HIV/AIDS, tuberculosis, or malaria 
        programs with other health or development programs, as 
        appropriate;
            ``(4) provide a plan to--
                    ``(A) prevent 12,000,000 new HIV infections 
                worldwide;
                    ``(B) support--
                            ``(i) the increase in the number of 
                        individuals with HIV/AIDS receiving 
                        antiretroviral treatment above the goal 
                        established under section 402(a)(3) and 
                        increased pursuant to paragraphs (1) through 
                        (3) of section 403(d); and
                            ``(ii) additional treatment through 
                        coordinated multilateral efforts;
                    ``(C) support care for 12,000,000 individuals 
                infected with or affected by HIV/AIDS, including 
                5,000,000 orphans and vulnerable children affected by 
                HIV/AIDS, with an emphasis on promoting a 
                comprehensive, coordinated system of services to be 
                integrated throughout the continuum of care;
                    ``(D) help partner countries in the effort to 
                achieve goals of 80 percent access to counseling, 
                testing, and treatment to prevent the transmission of 
                HIV from mother to child, emphasizing a continuum of 
                care model;
                    ``(E) help partner countries to provide care and 
                treatment services to children with HIV in proportion 
                to their percentage within the HIV-infected population 
                in each country;
                    ``(F) promote preservice training for health 
                professionals designed to strengthen the capacity of 
                institutions to develop and implement policies for 
                training health workers to combat HIV/AIDS, 
                tuberculosis, and malaria;
                    ``(G) equip teachers with skills needed for HIV/
                AIDS prevention and support for persons with, or 
                affected by, HIV/AIDS;
                    ``(H) provide and share best practices for 
                combating HIV/AIDS with health professionals;
                    ``(I) promote pediatric HIV/AIDS training for 
                physicians, nurses, and other health care workers, 
                through public-private partnerships if possible, 
                including through the designation, if appropriate, of 
                centers of excellence for training in pediatric HIV/
                AIDS prevention, care, and treatment in partner 
                countries; and
                    ``(J) help partner countries to train and support 
                retention of health care professionals and 
                paraprofessionals, with the target of training and 
                retaining at least 140,000 new health care 
                professionals and paraprofessionals with an emphasis on 
                training and in country deployment of critically needed 
                doctors and nurses and to strengthen capacities in 
                developing countries, especially in sub-Saharan Africa, 
                to deliver primary health care with the objective of 
                helping countries achieve staffing levels of at least 
                2.3 doctors, nurses, and midwives per 1,000 population, 
                as called for by the World Health Organization;
            ``(5) include multisectoral approaches and specific 
        strategies to treat individuals infected with HIV/AIDS and to 
        prevent the further transmission of HIV infections, with a 
        particular focus on the needs of families with children 
        (including the prevention of mother-to-child transmission), 
        women, young people, orphans, and vulnerable children;
            ``(6) establish a timetable with annual global treatment 
        targets with country-level benchmarks for antiretroviral 
        treatment;
            ``(7) expand the integration of timely and relevant 
        research within the prevention, care, and treatment of HIV/
        AIDS;
            ``(8) include a plan for program monitoring, operations 
        research, and impact evaluation and for the dissemination of a 
        best practices report to highlight findings;
            ``(9) support the in-country or intra-regional training, 
        preferably through public-private partnerships, of scientific 
        investigators, managers, and other staff who are capable of 
        promoting the systematic uptake of clinical research findings 
        and other evidence-based interventions into routine practice, 
        with the goal of improving the quality, effectiveness, and 
        local leadership of HIV/AIDS health care;
            ``(10) expand and accelerate research on and development of 
        HIV/AIDS prevention methods for women, including enhancing 
        inter-agency collaboration, staffing, and organizational 
        infrastructure dedicated to microbicide research;
            ``(11) provide for consultation with local leaders and 
        officials to develop prevention strategies and programs that 
        are tailored to the unique needs of each country and community 
        and targeted particularly toward those most at risk of 
        acquiring HIV infection;
            ``(12) make the reduction of HIV/AIDS behavioral risks a 
        priority of all prevention efforts by--
                    ``(A) promoting abstinence from sexual activity and 
                encouraging monogamy and faithfulness;
                    ``(B) encouraging the correct and consistent use of 
                male and female condoms and increasing the availability 
                of, and access to, these commodities;
                    ``(C) promoting the delay of sexual debut and the 
                reduction of multiple concurrent sexual partners;
                    ``(D) promoting education for discordant couples 
                (where an individual is infected with HIV and the other 
                individual is uninfected or whose status is unknown) 
                about safer sex practices;
                    ``(E) promoting voluntary counseling and testing, 
                addiction therapy, and other prevention and treatment 
                tools for illicit injection drug users and other 
                substance abusers;
                    ``(F) educating men and boys about the risks of 
                procuring sex commercially and about the need to end 
                violent behavior toward women and girls;
                    ``(G) supporting partner country and community 
                efforts to identify and address social, economic, or 
                cultural factors, such as migration, urbanization, 
                conflict, gender-based violence, lack of empowerment 
                for women, and transportation patterns, which directly 
                contribute to the transmission of HIV;
                    ``(H) supporting comprehensive programs to promote 
                alternative livelihoods, safety, and social 
                reintegration strategies for commercial sex workers and 
                their families;
                    ``(I) promoting cooperation with law enforcement to 
                prosecute offenders of trafficking, rape, and sexual 
                assault crimes with the goal of eliminating such 
                crimes; and
                    ``(J) working to eliminate rape, gender-based 
                violence, sexual assault, and the sexual exploitation 
                of women and children;
            ``(13) include programs to reduce the transmission of HIV, 
        particularly addressing the heightened vulnerabilities of women 
        and girls to HIV in many countries; and
            ``(14) support other important means of preventing or 
        reducing the transmission of HIV, including--
                    ``(A) medical male circumcision;
                    ``(B) the maintenance of a safe blood supply;
                    ``(C) promoting universal precautions in formal and 
                informal health care settings;
                    ``(D) educating the public to recognize and to 
                avoid risks to contract HIV through blood exposures 
                during formal and informal health care and cosmetic 
                services;
                    ``(E) investigating suspected nosocomial infections 
                to identify and stop further nosocomial transmission; 
                and
                    ``(F) other mechanisms to reduce the transmission 
                of HIV;
            ``(15) increase support for prevention of mother-to-child 
        transmission;
            ``(16) build capacity within the public health sector of 
        developing countries by improving health systems and public 
        health infrastructure and developing indicators to measure 
        changes in broader public health sector capabilities;
            ``(17) increase the coordination of HIV/AIDS programs with 
        development programs;
            ``(18) provide a framework for expanding or developing 
        existing or new country or regional programs, including--
                    ``(A) drafting compacts or other agreements, as 
                appropriate;
                    ``(B) establishing criteria and objectives for such 
                compacts and agreements; and
                    ``(C) promoting sustainability;
            ``(19) provide a plan for national and regional priorities 
        for resource distribution and a global investment plan by 
        region;
            ``(20) provide a plan to address the immediate and ongoing 
        needs of women and girls, which--
                    ``(A) addresses the vulnerabilities that contribute 
                to their elevated risk of infection;
                    ``(B) includes specific goals and targets to 
                address these factors;
                    ``(C) provides clear guidance to field missions to 
                integrate gender across prevention, care, and treatment 
                programs;
                    ``(D) sets forth gender-specific indicators to 
                monitor progress on outcomes and impacts of gender 
                programs;
                    ``(E) supports efforts in countries in which women 
                or orphans lack inheritance rights and other 
                fundamental protections to promote the passage, 
                implementation, and enforcement of such laws;
                    ``(F) supports life skills training, especially 
                among women and girls, with the goal of reducing 
                vulnerabilities to HIV/AIDS;
                    ``(G) addresses and prevents gender-based violence; 
                and
                    ``(H) addresses the posttraumatic and psychosocial 
                consequences and provides postexposure prophylaxis 
                protecting against HIV infection to victims of gender-
                based violence and rape;
            ``(21) provide a plan to--
                    ``(A) determine the local factors that may put men 
                and boys at elevated risk of contracting or 
                transmitting HIV;
                    ``(B) address male norms and behaviors to reduce 
                these risks, including by reducing alcohol abuse;
                    ``(C) promote responsible male behavior; and
                    ``(D) promote male participation and leadership at 
                the community level in efforts to promote HIV 
                prevention, reduce stigma, promote participation in 
                voluntary counseling and testing, and provide care, 
                treatment, and support for persons with HIV/AIDS;
            ``(22) provide a plan to address the vulnerabilities and 
        needs of orphans and children who are vulnerable to, or 
        affected by, HIV/AIDS;
            ``(23) encourage partner countries to develop health care 
        curricula and promote access to training tailored to 
        individuals receiving services through, or exiting from, 
        existing programs geared to orphans and vulnerable children;
            ``(24) provide a framework to work with international 
        actors and partner countries toward universal access to HIV/
        AIDS prevention, treatment, and care programs, recognizing that 
        prevention is of particular importance;
            ``(25) enhance the coordination of United States bilateral 
        efforts to combat global HIV/AIDS with other major public and 
        private entities;
            ``(26) enhance the attention given to the national 
        strategic HIV/AIDS plans of countries receiving United States 
        assistance by--
                    ``(A) reviewing the planning and programmatic 
                decisions associated with that assistance; and
                    ``(B) helping to strengthen such national 
                strategies, if necessary;
            ``(27) support activities described in the Global Plan to 
        Stop TB, including--
                    ``(A) expanding and enhancing the coverage of the 
                Directly Observed Treatment Short-course (DOTS) in 
                order to treat individuals infected with tuberculosis 
                and HIV, including multi-drug resistant or extensively 
                drug resistant tuberculosis; and
                    ``(B) improving coordination and integration of 
                HIV/AIDS and tuberculosis programming;
            ``(28) ensure coordination between the Global AIDS 
        Coordinator and the Malaria Coordinator and address issues of 
        comorbidity between HIV/AIDS and malaria; and
            ``(29) include a longer term estimate of the projected 
        resource needs, progress toward greater sustainability and 
        country ownership of HIV/AIDS programs, and the anticipated 
        role of the United States in the global effort to combat HIV/
        AIDS during the 10-year period beginning on October 1, 2013.''.
    (b) Report.--Section 101(b) of such Act (22 U.S.C. 7611(b)) is 
amended to read as follows:
    ``(b) Report.--
            ``(1) In general.--Not later than October 1, 2009, the 
        President shall submit a report to the appropriate 
        congressional committees that sets forth the strategy described 
        in subsection (a).
            ``(2) Contents.--The report required under paragraph (1) 
        shall include a discussion of the following elements:
                    ``(A) The purpose, scope, methodology, and general 
                and specific objectives of the strategy.
                    ``(B) The problems, risks, and threats to the 
                successful pursuit of the strategy.
                    ``(C) The desired goals, objectives, activities, 
                and outcome-related performance measures of the 
                strategy.
                    ``(D) A description of future costs and resources 
                needed to carry out the strategy.
                    ``(E) A delineation of United States Government 
                roles, responsibility, and coordination mechanisms of 
                the strategy.
                    ``(F) A description of the strategy--
                            ``(i) to promote harmonization of United 
                        States assistance with that of other 
                        international, national, and private actors as 
                        elucidated in the `Three Ones'; and
                            ``(ii) to address existing challenges in 
                        harmonization and alignment.
                    ``(G) A description of the manner in which the 
                strategy will--
                            ``(i) further the development and 
                        implementation of the national multisectoral 
                        strategic HIV/AIDS frameworks of partner 
                        governments; and
                            ``(ii) enhance the centrality, 
                        effectiveness, and sustainability of those 
                        national plans.
                    ``(H) A description of how the strategy will seek 
                to achieve the specific targets described in subsection 
                (a) and other targets, as appropriate.
                    ``(I) A description of, and rationale for, the 
                timetable for annual global treatment targets with 
                country-level estimates of numbers of persons in need 
                of antiretroviral treatment, country-level benchmarks 
                for United States support for assistance for 
                antiretroviral treatment, and numbers of persons 
                enrolled in antiretroviral treatment programs receiving 
                United States support. If global benchmarks are not 
                achieved within the reporting period, the report shall 
                include a description of steps being taken to ensure 
                that global benchmarks will be achieved and a detailed 
                breakdown and justification of spending priorities in 
                countries in which benchmarks are not being met, 
                including a description of other donor or national 
                support for antiretroviral treatment in the country, if 
                appropriate.
                    ``(J) A description of how operations research is 
                addressed in the strategy and how such research can 
                most effectively be integrated into care, treatment, 
                and prevention activities in order to--
                            ``(i) improve program quality and 
                        efficiency;
                            ``(ii) ascertain cost effectiveness;
                            ``(iii) ensure transparency and 
                        accountability;
                            ``(iv) assess population-based impact;
                            ``(v) disseminate findings and best 
                        practices; and
                            ``(vi) optimize delivery of services.
                    ``(K) An analysis of United States-assisted 
                strategies to prevent the transmission of HIV/AIDS, 
                including methodologies to promote abstinence, 
                monogamy, faithfulness, the correct and consistent use 
                of male and female condoms, reductions in concurrent 
                sexual partners, and delay of sexual debut, and of 
                intended monitoring and evaluation approaches to 
                measure the effectiveness of prevention programs and 
                ensure that they are targeted to appropriate audiences.
                    ``(L) Within the analysis required under 
                subparagraph (K), an examination of additional planned 
                means of preventing the transmission of HIV including 
                medical male circumcision, maintenance of a safe blood 
                supply, public education about risks to acquire HIV 
                infection from blood exposures, promotion of universal 
                precautions, investigation of suspected nosocomial 
                infections and other tools.
                    ``(M) A description of efforts to assist partner 
                country and community to identify and address social, 
                economic, or cultural factors, such as migration, 
                urbanization, conflict, gender-based violence, lack of 
                empowerment for women, and transportation patterns, 
                which directly contribute to the transmission of HIV.
                    ``(N) A description of the specific targets, goals, 
                and strategies developed to address the needs and 
                vulnerabilities of women and girls to HIV/AIDS, 
                including--
                            ``(i) activities directed toward men and 
                        boys;
                            ``(ii) activities to enhance educational, 
                        microfinance, and livelihood opportunities for 
                        women and girls;
                            ``(iii) activities to promote and protect 
                        the legal empowerment of women, girls, and 
                        orphans and vulnerable children;
                            ``(iv) programs targeted toward gender-
                        based violence and sexual coercion;
                            ``(v) strategies to meet the particular 
                        needs of adolescents;
                            ``(vi) assistance for victims of rape, 
                        sexual abuse, assault, exploitation, and 
                        trafficking; and
                            ``(vii) programs to prevent alcohol abuse.
                    ``(O) A description of strategies to address male 
                norms and behaviors that contribute to the transmission 
                of HIV, to promote responsible male behavior, and to 
                promote male participation and leadership in HIV/AIDS 
                prevention, care, treatment, and voluntary counseling 
                and testing.
                    ``(P) A description of strategies--
                            ``(i) to address the needs of orphans and 
                        vulnerable children, including an analysis of--
                                    ``(I) factors contributing to 
                                children's vulnerability to HIV/AIDS; 
                                and
                                    ``(II) vulnerabilities caused by 
                                the impact of HIV/AIDS on children and 
                                their families; and
                            ``(ii) in areas of higher HIV/AIDS 
                        prevalence, to promote a community-based 
                        approach to vulnerability, maximizing community 
                        input into determining which children 
                        participate.
                    ``(Q) A description of capacity-building efforts 
                undertaken by countries themselves, including adherents 
                of the Abuja Declaration and an assessment of the 
                impact of International Monetary Fund macroeconomic and 
                fiscal policies on national and donor investments in 
                health.
                    ``(R) A description of the strategy to--
                            ``(i) strengthen capacity building within 
                        the public health sector;
                            ``(ii) improve health care in those 
                        countries;
                            ``(iii) help countries to develop and 
                        implement national health workforce strategies;
                            ``(iv) strive to achieve goals in training, 
                        retaining, and effectively deploying health 
                        staff;
                            ``(v) promote the use of codes of conduct 
                        for ethical recruiting practices for health 
                        care workers; and
                            ``(vi) increase the sustainability of 
                        health programs.
                    ``(S) A description of the criteria for selection, 
                objectives, methodology, and structure of compacts or 
                other framework agreements with countries or regional 
                organizations, including--
                            ``(i) the role of civil society;
                            ``(ii) the degree of transparency;
                            ``(iii) benchmarks for success of such 
                        compacts or agreements; and
                            ``(iv) the relationship between such 
                        compacts or agreements and the national HIV/
                        AIDS and public health strategies and 
                        commitments of partner countries.
                    ``(T) A strategy to better coordinate HIV/AIDS 
                assistance with nutrition and food assistance programs.
                    ``(U) A description of transnational or regional 
                initiatives to combat regionalized epidemics in highly 
                affected areas such as the Caribbean.
                    ``(V) A description of planned resource 
                distribution and global investment by region.
                    ``(W) A description of coordination efforts in 
                order to better implement the Stop TB Strategy and to 
                address the problem of coinfection of HIV/AIDS and 
                tuberculosis and of projected challenges or barriers to 
                successful implementation.
                    ``(X) A description of coordination efforts to 
                address malaria and comorbidity with malaria and HIV/
                AIDS.''.
    (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) is 
amended to read as follows:
    ``(c) Study of Progress Toward Achievement of Policy Objectives.--
            ``(1) Design and budget plan for data evaluation.--The 
        Global AIDS Coordinator shall enter into a contract with the 
        Institute of Medicine of the National Academies that provides 
        that not later than 18 months after the date of the enactment 
        of the Tom Lantos and Henry J. Hyde United States Global 
        Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, the Institute, in consultation 
        with the Global AIDS Coordinator and other relevant parties 
        representing the public and private sector, shall provide the 
        Global AIDS Coordinator with a design plan and budget for the 
        evaluation and collection of baseline and subsequent data to 
        address the elements set forth in paragraph (2)(B). The Global 
        AIDS Coordinator shall submit the budget and design plan to the 
        appropriate congressional committees.
            ``(2) Study.--
                    ``(A) In general.--Not later than 4 years after the 
                date of the enactment of the Tom Lantos and Henry J. 
                Hyde United States Global Leadership Against HIV/AIDS, 
                Tuberculosis, and Malaria Reauthorization Act of 2008, 
                the Institute of Medicine of the National Academies 
                shall publish a study that includes--
                            ``(i) an assessment of the performance of 
                        United States-assisted global HIV/AIDS 
                        programs; and
                            ``(ii) an evaluation of the impact on 
                        health of prevention, treatment, and care 
                        efforts that are supported by United States 
                        funding, including multilateral and bilateral 
                        programs involving joint operations.
                    ``(B) Content.--The study conducted under this 
                paragraph shall include--
                            ``(i) an assessment of progress toward 
                        prevention, treatment, and care targets;
                            ``(ii) an assessment of the effects on 
                        health systems, including on the financing and 
                        management of health systems and the quality of 
                        service delivery and staffing;
                            ``(iii) an assessment of efforts to address 
                        gender-specific aspects of HIV/AIDS, including 
                        gender related constraints to accessing 
                        services and addressing underlying social and 
                        economic vulnerabilities of women and men;
                            ``(iv) an evaluation of the impact of 
                        treatment and care programs on 5-year survival 
                        rates, drug adherence, and the emergence of 
                        drug resistance;
                            ``(v) an evaluation of the impact of 
                        prevention programs on HIV incidence in 
                        relevant population groups;
                            ``(vi) an evaluation of the impact on child 
                        health and welfare of interventions authorized 
                        under this Act on behalf of orphans and 
                        vulnerable children;
                            ``(vii) an evaluation of the impact of 
                        programs and activities authorized in this Act 
                        on child mortality; and
                            ``(viii) recommendations for improving the 
                        programs referred to in subparagraph (A)(i).
                    ``(C) Methodologies.--Assessments and impact 
                evaluations conducted under the study shall utilize 
                sound statistical methods and techniques for the 
                behavioral sciences, including random assignment 
                methodologies as feasible. Qualitative data on process 
                variables should be used for assessments and impact 
                evaluations, wherever possible.
            ``(3) Contract authority.--The Institute of Medicine may 
        enter into contracts or cooperative agreements or award grants 
        to conduct the study under paragraph (2).
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated such sums as may be necessary to 
        carry out the study under this subsection.''.
    (d) Report.--Section 101 of such Act, as amended by this section, 
is further amended by adding at the end the following:
    ``(d) Comptroller General Report.--
            ``(1) Report required.--Not later than 3 years after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, the Comptroller 
        General of the United States shall submit a report on the 
        global HIV/AIDS programs of the United States to the 
        appropriate congressional committees.
            ``(2) Contents.--The report required under paragraph (1) 
        shall include--
                    ``(A) a description and assessment of the 
                monitoring and evaluation practices and policies in 
                place for these programs;
                    ``(B) an assessment of coordination within Federal 
                agencies involved in these programs, examining both 
                internal coordination within these programs and 
                integration with the larger global health and 
                development agenda of the United States;
                    ``(C) an assessment of procurement policies and 
                practices within these programs;
                    ``(D) an assessment of harmonization with national 
                government HIV/AIDS and public health strategies as 
                well as other international efforts;
                    ``(E) an assessment of the impact of global HIV/
                AIDS funding and programs on other United States global 
                health programming; and
                    ``(F) recommendations for improving the global HIV/
                AIDS programs of the United States.
    ``(e) Best Practices Report.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, and annually thereafter, the 
        Global AIDS Coordinator shall publish a best practices report 
        that highlights the programs receiving financial assistance 
        from the United States that have the potential for replication 
        or adaption, particularly at a low cost, across global AIDS 
        programs, including those that focus on both generalized and 
        localized epidemics.
            ``(2) Dissemination of findings.--
                    ``(A) Publication on internet website.--The Global 
                AIDS Coordinator shall disseminate the full findings of 
                the annual best practices report on the Internet 
                website of the Office of the Global AIDS Coordinator.
                    ``(B) Dissemination guidance.--The Global AIDS 
                Coordinator shall develop guidance to ensure timely 
                submission and dissemination of significant information 
                regarding best practices with respect to global AIDS 
                programs.
    ``(f) Inspectors General.--
            ``(1) Oversight plan.--
                    ``(A) Development.--The Inspectors General of the 
                Department of State and Broadcasting Board of 
                Governors, the Department of Health and Human Services, 
                and the United States Agency for International 
                Development shall jointly develop 5 coordinated annual 
                plans for oversight activity in each of the fiscal 
                years 2009 through 2013, with regard to the programs 
                authorized under this Act and sections 104A, 104B, and 
                104C of the Foreign Assistance Act of 1961 (22 U.S.C. 
                2151b-2, 2151b-3, and 2151b-4).
                    ``(B) Contents.--The plans developed under 
                subparagraph (A) shall include a schedule for financial 
                audits, inspections, and performance reviews, as 
                appropriate.
                    ``(C) Deadline.--
                            ``(i) Initial plan.--The first plan 
                        developed under subparagraph (A) shall be 
                        completed not later than the later of--
                                    ``(I) September 1, 2008; or
                                    ``(II) 60 days after the date of 
                                the enactment of the Tom Lantos and 
                                Henry J. Hyde United States Global 
                                Leadership Against HIV/AIDS, 
                                Tuberculosis, and Malaria 
                                Reauthorization Act of 2008.
                            ``(ii) Subsequent plans.--Each of the last 
                        four plans developed under subparagraph (A) 
                        shall be completed not later than 30 days 
                        before each of the fiscal years 2010 through 
                        2013, respectively.
            ``(2) Coordination.--In order to avoid duplication and 
        maximize efficiency, the Inspectors General described in 
        paragraph (1) shall coordinate their activities with--
                    ``(A) the Government Accountability Office; and
                    ``(B) the Inspectors General of the Department of 
                Commerce, the Department of Defense, the Department of 
                Labor, and the Peace Corps, as appropriate, pursuant to 
                the 2004 Memorandum of Agreement Coordinating Audit 
                Coverage of Programs and Activities Implementing the 
                President's Emergency Plan for AIDS Relief, or any 
                successor agreement.
            ``(3) Funding.--The Global AIDS Coordinator and the 
        Coordinator of the United States Government Activities to 
        Combat Malaria Globally shall make available necessary funds 
        not exceeding $15,000,000 during the 5-year period beginning on 
        October 1, 2008 to the Inspectors General described in 
        paragraph (1) for the audits, inspections, and reviews 
        described in that paragraph.''.
    (e) Annual Study; Message.--Section 101 of such Act, as amended by 
this section, is further amended by adding at the end the following:
    ``(g) Annual Study.--
            ``(1) In general.--Not later than September 30, 2009, and 
        annually thereafter through September 30, 2013, the Global AIDS 
        Coordinator shall complete a study of treatment providers 
        that--
                    ``(A) represents a range of countries and service 
                environments;
                    ``(B) estimates the per-patient cost of 
                antiretroviral HIV/AIDS treatment and the care of 
                people with HIV/AIDS not receiving antiretroviral 
                treatment, including a comparison of the costs for 
                equivalent services provided by programs not receiving 
                assistance under this Act;
                    ``(C) estimates per-patient costs across the 
                program and in specific categories of service 
                providers, including--
                            ``(i) urban and rural providers;
                            ``(ii) country-specific providers; and
                            ``(iii) other subcategories, as 
                        appropriate.
            ``(2) Publication.--Not later than 90 days after the 
        completion of each study under paragraph (1), the Global AIDS 
        Coordinator shall make the results of such study available on a 
        publicly accessible Web site.
    ``(h) Message.--The Global AIDS Coordinator shall develop a 
message, to be prominently displayed by each program receiving funds 
under this Act, that--
            ``(1) demonstrates that the program is a commitment by 
        citizens of the United States to the global fight against HIV/
        AIDS, tuberculosis, and malaria; and
            ``(2) enhances awareness by program recipients that the 
        program is an effort on behalf of the citizens of the United 
        States.''.

