In the Senate of the United States, 
July 16, 2008. 
Resolved, That the bill from the House of Representa-
tives (H.R. 5501) entitled ‘‘An Act to authorize appropria-
tions for fiscal years 2009 through 2013 to provide assistance 
to foreign countries to combat HIV/AIDS, tuberculosis, and 
malaria, and for other purposes.’’, do pass with the following 
AMENDMENT: 
Strike all after the enacting clause and insert the 
following: 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Tom Lantos and Henry J. Hyde United States Global 
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; table of contents. 
Sec. 2. Findings. 
Sec. 3. Definitions. 
Sec. 4. Purpose. 
Sec. 5. Authority to consolidate and combine reports.
TITLE I—POLICY PLANNING AND COORDINATION 
Sec. 101. Development of an updated, comprehensive, 5-year, global strategy. 
Sec. 102. Interagency working group. 
Sec. 103. Sense of Congress. 
TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND 
PUBLIC-PRIVATE PARTNERSHIPS 
Sec. 201. Voluntary contributions to international vaccine funds. 
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and Ma-
laria. 
Sec. 203. Research on methods for women to prevent transmission of HIV and 
other diseases. 
Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by strengthening 
health policies and health systems of partner countries. 
Sec. 205. Facilitating effective operations of the Centers for Disease Control. 
Sec. 206. Facilitating vaccine development. 
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. Malaria Response Coordinator. 
Sec. 305. Amendment to Immigration and Nationality Act. 
Sec. 306. Clerical amendment. 
Sec. 307. Requirements. 
Sec. 308. Annual report on prevention of mother-to-child transmission of HIV. 
Sec. 309. Prevention of mother-to-child transmission expert panel. 
TITLE IV—FUNDING ALLOCATIONS 
Sec. 401. Authorization of appropriations. 
Sec. 402. Sense of Congress. 
Sec. 403. Allocation of funds. 
TITLE V—MISCELLANEOUS 
Sec. 501. Machine readable visa fees. 
TITLE VI—EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH 
Sec. 601. Emergency plan for Indian safety and health. 
SEC. 2. FINDINGS. 
Section 2 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7601) is amended by adding at the end the following:
‘‘(29) On May 27, 2003, the President signed 
this Act into law, launching the largest international 
public health program of its kind ever created. 
‘‘(30) Between 2003 and 2008, the United States, 
through the President’s Emergency Plan for AIDS 
Relief (PEPFAR) and in conjunction with other bi-
lateral programs and the multilateral Global Fund 
has helped to— 
‘‘(A) provide antiretroviral therapy for over 
1,900,000 people; 
‘‘(B) ensure that over 150,000 infants, most 
of whom would have likely been infected with 
HIV during pregnancy or childbirth, were not 
infected; and 
‘‘(C) provide palliative care and HIV pre-
vention assistance to millions of other people. 
‘‘(31) While United States leadership in the bat-
tles against HIV/AIDS, tuberculosis, and malaria has 
had an enormous impact, these diseases continue to 
take a terrible toll on the human race. 
‘‘(32) According to the 2007 AIDS Epidemic 
Update of the Joint United Nations Programme on 
HIV/AIDS (UNAIDS)— 
‘‘(A) an estimated 2,100,000 people died of 
AIDS-related causes in 2007; and
‘‘(C) gender issues are critical components 
in the effort to prevent HIV/AIDS and to care 
for those affected by the disease. 
‘‘(37) Children who have lost a parent to HIV/ 
AIDS, who are otherwise directly affected by the dis-
ease, or who live in areas of high HIV prevalence may 
be vulnerable to the disease or its socioeconomic ef-
fects. 
‘‘(38) Lack of health capacity, including insuffi-
cient personnel and inadequate infrastructure, in sub- 
Saharan Africa and other regions of the world is a 
critical barrier that limits the effectiveness of efforts 
to combat HIV/AIDS, tuberculosis, and malaria, and 
to achieve other global health goals. 
