[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2472 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 2472

   To amend the U.S. Leadership Against HIV/AIDS, Tuberculosis, and 
                          Malaria Act of 2003.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 13, 2007

  Mr. Dodd (for himself and Mr. Smith) introduced the following bill; 
which was read twice and referred to the Committee on Foreign Relations

_______________________________________________________________________

                                 A BILL


 
   To amend the U.S. Leadership Against HIV/AIDS, Tuberculosis, and 
                          Malaria Act of 2003.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Global Pediatric HIV/AIDS Prevention 
and Treatment Act''.

SEC. 2. FINDINGS.

    Section 2 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (26 U.S.C. 7601) is amended--
            (1) in paragraph (3), by adding at the end the following:
            ``(D) In 2007, the rate at which children accessed 
        treatment failed to keep pace with new pediatric infections. 
        While children account for almost 16 percent of all new HIV 
        infections, they make up only 9 percent of those receiving 
        treatment under this Act.'';
            (2) by amending paragraph (16) to read as follows:
            ``(16) Basic interventions to prevent new HIV infections 
        and to bring care and treatment to people living with AIDS, 
        such as voluntary counseling and testing, are achieving 
        meaningful results and are cost-effective. The challenge is to 
        expand these interventions to a national basis in a coherent 
        and sustainable manner.''; and
            (3) by amending paragraph (20) to read as follows:
            ``(20) With no medical intervention, mothers infected with 
        HIV have a 25 to 30 percent chance of passing the virus to 
        their babies during pregnancy and childbirth. A simple and 
        effective intervention can significantly reduce mother to child 
        transmission of HIV. A single dose of an anti-retroviral drug 
        given once to the mother at the onset of labor, and once to the 
        baby during the first 3 days of life reduces transmission by 
        approximately 50 percent. Other more complex drug regimens can 
        further reduce transmission from mother-to-child. A dramatic 
        expansion of access to prevention of mother-to-child 
        transmission services is critical to preventing thousands of 
        new pediatric HIV infections.''.

SEC. 3. POLICY PLANNING AND COORDINATION.

    Section 101(b)(3) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7611(b)(3)) is amended 
by adding at the end the following:
                    ``(X) A description of the activities that will be 
                conducted to achieve the targets described in 
                paragraphs (1) and (2) of section 312(b).''.

SEC. 4. BILATERAL EFFORTS.

    (a) Assistance To Combat HIV/AIDS.--Section 104A of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b-2) is amended--
            (1) in subsection (d)(1)--
                    (A) by amending subparagraph (E) to read as 
                follows:
                    ``(E) assistance to--
                            ``(i) achieve the target described in 
                        section 312(b)(1) of the United States 
                        Leadership Against HIV/AIDS, Tuberculosis, and 
                        Malaria Act of 2003; and
                            ``(ii) promote infant feeding options for 
                        HIV positive mothers that are consistent with 
                        the most recent infant feeding recommendations 
                        and guidelines supported by the World Health 
                        Organization;'';
                    (B) in subparagraph (G), by striking ``and'' at the 
                end;
                    (C) in subparagraph (H), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by adding at the end the following:
                    ``(I) assistance to achieve the target described in 
                section 312(b)(2) of the United States Leadership 
                Against HIV/AIDS, Tuberculosis, and Malaria Act of 
                2003.''; and
            (2) in subsection (e)(2)(C)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) in clause (iv), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(v) the number of HIV-infected children 
                        currently receiving antiretroviral medications 
                        in each country under the United States 
                        Leadership Against HIV/AIDS, Tuberculosis, and 
                        Malaria Act of 2003.''.
    (b) Assistance to Children and Families.--Subtitle B of Title III 
of the United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7651 et seq.) is amended by striking 
sections 311 and 312 and inserting the following:

``SEC. 311. FINDINGS.

