I 
112TH CONGRESS 
2D SESSION 
H. R. 6138 
To bring an end to the spread of HIV/AIDS in the United States and 
around the world. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 18, 2012 
Ms. LEE of California (for herself, Mr. MORAN, Ms. CLARKE of New York, 
Ms. SCHAKOWSKY, Ms. NORTON, Mr. SCHIFF, Ms. WOOLSEY, Mr. 
TOWNS, Mr. NADLER, Mr. CONYERS, Mr. RANGEL, Mr. HINCHEY, Mr. 
SERRANO, Mr. JOHNSON of Georgia, Mr. HONDA, Ms. MCCOLLUM, Mr. 
ENGEL, Mr. HIMES, Mr. MCDERMOTT, Ms. CHU, Mr. LEWIS of Georgia, 
Ms. BASS of California, Mrs. CHRISTENSEN, Ms. LINDA T. SA´NCHEZ of 
California, Ms. WATERS, Mr. RUSH, and Mr. GRIJALVA) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Foreign Affairs, Education 
and the Workforce, the Judiciary, Armed Services, Financial Services, 
and Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To bring an end to the spread of HIV/AIDS in the United 
States and around the world. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ending the HIV/AIDS 
Epidemic Act of 2012’’. 
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SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
Sec. 3. Statement of policy. 
Sec. 4. Findings. 
Sec. 5. Nondiscrimination. 
DIVISION A—ENDING HIV/AIDS IN THE UNITED STATES 
TITLE I—INCREASING AND TARGETING INVESTMENT TO 
MAXIMIZE PREVENTION AND TREATMENT IMPACT 
Sec. 101. Additional funding for AIDS Drug Assistance Program treatments. 
Sec. 102. Enhancing the national HIV surveillance system. 
Sec. 103. Evidence-based strategies for improving linkage to and retention in 
appropriate care. 
Sec. 104. Improving entry into and retention in care and antiretroviral adher-
ence for persons with HIV. 
Sec. 105. Health care professionals treating individuals with HIV/AIDS. 
Sec. 106. HIV/AIDS provider loan repayment program. 
Sec. 107. Reducing new HIV infections among injecting drug users. 
Sec. 108. Support for expansion of comprehensive sexual health and education 
programs. 
Sec. 109. Elimination of abstinence-only education program. 
TITLE II—ENDING STIGMA AND DISCRIMINATION THAT INHIBIT 
ACCESS TO CARE AND MAKE PEOPLE MORE VULNERABLE 
Sec. 201. Review of all Federal and State laws, policies, and regulations regard-
ing the criminal prosecution of individuals for HIV-related of-
fenses. 
TITLE III—ADDRESSING LEGAL AND POLICY BARRIERS TO 
ACCESSING HEALTH CARE 
Sec. 301. Repeal of limitation against use of funds for education or information 
designed to promote or encourage, directly, homosexual or het-
erosexual activity or intravenous substance abuse. 
Sec. 302. Expanding support for condoms in prisons. 
Sec. 303. Automatic reinstatement or enrollment in Medicaid for people who 
test positive for HIV before reentering communities. 
TITLE IV—COORDINATING EFFORTS TO DRIVE GREATER 
EFFICIENCY AND IMPROVED RESULTS 
Sec. 401. Support data system review and indicators for monitoring HIV care. 
Sec. 402. Transfer of funds for implementation of National HIV/AIDS Strat-
egy. 
Sec. 403. HIV integrated services delivery model demonstration. 
Sec. 404. Report on the implementation of the National HIV/AIDS Strategy. 
DIVISION B—ENDING HIV/AIDS GLOBALLY 
TITLE X—GLOBAL HIV/AIDS-FREE GENERATION STRATEGY 
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Sec. 1001. Global HIV/AIDS-Free Generation Strategy. 
TITLE XI—USING FUNDS STRATEGICALLY TO MAXIMIZE 
RESULTS 
Sec. 1101. Support for operations research to improve program delivery, effi-
ciency, impact, and effectiveness. 
