IIB 
110TH CONGRESS 
2D SESSION 
H. R. 5501 
IN THE SENATE OF THE UNITED STATES 
APRIL 3, 2008 
Received; read twice and referred to the Committee on Foreign Relations 
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 pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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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. 
TITLE IV—AUTHORIZATION OF APPROPRIATIONS 
Sec. 401. Authorization of appropriations. 
Sec. 402. Sense of Congress. 
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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-
cent of children with HIV/AIDS live in sub-Saharan 
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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 
420,000 in 2001, with 92,000 new HIV infec-
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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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‘‘(46) According to the United Nations High 
Commissioner for Refugees (UNHCR), HIV/AIDS 
prevalence rates among refugees are generally lower 
than the HIV/AIDS prevalence rates for their host 
communities, though perceptions run counter to this 
fact. However, peacekeeping operations that no 
longer deploy HIV/AIDS-positive troops still face 
vulnerabilities to sexual transmission of HIV with 
HIV-positive individuals in refugee camps. Host 
countries generally do not provide HIV/AIDS pre-
vention, treatment, and care services for refugees. 
‘‘(47) Continuing progress to reach the millions 
of impoverished individuals who need voluntary test-
ing, counseling, treatment, and care for HIV/AIDS 
requires increased efforts to strengthen health care 
delivery systems and infrastructure, rebuild and ex-
pand the health care workforce, and strengthen al-
lied and support services in countries receiving 
United States global HIV/AIDS assistance. 
‘‘(48) While HIV/AIDS poses the greatest 
health threat of modern times, it also poses the 
greatest development challenge for developing coun-
tries with fragile economies and weak public finan-
cial management systems that are ill equipped to 
shoulder the burden of this disease. International 
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donors will have to play a critical role in providing 
resources for HIV/AIDS programs far into the fu-
ture. 
‘‘(49) The emerging partnerships between coun-
tries most affected by HIV/AIDS and the United 
States must include stronger coordination between 
HIV/AIDS programs and other United States for-
eign assistance programs, and stronger collaboration 
with other donors in the areas of economic develop-
ment and growth strategies. 
‘‘(50) The future control of HIV/AIDS de-
mands coordination between international organiza-
tions such as the Global Fund to Fight AIDS, Tu-
berculosis and Malaria, UNAIDS, the World Health 
Organization (WHO), the World Bank and the 
International Monetary Fund (IMF), the inter-
national donor community, national governments, 
and private sector organizations, including commu-
nity and faith-based organizations. 
‘‘(51) The future control of HIV/AIDS further 
requires effective and transparent public finance 
management systems in developing countries to ad-
vance the ability of such countries to manage public 
revenues and donor funds aimed at combating HIV/ 
AIDS and other diseases. 
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‘‘(52) The HIV/AIDS pandemic contributes to 
the shortage of health care personnel through loss of 
life and illness, unsafe working conditions, increased 
workloads for diminished staff, and resulting stress 
and burnout, while the shortage of health care per-
sonnel undermines efforts to prevent and provide 
care and treatment for individuals with HIV/AIDS. 
‘‘(53) The shortage of health care personnel, in-
cluding doctors, nurses, pharmacists, counselors, lab-
oratory staff, paraprofessionals, trained lay workers, 
and researchers is one of the leading obstacles to 
combating HIV/AIDS in sub-Saharan Africa. 
‘‘(54) Since 2003, important progress has been 
made in combating HIV/AIDS, yet there is more to 
be done. The number of new HIV infections is still 
increasing at an alarming rate. According to the 
United States National Institute of Allergy and In-
fectious Diseases, globally, for every 1 individual put 
on antiretroviral therapy, 6 individuals are newly in-
fected with HIV. 
‘‘(55) The United States Government continues 
to be the world’s leader in the fight against HIV/ 
AIDS and the unsurpassed partner with developing 
countries in their efforts to control this disease. 
