[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5501 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 5501
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 27, 2008
Mr. Berman (for himself, Ms. Ros-Lehtinen, Mr. Payne, Ms. Lee, Mr.
Waxman, and Ms. Jackson-Lee of Texas) introduced the following bill;
which was referred to the Committee on Foreign Affairs, and in addition
to the Committee on Financial Services, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
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 AND TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Tom Lantos and
Henry J. Hyde United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act of 2008''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title and table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis
and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.
Sec. 204. Program to facilitate availability of microbicides to prevent
transmission of HIV and other diseases.
Sec. 205. Plan to combat HIV/AIDS, tuberculosis, and malaria by
strengthening health policies and health
systems of host countries.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Health care partnerships to combat HIV/AIDS.
Subtitle B--Assistance for Women, Children, and Families
Sec. 311. Policy and requirements.
Sec. 312. Annual reports on prevention of mother-to-child transmission
of the HIV infection.
Sec. 313. Strategy to prevent HIV infections among women and youth.
Sec. 314. Clerical amendment.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Prohibition on taxation by foreign governments.
TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
Sec. 501. Sustainability and strengthening of health care systems.
Sec. 502. Clerical amendment.
SEC. 2. FINDINGS.
Section 2 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by
adding at the end the following:
``(29) The HIV/AIDS pandemic continues to pose a major
threat to the health of the global community, from the most
severely-affected regions of sub-Saharan Africa and the
Caribbean, to the emerging epidemics of Eastern Europe, Central
Asia, South and Southeast Asia, and Latin America.
``(30) According to UNAIDS' 2007 global estimates, there
are 33.2 million individuals with HIV/AIDS worldwide, including
2.5 million people newly-infected with HIV. Of those infected
with HIV, 2.5 million are children under 15 who also account
for 460,000 of the newly-infected individuals.
``(31) Sub-Saharan Africa continues to be the region most
affected by the HIV/AIDS pandemic. More than 68 percent of
adults and nearly 90 percent of children with HIV/AIDS live in
sub-Saharan Africa, and more than 76 percent of AIDS deaths in
2007 occurred in sub-Saharan Africa.
``(32) Although sub-Saharan Africa carries the heaviest
disease burden of HIV/AIDS, the HIV/AIDS pandemic continues to
affect virtually every world region. While prevalence rates are
relatively low in Eastern Europe, Central Asia, South and
Southeast Asia, and Latin America, without effective prevention
strategies, HIV prevalence rates could rise quickly in these
regions.
``(33) By world region, according to UNAIDS' 2007 global
estimates--
``(A) in sub-Saharan Africa, there were 22.5
million adults and children infected with HIV, up from
20.9 million in 2001, with 1.7 million new HIV
infections, a 5 percent prevalence rate, and 1.6
million deaths;
``(B) in South and Southeast Asia, there were 4
million adults and children infected with HIV, up from
3.5 million in 2001, with 340,000 new HIV infections, a
0.3 percent prevalence rate, and 270,000 deaths;
``(C) in East Asia, there were 800,000 adults and
children infected with HIV, up from 420,000 in 2001,
with 92,000 new HIV infections, a 0.1 percent
prevalence rate, and 32,000 deaths;
``(D) in Eastern and Central Europe, there were 1.6
million adults and children infected with HIV, up from
630,000 in 2001, with 150,000 new HIV infections, a 0.9
percent prevalence rate, and 55,000 deaths; and
``(E) in the Caribbean, there were 230,000 adults
and children infected with HIV, up from 190,000 in
2001, with 17,000 new HIV infections, a 1 percent
prevalence rate, and 11,000 deaths.
``(34) Tuberculosis is the number one killer of individuals
with HIV/AIDS and is responsible for up to one-half of HIV/AIDS
deaths in Africa.
``(35) The wide extent of drug resistant tuberculosis,
including both multi-drug resistant tuberculosis (MDR-TB) and
extensively drug resistant tuberculosis (XDR-TB), driven by the
HIV/AIDS pandemic in sub-Saharan Africa, has hampered both HIV/
AIDS and tuberculosis treatment services. The World Health
Organization (WHO) has declared the prevalence of tuberculosis
to be at emergency levels in sub-Saharan Africa.
``(36) Forty percent of the world's population, mostly
poor, live in malarial zones, and malaria, which is highly
preventable, kills more than 1 million individuals worldwide
each year. Ninety percent of malaria's victims are in sub-
Saharan Africa and 70 percent of malaria's victims are children
under the age of 5. Additionally, hunger and malnutrition kill
another 6 million individuals worldwide each year.
``(37) Assistance to combat HIV/AIDS must address the
nutritional factors associated with the disease in order to be
effective and sustainable. The World Food Program estimates
that 6.4 million individuals affected by HIV will need
nutritional support by 2008.
``(38) Women and girls continue to be vulnerable to HIV, in
large part, due to gender-based cultural norms that leave many
women and girls powerless to negotiate social relationships.
``(39) Women make up 50 percent of individuals infected
with HIV worldwide. In sub-Saharan Africa, where the HIV/AIDS
epidemic is most severe, women make up 57 percent of
individuals infected with HIV, and 75 percent of young people
infected with HIV in sub-Saharan Africa are young women ages 15
to 24.
``(40) Women and girls are biologically, socially, and
economically more vulnerable to HIV infection. Gender
disparities in the rate of HIV infection are the result of a
number of factors, including the following:
``(A) Cross-generational sex with older men who are
more likely to be infected with HIV, and a lack of
choice regarding when and whom to marry, leading to
early marriages and high rates of child marriages with
older men. About one-half of all adolescent females in
sub-Saharan Africa and two-thirds of adolescent females
in Asia are married by age 18.
``(B) Studies show that married women and married
and unmarried girls often are unable or find it
difficult to negotiate the frequency and timing of
sexual intercourse, ensure their partner's
faithfulness, or insist on condom use. Under these
circumstances, women often run the risk of being
infected by husbands or male partners in societies
where men in relationships have more than one partner.
Behavior change is particularly important in societies
in which this is a common practice.
``(C) Because young married women and girls are
more likely to have unprotected sex and have more
frequent sex than their unmarried peers, and women and
girls who are faithful to their spouses can be placed
at risk of HIV/AIDS through a husband's infidelity or
prior infection, marriage is not always a guarantee
against HIV infection, although it is a protective
factor overall.
``(D) Social and economic inequalities based
largely on gender limit access for women and girls to
education and employment opportunities and prevent them
from asserting their inheritance and property rights.
For many women, a lack of independent economic means
combines with socio-cultural practices to sustain and
exacerbate their fear of abandonment, eviction, or
ostracism from their homes and communities and can
leave many more women trapped within relationships
where they are vulnerable to HIV infection.
``(E) A lack of educational opportunities for women
and girls is linked to younger sexual debut, earlier
childhood marriage, earlier childbearing, decreased
child survival, worsening nutrition, and increased risk
of HIV infection.
``(F) High rates of gender-based violence, rape,
and sexual coercion within and outside marriage
contribute to high rates of HIV infection. According to
the World Health Organization, between one-sixth and
three-quarters of women in various countries and
settings have experienced some form of physical or
sexual violence since the age of 15 within or outside
of marriage. Women who are unable to protect themselves
from such violence are often unable to protect
themselves from being infected with HIV through forced
sexual contact.
``(G) Fear of domestic violence and the continuing
stigma and discrimination associated with HIV/AIDS
prevent many women from accessing information about
HIV/AIDS, getting tested, disclosing their HIV status,
accessing services to prevent mother-to-child
transmission of HIV, or receiving treatment and
counseling even when they already know they have been
infected with HIV.
``(H) According to UNAIDS, the vulnerability of
individuals involved in commercial sex acts to HIV
infection is heightened by stigmatization and
marginalization, limited economic options, limited
access to health, social, and legal services, limited
access to information and prevention means, gender-
related differences and inequalities, sexual
exploitation and trafficking, harmful or non-protective
laws and policies, and exposure to risks associated
with commercial sex acts, such as violence, substance
abuse, and increased mobility.
``(I) Lack of access to basic HIV prevention
information and education and lack of coordination with
existing primary health care to reduce stigma and
maximize coverage.
``(J) Lack of access to currently available female-
controlled HIV prevention methods, such as the female
condom, and lack of training on proper use of either
male or female condoms.
``(K) High rates of other sexually transmitted
infections and complications during pregnancies and
childbirth.
``(L) An absence of functioning legal frameworks to
protect women and girls and, where such frameworks
exist, the lack of accountable and effective
enforcement of such frameworks.
``(41) In addition to vulnerabilities to HIV infection,
women in sub-Saharan Africa face a 1-in-13 chance of dying in
childbirth compared to a 1-in-16 chance in least-developed
countries worldwide, a 1-in-60 chance in developing countries,
and a 1-in-4,100 chance in developed countries.
``(42) Due to these high maternal mortality rates and high
HIV prevalence rates in certain countries, special attention is
needed in these countries to help HIV-positive women safely
deliver healthy babies and save women's lives.
``(43) Unprotected sex within or outside of marriage is the
single greatest factor in the transmission of HIV worldwide and
is responsible for 80 percent of new HIV infections in sub-
Saharan Africa.
``(44) Multiple randomized controlled trials have
established that male circumcision reduces a man's risk of
contracting HIV by 60 percent or more. Twelve acceptability
studies have found that in regions of sub-Saharan Africa where
circumcision is not traditionally practiced, a majority of men
want the procedure. Broader availability of male circumcision
services could prevent millions of HIV infections not only in
men but also in their female partners.
``(45)(A) Youth also face particular challenges in
receiving services for HIV/AIDS.
``(B) Nearly one-half of all orphans who have lost one
parent and two-thirds of those who have lost both parents are
ages 12 to 17. These orphans are in particular need of services
to protect themselves against sexually-transmitted infections,
including HIV.
``(C) Research indicates that many youth benefit from full
disclosure of medically accurate, age-appropriate information
about abstinence, partner reduction, and condoms. Providing
comprehensive information about HIV, including delay of sexual
debut and the ABC model: `Abstain, Be faithful, use Condoms',
and linking such information to health care can help improve
awareness of safe sex practices and address the fact that only
1 in 3 young men and 1 in 5 young women ages 15 to 24 can
correctly identify ways to prevent HIV infection.
``(D) Surveys indicate that no country has succeeded in
fully educating more than one-half of its youth about the
prevention and transmission of HIV.
``(46) According to the United Nations High Commissioner
for Refugees (UNHCR), HIV/AIDS prevalence rates among refugees
are generally lower than the HIV/AIDS prevalence rates for
their host communities, though perceptions run counter to this
fact. However, peacekeeping operations that no longer deploy
HIV/AIDS-positive troops still face vulnerabilities to sexual
transmission of HIV with HIV-positive individuals in refugee
camps. Host countries generally do not provide HIV/AIDS
prevention, treatment, and care services for refugees.
``(47) Continuing progress to reach the millions of
impoverished individuals who need voluntary testing,
counseling, treatment, and care for HIV/AIDS requires increased
efforts to strengthen health care delivery systems and
infrastructure, rebuild and expand the health care workforce,
and strengthen allied and support services in countries
receiving United States global HIV/AIDS assistance.
``(48) While HIV/AIDS poses the greatest health threat of
modern times, it also poses the greatest development challenge
for developing countries with fragile economies and weak public
financial management systems that are ill equipped to shoulder
the burden of this disease. International donors will have to
play a critical role in providing resources for HIV/AIDS
programs far into the future.
``(49) The emerging partnerships between countries most
affected by HIV/AIDS and the United States must include
stronger coordination between HIV/AIDS programs and other
United States foreign assistance programs, and stronger
collaboration with other donors in the areas of economic
development and growth strategies.
``(50) The future control of HIV/AIDS demands coordination
between international organizations such as the Global Fund to
Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Health
Organization (WHO), the World Bank and the International
Monetary Fund (IMF), the international donor community,
national governments, and private sector organizations,
including community and faith-based organizations.
``(51) The future control of HIV/AIDS further requires
effective and transparent public finance management systems in
developing countries to advance the ability of such countries
to manage public revenues and donor funds aimed at combating
HIV/AIDS and other diseases.
