(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
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.
‘‘(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.
‘‘(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
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
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
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.
(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
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
drug treatment for individuals with HIV or at 
risk of HIV, and HIV prevention programs 
demonstrated to be effective in reducing HIV 
transmission without increasing drug use; and 
‘‘(H) a detailed description of monitoring, 
impact evaluation research, and operations re-
search of programs, projects, and activities car-
ried out pursuant to subsection (d)(4)(A)(v).’’; 
and 
(C) by adding at the end the following: 
‘‘(3) PUBLIC AVAILABILITY.—The Coordinator 
of United States Government Activities to Combat 
HIV/AIDS Globally shall make publicly available on 
the Internet website of the Office of the Coordinator 
the information contained in paragraph (2)(H) of 
each report and, in addition, the individual evalua-
tions and other reports that were the basis of such 
information, including lessons learned and collected 
in such evaluations and reports.’’. 
(b) AUTHORIZATION
OF
APPROPRIATIONS.—Sub-
section (b) of section 301 of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7631) 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’’. 
(c) FOOD SECURITY AND NUTRITION SUPPORT.— 
Subsection (c) of such section is amended to read as fol-
lows: 
‘‘(c) FOOD SECURITY AND NUTRITION SUPPORT.— 
‘‘(1) FINDINGS.—Congress finds the following: 
‘‘(A) The United States provides more 
than 60 percent of all food assistance world-
wide. 
‘‘(B) According to the United Nations 
World Food Program and other United Nations 
agencies, food insecurity of individuals with 
HIV/AIDS is a major problem in countries with 
large populations of such individuals, particu-
larly in sub-Saharan African countries. 
‘‘(C) Individuals infected with HIV have 
higher nutritional requirements than individuals 
who are not infected with HIV, particularly 
with respect to the need for protein. Also, there 
is evidence to suggest that the full benefit of
therapy to treat HIV/AIDS may not be 
achieved in individuals who are malnourished, 
particularly in pregnant and lactating women. 
‘‘(2) SENSE OF CONGRESS.—It is the sense of 
Congress that— 
‘‘(A) malnutrition, especially for individ-
uals with HIV/AIDS, is a clinical health issue 
with wider nutrition, health, and social implica-
tions for such individuals, their families, and 
their communities that must be addressed by 
United States HIV/AIDS prevention, treat-
ment, and care programs; 
‘‘(B) food security and nutrition directly 
impact an individual’s vulnerability to HIV in-
fection, the progression of HIV to AIDS, an in-
dividual’s ability to begin an antiretroviral 
medication treatment regimen, the efficacy of 
an antiretroviral medication treatment regimen 
once an individual begins such a regimen, and 
the ability of communities to effectively cope 
with the HIV/AIDS epidemic and its impacts; 
‘‘(C) international guidelines established by 
the World Health Organization (WHO) should 
serve as the reference standard for HIV/AIDS
food and nutrition activities supported by this 
Act and the amendments made by this Act; 
‘‘(D) the Coordinator of United States 
Government Activities to Combat HIV/AIDS 
Globally and the Administrator of the United 
States Agency for International Development 
should make it a priority to work together and 
with other United States Government agencies, 
donors, and multilateral institutions to increase 
the integration of food and nutrition support 
and livelihood activities into HIV/AIDS preven-
tion, treatment, and care activities funded by 
the United States and other governments and 
organizations; 
‘‘(E) for purposes of determining which in-
dividuals infected with HIV should be provided 
with nutrition and food support— 
‘‘(i) children with moderate or severe 
malnutrition, according to WHO stand-
ards, shall be given priority for such nutri-
tion and food support; and 
‘‘(ii) adults with a body mass index 
(BMI) of 18.5 or less, or at the prevailing 
WHO-approved measurement for BMI, 
should be considered ‘malnourished’ and
should be given priority for such nutrition 
and food support; 
‘‘(F) programs funded by the United 
States should include therapeutic and supple-
mentary feeding, food, and nutrition support 
and should include strong links to development 
programs that provide support for livelihoods; 
and 
‘‘(G) the inability of individuals with HIV/ 
AIDS to access food for themselves or their 
families should not be allowed to impair or 
erode the therapeutic status of such individuals 
with respect to HIV/AIDS or related co- 
morbidities. 
‘‘(3) STATEMENT OF POLICY.—It is the policy 
of the United States to— 
‘‘(A) address the food and nutrition needs 
of individuals with HIV/AIDS and affected in-
dividuals, including orphans and vulnerable 
children; 
‘‘(B) fully integrate food and nutrition 
support into HIV/AIDS prevention, treatment, 
and care programs carried out under this Act 
and the amendments made by this Act;
‘‘(C) ensure, to the extent practicable, 
that— 
‘‘(i) HIV/AIDS prevention, treatment, 
and care providers and health care workers 
are adequately trained so that such pro-
viders and workers can provide accurate 
and informed information regarding food 
and nutrition support to individuals en-
rolled in treatment and care programs and 
individuals affected by HIV/AIDS; and 
‘‘(ii) individuals with HIV/AIDS who, 
with their households, are identified as 
food insecure are provided with adequate 
food and nutrition support; and 
‘‘(D) effectively link food and nutrition 
support provided under this Act and the 
amendments made by this Act to individuals 
with HIV/AIDS, their households, and their 
communities, to other food security and liveli-
hood programs funded by the United States 
and other donors and multilateral agencies. 