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‘‘(56) By September 2007, the United States, 
through the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7601 et seq.), had provided services to pre-
vent mother-to-child-transmission of HIV to women 
during 
million 
pregnancies; 
provided 
antiretroviral prophylaxis for women during over 
827,300 
pregnancies; 
prevented 
an 
estimated 
157,240 HIV infections in infants; cared for over 
6.6 million individuals, including over 2.7 million or-
phans and vulnerable children; supported lifesaving 
antiretroviral therapies for approximately 1.4 million 
men, women, and children in sub-Saharan Africa, 
Asia, and the Carribean; and provided counseling 
and testing to over 33.7 million men, women, and 
children in developing countries. 
‘‘(57) These numbers were achieved because of 
the commitment of substantial resources and sup-
port of the United States Government to our part-
ners on the front lines—the dedicated and com-
mitted women and men, communities, and nations 
who are taking control of the HIV/AIDS epidemics 
in their own countries.’’. 
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SEC. 3. DEFINITIONS. 
Section 3(2) of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7602(2)) is amended by striking ‘‘Committee on 
International Relations’’ and inserting ‘‘Committee on 
Foreign Affairs’’. 
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 en-
hance United States global leadership and the effective-
ness of the United States response to the HIV/AIDS, tu-
berculosis, and malaria pandemics and other related and 
preventable infectious diseases in developing countries 
by— 
‘‘(1) establishing a comprehensive, integrated 
five-year, global strategy to fight HIV/AIDS, tuber-
culosis, and malaria that encompasses a plan for 
continued expansion and coordination of critical pro-
grams and improved coordination among relevant 
executive branch agencies and between the United 
States and foreign governments and international 
organizations; 
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‘‘(2) providing increased resources for United 
States bilateral efforts to combat HIV/AIDS, tuber-
culosis, and malaria, particularly for prevention, 
treatment, and care (including nutritional support), 
technical assistance and training, the strengthening 
of health care systems, health care workforce devel-
opment, monitoring and evaluations systems, and 
operations research; 
‘‘(3) providing increased resources for multilat-
eral efforts to combat HIV/AIDS, tuberculosis, and 
malaria; 
‘‘(4) encouraging the expansion of private sec-
tor efforts and expanding public-private sector part-
nerships to combat HIV/AIDS; and 
‘‘(5) intensifying efforts to support the develop-
ment of vaccines, microbicides, and other prevention 
technologies and improved diagnostics treatment for 
HIV/AIDS, tuberculosis, and malaria.’’. 
TITLE I—POLICY PLANNING AND 
COORDINATION 
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE- 
YEAR, GLOBAL STRATEGY. 
(a) STRATEGY.—Subsection (a) of section 101 of the 
United States Leadership Against HIV/AIDS, Tuber-
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culosis, and Malaria Act of 2003 (22 U.S.C. 7611) is 
amended— 
(1) in the first sentence of the matter preceding 
paragraph (1), by striking ‘‘to combat’’ and insert-
ing ‘‘to develop efforts further to combat’’; 
(2) by amending paragraph (4) to read as fol-
lows: 
‘‘(4) provide that the reduction of HIV/AIDS 
behavioral risks shall be a priority of all prevention 
efforts in terms of funding, scientifically-accurate 
educational services, and activities by— 
‘‘(A) designing prevention strategies and 
programs based on sound epidemiological evi-
dence, tailored to the unique needs of each 
country and community, and reaching those 
populations found to be most at risk for acquir-
ing HIV infection; 
‘‘(B) promoting abstinence from sexual ac-
tivity and substance abuse; 
‘‘(C) encouraging delay of sexual debut, 
monogamy, fidelity, and partner reduction; 
‘‘(D) promoting the effective use of male 
and female condoms; 
‘‘(E) promoting the use of measures to re-
duce the risk of HIV transmission for discord-
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ant couples (where one individual has HIV/ 
