The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that 33.2 million people are living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS); some 16% fewer people than it initially estimated in 2006 (about 39.5 million). UNAIDS asserts that the decline reflects improvements in data collection and analysis. Expanded and improved HIV surveillance systems and household surveys reportedly provided a more precise count of HIV prevalence than earlier studies. In most of the 30 countries where household studies were conducted, prevalence rates in 2007 were lower than those reported in 2006 ( Table 1 ). UNAIDS also used the expanded studies to adjust prevalence estimates of countries that had not conducted household surveys but had similar epidemics. After retrospectively applying the improved methodology, UNAIDS estimated that in 2006, 32.7 million people were living with HIV (adjusted from the original estimate of 39.5 million). The revised estimates for India (2.5 million, down from 5.7 million), combined with revisions in five sub-Saharan African countries (Angola, Kenya, Mozambique, Nigeria, and Zimbabwe) accounted for 70% of the reduction. UNAIDS notes that HIV/AIDS prevalence rates have largely stabilized since 2001 and HIV/AIDS incidence rates are mostly declining ( see Table 2 ). Although prevalence rates have stabilized and incidence rates are mostly declining, the total number of people living with HIV/AIDS continue to rise, though at a slower rate. UNAIDS predicts that 2.5 million people will contract HIV in 2007, compared to the estimated 3.2 million who became HIV-positive in 2001. UNAIDS does not expect the number of HIV/AIDS-related deaths to decrease, however; in 2007, some 2.1 are expected to die from AIDS, while 1.7 million died in 2001. HIV/AIDS is contributing to rising TB prevalence in areas with high HIV/AIDS prevalence, particularly in Africa. The weakened immune systems of HIV-positive people places them at greater risk of contracting TB. Correspondingly, TB considerably shortens the survival of people with HIV/AIDS. In 2005, about 80% of all HIV-positive people with TB were found in Africa. That year, nearly 630,000 people were co-infected with HIV/AIDS and TB, some 500,000 of whom were African. About 160,000 of the nearly 195,000 co-infected patients who died from TB were African, representing 82% of those deaths. Although most forms of TB are curable, the World Health Organization (WHO) estimates that in 2005 (the year for which the most current data are available), the disease killed 1.6 million people, including 195,000 who were also infected with HIV/AIDS. Some 8.8 million people contracted the disease in 2005, of which 84% of the cases occurred in 22 countries. All but three of those high-burden countries were found in Africa or Asia. About half of all new TB cases were in six countries: Bangladesh, China, India, Indonesia, Pakistan, and the Philippines. While HIV/AIDS, TB, and malaria are preventable diseases, their impacts have been catastrophic, particularly in sub-Saharan Africa. Researchers have found that people infected with one of the three illnesses are more likely to contract either of the other two, and the symptoms are more severe in people with two or more of the diseases. According to WHO, each year there are about 300 million acute malaria cases, which cause more than 1 million deaths annually. Health experts believe that between 85% and 90% of malaria deaths occur in Africa, mostly among children, killing an African child every 30 seconds. UNAIDS asserts that it would cost $15 billion in 2006, $18 billion in 2007, and $22 billion in 2008 to effectively fight HIV/AIDS. In FY2006, Congress provided $3.4 billion for global HIV/AIDS, tuberculosis (TB), and malaria programs ( Table 3 ). Most recent statistics indicate that in 2006, global spending reached nearly $9 billion, $6 billion less than UNAIDS advocated. In 2003, Congress authorized $3 billion for each fiscal year from 2004 through 2008 to support the President's Emergency Plan for AIDS Relief (PEFAR). The 5-year initiative was created to aid the millions of people sickened and killed by HIV/AIDS, malaria, and tuberculosis (TB). Some estimate that since HIV/AIDS was first identified in 1981, 65 million people have contracted the virus and it has killed more than 25 million. PEPFAR provided an unprecedented amount of assistance for global HIV/AIDS efforts. The United States remains the largest single donor for global HIV/AIDS efforts in the world, providing nearly 50% of all donor funds. As Congress prepares to consider whether, and at what level, to reauthorize PEPFAR, there has been considerable debate about the effectiveness of PEPFAR. Some health experts contend that the life-saving intention of PEPFAR is weakened by the single-disease approach. Other critics