I 
110TH CONGRESS 
2D SESSION 
H. R. 5501 
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. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 27, 2008 
Mr. BERMAN (for himself, Ms. ROS-LEHTINEN, Mr. PAYNE, Ms. LEE, Mr. 
WAXMAN, and Ms. JACKSON-LEE of Texas) introduced the following bill; 
which was referred to the Committee on Foreign Affairs, and in addition 
to the Committee on Financial Services, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
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 pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Tom Lantos and Henry J. Hyde United States Global 
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Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title and table of contents. 
Sec. 2. Findings. 
Sec. 3. Definitions. 
Sec. 4. Purpose. 
TITLE I—POLICY PLANNING AND COORDINATION 
Sec. 101. Development of a comprehensive, five-year, global strategy. 
Sec. 102. HIV/AIDS Response Coordinator. 
TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PARTNERSHIPS 
Sec. 201. Sense of Congress on public-private partnerships. 
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and 
Malaria. 
Sec. 203. Voluntary contributions to international vaccine funds. 
Sec. 204. Program to facilitate availability of microbicides to prevent trans-
mission of HIV and other diseases. 
Sec. 205.
Plan to combat HIV/AIDS, tuberculosis, and malaria by strength-
ening health policies and health systems of host countries. 
TITLE III—BILATERAL EFFORTS 
Subtitle A—General Assistance and Programs 
Sec. 301. Assistance to combat HIV/AIDS. 
Sec. 302. Assistance to combat tuberculosis. 
Sec. 303. Assistance to combat malaria. 
Sec. 304. Health care partnerships to combat HIV/AIDS. 
Subtitle B—Assistance for Women, Children, and Families 
Sec. 311. Policy and requirements. 
Sec. 312. Annual reports on prevention of mother-to-child transmission of the 
HIV infection. 
Sec. 313. Strategy to prevent HIV infections among women and youth. 
Sec. 314. Clerical amendment. 
TITLE IV—AUTHORIZATION OF APPROPRIATIONS 
Sec. 401. Authorization of appropriations. 
Sec. 402. Sense of Congress. 
Sec. 403. Allocation of funds. 
Sec. 404. Prohibition on taxation by foreign governments. 
TITLE V—SUSTAINABILITY AND STRENGTHENING OF HEALTH 
CARE SYSTEMS 
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longer deploy HIV/AIDS-positive troops still face 
vulnerabilities to sexual transmission of HIV with 
HIV-positive individuals in refugee camps. Host 
countries generally do not provide HIV/AIDS pre-
vention, treatment, and care services for refugees. 
‘‘(47) Continuing progress to reach the millions 
of impoverished individuals who need voluntary test-
ing, counseling, treatment, and care for HIV/AIDS 
requires increased efforts to strengthen health care 
delivery systems and infrastructure, rebuild and ex-
pand the health care workforce, and strengthen al-
lied and support services in countries receiving 
United States global HIV/AIDS assistance. 
‘‘(48) While HIV/AIDS poses the greatest 
health threat of modern times, it also poses the 
greatest development challenge for developing coun-
tries with fragile economies and weak public finan-
cial management systems that are ill equipped to 
shoulder the burden of this disease. International 
donors will have to play a critical role in providing 
resources for HIV/AIDS programs far into the fu-
ture. 
‘‘(49) The emerging partnerships between coun-
tries most affected by HIV/AIDS and the United 
States must include stronger coordination between 
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HIV/AIDS programs and other United States for-
eign assistance programs, and stronger collaboration 
with other donors in the areas of economic develop-
ment and growth strategies. 
‘‘(50) The future control of HIV/AIDS de-
mands coordination between international organiza-
tions such as the Global Fund to Fight AIDS, Tu-
berculosis and Malaria, UNAIDS, the World Health 
Organization (WHO), the World Bank and the 
International Monetary Fund (IMF), the inter-
national donor community, national governments, 
and private sector organizations, including commu-
nity and faith-based organizations. 
‘‘(51) The future control of HIV/AIDS further 
requires effective and transparent public finance 
management systems in developing countries to ad-
vance the ability of such countries to manage public 
revenues and donor funds aimed at combating HIV/ 
AIDS and other diseases. 
‘‘(52) The HIV/AIDS pandemic contributes to 
the shortage of health care personnel through loss of 
life and illness, unsafe working conditions, increased 
workloads for diminished staff, and resulting stress 
and burnout, while the shortage of health care per-
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sonnel undermines efforts to prevent and provide 
care and treatment for individuals with HIV/AIDS. 
‘‘(53) The shortage of health care personnel, in-
cluding doctors, nurses, pharmacists, counselors, lab-
oratory staff, paraprofessionals, trained lay workers, 
and researchers is one of the leading obstacles to 
combating HIV/AIDS in sub-Saharan Africa. 
‘‘(54) Since 2003, important progress has been 
made in combating HIV/AIDS, yet there is more to 
be done. The number of new HIV infections is still 
increasing at an alarming rate. According to the 
United States National Institute of Allergy and In-
fectious Diseases, globally, for every 1 individual put 
on antiretroviral therapy, 6 individuals are newly in-
fected with HIV. 
‘‘(55) The United States Government continues 
to be the world’s leader in the fight against HIV/ 
AIDS and the unsurpassed partner with developing 
countries in their efforts to control this disease. 
‘‘(56) By September 2007, the United States, 
through the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7601 et seq.), had provided services to pre-
vent mother-to-child-transmission of HIV to women 
during 
million 
pregnancies; 
provided 
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antiretroviral prophylaxis for women during over 
827,300 
pregnancies; 
prevented 
an 
estimated 
157,240 HIV infections in infants; cared for over 
6.6 million individuals, including over 2.7 million or-
phans and vulnerable children; supported lifesaving 
antiretroviral therapies for approximately 1.4 million 
men, women, and children in sub-Saharan Africa, 
Asia, and the Carribean; and provided counseling 
and testing to over 33.7 million men, women, and 
children in developing countries. 
‘‘(57) These numbers were achieved because of 
the commitment of substantial resources and sup-
port of the United States Government to our part-
ners on the front lines—the dedicated and com-
mitted women and men, communities, and nations 
who are taking control of the HIV/AIDS epidemics 
in their own countries.’’. 
SEC. 3. DEFINITIONS. 
Section 3(2) of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7602(2)) is amended by striking ‘‘Committee on 
International Relations’’ and inserting ‘‘Committee on 
Foreign Affairs’’. 
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SEC. 4. PURPOSE. 
Section 4 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7603) is amended to read as follows: 
‘‘SEC. 4. PURPOSE. 