‘‘(4) INTEGRATION
OF
FOOD
SECURITY
AND 
NUTRITION ACTIVITIES INTO HIV/AIDS PREVENTION, 
TREATMENT, AND CARE ACTIVITIES.—
‘‘(A) REQUIREMENTS RELATING TO GLOB-
AL
AIDS
COORDINATOR.—Consistent with the 
statement of policy described in paragraph (3), 
the Coordinator of United States Government 
Activities 
to 
Combat 
HIV/AIDS 
Globally 
shall— 
‘‘(i) ensure, to the extent practicable, 
that— 
‘‘(I) an assessment, using vali-
dated criteria, of the food security and 
nutritional status of each individual 
enrolled in antiretroviral medication 
treatment programs supported with 
funds authorized under this Act or 
any amendment made by this Act is 
carried out; and 
‘‘(II) 
appropriate 
nutritional 
counseling is provided to each indi-
vidual described in subclause (I); 
‘‘(ii) coordinate with the Adminis-
trator of the United States Agency for 
International Development, the Secretary 
of Agriculture, and the heads of other rel-
evant executive branch agencies to—
‘‘(I) ensure, to the extent prac-
ticable, that, in communities in which 
a significant proportion of individuals 
with HIV/AIDS are in need of food 
and nutrition support, a status and 
needs assessment for such support 
employing validated criteria is con-
ducted and a plan to provide such 
support is developed and implemented; 
‘‘(II) improve and enhance co-
ordination between food security and 
livelihood programs for individuals in-
fected with HIV in host countries and 
food security and livelihood programs 
that may already exist in such coun-
tries; 
‘‘(III) establish effective linkages 
between the health and agricultural 
development and livelihoods sectors in 
order to enhance food security; and 
‘‘(IV) ensure, by providing in-
creased resources if necessary, effec-
tive coordination between activities 
authorized under this Act and the 
amendments made by this Act and ac-
tivities carried out under other provi-
sions of the Foreign Assistance Act of 
1961 when establishing new HIV/ 
AIDS treatment sites; 
‘‘(iii) develop effective, validated indi-
cators that measure outcomes of nutrition 
and food security interventions carried out 
under this section and use such indicators 
to monitor and evaluate the effectiveness 
of such interventions; and 
‘‘(iv) evaluate the role of and, to the 
extent appropriate, support and expand 
partnerships and linkages between United 
States postsecondary educational institu-
tions with postsecondary educational insti-
tutions in host countries in order to pro-
vide training and build indigenous human 
and institutional capacity and expertise to 
respond to HIV/AIDS, and to improve ca-
pacity to address nutrition, food security, 
and livelihood needs of HIV/AIDS-affected 
and impoverished communities. 
‘‘(B) REQUIREMENTS RELATING TO USAID 
ADMINISTRATOR.—Consistent with the state-
ment of policy described in paragraph (3), 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 and 
the Secretary of Agriculture, shall provide, to 
the extent practicable, as an essential compo-
nent of antiretroviral medication treatment pro-
grams supported with funds authorized under 
this Act and the amendments made by this Act, 
food and nutrition support to each individual 
with HIV/AIDS who is determined to need such 
support by the assessing health professional, 
based on a body mass index (BMI) of 18.5 or 
less, or at the prevailing WHO-approved meas-
urement for BMI, and the individual’s house-
hold, for a period of not less than 180 days, ei-
ther directly or through referral to an assist-
ance program or organization with demon-
strable ability to provide such support. 
‘‘(C) REPORT.—Not later than October 31, 
2010, and annually thereafter, the Coordinator 
of United States Government Activities to Com-
bat HIV/AIDS Globally, in consultation with 
the Administrator of the United States Agency 
for International Development, shall submit to
necessary for each of the fiscal years 2009 
through 2013 to carry out this subsection.’’. 
(d) ELIGIBILITY FOR ASSISTANCE.—Subsection (d) 
of such section is amended to read as follows: 
‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organiza-
tion, including a faith-based organization, that is other-
wise eligible to receive assistance under section 104A of 
the Foreign Assistance Act of 1961 (as added by sub-
section (a)) or under any other provision of this Act (or 
any amendment made by this Act or the Tom Lantos and 
Henry J. Hyde Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008) 
to prevent, treat, or monitor HIV/AIDS— 
‘‘(1) shall not be required, as a condition of re-
ceiving the assistance, to endorse or utilize a multi-
sectoral approach to combating HIV/AIDS, or to en-
dorse, utilize, make a referral to, become integrated 
with or otherwise participate in any program or ac-
tivity 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 coop-
erative agreements under such provisions of law for 
refusing to do so.’’.
(e) SENSE OF CONGRESS.—Such section is further 
amended by striking subsection (g). 
(f) REPORT.— 
(1) IN
GENERAL.—Not later than 270 days 
after the date of the enactment of this Act, the Co-
ordinator of United States Government Activities to 
Combat HIV/AIDS Globally shall submit to the ap-
propriate congressional committees a report identi-
fying a target for the number of additional health 
professionals and workers needed in host countries 
to provide HIV/AIDS prevention, treatment, and 
care and the training needs of such health profes-
sionals and workers. The target should reflect avail-
able data and should identify the need for United 
States Government contributions to meet the target. 
(2) DEFINITION.—In this subsection, the term 
‘‘appropriate congressional committees’’ has the 
meaning given the term in section 3 of the United 
States Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Act of 2003 (22 U.S.C. 7602). 
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 
(a) AMENDMENTS
TO
THE FOREIGN ASSISTANCE 
ACT OF 1961.— 
(1) FINDINGS.—Subsection (a) of section 104B 
of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b–3) is amended by striking paragraphs (1) 
and (2) and inserting the following: 
‘‘(1) Tuberculosis is one of the greatest infec-
tious causes of death of adults worldwide, killing 1.6 
million individuals per year—one person every 20 
seconds. 
‘‘(2) Tuberculosis is the leading infectious cause 
of death among individuals who are infected with 
HIV due to their weakened immune systems, and it 
is estimated that one-third of such individuals have 
tuberculosis. Tuberculosis is also a leading killer of 
women of reproductive age. 
‘‘(3) Driven by the HIV/AIDS pandemic, inci-
dence rates of tuberculosis in sub-Saharan Africa 
have more than doubled on average since 1990. The 
problem is so pervasive that in August 2005, African 
health ministers and the World Health Organization 
(WHO) declared tuberculosis to be an emergency in 
sub-Saharan Africa. 
‘‘(4)(A) The wide extent of drug resistance, in-
cluding 
both 
multi-drug 
resistant 
tuberculosis 
(MDR–TB) and extensively drug resistant tuber-
culosis (XDR–TB), represents both a critical chal-
lenge to the global control of tuberculosis and a seri-
ous worldwide public health threat.
‘‘(B) XDR–TB, which is a form of MDR–TB 
with additional resistance to multiple second-line 
anti-tuberculosis drugs, is associated with worst 
treatment outcomes of any form of tuberculosis. 
‘‘(C) XDR–TB is converging with the HIV/ 
AIDS epidemic, undermining gains in HIV/AIDS 
prevention and treatment programs and requires ur-
gent interventions. 
‘‘(D) Drug resistance surveillance reports have 
confirmed the serious scale and spread of tuber-
culosis, with XDR–TB strains confirmed on six con-
tinents. 
‘‘(E) Demonstrating the lethality of XDR–TB, 
an initial outbreak in Tugela Ferry, South Africa, in 
2006 killed 52 of 53 patients with hundreds more 
cases reported since that time. 