‘‘(39) On March 30, 2007, the Institute of Medi-
cine of the National Academies released a report enti-
tled ‘PEPFAR Implementation: Progress and Prom-
ise’, which found that budget allocations setting per-
centage levels for spending on prevention, care, and 
treatment and for certain subsets of activities within 
the prevention category— 
‘‘(A) have ‘adversely affected implementa-
tion of the U.S. Global AIDS Initiative’; 
‘‘(B) have inhibited comprehensive, inte-
grated, evidence based approaches;
‘‘(C) ‘have been counterproductive’; 
‘‘(D) ‘may have been helpful initially in en-
suring a balance of attention to activities within 
the 4 categories of prevention, treatment, care, 
and orphans and vulnerable children’; 
‘‘(E) ‘have also limited PEPFAR’s ability 
to tailor its activities in each country to the 
local epidemic and to coordinate with the level of 
activities in the countries’ national plans’; and 
‘‘(F) should be removed by Congress and re-
placed with more appropriate mechanisms 
that— 
‘‘(i) ‘ensure accountability for results 
from Country Teams to the U.S. Global 
AIDS Coordinator and to Congress’; and 
‘‘(ii) ‘ensure that spending is directly 
linked to and commensurate with necessary 
efforts to achieve both country and overall 
performance targets for prevention, treat-
ment, care, and orphans and vulnerable 
children’. 
‘‘(40) The United States Government has en-
dorsed the principles of harmonization in coordi-
nating efforts to combat HIV/AIDS commonly re-
ferred to as the ‘Three Ones’, which includes—
‘‘(A) 1 agreed HIV/AIDS action framework 
that provides the basis for coordination of the 
work of all partners; 
‘‘(B) 1 national HIV/AIDS coordinating 
authority, with a broadbased multisectoral man-
date; and 
‘‘(C) 1 agreed HIV/AIDS country-level 
monitoring and evaluating system. 
‘‘(41) In the Abuja Declaration on HIV/AIDS, 
Tuberculosis and Other Related Infectious Diseases, of 
April 26–27, 2001 (referred to in this Act as the 
‘Abuja Declaration’), the Heads of State and Govern-
ment of the Organization of African Unity (OAU)— 
‘‘(A) declared that they would ‘place the 
fight against HIV/AIDS at the forefront and as 
the highest priority issue in our respective na-
tional development plans’; 
‘‘(B) committed ‘TO TAKE PERSONAL 
RESPONSIBILITY AND PROVIDE LEADER-
SHIP for the activities of the National AIDS 
Commissions/Councils’; 
‘‘(C) resolved ‘to lead from the front the bat-
tle against HIV/AIDS, Tuberculosis and Other 
Related Infectious Diseases by personally ensur-
ing that such bodies were properly convened in
mobilizing our societies as a whole and pro-
viding focus for unified national policymaking 
and programme implementation, ensuring co-
ordination of all sectors at all levels with a gen-
der perspective and respect for human rights, 
particularly to ensure equal rights for people liv-
ing with HIV/AIDS’; and 
‘‘(D) pledged ‘to set a target of allocating at 
least 15% of our annual budget to the improve-
ment of the health sector’.’’. 
SEC. 3. DEFINITIONS. 
Section 3 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7602) is amended— 
(1) in paragraph (2), by striking ‘‘Committee on 
International Relations’’ and inserting ‘‘Committee 
on Foreign Affairs of the House of Representatives, 
the Committee on Appropriations of the Senate, and 
the Committee on Appropriations’’; 
(2) by redesignating paragraph (6) as para-
graph (12); 
(3) by redesignating paragraphs (3) through (5), 
as paragraphs (4) through (6), respectively; 
(4) by inserting after paragraph (2) the fol-
lowing:
‘‘(3) GLOBAL
AIDS
COORDINATOR.—The term 
‘Global AIDS Coordinator’ means the Coordinator of 
United States Government Activities to Combat HIV/ 
AIDS Globally.’’; and 
(5) by inserting after paragraph (6), as redesig-
nated, the following: 
‘‘(7) IMPACT EVALUATION RESEARCH.—The term 
‘impact evaluation research’ means the application of 
research methods and statistical analysis to measure 
the extent to which change in a population-based out-
come can be attributed to program intervention in-
stead of other environmental factors. 
‘‘(8) OPERATIONS RESEARCH.—The term ‘oper-
ations research’ means the application of social 
science research methods, statistical analysis, and 
other appropriate scientific methods to judge, com-
pare, and improve policies and program outcomes, 
from the earliest stages of defining and designing pro-
grams through their development and implementa-
tion, with the objective of the rapid dissemination of 
conclusions and concrete impact on programming. 
‘‘(9) 
PARAPROFESSIONAL.—The 
term 
‘para-
professional’ means an individual who is trained and 
employed as a health agent for the provision of basic
assistance in the identification, prevention, or treat-
ment of illness or disability. 
‘‘(10) PARTNER GOVERNMENT.—The term ‘part-
ner government’ means a government with which the 
United States is working to provide assistance to 
combat HIV/AIDS, tuberculosis, or malaria on behalf 
of people living within the jurisdiction of such govern-
ment. 
