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(vi) in subparagraph (H), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(vii) by adding at the end the fol-
lowing: 
‘‘(I)(i) assistance for counseling, testing, 
treatment, care, and support programs for pre-
vention of re-infection of individuals with HIV/ 
AIDS; 
‘‘(ii) counseling to prevent sexual trans-
mission of HIV, including skill development for 
practicing abstinence, reducing the number of 
sexual partners, and providing information on 
correct and consistent use of male and female 
condoms; 
‘‘(iii) assistance to provide male and female 
condoms; 
‘‘(iv) diagnosis and treatment of other sex-
ually-transmitted infections; 
‘‘(v) strategies to address the stigma and 
discrimination that impede HIV/AIDS preven-
tion efforts; and 
‘‘(vi) assistance to facilitate widespread ac-
cess to microbicides for HIV prevention, as safe 
and effective products become available, includ-
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ing financial and technical support for cul-
turally appropriate introductory programs, pro-
curement, distribution, logistics management, 
program delivery, acceptability studies, provider 
training, demand generation, and post-introduc-
tion monitoring; and 
‘‘(J) assistance for HIV/AIDS education 
targeted to reach and prevent the spread of 
HIV among men who have sex with men.’’. 
(B) TREATMENT.—Subsection (d)(2) of 
such section is amended— 
(i) in subparagraph (B), by striking ‘‘; 
and’’ at the end and inserting a semicolon; 
(ii) in subparagraph (C), by striking 
the period at the end and inserting a semi-
colon; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(D) assistance specifically to address bar-
riers that might limit the start of and adher-
ence to treatment services, especially in rural 
areas, through such measures as mobile and de-
centralized distribution of treatment services, 
and where feasible and necessary, direct link-
ages with nutrition, safe drinking water, and in-
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come security programs, referrals to services for 
victims of violence, support groups for individ-
uals with HIV/AIDS, and efforts to combat 
stigma and discrimination against all such indi-
viduals; 
‘‘(E) assistance to support comprehensive 
HIV/AIDS treatment (including free prophy-
laxis and treatment for common HIV/AIDS-re-
lated opportunistic infections) for at least one- 
third of individuals with HIV/AIDS in the poor-
est countries worldwide who are in clinical need 
of antiretroviral treatment; and 
‘‘(F) assistance to improve access to psy-
chosocial support systems and other necessary 
services for youth who are infected with HIV to 
ensure the start of and adherence to treatment 
services.’’. 
(C) MONITORING.—Subsection (d)(4) of 
such section is amended— 
(i) by striking ‘‘The monitoring’’ and 
inserting the following: 
‘‘(A) IN GENERAL.—The monitoring’’; 
(ii) by inserting ‘‘and paragraph (8)’’ 
after ‘‘paragraphs (1) through (3)’’; 
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(iii) by redesignating subparagraphs 
(A) through (D) as clauses (i) through 
(iv), respectively; 
(iv) in clause (iii) (as redesignated by 
clause (iii) of this subparagraph), by strik-
ing ‘‘and’’ at the end; 
(v) in clause (iv) (as redesignated by 
clause (iii) of this subparagraph), by strik-
ing the period at the end and inserting ‘‘; 
and’’; 
(vi) by adding at the end the fol-
lowing: 
‘‘(v) carrying out and expanding pro-
gram monitoring, impact evaluation re-
search, and operations research (including 
research and evaluations of gender-respon-
sive interventions, disaggregated by age 
and sex, in order to identify and replicate 
effective models, develop gender indicators 
to measure both outcomes and impacts of 
interventions, especially interventions de-
signed to reduce gender inequalities, and 
collect lessons learned for dissemination 
among different countries) in order to— 
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‘‘(I) improve the coverage, effi-
ciency, effectiveness, quality and ac-
cessibility of services provided under 
this section; 
‘‘(II) establish the cost-effective-
ness of program models; 
‘‘(III) assess the population-level 
impact of programs, projects, and ac-
tivities implemented; 
‘‘(IV) ensure the transparency 
and accountability of services provided 
under this section; 
‘‘(V) disseminate and promote 
the utilization of evaluation findings, 
lessons, and best practices in the im-
plementation of programs, projects, 
and activities supported under this 
section; and 
‘‘(VI) encourage and evaluate in-
novative service models and strategies 
to optimize functionality of programs, 
projects, and activities.’’; and 
(vii) by further adding at the end the 
following: 
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‘‘(B) DEFINITIONS.—For purposes of sub-
paragraph (A)(v)— 
‘‘(i) the term ‘impact evaluation re-
search’ means the application of research 
methods and statistical analysis to meas-
ure the extent to which a change in a pop-
ulation-based outcome can be attributed to 
a program, project, or activity as opposed 
to other factors in the environment; 
‘‘(ii) the term ‘program monitoring’ 
means the collection, analysis, and use of 
routine data with respect to a program, 
project, or activity to determine how well 
the program, project, or activity is carried 
out and at what cost; and 
‘‘(iii) the term ‘operations research’ 
means the application of social science re-
search methods and statistical analysis to 
judge, compare, and improve policy out-
comes and outcomes of a program, project, 
or activity, from the earliest stages of de-
fining and designing the program, project, 
or activity through the development and 
implementation of the program, project, or 
activity.’’. 