AIDS and the other individual does not have 
HIV/AIDS or whose status is unknown); 
‘‘(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) promoting the rapid expansion of safe 
and voluntary male circumcision services; 
‘‘(H) promoting life skills training and de-
velopment for children and youth; 
‘‘(I) supporting advocacy for child and 
youth community-based protective social serv-
ices; 
‘‘(J) eradicating trafficking in persons and 
creating alternatives to prostitution; 
‘‘(K) promoting cooperation with law en-
forcement to prosecute offenders of trafficking, 
rape, and sexual assault crimes with the goal of 
eliminating such crimes; 
‘‘(L) promoting services demonstrated to 
be effective in reducing the transmission of HIV 
infection among injection drug users without in-
creasing illicit drug use; 
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‘‘(M) promoting policies and programs to 
end the sexual exploitation of and violence 
against women and children; and 
‘‘(N) promoting prevention and treatment 
services for men who have sex with men;’’; 
(3) by redesignating paragraphs (5) through 
(10) as paragraphs (6) through (11), respectively; 
(4) by inserting after paragraph (4) (as amend-
ed by paragraph (2) of this subsection) the fol-
lowing: 
‘‘(5) include specific plans for linkage to, and 
referral systems for nongovernmental organizations 
that implement multisectoral approaches, including 
faith-based and community-based organizations, 
for— 
‘‘(A) nutrition and food support for indi-
viduals with HIV/AIDS and affected commu-
nities; 
‘‘(B) child health services and development 
programs; 
‘‘(C) HIV/AIDS prevention and treatment 
services for injection drug users; 
‘‘(D) access to HIV/AIDS education and 
testing in family planning and maternal health 
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programs supported by the United States Gov-
ernment; and 
‘‘(E) medical, social, and legal services for 
victims of violence;’’; 
(5) by redesignating paragraphs (10) and (11) 
(as redesignated by paragraph (3) of this sub-
section) as paragraphs (11) and (12), respectively; 
and 
(6) by inserting after paragraph (9) (as redesig-
nated by paragraph (3) of this subsection) the fol-
lowing: 
‘‘(10) maximize host country capacities in train-
ing and research, particularly operations research;’’. 
(b) REPORT.—Subsection (b) of such section is 
amended— 
(1) in paragraph (1), by striking ‘‘this Act’’ and 
inserting ‘‘the Tom Lantos and Henry J. Hyde 
Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act of 2008’’; and 
(2) in paragraph (3)— 
(A) by amending subparagraph (C) to read 
as follows: 
‘‘(C) A description of the manner in which 
the strategy will address the following: 
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‘‘(i) The fundamental elements of pre-
vention and education, care and treatment, 
including increasing access to pharma-
ceuticals, vaccines, and microbicides, as 
they become available, screening, prophy-
laxis, and treatment of major opportunistic 
infections, including tuberculosis, and in-
creasing access to nutrition and food for 
individuals on antiretroviral therapies. 
‘‘(ii) The promotion of delay of sexual 
debut, abstinence, monogamy, fidelity, and 
partner reduction. 
‘‘(iii) The promotion of correct and 
consistent use of male and female condoms 
and other strategies and skills development 
to reduce the risk of HIV transmission. 
‘‘(iv) Increasing voluntary access to 
safe male circumcision services. 
‘‘(v) Life-skills training. 
‘‘(vi) The provision of information and 
services to encourage young people to delay 
sexual debut and ensure access to HIV/ 
AIDS prevention information and services. 
‘‘(vii) Prevention of sexual violence 
leading to transmission of HIV and assist-
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ance for victims of violence who are at risk 
of HIV transmission. 
‘‘(viii) HIV/AIDS prevention, care, 
and treatment services for injection drug 
users. 
‘‘(ix) Research, including incentives 
for HIV vaccine development and new pro-
tocols. 
‘‘(x) Advocacy for community-based 
child and youth protective services. 
‘‘(xi) Training of health care workers. 
‘‘(xii) The development of health care 
infrastructure and delivery systems. 
‘‘(xiii) Prevention efforts for sub-
stance abusers. 
