[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2731 Reported in Senate (RS)]






                                                       Calendar No. 698
110th CONGRESS
  2d Session
                                S. 2731

                          [Report No. 110-325]

   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 SENATE OF THE UNITED STATES

                             March 7, 2008

Mr. Biden (for himself, Mr. Lugar, Mr. Kennedy, Mr. Sununu, Mr. Hagel, 
  Mr. Kerry, Mr. Dodd, and Mr. Durbin) introduced the following bill; 
which was read twice and referred to the Committee on Foreign Relations

                             April 15, 2008

                Reported by Mr. Biden, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (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''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents for this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
<DELETED>Sec. 2. Findings.
<DELETED>Sec. 3. Definitions.
<DELETED>Sec. 4. Purpose.
<DELETED>Sec. 5. Authority to consolidate and combine reports.
           <DELETED>TITLE I--POLICY PLANNING AND COORDINATION

<DELETED>Sec. 101. Development of an updated, comprehensive, 5-year, 
                            global strategy.
<DELETED>Sec. 102. Interagency working group.
<DELETED>Sec. 103. Sense of Congress.
   <DELETED>TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND 
                      PUBLIC-PRIVATE PARTNERSHIPS

<DELETED>Sec. 201. Voluntary contributions to international vaccine 
                            funds.
<DELETED>Sec. 202. Participation in the Global Fund to Fight AIDS, 
                            Tuberculosis and Malaria.
<DELETED>Sec. 203. Program to facilitate availability of microbicides 
                            to prevent transmission of HIV and other 
                            diseases.
<DELETED>Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
                            strengthening health policies and health 
                            systems of partner countries.
<DELETED>Sec. 205. Facilitating effective operations of the Centers for 
                            Disease Control.
                 <DELETED>TITLE III--BILATERAL EFFORTS

          <DELETED>Subtitle A--General Assistance and Programs

<DELETED>Sec. 301. Assistance to combat HIV/AIDS.
<DELETED>Sec. 302. Assistance to combat tuberculosis.
<DELETED>Sec. 303. Assistance to combat malaria.
<DELETED>Sec. 304. Malaria Response Coordinator.
<DELETED>Sec. 305. Amendment to Immigration and Nationality Act.
<DELETED>Sec. 306. Clerical amendment.
<DELETED>Sec. 308. Requirements.
<DELETED>Sec. 309. Annual report on prevention of mother-to-child 
                            transmission of HIV.
                 <DELETED>TITLE IV--FUNDING ALLOCATIONS

<DELETED>Sec. 401. Authorization of appropriations.
<DELETED>Sec. 402. Sense of Congress.
<DELETED>Sec. 403. Allocation of funds.

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    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:</DELETED>
        <DELETED>    ``(29) On May 27, 2003, the President signed this 
        Act into law, launching the largest international public health 
        program of its kind ever created.</DELETED>
        <DELETED>    ``(30) Between 2003 and 2008, the United States, 
        through the President's Emergency Plan for AIDS Relief (PEPFAR) 
        and in conjunction with other bilateral programs and the 
        multilateral Global Fund has helped to--</DELETED>
                <DELETED>    ``(A) provide antiretroviral therapy for 
                over 1,900,000 people;</DELETED>
                <DELETED>    ``(B) ensure that over 150,000 infants, 
                most of whom would have likely been infected with HIV 
                during pregnancy or childbirth, were not infected; 
                and</DELETED>
                <DELETED>    ``(C) provide palliative care and HIV 
                prevention assistance to millions of other 
                people.</DELETED>
        <DELETED>    ``(31) While United States leadership in the 
        battles against HIV/AIDS, tuberculosis, and malaria has had an 
        enormous impact, these diseases continue to take a terrible 
        toll on the human race.</DELETED>
        <DELETED>    ``(32) According to the 2007 AIDS Epidemic Update 
        of the Joint United Nations Programme on HIV/AIDS (UNAIDS)--
        </DELETED>
                <DELETED>    ``(A) an estimated 2,100,000 people died 
                of AIDS-related causes in 2007; and</DELETED>
                <DELETED>    ``(B) an estimated 2,500,000 people were 
                newly infected with HIV during that year.</DELETED>
        <DELETED>    ``(33) According to the World Health Organization, 
        malaria kills more than 1,000,000 people per year, 70 percent 
        of whom are children under 5 years of age.</DELETED>
        <DELETED>    ``(34) According to the World Health Organization, 
        </DELETED>\<DELETED>1/3</DELETED>\ <DELETED>of the world's 
        population is infected with the tuberculosis bacterium, and 
        tuberculosis is 1 of the greatest infectious causes of death of 
        adults worldwide, killing 1,600,000 people per year.</DELETED>
        <DELETED>    ``(35) Efforts to promote abstinence, fidelity, 
        the correct and consistent use of condoms, the delay of sexual 
        debut, and the reduction of concurrent sexual partners 
        represent important elements of strategies to prevent the 
        transmission of HIV/AIDS.</DELETED>
        <DELETED>    ``(36) According to UNAIDS--</DELETED>
                <DELETED>    ``(A) women and girls make up nearly 60 
                percent of persons in sub-Saharan Africa who are HIV 
                positive;</DELETED>
                <DELETED>    ``(B) women and girls are more 
                biologically, economically, and socially vulnerable to 
                HIV infection; and</DELETED>
                <DELETED>    ``(C) gender issues are critical 
                components in the effort to prevent HIV/AIDS and to 
                care for those affected by the disease.</DELETED>
        <DELETED>    ``(37) Children who have lost a parent to HIV/
        AIDS, who are otherwise directly affected by the disease, or 
        who live in areas of high HIV prevalence may be vulnerable to 
        the disease or its socioeconomic effects.</DELETED>
        <DELETED>    ``(38) Lack of health capacity, including 
        insufficient personnel and inadequate infrastructure, in sub-
        Saharan Africa and other regions of the world is a critical 
        barrier that limits the effectiveness of efforts to combat HIV/
        AIDS, tuberculosis, and malaria, and to achieve other global 
        health goals.</DELETED>
        <DELETED>    ``(39) On March 30, 2007, the Institute of 
        Medicine of the National Academies released a report entitled 
        `PEPFAR Implementation: Progress and Promise', which found that 
        budget allocations setting percentage levels for spending on 
        prevention, care, and treatment and for certain subsets of 
        activities within the prevention category--</DELETED>
                <DELETED>    ``(A) have `adversely affected 
                implementation of the U.S. Global AIDS 
                Initiative';</DELETED>
                <DELETED>    ``(B) have inhibited comprehensive, 
                integrated, evidence based approaches;</DELETED>
                <DELETED>    ``(C) `have been 
                counterproductive';</DELETED>
                <DELETED>    ``(D) `may have been helpful initially in 
                ensuring a balance of attention to activities within 
                the 4 categories of prevention, treatment, care, and 
                orphans and vulnerable children';</DELETED>
                <DELETED>    ``(E) `have also limited PEPFAR's ability 
                to tailor its activities in each country to the local 
                epidemic and to coordinate with the level of activities 
                in the countries' national plans'; and</DELETED>
                <DELETED>    ``(F) should be removed by Congress and 
                replaced with more appropriate mechanisms that--
                </DELETED>
                        <DELETED>    ``(i) `ensure accountability for 
                        results from Country Teams to the U.S. Global 
                        AIDS Coordinator and to Congress'; 
                        and</DELETED>
                        <DELETED>    ``(ii) `ensure that spending is 
                        directly linked to and commensurate with 
                        necessary efforts to achieve both country and 
                        overall performance targets for prevention, 
                        treatment, care, and orphans and vulnerable 
                        children'.</DELETED>
        <DELETED>    ``(40) The United States Government has endorsed 
        the principles of harmonization in coordinating efforts to 
        combat HIV/AIDS commonly referred to as the `Three Ones', which 
        includes--</DELETED>
                <DELETED>    ``(A) 1 agreed HIV/AIDS action framework 
                that provides the basis for coordination of the work of 
                all partners;</DELETED>
                <DELETED>    ``(B) 1 national HIV/AIDS coordinating 
                authority, with a broadbased multisectoral mandate; 
                and</DELETED>
                <DELETED>    ``(C) 1 agreed HIV/AIDS country-level 
                monitoring and evaluating system.</DELETED>
        <DELETED>    ``(41) In the Abuja Declaration on HIV/AIDS, 
        Tuberculosis and Other Related Infectious Diseases, of April 
        26-27, 2001 (referred to in this Act as the `Abuja 
        Declaration'), the Heads of State and Government of the 
        Organization of African Unity (OAU)--</DELETED>
                <DELETED>    ``(A) declared that they would `place the 
                fight against HIV/AIDS at the forefront and as the 
                highest priority issue in our respective national 
                development plans';</DELETED>
                <DELETED>    ``(B) committed `TO TAKE PERSONAL 
                RESPONSIBILITY AND PROVIDE LEADERSHIP for the 
                activities of the National AIDS Commissions/
                Councils';</DELETED>
                <DELETED>    ``(C) resolved `to lead from the front the 
                battle against HIV/AIDS, Tuberculosis and Other Related 
                Infectious Diseases by personally ensuring that such 
                bodies were properly convened in mobilizing our 
                societies as a whole and providing focus for unified 
                national policymaking and programme implementation, 
                ensuring coordination of all sectors at all levels with 
                a gender perspective and respect for human rights, 
                particularly to ensure equal rights for people living 
                with HIV/AIDS'; and</DELETED>
                <DELETED>    ``(D) pledged `to set a target of 
                allocating at least 15% of our annual budget to the 
                improvement of the health sector'.''.</DELETED>

<DELETED>SEC. 3. DEFINITIONS.</DELETED>

<DELETED>    Section 3 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (2), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs of the House of Representatives, the Committee on 
        Appropriations of the Senate, and the Committee on 
        Appropriations'';</DELETED>
        <DELETED>    (2) by redesignating paragraph (6) as paragraph 
        (11);</DELETED>
        <DELETED>    (3) by redesignating paragraphs (3) through (5), 
        as paragraphs (4) through (6), respectively;</DELETED>
        <DELETED>    (4) by inserting after paragraph (2) the 
        following:</DELETED>
        <DELETED>    ``(3) Global aids coordinator.--The term `Global 
        AIDS Coordinator' means the Coordinator of United States 
        Government Activities to Combat HIV/AIDS Globally.''; 
        and</DELETED>
        <DELETED>    (5) by inserting after paragraph (6), as 
        redesignated, the following:</DELETED>
        <DELETED>    ``(7) Impact evaluation research.--The term 
        `impact evaluation research' means the application of research 
        methods and statistical analysis to measure the extent to which 
        change in a population-based outcome can be attributed to 
        program intervention instead of other environmental 
        factors.</DELETED>
        <DELETED>    ``(8) Operations research.--The term `operations 
        research' means the application of social science research 
        methods and statistical analysis to judge, compare, and improve 
        policies and program outcomes, from the earliest stages of 
        defining and designing programs through their development and 
        implementation, with the objective of the rapid dissemination 
        of conclusions and concrete impact on programming.</DELETED>
        <DELETED>    ``(9) Partner government.--The term `partner 
        government' means a government with which the United States is 
        working to provide assistance to combat HIV/AIDS, tuberculosis, 
        or malaria on behalf of people living within the jurisdiction 
        of such government.</DELETED>
        <DELETED>    ``(10) Program monitoring.--The term `program 
        monitoring' means the collection, analysis, and use of routine 
        program data to determine--</DELETED>
                <DELETED>    ``(A) how well a program is carried out; 
                and</DELETED>
                <DELETED>    ``(B) how much the program 
                costs.''.</DELETED>

<DELETED>SEC. 4. PURPOSE.</DELETED>

<DELETED>    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:</DELETED>

<DELETED>``SEC. 4. PURPOSE.</DELETED>

<DELETED>    ``The purpose of this Act is to strengthen and enhance 
United States leadership and the effectiveness of the United States 
response to the HIV/AIDS, tuberculosis, and malaria pandemics and other 
related and preventable infectious diseases as part of the overall 
United States health and development agenda by--</DELETED>
        <DELETED>    ``(1) establishing comprehensive, coordinated, and 
        integrated 5-year, global strategies to combat HIV/AIDS, 
        tuberculosis, and malaria by--</DELETED>
                <DELETED>    ``(A) building on progress and successes 
                to date;</DELETED>
                <DELETED>    ``(B) improving harmonization of United 
                States efforts with national strategies of partner 
                governments and other public and private entities; 
                and</DELETED>
                <DELETED>    ``(C) emphasizing capacity building 
                initiatives in order to promote a transition toward 
                greater sustainability through the support of country-
                driven efforts;</DELETED>
        <DELETED>    ``(2) providing increased resources for bilateral 
        and multilateral efforts to fight HIV/AIDS, tuberculosis, and 
        malaria as integrated components of United States development 
        assistance;</DELETED>
        <DELETED>    ``(3) intensifying efforts to--</DELETED>
                <DELETED>    ``(A) prevent HIV infection;</DELETED>
                <DELETED>    ``(B) ensure the continued support for, 
                and expanded access to, treatment and care 
                programs;</DELETED>
                <DELETED>    ``(C) enhance the effectiveness of 
                prevention, treatment, and care programs; and</DELETED>
                <DELETED>    ``(D) address the particular 
                vulnerabilities of girls and women;</DELETED>
        <DELETED>    ``(4) encouraging the expansion of private sector 
        efforts and expanding public-private sector partnerships to 
        combat HIV/AIDS, tuberculosis, and malaria;</DELETED>
        <DELETED>    ``(5) reinforcing efforts to--</DELETED>
                <DELETED>    ``(A) develop safe and effective vaccines, 
                microbicides, and other prevention and treatment 
                technologies; and</DELETED>
                <DELETED>    ``(B) improve diagnostics capabilities for 
                HIV/AIDS, tuberculosis, and malaria; and</DELETED>
        <DELETED>    ``(6) helping partner countries to--</DELETED>
                <DELETED>    ``(A) strengthen health systems;</DELETED>
                <DELETED>    ``(B) improve human health capacity; 
                and</DELETED>
                <DELETED>    ``(C) address infrastructural 
                weaknesses.''.</DELETED>

<DELETED>SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE 
              REPORTS.</DELETED>

<DELETED>    Section 5 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7604) is amended 
by inserting ``, with the exception of the 5-year strategy'' before the 
period at the end.</DELETED>

      <DELETED>TITLE I--POLICY PLANNING AND COORDINATION</DELETED>

<DELETED>SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 5-YEAR, 
              GLOBAL STRATEGY.</DELETED>