‘‘(F) Of the world’s regions, sub-Saharan Afri-
ca, faces the greatest gap in capacity to prevent, 
treat, and care for individuals with XDR–TB.’’. 
(2) POLICY.—Subsection (b) of such section is 
amended to read as follows: 
‘‘(b) POLICY.—It is a major objective of the foreign 
assistance program of the United States to control tuber-
culosis. In all countries in which the Government of the 
United States has established development programs, par-
ticularly in countries with the highest burden of tuber-
culosis and other countries with high rates of tuberculosis, 
the United States Government should prioritize the 
achievement of the following goals by not later than De-
cember 31, 2015: 
‘‘(1) Reduce by one-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 tuber-
culosis and the cure of at least 85 percent of such 
cases detected.’’. 
(3) ACTIVITIES SUPPORTED.—Such section is 
further amended— 
(A) 
by 
redesignating 
subsections 
(d) 
through (f) as subsections (e) through (g); and 
(B) by inserting after subsection (c) the 
following: 
‘‘(d) ACTIVITIES SUPPORTED.—Assistance provided 
under subsection (c) shall, to the maximum extent prac-
ticable, be used to carry out the following activities: 
‘‘(1) Provide diagnostic counseling and testing 
to individuals with HIV/AIDS for tuberculosis (in-
cluding a culture diagnosis to rule out multi-drug re-
sistant tuberculosis (MDR–TB) and extensively drug 
resistant tuberculosis (XDR–TB) and provide HIV/
AIDS voluntary counseling and testing to individuals 
with any form of tuberculosis. 
‘‘(2) Provide tuberculosis treatment to individ-
uals receiving treatment and care for HIV/AIDS 
who have active tuberculosis and provide prophy-
lactic treatment to individuals with HIV/AIDS who 
also have a latent tuberculosis infection. 
‘‘(3) Link individuals with both HIV/AIDS and 
tuberculosis to HIV/AIDS treatment and care serv-
ices, 
including 
antiretroviral 
therapy 
and 
cotrimoxazole therapy. 
‘‘(4) Ensure that health care workers trained to 
diagnose, treat, and provide care for HIV/AIDS are 
also trained to diagnose, treat, and provide care for 
individuals with both HIV/AIDS and tuberculosis. 
‘‘(5) Ensure that individuals with active pul-
monary tuberculosis are provided a culture diag-
nosis, including drug susceptibility testing to rule 
out multi-drug resistant tuberculosis (MDR–TB) 
and extensively drug resistant tuberculosis (XDR– 
TB) in areas with high prevalence of tuberculosis 
drug resistance.’’. 
(4) PRIORITY
TO
STOP
TB
STRATEGY.—Sub-
section (f) of such section (as redesignated by para-
graph (3) of this subsection) is amended—
(A) by amending the heading to read as 
follows: ‘‘PRIORITY TO STOP TB STRATEGY’’; 
(B) in the first sentence, by striking ‘‘In 
furnishing’’ and all that follows through ‘‘, in-
cluding funding’’ and inserting the following: 
‘‘(1) PRIORITY.—In furnishing assistance under 
subsection (c), the President shall give priority to— 
‘‘(A) activities described in the Stop TB 
Strategy, including expansion and enhancement 
of Directly Observed Treatment Short-course 
(DOTS) coverage, treatment for individuals in-
fected with both tuberculosis and HIV and 
treatment for individuals with multi-drug resist-
ant tuberculosis (MDR–TB), strengthening of 
health systems, use of the International Stand-
ards for Tuberculosis Care by all care pro-
viders, empowering individuals with tuber-
culosis, and enabling and promoting research to 
develop new diagnostics, drugs, and vaccines, 
and program-based operational research relat-
ing to tuberculosis; and 
‘‘(B) funding’’; and 
(C) in the second sentence—
(i) by striking ‘‘In order to’’ and all 
that follows through ‘‘not less than’’ and 
inserting the following: 
‘‘(2) AVAILABILITY OF AMOUNTS.—In order to 
meet the requirements of paragraph (1), the Presi-
dent— 
‘‘(A) shall ensure that not less than’’; 
(ii) by striking ‘‘for Directly Observed 
Treatment Short-course (DOTS) coverage 
and treatment of multi-drug resistant tu-
berculosis using DOTS–Plus,’’ and insert-
ing ‘‘to implement the Stop TB Strategy; 
and’’; and 
(iii) by striking ‘‘including’’ and all 
that follows and inserting the following: 
‘‘(B) should ensure that not less than 
$15,000,000 of the amount made available to 
carry out this section for a fiscal year is used 
to make a contribution to the Global Tuber-
culosis Drug Facility.’’. 
(5) ASSISTANCE FOR WHO AND THE STOP TU-
BERCULOSIS PARTNERSHIP.—Such section is further 
amended—
(A) by redesignating subsection (g) (as re-
designated by paragraph (3) of this subsection) 
as subsection (h); and 
(B) by inserting after subsection (f) (as re-
designated by paragraph (4) and amended by 
paragraph (5) of this subsection) the following 
new subsection: 
‘‘(g) ASSISTANCE FOR WHO AND THE STOP TUBER-
CULOSIS PARTNERSHIP.—In carrying out this section, the 
President, acting through the Administrator of the United 
States Agency for International Development, is author-
ized to provide increased resources to the World Health 
Organization (WHO) and the Stop Tuberculosis Partner-
ship 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 extensively drug resistant tuberculosis (XDR– 
TB).’’. 
(6) DEFINITIONS.—Subsection (h) of such sec-
tion (as redesignated by paragraph (5)(A) of this 
subsection) is amended— 
(A) in paragraph (1), by adding at the end 
before the period the following: ‘‘, including low 
cost and effective diagnosis and evaluation of 
treatment regimes, vaccines, and monitoring of
tuberculosis, as well as a reliable drug supply, 
and a management strategy for public health 
systems, with health system strengthening, pro-
motion of the use of the International Stand-
ards for Tuberculosis Care by all care pro-
viders, bacteriology under an external quality 
assessment framework, short-course chemo-
therapy, and sound reporting and recording sys-
tems’’; and 
(B) by adding after paragraph (5) the fol-
lowing new paragraph: 
‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 
Strategy’ means the six-point strategy to reduce tu-
berculosis developed by the World Health Organiza-
tion. The strategy is described in the Global Plan to 
Stop TB 2007–2016: Actions for Life, a comprehen-
sive plan developed by the Stop Tuberculosis Part-
nership that sets out the actions necessary to 
achieve the millennium development goal of cutting 
tuberculosis deaths and disease burden in half by 
2016.’’. 
