H. R. 5501 
One Hundred Tenth Congress 
of the 
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Thursday, 
the third day of January, two thousand and eight 
An Act 
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. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
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.
H. R. 5501—2 
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 bilateral programs and the multi-
lateral 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 prevention assist-
ance to millions of other people. 
‘‘(31) While United States leadership in the battles 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 
‘‘(B) an estimated 2,500,000 people were newly infected 
with HIV during that year. 
‘‘(33) According to the World Health Organization, malaria 
kills more than 1,000,000 people per year, 70 percent of whom 
are children under 5 years of age. 
‘‘(34) According to the World Health Organization, 1⁄3 of 
the world’s population is infected with the tuberculosis bac-
terium, and tuberculosis is 1 of the greatest infectious causes 
of death of adults worldwide, killing 1,600,000 people per year. 
‘‘(35) Efforts to promote abstinence, fidelity, the correct 
and consistent use of condoms, the delay of sexual debut, and 
the reduction of concurrent sexual partners represent important 
elements of strategies to prevent the transmission of HIV/ 
AIDS. 
‘‘(36) According to UNAIDS— 
‘‘(A) women and girls make up nearly 60 percent of 
persons in sub-Saharan Africa who are HIV positive; 
‘‘(B) women and girls are more biologically, economi-
cally, and socially vulnerable to HIV infection; 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 disease, or who live
H. R. 5501—3 
in areas of high HIV prevalence may be vulnerable to the 
disease or its socioeconomic effects. 
‘‘(38) Lack of health capacity, including insufficient per-
sonnel 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 Medicine of 
the National Academies released a report entitled ‘PEPFAR 
Implementation: Progress and Promise’, which found that 
budget allocations setting percentage levels for spending on 
prevention, care, and treatment and for certain subsets of activi-
ties within the prevention category— 
‘‘(A) have ‘adversely affected implementation of the 
U.S. Global AIDS Initiative’; 
‘‘(B) have inhibited comprehensive, integrated, evidence 
based approaches; 
‘‘(C) ‘have been counterproductive’; 
‘‘(D) ‘may have been helpful initially in ensuring 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 replaced 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, treatment, care, and orphans and vulner-
able children’. 
‘‘(40) The United States Government has endorsed the prin-
ciples of harmonization in coordinating efforts to combat HIV/ 
AIDS commonly referred to as the ‘Three Ones’, which 
includes— 
‘‘(A) 1 agreed HIV/AIDS action framework that pro-
vides the basis for coordination of the work of all partners; 
‘‘(B) 1 national HIV/AIDS coordinating authority, with 
a broadbased multisectoral mandate; 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 Government 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 national development plans’; 
‘‘(B) committed ‘TO TAKE PERSONAL RESPONSI-
BILITY AND PROVIDE LEADERSHIP for the activities 
of the National AIDS Commissions/Councils’;
H. R. 5501—4 
‘‘(C) resolved ‘to lead from the front the battle against 
HIV/AIDS, Tuberculosis and Other Related Infectious Dis-
eases by personally ensuring that such bodies were properly 
convened in mobilizing our societies as a whole and pro-
viding focus for unified national policymaking and pro-
gramme implementation, ensuring coordination of all sec-
tors at all levels with a gender perspective and respect 
for human rights, particularly to ensure equal rights for 
people living with HIV/AIDS’; and 
‘‘(D) pledged ‘to set a target of allocating at least 15% 
of our annual budget to the improvement 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 Inter-
national Relations’’ and inserting ‘‘Committee on Foreign 
Affairs of the House of Representatives, the Committee on 
Appropriations of the Senate, and the Committee on Appropria-
tions’’; 
(2) by redesignating paragraph (6) as paragraph (12); 
(3) by redesignating paragraphs (3) through (5), as para-
graphs (4) through (6), respectively; 
(4) by inserting after paragraph (2) the following: 
‘‘(3) GLOBAL AIDS COORDINATOR.—The term ‘Global AIDS 
Coordinator’ means the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally.’’; and 
(5) by inserting after paragraph (6), as redesignated, 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 outcome can be attributed to program 
intervention instead of other environmental factors. 
