as the female condom, and lack of training on 
proper use of either male or female condoms. 
(K) High rates of other sexually trans-
mitted infections, unintended pregnancy, and 
complications during pregnancy and childbirth. 
(L) An absence of legal frameworks de-
signed to protect the rights of women and girls 
and the lack of accountable and effective en-
forcement of such frameworks, where they exist. 
(5) Efforts to increase women’s access to com-
prehensive prevention information and services, ad-
dress gender violence, increase women’s economic 
and social status, and foster equitable partnerships 
between women and men are all central to reducing 
the spread of HIV/AIDS worldwide and to enhanc-
ing the success of effective treatment and care pro-
grams supported by the United States. 
(6) The comprehensive, integrated, five-year 
strategy to combat global HIV/AIDS submitted to 
Congress on February 23, 2004, as required by sec-
tion 101 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 
(Public Law 108–25; 22 U.S.C. 7611), does not 
adequately focus or provide sufficient details on how 
the United States Government plans to address the 
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factors that lead to gender disparities in the rate of 
HIV infection in order to successfully prevent HIV 
infection among both married and unmarried women 
and girls. 
SEC. 3. STRATEGY TO PREVENT HIV INFECTIONS AMONG 
MARRIED AND UNMARRIED WOMEN AND 
GIRLS. 
(a) STATEMENT OF POLICY.—In order to meet the 
stated goal of preventing 7,000,000 new HIV infections 
worldwide, as announced by President George W. Bush 
in his address to Congress on January 28, 2003, it shall 
be the policy of the United States to pursue a global HIV 
prevention strategy that emphasizes the immediate and 
ongoing needs of married and unmarried women and girls 
and addresses the factors that lead to gender disparities 
in the rate of HIV infection. 
(b) STRATEGY.—Not later than 180 days after the 
date of the enactment of this Act, the President shall for-
mulate and submit to the appropriate congressional com-
mittees, and make available to the public, a comprehen-
sive, integrated, and culturally relevant global HIV pre-
vention strategy that addresses the vulnerabilities of mar-
ried and unmarried women and girls to HIV infection and 
seeks to reduce the factors that lead to gender disparities 
in the rate of HIV infection. The strategy shall encompass 
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comprehensive health and HIV prevention education at 
the individual and population level beyond the ABC model 
(‘‘Abstain, Be faithful, use Condoms’’) as a means to re-
duce HIV infections and shall include the following strate-
gies: 
(1) Empowering women and girls to avoid 
cross-generational sex and to decide when and whom 
to marry in order to reduce the incidence of early- 
or child-marriage. 
(2) Dramatically increasing access to currently 
available female-controlled prevention methods and 
including investments in training to increase the ef-
fective and consistent use of both male and female 
condoms. 
(3) Accelerating the destigmatization of HIV/ 
AIDS, as women are generally at a disadvantage in 
combating stigma. 
(4) Addressing and preventing the consequences 
of gender based violence and rape against women 
and girls. 
(5) Promoting male attitudes and behavior that 
respect the human rights of women and girls and 
that support and foster gender equality. 
(6) Supporting the development of micro-enter-
prise initiatives, job training programs, and other 
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such efforts to assist women in developing and re-
taining independent economic means. 
(7) Supporting expanded educational opportuni-
ties for women and girls. 
(8) Protecting the property and inheritance 
rights of women. 
(9) Coordinating HIV prevention information 
and education services and programs for people liv-
ing with HIV/AIDS with existing health care serv-
ices targeted to women and girls, such as family 
planning, comprehensive reproductive health serv-
ices, and programs to reduce the transmission of 
HIV between parents and children, and expanding 
the reach of such health services. 
(10) Promoting gender equality by supporting 
the development of civil society organizations focused 
on the needs of women and utilizing such organiza-
tions that are already empowering women and girls 
at the community level. 
(11) Encouraging the creation and effective en-
forcement of legal frameworks that guarantee 
women equal rights and equal protection under the 
law. 