‘‘(xiv) Prevention, treatment, care, 
and outreach efforts for men who have sex 
with men.’’; 
(B) in subparagraph (D), by adding at the 
end before the period the following: ‘‘, including 
through faith-based and other nongovernmental 
organizations’’; 
(C) in subparagraph (E), by inserting ‘‘ac-
cess to HIV/AIDS education and testing in 
family planning and maternal and child health 
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programs supported by the United States Gov-
ernment and’’ after ‘‘the unique needs of 
women, including’’; 
(D) in subparagraph (F), by inserting 
‘‘(including by accessing voluntary clinical cir-
cumcision services)’’ after ‘‘in their sexual be-
havior’’; 
(E) in subparagraph (G), by inserting 
‘‘and men’s’’ after ‘‘women’s’’; 
(F) by redesignating subparagraphs (M) 
through (W) as subparagraphs (N) through 
(X); 
(G) by inserting after subparagraph (L) 
the following: 
‘‘(M) A description of efforts to be under-
taken to strengthen the public finance manage-
ment systems of selected host countries to en-
sure transparent, efficient, and effective man-
agement of national and donor financial invest-
ments in health.’’; 
(H) in subparagraph (O) (as redesignated 
by subparagraph (F) of this paragraph), by 
striking ‘‘evaluating programs,’’ and inserting 
‘‘evaluating programs to ensure medical accu-
racy, operations research,’’; 
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(I) in subparagraph (Q) (as redesignated 
by subparagraph (F) of this paragraph), by in-
serting ‘‘, strengthen national health care deliv-
ery systems, and increase national health work-
force capacities,’’ after ‘‘HIV/AIDS pandemic’’; 
(J) in subparagraph (R) (as redesignated 
by subparagraph (F) of this paragraph), by in-
serting at the end before the period the fol-
lowing: ‘‘, including strategies relating to agri-
cultural development, trade and economic 
growth, and education’’; 
(K) in subparagraph (T) (as redesignated 
by subparagraph (F) of this paragraph), by in-
serting ‘‘efforts of intergenerational caregivers 
and’’ after ‘‘, including’’; 
(L) by redesignating subparagraphs (V) 
through (X) (as redesignated by subparagraph 
(F) of this paragraph), as subparagraphs (W) 
through (Y), respectively; 
(M) by inserting after subparagraph (U) 
(as redesignated by subparagraph (F) of this 
paragraph) the following: 
‘‘(V) A plan to strengthen and implement 
health care workforce strategies to enable coun-
tries to increase the supply and retention of all 
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cadres of trained professional and paraprofes-
sional health care workers by numbers that 
move toward global health program needs and 
toward targets established by the World Health 
Organization, while enabling health systems to 
expand coverage consistent with national and 
international targets and goals.’’; and 
(N) by striking subparagraph (Y) (as re-
designated by subparagraphs (F) and (L) of 
this paragraph) and inserting the following: 
‘‘(Y) A description of the specific strate-
gies, developed in coordination with existing 
health programs, to prevent mother-to-child 
transmission of HIV, including the extent to 
which HIV-positive women and men in treat-
ment, care, and support programs and HIV- 
negative women and men are counseled about 
methods of preventing HIV transmission and 
the extent to which HIV prevention methods 
are provided on-site or by referral in treatment, 
care, and support programs. 
‘‘(Z) A description of the specific strategies 
developed to maximize the capacity of health 
care providers, including faith-based and other 
nongovernmental 
organizations, 
and 
family 
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planning providers supported by the United 
States Government to ensure access to nec-
essary and comprehensive information about re-
ducing sexual transmission of HIV among 
women, men, and young people, including strat-
egies to ensure HIV/AIDS prevention training 
for such providers. 
‘‘(AA) A strategy to work with inter-
national and host country partners toward uni-
versal access to HIV/AIDS prevention, treat-
ment, and care programs.’’. 
(c) STRATEGIC PLAN FOR PROGRAM MONITORING, 
OPERATIONS RESEARCH, AND IMPACT EVALUATION RE-
SEARCH.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Coordi-
nator of United States Government Activities to 
Combat HIV/AIDS Globally shall develop a 5-year 
strategic plan for program monitoring, operations 
research, and impact evaluation research of United 
States HIV/AIDS, tuberculosis, and malaria pro-
grams. 