‘‘The purpose of this Act is to strengthen and en-
hance United States global leadership and the effective-
ness of the United States response to the HIV/AIDS, tu-
berculosis, and malaria pandemics and other related and 
preventable infectious diseases in developing countries 
by— 
‘‘(1) establishing a comprehensive, integrated 
five-year, global strategy to fight HIV/AIDS, tuber-
culosis, and malaria that encompasses a plan for 
continued expansion and coordination of critical pro-
grams and improved coordination among relevant 
executive branch agencies and between the United 
States and foreign governments and international 
organizations; 
‘‘(2) providing increased resources for United 
States bilateral efforts to combat HIV/AIDS, tuber-
culosis, and malaria, particularly for prevention, 
treatment, and care (including nutritional support), 
technical assistance and training, the strengthening 
of health care systems, health care workforce devel-
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opment, monitoring and evaluations systems, and 
operations research; 
‘‘(3) providing increased resources for multilat-
eral efforts to combat HIV/AIDS, tuberculosis, and 
malaria; 
‘‘(4) encouraging the expansion of private sec-
tor efforts and expanding public-private sector part-
nerships to combat HIV/AIDS; and 
‘‘(5) intensifying efforts to support the develop-
ment of vaccines, microbicides, and other prevention 
technologies and improved diagnostics treatment for 
HIV/AIDS, tuberculosis, and malaria.’’. 
TITLE I—POLICY PLANNING AND 
COORDINATION 
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE- 
YEAR, GLOBAL STRATEGY. 
(a) STRATEGY.—Subsection (a) of section 101 of the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (22 U.S.C. 7611) is 
amended— 
(1) in the first sentence of the matter preceding 
paragraph (1), by striking ‘‘to combat’’ and insert-
ing ‘‘to develop efforts further to combat’’; 
(2) by amending paragraph (4) to read as fol-
lows: 
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‘‘(4) provide that the reduction of HIV/AIDS 
behavioral risks shall be a priority of all prevention 
efforts in terms of funding, scientifically-accurate 
educational services, and activities by— 
‘‘(A) designing prevention strategies and 
programs based on sound epidemiological evi-
dence, tailored to the unique needs of each 
country and community, and reaching those 
populations found to be most at risk for acquir-
ing HIV infection; 
‘‘(B) promoting abstinence from sexual ac-
tivity and substance abuse; 
‘‘(C) encouraging delay of sexual debut, 
monogamy, fidelity, and partner reduction; 
‘‘(D) promoting the effective use of male 
and female condoms; 
‘‘(E) promoting the use of measures to re-
duce the risk of HIV transmission for discord-
ant couples (where one individual has HIV/ 
AIDS and the other individual does not have 
HIV/AIDS or whose status is unknown); 
‘‘(F) educating men and boys about the 
risks of procuring sex commercially and about 
the need to end violent behavior toward women 
and girls; 
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‘‘(G) promoting the rapid expansion of safe 
and voluntary male circumcision services; 
‘‘(H) promoting life skills training and de-
velopment for children and youth; 
‘‘(I) supporting advocacy for child and 
youth community-based protective social serv-
ices; 
‘‘(J) eradicating trafficking in persons and 
creating alternatives to prostitution; 
‘‘(K) promoting cooperation with law en-
forcement to prosecute offenders of trafficking, 
rape, and sexual assault crimes with the goal of 
eliminating such crimes; 
‘‘(L) promoting services demonstrated to 
be effective in reducing the transmission of HIV 
infection among injection drug users without in-
creasing illicit drug use; 
‘‘(M) promoting policies and programs to 
end the sexual exploitation of and violence 
against women and children; and 
‘‘(N) promoting prevention and treatment 
services for men who have sex with men;’’; 
(3) by redesignating paragraphs (5) through 
(10) as paragraphs (6) through (11), respectively; 
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(4) by inserting after paragraph (4) (as amend-
ed by paragraph (2) of this subsection) the fol-
lowing: 
‘‘(5) include specific plans for linkage to, and 
referral systems for nongovernmental organizations 
that implement multisectoral approaches, including 
faith-based and community-based organizations, 
for— 
‘‘(A) nutrition and food support for indi-
viduals with HIV/AIDS and affected commu-
nities; 
‘‘(B) child health services and development 
programs; 
‘‘(C) HIV/AIDS prevention and treatment 
services for injection drug users; 
‘‘(D) access to HIV/AIDS education and 
testing in family planning and maternal health 
programs supported by the United States Gov-
ernment; and 
‘‘(E) medical, social, and legal services for 
victims of violence;’’; 
(5) by redesignating paragraphs (10) and (11) 
(as redesignated by paragraph (3) of this sub-
section) as paragraphs (11) and (12), respectively; 
and 
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(6) by inserting after paragraph (9) (as redesig-
nated by paragraph (3) of this subsection) the fol-
lowing: 
‘‘(10) maximize host country capacities in train-
ing and research, particularly operations research;’’. 
(b) REPORT.—Subsection (b) of such section is 
amended— 
(1) in paragraph (1), by striking ‘‘this Act’’ and 
inserting ‘‘the Tom Lantos and Henry J. Hyde 
Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act of 2008’’; and 
(2) in paragraph (3)— 
(A) by amending subparagraph (C) to read 
as follows: 
‘‘(C) A description of the manner in which 
the strategy will address the following: 
‘‘(i) The fundamental elements of pre-
vention and education, care and treatment, 
including increasing access to pharma-
ceuticals, vaccines, and microbicides, as 
they become available, screening, prophy-
laxis, and treatment of major opportunistic 
infections, including tuberculosis, and in-
creasing access to nutrition and food for 
individuals on antiretroviral therapies. 
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‘‘(ii) The promotion of delay of sexual 
debut, abstinence, monogamy, fidelity, and 
partner reduction. 
‘‘(iii) The promotion of correct and 
consistent use of male and female condoms 
and other strategies and skills development 
to reduce the risk of HIV transmission. 
‘‘(iv) Increasing voluntary access to 
safe male circumcision services. 
‘‘(v) Life-skills training. 
‘‘(vi) The provision of information and 
services to encourage young people to delay 
sexual debut and ensure access to HIV/ 
AIDS prevention information and services. 
‘‘(vii) Prevention of sexual violence 
leading to transmission of HIV and assist-
ance for victims of violence who are at risk 
of HIV transmission. 
‘‘(viii) HIV/AIDS prevention, care, 
and treatment services for injection drug 
users. 
‘‘(ix) Research, including incentives 
for HIV vaccine development and new pro-
tocols. 
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‘‘(x) Advocacy for community-based 
child and youth protective services. 
‘‘(xi) Training of health care workers. 
‘‘(xii) The development of health care 
infrastructure and delivery systems. 
‘‘(xiii) Prevention efforts for sub-
stance abusers. 