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(D) 
PHARMACEUTICALS.—Subsection 
(d)(5) of such section is amended— 
(i) by redesignating subparagraph (C) 
as subparagraph (D); and 
(ii) by inserting after subparagraph 
(B) the following: 
‘‘(C) MECHANISMS TO ENSURE COST-EF-
FECTIVE DRUG PURCHASING.—Mechanisms to 
ensure 
that 
pharmaceuticals, 
including 
antiretrovirals and medicines to treat opportun-
istic infections, are purchased at the lowest pos-
sible price at which such pharmaceuticals may 
be obtained in sufficient quantity on the world 
market.’’. 
(E) REFERRAL SYSTEMS AND COORDINA-
TION WITH OTHER ASSISTANCE PROGRAMS.— 
(i) FINDING.—The effectiveness of all 
HIV/AIDS prevention, treatment, and care 
programs and the survival of individuals 
with HIV/AIDS would be enhanced by en-
suring that such individuals are referred to 
appropriate support programs, including 
education, income generation, HIV/AIDS 
support group and food and nutrition pro-
grams, and by providing assistance directly 
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to such programs to the extent such pro-
grams would further the purposes of ex-
panding access to and the success of HIV/ 
AIDS prevention, treatment, and care. 
(ii) AMENDMENT.—Subsection (d) of 
such section is further amended by adding 
at the end the following: 
‘‘(8) REFERRAL SYSTEMS AND COORDINATION 
WITH OTHER ASSISTANCE PROGRAMS.— 
‘‘(A) REFERRAL SYSTEMS.—Assistance to 
ensure that a continuum of care is available to 
individuals participating in HIV/AIDS preven-
tion, treatment, and care programs through the 
development of referral systems for such indi-
viduals to community-based programs that, 
where practicable, are co-located with such 
HIV/AIDS programs, and that provide support 
activities for such individuals, including HIV/ 
AIDS treatment adherence, HIV/AIDS support 
groups, food and nutrition support, maternal 
health services, substance abuse prevention and 
treatment 
services, 
income-generation 
pro-
grams, legal services, and other program sup-
port. 
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‘‘(B) COORDINATION WITH OTHER ASSIST-
ANCE PROGRAMS.— 
‘‘(i)(I) Assistance to integrate HIV/AIDS 
testing with testing for other easily detectable 
and treatable infectious diseases, such as ma-
laria, tuberculosis, and respiratory infections, 
and to provide treatment if possible or referral 
to appropriate treatment programs. 
‘‘(II) Assistance to provide, whenever pos-
sible, as a component of HIV/AIDS prevention, 
treatment, and care services, and co-treatment 
of curable diseases, such as other sexually 
transmitted diseases. 
‘‘(III) Assistance and other activities to en-
sure, through interagency and international co-
ordination, that United States global HIV/ 
AIDS programs are integrated and complemen-
tary to delivering related health services. 
