Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008
PL 110-293 (H.R.5501), enacted 07/30/2008

122 STAT. 2918 
PUBLIC LAW 110–293—JULY 30, 2008 
Public Law 110–293 
110th Congress 
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. 
Tom Lantos and 
Henry J. Hyde 
United States 
Global 
Leadership 
Against 
HIV/AIDS, 
Tuberculosis, 
and Malaria 
Reauthorization 
Act of 2008. 
22 USC 7601 
note. 
July 30, 2008 
[H.R. 5501] 
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122 STAT. 2919 
PUBLIC LAW 110–293—JULY 30, 2008 
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 
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122 STAT. 2920 
PUBLIC LAW 110–293—JULY 30, 2008 
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’; 
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122 STAT. 2921 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(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 
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122 STAT. 2922 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(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. 
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122 STAT. 2923 
PUBLIC LAW 110–293—JULY 30, 2008 
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 
President. 
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122 STAT. 2924 
PUBLIC LAW 110–293—JULY 30, 2008 
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— 
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122 STAT. 2925 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(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; 
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122 STAT. 2926 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(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; 
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122 STAT. 2927 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(25) enhance the coordination of United States bilateral 
efforts to combat global HIV/AIDS with other major public 
and private entities; 
‘‘(26) enhance the attention given to the national strategic 
HIV/AIDS plans of countries receiving United States assistance 
by— 
‘‘(A) 
reviewing 
the 
planning 
and 
programmatic 
decisions associated with that assistance; and 
‘‘(B) helping to strengthen such national strategies, 
if necessary; 
‘‘(27) support activities described in the Global Plan to 
Stop TB, including— 
‘‘(A) expanding and enhancing the coverage of the 
Directly Observed Treatment Short-course (DOTS) in order 
to treat individuals infected with tuberculosis and HIV, 
including multi-drug resistant or extensively drug resistant 
tuberculosis; and 
‘‘(B) improving coordination and integration of HIV/ 
AIDS and tuberculosis programming; 
‘‘(28) ensure coordination between the Global AIDS Coordi-
nator and the Malaria Coordinator and address issues of comor-
bidity between HIV/AIDS and malaria; and 
‘‘(29) include a longer term estimate of the projected 
resource needs, progress toward greater sustainability and 
country ownership of HIV/AIDS programs, and the anticipated 
role of the United States in the global effort to combat HIV/ 
AIDS during the 10-year period beginning on October 1, 2013.’’. 
(b) REPORT.—Section 101(b) of such Act (22 U.S.C. 7611(b)) 
is amended to read as follows: 
‘‘(b) REPORT.— 
‘‘(1) IN
GENERAL.—Not later than October 1, 2009, the 
President shall submit a report to the appropriate congressional 
committees that sets forth the strategy described in subsection 
(a). 
‘‘(2) CONTENTS.—The report required under paragraph (1) 
shall include a discussion of the following elements: 
‘‘(A) The purpose, scope, methodology, and general and 
specific objectives of the strategy. 
‘‘(B) The problems, risks, and threats to the successful 
pursuit of the strategy. 
‘‘(C) The desired goals, objectives, activities, and out-
come-related performance measures of the strategy. 
‘‘(D) A description of future costs and resources needed 
to carry out the strategy. 
‘‘(E) A delineation of United States Government roles, 
responsibility, 
and 
coordination 
mechanisms 
of 
the 
strategy. 
‘‘(F) A description of the strategy— 
‘‘(i) to promote harmonization of United States 
assistance with that of other international, national, 
and private actors as elucidated in the ‘Three Ones’; 
and 
‘‘(ii) to address existing challenges in harmoni-
zation and alignment. 
‘‘(G) A description of the manner in which the strategy 
will— 
President. 
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122 STAT. 2928 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(i) further the development and implementation 
of the national multisectoral strategic HIV/AIDS 
frameworks of partner governments; and 
‘‘(ii) enhance the centrality, effectiveness, and 
sustainability of those national plans. 
‘‘(H) A description of how the strategy will seek to 
achieve the specific targets described in subsection (a) and 
other targets, as appropriate. 
‘‘(I) A description of, and rationale for, the timetable 
for annual global treatment targets with country-level esti-
mates of numbers of persons in need of antiretroviral treat-
ment, country-level benchmarks for United States support 
for assistance for antiretroviral treatment, and numbers 
of persons enrolled in antiretroviral treatment programs 
receiving United States support. If global benchmarks are 
not achieved within the reporting period, the report shall 
include a description of steps being taken to ensure that 
global benchmarks will be achieved and a detailed break-
down and justification of spending priorities in countries 
in which benchmarks are not being met, including a 
description of other donor or national support for 
antiretroviral treatment in the country, if appropriate. 
‘‘(J) A description of how operations research is 
addressed in the strategy and how such research can most 
effectively be integrated into care, treatment, and preven-
tion activities in order to— 
‘‘(i) improve program quality and efficiency; 
‘‘(ii) ascertain cost effectiveness; 
‘‘(iii) ensure transparency and accountability; 
‘‘(iv) assess population-based impact; 
‘‘(v) disseminate findings and best practices; and 
‘‘(vi) optimize delivery of services. 
‘‘(K) An analysis of United States-assisted strategies 
to prevent the transmission of HIV/AIDS, including meth-
odologies to promote abstinence, monogamy, faithfulness, 
the correct and consistent use of male and female condoms, 
reductions in concurrent sexual partners, and delay of 
sexual debut, and of intended monitoring and evaluation 
approaches to measure the effectiveness of prevention pro-
grams and ensure that they are targeted to appropriate 
audiences. 
‘‘(L) Within the analysis required under subparagraph 
(K), an examination of additional planned means of pre-
venting the transmission of HIV including medical male 
circumcision, maintenance of a safe blood supply, public 
education about risks to acquire HIV infection from blood 
exposures, promotion of universal precautions, investiga-
tion of suspected nosocomial infections and other tools. 
‘‘(M) A description of efforts to assist partner country 
and community to identify and address social, economic, 
or cultural factors, such as migration, urbanization, conflict, 
gender-based violence, lack of empowerment for women, 
and transportation patterns, which directly contribute to 
the transmission of HIV. 
‘‘(N) A description of the specific targets, goals, and 
strategies 
developed 
to 
address 
the 
needs 
and 
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122 STAT. 2929 
PUBLIC LAW 110–293—JULY 30, 2008 
vulnerabilities 
of 
women 
and 
girls 
to 
HIV/AIDS, 
including— 
‘‘(i) activities directed toward men and boys; 
‘‘(ii) activities to enhance educational, micro-
finance, and livelihood opportunities for women and 
girls; 
‘‘(iii) activities to promote and protect the legal 
empowerment of women, girls, and orphans and 
vulnerable children; 
‘‘(iv) programs targeted toward gender-based 
violence and sexual coercion; 
‘‘(v) strategies to meet the particular needs of 
adolescents; 
‘‘(vi) assistance for victims of rape, sexual abuse, 
assault, exploitation, and trafficking; and 
‘‘(vii) programs to prevent alcohol abuse. 
‘‘(O) A description of strategies to address male norms 
and behaviors that contribute to the transmission of HIV, 
to promote responsible male behavior, and to promote male 
participation and leadership in HIV/AIDS prevention, care, 
treatment, and voluntary counseling and testing. 
‘‘(P) A description of strategies— 
‘‘(i) to address the needs of orphans and vulnerable 
children, including an analysis of— 
‘‘(I) factors contributing to children’s vulner-
ability to HIV/AIDS; and 
‘‘(II) vulnerabilities caused by the impact of 
HIV/AIDS on children and their families; and 
‘‘(ii) in areas of higher HIV/AIDS prevalence, to 
promote a community-based approach to vulnerability, 
maximizing community input into determining which 
children participate. 
‘‘(Q) A description of capacity-building efforts under-
taken by countries themselves, including adherents of the 
Abuja Declaration and an assessment of the impact of 
International Monetary Fund macroeconomic and fiscal 
policies on national and donor investments in health. 
‘‘(R) A description of the strategy to— 
‘‘(i) strengthen capacity building within the public 
health sector; 
‘‘(ii) improve health care in those countries; 
‘‘(iii) help countries to develop and implement 
national health workforce strategies; 
‘‘(iv) strive to achieve goals in training, retaining, 
and effectively deploying health staff; 
‘‘(v) promote the use of codes of conduct for ethical 
recruiting practices for health care workers; and 
‘‘(vi) increase the sustainability of health programs. 
‘‘(S) A description of the criteria for selection, objec-
tives, methodology, and structure of compacts or other 
framework agreements with countries or regional organiza-
tions, including— 
‘‘(i) the role of civil society; 
‘‘(ii) the degree of transparency; 
‘‘(iii) benchmarks for success of such compacts or 
agreements; and 
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122 STAT. 2930 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(iv) the relationship between such compacts or 
agreements and the national HIV/AIDS and public 
health strategies and commitments of partner coun-
tries. 
‘‘(T) A strategy to better coordinate HIV/AIDS assist-
ance with nutrition and food assistance programs. 
‘‘(U) A description of transnational or regional initia-
tives to combat regionalized epidemics in highly affected 
areas such as the Caribbean. 
‘‘(V) A description of planned resource distribution and 
global investment by region. 
‘‘(W) A description of coordination efforts in order to 
better implement the Stop TB Strategy and to address 
the problem of coinfection of HIV/AIDS and tuberculosis 
and of projected challenges or barriers to successful 
implementation. 
‘‘(X) A description of coordination efforts to address 
malaria and comorbidity with malaria and HIV/AIDS.’’. 
(c) STUDY.—Section 101(c) of such Act (22 U.S.C. 7611(c)) is 
amended to read as follows: 
‘‘(c) STUDY
OF PROGRESS TOWARD ACHIEVEMENT
OF POLICY 
OBJECTIVES.— 
‘‘(1) DESIGN AND BUDGET PLAN FOR DATA EVALUATION.— 
The Global AIDS Coordinator shall enter into a contract with 
the Institute of Medicine of the National Academies that pro-
vides that not later than 18 months after the date of the 
enactment of the Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Reauthorization Act of 2008, the Institute, in consulta-
tion with the Global AIDS Coordinator and other relevant 
parties representing the public and private sector, shall provide 
the Global AIDS Coordinator with a design plan and budget 
for the evaluation and collection of baseline and subsequent 
data to address the elements set forth in paragraph (2)(B). 
The Global AIDS Coordinator shall submit the budget and 
design plan to the appropriate congressional committees. 
‘‘(2) STUDY.— 
‘‘(A) IN GENERAL.—Not later than 4 years after the 
date of the enactment of the Tom Lantos and Henry J. 
Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008, 
the Institute of Medicine of the National Academies shall 
publish a study that includes— 
‘‘(i) an assessment of the performance of United 
States-assisted global HIV/AIDS programs; and 
‘‘(ii) an evaluation of the impact on health of 
prevention, treatment, and care efforts that are sup-
ported by United States funding, including multilateral 
and bilateral programs involving joint operations. 
‘‘(B) CONTENT.—The study conducted under this para-
graph shall include— 
‘‘(i) an assessment of progress toward prevention, 
treatment, and care targets; 
‘‘(ii) an assessment of the effects on health systems, 
including on the financing and management of health 
systems and the quality of service delivery and staffing; 
Deadline. 
Publication. 
Contracts. 
Deadline. 
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122 STAT. 2931 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(iii) an assessment of efforts to address gender- 
specific aspects of HIV/AIDS, including gender related 
constraints to accessing services and addressing under-
lying social and economic vulnerabilities of women and 
men; 
‘‘(iv) an evaluation of the impact of treatment and 
care programs on 5-year survival rates, drug adher-
ence, and the emergence of drug resistance; 
‘‘(v) an evaluation of the impact of prevention pro-
grams on HIV incidence in relevant population groups; 
‘‘(vi) an evaluation of the impact on child health 
and welfare of interventions authorized under this Act 
on behalf of orphans and vulnerable children; 
‘‘(vii) an evaluation of the impact of programs and 
activities authorized in this Act on child mortality; 
and 
‘‘(viii) recommendations for improving the pro-
grams referred to in subparagraph (A)(i). 
‘‘(C) 
METHODOLOGIES.—Assessments 
and 
impact 
evaluations conducted under the study shall utilize sound 
statistical methods and techniques for the behavioral 
sciences, including random assignment methodologies as 
feasible. Qualitative data on process variables should be 
used for assessments and impact evaluations, wherever 
possible. 
‘‘(3) CONTRACT AUTHORITY.—The Institute of Medicine may 
enter into contracts or cooperative agreements or award grants 
to conduct the study under paragraph (2). 
‘‘(4) 
AUTHORIZATION
OF
APPROPRIATIONS.—There 
are 
authorized to be appropriated such sums as may be necessary 
to carry out the study under this subsection.’’. 
(d) REPORT.—Section 101 of such Act, as amended by this 
section, is further amended by adding at the end the following: 
‘‘(d) COMPTROLLER GENERAL REPORT.— 
‘‘(1) REPORT REQUIRED.—Not later than 3 years after the 
date of the enactment of the Tom Lantos and Henry J. Hyde 
United States Global Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Reauthorization Act of 2008, the Comp-
troller General of the United States shall submit a report 
on the global HIV/AIDS programs of the United States to 
the appropriate congressional committees. 
‘‘(2) CONTENTS.—The report required under paragraph (1) 
shall include— 
‘‘(A) a description and assessment of the monitoring 
and evaluation practices and policies in place for these 
programs; 
‘‘(B) an assessment of coordination within Federal 
agencies involved in these programs, examining both 
internal coordination within these programs and integra-
tion with the larger global health and development agenda 
of the United States; 
‘‘(C) an assessment of procurement policies and prac-
tices within these programs; 
‘‘(D) an assessment of harmonization with national 
government HIV/AIDS and public health strategies as well 
as other international efforts; 
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122 STAT. 2932 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(E) an assessment of the impact of global HIV/AIDS 
funding and programs on other United States global health 
programming; and 
‘‘(F) recommendations for improving the global HIV/ 
AIDS programs of the United States. 