contend that ideological factors lessen the effectiveness of the plan. A number of HIV/AIDS advocates urge the United States to harmonize its anti-HIV/AIDS efforts with other donors to boost the impact of PEPFAR. Some of the key policy prescriptions are discussed below. As Congress considers reauthorizing PEPFAR, there may be some debate on how many diseases the initiative should address. The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 ( P.L. 108-25 ), requires the President to submit annual reports to appropriation committees that describe how U.S. funds support efforts to prevent HIV/AIDS, TB, and malaria and provide care and treatment for those affected by the three diseases. However, since President Bush launched the President's Malaria Initiative (PMI) in June 2005, the Office of the Global AIDS Coordinator (OGAC) determined that it would no longer include malaria spending in its annual reports to Congress and that budgetary requests for the disease would be made separately from HIV/AIDS and TB requests. The Administration requests support for PMI through the U.S. Agency for International Development (USAID) as the coordinating agency. For comparability, and because P.L. 108-25 considers efforts to combat malaria as a critical part of PEPFAR, Table 3 includes appropriations to malaria programs. As Congress considers whether to authorize funds to extend PEPFAR, Members might decide whether to define it as solely an HIV/AIDS initiative or one that includes the three diseases. As Congress considers reauthorizing PEPFAR, there is likely to be considerable debate on how much funding to allocate to prevention. Consensus is growing among health experts that greater emphasis needs to be placed on HIV prevention in global HIV/AIDS programs. The international community has supported a tremendous increase in the number of people receiving HIV/AIDS treatment. In 2001, about 240,000 people had access to anti-retroviral treatment (ARVs); in 2006, more than 2 million were treated. Nonetheless, WHO estimated that in 2006, an additional 5.1 million people who needed treatment received none. In sub-Saharan Africa, more than 1.3 million people received treatment, reaching some 28% of those in need; three years prior, 100,000 were treated and coverage amounted to 2%. In spite of these advances, the rate at which individuals become infected with HIV far outpaces the rate at which they are treated. In 2006, 4.3 million people contracted HIV, 2.8 million of whom were African (65%), and 2.9 million people died of AIDS, 2.1 million of whom were African (72%). Many health experts advocate greater spending on PMTCT initiatives. Advocates of greater PMTCT spending argue that providing ARVs during pregnancy is a well-documented way to avert millions of HIV infections in a cost-efficient and effective manner, including in low-resource settings. UNAIDS estimates that 1,800 children worldwide become infected with HIV each day, the vast majority of whom are newborns. More than 85% of children infected with HIV live in sub-Saharan Africa, although mother-to-child transmission (MTCT) rates are rapidly rising in Eastern Europe and Central Asia. UNAIDS estimates that in 2005, just less than 8% of pregnant women in low- and middle-income countries had access to services that could prevent the transmission of HIV to their babies. Two-thirds of all women who lack access to PMTCT interventions come from 10 countries, all but one of which are in Africa; India is the exception. Some reproductive health experts want HIV/AIDS and family planning services to be better integrated should PEPFAR be reauthorized. Supporters of this idea contend that women who receive PMTCT services should be subsequently offered contraceptives to lessen the likelihood that they might give birth to HIV-positive children. Additionally, women who fear being stigmatized if they visit an HIV center could receive PMTCT services while receiving standard prenatal care. Members who endorsed the Ensuring Access to Contraceptives Act ( H.R. 2367 ) demonstrated their support for expanding access to family planning and contraceptives. The bill would authorize $150 million for such services in each of fiscal years 2008 and 2009. Some in Congress also support the United Nations Population Fund Women's Health and Dignity Act ( H.R. 2604 ), which would provide financial and other support to UNFPA's activities that save women's lives, limit the incidence of abortion and maternal mortality associated with unsafe abortion, promote universal access to safe and reliable family planning, and assist women, children, and men in developing countries live better lives. Women's rights advocates also assert that the lower status of women in many of the most affected countries must be better addressed in order to prevent new HIV infections.