SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PRE-
VENT TRANSMISSION OF HIV AND OTHER DIS-
EASES. 
(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 sec-
tion 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 Pub-
lic Health Service Act (42 U.S.C. 283(a)(5)) regard-
ing the conduct and support of research on, and de-
velopment of, a microbicide to prevent the trans-
mission of the human immunodeficiency virus; and 
‘‘(2) review and, as appropriate, revise such plan 
to prioritize funding and activities relative to their 
scientific urgency and potential market readiness. 
‘‘(b) COORDINATION.—In implementing, reviewing, 
and prioritizing elements of the plan described in subsection
(a), the Director of the Office shall consult, as appropriate, 
with— 
‘‘(1) representatives of other Federal agencies in-
volved in microbicide research, including the Coordi-
nator of United States Government Activities to Com-
bat HIV/AIDS Globally, the Director of the Centers 
for Disease Control and Prevention, and the Adminis-
trator 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 INFEC-
TIOUS DISEASES.—Subpart 6 of part C of title IV of the 
Public Health Service Act (42 U.S.C. 285f et seq.) is amend-
ed 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-re-
view 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 nec-
essary for each of fiscal years 2009 through 2013 to carry 
out this section.’’. 
(e) UNITED STATES AGENCY FOR INTERNATIONAL DE-
VELOPMENT.— 
(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 Glob-
ally, may facilitate availability and accessibility of 
microbicides, provided that such pharmaceuticals are 
approved, tentatively approved, or otherwise author-
ized 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 accept-
able to the Secretary of Health and Human 
Services. 
(2) AUTHORIZATION
OF
APPROPRIATIONS.—Of 
the amounts authorized to be appropriated under sec-
tion 401 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 
(22 U.S.C. 7671) for HIV/AIDS assistance, there are 
authorized to be appropriated to the President such 
sums as may be necessary for each of the fiscal years 
2009 through 2013 to carry out this subsection. 
SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MA-
LARIA BY STRENGTHENING HEALTH POLI-
CIES AND HEALTH SYSTEMS OF PARTNER 
COUNTRIES. 
(a) IN GENERAL.—Title II of the United States Lead-
ership 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 MA-
LARIA BY STRENGTHENING HEALTH POLI-
CIES 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 ca-
pacity-building consistent with the goals and ob-
jectives of this Act; and 
‘‘(2) to support the development of a sound pol-
icy 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 effective-
ness of such investments; 
‘‘(C) to improve national HIV/AIDS, tuber-
culosis, and malaria strategies; 
‘‘(D) to deliver evidence-based services in an 
effective and efficient manner; and
‘‘(E) to reduce barriers that prevent recipi-
ents of services from achieving maximum benefit 
from such services. 
‘‘(b) ASSISTANCE TO IMPROVE PUBLIC FINANCE MAN-
AGEMENT SYSTEMS.— 
‘‘(1) IN GENERAL.—Consistent with the author-
ity 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 As-
sistance, is authorized to provide assistance for advi-
sors and partner country finance, health, and other 
relevant ministries to improve the effectiveness of pub-
lic 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 sec-
tion 401 for HIV/AIDS assistance, there are author-
ized to be appropriated to the Secretary of the Treas-
ury such sums as may be necessary for each of the fis-
cal years 2009 through 2013 to carry out this sub-
section. 
‘‘(c) PLAN REQUIRED.—The Global AIDS Coordi-
nator, 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 sys-
tems of partner countries as part of USAID’s ‘Health Sys-
tems 2020’ project. Recognizing that human and institu-
tional 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 histori-
cally 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, Tuber-
culosis, 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 fol-
lows: 
‘‘(a) The Secretary may participate with other coun-
tries in cooperative endeavors in— 
‘‘(1) biomedical research, health care technology, 
and the health services research and statistical anal-
ysis authorized under section 306 and title IX; and 
‘‘(2) biomedical research, health care services, 
health care research, or other related activities in fur-
therance of the activities, objectives or goals author-
ized 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 reim-
bursement to the Secretary of State, as may be nec-
essary, to pay the costs of acquisition, lease, construc-
tion, alteration, equipping, furnishing or manage-
ment 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 institu-
tions or agencies in foreign countries in which the 
Secretary is participating in activities described 
under subsection (a) to acquire, lease, construct, alter, 
or renovate facilities in those countries.’’. 
(3) in subsection (c)— 
(A) by striking ‘‘1990’’ and inserting 
‘‘1980’’; and 
(B) by inserting or ‘‘or section 903 of the 
Foreign Service Act of 1980 (22 U.S.C. 4083)’’ 
after ‘‘Code’’. 
SEC. 206. FACILITATING VACCINE DEVELOPMENT. 
(a) TECHNICAL ASSISTANCE FOR DEVELOPING COUN-
TRIES.—The Administrator of the United States Agency for 
International Development, utilizing public-private part-
ners, as appropriate, and working in coordination with 
other international development agencies, is authorized to
strengthen the capacity of developing countries’ govern-
mental 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 im-
pact studies and improve the implementation of clin-
ical 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 mar-
ket commitments for the development of future vac-
cines, including potential vaccines for HIV/AIDS, tu-
berculosis, and malaria. 