‘‘(e) BEST PRACTICES REPORT.— 
‘‘(1) IN GENERAL.—Not later than 1 year after the date 
of the enactment of the Tom Lantos and Henry J. Hyde United 
States Global Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Reauthorization Act of 2008, and annually thereafter, 
the Global AIDS Coordinator shall publish a best practices 
report that highlights the programs receiving financial assist-
ance from the United States that have the potential for replica-
tion or adaption, particularly at a low cost, across global AIDS 
programs, including those that focus on both generalized and 
localized epidemics. 
‘‘(2) DISSEMINATION OF FINDINGS.— 
‘‘(A) PUBLICATION ON INTERNET WEBSITE.—The Global 
AIDS Coordinator shall disseminate the full findings of 
the annual best practices report on the Internet website 
of the Office of the Global AIDS Coordinator. 
‘‘(B) DISSEMINATION
GUIDANCE.—The Global AIDS 
Coordinator shall develop guidance to ensure timely 
submission and dissemination of significant information 
regarding best practices with respect to global AIDS pro-
grams. 
‘‘(f) INSPECTORS GENERAL.— 
‘‘(1) OVERSIGHT PLAN.— 
‘‘(A) DEVELOPMENT.—The Inspectors General of the 
Department of State and Broadcasting Board of Governors, 
the Department of Health and Human Services, and the 
United States Agency for International Development shall 
jointly develop 5 coordinated annual plans for oversight 
activity in each of the fiscal years 2009 through 2013, 
with regard to the programs authorized under this Act 
and sections 104A, 104B, and 104C of the Foreign Assist-
ance Act of 1961 (22 U.S.C. 2151b–2, 2151b–3, and 2151b– 
4). 
‘‘(B) CONTENTS.—The plans developed under subpara-
graph (A) shall include a schedule for financial audits, 
inspections, and performance reviews, as appropriate. 
‘‘(C) DEADLINE.— 
‘‘(i) INITIAL PLAN.—The first plan developed under 
subparagraph (A) shall be completed not later than 
the later of— 
‘‘(I) September 1, 2008; or 
‘‘(II) 60 days after the date of the enactment 
of the Tom Lantos and Henry J. Hyde United 
States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 
2008. 
‘‘(ii) SUBSEQUENT
PLANS.—Each of the last four 
plans developed under subparagraph (A) shall be com-
pleted not later than 30 days before each of the fiscal 
years 2010 through 2013, respectively. 
Publication. 
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122 STAT. 2933 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(2) COORDINATION.—In order to avoid duplication and 
maximize efficiency, the Inspectors General described in para-
graph (1) shall coordinate their activities with— 
‘‘(A) the Government Accountability Office; and 
‘‘(B) the Inspectors General of the Department of Com-
merce, the Department of Defense, the Department of 
Labor, and the Peace Corps, as appropriate, pursuant to 
the 2004 Memorandum of Agreement Coordinating Audit 
Coverage of Programs and Activities Implementing the 
President’s Emergency Plan for AIDS Relief, or any suc-
cessor agreement. 
‘‘(3) FUNDING.—The Global AIDS Coordinator and the 
Coordinator of the United States Government Activities to Com-
bat Malaria Globally shall make available necessary funds not 
exceeding $15,000,000 during the 5-year period beginning on 
October 1, 2008 to the Inspectors General described in para-
graph (1) for the audits, inspections, and reviews described 
in that paragraph.’’. 
(e) ANNUAL STUDY; MESSAGE.—Section 101 of such Act, as 
amended by this section, is further amended by adding at the 
end the following: 
‘‘(g) ANNUAL STUDY.— 
‘‘(1) IN GENERAL.—Not later than September 30, 2009, and 
annually thereafter through September 30, 2013, the Global 
AIDS Coordinator shall complete a study of treatment providers 
that— 
‘‘(A) represents a range of countries and service 
environments; 
‘‘(B) estimates the per-patient cost of antiretroviral 
HIV/AIDS treatment and the care of people with HIV/ 
AIDS not receiving antiretroviral treatment, including a 
comparison of the costs for equivalent services provided 
by programs not receiving assistance under this Act; 
‘‘(C) estimates per-patient costs across the program 
and in specific categories of service providers, including— 
‘‘(i) urban and rural providers; 
‘‘(ii) country-specific providers; and 
‘‘(iii) other subcategories, as appropriate. 
‘‘(2) PUBLICATION.—Not later than 90 days after the comple-
tion of each study under paragraph (1), the Global AIDS Coordi-
nator shall make the results of such study available on a 
publicly accessible Web site. 
‘‘(h) MESSAGE.—The Global AIDS Coordinator shall develop 
a message, to be prominently displayed by each program receiving 
funds under this Act, that— 
‘‘(1) demonstrates that the program is a commitment by 
citizens of the United States to the global fight against HIV/ 
AIDS, tuberculosis, and malaria; and 
‘‘(2) enhances awareness by program recipients that the 
program is an effort on behalf of the citizens of the United 
States.’’. 
SEC. 102. INTERAGENCY WORKING GROUP. 
Section 1(f)(2) of the State Department Basic Authorities Act 
of 1956 (22 U.S.C. 2651a(f)(2)) is amended— 
Web site. 
Deadlines. 
Effective date. 
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122 STAT. 2934 
PUBLIC LAW 110–293—JULY 30, 2008 
(1) in subparagraph (A), by inserting ‘‘, partner country 
finance, health, and other relevant ministries,’’ after ‘‘commu-
nity based organizations)’’ each place it appears; 
(2) in subparagraph (B)(ii)— 
(A) by striking subclauses (IV) and (V); 
(B) by inserting after subclause (III) the following: 
‘‘(IV) Establishing an interagency working 
group on HIV/AIDS headed by the Global AIDS 
Coordinator and comprised of representatives from 
the United States Agency for International 
Development and the Department of Health and 
Human Services, for the purposes of coordination 
of activities relating to HIV/AIDS, including— 
‘‘(aa) meeting regularly to review progress 
in partner countries toward HIV/AIDS preven-
tion, treatment, and care objectives; 
‘‘(bb) participating in the process of identi-
fying countries to consider for increased assist-
ance based on the epidemiology of HIV/AIDS 
in those countries, including clear evidence 
of a public health threat, as well as govern-
ment commitment to address the HIV/AIDS 
problem, relative need, and coordination and 
joint planning with other significant actors; 
‘‘(cc) assisting the Coordinator in the 
evaluation, execution, and oversight of country 
operational plans; 
‘‘(dd) reviewing policies that may be 
obstacles to reaching targets set forth for HIV/ 
AIDS prevention, treatment, and care; and 
‘‘(ee) consulting with representatives from 
additional relevant agencies, including the 
National Institutes of Health, the Health 
Resources and Services Administration, the 
Department of Labor, the Department of Agri-
culture, the Millennium Challenge Corpora-
tion, the Peace Corps, and the Department 
of Defense. 
‘‘(V) Coordinating overall United States HIV/ 
AIDS policy and programs, including ensuring the 
coordination of relevant executive branch agency 
activities in the field, with efforts led by partner 
countries, and with the assistance provided by 
other relevant bilateral and multilateral aid agen-
cies and other donor institutions to promote 
harmonization with other programs aimed at pre-
venting and treating HIV/AIDS and other health 
challenges, improving primary health, addressing 
food security, promoting education and develop-
ment, and strengthening health care systems.’’; 
(C) by redesignating subclauses (VII) and VIII) as sub-
clauses (IX) and (XII), respectively; 
(D) by inserting after subclause (VI) the following: 
‘‘(VII) Holding annual consultations with non-
governmental organizations in partner countries 
that provide services to improve health, and advo-
cating on behalf of the individuals with HIV/AIDS 
Government 
organization. 
Establishment. 
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122 STAT. 2935 
PUBLIC LAW 110–293—JULY 30, 2008 
and those at particular risk of contracting HIV/ 
AIDS, including organizations with members who 
are living with HIV/AIDS. 
‘‘(VIII) Ensuring, through interagency and 
international coordination, that HIV/AIDS pro-
grams of the United States are coordinated with, 
and complementary to, the delivery of related 
global health, food security, development, and edu-
cation.’’; 
(E) in subclause (IX), as redesignated by subparagraph 
(C)— 
(i) by inserting ‘‘Vietnam,’’ after ‘‘Uganda,’’; 
(ii) by inserting after ‘‘of 2003’’ the following: ‘‘and 
other countries in which the United States is imple-
menting HIV/AIDS programs as part of its foreign 
assistance program’’; and 
(iii) by adding at the end the following: ‘‘In desig-
nating additional countries under this subparagraph, 
the President shall give priority to those countries 
in which there is a high prevalence of HIV or risk 
of significantly increasing incidence of HIV within the 
general population and inadequate financial means 
within the country.’’; 
(F) by inserting after subclause (IX), as redesignated 
by subparagraph (C), the following: 
‘‘(X) Working with partner countries in which 
the HIV/AIDS epidemic is prevalent among injec-
tion drug users to establish, as a national priority, 
national HIV/AIDS prevention programs. 
‘‘(XI) Working with partner countries in which 
the HIV/AIDS epidemic is prevalent among 
individuals involved in commercial sex acts to 
establish, as a national priority, national preven-
tion programs, including education, voluntary 
testing, and counseling, and referral systems that 
link HIV/AIDS programs with programs to eradi-
cate trafficking in persons and support alternatives 
to prostitution.’’; 
(G) in subclause (XII), as redesignated by subpara-
graph (C), by striking ‘‘funds section’’ and inserting ‘‘funds 
appropriated for HIV/ AIDS assistance pursuant to the 
authorization of appropriations under section 401 of the 
United States Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Act of 2003 (22 U.S.C. 7671)’’; and 
(H) by adding at the end the following: 
‘‘(XIII) Publicizing updated drug pricing data 
to inform the purchasing decisions of pharma-
ceutical procurement partners.’’. 
SEC. 103. SENSE OF CONGRESS. 
Section 102 of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) 
is amended by adding at the end the following: 
‘‘(d) SENSE OF CONGRESS.—It is the sense of Congress that— 
‘‘(1) full-time country level coordinators, preferably with 
management experience, should head each HIV/AIDS country 
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122 STAT. 2936 
PUBLIC LAW 110–293—JULY 30, 2008 
team for United States missions overseeing significant HIV/ 
AIDS programs; 
‘‘(2) foreign service nationals provide critically important 
services in the design and implementation of United States 
country-level HIV/AIDS programs and their skills and experi-
ence as public health professionals should be recognized within 
hiring and compensation practices; and 
‘‘(3) staffing levels for United States country-level HIV/ 
AIDS teams should be adequately maintained to fulfill oversight 
and other obligations of the positions.’’. 
TITLE 
II—SUPPORT 
FOR 
MULTILAT-
ERAL FUNDS, PROGRAMS, AND PUB-
LIC-PRIVATE PARTNERSHIPS 
SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE 
FUNDS. 
Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 
2222) is amended— 
(1) by inserting after subsection (c) the following: 
‘‘(d) TUBERCULOSIS
VACCINE
DEVELOPMENT
PROGRAMS.—In 
addition to amounts otherwise available under this section, there 
are authorized to be appropriated to the President such sums as 
may be necessary for each of the fiscal years 2009 through 2013, 
which shall be used for United States contributions to tuberculosis 
vaccine development programs, which may include the Aeras Global 
TB Vaccine Foundation.’’; 
(2) in subsection (k)— 
(A) by striking ‘‘fiscal years 2004 through 2008’’ and 
inserting ‘‘fiscal years 2009 through 2013’’; and 
(B) by striking ‘‘Vaccine Fund’’ and inserting ‘‘GAVI 
Fund’’. 
(3) in subsection (l), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013’’; and 
(4) in subsection (m), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013’’. 
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, 
TUBERCULOSIS AND MALARIA. 
(a) FINDINGS; SENSE
OF CONGRESS.—Section 202(a) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7622(a)) is amended to read as 
follows: 
‘‘(a) FINDINGS; SENSE OF CONGRESS.— 
‘‘(1) FINDINGS.—Congress makes the following findings: 
‘‘(A) The establishment of the Global Fund in January 
2002 is consistent with the general principles for an inter-
national AIDS trust fund first outlined by Congress in 
the Global AIDS and Tuberculosis Relief Act of 2000 (Public 
Law 106–264). 
‘‘(B) The Global Fund is an innovative financing mecha-
nism which— 
‘‘(i) has made progress in many areas in combating 
HIV/AIDS, tuberculosis, and malaria; and 
Appropriations 
authorizations. 
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122 STAT. 2937 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(ii) represents the multilateral component of this 
Act, extending United States efforts to more than 130 
countries around the world. 
‘‘(C) The Global Fund and United States bilateral 
assistance programs— 
‘‘(i) 
are 
demonstrating 
increasingly 
effective 
coordination, with each possessing certain comparative 
advantages in the fight against HIV/AIDS, tuber-
culosis, and malaria; and 
‘‘(ii) often work most effectively in concert with 
each other. 
‘‘(D) The United States Government— 
‘‘(i) is the largest supporter of the Global Fund 
in terms of resources and technical support; 
‘‘(ii) made the founding contribution to the Global 
Fund; and 
‘‘(iii) is fully committed to the success of the Global 
Fund as a multilateral public-private partnership. 