``(52) The HIV/AIDS pandemic contributes to the shortage of
health care personnel through loss of life and illness, unsafe
working conditions, increased workloads for diminished staff,
and resulting stress and burnout, while the shortage of health
care personnel undermines efforts to prevent and provide care
and treatment for individuals with HIV/AIDS.
``(53) The shortage of health care personnel, including
doctors, nurses, pharmacists, counselors, laboratory staff,
paraprofessionals, trained lay workers, and researchers is one
of the leading obstacles to combating HIV/AIDS in sub-Saharan
Africa.
``(54) Since 2003, important progress has been made in
combating HIV/AIDS, yet there is more to be done. The number of
new HIV infections is still increasing at an alarming rate.
According to the United States National Institute of Allergy
and Infectious Diseases, globally, for every 1 individual put
on antiretroviral therapy, 6 individuals are newly infected
with HIV.
``(55) The United States Government continues to be the
world's leader in the fight against HIV/AIDS and the
unsurpassed partner with developing countries in their efforts
to control this disease.
``(56) By September 2007, the United States, through the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 et seq.), had provided
services to prevent mother-to-child-transmission of HIV to
women during 10 million pregnancies; provided antiretroviral
prophylaxis for women during over 827,300 pregnancies;
prevented an estimated 157,240 HIV infections in infants; cared
for over 6.6 million individuals, including over 2.7 million
orphans and vulnerable children; supported lifesaving
antiretroviral therapies for approximately 1.4 million men,
women, and children in sub-Saharan Africa, Asia, and the
Carribean; and provided counseling and testing to over 33.7
million men, women, and children in developing countries.
``(57) These numbers were achieved because of the
commitment of substantial resources and support of the United
States Government to our partners on the front lines--the
dedicated and committed women and men, communities, and nations
who are taking control of the HIV/AIDS epidemics in their own
countries.''.
SEC. 3. DEFINITIONS.
Section 3(2) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602(2)) is amended by
striking ``Committee on International Relations'' and inserting
``Committee on Foreign Affairs''.
SEC. 4. PURPOSE.
Section 4 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7603) is amended to
read as follows:
``SEC. 4. PURPOSE.
``The purpose of this Act is to strengthen and enhance United
States global leadership and the effectiveness of the United States
response to the HIV/AIDS, tuberculosis, and malaria pandemics and other
related and preventable infectious diseases in developing countries
by--
``(1) establishing a comprehensive, integrated five-year,
global strategy to fight HIV/AIDS, tuberculosis, and malaria
that encompasses a plan for continued expansion and
coordination of critical programs and improved coordination
among relevant executive branch agencies and between the United
States and foreign governments and international organizations;
``(2) providing increased resources for United States
bilateral efforts to combat HIV/AIDS, tuberculosis, and
malaria, particularly for prevention, treatment, and care
(including nutritional support), technical assistance and
training, the strengthening of health care systems, health care
workforce development, monitoring and evaluations systems, and
operations research;
``(3) providing increased resources for multilateral
efforts to combat HIV/AIDS, tuberculosis, and malaria;
``(4) encouraging the expansion of private sector efforts
and expanding public-private sector partnerships to combat HIV/
AIDS; and
``(5) intensifying efforts to support the development of
vaccines, microbicides, and other prevention technologies and
improved diagnostics treatment for HIV/AIDS, tuberculosis, and
malaria.''.
TITLE I--POLICY PLANNING AND COORDINATION
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL STRATEGY.
(a) Strategy.--Subsection (a) of section 101 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7611) is amended--
(1) in the first sentence of the matter preceding paragraph
(1), by striking ``to combat'' and inserting ``to develop
efforts further to combat'';
(2) by amending paragraph (4) to read as follows:
``(4) provide that the reduction of HIV/AIDS behavioral
risks shall be a priority of all prevention efforts in terms of
funding, scientifically-accurate educational services, and
activities by--
``(A) designing prevention strategies and programs
based on sound epidemiological evidence, tailored to
the unique needs of each country and community, and
reaching those populations found to be most at risk for
acquiring HIV infection;
``(B) promoting abstinence from sexual activity and
substance abuse;
``(C) encouraging delay of sexual debut, monogamy,
fidelity, and partner reduction;
``(D) promoting the effective use of male and
female condoms;
``(E) promoting the use of measures to reduce the
risk of HIV transmission for discordant couples (where
one individual has HIV/AIDS and the other individual
does not have HIV/AIDS or whose status is unknown);
``(F) educating men and boys about the risks of
procuring sex commercially and about the need to end
violent behavior toward women and girls;
``(G) promoting the rapid expansion of safe and
voluntary male circumcision services;
``(H) promoting life skills training and
development for children and youth;
``(I) supporting advocacy for child and youth
community-based protective social services;
``(J) eradicating trafficking in persons and
creating alternatives to prostitution;
``(K) promoting cooperation with law enforcement to
prosecute offenders of trafficking, rape, and sexual
assault crimes with the goal of eliminating such
crimes;
``(L) promoting services demonstrated to be
effective in reducing the transmission of HIV infection
among injection drug users without increasing illicit
drug use;
``(M) promoting policies and programs to end the
sexual exploitation of and violence against women and
children; and
``(N) promoting prevention and treatment services
for men who have sex with men;'';
(3) by redesignating paragraphs (5) through (10) as
paragraphs (6) through (11), respectively;
(4) by inserting after paragraph (4) (as amended by
paragraph (2) of this subsection) the following:
``(5) include specific plans for linkage to, and referral
systems for nongovernmental organizations that implement
multisectoral approaches, including faith-based and community-
based organizations, for--
``(A) nutrition and food support for individuals
with HIV/AIDS and affected communities;
``(B) child health services and development
programs;
``(C) HIV/AIDS prevention and treatment services
for injection drug users;
``(D) access to HIV/AIDS education and testing in
family planning and maternal health programs supported
by the United States Government; and
``(E) medical, social, and legal services for
victims of violence;'';
(5) by redesignating paragraphs (10) and (11) (as
redesignated by paragraph (3) of this subsection) as paragraphs
(11) and (12), respectively; and
(6) by inserting after paragraph (9) (as redesignated by
paragraph (3) of this subsection) the following:
``(10) maximize host country capacities in training and
research, particularly operations research;''.
(b) Report.--Subsection (b) of such section is amended--
(1) in paragraph (1), by striking ``this Act'' and
inserting ``the Tom Lantos and Henry J. Hyde Global Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act
of 2008''; and
(2) in paragraph (3)--
(A) by amending subparagraph (C) to read as
follows:
``(C) A description of the manner in which the
strategy will address the following:
``(i) The fundamental elements of
prevention and education, care and treatment,
including increasing access to pharmaceuticals,
vaccines, and microbicides, as they become
available, screening, prophylaxis, and
treatment of major opportunistic infections,
including tuberculosis, and increasing access
to nutrition and food for individuals on
antiretroviral therapies.
``(ii) The promotion of delay of sexual
debut, abstinence, monogamy, fidelity, and
partner reduction.
``(iii) The promotion of correct and
consistent use of male and female condoms and
other strategies and skills development to
reduce the risk of HIV transmission.
``(iv) Increasing voluntary access to safe
male circumcision services.
``(v) Life-skills training.
``(vi) The provision of information and
services to encourage young people to delay
sexual debut and ensure access to HIV/AIDS
prevention information and services.
``(vii) Prevention of sexual violence
leading to transmission of HIV and assistance
for victims of violence who are at risk of HIV
transmission.
``(viii) HIV/AIDS prevention, care, and
treatment services for injection drug users.
``(ix) Research, including incentives for
HIV vaccine development and new protocols.
``(x) Advocacy for community-based child
and youth protective services.
``(xi) Training of health care workers.
``(xii) The development of health care
infrastructure and delivery systems.
``(xiii) Prevention efforts for substance
abusers.
``(xiv) Prevention, treatment, care, and
outreach efforts for men who have sex with
men.'';
(B) in subparagraph (D), by adding at the end
before the period the following: ``, including through
faith-based and other nongovernmental organizations'';
(C) in subparagraph (E), by inserting ``access to
HIV/AIDS education and testing in family planning and
maternal and child health programs supported by the
United States Government and'' after ``the unique needs
of women, including'';
(D) in subparagraph (F), by inserting ``(including
by accessing voluntary clinical circumcision
services)'' after ``in their sexual behavior'';
(E) in subparagraph (G), by inserting ``and men's''
after ``women's'';
(F) by redesignating subparagraphs (M) through (W)
as subparagraphs (N) through (X);
(G) by inserting after subparagraph (L) the
following:
``(M) A description of efforts to be undertaken to
strengthen the public finance management systems of
selected host countries to ensure transparent,
efficient, and effective management of national and
donor financial investments in health.'';
(H) in subparagraph (O) (as redesignated by
subparagraph (F) of this paragraph), by striking
``evaluating programs,'' and inserting ``evaluating
programs to ensure medical accuracy, operations
research,'';
(I) in subparagraph (Q) (as redesignated by
subparagraph (F) of this paragraph), by inserting ``,
strengthen national health care delivery systems, and
increase national health workforce capacities,'' after
``HIV/AIDS pandemic'';
(J) in subparagraph (R) (as redesignated by
subparagraph (F) of this paragraph), by inserting at
the end before the period the following: ``, including
strategies relating to agricultural development, trade
and economic growth, and education'';
(K) in subparagraph (T) (as redesignated by
subparagraph (F) of this paragraph), by inserting
``efforts of intergenerational caregivers and'' after
``, including'';
(L) by redesignating subparagraphs (V) through (X)
(as redesignated by subparagraph (F) of this
paragraph), as subparagraphs (W) through (Y),
respectively;
(M) by inserting after subparagraph (U) (as
redesignated by subparagraph (F) of this paragraph) the
following:
``(V) A plan to strengthen and implement health
care workforce strategies to enable countries to
increase the supply and retention of all cadres of
trained professional and paraprofessional health care
workers by numbers that move toward global health
program needs and toward targets established by the
World Health Organization, while enabling health
systems to expand coverage consistent with national and
international targets and goals.''; and
(N) by striking subparagraph (Y) (as redesignated
by subparagraphs (F) and (L) of this paragraph) and
inserting the following:
``(Y) A description of the specific strategies,
developed in coordination with existing health
programs, to prevent mother-to-child transmission of
HIV, including the extent to which HIV-positive women
and men in treatment, care, and support programs and
HIV-negative women and men are counseled about methods
of preventing HIV transmission and the extent to which
HIV prevention methods are provided on-site or by
referral in treatment, care, and support programs.
``(Z) A description of the specific strategies
developed to maximize the capacity of health care
providers, including faith-based and other
nongovernmental organizations, and family planning
providers supported by the United States Government to
ensure access to necessary and comprehensive
information about reducing sexual transmission of HIV
among women, men, and young people, including
strategies to ensure HIV/AIDS prevention training for
such providers.
``(AA) A strategy to work with international and
host country partners toward universal access to HIV/
AIDS prevention, treatment, and care programs.''.
(c) Strategic Plan for Program Monitoring, Operations Research, and
Impact Evaluation Research.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally shall develop
a 5-year strategic plan for program monitoring, operations
research, and impact evaluation research of United States HIV/
AIDS, tuberculosis, and malaria programs.
(2) Elements of plan.--The strategic plan developed under
this subsection shall include--
(A) the amount of funding provided for program
monitoring, operations research, and impact evaluation
research under sections 104A, 104B, and 104C of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2,
2151b-3, and 2151b-4) and the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(22 U.S.C. 7601 et seq.) available through fiscal year
2009;
(B) strategies to--
(i) improve the efficiency, effectiveness,
quality, and accessibility of services provided
under the provisions of law described in
subparagraph (A);
(ii) establish the cost-effectiveness of
program models;
(iii) ensure the transparency and
accountability of services provided under the
provisions of law described in subparagraph
(A);
(iv) disseminate and promote the
utilization of evaluation findings, lessons,
and best practices in services provided under
the provisions of law described in subparagraph
(A); and
(v) encourage and evaluate innovative
service models and strategies to optimize the
delivery of care, treatment, and prevention
programs financed by the United States
Government;
(C) priorities for program monitoring, operations
research, and impact evaluation research and a time
line for completion of activities associated with such
priorities; and
(D) other information that the Coordinator
determines to be necessary.
