[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5501 Enrolled Bill (ENR)]
H.R.5501
One Hundred Tenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Thursday,
the third day of January, two thousand and eight
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 Malaria.
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.
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 multilateral
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 assistance
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 bacterium, 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, economically,
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 in areas of
high HIV prevalence may be vulnerable to the disease or its
socioeconomic effects.
``(38) Lack of health capacity, including insufficient
personnel 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 activities 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 vulnerable children'.
``(40) The United States Government has endorsed the principles
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 provides 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 RESPONSIBILITY AND
PROVIDE LEADERSHIP for the activities of the National AIDS
Commissions/Councils';
``(C) resolved `to lead from the front the battle against
HIV/AIDS, Tuberculosis and Other Related Infectious Diseases by
personally ensuring that such bodies were properly convened in
mobilizing our societies as a whole and providing focus for
unified national policymaking and programme implementation,
ensuring coordination of all sectors 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 International
Relations'' and inserting ``Committee on Foreign Affairs of the
House of Representatives, the Committee on Appropriations of the
Senate, and the Committee on Appropriations'';
(2) by redesignating paragraph (6) as paragraph (12);
(3) by redesignating paragraphs (3) through (5), as paragraphs
(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 Government
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 government' means
a government with which the United States is working to provide
assistance to combat HIV/AIDS, tuberculosis, or malaria on behalf
of people living within the jurisdiction of such government.
``(11) Program monitoring.--The term `program monitoring' means
the collection, analysis, and use of routine program data to
determine--
``(A) how well a program is carried out; and
``(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, tuberculosis, 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
multilateral efforts to fight HIV/AIDS, tuberculosis, and malaria
as integrated components of United States development assistance;
``(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.
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 experiencing 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 appropriate;
``(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 continuum of care;
``(D) help partner countries in the effort to achieve goals
of 80 percent access to counseling, testing, and treatment to
prevent the transmission of HIV from mother to child,
emphasizing a continuum of care model;
``(E) help partner countries to provide care and treatment
services to children with HIV in proportion to their percentage
within the HIV-infected population in each country;
``(F) promote preservice training for health professionals
designed to strengthen the capacity of institutions 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 physicians,
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 retention
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-Saharan 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 treatment;
``(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,
preferably through public-private partnerships, of scientific
investigators, managers, and other staff who are capable of
promoting 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 leadership
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 organizational 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
targeted 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--
``(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 reduction
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, addiction
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 procuring
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 transportation
patterns, which directly contribute to the transmission 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
developing 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;
``(18) provide a framework for expanding or developing existing
or new country or regional programs, including--
``(A) drafting compacts or other agreements, as
appropriate;
``(B) establishing criteria and objectives for such
compacts 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
consequences and provides postexposure prophylaxis protecting
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 counseling 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;
``(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 Coordinator
and the Malaria Coordinator and address issues of comorbidity
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
outcome-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 harmonization
and alignment.
``(G) A description of the manner in which the strategy
will--
``(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
estimates of numbers of persons in need of antiretroviral
treatment, 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 breakdown 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 prevention 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 methodologies
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 programs and ensure that they are
targeted to appropriate audiences.
``(L) Within the analysis required under subparagraph (K),
an examination of additional planned means of preventing 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, investigation 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 vulnerabilities
of women and girls to HIV/AIDS, including--
``(i) activities directed toward men and boys;
``(ii) activities to enhance educational, microfinance,
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
vulnerability 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 undertaken
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,
objectives, methodology, and structure of compacts or other
framework agreements with countries or regional organizations,
including--
``(i) the role of civil society;
``(ii) the degree of transparency;
``(iii) benchmarks for success of such compacts or
agreements; and
``(iv) the relationship between such compacts or
agreements and the national HIV/AIDS and public health
strategies and commitments of partner countries.
``(T) A strategy to better coordinate HIV/AIDS assistance
with nutrition and food assistance programs.
``(U) A description of transnational or regional
initiatives 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 provides 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 consultation 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 supported
by United States funding, including multilateral and
bilateral programs involving joint operations.
