[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5501 Reported in House (RH)]






                                                 Union Calendar No. 333
110th CONGRESS
  2d Session
                                H. R. 5501

                      [Report No. 110-546, Part I]

   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

                             March 10, 2008

             Reported from the Committee on Foreign Affairs

                             March 10, 2008

Committee on Financial Services discharged; committed to the Committee 
 of the Whole House on the State of the Union and ordered to be printed

_______________________________________________________________________

                                 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.''.
                                                 Union Calendar No. 333

110th CONGRESS

  2d Session

                               H. R. 5501

                      [Report No. 110-546, Part I]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                             March 10, 2008

Committee on Financial Services discharged; committed to the Committee 
 of the Whole House on the State of the Union and ordered to be printed