Sec. 1102. Increasing coordination and integration of HIV/AIDS programs 
with development programs. 
Sec. 1103. Increasing program effectiveness and sustainability to achieve suc-
cessful country ownership. 
TITLE XII—ADDRESSING LEGAL AND POLICY BARRIERS TO 
ACCESSING HEALTH CARE 
Subtitle A—General Provisions 
Sec. 1201. Support for laws and regulations that improve health outcomes and 
promote human rights. 
Sec. 1202. Intensifying efforts to establish effective programs for engaging key 
affected populations. 
Sec. 1203. Ensuring United States trade policy does not restrict access to af-
fordable medicines. 
Subtitle B—Repeal of Certain Provisions of Public Law 108–25 
Sec. 1211. Repeal of ‘‘conscience clause’’ requirement for eligibility for assist-
ance. 
Sec. 1212. Repeal of limitation on use of funds for assistance for sex workers. 
Sec. 1213. Repeal of reporting requirement on activities promoting abstinence 
and related activities. 
Sec. 1214. Effective date. 
TITLE XIII—DEFINITIONS 
Sec. 1301. Definitions. 
SEC. 3. STATEMENT OF POLICY. 
It is the policy of the United States to achieve an 
AIDS-free generation, and to— 
(1) expand access to lifesaving antiretroviral 
therapy for people living with HIV/AIDS and imme-
diately link people to continuous and coordinated 
high-quality care when they learn they are infected 
with HIV; 
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(2) expand targeted efforts to prevent HIV in-
fection using a combination of effective, evidence- 
based approaches, including the elimination of new 
pediatric HIV infections worldwide, routine HIV 
screening, and universal access to HIV prevention 
tools in the communities where HIV/AIDS is most 
heavily concentrated; 
(3) ensure laws, policies, and regulations do not 
impede access to prevention, treatment, and care for 
people living with HIV/AIDS or at risk for acquiring 
HIV; 
(4) accelerate research for more efficacious HIV 
prevention and treatments tools, a cure, and a vac-
cine; and 
(5) respect the human rights and dignity of 
persons living with HIV/AIDS. 
SEC. 4. FINDINGS. 
The Congress makes the following findings: 
(1) An estimated 34,000,000 people around the 
world were living with HIV at the end of 2010, up 
from 8,000,000 in 1990. 
(2) The annual number of new HIV infections 
has gradually declined, and due to the significant in-
crease in people receiving antiretroviral therapy, the 
number of AIDS-related deaths has also declined. 
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(3) Over 1,200,000 people are estimated to be 
living with HIV in the United States according to 
the Centers for Disease Control and Prevention. 
(4) One in five individuals living with HIV/ 
AIDS in the United States is unaware of being in-
fected, and significant disparities persist across dif-
ferent communities and populations with regard to 
incidence of infection, access to treatment, and 
health outcomes. 
(5) Each year, 50,000 people become newly in-
fected with HIV in the United States. 
(6) Among women, the rate of new HIV infec-
tion for African-American women is nearly 15 times 
higher than White women, while the rate among 
Hispanic women is nearly 4 times higher. 
(7) In 1998, Congress created the National Mi-
nority AIDS Initiative to provide technical assist-
ance, build capacity, and strengthen outreach efforts 
among local institutions and community-based orga-
nizations that serve racial and ethnic minorities liv-
ing with or vulnerable to HIV/AIDS. 
(8) In the United States, the only increase in 
HIV incidence remains among young people ages 13 
to 29, specifically young men of color who have sex 
with men. Additionally, only 84 percent of young 
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people report learning about HIV or AIDS in school, 
which is fewer than in previous years. 
(9) In 2009, the Ryan White HIV/AIDS Treat-
ment Extension Act of 2009 was enacted into law, 
reauthorizing Federal HIV/AIDS care and treatment 
programs for 4 years and making funding available 
to United States metropolitan areas, States, and 
service providers to assist affected families and per-
sons living with HIV/AIDS with health care and 
support services. 