‘‘(2) SENSE OF CONGRESS.—It is the sense of Congress that— 
‘‘(A) transparency and accountability are crucial to the 
long-term success and viability of the Global Fund; 
‘‘(B) the Global Fund has made significant progress 
toward addressing concerns raised by the Government 
Accountability Office by— 
‘‘(i) improving risk assessment and risk manage-
ment capabilities; 
‘‘(ii) providing clearer guidance for and oversight 
of Local Fund Agents; and 
‘‘(iii) strengthening the Office of the Inspector Gen-
eral for the Global Fund; 
‘‘(C) the provision of sufficient resources and authority 
to the Office of the Inspector General for the Global Fund 
to ensure that office has the staff and independence nec-
essary to carry out its mandate will be a measure of the 
commitment of the Global Fund to transparency and 
accountability; 
‘‘(D) 
regular, 
publicly 
published 
financial, 
pro-
grammatic, and reporting audits of the Fund, its grantees, 
and Local Fund Agents are also important benchmarks 
of transparency; 
‘‘(E) the Global Fund should establish and maintain 
a system to track— 
‘‘(i) the amount of funds disbursed to each sub-
recipient on the grant’s fiscal cycle; and 
‘‘(ii) the distribution of resources, by grant and 
principal recipient, for prevention, care, treatment, 
drug and commodity purchases, and other purposes; 
‘‘(F) relevant national authorities in recipient countries 
should exempt from duties and taxes all products financed 
by Global Fund grants and procured by any principal 
recipient or subrecipient for the purpose of carrying out 
such grants; 
‘‘(G) the Global Fund, UNAIDS, and the Global AIDS 
Coordinator should work together to standardize program 
indicators wherever possible; 
‘‘(H) for purposes of evaluating total amounts of funds 
contributed 
to 
the 
Global 
Fund 
under 
subsection 
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122 STAT. 2938 
PUBLIC LAW 110–293—JULY 30, 2008 
(d)(4)(A)(i), the timetable for evaluations of contributions 
from sources other than the United States should take 
into account the fiscal calendars of other major contribu-
tors; and 
‘‘(I) the Global Fund should not support activities 
involving the ‘Affordable Medicines Facility-Malaria’ or 
similar entities pending compelling evidence of success from 
pilot programs as evaluated by the Coordinator of United 
States Government Activities to Combat Malaria Globally.’’. 
(b) STATEMENT
OF POLICY.—Section 202(b) of such Act is 
amended by adding at the end the following: 
‘‘(3) STATEMENT OF POLICY.—The United States Govern-
ment regards the imposition by recipient countries of taxes 
or tariffs on goods or services provided by the Global Fund, 
which are supported through public and private donations, 
including the substantial contribution of the American people, 
as inappropriate and inconsistent with standards of good 
governance. The Global AIDS Coordinator or other representa-
tives of the United States Government shall work with the 
Global Fund to dissuade governments from imposing such 
duties, tariffs, or taxes.’’. 
(c) UNITED STATES FINANCIAL PARTICIPATION.—Section 202(d) 
of such Act (22 U.S.C. 7622(d)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘$1,000,000,000 for the period of fiscal 
year 2004 beginning on January 1, 2004’’ and inserting 
‘‘$2,000,000,000 for fiscal year 2009,’’; and 
(B) by striking ‘‘the fiscal years 2005–2008’’ and 
inserting ‘‘each of the fiscal years 2010 through 2013’’; 
(2) in paragraph (4)— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking ‘‘fiscal years 2004 
through 2008’’ and inserting ‘‘fiscal years 2009 through 
2013’’; 
(ii) in clause (ii)— 
(I) by striking ‘‘during any of the fiscal years 
2004 through 2008’’ and inserting ‘‘during any of 
the fiscal years 2009 through 2013’’; and 
(II) by adding at the end the following: ‘‘The 
President may waive the application of this clause 
with respect to assistance for Sudan that is over-
seen by the Southern Country Coordinating 
Mechanism, including Southern Sudan, Southern 
Kordofan, Blue Nile State, and Abyei, if the Presi-
dent determines that the national interest or 
humanitarian reasons justify such a waiver. The 
President shall publish each waiver of this clause 
in the Federal Register and, not later than 15 
days before the waiver takes effect, shall consult 
with the Committee on Foreign Relations of the 
Senate and the Committee on Foreign Affairs of 
the House of Representatives regarding the pro-
posed waiver.’’; and 
(iii) in clause (vi)— 
(I) by striking ‘‘for the purposes’’ and inserting 
‘‘For the purposes’’; 
Federal Register, 
publication. 
Deadline. 
Taxes. 
Tariffs. 
22 USC 7622. 
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122 STAT. 2939 
PUBLIC LAW 110–293—JULY 30, 2008 
(II) by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 
2013’’; and 
(III) by striking ‘‘prior to fiscal year 2004’’ 
and inserting ‘‘before fiscal year 2009’’; 
(B) in subparagraph (B)(iv), by striking ‘‘fiscal years 
2004 through 2008’’ and inserting ‘‘fiscal years 2009 
through 2013’’; and 
(C) in subparagraph (C)(ii), by striking ‘‘Committee 
on International Relations’’ and inserting ‘‘Committee on 
Foreign Affairs’’; and 
(3) by adding at the end the following: 
‘‘(5) WITHHOLDING
FUNDS.—Notwithstanding any other 
provision of this Act, 20 percent of the amounts appropriated 
pursuant to this Act for a contribution to support the Global 
Fund for each of the fiscal years 2010 through 2013 shall 
be withheld from obligation to the Global Fund until the Sec-
retary of State certifies to the appropriate congressional 
committees that the Global Fund— 
‘‘(A) has established an evaluation framework for the 
performance of Local Fund Agents (referred to in this para-
graph as ‘LFAs’); 
‘‘(B) is undertaking a systematic assessment of the 
performance of LFAs; 
‘‘(C) has adopted, and is implementing, a policy to 
publish on a publicly available Web site— 
‘‘(i) grant performance reviews; 
‘‘(ii) all reports of the Inspector General of the 
Global Fund, in a manner that is consistent with the 
Policy for Disclosure of Reports of the Inspector Gen-
eral, approved at the 16th Meeting of the Board of 
the Global Fund; 
‘‘(iii) decision points of the Board of the Global 
Fund; 
‘‘(iv) reports from Board committees to the Board; 
and 
‘‘(v) a regular collection and analysis of perform-
ance data and funding of grants of the Global Fund, 
which shall cover all principal recipients and all sub-
recipients; 
‘‘(D) is maintaining an independent, well-staffed Office 
of the Inspector General that— 
‘‘(i) reports directly to the Board of the Global 
Fund; and 
‘‘(ii) compiles regular, publicly published audits of 
financial, programmatic, and reporting aspects of the 
Global Fund, its grantees, and LFAs; 
‘‘(E) has established, and is reporting publicly on, 
standard indicators for all program areas; 
‘‘(F) has established a methodology to track and is 
publicly reporting on— 
‘‘(i) all subrecipients and the amount of funds dis-
bursed to each subrecipient on the grant’s fiscal cycle; 
and 
‘‘(ii) the distribution of resources, by grant and 
principal recipient, for prevention, care, treatment, 
drugs and commodities purchase, and other purposes; 
Public 
information. 
Reports. 
Public 
information. 
Reports. 
Public 
information. 
Reports. 
Public 
information. 
Web site. 
Performance 
evaluation. 
Certification. 
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122 STAT. 2940 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(G) has established a policy on tariffs imposed by 
national governments on all goods and services financed 
by the Global Fund; 
‘‘(H) through its Secretariat, has taken meaningful 
steps to prevent national authorities in recipient countries 
from imposing taxes or tariffs on goods or services provided 
by the Fund; 
‘‘(I) is maintaining its status as a financing institution 
focused on programs directly related to HIV/AIDS, malaria, 
and tuberculosis; 
‘‘(J) is maintaining and making progress on— 
‘‘(i) sustaining its multisectoral approach, through 
country coordinating mechanisms; and 
‘‘(ii) the implementation of grants, as reflected in 
the proportion of resources allocated to different sec-
tors, including governments, civil society, and faith- 
and community-based organizations; and 
‘‘(K) has established procedures providing access by 
the Office of Inspector General of the Department of State 
and Broadcasting Board of Governors, as cognizant 
Inspector General, and the Inspector General of the Health 
and Human Services and the Inspector General of the 
United States Agency for International Development, to 
Global Fund financial data, and other information relevant 
to United States contributions (as determined by the 
Inspector General in consultation with the Global AIDS 
Coordinator). 
‘‘(6) SUMMARIES OF BOARD DECISIONS AND UNITED STATES 
POSITIONS.—Following each meeting of the Board of the Global 
Fund, the Coordinator of United States Government Activities 
to Combat HIV/AIDS Globally shall report on the public website 
of the Coordinator a summary of Board decisions and how 
the United States Government voted and its positions on such 
decisions.’’. 
SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PREVENT TRANS-
MISSION OF HIV AND OTHER DISEASES. 
(a) SENSE OF CONGRESS.—Congress recognizes the need and 
urgency to expand the range of interventions for preventing the 
transmission of human immunodeficiency virus (HIV), including 
nonvaccine prevention methods that can be controlled by women. 
(b) NIH OFFICE OF AIDS RESEARCH.—Subpart 1 of part D 
of title XXIII of the Public Health Service Act (42 U.S.C. 300cc– 
40 et seq.) is amended by inserting after section 2351 the following: 
‘‘SEC. 2351A. MICROBICIDE RESEARCH. 
‘‘(a) FEDERAL STRATEGIC PLAN.—The Director of the Office 
shall— 
‘‘(1) expedite the implementation of the Federal strategic 
plans required by section 403(a) of the Public Health Service 
Act (42 U.S.C. 283(a)(5)) regarding the conduct and support 
of research on, and development of, a microbicide to prevent 
the transmission of the human immunodeficiency virus; and 
‘‘(2) review and, as appropriate, revise such plan to 
prioritize funding and activities relative to their scientific 
urgency and potential market readiness. 
42 USC 
300cc–40a. 
42 USC 
300cc–40a note. 
Reports. 
Public 
information. 
Web site. 
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122 STAT. 2941 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(b) 
COORDINATION.—In 
implementing, 
reviewing, 
and 
prioritizing elements of the plan described in subsection (a), the 
Director of the Office shall consult, as appropriate, with— 
‘‘(1) representatives of other Federal agencies involved in 
microbicide research, including the Coordinator of United 
States Government Activities to Combat HIV/AIDS Globally, 
the Director of the Centers for Disease Control and Prevention, 
and the Administrator of the United States Agency for Inter-
national Development; 
‘‘(2) the microbicide research and development community; 
and 
‘‘(3) health advocates.’’. 
(c) NATIONAL INSTITUTE
OF ALLERGY
AND INFECTIOUS DIS-
EASES.—Subpart 6 of part C of title IV of the Public Health Service 
Act (42 U.S.C. 285f et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT. 
‘‘The Director of the Institute, acting through the head of the 
Division of AIDS, shall, consistent with the peer-review process 
of the National Institutes of Health, carry out research on, and 
development of, safe and effective methods for use by women to 
prevent the transmission of the human immunodeficiency virus, 
which may include microbicides.’’. 
(d) CDC.—Part B of title III of the Public Health Service 
Act (42 U.S.C. 243 et seq.) is amended by inserting after section 
317S the following: 
‘‘SEC. 317T. MICROBICIDE RESEARCH. 
‘‘(a) IN GENERAL.—The Director of the Centers for Disease 
Control and Prevention is strongly encouraged to fully implement 
the Centers’ microbicide agenda to support research and develop-
ment of microbicides for use to prevent the transmission of the 
human immunodeficiency virus. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated such sums as may be necessary for each of 
fiscal years 2009 through 2013 to carry out this section.’’. 
(e) UNITED STATES AGENCY
FOR INTERNATIONAL DEVELOP-
MENT.— 
(1) IN GENERAL.—The Administrator of the United States 
Agency for International Development, in coordination with 
the Coordinator of United States Government Activities to Com-
bat HIV/AIDS Globally, may facilitate availability and accessi-
bility of microbicides, provided that such pharmaceuticals are 
approved, tentatively approved, or otherwise authorized for use 
by— 
(A) the Food and Drug Administration; 
(B) a stringent regulatory agency acceptable to the 
Secretary of Health and Human Services; or 
(C) a quality assurance mechanism acceptable to the 
Secretary of Health and Human Services. 
(2) AUTHORIZATION OF APPROPRIATIONS.—Of the amounts 
authorized to be appropriated under section 401 of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, 
there are authorized to be appropriated to the President such 
sums as may be necessary for each of the fiscal years 2009 
through 2013 to carry out this subsection. 
22 USC 7631a. 
42 USC 247b–22. 
Women. 
42 USC 285f–4. 
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122 STAT. 2942 
PUBLIC LAW 110–293—JULY 30, 2008 
SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
STRENGTHENING HEALTH POLICIES AND HEALTH SYS-
TEMS OF PARTNER COUNTRIES. 
(a) IN GENERAL.—Title II of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7621) is amended by adding at the end the following: 
‘‘SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
STRENGTHENING HEALTH POLICIES AND HEALTH SYS-
TEMS OF PARTNER COUNTRIES. 
‘‘(a) STATEMENT OF POLICY.—It shall be the policy of the United 
States Government— 
‘‘(1) to invest appropriate resources authorized under this 
Act— 
‘‘(A) to carry out activities to strengthen HIV/AIDS, 
tuberculosis, and malaria health policies and health sys-
tems; and 
‘‘(B) to provide workforce training and capacity- 
building consistent with the goals and objectives of this 
Act; and 
‘‘(2) to support the development of a sound policy environ-
ment in partner countries to increase the ability of such coun-
tries— 
‘‘(A) to maximize utilization of health care resources 
from donor countries; 
‘‘(B) to increase national investments in health and 
education and maximize the effectiveness of such invest-
ments; 
‘‘(C) to improve national HIV/AIDS, tuberculosis, and 
malaria strategies; 
‘‘(D) to deliver evidence-based services in an effective 
and efficient manner; and 
‘‘(E) to reduce barriers that prevent recipients of serv-
ices from achieving maximum benefit from such services. 
‘‘(b) ASSISTANCE TO IMPROVE PUBLIC FINANCE MANAGEMENT 
SYSTEMS.— 
‘‘(1) IN GENERAL.—Consistent with the authority under sec-
tion 129 of the Foreign Assistance Act of 1961 (22 U.S.C. 
2152), the Secretary of the Treasury, acting through the head 
of the Office of Technical Assistance, is authorized to provide 
assistance for advisors and partner country finance, health, 
and other relevant ministries to improve the effectiveness of 
public finance management systems in partner countries to 
enable such countries to receive funding to carry out programs 
to combat HIV/AIDS, tuberculosis, and malaria and to manage 
such programs. 
‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—Of the amounts 
authorized to be appropriated under section 401 for HIV/AIDS 
assistance, there are authorized to be appropriated to the Sec-
retary of the Treasury such sums as may be necessary for 
each of the fiscal years 2009 through 2013 to carry out this 
subsection. 
‘‘(c) PLAN
REQUIRED.—The Global AIDS Coordinator, in 
collaboration with the Administrator of the United States Agency 
for International Development (USAID), shall develop and imple-
ment a plan to combat HIV/AIDS by strengthening health policies 
and health systems of partner countries as part of USAID’s ‘Health 
22 USC 7623. 
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122 STAT. 2943 
PUBLIC LAW 110–293—JULY 30, 2008 
Systems 2020’ project. Recognizing that human and institutional 
capacity form the core of any health care system that can sustain 
the fight against HIV/AIDS, tuberculosis, and malaria, the plan 
shall include a strategy to encourage postsecondary educational 
institutions in partner countries, particularly in Africa, in collabora-
tion with United States postsecondary educational institutions, 
including historically black colleges and universities, to develop 
such human and institutional capacity and in the process further 
build their capacity to sustain the fight against these diseases.’’. 
(b) CLERICAL AMENDMENT.—The table of contents for the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7601 note) is amended by inserting after 
the item relating to section 203, as added by section 203 of this 
Act, the following: 
‘‘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. 
Section 307 of the Public Health Service Act (42 U.S.C. 242l) 
is amended— 
(1) by amending subsection (a) to read as follows: 
‘‘(a) The Secretary may participate with other countries in 
cooperative endeavors in— 
‘‘(1) biomedical research, health care technology, and the 
health services research and statistical analysis authorized 
under section 306 and title IX; and 
‘‘(2) biomedical research, health care services, health care 
research, or other related activities in furtherance of the activi-
ties, objectives or goals authorized under the Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.’’; 
and 
(2) in subsection (b)— 
(A) in paragraph (7), by striking ‘‘and’’ after the semi-
colon at the end; 
(B) by striking ‘‘The Secretary may not, in the exercise 
of his authority under this section, provide financial assist-
ance for the construction of any facility in any foreign 
country.’’ 
(C) in paragraph (8), by striking ‘‘for any purpose.’’ 
and inserting ‘‘for the purpose of any law administered 
by the Office of Personnel Management;’’; and 
(D) by adding at the end the following: 
‘‘(9) provide such funds by advance or reimbursement to 
the Secretary of State, as may be necessary, to pay the costs 
of acquisition, lease, construction, alteration, equipping, fur-
nishing or management of facilities outside of the United States; 
and 
‘‘(10) in consultation with the Secretary of State, through 
grant or cooperative agreement, make funds available to public 
or nonprofit private institutions or agencies in foreign countries 
in which the Secretary is participating in activities described 
under subsection (a) to acquire, lease, construct, alter, or ren-
ovate facilities in those countries.’’. 
(3) in subsection (c)— 
(A) by striking ‘‘1990’’ and inserting ‘‘1980’’; and 
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122 STAT. 2944 
PUBLIC LAW 110–293—JULY 30, 2008 
(B) by inserting or ‘‘or section 903 of the Foreign 
Service Act of 1980 (22 U.S.C. 4083)’’ after ‘‘Code’’. 
SEC. 206. FACILITATING VACCINE DEVELOPMENT. 
(a) TECHNICAL ASSISTANCE FOR DEVELOPING COUNTRIES.—The 
Administrator of the United States Agency for International 
Development, utilizing public-private partners, as appropriate, and 
working in coordination with other international development agen-
cies, is authorized to strengthen the capacity of developing countries’ 
governmental institutions to— 
(1) collect evidence for informed decision-making and 
introduction of new vaccines, including potential HIV/AIDS, 
tuberculosis, and malaria vaccines, if such vaccines are deter-
mined to be safe and effective; 
(2) review protocols for clinical trials and impact studies 
and improve the implementation of clinical trials; and 
(3) ensure adequate supply chain and delivery systems. 
(b) ADVANCED MARKET COMMITMENTS.— 
(1) PURPOSE.—The purpose of this subsection is to improve 
global health by requiring the United States to participate 
in negotiations for advance market commitments for the 
development of future vaccines, including potential vaccines 
for HIV/AIDS, tuberculosis, and malaria. 
(2) NEGOTIATION
REQUIREMENT.—The Secretary of the 
Treasury shall enter into negotiations with the appropriate 
officials of the International Bank of Reconstruction and 
Development (World Bank) and the GAVI Alliance, the member 
nations of such entities, and other interested parties to establish 
advanced market commitments to purchase vaccines to combat 
HIV/AIDS, tuberculosis, malaria, and other related infectious 
diseases. 
(3) REQUIREMENTS.—In negotiating the United States 
participation in programs for advanced market commitments, 
the Secretary of the Treasury shall take into account whether 
programs for advance market commitments include— 
(A) legally binding contracts for product purchase that 
include a fair market price for up to a maximum number 
of treatments, creating a strong market incentive; 
(B) clearly defined and transparent rules of program 
participation for qualified developers and suppliers of the 
product; 
(C) clearly defined requirements for eligible vaccines 
to ensure that they are safe and effective and can be 
delivered in developing country contexts; 
(D) dispute settlement mechanisms; and 
(E) sufficient flexibility to enable the contracts to be 
adjusted in accord with new information related to pro-
jected market size and other factors while still maintaining 
the purchase commitment at a fair price. 
(4) REPORT.—Not later than 1 year after the date of the 
enactment of this Act— 
(A) the Secretary of the Treasury shall submit a report 
to the appropriate congressional committees on the status 
of the United States negotiations to participate in programs 
for the advanced market commitments under this sub-
section; and 
Deadline. 
22 USC 7624. 
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122 STAT. 2945 
PUBLIC LAW 110–293—JULY 30, 2008 
(B) the President shall produce a comprehensive report, 
written by a study group of qualified professionals from 
relevant Federal agencies and initiatives, nongovernmental 
organizations, and industry representatives, that sets forth 
a coordinated strategy to accelerate development of vac-
cines for infectious diseases, such as HIV/AIDS, malaria, 
and tuberculosis, which includes— 
(i) initiatives to create economic incentives for the 
research, development, and manufacturing of vaccines 
for HIV/AIDS, tuberculosis, malaria, and other infec-
tious diseases; 
(ii) an expansion of public-private partnerships and 
the leveraging of resources from other countries and 
the private sector; and 
(iii) efforts to maximize United States capabilities 
to support clinical trials of vaccines in developing coun-
tries and to address the challenges of delivering vac-
cines in developing countries to minimize delays in 
access once vaccines are available. 
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.—Section 104A(a) of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b–2(a)) is amended by inserting 
‘‘Central Asia, Eastern Europe, Latin America’’ after ‘‘Carib-
bean,’’. 
(2) POLICY.—Section 104A(b) of such Act is amended to 
read as follows: 
‘‘(b) POLICY.— 
‘‘(1) OBJECTIVES.—It is a major objective of the foreign 
assistance program of the United States to provide assistance 
for the prevention and treatment of HIV/AIDS and the care 
of those affected by the disease. It is the policy objective of 
the United States, by 2013, to— 
‘‘(A) assist partner countries to— 
‘‘(i) prevent 12,000,000 new HIV infections world-
wide; 
‘‘(ii) 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; 
‘‘(iii) support care for 12,000,000 individuals 
infected with or affected by HIV/AIDS, including 
5,000,000 orphans and vulnerable children affected by 
President. 
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122 STAT. 2946 
PUBLIC LAW 110–293—JULY 30, 2008 
HIV/AIDS, with an emphasis on promoting a com-
prehensive, coordinated system of services to be 
integrated throughout the continuum of care; 
‘‘(iv) provide at least 80 percent of the target popu-
lation with access to counseling, testing, and treatment 
to prevent the transmission of HIV from mother-to- 
child; 
‘‘(v) provide care and treatment services to children 
with HIV in proportion to their percentage within the 
HIV-infected population of a given partner country; 
and 
‘‘(vi) train and support retention of health care 
professionals, paraprofessionals, and community health 
workers in HIV/AIDS prevention, treatment, and care, 
with the target of providing such training to at least 
140,000 new health care professionals and paraprofes-
sionals with an emphasis on training and in country 
deployment of critically needed doctors and nurses; 
‘‘(B) strengthen the capacity to deliver primary health 
care in developing countries, especially in sub-Saharan 
Africa; 
‘‘(C) support and help countries in their efforts to 
achieve staffing levels of at least 2.3 doctors, nurses, and 
midwives per 1,000 population, as called for by the World 
Health Organization; and 
‘‘(D) help partner countries to develop independent, 
sustainable HIV/AIDS programs. 
‘‘(2) COORDINATED GLOBAL STRATEGY.—The United States 
and other countries with the sufficient capacity should provide 
assistance to countries in sub-Saharan Africa, the Caribbean, 
Central Asia, Eastern Europe, and Latin America, and other 
countries and regions confronting HIV/AIDS epidemics in a 
coordinated global strategy to help address generalized and 
concentrated epidemics through HIV/AIDS prevention, treat-
ment, care, monitoring and evaluation, and related activities. 
‘‘(3) PRIORITIES.—The United States Government’s response 
to the global HIV/AIDS pandemic and the Government’s efforts 
to help countries assume leadership of sustainable campaigns 
to combat their local epidemics should place high priority on— 
‘‘(A) the prevention of the transmission of HIV; 
‘‘(B) moving toward universal access to HIV/AIDS 
prevention counseling and services; 
‘‘(C) the inclusion of cost sharing assurances that meet 
the requirements under section 110; and 
‘‘(D) the inclusion of transition strategies to ensure 
sustainability of such programs and activities, including 
health care systems, under other international donor sup-
port, or budget support by respective foreign governments.’’. 
(b) AUTHORIZATION.—Section 104A(c) of such Act is amended— 
(1) in paragraph (1), by striking ‘‘and other countries and 
areas.’’ and inserting ‘‘Central Asia, Eastern Europe, Latin 
America, and other countries and areas, particularly with 
respect to refugee populations or those in postconflict settings 
in such countries and areas with significant or increasing HIV 
incidence rates.’’; 
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122 STAT. 2947 
PUBLIC LAW 110–293—JULY 30, 2008 
(2) in paragraph (2), by striking ‘‘and other countries and 
areas affected by the HIV/AIDS pandemic’’ and inserting ‘‘Cen-
tral Asia, Eastern Europe, Latin America, and other countries 
and areas affected by the HIV/AIDS pandemic, particularly 
with respect to refugee populations or those in post-conflict 
settings in such countries and areas with significant or 
increasing HIV incidence rates.’’; and 
(3) in paragraph (3)— 
(A) by striking ‘‘foreign countries’’ and inserting 
‘‘partner countries, other international actors,’’; and 
(B) by inserting ‘‘within the framework of the principles 
of the Three Ones’’ before the period at the end. 