<DELETED>    (a) Strategy.--Section 101(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7611(a)) is amended to read as follows:</DELETED>
<DELETED>    ``(a) Strategy.--The President shall establish a 
comprehensive, integrated, 5-year strategy to expand and improve 
efforts to combat global HIV/AIDS. This strategy shall--</DELETED>
        <DELETED>    ``(1) further strengthen the capability of the 
        United States to be an effective leader of the international 
        campaign against this disease and strengthen the capacities of 
        nations experiencing HIV/AIDS epidemics to combat this 
        disease;</DELETED>
        <DELETED>    ``(2) maintain sufficient flexibility and remain 
        responsive to--</DELETED>
                <DELETED>    ``(A) changes in the epidemic;</DELETED>
                <DELETED>    ``(B) challenges facing partner countries 
                in developing and implementing an effective national 
                response; and</DELETED>
                <DELETED>    ``(C) evidence-based improvements and 
                innovations in the prevention, care, and treatment of 
                HIV/AIDS;</DELETED>
        <DELETED>    ``(3) situate United States efforts to combat HIV/
        AIDS, tuberculosis, and malaria within the broader United 
        States global health and development agenda, establishing a 
        roadmap to link investments in specific disease programs to the 
        broader goals of strengthening health systems and 
        infrastructure and to integrate and coordinate HIV/AIDS, 
        tuberculosis, or malaria programs with other health or 
        development programs, as appropriate;</DELETED>
        <DELETED>    ``(4) provide a plan to--</DELETED>
                <DELETED>    ``(A) prevent 12,000,000 new HIV 
                infections worldwide;</DELETED>
                <DELETED>    ``(B) support treatment of at least 
                3,000,000 individuals with HIV/AIDS and support 
                additional treatment through coordinated multilateral 
                efforts;</DELETED>
                <DELETED>    ``(C) support care for 12,000,000 
                individuals with HIV/AIDS, including 5,000,000 orphans 
                and vulnerable children affected by HIV/AIDS, with an 
                emphasis on promoting a comprehensive, coordinated 
                system of services to be integrated throughout the 
                continuum of care;</DELETED>
                <DELETED>    ``(D) help partner countries in the effort 
                to achieve goals of 80 percent access to counseling, 
                testing, and treatment to prevent the transmission of 
                HIV from mother to child, emphasizing a continuum of 
                care model;</DELETED>
                <DELETED>    ``(E) help partner countries to achieve 
                access for children with HIV to care and treatment 
                services in proportion to their percentage within the 
                HIV-infected population in each country; and</DELETED>
                <DELETED>    ``(F) help partner countries to train 
                health care professionals and workers, with a goal of 
                training and retaining at least 140,000 new health care 
                professionals and workers and to strengthen capacities 
                in developing countries, especially in sub-Saharan 
                Africa, to deliver primary health care with the 
                objective of helping countries achieve staffing levels 
                of at least 2.3 doctors, nurses, and midwives per 1,000 
                population, as called for by the World Health 
                Organization;</DELETED>
        <DELETED>    ``(5) include multisectoral approaches and 
        specific strategies to treat individuals infected with HIV/AIDS 
        and to prevent the further transmission of HIV infections, with 
        a particular focus on the needs of families with children 
        (including the prevention of mother-to-child transmission), 
        women, young people, orphans, and vulnerable 
        children;</DELETED>
        <DELETED>    ``(6) establish a timetable with annual global 
        treatment targets;</DELETED>
        <DELETED>    ``(7) expand the integration of timely and 
        relevant research within the prevention, care, and treatment of 
        HIV/AIDS;</DELETED>
        <DELETED>    ``(8) include a plan for program monitoring, 
        operations research, and impact evaluation and for the 
        dissemination of a best practices report to highlight 
        findings;</DELETED>
        <DELETED>    ``(9) provide for consultation with local leaders 
        and officials to develop prevention strategies and programs 
        that are tailored to the unique needs of each country and 
        community and targeted particularly toward those most at risk 
        of acquiring HIV infection;</DELETED>
        <DELETED>    ``(10) make the reduction of HIV/AIDS behavioral 
        risks a priority of all prevention efforts by--</DELETED>
                <DELETED>    ``(A) promoting abstinence from sexual 
                activity and encouraging monogamy and 
                faithfulness;</DELETED>
                <DELETED>    ``(B) encouraging the correct and 
                consistent use of male and female condoms and 
                increasing the availability of, and access to, these 
                commodities;</DELETED>
                <DELETED>    ``(C) promoting the delay of sexual debut 
                and the reduction of multiple concurrent sexual 
                partners;</DELETED>
                <DELETED>    ``(D) promoting education for discordant 
                couples (where an individual is infected with HIV and 
                the other individual is uninfected or whose status is 
                unknown) about safer sex practices;</DELETED>
                <DELETED>    ``(E) promoting voluntary counseling and 
                testing, addiction therapy, and other prevention and 
                treatment tools for illicit injection drug users and 
                other substance abusers;</DELETED>
                <DELETED>    ``(F) educating men and boys about the 
                risks of procuring sex commercially and about the need 
                to end violent behavior toward women and 
                girls;</DELETED>
                <DELETED>    ``(G) supporting comprehensive programs to 
                promote alternative livelihoods, safety, and social 
                reintegration strategies for commercial sex workers and 
                their families;</DELETED>
                <DELETED>    ``(H) promoting cooperation with law 
                enforcement to prosecute offenders of trafficking, 
                rape, and sexual assault crimes with the goal of 
                eliminating such crimes; and</DELETED>
                <DELETED>    ``(I) working to eliminate rape, gender-
                based violence, sexual assault, and the sexual 
                exploitation of women and children;</DELETED>
        <DELETED>    ``(11) include programs to reduce the transmission 
        of HIV through structural prevention efforts, particularly 
        addressing the heightened vulnerabilities of women and girls to 
        HIV in many countries; and</DELETED>
        <DELETED>    ``(12) support other important means of preventing 
        or reducing the transmission of HIV, including--</DELETED>
                <DELETED>    ``(A) medical male circumcision;</DELETED>
                <DELETED>    ``(B) the maintenance of a safe blood 
                supply; and</DELETED>
                <DELETED>    ``(C) other nonbehavior change mechanisms 
                to reduce the transmission of HIV;</DELETED>
        <DELETED>    ``(13) increase support for prevention of mother-
        to-child transmission;</DELETED>
        <DELETED>    ``(14) build capacity within the public health 
        sector of developing countries by improving health systems and 
        public health infrastructure and developing indicators to 
        measure changes in broader public health sector 
        capabilities;</DELETED>
        <DELETED>    ``(15) increase the coordination of HIV/AIDS 
        programs with development programs;</DELETED>
        <DELETED>    ``(16) provide a framework for expanding or 
        developing existing or new country or regional programs, 
        including--</DELETED>
                <DELETED>    ``(A) drafting compacts or other 
                agreements, as appropriate;</DELETED>
                <DELETED>    ``(B) establishing criteria and objectives 
                for such compacts and agreements; and</DELETED>
                <DELETED>    ``(C) promoting sustainability;</DELETED>
        <DELETED>    ``(17) provide a plan for national and regional 
        priorities for resource distribution and a global investment 
        plan by region;</DELETED>
        <DELETED>    ``(18) provide a plan to address the immediate and 
        ongoing needs of women and girls, which--</DELETED>
                <DELETED>    ``(A) addresses the vulnerabilities that 
                contribute to their elevated risk of 
                infection;</DELETED>
                <DELETED>    ``(B) includes specific goals and targets 
                to address these factors;</DELETED>
                <DELETED>    ``(C) provides clear guidance to field 
                missions to integrate gender across prevention, care, 
                and treatment programs;</DELETED>
                <DELETED>    ``(D) sets forth gender-specific 
                indicators to monitor progress on outcomes and impacts 
                of gender programs;</DELETED>
                <DELETED>    ``(E) supports efforts in countries in 
                which women or orphans lack inheritance rights and 
                other fundamental protections to promote the passage, 
                implementation, and enforcement of such laws;</DELETED>
                <DELETED>    ``(F) supports life skills training and 
                other structural prevention activities, especially 
                among women and girls, with the goal of reducing 
                vulnerabilities to HIV/AIDS;</DELETED>
                <DELETED>    ``(G) addresses and prevents gender-based 
                violence; and</DELETED>
                <DELETED>    ``(H) addresses the posttraumatic and 
                psychosocial consequences and provides postexposure 
                prophylaxis protecting against HIV infection to victims 
                of gender-based violence and rape;</DELETED>
        <DELETED>    ``(19) provide a plan to address the 
        vulnerabilities and needs of orphans and children who are 
        vulnerable to, or affected by, HIV/AIDS;</DELETED>
        <DELETED>    ``(20) provide a framework to work with 
        international actors and partner countries toward universal 
        access to HIV/AIDS prevention, treatment, and care programs, 
        recognizing that prevention is of particular importance in 
        terms of sequencing;</DELETED>
        <DELETED>    ``(21) enhance the coordination of United States 
        bilateral efforts to combat global HIV/AIDS with other major 
        public and private entities;</DELETED>
        <DELETED>    ``(22) enhance the attention given to the national 
        strategic HIV/AIDS plans of countries receiving United States 
        assistance by--</DELETED>
                <DELETED>    ``(A) reviewing the planning and 
                programmatic decisions associated with that assistance; 
                and</DELETED>
                <DELETED>    ``(B) helping to strengthen such national 
                strategies, if necessary;</DELETED>
        <DELETED>    ``(23) support activities described in the Global 
        Plan to Stop TB, including--</DELETED>
                <DELETED>    ``(A) expanding and enhancing the coverage 
                of the Directly Observed Treatment Short-course (DOTS) 
                in order to treat individuals infected with 
                tuberculosis and HIV, including multi-drug resistant or 
                extensively drug resistant tuberculosis; and</DELETED>
                <DELETED>    ``(B) improving coordination and 
                integration of HIV/AIDS and tuberculosis 
                programming;</DELETED>
        <DELETED>    ``(24) ensure coordination between the Global AIDS 
        Coordinator and the Malaria Coordinator and address issues of 
        comorbidity between HIV/AIDS and malaria; and</DELETED>
        <DELETED>    ``(25) include a longer term estimate of the 
        projected resource needs, progress toward greater 
        sustainability and country ownership of HIV/AIDS programs, and 
        the anticipated role of the United States in the global effort 
        to combat HIV/AIDS during the 10-year period beginning on 
        October 1, 2013.''.</DELETED>
<DELETED>    (b) Report.--Section 101(b) of such Act (22 U.S.C. 
7611(b)) is amended to read as follows:</DELETED>
<DELETED>    ``(b) Report.--</DELETED>
        <DELETED>    ``(1) In general.--Not later than October 1, 2009, 
        the President shall submit a report to the appropriate 
        congressional committees that sets forth the strategy described 
        in subsection (a).</DELETED>
        <DELETED>    ``(2) Contents.--The report required under 
        paragraph (1) shall include a discussion of the following 
        elements:</DELETED>
                <DELETED>    ``(A) The purpose, scope, methodology, and 
                general and specific objectives of the 
                strategy.</DELETED>
                <DELETED>    ``(B) The problems, risks, and threats to 
                the successful pursuit of the strategy.</DELETED>
                <DELETED>    ``(C) The desired goals, objectives, 
                activities, and outcome-related performance measures of 
                the strategy.</DELETED>
                <DELETED>    ``(D) A description of future costs and 
                resources needed to carry out the strategy.</DELETED>
                <DELETED>    ``(E) A delineation of United States 
                Government roles, responsibility, and coordination 
                mechanisms of the strategy.</DELETED>
                <DELETED>    ``(F) A description of the strategy--
                </DELETED>
                        <DELETED>    ``(i) to promote harmonization of 
                        United States assistance with that of other 
                        international, national, and private actors as 
                        elucidated in the `Three Ones'; and</DELETED>
                        <DELETED>    ``(ii) to address existing 
                        challenges in harmonization and 
                        alignment.</DELETED>
                <DELETED>    ``(G) A description of the manner in which 
                the strategy will--</DELETED>
                        <DELETED>    ``(i) further the development and 
                        implementation of the national multisectoral 
                        strategic HIV/AIDS frameworks of partner 
                        governments; and</DELETED>
                        <DELETED>    ``(ii) enhance the centrality, 
                        effectiveness, and sustainability of those 
                        national plans.</DELETED>
                <DELETED>    ``(H) A description of how the strategy 
                will seek to achieve the specific targets described in 
                subsection (a) and other targets, as 
                appropriate.</DELETED>
                <DELETED>    ``(I) A description of, and rationale for, 
                the timetable for annual global treatment 
                targets.</DELETED>
                <DELETED>    ``(J) A description of how operations 
                research is addressed in the strategy and how such 
                research can most effectively be integrated into care, 
                treatment, and prevention activities in order to--
                </DELETED>
                        <DELETED>    ``(i) improve program quality and 
                        efficiency;</DELETED>
                        <DELETED>    ``(ii) ascertain cost 
                        effectiveness;</DELETED>
                        <DELETED>    ``(iii) ensure transparency and 
                        accountability;</DELETED>
                        <DELETED>    ``(iv) assess population-based 
                        impact;</DELETED>
                        <DELETED>    ``(v) disseminate findings and 
                        best practices; and</DELETED>
                        <DELETED>    ``(vi) optimize delivery of 
                        services.</DELETED>
                <DELETED>    ``(K) An analysis of United States-
                assisted strategies to prevent the transmission of HIV/
                AIDS, including behavior change methodologies to 
                promote abstinence, monogamy, faithfulness, the correct 
                and consistent use of male and female condoms, 
                reductions in concurrent sexual partners, and delay of 
                sexual debut, and of intended monitoring and evaluation 
                approaches to measure the effectiveness of prevention 
                programs and ensure that they are targeted to 
                appropriate audiences.</DELETED>
                <DELETED>    ``(L) Within the analysis required under 
                subparagraph (J), an examination of additional planned 
                means of preventing the transmission of HIV including 
                medical male circumcision, maintenance of a safe blood 
                supply, and other tools.</DELETED>
                <DELETED>    ``(M) A description of the specific 
                targets, goals, and strategies developed to address the 
                needs and vulnerabilities of women and girls to HIV/
                AIDS, including--</DELETED>
                        <DELETED>    ``(i) structural prevention 
                        activities;</DELETED>
                        <DELETED>    ``(ii) activities directed toward 
                        men and boys;</DELETED>
                        <DELETED>    ``(iii) activities to enhance 
                        educational, microfinance, and livelihood 
                        opportunities for women and girls;</DELETED>
                        <DELETED>    ``(iv) activities to promote and 
                        protect the legal empowerment of women, girls, 
                        and orphans and vulnerable children;</DELETED>
                        <DELETED>    ``(v) programs targeted toward 
                        gender-based violence and sexual 
                        coercion;</DELETED>
                        <DELETED>    ``(vi) strategies to meet the 
                        particular needs of adolescents;</DELETED>
                        <DELETED>    ``(vii) assistance for victims of 
                        rape, sexual abuse, assault, exploitation, and 
                        trafficking; and</DELETED>
                        <DELETED>    ``(viii) programs to prevent 
                        alcohol abuse.</DELETED>
                <DELETED>    ``(N) A description of strategies--
                </DELETED>
                        <DELETED>    ``(i) to address the needs of 
                        orphans and vulnerable children, including an 
                        analysis of--</DELETED>
                                <DELETED>    ``(I) factors contributing 
                                to children's vulnerability to HIV/
                                AIDS; and</DELETED>
                                <DELETED>    ``(II) vulnerabilities 
                                caused by the impact of HIV/AIDS on 
                                children and their families; 
                                and</DELETED>
                        <DELETED>    ``(ii) in areas of higher HIV/AIDS 
                        prevalence, to promote a community-based 
                        approach to vulnerability, maximizing community 
                        input into determining which children 
                        participate.</DELETED>
                <DELETED>    ``(O) A description of capacity-building 
                efforts undertaken by countries themselves, including 
                adherents of the Abuja Declaration and an assessment of 
                the impact of International Monetary Fund macroeconomic 
                and fiscal policies on national and donor investments 
                in health.</DELETED>
                <DELETED>    ``(P) A description of the strategy to--
                </DELETED>
                        <DELETED>    ``(i) strengthen capacity building 
                        within the public health sector;</DELETED>
                        <DELETED>    ``(ii) improve health care in 
                        those countries;</DELETED>
                        <DELETED>    ``(iii) help countries to develop 
                        and implement national health workforce 
                        strategies;</DELETED>
                        <DELETED>    ``(iv) strive to achieve goals in 
                        training, retaining, and effectively deploying 
                        health staff;</DELETED>
                        <DELETED>    ``(v) promote ethical recruiting 
                        practices for health care workers; 
                        and</DELETED>
                        <DELETED>    ``(vi) increase the sustainability 
                        of health programs.</DELETED>
                <DELETED>    ``(Q) A description of the criteria for 
                selection, objectives, methodology, and structure of 
                compacts or other framework agreements with countries 
                or regional organizations, including--</DELETED>
                        <DELETED>    ``(i) the role of civil 
                        society;</DELETED>
                        <DELETED>    ``(ii) the degree of 
                        transparency;</DELETED>
                        <DELETED>    ``(iii) benchmarks for success of 
                        such compacts or agreements; and</DELETED>
                        <DELETED>    ``(iv) the relationship between 
                        such compacts or agreements and the national 
                        HIV/AIDS and public health strategies and 
                        commitments of partner countries.</DELETED>
                <DELETED>    ``(R) A strategy to better coordinate HIV/
                AIDS assistance with nutrition and food assistance 
                programs.</DELETED>
                <DELETED>    ``(S) A description of transnational or 
                regional initiatives to combat regionalized 
                epidemics.</DELETED>
                <DELETED>    ``(T) A description of planned resource 
                distribution and global investment by region.</DELETED>
                <DELETED>    ``(U) A description of coordination 
                efforts in order to better implement the Stop TB 
                Strategy and to address the problem of coinfection of 
                HIV/AIDS and tuberculosis and of projected challenges 
                or barriers to successful implementation.</DELETED>
                <DELETED>    ``(V) A description of coordination 
                efforts to address malaria and comorbidity with malaria 
                and HIV/AIDS.''.</DELETED>
<DELETED>    (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) 
is amended to read as follows:</DELETED>
<DELETED>    ``(c) Study of Progress Toward Achievement of Policy 
Objectives.--</DELETED>
        <DELETED>    ``(1) Design and budget plan for data 
        evaluation.--The Global AIDS Coordinator shall enter into a 
        contract with the Institute of Medicine of the National 
        Academies that provides that not later than 18 months after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, the Institute, in 
        consultation with the Global AIDS Coordinator and other 
        relevant parties representing the public and private sector, 
        shall provide the Global AIDS Coordinator with a design plan 
        and budget for the evaluation and collection of baseline and 
        subsequent data to address the elements set forth in paragraph 
        (2)(B). The Global AIDS Coordinator shall submit the budget and 
        design plan to the appropriate congressional 
        committees.</DELETED>
        <DELETED>    ``(2) Study.--</DELETED>
                <DELETED>    ``(A) In general.--Not later than 4 years 
                after the date of the enactment of the Tom Lantos and 
                Henry J. Hyde United States Global Leadership Against 
                HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act 
                of 2008, the Institute of Medicine of the National 
                Academies shall publish a study that includes--
                </DELETED>
                        <DELETED>    ``(i) an assessment of the 
                        performance of United States-assisted global 
                        HIV/AIDS programs; and</DELETED>
                        <DELETED>    ``(ii) an evaluation of the impact 
                        on health of prevention, treatment, and care 
                        efforts that are supported by United States 
                        funding, including multilateral and bilateral 
                        programs involving joint operations.</DELETED>
                <DELETED>    ``(B) Content.--The study conducted under 
                this paragraph shall include--</DELETED>
                        <DELETED>    ``(i) an assessment of progress 
                        toward prevention, treatment, and care 
                        targets;</DELETED>
                        <DELETED>    ``(ii) an assessment of the 
                        effects on health systems, including on the 
                        financing and management of health systems and 
                        the quality of service delivery and 
                        staffing;</DELETED>
                        <DELETED>    ``(iii) an assessment of efforts 
                        to address gender-specific aspects of HIV/AIDS, 
                        including gender related constraints to 
                        accessing services and addressing underlying 
                        social and economic vulnerabilities of women 
                        and men;</DELETED>
                        <DELETED>    ``(iv) an evaluation of the impact 
                        of treatment and care programs on 5-year 
                        survival rates, drug adherence, and the 
                        emergence of drug resistance;</DELETED>
                        <DELETED>    ``(v) an evaluation of the impact 
                        of prevention programs on HIV incidence in 
                        relevant population groups;</DELETED>
                        <DELETED>    ``(vi) an evaluation of the impact 
                        on child health and welfare of interventions 
                        authorized under this Act on behalf of orphans 
                        and vulnerable children;</DELETED>
                        <DELETED>    ``(vii) an evaluation of the 
                        impact of programs and activities authorized in 
                        this Act on child mortality; and</DELETED>
                        <DELETED>    ``(viii) recommendations for 
                        improving the programs referred to in 
                        subparagraph (A)(i).</DELETED>
                <DELETED>    ``(C) Methodologies.--Assessments and 
                impact evaluations conducted under the study shall 
                utilize sound statistical methods and techniques for 
                the behavioral sciences, including random assignment 
                methodologies as feasible. Qualitative data on process 
                variables should be used for assessments and impact 
                evaluations, wherever possible.</DELETED>
        <DELETED>    ``(3) Contract authority.--The Institute of 
        Medicine may enter into contracts or cooperative agreements or 
        award grants to conduct the study under paragraph 
        (2).</DELETED>
        <DELETED>    ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated such sums as may be necessary to 
        carry out the study under this subsection.''.</DELETED>
<DELETED>    (d) Report.--Section 101 of such Act, as amended by this 
section, is further amended by adding at the end the 
following:</DELETED>
<DELETED>    ``(d) Comptroller General Report.--</DELETED>
        <DELETED>    ``(1) Report required.--Not later than 3 years 
        after the date of the enactment of the Tom Lantos and Henry J. 
        Hyde United States Global Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Reauthorization Act of 2008, the 
        Comptroller General of the United States shall submit a report 
        on the global HIV/AIDS programs of the United States to the 
        appropriate congressional committees.</DELETED>
        <DELETED>    ``(2) Contents.--The report required under 
        paragraph (1) shall include--</DELETED>
                <DELETED>    ``(A) a description and assessment of the 
                monitoring and evaluation practices and policies in 
                place for these programs;</DELETED>
                <DELETED>    ``(B) an assessment of coordination within 
                Federal agencies involved in these programs, examining 
                both internal coordination within these programs and 
                integration with the larger global health and 
                development agenda of the United States;</DELETED>
                <DELETED>    ``(C) an assessment of procurement 
                policies and practices within these programs;</DELETED>
                <DELETED>    ``(D) an assessment of harmonization with 
                national government HIV/AIDS and public health 
                strategies as well as other international 
                efforts;</DELETED>
                <DELETED>    ``(E) an assessment of the impact of 
                global HIV/AIDS funding and programs on other United 
                States global health programming; and</DELETED>
                <DELETED>    ``(F) recommendations for improving the 
                global HIV/AIDS programs of the United 
                States.</DELETED>
<DELETED>    ``(e) Best Practices Report.--</DELETED>
        <DELETED>    ``(1) In general.--Not later than 1 year after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, and annually 
        thereafter, the Global AIDS Coordinator shall publish a best 
        practices report that highlights the programs receiving 
        financial assistance from the United States that have the 
        potential for replication or adaption, particularly at a low 
        cost, across global AIDS programs, including those that focus 
        on both generalized and localized epidemics.</DELETED>
        <DELETED>    ``(2) Dissemination of findings.--</DELETED>
                <DELETED>    ``(A) Publication on internet website.--
                The Global AIDS Coordinator shall disseminate the full 
                findings of the annual best practices report on the 
                Internet website of the Office of the Global AIDS 
                Coordinator.</DELETED>
                <DELETED>    ``(B) Dissemination guidance.--The Global 
                AIDS Coordinator shall develop guidance to ensure 
                timely submission and dissemination of significant 
                information regarding best practices with respect to 
                global AIDS programs.</DELETED>
<DELETED>    ``(f) Inspectors General.--</DELETED>
        <DELETED>    ``(1) Oversight plan.--</DELETED>
                <DELETED>    ``(A) Development.--The Inspectors General 
                of the Department of State, the Department of Health 
                and Human Services, and the United States Agency for 
                International Development shall jointly develop 5 
                coordinated annual plans for oversight activity in each 
                of the fiscal years 2009 through 2013, with regard to 
                the programs authorized under this Act and section 104A 
                of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-
                2).</DELETED>
                <DELETED>    ``(B) Contents.--The plans developed under 
                subparagraph (A) shall include a schedule for financial 
                audits and performance reviews, as 
                appropriate.</DELETED>
                <DELETED>    ``(C) Submission deadline.--</DELETED>
                        <DELETED>    ``(i) Initial plan.--The first 
                        plan developed under subparagraph (A) shall be 
                        submitted to the appropriate congressional 
                        committees not later than the later of--
                        </DELETED>
                                <DELETED>    ``(I) September 1, 2008; 
                                or</DELETED>
                                <DELETED>    ``(II) 60 days after the 
                                date of the enactment of the Tom Lantos 
                                and Henry J. Hyde United States Global 
                                Leadership Against HIV/AIDS, 
                                Tuberculosis, and Malaria 
                                Reauthorization Act of 2008.</DELETED>
                        <DELETED>    ``(ii) Subsequent plans.--Each of 
                        the last four plans developed under 
                        subparagraph (A) shall be submitted 30 days 
                        before each of the fiscal years 2010 and 2013, 
                        respectively.</DELETED>
        <DELETED>    ``(2) Coordination.--In order to avoid duplication 
        and maximize efficiency, the Inspectors General described in 
        paragraph (1) shall coordinate their activities with--
        </DELETED>
                <DELETED>    ``(A) the Government Accountability 
                Office; and</DELETED>
                <DELETED>    ``(B) the Inspectors General of the 
                Department of Commerce, the Department of Defense, the 
                Department of Labor, and the Peace Corps, as 
                appropriate, pursuant to the 2004 Memorandum of 
                Agreement Coordinating Audit Coverage of Programs and 
                Activities Implementing the President's Emergency Plan 
                for AIDS Relief, or any successor agreement.</DELETED>
        <DELETED>    ``(3) Funding.--The Global AIDS Coordinator and 
        the Coordinator of the United States Government Activities to 
        Combat Malaria Globally shall make available necessary funds 
        not exceeding $10,000,000 during the 5-year period beginning on 
        October 1, 2008 to the Inspectors General described in 
        paragraph (1) for the audits and reviews described in that 
        paragraph.''.</DELETED>