(10) To combat the HIV epidemic in the United 
States, the National HIV/AIDS Strategy (NHAS) 
from the White House Office of National AIDS Pol-
icy provides a framework of increasing access to 
care, reducing new infections, and eliminating HIV- 
related health disparities. The vision of NHAS is: 
‘‘The United States will become a place where new 
HIV infections are rare and when they do occur, 
every person, regardless of age, gender, race/eth-
nicity, sexual orientation, gender identity, or socio- 
economic circumstance, will have unfettered access 
to high quality, life extending care, free from stigma 
and discrimination.’’. 
(11) In recent years, several thousand people 
across the country were waiting to receive AIDS 
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treatment through the AIDS Drug Assistance Pro-
gram authorized by the provisions popularly known 
as the Ryan White CARE Act. 
(12) The Centers for Disease Control and Pre-
vention has determined that increasing the propor-
tion of people who know their HIV status is an es-
sential component of comprehensive HIV/AIDS 
treatment and prevention efforts and that early di-
agnosis is critical in order for people with HIV/ 
AIDS to receive life-extending therapy. Additionally, 
the Centers for Disease Control and Prevention rec-
ommends recommend routine HIV screening in 
health care settings for all patients aged 13 to 64, 
regardless of risk. 
(13) Advances in HIV diagnostic technology 
(such as rapid HIV testing and, recently, the avail-
ability of over-the-counter HIV tests) reduce barriers 
to testing and allow more people to know their sta-
tus. 
(14) Routine HIV screening is a preventive 
health service, and if health plans covered routine 
HIV screenings, health providers would be more 
likely to recommend routine HIV screening for their 
patients. 
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(15) Requiring health plans to cover routine 
HIV screening as a preventive health service without 
imposing cost sharing requirements could play a 
critical role in preventing the spread of HIV and al-
lowing infected individuals to receive effective treat-
ment. 
(16) Developing countries continue to bear the 
brunt of the HIV/AIDS epidemic, with sub-Saharan 
Africa accounting for 68 percent of all adults and 
children living with HIV/AIDS, 59 percent of whom 
are female. 
(17) Despite global efforts, 1,000 children 
around the world still contract HIV each day, the 
majority through mother-to-child transmission of 
HIV. 
(18) HIV prevalence among young people aged 
15 to 24 has declined in many countries most im-
pacted by HIV; nevertheless, young people still ac-
count for 42 percent of all new infections among in-
dividuals aged 15 and older. 
(19) A substantial number of HIV-positive 
women in HIV care and treatment programs or pre-
vention of mother-to-child transmission (PMTCT) 
programs experience an unplanned pregnancy. 
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(20) Making contraceptive services more widely 
available through HIV care, treatment, and PMTCT 
programs would make it easier for women to coordi-
nate their HIV-related care with their pregnancy 
prevention goals, and at the same time, help prevent 
mother-to-child HIV transmission. 
(21) In 2008, the Tom Lantos and Henry J. 
Hyde United States Global Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Reauthorization 
Act was enacted into law, reauthorizing the Presi-
dent’s Emergency Plan for AIDS Relief (PEPFAR) 
and continued United States participation and con-
tributions to the Global Fund to Fight AIDS, Tu-
berculosis and Malaria. 
(22) The United States President’s Emergency 
Plan for AIDS Relief (PEPFAR), which represents 
the largest commitment by any nation to combat a 
single disease, has saved the lives of millions of peo-
ple around the world by establishing and expanding 
the infrastructure necessary to deliver prevention, 
care, and treatment services in low-resource settings. 
(23) Over 7,000,000 people around the world 
currently receive support for antiretroviral treatment 
as a result of PEPFAR bilateral programs, the 
Global Fund, or both. 
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(24) Early detection and treatment of HIV can 
have significant positive health effects. New research 
demonstrates conclusively that treatment of individ-
uals not only slows disease progression, but can also 
reduce the risk of transmission to other individuals 
by 96 percent. 