(c) ACTIVITIES SUPPORTED.—Section 104A(d) of such Act is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) by inserting ‘‘and multiple concurrent sexual 
partnering,’’ after ‘‘casual sexual partnering’’; and 
(ii) by striking ‘‘condoms’’ and inserting ‘‘male and 
female condoms’’; 
(B) in subparagraph (B)— 
(i) by striking ‘‘programs that’’ and inserting ‘‘pro-
grams that are designed with local input and’’; and 
(ii) by striking ‘‘those organizations’’ and inserting 
‘‘those locally based organizations’’; 
(C) in subparagraph (D), by inserting ‘‘and promoting 
the use of provider-initiated or ‘opt-out’ voluntary testing 
in accordance with World Health Organization guidelines’’ 
before the semicolon at the end; 
(D) by redesignating subparagraphs (F), (G), and (H) 
as subparagraphs (H), (I), and (J), respectively; 
(E) by inserting after subparagraph (E) the following: 
‘‘(F) assistance to— 
‘‘(i) achieve the goal of reaching 80 percent of preg-
nant women for prevention and treatment of mother- 
to-child transmission of HIV in countries in which the 
United States is implementing HIV/AIDS programs 
by 2013; and 
‘‘(ii) promote infant feeding options and treatment 
protocols that meet the most recent criteria established 
by the World Health Organization; 
‘‘(G) medical male circumcision programs as part of 
national strategies to combat the transmission of HIV/ 
AIDS;’’; 
(F) in subparagraph (I), as redesignated, by striking 
‘‘and’’ at the end; and 
(G) by adding at the end the following: 
‘‘(K) assistance for counseling, testing, treatment, care, 
and support programs, including— 
‘‘(i) counseling and other services for the preven-
tion of reinfection of individuals with HIV/AIDS; 
‘‘(ii) counseling to prevent sexual transmission of 
HIV, including— 
‘‘(I) life skills development for practicing 
abstinence and faithfulness; 
‘‘(II) reducing the number of sexual partners; 
‘‘(III) delaying sexual debut; and 
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122 STAT. 2948 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(IV) ensuring correct and consistent use of 
condoms; 
‘‘(iii) 
assistance 
to 
engage 
underlying 
vulnerabilities to HIV/AIDS, especially those of women 
and girls; 
‘‘(iv) assistance for appropriate HIV/AIDS edu-
cation programs and training targeted to prevent the 
transmission of HIV among men who have sex with 
men; 
‘‘(v) assistance to provide male and female 
condoms; 
‘‘(vi) diagnosis and treatment of other sexually 
transmitted infections; 
‘‘(vii) strategies to address the stigma and discrimi-
nation that impede HIV/AIDS prevention efforts; and 
‘‘(viii) assistance to facilitate widespread access to 
microbicides for HIV prevention, if safe and effective 
products become available, including financial and 
technical support for culturally appropriate introduc-
tory programs, procurement, distribution, logistics 
management, program delivery, acceptability studies, 
provider 
training, 
demand 
generation, 
and 
postintroduction monitoring.’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (B), by striking ‘‘and’’ at the end; 
(B) in subparagraph (C)— 
(i) 
by 
inserting 
‘‘pain 
management,’’ 
after 
‘‘opportunistic infections,’’; and 
(ii) by striking the period at the end and inserting 
a semicolon; and 
(C) by adding at the end the following: 
‘‘(D) as part of care and treatment of HIV/AIDS, assist-
ance (including prophylaxis and treatment) for common 
HIV/AIDS-related opportunistic infections for free or at 
a rate at which it is easily affordable to the individuals 
and populations being served; 
‘‘(E) as part of care and treatment of HIV/AIDS, assist-
ance or referral to available and adequately resourced 
service providers for nutritional support, including coun-
seling and where necessary the provision of commodities, 
for persons meeting malnourishment criteria and their 
families;’’; 
(3) in paragraph (4)— 
(A) in subparagraph (C), by striking ‘‘and’’ at the end; 
(B) in subparagraph (D), by striking the period at 
the end and inserting a semicolon; and 
(C) by adding at the end the following: 
‘‘(E) carrying out and expanding program monitoring, 
impact evaluation research and analysis, and operations 
research and disseminating data and findings through 
mechanisms to be developed by the Coordinator of United 
States Government Activities to Combat HIV/AIDS Glob-
ally, in coordination with the Director of the Centers for 
Disease Control, in order to— 
‘‘(i) improve accountability, increase transparency, 
and ensure the delivery of evidence-based services 
through the collection, evaluation, and analysis of data 
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122 STAT. 2949 
PUBLIC LAW 110–293—JULY 30, 2008 
regarding 
gender-responsive 
interventions, 
disaggregated by age and sex; 
‘‘(ii) identify and replicate effective models; and 
‘‘(iii) develop gender indicators to measure out-
comes and the impacts of interventions; and 
‘‘(F) establishing appropriate systems to— 
‘‘(i) gather epidemiological and social science data 
on HIV; and 
‘‘(ii) evaluate the effectiveness of prevention efforts 
among men who have sex with men, with due consider-
ation to stigma and risks associated with disclosure.’’; 
(4) in paragraph (5)— 
(A) by redesignating subparagraph (C) as subpara-
graph (D); and 
(B) by inserting after subparagraph (B) the following: 
‘‘(C) MECHANISM TO ENSURE COST-EFFECTIVE DRUG PUR-
CHASING.—Subject to subparagraph (B), mechanisms to 
ensure that safe and effective pharmaceuticals, including 
antiretrovirals and medicines to treat opportunistic infec-
tions, are purchased at the lowest possible price at which 
such pharmaceuticals may be obtained in sufficient 
quantity on the world market, provided that such pharma-
ceuticals are approved, tentatively approved, or otherwise 
authorized for use by— 
‘‘(i) the Food and Drug Administration; 
‘‘(ii) a stringent regulatory agency acceptable to 
the Secretary of Health and Human Services; or 
‘‘(iii) a quality assurance mechanism acceptable 
to the Secretary of Health and Human Services.’’; 
(5) in paragraph (6)— 
(A) by amending the paragraph heading to read as 
follows: 
‘‘(6) RELATED AND COORDINATED ACTIVITIES.—’’; 
(B) in subparagraph (B), by striking ‘‘and’’ at the end; 
(C) in subparagraph (C), by striking the period at 
the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(D) coordinated or referred activities to— 
‘‘(i) enhance the clinical impact of HIV/AIDS care 
and treatment; and 
‘‘(ii) ameliorate the adverse social and economic 
costs often affecting AIDS-impacted families and 
communities through the direct provision, as necessary, 
or through the referral, if possible, of support services, 
including— 
‘‘(I) nutritional and food support; 
‘‘(II) safe drinking water and adequate sanita-
tion; 
‘‘(III) nutritional counseling; 
‘‘(IV) income-generating activities and liveli-
hood initiatives; 
‘‘(V) maternal and child health care; 
‘‘(VI) primary health care; 
‘‘(VII) the diagnosis and treatment of other 
infectious or sexually transmitted diseases; 
‘‘(VIII) substance abuse and treatment serv-
ices; and 
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122 STAT. 2950 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(IX) legal services; 
‘‘(E) coordinated or referred activities to link programs 
addressing HIV/AIDS with programs addressing gender- 
based violence in areas of significant HIV prevalence to 
assist countries in the development and enforcement of 
women’s health, children’s health, and HIV/AIDS laws and 
policies that— 
‘‘(i) prevent and respond to violence against women 
and girls; 
‘‘(ii) promote the integration of screening and 
assessment for gender-based violence into HIV/AIDS 
programming; 
‘‘(iii) promote appropriate HIV/AIDS counseling, 
testing, and treatment into gender-based violence pro-
grams; and 
‘‘(iv) assist governments to develop partnerships 
with civil society organizations to create networks for 
psychosocial, legal, economic, or other support services; 
‘‘(F) coordinated or referred activities to— 
‘‘(i) address the frequent coinfection of HIV and 
tuberculosis, 
in 
accordance 
with 
World 
Health 
Organization guidelines; 
‘‘(ii) promote provider-initiated or ‘opt-out’ HIV/ 
AIDS counseling and testing and appropriate referral 
for treatment and care to individuals with tuberculosis 
or its symptoms, particularly in areas with significant 
HIV prevalence; and 
‘‘(iii) strengthen programs to ensure that individ-
uals testing positive for HIV receive tuberculosis 
screening and to improve laboratory capacities, infec-
tion control, and adherence; and 
‘‘(G) activities to— 
‘‘(i) improve the effectiveness of national responses 
to HIV/AIDS; 
‘‘(ii) strengthen overall health systems in high- 
prevalence countries, including support for workforce 
training, retention, and effective deployment, capacity 
building, laboratory development, equipment mainte-
nance and repair, and public health and related public 
financial management systems and operations; and 
‘‘(iii) encourage fair and transparent procurement 
practices among partner countries; and 
‘‘(iv) promote in-country or intra-regional pediatric 
training for physicians and other health professionals, 
preferably 
through 
public-private 
partnerships 
involving colleges and universities, with the goal of 
increasing pediatric HIV workforce capacity.’’; and 
(6) by adding at the end the following: 
‘‘(8) 
COMPACTS
AND
FRAMEWORK
AGREEMENTS.—The 
development of compacts or framework agreements, tailored 
to local circumstances, with national governments or regional 
partnerships in countries with significant HIV/AIDS burdens 
to promote host government commitment to deeper integration 
of HIV/AIDS services into health systems, contribute to health 
systems overall, and enhance sustainability, including— 
‘‘(A) cost sharing assurances that meet the require-
ments under section 110; and 
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122 STAT. 2951 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(B) transition strategies to ensure sustainability of 
such programs and activities, including health care sys-
tems, under other international donor support, or budget 
support by respective foreign governments.’’. 
(d) COMPACTS AND FRAMEWORK AGREEMENTS.—Section 104A 
of such Act is amended— 
(1) by redesignating subsections (e) through (g) as sub-
sections (f) through (h); and 
(2) by inserting after subsection (d) the following: 
‘‘(e) COMPACTS AND FRAMEWORK AGREEMENTS.— 
‘‘(1) FINDINGS.—Congress makes the following findings: 
‘‘(A) The congressionally mandated Institute of Medi-
cine report entitled ‘PEPFAR Implementation: Progress 
and Promise’ states: ‘The next strategy [of the U.S. Global 
AIDS Initiative] should squarely address the needs and 
challenges involved in supporting sustainable country HIV/ 
AIDS programs, thereby transitioning from a focus on 
emergency relief.’. 
‘‘(B) One mechanism to promote the transition from 
an emergency to a public health and development approach 
to HIV/AIDS is through compacts or framework agreements 
between the United States Government and each partici-
pating nation. 
‘‘(2) ELEMENTS.—Compacts on HIV/AIDS authorized under 
subsection (d)(8) shall include the following elements: 
‘‘(A) Compacts whose primary purpose is to provide 
direct services to combat HIV/AIDS are to be made 
between— 
‘‘(i) the United States Government; and 
‘‘(ii)(I) national or regional entities representing 
low-income countries served by an existing United 
States Agency for International Development or 
Department of Health and Human Services presence 
or regional platform; or 
‘‘(II) countries or regions— 
‘‘(aa) experiencing significantly high HIV 
prevalence or risk of significantly increasing 
incidence within the general population; 
‘‘(bb) served by an existing United States 
Agency for International Development or Depart-
ment of Health and Human Services presence or 
regional platform; and 
‘‘(cc) that have inadequate financial means 
within such country or region. 
‘‘(B) Compacts whose primary purpose is to provide 
limited technical assistance to a country or region con-
nected to services provided within the country or region— 
‘‘(i) may be made with other countries or regional 
entities served by an existing United States Agency 
for International Development or Department of 
Health and Human Services presence or regional plat-
form; 
‘‘(ii) shall require significant investments in HIV 
prevention, care, and treatment services by the host 
country; 
‘‘(iii) shall be time-limited in terms of United 
States contributions; and 
Deadlines. 
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122 STAT. 2952 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(iv) shall be made only upon prior notification 
to Congress— 
‘‘(I) justifying the need for such compacts; 
‘‘(II) describing the expected investment by the 
country or regional entity; and 
‘‘(III) describing the scope, nature, expected 
total United States investment, and time frame 
of the limited technical assistance under the com-
pact and its intended impact. 
‘‘(C) Compacts shall include provisions to— 
‘‘(i) promote local and national efforts to reduce 
stigma associated with HIV/AIDS; and 
‘‘(ii) work with and promote the role of civil society 
in combating HIV/AIDS. 
‘‘(D) Compacts shall take into account the overall 
national health and development and national HIV/AIDS 
and public health strategies of each country. 
‘‘(E) Compacts shall contain— 
‘‘(i) consideration of the specific objectives that the 
country and the United States expect to achieve during 
the term of a compact; 
‘‘(ii) consideration of the respective responsibilities 
of the country and the United States in the achieve-
ment of such objectives; 
‘‘(iii) consideration of regular benchmarks to 
measure progress toward achieving such objectives; 
‘‘(iv) an identification of the intended beneficiaries, 
disaggregated by gender and age, and including 
information on orphans and vulnerable children, to 
the maximum extent practicable; 
‘‘(v) consideration of the methods by which the 
compact is intended to— 
‘‘(I) address the factors that put women and 
girls at greater risk of HIV/AIDS; and 
‘‘(II) strengthen elements such as the eco-
nomic, educational, and social status of women, 
girls, orphans, and vulnerable children and the 
inheritance rights and safety of such individuals; 
‘‘(vi) consideration of the methods by which the 
compact will— 
‘‘(I) strengthen the health care capacity, 
including factors such as the training, retention, 
deployment, recruitment, and utilization of health 
care workers; 
‘‘(II) improve supply chain management; and 
‘‘(III) improve the health systems and infra-
structure of the partner country, including the 
ability of compact participants to maintain and 
operate equipment transferred or purchased as 
part of the compact; 
‘‘(vii) consideration of proposed mechanisms to pro-
vide oversight; 
‘‘(viii) consideration of the role of civil society in 
the development of a compact and the achievement 
of its objectives; 
Notification. 
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122 STAT. 2953 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(ix) a description of the current and potential 
participation of other donors in the achievement of 
such objectives, as appropriate; and 
‘‘(x) consideration of a plan to ensure appropriate 
fiscal accountability for the use of assistance. 
‘‘(F) For regional compacts, priority shall be given to 
countries that are included in regional funds and programs 
in existence as of the date of the enactment of the Tom 
Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthoriza-
tion Act of 2008. 
‘‘(G) Amounts made available for compacts described 
in subparagraphs (A) and (B) shall be subject to the inclu-
sion of— 
‘‘(i) cost sharing assurances that meet the require-
ments under section 110; and 
‘‘(ii) transition strategies to ensure sustainability 
of such programs and activities, including health care 
systems, under other international donor support, and 
budget support by respective foreign governments. 
‘‘(3) LOCAL INPUT.—In entering into a compact on HIV/ 
AIDS authorized under subsection (d)(8), the Coordinator of 
United States Government Activities to Combat HIV/AIDS 
Globally shall seek to ensure that the government of a 
country— 
‘‘(A) takes into account the local perspectives of the 
rural and urban poor, including women, in each country; 
and 
‘‘(B) consults with private and voluntary organizations, 
including faith-based organizations, the business commu-
nity, and other donors in the country. 
‘‘(4) CONGRESSIONAL
AND
PUBLIC
NOTIFICATION
AFTER 
ENTERING
INTO
A
COMPACT.—Not later than 10 days after 
entering into a compact authorized under subsection (d)(8), 
the Global AIDS Coordinator shall— 
‘‘(A) submit a report containing a detailed summary 
of the compact and a copy of the text of the compact 
to— 
‘‘(i) the Committee on Foreign Relations of the 
Senate; 
‘‘(ii) the Committee on Appropriations of the 
Senate; 
‘‘(iii) the Committee on Foreign Affairs of the 
House of Representatives; and 
‘‘(iv) the Committee on Appropriations of the House 
of Representatives; and 
‘‘(B) publish such information in the Federal Register 
and on the Internet website of the Office of the Global 
AIDS Coordinator.’’. 
(e) ANNUAL REPORT.—Section 104A(f) of such Act, as redesig-
nated, is amended— 
(1) in paragraph (1), by striking ‘‘Committee on Inter-
national Relations’’ and inserting ‘‘Committee on Foreign 
Affairs’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (B), by striking ‘‘and’’ at the end; 
Federal Register, 
publication. 
Web site. 
Deadline. 
Reports. 