(12) Encouraging the participation and involve-
ment of women in drafting, coordinating, and imple-
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menting the national HIV/AIDS strategic plans of 
their countries. 
(13) Responding to other economic and social 
factors that increase the vulnerability of women and 
girls to HIV infection. 
(c) COORDINATION.—In formulating and imple-
menting the global HIV prevention strategy pursuant to 
subsection (b), the President shall ensure that the United 
States coordinates its overall HIV/AIDS policy and pro-
grams with the national governments of the countries for 
which the United States provides assistance to combat 
HIV/AIDS and with international organizations, other 
donor countries, and indigenous organizations, including, 
specifically, organizations focused on or providing services 
to expanding and enforcing women’s rights, improving 
women’s health, and expanding education for women and 
girls, and organizations providing services to and advo-
cating on behalf of individuals living with and affected by 
HIV/AIDS. 
(d) GUIDANCE.—The President shall provide clear 
guidance to field missions of the United States Govern-
ment in countries for which the United States provides 
assistance to combat HIV/AIDS, based on the strategies 
specified under subsection (b), and shall submit to the ap-
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propriate congressional committees and make available to 
the public such guidance. 
(e) REPORT.—Not later than one year after the date 
of the enactment of this Act 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 submit to the appropriate con-
gressional committees and make available to the public a 
report on the implementation of this Act for the prior fis-
cal year. The report shall include the following informa-
tion: 
(1) A description of the prevention programs 
designed to address the vulnerabilities to HIV/AIDS 
of married and unmarried women and girls. 
(2) A list of all nongovernmental organizations 
in each country that receive assistance from the 
United States to carry out HIV prevention activities, 
including the amount and the source of funding re-
ceived. 
SEC. 4. BALANCING FUNDING FOR HIV PREVENTION METH-
ODS. 
(a) FINDINGS.—Congress finds the following: 
(1) While effective evidence-based and measur-
able strategies for delaying sexual debut are critical 
components of comprehensive HIV prevention pro-
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grams, current United States funded HIV preven-
tion programs based on the ABC model of ‘‘Abstain, 
Be faithful, use Condoms’’ are too narrow in scope 
and do not respond to the specific vulnerabilities of 
women and girls. 
(2) In order to maximize the impact of United 
States foreign assistance to combat HIV/AIDS, all 
sexually active persons in each country must be 
equipped with all the skills and tools necessary to 
avoid infection, including information and training 
on delay of sexual debut and the practice of safer 
sex, whether sexual activity begins within or outside 
of marriage. 
(3) Under section 403(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (Public Law 108–25; 22 U.S.C. 
7673), 33 percent of all United States foreign assist-
ance provided for preventing the spread of HIV 
must be spent on abstinence-until-marriage pro-
grams. Based on operational guidance to field mis-
sions of the United States Government, in order to 
meet this requirement, 50 percent of all United 
States foreign assistance provided for preventing the 
spread of HIV at the country level must be spent on 
prevention of sexual transmission and 66 percent of 
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all such funding for sexual transmission must be 
spent on the Abstinence and Be faithful components 
of the ABC model. 
(4) A recent report by the Government Ac-
countability Office (Global Health: Spending Re-
quirement Presents Challenges for Allocating Pre-
vention Funding under the President’s Emergency 
Plan for AIDS Relief, GAO–06–395, April 4, 2006) 
found the following: 
(A) Because it requires country teams to 
segregate the Abstinence and Be faithful com-
ponents of the ABC model from funding for 
‘‘other prevention’’, the abstinence-until-mar-
riage spending requirement can undermine the 
team’s ability to design and implement pro-
grams that integrate the components of the 
ABC model, one of the guiding principles of the 
President’s Emergency Plan for AIDS Relief 
(PEPFAR) 
sexual 
transmission 
prevention 
strategy. Eight of the 15 focus country teams 
indicated that segregating the Abstinence and 
Be faithful components of the ABC model from 
‘‘other prevention’’ funding compromised the in-
tegration of their programs. Examples of the 
problems they cited include the following: 
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(i) Segregating program funding com-
promises the integration of ABC activities, 
especially for at-risk groups that need com-
prehensive messages. 
