Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title and table of contents. 
Sec. 2. Findings. 
Sec. 3. Definitions. 
Sec. 4. Purpose. 
TITLE I—POLICY PLANNING AND COORDINATION 
Sec. 101. Development of a comprehensive, five-year, global strategy. 
Sec. 102. HIV/AIDS Response Coordinator. 
TITLE II—SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PARTNERSHIPS 
Sec. 201. Sense of Congress on public-private partnerships. 
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis and 
Malaria. 
Sec. 203. Voluntary contributions to international vaccine funds. 
Sec. 204. Program to facilitate availability of microbicides to prevent trans-
mission of HIV and other diseases. 
Sec. 205.
Plan to combat HIV/AIDS, tuberculosis, and malaria by strength-
ening health policies and health systems of host countries. 
TITLE III—BILATERAL EFFORTS 
Subtitle A—General Assistance and Programs 
Sec. 301. Assistance to combat HIV/AIDS. 
Sec. 302. Assistance to combat tuberculosis. 
Sec. 303. Assistance to combat malaria. 
Sec. 304. Health care partnerships to combat HIV/AIDS. 
Subtitle B—Assistance for Women, Children, and Families 
Sec. 311. Policy and requirements. 
Sec. 312. Annual reports on prevention of mother-to-child transmission of the 
HIV infection. 
Sec. 313. Strategy to prevent HIV infections among women and youth. 
Sec. 314. Clerical amendment. 
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TITLE IV—AUTHORIZATION OF APPROPRIATIONS 
Sec. 401. Authorization of appropriations. 
Sec. 402. Sense of Congress. 
Sec. 403. Allocation of funds. 
Sec. 404. Prohibition on taxation by foreign governments. 
TITLE V—SUSTAINABILITY AND STRENGTHENING OF HEALTH 
CARE SYSTEMS 
Sec. 501. Sustainability and strengthening of health care systems. 
Sec. 502. Clerical amendment. 
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 fol-
lowing: 
‘‘(29) The HIV/AIDS pandemic continues to 
pose a major threat to the health of the global com-
munity, from the most severely-affected regions of 
sub-Saharan Africa and the Caribbean, to the 
emerging epidemics of Eastern Europe, Central 
Asia, South and Southeast Asia, and Latin America. 
‘‘(30) According to UNAIDS’ 2007 global esti-
mates, there are 33.2 million individuals with HIV/ 
AIDS worldwide, including 2.5 million people newly- 
infected with HIV. Of those infected with HIV, 2.5 
million are children under 15 who also account for 
460,000 of the newly-infected individuals. 
‘‘(31) Sub-Saharan Africa continues to be the 
region most affected by the HIV/AIDS pandemic. 
More than 68 percent of adults and nearly 90 per-
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cent of children with HIV/AIDS live in sub-Saharan 
Africa, and more than 76 percent of AIDS deaths 
in 2007 occurred in sub-Saharan Africa. 
‘‘(32) Although sub-Saharan Africa carries the 
heaviest disease burden of HIV/AIDS, the HIV/ 
AIDS pandemic continues to affect virtually every 
world region. While prevalence rates are relatively 
low in Eastern Europe, Central Asia, South and 
Southeast Asia, and Latin America, without effective 
prevention strategies, HIV prevalence rates could 
rise quickly in these regions. 
‘‘(33) By world region, according to UNAIDS’ 
2007 global estimates— 
‘‘(A) in sub-Saharan Africa, there were 
22.5 million adults and children infected with 
HIV, up from 20.9 million in 2001, with 1.7 
million new HIV infections, a 5 percent preva-
lence rate, and 1.6 million deaths; 
‘‘(B) in South and Southeast Asia, there 
were 4 million adults and children infected with 
HIV, up from 3.5 million in 2001, with 
340,000 new HIV infections, a 0.3 percent 
prevalence rate, and 270,000 deaths; 
‘‘(C) in East Asia, there were 800,000 
adults and children infected with HIV, up from 
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420,000 in 2001, with 92,000 new HIV infec-
tions, a 0.1 percent prevalence rate, and 32,000 
deaths; 
‘‘(D) in Eastern and Central Europe, there 
were 1.6 million adults and children infected 
with HIV, up from 630,000 in 2001, with 
150,000 new HIV infections, a 0.9 percent 
prevalence rate, and 55,000 deaths; and 
‘‘(E) in the Caribbean, there were 230,000 
adults and children infected with HIV, up from 
190,000 in 2001, with 17,000 new HIV infec-
tions, a 1 percent prevalence rate, and 11,000 
deaths. 