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122 STAT. 2954 
PUBLIC LAW 110–293—JULY 30, 2008 
(B) by striking subparagraph (C) and inserting the 
following: 
‘‘(C) a detailed breakdown of funding allocations, by 
program and by country, for prevention activities; and 
‘‘(D) a detailed assessment of the impact of programs 
established pursuant to such sections, including— 
‘‘(i)(I) the effectiveness of such programs in 
reducing— 
‘‘(aa) the transmission of HIV, particularly in 
women and girls; 
‘‘(bb) mother-to-child transmission of HIV, 
including through drug treatment and therapies, 
either directly or by referral; and 
‘‘(cc) mortality rates from HIV/AIDS; 
‘‘(II) the number of patients receiving treatment 
for AIDS in each country that receives assistance under 
this Act; 
‘‘(III) an assessment of progress towards the 
achievement of annual goals set forth in the timetable 
required under the 5-year strategy established under 
section 101 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and, 
if annual goals are not being met, the reasons for 
such failure; and 
‘‘(IV) retention and attrition data for programs 
receiving United States assistance, including mortality 
and loss to follow-up rates, organized overall and by 
country; 
‘‘(ii) the progress made toward— 
‘‘(I) improving health care delivery systems 
(including the training of health care workers, 
including doctors, nurses, midwives, pharmacists, 
laboratory technicians, and compensated commu-
nity health workers, and the use of codes of con-
duct for ethical recruiting practices for health care 
workers); 
‘‘(II) advancing safe working conditions for 
health care workers; and 
‘‘(III) improving infrastructure to promote 
progress toward universal access to HIV/AIDS 
prevention, treatment, and care by 2013; 
‘‘(iii) a description of coordination efforts with rel-
evant executive branch agencies to link HIV/AIDS clin-
ical and social services with non-HIV/AIDS services 
as part of the United States health and development 
agenda; 
‘‘(iv) a detailed description of integrated HIV/AIDS 
and food and nutrition programs and services, 
including— 
‘‘(I) the amount spent on food and nutrition 
support; 
‘‘(II) the types of activities supported; and 
‘‘(III) an assessment of the effectiveness of 
interventions carried out to improve the health 
status of persons with HIV/AIDS receiving food 
or nutritional support; 
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122 STAT. 2955 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(v) a description of efforts to improve harmoni-
zation, in terms of relevant executive branch agencies, 
coordination with other public and private entities, 
and coordination with partner countries’ national stra-
tegic plans as called for in the ‘Three Ones’; 
‘‘(vi) a description of— 
‘‘(I) the efforts of partner countries that were 
signatories to the Abuja Declaration on HIV/AIDS, 
Tuberculosis and Other Related Infectious Dis-
eases to adhere to the goals of such Declaration 
in terms of investments in public health, including 
HIV/AIDS; and 
‘‘(II) a description of the HIV/AIDS invest-
ments of partner countries that were not signato-
ries to such Declaration; 
‘‘(vii) a detailed description of any compacts or 
framework agreements reached or negotiated between 
the United States and any partner countries, including 
a description of the elements of compacts described 
in subsection (e); 
‘‘(viii) a description of programs serving women 
and girls, including— 
‘‘(I) HIV/AIDS prevention programs that 
address the vulnerabilities of girls and women to 
HIV/AIDS; 
‘‘(II) information on the number of individuals 
served by programs aimed at reducing the 
vulnerabilities of women and girls to HIV/AIDS 
and data on the types, objectives, and duration 
of programs to address these issues; 
‘‘(III) information on programs to address the 
particular needs of adolescent girls and young 
women; and 
‘‘(IV) 
programs 
to 
prevent 
gender-based 
violence or to assist victims of gender based 
violence as part of, or in coordination with, HIV/ 
AIDS programs; 
‘‘(ix) a description of strategies, goals, programs, 
and interventions to— 
‘‘(I) address the needs and vulnerabilities of 
youth populations; 
‘‘(II) expand access among young men and 
women to evidence-based HIV/AIDS health care 
services and HIV prevention programs, including 
abstinence education programs; and 
‘‘(III) expand community-based services to 
meet the needs of orphans and of children and 
adolescents affected by or vulnerable to HIV/AIDS 
without increasing stigmatization; 
‘‘(x) a description of— 
‘‘(I) the specific strategies funded to ensure 
the reduction of HIV infection among injection 
drug users; 
‘‘(II) the number of injection drug users, by 
country, reached by such strategies; and 
‘‘(III) medication-assisted drug treatment for 
individuals with HIV or at risk of HIV; 
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122 STAT. 2956 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(xi) a detailed description of program monitoring, 
operations research, and impact evaluation research, 
including— 
‘‘(I) the amount of funding provided for each 
research type; 
‘‘(II) an analysis of cost-effectiveness models; 
and 
‘‘(III) conclusions regarding the efficiency, 
effectiveness, and quality of services as derived 
from previous or ongoing research and monitoring 
efforts; 
‘‘(xii) building capacity to identify, investigate, and 
stop nosocomial transmission of infectious diseases, 
including HIV and tuberculosis; and 
‘‘(xiii) a description of staffing levels of United 
States government HIV/AIDS teams in countries with 
significant HIV/AIDS programs, including whether or 
not a full-time coordinator was on staff for the year.’’. 
(f) AUTHORIZATION OF APPROPRIATIONS.—Section 301(b) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7631(b)) is amended— 
(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’’. 
(g) RELATIONSHIP TO ASSISTANCE PROGRAMS TO ENHANCE 
NUTRITION.—Section 301(c) of such Act is amended to read as 
follows: 
‘‘(c) FOOD AND NUTRITIONAL SUPPORT.— 
‘‘(1) IN GENERAL.—As indicated in the report produced by 
the Institute of Medicine, entitled ‘PEPFAR Implementation: 
Progress and Promise’, inadequate caloric intake has been 
clearly identified as a principal reason for failure of clinical 
response to antiretroviral therapy. In recognition of the impact 
of malnutrition as a clinical health issue for many persons 
living with HIV/AIDS that is often associated with health and 
economic impacts on these individuals and their families, the 
Global AIDS Coordinator and the Administrator of the United 
States Agency for International Development shall— 
‘‘(A) follow World Health Organization guidelines for 
HIV/AIDS food and nutrition services; 
‘‘(B) integrate nutrition programs with HIV/AIDS 
activities through effective linkages among the health, agri-
cultural, and livelihood sectors and establish additional 
services in circumstances in which referrals are inadequate 
or impossible; 
‘‘(C) provide, as a component of care and treatment 
programs for persons with HIV/AIDS, food and nutritional 
support to individuals infected with, and affected by, HIV/ 
AIDS who meet established criteria for nutritional support 
(including clinically malnourished children and adults, and 
pregnant and lactating women in programs in need of 
supplemental support), including— 
‘‘(i) anthropometric and dietary assessment; 
‘‘(ii) counseling; and 
‘‘(iii) therapeutic and supplementary feeding; 
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122 STAT. 2957 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(D) provide food and nutritional support for children 
affected by HIV/AIDS and to communities and households 
caring for children affected by HIV/AIDS; and 
‘‘(E) in communities where HIV/AIDS and food insecu-
rity are highly prevalent, support programs to address 
these often intersecting health problems through commu-
nity-based assistance programs, with an emphasis on 
sustainable approaches. 
‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—Of the amounts 
authorized to be appropriated under section 401, there are 
authorized to be appropriated to the President such sums as 
may be necessary for each of the fiscal years 2009 through 
2013 to carry out this subsection.’’. 
(h) ELIGIBILITY FOR ASSISTANCE.—Section 301(d) of such Act 
is amended to read as follows: 
‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organization, including 
a faith-based organization, that is otherwise eligible to receive 
assistance under section 104A of the Foreign Assistance Act of 
1961, under this Act, or under any amendment made by this Act 
or by the Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthor-
ization Act of 2008, for HIV/AIDS prevention, treatment, or care— 
‘‘(1) shall not be required, as a condition of receiving such 
assistance— 
‘‘(A) to endorse or utilize a multisectoral or comprehen-
sive approach to combating HIV/AIDS; or 
‘‘(B) to endorse, utilize, make a referral to, become 
integrated with, or otherwise participate in any program 
or activity 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 cooperative agreements 
under such provisions of law for refusing to meet any require-
ment described in paragraph (1).’’. 
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 
(a) POLICY.—Section 104B(b) of the Foreign Assistance Act of 
1961 (22 U.S.C. 2151b–3(b)) is amended to read as follows: 
‘‘(b) POLICY.—It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest 
burden of tuberculosis and other countries with high rates of tuber-
culosis, the United States should support the objectives of the 
Global Plan to Stop TB, including through achievement of the 
following goals: 
‘‘(1) Reduce by 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 tuberculosis and the success-
ful treatment of at least 85 percent of the cases detected in 
countries with established United States Agency for Inter-
national Development tuberculosis programs. 
‘‘(3) In support of the Global Plan to Stop TB, the President 
shall establish a comprehensive, 5-year United States strategy 
to expand and improve United States efforts to combat tuber-
culosis globally, including a plan to support— 
President. 
Plans. 
Non- 
discrimination. 
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122 STAT. 2958 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(A) the successful treatment of 4,500,000 new sputum 
smear tuberculosis patients under DOTS programs by 2013, 
primarily through direct support for needed services, 
commodities, health workers, and training, and additional 
treatment through coordinated multilateral efforts; and 
‘‘(B) the diagnosis and treatment of 90,000 new mul-
tiple drug resistant tuberculosis cases by 2013, and addi-
tional treatment through coordinated multilateral efforts.’’. 
(b) PRIORITY TO STOP TB STRATEGY.—Section 104B(e) of such 
Act is amended to read as follows: 
‘‘(e) PRIORITY TO STOP TB STRATEGY.—In furnishing assistance 
under subsection (c), the President shall give priority to— 
‘‘(1) direct services described in the Stop TB Strategy, 
including expansion and enhancement of Directly Observed 
Treatment Short-course (DOTS) coverage, rapid testing, treat-
ment for individuals infected with both tuberculosis and HIV, 
and treatment for individuals with multi-drug resistant tuber-
culosis (MDR–TB), strengthening of health systems, use of the 
International Standards for Tuberculosis Care by all providers, 
empowering individuals with tuberculosis, and enabling and 
promoting research to develop new diagnostics, drugs, and vac-
cines, and program-based operational research relating to tuber-
culosis; and 
‘‘(2) funding for the Global Tuberculosis Drug Facility, the 
Stop Tuberculosis Partnership, and the Global Alliance for TB 
Drug Development.’’. 
(c) ASSISTANCE FOR THE WORLD HEALTH ORGANIZATION AND 
THE STOP TUBERCULOSIS PARTNERSHIP.—Section 104B of such Act 
is amended— 
(1) by redesignating subsection (f) as subsection (h); and 
(2) by inserting after subsection (e) the following: 
‘‘(f) ASSISTANCE FOR THE WORLD HEALTH ORGANIZATION AND 
THE STOP TUBERCULOSIS PARTNERSHIP.—In carrying out this sec-
tion, the President, acting through the Administrator of the United 
States Agency for International Development, is authorized to pro-
vide increased resources to the World Health Organization and 
the Stop Tuberculosis Partnership to improve the capacity of coun-
tries with high rates of tuberculosis and other affected countries 
to implement the Stop TB Strategy and specific strategies related 
to addressing multiple drug resistant tuberculosis (MDR–TB) and 
extensively drug resistant tuberculosis (XDR–TB).’’. 
(d) ANNUAL REPORT.—Section 104B of such Act is amended 
by inserting after subsection (f), as added by subsection (c) of 
this section, the following: 
‘‘(g) ANNUAL REPORT.—The President shall submit an annual 
report to Congress that describes the impact of United States foreign 
assistance on efforts to control tuberculosis, including— 
‘‘(1) the number of tuberculosis cases diagnosed and the 
number of cases cured in countries receiving United States 
bilateral foreign assistance for tuberculosis control purposes; 
‘‘(2) a description of activities supported with United States 
tuberculosis resources in each country, including a description 
of how those activities specifically contribute to increasing the 
number of people diagnosed and treated for tuberculosis; 
‘‘(3) in each country receiving bilateral United States for-
eign assistance for tuberculosis control purposes, the percentage 
provided for direct tuberculosis services in countries receiving 
President. 
Foreign 
assistance. 
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122 STAT. 2959 
PUBLIC LAW 110–293—JULY 30, 2008 
United States bilateral foreign assistance for tuberculosis con-
trol purposes; 
‘‘(4) a description of research efforts and clinical trials 
to develop new tools to combat tuberculosis, including 
diagnostics, drugs, and vaccines supported by United States 
bilateral assistance; 
‘‘(5) the number of persons who have been diagnosed and 
started treatment for multidrug-resistant tuberculosis in coun-
tries receiving United States bilateral foreign assistance for 
tuberculosis control programs; 
‘‘(6) a description of the collaboration and coordination of 
United States anti-tuberculosis efforts with the World Health 
Organization, the Global Fund, and other major public and 
private entities within the Stop TB Strategy; 
‘‘(7) the constraints on implementation of programs posed 
by health workforce shortages and capacities; 
‘‘(8) the number of people trained in tuberculosis control; 
and 
‘‘(9) a breakdown of expenditures for direct patient tuber-
culosis services, drugs and other commodities, drug manage-
ment, training in diagnosis and treatment, health systems 
strengthening, research, and support costs.’’. 
(e) DEFINITIONS.—Section 104B(h) of such Act, as redesignated 
by subsection (c), is amended— 
(1) in paragraph (1), by striking the period at the end 
and inserting the following: ‘‘including— 
‘‘(A) low-cost and effective diagnosis, treatment, and 
monitoring of tuberculosis; 
‘‘(B) a reliable drug supply; 
‘‘(C) a management strategy for public health systems; 
‘‘(D) health system strengthening; 
‘‘(E) promotion of the use of the International Stand-
ards for Tuberculosis Care by all care providers; 
‘‘(F) bacteriology under an external quality assessment 
framework; 
‘‘(G) short-course chemotherapy; and 
‘‘(H) sound reporting and recording systems.’’; and 
(2) by redesignating paragraph (5) as paragraph (6); and 
(3) by inserting after paragraph (4) the following: 
‘‘(5) STOP
TB
STRATEGY.—The term ‘Stop TB Strategy’ 
means the 6-point strategy to reduce tuberculosis developed 
by the World Health Organization, which is described in the 
Global Plan to Stop TB 2006–2015: Actions for Life, a com-
prehensive plan developed by the Stop TB Partnership that 
sets out the actions necessary to achieve the millennium 
development goal of cutting tuberculosis deaths and disease 
burden in half by 2015.’’. 
(f) AUTHORIZATION OF APPROPRIATIONS.—Section 302 (b) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended— 
(1) in paragraph (1), by striking ‘‘such sums as may be 
necessary for each of the fiscal years 2004 through 2008’’ and 
inserting ‘‘a total of $4,000,000,000 for the 5-year period begin-
ning on October 1, 2008.’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013.’’. 