<DELETED>SEC. 102. INTERAGENCY WORKING GROUP.</DELETED>

<DELETED>    Section 1(f)(2) of the State Department Basic Authorities 
Act of 1956 (22 U.S.C. 2651a(f)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A), by inserting ``, partner 
        country finance, health, and other relevant ministries,'' after 
        ``community based organizations)'' each place it 
        appears;</DELETED>
        <DELETED>    (2) in subparagraph (B)(ii)--</DELETED>
                <DELETED>    (A) by striking subclauses (IV) and 
                (V);</DELETED>
                <DELETED>    (B) by inserting after subclause (III) the 
                following:</DELETED>
                                <DELETED>    ``(IV) Establishing an 
                                interagency working group on HIV/AIDS 
                                headed by the Global AIDS Coordinator 
                                and comprised of representatives from 
                                the United States Agency for 
                                International Development and the 
                                Department of Health and Human 
                                Services, for the purposes of 
                                coordination of activities relating to 
                                HIV/AIDS, including--</DELETED>
                                        <DELETED>    ``(aa) meeting 
                                        regularly to review progress in 
                                        partner countries toward HIV/
                                        AIDS prevention, treatment, and 
                                        care objectives;</DELETED>
                                        <DELETED>    ``(bb) 
                                        participating in the process of 
                                        identifying countries to 
                                        consider for increased 
                                        assistance based on the 
                                        epidemiology of HIV/AIDS in 
                                        those countries, including 
                                        clear evidence of a public 
                                        health threat, as well as 
                                        government commitment to 
                                        address the HIV/AIDS problem, 
                                        relative need, and coordination 
                                        and joint planning with other 
                                        significant actors;</DELETED>
                                        <DELETED>    ``(cc) assisting 
                                        the Coordinator in the 
                                        evaluation, execution, and 
                                        oversight of country 
                                        operational plans;</DELETED>
                                        <DELETED>    ``(dd) reviewing 
                                        policies that may be obstacles 
                                        to reaching targets set forth 
                                        for HIV/AIDS prevention, 
                                        treatment, and care; 
                                        and</DELETED>
                                        <DELETED>    ``(ee) consulting 
                                        with representatives from 
                                        additional relevant agencies, 
                                        including the National 
                                        Institutes of Health, the 
                                        Health Resources and Services 
                                        Administration, the Department 
                                        of Labor, the Department of 
                                        Agriculture, the Millennium 
                                        Challenge Corporation, the 
                                        Peace Corps, and the Department 
                                        of Defense.</DELETED>
                                <DELETED>    ``(V) Coordinating overall 
                                United States HIV/AIDS policy and 
                                programs, including ensuring the 
                                coordination of relevant executive 
                                branch agency activities in the field, 
                                with efforts led by partner countries, 
                                and with the assistance provided by 
                                other relevant bilateral and 
                                multilateral aid agencies and other 
                                donor institutions to promote 
                                harmonization with other programs aimed 
                                at preventing and treating HIV/AIDS and 
                                other health challenges, improving 
                                primary health, addressing food 
                                security, promoting education and 
                                development, and strengthening health 
                                care systems.'';</DELETED>
                <DELETED>    (C) by redesignating subclauses (VII) and 
                VIII) as subclauses (IX) and (XII), 
                respectively;</DELETED>
                <DELETED>    (D) by inserting after subclause (VI) the 
                following:</DELETED>
                                <DELETED>    ``(VII) Holding annual 
                                consultations with nongovernmental 
                                organizations in partner countries that 
                                provide services to improve health, and 
                                advocating on behalf of the individuals 
                                with HIV/AIDS and those at particular 
                                risk of contracting HIV/AIDS, including 
                                organizations with members who are 
                                living with HIV/AIDS.</DELETED>
                                <DELETED>    ``(VIII) Ensuring, through 
                                interagency and international 
                                coordination, that HIV/AIDS programs of 
                                the United States are coordinated with, 
                                and complementary to, the delivery of 
                                related global health, food security, 
                                development, and 
                                education.'';</DELETED>
                <DELETED>    (E) in subclause (IX), as redesignated by 
                subparagraph (C)--</DELETED>
                        <DELETED>    (i) by inserting ``Vietnam,'' 
                        after ``Uganda,'';</DELETED>
                        <DELETED>    (ii) by inserting after ``of 
                        2003'' the following: ``and other countries in 
                        which the United States is implementing HIV/
                        AIDS programs as part of its foreign assistance 
                        program''; and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following: ``In designating additional 
                        countries under this subparagraph, the 
                        President shall give priority to those 
                        countries in which there is a high prevalence 
                        or significantly rising incidence of HIV/AIDS, 
                        countries with large populations and inadequate 
                        health infrastructure, countries in which a 
                        concentrated HIV/AIDS epidemic could become 
                        generalized to the entire population of the 
                        country, and in countries whose governments 
                        demonstrate a commitment to combating HIV/
                        AIDS.'';</DELETED>
                <DELETED>    (F) by inserting after subclause (IX), as 
                redesignated by subparagraph (C), the 
                following:</DELETED>
                                <DELETED>    ``(X) Working with partner 
                                countries in which the HIV/AIDS 
                                epidemic is prevalent among injection 
                                drug users to establish, as a national 
                                priority, national HIV/AIDS prevention 
                                programs, including education and 
                                services demonstrated to be effective 
                                in reducing the transmission of HIV 
                                infection among injection drug users 
                                without increasing illicit drug 
                                use.</DELETED>
                                <DELETED>    ``(XI) Working with 
                                partner countries in which the HIV/AIDS 
                                epidemic is prevalent among individuals 
                                involved in commercial sex acts to 
                                establish, as a national priority, 
                                national prevention programs, including 
                                education, voluntary testing, and 
                                counseling, and referral systems that 
                                link HIV/AIDS programs with programs to 
                                eradicate trafficking in persons and 
                                support alternatives to 
                                prostitution.'';</DELETED>
                <DELETED>    (G) in subclause (XII), as redesignated by 
                subparagraph (C), by striking ``funds section'' and 
                inserting ``funds appropriated for HIV/ AIDS assistance 
                pursuant to the authorization of appropriations under 
                section 401 of the United States Leadership Against 
                HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
                U.S.C. 7671)''; and</DELETED>
                <DELETED>    (H) by adding at the end the 
                following:</DELETED>
                                <DELETED>    ``(XIII) Publicizing 
                                updated drug pricing data to inform the 
                                purchasing decisions of pharmaceutical 
                                procurement partners.''.</DELETED>