‘‘(34) Tuberculosis is the number one killer of 
individuals with HIV/AIDS and is responsible for up 
to one-half of HIV/AIDS deaths in Africa. 
‘‘(35) The wide extent of drug resistant tuber-
culosis, including both multi-drug resistant tuber-
culosis (MDR–TB) and extensively drug resistant 
tuberculosis (XDR–TB), driven by the HIV/AIDS 
pandemic in sub-Saharan Africa, has hampered both 
HIV/AIDS and tuberculosis treatment services. The 
World Health Organization (WHO) has declared the 
prevalence of tuberculosis to be at emergency levels 
in sub-Saharan Africa. 
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‘‘(36) Forty percent of the world’s population, 
mostly poor, live in malarial zones, and malaria, 
which is highly preventable, kills more than 1 million 
individuals worldwide each year. Ninety percent of 
malaria’s victims are in sub-Saharan Africa and 70 
percent of malaria’s victims are children under the 
age of 5. Additionally, hunger and malnutrition kill 
another 6 million individuals worldwide each year. 
‘‘(37) Assistance to combat HIV/AIDS must 
address the nutritional factors associated with the 
disease in order to be effective and sustainable. The 
World Food Program estimates that 6.4 million indi-
viduals affected by HIV will need nutritional support 
by 2008. 
‘‘(38) Women and girls continue to be vulner-
able to HIV, in large part, due to gender-based cul-
tural norms that leave many women and girls power-
less to negotiate social relationships. 
‘‘(39) Women make up 50 percent of individ-
uals infected with HIV worldwide. In sub-Saharan 
Africa, where the HIV/AIDS epidemic is most se-
vere, women make up 57 percent of individuals in-
fected with HIV, and 75 percent of young people in-
fected with HIV in sub-Saharan Africa are young 
women ages 15 to 24. 
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‘‘(40) Women and girls are biologically, socially, 
and economically more vulnerable to HIV infection. 
Gender disparities in the rate of HIV infection are 
the result of a number of factors, including the fol-
lowing: 
‘‘(A) Cross-generational sex with older men 
who are more likely to be infected with HIV, 
and a lack of choice regarding when and whom 
to marry, leading to early marriages and high 
rates of child marriages with older men. About 
one-half of all adolescent females in sub-Saha-
ran Africa and two-thirds of adolescent females 
in Asia are married by age 18. 
‘‘(B) Studies show that married women 
and married and unmarried girls often are un-
able or find it difficult to negotiate the fre-
quency and timing of sexual intercourse, ensure 
their partner’s faithfulness, or insist on condom 
use. Under these circumstances, women often 
run the risk of being infected by husbands or 
male partners in societies where men in rela-
tionships have more than one partner. Behavior 
change is particularly important in societies in 
which this is a common practice. 
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‘‘(C) Because young married women and 
girls are more likely to have unprotected sex 
and have more frequent sex than their unmar-
ried peers, and women and girls who are faith-
ful to their spouses can be placed at risk of 
HIV/AIDS through a husband’s infidelity or 
prior infection, marriage is not always a guar-
antee against HIV infection, although it is a 
protective factor overall. 
‘‘(D) Social and economic inequalities 
based largely on gender limit access for women 
and girls to education and employment opportu-
nities and prevent them from asserting their in-
heritance and property rights. For many 
women, a lack of independent economic means 
combines with socio-cultural practices to sustain 
and exacerbate their fear of abandonment, evic-
tion, or ostracism from their homes and com-
munities and can leave many more women 
trapped within relationships where they are vul-
nerable to HIV infection. 
‘‘(E) A lack of educational opportunities 
for women and girls is linked to younger sexual 
debut, earlier childhood marriage, earlier child-
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bearing, decreased child survival, worsening nu-
trition, and increased risk of HIV infection. 