‘‘(ii) Assistance to support schools and re-
lated programs for children and youth that in-
crease the effectiveness of programs described 
in this subsection by providing the infrastruc-
ture, teachers, and other support to such pro-
grams. 
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‘‘(iii) Assistance and other activities to 
provide access to HIV/AIDS prevention, treat-
ment, and care programs in family planning 
and maternal and child health programs sup-
ported by the United States Government. 
‘‘(iv) Assistance to United States and host 
country nonprofit development organizations 
that directly support livelihood initiatives in 
HIV/AIDS-affected countries that provide op-
portunities for direct lending to microentre-
preneurs by United States citizens or opportu-
nities for United States citizens to purchase 
livestock and plants for families to provide nu-
trition and generate income for individual 
households and communities. 
‘‘(v) Assistance to coordinate and provide 
linkages between HIV/AIDS prevention, treat-
ment, and care programs with efforts to im-
prove the economic and legal status of women 
and girls. 
‘‘(vi) 
Technical 
assistance 
coordinated 
across implementing agencies, offered on a reg-
ular basis, and made available upon request, for 
faith-based and community-based organizations, 
especially indigenous organizations and new 
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partners who do not have extensive experience 
managing United States foreign assistance pro-
grams, including for training and logistical sup-
port to establish financial mechanisms to track 
program receipts and expenditures and data 
management systems to ensure data quality 
and strengthen reporting. 
‘‘(vii) In accordance with the World Health 
Organization’s Interim Policy on TB/HIV Ac-
tivities (2004), assistance to individuals with or 
symptomatic of tuberculosis, and assistance to 
implement the following: 
‘‘(I) Provide opt-out HIV/AIDS coun-
seling and testing and appropriate referral 
for treatment and care to individuals with 
or symptomatic of tuberculosis, and work 
with host countries to ensure that such in-
dividuals in host countries are provided 
such services. 
‘‘(II) Ensure, in coordination with 
host countries, that individuals with HIV/ 
AIDS receive tuberculosis screening and 
other appropriate treatment. 
‘‘(III) Provide increased funding for 
HIV/AIDS and tuberculosis activities, by 
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increasing total resources for such activi-
ties, including lab strengthening and infec-
tion control. 
‘‘(IV) Improve the management and 
dissemination of knowledge gained from 
HIV/AIDS and tuberculosis activities to 
increase the replication of best practices.’’. 
(5) ANNUAL REPORT.—Subsection (e) of such 
section is amended— 
(A) in paragraph (1), by striking ‘‘Com-
mittee on International Relations’’ and insert-
ing ‘‘Committee on Foreign Affairs’’; 
(B) in paragraph (2)— 
(i) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (C)— 
(I) in the matter preceding clause 
(i), by striking ‘‘including’’ and insert-
ing ‘‘including—’’; 
(II) by striking clauses (i) and 
(ii) and inserting the following: 
‘‘(i)(I) the effectiveness of such pro-
grams in reducing the transmission of 
HIV, particularly in women and girls, in 
reducing mother-to-child transmission of 
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HIV, including through drug treatment 
and therapies, either directly or by refer-
ral, and in reducing mortality rates from 
HIV/AIDS, including through drug treat-
ment, and addiction therapies; 
‘‘(II) a description of strategies, goals, 
programs, and interventions to address the 
specific needs and vulnerabilities of young 
women and young men; the progress to-
ward expanding access among young 
women and young men to evidence-based, 
comprehensive HIV/AIDS health care serv-
ices and HIV prevention and sexuality and 
abstinence education programs at the indi-
vidual, community, and national levels; and 
clear targets for integrating adolescents 
who are orphans, including adolescents 
who are infected with HIV, into programs 
for orphans and vulnerable children; and 
‘‘(III) the amount of United States 
funding provided under the authorities of 
this Act to procure drugs for HIV/AIDS 
programs in countries described in section 
1(f)(2)(B)(IX) of the State Department 
Basic Authorities Act of 1956 (22 U.S.C. 