(b) 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 ‘‘$4,000,000,000 for 
fiscal years 2009 through 2013’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 
2004 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’. 
SEC. 303. ASSISTANCE TO COMBAT MALARIA. 
(a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT 
OF 1961.—Section 104C(b) of the Foreign Assistance Act 
of 1961 (22 U.S.C. 21516–4(b)) is amended by striking 
‘‘control, and cure’’ and inserting ‘‘treatment, and care’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
303(b) of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7633(b)) is amended— 
(1) in paragraph (1), by striking ‘‘such sums as 
may be necessary for fiscal years 2004 through 
2008’’ and inserting ‘‘$5,000,000,000 for fiscal 
years 2009 through 2013’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 
2004 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’. 
(c) DEVELOPMENT
OF
A COMPREHENSIVE FIVE- 
YEAR STRATEGY.—Section 303 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7633) is amended by adding at 
the end the following: 
‘‘(d) DEVELOPMENT OF A COMPREHENSIVE FIVE- 
YEAR STRATEGY.—The President shall establish a com-
prehensive, five-year strategy to combat global malaria 
that strengthens the capacity of the United States to be 
an effective leader of international efforts to reduce the 
global malaria disease burden. Such strategy shall main-
tain sufficient flexibility and remain responsive to the 
ever-changing nature of the global malaria challenge and 
shall— 
‘‘(1) include specific objectives, multisectoral 
approaches and strategies to treat and provide care 
to individuals infected with malaria, to prevent the 
further spread of malaria; 
‘‘(2) describe how this strategy would con-
tribute to the United States’ overall global health 
and development goals; 
‘‘(3) clearly explain how proposed activities to 
combat malaria will be coordinated with other 
United States global health activities, including the 
five-year global HIV/AIDS and tuberculosis strate-
gies developed pursuant to section 101 of this Act;
‘‘(4) expand public-private partnerships and 
leveraging of resources to combat malaria, including 
private sector resources; 
‘‘(5) 
coordinate 
among 
relevant 
executive 
branch agencies providing assistance to combat ma-
laria in order to maximize human and financial re-
sources and reduce unnecessary duplication among 
such agencies and other donors; 
‘‘(6) maximize United States capabilities in the 
areas of technical assistance, training, and research, 
including vaccine research, to combat malaria; and 
‘‘(7) establish priorities and selection criteria 
for the distribution of resources to combat malaria 
based on factors such as the size and demographics 
of the population with malaria, the needs of that 
population, the host countries’ existing infrastruc-
ture, and the host countries’ ability to complement 
United States efforts with strategies outlined in na-
tional malaria control plans. 
‘‘(e) MALARIA RESPONSE COORDINATOR.— 
‘‘(1) IN GENERAL.—There should be established 
within the United States Agency for International 
Development a Coordinator of United States Gov-
ernment Activities to Combat Malaria Globally, who 
should be appointed by the President.
100 
‘‘(2) AUTHORITIES.—The Coordinator, acting 
through such nongovernmental organizations and 
relevant executive branch agencies as may be nec-
essary and appropriate to effect the purposes of sec-
tion 104C of the Foreign Assistance Act of 1961 (22 
U.S.C. 2151b–4), is authorized— 
‘‘(A) to operate internationally to carry out 
prevention, treatment, care, support, capacity 
development of health systems, and other activi-
ties for combating malaria; 
‘‘(B) to transfer and allocate funds to rel-
evant executive branch agencies; 
‘‘(C) to provide grants to, and enter into 
contracts with, nongovernmental organizations 
to carry out the purposes of such section 104C; 
‘‘(D) to enter into contracts and transfer 
and allocate funds to international organiza-
tions to carry out the purposes of such section 
104C; and 
‘‘(E) to coordinate with a public-private 
partnership to discover and develop effective 
new antimalarial drugs, including drugs for 
multi-drug resistant malaria and malaria in 
pregnant women. 
‘‘(3) DUTIES.—
101 
‘‘(A) IN GENERAL.—The Coordinator shall 
have primary responsibility for the oversight 
and coordination of all resources and global 
United States government activities to combat 
malaria. 
‘‘(B) SPECIFIC DUTIES.—The Coordinator 
shall— 
‘‘(i) facilitate program and policy co-
ordination 
among 
relevant 
executive 
branch agencies and nongovernmental or-
ganizations, including auditing, monitoring 
and evaluation of such programs; 
‘‘(ii) ensure that each relevant execu-
tive branch agency has sufficient resources 
to execute programs in areas in which the 
agency has the greatest expertise, technical 
capability, and potential for success; 
‘‘(iii) coordinate with the Office of the 
Coordinator of United States Government 
Activities to Combat HIV/AIDS Globally 
and equivalent managers of other relevant 
executive branch agencies that are imple-
menting global health programs to develop 
and implement program plans, country- 
level interactions, and recipient administra-
102 
tive requirements in countries in which 
more than one program operates; 
‘‘(iv) coordinate relevant executive 
branch agency activities in the field, in-
cluding coordination of planning, imple-
mentation, and evaluation of malaria pro-
grams with HIV/AIDS programs in coun-
tries in which both programs are being 
carried out; 
‘‘(v) pursue coordinate program im-
plementation with host governments, other 
donors, and the private sector; and 
‘‘(vi) establish due diligence criteria 
for all recipients of funds appropriated 
pursuant to the authorizations of appro-
priations under section 401 for malaria as-
sistance. 
‘‘(f) ASSISTANCE TO WHO.—In carrying out this sec-
tion, the President is authorized to make a United States 
contribution to the Roll Back Malaria Partnership and the 
World Health Organization (WHO) to improve the capac-
ity of countries with high rates of malaria and other af-
fected countries to implement comprehensive malaria con-
trol programs. 
‘‘(g) ANNUAL REPORT.—
103 
‘‘(1) IN GENERAL.—Not later than 270 days 
after the date of the enactment of the Tom Lantos 
and Henry J. Hyde Global Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008, and annually thereafter, the President 
shall transmit to the appropriate congressional com-
mittees a report on United States assistance for the 
prevention, treatment, control, and elimination of 
malaria. 