‘‘(xiv) Prevention, treatment, care, 
and outreach efforts for men who have sex 
with men.’’; 
(B) in subparagraph (D), by adding at the 
end before the period the following: ‘‘, including 
through faith-based and other nongovernmental 
organizations’’; 
(C) in subparagraph (E), by inserting ‘‘ac-
cess to HIV/AIDS education and testing in 
family planning and maternal and child health 
programs supported by the United States Gov-
ernment and’’ after ‘‘the unique needs of 
women, including’’; 
(D) in subparagraph (F), by inserting 
‘‘(including by accessing voluntary clinical cir-
cumcision services)’’ after ‘‘in their sexual be-
havior’’; 
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(E) in subparagraph (G), by inserting 
‘‘and men’s’’ after ‘‘women’s’’; 
(F) by redesignating subparagraphs (M) 
through (W) as subparagraphs (N) through 
(X); 
(G) by inserting after subparagraph (L) 
the following: 
‘‘(M) A description of efforts to be under-
taken to strengthen the public finance manage-
ment systems of selected host countries to en-
sure transparent, efficient, and effective man-
agement of national and donor financial invest-
ments in health.’’; 
(H) in subparagraph (O) (as redesignated 
by subparagraph (F) of this paragraph), by 
striking ‘‘evaluating programs,’’ and inserting 
‘‘evaluating programs to ensure medical accu-
racy, operations research,’’; 
(I) in subparagraph (Q) (as redesignated 
by subparagraph (F) of this paragraph), by in-
serting ‘‘, strengthen national health care deliv-
ery systems, and increase national health work-
force capacities,’’ after ‘‘HIV/AIDS pandemic’’; 
(J) in subparagraph (R) (as redesignated 
by subparagraph (F) of this paragraph), by in-
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serting at the end before the period the fol-
lowing: ‘‘, including strategies relating to agri-
cultural development, trade and economic 
growth, and education’’; 
(K) in subparagraph (T) (as redesignated 
by subparagraph (F) of this paragraph), by in-
serting ‘‘efforts of intergenerational caregivers 
and’’ after ‘‘, including’’; 
(L) by redesignating subparagraphs (V) 
through (X) (as redesignated by subparagraph 
(F) of this paragraph), as subparagraphs (W) 
through (Y), respectively; 
(M) by inserting after subparagraph (U) 
(as redesignated by subparagraph (F) of this 
paragraph) the following: 
‘‘(V) A plan to strengthen and implement 
health care workforce strategies to enable coun-
tries to increase the supply and retention of all 
cadres of trained professional and paraprofes-
sional health care workers by numbers that 
move toward global health program needs and 
toward targets established by the World Health 
Organization, while enabling health systems to 
expand coverage consistent with national and 
international targets and goals.’’; and 
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(N) by striking subparagraph (Y) (as re-
designated by subparagraphs (F) and (L) of 
this paragraph) and inserting the following: 
‘‘(Y) A description of the specific strate-
gies, developed in coordination with existing 
health programs, to prevent mother-to-child 
transmission of HIV, including the extent to 
which HIV-positive women and men in treat-
ment, care, and support programs and HIV- 
negative women and men are counseled about 
methods of preventing HIV transmission and 
the extent to which HIV prevention methods 
are provided on-site or by referral in treatment, 
care, and support programs. 
‘‘(Z) A description of the specific strategies 
developed to maximize the capacity of health 
care providers, including faith-based and other 
nongovernmental 
organizations, 
and 
family 
planning providers supported by the United 
States Government to ensure access to nec-
essary and comprehensive information about re-
ducing sexual transmission of HIV among 
women, men, and young people, including strat-
egies to ensure HIV/AIDS prevention training 
for such providers. 
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‘‘(AA) A strategy to work with inter-
national and host country partners toward uni-
versal access to HIV/AIDS prevention, treat-
ment, and care programs.’’. 
(c) STRATEGIC PLAN FOR PROGRAM MONITORING, 
OPERATIONS RESEARCH, AND IMPACT EVALUATION RE-
SEARCH.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Coordi-
nator of United States Government Activities to 
Combat HIV/AIDS Globally shall develop a 5-year 
strategic plan for program monitoring, operations 
research, and impact evaluation research of United 
States HIV/AIDS, tuberculosis, and malaria pro-
grams. 
(2) ELEMENTS OF PLAN.—The strategic plan 
developed under this subsection shall include— 
(A) the amount of funding provided for 
program monitoring, operations research, and 
impact evaluation research under sections 
104A, 104B, and 104C of the Foreign Assist-
ance Act of 1961 (22 U.S.C. 2151b–2, 2151b– 
3, and 2151b–4) and the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Ma-
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laria Act of 2003 (22 U.S.C. 7601 et seq.) 
available through fiscal year 2009; 
(B) strategies to— 
(i) improve the efficiency, effective-
ness, quality, and accessibility of services 
provided under the provisions of law de-
scribed in subparagraph (A); 
(ii) establish the cost-effectiveness of 
program models; 
(iii) ensure the transparency and ac-
countability of services provided under the 
provisions of law described in subpara-
graph (A); 
(iv) disseminate and promote the utili-
zation of evaluation findings, lessons, and 
best practices in services provided under 
the provisions of law described in subpara-
graph (A); and 
(v) encourage and evaluate innovative 
service models and strategies to optimize 
the delivery of care, treatment, and preven-
tion programs financed by the United 
States Government; 
(C) priorities for program monitoring, op-
erations research, and impact evaluation re-
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search and a time line for completion of activi-
ties associated with such priorities; and 
(D) other information that the Coordinator 
determines to be necessary. 
(3) CONSULTATION.—In developing the stra-
tegic plan under this subsection and implementing, 
disseminating, and promoting the use of program 
monitoring, operations research, and impact evalua-
tion research, the Coordinator shall consult with rep-
resentatives of relevant executive branch agencies, 
other appropriate executive branch agencies, multi-
lateral institutions involved in providing HIV/AIDS 
assistance, nongovernmental organizations involved 
in implementing HIV/AIDS programs, and the gov-
ernments of host countries. 
(4) DEFINITIONS.—In this subsection— 
(A) the terms ‘‘program monitoring’’, ‘‘op-
erations research’’, and ‘‘impact evaluation re-
search’’, have the meanings given such terms in 
section 104A(d)(4)(B) of the Foreign Assist-
ance Act of 1961 (as added by section 
301(a)(4)(C) of this Act); and 
(B) the term ‘‘relevant executive branch 
agencies’’ has the meaning given the term in 
section 3 of the United States Leadership 
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Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7602). 
SEC. 102. HIV/AIDS RESPONSE COORDINATOR. 