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122 STAT. 2960 
PUBLIC LAW 110–293—JULY 30, 2008 
SEC. 303. ASSISTANCE TO COMBAT MALARIA. 
(a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT OF 1961.— 
Section 104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151–4(b)) is amended by inserting ‘‘treatment,’’ after ‘‘control,’’. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—Section 303 of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003, and Malaria Act of 2003 (22 U.S.C. 7633) 
is amended— 
(1) in subsection (b)— 
(A) in paragraph (1), by striking ‘‘such sums as may 
be necessary for fiscal years 2004 through 2008’’ and 
inserting ‘‘$5,000,000,000 during the 5-year period begin-
ning on October 1, 2008’’; and 
(B) in paragraph (3), by striking ‘‘fiscal years 2004 
through 2008’’ and inserting ‘‘fiscal years 2009 through 
2013’’; and 
(2) by adding at the end the following: 
‘‘(c) STATEMENT
OF
POLICY.—Providing assistance for the 
prevention, control, treatment, and the ultimate eradication of 
malaria is— 
‘‘(1) a major objective of the foreign assistance program 
of the United States; and 
‘‘(2) 1 component of a comprehensive United States global 
health strategy to reduce disease burdens and strengthen 
communities around the world. 
‘‘(d) DEVELOPMENT OF A COMPREHENSIVE 5-YEAR STRATEGY.— 
The President shall establish a comprehensive, 5-year strategy to 
combat global malaria that— 
‘‘(1) strengthens the capacity of the United States to be 
an effective leader of international efforts to reduce malaria 
burden; 
‘‘(2) maintains sufficient flexibility and remains responsive 
to the ever-changing nature of the global malaria challenge; 
‘‘(3) 
includes 
specific 
objectives 
and 
multisectoral 
approaches and strategies to reduce the prevalence, mortality, 
incidence, and spread of malaria; 
‘‘(4) describes how this strategy would contribute to the 
United States’ overall global health and development goals; 
‘‘(5) clearly explains how outlined activities will interact 
with other United States Government global health activities, 
including the 5-year global AIDS strategy required under this 
Act; 
‘‘(6) expands public-private partnerships and leverage of 
resources; 
‘‘(7) coordinates among relevant Federal agencies to maxi-
mize human and financial resources and to reduce duplication 
among these agencies, foreign governments, and international 
organizations; 
‘‘(8) coordinates with other international entities, including 
the Global Fund; 
‘‘(9) maximizes United States capabilities in the areas of 
technical assistance and training and research, including vac-
cine research; and 
‘‘(10) establishes priorities and selection criteria for the 
distribution of resources based on factors such as— 
‘‘(A) the size and demographics of the population with 
malaria; 
President. 
22 USC 7633. 
22 USC 2151b–4. 
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122 STAT. 2961 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(B) the needs of that population; 
‘‘(C) the country’s existing infrastructure; and 
‘‘(D) the ability to closely coordinate United States 
Government efforts with national malaria control plans 
of partner countries.’’. 
SEC. 304. MALARIA RESPONSE COORDINATOR. 
Section 304 of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) 
is amended to read as follows: 
‘‘SEC. 304. MALARIA RESPONSE COORDINATOR. 
‘‘(a) IN GENERAL.—There is established within the United 
States Agency for International Development a Coordinator of 
United States Government Activities to Combat Malaria Globally 
(referred to in this section as the ‘Malaria Coordinator’), who shall 
be appointed by the President. 
‘‘(b) AUTHORITIES.—The Malaria Coordinator, acting through 
nongovernmental organizations (including faith-based and commu-
nity-based organizations), partner country finance, health, and other 
relevant ministries, and relevant executive branch agencies as may 
be necessary and appropriate to carry out this section, is authorized 
to— 
‘‘(1) operate internationally to carry out prevention, care, 
treatment, support, capacity development, and other activities 
to reduce the prevalence, mortality, and incidence of malaria; 
‘‘(2) provide grants to, and enter into contracts and coopera-
tive 
agreements 
with, 
nongovernmental 
organizations 
(including faith-based organizations) to carry out this section; 
and 
‘‘(3) transfer and allocate executive branch agency funds 
that have been appropriated for the purposes described in para-
graphs (1) and (2). 
‘‘(c) DUTIES.— 
‘‘(1) IN GENERAL.—The Malaria Coordinator has primary 
responsibility for the oversight and coordination of all resources 
and international activities of the United States Government 
relating to efforts to combat malaria. 
‘‘(2) SPECIFIC DUTIES.—The Malaria Coordinator shall— 
‘‘(A) facilitate program and policy coordination of anti-
malarial efforts among relevant executive branch agencies 
and nongovernmental organizations by auditing, moni-
toring, and evaluating such programs; 
‘‘(B) ensure that each relevant executive branch agency 
undertakes antimalarial programs primarily in those areas 
in which the agency has the greatest expertise, technical 
capability, and potential for success; 
‘‘(C) coordinate relevant executive branch agency activi-
ties in the field of malaria prevention and treatment; 
‘‘(D) coordinate planning, implementation, and evalua-
tion with the Global AIDS Coordinator in countries in 
which both programs have a significant presence; 
‘‘(E) coordinate with national governments, inter-
national agencies, civil society, and the private sector; and 
‘‘(F) establish due diligence criteria for all recipients 
of funds appropriated by the Federal Government for 
malaria assistance. 
Criteria. 
Establishment. 
Government 
organization. 
President. 
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122 STAT. 2962 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(d) ASSISTANCE FOR THE WORLD HEALTH ORGANIZATION.—In 
carrying out this section, the President may provide financial assist-
ance to the Roll Back Malaria Partnership of the World Health 
Organization to improve the capacity of countries with high rates 
of malaria and other affected countries to implement comprehensive 
malaria control programs. 
‘‘(e) COORDINATION OF ASSISTANCE EFFORTS.—In carrying out 
this section and in accordance with section 104C of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b–4), the Malaria Coordinator 
shall coordinate the provision of assistance by working with— 
‘‘(1) relevant executive branch agencies, including— 
‘‘(A) the Department of State (including the Office of 
the Global AIDS Coordinator); 
‘‘(B) the Department of Health and Human Services; 
‘‘(C) the Department of Defense; and 
‘‘(D) the Office of the United States Trade Representa-
tive; 
‘‘(2) relevant multilateral institutions, including— 
‘‘(A) the World Health Organization; 
‘‘(B) the United Nations Children’s Fund; 
‘‘(C) the United Nations Development Programme; 
‘‘(D) the Global Fund; 
‘‘(E) the World Bank; and 
‘‘(F) the Roll Back Malaria Partnership; 
‘‘(3) program delivery and efforts to lift barriers that would 
impede effective and comprehensive malaria control programs; 
and 
‘‘(4) partner or recipient country governments and national 
entities including universities and civil society organizations 
(including faith- and community-based organizations). 
‘‘(f) RESEARCH.—To carry out this section, the Malaria Coordi-
nator, in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 1151d–4), shall ensure that operations and 
implementation research conducted under this Act will closely com-
plement the clinical and program research being undertaken by 
the National Institutes of Health. The Centers for Disease Control 
and Prevention should advise the Malaria Coordinator on priorities 
for operations and implementation research and should be a key 
implementer of this research. 
‘‘(g) MONITORING.—To ensure that adequate malaria controls 
are established and implemented, the Centers for Disease Control 
and Prevention should advise the Malaria Coordinator on moni-
toring, surveillance, and evaluation activities and be a key imple-
menter of such activities under this Act. Such activities shall com-
plement, rather than duplicate, the work of the World Health 
Organization. 
‘‘(h) ANNUAL REPORT.— 
‘‘(1) SUBMISSION.—Not later than 1 year after the date 
of the enactment of the Tom Lantos and Henry J. Hyde United 
States Global Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Reauthorization Act of 2008, and annually thereafter, 
the President shall submit a report to the appropriate congres-
sional committees that describes United States assistance for 
the prevention, treatment, control, and elimination of malaria. 
‘‘(2) CONTENTS.—The report required under paragraph (1) 
shall describe— 
President. 
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122 STAT. 2963 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(A) the countries and activities to which malaria 
resources have been allocated; 
‘‘(B) the number of people reached through malaria 
assistance programs, including data on children and preg-
nant women; 
‘‘(C) research efforts to develop new tools to combat 
malaria, including drugs and vaccines; 
‘‘(D) the collaboration and coordination of United States 
antimalarial efforts with the World Health Organization, 
the Global Fund, the World Bank, other donor govern-
ments, major private efforts, and relevant executive agen-
cies; 
‘‘(E) the coordination of United States antimalarial 
efforts with the national malarial strategies of other donor 
or partner governments and major private initiatives; 
‘‘(F) the estimated impact of United States assistance 
on childhood mortality and morbidity from malaria; 
‘‘(G) the coordination of antimalarial efforts with 
broader health and development programs; and 
‘‘(H) the constraints on implementation of programs 
posed by health workforce shortages or capacities; and 
‘‘(I) the number of personnel trained as health workers 
and the training levels achieved.’’. 
SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT. 
Section 212(a)(1)(A)(i) of the Immigration and Nationality Act 
(8 U.S.C. 1182(a)(1)(A)(i)) is amended by striking ‘‘, which shall 
include infection with the etiologic agent for acquired immune defi-
ciency syndrome,’’ and inserting a semicolon. 
SEC. 306. CLERICAL AMENDMENT. 
Title III of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) 
is amended by striking the heading for subtitle B and inserting 
the following: 
‘‘Subtitle B—Assistance for Women, 
Children, and Families’’. 
SEC. 307. REQUIREMENTS. 
Section 312(b) of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) 
is amended by striking paragraphs (1), (2), and (3) and inserting 
the following: 
‘‘(1) establish a target for the prevention and treatment 
of mother-to-child transmission of HIV that, by 2013, will reach 
at least 80 percent of pregnant women in those countries most 
affected by HIV/AIDS in which the United States has HIV/ 
AIDS programs; 
‘‘(2) establish a target that, by 2013, the proportion of 
children receiving care and treatment under this Act is propor-
tionate to their numbers within the population of HIV infected 
individuals in each country; 
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122 STAT. 2964 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(3) integrate care and treatment with prevention of 
mother-to-child transmission of HIV programs to improve out-
comes for HIV-affected women and families as soon as is fea-
sible and support strategies that promote successful follow- 
up and continuity of care of mother and child; 
‘‘(4) expand programs designed to care for children 
orphaned by, affected by, or vulnerable to HIV/AIDS; 
‘‘(5) ensure that women in prevention of mother-to-child 
transmission of HIV programs are provided with, or referred 
to, appropriate maternal and child services; and 
‘‘(6) develop a timeline for expanding access to more effec-
tive regimes to prevent mother-to-child transmission of HIV, 
consistent with the national policies of countries in which pro-
grams are administered under this Act and the goal of achieving 
universal use of such regimes as soon as possible.’’. 
SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD 
TRANSMISSION OF HIV. 
Section 313(a) of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) 
is amended by striking ‘‘5 years’’ and inserting ‘‘10 years’’. 
SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT 
PANEL. 
Section 312 of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) 
is amended by adding at the end the following: 
‘‘(c) PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT 
PANEL.— 
‘‘(1) ESTABLISHMENT.—The Global AIDS Coordinator shall 
establish a panel of experts to be known as the Prevention 
of Mother-to-Child Transmission Panel (referred to in this sub-
section as the ‘Panel’) to— 
‘‘(A) provide an objective review of activities to prevent 
mother-to-child transmission of HIV; and 
‘‘(B) provide recommendations to the Global AIDS 
Coordinator and to the appropriate congressional commit-
tees for scale-up of mother-to-child transmission prevention 
services under this Act in order to achieve the target estab-
lished in subsection (b)(1). 
‘‘(2) MEMBERSHIP.—The Panel shall be convened and 
chaired by the Global AIDS Coordinator, who shall serve as 
a nonvoting member. The Panel shall consist of not more than 
15 members (excluding the Global AIDS Coordinator), to be 
appointed by the Global AIDS Coordinator not later than 1 
year after the date of the enactment of this Act, including— 
‘‘(A) 2 members from the Department of Health and 
Human Services with expertise relating to the prevention 
of mother-to-child transmission activities; 
‘‘(B) 2 members from the United States Agency for 
International Development with expertise relating to the 
prevention of mother-to-child transmission activities; 
‘‘(C) 2 representatives from among health ministers 
of national governments of foreign countries in which pro-
grams under this Act are administered; 
‘‘(D) 3 members representing organizations imple-
menting prevention of mother-to-child transmission activi-
ties under this Act; 
Appointments. 
Deadline. 
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122 STAT. 2965 
PUBLIC LAW 110–293—JULY 30, 2008 
‘‘(E) 2 health care researchers with expertise relating 
to global HIV/AIDS activities; and 
‘‘(F) representatives from among patient advocate 
groups, health care professionals, persons living with HIV/ 
AIDS, and non-governmental organizations with expertise 
relating to the prevention of mother-to-child transmission 
activities, giving priority to individuals in foreign countries 
in which programs under this Act are administered. 
‘‘(3) DUTIES OF PANEL.—The Panel shall— 
‘‘(A) assess the effectiveness of current activities in 
reaching the target described in subsection (b)(1); 
‘‘(B) review scientific evidence related to the provision 
of 
mother-to-child 
transmission 
prevention 
services, 
including programmatic data and data from clinical trials; 
‘‘(C) review and assess ways in which the Office of 
the United States Global AIDS Coordinator collaborates 
with international and multilateral entities on efforts to 
prevent mother-to-child transmission of HIV in affected 
countries; 
‘‘(D) identify barriers and challenges to increasing 
access to mother-to-child transmission prevention services 
and evaluate potential mechanisms to alleviate those bar-
riers and challenges; 
‘‘(E) identify the extent to which stigma has hindered 
pregnant women from obtaining HIV counseling and testing 
or returning for results, and provide recommendations to 
address such stigma and its effects; 
‘‘(F) identify opportunities to improve linkages between 
mother-to-child transmission prevention services and care 
and treatment programs; and 
‘‘(G) recommend specific activities to facilitate reaching 
the target described in subsection (b)(1). 