SEC. 102. INTERAGENCY WORKING GROUP.

    Section 1(f)(2) of the State Department Basic Authorities Act of 
1956 (22 U.S.C. 2651a(f)(2)) is amended--
            (1) in subparagraph (A), by inserting ``, partner country 
        finance, health, and other relevant ministries,'' after 
        ``community based organizations)'' each place it appears;
            (2) in subparagraph (B)(ii)--
                    (A) by striking subclauses (IV) and (V);
                    (B) by inserting after subclause (III) the 
                following:
                                    ``(IV) Establishing an interagency 
                                working group on HIV/AIDS headed by the 
                                Global AIDS Coordinator and comprised 
                                of representatives from the United 
                                States Agency for International 
                                Development and the Department of 
                                Health and Human Services, for the 
                                purposes of coordination of activities 
                                relating to HIV/AIDS, including--
                                            ``(aa) meeting regularly to 
                                        review progress in partner 
                                        countries toward HIV/AIDS 
                                        prevention, treatment, and care 
                                        objectives;
                                            ``(bb) participating in the 
                                        process of identifying 
                                        countries to consider for 
                                        increased assistance based on 
                                        the epidemiology of HIV/AIDS in 
                                        those countries, including 
                                        clear evidence of a public 
                                        health threat, as well as 
                                        government commitment to 
                                        address the HIV/AIDS problem, 
                                        relative need, and coordination 
                                        and joint planning with other 
                                        significant actors;
                                            ``(cc) assisting the 
                                        Coordinator in the evaluation, 
                                        execution, and oversight of 
                                        country operational plans;
                                            ``(dd) reviewing policies 
                                        that may be obstacles to 
                                        reaching targets set forth for 
                                        HIV/AIDS prevention, treatment, 
                                        and care; and
                                            ``(ee) consulting with 
                                        representatives from additional 
                                        relevant agencies, including 
                                        the National Institutes of 
                                        Health, the Health Resources 
                                        and Services Administration, 
                                        the Department of Labor, the 
                                        Department of Agriculture, the 
                                        Millennium Challenge 
                                        Corporation, the Peace Corps, 
                                        and the Department of Defense.
                                    ``(V) Coordinating overall United 
                                States HIV/AIDS policy and programs, 
                                including ensuring the coordination of 
                                relevant executive branch agency 
                                activities in the field, with efforts 
                                led by partner countries, and with the 
                                assistance provided by other relevant 
                                bilateral and multilateral aid agencies 
                                and other donor institutions to promote 
                                harmonization with other programs aimed 
                                at preventing and treating HIV/AIDS and 
                                other health challenges, improving 
                                primary health, addressing food 
                                security, promoting education and 
                                development, and strengthening health 
                                care systems.'';
                    (C) by redesignating subclauses (VII) and VIII) as 
                subclauses (IX) and (XII), respectively;
                    (D) by inserting after subclause (VI) the 
                following:
                                    ``(VII) Holding annual 
                                consultations with nongovernmental 
                                organizations in partner countries that 
                                provide services to improve health, and 
                                advocating on behalf of the individuals 
                                with HIV/AIDS and those at particular 
                                risk of contracting HIV/AIDS, including 
                                organizations with members who are 
                                living with HIV/AIDS.
                                    ``(VIII) Ensuring, through 
                                interagency and international 
                                coordination, that HIV/AIDS programs of 
                                the United States are coordinated with, 
                                and complementary to, the delivery of 
                                related global health, food security, 
                                development, and education.'';
                    (E) in subclause (IX), as redesignated by 
                subparagraph (C)--
                            (i) by inserting ``Vietnam,'' after 
                        ``Uganda,'';
                            (ii) by inserting after ``of 2003'' the 
                        following: ``and other countries in which the 
                        United States is implementing HIV/AIDS programs 
                        as part of its foreign assistance program''; 
                        and
                            (iii) by adding at the end the following: 
                        ``In designating additional countries under 
                        this subparagraph, the President shall give 
                        priority to those countries in which there is a 
                        high prevalence of HIV or risk of significantly 
                        increasing incidence of HIV within the general 
                        population and inadequate financial means 
                        within the country.'';
                    (F) by inserting after subclause (IX), as 
                redesignated by subparagraph (C), the following:
                                    ``(X) Working with partner 
                                countries in which the HIV/AIDS 
                                epidemic is prevalent among injection 
                                drug users to establish, as a national 
                                priority, national HIV/AIDS prevention 
                                programs.
                                    ``(XI) Working with partner 
                                countries in which the HIV/AIDS 
                                epidemic is prevalent among individuals 
                                involved in commercial sex acts to 
                                establish, as a national priority, 
                                national prevention programs, including 
                                education, voluntary testing, and 
                                counseling, and referral systems that 
                                link HIV/AIDS programs with programs to 
                                eradicate trafficking in persons and 
                                support alternatives to 
                                prostitution.'';
                    (G) in subclause (XII), as redesignated by 
                subparagraph (C), by striking ``funds section'' and 
                inserting ``funds appropriated for HIV/ AIDS assistance 
                pursuant to the authorization of appropriations under 
                section 401 of the United States Leadership Against 
                HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
                U.S.C. 7671)''; and
                    (H) by adding at the end the following:
                                    ``(XIII) Publicizing updated drug 
                                pricing data to inform the purchasing 
                                decisions of pharmaceutical procurement 
                                partners.''.

SEC. 103. SENSE OF CONGRESS.

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

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

SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.

    Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 
is amended--
            (1) by inserting after subsection (c) the following:
    ``(d) Tuberculosis Vaccine Development Programs.--In addition to 
amounts otherwise available under this section, there are authorized to 
be appropriated to the President such sums as may be necessary for each 
of the fiscal years 2009 through 2013, which shall be used for United 
States contributions to tuberculosis vaccine development programs, 
which may include the Aeras Global TB Vaccine Foundation.'';
            (2) in subsection (k)--
                    (A) by striking ``fiscal years 2004 through 2008'' 
                and inserting ``fiscal years 2009 through 2013''; and
                    (B) by striking ``Vaccine Fund'' and inserting 
                ``GAVI Fund''.
            (3) in subsection (l), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
            (4) in subsection (m), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''.

SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS 
              AND MALARIA.

    (a) Findings; Sense of Congress.--Section 202(a) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7622(a)) is amended to read as follows:
    ``(a) Findings; Sense of Congress.--
            ``(1) Findings.--Congress makes the following findings:
                    ``(A) The establishment of the Global Fund in 
                January 2002 is consistent with the general principles 
                for an international AIDS trust fund first outlined by 
                Congress in the Global AIDS and Tuberculosis Relief Act 
                of 2000 (Public Law 106-264).
                    ``(B) The Global Fund is an innovative financing 
                mechanism which--
                            ``(i) has made progress in many areas in 
                        combating HIV/AIDS, tuberculosis, and malaria; 
                        and
                            ``(ii) represents the multilateral 
                        component of this Act, extending United States 
                        efforts to more than 130 countries around the 
                        world.
                    ``(C) The Global Fund and United States bilateral 
                assistance programs--
                            ``(i) are demonstrating increasingly 
                        effective coordination, with each possessing 
                        certain comparative advantages in the fight 
                        against HIV/AIDS, tuberculosis, and malaria; 
                        and
                            ``(ii) often work most effectively in 
                        concert with each other.
                    ``(D) The United States Government--
                            ``(i) is the largest supporter of the 
                        Global Fund in terms of resources and technical 
                        support;
                            ``(ii) made the founding contribution to 
                        the Global Fund; and
                            ``(iii) is fully committed to the success 
                        of the Global Fund as a multilateral public-
                        private partnership.
            ``(2) Sense of congress.--It is the sense of Congress 
        that--
                    ``(A) transparency and accountability are crucial 
                to the long-term success and viability of the Global 
                Fund;
                    ``(B) the Global Fund has made significant progress 
                toward addressing concerns raised by the Government 
                Accountability Office by--
                            ``(i) improving risk assessment and risk 
                        management capabilities;
                            ``(ii) providing clearer guidance for and 
                        oversight of Local Fund Agents; and
                            ``(iii) strengthening the Office of the 
                        Inspector General for the Global Fund;
                    ``(C) the provision of sufficient resources and 
                authority to the Office of the Inspector General for 
                the Global Fund to ensure that office has the staff and 
                independence necessary to carry out its mandate will be 
                a measure of the commitment of the Global Fund to 
                transparency and accountability;
                    ``(D) regular, publicly published financial, 
                programmatic, and reporting audits of the Fund, its 
                grantees, and Local Fund Agents are also important 
                benchmarks of transparency;
                    ``(E) the Global Fund should establish and maintain 
                a system to track--
                            ``(i) the amount of funds disbursed to each 
                        subrecipient on the grant's fiscal cycle; and
                            ``(ii) the distribution of resources, by 
                        grant and principal recipient, for prevention, 
                        care, treatment, drug and commodity purchases, 
                        and other purposes;
                    ``(F) relevant national authorities in recipient 
                countries should exempt from duties and taxes all 
                products financed by Global Fund grants and procured by 
                any principal recipient or subrecipient for the purpose 
                of carrying out such grants;
                    ``(G) the Global Fund, UNAIDS, and the Global AIDS 
                Coordinator should work together to standardize program 
                indicators wherever possible;
                    ``(H) for purposes of evaluating total amounts of 
                funds contributed to the Global Fund under subsection 
                (d)(4)(A)(i), the timetable for evaluations of 
                contributions from sources other than the United States 
                should take into account the fiscal calendars of other 
                major contributors; and
                    ``(I) the Global Fund should not support activities 
                involving the `Affordable Medicines Facility-Malaria' 
                or similar entities pending compelling evidence of 
                success from pilot programs as evaluated by the 
                Coordinator of United States Government Activities to 
                Combat Malaria Globally.''.
    (b) Statement of Policy.--Section 202(b) of such Act is amended by 
adding at the end the following:
            ``(3) Statement of policy.--The United States Government 
        regards the imposition by recipient countries of taxes or 
        tariffs on goods or services provided by the Global Fund, which 
        are supported through public and private donations, including 
        the substantial contribution of the American people, as 
        inappropriate and inconsistent with standards of good 
        governance. The Global AIDS Coordinator or other 
        representatives of the United States Government shall work with 
        the Global Fund to dissuade governments from imposing such 
        duties, tariffs, or taxes.''.
    (c) United States Financial Participation.--Section 202(d) of such 
Act (22 U.S.C. 7622(d)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``$1,000,000,000 for the period of 
                fiscal year 2004 beginning on January 1, 2004'' and 
                inserting ``$2,000,000,000 for fiscal year 2009,''; and
                    (B) by striking ``the fiscal years 2005-2008'' and 
                inserting ``each of the fiscal years 2010 through 
                2013'';
            (2) in paragraph (4)--
                    (A) in subparagraph (A)--
                            (i) in clause (i), by striking ``fiscal 
                        years 2004 through 2008'' and inserting 
                        ``fiscal years 2009 through 2013'';
                            (ii) in clause (ii)--
                                    (I) by striking ``during any of the 
                                fiscal years 2004 through 2008'' and 
                                inserting ``during any of the fiscal 
                                years 2009 through 2013''; and
                                    (II) by adding at the end the 
                                following: ``The President may waive 
                                the application of this clause with 
                                respect to assistance for Sudan that is 
                                overseen by the Southern Country 
                                Coordinating Mechanism, including 
                                Southern Sudan, Southern Kordofan, Blue 
                                Nile State, and Abyei, if the President 
                                determines that the national interest 
                                or humanitarian reasons justify such a 
                                waiver. The President shall publish 
                                each waiver of this clause in the 
                                Federal Register and, not later than 15 
                                days before the waiver takes effect, 
                                shall consult with the Committee on 
                                Foreign Relations of the Senate and the 
                                Committee on Foreign Affairs of the 
                                House of Representatives regarding the 
                                proposed waiver.''; and
                            (iii) in clause (vi)--
                                    (I) by striking ``for the 
                                purposes'' and inserting ``For the 
                                purposes'';
                                    (II) by striking ``fiscal years 
                                2004 through 2008'' and inserting 
                                ``fiscal years 2009 through 2013''; and
                                    (III) by striking ``prior to fiscal 
                                year 2004'' and inserting ``before 
                                fiscal year 2009'';
                    (B) in subparagraph (B)(iv), by striking ``fiscal 
                years 2004 through 2008'' and inserting ``fiscal years 
                2009 through 2013''; and
                    (C) in subparagraph (C)(ii), by striking 
                ``Committee on International Relations'' and inserting 
                ``Committee on Foreign Affairs''; and
            (3) by adding at the end the following:
            ``(5) Withholding funds.--Notwithstanding any other 
        provision of this Act, 20 percent of the amounts appropriated 
        pursuant to this Act for a contribution to support the Global 
        Fund for each of the fiscal years 2010 through 2013 shall be 
        withheld from obligation to the Global Fund until the Secretary 
        of State certifies to the appropriate congressional committees 
        that the Global Fund--
                    ``(A) has established an evaluation framework for 
                the performance of Local Fund Agents (referred to in 
                this paragraph as `LFAs');
                    ``(B) is undertaking a systematic assessment of the 
                performance of LFAs;
                    ``(C) has adopted, and is implementing, a policy to 
                publish on a publicly available Web site--
                            ``(i) grant performance reviews;
                            ``(ii) all reports of the Inspector General 
                        of the Global Fund, in a manner that is 
                        consistent with the Policy for Disclosure of 
                        Reports of the Inspector General, approved at 
                        the 16th Meeting of the Board of the Global 
                        Fund;
                            ``(iii) decision points of the Board of the 
                        Global Fund;
                            ``(iv) reports from Board committees to the 
                        Board; and
                            ``(v) a regular collection and analysis of 
                        performance data and funding of grants of the 
                        Global Fund, which shall cover all principal 
                        recipients and all subrecipients;
                    ``(D) is maintaining an independent, well-staffed 
                Office of the Inspector General that--
                            ``(i) reports directly to the Board of the 
                        Global Fund; and
                            ``(ii) compiles regular, publicly published 
                        audits of financial, programmatic, and 
                        reporting aspects of the Global Fund, its 
                        grantees, and LFAs;
                    ``(E) has established, and is reporting publicly 
                on, standard indicators for all program areas;
                    ``(F) has established a methodology to track and is 
                publicly reporting on--
                            ``(i) all subrecipients and the amount of 
                        funds disbursed to each subrecipient on the 
                        grant's fiscal cycle; and
                            ``(ii) the distribution of resources, by 
                        grant and principal recipient, for prevention, 
                        care, treatment, drugs and commodities 
                        purchase, and other purposes;
                    ``(G) has established a policy on tariffs imposed 
                by national governments on all goods and services 
                financed by the Global Fund;
                    ``(H) through its Secretariat, has taken meaningful 
                steps to prevent national authorities in recipient 
                countries from imposing taxes or tariffs on goods or 
                services provided by the Fund;
                    ``(I) is maintaining its status as a financing 
                institution focused on programs directly related to 
                HIV/AIDS, malaria, and tuberculosis;
                    ``(J) is maintaining and making progress on--
                            ``(i) sustaining its multisectoral 
                        approach, through country coordinating 
                        mechanisms; and
                            ``(ii) the implementation of grants, as 
                        reflected in the proportion of resources 
                        allocated to different sectors, including 
                        governments, civil society, and faith- and 
                        community-based organizations; and
                    ``(K) has established procedures providing access 
                by the Office of Inspector General of the Department of 
                State and Broadcasting Board of Governors, as cognizant 
                Inspector General, and the Inspector General of the 
                Health and Human Services and the Inspector General of 
                the United States Agency for International Development, 
                to Global Fund financial data, and other information 
                relevant to United States contributions (as determined 
                by the Inspector General in consultation with the 
                Global AIDS Coordinator).
            ``(6) Summaries of board decisions and united states 
        positions.--Following each meeting of the Board of the Global 
        Fund, the Coordinator of United States Government Activities to 
        Combat HIV/AIDS Globally shall report on the public website of 
        the Coordinator a summary of Board decisions and how the United 
        States Government voted and its positions on such decisions.''.

SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PREVENT TRANSMISSION OF HIV 
              AND OTHER DISEASES.

    (a) Sense of Congress.--Congress recognizes the need and urgency to 
expand the range of interventions for preventing the transmission of 
human immunodeficiency virus (HIV), including nonvaccine prevention 
methods that can be controlled by women.
    (b) NIH Office of AIDS Research.--Subpart 1 of part D of title 
XXIII of the Public Health Service Act (42 U.S.C. 300cc-40 et seq.) is 
amended by inserting after section 2351 the following:

``SEC. 2351A. MICROBICIDE RESEARCH.

    ``(a) Federal Strategic Plan.--The Director of the Office shall--
            ``(1) expedite the implementation of the Federal strategic 
        plans required by section 403(a) of the Public Health Service 
        Act (42 U.S.C. 283(a)(5)) regarding the conduct and support of 
        research on, and development of, a microbicide to prevent the 
        transmission of the human immunodeficiency virus; and
            ``(2) review and, as appropriate, revise such plan to 
        prioritize funding and activities relative to their scientific 
        urgency and potential market readiness.
    ``(b) Coordination.--In implementing, reviewing, and prioritizing 
elements of the plan described in subsection (a), the Director of the 
Office shall consult, as appropriate, with--
            ``(1) representatives of other Federal agencies involved in 
        microbicide research, including the Coordinator of United 
        States Government Activities to Combat HIV/AIDS Globally, the 
        Director of the Centers for Disease Control and Prevention, and 
        the Administrator of the United States Agency for International 
        Development;
            ``(2) the microbicide research and development community; 
        and
            ``(3) health advocates.''.
    (c) National Institute of Allergy and Infectious Diseases.--Subpart 
6 of part C of title IV of the Public Health Service Act (42 U.S.C. 
285f et seq.) is amended by adding at the end the following:

``SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT.

    ``The Director of the Institute, acting through the head of the 
Division of AIDS, shall, consistent with the peer-review process of the 
National Institutes of Health, carry out research on, and development 
of, safe and effective methods for use by women to prevent the 
transmission of the human immunodeficiency virus, which may include 
microbicides.''.
    (d) CDC.--Part B of title III of the Public Health Service Act (42 
U.S.C. 243 et seq.) is amended by inserting after section 317S the 
following:

``SEC. 317T. MICROBICIDE RESEARCH.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention is strongly encouraged to fully implement the Centers' 
microbicide agenda to support research and development of microbicides 
for use to prevent the transmission of the human immunodeficiency 
virus.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2009 through 2013 to carry out this section.''.
    (e) United States Agency for International Development.--
            (1) In general.--The Administrator of the United States 
        Agency for International Development, in coordination with the 
        Coordinator of United States Government Activities to Combat 
        HIV/AIDS Globally, may facilitate availability and 
        accessibility of microbicides, provided that such 
        pharmaceuticals are approved, tentatively approved, or 
        otherwise authorized for use by--
                    (A) the Food and Drug Administration;
                    (B) a stringent regulatory agency acceptable to the 
                Secretary of Health and Human Services; or
                    (C) a quality assurance mechanism acceptable to the 
                Secretary of Health and Human Services.
            (2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401 of the United 
        States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there are 
        authorized to be appropriated to the President such sums as may 
        be necessary for each of the fiscal years 2009 through 2013 to 
        carry out this subsection.

SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.

    (a) In General.--Title II of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621) is 
amended by adding at the end the following:

``SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.

    ``(a) Statement of Policy.--It shall be the policy of the United 
States Government--
            ``(1) to invest appropriate resources authorized under this 
        Act--
                    ``(A) to carry out activities to strengthen HIV/
                AIDS, tuberculosis, and malaria health policies and 
                health systems; and
                    ``(B) to provide workforce training and capacity-
                building consistent with the goals and objectives of 
                this Act; and
            ``(2) to support the development of a sound policy 
        environment in partner countries to increase the ability of 
        such countries--
                    ``(A) to maximize utilization of health care 
                resources from donor countries;
                    ``(B) to increase national investments in health 
                and education and maximize the effectiveness of such 
                investments;
                    ``(C) to improve national HIV/AIDS, tuberculosis, 
                and malaria strategies;
                    ``(D) to deliver evidence-based services in an 
                effective and efficient manner; and
                    ``(E) to reduce barriers that prevent recipients of 
                services from achieving maximum benefit from such 
                services.
    ``(b) Assistance To Improve Public Finance Management Systems.--
            ``(1) In general.--Consistent with the authority under 
        section 129 of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2152), the Secretary of the Treasury, acting through the head 
        of the Office of Technical Assistance, is authorized to provide 
        assistance for advisors and partner country finance, health, 
        and other relevant ministries to improve the effectiveness of 
        public finance management systems in partner countries to 
        enable such countries to receive funding to carry out programs 
        to combat HIV/AIDS, tuberculosis, and malaria and to manage 
        such programs.
            ``(2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401 for HIV/AIDS 
        assistance, there are authorized to be appropriated to the 
        Secretary of the Treasury such sums as may be necessary for 
        each of the fiscal years 2009 through 2013 to carry out this 
        subsection.
    ``(c) Plan Required.--The Global AIDS Coordinator, in collaboration 
with the Administrator of the United States Agency for International 
Development (USAID), shall develop and implement a plan to combat HIV/
AIDS by strengthening health policies and health systems of partner 
countries as part of USAID's `Health Systems 2020' project. Recognizing 
that human and institutional capacity form the core of any health care 
system that can sustain the fight against HIV/AIDS, tuberculosis, and 
malaria, the plan shall include a strategy to encourage postsecondary 
educational institutions in partner countries, particularly in Africa, 
in collaboration with United States postsecondary educational 
institutions, including historically black colleges and universities, 
to develop such human and institutional capacity and in the process 
further build their capacity to sustain the fight against these 
diseases.''.
    (b) Clerical Amendment.--The table of contents for the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7601 note) is amended by inserting after the item 
relating to section 203, as added by section 203 of this Act, the 
following:

``Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
                            strengthening health policies and health 
                            systems of partner countries.''.

SEC. 205. FACILITATING EFFECTIVE OPERATIONS OF THE CENTERS FOR DISEASE 
              CONTROL.

    Section 307 of the Public Health Service Act (42 U.S.C. 242l) is 
amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) The Secretary may participate with other countries in 
cooperative endeavors in--
            ``(1) biomedical research, health care technology, and the 
        health services research and statistical analysis authorized 
        under section 306 and title IX; and
            ``(2) biomedical research, health care services, health 
        care research, or other related activities in furtherance of 
        the activities, objectives or goals authorized under the Tom 
        Lantos and Henry J. Hyde United States Global Leadership 
        Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act 
        of 2008.''; and
            (2) in subsection (b)--
                    (A) in paragraph (7), by striking ``and'' after the 
                semicolon at the end;
                    (B) by striking ``The Secretary may not, in the 
                exercise of his authority under this section, provide 
                financial assistance for the construction of any 
                facility in any foreign country.''
                    (C) in paragraph (8), by striking ``for any 
                purpose.'' and inserting ``for the purpose of any law 
                administered by the Office of Personnel Management;''; 
                and
                    (D) by adding at the end the following:
            ``(9) provide such funds by advance or reimbursement to the 
        Secretary of State, as may be necessary, to pay the costs of 
        acquisition, lease, construction, alteration, equipping, 
        furnishing or management of facilities outside of the United 
        States; and
            ``(10) in consultation with the Secretary of State, through 
        grant or cooperative agreement, make funds available to public 
        or nonprofit private institutions or agencies in foreign 
        countries in which the Secretary is participating in activities 
        described under subsection (a) to acquire, lease, construct, 
        alter, or renovate facilities in those countries.''.
            (3) in subsection (c)--
                    (A) by striking ``1990'' and inserting ``1980''; 
                and
                    (B) by inserting or ``or section 903 of the Foreign 
                Service Act of 1980 (22 U.S.C. 4083)'' after ``Code''.