Section 1(f)(2) of the State Department Basic Au-
thorities Act of 1956 (22 U.S.C. 2651a(f)(2)) is amend-
ed— 
(1) in subparagraph (A)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘, host country finance, health, and 
other relevant ministries’’ after ‘‘community- 
based organizations)’’; and 
(B) in clause (iii), by inserting ‘‘and host 
country finance, health, and other relevant min-
istries’’ 
after 
‘‘community-based 
organiza-
tions)’’; and 
(2) in subparagraph (B)(ii)— 
(A) by striking subclauses (IV) and (V) 
and inserting the following: 
‘‘(IV) 
Establishing 
an 
inter-
agency working group on HIV/AIDS 
that is comprised of, but not limited 
to, representatives from the United 
States Agency for International Devel-
opment, the Department of Health 
and Human Services (including the 
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Centers for Disease Control and Pre-
vention, the National Institutes of 
Health, and the Health Resources and 
Services Administration), the Depart-
ment of Labor, the Department of 
Agriculture, the Millennium Challenge 
Corporation, the Department of De-
fense, and the Office of the Coordi-
nator of United States Government 
Activities to Combat Malaria Globally, 
for the purposes of coordination of ac-
tivities relating to HIV/AIDS. The 
interagency working group shall— 
‘‘(aa) meet regularly to re-
view progress in host countries 
toward 
HIV/AIDS 
prevention, 
treatment, and care objectives; 
‘‘(bb) 
participate 
in 
the 
process of identifying countries in 
need 
of 
increased 
assistance 
based on the epidemiology of 
HIV/AIDS in those countries; 
and 
‘‘(cc) review policies that 
may be obstacles to reaching ob-
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jectives set forth for HIV/AIDS 
prevention, treatment, and care. 
‘‘(V) Coordinating overall United 
States HIV/AIDS policy and pro-
grams with efforts led by host coun-
tries and with the assistance provided 
by other relevant bilateral and multi-
lateral aid agencies and other donor 
institutions 
to 
achieve 
complementarity with other programs 
aimed at improving child and mater-
nal health, and food security, pro-
moting education, and strengthening 
health care systems.’’; 
(B) by redesignating subclauses (VII) and 
(VIII) as subclauses (IX) and (X), respectively; 
(C) by inserting after subclause (VI) the 
following: 
‘‘(VII) Holding annual consulta-
tions with host country nongovern-
mental organizations providing serv-
ices to improve health, and advocating 
on behalf of the individuals with HIV/ 
AIDS and those at particular risk of 
contracting HIV/AIDS. 
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‘‘(VIII) Ensuring, through inter-
agency and international coordination, 
that United States HIV/AIDS pro-
grams are coordinated with and com-
plementary to the delivery of related 
global health, food security, and edu-
cation services, including— 
‘‘(aa) maternal and child 
health care; 
‘‘(bb) services for other ne-
glected and easily preventable 
and treatable infectious diseases, 
such as tuberculosis; 
‘‘(cc) treatment and care 
services for injection drug users; 
and 
‘‘(dd) programs and services 
to improve legal, social, and eco-
nomic status of women and 
girls.’’; 
(D) in subclause (IX) (as redesignated by 
subparagraph (B) of this paragraph)— 
(i) by inserting ‘‘Vietnam, Antigua 
and Barbuda, the Bahamas, Barbados, 
Belize, 
Dominica, 
Grenada, 
Jamaica, 
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Montserrat, Saint Kitts and Nevis, Saint 
Vincent and the Grenadines, Saint Lucia, 
Suriname, Trinidad and Tobago, the Do-
minican Republic’’ after ‘‘Zambia,’’; 
(ii) by adding at the end before the 
period the following: ‘‘and other countries 
in which the United States is implementing 
HIV/AIDS programs’’; and 
(iii) by adding at the end the fol-
lowing: ‘‘In designating countries under 
this subclause, the President shall give pri-
ority to those countries in which there is a 
high prevalence of HIV/AIDS and coun-
tries with large populations that have a 
concentrated HIV/AIDS epidemic.’’; 
(E) by redesignating subclause (X) (as re-
designated by subparagraph (B) of this para-
graph) as subclause (XII); 
(F) by inserting after subclause (IX) (as 
redesignated by subparagraph (B) and amended 
by subparagraph (D) of this paragraph) the fol-
lowing: 
‘‘(X) Working, in partnership with 
host countries in which the HIV/AIDS epi-
demic is prevalent among injection drug 
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users, to establish, as a national priority, 
national HIV/AIDS prevention programs, 
including education, and services dem-
onstrated to be effective in reducing the 
transmission of HIV infection among injec-
tion drug users without increasing drug 
use. 
‘‘(XI) Working, in partnership with 
host countries in which the HIV/AIDS epi-
demic is prevalent among individuals in-
volved in commercial sex acts, to establish, 
as a national priority, national prevention 
programs, including education, voluntary 
testing, and counseling, and referral sys-
tems that link HIV/AIDS programs with 
programs to eradicate trafficking in per-
sons and create alternatives to prostitu-
tion.’’; 
(G) in subclause (XII) (as redesignated by 
subparagraphs (B) and (E) of this paragraph), 
by striking ‘‘funds section’’ and inserting 
‘‘funds appropriated pursuant to the authoriza-
tion of appropriations under section 401 of the 
United States Leadership Against HIV/AIDS, 
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Tuberculosis, and Malaria Act of 2003 for HIV/ 
AIDS assistance’’; and 
(H) by adding at the end the following: 
‘‘(XIII) Publicizing updated drug 
pricing data to inform pharmaceutical 
procurement partners’ purchasing de-
cisions. 
‘‘(XIV) Working in partnership 
with host countries in which the HIV/ 
AIDS epidemic is prevalent among 
men who have sex with men, to estab-
lish, as a national priority, national 
HIV/AIDS prevention programs, in-
cluding education and services dem-
onstrated to be effective in reducing 
the transmission of HIV among men 
who have sex with men.’’. 
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TITLE II—SUPPORT FOR MULTI-
LATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PART-
NERSHIPS 
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PART-
NERSHIPS. 
Section 201(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7621(a)) is amended— 
(1) in paragraph (2), by striking ‘‘infectious 
diseases’’ and inserting ‘‘easily preventable and 
treatable infectious diseases’’; and 
(2) in paragraph (4), by striking ‘‘infectious 
diseases’’ and inserting ‘‘easily preventable and 
treatable infectious diseases’’. 
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 
AIDS, TUBERCULOSIS AND MALARIA. 