(2) ELEMENTS OF PLAN.—The strategic plan 
developed under this subsection shall include— 
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(A) the amount of funding provided for 
program monitoring, operations research, and 
impact evaluation research under sections 
104A, 104B, and 104C of the Foreign Assist-
ance Act of 1961 (22 U.S.C. 2151b–2, 2151b– 
3, and 2151b–4) and the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Ma-
laria Act of 2003 (22 U.S.C. 7601 et seq.) 
available through fiscal year 2009; 
(B) strategies to— 
(i) improve the efficiency, effective-
ness, quality, and accessibility of services 
provided under the provisions of law de-
scribed in subparagraph (A); 
(ii) establish the cost-effectiveness of 
program models; 
(iii) ensure the transparency and ac-
countability of services provided under the 
provisions of law described in subpara-
graph (A); 
(iv) disseminate and promote the utili-
zation of evaluation findings, lessons, and 
best practices in services provided under 
the provisions of law described in subpara-
graph (A); and 
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(v) encourage and evaluate innovative 
service models and strategies to optimize 
the delivery of care, treatment, and preven-
tion programs financed by the United 
States Government; 
(C) priorities for program monitoring, op-
erations research, and impact evaluation re-
search and a time line for completion of activi-
ties associated with such priorities; and 
(D) other information that the Coordinator 
determines to be necessary. 
(3) CONSULTATION.—In developing the stra-
tegic plan under this subsection and implementing, 
disseminating, and promoting the use of program 
monitoring, operations research, and impact evalua-
tion research, the Coordinator shall consult with rep-
resentatives of relevant executive branch agencies, 
other appropriate executive branch agencies, multi-
lateral institutions involved in providing HIV/AIDS 
assistance, nongovernmental organizations involved 
in implementing HIV/AIDS programs, and the gov-
ernments of host countries. 
(4) DEFINITIONS.—In this subsection— 
(A) the terms ‘‘program monitoring’’, ‘‘op-
erations research’’, and ‘‘impact evaluation re-
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search’’, have the meanings given such terms in 
section 104A(d)(4)(B) of the Foreign Assist-
ance Act of 1961 (as added by section 
301(a)(4)(C) of this Act); and 
(B) the term ‘‘relevant executive branch 
agencies’’ 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. 102. HIV/AIDS RESPONSE COORDINATOR. 
Section 1(f)(2) of the State Department Basic Au-
thorities Act of 1956 (22 U.S.C. 2651a(f)(2)) is amend-
ed— 
(1) in subparagraph (A)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘, host country finance, health, and 
other relevant ministries’’ after ‘‘community- 
based organizations)’’; and 
(B) in clause (iii), by inserting ‘‘and host 
country finance, health, and other relevant min-
istries’’ 
after 
‘‘community-based 
organiza-
tions)’’; and 
(2) in subparagraph (B)(ii)— 
(A) by striking subclauses (IV) and (V) 
and inserting the following: 
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‘‘(IV) 
Establishing 
an 
inter-
agency working group on HIV/AIDS 
that is comprised of, but not limited 
to, representatives from the United 
States Agency for International Devel-
opment, the Department of Health 
and Human Services (including the 
Centers for Disease Control and Pre-
vention, the National Institutes of 
Health, and the Health Resources and 
Services Administration), the Depart-
ment of Labor, the Department of 
Agriculture, the Millennium Challenge 
Corporation, the Department of De-
fense, and the Office of the Coordi-
nator of United States Government 
Activities to Combat Malaria Globally, 
for the purposes of coordination of ac-
tivities relating to HIV/AIDS. The 
interagency working group shall— 
‘‘(aa) meet regularly to re-
view progress in host countries 
toward 
HIV/AIDS 
prevention, 
treatment, and care objectives; 
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‘‘(bb) 
participate 
in 
the 
process of identifying countries in 
need 
of 
increased 
assistance 
based on the epidemiology of 
HIV/AIDS in those countries; 
and 
‘‘(cc) review policies that 
may be obstacles to reaching ob-
jectives set forth for HIV/AIDS 
prevention, treatment, and care. 
‘‘(V) Coordinating overall United 
States HIV/AIDS policy and pro-
grams with efforts led by host coun-
tries and with the assistance provided 
by other relevant bilateral and multi-
lateral aid agencies and other donor 
institutions 
to 
achieve 
complementarity with other programs 
aimed at improving child and mater-
nal health, and food security, pro-
moting education, and strengthening 
health care systems.’’; 
(B) by redesignating subclauses (VII) and 
(VIII) as subclauses (IX) and (X), respectively; 
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(C) by inserting after subclause (VI) the 
following: 
‘‘(VII) Holding annual consulta-
tions with host country nongovern-
mental organizations providing serv-
ices to improve health, and advocating 
on behalf of the individuals with HIV/ 
AIDS and those at particular risk of 
contracting HIV/AIDS. 