<DELETED>SEC. 103. SENSE OF CONGRESS.</DELETED>

<DELETED>    Section 102 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) is amended 
by adding at the end the following:</DELETED>
<DELETED>    ``(d) Sense of Congress.--It is the sense of Congress 
that--</DELETED>
        <DELETED>    ``(1) full-time country level coordinators, 
        preferably with management experience, should head each HIV/
        AIDS country team for United States missions overseeing 
        significant HIV/AIDS programs;</DELETED>
        <DELETED>    ``(2) foreign service nationals provide critically 
        important services in the design and implementation of United 
        States country-level HIV/AIDS programs and their skills and 
        experience as public health professionals should be recognized 
        within hiring and compensation practices; and</DELETED>
        <DELETED>    ``(3) staffing levels for United States country-
        level HIV/AIDS teams should be adequately maintained to fulfill 
        oversight and other obligations of the positions.''.</DELETED>

   <DELETED>TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND 
                 PUBLIC-PRIVATE PARTNERSHIPS</DELETED>

<DELETED>SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE 
              FUNDS.</DELETED>

<DELETED>    Section 302 of the Foreign Assistance Act of 1961 (22 
U.S.C. 2222) is amended--</DELETED>
        <DELETED>    (1) by inserting after subsection (c) the 
        following:</DELETED>
<DELETED>    ``(d) Tuberculosis Vaccine Development Programs.--In 
addition to amounts otherwise available under this section, there are 
authorized to be appropriated to the President such sums as may be 
necessary for each of the fiscal years 2009 through 2013, which shall 
be used for United States contributions to tuberculosis vaccine 
development programs, which may include the Aeras Global TB Vaccine 
Foundation.'';</DELETED>
        <DELETED>    (2) in subsection (k), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013'';</DELETED>
        <DELETED>    (3) in subsection (l), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and</DELETED>
        <DELETED>    (4) in subsection (m), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013''.</DELETED>

<DELETED>SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, 
              TUBERCULOSIS AND MALARIA.</DELETED>

<DELETED>    (a) Findings; Sense of Congress.--Section 202(a) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7622(a)) is amended to read as 
follows:</DELETED>
<DELETED>    ``(a) Findings; Sense of Congress.--</DELETED>
        <DELETED>    ``(1) Findings.--Congress makes the following 
        findings:</DELETED>
                <DELETED>    ``(A) The establishment of the Global Fund 
                in January 2002 is consistent with the general 
                principles for an international AIDS trust fund first 
                outlined by Congress in the Global AIDS and 
                Tuberculosis Relief Act of 2000 (Public Law 106-
                264).</DELETED>
                <DELETED>    ``(B) The Global Fund is an innovative 
                financing mechanism which--</DELETED>
                        <DELETED>    ``(i) has made progress in many 
                        areas in combating HIV/AIDS, tuberculosis, and 
                        malaria; and</DELETED>
                        <DELETED>    ``(ii) represents the multilateral 
                        component of this Act, extending United States 
                        efforts to more than 130 countries around the 
                        world.</DELETED>
                <DELETED>    ``(C) The Global Fund and United States 
                bilateral assistance programs--</DELETED>
                        <DELETED>    ``(i) are demonstrating 
                        increasingly effective coordination, with each 
                        possessing certain comparative advantages in 
                        the fight against HIV/AIDS, tuberculosis, and 
                        malaria; and</DELETED>
                        <DELETED>    ``(ii) often work most effectively 
                        in concert with each other.</DELETED>
                <DELETED>    ``(D) The United States Government--
                </DELETED>
                        <DELETED>    ``(i) is the largest supporter of 
                        the Global Fund in terms of resources and 
                        technical support;</DELETED>
                        <DELETED>    ``(ii) made the founding 
                        contribution to the Global Fund; and</DELETED>
                        <DELETED>    ``(iii) is fully committed to the 
                        success of the Global Fund as a multilateral 
                        public-private partnership.</DELETED>
        <DELETED>    ``(2) Sense of congress.--It is the sense of 
        Congress that--</DELETED>
                <DELETED>    ``(A) transparency and accountability are 
                crucial to the long-term success and viability of the 
                Global Fund;</DELETED>
                <DELETED>    ``(B) the Global Fund has made significant 
                progress toward addressing concerns raised by the 
                Government Accountability Office by--</DELETED>
                        <DELETED>    ``(i) improving risk assessment 
                        and risk management capabilities;</DELETED>
                        <DELETED>    ``(ii) providing clearer guidance 
                        for and oversight of Local Fund Agents; 
                        and</DELETED>
                        <DELETED>    ``(iii) strengthening the Office 
                        of the Inspector General for the Global 
                        Fund;</DELETED>
                <DELETED>    ``(C) the provision of sufficient 
                resources and authority to the Office of the Inspector 
                General for the Global Fund to ensure that office has 
                the staff and independence necessary to carry out its 
                mandate will be a measure of the commitment of the 
                Global Fund to transparency and 
                accountability;</DELETED>
                <DELETED>    ``(D) regular, publicly published 
                financial, programmatic, and reporting audits of the 
                Fund, its grantees, and Local Fund Agents are also 
                important benchmarks of transparency;</DELETED>
                <DELETED>    ``(E) the Global Fund should establish and 
                maintain a system to track--</DELETED>
                        <DELETED>    ``(i) the amount of funds 
                        disbursed to each subrecipient on the grant's 
                        fiscal cycle; and</DELETED>
                        <DELETED>    ``(ii) the distribution of 
                        resources, by grant and principal recipient, 
                        for prevention, care, treatment, drug and 
                        commodity purchases, and other 
                        purposes;</DELETED>
                <DELETED>    ``(F) relevant national authorities in 
                recipient countries should exempt from duties and taxes 
                all products financed by Global Fund grants and 
                procured by any principal recipient or subrecipient for 
                the purpose of carrying out such grants;</DELETED>
                <DELETED>    ``(G) the Global Fund, UNAIDS, and the 
                Global AIDS Coordinator should work together to 
                standardize program indicators wherever possible; 
                and</DELETED>
                <DELETED>    ``(H) for purposes of evaluating total 
                amounts of funds contributed to the Global Fund under 
                subsection (d)(4)(A)(i), the timetable for evaluations 
                of contributions from sources other than the United 
                States should take into account the fiscal calendars of 
                other major contributors.''.</DELETED>
<DELETED>    (b) United States Financial Participation.--Section 202(d) 
of such Act (22 U.S.C. 7622(d)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) by striking ``$1,000,000,000 for the 
                period of fiscal year 2004 beginning on January 1, 
                2004'' and inserting ``$2,000,000,000 for fiscal year 
                2009,''; and</DELETED>
                <DELETED>    (B) by striking ``the fiscal years 2005-
                2008'' and inserting ``each of the fiscal years 2010 
                through 2013'';</DELETED>
        <DELETED>    (2) in paragraph (4)--</DELETED>
                <DELETED>    (A) in subparagraph (A)--</DELETED>
                        <DELETED>    (i) in clause (i), by striking 
                        ``At any time during fiscal years 2004 through 
                        2008,'' and inserting ``During each of the 
                        fiscal years 2009 through 2013, at an 
                        appropriate time of measure, as determined by 
                        the Global AIDS Coordinator,'';</DELETED>
                        <DELETED>    (ii) in clause (ii), by striking 
                        ``during any of the fiscal years 2004 through 
                        2008'' and inserting ``during any of the fiscal 
                        years 2009 through 2013''; and</DELETED>
                        <DELETED>    (iii) in clause (vi)--</DELETED>
                                <DELETED>    (I) by striking ``for the 
                                purposes'' and inserting ``For the 
                                purposes'';</DELETED>
                                <DELETED>    (II) by striking ``fiscal 
                                years 2004 through 2008'' and inserting 
                                ``fiscal years 2009 through 2013''; 
                                and</DELETED>
                                <DELETED>    (III) by striking ``prior 
                                to fiscal year 2004'' and inserting 
                                ``before fiscal year 2009'';</DELETED>
                <DELETED>    (B) in subparagraph (B)(iv), by striking 
                ``fiscal years 2004 through 2008'' and inserting 
                ``fiscal years 2009 through 2013''; and</DELETED>
                <DELETED>    (C) in subparagraph (C)(ii), by striking 
                ``Committee on International Relations'' and inserting 
                ``Committee on Foreign Affairs''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(5) Withholding funds.--Notwithstanding any 
        other provision of this Act, 20 percent of the amounts 
        appropriated pursuant to this Act for a contribution to support 
        the Global Fund for each of the fiscal years 2010 through 2013 
        shall be withheld from obligation to the Global Fund until the 
        Secretary of State certifies to the appropriate congressional 
        committees that the Global Fund--</DELETED>
                <DELETED>    ``(A) has established an evaluation 
                framework for the performance of Local Fund Agents 
                (referred to in this paragraph as `LFAs');</DELETED>
                <DELETED>    ``(B) is undertaking a systematic 
                assessment of the performance of LFAs;</DELETED>
                <DELETED>    ``(C) 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 principal recipients and 
                subrecipients;</DELETED>
                <DELETED>    ``(D) is maintaining an independent, well-
                staffed Office of the Inspector General that--
                </DELETED>
                        <DELETED>    ``(i) reports directly to the 
                        Board of the Global Fund; and</DELETED>
                        <DELETED>    ``(ii) is responsible for regular, 
                        publicly published audits of financial, 
                        programmatic, and reporting aspects of the 
                        Global Fund, its grantees, and LFAs;</DELETED>
                <DELETED>    ``(E) has established, and is reporting 
                publicly on, standard indicators for all program 
                areas;</DELETED>
                <DELETED>    ``(F) has established a methodology to 
                track and is reporting on--</DELETED>
                        <DELETED>    ``(i) all subrecipients and the 
                        amount of funds disbursed to each subrecipient 
                        on the grant's fiscal cycle; and</DELETED>
                        <DELETED>    ``(ii) the distribution of 
                        resources, by grant and principal recipient, 
                        for prevention, care, treatment, drugs and 
                        commodities purchase, and other 
                        purposes;</DELETED>
                <DELETED>    ``(G) has established a policy on tariffs 
                imposed by national governments on all goods and 
                services financed by the Global Fund;</DELETED>
                <DELETED>    ``(H) through its Secretariat, has taken 
                meaningful steps to prevent national authorities in 
                recipient countries from imposing taxes or tariffs on 
                goods or services provided by the Fund;</DELETED>
                <DELETED>    ``(I) is maintaining its status as a 
                financing institution focused on programs directly 
                related to HIV/AIDS, malaria, and tuberculosis; 
                and</DELETED>
                <DELETED>    ``(J) is maintaining and making progress 
                on--</DELETED>
                        <DELETED>    ``(i) sustaining its multisectoral 
                        approach, through country coordinating 
                        mechanisms; and</DELETED>
                        <DELETED>    ``(ii) the implementation of 
                        grants, as reflected in the proportion of 
                        resources allocated to different sectors, 
                        including governments, civil society, and 
                        faith- and community-based 
                        organizations.''.</DELETED>

<DELETED>SEC. 203. PROGRAM TO FACILITATE AVAILABILITY OF MICROBICIDES 
              TO PREVENT TRANSMISSION OF HIV AND OTHER 
              DISEASES.</DELETED>

<DELETED>    (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.</DELETED>
<DELETED>    (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 widescale 
availability of microbicides that prevent the transmission of HIV after 
such microbicides are proven safe and effective.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.</DELETED>

<DELETED>    (a) In General.--Title II of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7621) is amended by adding at the end the following:</DELETED>

<DELETED>``SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.</DELETED>

<DELETED>    ``(a) Statement of Policy.--It shall be the policy of the 
United States Government--</DELETED>
        <DELETED>    ``(1) to invest appropriate resources authorized 
        under this Act--</DELETED>
                <DELETED>    ``(A) to carry out activities to 
                strengthen HIV/AIDS, tuberculosis, and malaria health 
                policies and health systems; and</DELETED>
                <DELETED>    ``(B) to provide workforce training and 
                capacity-building consistent with the goals and 
                objectives of this Act; and</DELETED>
        <DELETED>    ``(2) to support the development of a sound policy 
        environment in partner countries to increase the ability of 
        such countries--</DELETED>
                <DELETED>    ``(A) to maximize utilization of health 
                care resources from donor countries;</DELETED>
                <DELETED>    ``(B) to increase national investments in 
                health and education and maximize the effectiveness of 
                such investments;</DELETED>
                <DELETED>    ``(C) to improve national HIV/AIDS, 
                tuberculosis, and malaria strategies;</DELETED>
                <DELETED>    ``(D) to deliver evidence-based services 
                in an effective and efficient manner; and</DELETED>
                <DELETED>    ``(E) to reduce barriers that prevent 
                recipients of services from achieving maximum benefit 
                from such services.</DELETED>
<DELETED>    ``(b) Assistance To Improve Public Finance Management 
Systems.--</DELETED>
        <DELETED>    ``(1) In general.--Consistent with the authority 
        under section 129 of the Foreign Assistance Act of 1961 (22 
        U.S.C. 2152), the Secretary of the Treasury, acting through the 
        head of the Office of Technical Assistance, is authorized to 
        provide assistance for advisors and partner country finance, 
        health, and other relevant ministries to improve the 
        effectiveness of public finance management systems in partner 
        countries to enable such countries to receive funding to carry 
        out programs to combat HIV/AIDS, tuberculosis, and malaria and 
        to manage such programs.</DELETED>
        <DELETED>    ``(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.''.</DELETED>
<DELETED>    (b) Clerical Amendment.--The table of contents for the 
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7601 note) is amended by inserting after the 
item relating to section 203, as added by section 203 of this Act, the 
following:</DELETED>

<DELETED>``Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
                            strengthening health policies and health 
                            systems of partner countries.''.