(3) Consultation.--In developing the strategic plan under
this subsection and implementing, disseminating, and promoting
the use of program monitoring, operations research, and impact
evaluation research, the Coordinator shall consult with
representatives of relevant executive branch agencies, other
appropriate executive branch agencies, multilateral
institutions involved in providing HIV/AIDS assistance,
nongovernmental organizations involved in implementing HIV/AIDS
programs, and the governments of host countries.
(4) Definitions.--In this subsection--
(A) the terms ``program monitoring'', ``operations
research'', and ``impact evaluation research'', have
the meanings given such terms in section 104A(d)(4)(B)
of the Foreign Assistance Act of 1961 (as added by
section 301(a)(4)(C) of this Act); and
(B) the term ``relevant executive branch agencies''
has the meaning given the term in section 3 of the
United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602).
SEC. 102. HIV/AIDS RESPONSE COORDINATOR.
Section 1(f)(2) of the State Department Basic Authorities Act of
1956 (22 U.S.C. 2651a(f)(2)) is amended--
(1) in subparagraph (A)--
(A) in the matter preceding clause (i), by
inserting ``, host country finance, health, and other
relevant ministries'' after ``community-based
organizations)''; and
(B) in clause (iii), by inserting ``and host
country finance, health, and other relevant
ministries'' after ``community-based organizations)'';
and
(2) in subparagraph (B)(ii)--
(A) by striking subclauses (IV) and (V) and
inserting the following:
``(IV) Establishing an interagency
working group on HIV/AIDS that is
comprised of, but not limited to,
representatives from the United States
Agency for International Development,
the Department of Health and Human
Services (including the Centers for
Disease Control and Prevention, the
National Institutes of Health, and the
Health Resources and Services
Administration), the Department of
Labor, the Department of Agriculture,
the Millennium Challenge Corporation,
the Department of Defense, and the
Office of the Coordinator of United
States Government Activities to Combat
Malaria Globally, for the purposes of
coordination of activities relating to
HIV/AIDS. The interagency working group
shall--
``(aa) meet regularly to
review progress in host
countries toward HIV/AIDS
prevention, treatment, and care
objectives;
``(bb) participate in the
process of identifying
countries in need of increased
assistance based on the
epidemiology of HIV/AIDS in
those countries; and
``(cc) review policies that
may be obstacles to reaching
objectives set forth for HIV/
AIDS prevention, treatment, and
care.
``(V) Coordinating overall United
States HIV/AIDS policy and programs
with efforts led by host countries and
with the assistance provided by other
relevant bilateral and multilateral aid
agencies and other donor institutions
to achieve complementarity with other
programs aimed at improving child and
maternal health, and food security,
promoting education, and strengthening
health care systems.'';
(B) by redesignating subclauses (VII) and (VIII) as
subclauses (IX) and (X), respectively;
(C) by inserting after subclause (VI) the
following:
``(VII) Holding annual
consultations with host country
nongovernmental organizations providing
services to improve health, and
advocating on behalf of the individuals
with HIV/AIDS and those at particular
risk of contracting HIV/AIDS.
``(VIII) Ensuring, through
interagency and international
coordination, that United States HIV/
AIDS programs are coordinated with and
complementary to the delivery of
related global health, food security,
and education services, including--
``(aa) maternal and child
health care;
``(bb) services for other
neglected and easily
preventable and treatable
infectious diseases, such as
tuberculosis;
``(cc) treatment and care
services for injection drug
users; and
``(dd) programs and
services to improve legal,
social, and economic status of
women and girls.'';
(D) in subclause (IX) (as redesignated by
subparagraph (B) of this paragraph)--
(i) by inserting ``Vietnam, Antigua and
Barbuda, the Bahamas, Barbados, Belize,
Dominica, Grenada, Jamaica, Montserrat, Saint
Kitts and Nevis, Saint Vincent and the
Grenadines, Saint Lucia, Suriname, Trinidad and
Tobago, the Dominican Republic'' after
``Zambia,'';
(ii) by adding at the end before the period
the following: ``and other countries in which
the United States is implementing HIV/AIDS
programs''; and
(iii) by adding at the end the following:
``In designating countries under this
subclause, the President shall give priority to
those countries in which there is a high
prevalence of HIV/AIDS and countries with large
populations that have a concentrated HIV/AIDS
epidemic.'';
(E) by redesignating subclause (X) (as redesignated
by subparagraph (B) of this paragraph) as subclause
(XII);
(F) by inserting after subclause (IX) (as
redesignated by subparagraph (B) and amended by
subparagraph (D) of this paragraph) the following:
``(X) Working, in partnership with host
countries in which the HIV/AIDS epidemic is
prevalent among injection drug users, to
establish, as a national priority, national
HIV/AIDS prevention programs, including
education, and services demonstrated to be
effective in reducing the transmission of HIV
infection among injection drug users without
increasing drug use.
``(XI) Working, in partnership with host
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 create
alternatives to prostitution.'';
(G) in subclause (XII) (as redesignated by
subparagraphs (B) and (E) of this paragraph), by
striking ``funds section'' and inserting ``funds
appropriated pursuant to the authorization of
appropriations under section 401 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 for HIV/AIDS assistance''; and
(H) by adding at the end the following:
``(XIII) Publicizing updated drug
pricing data to inform pharmaceutical
procurement partners' purchasing
decisions.
``(XIV) Working in partnership with
host countries in which the HIV/AIDS
epidemic is prevalent among men who
have sex with men, to establish, as a
national priority, national HIV/AIDS
prevention programs, including
education and services demonstrated to
be effective in reducing the
transmission of HIV among men who have
sex with men.''.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.
Section 201(a) of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621(a)) is amended--
(1) in paragraph (2), by striking ``infectious diseases''
and inserting ``easily preventable and treatable infectious
diseases''; and
(2) in paragraph (4), by striking ``infectious diseases''
and inserting ``easily preventable and treatable infectious
diseases''.
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS
AND MALARIA.
(a) Findings.--Subsection (a) of section 202 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7622) is amended--
(1) by redesignating paragraphs (1) through (3) as
paragraphs (7) through (9), respectively; and
(2) by inserting before paragraph (7) (as redesignated by
paragraph (1) of this subsection) the following:
``(1) The Global Fund to Fight AIDS, Tuberculosis and
Malaria is the multilateral component of this Act, extending
United States efforts to a total of 136 countries around the
world.
``(2) Created in 2002, the Global Fund has played a leading
role in the fight against HIV/AIDS, tuberculosis, and malaria
around the world and has grown into an organization that
currently provides nearly a quarter of all international
financing to combat HIV/AIDS and two-thirds of all
international financing to combat tuberculosis and malaria.
``(3) By 2010, it is estimated that the demand for funding
by the Global Fund will grow in size to between $6 and $8
billion annually, requiring significant contributions from
donors around the world, including at least $2 billion annually
from the United States.
``(4) The Global Fund is an innovative financing mechanism
to combat HIV/AIDS, tuberculosis, and malaria, and has made
progress in many areas.
``(5) The United States Government is the largest supporter
of the Global Fund, both in terms of resources and technical
support.
``(6) The United States made the initial contribution to
the Global Fund and is fully committed to its success.''.
(b) United States Financial Participation.--
(1) Authorization of appropriations.--Subsection (d)(1) of
such section is amended--
(A) by striking ``$1,000,000,000'' and inserting
``$2,000,000,000'';
(B) by striking ``for the period of fiscal year
2004 beginning on January 1, 2004,'' and inserting
``for each of the fiscal years 2009 and 2010,''; and
(C) by striking ``the fiscal years 2005-2008'' and
inserting ``each of the fiscal years 2011 through
2013''.
(2) Limitation.--Subsection (d)(4) of such section is
amended--
(A) in subparagraph (A)--
(i) in clause (i), by striking ``fiscal
years 2004 through 2008'' and inserting
``fiscal years 2009 through 2013'';
(ii) in clause (ii), by striking ``fiscal
years 2004 through 2008'' and inserting
``fiscal years 2009 through 2013''; and
(iii) in clause (vi)--
(I) by striking ``for the
purposes'' and inserting ``For the
purposes'';
(II) by striking ``fiscal years
2004 through 2008'' and inserting
``fiscal years 2009 through 2013''; and
(III) by striking ``fiscal year
2004'' and inserting ``fiscal year
2009'';
(B) in subparagraph (B)(iv)--
(i) by striking ``fiscal years 2004 through
2008'' and inserting ``fiscal years 2009
through 2013''; and
(ii) by adding at the end before the period
the following: ``, unless such amount is made
available for more than one fiscal year, in
which case such amount is authorized to be made
available for such purposes after December 31
of the fiscal year following the fiscal year in
which such funds first became available.''; and
(C) in subparagraph (C)(ii) by striking ``Committee
on International Relations'' and inserting ``Committee
on Foreign Affairs''.
(3) Statement of policy.--The following shall be the policy
of the United States:
(A) Support for the Global Fund to Fight AIDS,
Tuberculosis and Malaria should be based upon
achievement of the following benchmarks related to
transparency and accountability:
(i) As recommended by the Government
Accountability Office, the Fund Secretariat has
established standardized expectations for the
performance of Local Fund Agents (LFAs), is
undertaking a systematic assessment of the
performance of LFAs, and is making available
for public review, according to the Fund
Board's policies and practices on disclosure of
information, a regular collection and analysis
of performance data of Fund grants, which shall
cover both Principal Recipients and sub-
recipients.
(ii) A well-staffed, independent Office of
the Inspector General reports directly to the
Board and is responsible for regular, publicly
published audits of both financial and
programmatic and reporting aspects of the Fund,
its grantees, and LFAs.
(iii) The Fund Secretariat has established
and is reporting publicly on standard
indicators for all program areas.
(iv) The Fund Secretariat has established a
database that tracks all subrecipients and the
amounts of funds disbursed to each, as well as
the distribution of resources, by grant and
Principal Recipient, for prevention, care,
treatment, the purchases of drugs and
commodities, and other purposes.
(v) The Fund Board has established a
penalty to offset tariffs imposed by national
governments on all goods and services provided
by the Fund.
(vi) The Fund Board has successfully
terminated its Administrative Services
Agreement with the World Health Organization
and completed the Fund Secretariat's transition
to a fully independent status under the
Headquarters Agreement the Fund has established
with the Government of Switzerland.
(B) Support for the Global Fund to Fight AIDS,
Tuberculosis and Malaria should be based upon
achievement of the following benchmarks related to the
founding principles of the Fund:
(i) The Fund must maintain its status as a
financing institution.
(ii) The Fund must remain focused on
programs directly related to HIV/AIDS, malaria,
and tuberculosis.
(iii) The Fund must maintain its
Comprehensive Funding Policy, which requires
confirmed pledges to cover the full amount of
new grants before the Board approves them.
(iv) The Fund must maintain and make
progress on sustaining its multisectoral
approach, through Country Coordinating
Mechanisms (CCMs) and in the implementation of
grants, as reflected in percent and resources
allocated to different sectors, including
governments, civil society, and faith- and
community-based organizations.
(4) Sense of congress.--Congress--
(A) notes that section 625 of Public Law 110-161
establishes a requirement to withhold 20 percent of
funds appropriated for the Global Fund if the Global
Fund fails to meet certain benchmarks; and
(B) will continue to review the implementation of
the benchmarks to ensure accountability and
transparency of the Global Fund.
SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.
(a) Vaccine Fund.--Subsection (k) of section 302 of the Foreign
Assistance Act of 1961 (22 U.S.C. 2222) is amended by striking ``fiscal
years 2004 through 2008'' and inserting ``fiscal years 2009 through
2013''.
(b) International AIDS Vaccine Initiative.--Subsection (l) of such
section is amended by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''.
(c) Malaria Vaccine Development Programs.--Subsection (m) of such
section is amended by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''.
(d) Research and Development of a Tuberculosis Vaccine.--Such
section is further amended by adding at the end the following:
``(n) 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
to be available for United States contributions to research and
development of a tuberculosis vaccine.''.
SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF MICROBICIDES TO PREVENT
TRANSMISSION OF HIV AND OTHER DISEASES.
(a) Statement of Policy.--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) Program Authorized.--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, shall develop and implement a program to facilitate wide-
scale availability of microbicides that prevent the transmission of HIV
after such microbicides are proven safe and effective.
(c) 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 section.
SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA BY
STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF HOST
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 et
seq.) is amended by adding at the end the following:
``SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA BY
STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF HOST
COUNTRIES.
``(a) Findings.--Congress makes the following findings:
``(1) One of the most significant barriers to achieving
universal access to HIV/AIDS treatment and prevention in
developing countries is the lack of health infrastructure,
particularly in sub-Saharan Africa.
``(2) In addition to HIV/AIDS programs, other treatable and
preventable infectious diseases could be treated concurrently
and easily if health care delivery systems in developing
countries were significantly improved.
``(3) More public investment in basic primary health care
should be a priority in public spending in developing
countries.
``(b) Statement of Policy.--It shall be the policy of the United
States Government--
``(1) to invest appropriate resources authorized under this
Act and the amendments made by this Act to carry out activities
to strengthen HIV/AIDS health policies and health systems and
provide workforce training and capacity-building consistent
with the goals and objectives of this Act and the amendments
made by this Act; and
``(2) to support the development of a sound policy
environment in host countries to increase the ability of such
countries to maximize utilization of health care resources from
donor countries, deliver services to the people of such host
countries in an effective and efficient manner, and reduce
barriers that prevent recipients of services from achieving
maximum benefit from such services.
``(c) Plan Required.--The Coordinator of United States Government
Activities to Combat HIV/AIDS Globally, in collaboration with the
Administrator of the United States Agency for International
Development, shall develop and implement a plan to combat HIV/AIDS by
strengthening health policies and health systems of host countries as
part of the United States Agency for International Development's
`Health Systems 2020' project.
``(d) Assistance To Improve Public Finance Management Systems.--
``(1) In general.--The Secretary of the Treasury, acting
through the head of the Office of Technical Assistance, is
authorized to provide assistance for advisors and host country
finance, health, and other relevant ministries to improve the
effectiveness of public finance management systems in host
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.''.
(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 the following:
``Sec. 204. Plan to combat HIV/AIDS by strengthening health policies
and health systems of host countries.''.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Amendments to the Foreign Assistance Act of 1961.--
(1) Finding.--Subsection (a) of section 104A of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2) is amended by
inserting ``, South and Southeast Asia, Central and Eastern
Europe'' after ``the Caribbean''.
(2) Policy.--Subsection (b) of such section is amended--
(A) in the first sentence--
(i) by striking ``It is a major'' and
inserting the following:
``(1) General policy.--It is a major'';
(ii) by striking ``control'' and inserting
``care''; and
(iii) by adding at the end before the
period the following: ``and to fulfill United
States commitments to move toward the goal of
universal access to prevention, treatment, and
care of HIV/AIDS'';
(B) by adding at the end the following: ``The
United States and other developed countries should
provide assistance for the prevention, treatment, and
care of HIV/AIDS to countries in sub-Saharan Africa,
the Caribbean, South and Southeast Asia and Central and
Eastern Europe, addressing both generalized epidemics
and epidemics concentrated among populations at high
risk of infection.''; and
(C) by further adding at the end the following:
``(2) Specific policy.--It is therefore the policy of the
United States, by 2013, to--
``(A) prevent 12,000,000 new HIV infections
worldwide;
``(B) support treatment of at least 3,000,000
individuals with HIV/AIDS with the goal of treating
450,000 children;
``(C) provide care for 12,000,000 individuals
affected by HIV/AIDS, including 5,000,000 orphans and
vulnerable children in communities affected by HIV/
AIDS, including orphans with HIV/AIDS; and
``(D) train at least 140,000 new health care
professionals and workers for HIV/AIDS prevention,
treatment and care.''.
(3) Authorization.--Subsection (c) of such section is
amended--
(A) in paragraph (1)--
(i) by inserting ``, South and Southeast
Asia, Central and Eastern Europe'' after ``the
Caribbean''; and
(ii) by adding at the end before the period
the following: ``, and particularly with
respect to refugee populations in such
countries and areas'';
(B) in paragraph (2)--
(i) by inserting ``, South and Southeast
Asia, Central and Eastern Europe'' after ``the
Caribbean''; and
(ii) by adding at the end before the period
the following: ``, and particularly with
respect to refugee populations in such
countries and areas'';
(C) by redesignating paragraph (3) as paragraph
(4);
(D) by inserting after paragraph (2) the following:
``(3) Role of public health care delivery systems.--It is
the sense of Congress that--
``(A) the President should provide an appropriate
level of assistance under paragraph (1) to help
strengthen public health care delivery systems financed
by host countries; and
``(B) the President, acting through the Coordinator
of United States Government Activities to Combat HIV/
AIDS Globally, should support the development of a
policy framework in such host countries for the long-
term sustainability of HIV/AIDS prevention, treatment,
and care programs, and for strengthening health care
delivery systems and increasing health workforces
through recruitment, training, and policies that allows
the devolution of clinical responsibilities to increase
the work force able to deliver prevention, treatment,
and care services, as necessary, with clearly
identified objectives and reporting strategies for such
services.'';
(E) in paragraph (4) (as redesignated by
subparagraph (C) of this paragraph), by striking
``foreign countries'' and inserting ``host countries
and donor countries''; and
(F) by adding at the end the following:
``(5) Sense of congress.--
``(A) In general.--It is the sense of Congress that
the Coordinator of United States Government Activities
to Combat HIV/AIDS Globally and the heads of relevant
executive branch agencies (as such term is defined in
section 3 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003) should
operate in a manner consistent with the `Three Ones'
goals of UNAIDS.
``(B) `Three ones' goals of unaids defined.--In
this paragraph, the term ```Three Ones'' goals of
UNAIDS' means--
``(i) the goal of one agreed HIV/AIDS
action framework that provides the basis for
coordinating the work of all partners in host
countries;
``(ii) the goal of one national HIV/AIDS
coordinating authority, with a broad-based
multisectoral mandate; and
``(iii) the goal of one agreed country-
level data-collection, monitoring, and
evaluation system.''.
(4) Activities supported.--
(A) Prevention.--Subsection (d)(1) of such section
is amended--
(i) in subparagraph (A)--
(I) by inserting ``efforts by
faith-based and other nongovernmental
organizations and'' after ``infection,
including'';
(II) by inserting ``, including
access to such programs and efforts in
family planning programs supported by
the United States Government,'' after
``health programs''; and
(III) by inserting ``male and
female'' before ``condoms'';
(ii) in subparagraph (B)--
(I) by inserting ``relevant and''
after ``culturally'';
(II) by inserting ``and programs''
after ``those organizations''; and
(III) by inserting ``, level of
scientific and fact-based knowledge''
after ``experience'';
(iii) in subparagraph (D), by inserting
``and nonjudgmental approaches'' after
``protections'';
(iv) by amending subparagraph (E) to read
as follows:
``(E) assistance to achieve the target 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, as described in section
312(b)(1) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003, and to
promote infant feeding options that meet the criteria
described in the World Health Organization's Global
Strategy for Infant and Young Child Feeding;'';
(v) in subparagraph (G)--
(I) by adding at the end before the
semicolon the following: ``, including
education and services demonstrated to
be effective in reducing the
transmission of HIV infection without
increasing illicit drug use''; and
(II) by striking ``and'' at the
end;
(vi) in subparagraph (H), by striking the
period at the end and inserting ``; and''; and
(vii) by adding at the end the following:
``(I)(i) assistance for counseling, testing,
treatment, care, and support programs for prevention of
re-infection of individuals with HIV/AIDS;
``(ii) counseling to prevent sexual transmission of
HIV, including skill development for practicing
abstinence, reducing the number of sexual partners, and
providing information on correct and consistent use of
male and female condoms;
``(iii) assistance to provide male and female
condoms;
``(iv) diagnosis and treatment of other sexually-
transmitted infections;
``(v) strategies to address the stigma and
discrimination that impede HIV/AIDS prevention efforts;
and
``(vi) assistance to facilitate widespread access
to microbicides for HIV prevention, as 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 post-introduction monitoring; and
``(J) assistance for HIV/AIDS education targeted to
reach and prevent the spread of HIV among men who have
sex with men.''.
(B) Treatment.--Subsection (d)(2) of such section
is amended--
(i) in subparagraph (B), by striking ``;
and'' at the end and inserting a semicolon;
(ii) in subparagraph (C), by striking the
period at the end and inserting a semicolon;
and
(iii) by adding at the end the following:
``(D) assistance specifically to address barriers
that might limit the start of and adherence to
treatment services, especially in rural areas, through
such measures as mobile and decentralized distribution
of treatment services, and where feasible and
necessary, direct linkages with nutrition and income
security programs, referrals to services for victims of
violence, support groups for individuals with HIV/AIDS,
and efforts to combat stigma and discrimination against
all such individuals;
``(E) assistance to support comprehensive HIV/AIDS
treatment (including free prophylaxis and treatment for
common HIV/AIDS-related opportunistic infections) for
at least one-third of individuals with HIV/AIDS in the
poorest countries worldwide who are in clinical need of
antiretroviral treatment; and
``(F) assistance to improve access to psychosocial
support systems and other necessary services for youth
who are infected with HIV to ensure the start of and
adherence to treatment services.''.
(C) Monitoring.--Subsection (d)(4) of such section
is amended--
(i) by striking ``The monitoring'' and
inserting the following:
``(A) In general.--The monitoring'';
(ii) by inserting ``and paragraph (8)''
after ``paragraphs (1) through (3)'';
(iii) by redesignating subparagraphs (A)
through (D) as clauses (i) through (iv),
respectively;
(iv) in clause (iii) (as redesignated by
clause (iii) of this subparagraph), by striking
``and'' at the end;
(v) in clause (iv) (as redesignated by
clause (iii) of this subparagraph), by striking
the period at the end and inserting ``; and'';
(vi) by adding at the end the following:
``(v) carrying out and expanding program
monitoring, impact evaluation research, and
operations research (including research and
evaluations of gender-responsive interventions,
disaggregated by age and sex, in order to
identify and replicate effective models,
develop gender indicators to measure both
outcomes and impacts of interventions,
especially interventions designed to reduce
gender inequalities, and collect lessons
learned for dissemination among different
countries) in order to--
``(I) improve the coverage,
efficiency, effectiveness, quality and
accessibility of services provided
under this section;
``(II) establish the cost-
effectiveness of program models;
``(III) assess the population-level
impact of programs, projects, and
activities implemented;
``(IV) ensure the transparency and
accountability of services provided
under this section;
``(V) disseminate and promote the
utilization of evaluation findings,
lessons, and best practices in the
implementation of programs, projects,
and activities supported under this
section; and
``(VI) encourage and evaluate
innovative service models and
strategies to optimize functionality of
programs, projects, and activities.'';
and
(vii) by further adding at the end the
following:
``(B) Definitions.--For purposes of subparagraph
(A)(v)--
``(i) the term `impact evaluation research'
means the application of research methods and
statistical analysis to measure the extent to
which a change in a population-based outcome
can be attributed to a program, project, or
activity as opposed to other factors in the
environment;
``(ii) the term `program monitoring' means
the collection, analysis, and use of routine
data with respect to a program, project, or
activity to determine how well the program,
project, or activity is carried out and at what
cost; and
``(iii) the term `operations research'
means the application of social science
research methods and statistical analysis to
judge, compare, and improve policy outcomes and
outcomes of a program, project, or activity,
from the earliest stages of defining and
designing the program, project, or activity
through the development and implementation of
the program, project, or activity.''.
(D) Pharmaceuticals.--Subsection (d)(5) of such
section is amended--
(i) by redesignating subparagraph (C) as
subparagraph (D); and
(ii) by inserting after subparagraph (B)
the following:
``(C) Mechanisms to ensure cost-effective drug
purchasing.--Mechanisms to ensure that 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.''.
(E) Referral systems and coordination with other
assistance programs.--
(i) Finding.--The effectiveness of all HIV/
AIDS prevention, treatment, and care programs
and the survival of individuals with HIV/AIDS
would be enhanced by ensuring that such
individuals are referred to appropriate support
programs, including education, income
generation, HIV/AIDS support group and food and
nutrition programs, and by providing assistance
directly to such programs to the extent such
programs would further the purposes of
expanding access to and the success of HIV/AIDS
prevention, treatment, and care.