‘‘(8) 
OPERATIONS
RESEARCH.—The 
term 
‘operations 
research’ means the application of social science research 
methods, statistical analysis, and other appropriate scientific 
methods to judge, compare, and improve policies and program 
outcomes, from the earliest stages of defining and designing 
programs through their development and implementation, with 
the objective of the rapid dissemination of conclusions and 
concrete impact on programming. 
‘‘(9) 
PARAPROFESSIONAL.—The 
term 
‘paraprofessional’ 
means an individual who is trained and employed as a health 
agent for the provision of basic assistance in the identification, 
prevention, or treatment of illness or disability. 
‘‘(10) PARTNER GOVERNMENT.—The term ‘partner govern-
ment’ means a government with which the United States is 
working to provide assistance to combat HIV/AIDS, tuber-
culosis, or malaria on behalf of people living within the jurisdic-
tion of such government. 
‘‘(11) PROGRAM
MONITORING.—The term ‘program moni-
toring’ means the collection, analysis, and use of routine pro-
gram data to determine— 
‘‘(A) how well a program is carried out; and
H. R. 5501—5 
‘‘(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 diseases as part of 
the overall United States health and development agenda by— 
‘‘(1) 
establishing 
comprehensive, 
coordinated, 
and 
integrated 5-year, global strategies to combat HIV/AIDS, tuber-
culosis, 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 entities; and 
‘‘(C) emphasizing capacity building initiatives in order 
to promote a transition toward greater sustainability 
through the support of country-driven efforts; 
‘‘(2) providing increased resources for bilateral and multi-
lateral efforts to fight HIV/AIDS, tuberculosis, and malaria 
as integrated components of United States development assist-
ance; 
‘‘(3) intensifying efforts to— 
‘‘(A) prevent HIV infection; 
‘‘(B) ensure the continued support for, and expanded 
access to, treatment and care programs; 
‘‘(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 partnerships to combat 
HIV/AIDS, tuberculosis, and malaria; 
‘‘(5) reinforcing efforts to— 
‘‘(A) develop safe and effective vaccines, microbicides, 
and other prevention and treatment 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 REPORTS. 
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.
H. R. 5501—6 
TITLE I—POLICY PLANNING AND 
COORDINATION 
SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 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 follows: 
‘‘(a) STRATEGY.—The President shall establish a comprehensive, 
integrated, 5-year strategy to expand and improve 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 international campaign against 
this disease and strengthen the capacities of nations experi-
encing 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 national response; and 
‘‘(C) evidence-based improvements and innovations 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 appro-
priate; 
‘‘(4) provide a plan to— 
‘‘(A) prevent 12,000,000 new HIV infections worldwide; 
‘‘(B) support— 
‘‘(i) the increase in the number of individuals with 
HIV/AIDS receiving antiretroviral treatment above the 
goal established under section 402(a)(3) and increased 
pursuant to paragraphs (1) through (3) of section 
403(d); and 
‘‘(ii) additional treatment through coordinated 
multilateral efforts; 
‘‘(C) support care for 12,000,000 individuals infected 
with or affected by HIV/AIDS, including 5,000,000 orphans 
and vulnerable children affected by HIV/AIDS, with an 
emphasis on promoting a comprehensive, coordinated 
system of services to be integrated throughout the con-
tinuum of care; 
‘‘(D) help partner countries in the effort to achieve 
goals of 80 percent access to counseling, testing, and treat-
ment to prevent the transmission of HIV from mother 
to child, emphasizing a continuum of care model; 
‘‘(E) help partner countries to provide care and treat-
ment services to children with HIV in proportion to their 
percentage within the HIV-infected population in each 
country; 
‘‘(F) promote preservice training for health profes-
sionals designed to strengthen the capacity of institutions
H. R. 5501—7 
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 physi-
cians, 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 reten-
tion of health care professionals and paraprofessionals, 
with the target of training and retaining at least 140,000 
new health care professionals and paraprofessionals with 
an emphasis on training and in country deployment of 
critically needed doctors and nurses and to strengthen 
capacities in developing countries, especially in sub-Saha-
ran Africa, to deliver primary health care with the objective 
of helping countries achieve staffing levels of at least 2.3 
doctors, nurses, and midwives per 1,000 population, as 