‘‘(11) PROGRAM MONITORING.—The term ‘pro-
gram monitoring’ means the collection, analysis, and 
use of routine program data to determine— 
‘‘(A) how well a program is carried out; 
and 
‘‘(B) how much the program costs.’’. 
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 enhance 
United States leadership and the effectiveness of the United 
States response to the HIV/AIDS, tuberculosis, and malaria 
pandemics and other related and preventable infectious dis-
eases as part of the overall United States health and devel-
opment agenda by—
‘‘(1) establishing comprehensive, coordinated, 
and integrated 5-year, global strategies to combat 
HIV/AIDS, tuberculosis, and malaria by— 
‘‘(A) building on progress and successes to 
date; 
‘‘(B) improving harmonization of United 
States efforts with national strategies of partner 
governments and other public and private enti-
ties; and 
‘‘(C) emphasizing capacity building initia-
tives in order to promote a transition toward 
greater sustainability through the support of 
country-driven efforts; 
‘‘(2) providing increased resources for bilateral 
and multilateral efforts to fight HIV/AIDS, tuber-
culosis, and malaria as integrated components of 
United States development assistance; 
‘‘(3) intensifying efforts to— 
‘‘(A) prevent HIV infection; 
‘‘(B) ensure the continued support for, and 
expanded access to, treatment and care pro-
grams; 
‘‘(C) enhance the effectiveness of prevention, 
treatment, and care programs; and
‘‘(D) address the particular vulnerabilities 
of girls and women; 
‘‘(4) encouraging the expansion of private sector 
efforts and expanding public-private sector partner-
ships to combat HIV/AIDS, tuberculosis, and ma-
laria; 
‘‘(5) reinforcing efforts to— 
‘‘(A) develop safe and effective vaccines, 
microbicides, and other prevention and treat-
ment technologies; and 
‘‘(B) improve diagnostics capabilities for 
HIV/AIDS, tuberculosis, and malaria; and 
‘‘(6) helping partner countries to— 
‘‘(A) strengthen health systems; 
‘‘(B) expand health workforce; and 
‘‘(C) address infrastructural weaknesses.’’. 
SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE RE-
PORTS. 
Section 5 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7604) is amended by inserting ‘‘, with the exception 
of the 5-year strategy’’ before the period at the end.
TITLE I—POLICY PLANNING AND 
COORDINATION 
SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHEN-
SIVE, 5-YEAR, GLOBAL STRATEGY. 
(a) STRATEGY.—Section 101(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7611(a)) is amended to read as fol-
lows: 
‘‘(a) STRATEGY.—The President shall establish a com-
prehensive, integrated, 5-year strategy to expand and im-
prove efforts to combat global HIV/AIDS. This strategy 
shall— 
‘‘(1) further strengthen the capability of the 
United States to be an effective leader of the inter-
national campaign against this disease and strength-
en the capacities of nations experiencing HIV/AIDS 
epidemics to combat this disease; 
‘‘(2) maintain sufficient flexibility and remain 
responsive to— 
‘‘(A) changes in the epidemic; 
‘‘(B) challenges facing partner countries in 
developing and implementing an effective na-
tional response; and
‘‘(C) evidence-based improvements and in-
novations in the prevention, care, and treatment 
of HIV/AIDS; 
‘‘(3) situate United States efforts to combat HIV/ 
AIDS, tuberculosis, and malaria within the broader 
United States global health and development agenda, 
establishing a roadmap to link investments in specific 
disease programs to the broader goals of strengthening 
health systems and infrastructure and to integrate 
and coordinate HIV/AIDS, tuberculosis, or malaria 
programs with other health or development programs, 
as appropriate; 
‘‘(4) provide a plan to— 
‘‘(A) prevent 12,000,000 new HIV infections 
worldwide; 
‘‘(B) support— 
‘‘(i) the increase in the number of indi-
viduals 
with 
HIV/AIDS 
receiving 
antiretroviral treatment above the goal es-
tablished under section 402(a)(3) and in-
creased pursuant to paragraphs (1) through 
(3) of section 403(d); and 
‘‘(ii) additional treatment through co-
ordinated multilateral efforts;
‘‘(C) support care for 12,000,000 individ-
uals infected with or affected by HIV/AIDS, in-
cluding 5,000,000 orphans and vulnerable chil-
dren affected by HIV/AIDS, with an emphasis 
on promoting a comprehensive, coordinated sys-
tem of services to be integrated throughout the 
continuum of care; 
‘‘(D) help partner countries in the effort to 
achieve goals of 80 percent access to counseling, 
testing, and treatment to prevent the trans-
mission of HIV from mother to child, empha-
sizing a continuum of care model; 
‘‘(E) help partner countries to provide care 
and treatment services to children with HIV in 