(ii) Amendment.--Subsection (d) of such
section is further amended by adding at the end
the following:
``(8) Referral systems and coordination with other
assistance programs.--
``(A) Referral systems.--Assistance to ensure that
a continuum of care is available to individuals
participating in HIV/AIDS prevention, treatment, and
care programs through the development of referral
systems for such individuals to community-based
programs that, where practicable, are co-located with
such HIV/AIDS programs, and that provide support
activities for such individuals, including HIV/AIDS
treatment adherence, HIV/AIDS support groups, food and
nutrition support, maternal health services, substance
abuse prevention and treatment services, income-
generation programs, legal services, and other program
support.
``(B) Coordination with other assistance
programs.--
``(i)(I) Assistance to integrate HIV/AIDS testing
with testing for other easily detectable and treatable
infectious diseases, such as malaria, tuberculosis, and
respiratory infections, and to provide treatment if
possible or referral to appropriate treatment programs.
``(II) Assistance to provide, whenever possible, as
a component of HIV/AIDS prevention, treatment, and care
services, and co-treatment of curable diseases, such as
other sexually transmitted diseases.
``(III) Assistance and other activities to ensure,
through interagency and international coordination,
that United States global HIV/AIDS programs are
integrated and complementary to delivering related
health services.
``(ii) Assistance to support schools and related
programs for children and youth that increase the
effectiveness of programs described in this subsection
by providing the infrastructure, teachers, and other
support to such programs.
``(iii) Assistance and other activities to provide
access to HIV/AIDS prevention, treatment, and care
programs in family planning and maternal and child
health programs supported by the United States
Government.
``(iv) Assistance to United States and host country
nonprofit development organizations that directly
support livelihood initiatives in HIV/AIDS-affected
countries that provide opportunities for direct lending
to microentrepreneurs by United States citizens or
opportunities for United States citizens to purchase
livestock and plants for families to provide nutrition
and generate income for individual households and
communities.
``(v) Assistance to coordinate and provide linkages
between HIV/AIDS prevention, treatment, and care
programs with efforts to improve the economic and legal
status of women and girls.
``(vi) Technical assistance coordinated across
implementing agencies, offered on a regular basis, and
made available upon request, for faith-based and
community-based organizations, especially indigenous
organizations and new partners who do not have
extensive experience managing United States foreign
assistance programs, including for training and
logistical support to establish financial mechanisms to
track program receipts and expenditures and data
management systems to ensure data quality and
strengthen reporting.
``(vii) In accordance with the World Health
Organization's Interim Policy on TB/HIV Activities
(2004), assistance to individuals with or symptomatic
of tuberculosis, and assistance to implement the
following:
``(I) Provide opt-out HIV/AIDS counseling
and testing and appropriate referral for
treatment and care to individuals with or
symptomatic of tuberculosis, and work with host
countries to ensure that such individuals in
host countries are provided such services.
``(II) Ensure, in coordination with host
countries, that individuals with HIV/AIDS
receive tuberculosis screening and other
appropriate treatment.
``(III) Provide increased funding for HIV/
AIDS and tuberculosis activities, by increasing
total resources for such activities, including
lab strengthening and infection control.
``(IV) Improve the management and
dissemination of knowledge gained from HIV/AIDS
and tuberculosis activities to increase the
replication of best practices.''.
(5) Annual report.--Subsection (e) of such section is
amended--
(A) in paragraph (1), by striking ``Committee on
International Relations'' and inserting ``Committee on
Foreign Affairs'';
(B) in paragraph (2)--
(i) in subparagraph (B), by striking
``and'' at the end;
(ii) in subparagraph (C)--
(I) in the matter preceding clause
(i), by striking ``including'' and
inserting ``including--'';
(II) by striking clauses (i) and
(ii) and inserting the following:
``(i)(I) the effectiveness of such programs
in reducing the transmission of HIV,
particularly in women and girls, in reducing
mother-to-child transmission of HIV, including
through drug treatment and therapies, either
directly or by referral, and in reducing
mortality rates from HIV/AIDS, including
through drug treatment, and addiction
therapies;
``(II) a description of strategies, goals,
programs, and interventions to address the
specific needs and vulnerabilities of young
women and young men; the progress toward
expanding access among young women and young
men to evidence-based, comprehensive HIV/AIDS
health care services and HIV prevention and
sexuality and abstinence education programs at
the individual, community, and national levels;
and clear targets for integrating adolescents
who are orphans, including adolescents who are
infected with HIV, into programs for orphans
and vulnerable children; and
``(III) the amount of United States funding
provided under the authorities of this Act to
procure drugs for HIV/AIDS programs in
countries described in section 1(f)(2)(B)(IX)
of the State Department Basic Authorities Act
of 1956 (22 U.S.C. 2651a(f)(2)(B)(VIII)),
including a detailed description of anti-
retroviral drugs procured, including--
``(aa) the total amount expended
for each generic and name brand drug;
``(bb) the price paid per unit of
each drug; and
``(cc) the vendor from which each
drug was purchased; and
``(ii) the progress made toward improving
health care delivery systems (including the
training of adequate numbers of health care
professionals) and infrastructure to ensure
increased access to care and treatment,
including a description of progress toward--
``(I)(aa) the training and
retention of adequate numbers of health
care professionals in order to meet a
nationally-determined ratio of doctors,
nurses, and midwives to patients, based
on the target of the 2.3 per-thousand
ratio established by the World Health
Organization (WHO);
``(bb) increases in the number of
other health care professions, such as
pharmacists and lab technicians, as
necessary; and
``(cc) the improvement of
infrastructure needed to ensure
universal access to HIV/AIDS
prevention, treatment, and care by
2015;
``(II) national health care
workforce strategy benchmarks, as
required by section 202(d)(5)(B) of the
United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of
2003, United States contributions to
developing and implementing the
benchmarks, and main challenges to
implementing the benchmarks;
``(III) ensuring, to the extent
practicable, that health care workers
providing services under this Act have
safe working conditions and are
receiving health care services,
including services relating to HIV/
AIDS;
``(IV) activities to strengthen
health care systems in order to
overcome obstacles and barriers to the
provision of HIV/AIDS, tuberculosis,
and malaria services;
``(V) improving integration and
coordination of HIV/AIDS programs with
related health care services and
supporting the capacity of health care
programs to refer individuals to
community-based services; and
``(VI) strengthening procurement
and supply chain management systems of
host countries;'';
(III) in clause (iii), by adding at
the end before the semicolon the
following: ``, including the percentage
of such United States foreign
assistance provided for diagnosis and
treatment of individuals with
tuberculosis in countries with the
highest burden of tuberculosis, as
determined by the World Health
Organization (WHO)''; and
(IV) in clause (iv), by striking
the period at the end and inserting a
semicolon; and
(iii) by adding at the end the following:
``(D) a description of efforts to integrate HIV/
AIDS and tuberculosis prevention, treatment, and care
programs, including--
``(i) the number and percentage of HIV-
infected individuals receiving HIV/AIDS
treatment or care services who are also
receiving screening and subsequent treatment
for tuberculosis;
``(ii) the number and percentage of
individuals with tuberculosis who are receiving
HIV/AIDS counseling and testing, and
appropriate referral to HIV/AIDS services;
``(iii) the number and location of
laboratories with the capacity to perform
tuberculosis culture tests and tuberculosis
drug susceptibility tests;
``(iv) the number and location of
laboratories with the capacity to perform
appropriate tests for multi-drug resistant
tuberculosis (MDR-TB) and extensively drug
resistant tuberculosis (XDR-TB); and
``(v) the number of HIV-infected
individuals suspected of having tuberculosis
who are provided tuberculosis culture diagnosis
or tuberculosis drug susceptibility testing;
``(E) a description of coordination efforts with
relevant executive branch agencies (as such term is
defined in section 3 of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003) and at the global level in the effort to link
HIV/AIDS services with non-HIV/AIDS services;
``(F) a description of programs serving women and
girls, including--
``(i) a description of HIV/AIDS prevention
programs that address the vulnerabilities of
girls and women to HIV/AIDS; and
``(ii) information on the number of
individuals served by programs aimed at
reducing the vulnerabilities of women and girls
to HIV/AIDS;
``(G) a description of the specific strategies
funded to ensure the reduction of HIV infection among
injection drug users, and the number of injection drug
users, by country, reached by such strategies,
including medication-assisted drug treatment for
individuals with HIV or at risk of HIV, and HIV
prevention programs demonstrated to be effective in
reducing HIV transmission without increasing drug use;
and
``(H) a detailed description of monitoring, impact
evaluation research, and operations research of
programs, projects, and activities carried out pursuant
to subsection (d)(4)(A)(v).''; and
(C) by adding at the end the following:
``(3) Public availability.--The Coordinator of United
States Government Activities to Combat HIV/AIDS Globally shall
make publicly available on the Internet website of the Office
of the Coordinator the information contained in paragraph
(2)(H) of each report and, in addition, the individual
evaluations and other reports that were the basis of such
information, including lessons learned and collected in such
evaluations and reports.''.
(b) Authorization of Appropriations.--Subsection (b) of section 301
of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7631) 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''.
(c) Food Security and Nutrition Support.--Subsection (c) of such
section is amended to read as follows:
``(c) Food Security and Nutrition Support.--
``(1) Findings.--Congress finds the following:
``(A) The United States provides more than 60
percent of all food assistance worldwide.
``(B) According to the United Nations World Food
Program and other United Nations agencies, food
insecurity of individuals with HIV/AIDS is a major
problem in countries with large populations of such
individuals, particularly in sub-Saharan African
countries.
``(C) Individuals infected with HIV have higher
nutritional requirements than individuals who are not
infected with HIV, particularly with respect to the
need for protein. Also, there is evidence to suggest
that the full benefit of therapy to treat HIV/AIDS may
not be achieved in individuals who are malnourished,
particularly in pregnant and lactating women.
``(2) Sense of congress.--It is the sense of Congress
that--
``(A) malnutrition, especially for individuals with
HIV/AIDS, is a clinical health issue with wider
nutrition, health, and social implications for such
individuals, their families, and their communities that
must be addressed by United States HIV/AIDS prevention,
treatment, and care programs;
``(B) food security and nutrition directly impact
an individual's vulnerability to HIV infection, the
progression of HIV to AIDS, an individual's ability to
begin an antiretroviral medication treatment regimen,
the efficacy of an antiretroviral medication treatment
regimen once an individual begins such a regimen, and
the ability of communities to effectively cope with the
HIV/AIDS epidemic and its impacts;
``(C) international guidelines established by the
World Health Organization (WHO) should serve as the
reference standard for HIV/AIDS food and nutrition
activities supported by this Act and the amendments
made by this Act;
``(D) the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally and the
Administrator of the United States Agency for
International Development should make it a priority to
work together and with other United States Government
agencies, donors, and multilateral institutions to
increase the integration of food and nutrition support
and livelihood activities into HIV/AIDS prevention,
treatment, and care activities funded by the United
States and other governments and organizations;
``(E) for purposes of determining which individuals
infected with HIV should be provided with nutrition and
food support--
``(i) children with moderate or severe
malnutrition, according to WHO standards, shall
be given priority for such nutrition and food
support; and
``(ii) adults with a body mass index (BMI)
of 18.5 or less, or at the prevailing WHO-
approved measurement for BMI, should be
considered `malnourished' and should be given
priority for such nutrition and food support;
``(F) programs funded by the United States should
include therapeutic and supplementary feeding, food,
and nutrition support and should include strong links
to development programs that provide support for
livelihoods; and
``(G) the inability of individuals with HIV/AIDS to
access food for themselves or their families should not
be allowed to impair or erode the therapeutic status of
such individuals with respect to HIV/AIDS or related
co-morbidities.
``(3) Statement of policy.--It is the policy of the United
States to--
``(A) address the food and nutrition needs of
individuals with HIV/AIDS and affected individuals,
including orphans and vulnerable children;
``(B) fully integrate food and nutrition support
into HIV/AIDS prevention, treatment, and care programs
carried out under this Act and the amendments made by
this Act;
``(C) ensure, to the extent practicable, that--
``(i) HIV/AIDS prevention, treatment, and
care providers and health care workers are
adequately trained so that such providers and
workers can provide accurate and informed
information regarding food and nutrition
support to individuals enrolled in treatment
and care programs and individuals affected by
HIV/AIDS; and
``(ii) individuals with HIV/AIDS who, with
their households, are identified as food
insecure are provided with adequate food and
nutrition support; and
``(D) effectively link food and nutrition support
provided under this Act and the amendments made by this
Act to individuals with HIV/AIDS, their households, and
their communities, to other food security and
livelihood programs funded by the United States and
other donors and multilateral agencies.