(25) In most countries HIV is a disease that 
discriminates, disproportionately affecting society’s 
most vulnerable. Even in generalized epidemics in 
which a significant share of the wider population is 
living with HIV/AIDS, people in vulnerable commu-
nities often have considerably higher rates of HIV 
infection. 
(26) Reaching men who have sex with men, 
transgender people, people who inject drugs, sex 
workers, and other vulnerable populations with effec-
tive HIV prevention and treatment is critical to 
bringing the AIDS epidemic under control. 
(27) According to the Centers for Disease Con-
trol and Prevention, approximately one-third of per-
sons with HIV are co-infected with hepatitis B virus 
(HBV) or hepatitis C virus (HCV). About 80 per-
cent of injection drug users with HIV infection also 
have HCV. HIV co-infection more than triples the 
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risk for liver disease, liver failure, and liver-related 
death from HCV. 
(28) The Global Commission on HIV and the 
Law was launched in June 2010 to examine laws 
and practices that criminalize people living with and 
vulnerable to HIV and to develop evidence-based rec-
ommendations for effective HIV responses that pro-
mote and protect human rights. 
(29) The 19th International AIDS Conference 
will be held in Washington, DC, in 2012, from July 
22 to 27, returning to the United States after a 
nearly two-decade-long international boycott that 
was lifted following the statutory repeal of a ban on 
travel and immigration of people living with HIV/ 
AIDS. 
(30) The District of Columbia, the site of the 
XIX International AIDS Conference, has an HIV 
prevalence rate of over 2.7 percent, which far ex-
ceeds the threshold that constitutes a ‘‘generalized 
and severe’’ epidemic, and is comparable to the rate 
in many parts of the developing world. 
(31) The XIX International AIDS Conference 
offers a unique opportunity to change the course of 
the HIV/AIDS epidemic by informing people globally 
about scientific advances in treatment and preven-
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tion, building consensus to improve service delivery 
and maximize outcomes, facilitating global civil soci-
ety engagement, and accelerating momentum toward 
a cure. 
(32) At present, 34 States and 2 United States 
territories have criminal statutes based on ‘‘expo-
sure’’ to HIV. Most of these laws were adopted be-
fore the availability of effective antiretroviral treat-
ment for HIV/AIDS. 
(33) Although HIV/AIDS currently is viewed as 
a chronic, treatable medical condition, people living 
with HIV in the United States have been charged 
under aggravated assault, attempted murder, and 
even bioterrorism statutes because prosecutors, 
courts, and legislators continue to view and charac-
terize the blood, semen, and saliva of people living 
with HIV as a ‘‘deadly weapon’’. 
(34) The National Alliance of State and Terri-
torial AIDS Directors released a statement in Feb-
ruary 2011 saying that ‘‘HIV criminalization under-
cuts our most basic HIV prevention and sexual 
health messages, and breeds ignorance, fear and dis-
crimination against people living with HIV’’. 
NASTAD further ‘‘supports efforts to examine and 
support level-headed, proven public health ap-
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proaches that end punitive laws that single out HIV 
over other STDs and that impose penalties for al-
leged nondisclosure, exposure and transmission that 
are severely disproportionate to the actual resulting 
harm’’. 
(35) In 2010, the President released a National 
HIV/AIDS Strategy (NHAS), which addressed HIV- 
specific criminal laws, stating: ‘‘[W]hile we under-
stand the intent behind [these] laws, they may not 
have the desired effect and they may make people 
less willing to disclose their status by making people 
feel at even greater risk of discrimination. In some 
cases, it may be appropriate for legislators to recon-
sider whether existing laws continue to further the 
public interest and public health. In many instances, 
the continued existence and enforcement of these 
types of laws run counter to scientific evidence about 
routes of HIV transmission and may undermine the 
public health goals of promoting HIV screening and 
treatment.’’. 
