H. R. 5501—30 
(2) in paragraph (2), by striking ‘‘and other countries and 
areas affected by the HIV/AIDS pandemic’’ and inserting ‘‘Cen-
tral Asia, Eastern Europe, Latin America, and other countries 
and areas affected by the HIV/AIDS pandemic, particularly 
with respect to refugee populations or those in post-conflict 
settings in such countries and areas with significant or 
increasing HIV incidence rates.’’; and 
(3) in paragraph (3)— 
(A) by striking ‘‘foreign countries’’ and inserting 
‘‘partner countries, other international actors,’’; and 
(B) by inserting ‘‘within the framework of the principles 
of the Three Ones’’ before the period at the end. 
(c) ACTIVITIES SUPPORTED.—Section 104A(d) of such Act is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) by inserting ‘‘and multiple concurrent sexual 
partnering,’’ after ‘‘casual sexual partnering’’; and 
(ii) by striking ‘‘condoms’’ and inserting ‘‘male and 
female condoms’’; 
(B) in subparagraph (B)— 
(i) by striking ‘‘programs that’’ and inserting ‘‘pro-
grams that are designed with local input and’’; and 
(ii) by striking ‘‘those organizations’’ and inserting 
‘‘those locally based organizations’’; 
(C) in subparagraph (D), by inserting ‘‘and promoting 
the use of provider-initiated or ‘opt-out’ voluntary testing 
in accordance with World Health Organization guidelines’’ 
before the semicolon at the end; 
(D) by redesignating subparagraphs (F), (G), and (H) 
as subparagraphs (H), (I), and (J), respectively; 
(E) by inserting after subparagraph (E) the following: 
‘‘(F) assistance to— 
‘‘(i) achieve the goal of reaching 80 percent of preg-
nant women for prevention and treatment of mother- 
to-child transmission of HIV in countries in which the 
United States is implementing HIV/AIDS programs 
by 2013; and 
‘‘(ii) promote infant feeding options and treatment 
protocols that meet the most recent criteria established 
by the World Health Organization; 
‘‘(G) medical male circumcision programs as part of 
national strategies to combat the transmission of HIV/ 
AIDS;’’; 
(F) in subparagraph (I), as redesignated, by striking 
‘‘and’’ at the end; and 
(G) by adding at the end the following: 
‘‘(K) assistance for counseling, testing, treatment, care, 
and support programs, including— 
‘‘(i) counseling and other services for the preven-
tion of reinfection of individuals with HIV/AIDS; 
‘‘(ii) counseling to prevent sexual transmission of 
HIV, including— 
‘‘(I) life skills development for practicing 
abstinence and faithfulness; 
‘‘(II) reducing the number of sexual partners; 
‘‘(III) delaying sexual debut; and
H. R. 5501—31 
‘‘(IV) ensuring correct and consistent use of 
condoms; 
‘‘(iii) 
assistance 
to 
engage 
underlying 
vulnerabilities to HIV/AIDS, especially those of women 
and girls; 
‘‘(iv) assistance for appropriate HIV/AIDS edu-
cation programs and training targeted to prevent the 
transmission of HIV among men who have sex with 
men; 
‘‘(v) assistance to provide male and female 
condoms; 
‘‘(vi) diagnosis and treatment of other sexually 
transmitted infections; 
‘‘(vii) strategies to address the stigma and discrimi-
nation that impede HIV/AIDS prevention efforts; and 
‘‘(viii) assistance to facilitate widespread access to 
microbicides for HIV prevention, if safe and effective 
products become available, including financial and 
technical support for culturally appropriate introduc-
tory programs, procurement, distribution, logistics 
management, program delivery, acceptability studies, 
provider 
training, 
demand 
generation, 
and 
postintroduction monitoring.’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (B), by striking ‘‘and’’ at the end; 
(B) in subparagraph (C)— 
(i) 
by 
inserting 
‘‘pain 
management,’’ 
after 
‘‘opportunistic infections,’’; and 
(ii) by striking the period at the end and inserting 
a semicolon; and 
(C) by adding at the end the following: 
‘‘(D) as part of care and treatment of HIV/AIDS, assist-
ance (including prophylaxis and treatment) for common 
HIV/AIDS-related opportunistic infections for free or at 
a rate at which it is easily affordable to the individuals 
and populations being served; 
‘‘(E) as part of care and treatment of HIV/AIDS, assist-
ance or referral to available and adequately resourced 
service providers for nutritional support, including coun-
seling and where necessary the provision of commodities, 
for persons meeting malnourishment criteria and their 
families;’’; 
(3) in paragraph (4)— 
(A) in subparagraph (C), by striking ‘‘and’’ at the end; 
(B) in subparagraph (D), by striking the period at 
the end and inserting a semicolon; and 
(C) by adding at the end the following: 
‘‘(E) carrying out and expanding program monitoring, 
impact evaluation research and analysis, and operations 
research and disseminating data and findings through 
mechanisms to be developed by the Coordinator of United 
States Government Activities to Combat HIV/AIDS Glob-
ally, in coordination with the Director of the Centers for 
Disease Control, in order to— 
‘‘(i) improve accountability, increase transparency, 
and ensure the delivery of evidence-based services 