‘‘(VIII) Ensuring, through inter-
agency and international coordination, 
that United States HIV/AIDS pro-
grams are coordinated with and com-
plementary to the delivery of related 
global health, food security, and edu-
cation services, including— 
‘‘(aa) maternal and child 
health care; 
‘‘(bb) services for other ne-
glected and easily preventable 
and treatable infectious diseases, 
such as tuberculosis; 
‘‘(cc) treatment and care 
services for injection drug users; 
and 
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‘‘(dd) programs and services 
to improve legal, social, and eco-
nomic status of women and 
girls.’’; 
(D) in subclause (IX) (as redesignated by 
subparagraph (B) of this paragraph)— 
(i) by inserting ‘‘Vietnam, Antigua 
and Barbuda, the Bahamas, Barbados, 
Belize, 
Dominica, 
Grenada, 
Jamaica, 
Montserrat, Saint Kitts and Nevis, Saint 
Vincent and the Grenadines, Saint Lucia, 
Suriname, Trinidad and Tobago, the Do-
minican Republic, Malawi, Swaziland, Le-
sotho’’ after ‘‘Zambia,’’; 
(ii) by adding at the end before the 
period the following: ‘‘and other countries 
in which the United States is implementing 
HIV/AIDS programs’’; and 
(iii) by adding at the end the fol-
lowing: ‘‘In designating countries under 
this subclause, the President shall give pri-
ority to those countries in which there is a 
high prevalence of HIV/AIDS and coun-
tries with large populations that have a 
concentrated HIV/AIDS epidemic.’’; 
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(E) by redesignating subclause (X) (as re-
designated by subparagraph (B) of this para-
graph) as subclause (XII); 
(F) by inserting after subclause (IX) (as 
redesignated by subparagraph (B) and amended 
by subparagraph (D) of this paragraph) the fol-
lowing: 
‘‘(X) Working, in partnership with 
host countries in which the HIV/AIDS epi-
demic is prevalent among injection drug 
users, to establish, as a national priority, 
national HIV/AIDS prevention programs, 
including education, and services dem-
onstrated to be effective in reducing the 
transmission of HIV infection among injec-
tion drug users without increasing drug 
use. 
‘‘(XI) Working, in partnership with 
host countries in which the HIV/AIDS epi-
demic is prevalent among individuals in-
volved in commercial sex acts, to establish, 
as a national priority, national prevention 
programs, including education, voluntary 
testing, and counseling, and referral sys-
tems that link HIV/AIDS programs with 
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programs to eradicate trafficking in per-
sons and create alternatives to prostitu-
tion.’’; 
(G) in subclause (XII) (as redesignated by 
subparagraphs (B) and (E) of this paragraph), 
by striking ‘‘funds section’’ and inserting 
‘‘funds appropriated pursuant to the authoriza-
tion of appropriations under section 401 of the 
United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 for HIV/ 
AIDS assistance’’; and 
(H) by adding at the end the following: 
‘‘(XIII) Publicizing updated drug 
pricing data to inform pharmaceutical 
procurement partners’ purchasing de-
cisions. 
‘‘(XIV) Working in partnership 
with host countries in which the HIV/ 
AIDS epidemic is prevalent among 
men who have sex with men, to estab-
lish, as a national priority, national 
HIV/AIDS prevention programs, in-
cluding education and services dem-
onstrated to be effective in reducing 
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the transmission of HIV among men 
who have sex with men.’’. 
TITLE II—SUPPORT FOR MULTI-
LATERAL FUNDS, PROGRAMS, 
AND PUBLIC-PRIVATE PART-
NERSHIPS 
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PART-
NERSHIPS. 