``(4) Integration of food security and nutrition activities
into hiv/aids prevention, treatment, and care activities.--
``(A) Requirements relating to global aids
coordinator.--Consistent with the statement of policy
described in paragraph (3), the Coordinator of United
States Government Activities to Combat HIV/AIDS
Globally shall--
``(i) ensure, to the extent practicable,
that--
``(I) an assessment, using
validated criteria, of the food
security and nutritional status of each
individual enrolled in antiretroviral
medication treatment programs supported
with funds authorized under this Act or
any amendment made by this Act is
carried out; and
``(II) appropriate nutritional
counseling is provided to each
individual described in subclause (I);
``(ii) coordinate with the Administrator of
the United States Agency for International
Development, the Secretary of Agriculture, and
the heads of other relevant executive branch
agencies to--
``(I) ensure, to the extent
practicable, that, in communities in
which a significant proportion of
individuals with HIV/AIDS are in need
of food and nutrition support, a status
and needs assessment for such support
employing validated criteria is
conducted and a plan to provide such
support is developed and implemented;
``(II) improve and enhance
coordination between food security and
livelihood programs for individuals
infected with HIV in host countries and
food security and livelihood programs
that may already exist in such
countries;
``(III) establish effective
linkages between the health and
agricultural development and
livelihoods sectors in order to enhance
food security; and
``(IV) ensure, by providing
increased resources if necessary,
effective coordination between
activities authorized under this Act
and the amendments made by this Act and
activities carried out under other
provisions of the Foreign Assistance
Act of 1961 when establishing new HIV/
AIDS treatment sites;
``(iii) develop effective, validated
indicators that measure outcomes of nutrition
and food security interventions carried out
under this section and use such indicators to
monitor and evaluate the effectiveness of such
interventions; and
``(iv) evaluate the role of and, to the
extent appropriate, support and expand
partnerships and linkages between United States
postsecondary educational institutions with
postsecondary educational institutions in host
countries in order to provide training and
build indigenous human and institutional
capacity and expertise to respond to HIV/AIDS,
and to improve capacity to address nutrition,
food security, and livelihood needs of HIV/
AIDS-affected and impoverished communities.
``(B) Requirements relating to usaid
administrator.--Consistent with the statement of policy
described in paragraph (3), 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 and
the Secretary of Agriculture, shall provide, to the
extent practicable, as an essential component of
antiretroviral medication treatment programs supported
with funds authorized under this Act and the amendments
made by this Act, food and nutrition support to each
individual with HIV/AIDS who is determined to need such
support by the assessing health professional, based on
a body mass index (BMI) of 18.5 or less, or at the
prevailing WHO-approved measurement for BMI, and the
individual's household, for a period of not less than
180 days, either directly or through referral to an
assistance program or organization with demonstrable
ability to provide such support.
``(C) Report.--Not later than October 31, 2010, and
annually thereafter, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, in
consultation with the Administrator of the United
States Agency for International Development, shall
submit to the appropriate congressional committees a
report on the implementation of this subsection for the
prior fiscal year. The report shall include a
description of--
``(i) the effectiveness of interventions
carried out to improve the nutritional status
of individuals with HIV/AIDS;
``(ii) the amount of funds provided for
food and nutrition support for individuals with
HIV/AIDS and affected individuals in the prior
fiscal year and the projected amount of funds
to be provided for such purpose for next fiscal
year; and
``(iii) a strategy for improving the
linkage between assistance provided with funds
authorized under this subsection and food
security and livelihood programs under other
provisions of law as well as activities funded
by other donors and multilateral organizations.
``(D) 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 President such sums as may be
necessary for each of the fiscal years 2009 through
2013 to carry out this subsection.''.
(d) Eligibility for Assistance.--Subsection (d) of such section 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 (as
added by subsection (a)) or under any other provision of this Act (or
any amendment made by this Act or the Tom Lantos and Henry J. Hyde
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008) to prevent, treat, or monitor HIV/AIDS--
``(1) shall not be required, as a condition of receiving
the assistance, to endorse or utilize a multisectoral approach
to combating HIV/AIDS, or 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 do
so.''.
(e) Sense of Congress.--Such section is further amended by striking
subsection (g).
(f) Report.--
(1) In general.--Not later than 270 days after the date of
the enactment of this Act, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally shall submit
to the appropriate congressional committees a report
identifying a target for the number of additional health
professionals and workers needed in host countries to provide
HIV/AIDS prevention, treatment, and care and the training needs
of such health professionals and workers. The target should
reflect available data and should identify the need for United
States Government contributions to meet the target.
(2) Definition.--In this subsection, the term ``appropriate
congressional committees'' has the meaning given the term in
section 3 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602).
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Amendments to the Foreign Assistance Act of 1961.--
(1) Findings.--Subsection (a) of section 104B of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3) is amended
by striking paragraphs (1) and (2) and inserting the following:
``(1) Tuberculosis is one of the greatest infectious causes
of death of adults worldwide, killing 1.6 million individuals
per year--one person every 20 seconds.
``(2) Tuberculosis is the leading infectious cause of death
among individuals who are infected with HIV due to their
weakened immune systems, and it is estimated that one-third of
such individuals have tuberculosis. Tuberculosis is also a
leading killer of women of reproductive age.
``(3) Driven by the HIV/AIDS pandemic, incidence rates of
tuberculosis in sub-Saharan Africa have more than doubled on
average since 1990. The problem is so pervasive that in August
2005, African health ministers and the World Health
Organization (WHO) declared tuberculosis to be an emergency in
sub-Saharan Africa.
``(4)(A) The wide extent of drug resistance, including both
multi-drug resistant tuberculosis (MDR-TB) and extensively drug
resistant tuberculosis (XDR-TB), represents both a critical
challenge to the global control of tuberculosis and a serious
worldwide public health threat.
``(B) XDR-TB, which is a form of MDR-TB with additional
resistance to multiple second-line anti-tuberculosis drugs, is
associated with worst treatment outcomes of any form of
tuberculosis.
``(C) XDR-TB is converging with the HIV/AIDS epidemic,
undermining gains in HIV/AIDS prevention and treatment programs
and requires urgent interventions.
``(D) Drug resistance surveillance reports have confirmed
the serious scale and spread of tuberculosis, with XDR-TB
strains confirmed on six continents.
``(E) Demonstrating the lethality of XDR-TB, an initial
outbreak in Tugela Ferry, South Africa, in 2006 killed 52 of 53
patients with hundreds more cases reported since that time.
``(F) Of the world's regions, sub-Saharan Africa, faces the
greatest gap in capacity to prevent, treat, and care for
individuals with XDR-TB.''.
(2) Policy.--Subsection (b) of such section 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 Government should prioritize the achievement of the
following goals by not later than December 31, 2015:
``(1) Reduce by one-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
cure of at least 85 percent of such cases detected.''.
(3) Activities supported.--Such section is further
amended--
(A) by redesignating subsections (d) through (f) as
subsections (e) through (g); and
(B) by inserting after subsection (c) the
following:
``(d) Activities Supported.--Assistance provided under subsection
(c) shall, to the maximum extent practicable, be used to carry out the
following activities:
``(1) Provide diagnostic counseling and testing to
individuals with HIV/AIDS for tuberculosis (including a culture
diagnosis to rule out multi-drug resistant tuberculosis (MDR-
TB) and extensively drug resistant tuberculosis (XDR-TB) and
provide HIV/AIDS voluntary counseling and testing to
individuals with any form of tuberculosis.
``(2) Provide tuberculosis treatment to individuals
receiving treatment and care for HIV/AIDS who have active
tuberculosis and provide prophylactic treatment to individuals
with HIV/AIDS who also have a latent tuberculosis infection.
``(3) Link individuals with both HIV/AIDS and tuberculosis
to HIV/AIDS treatment and care services, including
antiretroviral therapy and cotrimoxazole therapy.
``(4) Ensure that health care workers trained to diagnose,
treat, and provide care for HIV/AIDS are also trained to
diagnose, treat, and provide care for individuals with both
HIV/AIDS and tuberculosis.
``(5) Ensure that individuals with active pulmonary
tuberculosis are provided a culture diagnosis, including drug
susceptibility testing to rule out multi-drug resistant
tuberculosis (MDR-TB) and extensively drug resistant
tuberculosis (XDR-TB) in areas with high prevalence of
tuberculosis drug resistance.''.
(4) Priority to stop tb strategy.--Subsection (f) of such
section (as redesignated by paragraph (3) of this subsection)
is amended--
(A) by amending the heading to read as follows:
``Priority To Stop TB Strategy'';
(B) in the first sentence, by striking ``In
furnishing'' and all that follows through ``, including
funding'' and inserting the following:
``(1) Priority.--In furnishing assistance under subsection
(c), the President shall give priority to--
``(A) activities described in the Stop TB Strategy,
including expansion and enhancement of Directly
Observed Treatment Short-course (DOTS) coverage,
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
care 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
``(B) funding''; and
(C) in the second sentence--
(i) by striking ``In order to'' and all
that follows through ``not less than'' and
inserting the following:
``(2) Availability of amounts.--In order to meet the
requirements of paragraph (1), the President--
``(A) shall ensure that not less than'';
(ii) by striking ``for Directly Observed
Treatment Short-course (DOTS) coverage and
treatment of multi-drug resistant tuberculosis
using DOTS-Plus,'' and inserting ``to implement
the Stop TB Strategy; and''; and
(iii) by striking ``including'' and all
that follows and inserting the following:
``(B) should ensure that not less than $15,000,000
of the amount made available to carry out this section
for a fiscal year is used to make a contribution to the
Global Tuberculosis Drug Facility.''.
(5) Assistance for who and the stop tuberculosis
partnership.--Such section is further amended--
(A) by redesignating subsection (g) (as
redesignated by paragraph (3) of this subsection) as
subsection (h); and
(B) by inserting after subsection (f) (as
redesignated by paragraph (4) and amended by paragraph
(5) of this subsection) the following new subsection:
``(g) Assistance for WHO 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 (WHO) 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 extensively drug resistant
tuberculosis (XDR-TB).''.
(6) Definitions.--Subsection (h) of such section (as
redesignated by paragraph (5)(A) of this subsection) is
amended--
(A) in paragraph (1), by adding at the end before
the period the following: ``, including low cost and
effective diagnosis and evaluation of treatment
regimes, vaccines, and monitoring of tuberculosis, as
well as a reliable drug supply, and a management
strategy for public health systems, with health system
strengthening, promotion of the use of the
International Standards for Tuberculosis Care by all
care providers, bacteriology under an external quality
assessment framework, short-course chemotherapy, and
sound reporting and recording systems''; and
(B) by adding after paragraph (5) the following new
paragraph:
``(6) Stop tb strategy.--The term `Stop TB Strategy' means
the six-point strategy to reduce tuberculosis developed by the
World Health Organization. The strategy is described in the
Global Plan to Stop TB 2007-2016: Actions for Life, a
comprehensive plan developed by the Stop Tuberculosis
Partnership that sets out the actions necessary to achieve the
millennium development goal of cutting tuberculosis deaths and
disease burden in half by 2016.''.
(b) 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 ``$4,000,000,000 for fiscal years 2009 through
2013''; 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. 21516-4(b)) is
amended by striking ``control, and cure'' and inserting ``treatment,
and care''.