SEC. 206. FACILITATING VACCINE DEVELOPMENT.

    (a) Technical Assistance for Developing Countries.--The 
Administrator of the United States Agency for International 
Development, utilizing public-private partners, as appropriate, and 
working in coordination with other international development agencies, 
is authorized to strengthen the capacity of developing countries' 
governmental institutions to--
            (1) collect evidence for informed decision-making and 
        introduction of new vaccines, including potential HIV/AIDS, 
        tuberculosis, and malaria vaccines, if such vaccines are 
        determined to be safe and effective;
            (2) review protocols for clinical trials and impact studies 
        and improve the implementation of clinical trials; and
            (3) ensure adequate supply chain and delivery systems.
    (b) Advanced Market Commitments.--
            (1) Purpose.--The purpose of this subsection is to improve 
        global health by requiring the United States to participate in 
        negotiations for advance market commitments for the development 
        of future vaccines, including potential vaccines for HIV/AIDS, 
        tuberculosis, and malaria.
            (2) Negotiation requirement.--The Secretary of the Treasury 
        shall enter into negotiations with the appropriate officials of 
        the International Bank of Reconstruction and Development (World 
        Bank) and the GAVI Alliance, the member nations of such 
        entities, and other interested parties to establish advanced 
        market commitments to purchase vaccines to combat HIV/AIDS, 
        tuberculosis, malaria, and other related infectious diseases.
            (3) Requirements.--In negotiating the United States 
        participation in programs for advanced market commitments, the 
        Secretary of the Treasury shall take into account whether 
        programs for advance market commitments include--
                    (A) legally binding contracts for product purchase 
                that include a fair market price for up to a maximum 
                number of treatments, creating a strong market 
                incentive;
                    (B) clearly defined and transparent rules of 
                program participation for qualified developers and 
                suppliers of the product;
                    (C) clearly defined requirements for eligible 
                vaccines to ensure that they are safe and effective and 
                can be delivered in developing country contexts;
                    (D) dispute settlement mechanisms; and
                    (E) sufficient flexibility to enable the contracts 
                to be adjusted in accord with new information related 
                to projected market size and other factors while still 
                maintaining the purchase commitment at a fair price.
            (4) Report.--Not later than 1 year after the date of the 
        enactment of this Act--
                    (A) the Secretary of the Treasury shall submit a 
                report to the appropriate congressional committees on 
                the status of the United States negotiations to 
                participate in programs for the advanced market 
                commitments under this subsection; and
                    (B) the President shall produce a comprehensive 
                report, written by a study group of qualified 
                professionals from relevant Federal agencies and 
                initiatives, nongovernmental organizations, and 
                industry representatives, that sets forth a coordinated 
                strategy to accelerate development of vaccines for 
                infectious diseases, such as HIV/AIDS, malaria, and 
                tuberculosis, which includes--
                            (i) initiatives to create economic 
                        incentives for the research, development, and 
                        manufacturing of vaccines for HIV/AIDS, 
                        tuberculosis, malaria, and other infectious 
                        diseases;
                            (ii) an expansion of public-private 
                        partnerships and the leveraging of resources 
                        from other countries and the private sector; 
                        and
                            (iii) efforts to maximize United States 
                        capabilities to support clinical trials of 
                        vaccines in developing countries and to address 
                        the challenges of delivering vaccines in 
                        developing countries to minimize delays in 
                        access once vaccines are available.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