through the collection, evaluation, and analysis of data
H. R. 5501—32 
regarding 
gender-responsive 
interventions, 
disaggregated by age and sex; 
‘‘(ii) identify and replicate effective models; and 
‘‘(iii) develop gender indicators to measure out-
comes and the impacts of interventions; and 
‘‘(F) establishing appropriate systems to— 
‘‘(i) gather epidemiological and social science data 
on HIV; and 
‘‘(ii) evaluate the effectiveness of prevention efforts 
among men who have sex with men, with due consider-
ation to stigma and risks associated with disclosure.’’; 
(4) in paragraph (5)— 
(A) by redesignating subparagraph (C) as subpara-
graph (D); and 
(B) by inserting after subparagraph (B) the following: 
‘‘(C) MECHANISM TO ENSURE COST-EFFECTIVE DRUG PUR-
CHASING.—Subject to subparagraph (B), mechanisms to 
ensure that safe and effective pharmaceuticals, including 
antiretrovirals and medicines to treat opportunistic infec-
tions, are purchased at the lowest possible price at which 
such pharmaceuticals may be obtained in sufficient 
quantity on the world market, provided that such pharma-
ceuticals are approved, tentatively approved, or otherwise 
authorized for use by— 
‘‘(i) the Food and Drug Administration; 
‘‘(ii) a stringent regulatory agency acceptable to 
the Secretary of Health and Human Services; or 
‘‘(iii) a quality assurance mechanism acceptable 
to the Secretary of Health and Human Services.’’; 
(5) in paragraph (6)— 
(A) by amending the paragraph heading to read as 
follows: 
‘‘(6) RELATED AND COORDINATED ACTIVITIES.—’’; 
(B) in subparagraph (B), by striking ‘‘and’’ at the end; 
(C) in subparagraph (C), by striking the period at 
the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(D) coordinated or referred activities to— 
‘‘(i) enhance the clinical impact of HIV/AIDS care 
and treatment; and 
‘‘(ii) ameliorate the adverse social and economic 
costs often affecting AIDS-impacted families and 
communities through the direct provision, as necessary, 
or through the referral, if possible, of support services, 
including— 
‘‘(I) nutritional and food support; 
‘‘(II) safe drinking water and adequate sanita-
tion; 
‘‘(III) nutritional counseling; 
‘‘(IV) income-generating activities and liveli-
hood initiatives; 
‘‘(V) maternal and child health care; 
‘‘(VI) primary health care; 
‘‘(VII) the diagnosis and treatment of other 
infectious or sexually transmitted diseases; 
‘‘(VIII) substance abuse and treatment serv-
ices; and
H. R. 5501—33 
‘‘(IX) legal services; 
‘‘(E) coordinated or referred activities to link programs 
addressing HIV/AIDS with programs addressing gender- 
based violence in areas of significant HIV prevalence to 
assist countries in the development and enforcement of 
women’s health, children’s health, and HIV/AIDS laws and 
policies that— 
‘‘(i) prevent and respond to violence against women 
and girls; 
‘‘(ii) promote the integration of screening and 
assessment for gender-based violence into HIV/AIDS 
programming; 
‘‘(iii) promote appropriate HIV/AIDS counseling, 
testing, and treatment into gender-based violence pro-
grams; and 
‘‘(iv) assist governments to develop partnerships 
with civil society organizations to create networks for 
psychosocial, legal, economic, or other support services; 
‘‘(F) coordinated or referred activities to— 
‘‘(i) address the frequent coinfection of HIV and 
tuberculosis, 
in 
accordance 
with 
World 
Health 
Organization guidelines; 
‘‘(ii) promote provider-initiated or ‘opt-out’ HIV/ 
AIDS counseling and testing and appropriate referral 
for treatment and care to individuals with tuberculosis 
or its symptoms, particularly in areas with significant 
HIV prevalence; and 
‘‘(iii) strengthen programs to ensure that individ-
uals testing positive for HIV receive tuberculosis 
screening and to improve laboratory capacities, infec-
tion control, and adherence; and 
‘‘(G) activities to— 
‘‘(i) improve the effectiveness of national responses 
to HIV/AIDS; 
‘‘(ii) strengthen overall health systems in high- 
prevalence countries, including support for workforce 
training, retention, and effective deployment, capacity 
building, laboratory development, equipment mainte-
nance and repair, and public health and related public 
financial management systems and operations; and 
‘‘(iii) encourage fair and transparent procurement 
practices among partner countries; and 
‘‘(iv) promote in-country or intra-regional pediatric 
training for physicians and other health professionals, 
preferably 
through 
public-private 
partnerships 
involving colleges and universities, with the goal of 
increasing pediatric HIV workforce capacity.’’; and 
(6) by adding at the end the following: 
‘‘(8) 
COMPACTS
AND
FRAMEWORK
AGREEMENTS.—The 
development of compacts or framework agreements, tailored 
to local circumstances, with national governments or regional 
partnerships in countries with significant HIV/AIDS burdens 
to promote host government commitment to deeper integration 
of HIV/AIDS services into health systems, contribute to health 
systems overall, and enhance sustainability, including— 
‘‘(A) cost sharing assurances that meet the require-
ments under section 110; and