(a) FINDINGS.—Subsection (a) of section 202 of the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (22 U.S.C. 7622) is 
amended— 
(1) by redesignating paragraphs (1) through 
(3) as paragraphs (7) through (9), respectively; and 
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(2) by inserting before paragraph (7) (as redes-
ignated by paragraph (1) of this subsection) the fol-
lowing: 
‘‘(1) The Global Fund to Fight AIDS, Tuber-
culosis and Malaria is the multilateral component of 
this Act, extending United States efforts to a total 
of 136 countries around the world. 
‘‘(2) Created in 2002, the Global Fund has 
played a leading role in the fight against HIV/AIDS, 
tuberculosis, and malaria around the world and has 
grown into an organization that currently provides 
nearly a quarter of all international financing to 
combat HIV/AIDS and two-thirds of all inter-
national financing to combat tuberculosis and ma-
laria. 
‘‘(3) By 2010, it is estimated that the demand 
for funding by the Global Fund will grow in size to 
between $6 and $8 billion annually, requiring signifi-
cant contributions from donors around the world, in-
cluding at least $2 billion annually from the United 
States. 
‘‘(4) The Global Fund is an innovative financ-
ing mechanism to combat HIV/AIDS, tuberculosis, 
and malaria, and has made progress in many areas. 
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‘‘(5) The United States Government is the larg-
est supporter of the Global Fund, both in terms of 
resources and technical support. 
‘‘(6) The United States made the initial con-
tribution to the Global Fund and is fully committed 
to its success.’’. 
(b) UNITED STATES FINANCIAL PARTICIPATION.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
Subsection (d)(1) of such section is amended— 
(A) by striking ‘‘$1,000,000,000’’ and in-
serting ‘‘$2,000,000,000’’; 
(B) by striking ‘‘for the period of fiscal 
year 2004 beginning on January 1, 2004,’’ and 
inserting ‘‘for each of the fiscal years 2009 and 
2010,’’; and 
(C) by striking ‘‘the fiscal years 2005– 
2008’’ and inserting ‘‘each of the fiscal years 
2011 through 2013’’. 
(2) LIMITATION.—Subsection (d)(4) of such 
section is amended— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking ‘‘fiscal 
years 2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; 
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(ii) in clause (ii), by striking ‘‘fiscal 
years 2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; and 
(iii) in clause (vi)— 
(I) by striking ‘‘for the purposes’’ 
and inserting ‘‘For the purposes’’; 
(II) by striking ‘‘fiscal years 
2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; 
and 
(III) by striking ‘‘fiscal year 
2004’’ and inserting ‘‘fiscal year 
2009’’; 
(B) in subparagraph (B)(iv)— 
(i) by striking ‘‘fiscal years 2004 
through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’; and 
(ii) by adding at the end before the 
period the following: ‘‘, unless such amount 
is made available for more than one fiscal 
year, in which case such amount is author-
ized to be made available for such purposes 
after December 31 of the fiscal year fol-
lowing the fiscal year in which such funds 
first became available.’’; and 
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(C) in subparagraph (C)(ii) by striking 
‘‘Committee on International Relations’’ and in-
serting ‘‘Committee on Foreign Affairs’’. 
(3) STATEMENT
OF
POLICY.—The following 
shall be the policy of the United States: 
(A) Support for the Global Fund to Fight 
AIDS, Tuberculosis and Malaria should be 
based upon achievement of the following bench-
marks related to transparency and account-
ability: 
(i) As recommended by the Govern-
ment Accountability Office, the Fund Sec-
retariat has established standardized ex-
pectations for the performance of Local 
Fund Agents (LFAs), is undertaking a 
systematic assessment of the performance 
of LFAs, and is making available for pub-
lic review, according to the Fund Board’s 
policies and practices on disclosure of in-
formation, a regular collection and analysis 
of performance data of Fund grants, which 
shall cover both Principal Recipients and 
sub-recipients. 
(ii) A well-staffed, independent Office 
of the Inspector General reports directly to 
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the Board and is responsible for regular, 
publicly published audits of both financial 
and programmatic and reporting aspects of 
the Fund, its grantees, and LFAs. 
(iii) The Fund Secretariat has estab-
lished and is reporting publicly on stand-
ard indicators for all program areas. 
(iv) The Fund Secretariat has estab-
lished a database that tracks all subrecipi-
ents and the amounts of funds disbursed 
to each, as well as the distribution of re-
sources, by grant and Principal Recipient, 
for prevention, care, treatment, the pur-
chases of drugs and commodities, and 
other purposes. 
(v) The Fund Board has established a 
penalty to offset tariffs imposed by na-
tional governments on all goods and serv-
ices provided by the Fund. 
(vi) The Fund Board has successfully 
terminated its Administrative Services 
Agreement with the World Health Organi-
zation and completed the Fund Secretar-
iat’s transition to a fully independent sta-
tus under the Headquarters Agreement the 
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Fund has established with the Government 
of Switzerland. 
(B) Support for the Global Fund to Fight 
AIDS, Tuberculosis and Malaria should be 
based upon achievement of the following bench-
marks related to the founding principles of the 
Fund: 
(i) The Fund must maintain its status 
as a financing institution. 
(ii) The Fund must remain focused on 
programs directly related to HIV/AIDS, 
malaria, and tuberculosis. 
(iii) The Fund must maintain its 
Comprehensive Funding Policy, which re-
quires confirmed pledges to cover the full 
amount of new grants before the Board 
approves them. 
(iv) The Fund must maintain and 
make progress on sustaining its multisec-
toral approach, through Country Coordi-
nating Mechanisms (CCMs) and in the im-
plementation of grants, as reflected in per-
cent and resources allocated to different 
sectors, including governments, civil soci-
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ety, and faith- and community-based orga-
nizations. 
(4) SENSE OF CONGRESS.—Congress— 
(A) notes that section 625 of Public Law 
110–161 establishes a requirement to withhold 
20 percent of funds appropriated for the Global 
Fund if the Global Fund fails to meet certain 
benchmarks; and 
(B) will continue to review the implementa-
tion of the benchmarks to ensure accountability 
and transparency of the Global Fund. 
SEC. 
203. 
VOLUNTARY 
CONTRIBUTIONS 
TO 
INTER-
NATIONAL VACCINE FUNDS. 
(a) VACCINE FUND.—Subsection (k) of section 302 
of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 
is amended by striking ‘‘fiscal years 2004 through 2008’’ 
and inserting ‘‘fiscal years 2009 through 2013’’. 
(b) INTERNATIONAL AIDS VACCINE INITIATIVE.— 
Subsection (l) of such section is amended by striking ‘‘fis-
cal years 2004 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’. 
(c) MALARIA VACCINE DEVELOPMENT PROGRAMS.— 
Subsection (m) of such section is amended by striking 
‘‘fiscal years 2004 through 2008’’ and inserting ‘‘fiscal 
years 2009 through 2013’’. 