    (a) Amendments to the Foreign Assistance Act of 1961.--
            (1) Finding.--Section 104A(a) of the Foreign Assistance Act 
        of 1961 (22 U.S.C. 2151b-2(a)) is amended by inserting 
        ``Central Asia, Eastern Europe, Latin America'' after 
        ``Caribbean,''.
            (2) Policy.--Section 104A(b) of such Act is amended to read 
        as follows:
    ``(b) Policy.--
            ``(1) Objectives.--It is a major objective of the foreign 
        assistance program of the United States to provide assistance 
        for the prevention and treatment of HIV/AIDS and the care of 
        those affected by the disease. It is the policy objective of 
        the United States, by 2013, to--
                    ``(A) assist partner countries to--
                            ``(i) prevent 12,000,000 new HIV infections 
                        worldwide;
                            ``(ii) support--
                                    ``(I) the increase in the number of 
                                individuals with HIV/AIDS receiving 
                                antiretroviral treatment above the goal 
                                established under section 402(a)(3) and 
                                increased pursuant to paragraphs (1) 
                                through (3) of section 403(d); and
                                    ``(II) additional treatment through 
                                coordinated multilateral efforts;
                            ``(iii) support care for 12,000,000 
                        individuals infected with or affected by HIV/
                        AIDS, including 5,000,000 orphans and 
                        vulnerable children affected by HIV/AIDS, with 
                        an emphasis on promoting a comprehensive, 
                        coordinated system of services to be integrated 
                        throughout the continuum of care;
                            ``(iv) provide at least 80 percent of the 
                        target population with access to counseling, 
                        testing, and treatment to prevent the 
                        transmission of HIV from mother-to-child;
                            ``(v) provide care and treatment services 
                        to children with HIV in proportion to their 
                        percentage within the HIV-infected population 
                        of a given partner country; and
                            ``(vi) train and support retention of 
                        health care professionals, paraprofessionals, 
                        and community health workers in HIV/AIDS 
                        prevention, treatment, and care, with the 
                        target of providing such training to at least 
                        140,000 new health care professionals and 
                        paraprofessionals with an emphasis on training 
                        and in country deployment of critically needed 
                        doctors and nurses;
                    ``(B) strengthen the capacity to deliver primary 
                health care in developing countries, especially in sub-
                Saharan Africa;
                    ``(C) support and help countries in their efforts 
                to achieve staffing levels of at least 2.3 doctors, 
                nurses, and midwives per 1,000 population, as called 
                for by the World Health Organization; and
                    ``(D) help partner countries to develop 
                independent, sustainable HIV/AIDS programs.
            ``(2) Coordinated global strategy.--The United States and 
        other countries with the sufficient capacity should provide 
        assistance to countries in sub-Saharan Africa, the Caribbean, 
        Central Asia, Eastern Europe, and Latin America, and other 
        countries and regions confronting HIV/AIDS epidemics in a 
        coordinated global strategy to help address generalized and 
        concentrated epidemics through HIV/AIDS prevention, treatment, 
        care, monitoring and evaluation, and related activities.
            ``(3) Priorities.--The United States Government's response 
        to the global HIV/AIDS pandemic and the Government's efforts to 
        help countries assume leadership of sustainable campaigns to 
        combat their local epidemics should place high priority on--
                    ``(A) the prevention of the transmission of HIV;
                    ``(B) moving toward universal access to HIV/AIDS 
                prevention counseling and services;
                    ``(C) the inclusion of cost sharing assurances that 
                meet the requirements under section 110; and
                    ``(D) the inclusion of transition strategies to 
                ensure sustainability of such programs and activities, 
                including health care systems, under other 
                international donor support, or budget support by 
                respective foreign governments.''.
    (b) Authorization.--Section 104A(c) of such Act is amended--
            (1) in paragraph (1), by striking ``and other countries and 
        areas.'' and inserting ``Central Asia, Eastern Europe, Latin 
        America, and other countries and areas, particularly with 
        respect to refugee populations or those in postconflict 
        settings in such countries and areas with significant or 
        increasing HIV incidence rates.'';
            (2) in paragraph (2), by striking ``and other countries and 
        areas affected by the HIV/AIDS pandemic'' and inserting 
        ``Central Asia, Eastern Europe, Latin America, and other 
        countries and areas affected by the HIV/AIDS pandemic, 
        particularly with respect to refugee populations or those in 
        post-conflict settings in such countries and areas with 
        significant or increasing HIV incidence rates.''; and
            (3) in paragraph (3)--
                    (A) by striking ``foreign countries'' and inserting 
                ``partner countries, other international actors,''; and
                    (B) by inserting ``within the framework of the 
                principles of the Three Ones'' before the period at the 
                end.
    (c) Activities Supported.--Section 104A(d) of such Act is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)--
                            (i) by inserting ``and multiple concurrent 
                        sexual partnering,'' after ``casual sexual 
                        partnering''; and
                            (ii) by striking ``condoms'' and inserting 
                        ``male and female condoms'';
                    (B) in subparagraph (B)--
                            (i) by striking ``programs that'' and 
                        inserting ``programs that are designed with 
                        local input and''; and
                            (ii) by striking ``those organizations'' 
                        and inserting ``those locally based 
                        organizations'';
                    (C) in subparagraph (D), by inserting ``and 
                promoting the use of provider-initiated or `opt-out' 
                voluntary testing in accordance with World Health 
                Organization guidelines'' before the semicolon at the 
                end;
                    (D) by redesignating subparagraphs (F), (G), and 
                (H) as subparagraphs (H), (I), and (J), respectively;
                    (E) by inserting after subparagraph (E) the 
                following:
                    ``(F) assistance to--
                            ``(i) achieve the goal of reaching 80 
                        percent of pregnant women for prevention and 
                        treatment of mother-to-child transmission of 
                        HIV in countries in which the United States is 
                        implementing HIV/AIDS programs by 2013; and
                            ``(ii) promote infant feeding options and 
                        treatment protocols that meet the most recent 
                        criteria established by the World Health 
                        Organization;
                    ``(G) medical male circumcision programs as part of 
                national strategies to combat the transmission of HIV/
                AIDS;'';
                    (F) in subparagraph (I), as redesignated, by 
                striking ``and'' at the end; and
                    (G) by adding at the end the following:
                    ``(K) assistance for counseling, testing, 
                treatment, care, and support programs, including--
                            ``(i) counseling and other services for the 
                        prevention of reinfection of individuals with 
                        HIV/AIDS;
                            ``(ii) counseling to prevent sexual 
                        transmission of HIV, including--
                                    ``(I) life skills development for 
                                practicing abstinence and faithfulness;
                                    ``(II) reducing the number of 
                                sexual partners;
                                    ``(III) delaying sexual debut; and
                                    ``(IV) ensuring correct and 
                                consistent use of condoms;
                            ``(iii) assistance to engage underlying 
                        vulnerabilities to HIV/AIDS, especially those 
                        of women and girls;
                            ``(iv) assistance for appropriate HIV/AIDS 
                        education programs and training targeted to 
                        prevent the transmission of HIV among men who 
                        have sex with men;
                            ``(v) assistance to provide male and female 
                        condoms;
                            ``(vi) diagnosis and treatment of other 
                        sexually transmitted infections;
                            ``(vii) strategies to address the stigma 
                        and discrimination that impede HIV/AIDS 
                        prevention efforts; and
                            ``(viii) assistance to facilitate 
                        widespread access to microbicides for HIV 
                        prevention, if safe and effective products 
                        become available, including financial and 
                        technical support for culturally appropriate 
                        introductory programs, procurement, 
                        distribution, logistics management, program 
                        delivery, acceptability studies, provider 
                        training, demand generation, and 
                        postintroduction monitoring.''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C)--
                            (i) by inserting ``pain management,'' after 
                        ``opportunistic infections,''; and
                            (ii) by striking the period at the end and 
                        inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(D) as part of care and treatment of HIV/AIDS, 
                assistance (including prophylaxis and treatment) for 
                common HIV/AIDS-related opportunistic infections for 
                free or at a rate at which it is easily affordable to 
                the individuals and populations being served;
                    ``(E) as part of care and treatment of HIV/AIDS, 
                assistance or referral to available and adequately 
                resourced service providers for nutritional support, 
                including counseling and where necessary the provision 
                of commodities, for persons meeting malnourishment 
                criteria and their families;'';
            (3) in paragraph (4)--
                    (A) in subparagraph (C), by striking ``and'' at the 
                end;
                    (B) in subparagraph (D), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(E) carrying out and expanding program 
                monitoring, impact evaluation research and analysis, 
                and operations research and disseminating data and 
                findings through mechanisms to be developed by the 
                Coordinator of United States Government Activities to 
                Combat HIV/AIDS Globally, in coordination with the 
                Director of the Centers for Disease Control, in order 
                to--
                            ``(i) improve accountability, increase 
                        transparency, and ensure the delivery of 
                        evidence-based services through the collection, 
                        evaluation, and analysis of data regarding 
                        gender-responsive interventions, disaggregated 
                        by age and sex;
                            ``(ii) identify and replicate effective 
                        models; and
                            ``(iii) develop gender indicators to 
                        measure outcomes and the impacts of 
                        interventions; and
                    ``(F) establishing appropriate systems to--
                            ``(i) gather epidemiological and social 
                        science data on HIV; and
                            ``(ii) evaluate the effectiveness of 
                        prevention efforts among men who have sex with 
                        men, with due consideration to stigma and risks 
                        associated with disclosure.'';
            (4) in paragraph (5)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (B) by inserting after subparagraph (B) the 
                following:
                    ``(C) Mechanism to ensure cost-effective drug 
                purchasing.--Subject to subparagraph (B), mechanisms to 
                ensure that safe and effective pharmaceuticals, 
                including antiretrovirals and medicines to treat 
                opportunistic infections, are purchased at the lowest 
                possible price at which such pharmaceuticals may be 
                obtained in sufficient quantity on the world market, 
                provided that such pharmaceuticals are approved, 
                tentatively approved, or otherwise authorized for use 
                by--
                            ``(i) the Food and Drug Administration;
                            ``(ii) a stringent regulatory agency 
                        acceptable to the Secretary of Health and Human 
                        Services; or
                            ``(iii) a quality assurance mechanism 
                        acceptable to the Secretary of Health and Human 
                        Services.'';
            (5) in paragraph (6)--
                    (A) by amending the paragraph heading to read as 
                follows:
            ``(6) Related and coordinated activities.--'';
                    (B) in subparagraph (B), by striking ``and'' at the 
                end;
                    (C) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by adding at the end the following:
                    ``(D) coordinated or referred activities to--
                            ``(i) enhance the clinical impact of HIV/
                        AIDS care and treatment; and
                            ``(ii) ameliorate the adverse social and 
                        economic costs often affecting AIDS-impacted 
                        families and communities through the direct 
                        provision, as necessary, or through the 
                        referral, if possible, of support services, 
                        including--
                                    ``(I) nutritional and food support;
                                    ``(II) safe drinking water and 
                                adequate sanitation;
                                    ``(III) nutritional counseling;
                                    ``(IV) income-generating activities 
                                and livelihood initiatives;
                                    ``(V) maternal and child health 
                                care;
                                    ``(VI) primary health care;
                                    ``(VII) the diagnosis and treatment 
                                of other infectious or sexually 
                                transmitted diseases;
                                    ``(VIII) substance abuse and 
                                treatment services; and
                                    ``(IX) legal services;
                    ``(E) coordinated or referred activities to link 
                programs addressing HIV/AIDS with programs addressing 
                gender-based violence in areas of significant HIV 
                prevalence to assist countries in the development and 
                enforcement of women's health, children's health, and 
                HIV/AIDS laws and policies that--
                            ``(i) prevent and respond to violence 
                        against women and girls;
                            ``(ii) promote the integration of screening 
                        and assessment for gender-based violence into 
                        HIV/AIDS programming;
                            ``(iii) promote appropriate HIV/AIDS 
                        counseling, testing, and treatment into gender-
                        based violence programs; and
                            ``(iv) assist governments to develop 
                        partnerships with civil society organizations 
                        to create networks for psychosocial, legal, 
                        economic, or other support services;
                    ``(F) coordinated or referred activities to--
                            ``(i) address the frequent coinfection of 
                        HIV and tuberculosis, in accordance with World 
                        Health Organization guidelines;
                            ``(ii) promote provider-initiated or `opt-
                        out' HIV/AIDS counseling and testing and 
                        appropriate referral for treatment and care to 
                        individuals with tuberculosis or its symptoms, 
                        particularly in areas with significant HIV 
                        prevalence; and
                            ``(iii) strengthen programs to ensure that 
                        individuals testing positive for HIV receive 
                        tuberculosis screening and to improve 
                        laboratory capacities, infection control, and 
                        adherence; and
                    ``(G) activities to--
                            ``(i) improve the effectiveness of national 
                        responses to HIV/AIDS;
                            ``(ii) strengthen overall health systems in 
                        high-prevalence countries, including support 
                        for workforce training, retention, and 
                        effective deployment, capacity building, 
                        laboratory development, equipment maintenance 
                        and repair, and public health and related 
                        public financial management systems and 
                        operations; and
                            ``(iii) encourage fair and transparent 
                        procurement practices among partner countries; 
                        and
                            ``(iv) promote in-country or intra-regional 
                        pediatric training for physicians and other 
                        health professionals, preferably through 
                        public-private partnerships involving colleges 
                        and universities, with the goal of increasing 
                        pediatric HIV workforce capacity.''; and
            (6) by adding at the end the following:
            ``(8) Compacts and framework agreements.--The development 
        of compacts or framework agreements, tailored to local 
        circumstances, with national governments or regional 
        partnerships in countries with significant HIV/AIDS burdens to 
        promote host government commitment to deeper integration of 
        HIV/AIDS services into health systems, contribute to health 
        systems overall, and enhance sustainability, including--
                    ``(A) cost sharing assurances that meet the 
                requirements under section 110; and
                    ``(B) transition strategies to ensure 
                sustainability of such programs and activities, 
                including health care systems, under other 
                international donor support, or budget support by 
                respective foreign governments.''.
    (d) Compacts and Framework Agreements.--Section 104A of such Act is 
amended--
            (1) by redesignating subsections (e) through (g) as 
        subsections (f) through (h); and
            (2) by inserting after subsection (d) the following:
    ``(e) Compacts and Framework Agreements.--
            ``(1) Findings.--Congress makes the following findings:
                    ``(A) The congressionally mandated Institute of 
                Medicine report entitled `PEPFAR Implementation: 
                Progress and Promise' states: `The next strategy [of 
                the U.S. Global AIDS Initiative] should squarely 
                address the needs and challenges involved in supporting 
                sustainable country HIV/AIDS programs, thereby 
                transitioning from a focus on emergency relief.'.
                    ``(B) One mechanism to promote the transition from 
                an emergency to a public health and development 
                approach to HIV/AIDS is through compacts or framework 
                agreements between the United States Government and 
                each participating nation.
            ``(2) Elements.--Compacts on HIV/AIDS authorized under 
        subsection (d)(8) shall include the following elements:
                    ``(A) Compacts whose primary purpose is to provide 
                direct services to combat HIV/AIDS are to be made 
                between--
                            ``(i) the United States Government; and
                            ``(ii)(I) national or regional entities 
                        representing low-income countries served by an 
                        existing United States Agency for International 
                        Development or Department of Health and Human 
                        Services presence or regional platform; or
                            ``(II) countries or regions--
                                    ``(aa) experiencing significantly 
                                high HIV prevalence or risk of 