proportion to their percentage within the HIV- 
infected population in each country; 
‘‘(F) promote preservice training for health 
professionals designed to strengthen the capacity 
of institutions to develop and implement policies 
for training health workers to combat HIV/ 
AIDS, tuberculosis, and malaria; 
‘‘(G) equip teachers with skills needed for 
HIV/AIDS prevention and support for persons 
with, or affected by, HIV/AIDS;
‘‘(H) provide and share best practices for 
combating HIV/AIDS with health professionals; 
‘‘(I) promote pediatric HIV/AIDS training 
for physicians, nurses, and other health care 
workers, through public-private partnerships if 
possible, including through the designation, if 
appropriate, of centers of excellence for training 
in pediatric HIV/AIDS prevention, care, and 
treatment in partner countries; and 
‘‘(J) help partner countries to train and 
support retention of health care professionals 
and paraprofessionals, with the target of train-
ing and retaining at least 140,000 new health 
care professionals and paraprofessionals with an 
emphasis on training and in country deploy-
ment of critically needed doctors and nurses and 
to strengthen capacities in developing countries, 
especially in sub-Saharan Africa, to deliver pri-
mary health care with the objective of helping 
countries achieve staffing levels of at least 2.3 
doctors, nurses, and midwives per 1,000 popu-
lation, as called for by the World Health Organi-
zation; 
‘‘(5) include multisectoral approaches and spe-
cific strategies to treat individuals infected with HIV/
AIDS and to prevent the further transmission of HIV 
infections, with a particular focus on the needs of 
families with children (including the prevention of 
mother-to-child transmission), women, young people, 
orphans, and vulnerable children; 
‘‘(6) establish a timetable with annual global 
treatment targets with country-level benchmarks for 
antiretroviral treatment; 
‘‘(7) expand the integration of timely and rel-
evant research within the prevention, care, and treat-
ment of HIV/AIDS; 
‘‘(8) include a plan for program monitoring, op-
erations research, and impact evaluation and for the 
dissemination of a best practices report to highlight 
findings; 
‘‘(9) support the in-country or intra-regional 
training, preferably through public-private partner-
ships, of scientific investigators, managers, and other 
staff who are capable of promoting the systematic up-
take of clinical research findings and other evidence- 
based interventions into routine practice, with the 
goal of improving the quality, effectiveness, and local 
leadership of HIV/AIDS health care; 
‘‘(10) expand and accelerate research on and de-
velopment of HIV/AIDS prevention methods for
women, including enhancing inter-agency collabora-
tion, staffing, and organizational infrastructure dedi-
cated to microbicide research; 
‘‘(11) provide for consultation with local leaders 
and officials to develop prevention strategies and pro-
grams that are tailored to the unique needs of each 
country and community and targeted particularly to-
ward those most at risk of acquiring HIV infection; 
‘‘(12) make the reduction of HIV/AIDS behav-
ioral risks a priority of all prevention efforts by— 
‘‘(A) promoting abstinence from sexual ac-
tivity and encouraging monogamy and faithful-
ness; 
‘‘(B) encouraging the correct and consistent 
use of male and female condoms and increasing 
the availability of, and access to, these commod-
ities; 
‘‘(C) promoting the delay of sexual debut 
and the reduction of multiple concurrent sexual 
partners; 
‘‘(D) promoting education for discordant 
couples (where an individual is infected with 
HIV and the other individual is uninfected or 
whose status is unknown) about safer sex prac-
tices;
‘‘(E) promoting voluntary counseling and 
testing, addiction therapy, and other prevention 
and treatment tools for illicit injection drug 
users and other substance abusers; 
‘‘(F) educating men and boys about the 
risks of procuring sex commercially and about 
the need to end violent behavior toward women 
and girls; 
‘‘(G) supporting partner country and com-
munity efforts to identify and address social, 
economic, or cultural factors, such as migration, 
urbanization, conflict, gender-based violence, lack 
of empowerment for women, and transportation 
patterns, which directly contribute to the trans-
mission of HIV; 
‘‘(H) supporting comprehensive programs to 
promote alternative livelihoods, safety, and social 
reintegration strategies for commercial sex work-
ers and their families; 
‘‘(I) promoting cooperation with law en-
forcement to prosecute offenders of trafficking, 
rape, and sexual assault crimes with the goal of 