‘‘(4) REPORT.— 
‘‘(A) IN
GENERAL.—Not later than 1 year after the 
date on which the Panel is first convened, the Panel shall 
submit a report containing a detailed statement of the 
recommendations, findings, and conclusions of the Panel 
to the appropriate congressional committees. 
‘‘(B) 
AVAILABILITY.—The 
report 
submitted 
under 
subparagraph (A) shall be made available to the public. 
‘‘(C) CONSIDERATION
BY
COORDINATOR.—The Coordi-
nator shall— 
‘‘(i) consider any recommendations contained in 
the report submitted under subparagraph (A); and 
‘‘(ii) include in the annual report required under 
section 104A(f) of the Foreign Assistance Act of 1961 
a description of the activities conducted in response 
to the recommendations made by the Panel and an 
explanation of any recommendations not implemented 
at the time of the report. 
‘‘(5) 
AUTHORIZATION
OF
APPROPRIATIONS.—There 
are 
authorized to be appropriated to the Panel such sums as may 
be necessary for each of the fiscal years 2009 through 2011 
to carry out this section. 
‘‘(6) TERMINATION.—The Panel shall terminate on the date 
that is 60 days after the date on which the Panel submits 
Public 
information. 
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122 STAT. 2966 
PUBLIC LAW 110–293—JULY 30, 2008 
the report to the appropriate congressional committees under 
paragraph (4).’’. 
TITLE IV—FUNDING ALLOCATIONS 
SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—Section 401(a) of the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 
(22 U.S.C. 7671(a)) is amended by striking ‘‘$3,000,000,000 for 
each of the fiscal years 2004 through 2008’’ and inserting 
‘‘$48,000,000,000 for the 5-year period beginning on October 1, 
2008’’. 
(b) SENSE OF CONGRESS.—It is the sense of the Congress that 
the appropriations authorized under section 401(a) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003, as amended by subsection (a), should be allocated 
among fiscal years 2009 through 2013 in a manner that allows 
for the appropriations to be gradually increased in a manner that 
is consistent with program requirements, absorptive capacity, and 
priorities set forth in such Act, as amended by this Act. 
SEC. 402. SENSE OF CONGRESS. 
Section 402(b) of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) 
is amended by striking ‘‘an effective distribution of such amounts 
would be’’ and all that follows through ‘‘10 percent of such amounts’’ 
and inserting ‘‘10 percent should be used’’. 
SEC. 403. ALLOCATION OF FUNDS. 
Section 403 of the United States Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) 
is amended— 
(1) by amending subsection (a) to read as follows: 
‘‘(a) BALANCED FUNDING REQUIREMENT.— 
‘‘(1) IN GENERAL.—The Global AIDS Coordinator shall— 
‘‘(A) provide balanced funding for prevention activities 
for sexual transmission of HIV/AIDS; and 
‘‘(B) ensure that activities promoting abstinence, delay 
of sexual debut, monogamy, fidelity, and partner reduction 
are implemented and funded in a meaningful and equitable 
way in the strategy for each host country based on objective 
epidemiological evidence as to the source of infections and 
in consultation with the government of each host county 
involved in HIV/AIDS prevention activities. 
‘‘(2) PREVENTION STRATEGY.— 
‘‘(A) ESTABLISHMENT.—In carrying out paragraph (1), 
the Global AIDS Coordinator shall establish an HIV sexual 
transmission prevention strategy governing the expendi-
ture of funds authorized under this Act to prevent the 
sexual transmission of HIV in any host country with a 
generalized epidemic. 
‘‘(B) REPORT.—In each host country described in 
subparagraph (A), if the strategy established under 
subparagraph (A) provides less than 50 percent of the 
funds described in subparagraph (A) for activities pro-
moting abstinence, delay of sexual debut, monogamy, 
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122 STAT. 2967 
PUBLIC LAW 110–293—JULY 30, 2008 
fidelity, and partner reduction, the Global AIDS Coordi-
nator shall, not later than 30 days after the issuance of 
this strategy, report to the appropriate congressional 
committees on the justification for this decision. 
‘‘(3) EXCLUSION.—Programs and activities that implement 
or purchase new prevention technologies or modalities, such 
as medical male circumcision, public education about risks to 
acquire HIV infection from blood exposures, promoting uni-
versal precautions, investigating suspected nosocomial infec-
tions, pre-exposure pharmaceutical prophylaxis to prevent 
transmission of HIV, or microbicides and programs and activi-
ties that provide counseling and testing for HIV or prevent 
mother-to-child prevention of HIV, shall not be included in 
determining compliance with paragraph (2). 
‘‘(4) REPORT.—Not later than 1 year after the date of the 
enactment of the Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Reauthorization Act of 2008, and annually thereafter 
as part of the annual report required under section 104A(e) 
of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–2(e)), 
the President shall— 
‘‘(A) submit a report on the implementation of para-
graph (2) for the most recently concluded fiscal year to 
the appropriate congressional committees; and 
‘‘(B) make the report described in subparagraph (A) 
available to the public.’’; 
(2) in subsection (b)— 
(A) by striking ‘‘fiscal years 2006 through 2008’’ and 
inserting ‘‘fiscal years 2009 through 2013’’; and 
(B) by striking ‘‘vulnerable children affected by’’ and 
inserting ‘‘other children affected by, or vulnerable to,’’; 
and 
(3) by adding at the end the following: 
‘‘(c) FUNDING ALLOCATION.—For each of the fiscal years 2009 
through 2013, more than half of the amounts appropriated for 
bilateral global HIV/AIDS assistance pursuant to section 401 shall 
be expended for— 
‘‘(1) antiretroviral treatment for HIV/AIDS; 
‘‘(2) clinical monitoring of HIV-seropositive people not in 
need of antiretroviral treatment; 
‘‘(3) care for associated opportunistic infections; 
‘‘(4) nutrition and food support for people living with HIV/ 
AIDS; and 
‘‘(5) other essential HIV/AIDS-related medical care for 
people living with HIV/AIDS. 
‘‘(d) TREATMENT, PREVENTION, AND CARE GOALS.—For each of 
the fiscal years 2009 through 2013— 
‘‘(1) the treatment goal under section 402(a)(3) shall be 
increased above 2,000,000 by at least the percentage increase 
in the amount appropriated for bilateral global HIV/AIDS 
assistance for such fiscal year compared with fiscal year 2008; 
‘‘(2) any increase in the treatment goal under section 
402(a)(3) above the percentage increase in the amount appro-
priated for bilateral global HIV/AIDS assistance for such fiscal 
year compared with fiscal year 2008 shall be based on long- 
Public 
information. 
President. 
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122 STAT. 2968 
PUBLIC LAW 110–293—JULY 30, 2008 
term requirements, epidemiological evidence, the share of treat-
ment needs being met by partner governments and other 
sources of treatment funding, and other appropriate factors; 
‘‘(3) the treatment goal under section 402(a)(3) shall be 
increased above the number calculated under paragraph (1) 
by the same percentage that the average United States Govern-
ment cost per patient of providing treatment in countries 
receiving bilateral HIV/AIDS assistance has decreased com-
pared with fiscal year 2008; and 
‘‘(4) the prevention and care goals established in clauses 
(i) and (iv) of section 104A(b)(1)(A) of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b–2(b)(1)(A)) shall be increased 
consistent 
with 
epidemiological 
evidence 
and 
available 
resources.’’. 
TITLE V—MISCELLANEOUS 
SEC. 501. MACHINE READABLE VISA FEES. 
(a) FEE INCREASE.—Notwithstanding any other provision of 
law— 
(1) not later than October 1, 2010, the Secretary of State 
shall increase by $1 the fee or surcharge authorized under 
section 140(a) of the Foreign Relations Authorization Act, Fiscal 
Years 1994 and 1995 (Public Law 103–236; 8 U.S.C. 1351 
note) for processing machine readable nonimmigrant visas and 
machine readable combined border crossing identification cards 
and nonimmigrant visas; and 
(2) not later than October 1, 2013, the Secretary shall 
increase the fee or surcharge described in paragraph (1) by 
an additional $1. 
(b) DEPOSIT OF AMOUNTS.—Notwithstanding section 140(a)(2) 
of the Foreign Relations Authorization Act, Fiscal Years 1994 and 
1995 (Public Law 103–236; 8 U.S.C. 1351 note), fees collected under 
the authority of subsection (a) shall be deposited in the Treasury. 
TITLE VI—EMERGENCY PLAN FOR 
INDIAN SAFETY AND HEALTH 
SEC. 601. EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH. 
(a) ESTABLISHMENT
OF FUND.—There is established in the 
Treasury of the United States a fund, to be known as the ‘‘Emer-
gency Fund for Indian Safety and Health’’ (referred to in this 
section as the ‘‘Fund’’), consisting of such amounts as are appro-
priated to the Fund under subsection (b). 
(b) TRANSFERS TO FUND.— 
(1) IN GENERAL.—There is authorized to be appropriated 
to the Fund, out of funds of the Treasury not otherwise appro-
priated, $2,000,000,000 for the 5-year period beginning on 
October 1, 2008. 
(2) AVAILABILITY OF AMOUNTS.—Amounts deposited in the 
Fund under this section shall— 
(A) be made available without further appropriation; 
(B) be in addition to amounts made available under 
any other provision of law; and 
(C) remain available until expended. 
Effective date. 
25 USC 443c. 
Deadlines. 
8 USC 1351 note. 
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122 STAT. 2969 
PUBLIC LAW 110–293—JULY 30, 2008 
(c) EXPENDITURES FROM FUND.—On request by the Attorney 
General, the Secretary of the Interior, or the Secretary of Health 
and Human Services, the Secretary of the Treasury shall transfer 
from the Fund to the Attorney General, the Secretary of the Interior, 
or the Secretary of Health and Human Services, as appropriate, 
such amounts as the Attorney General, the Secretary of the Interior, 
or the Secretary of Health and Human Services determines to 
be necessary to carry out the emergency plan under subsection 
(f). 
(d) TRANSFERS OF AMOUNTS.— 
(1) IN GENERAL.—The amounts required to be transferred 
to the Fund under this section shall be transferred at least 
monthly from the general fund of the Treasury to the Fund 
on the basis of estimates made by the Secretary of the Treasury. 
(2) ADJUSTMENTS.—Proper adjustment shall be made in 
amounts subsequently transferred to the extent prior estimates 
were in excess of or less than the amounts required to be 
transferred. 
(e) REMAINING AMOUNTS.—Any amounts remaining in the Fund 
on September 30 of an applicable fiscal year may be used by 
the Attorney General, the Secretary of the Interior, or the Secretary 
of Health and Human Services to carry out the emergency plan 
under subsection (f) for any subsequent fiscal year. 
(f) EMERGENCY PLAN.—Not later than 1 year after the date 
of enactment of this Act, the Attorney General, the Secretary of 
the Interior, and the Secretary of Health and Human Services, 
in consultation with Indian tribes (as defined in section 4 of the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 
450b)), shall jointly establish an emergency plan that addresses 
law enforcement, water, and health care needs of Indian tribes 
under which, for each of fiscal years 2010 through 2019, of amounts 
in the Fund— 
(1) the Attorney General shall use— 
(A) 18.5 percent for the construction, rehabilitation, 
and replacement of Federal Indian detention facilities; 
(B) 1.5 percent to investigate and prosecute crimes 
in Indian country (as defined in section 1151 of title 18, 
United States Code); 
(C) 1.5 percent for use by the Office of Justice Programs 
for Indian and Alaska Native programs; and 
(D) 0.5 percent to provide assistance to— 
(i) parties to cross-deputization or other coopera-
tive agreements between State or local governments 
and Indian tribes (as defined in section 102 of the 
Federally Recognized Indian Tribe List Act of 1994 
(25 U.S.C. 479a)) carrying out law enforcement activi-
ties in Indian country; and 
(ii) the State of Alaska (including political subdivi-
sions of that State) for carrying out the Village Public 
Safety Officer Program and law enforcement activities 
on Alaska Native land (as defined in section 3 of Public 
Law 103–399 (25 U.S.C. 3902)); 
(2) the Secretary of the Interior shall— 
(A) deposit 15.5 percent in the public safety and justice 
account of the Bureau of Indian Affairs for use by the 
Office of Justice Services of the Bureau in providing law 
Alaska. 
Deadline. 
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122 STAT. 2970 
PUBLIC LAW 110–293—JULY 30, 2008 
LEGISLATIVE HISTORY—H.R. 5501 (S. 2731): 
HOUSE REPORTS: No. 110–546, Pts. 1 and 2 (Comm. on Foreign Affairs). 
SENATE REPORTS: No. 110–325 accompanying S. 2731 (Comm. on Foreign Rela-
tions). 
CONGRESSIONAL RECORD, Vol. 154 (2008): 
Apr. 2, considered and passed House. 
July 16, considered and passed Senate, amended, in lieu of S. 2731. 
July 24, House concurred in Senate amendment. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 44 (2008): 
July 30, Presidential remarks. 
enforcement or detention services, directly or through con-
tracts or compacts with Indian tribes under the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.); and 
(B) use 50 percent to implement requirements of Indian 
water settlement agreements that are approved by Con-
gress (or the legislation to implement such an agreement) 
under which the United States shall plan, design, rehabili-
tate, or construct, or provide financial assistance for the 
planning, design, rehabilitation, or construction of, water 
supply or delivery infrastructure that will serve an Indian 
tribe (as defined in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450b)); and 
(3) the Secretary of Health and Human Services, acting 
through the Director of the Indian Health Service, shall use 
12.5 percent to provide, directly or through contracts or com-
pacts with Indian tribes under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.)— 
(A) contract health services; 
(B) construction, rehabilitation, and replacement of 
Indian health facilities; and 
(C) domestic and community sanitation facilities 
serving members of Indian tribes (as defined in section 
4 of the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 450b)) pursuant to section 7 of the 
Act of August 5, 1954 (42 U.S.C. 2004a). 
Approved July 30, 2008. 
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