``(B) Content.--The study conducted under this paragraph
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;
``(iii) an assessment of efforts to address gender-
specific aspects of HIV/AIDS, including gender related
constraints to accessing services and addressing underlying
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 adherence, and
the emergence of drug resistance;
``(v) an evaluation of the impact of prevention
programs 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 programs
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, Tuberculosis, and Malaria
Reauthorization Act of 2008, the Comptroller 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 integration with the
larger global health and development agenda of the United
States;
``(C) an assessment of procurement policies and practices
within these programs;
``(D) an assessment of harmonization with national
government HIV/AIDS and public health strategies as well as
other international efforts;
``(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 assistance from the
United States that have the potential for replication 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 programs.
``(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 Assistance Act of 1961 (22 U.S.C. 2151b-2, 2151b-3,
and 2151b-4).
``(B) Contents.--The plans developed under subparagraph (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 completed not
later than 30 days before each of the fiscal years 2010
through 2013, respectively.
``(2) Coordination.--In order to avoid duplication and maximize
efficiency, the Inspectors General described in paragraph (1) shall
coordinate their activities with--
``(A) the Government Accountability Office; and
``(B) the Inspectors General of the Department of Commerce,
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 successor agreement.
``(3) Funding.--The Global AIDS Coordinator and the Coordinator
of the United States Government Activities to Combat 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 paragraph (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 completion
of each study under paragraph (1), the Global AIDS Coordinator
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--
(1) in subparagraph (A), by inserting ``, partner country
finance, health, and other relevant ministries,'' after ``community
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 prevention,
treatment, and care objectives;
``(bb) participating in the process of
identifying countries to consider for increased
assistance based on the epidemiology of HIV/AIDS in
those countries, including clear evidence of a
public health threat, as well as government
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 Agriculture, the
Millennium Challenge Corporation, 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 agencies and
other donor institutions to promote harmonization with
other programs aimed at preventing and treating HIV/
AIDS and other health challenges, improving primary
health, addressing food security, promoting education
and development, and strengthening health care
systems.'';
(C) by redesignating subclauses (VII) and VIII) as
subclauses (IX) and (XII), respectively;
(D) by inserting after subclause (VI) the following:
``(VII) Holding annual consultations with
nongovernmental organizations in partner countries that
provide services to improve health, and advocating on
behalf of the individuals with HIV/AIDS 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 programs of
the United States are coordinated with, and
complementary to, the delivery of related global
health, food security, development, and education.'';
(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
implementing HIV/AIDS programs as part of its foreign
assistance program''; and
(iii) by adding at the end the following: ``In
designating 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 injection 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 prevention programs,
including education, voluntary testing, and counseling,
and referral systems that link HIV/AIDS programs with
programs to eradicate trafficking in persons and
support alternatives to prostitution.'';
(G) in subclause (XII), as redesignated by subparagraph
(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 pharmaceutical
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 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 experience 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 MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-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 international
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 mechanism
which--
``(i) has made progress in many areas in combating HIV/
AIDS, tuberculosis, and malaria; and
``(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, tuberculosis, 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 management
capabilities;
``(ii) providing clearer guidance for and oversight of
Local Fund Agents; and
``(iii) strengthening the Office of the Inspector
General 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 necessary 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, programmatic,
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
subrecipient 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 (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 contributors; 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 Government
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 representatives 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 overseen by the
Southern Country Coordinating Mechanism, including
Southern Sudan, Southern Kordofan, Blue Nile State, and
Abyei, if the President 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 proposed waiver.''; and
(iii) in clause (vi)--
(I) by striking ``for the purposes'' and inserting
``For the purposes'';
(II) by striking ``fiscal years 2004 through 2008''
and inserting ``fiscal years 2009 through 2013''; and
(III) by striking ``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 Secretary 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 paragraph
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 General,
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 performance
data and funding of grants of the Global Fund, which shall
cover all principal recipients and all subrecipients;
``(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
disbursed 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;
``(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 sectors,
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 TRANSMISSION 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.