‘‘(2) MATTERS TO BE INCLUDED.—The report 
required under paragraph (1) shall include a de-
scription of— 
‘‘(A) the countries and activities to which 
malaria assistance has been allocated; 
‘‘(B) the number of people reached 
through malaria assistance programs; 
‘‘(C) the percentage and number of chil-
dren and mothers reached through malaria as-
sistance programs; 
‘‘(D) research efforts to develop new tools 
to combat malaria, including drugs and vac-
cines; 
‘‘(E) collaboration with the World Health 
Organization (WHO), the Global Fund to Fight 
AIDS, Tuberculosis and Malaria, other donor
104 
governments, and relevant executive branch 
agencies to combat malaria; 
‘‘(F) quantified impact of United States 
assistance on childhood morbidity and mor-
tality; 
‘‘(G) the number of children who received 
immunizations through malaria assistance pro-
grams; and 
‘‘(H) the number of women receiving ante- 
natal care through malaria assistance pro-
grams.’’. 
SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/ 
AIDS. 
(a) IN GENERAL.—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 strik-
ing section 304 and inserting the following: 
‘‘SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/ 
AIDS. 
‘‘(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that the use of health care partnerships that link 
United States and host country health care institutions 
create opportunities for sharing of knowledge and exper-
tise among individuals with significant experience in 
health-related fields and build local capacity to combat
105 
HIV/AIDS and increase scientific understanding of the 
progression of HIV/AIDS and the HIV/AIDS epidemic. 
‘‘(b) AUTHORITY TO FACILITATE HEALTH CARE 
PARTNERSHIPS TO COMBAT HIV/AIDS.—The President, 
acting through the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally, shall fa-
cilitate the development of health care partnerships de-
scribed in subsection (a) by— 
‘‘(1) supporting short- and long-term institu-
tional partnerships, including partnerships that build 
human and institutional capacity in ministries of 
health, central- and district-level health agencies, 
medical facilities, health education and training in-
stitutions, academic centers, and faith- and commu-
nity-based organizations involved in prevention, 
treatment, and care of HIV/AIDS; 
‘‘(2) supporting the development of consultation 
services using appropriate technologies, including on-
line courses, DVDs, telecommunications services, 
partnerships, and other technologies to eliminate the 
barriers that prevent host country professionals from 
accessing high quality health care services informa-
tion, particularly providers located in rural areas; 
‘‘(3) supporting the placements of highly quali-
fied individuals to strengthen human and organiza-
106 
tional capacity through the use of health care profes-
sionals to facilitate skills transfer, building local ca-
pacity, and to expand rapidly the pool of providers, 
managers, and other health care staff delivering 
HIV/AID services in host countries; and 
‘‘(4) meeting individual country needs and, 
where possible, insisting on the implementation of a 
national strategic plan, by providing training and 
mentoring to strengthen human and organizational 
capacity among local health care service organiza-
tions. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—Of the 
amounts authorized to be appropriated under section 401 
for HIV/AIDS assistance, there are authorized to be ap-
propriated to the President such sums as may be nec-
essary for each of the fiscal years 2009 through 2013 to 
carry out this section.’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
for the United States Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 
is amended by striking the item relating to section 304 
and inserting the following new item: 
‘‘Sec. 304. Health care partnerships to combat HIV/AIDS.’’.
107 
Subtitle B—Assistance for Women, 
Children, and Families 
SEC. 311. POLICY AND REQUIREMENTS. 
(a) POLICY.—Subsection (a) of section 312 of the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (22 U.S.C. 7652) is 
amended— 
(1) in the first sentence, by striking ‘‘The 
United States Government’s’’ and inserting the fol-
lowing: 
‘‘(1) IN GENERAL.—The United States’’; and 
(2) by adding at the end the following: 
‘‘(2) COLLABORATION.—The United States 
should work in collaboration with governments, do-
nors, the private sector, nongovernmental organiza-
tions, and other key stakeholders to carry out the 
policy described in paragraph (1).’’. 
(b) REQUIREMENTS.—Subsection (b) of such section 
is amended to read as follows: 
‘‘(b) REQUIREMENTS.—The 5-year United States 
strategy required by section 101 of this Act shall— 
‘‘(1) establish a target for prevention and treat-
ment of mother-to-child transmission of HIV that by 
2013 will reach at least 80 percent of pregnant
108 
women in those countries most affected by HIV/ 
AIDS; 
‘‘(2) establish a target requiring that by 2013 
up to 15 percent of individuals receiving care and up 
to 15 percent of individuals receiving treatment 
under this Act and the amendments made by this 
Act are children; 
‘‘(3) integrate care and treatment with preven-
tion of mother-to-child transmission of HIV pro-
grams in order to improve outcomes for HIV-af-
fected women and families as soon as is feasible, 
consistent with the national government policies of 
countries in which programs under this Act are ad-
ministered, and including support for strategies to 
ensure successful follow-up and continuity of care; 
‘‘(4) expand programs designed to care for chil-
dren orphaned by HIV/AIDS; 
‘‘(5) develop a timeline for expanding access to 
more effective regimes to prevent mother-to-child 
transmission of HIV, consistent with the national 
government policies of countries in which programs 
under this Act are administered and the goal of 
achieving universal use of such regimens as soon as 
possible;
109 
‘‘(6) ensure that women receiving voluntary 
contraceptive counseling, services, or commodities in 
programs supported by the United States Govern-
ment have access to the full range of HIV/AIDS 
services; and 
‘‘(7) ensure that women in prevention of moth-
er-to-child transmission of HIV programs are pro-
vided with appropriate maternal and child services, 
either directly or by referral.’’. 
SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER- 
TO-CHILD TRANSMISSION OF THE HIV INFEC-
TION. 
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. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG 
WOMEN AND YOUTH. 
(a) IN GENERAL.—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 add-
ing at the end the following:
110 
‘‘SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG 
WOMEN AND YOUTH. 
‘‘(a) STATEMENT OF POLICY.—In order to meet the 
United 
States 
Government’s 
goal 
of 
preventing 
12,000,000 new HIV infections worldwide, it shall be the 
policy of the United States to pursue a global HIV/AIDS 
prevention strategy that emphasizes the immediate and 
ongoing needs of women and youth and addresses the fac-
tors that lead to gender disparities in the rate of HIV in-
fection. 
‘‘(b) STRATEGY.— 
‘‘(1) IN GENERAL.—The President shall formu-
late a comprehensive, integrated, and culturally-ap-
propriate global HIV/AIDS prevention strategy that, 
to the extent epidemiologically appropriate, address-
es the vulnerabilities of women and youth to HIV in-
fection and seeks to reduce the factors that lead to 
gender disparities in the rate of HIV infection. 