(b) Authorization of Appropriations.--Section 303(b) of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7633(b)) is amended--
(1) in paragraph (1), by striking ``such sums as may be
necessary for fiscal years 2004 through 2008'' and inserting
``$5,000,000,000 for fiscal years 2009 through 2013''; and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
(c) Development of a Comprehensive Five-Year Strategy.--Section 303
of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7633) is amended by adding at the end
the following:
``(d) Development of a Comprehensive Five-Year Strategy.--The
President shall establish a comprehensive, five-year strategy to combat
global malaria that strengthens the capacity of the United States to be
an effective leader of international efforts to reduce the global
malaria disease burden. Such strategy shall maintain sufficient
flexibility and remain responsive to the ever-changing nature of the
global malaria challenge and shall--
``(1) include specific objectives, multisectoral approaches
and strategies to treat and provide care to individuals
infected with malaria, to prevent the further spread of
malaria;
``(2) describe how this strategy would contribute to the
United States' overall global health and development goals;
``(3) clearly explain how proposed activities to combat
malaria will be coordinated with other United States global
health activities, including the five-year global HIV/AIDS and
tuberculosis strategies developed pursuant to section 101 of
this Act;
``(4) expand public-private partnerships and leveraging of
resources to combat malaria, including private sector
resources;
``(5) coordinate among relevant executive branch agencies
providing assistance to combat malaria in order to maximize
human and financial resources and reduce unnecessary
duplication among such agencies and other donors;
``(6) maximize United States capabilities in the areas of
technical assistance, training, and research, including vaccine
research, to combat malaria; and
``(7) establish priorities and selection criteria for the
distribution of resources to combat malaria based on factors
such as the size and demographics of the population with
malaria, the needs of that population, the host countries'
existing infrastructure, and the host countries' ability to
complement United States efforts with strategies outlined in
national malaria control plans.
``(e) Malaria Response Coordinator.--
``(1) In general.--There should be established within the
United States Agency for International Development a
Coordinator of United States Government Activities to Combat
Malaria Globally, who should be appointed by the President.
``(2) Authorities.--The Coordinator, acting through such
nongovernmental organizations and relevant executive branch
agencies as may be necessary and appropriate to effect the
purposes of section 104C of the Foreign Assistance Act of 1961
(22 U.S.C. 2151b-4), is authorized--
``(A) to operate internationally to carry out
prevention, treatment, care, support, capacity
development of health systems, and other activities for
combating malaria;
``(B) to transfer and allocate funds to relevant
executive branch agencies;
``(C) to provide grants to, and enter into
contracts with, nongovernmental organizations to carry
out the purposes of such section 104C;
``(D) to enter into contracts and transfer and
allocate funds to international organizations to carry
out the purposes of such section 104C; and
``(E) to coordinate with a public-private
partnership to discover and develop effective new
antimalarial drugs, including drugs for multi-drug
resistant malaria and malaria in pregnant women.
``(3) Duties.--
``(A) In general.--The Coordinator shall have
primary responsibility for the oversight and
coordination of all resources and global United States
government activities to combat malaria.
``(B) Specific duties.--The Coordinator shall--
``(i) facilitate program and policy
coordination among relevant executive branch
agencies and nongovernmental organizations,
including auditing, monitoring and evaluation
of such programs;
``(ii) ensure that each relevant executive
branch agency has sufficient resources to
execute programs in areas in which the agency
has the greatest expertise, technical
capability, and potential for success;
``(iii) coordinate with the Office of the
Coordinator of United States Government
Activities to Combat HIV/AIDS Globally and
equivalent managers of other relevant executive
branch agencies that are implementing global
health programs to develop and implement
program plans, country-level interactions, and
recipient administrative requirements in
countries in which more than one program
operates;
``(iv) coordinate relevant executive branch
agency activities in the field, including
coordination of planning, implementation, and
evaluation of malaria programs with HIV/AIDS
programs in countries in which both programs
are being carried out;
``(v) pursue coordinate program
implementation with host governments, other
donors, and the private sector; and
``(vi) establish due diligence criteria for
all recipients of funds appropriated pursuant
to the authorizations of appropriations under
section 401 for malaria assistance.
``(f) Assistance to Who.--In carrying out this section, the
President is authorized to make a United States contribution to the
Roll Back Malaria Partnership and the World Health Organization (WHO)
to improve the capacity of countries with high rates of malaria and
other affected countries to implement comprehensive malaria control
programs.
``(g) Annual Report.--
``(1) In general.--Not later than 270 days after the date
of the enactment of the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter, the
President shall transmit to the appropriate congressional
committees a report on United States assistance for the
prevention, treatment, control, and elimination of malaria.
``(2) Matters to be included.--The report required under
paragraph (1) shall include a description of--
``(A) the countries and activities to which malaria
assistance has been allocated;
``(B) the number of people reached through malaria
assistance programs;
``(C) the percentage and number of children and
mothers reached through malaria assistance programs;
``(D) research efforts to develop new tools to
combat malaria, including drugs and vaccines;
``(E) collaboration with the World Health
Organization (WHO), the Global Fund to Fight AIDS,
Tuberculosis and Malaria, other donor governments, and
relevant executive branch agencies to combat malaria;
``(F) quantified impact of United States assistance
on childhood morbidity and mortality;
``(G) the number of children who received
immunizations through malaria assistance programs; and
``(H) the number of women receiving ante-natal care
through malaria assistance programs.''.
SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.
(a) In General.--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 section 304 and inserting the following:
``SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.
``(a) Sense of Congress.--It is the sense of Congress that the use
of health care partnerships that link United States and host country
health care institutions create opportunities for sharing of knowledge
and expertise among individuals with significant experience in health-
related fields and build local capacity to combat HIV/AIDS and increase
scientific understanding of the progression of HIV/AIDS and the HIV/
AIDS epidemic.
``(b) Authority To Facilitate Health Care Partnerships To Combat
HIV/AIDS.--The President, acting through the Coordinator of United
States Government Activities to Combat HIV/AIDS Globally, shall
facilitate the development of health care partnerships described in
subsection (a) by-
``(1) supporting short- and long-term institutional
partnerships, including partnerships that build capacity in
ministries of health, central- and district-level health
agencies, medical facilities, health education and training
institutions, academic centers, and faith- and community-based
organizations involved in prevention, treatment, and care of
HIV/AIDS;
``(2) supporting the development of consultation services
using appropriate technologies, including online courses, DVDs,
telecommunications services, and other technologies to
eliminate the barriers that prevent host country professionals
from accessing high quality health care services information,
particularly providers located in rural areas;
``(3) supporting the placements of highly qualified
individuals to strengthen human and organizational capacity
through the use of health care professionals to facilitate
skills transfer, building local capacity, and to expand rapidly
the pool of providers, managers, and other health care staff
delivering HIV/AID services in host countries; and
``(4) meeting individual country needs and, where possible,
insisting on the implementation of a national strategic plan,
by providing training and mentoring to strengthen human and
organizational capacity among local health care service
organizations.
``(c) 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 President such sums as may be
necessary for each of the fiscal years 2009 through 2013 to carry out
this section.''.
(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 striking the item relating to
section 304 and inserting the following new item:
``Sec. 304. Health care partnerships to combat HIV/AIDS.''.
Subtitle B--Assistance for Women, Children, and Families
SEC. 311. POLICY AND REQUIREMENTS.
(a) Policy.--Subsection (a) of section 312 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7652) is amended--
(1) in the first sentence, by striking ``The United States
Government's'' and inserting the following:
``(1) In general.--The United States''; and
(2) by adding at the end the following:
``(2) Collaboration.--The United States should work in
collaboration with governments, donors, the private sector,
nongovernmental organizations, and other key stakeholders to
carry out the policy described in paragraph (1).''.
(b) Requirements.--Subsection (b) of such section is amended to
read as follows:
``(b) Requirements.--The 5-year United States strategy required by
section 101 of this Act shall--
``(1) establish a target for 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;
``(2) establish a target requiring that by 2013 up to 15
percent of individuals receiving care and up to 15 percent of
individuals receiving treatment under this Act and the
amendments made by this Act are children;
``(3) integrate care and treatment with prevention of
mother-to-child transmission of HIV programs in order to
improve outcomes for HIV-affected women and families as soon as
is feasible, consistent with the national government policies
of countries in which programs under this Act are administered,
and including support for strategies to ensure successful
follow-up and continuity of care;
``(4) expand programs designed to care for children
orphaned by HIV/AIDS;
``(5) develop a timeline for expanding access to more
effective regimes to prevent mother-to-child transmission of
HIV, consistent with the national government policies of
countries in which programs under this Act are administered and
the goal of achieving universal use of such regimens as soon as
possible;
``(6) ensure that women receiving voluntary contraceptive
counseling, services, or commodities in programs supported by
the United States Government have access to the full range of
HIV/AIDS services; and
``(7) ensure that women in prevention of mother-to-child
transmission of HIV programs are provided with appropriate
maternal and child services, either directly or by referral.''.
SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
OF THE HIV INFECTION.
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. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN AND YOUTH.
(a) In General.--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 adding at the end the following:
``SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN AND YOUTH.
``(a) Statement of Policy.--In order to meet the United States
Government's goal of preventing 12,000,000 new HIV infections
worldwide, it shall be the policy of the United States to pursue a
global HIV/AIDS prevention strategy that emphasizes the immediate and
ongoing needs of women and youth and addresses the factors that lead to
gender disparities in the rate of HIV infection.
``(b) Strategy.--
``(1) In general.--The President shall formulate a
comprehensive, integrated, and culturally-appropriate global
HIV/AIDS prevention strategy that, to the extent
epidemiologically appropriate, addresses the vulnerabilities of
women and youth to HIV infection and seeks to reduce the
factors that lead to gender disparities in the rate of HIV
infection.
``(2) Elements.--The strategy required under paragraph (1)
shall include specific goals and targets under the 5-year
strategy outlined in section 101 and shall include
comprehensive HIV/AIDS prevention education at the individual
and national level including the ABC (`Abstain, Be faithful,
use Condoms') model as a means to reduce HIV infections and
shall include the following:
``(A) Specific goals under the five-year strategy
outlined in section 101.
``(B) Empowering women and youth to avoid cross-
generational sex and to decide when and whom to marry
in order to reduce the incidence of early or child
marriage.
``(C) Dramatically increasing access to currently
available female-controlled prevention methods and
including investments in training to increase the
effective and consistent use of both male and female
condoms.
``(D) Accelerating the de-stigmatization of HIV/
AIDS among women and youth as a major risk factor for
the transmission of HIV.
``(E) Addressing and preventing post-traumatic and
psycho-social consequences and providing post-exposure
prophylaxis to victims of gender-based violence and
rape against women and youth through appropriate
medical, social, educational, and legal assistance and
through prosecutions and legal penalties to address
such violence.
``(F) Promoting changes in male attitudes and
behavior that respect the human rights of women and
youth and that support and foster gender equality.
``(G) Supporting the development of microenterprise
initiatives, job training programs, and other such
efforts to assist women in developing and retaining
independent economic means.
``(H) Supporting universal basic education and
expanded educational opportunities for women and youth.
``(I) Protecting the property and inheritance
rights of women.
``(J) Coordinating inclusion of HIV/AIDS prevention
information and education services and programs for
individuals with HIV/AIDS with existing health care
services targeted to women and youth, such as ensuring
access to HIV/AIDS education and testing in family
planning programs supported by the United States
Government and programs to reduce mother-to-child
transmission of HIV, and expanding the reach of such
HIV/AIDS health services.
``(K) Promoting gender equality by supporting the
development of nongovernmental organizations, including
faith-based and community-based organizations, that
support the needs of women and utilizing such
organizations that are already empowering women and
youth at the community level.
``(L) Encouraging the creation and effective
enforcement of legal frameworks that guarantee women
equal rights and equal protection under the law.
``(M) Encouraging the participation and involvement
of women in drafting, coordinating, and implementing
the national HIV/AIDS strategic plans of their
countries.
``(N) Responding to other economic and social
factors that increase the vulnerability of women and
youth to HIV infection.
``(3) Transmission to congress and public availability.--
Not later than 180 days after the date of the enactment of the
Tom Lantos and Henry J. Hyde Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008,
the President shall transmit to the appropriate congressional
committees and make available to the public the strategy
required under paragraph (1).
``(c) Coordination.--In formulating and implementing the strategy
required under subsection (b), the President shall ensure that the
United States coordinates its overall HIV/AIDS policy and programs with
the national governments of the countries for which the United States
provides assistance to combat HIV/AIDS and, to the extent practicable,
with international organizations, other donor countries, and indigenous
organizations, including faith-based and community-based organizations
specifically for the purposes of ensuring gender equality and promoting
respect of the human rights of women that impact their susceptibility
to HIV/AIDS, improving women's health, and expanding education for
women and youth, and organizations, including faith-based and other
nonprofit organizations, providing services to and advocating on behalf
of individuals with HIV/AIDS and individuals affected by HIV/AIDS.