<DELETED>SEC. 205. FACILITATING EFFECTIVE OPERATIONS OF THE CENTERS FOR 
              DISEASE CONTROL.</DELETED>

<DELETED>    Section 307 of the Public Health Service Act (42 U.S.C. 
242l) is amended--</DELETED>
        <DELETED>    (1) by amending subsection (a) to read as 
        follows:</DELETED>
<DELETED>    ``(a) The Secretary may participate with other countries 
in cooperative endeavors in--</DELETED>
        <DELETED>    ``(1) biomedical research, health care technology, 
        and the health services research and statistical analysis 
        authorized under section 306 and title IX; and</DELETED>
        <DELETED>    ``(2) biomedical research, health care services, 
        health care research, or other related activities in 
        furtherance of the activities, objectives or goals authorized 
        under the Tom Lantos and Henry J. Hyde United States Global 
        Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008.''; and</DELETED>
        <DELETED>    (2) in subsection (b)--</DELETED>
                <DELETED>    (A) in paragraph (7), by striking ``and'' 
                after the semicolon at the end;</DELETED>
                <DELETED>    (B) by striking ``The Secretary may not, 
                in the exercise of his authority under this section, 
                provide financial assistance for the construction of 
                any facility in any foreign country.''</DELETED>
                <DELETED>    (C) in paragraph (8), by striking ``for 
                any purpose.'' and inserting ``for the purpose of any 
                law administered by the Office of Personnel 
                Management;''; and</DELETED>
                <DELETED>    (D) by adding at the end the 
                following:</DELETED>
        <DELETED>    ``(9) provide such funds by advance or 
        reimbursement to the Secretary of State, as may be necessary, 
        to pay the costs of acquisition, lease, construction, 
        alteration, equipping, furnishing or management of facilities 
        outside of the United States; and</DELETED>
        <DELETED>    ``(10) in consultation with the Secretary of 
        State, through grant or cooperative agreement, make funds 
        available to public or nonprofit private institutions or 
        agencies in foreign countries in which the Secretary is 
        participating in activities described under subsection (a) to 
        acquire, lease, construct, alter, or renovate facilities in 
        those countries.''.</DELETED>
        <DELETED>    (3) in subsection (c)--</DELETED>
                <DELETED>    (A) by striking ``1990'' and inserting 
                ``1980''; and</DELETED>
                <DELETED>    (B) by inserting or ``or section 903 of 
                the Foreign Service Act of 1980 (22 U.S.C. 4083)'' 
                after ``Code''.</DELETED>