Section 201(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7621(a)) is amended— 
(1) in paragraph (2), by striking ‘‘infectious 
diseases’’ and inserting ‘‘easily preventable and 
treatable infectious diseases’’; and 
(2) in paragraph (4), by striking ‘‘infectious 
diseases’’ and inserting ‘‘easily preventable and 
treatable infectious diseases’’. 
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 
AIDS, TUBERCULOSIS AND MALARIA. 
(a) FINDINGS.—Subsection (a) of section 202 of the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (22 U.S.C. 7622) is 
amended— 
(1) by redesignating paragraphs (1) through 
(3) as paragraphs (7) through (9), respectively; and 
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(2) by inserting before paragraph (7) (as redes-
ignated by paragraph (1) of this subsection) the fol-
lowing: 
‘‘(1) The Global Fund to Fight AIDS, Tuber-
culosis and Malaria is the multilateral component of 
this Act, extending United States efforts to a total 
of 136 countries around the world. 
‘‘(2) Created in 2002, the Global Fund has 
played a leading role in the fight against HIV/AIDS, 
tuberculosis, and malaria around the world and has 
grown into an organization that currently provides 
nearly a quarter of all international financing to 
combat HIV/AIDS and two-thirds of all inter-
national financing to combat tuberculosis and ma-
laria. 
‘‘(3) By 2010, it is estimated that the demand 
for funding by the Global Fund will grow in size to 
between $6 and $8 billion annually, requiring signifi-
cant contributions from donors around the world, in-
cluding at least $2 billion annually from the United 
States. 
‘‘(4) The Global Fund is an innovative financ-
ing mechanism to combat HIV/AIDS, tuberculosis, 
and malaria, and has made progress in many areas. 
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‘‘(5) The United States Government is the larg-
est supporter of the Global Fund, both in terms of 
resources and technical support. 
‘‘(6) The United States made the initial con-
tribution to the Global Fund and is fully committed 
to its success.’’. 
(b) UNITED STATES FINANCIAL PARTICIPATION.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
Subsection (d)(1) of such section is amended— 
(A) by striking ‘‘$1,000,000,000’’ and in-
serting ‘‘$2,000,000,000’’; 
(B) by striking ‘‘for the period of fiscal 
year 2004 beginning on January 1, 2004,’’ and 
inserting ‘‘for each of the fiscal years 2009 and 
2010,’’; and 
(C) by striking ‘‘the fiscal years 2005– 
2008’’ and inserting ‘‘each of the fiscal years 
2011 through 2013’’. 
(2) LIMITATION.—Subsection (d)(4) of such 
section is amended— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking ‘‘fiscal 
years 2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; 
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(ii) in clause (ii), by striking ‘‘fiscal 
years 2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; and 
(iii) in clause (vi)— 
(I) by striking ‘‘for the purposes’’ 
and inserting ‘‘For the purposes’’; 
(II) by striking ‘‘fiscal years 
2004 through 2008’’ and inserting 
‘‘fiscal years 2009 through 2013’’; 
and 
(III) by striking ‘‘fiscal year 
2004’’ and inserting ‘‘fiscal year 
2009’’; 
(B) in subparagraph (B)(iv)— 
(i) by striking ‘‘fiscal years 2004 
through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’; and 
(ii) by adding at the end before the 
period the following: ‘‘, unless such amount 
is made available for more than one fiscal 
year, in which case such amount is author-
ized to be made available for such purposes 
after December 31 of the fiscal year fol-
lowing the fiscal year in which such funds 
first became available.’’; and 
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(C) in subparagraph (C)(ii) by striking 
‘‘Committee on International Relations’’ and in-
serting ‘‘Committee on Foreign Affairs’’. 
(3) STATEMENT
OF
POLICY.—The following 
shall be the policy of the United States: 
(A) Support for the Global Fund to Fight 
AIDS, Tuberculosis and Malaria should be 
based upon achievement of the following bench-
marks related to transparency and account-
ability: 
(i) As recommended by the Govern-
ment Accountability Office, the Fund Sec-
retariat has established standardized ex-
pectations for the performance of Local 
Fund Agents (LFAs), is undertaking a 
systematic assessment of the performance 
of LFAs, and is making available for pub-
lic review, according to the Fund Board’s 
policies and practices on disclosure of in-
formation, a regular collection and analysis 
of performance data of Fund grants, which 
shall cover both Principal Recipients and 
sub-recipients. 