``(d) Guidance.--
``(1) In general.--The President shall provide clear
guidance to field missions of the United States Government in
countries for which the United States provides assistance to
combat HIV/AIDS, based on the strategy required under
subsection (b).
``(2) Transmission to congress and public availability.--
The President shall transmit to the appropriate congressional
committees and make available to the public a description of
the guidance required under paragraph (1).
``(e) Report.--
``(1) In general.--Not later than 1 year after the date of
the enactment of the Tom Lantos and Henry J. Hyde 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 transmit to the appropriate congressional committees and
make available to the public a report on the implementation of
this section for the prior fiscal year.
``(2) Matters to be included.--The report required under
paragraph (1) shall include the following:
``(A) A description of the prevention programs
designed to address the vulnerabilities of women and
youth to HIV/AIDS.
``(B) A list of nongovernmental organizations in
each country that receive assistance from the United
States to carry out HIV prevention activities,
including the amount and the source of funding
received.''.
(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 315 the following:
``Sec. 316. Strategy to prevent HIV infections among women and
youth.''.
SEC. 314. 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 striking the item relating to subtitle B of title III and
inserting the following:
``Subtitle B--Assistance for Women, Children, and Families''.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
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--
(1) by striking ``$3,000,000,000'' and inserting
``$10,000,000,000''; and
(2) by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''.
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) is amended--
(1) by striking paragraph (1);
(2) by redesignating paragraphs (2) through (4) as
paragraphs (1) through (3), respectively; and
(3) in paragraph (2) (as redesignated by paragraph (2) of
this section), by striking ``, of which'' and all that follows
through ``programs''.
SEC. 403. ALLOCATION OF FUNDS.
(a) HIV/AIDS Prevention Activities.--Subsection (a) of section 403
of the United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7673) is amended to read as follows:
``(a) HIV/AIDS Prevention Activities.--
``(1) In general.--For each of the fiscal years 2009
through 2013, not less than 20 percent of the amounts
appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance for each such fiscal
year shall be expended for HIV/AIDS prevention activities
consistent with section 104A(d) of the Foreign Assistance Act
of 1961.
``(2) Balanced funding requirement.--(A) The Coordinator of
United States Government Activities to Combat HIV/AIDS Globally
shall provide balanced funding for prevention activities for
sexual transmission of HIV/AIDS and shall ensure that
behavioral change programs, including 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.
``(B) In fulfilling the requirement under subparagraph (A),
the Coordinator shall establish a HIV sexual transmission
prevention strategy governing the expenditure of funds
authorized by the Act used to prevent the sexual transmission
of HIV in any host country with a generalized epidemic. In each
such host country, if this strategy provides less than 50
percent of such funds for behavioral change programs, including
abstinence, delay of sexual debut, monogamy, fidelity, and
partner reduction, the Coordinator shall, within 30 days of the
issuance of this strategy, report to the appropriate
congressional committees on the justification for this
decision.
``(C) Programs and activities that implement or purchase
new prevention technologies or modalities such as medical male
circumcision, pre-exposure prophylaxis, 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 this paragraph.
``(3) Report.--Not later than 1 year after the date of the
enactment of the Tom Lantos and Henry J. Hyde 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 transmit to
the appropriate congressional committees and make available to
the public a report on the implementation of paragraph (2) for
the prior fiscal year.''.
(b) Orphans and Vulnerable Children.--Subsection (b) of such
section is amended by striking ``fiscal years 2006 through 2008'' and
inserting ``fiscal years 2009 through 2013''.
SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOVERNMENTS.
(a) Prohibition on Taxation.--None of the funds appropriated
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) may be made available to provide
assistance for a foreign country under a new bilateral agreement
governing the terms and conditions under which such assistance is to be
provided unless such agreement includes a provision stating that
assistance provided by the United States shall be exempt from taxation,
or reimbursed, by the foreign government, and the Secretary of State
shall expeditiously seek to negotiate amendments to existing bilateral
agreements, as necessary, to conform with this requirement.
(b) De Minimus Exception.--Foreign taxes of a de minimus nature
shall not be subject to the provisions of subsection (a).
(c) Reprogramming of Funds.--Funds withheld from obligation for
each country or entity pursuant to subsection (a) shall be reprogrammed
for assistance to countries which do not assess taxes on United States
assistance or which have an effective arrangement that is providing
substantial reimbursement of such taxes.
(d) Determinations.--
(1) In general.--The provisions of this section shall not
apply to any country or entity the Secretary of State
determines--
(A) does not assess taxes on United States
assistance or which has an effective arrangement that
is providing substantial reimbursement of such taxes;
or
(B) the foreign policy interests of the United
States outweigh the policy of this section to ensure
that United States assistance is not subject to
taxation.
(2) Consultation.--The Secretary of State shall consult
with the Committees on Foreign Affairs and Appropriations at
least 15 days prior to exercising the authority of this
subsection with regard to any country or entity.
(e) Implementation.--The Secretary of State shall issue rules,
regulations, or policy guidance, as appropriate, to implement the
prohibition against the taxation of assistance contained in this
section.
(f) Definitions.--As used in this section--
(1) the terms ``taxes'' and ``taxation'' refer to value
added taxes and customs duties imposed on commodities financed
with United States assistance for programs for which funds are
authorized by this Act; and
(2) the term ``bilateral agreement'' refers to a framework
bilateral agreement between the Government of the United States
and the government of the country receiving assistance that
describes the privileges and immunities applicable to United
States foreign assistance for such country generally, or an
individual agreement between the Government of the United
States and such government that describes, among other things,
the treatment for tax purposes that will be accorded the United
States assistance provided under that agreement.
TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
SEC. 501. SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS.
The United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 et seq.) is amended by adding at
the end the following:
``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
``SEC. 601. FINDINGS.
``Congress makes the following findings:
``(1) The shortage of health personnel, including doctors,
nurses, pharmacists, counselors, laboratory staff, and
paraprofessionals, is one of the leading obstacles to fighting
HIV/AIDS in sub-Saharan Africa.
``(2) The HIV/AIDS pandemic aggravates the shortage of
health workers through loss of life and illness among medical
staff, unsafe working conditions for medical personnel, and
increased workloads for diminished staff, while the shortage of
health personnel undermines efforts to prevent and provide care
and treatment for individuals with HIV/AIDS.
``(3) Failure to address the shortage of health care
professionals and paraprofessionals, and the factors forcing
such individuals to leave sub-Saharan Africa, will undermine
the objectives of United States development policy and will
subvert opportunities to achieve internationally-recognized
goals for the prevention, treatment, and care of HIV/AIDS and
other diseases, the reduction of child and maternal mortality,
and for economic growth and development in sub-Saharan Africa.
``SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES AND OTHER POLICIES.
``(a) National Health Workforce Strategies.--
``(1) Statement of policy.--It shall be the policy of the
United States Government to support countries receiving United
States assistance to combat HIV/AIDS, tuberculosis, and
malaria, and other health programs in developing,
strengthening, and implementing 5-year health workforce
strategies.
``(2) Technical and financial assistance.--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, is
authorized to provide technical and financial assistance to
countries described in paragraph (1) to enable such countries,
in conjunction with other funding sources, to develop,
strengthen, and implement health workforce strategies.
``(3) Activities supported.--Assistance provided under
paragraph (2) shall, to the maximum extent practicable, be used
to carry out the following:
``(A) Activities to promote an inclusive process
that includes nongovernmental organizations and
individuals with HIV/AIDS in developing health
workforce strategies.
``(B) Activities to achieve and sustain a health
workforce sufficient in numbers, skill, and capacity to
meet United States and host-country international
health commitments, including the Millennium
Development Goals and universal access to HIV/AIDS
prevention, treatment, and care. In particular, such
health workforce strategies should include plans for
progress toward achieving the minimum ratio of health
professionals required to achieve these goals by 2015,
estimated by the World Health Organization to require
at least 2.3 doctors, nurses, and midwives per 1,000
population, and additional health workers such as
pharmacists and lab technicians.
``(C) Activities to ensure that health workforce
strategies are aimed at creating appropriate
distribution of health workers and prioritizing
activities required to ensure rural, marginalized, and
other underserved populations are able to access
skilled and equipped health workers.
``(D) Activities to expand the capacity of public
and private medical, nursing, pharmaceutical, and other
health training institutions.
``(b) Positive Broader Health Impact.--It shall be the policy of
the United States to ensure to expand the capacity of the health
workforce engaged in HIV/AIDS programming in ways that contribute to,
and do not detract from, the capacity of countries to meet other health
needs, particularly child survival and maternal health.
``(c) Safety for Health Workers.--It is the sense of Congress that
the United States should ensure that all health workers participating
in programs that receive assistance under this Act and the amendments
made by this Act have the proper training to create safe and sanitary
working conditions in accordance with universal precautions and other
forms of infection prevention and control.
``(d) Health Care for Health Workers.--The Coordinator of United
States Government Activities to Combat HIV/AIDS Globally shall ensure
that comprehensive and confidential health services shall be provided
to all health workers participating in programs that receive assistance
under this Act and the amendments made by this Act, including--
``(1) testing and counseling for all such employees;
``(2) providing HIV/AIDS treatment to HIV-positive
employees; and
``(3) taking measures to reduce HIV-related stigma in the
workplace.
``(e) Training and Compensation Finance.--Where the Coordinator
determines such financial support is essential to fulfill the purposes
of this Act, the Coordinator shall finance training and provide
compensation or other benefits for health workers in order to enhance
recruitment and retention of such workers.
``SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM LIMITS SOUGHT BY
INTERNATIONAL FINANCIAL INSTITUTIONS.
``(a) Coordination Within the United States Government.--The
Coordinator of United States Government Activities to Combat HIV/AIDS
Globally shall work with the Secretary of the Treasury to reform
International Monetary Fund macroeconomic and fiscal policies that
result in limitations on national and donor investments in health.
``(b) Position of the United States at the Imf.--The Secretary of
the Treasury shall instruct the United States Executive Director at the
International Monetary Fund to use the voice, vote, and influence of
the United States to oppose any loan, project, agreement, memorandum,
instrument, plan, or other program of the International Monetary Fund
that does not exempt increased government spending on health care from
national budget caps or restraints, hiring or wage bill ceilings, or
other limits sought by any international financial institution.
``SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REGISTRATION, AND SUPPLY
CHAIN MANAGEMENT SYSTEMS.
``(a) In General.--The Coordinator of United States Government
Activities to Combat AIDS Globally shall work with the Partnership for
Supply Chain Management Systems, host countries, and nongovernmental
organizations to develop effective, reliable host country-owned and
operated public-sector procurement and supply chain management systems,
including regional distribution, with ongoing technical assistance and
sustained support to ensure the function of such systems, as well as
the function of existing non-public sector supply chains, including
those operated by faith-based and other humanitarian organizations that
procure and distribute medical supplies.
``(b) Availability of Equipment and Supplies.--The public-sector
procurement and supply chain management systems developed pursuant to
subsection (a) should ensure that adequate laboratory equipment and
supplies commonly needed to fight HIV/AIDS, including diagnostic tests
for CD4 and viral load counts, x-ray machines, mobile and facility-
based rapid HIV test kits and other necessary assays, reagents and
basic supplies such as sterile syringes and gloves, are available and
distributed in a manner that is accessible to urban and rural
populations.
``(c) Drug Registration.--The Coordinator shall work with host
country partners and development partners to support efficient and
effective drug approval and registration systems that allow expeditious
access to safe and effective drugs, including antiretroviral drugs.
``(d) Report.--The Coordinator shall submit to the appropriate
congressional committees an annual report on the implementation of this
section, including progress toward specific benchmarks established by
the Partnership for Supply Chain Management Systems, and the projection
of when host countries can fully sustain their own procurement and
supply chain management and distribution systems at a scale necessary
for national primary health needs.
``SEC. 605. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--Of the amounts authorized to be appropriated
under section 401 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 title.
``(b) Availability.--Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are authorized to
remain available until expended.''.
SEC. 502. 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 items relating to title V the following:
``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
``Sec. 601. Findings.
``Sec. 602. National health workforce strategies and other policies.
``Sec. 603. Exemption of investments in health from limits sought by
international financial institutions.
``Sec. 604. Public-sector procurement, drug registration, and supply
chain management systems.
``Sec. 605. Authorization of appropriations.''.
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