            <DELETED>TITLE III--BILATERAL EFFORTS</DELETED>

     <DELETED>Subtitle A--General Assistance and Programs</DELETED>

<DELETED>SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.</DELETED>

<DELETED>    (a) Amendments to the Foreign Assistance Act of 1961.--
</DELETED>
        <DELETED>    (1) Finding.--Section 104A(a) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2151b-2(a)) is amended by 
        inserting ``Central Asia, Eastern Europe, Latin America'' after 
        ``Caribbean,''.</DELETED>
        <DELETED>    (2) Policy.--Section 104A(b) of such Act is 
        amended to read as follows:</DELETED>
<DELETED>    ``(b) Policy.--</DELETED>
        <DELETED>    ``(1) Objectives.--It is a major objective of the 
        foreign assistance program of the United States to provide 
        assistance for the prevention and treatment of HIV/AIDS and the 
        care of those affected by the disease. It is the policy 
        objective of the United States, by 2013, to--</DELETED>
                <DELETED>    ``(A) assist partner countries to--
                </DELETED>
                        <DELETED>    ``(i) prevent 12,000,000 new HIV 
                        infections worldwide;</DELETED>
                        <DELETED>    ``(ii) support treatment of at 
                        least 3,000,000 individuals with HIV/
                        AIDS;</DELETED>
                        <DELETED>    ``(iii) support additional 
                        treatment through coordinated multilateral 
                        efforts;</DELETED>
                        <DELETED>    ``(iv) support care for 12,000,000 
                        individuals with HIV/AIDS, including 5,000,000 
                        orphans and vulnerable children affected by 
                        HIV/AIDS, with an emphasis on promoting a 
                        comprehensive, coordinated system of services 
                        to be integrated throughout the continuum of 
                        care;</DELETED>
                        <DELETED>    ``(v) provide at least 80 percent 
                        of the target population with access to 
                        counseling, testing, and treatment to prevent 
                        the transmission of HIV from mother-to-
                        child;</DELETED>
                        <DELETED>    ``(vi) provide access for children 
                        with HIV to care and treatment services in 
                        proportion to their percentage within the HIV-
                        infected population of a given partner country; 
                        and</DELETED>
                        <DELETED>    ``(vii) train health care 
                        professionals and workers in HIV/AIDS 
                        prevention, treatment, and care, with a goal of 
                        providing such training to at least 140,000 new 
                        health care professionals and 
                        workers;</DELETED>
                <DELETED>    ``(B) strengthen the capacity to deliver 
                primary health care in developing countries, especially 
                in sub-Saharan Africa; and</DELETED>
                <DELETED>    ``(C) help countries achieve staffing 
                levels of at least 2.3 doctors, nurses, and midwives 
                per 1,000 population, as called for by the World Health 
                Organization.</DELETED>
        <DELETED>    ``(2) Coordinated global strategy.--The United 
        States and other countries with the sufficient capacity should 
        provide assistance to countries in sub-Saharan Africa, the 
        Caribbean, Central Asia, Eastern Europe, and Latin America, and 
        other countries and regions confronting HIV/AIDS epidemics in a 
        coordinated global strategy to help address generalized and 
        concentrated epidemics through HIV/AIDS prevention, treatment, 
        care, monitoring and evaluation, and related 
        activities.</DELETED>
        <DELETED>    ``(3) Priorities.--The United States Government's 
        response to the global HIV/AIDS pandemic and the Government's 
        efforts to help countries assume leadership of sustainable 
        campaigns to combat their local epidemics should place high 
        priority on--</DELETED>
                <DELETED>    ``(A) the prevention of the transmission 
                of HIV; and</DELETED>
                <DELETED>    ``(B) moving toward universal access to 
                HIV/AIDS prevention counseling and 
                services.''.</DELETED>
<DELETED>    (b) Authorization.--Section 104A(c) of such Act is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``and other 
        countries and areas.'' and inserting ``Central Asia, Eastern 
        Europe, Latin America, and other countries and areas, 
        particularly with respect to refugee populations or those in 
        postconflict settings in such countries and areas with 
        significant or increasing HIV incidence rates.'';</DELETED>
        <DELETED>    (2) in paragraph (2), by striking ``and other 
        countries and areas affected by the HIV/AIDS pandemic'' and 
        inserting ``Central Asia, Eastern Europe, Latin America, and 
        other countries and areas affected by the HIV/AIDS pandemic, 
        particularly with respect to refugee populations or those in 
        post-conflict settings in such countries and areas with 
        significant or increasing HIV incidence rates.''; and</DELETED>
        <DELETED>    (3) in paragraph (3)--</DELETED>
                <DELETED>    (A) by striking ``foreign countries'' and 
                inserting ``partner countries, other international 
                actors,''; and</DELETED>
                <DELETED>    (B) by inserting ``within the framework of 
                the principles of the Three Ones'' before the period at 
                the end.</DELETED>
<DELETED>    (c) Activities Supported.--Section 104A(d) of such Act is 
amended--</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) in subparagraph (A)--</DELETED>
                        <DELETED>    (i) by inserting ``and multiple 
                        concurrent sexual partnering,'' after ``casual 
                        sexual partnering''; and</DELETED>
                        <DELETED>    (ii) by striking ``condoms'' and 
                        inserting ``male and female 
                        condoms'';</DELETED>
                <DELETED>    (B) in subparagraph (B)--</DELETED>
                        <DELETED>    (i) by striking ``programs that'' 
                        and inserting ``programs that are designed with 
                        local input and''; and</DELETED>
                        <DELETED>    (ii) by striking ``those 
                        organizations'' and inserting ``those locally 
                        based organizations'';</DELETED>
                <DELETED>    (C) in subparagraph (D), by inserting 
                ``and promoting the use of provider-initiated or `opt-
                out' voluntary testing in accordance with World Health 
                Organization guidelines'' before the semicolon at the 
                end;</DELETED>
                <DELETED>    (D) by redesignating subparagraphs (F), 
                (G), and (H) as subparagraphs (H), (I), and (J), 
                respectively;</DELETED>
                <DELETED>    (E) by inserting after subparagraph (E) 
                the following:</DELETED>
                <DELETED>    ``(F) assistance to--</DELETED>
                        <DELETED>    ``(i) achieve the goal of reaching 
                        80 percent of pregnant women for prevention and 
                        treatment of mother-to-child transmission of 
                        HIV in countries in which the United States is 
                        implementing HIV/AIDS programs by 2013; 
                        and</DELETED>
                        <DELETED>    ``(ii) promote infant feeding 
                        options and treatment protocols that meet the 
                        most recent criteria established by the World 
                        Health Organization;</DELETED>
                <DELETED>    ``(G) medical male circumcision programs 
                as part of national strategies to combat the 
                transmission of HIV/AIDS;'';</DELETED>
                <DELETED>    (F) in subparagraph (I), as redesignated, 
                by striking ``and'' at the end;</DELETED>
                <DELETED>    (G) in subparagraph (H), as redesignated--
                </DELETED>
                        <DELETED>    (i) by striking the period at the 
                        end and inserting ``, including education and 
                        services demonstrated to be effective in 
                        reducing the transmission of HIV infection 
                        without increasing illicit drug use; and''; 
                        and</DELETED>
                <DELETED>    (H) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(K) assistance for counseling, testing, 
                treatment, care, and support programs, including--
                </DELETED>
                        <DELETED>    ``(i) counseling and other 
                        services for the prevention of reinfection of 
                        individuals with HIV/AIDS;</DELETED>
                        <DELETED>    ``(ii) counseling to prevent 
                        sexual transmission of HIV, including--
                        </DELETED>
                                <DELETED>    ``(I) life skills 
                                development for practicing abstinence 
                                and faithfulness;</DELETED>
                                <DELETED>    ``(II) reducing the number 
                                of sexual partners;</DELETED>
                                <DELETED>    ``(III) delaying sexual 
                                debut; and</DELETED>
                                <DELETED>    ``(IV) ensuring correct 
                                and consistent use of 
                                condoms;</DELETED>
                        <DELETED>    ``(iii) assistance to engage 
                        underlying vulnerabilities to HIV/AIDS, 
                        especially those of women and girls, through 
                        structural prevention programs;</DELETED>
                        <DELETED>    ``(iv) assistance for appropriate 
                        HIV/AIDS education programs and training 
                        targeted to prevent the transmission of HIV 
                        among men who have sex with men;</DELETED>
                        <DELETED>    ``(v) assistance to provide male 
                        and female condoms;</DELETED>
                        <DELETED>    ``(vi) diagnosis and treatment of 
                        other sexually transmitted 
                        infections;</DELETED>
                        <DELETED>    ``(vii) strategies to address the 
                        stigma and discrimination that impede HIV/AIDS 
                        prevention efforts; and</DELETED>
                        <DELETED>    ``(viii) assistance to facilitate 
                        widespread access to microbicides for HIV 
                        prevention, if safe and effective products 
                        become available, including financial and 
                        technical support for culturally appropriate 
                        introductory programs, procurement, 
                        distribution, logistics management, program 
                        delivery, acceptability studies, provider 
                        training, demand generation, and 
                        postintroduction monitoring.''; and</DELETED>
        <DELETED>    (2) in paragraph (2)--</DELETED>
                <DELETED>    (A) in subparagraph (B), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) in subparagraph (C)--</DELETED>
                        <DELETED>    (i) by inserting ``pain 
                        management,'' after ``opportunistic 
                        infections,''; and</DELETED>
                        <DELETED>    (ii) by striking the period at the 
                        end and inserting a semicolon; and</DELETED>
                <DELETED>    (C) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(D) as part of care and treatment of 
                HIV/AIDS, assistance (including prophylaxis and 
                treatment) for common HIV/AIDS-related opportunistic 
                infections for free or at a rate at which it is easily 
                affordable to the individuals and populations being 
                served;</DELETED>
                <DELETED>    ``(E) as part of care and treatment of 
                HIV/AIDS, assistance or referral to available and 
                adequately resourced service providers for nutritional 
                support, including counseling and where necessary the 
                provision of commodities, for persons meeting 
                malnourishment criteria and their 
                families;'';</DELETED>
        <DELETED>    (3) in paragraph (4)--</DELETED>
                <DELETED>    (A) in subparagraph (C), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) in subparagraph (D), by striking the 
                period at the end and inserting a semicolon; 
                and</DELETED>
                <DELETED>    (C) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(E) carrying out and expanding program 
                monitoring, impact evaluation research and analysis, 
                and operations research and disseminating data and 
                findings through mechanisms to be developed by the 
                Coordinator of United States Government Activities to 
                Combat HIV/AIDS Globally, in coordination with the 
                Director of the Centers for Disease Control, in order 
                to--</DELETED>
                        <DELETED>    ``(i) improve accountability, 
                        increase transparency, and ensure the delivery 
                        of evidence-based services through the 
                        collection, evaluation, and analysis of data 
                        regarding gender-responsive interventions, 
                        disaggregated by age and sex;</DELETED>
                        <DELETED>    ``(ii) identify and replicate 
                        effective models; and</DELETED>
                        <DELETED>    ``(iii) develop gender indicators 
                        to measure outcomes and the impacts of 
                        interventions; and</DELETED>
                <DELETED>    ``(F) establishing appropriate systems 
                to--</DELETED>
                        <DELETED>    ``(i) gather epidemiological and 
                        social science data on HIV; and</DELETED>
                        <DELETED>    ``(ii) evaluate the effectiveness 
                        of prevention efforts among men who have sex 
                        with men, with due consideration to stigma and 
                        risks associated with disclosure.'';</DELETED>
        <DELETED>    (4) in paragraph (5)--</DELETED>
                <DELETED>    (A) by redesignating subparagraph (C) as 
                subparagraph (D); and</DELETED>
                <DELETED>    (B) by inserting after subparagraph (B) 
                the following:</DELETED>
                <DELETED>    ``(C) Mechanism to ensure cost-effective 
                drug purchasing.--Subject to subparagraph (B), 
                mechanisms to ensure that safe and effective 
                pharmaceuticals, including antiretrovirals and 
                medicines to treat opportunistic infections, are 
                purchased at the lowest possible price at which such 
                pharmaceuticals may be obtained in sufficient quantity 
                on the world market.'';</DELETED>
        <DELETED>    (5) in paragraph (6)--</DELETED>
                <DELETED>    (A) by amending the paragraph heading to 
                read as follows:</DELETED>
        <DELETED>    ``(6) Related and coordinated activities.--
        '';</DELETED>
                <DELETED>    (B) in subparagraph (B), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (C) in subparagraph (C), by striking the 
                period at the end and inserting ``; and''; 
                and</DELETED>
                <DELETED>    (D) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(D) coordinated or referred activities 
                to--</DELETED>
                        <DELETED>    ``(i) enhance the clinical impact 
                        of HIV/AIDS care and treatment; and</DELETED>
                        <DELETED>    ``(ii) ameliorate the adverse 
                        social and economic costs often affecting AIDS-
                        impacted families and communities through the 
                        direct provision, as necessary, or through the 
                        referral, if possible, of support services, 
                        including--</DELETED>
                                <DELETED>    ``(I) nutritional and food 
                                support;</DELETED>
                                <DELETED>    ``(II) nutritional 
                                counseling;</DELETED>
                                <DELETED>    ``(III) income-generating 
                                activities and livelihood 
                                initiatives;</DELETED>
                                <DELETED>    ``(IV) maternal and child 
                                health care;</DELETED>
                                <DELETED>    ``(V) primary health 
                                care;</DELETED>
                                <DELETED>    ``(VI) the diagnosis and 
                                treatment of other infectious or 
                                sexually transmitted 
                                diseases;</DELETED>
                                <DELETED>    ``(VII) substance abuse 
                                and treatment services; and</DELETED>
                                <DELETED>    ``(VIII) legal 
                                services;</DELETED>
                <DELETED>    ``(E) coordinated or referred activities 
                to link programs addressing HIV/AIDS with programs 
                addressing gender-based violence in areas of 
                significant HIV prevalence to assist countries in the 
                development and enforcement of women's health, 
                children's health, and HIV/AIDS laws and policies 
                that--</DELETED>
                        <DELETED>    ``(i) prevent and respond to 
                        violence against women and girls;</DELETED>
                        <DELETED>    ``(ii) promote the integration of 
                        screening and assessment for gender-based 
                        violence into HIV/AIDS programming;</DELETED>
                        <DELETED>    ``(iii) promote appropriate HIV/
                        AIDS counseling, testing, and treatment into 
                        gender-based violence programs; and</DELETED>
                        <DELETED>    ``(iv) assist governments to 
                        develop partnerships with civil society 
                        organizations to create networks for 
                        psychosocial, legal, economic, or other support 
                        services;</DELETED>
                <DELETED>    ``(F) coordinated or referred activities 
                to--</DELETED>
                        <DELETED>    ``(i) address the frequent 
                        coinfection of HIV and tuberculosis, in 
                        accordance with World Health Organization 
                        guidelines;</DELETED>
                        <DELETED>    ``(ii) promote provider-initiated 
                        or `opt-out' HIV/AIDS counseling and testing 
                        and appropriate referral for treatment and care 
                        to individuals with tuberculosis or its 
                        symptoms, particularly in areas with 
                        significant HIV prevalence; and</DELETED>
                        <DELETED>    ``(iii) strengthen programs to 
                        ensure that individuals testing positive for 
                        HIV receive tuberculosis screening and 
                        appropriate screening and to improve laboratory 
                        capacities, infection control, and adherence; 
                        and</DELETED>
                <DELETED>    ``(G) activities to--</DELETED>
                        <DELETED>    ``(i) improve the effectiveness of 
                        national responses to HIV/AIDS; and</DELETED>
                        <DELETED>    ``(ii) strengthen overall health 
                        systems in high-prevalence countries, including 
                        support for workforce training, retention, and 
                        effective deployment, capacity building, 
                        laboratory development, equipment maintenance 
                        and repair, and public health and related 
                        public financial management systems and 
                        operations.''; and</DELETED>
        <DELETED>    (6) by adding at the end the following:</DELETED>
        <DELETED>    ``(8) Compacts and framework agreements.--The 
        development of compacts or framework agreements, tailored to 
        local circumstances, with national governments or regional 
        partnerships in countries with significant HIV/AIDS burdens to 
        promote host government commitment to deeper integration of 
        HIV/AIDS services into health systems, contribute to health 
        systems overall, and enhance sustainability.''.</DELETED>
<DELETED>    (d) Compacts and Framework Agreements.--Section 104A of 
such Act is amended--</DELETED>
        <DELETED>    (1) by redesignating subsections (e) through (g) 
        as subsections (f) through (h); and</DELETED>
        <DELETED>    (2) by inserting after subsection (d) the 
        following:</DELETED>
<DELETED>    ``(e) Compacts and Framework Agreements.--</DELETED>
        <DELETED>    ``(1) Findings.--Congress makes the following 
        findings:</DELETED>
                <DELETED>    ``(A) The congressionally mandated 
                Institute of Medicine report entitled `PEPFAR 
                Implementation: Progress and Promise' states: `The next 
                strategy [of the U.S. Global AIDS Initiative] should 
                squarely address the needs and challenges involved in 
                supporting sustainable country HIV/AIDS programs, 
                thereby transitioning from a focus on emergency 
                relief.'.</DELETED>
                <DELETED>    ``(B) One mechanism to promote the 
                transition from an emergency to a public health and 
                development approach to HIV/AIDS is through compacts or 
                framework agreements between the United States 
                Government and each participating nation.</DELETED>
                <DELETED>    ``(C) Key components of a transition 
                toward a more sustainable approach toward fighting HIV/
                AIDS, tuberculosis, and malaria and thus priorities for 
                such compacts include--</DELETED>
                        <DELETED>    ``(i) building capacity to expand 
                        the size of the trained health care workforce 
                        in partner countries and improve its retention, 
                        safety, deployment, and utilization of skills 
                        and to improve public health infrastructure and 
                        systems;</DELETED>
                        <DELETED>    ``(ii) partner governments 
                        increasing their national investments in health 
                        and education systems, as called for in the 
                        Abuja Declaration;</DELETED>
                        <DELETED>    ``(iii) increasing the focus of 
                        United States government efforts to address the 
                        factors that put women and girls at greater 
                        risk of HIV/AIDS and to strengthen the legal, 
                        economic, educational, and social status of 
                        women, girls, orphans, and vulnerable children 
                        and encouraging partner governments to do the 
                        same;</DELETED>
                        <DELETED>    ``(iv) building on the New 
                        Partners Initiative and other efforts currently 
                        underway to strengthen the capacities of 
                        community- and faith-based organizations and 
                        civil society in partner countries to 
                        contribute to country efforts to prevent or 
                        manage the effects of HIV/AIDS, tuberculosis, 
                        and malaria epidemics and to improve health 
                        care delivery;</DELETED>
                        <DELETED>    ``(v) improving the coordination 
                        of efforts to combat HIV/AIDS, tuberculosis, 
                        and malaria with broader national health and 
                        development strategies;</DELETED>
                        <DELETED>    ``(vi) promoting HIV/AIDS-related 
                        laws, regulations, and policies that support 
                        voluntary diagnostic counseling and rapid 
                        testing, pediatric diagnosis, rapid, tariff-
                        free regulatory procedures for drugs and 
                        commodities, and full inclusion of people 
                        living with HIV/AIDS in a multisectoral 
                        national response.</DELETED>
                        <DELETED>    ``(vii) sharing and implementing 
                        findings based on program evaluations and 
                        operations research; and</DELETED>
                        <DELETED>    ``(viii) reducing the disease 
                        burden of HIV/AIDS, tuberculosis, and malaria 
                        through improved prevention efforts.</DELETED>
                <DELETED>    ``(D) Such compacts should also take into 
                account the overall national health and development and 
                national HIV/AIDS and public health strategies of each 
                country and should contain provisions including--
                </DELETED>
                        <DELETED>    ``(i) the specific objectives that 
                        the country and the United States expect to 
                        achieve during the term of a compact;</DELETED>
                        <DELETED>    ``(ii) the respective 
                        responsibilities of the country and the United 
                        States in the achievement of such 
                        objectives;</DELETED>
                        <DELETED>    ``(iii) regular benchmarks to 
                        measure, where appropriate, progress toward 
                        achieving such objectives;</DELETED>
                        <DELETED>    ``(iv) an identification of the 
                        intended beneficiaries, disaggregated by gender 
                        and age, and including information on orphans 
                        and vulnerable children, to the maximum extent 
                        practicable;</DELETED>
                        <DELETED>    ``(v) the methods by which the 
                        compact is intended to address the factors that 
                        put women and girls at greater risk of HIV/AIDS 
                        and to strengthen the legal, economic, 
                        educational, and social status of women, girls, 
                        orphans, and vulnerable children;</DELETED>
                        <DELETED>    ``(vi) the methods by which the 
                        compact will strengthen the health care 
                        capacity, including the training, retention, 
                        deployment, and utilization of health care 
                        workers, improve supply chain management, and 
                        improve the health systems and infrastructure 
                        of the partner country, including the ability 
                        of compact participants to maintain and operate 
                        equipment transferred or purchased as part of 
                        the compact;</DELETED>
                        <DELETED>    ``(vii) proposed mechanisms to 
                        provide oversight;</DELETED>
                        <DELETED>    ``(viii) the role of civil society 
                        in the development of a compact and the 
                        achievement of its objectives;</DELETED>
                        <DELETED>    ``(ix) a description of the 
                        current and potential participation of other 
                        donors in the achievement of such objectives, 
                        as appropriate; and</DELETED>
                        <DELETED>    ``(x) a plan to ensure appropriate 
                        fiscal accountability for the use of 
                        assistance.</DELETED>
        <DELETED>    ``(2) Local input.--In entering into a compact 
        authorized under subsection (d)(8), the Coordinator of United 
        States Government Activities to Combat HIV/AIDS Globally shall 
        seek to ensure that the government of a country--</DELETED>
                <DELETED>    ``(A) takes into account the local 
                perspectives of the rural and urban poor, including 
                women, in each country; and</DELETED>
                <DELETED>    ``(B) consults with private and voluntary 
                organizations, including faith-based organizations, the 
                business community, and other donors in the 
                country.</DELETED>
        <DELETED>    ``(3) Congressional and public notification after 
        entering into a compact.--Not later than 10 days after entering 
        into a compact authorized under subsection (d)(8), the Global 
        AIDS Coordinator shall--</DELETED>
                <DELETED>    ``(A) submit a report containing a 
                detailed summary of the compact and a copy of the text 
                of the compact to--</DELETED>
                        <DELETED>    ``(i) the Committee on Foreign 
                        Relations of the Senate;</DELETED>
                        <DELETED>    ``(ii) the Committee on 
                        Appropriations of the Senate;</DELETED>
                        <DELETED>    ``(iii) the Committee on Foreign 
                        Affairs of the House of Representatives; 
                        and</DELETED>
                        <DELETED>    ``(iv) the Committee on 
                        Appropriations of the House of Representatives; 
                        and</DELETED>
                <DELETED>    ``(B) publish such information in the 
                Federal Register and on the Internet website of the 
                Office of the Global AIDS Coordinator.''.</DELETED>
<DELETED>    (e) Annual Report.--Section 104A(f) of such Act, as 
redesignated, is amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs''; and</DELETED>
        <DELETED>    (2) in paragraph (2)--</DELETED>
                <DELETED>    (A) in subparagraph (B), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) by striking subparagraph (C) and 
                inserting the following:</DELETED>
                <DELETED>    ``(C) a detailed breakdown of funding 
                allocations, by program and by country, for prevention 
                activities; and</DELETED>
                <DELETED>    ``(D) a detailed assessment of the impact 
                of programs established pursuant to such sections, 
                including--</DELETED>
                        <DELETED>    ``(i)(I) the effectiveness of such 
                        programs in reducing--</DELETED>
                                <DELETED>    ``(aa) the transmission of 
                                HIV, particularly in women and 
                                girls;</DELETED>
                                <DELETED>    ``(bb) mother-to-child 
                                transmission of HIV, including through 
                                drug treatment and therapies, either 
                                directly or by referral; and</DELETED>
                                <DELETED>    ``(cc) mortality rates 
                                from HIV/AIDS;</DELETED>
                        <DELETED>    ``(II) the number of patients 
                        receiving treatment for AIDS in each country 
                        that receives assistance under this 
                        Act;</DELETED>
                        <DELETED>    ``(III) an assessment of progress 
                        towards the achievement of annual goals set 
                        forth in the timetable required under the 5-
                        year strategy established under section 101 of 
                        the United States Leadership Against HIV/AIDS, 
                        Tuberculosis, and Malaria Act of 2003 and, if 
                        annual goals are not being met, the reasons for 
                        such failure; and</DELETED>
                        <DELETED>    ``(IV) retention and attrition 
                        data for programs receiving United States 
                        assistance, including mortality and loss to 
                        follow-up rates, organized overall and by 
                        country;</DELETED>
                        <DELETED>    ``(ii) the progress made toward--
                        </DELETED>
                                <DELETED>    ``(I) improving health 
                                care delivery systems (including the 
                                training of health care workers, 
                                including doctors, nurses, midwives, 
                                pharmacists, laboratory technicians, 
                                and compensated community health 
                                workers);</DELETED>
                                <DELETED>    ``(II) advancing safe 
                                working conditions for health care 
                                workers; and</DELETED>
                                <DELETED>    ``(III) improving 
                                infrastructure to promote progress 
                                toward universal access to HIV/AIDS 
                                prevention, treatment, and care by 
                                2013;</DELETED>
                        <DELETED>    ``(iii) with respect to 
                        tuberculosis--</DELETED>
                                <DELETED>    ``(I) the increase in the 
                                number of people treated and the number 
                                of tuberculosis patients cured through 
                                each program, project, or activity 
                                receiving United States foreign 
                                assistance for tuberculosis control 
                                purposes through, or in coordination 
                                with, HIV/AIDS programs;</DELETED>
                                <DELETED>    ``(II) a description of 
                                drug resistance rates among persons 
                                treated;</DELETED>
                                <DELETED>    ``(III) 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; 
                                and</DELETED>
                                <DELETED>    ``(IV) a detailed 
                                description of efforts to integrate 
                                HIV/AIDS and tuberculosis prevention, 
                                treatment, and care programs; 
                                and</DELETED>
                        <DELETED>    ``(iv) a description of 
                        coordination efforts with relevant executive 
                        branch agencies to link HIV/AIDS clinical and 
                        social services with non-HIV/AIDS services as 
                        part of the United States health and 
                        development agenda;</DELETED>
                        <DELETED>    ``(v) a detailed description of 
                        integrated HIV/AIDS and food and nutrition 
                        programs and services, including--</DELETED>
                                <DELETED>    ``(I) the amount spent on 
                                food and nutrition support;</DELETED>
                                <DELETED>    ``(II) the types of 
                                activities supported; and</DELETED>
                                <DELETED>    ``(III) an assessment of 
                                the effectiveness of interventions 
                                carried out to improve the health 
                                status of persons with HIV/AIDS 
                                receiving food or nutritional 
                                support;</DELETED>
                        <DELETED>    ``(vi) a description of efforts to 
                        improve harmonization, in terms of relevant 
                        executive branch agencies, coordination with 
                        other public and private entities, and 
                        coordination with partner countries' national 
                        strategic plans as called for in the `Three 
                        Ones';</DELETED>
                        <DELETED>    ``(vii) a description of--
                        </DELETED>
                                <DELETED>    ``(I) the efforts of 
                                partner countries that were signatories 
                                to the Abuja Declaration on HIV/AIDS, 
                                Tuberculosis and Other Related 
                                Infectious Diseases to adhere to the 
                                goals of such Declaration in terms of 
                                investments in public health, including 
                                HIV/AIDS; and</DELETED>
                                <DELETED>    ``(II) a description of 
                                the HIV/AIDS investments of partner 
                                countries that were not signatories to 
                                such Declaration;</DELETED>
                        <DELETED>    ``(viii) a detailed description of 
                        any compacts or framework agreements reached or 
                        negotiated between the United States and any 
                        partner countries, including a description of 
                        the elements of compacts described in 
                        subsection (e);</DELETED>
                        <DELETED>    ``(ix) a description of programs 
                        serving women and girls, including--</DELETED>
                                <DELETED>    ``(I) HIV/AIDS prevention 
                                programs that address the 
                                vulnerabilities of girls and women to 
                                HIV/AIDS;</DELETED>
                                <DELETED>    ``(II) information on the 
                                number of individuals served by 
                                programs aimed at reducing the 
                                vulnerabilities of women and girls to 
                                HIV/AIDS and data on the types, 
                                objectives, and duration of programs to 
                                address these issues;</DELETED>
                                <DELETED>    ``(III) information on 
                                programs to address the particular 
                                needs of adolescent girls and young 
                                women; and</DELETED>
                                <DELETED>    ``(IV) programs to prevent 
                                gender-based violence or to assist 
                                victims of gender based violence as 
                                part, of or in coordination with, HIV/
                                AIDS programs;</DELETED>
                        <DELETED>    ``(x) a description of strategies, 
                        goals, programs, and interventions to--
                        </DELETED>
                                <DELETED>    ``(I) address the needs 
                                and vulnerabilities of youth 
                                populations;</DELETED>
                                <DELETED>    ``(II) expand access among 
                                young men and women to evidence-based 
                                HIV/AIDS health care services and HIV 
                                prevention programs, including 
                                abstinence education programs; 
                                and</DELETED>
                                <DELETED>    ``(III) expand community-
                                based services to meet the needs of 
                                orphans and of children and adolescents 
                                affected by or vulnerable to HIV/AIDS 
                                without increasing 
                                stigmatization;</DELETED>
                        <DELETED>    ``(xi) a description of--
                        </DELETED>
                                <DELETED>    ``(I) the specific 
                                strategies funded to ensure the 
                                reduction of HIV infection among 
                                injection drug users;</DELETED>
                                <DELETED>    ``(II) the number of 
                                injection drug users, by country, 
                                reached by such strategies;</DELETED>
                                <DELETED>    ``(III) medication-
                                assisted drug treatment for individuals 
                                with HIV or at risk of HIV; 
                                and</DELETED>
                                <DELETED>    ``(IV) HIV prevention 
                                programs demonstrated to be effective 
                                in reducing HIV transmission without 
                                increasing drug use;</DELETED>
                        <DELETED>    ``(xii) a detailed description of 
                        program monitoring, operations research, and 
                        impact evaluation research, including--
                        </DELETED>
                                <DELETED>    ``(I) the amount of 
                                funding provided for each research 
                                type;</DELETED>
                                <DELETED>    ``(II) an analysis of 
                                cost-effectiveness models; 
                                and</DELETED>
                                <DELETED>    ``(III) conclusions 
                                regarding the efficiency, 
                                effectiveness, and quality of services 
                                as derived from previous or ongoing 
                                research and monitoring efforts; 
                                and</DELETED>
                        <DELETED>    ``(xiii) a description of staffing 
                        levels of United States government HIV/AIDS 
                        teams in countries with significant HIV/AIDS 
                        programs, including whether or not a full-time 
                        coordinator was on staff for the 
                        year.''.</DELETED>
<DELETED>    (f) Authorization of Appropriations.--Section 301(b) of 
the United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7631(b)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and</DELETED>
        <DELETED>    (2) in paragraph (3), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013''.</DELETED>
<DELETED>    (g) Relationship To Assistance Programs To Enhance 
Nutrition.--Section 301(c) of such Act is amended to read as 
follows:</DELETED>
<DELETED>    ``(c) Food and Nutritional Support.--</DELETED>
        <DELETED>    ``(1) In general.--As indicated in the report 
        produced by the Institute of Medicine, entitled `PEPFAR 
        Implementation: Progress and Promise', inadequate caloric 
        intake has been clearly identified as a principal reason for 
        failure of clinical response to antiretroviral therapy. In 
        recognition of the impact of malnutrition as a clinical health 
        issue for many persons living with HIV/AIDS that is often 
        associated with health and economic impacts on these 
        individuals and their families, the Global AIDS Coordinator and 
        the Administrator of the United States Agency for International 
        Development shall--</DELETED>
                <DELETED>    ``(A) follow World Health Organization 
                guidelines for HIV/AIDS food and nutrition 
                services;</DELETED>
                <DELETED>    ``(B) integrate nutrition programs with 
                HIV/AIDS activities through effective linkages among 
                the health, agricultural, and livelihood sectors and 
                establish additional services in circumstances in which 
                referrals are inadequate or impossible;</DELETED>
                <DELETED>    ``(C) provide, as a component of care and 
                treatment programs for persons with HIV/AIDS, food and 
                nutritional support to individuals infected with, and 
                affected by, HIV/AIDS who meet established criteria for 
                nutritional support (including clinically malnourished 
                children and adults, and pregnant and lactating women 
                in programs in need of supplemental support), 
                including--</DELETED>
                        <DELETED>    ``(i) anthropometric and dietary 
                        assessment;</DELETED>
                        <DELETED>    ``(ii) counseling; and</DELETED>
                        <DELETED>    ``(iii) therapeutic and 
                        supplementary feeding;</DELETED>
                <DELETED>    ``(D) provide food and nutritional support 
                for children affected by HIV/AIDS and to communities 
                and households caring for children affected by HIV/
                AIDS; and</DELETED>
                <DELETED>    ``(E) in communities where HIV/AIDS and 
                food insecurity are highly prevalent, support programs 
                to address these often intersecting health problems 
                through community-based assistance programs, with an 
                emphasis on sustainable approaches.</DELETED>
        <DELETED>    ``(2) Authorization of appropriations.--Of the 
        amounts authorized to be appropriated under section 401, there 
        are authorized to be appropriated to the President such sums as 
        may be necessary for each of the fiscal years 2009 through 2013 
        to carry out this subsection.''.</DELETED>
<DELETED>    (h) Eligibility for Assistance.--Section 301(d) of such 
Act is amended to read as follows:</DELETED>
<DELETED>    ``(d) Eligibility for Assistance.--An organization, 
including a faith-based organization, that is otherwise eligible to 
receive assistance under section 104A of the Foreign Assistance Act of 
1961, under this Act, or under any amendment made by this Act or by the 
Tom Lantos and Henry J. Hyde United States Global Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, to 
prevent, treat, or monitor HIV/AIDS--</DELETED>
        <DELETED>    ``(1) shall not be required, as a condition of 
        receiving such assistance--</DELETED>
                <DELETED>    ``(A) to endorse or utilize a 
                multisectoral or comprehensive approach to combating 
                HIV/AIDS; or</DELETED>
                <DELETED>    ``(B) to endorse, utilize, make a referral 
                to, become integrated with, or otherwise participate in 
                a prevention method or treatment program to which the 
                organization has a religious or moral objection; 
                and</DELETED>
        <DELETED>    ``(2) shall not be discriminated against in the 
        solicitation or issuance of grants, contracts, or cooperative 
        agreements under such provisions of law for refusing to meet 
        any requirement described in paragraph (1).''.</DELETED>