``(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 International
Development;
``(2) the microbicide research and development community; and
``(3) health advocates.''.
(c) National Institute of Allergy and Infectious Diseases.--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 development 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 Development.--
(1) In general.--The Administrator of the United States Agency
for International Development, in coordination with the Coordinator
of United States Government Activities to Combat HIV/AIDS Globally,
may facilitate availability and accessibility 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.
SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY
STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS 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 SYSTEMS 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 systems;
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 environment
in partner countries to increase the ability of such countries--
``(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 investments;
``(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
services from achieving maximum benefit from such services.
``(b) Assistance To Improve Public Finance Management Systems.--
``(1) In general.--Consistent with the authority under section
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
Secretary 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 implement a plan to combat HIV/
AIDS by strengthening health policies and health systems of partner
countries as part of USAID's `Health 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 collaboration 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
activities, 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
semicolon at the end;
(B) by striking ``The Secretary may not, in the exercise of
his authority under this section, provide financial assistance
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, furnishing
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 renovate
facilities in those countries.''.
(3) in subsection (c)--
(A) by striking ``1990'' and inserting ``1980''; and
(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 agencies,
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 determined
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 projected
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 subsection; and
(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 vaccines 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 infectious
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 countries
and to address the challenges of delivering vaccines 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 ``Caribbean,''.
(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 worldwide;
``(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 HIV/AIDS, with
an emphasis on promoting a comprehensive, coordinated
system of services to be integrated throughout the
continuum of care;
``(iv) provide at least 80 percent of the target
population 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 paraprofessionals 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, treatment, 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 support,
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.'';
(2) in paragraph (2), by striking ``and other countries and
areas affected by the HIV/AIDS pandemic'' and inserting ``Central
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
``programs 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
pregnant 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 prevention
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
``(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 education
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
discrimination 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 introductory
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, assistance
(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, assistance
or referral to available and adequately resourced service
providers for nutritional support, including counseling 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 Globally, 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 regarding
gender-responsive interventions, disaggregated by age and
sex;
``(ii) identify and replicate effective models; and
``(iii) develop gender indicators to measure outcomes
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 consideration to
stigma and risks associated with disclosure.'';
(4) in paragraph (5)--
(A) by redesignating subparagraph (C) as subparagraph (D);
and
(B) by inserting after subparagraph (B) the following:
``(C) Mechanism to ensure cost-effective drug purchasing.--
Subject to subparagraph (B), mechanisms to ensure that safe and
effective pharmaceuticals, including antiretrovirals and
medicines to treat opportunistic infections, are purchased at
the lowest possible price at which such pharmaceuticals may be
obtained in sufficient quantity on the world market, provided
that such pharmaceuticals 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 sanitation;
``(III) nutritional counseling;
``(IV) income-generating activities and livelihood
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 services;
and
``(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 programs;
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 individuals
testing positive for HIV receive tuberculosis screening and
to improve laboratory capacities, infection 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 maintenance 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 requirements
under section 110; and
``(B) transition strategies to ensure sustainability of
such programs and activities, including health care systems,
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 subsections
(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 Medicine
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 participating 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 Department 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 connected 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 platform;
``(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
``(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 compact 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 achievement 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 economic,
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
infrastructure 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 provide
oversight;
``(viii) consideration of the role of civil society in
the development of a compact and the achievement of its
objectives;
``(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 Reauthorization Act of 2008.