(2) NEGOTIATION REQUIREMENT.—The Secretary 
of the Treasury shall enter into negotiations with the 
appropriate officials of the International Bank of Re-
construction 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 mar-
ket commitments, the Secretary of the Treasury shall 
take into account whether programs for advance mar-
ket 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 con-
texts; 
(D) dispute settlement mechanisms; and 
(E) sufficient flexibility to enable the con-
tracts to be adjusted in accord with new infor-
mation related to projected market size and other 
factors while still maintaining the purchase com-
mitment 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 sub-
mit a report to the appropriate congressional 
committees on the status of the United States ne-
gotiations to participate in programs for the ad-
vanced market commitments under this sub-
section; and 
(B) the President shall produce a com-
prehensive report, written by a study group of 
qualified professionals from relevant Federal 
agencies and initiatives, nongovernmental orga-
nizations, and industry representatives, that sets 
forth a coordinated strategy to accelerate devel-
opment of vaccines for infectious diseases, such 
as HIV/AIDS, malaria, and tuberculosis, which 
includes— 
(i) initiatives to create economic incen-
tives 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 vac-
cines in developing countries and to address 
the challenges of delivering vaccines in de-
veloping countries to minimize delays in ac-
cess 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 dis-
ease. It is the policy objective of the United States, by 
2013, to— 
‘‘(A) assist partner countries to— 
‘‘(i) prevent 12,000,000 new HIV infec-
tions 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 ef-
forts; 
‘‘(iii) support care for 12,000,000 indi-
viduals 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 com-
prehensive, 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 trans-
mission of HIV from mother-to-child; 
‘‘(v) provide care and treatment serv-
ices 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 pri-
mary health care in developing countries, espe-
cially in sub-Saharan Africa; 
‘‘(C) support and help countries in their ef-
forts to achieve staffing levels of at least 2.3 doc-
tors, nurses, and midwives per 1,000 population, 
as called for by the World Health Organization; 
and 
‘‘(D) help partner countries to develop inde-
pendent, 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 coun-
tries and regions confronting HIV/AIDS epidemics in 
a coordinated global strategy to help address general-
ized and concentrated epidemics through HIV/AIDS 
prevention, treatment, care, monitoring and evalua-
tion, and related activities. 
‘‘(3) PRIORITIES.—The United States Govern-
ment’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 assur-
ances that meet the requirements under section 
110; and 
‘‘(D) the inclusion of transition strategies to 
ensure sustainability of such programs and ac-
tivities, 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 popu-
lations or those in postconflict settings in such coun-
tries and areas with significant or increasing HIV 
incidence rates.’’; 
(2) in paragraph (2), by striking ‘‘and other 
countries and areas affected by the HIV/AIDS pan-
demic’’ 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 in-
creasing HIV incidence rates.’’; and 
(3) in paragraph (3)— 
(A) by striking ‘‘foreign countries’’ and in-
serting ‘‘partner countries, other international 
actors,’’; and
(B) by inserting ‘‘within the framework of 
the principles of the Three Ones’’ before the pe-
riod 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 concur-
rent sexual partnering,’’ after ‘‘casual sex-
ual partnering’’; and 
(ii) by striking ‘‘condoms’’ and insert-
ing ‘‘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 organiza-
tions’’; 
(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 semi-
colon at the end;
(D) by redesignating subparagraphs (F), 
(G), and (H) as subparagraphs (H), (I), and 
(J), respectively; 
(E) by inserting after subparagraph (E) the 
following: 
‘‘(F) assistance to— 
‘‘(i) achieve the goal of reaching 80 
percent of pregnant women for prevention 
and treatment of mother-to-child trans-
mission 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, includ-
ing—
‘‘(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 sex-
ual partners; 
‘‘(III) delaying sexual debut; and 
‘‘(IV) ensuring correct and con-
sistent 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 fe-
male 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 wide-
spread access to microbicides for HIV pre-
vention, if safe and effective products be-
come available, including financial and 
technical support for culturally appropriate 
introductory programs, procurement, dis-
tribution, 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 oppor-
tunistic infections for free or at a rate at which 
it is easily affordable to the individuals and pop-
ulations being served; 
‘‘(E) as part of care and treatment of HIV/ 
AIDS, assistance or referral to available and 
adequately resourced service providers for nutri-
tional support, including counseling and where 
necessary the provision of commodities, for per-
sons 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 dissemi-
nating 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 collec-
tion, evaluation, and analysis of data re-
garding 
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 inter-
ventions; and 
‘‘(F) establishing appropriate systems to— 
‘‘(i) gather epidemiological and social 
science data on HIV; and 
‘‘(ii) evaluate the effectiveness of pre-
vention 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-EFFEC-
TIVE DRUG PURCHASING.—Subject to subpara-