called for by the World Health Organization; 
‘‘(5) include multisectoral approaches and specific 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 treat-
ment; 
‘‘(7) expand the integration of timely and relevant research 
within the prevention, care, and treatment of HIV/AIDS; 
‘‘(8) include a plan for program monitoring, operations 
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, pref-
erably through public-private partnerships, of scientific inves-
tigators, managers, and other staff who are capable of pro-
moting the systematic uptake of clinical research findings and 
other evidence-based interventions into routine practice, with 
the goal of improving the quality, effectiveness, and local leader-
ship of HIV/AIDS health care; 
‘‘(10) expand and accelerate research on and development 
of HIV/AIDS prevention methods for women, including 
enhancing inter-agency collaboration, staffing, and organiza-
tional infrastructure dedicated to microbicide research; 
‘‘(11) provide for consultation with local leaders and officials 
to develop prevention strategies and programs that are tailored 
to the unique needs of each country and community and tar-
geted particularly toward those most at risk of acquiring HIV 
infection; 
‘‘(12) make the reduction of HIV/AIDS behavioral risks 
a priority of all prevention efforts by—
H. R. 5501—8 
‘‘(A) promoting abstinence from sexual activity and 
encouraging monogamy and faithfulness; 
‘‘(B) encouraging the correct and consistent use of male 
and female condoms and increasing the availability of, 
and access to, these commodities; 
‘‘(C) promoting the delay of sexual debut and the reduc-
tion 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 practices; 
‘‘(E) promoting voluntary counseling and testing, addic-
tion 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 pro-
curing sex commercially and about the need to end violent 
behavior toward women and girls; 
‘‘(G) supporting partner country and community efforts 
to identify and address social, economic, or cultural factors, 
such as migration, urbanization, conflict, gender-based 
violence, lack of empowerment for women, and transpor-
tation 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 workers and their families; 
‘‘(I) promoting cooperation with law enforcement 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 exploitation of women and 
children; 
‘‘(13) include programs to reduce the transmission of HIV, 
particularly addressing the heightened vulnerabilities of women 
and girls to HIV in many countries; and 
‘‘(14) support other important means of preventing or 
reducing the transmission of HIV, including— 
‘‘(A) medical male circumcision; 
‘‘(B) the maintenance of a safe blood supply; 
‘‘(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 exposures during 
formal and informal health care and cosmetic services; 
‘‘(E) investigating suspected nosocomial infections to 
identify and stop further nosocomial transmission; and 
‘‘(F) other mechanisms to reduce the transmission of 
HIV; 
‘‘(15) increase support for prevention of mother-to-child 
transmission; 
‘‘(16) build capacity within the public health sector of devel-
oping countries by improving health systems and public health 
infrastructure and developing indicators to measure changes 
in broader public health sector capabilities; 
‘‘(17) increase the coordination of HIV/AIDS programs with 
development programs;
H. R. 5501—9 
‘‘(18) provide a framework for expanding or developing 
existing or new country or regional programs, including— 
‘‘(A) drafting compacts or other agreements, as appro-
priate; 
‘‘(B) establishing criteria and objectives for such com-
pacts and agreements; and 
‘‘(C) promoting sustainability; 
‘‘(19) provide a plan for national and regional priorities 
for resource distribution and a global investment plan by region; 
‘‘(20) provide a plan to address the immediate and ongoing 
needs of women and girls, which— 
‘‘(A) addresses the vulnerabilities that contribute to 
their elevated risk of infection; 
‘‘(B) includes specific goals and targets to address these 
factors; 
‘‘(C) provides clear guidance to field missions 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 reducing vulnerabilities 
to HIV/AIDS; 
‘‘(G) addresses and prevents gender-based violence; and 
‘‘(H) addresses the posttraumatic and psychosocial con-
sequences and provides postexposure prophylaxis pro-
tecting 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 leadership at the 
community level in efforts to promote HIV prevention, 
reduce stigma, promote participation in voluntary coun-
seling and testing, 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 international actors 
and partner countries toward universal access to HIV/AIDS 
prevention, treatment, and care programs, recognizing that 
prevention is of particular importance;