<DELETED>SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.</DELETED>

<DELETED>    (a) Policy.--Section 104B(b) of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151b-3(b)) is amended to read as follows:</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) Reduce by half the tuberculosis death and 
        disease burden from the 1990 baseline.</DELETED>
        <DELETED>    ``(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 those cases 
        detected.''.</DELETED>
<DELETED>    (b) Priority To Stop TB Strategy.--Section 104B(e) of such 
Act is amended to read as follows:</DELETED>
<DELETED>    ``(e) Priority To Stop TB Strategy.--In furnishing 
assistance under subsection (c), the President shall give priority to--
</DELETED>
        <DELETED>    ``(1) activities described in the Stop TB 
        Strategy, including expansion and enhancement of Directly 
        Observed Treatment Short-course (DOTS) coverage, rapid testing, 
        treatment for individuals infected with both tuberculosis and 
        HIV, and treatment for individuals with multi-drug resistant 
        tuberculosis (MDR-TB), strengthening of health systems, use of 
        the International Standards for Tuberculosis Care by all 
        providers, empowering individuals with tuberculosis, and 
        enabling and promoting research to develop new diagnostics, 
        drugs, and vaccines, and program-based operational research 
        relating to tuberculosis; and</DELETED>
        <DELETED>    ``(2) funding for the Global Tuberculosis Drug 
        Facility, the Stop Tuberculosis Partnership, and the Global 
        Alliance for TB Drug Development.''.</DELETED>
<DELETED>    (c) Assistance for the World Health Organization and the 
Stop Tuberculosis Partnership.--Section 104B of such Act is amended--
</DELETED>
        <DELETED>    (1) by redesignating subsection (f) as subsection 
        (g); and</DELETED>
        <DELETED>    (2) by inserting after subsection (e) the 
        following:</DELETED>
<DELETED>    ``(f) Assistance for the World Health Organization and the 
Stop Tuberculosis Partnership.--In carrying out this section, the 
President, acting through the Administrator of the United States Agency 
for International Development, is authorized to provide increased 
resources to the World Health Organization and the Stop Tuberculosis 
Partnership to improve the capacity of countries with high rates of 
tuberculosis and other affected countries to implement the Stop TB 
Strategy and specific strategies related to addressing multiple drug 
resistant tuberculosis (MDR-TB) and extensively drug resistant 
tuberculosis (XDR-TB).''.</DELETED>
<DELETED>    (d) Definitions.--Section 104B(g) of such Act, as 
redesignated, is amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking the period at 
        the end and inserting the following: ``including--</DELETED>
                <DELETED>    ``(A) low-cost and effective diagnosis, 
                treatment, and monitoring of tuberculosis;</DELETED>
                <DELETED>    ``(B) a reliable drug supply;</DELETED>
                <DELETED>    ``(C) a management strategy for public 
                health systems;</DELETED>
                <DELETED>    ``(D) health system 
                strengthening;</DELETED>
                <DELETED>    ``(E) promotion of the use of the 
                International Standards for Tuberculosis Care by all 
                care providers;</DELETED>
                <DELETED>    ``(F) bacteriology under an external 
                quality assessment framework;</DELETED>
                <DELETED>    ``(G) short-course chemotherapy; 
                and</DELETED>
                <DELETED>    ``(H) sound reporting and recording 
                systems.''; and</DELETED>
        <DELETED>    (2) by redesignating paragraph (5) as paragraph 
        (6); and</DELETED>
        <DELETED>    (3) by inserting after paragraph (4) the 
        following:</DELETED>
        <DELETED>    ``(5) Stop tb strategy.--The term `Stop TB 
        Strategy' means the 6-point strategy to reduce tuberculosis 
        developed by the World Health Organization, which is described 
        in the Global Plan to Stop TB 2006-2015: Actions for Life, a 
        comprehensive plan developed by the Stop TB Partnership that 
        sets out the actions necessary to achieve the millennium 
        development goal of cutting tuberculosis deaths and disease 
        burden in half by 2015.''.</DELETED>
<DELETED>    (e) 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--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``such sums as 
        may be necessary for each of the fiscal years 2004 through 
        2008'' and inserting ``a total of $4,000,000,000 for the 5-year 
        period beginning on October 1, 2008.''; and</DELETED>
        <DELETED>    (2) in paragraph (3), by striking ``fiscal years 
        2004 through 2008'' and inserting ``fiscal years 2009 through 
        2013.''.</DELETED>