    ``Congress makes the following findings:
            ``(1) Every day, approximately 1,100 children around the 
        world are infected with HIV, the vast majority through mother-
        to-child transmission during pregnancy, labor or delivery or 
        soon after through breast-feeding. Approximately 90 percent of 
        these infections occur in Africa.
            ``(2) With no medical intervention, mothers infected with 
        HIV have a 25 to 30 percent chance of passing the virus to 
        their babies during pregnancy and childbirth. A single dose of 
        an anti-retroviral drug given once to the mother at the onset 
        of labor, and once to the baby during the first 3 days of life 
        reduces transmission by approximately 50 percent.
            ``(3) Providing the full range of interventions, as is the 
        standard of care in the United States, could reduce the rate of 
        mother-to-child transmission of HIV to as little as 2 percent.
            ``(4) Global coverage of services to prevent transmission 
        from mother-to-child remains unacceptably low. The Joint United 
        Nations Program on HIV/AIDS (UNAIDS) reports that fewer than 10 
        percent of pregnant women with HIV in resource-poor countries 
        have access to prevention of mother-to-child transmission 
        services.
            ``(5) Prevention of mother-to-child transmission programs 
        provide health benefits for women and children beyond 
        preventing the vertical transmission of HIV. They serve as an 
        entry point for mothers to access treatment for their own HIV 
        infection, allowing them to stay healthy and to care for their 
        children. Efforts to connect and integrate prevention of 
        mother-to-child transmission and HIV care, treatment and 
        prevention programs are crucial to achieving improved outcomes 
        for HIV-affected and HIV-infected women and families.
            ``(6) Access to comprehensive HIV prevention services must 
        be drastically scaled-up among pregnant women infected with HIV 
        and pregnant women not infected with HIV to further protect 
        themselves and their partners against the sexual transmission 
        of HIV/AIDS.
            ``(7) Preventing unintended pregnancy among HIV-infected 
        women is recognized by the World Health Organization and the 
        Office of the United States Global AIDS Coordinator to be an 
        integral component of prevention of mother-to-child 
        transmission programs. To further reduce infection rates, women 
        accessing prevention of mother-to-child transmission services 
        must have access to a range of high-quality family planning and 
        reproductive health care, so they can make informed decisions 
        about future pregnancies and contraception.
            ``(8) In 2007, the rate at which children were accessing 
        treatment failed to keep pace with new pediatric infections. 
        While children account for almost 16 percent of all new HIV 
        infections, they make up only 9 percent of those on treatment 
        under this Act.
            ``(9) Of the more than 2,500,000 people who were newly 
        infected with HIV in 2007, more than 420,000 were children.
            ``(10) Without proper care and treatment, half of newly 
        HIV-infected children will die before they reach 2 years of 
        age, and 75 percent will die before 5 years of age.
            ``(11) Because children are not just small adults, 
        providing HIV care and treatment presents special challenges, 
        including--
                    ``(A) limited access to reliable HIV testing for 
                the youngest children;
                    ``(B) a shortage of providers trained in delivering 
                pediatric care;
                    ``(C) weak linkages between services to prevent 
                mother-to-child transmission and care and treatment 
                programs; and
                    ``(D) the need for low-cost pediatric formulations 
                of HIV/AIDS medications.

``SEC. 312. POLICY AND REQUIREMENTS.