                                significantly increasing incidence 
                                within the general population;
                                    ``(bb) served by an existing United 
                                States Agency for International 
                                Development or Department of Health and 
                                Human Services presence or regional 
                                platform; and
                                    ``(cc) that have inadequate 
                                financial means within such country or 
                                region.
                    ``(B) Compacts whose primary purpose is to provide 
                limited technical assistance to a country or region 
                connected to services provided within the country or 
                region--
                            ``(i) may be made with other countries or 
                        regional entities served by an existing United 
                        States Agency for International Development or 
                        Department of Health and Human Services 
                        presence or regional platform;
                            ``(ii) shall require significant 
                        investments in HIV prevention, care, and 
                        treatment services by the host country;
                            ``(iii) shall be time-limited in terms of 
                        United States contributions; and
                            ``(iv) shall be made only upon prior 
                        notification to Congress--
                                    ``(I) justifying the need for such 
                                compacts;
                                    ``(II) describing the expected 
                                investment by the country or regional 
                                entity; and
                                    ``(III) describing the scope, 
                                nature, expected total United States 
                                investment, and time frame of the 
                                limited technical assistance under the 
                                compact and its intended impact.
                    ``(C) Compacts shall include provisions to--
                            ``(i) promote local and national efforts to 
                        reduce stigma associated with HIV/AIDS; and
                            ``(ii) work with and promote the role of 
                        civil society in combating HIV/AIDS.
                    ``(D) Compacts shall take into account the overall 
                national health and development and national HIV/AIDS 
                and public health strategies of each country.
                    ``(E) Compacts shall contain--
                            ``(i) consideration of the specific 
                        objectives that the country and the United 
                        States expect to achieve during the term of a 
                        compact;
                            ``(ii) consideration of the respective 
                        responsibilities of the country and the United 
                        States in the achievement of such objectives;
                            ``(iii) consideration of regular benchmarks 
                        to measure progress toward achieving such 
                        objectives;
                            ``(iv) an identification of the intended 
                        beneficiaries, disaggregated by gender and age, 
                        and including information on orphans and 
                        vulnerable children, to the maximum extent 
                        practicable;
                            ``(v) consideration of the methods by which 
                        the compact is intended to--
                                    ``(I) address the factors that put 
                                women and girls at greater risk of HIV/
                                AIDS; and
                                    ``(II) strengthen elements such as 
                                the economic, educational, and social 
                                status of women, girls, orphans, and 
                                vulnerable children and the inheritance 
                                rights and safety of such individuals;
                            ``(vi) consideration of the methods by 
                        which the compact will--
                                    ``(I) strengthen the health care 
                                capacity, including factors such as the 
                                training, retention, deployment, 
                                recruitment, and utilization of health 
                                care workers;
                                    ``(II) improve supply chain 
                                management; and
                                    ``(III) improve the health systems 
                                and infrastructure of the partner 
                                country, including the ability of 
                                compact participants to maintain and 
                                operate equipment transferred or 
                                purchased as part of the compact;
                            ``(vii) consideration of proposed 
                        mechanisms to provide oversight;
                            ``(viii) consideration of the role of civil 
                        society in the development of a compact and the 
                        achievement of its objectives;
                            ``(ix) a description of the current and 
                        potential participation of other donors in the 
                        achievement of such objectives, as appropriate; 
                        and
                            ``(x) consideration of a plan to ensure 
                        appropriate fiscal accountability for the use 
                        of assistance.
                    ``(F) For regional compacts, priority shall be 
                given to countries that are included in regional funds 
                and programs in existence as of the date of the 
                enactment of the Tom Lantos and Henry J. Hyde United 
                States Global Leadership Against HIV/AIDS, 
                Tuberculosis, and Malaria Reauthorization Act of 2008.
                    ``(G) Amounts made available for compacts described 
                in subparagraphs (A) and (B) shall be subject to the 
                inclusion of--
                            ``(i) cost sharing assurances that meet the 
                        requirements under section 110; and
                            ``(ii) transition strategies to ensure 
                        sustainability of such programs and activities, 
                        including health care systems, under other 
                        international donor support, and budget support 
                        by respective foreign governments.
            ``(3) Local input.--In entering into a compact on HIV/AIDS 
        authorized under subsection (d)(8), the Coordinator of United 
        States Government Activities to Combat HIV/AIDS Globally shall 
        seek to ensure that the government of a country--
                    ``(A) takes into account the local perspectives of 
                the rural and urban poor, including women, in each 
                country; and
                    ``(B) consults with private and voluntary 
                organizations, including faith-based organizations, the 
                business community, and other donors in the country.
            ``(4) Congressional and public notification after entering 
        into a compact.--Not later than 10 days after entering into a 
        compact authorized under subsection (d)(8), the Global AIDS 
        Coordinator shall--
                    ``(A) submit a report containing a detailed summary 
                of the compact and a copy of the text of the compact 
                to--
                            ``(i) the Committee on Foreign Relations of 
                        the Senate;
                            ``(ii) the Committee on Appropriations of 
                        the Senate;
                            ``(iii) the Committee on Foreign Affairs of 
                        the House of Representatives; and
                            ``(iv) the Committee on Appropriations of 
                        the House of Representatives; and
                    ``(B) publish such information in the Federal 
                Register and on the Internet website of the Office of 
                the Global AIDS Coordinator.''.
    (e) Annual Report.--Section 104A(f) of such Act, as redesignated, 
is amended--
            (1) in paragraph (1), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) by striking subparagraph (C) and inserting the 
                following:
                    ``(C) a detailed breakdown of funding allocations, 
                by program and by country, for prevention activities; 
                and
                    ``(D) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                including--
                            ``(i)(I) the effectiveness of such programs 
                        in reducing--
                                    ``(aa) the transmission of HIV, 
                                particularly in women and girls;
                                    ``(bb) mother-to-child transmission 
                                of HIV, including through drug 
                                treatment and therapies, either 
                                directly or by referral; and
                                    ``(cc) mortality rates from HIV/
                                AIDS;
                            ``(II) the number of patients receiving 
                        treatment for AIDS in each country that 
                        receives assistance under this Act;
                            ``(III) an assessment of progress towards 
                        the achievement of annual goals set forth in 
                        the timetable required under the 5-year 
                        strategy established under section 101 of the 
                        United States Leadership Against HIV/AIDS, 
                        Tuberculosis, and Malaria Act of 2003 and, if 
                        annual goals are not being met, the reasons for 
                        such failure; and
                            ``(IV) retention and attrition data for 
                        programs receiving United States assistance, 
                        including mortality and loss to follow-up 
                        rates, organized overall and by country;
                            ``(ii) the progress made toward--
                                    ``(I) improving health care 
                                delivery systems (including the 
                                training of health care workers, 
                                including doctors, nurses, midwives, 
                                pharmacists, laboratory technicians, 
                                and compensated community health 
                                workers, and the use of codes of 
                                conduct for ethical recruiting 
                                practices for health care workers);
                                    ``(II) advancing safe working 
                                conditions for health care workers; and
                                    ``(III) improving infrastructure to 
                                promote progress toward universal 
                                access to HIV/AIDS prevention, 
                                treatment, and care by 2013;
                            ``(iii) a description of coordination 
                        efforts with relevant executive branch agencies 
                        to link HIV/AIDS clinical and social services 
                        with non-HIV/AIDS services as part of the 
                        United States health and development agenda;
                            ``(iv) a detailed description of integrated 
                        HIV/AIDS and food and nutrition programs and 
                        services, including--
                                    ``(I) the amount spent on food and 
                                nutrition support;
                                    ``(II) the types of activities 
                                supported; and
                                    ``(III) an assessment of the 
                                effectiveness of interventions carried 
                                out to improve the health status of 
                                persons with HIV/AIDS receiving food or 
                                nutritional support;
                            ``(v) a description of efforts to improve 
                        harmonization, in terms of relevant executive 
                        branch agencies, coordination with other public 
                        and private entities, and coordination with 
                        partner countries' national strategic plans as 
                        called for in the `Three Ones';
                            ``(vi) a description of--
                                    ``(I) the efforts of partner 
                                countries that were signatories to the 
                                Abuja Declaration on HIV/AIDS, 
                                Tuberculosis and Other Related 
                                Infectious Diseases to adhere to the 
                                goals of such Declaration in terms of 
                                investments in public health, including 
                                HIV/AIDS; and
                                    ``(II) a description of the HIV/
                                AIDS investments of partner countries 
                                that were not signatories to such 
                                Declaration;
                            ``(vii) a detailed description of any 
                        compacts or framework agreements reached or 
                        negotiated between the United States and any 
                        partner countries, including a description of 
                        the elements of compacts described in 
                        subsection (e);
                            ``(viii) a description of programs serving 
                        women and girls, including--
                                    ``(I) HIV/AIDS prevention programs 
                                that address the vulnerabilities of 
                                girls and women to HIV/AIDS;
                                    ``(II) information on the number of 
                                individuals served by programs aimed at 
                                reducing the vulnerabilities of women 
                                and girls to HIV/AIDS and data on the 
                                types, objectives, and duration of 
                                programs to address these issues;
                                    ``(III) information on programs to 
                                address the particular needs of 
                                adolescent girls and young women; and
                                    ``(IV) programs to prevent gender-
                                based violence or to assist victims of 
                                gender based violence as part of, or in 
                                coordination with, HIV/AIDS programs;
                            ``(ix) a description of strategies, goals, 
                        programs, and interventions to--
                                    ``(I) address the needs and 
                                vulnerabilities of youth populations;
                                    ``(II) expand access among young 
                                men and women to evidence-based HIV/
                                AIDS health care services and HIV 
                                prevention programs, including 
                                abstinence education programs; and
                                    ``(III) expand community-based 
                                services to meet the needs of orphans 
                                and of children and adolescents 
                                affected by or vulnerable to HIV/AIDS 
                                without increasing stigmatization;
                            ``(x) a description of--
                                    ``(I) the specific strategies 
                                funded to ensure the reduction of HIV 
                                infection among injection drug users;
                                    ``(II) the number of injection drug 
                                users, by country, reached by such 
                                strategies; and
                                    ``(III) medication-assisted drug 
                                treatment for individuals with HIV or 
                                at risk of HIV;
                            ``(xi) a detailed description of program 
                        monitoring, operations research, and impact 
                        evaluation research, including--
                                    ``(I) the amount of funding 
                                provided for each research type;
                                    ``(II) an analysis of cost-
                                effectiveness models; and
                                    ``(III) conclusions regarding the 
                                efficiency, effectiveness, and quality 
                                of services as derived from previous or 
                                ongoing research and monitoring 
                                efforts;
                            ``(xii) building capacity to identify, 
                        investigate, and stop nosocomial transmission 
                        of infectious diseases, including HIV and 
                        tuberculosis; and
                            ``(xiii) a description of staffing levels 
                        of United States government HIV/AIDS teams in 
                        countries with significant HIV/AIDS programs, 
                        including whether or not a full-time 
                        coordinator was on staff for the year.''.
    (f) Authorization of Appropriations.--Section 301(b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7631(b)) is amended--
            (1) in paragraph (1), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
            (2) in paragraph (3), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''.
    (g) Relationship To Assistance Programs To Enhance Nutrition.--
Section 301(c) of such Act is amended to read as follows:
    ``(c) Food and Nutritional Support.--
            ``(1) In general.--As indicated in the report produced by 
        the Institute of Medicine, entitled `PEPFAR Implementation: 
        Progress and Promise', inadequate caloric intake has been 
        clearly identified as a principal reason for failure of 
        clinical response to antiretroviral therapy. In recognition of 
        the impact of malnutrition as a clinical health issue for many 
        persons living with HIV/AIDS that is often associated with 
        health and economic impacts on these individuals and their 
        families, the Global AIDS Coordinator and the Administrator of 
        the United States Agency for International Development shall--
                    ``(A) follow World Health Organization guidelines 
                for HIV/AIDS food and nutrition services;
                    ``(B) integrate nutrition programs with HIV/AIDS 
                activities through effective linkages among the health, 
                agricultural, and livelihood sectors and establish 
                additional services in circumstances in which referrals 
                are inadequate or impossible;
                    ``(C) provide, as a component of care and treatment 
                programs for persons with HIV/AIDS, food and 
                nutritional support to individuals infected with, and 
                affected by, HIV/AIDS who meet established criteria for 
                nutritional support (including clinically malnourished 
                children and adults, and pregnant and lactating women 
                in programs in need of supplemental support), 
                including--
                            ``(i) anthropometric and dietary 
                        assessment;
                            ``(ii) counseling; and
                            ``(iii) therapeutic and supplementary 
                        feeding;
                    ``(D) provide food and nutritional support for 
                children affected by HIV/AIDS and to communities and 
                households caring for children affected by HIV/AIDS; 
                and
                    ``(E) in communities where HIV/AIDS and food 
                insecurity are highly prevalent, support programs to 
                address these often intersecting health problems 
                through community-based assistance programs, with an 
                emphasis on sustainable approaches.
            ``(2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401, there are 
        authorized to be appropriated to the President such sums as may 
        be necessary for each of the fiscal years 2009 through 2013 to 
        carry out this subsection.''.
    (h) Eligibility for Assistance.--Section 301(d) of such Act is 
amended to read as follows:
    ``(d) Eligibility for Assistance.--An organization, including a 
faith-based organization, that is otherwise eligible to receive 
assistance under section 104A of the Foreign Assistance Act of 1961, 
under this Act, or under any amendment made by this Act or by the Tom 
Lantos and Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, for HIV/
AIDS prevention, treatment, or care--
            ``(1) shall not be required, as a condition of receiving 
        such assistance--
                    ``(A) to endorse or utilize a multisectoral or 
                comprehensive approach to combating HIV/AIDS; or
                    ``(B) to endorse, utilize, make a referral to, 
                become integrated with, or otherwise participate in any 
                program or activity to which the organization has a 
                religious or moral objection; and
            ``(2) shall not be discriminated against in the 
        solicitation or issuance of grants, contracts, or cooperative 
        agreements under such provisions of law for refusing to meet 
        any requirement described in paragraph (1).''.

SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

    (a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest burden 
of tuberculosis and other countries with high rates of tuberculosis, 
the United States should support the objectives of the Global Plan to 
Stop TB, including through achievement of the following goals:
            ``(1) Reduce by half the tuberculosis death and disease 
        burden from the 1990 baseline.
            ``(2) Sustain or exceed the detection of at least 70 
        percent of sputum smear-positive cases of tuberculosis and the 
        successful treatment of at least 85 percent of the cases 
        detected in countries with established United States Agency for 
        International Development tuberculosis programs.
            ``(3) In support of the Global Plan to Stop TB, the 
        President shall establish a comprehensive, 5-year United States 
        strategy to expand and improve United States efforts to combat 
        tuberculosis globally, including a plan to support--
                    ``(A) the successful treatment of 4,500,000 new 
                sputum smear tuberculosis patients under DOTS programs 
                by 2013, primarily through direct support for needed 
                services, commodities, health workers, and training, 
                and additional treatment through coordinated 
                multilateral efforts; and
                    ``(B) the diagnosis and treatment of 90,000 new 
                multiple drug resistant tuberculosis cases by 2013, and 
                additional treatment through coordinated multilateral 
                efforts.''.
    (b) Priority To Stop TB Strategy.--Section 104B(e) of such Act is 
amended to read as follows:
    ``(e) Priority To Stop TB Strategy.--In furnishing assistance under 
subsection (c), the President shall give priority to--
            ``(1) direct services described in the Stop TB Strategy, 
        including expansion and enhancement of Directly Observed 
        Treatment Short-course (DOTS) coverage, rapid testing, 
        treatment for individuals infected with both tuberculosis and 
        HIV, and treatment for individuals with multi-drug resistant 
        tuberculosis (MDR-TB), strengthening of health systems, use of 
        the International Standards for Tuberculosis Care by all 
        providers, empowering individuals with tuberculosis, and 
        enabling and promoting research to develop new diagnostics, 
        drugs, and vaccines, and program-based operational research 
        relating to tuberculosis; and
            ``(2) funding for the Global Tuberculosis Drug Facility, 
        the Stop Tuberculosis Partnership, and the Global Alliance for 
        TB Drug Development.''.
    (c) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--Section 104B of such Act is amended--
            (1) by redesignating subsection (f) as subsection (h); and
            (2) by inserting after subsection (e) the following:
    ``(f) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--In carrying out this section, the President, 
acting through the Administrator of the United States Agency for 
International Development, is authorized to provide increased resources 
to the World Health Organization and the Stop Tuberculosis Partnership 
to improve the capacity of countries with high rates of tuberculosis 
and other affected countries to implement the Stop TB Strategy and 
specific strategies related to addressing multiple drug resistant 
tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-
TB).''.
    (d) Annual Report.--Section 104B of such Act is amended by 
inserting after subsection (f), as added by subsection (c) of this 
section, the following:
    ``(g) Annual Report.--The President shall submit an annual report 
to Congress that describes the impact of United States foreign 
assistance on efforts to control tuberculosis, including--
            ``(1) the number of tuberculosis cases diagnosed and the 
        number of cases cured in countries receiving United States 
        bilateral foreign assistance for tuberculosis control purposes;
            ``(2) a description of activities supported with United 
        States tuberculosis resources in each country, including a 
        description of how those activities specifically contribute to 
        increasing the number of people diagnosed and treated for 
        tuberculosis;
            ``(3) in each country receiving bilateral United States 
        foreign assistance for tuberculosis control purposes, the 
        percentage provided for direct tuberculosis services in 
        countries receiving United States bilateral foreign assistance 
        for tuberculosis control purposes;
            ``(4) a description of research efforts and clinical trials 
        to develop new tools to combat tuberculosis, including 
        diagnostics, drugs, and vaccines supported by United States 
        bilateral assistance;
            ``(5) the number of persons who have been diagnosed and 
        started treatment for multidrug-resistant tuberculosis in 
        countries receiving United States bilateral foreign assistance 
        for tuberculosis control programs;
            ``(6) a description of the collaboration and coordination 
        of United States anti-tuberculosis efforts with the World 
        Health Organization, the Global Fund, and other major public 
        and private entities within the Stop TB Strategy;
            ``(7) the constraints on implementation of programs posed 
        by health workforce shortages and capacities;
            ``(8) the number of people trained in tuberculosis control; 
        and
            ``(9) a breakdown of expenditures for direct patient 
        tuberculosis services, drugs and other commodities, drug 
        management, training in diagnosis and treatment, health systems 
        strengthening, research, and support costs.''.
    (e) Definitions.--Section 104B(h) of such Act, as redesignated by 
subsection (c), is amended--
            (1) in paragraph (1), by striking the period at the end and 
        inserting the following: ``including--
                    ``(A) low-cost and effective diagnosis, treatment, 
                and monitoring of tuberculosis;
                    ``(B) a reliable drug supply;
                    ``(C) a management strategy for public health 
                systems;
                    ``(D) health system strengthening;
                    ``(E) promotion of the use of the International 
                Standards for Tuberculosis Care by all care providers;
                    ``(F) bacteriology under an external quality 
                assessment framework;
                    ``(G) short-course chemotherapy; and
                    ``(H) sound reporting and recording systems.''; and
            (2) by redesignating paragraph (5) as paragraph (6); and
            (3) by inserting after paragraph (4) the following:
            ``(5) Stop tb strategy.--The term `Stop TB Strategy' means 
        the 6-point strategy to reduce tuberculosis developed by the 
        World Health Organization, which is described in the Global 
        Plan to Stop TB 2006-2015: Actions for Life, a comprehensive 
        plan developed by the Stop TB Partnership that sets out the 
        actions necessary to achieve the millennium development goal of 
        cutting tuberculosis deaths and disease burden in half by 
        2015.''.
    (f) Authorization of Appropriations.--Section 302 (b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7632(b)) is amended--
            (1) in paragraph (1), by striking ``such sums as may be 
        necessary for each of the fiscal years 2004 through 2008'' and 
        inserting ``a total of $4,000,000,000 for the 5-year period 
        beginning on October 1, 2008.''; and
            (2) in paragraph (3), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013.''.