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(d) RESEARCH AND DEVELOPMENT OF A TUBER-
CULOSIS VACCINE.—Such section is further amended by 
adding at the end the following: 
‘‘(n) In addition to amounts otherwise available under 
this section, 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 be available for 
United States contributions to research and development 
of a tuberculosis vaccine.’’. 
SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF 
MICROBICIDES TO PREVENT TRANSMISSION 
OF HIV AND OTHER DISEASES. 
(a) STATEMENT OF POLICY.—Congress recognizes 
the need and urgency to expand the range of interventions 
for preventing the transmission of human immuno-
deficiency virus (HIV), including nonvaccine prevention 
methods that can be controlled by women. 
(b) PROGRAM AUTHORIZED.—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, 
shall develop and implement a program to facilitate wide- 
scale availability of microbicides that prevent the trans-
mission of HIV after such microbicides are proven safe 
and effective. 
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(c) AUTHORIZATION OF APPROPRIATIONS.—Of the 
amounts authorized to be appropriated under section 401 
of the United States Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Act of 2003 (22 U.S.C. 7671) for 
HIV/AIDS assistance, there are authorized to be appro-
priated to the President such sums as may be necessary 
for each of the fiscal years 2009 through 2013 to carry 
out this section. 
SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND 
MALARIA BY STRENGTHENING HEALTH POLI-
CIES AND HEALTH SYSTEMS OF HOST COUN-
TRIES. 
(a) IN GENERAL.—Title II of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7621 et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, 
AND MALARIA BY STRENGTHENING HEALTH 
POLICIES AND HEALTH SYSTEMS OF HOST 
COUNTRIES. 
‘‘(a) FINDINGS.—Congress makes the following find-
ings: 
‘‘(1) One of the most significant barriers to 
achieving universal access to HIV/AIDS treatment 
and prevention in developing countries is the lack of 
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health infrastructure, particularly in sub-Saharan 
Africa. 
‘‘(2) In addition to HIV/AIDS programs, other 
treatable and preventable infectious diseases could 
be treated concurrently and easily if health care de-
livery systems in developing countries were signifi-
cantly improved. 
‘‘(3) More public investment in basic primary 
health care should be a priority in public spending 
in developing countries. 
‘‘(b) STATEMENT OF POLICY.—It shall be the policy 
of the United States Government— 
‘‘(1) to invest appropriate resources authorized 
under this Act and the amendments made by this 
Act to carry out activities to strengthen HIV/AIDS 
health policies and health systems and provide work-
force training and capacity-building consistent with 
the goals and objectives of this Act and the amend-
ments made by this Act; and 
‘‘(2) to support the development of a sound pol-
icy environment in host countries to increase the 
ability of such countries to maximize utilization of 
health care resources from donor countries, deliver 
services to the people of such host countries in an 
effective and efficient manner, and reduce barriers 
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that prevent recipients of services from achieving 
maximum benefit from such services. 
‘‘(c) PLAN REQUIRED.—The Coordinator of United 
States Government Activities to Combat HIV/AIDS Glob-
ally, in collaboration with the Administrator of the United 
States Agency for International Development, shall de-
velop and implement a plan to combat HIV/AIDS by 
strengthening health policies and health systems of host 
countries as part of the United States Agency for Inter-
national Development’s ‘Health Systems 2020’ project. 
‘‘(d) ASSISTANCE TO IMPROVE PUBLIC FINANCE 
MANAGEMENT SYSTEMS.— 
‘‘(1) IN
GENERAL.—The Secretary of the 
Treasury, acting through the head of the Office of 
Technical Assistance, is authorized to provide assist-
ance for advisors and host country finance, health, 
and other relevant ministries to improve the effec-
tiveness of public finance management systems in 
host 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 
section 401 for HIV/AIDS assistance, there are au-
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thorized to be appropriated to the Secretary of the 
Treasury such sums as may be necessary for each 
of the fiscal years 2009 through 2013 to carry out 
this subsection.’’. 
(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 
203 the following: 
‘‘Sec. 204. Plan to combat HIV/AIDS by strengthening health policies and 
health systems of host countries.’’. 
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.—Subsection (a) of section 104A 
of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b–2) is amended by inserting ‘‘, South and 
Southeast Asia, Central and Eastern Europe’’ after 
‘‘the Caribbean’’. 
(2) POLICY.—Subsection (b) of such section is 
amended— 
(A) in the first sentence— 
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(i) by striking ‘‘It is a major’’ and in-
serting the following: 
‘‘(1) GENERAL POLICY.—It is a major’’; 
(ii) by striking ‘‘control’’ and insert-
ing ‘‘care’’; and 
(iii) by adding at the end before the 
period the following: ‘‘and to fulfill United 
States commitments to move toward the 
goal of universal access to prevention, 
treatment, and care of HIV/AIDS’’; 
(B) by adding at the end the following: 
‘‘The United States and other developed coun-
tries should provide assistance for the preven-
tion, treatment, and care of HIV/AIDS to coun-
tries in sub-Saharan Africa, the Caribbean, 
South and Southeast Asia and Central and 
Eastern Europe, addressing both generalized 
epidemics and epidemics concentrated among 
populations at high risk of infection.’’; and 
(C) by further adding at the end the fol-
lowing: 
‘‘(2) SPECIFIC POLICY.—It is therefore the pol-
icy of the United States, by 2013, to— 
‘‘(A) prevent 12,000,000 new HIV infec-
tions worldwide; 
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‘‘(B) 
support 
treatment 
of 
at 
least 
3,000,000 individuals with HIV/AIDS with the 
goal of treating 450,000 children; 
‘‘(C) provide care for 12,000,000 individ-
uals 
affected 
by 
HIV/AIDS, 
including 
5,000,000 orphans and vulnerable children in 
communities affected by HIV/AIDS, including 
orphans with HIV/AIDS; and 
‘‘(D) train at least 140,000 new health 
care professionals and workers for HIV/AIDS 
prevention, treatment and care.’’. 