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2651a(f)(2)(B)(VIII)), including a detailed 
description of anti-retroviral drugs pro-
cured, including— 
‘‘(aa) the total amount expended 
for each generic and name brand 
drug; 
‘‘(bb) the price paid per unit of 
each drug; and 
‘‘(cc) the vendor from which each 
drug was purchased; and 
‘‘(ii) the progress made toward im-
proving health care delivery systems (in-
cluding the training of adequate numbers 
of health care professionals) and infra-
structure to ensure increased access to 
care and treatment, including a description 
of progress toward— 
‘‘(I)(aa) the training and reten-
tion of adequate numbers of health 
care professionals in order to meet a 
nationally-determined ratio of doctors, 
nurses, and midwives to patients, 
based on the target of the 2.3 per- 
thousand ratio established by the 
World Health Organization (WHO); 
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‘‘(bb) increases in the number of 
other health care professions, such as 
pharmacists and lab technicians, as 
necessary; and 
‘‘(cc) the improvement of infra-
structure needed to ensure universal 
access to HIV/AIDS prevention, treat-
ment, and care by 2015; 
‘‘(II) national health care work-
force strategy benchmarks, as re-
quired by section 202(d)(5)(B) of the 
United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003, United States contribu-
tions to developing and implementing 
the benchmarks, and main challenges 
to implementing the benchmarks; 
‘‘(III) ensuring, to the extent 
practicable, that health care workers 
providing services under this Act have 
safe working conditions and are re-
ceiving health care services, including 
services relating to HIV/AIDS; 
‘‘(IV) activities to strengthen 
health care systems in order to over-
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come obstacles and barriers to the 
provision of HIV/AIDS, tuberculosis, 
and malaria services; 
‘‘(V) improving integration and 
coordination of HIV/AIDS programs 
with related health care services and 
supporting the capacity of health care 
programs to refer individuals to com-
munity-based services; and 
‘‘(VI) strengthening procurement 
and supply chain management sys-
tems of host countries;’’; 
(III) in clause (iii), by adding at 
the end before the semicolon the fol-
lowing: ‘‘, including the percentage of 
such United States foreign assistance 
provided for diagnosis and treatment 
of individuals with tuberculosis in 
countries with the highest burden of 
tuberculosis, as determined by the 
World Health Organization (WHO)’’; 
and 
(IV) in clause (iv), by striking 
the period at the end and inserting a 
semicolon; and 
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(iii) by adding at the end the fol-
lowing: 
‘‘(D) a description of efforts to integrate 
HIV/AIDS and tuberculosis prevention, treat-
ment, and care programs, including— 
‘‘(i) the number and percentage of 
HIV-infected individuals receiving HIV/ 
AIDS treatment or care services who are 
also receiving screening and subsequent 
treatment for tuberculosis; 
‘‘(ii) the number and percentage of in-
dividuals with tuberculosis who are receiv-
ing HIV/AIDS counseling and testing, and 
appropriate referral to HIV/AIDS services; 
‘‘(iii) the number and location of lab-
oratories with the capacity to perform tu-
berculosis culture tests and tuberculosis 
drug susceptibility tests; 
‘‘(iv) the number and location of lab-
oratories with the capacity to perform ap-
propriate tests for multi-drug resistant tu-
berculosis (MDR–TB) and extensively drug 
resistant tuberculosis (XDR–TB); and 
‘‘(v) the number of HIV-infected indi-
viduals suspected of having tuberculosis 
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who are provided tuberculosis culture diag-
nosis or tuberculosis drug susceptibility 
testing; 
‘‘(E) a description of coordination efforts 
with relevant executive branch agencies (as such 
term is defined in section 3 of the United 
States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003) and at the 
global level in the effort to link HIV/AIDS serv-
ices with non-HIV/AIDS services; 
‘‘(F) a description of programs serving 
women and girls, including— 
‘‘(i) a description of HIV/AIDS pre-
vention 
programs 
that 
address 
the 
vulnerabilities of girls and women to HIV/ 
AIDS; and 
‘‘(ii) information on the number of in-
dividuals served by programs aimed at re-
ducing the vulnerabilities of women and 
girls to HIV/AIDS; 
‘‘(G) a description of the specific strategies 
funded to ensure the reduction of HIV infection 
among injection drug users, and the number of 
injection drug users, by country, reached by 
such strategies, including medication-assisted 
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