(36) There is a disproportionately high rate of 
HIV/AIDS among incarcerated persons, especially 
among minorities. The Bureau of Justice Statistics 
(BJS) has determined that the rate of confirmed 
AIDS cases is 2.4 times higher among incarcerated 
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persons than in the general population. Minorities 
account for the majority of AIDS-related deaths 
among incarcerated persons, African-American in-
carcerated individuals are 2.8 times more likely than 
White incarcerated individuals and 1.4 times more 
likely than Hispanic incarcerated individuals to die 
from AIDS-related causes. Nearly two-thirds of 
AIDS-related deaths are among Black, non-Hispanic 
males. 
(37) Studies suggest that other sexually trans-
mitted 
infections 
(STIs), 
such 
as 
gonorrhea, 
chlamydia, syphilis, genital herpes, viral hepatitis, 
and human papillomavirus, also exist at a higher 
rate among incarcerated persons than in the general 
population. For instance, researchers have estimated 
that the rate of hepatitis C (HCV) infection among 
incarcerated persons is somewhere between 8 and 20 
times higher than that of the general population. 
(38) According to the Centers for Disease Con-
trol and Prevention (CDC), latex condoms, when 
used consistently and correctly, are highly effective 
in preventing the transmission of HIV. Latex 
condoms also reduce the risk of other STIs. Despite 
the effectiveness of condoms in reducing the spread 
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of STIs, the Bureau of Prisons does not recommend 
their use in correctional facilities. 
(39) The distribution of condoms in correctional 
facilities is currently legal in certain parts of the 
United States and the world. The States of Vermont 
and Mississippi, the District of Columbia, and the 
cities of New York, San Francisco, Los Angeles, 
Washington, DC, and Philadelphia allow condom 
distribution in their correctional facilities. However, 
these States and cities operate fewer than 1 percent 
of all correctional facilities. 
(40) Many correctional facilities in the United 
States do not provide comprehensive testing and 
treatment programs to reduce the spread of STIs. 
Fewer than half of correctional facilities provide 
counseling to HIV-positive incarcerated persons. 
(41) Incarcerated individuals living with HIV/ 
AIDS who are eligible for Medicaid would benefit 
from prompt and automatic enrollment upon their 
release in order to ensure their continued ability to 
access health services, including antiretroviral treat-
ment. 
(42) Research shows that stable housing leads 
to better health outcomes for those living with HIV. 
Inadequate or unstable housing is not only a barrier 
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to effective treatment, but also increases the likeli-
hood of engaging in risky behaviors leading to HIV 
infection. Insecure housing puts people with HIV/ 
AIDS at risk of premature death from exposure to 
other diseases, poor nutrition, stress, and lack of 
medical care. 
(43) On July 16, 2012, the Food and Drug Ad-
ministration 
approved 
Truvada 
(emtricitabine/ 
tenofovir disoproxil fumarate), the first drug ap-
proved to reduce the risk of HIV infection in 
uninfected individuals who are at high risk of HIV 
infection and who may engage in sexual activity with 
HIV-infected partners. 
SEC. 5. NONDISCRIMINATION. 
Programs funded under this Act shall not discrimi-
nate on the basis of actual or perceived sex, race, color, 
ethnicity, national origin, disability, sexual orientation, 
gender identity, or religion. Nothing in this Act shall be 
construed to invalidate or limit rights, remedies, proce-
dures, or legal standards available to victims of discrimi-
nation under any other Federal law or any law of a State 
or a political subdivision of a State, including title VI of 
the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), 
title IX of the Education Amendments of 1972 (20 U.S.C. 
1681 et seq.), section 504 of the Rehabilitation Act of 
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1973 (29 U.S.C. 794), the Americans with Disabilities Act 
of 1990 (42 U.S.C. 12101 et seq.), and section 1557 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18116). 
DIVISION A—ENDING HIV/AIDS 
IN THE UNITED STATES 
TITLE I—INCREASING AND TAR-
GETING 
INVESTMENT 
TO 
MAXIMIZE PREVENTION AND 
TREATMENT IMPACT 
SEC. 101. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST-
ANCE PROGRAM TREATMENTS. 