(ii) A well-staffed, independent Office 
of the Inspector General reports directly to 
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the Board and is responsible for regular, 
publicly published audits of both financial 
and programmatic and reporting aspects of 
the Fund, its grantees, and LFAs, includ-
ing both Principal Recipients and sub-re-
cipients. 
(iii) The Fund Secretariat has estab-
lished and is reporting publicly on stand-
ard indicators for all program areas. 
(iv) The Fund Secretariat has estab-
lished a database that tracks all subrecipi-
ents and the amounts of funds disbursed 
to each, as well as the distribution of re-
sources, by grant and Principal Recipient, 
for prevention, care, treatment, the pur-
chases of drugs and commodities, and 
other purposes. 
(v) The Fund Board has established a 
penalty to offset tariffs imposed by na-
tional governments on all goods and serv-
ices provided by the Fund. 
(vi) The Fund Board has successfully 
terminated its Administrative Services 
Agreement with the World Health Organi-
zation and completed the Fund Secretar-
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iat’s transition to a fully independent sta-
tus under the Headquarters Agreement the 
Fund has established with the Government 
of Switzerland. 
(B) Support for the Global Fund to Fight 
AIDS, Tuberculosis and Malaria should be 
based upon achievement of the following bench-
marks related to the founding principles of the 
Fund: 
(i) The Fund must maintain its status 
as a financing institution. 
(ii) The Fund must remain focused on 
programs directly related to HIV/AIDS, 
malaria, and tuberculosis. 
(iii) The Fund must maintain its 
Comprehensive Funding Policy, which re-
quires confirmed pledges to cover the full 
amount of new grants before the Board 
approves them. 
(iv) The Fund must maintain and 
make progress on sustaining its multisec-
toral approach, through Country Coordi-
nating Mechanisms (CCMs) and in the im-
plementation of grants, as reflected in per-
cent and resources allocated to different 
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sectors, including governments, civil soci-
ety, and faith- and community-based orga-
nizations. 
(4) SENSE OF CONGRESS.—Congress— 
(A) notes that section 625 of Public Law 
110–161 establishes a requirement to withhold 
20 percent of funds appropriated for the Global 
Fund if the Global Fund fails to meet certain 
benchmarks; and 
(B) will continue to review the implementa-
tion of the benchmarks to ensure accountability 
and transparency of the Global Fund. 
SEC. 
203. 
VOLUNTARY 
CONTRIBUTIONS 
TO 
INTER-
NATIONAL VACCINE FUNDS. 
(a) VACCINE FUND.—Subsection (k) of section 302 
of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 
is amended by striking ‘‘fiscal years 2004 through 2008’’ 
and inserting ‘‘fiscal years 2009 through 2013’’. 
(b) INTERNATIONAL AIDS VACCINE INITIATIVE.— 
Subsection (l) of such section is amended by striking ‘‘fis-
cal years 2004 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’. 
(c) MALARIA VACCINE DEVELOPMENT PROGRAMS.— 
Subsection (m) of such section is amended by striking 
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HR 5501 RFS
TITLE III—BILATERAL EFFORTS 
Subtitle A—General Assistance and 
Programs 
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS. 
(a) AMENDMENTS
TO
THE FOREIGN ASSISTANCE 
ACT OF 1961.— 
(1) FINDING.—Subsection (a) of section 104A 
of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b–2) is amended by inserting ‘‘, South and 
Southeast Asia, Central and Eastern Europe’’ after 
‘‘the Caribbean’’. 
(2) POLICY.—Subsection (b) of such section is 
amended— 
(A) in the first sentence— 
(i) by striking ‘‘It is a major’’ and in-
serting the following: 
‘‘(1) GENERAL POLICY.—It is a major’’; 
(ii) by striking ‘‘control’’ and insert-
ing ‘‘care’’; and 
(iii) by adding at the end before the 
period the following: ‘‘and to fulfill United 
States commitments to move toward the 
goal of universal access to prevention, 
treatment, and care of HIV/AIDS’’; 
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