eliminating such crimes; and
‘‘(J) working to eliminate rape, gender- 
based violence, sexual assault, and the sexual ex-
ploitation of women and children; 
‘‘(13) include programs to reduce the trans-
mission of HIV, particularly addressing the height-
ened vulnerabilities of women and girls to HIV in 
many countries; and 
‘‘(14) support other important means of pre-
venting or reducing the transmission of HIV, includ-
ing— 
‘‘(A) medical male circumcision; 
‘‘(B) the maintenance of a safe blood sup-
ply; 
‘‘(C) promoting universal precautions in 
formal and informal health care settings; 
‘‘(D) educating the public to recognize and 
to avoid risks to contract HIV through blood ex-
posures during formal and informal health care 
and cosmetic services; 
‘‘(E) investigating suspected nosocomial in-
fections to identify and stop further nosocomial 
transmission; and 
‘‘(F) other mechanisms to reduce the trans-
mission of HIV;
‘‘(15) increase support for prevention of mother- 
to-child transmission; 
‘‘(16) build capacity within the public health 
sector of developing countries by improving health 
systems and public health infrastructure and devel-
oping indicators to measure changes in broader pub-
lic health sector capabilities; 
‘‘(17) increase the coordination of HIV/AIDS 
programs with development programs; 
‘‘(18) provide a framework for expanding or de-
veloping existing or new country or regional pro-
grams, including— 
‘‘(A) drafting compacts or other agreements, 
as appropriate; 
‘‘(B) establishing criteria and objectives for 
such compacts and agreements; and 
‘‘(C) promoting sustainability; 
‘‘(19) provide a plan for national and regional 
priorities for resource distribution and a global in-
vestment plan by region; 
‘‘(20) provide a plan to address the immediate 
and ongoing needs of women and girls, which— 
‘‘(A) addresses the vulnerabilities that con-
tribute to their elevated risk of infection;
‘‘(B) includes specific goals and targets to 
address these factors; 
‘‘(C) provides clear guidance to field mis-
sions to integrate gender across prevention, care, 
and treatment programs; 
‘‘(D) sets forth gender-specific indicators to 
monitor progress on outcomes and impacts of 
gender programs; 
‘‘(E) supports efforts in countries in which 
women or orphans lack inheritance rights and 
other fundamental protections to promote the 
passage, implementation, and enforcement of 
such laws; 
‘‘(F) supports life skills training, especially 
among women and girls, with the goal of reduc-
ing vulnerabilities to HIV/AIDS; 
‘‘(G) addresses and prevents gender-based 
violence; and 
‘‘(H) addresses the posttraumatic and psy-
chosocial consequences and provides postexposure 
prophylaxis protecting against HIV infection to 
victims of gender-based violence and rape; 
‘‘(21) provide a plan to—
‘‘(A) determine the local factors that may 
put men and boys at elevated risk of contracting 
or transmitting HIV; 
‘‘(B) address male norms and behaviors to 
reduce these risks, including by reducing alcohol 
abuse; 
‘‘(C) promote responsible male behavior; 
and 
‘‘(D) promote male participation and lead-
ership at the community level in efforts to pro-
mote HIV prevention, reduce stigma, promote 
participation in voluntary counseling and test-
ing, and provide care, treatment, and support 
for persons with HIV/AIDS; 
‘‘(22) 
provide 
a 
plan 
to 
address 
the 
vulnerabilities and needs of orphans and children who 
are vulnerable to, or affected by, HIV/AIDS; 
‘‘(23) encourage partner countries to develop 
health care curricula and promote access to training 
tailored to individuals receiving services through, or 
exiting from, existing programs geared to orphans 
and vulnerable children; 
‘‘(24) provide a framework to work with inter-
national actors and partner countries toward uni-
versal access to HIV/AIDS prevention, treatment, and
‘‘(v) strategies to meet the particular 
needs of adolescents; 
‘‘(vi) assistance for victims of rape, 
sexual abuse, assault, exploitation, and traf-
ficking; and 
‘‘(vii) programs to prevent alcohol 
abuse. 
‘‘(O) A description of strategies to address 
male norms and behaviors that contribute to the 
transmission of HIV, to promote responsible 
male behavior, and to promote male participa-
tion and leadership in HIV/AIDS prevention, 
care, treatment, and voluntary counseling and 
testing. 
‘‘(P) A description of strategies— 
‘‘(i) to address the needs of orphans 
and vulnerable children, including an anal-
ysis of— 
‘‘(I) factors contributing to chil-
dren’s vulnerability to HIV/AIDS; and 
‘‘(II) vulnerabilities caused by the 
impact of HIV/AIDS on children and 
their families; and 
‘‘(ii) in areas of higher HIV/AIDS 
prevalence, to promote a community-based