(ii) Segregating program funding lim-
its some country teams’ ability to shift pro-
gram focuses to meet changing prevention 
needs. 
(B) A large majority of the 20 PEPFAR 
country teams required to meet the abstinence- 
until-marriage spending requirement or obtain 
exemptions reported that the requirement pre-
sented challenges to their efforts to respond to 
local prevention needs. Seventeen of these 
teams reported, either through documents sub-
mitted to the Office of the Global AIDS Coordi-
nator (OGAC) or through structured interviews, 
that meeting the spending requirement, includ-
ing OGAC’s 50 percent and 66 percent policies 
implementing it, challenged their ability to de-
velop interventions that are responsive to local 
epidemiology and social norms. 
(C) Between September 2005 and January 
2006, ten of these teams submitted documents 
to OGAC requesting exemption from the spend-
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ing requirement as it was defined in OGAC’s 
August 2005 guidance. These documents high-
light various challenges that the country teams 
associated with meeting the spending require-
ment, including the following: 
(i) Reduced spending for Prevention 
of 
Mother 
to 
Child 
Transmission 
(PMTCT). 
(ii) Limited funding to deliver appro-
priate prevention messaging to high-risk 
groups. 
(iii) Lack of responsiveness to cultural 
and social norms. 
(iv) Cuts in medical and blood safety 
activities. 
(v) Elimination of care programs. 
(D) In addition, seven teams that did not 
submit documents requesting exemption from 
the spending requirement (they did not meet 
OGAC’s proposed criteria for requesting exemp-
tions) identified, in structured interviews, spe-
cific program constraints related to meeting the 
abstinence-until-marriage spending requirement. 
These constraints included the following: 
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(i) Difficulty reaching certain popu-
lations with comprehensive ABC messages. 
(ii) Limited or reduced funding for 
programs targeted at high-risk groups. 
(iii) Reduced funding for PMTCT 
services. 
(iv) Difficulty funding programs for 
condom procurement and condom social 
marketing. 
(b) STATEMENT OF POLICY.—In carrying out the ac-
tivities required by the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public 
Law 108–25; 22 U.S.C. 7601 et seq.) and the amend-
ments made by that Act, it shall be the policy of the 
United States— 
(1) to provide flexibility to support the imple-
mentation of culturally relevant HIV prevention pro-
grams that are carried out in accordance with the 
global HIV prevention strategy established pursuant 
to section 3 of this Act; 
(2) to ensure that onerous requirements are not 
imposed with respect to how funds made available 
for such programs can be obligated and expended; 
and 
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(3) to prevent the unnecessary reduction in 
funding for effective HIV programs in order to meet 
any such onerous requirements. 
(c) AMENDMENTS TO FUNDING PROVISIONS OF THE 
UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TU-
BERCULOSIS, AND MALARIA ACT OF 2003.— 
(1) SENSE OF CONGRESS.—Section 402(b)(3) 
of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7672(b)(3)) is amended by striking ‘‘, of which such 
amount at least 33 percent should be expended for 
abstinence-until-marriage programs’’. 
(2) ALLOCATION OF FUNDS.—Section 403(a) of 
such Act (22 U.S.C. 7673(a)) is amended by strik-
ing the second sentence. 
SEC. 5. DEFINITIONS. 
In this Act: 
(1) AIDS.—The term ‘‘AIDS’’ means the ac-
quired immune deficiency syndrome. 
(2) APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES.—The term ‘‘appropriate congressional com-
mittees’’ means the Committee on Foreign Affairs of 
the House of Representatives and the Committee on 
Foreign Relations of the Senate. 
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(3) HIV.—The term ‘‘HIV’’ means the human 
immunodeficiency virus, the pathogen that causes 
AIDS. 
(4) 
HIV/AIDS.—The 
term 
‘‘HIV/AIDS’’ 
means, with respect to an individual, an individual 
who is infected with HIV or living with AIDS. 
Æ 
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