‘‘(F) High rates of gender-based violence, 
rape, and sexual coercion within and outside 
marriage contribute to high rates of HIV infec-
tion. According to the World Health Organiza-
tion, between one-sixth and three-quarters of 
women in various countries and settings have 
experienced some form of physical or sexual vio-
lence since the age of 15 within or outside of 
marriage. Women who are unable to protect 
themselves from such violence are often unable 
to protect themselves from being infected with 
HIV through forced sexual contact. 
‘‘(G) Fear of domestic violence and the 
continuing stigma and discrimination associated 
with HIV/AIDS prevent many women from ac-
cessing information about HIV/AIDS, getting 
tested, disclosing their HIV status, accessing 
services to prevent mother-to-child transmission 
of HIV, or receiving treatment and counseling 
even when they already know they have been in-
fected with HIV. 
‘‘(H) According to UNAIDS, the vulner-
ability of individuals involved in commercial sex 
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acts to HIV infection is heightened by stig-
matization and marginalization, limited eco-
nomic options, limited access to health, social, 
and legal services, limited access to information 
and prevention means, gender-related dif-
ferences and inequalities, sexual exploitation 
and trafficking, harmful or non-protective laws 
and policies, and exposure to risks associated 
with commercial sex acts, such as violence, sub-
stance abuse, and increased mobility. 
‘‘(I) Lack of access to basic HIV preven-
tion information and education and lack of co-
ordination with existing primary health care to 
reduce stigma and maximize coverage. 
‘‘(J) Lack of access to currently available 
female-controlled HIV prevention methods, such 
as the female condom, and lack of training on 
proper use of either male or female condoms. 
‘‘(K) High rates of other sexually trans-
mitted infections and complications during 
pregnancies and childbirth. 
‘‘(L) An absence of functioning legal 
frameworks to protect women and girls and, 
where such frameworks exist, the lack of ac-
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countable and effective enforcement of such 
frameworks. 
‘‘(41) In addition to vulnerabilities to HIV in-
fection, women in sub-Saharan Africa face a 1-in-13 
chance of dying in childbirth compared to a 1-in-16 
chance in least-developed countries worldwide, a 1- 
in-60 chance in developing countries, and a 1-in- 
4,100 chance in developed countries. 
‘‘(42) Due to these high maternal mortality 
rates and high HIV prevalence rates in certain coun-
tries, special attention is needed in these countries 
to help HIV-positive women safely deliver healthy 
babies and save women’s lives. 
‘‘(43) Unprotected sex within or outside of mar-
riage is the single greatest factor in the transmission 
of HIV worldwide and is responsible for 80 percent 
of new HIV infections in sub-Saharan Africa. 
‘‘(44) Multiple randomized controlled trials 
have established that male circumcision reduces a 
man’s risk of contracting HIV by 60 percent or 
more. Twelve acceptability studies have found that 
in regions of sub-Saharan Africa where circumcision 
is not traditionally practiced, a majority of men 
want the procedure. Broader availability of male cir-
cumcision services could prevent millions of HIV in-
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fections not only in men but also in their female 
partners. 
‘‘(45)(A) Youth also face particular challenges 
in receiving services for HIV/AIDS. 
‘‘(B) Nearly one-half of all orphans who have 
lost one parent and two-thirds of those who have lost 
both parents are ages 12 to 17. These orphans are 
in particular need of services to protect themselves 
against sexually-transmitted infections, including 
HIV. 
‘‘(C) Research indicates that many youth ben-
efit from full disclosure of medically accurate, age- 
appropriate information about abstinence, partner 
reduction, and condoms. Providing comprehensive 
information about HIV, including delay of sexual 
debut and the ABC model: ‘Abstain, Be faithful, use 
Condoms’, and linking such information to health 
care can help improve awareness of safe sex prac-
tices and address the fact that only 1 in 3 young 
men and 1 in 5 young women ages 15 to 24 can cor-
rectly identify ways to prevent HIV infection. 
‘‘(D) Surveys indicate that no country has suc-
ceeded in fully educating more than one-half of its 
youth about the prevention and transmission of 
HIV. 
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