    ``(a) Policy.--
            ``(1) In general.--The United States Government's response 
        to the global HIV/AIDS pandemic should place high priority on--
                    ``(A) the prevention of mother-to-child 
                transmission of HIV/AIDS; and
                    ``(B) the care and treatment of all children 
                affected by HIV/AIDS, including children orphaned by 
                AIDS.
            ``(2) Collaboration.--The United States Government should 
        work in collaboration with foreign governments, donors, the 
        private sector, nongovernmental organizations, and other key 
        stakeholders.
    ``(b) Requirements.--The comprehensive, 5-year, global strategy 
required under section 101 shall--
            ``(1) establish a target for prevention of mother-to-child 
        transmission efforts that by 2013, in those countries most 
        affected by HIV--
                    ``(A) 80 percent of pregnant women receive HIV 
                counseling and testing; and
                    ``(B) all of the pregnant women receiving HIV 
                counseling and testing who test positive for HIV 
                receive anti-retroviral medications for prevention of 
                mother-to-child transmission of HIV;
            ``(2) establish a target requiring that by 2013, children 
        account for at least 15 percent of those receiving treatment 
        under this Act;
            ``(3) integrate prevention, care, and treatment with 
        prevention of mother-to-child transmission programs, as soon as 
        feasible and consistent with the national government policies 
        of the foreign countries in which programs under this Act are 
        administered, to improve outcomes for HIV-affected women and 
        families and to promote follow-up and continuity of care;
            ``(4) expand programs designed to care for children 
        orphaned by AIDS; and
            ``(5) develop a time line for expanding access to more 
        effective mother-to-child transmission prevention regimens, 
        consistent with the national government policies of the foreign 
        countries in which programs under this Act are administered and 
        the goal of moving towards universal use of such regimens as 
        rapidly as possible.
    ``(c) Application of Requirements.--All strategic planning 
documents and bilateral funding agreements developed under the 
authority of the Office of the United States Global AIDS Coordinator, 
including country operating plans and any subsequent mechanisms through 
which funding under this Act is obligated, shall be consistent with, 
and in furtherance of, the requirements under subsection (b).
    ``(d) Prevention of Mother-to-Child Transmission Expert Panel.--
            ``(1) Establishment.--The Coordinator of United States 
        Government Activities to Combat HIV/AIDS Globally (referred to 
        in this section as the `Coordinator') shall establish a panel 
        of experts to be known as the Prevention of Mother to Child 
        Transmission Panel (referred to in this section as the `Panel') 
        to--
                    ``(A) provide an objective review of activities to 
                prevent mother-to-child transmission of HIV that 
                receive financial assistance under this Act; and
                    ``(B) provide recommendations to the Coordinator 
                and to the appropriate committees of Congress for 
                scale-up of mother-to-child transmission prevention 
                services under this Act in order to achieve the target 
                established in subsection (b)(1).
            ``(2) Membership.--The Panel shall be convened and chaired 
        by the Coordinator, who shall serve as a nonvoting member. The 
        Panel shall consist of not more than 15 members (excluding the 
        Coordinator), to be appointed by the Coordinator not later than 
        60 days after the date of the enactment of this Act, 
        including--
                    ``(A) 2 members from the Department of Health and 
                Human Services with expertise relating to the 
                prevention of mother-to-child transmission activities;
                    ``(B) 2 members from the United States Agency for 
                International Development with expertise relating to 
                the prevention of mother-to-child transmission 
                activities;
                    ``(C) 2 representatives from among health ministers 
                of national governments of foreign countries in which 
                programs under this Act are administered;
                    ``(D) 3 members representing organizations 
                implementing prevention of mother-to-child transmission 
                activities under this Act;
                    ``(E) 2 health care researchers with expertise 
                relating to global HIV/AIDS activities; and
                    ``(F) representatives from among patient advocate 
                groups, health care professionals, persons living with 
                HIV/AIDS, and non-governmental organizations with 
                expertise relating to the prevention of mother-to-child 
                transmission activities, giving priority to individuals 
                in foreign countries in which programs under this Act 
                are administered.
            ``(3) Duties of panel.--The Panel shall--
                    ``(A) review activities receiving financial 
                assistance under this Act to prevent mother-to-child 
                transmission of HIV and assess the effectiveness of 
                current activities in reaching the target described in 
                subsection (b)(1);
                    ``(B) review scientific evidence related to the 
                provision of mother-to-child transmission prevention 
                services, including programmatic data and data from 
                clinical trials;
                    ``(C) review and assess ways in which the Office of 
                the United States Global AIDS Coordinator and programs 
                funded under this Act collaborate with international 
                and multilateral entities on efforts to prevent mother-
                to-child transmission of HIV in affected countries;
                    ``(D) identify barriers and challenges to 
                increasing access to mother-to-child transmission 
                prevention services and evaluate potential mechanisms 
                to alleviate those barriers and challenges;
                    ``(E) identify the extent to which stigma has 
                hindered pregnant women from obtaining HIV counseling 
                and testing or returning for results, and provide 
                recommendations to address such stigma and its effects;
                    ``(F) identify opportunities to improve linkages 
                between mother-to-child transmission prevention 
                services and care and treatment programs;
                    ``(G) evaluate the adequacy of financial assistance 
                provided under this Act for mother-to-child 
                transmission of HIV prevention services; and
                    ``(H) recommend levels of financial assistance and 
                specific activities to facilitate reaching the target 
                described in subsection (b)(1).
            ``(4) Report.--
                    ``(A) In general.--Not later than 14 months after 
                the date of the enactment of this Act, the Panel shall 
                submit a report containing a detailed statement of the 
                recommendations, findings, and conclusions of the Panel 
                to the appropriate congressional committees.
                    ``(B) Availability.--The report submitted under 
                subparagraph (A) shall be made available to the public.
                    ``(C) Consideration by coordinator.--The 
                Coordinator shall--
                            ``(i) consider any recommendations 
                        contained in the report submitted under 
                        subparagraph (A); and
                            ``(ii) include in the annual report 
                        required under section 104A(e) of the Foreign 
                        Assistance Act of 1961 (22 U.S.C. 2151b-2(e)) a 
                        description of the activities conducted in 
                        response to the recommendations made by the 
                        Panel and an explanation of any recommendations 
                        not implemented at the time of the report.
            ``(5) Authorization of appropriations.--There are 
        authorized to be appropriated to the Panel such sums as may be 
        necessary for each of the fiscal years 2009 through 2011 to 
        carry out this section.
            ``(6) Termination.--The Panel shall terminate on the date 
        that is 60 days after the date on which the Panel submits the 
        report to Congress under paragraph (4).''.
    (c) Annual Report Elements.--Section 313(b)(2) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7653(b)(2)) is amended--
            (1) in subparagraph (C), by striking ``and'' at the end;
            (2) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
                    ``(E) coordination and collaboration with 
                governments, donors, the private sector, 
                nongovernmental organizations, and other key 
                stakeholders to achieve the target described in section 
                312(b)(1); and
                    ``(F) the number of women offered and receiving the 
                4 components of a comprehensive strategy to prevent 
                mother-to-child transmission of HIV, as recommended by 
                the World Health Organization.''.
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