‘‘(2) ELEMENTS.—The strategy required under 
paragraph (1) shall include specific goals and tar-
gets under the 5-year strategy outlined in section 
101 and shall include comprehensive HIV/AIDS pre-
vention education at the individual and national level 
including the ABC (‘Abstain, Be faithful, use 
Condoms’) model as a means to reduce HIV infec-
tions and shall include the following:
111 
‘‘(A) Specific goals under the five-year 
strategy outlined in section 101. 
‘‘(B) Empowering women and youth to 
avoid cross-generational sex and to decide when 
and whom to marry in order to reduce the inci-
dence of early or child marriage. 
‘‘(C) Dramatically increasing access to cur-
rently available female-controlled prevention 
methods and including investments in training 
to increase the effective and consistent use of 
both male and female condoms. 
‘‘(D) Accelerating the de-stigmatization of 
HIV/AIDS among women and youth as a major 
risk factor for the transmission of HIV. 
‘‘(E) Addressing and preventing post-trau-
matic and psycho-social consequences and pro-
viding post-exposure prophylaxis to victims of 
gender-based violence and rape against women 
and youth through appropriate medical, social, 
educational, and legal assistance and through 
prosecutions and legal penalties to address such 
violence. 
‘‘(F) Promoting changes in male attitudes 
and behavior that respect the human rights of
112 
women and youth and that support and foster 
gender equality. 
‘‘(G) Supporting the development of micro-
enterprise initiatives, job training programs, 
and other such efforts to assist women in devel-
oping and retaining independent economic 
means. 
‘‘(H) Supporting universal basic education 
and expanded educational opportunities for 
women and youth. 
‘‘(I) Protecting the property and inherit-
ance rights of women. 
‘‘(J) Coordinating inclusion of HIV/AIDS 
prevention information and education services 
and programs for individuals with HIV/AIDS 
with existing health care services targeted to 
women and youth, such as ensuring access to 
HIV/AIDS education and testing in family 
planning programs supported by the United 
States Government and programs to reduce 
mother-to-child transmission of HIV, and ex-
panding the reach of such HIV/AIDS health 
services. 
‘‘(K) Promoting gender equality by sup-
porting the development of nongovernmental or-
113 
ganizations, including faith-based and commu-
nity-based organizations, that support the needs 
of women and utilizing such organizations that 
are already empowering women and youth at 
the community level. 
‘‘(L) Encouraging the creation and effec-
tive enforcement of legal frameworks that guar-
antee women equal rights and equal protection 
under the law. 
‘‘(M) Encouraging the participation and 
involvement of women in drafting, coordinating, 
and implementing the national HIV/AIDS stra-
tegic plans of their countries. 
‘‘(N) Responding to other economic and 
social factors that increase the vulnerability of 
women and youth to HIV infection. 
‘‘(3) TRANSMISSION TO CONGRESS AND PUBLIC 
AVAILABILITY.—Not later than 180 days after the 
date of the enactment of the Tom Lantos and Henry 
J. Hyde Global Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Reauthorization Act of 
2008, the President shall transmit to the appro-
priate congressional committees and make available 
to the public the strategy required under paragraph 
(1).
114 
‘‘(c) COORDINATION.—In formulating and imple-
menting the strategy required under subsection (b), the 
President shall ensure that the United States coordinates 
its overall HIV/AIDS policy and programs with the na-
tional governments of the countries for which the United 
States provides assistance to combat HIV/AIDS and, to 
the extent practicable, with international organizations, 
other donor countries, and indigenous organizations, in-
cluding faith-based and community-based organizations 
specifically for the purposes of ensuring gender equality 
and promoting respect of the human rights of women that 
impact their susceptibility to HIV/AIDS, improving wom-
en’s health, and expanding education for women and 
youth, and organizations, including faith-based and other 
nonprofit organizations, providing services to and advo-
cating on behalf of individuals with HIV/AIDS and indi-
viduals affected by HIV/AIDS. 
‘‘(d) GUIDANCE.— 
‘‘(1) IN GENERAL.—The President shall provide 
clear guidance to field missions of the United States 
Government in countries for which the United States 
provides assistance to combat HIV/AIDS, based on 
the strategy required under subsection (b). 
‘‘(2) TRANSMISSION TO CONGRESS AND PUBLIC 
AVAILABILITY.—The President shall transmit to the
115 
appropriate congressional committees and make 
available to the public a description of the guidance 
required under paragraph (1). 
‘‘(e) REPORT.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of the Tom Lantos and 
Henry J. Hyde 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 transmit to the appro-
priate congressional committees and make available 
to the public a report on the implementation of this 
section for the prior fiscal year. 
‘‘(2) MATTERS TO BE INCLUDED.—The report 
required under paragraph (1) shall include the fol-
lowing: 
‘‘(A) A description of the prevention pro-
grams designed to address the vulnerabilities of 
women and youth to HIV/AIDS. 
‘‘(B) A list of nongovernmental organiza-
tions in each country that receive assistance 
from the United States to carry out HIV pre-
116 
vention activities, including the amount and the 
source of funding received.’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
for the United States Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 
is amended by inserting after the item relating to section 
315 the following: 
‘‘Sec. 316. Strategy to prevent HIV infections among women and youth.’’. 
SEC. 314. CLERICAL AMENDMENT. 
The table of contents for the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Malaria Act 
of 2003 (22 U.S.C. 7601 note) is amended by striking 
the item relating to subtitle B of title III and inserting 
the following: 
‘‘Subtitle B—Assistance for Women, Children, and Families’’. 
TITLE IV—AUTHORIZATION OF 
APPROPRIATIONS 
SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 
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— 
(1) by striking ‘‘$3,000,000,000’’ and inserting 
‘‘$10,000,000,000’’; and 
(2) by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 
2013’’.
117 
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) is amended— 
(1) by striking paragraph (1); 
(2) by redesignating paragraphs (2) through 
(4) as paragraphs (1) through (3), respectively; and 
(3) in paragraph (2) (as redesignated by para-
graph (2) of this section), by striking ‘‘, of which’’ 
and all that follows through ‘‘programs’’. 
SEC. 403. ALLOCATION OF FUNDS. 
(a) HIV/AIDS PREVENTION
ACTIVITIES.—Sub-
section (a) of section 403 of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7673) is amended to read as follows: 
‘‘(a) HIV/AIDS PREVENTION ACTIVITIES.— 
‘‘(1) IN GENERAL.—For each of the fiscal years 
2009 through 2013, not less than 20 percent of the 
amounts appropriated pursuant to the authorization 
of appropriations under section 401 for HIV/AIDS 
assistance for each such fiscal year shall be ex-
pended for HIV/AIDS prevention activities con-
sistent with section 104A(d) of the Foreign Assist-
ance Act of 1961. 