``(G) Amounts made available for compacts described in
subparagraphs (A) and (B) shall be subject to the inclusion
of--
``(i) cost sharing assurances that meet the
requirements 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 community,
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 redesignated,
is amended--
(1) in paragraph (1), by striking ``Committee on International
Relations'' and inserting ``Committee on Foreign Affairs''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(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 community
health workers, and the use of codes of conduct 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
relevant executive branch agencies to link HIV/AIDS
clinical 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;
``(v) a description of efforts to improve
harmonization, in terms of relevant executive branch
agencies, coordination with other public and private
entities, and coordination with partner countries' national
strategic 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 Diseases 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 investments of
partner countries that were not signatories 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;
``(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, agricultural, 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;
``(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 insecurity are
highly prevalent, support programs to address these often
intersecting health problems through community-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 Reauthorization 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
comprehensive 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 requirement 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 tuberculosis,
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 successful
treatment of at least 85 percent of the cases detected in countries
with established United States Agency for International 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 tuberculosis
globally, including a plan to support--
``(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 multiple
drug resistant tuberculosis cases by 2013, and additional
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, treatment for
individuals infected with both tuberculosis and HIV, and treatment
for individuals with multi-drug resistant tuberculosis (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 vaccines, and program-based operational
research relating to tuberculosis; 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 section, the President,
acting through the Administrator of the United States Agency for
International Development, is authorized to provide increased resources
to the World Health Organization and the Stop Tuberculosis Partnership
to improve the capacity of countries 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 foreign
assistance for tuberculosis control purposes, the percentage
provided for direct tuberculosis services in countries receiving
United States bilateral foreign assistance for tuberculosis control
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 countries
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
tuberculosis services, drugs and other commodities, drug
management, 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 Standards
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 comprehensive 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
beginning on October 1, 2008.''; and
(2) in paragraph (3), by striking ``fiscal years 2004 through
2008'' and inserting ``fiscal years 2009 through 2013.''.
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 beginning 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 maximize
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 vaccine
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;
``(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 community-
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
cooperative 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 paragraphs (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
antimalarial efforts among relevant executive branch agencies
and nongovernmental organizations by auditing, monitoring, 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
activities in the field of malaria prevention and treatment;
``(D) coordinate planning, implementation, and evaluation
with the Global AIDS Coordinator in countries in which both
programs have a significant presence;
``(E) coordinate with national governments, international
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.
``(d) Assistance for the World Health Organization.--In carrying
out this section, the President may provide financial assistance 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 Representative;
``(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
Coordinator, 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
complement 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 monitoring,
surveillance, and evaluation activities and be a key implementer of
such activities under this Act. Such activities shall complement,
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 congressional 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--
``(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 pregnant
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 governments, major
private efforts, and relevant executive agencies;
``(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 deficiency
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
proportionate to their numbers within the population of HIV
infected individuals in each country;
``(3) integrate care and treatment with prevention of mother-
to-child transmission of HIV programs to improve outcomes for HIV-
affected women and families as soon as is feasible 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 effective
regimes to prevent mother-to-child transmission of HIV, consistent
with the national policies of countries in which programs 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 subsection
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 committees for
scale-up of mother-to-child transmission prevention services
under this Act in order to achieve the target established 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 programs
under this Act are administered;
``(D) 3 members representing organizations implementing
prevention of mother-to-child transmission activities under
this Act;
``(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 barriers 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 Coordinator
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 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 Leadership
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 expenditure 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 promoting
abstinence, delay of sexual debut, monogamy, fidelity, and
partner reduction, the Global AIDS Coordinator 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 universal precautions,
investigating suspected nosocomial infections, pre-exposure
pharmaceutical prophylaxis to prevent transmission of HIV, or
microbicides and programs and activities 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 paragraph
(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 appropriated
for bilateral global HIV/AIDS assistance for such fiscal year
compared with fiscal year 2008 shall be based on long-term
requirements, epidemiological evidence, the share of treatment
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 Government cost per
patient of providing treatment in countries receiving bilateral
HIV/AIDS assistance has decreased compared 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 ``Emergency Fund for
Indian Safety and Health'' (referred to in this section as the
``Fund''), consisting of such amounts as are appropriated 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 appropriated,
$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.
(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 cooperative
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 activities in Indian country;
and
(ii) the State of Alaska (including political
subdivisions 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 enforcement
or detention services, directly or through contracts 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 Congress (or
the legislation to implement such an agreement) under which the
United States shall plan, design, rehabilitate, 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-Determination 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 compacts 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 Assistance Act (25 U.S.C.
450b)) pursuant to section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a).
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.