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

    (a) Amendment to the Foreign Assistance Act of 1961.--Section 
104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-4(b)) is 
amended by inserting ``treatment,'' after ``control,''.
    (b) Authorization of Appropriations.--Section 303 of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), by striking ``such sums as 
                may be necessary for fiscal years 2004 through 2008'' 
                and inserting ``$5,000,000,000 during the 5-year period 
                beginning on October 1, 2008''; and
                    (B) in paragraph (3), by striking ``fiscal years 
                2004 through 2008'' and inserting ``fiscal years 2009 
                through 2013''; and
            (2) by adding at the end the following:
    ``(c) Statement of Policy.--Providing assistance for the 
prevention, control, treatment, and the ultimate eradication of malaria 
is--
            ``(1) a major objective of the foreign assistance program 
        of the United States; and
            ``(2) 1 component of a comprehensive United States global 
        health strategy to reduce disease burdens and strengthen 
        communities around the world.
    ``(d) Development of a Comprehensive 5-Year Strategy.--The 
President shall establish a comprehensive, 5-year strategy to combat 
global malaria that--
            ``(1) strengthens the capacity of the United States to be 
        an effective leader of international efforts to reduce malaria 
        burden;
            ``(2) maintains sufficient flexibility and remains 
        responsive to the ever-changing nature of the global malaria 
        challenge;
            ``(3) includes specific objectives and multisectoral 
        approaches and strategies to reduce the prevalence, mortality, 
        incidence, and spread of malaria;
            ``(4) describes how this strategy would contribute to the 
        United States' overall global health and development goals;
            ``(5) clearly explains how outlined activities will 
        interact with other United States Government global health 
        activities, including the 5-year global AIDS strategy required 
        under this Act;
            ``(6) expands public-private partnerships and leverage of 
        resources;
            ``(7) coordinates among relevant Federal agencies to 
        maximize human and financial resources and to reduce 
        duplication among these agencies, foreign governments, and 
        international organizations;
            ``(8) coordinates with other international entities, 
        including the Global Fund;
            ``(9) maximizes United States capabilities in the areas of 
        technical assistance and training and research, including 
        vaccine research; and
            ``(10) establishes priorities and selection criteria for 
        the distribution of resources based on factors such as--
                    ``(A) the size and demographics of the population 
                with malaria;
                    ``(B) the needs of that population;
                    ``(C) the country's existing infrastructure; and
                    ``(D) the ability to closely coordinate United 
                States Government efforts with national malaria control 
                plans of partner countries.''.

SEC. 304. MALARIA RESPONSE COORDINATOR.

    Section 304 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended to 
read as follows:

``SEC. 304. MALARIA RESPONSE COORDINATOR.

    ``(a) In General.--There is established within the United States 
Agency for International Development a Coordinator of United States 
Government Activities to Combat Malaria Globally (referred to in this 
section as the `Malaria Coordinator'), who shall be appointed by the 
President.
    ``(b) Authorities.--The Malaria Coordinator, acting through 
nongovernmental organizations (including faith-based and community-
based organizations), partner country finance, health, and other 
relevant ministries, and relevant executive branch agencies as may be 
necessary and appropriate to carry out this section, is authorized to--
            ``(1) operate internationally to carry out prevention, 
        care, treatment, support, capacity development, and other 
        activities to reduce the prevalence, mortality, and incidence 
        of malaria;
            ``(2) provide grants to, and enter into contracts and 
        cooperative agreements with, nongovernmental organizations 
        (including faith-based organizations) to carry out this 
        section; and
            ``(3) transfer and allocate executive branch agency funds 
        that have been appropriated for the purposes described in 
        paragraphs (1) and (2).
    ``(c) Duties.--
            ``(1) In general.--The Malaria Coordinator has primary 
        responsibility for the oversight and coordination of all 
        resources and international activities of the United States 
        Government relating to efforts to combat malaria.
            ``(2) Specific duties.--The Malaria Coordinator shall--
                    ``(A) facilitate program and policy coordination of 
                antimalarial efforts among relevant executive branch 
                agencies and nongovernmental organizations by auditing, 
                monitoring, and evaluating such programs;
                    ``(B) ensure that each relevant executive branch 
                agency undertakes antimalarial programs primarily in 
                those areas in which the agency has the greatest 
                expertise, technical capability, and potential for 
                success;
                    ``(C) coordinate relevant executive branch agency 
                activities in the field of malaria prevention and 
                treatment;
                    ``(D) coordinate planning, implementation, and 
                evaluation with the Global AIDS Coordinator in 
                countries in which both programs have a significant 
                presence;
                    ``(E) coordinate with national governments, 
                international agencies, civil society, and the private 
                sector; and
                    ``(F) establish due diligence criteria for all 
                recipients of funds appropriated by the Federal 
                Government for malaria assistance.
    ``(d) Assistance for the World Health Organization.--In carrying 
out this section, the President may provide financial assistance to the 
Roll Back Malaria Partnership of the World Health Organization to 
improve the capacity of countries with high rates of malaria and other 
affected countries to implement comprehensive malaria control programs.
    ``(e) Coordination of Assistance Efforts.--In carrying out this 
section and in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator shall 
coordinate the provision of assistance by working with--
            ``(1) relevant executive branch agencies, including--
                    ``(A) the Department of State (including the Office 
                of the Global AIDS Coordinator);
                    ``(B) the Department of Health and Human Services;
                    ``(C) the Department of Defense; and
                    ``(D) the Office of the United States Trade 
                Representative;
            ``(2) relevant multilateral institutions, including--
                    ``(A) the World Health Organization;
                    ``(B) the United Nations Children's Fund;
                    ``(C) the United Nations Development Programme;
                    ``(D) the Global Fund;
                    ``(E) the World Bank; and
                    ``(F) the Roll Back Malaria Partnership;
            ``(3) program delivery and efforts to lift barriers that 
        would impede effective and comprehensive malaria control 
        programs; and
            ``(4) partner or recipient country governments and national 
        entities including universities and civil society organizations 
        (including faith- and community-based organizations).
    ``(f) Research.--To carry out this section, the Malaria 
Coordinator, in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 1151d-4), shall ensure that operations and 
implementation research conducted under this Act will closely 
complement the clinical and program research being undertaken by the 
National Institutes of Health. The Centers for Disease Control and 
Prevention should advise the Malaria Coordinator on priorities for 
operations and implementation research and should be a key implementer 
of this research.
    ``(g) Monitoring.--To ensure that adequate malaria controls are 
established and implemented, the Centers for Disease Control and 
Prevention should advise the Malaria Coordinator on monitoring, 
surveillance, and evaluation activities and be a key implementer of 
such activities under this Act. Such activities shall complement, 
rather than duplicate, the work of the World Health Organization.
    ``(h) Annual Report.--
            ``(1) Submission.--Not later than 1 year after the date of 
        the enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, and annually thereafter, the 
        President shall submit a report to the appropriate 
        congressional committees that describes United States 
        assistance for the prevention, treatment, control, and 
        elimination of malaria.
            ``(2) Contents.--The report required under paragraph (1) 
        shall describe--
                    ``(A) the countries and activities to which malaria 
                resources have been allocated;
                    ``(B) the number of people reached through malaria 
                assistance programs, including data on children and 
                pregnant women;
                    ``(C) research efforts to develop new tools to 
                combat malaria, including drugs and vaccines;
                    ``(D) the collaboration and coordination of United 
                States antimalarial efforts with the World Health 
                Organization, the Global Fund, the World Bank, other 
                donor governments, major private efforts, and relevant 
                executive agencies;
                    ``(E) the coordination of United States 
                antimalarial efforts with the national malarial 
                strategies of other donor or partner governments and 
                major private initiatives;
                    ``(F) the estimated impact of United States 
                assistance on childhood mortality and morbidity from 
                malaria;
                    ``(G) the coordination of antimalarial efforts with 
                broader health and development programs; and
                    ``(H) the constraints on implementation of programs 
                posed by health workforce shortages or capacities; and
                    ``(I) the number of personnel trained as health 
                workers and the training levels achieved.''.

SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.

    Section 212(a)(1)(A)(i) of the Immigration and Nationality Act (8 
U.S.C. 1182(a)(1)(A)(i)) is amended by striking ``, which shall include 
infection with the etiologic agent for acquired immune deficiency 
syndrome,'' and inserting a semicolon.

SEC. 306. CLERICAL AMENDMENT.

    Title III of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is 
amended by striking the heading for subtitle B and inserting the 
following:

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

SEC. 307. REQUIREMENTS.

    Section 312(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is amended by 
striking paragraphs (1), (2), and (3) and inserting the following:
            ``(1) establish a target for the prevention and treatment 
        of mother-to-child transmission of HIV that, by 2013, will 
        reach at least 80 percent of pregnant women in those countries 
        most affected by HIV/AIDS in which the United States has HIV/
        AIDS programs;
            ``(2) establish a target that, by 2013, the proportion of 
        children receiving care and treatment under this Act is 
        proportionate to their numbers within the population of HIV 
        infected individuals in each country;
            ``(3) integrate care and treatment with prevention of 
        mother-to-child transmission of HIV programs to improve 
        outcomes for HIV-affected women and families as soon as is 
        feasible and support strategies that promote successful follow-
        up and continuity of care of mother and child;
            ``(4) expand programs designed to care for children 
        orphaned by, affected by, or vulnerable to HIV/AIDS;
            ``(5) ensure that women in prevention of mother-to-child 
        transmission of HIV programs are provided with, or referred to, 
        appropriate maternal and child services; and
            ``(6) develop a timeline for expanding access to more 
        effective regimes to prevent mother-to-child transmission of 
        HIV, consistent with the national policies of countries in 
        which programs are administered under this Act and the goal of 
        achieving universal use of such regimes as soon as possible.''.

SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION 
              OF HIV.

    Section 313(a) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) is amended by 
striking ``5 years'' and inserting ``10 years''.

SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT PANEL.

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

                     TITLE IV--FUNDING ALLOCATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--Section 401(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7671(a)) is amended by striking ``$3,000,000,000 for each of the fiscal 
years 2004 through 2008'' and inserting ``$48,000,000,000 for the 5-
year period beginning on October 1, 2008''.
    (b) Sense of Congress.--It is the sense of the Congress that the 
appropriations authorized under section 401(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, as 
amended by subsection (a), should be allocated among fiscal years 2009 
through 2013 in a manner that allows for the appropriations to be 
gradually increased in a manner that is consistent with program 
requirements, absorptive capacity, and priorities set forth in such 
Act, as amended by this Act.

SEC. 402. SENSE OF CONGRESS.

    Section 402(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) is amended by 
striking ``an effective distribution of such amounts would be'' and all 
that follows through ``10 percent of such amounts'' and inserting ``10 
percent should be used''.

SEC. 403. ALLOCATION OF FUNDS.

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

                         TITLE V--MISCELLANEOUS

SEC. 501. MACHINE READABLE VISA FEES.

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

         TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

SEC. 601. EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH.

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

            Attest:

                                                             Secretary.
110th CONGRESS

  2d Session

                               H.R. 5501

_______________________________________________________________________

                               AMENDMENT
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