‘‘(2) BALANCED FUNDING REQUIREMENT.—(A) 
The Coordinator of United States Government Ac-
119 
‘‘(C) Programs and activities that implement or 
purchase new prevention technologies or modalities 
such as medical male circumcision, pre-exposure pro-
phylaxis, or microbicides and programs and activities 
that provide counseling and testing for HIV or pre-
vent mother-to-child prevention of HIV shall not be 
included in determining compliance with this para-
graph. 
‘‘(3) REPORT.—Not later than 1 year after the 
date of the enactment of the Tom Lantos and Henry 
J. Hyde Global Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Reauthorization Act of 
2008, and annually thereafter as part of the annual 
report required under section 104A(e) of the For-
eign Assistance Act of 1961 (22 U.S.C. 2151b– 
2(e)), the President shall transmit to the appro-
priate congressional committees and make available 
to the public a report on the implementation of 
paragraph (2) for the prior fiscal year.’’. 
(b) ORPHANS AND VULNERABLE CHILDREN.—Sub-
section (b) of such section is amended by striking ‘‘fiscal 
years 2006 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’.
120 
SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOV-
ERNMENTS. 
(a) PROHIBITION ON TAXATION.—None of the funds 
appropriated pursuant to the authorization of appropria-
tions under section 401 of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7671) may be made available to provide 
assistance for a foreign country under a new bilateral 
agreement governing the terms and conditions under 
which such assistance is to be provided unless such agree-
ment includes a provision stating that assistance provided 
by the United States shall be exempt from taxation, or 
reimbursed, by the foreign government, and the Secretary 
of State shall expeditiously seek to negotiate amendments 
to existing bilateral agreements, as necessary, to conform 
with this requirement. 
(b) DE MINIMUS EXCEPTION.—Foreign taxes of a de 
minimus nature shall not be subject to the provisions of 
subsection (a). 
(c) REPROGRAMMING OF FUNDS.—Funds withheld 
from obligation for each country or entity pursuant to sub-
section (a) shall be reprogrammed for assistance to coun-
tries which do not assess taxes on United States assistance 
or which have an effective arrangement that is providing 
substantial reimbursement of such taxes. 
(d) DETERMINATIONS.—
121 
(1) IN GENERAL.—The provisions of this sec-
tion shall not apply to any country or entity the Sec-
retary of State determines— 
(A) does not assess taxes on United States 
assistance or which has an effective arrange-
ment that is providing substantial reimburse-
ment of such taxes; or 
(B) the foreign policy interests of the 
United States outweigh the policy of this sec-
tion to ensure that United States assistance is 
not subject to taxation. 
(2) CONSULTATION.—The Secretary of State 
shall consult with the Committees on Foreign Af-
fairs and Appropriations at least 15 days prior to 
exercising the authority of this subsection with re-
gard to any country or entity. 
(e) IMPLEMENTATION.—The Secretary of State shall 
issue rules, regulations, or policy guidance, as appropriate, 
to implement the prohibition against the taxation of assist-
ance contained in this section. 
(f) DEFINITIONS.—As used in this section— 
(1) the terms ‘‘taxes’’ and ‘‘taxation’’ refer to 
value added taxes and customs duties imposed on 
commodities financed with United States assistance
122 
for programs for which funds are authorized by this 
Act; and 
(2) the term ‘‘bilateral agreement’’ refers to a 
framework bilateral agreement between the Govern-
ment of the United States and the government of 
the country receiving assistance that describes the 
privileges and immunities applicable to United 
States foreign assistance for such country generally, 
or an individual agreement between the Government 
of the United States and such government that de-
scribes, among other things, the treatment for tax 
purposes that will be accorded the United States as-
sistance provided under that agreement. 
TITLE V—SUSTAINABILITY AND 
STRENGTHENING OF HEALTH 
CARE SYSTEMS 
SEC. 
501. 
SUSTAINABILITY 
AND 
STRENGTHENING 
OF 
HEALTH CARE SYSTEMS. 
The United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 
et seq.) is amended by adding at the end the following:
123 
‘‘TITLE VI—SUSTAINABILITY AND 
STRENGTHENING OF HEALTH 
CARE SYSTEMS 
‘‘SEC. 601. FINDINGS. 
‘‘Congress makes the following findings: 
‘‘(1) The shortage of health personnel, includ-
ing doctors, nurses, pharmacists, counselors, labora-
tory staff, and paraprofessionals, is one of the lead-
ing obstacles to fighting HIV/AIDS in sub-Saharan 
Africa. 
‘‘(2) The HIV/AIDS pandemic aggravates the 
shortage of health workers through loss of life and 
illness among medical staff, unsafe working condi-
tions for medical personnel, and increased workloads 
for diminished staff, while the shortage of health 
personnel undermines efforts to prevent and provide 
care and treatment for individuals with HIV/AIDS. 
‘‘(3) Failure to address the shortage of health 
care professionals and paraprofessionals, and the 
factors forcing such individuals to leave sub-Saharan 
Africa, will undermine the objectives of United 
States development policy and will subvert opportu-
nities to achieve internationally-recognized goals for 
the prevention, treatment, and care of HIV/AIDS 
and other diseases, the reduction of child and mater-
124 
nal mortality, and for economic growth and develop-
ment in sub-Saharan Africa. 
‘‘SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES 
AND OTHER POLICIES. 
‘‘(a) NATIONAL
HEALTH
WORKFORCE
STRATE-
GIES.— 
‘‘(1) STATEMENT OF POLICY.—It shall be the 
policy of the United States Government to support 
countries receiving United States assistance to com-
bat HIV/AIDS, tuberculosis, and malaria, and other 
health programs in developing, strengthening, and 
implementing 5-year health workforce strategies. 
‘‘(2) TECHNICAL
AND
FINANCIAL
ASSIST-
ANCE.—The Administrator of the United States 
Agency for International Development, in coordina-
tion with the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally, is 
authorized to provide technical and financial assist-
ance to countries described in paragraph (1) to en-
able such countries, in conjunction with other fund-
ing sources, to develop, strengthen, and implement 
health workforce strategies. 
‘‘(3) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (2) shall, to the maximum
125 
extent practicable, be used to carry out the fol-
lowing: 
‘‘(A) Activities to promote an inclusive 
process that includes nongovernmental organi-
zations and individuals with HIV/AIDS in de-
veloping health workforce strategies. 