(3) AUTHORIZATION.—Subsection (c) of such 
section is amended— 
(A) in paragraph (1)— 
(i) by inserting ‘‘, South and South-
east Asia, Central and Eastern Europe’’ 
after ‘‘the Caribbean’’; and 
(ii) by adding at the end before the 
period the following: ‘‘, and particularly 
with respect to refugee populations in such 
countries and areas’’; 
(B) in paragraph (2)— 
(i) by inserting ‘‘, South and South-
east Asia, Central and Eastern Europe’’ 
after ‘‘the Caribbean’’; and 
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(ii) by adding at the end before the 
period the following: ‘‘, and particularly 
with respect to refugee populations in such 
countries and areas’’; 
(C) by redesignating paragraph (3) as 
paragraph (4); 
(D) by inserting after paragraph (2) the 
following: 
‘‘(3) ROLE OF PUBLIC HEALTH CARE DELIVERY 
SYSTEMS.—It is the sense of Congress that— 
‘‘(A) the President should provide an ap-
propriate level of assistance under paragraph 
(1) to help strengthen public health care deliv-
ery systems financed by host countries; and 
‘‘(B) the President, acting through the Co-
ordinator of United States Government Activi-
ties to Combat HIV/AIDS Globally, should sup-
port the development of a policy framework in 
such host countries for the long-term sustain-
ability of HIV/AIDS prevention, treatment, and 
care programs, and for strengthening health 
care delivery systems and increasing health 
workforces through recruitment, training, and 
policies that allows the devolution of clinical re-
sponsibilities to increase the work force able to 
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deliver prevention, treatment, and care services, 
as necessary, with clearly identified objectives 
and reporting strategies for such services.’’; 
(E) in paragraph (4) (as redesignated by 
subparagraph (C) of this paragraph), by strik-
ing ‘‘foreign countries’’ and inserting ‘‘host 
countries and donor countries’’; and 
(F) by adding at the end the following: 
‘‘(5) SENSE OF CONGRESS.— 
‘‘(A) IN GENERAL.—It is the sense of Con-
gress that the Coordinator of United States 
Government Activities to Combat HIV/AIDS 
Globally and the heads of relevant executive 
branch agencies (as such term is defined in sec-
tion 3 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 
2003) should operate in a manner consistent 
with the ‘Three Ones’ goals of UNAIDS. 
‘‘(B) ‘THREE ONES’ GOALS OF UNAIDS DE-
FINED.—In this paragraph, the term ‘‘ ‘Three 
Ones’’ goals of UNAIDS’ means— 
‘‘(i) the goal of one agreed HIV/AIDS 
action framework that provides the basis 
for coordinating the work of all partners in 
host countries; 
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‘‘(ii) the goal of one national HIV/ 
AIDS 
coordinating 
authority, 
with 
a 
broad-based multisectoral mandate; and 
‘‘(iii) the goal of one agreed country- 
level data-collection, monitoring, and eval-
uation system.’’. 
(4) ACTIVITIES SUPPORTED.— 
(A) PREVENTION.—Subsection (d)(1) of 
such section is amended— 
(i) in subparagraph (A)— 
(I) by inserting ‘‘efforts by faith- 
based and other nongovernmental or-
ganizations and’’ after ‘‘infection, in-
cluding’’; 
(II) by inserting ‘‘, including ac-
cess to such programs and efforts in 
family planning programs supported 
by the United States Government,’’ 
after ‘‘health programs’’; and 
(III) by inserting ‘‘male and fe-
male’’ before ‘‘condoms’’; 
(ii) in subparagraph (B)— 
(I) by inserting ‘‘relevant and’’ 
after ‘‘culturally’’; 
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(II) by inserting ‘‘and programs’’ 
after ‘‘those organizations’’; and 
(III) by inserting ‘‘, level of sci-
entific and fact-based knowledge’’ 
after ‘‘experience’’; 
(iii) in subparagraph (D), by inserting 
‘‘and nonjudgmental approaches’’ after 
‘‘protections’’; 
(iv) by amending subparagraph (E) to 
read as follows: 
‘‘(E) assistance to achieve the target of 
reaching 80 percent of pregnant women for pre-
vention and treatment of mother-to-child trans-
mission of HIV in countries in which the 
United States is implementing HIV/AIDS pro-
grams by 2013, as described in section 
312(b)(1) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003, and to promote infant feeding op-
tions that meet the criteria described in the 
World Health Organization’s Global Strategy 
for Infant and Young Child Feeding;’’; 
(v) in subparagraph (G)— 
(I) by adding at the end before 
the semicolon the following: ‘‘, includ-
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ing education and services dem-
onstrated to be effective in reducing 
the transmission of HIV infection 
without increasing illicit drug use’’; 
and 
(II) by striking ‘‘and’’ at the end; 
(vi) in subparagraph (H), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(vii) by adding at the end the fol-
lowing: 
‘‘(I)(i) assistance for counseling, testing, 
treatment, care, and support programs for pre-
vention of re-infection of individuals with HIV/ 
AIDS; 
‘‘(ii) counseling to prevent sexual trans-
mission of HIV, including skill development for 
practicing abstinence, reducing the number of 
sexual partners, and providing information on 
correct and consistent use of male and female 
condoms; 
‘‘(iii) assistance to provide male and female 
condoms; 
‘‘(iv) diagnosis and treatment of other sex-
ually-transmitted infections; 
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‘‘(v) strategies to address the stigma and 
discrimination that impede HIV/AIDS preven-
tion efforts; and 
‘‘(vi) assistance to facilitate widespread ac-
cess to microbicides for HIV prevention, as safe 
and effective products become available, includ-
ing financial and technical support for cul-
turally appropriate introductory programs, pro-
curement, distribution, logistics management, 
program delivery, acceptability studies, provider 
training, demand generation, and post-introduc-
tion monitoring; and 
‘‘(J) assistance for HIV/AIDS education 
targeted to reach and prevent the spread of 
HIV among men who have sex with men.’’. 
(B) TREATMENT.—Subsection (d)(2) of 
such section is amended— 
(i) in subparagraph (B), by striking ‘‘; 
and’’ at the end and inserting a semicolon; 
(ii) in subparagraph (C), by striking 
the period at the end and inserting a semi-
colon; and 
(iii) by adding at the end the fol-
lowing: 
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‘‘(D) assistance specifically to address bar-
riers that might limit the start of and adher-
ence to treatment services, especially in rural 
areas, through such measures as mobile and de-
centralized distribution of treatment services, 
and where feasible and necessary, direct link-
ages with nutrition and income security pro-
grams, referrals to services for victims of vio-
lence, support groups for individuals with HIV/ 
AIDS, and efforts to combat stigma and dis-
crimination against all such individuals; 
‘‘(E) assistance to support comprehensive 
HIV/AIDS treatment (including free prophy-
laxis and treatment for common HIV/AIDS-re-
lated opportunistic infections) for at least one- 
third of individuals with HIV/AIDS in the poor-
est countries worldwide who are in clinical need 
of antiretroviral treatment; and 
‘‘(F) assistance to improve access to psy-
chosocial support systems and other necessary 
services for youth who are infected with HIV to 
ensure the start of and adherence to treatment 
services.’’. 
