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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.’’. 
(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— 
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(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. 
‘‘(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 
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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 
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 
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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-
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 
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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-
dividuals, including orphans and vulnerable 
children; 
‘‘(B) fully integrate food and nutrition 
support into HIV/AIDS prevention, treatment, 
and care programs carried out under this Act 
and the amendments made by this Act; 
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‘‘(C) ensure, to the extent practicable, 
that— 
‘‘(i) HIV/AIDS prevention, treatment, 
and care providers and health care workers 
are adequately trained so that such pro-
viders and workers can provide accurate 
and informed information regarding food 
and nutrition support to individuals en-
rolled in treatment and care programs and 
individuals affected by HIV/AIDS; and 
‘‘(ii) individuals with HIV/AIDS who, 
with their households, are identified as 
food insecure are provided with adequate 
food and nutrition support; and 
‘‘(D) effectively link food and nutrition 
support provided under this Act and the 
amendments made by this Act to individuals 
with HIV/AIDS, their households, and their 
communities, to other food security and liveli-
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.— 
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‘‘(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); 
‘‘(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— 
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‘‘(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 
‘‘(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-
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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, 
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 
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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. 
‘‘(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 
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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-
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 
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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-
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.’’. 
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(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 
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. 
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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 
(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. 
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‘‘(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. 
‘‘(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-
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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 
(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/ 
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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. 
‘‘(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— 
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