‘‘(B) Activities to achieve and sustain a 
health workforce sufficient in numbers, skill, 
and capacity to meet United States and host- 
country international health commitments, in-
cluding the Millennium Development Goals and 
universal access to HIV/AIDS prevention, treat-
ment, and care. In particular, such health work-
force strategies should include plans for 
progress toward achieving the minimum ratio of 
health professionals required to achieve these 
goals by 2015, estimated by the World Health 
Organization to require at least 2.3 doctors, 
nurses, and midwives per 1,000 population, and 
additional health workers such as pharmacists 
and lab technicians. 
‘‘(C) Activities to ensure that health work-
force strategies are aimed at creating appro-
priate distribution of health workers and 
prioritizing activities required to ensure rural,
126 
marginalized, and other underserved popu-
lations are able to access skilled and equipped 
health workers. 
‘‘(D) Activities to expand the capacity of 
public and private medical, nursing, pharma-
ceutical, and other health training institutions. 
‘‘(b) POSITIVE BROADER HEALTH IMPACT.—It shall 
be the policy of the United States to ensure to expand 
the capacity of the health workforce engaged in HIV/AIDS 
programming in ways that contribute to, and do not de-
tract from, the capacity of countries to meet other health 
needs, particularly child survival and maternal health. 
‘‘(c) SAFETY
FOR HEALTH WORKERS.—It is the 
sense of Congress that the United States should ensure 
that all health workers participating in programs that re-
ceive assistance under this Act and the amendments made 
by this Act have the proper training to create safe and 
sanitary working conditions in accordance with universal 
precautions and other forms of infection prevention and 
control. 
‘‘(d) HEALTH CARE FOR HEALTH WORKERS.—The 
Coordinator of United States Government Activities to 
Combat HIV/AIDS Globally shall ensure that comprehen-
sive and confidential health services shall be provided to 
all health workers participating in programs that receive
127 
assistance under this Act and the amendments made by 
this Act, including— 
‘‘(1) testing and counseling for all such employ-
ees; 
‘‘(2) providing HIV/AIDS treatment to HIV- 
positive employees; and 
‘‘(3) taking measures to reduce HIV-related 
stigma in the workplace. 
‘‘(e) TRAINING
AND COMPENSATION FINANCE.— 
Where the Coordinator determines such financial support 
is essential to fulfill the purposes of this Act, the Coordi-
nator shall finance training and provide compensation or 
other benefits for health workers in order to enhance re-
cruitment and retention of such workers. 
‘‘SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM 
LIMITS SOUGHT BY INTERNATIONAL FINAN-
CIAL INSTITUTIONS. 
‘‘(a) COORDINATION WITHIN THE UNITED STATES 
GOVERNMENT.—The Coordinator of United States Gov-
ernment Activities to Combat HIV/AIDS Globally shall 
work with the Secretary of the Treasury to reform Inter-
national Monetary Fund macroeconomic and fiscal policies 
that result in limitations on national and donor invest-
ments in health.
128 
‘‘(b) POSITION OF THE UNITED STATES AT THE 
IMF.—The Secretary of the Treasury shall instruct the 
United States Executive Director at the International 
Monetary Fund to use the voice, vote, and influence of 
the United States to oppose any loan, project, agreement, 
memorandum, instrument, plan, or other program of the 
International Monetary Fund that does not exempt in-
creased government spending on health care from national 
budget caps or restraints, hiring or wage bill ceilings, or 
other limits sought by any international financial institu-
tion. 
‘‘SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REG-
ISTRATION, AND SUPPLY CHAIN MANAGE-
MENT SYSTEMS. 
‘‘(a) IN GENERAL.—The Coordinator of United 
States Government Activities to Combat AIDS Globally 
shall work with the Partnership for Supply Chain Manage-
ment Systems, host countries, and nongovernmental orga-
nizations to develop effective, reliable host country-owned 
and operated public-sector procurement and supply chain 
management systems, including regional distribution, with 
ongoing technical assistance and sustained support to en-
sure the function of such systems, as well as the function 
of existing non-public sector supply chains, including those
129 
operated by faith-based and other humanitarian organiza-
tions that procure and distribute medical supplies. 
‘‘(b) AVAILABILITY
OF
EQUIPMENT
AND
SUP-
PLIES.—The public-sector procurement and supply chain 
management systems developed pursuant to subsection (a) 
should ensure that adequate laboratory equipment and 
supplies commonly needed to fight HIV/AIDS, including 
diagnostic tests for CD4 and viral load counts, x-ray ma-
chines, mobile and facility-based rapid HIV test kits and 
other necessary assays, reagents and basic supplies such 
as sterile syringes and gloves, are available and distributed 
in a manner that is accessible to urban and rural popu-
lations. 
‘‘(c) DRUG REGISTRATION.—The Coordinator shall 
work with host country partners and development partners 
to support efficient and effective drug approval and reg-
istration systems that allow expeditious access to safe and 
effective drugs, including antiretroviral drugs. 
‘‘(d) REPORT.—The Coordinator shall submit to the 
appropriate congressional committees an annual report on 
the implementation of this section, including progress to-
ward specific benchmarks established by the Partnership 
for Supply Chain Management Systems, and the projec-
tion of when host countries can fully sustain their own 
procurement and supply chain management and distribu-
130 
tion systems at a scale necessary for national primary 
health needs. 
‘‘SEC. 605. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—Of the amounts authorized to be 
appropriated under section 401 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 title. 
‘‘(b) AVAILABILITY.—Amounts appropriated pursu-
ant to the authorization of appropriations under sub-
section (a) are authorized to remain available until ex-
pended.’’. 
SEC. 502. CLERICAL AMENDMENT. 
The table of contents for the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Malaria Act 
of 2003 (22 U.S.C. 7601 note) is amended by inserting 
after the items relating to title V the following: 
‘‘TITLE VI—SUSTAINABILITY AND STRENGTHENING OF HEALTH 
CARE SYSTEMS 
‘‘Sec. 601. Findings. 
‘‘Sec. 602. National health workforce strategies and other policies. 
‘‘Sec. 603. Exemption of investments in health from limits sought by inter-
national financial institutions.
131 
‘‘Sec. 604. Public-sector procurement, drug registration, and supply chain man-
agement systems. 
‘‘Sec. 605. Authorization of appropriations.’’. 
Passed the House of Representatives April 2, 2008. 
Attest: 
Clerk.
110TH CONGRESS 
2D SESSION 
H. R. 5501 
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.