Section 2623 of the Public Health Service Act (42 
U.S.C. 300ff–31b) is amended by adding at the end the 
following: 
‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS-
SISTANCE
PROGRAM
TREATMENTS.—In addition to 
amounts otherwise authorized to be appropriated for car-
rying out this subpart, there are authorized to be appro-
priated such sums as may be necessary to carry out sec-
tions 2612(b)(3)(B) and 2616 for each of fiscal years 
2013 through 2015.’’. 
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SEC. 102. ENHANCING THE NATIONAL HIV SURVEILLANCE 
SYSTEM. 
(a) GRANTS.—The Secretary of Health and Human 
Services, acting through the Director of the Centers for 
Disease Control and Prevention, shall make grants to 
States to support integration of public health surveillance 
systems into all electronic health records in order to allow 
rapid communications between the clinical setting and 
health departments, by means that include— 
(1) providing technical assistance and policy 
guidance to State and local health departments, clin-
ical providers, and other agencies serving individuals 
with HIV to improve the interoperability of data sys-
tems relevant to monitoring HIV care and sup-
portive services; 
(2) capturing longitudinal data pertaining to 
the initiation and ongoing prescription or dispensing 
of antiretroviral therapy for individuals diagnosed 
with HIV (such as through pharmacy-based report-
ing); 
(3) obtaining information— 
(A) on a voluntary basis, on sexual orienta-
tion and gender identity; and 
(B) on sources of coverage (or the lack 
thereof) for medical treatment (including cov-
erage through Medicaid, Medicare, the program 
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under title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff–11 et seq.; commonly re-
ferred to as the ‘‘Ryan White HIV/AIDS Pro-
gram’’), other public funding, private insurance, 
and health maintenance organizations); and 
(4) obtaining and using current geographic 
markers of residence (such as current address, zip 
code, partial zip code, and census block). 
(b) PRIVACY AND SECURITY SAFEGUARDS.—In car-
rying out this section, the Secretary of Health and Human 
Services shall ensure that appropriate privacy and security 
safeguards are met to prevent unauthorized disclosure of 
protected health information and compliance with the 
HIPAA privacy and security law (as defined in section 
3009 of the Public Health Service Act (42 U.S.C. 300jj– 
19)) and other relevant laws and regulations. 
(c) PROHIBITION
AGAINST
IMPROPER
USE
OF 
DATA.—No grant under this section may be used to allow 
or facilitate the collection or use of surveillance or clinical 
data or records— 
(1) for punitive measures of any kind, civil or 
criminal, against the subject of such data or records; 
or 
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(2) for imposing any requirement or restriction 
with respect to an individual without the individual’s 
written consent. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2013 through 2017. 
SEC. 103. EVIDENCE-BASED STRATEGIES FOR IMPROVING 
LINKAGE TO AND RETENTION IN APPRO-
PRIATE CARE. 
(a) STRATEGIES.—The Secretary of Health and 
Human Services, in collaboration with the Director of the 
Centers for Disease Control and Prevention, the Adminis-
trator of the Substance Abuse and Mental Health Services 
Administration, the Director of the Office of AIDS Re-
search, the Administrator of the Health Resources and 
Services Administration, and the Administrator of the 
Centers for Medicare & Medicaid Services, shall— 
(1) identify evidence-based strategies most ef-
fective at addressing the multifaceted issues that im-
pede disease status awareness and linkage to and re-
tention in appropriate care, taking into consideration 
health care systems issues, clinic and provider 
issues, and individual psycho-social, environmental, 
and other contextual factors; 
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(2) support the wide-scale implementation of 
the evidence-based strategies identified pursuant to 
paragraph (1), including through incorporating such 
strategies into health care coverage supported by the 
Medicaid program under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.), the program 
under title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff–11 et seq.; commonly referred to 
as the ‘‘Ryan White HIV/AIDS Program’’), and 
health plans purchased through an American Health 
Benefit Exchange established pursuant to section 
1311 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031); and 
(3) not later than 12 months after the date of 
the enactment of this Act, submit a report to the 
Congress on the status of activities under para-
graphs (1) and (2). 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2013 
through 2017. 
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