H. R. 5501 

One Hundred Tenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Thursday, 

the third day of January, two thousand and eight 

An Act 

To authorize appropriations for fiscal years 2009 through 2013 to provide assistance 

to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and for 

other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Tom Lantos 

and Henry J. Hyde United States Global Leadership Against HIV/ 

AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008’’. 

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

is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Definitions. 

Sec. 4. Purpose. 

Sec. 5. Authority to consolidate and combine reports. 

TITLE I—POLICY PLANNING AND COORDINATION 

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

Sec. 102. Interagency working group. 

Sec. 103. Sense of Congress. 

TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLICPRIVATE 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. 
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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 AIDSrelated 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 
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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’; 
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‘‘(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 
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‘‘(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. 
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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 
H. R. 5501—7 

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— 
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‘‘(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; 
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‘‘(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; 
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‘‘(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— 
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‘‘(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 
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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 
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‘‘(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; 
H. R. 5501—14 

‘‘(iii) an assessment of efforts to address genderspecific 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; 
H. R. 5501—15 

‘‘(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. 
H. R. 5501—16 

‘‘(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— 
H. R. 5501—17 

(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 
H. R. 5501—18 

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 
H. R. 5501—19 

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 
H. R. 5501—20 

‘‘(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 
H. R. 5501—21 

(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’’; 
H. R. 5501—22 

(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; 
H. R. 5501—23 

‘‘(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 faithand 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. 
H. R. 5501—24 

‘‘(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 DIS- EASES.—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 DEVELOP- MENT.— (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. 
H. R. 5501—25 

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 capacitybuilding 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 
H. R. 5501—26 

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 
H. R. 5501—27 

(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 
H. R. 5501—28 

(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 
H. R. 5501—29 

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-tochild; 

‘‘(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.’’; 
H. R. 5501—30 

(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 motherto-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 
H. R. 5501—31 

‘‘(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 
H. R. 5501—32 

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 
H. R. 5501—33 

‘‘(IX) legal services; 

‘‘(E) coordinated or referred activities to link programs 

addressing HIV/AIDS with programs addressing genderbased 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 highprevalence 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 
H. R. 5501—34 

‘‘(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 
H. R. 5501—35 

‘‘(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; 
H. R. 5501—36 

‘‘(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; 
H. R. 5501—37 

(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; 
H. R. 5501—38 

‘‘(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; 
H. R. 5501—39 

‘‘(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; 
H. R. 5501—40 

‘‘(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— 
H. R. 5501—41 

‘‘(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 
H. R. 5501—42 

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.’’. 
H. R. 5501—43 

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; 
H. R. 5501—44 

‘‘(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. 
H. R. 5501—45 

‘‘(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— 
H. R. 5501—46 

‘‘(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; 
H. R. 5501—47 

‘‘(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 followup 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; 
H. R. 5501—48 

‘‘(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 
H. R. 5501—49 

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, 
H. R. 5501—50 

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- 
H. R. 5501—51 

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. 
H. R. 5501—52 

(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 
H. R. 5501—53 

enforcement or detention services, directly or through contracts or compacts with Indian tribes under the Indian 

Self-Determination and Education Assistance Act (25 

U.S.C. 450 et seq.); and 

(B) use 50 percent to implement requirements of Indian 

water settlement agreements that are approved by Congress (or the legislation to implement such an agreement) 

under which the United States shall plan, design, rehabilitate, or construct, or provide financial assistance for the 

planning, design, rehabilitation, or construction of, water 

supply or delivery infrastructure that will serve an Indian 

tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)); and 

(3) the Secretary of Health and Human Services, acting 

through the Director of the Indian Health Service, shall use 

12.5 percent to provide, directly or through contracts or compacts with Indian tribes under the Indian Self-Determination 

and Education Assistance Act (25 U.S.C. 450 et seq.)— 

(A) contract health services; 

(B) construction, rehabilitation, and replacement of 

Indian health facilities; and 

(C) domestic and community sanitation facilities 

serving members of Indian tribes (as defined in section 

4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)) pursuant to section 7 of the 

Act of August 5, 1954 (42 U.S.C. 2004a). 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.