(C) MONITORING.—Subsection (d)(4) of 
such section is amended— 
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(i) by striking ‘‘The monitoring’’ and 
inserting the following: 
‘‘(A) IN GENERAL.—The monitoring’’; 
(ii) by inserting ‘‘and paragraph (8)’’ 
after ‘‘paragraphs (1) through (3)’’; 
(iii) by redesignating subparagraphs 
(A) through (D) as clauses (i) through 
(iv), respectively; 
(iv) in clause (iii) (as redesignated by 
clause (iii) of this subparagraph), by strik-
ing ‘‘and’’ at the end; 
(v) in clause (iv) (as redesignated by 
clause (iii) of this subparagraph), by strik-
ing the period at the end and inserting ‘‘; 
and’’; 
(vi) by adding at the end the fol-
lowing: 
‘‘(v) carrying out and expanding pro-
gram monitoring, impact evaluation re-
search, and operations research (including 
research and evaluations of gender-respon-
sive interventions, disaggregated by age 
and sex, in order to identify and replicate 
effective models, develop gender indicators 
to measure both outcomes and impacts of 
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interventions, especially interventions de-
signed to reduce gender inequalities, and 
collect lessons learned for dissemination 
among different countries) in order to— 
‘‘(I) improve the coverage, effi-
ciency, effectiveness, quality and ac-
cessibility of services provided under 
this section; 
‘‘(II) establish the cost-effective-
ness of program models; 
‘‘(III) assess the population-level 
impact of programs, projects, and ac-
tivities implemented; 
‘‘(IV) ensure the transparency 
and accountability of services provided 
under this section; 
‘‘(V) disseminate and promote 
the utilization of evaluation findings, 
lessons, and best practices in the im-
plementation of programs, projects, 
and activities supported under this 
section; and 
‘‘(VI) encourage and evaluate in-
novative service models and strategies 
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to optimize functionality of programs, 
projects, and activities.’’; and 
(vii) by further adding at the end the 
following: 
‘‘(B) DEFINITIONS.—For purposes of sub-
paragraph (A)(v)— 
‘‘(i) the term ‘impact evaluation re-
search’ means the application of research 
methods and statistical analysis to meas-
ure the extent to which a change in a pop-
ulation-based outcome can be attributed to 
a program, project, or activity as opposed 
to other factors in the environment; 
‘‘(ii) the term ‘program monitoring’ 
means the collection, analysis, and use of 
routine data with respect to a program, 
project, or activity to determine how well 
the program, project, or activity is carried 
out and at what cost; and 
‘‘(iii) the term ‘operations research’ 
means the application of social science re-
search methods and statistical analysis to 
judge, compare, and improve policy out-
comes and outcomes of a program, project, 
or activity, from the earliest stages of de-
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fining and designing the program, project, 
or activity through the development and 
implementation of the program, project, or 
activity.’’. 
(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 
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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 
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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-
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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 
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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. 
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‘‘(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 
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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 
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1(f)(2)(B)(IX) of the State Department 
Basic Authorities Act of 1956 (22 U.S.C. 
2651a(f)(2)(B)(VIII)), including a detailed 
description of anti-retroviral drugs pro-
cured, including— 
‘‘(aa) the total amount expended 
for each generic and name brand 
drug; 
‘‘(bb) the price paid per unit of 
each drug; and 
‘‘(cc) the vendor from which each 
drug was purchased; and 
‘‘(ii) the progress made toward im-
proving health care delivery systems (in-
cluding the training of adequate numbers 
of health care professionals) and infra-
structure to ensure increased access to 
care and treatment, including a description 
of progress toward— 
‘‘(I)(aa) the training and reten-
tion of adequate numbers of health 
care professionals in order to meet a 
nationally-determined ratio of doctors, 
nurses, and midwives to patients, 
based on the target of the 2.3 per- 
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thousand ratio established by the 
World Health Organization (WHO); 
‘‘(bb) increases in the number of 
other health care professions, such as 
pharmacists and lab technicians, as 
necessary; and 
‘‘(cc) the improvement of infra-
structure needed to ensure universal 
access to HIV/AIDS prevention, treat-
ment, and care by 2015; 
‘‘(II) national health care work-
force strategy benchmarks, as re-
quired by section 202(d)(5)(B) of the 
United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003, United States contribu-
tions to developing and implementing 
the benchmarks, and main challenges 
to implementing the benchmarks; 
‘‘(III) ensuring, to the extent 
practicable, that health care workers 
providing services under this Act have 
safe working conditions and are re-
ceiving health care services, including 
services relating to HIV/AIDS; 
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‘‘(IV) activities to strengthen 
health care systems in order to over-
come obstacles and barriers to the 
provision of HIV/AIDS, tuberculosis, 
and malaria services; 
‘‘(V) improving integration and 
coordination of HIV/AIDS programs 
with related health care services and 
supporting the capacity of health care 
programs to refer individuals to com-
munity-based services; and 
‘‘(VI) strengthening procurement 
and supply chain management sys-
tems of host countries;’’; 
(III) in clause (iii), by adding at 
the end before the semicolon the fol-
lowing: ‘‘, including the percentage of 
such United States foreign assistance 
provided for diagnosis and treatment 
of individuals with tuberculosis in 
countries with the highest burden of 
tuberculosis, as determined by the 
World Health Organization (WHO)’’; 
and 
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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; 
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‘‘(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.’’. 
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(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. 
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‘‘(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 
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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-
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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-
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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); 
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‘‘(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 
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‘‘(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, 
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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. 
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‘‘(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 
the appropriate congressional committees a re-
port on the implementation of this subsection 
for the prior fiscal year. The report shall in-
clude a description of— 
‘‘(i) the effectiveness of interventions 
carried out to improve the nutritional sta-
tus of individuals with HIV/AIDS; 
‘‘(ii) the amount of funds provided for 
food and nutrition support for individuals 
with HIV/AIDS and affected individuals in 
the prior fiscal year and the projected 
amount of funds to be provided for such 
purpose for next fiscal year; and 
‘‘(iii) a strategy for improving the 
linkage between assistance provided with 
funds authorized under this subsection and 
food security and livelihood programs 
under other provisions of law as well as ac-
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tivities funded by other donors and multi-
lateral organizations. 
‘‘(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—Of the amounts authorized to be ap-
propriated under section 401 for HIV/AIDS as-
sistance, there are authorized to be appro-
priated to the President such sums as may be 
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-
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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 
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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 
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(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. 
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‘‘(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 
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(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. 
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‘‘(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-
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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 
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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).’’. 
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(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 
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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 
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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; 
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‘‘(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 
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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. 
‘‘(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-
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100 
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.— 
‘‘(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; 
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101 
‘‘(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-
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. 
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102 
‘‘(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.— 
‘‘(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; 
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103 
‘‘(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 
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 
VerDate Aug 31 2005 
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