<DELETED>SEC. 303. ASSISTANCE TO COMBAT MALARIA.</DELETED>

<DELETED>    (a) Amendment to the Foreign Assistance Act of 1961.--
Section 104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-
4(b)) is amended by inserting ``treatment,'' after 
``control,''.</DELETED>
<DELETED>    (b) Authorization of Appropriations.--Section 303 of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
</DELETED>
        <DELETED>    (1) in subsection (b)--</DELETED>
                <DELETED>    (A) in paragraph (1), by striking ``such 
                sums as may be necessary for fiscal years 2004 through 
                2008'' and inserting ``$5,000,000,000 during the 5-year 
                period beginning on October 1, 2008''; and</DELETED>
                <DELETED>    (B) in paragraph (3), by striking ``fiscal 
                years 2004 through 2008'' and inserting ``fiscal years 
                2009 through 2013''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
<DELETED>    ``(c) Statement of Policy.--Providing assistance for the 
prevention, control, treatment, and the ultimate eradication of malaria 
is--</DELETED>
        <DELETED>    ``(1) a major objective of the foreign assistance 
        program of the United States; and</DELETED>
        <DELETED>    ``(2) 1 component of a comprehensive United States 
        global health strategy to reduce disease burdens and strengthen 
        communities around the world.</DELETED>
<DELETED>    ``(d) Development of a Comprehensive 5-Year Strategy.--The 
President shall establish a comprehensive, 5-year strategy to combat 
global malaria that--</DELETED>
        <DELETED>    ``(1) strengthens the capacity of the United 
        States to be an effective leader of international efforts to 
        reduce malaria burden;</DELETED>
        <DELETED>    ``(2) maintains sufficient flexibility and remains 
        responsive to the ever-changing nature of the global malaria 
        challenge;</DELETED>
        <DELETED>    ``(3) includes specific objectives and 
        multisectoral approaches and strategies to reduce the 
        prevalence, mortality, incidence, and spread of 
        malaria;</DELETED>
        <DELETED>    ``(4) describes how this strategy would contribute 
        to the United States' overall global health and development 
        goals;</DELETED>
        <DELETED>    ``(5) clearly explains how outlined activities 
        will interact with other United States Government global health 
        activities, including the 5-year global AIDS strategy required 
        under this Act;</DELETED>
        <DELETED>    ``(6) expands public-private partnerships and 
        leverage of resources;</DELETED>
        <DELETED>    ``(7) coordinates among relevant Federal agencies 
        to maximize human and financial resources and to reduce 
        duplication among these agencies, foreign governments, and 
        international organizations;</DELETED>
        <DELETED>    ``(8) coordinates with other international 
        entities, including the Global Fund;</DELETED>
        <DELETED>    ``(9) maximizes United States capabilities in the 
        areas of technical assistance and training and research, 
        including vaccine research; and</DELETED>
        <DELETED>    ``(10) establishes priorities and selection 
        criteria for the distribution of resources based on factors 
        such as--</DELETED>
                <DELETED>    ``(A) the size and demographics of the 
                population with malaria;</DELETED>
                <DELETED>    ``(B) the needs of that 
                population;</DELETED>
                <DELETED>    ``(C) the country's existing 
                infrastructure; and</DELETED>
                <DELETED>    ``(D) the ability to closely coordinate 
                United States Government efforts with national malaria 
                control plans of partner countries.''.</DELETED>

<DELETED>SEC. 304. MALARIA RESPONSE COORDINATOR.</DELETED>

<DELETED>    Section 304 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended 
to read as follows:</DELETED>

<DELETED>``SEC. 304. MALARIA RESPONSE COORDINATOR.</DELETED>

<DELETED>    ``(a) In General.--There is established within the United 
States Agency for International Development a Coordinator of United 
States Government Activities to Combat Malaria Globally (referred to in 
this section as the `Malaria Coordinator'), who shall be appointed by 
the President.</DELETED>
<DELETED>    ``(b) Authorities.--The Malaria Coordinator, acting 
through nongovernmental organizations (including faith-based and 
community-based organizations), partner country finance, health, and 
other relevant ministries, and relevant executive branch agencies as 
may be necessary and appropriate to carry out this section, is 
authorized to--</DELETED>
        <DELETED>    ``(1) operate internationally to carry out 
        prevention, care, treatment, support, capacity development, and 
        other activities to reduce the prevalence, mortality, and 
        incidence of malaria;</DELETED>
        <DELETED>    ``(2) provide grants to, and enter into contracts 
        and cooperative agreements with, nongovernmental organizations 
        (including faith-based organizations) to carry out this 
        section; and</DELETED>
        <DELETED>    ``(3) transfer and allocate executive branch 
        agency funds that have been appropriated for the purposes 
        described in paragraphs (1) and (2).</DELETED>
<DELETED>    ``(c) Duties.--</DELETED>
        <DELETED>    ``(1) In general.--The Malaria Coordinator has 
        primary responsibility for the oversight and coordination of 
        all resources and international activities of the United States 
        Government relating to efforts to combat malaria.</DELETED>
        <DELETED>    ``(2) Specific duties.--The Malaria Coordinator 
        shall--</DELETED>
                <DELETED>    ``(A) facilitate program and policy 
                coordination of antimalaria efforts among relevant 
                executive branch agencies and nongovernmental 
                organizations by auditing, monitoring, and evaluating 
                such programs;</DELETED>
                <DELETED>    ``(B) ensure that each relevant executive 
                branch agency undertakes antimalarial programs 
                primarily in those areas in which the agency has the 
                greatest expertise, technical capability, and potential 
                for success;</DELETED>
                <DELETED>    ``(C) coordinate relevant executive branch 
                agency activities in the field of malaria prevention 
                and treatment;</DELETED>
                <DELETED>    ``(D) coordinate planning, implementation, 
                and evaluation with the Global AIDS Coordinator in 
                countries in which both programs have a significant 
                presence;</DELETED>
                <DELETED>    ``(E) coordinate with national 
                governments, international agencies, civil society, and 
                the private sector; and</DELETED>
                <DELETED>    ``(F) establish due diligence criteria for 
                all recipients of funds appropriated by the Federal 
                Government for malaria assistance.</DELETED>
<DELETED>    ``(d) Assistance for the World Health Organization.--In 
carrying out this section, the President may provide financial 
assistance to the Roll Back Malaria Partnership of the World Health 
Organization to improve the capacity of countries with high rates of 
malaria and other affected countries to implement comprehensive malaria 
control programs.</DELETED>
<DELETED>    ``(e) Coordination of Assistance Efforts.--In carrying out 
this section and in accordance with section 104C of the Foreign 
Assistance Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator 
shall coordinate the provision of assistance by working with--
</DELETED>
        <DELETED>    ``(1) relevant executive branch agencies, 
        including--</DELETED>
                <DELETED>    ``(A) the Department of State (including 
                the Office of the Global AIDS Coordinator);</DELETED>
                <DELETED>    ``(B) the Department of Health and Human 
                Services;</DELETED>
                <DELETED>    ``(C) the Department of Defense; 
                and</DELETED>
                <DELETED>    ``(D) the Office of the United States 
                Trade Representative;</DELETED>
        <DELETED>    ``(2) relevant multilateral institutions, 
        including--</DELETED>
                <DELETED>    ``(A) the World Health 
                Organization;</DELETED>
                <DELETED>    ``(B) the United Nations Children's 
                Fund;</DELETED>
                <DELETED>    ``(C) the United Nations Development 
                Programme;</DELETED>
                <DELETED>    ``(D) the Global Fund;</DELETED>
                <DELETED>    ``(E) the World Bank; and</DELETED>
                <DELETED>    ``(F) the Roll Back Malaria 
                Partnership;</DELETED>
        <DELETED>    ``(3) program delivery and efforts to lift 
        barriers that would impede effective and comprehensive malaria 
        control programs; and</DELETED>
        <DELETED>    ``(4) partner or recipient country governments and 
        national entities including universities and civil society 
        organizations (including faith- and community-based 
        organizations).</DELETED>
<DELETED>    ``(f) Research.--To carry out this section and in 
accordance with section 104C of the Foreign Assistance Act of 1961 (22 
U.S.C. 1151d-4), the Secretary of Health and Human Services, through 
the Centers for Disease Control and Prevention and the National 
Institutes of Health, shall conduct appropriate programmatically 
relevant clinical and operational research to identify and evaluate new 
diagnostics, treatment regimens, and interventions to prevent and 
control malaria.</DELETED>
<DELETED>    ``(g) Monitoring.--To ensure that adequate malaria 
controls are established and implemented, the Centers for Disease 
Control and Prevention shall carry out appropriate surveillance and 
evaluation activities to monitor global malaria trends and assess 
environmental and health impacts of malarial control efforts.</DELETED>
<DELETED>    ``(h) Annual Report.--</DELETED>
        <DELETED>    ``(1) Submission.--Not later than 1 year after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, and annually 
        thereafter, the President shall submit a report to the 
        appropriate congressional committees that describes United 
        States assistance for the prevention, treatment, control, and 
        elimination of malaria.</DELETED>
        <DELETED>    ``(2) Contents.--The report required under 
        paragraph (1) shall describe--</DELETED>
                <DELETED>    ``(A) the countries and activities to 
                which malaria resources have been allocated;</DELETED>
                <DELETED>    ``(B) the number of people reached through 
                malaria assistance programs, including data on children 
                and pregnant women;</DELETED>
                <DELETED>    ``(C) research efforts to develop new 
                tools to combat malaria, including drugs and 
                vaccines;</DELETED>
                <DELETED>    ``(D) the collaboration and coordination 
                of United States antimalarial efforts with the World 
                Health Organization, the Global Fund, the World Bank, 
                other donor governments, major private efforts, and 
                relevant executive agencies;</DELETED>
                <DELETED>    ``(E) the coordination of United States 
                antimalarial efforts with the national malarial 
                strategies of other donor or partner governments and 
                major private initiatives;</DELETED>
                <DELETED>    ``(F) the estimated impact of United 
                States assistance on childhood mortality and morbidity 
                from malaria;</DELETED>
                <DELETED>    ``(G) the coordination of antimalarial 
                efforts with broader health and development programs; 
                and</DELETED>
                <DELETED>    ``(H) the constraints on implementation of 
                programs posed by health workforce shortages or 
                capacities; and</DELETED>
                <DELETED>    ``(I) the number of personnel trained as 
                health workers and the training levels 
                achieved.''.</DELETED>

<DELETED>SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY 
              ACT.</DELETED>

<DELETED>    Section 212(a)(1)(A)(i) of the Immigration and Nationality 
Act (8 U.S.C. 1182(a)(1)(A)(i)) is amended by striking ``, which shall 
include infection with the etiologic agent for acquired immune 
deficiency syndrome,'' and inserting a semicolon.</DELETED>

<DELETED>SEC. 306. CLERICAL AMENDMENT.</DELETED>

<DELETED>    Title III of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is 
amended by striking the heading for subtitle B and inserting the 
following:</DELETED>

      <DELETED>``Subtitle B--Assistance for Women, Children, and 
                         Families''.</DELETED>

<DELETED>SEC. 308. REQUIREMENTS.</DELETED>

<DELETED>    Section 312(b) of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is 
amended by striking paragraphs (1), (2), and (3) and inserting the 
following:</DELETED>
        <DELETED>    ``(1) establish a target for the prevention and 
        treatment of mother-to-child transmission of HIV that, by 2013, 
        will reach at least 80 percent of pregnant women in those 
        countries most affected by HIV/AIDS in which the United States 
        has HIV/AIDS programs;</DELETED>
        <DELETED>    ``(2) establish a target that, by 2013, the 
        proportion of children receiving care and treatment under this 
        Act is proportionate to their numbers within the population of 
        HIV infected individuals in each country;</DELETED>
        <DELETED>    ``(3) integrate care and treatment with prevention 
        of mother-to-child transmission of HIV programs to improve 
        outcomes for HIV-affected women and families as soon as is 
        feasible and support strategies that promote successful follow-
        up and continuity of care of mother and child;</DELETED>
        <DELETED>    ``(4) expand programs designed to care for 
        children orphaned by, affected by, or vulnerable to HIV/
        AIDS;</DELETED>
        <DELETED>    ``(5) ensure that women in prevention of mother-
        to-child transmission of HIV programs are provided with, or 
        referred to, appropriate maternal and child services; 
        and</DELETED>
        <DELETED>    ``(6) develop a timeline for expanding access to 
        more effective regimes to prevent mother-to-child transmission 
        of HIV, consistent with the national policies of countries in 
        which programs are administered under this Act and the goal of 
        achieving universal use of such regimes as soon as 
        possible.''.</DELETED>

<DELETED>SEC. 309. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD 
              TRANSMISSION OF HIV.</DELETED>

<DELETED>    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''.</DELETED>

            <DELETED>TITLE IV--FUNDING ALLOCATIONS</DELETED>

<DELETED>SEC. 401. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    Section 401(a) of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7671(a)) is 
amended by striking ``$3,000,000,000 for each of the fiscal years 2004 
through 2008'' and inserting ``$50,000,000,000 for the 5-year period 
beginning on October 1, 2008''.</DELETED>

<DELETED>SEC. 402. SENSE OF CONGRESS.</DELETED>

<DELETED>    Section 402(b) of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) is 
amended by striking ``an effective distribution of such amounts would 
be'' and all that follows through ``10 percent of such amounts'' and 
inserting ``10 percent should be used''.</DELETED>

<DELETED>SEC. 403. ALLOCATION OF FUNDS.</DELETED>

<DELETED>    Section 403 of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is 
amended--</DELETED>
        <DELETED>    (1) by amending subsection (a) to read as 
        follows:</DELETED>
<DELETED>    ``(a) Balanced Funding Requirement.--</DELETED>
        <DELETED>    ``(1) In general.--The Global AIDS Coordinator 
        shall--</DELETED>
                <DELETED>    ``(A) provide balanced funding for 
                prevention activities for sexual transmission of HIV/
                AIDS; and</DELETED>
                <DELETED>    ``(B) 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.</DELETED>
        <DELETED>    ``(2) Prevention strategy.--</DELETED>
                <DELETED>    ``(A) Establishment.--In carrying out 
                paragraph (1), the Global AIDS Coordinator shall 
                establish a HIV sexual transmission prevention strategy 
                governing the expenditure of funds authorized under 
                this Act to prevent the sexual transmission of HIV in 
                any host country with a generalized epidemic.</DELETED>
                <DELETED>    ``(B) Report.--In each host country 
                described in subparagraph (A), if the strategy 
                established under subparagraph (A) provides less than 
                50 percent of the funds described in subparagraph (A) 
                for behavioral change programs, including abstinence, 
                delay of sexual debut, monogamy, fidelity, and partner 
                reduction, the Global AIDS Coordinator shall, not later 
                than 30 days after the issuance of this strategy, 
                report to the appropriate congressional committees on 
                the justification for this decision.</DELETED>
        <DELETED>    ``(3) Exclusion.--Programs and activities that 
        implement or purchase new prevention technologies or 
        modalities, such as medical male circumcision, pre-exposure 
        pharmaceutical prophylaxis to prevent transmission of HIV, or 
        microbicides and programs and activities that provide 
        counseling and testing for HIV or prevent mother-to-child 
        prevention of HIV, shall not be included in determining 
        compliance with paragraph (2).</DELETED>
        <DELETED>    ``(4) Report.--Not later than 1 year after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, and annually 
        thereafter as part of the annual report required under section 
        104A(e) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-
        2(e)), the President shall--</DELETED>
                <DELETED>    ``(A) submit a report on the 
                implementation of paragraph (2) for the most recently 
                concluded fiscal year to the appropriate congressional 
                committees; and</DELETED>
                <DELETED>    ``(B) make the report described in 
                subparagraph (A) available to the public.''; 
                and</DELETED>
        <DELETED>    (2) in subsection (b)--</DELETED>
                <DELETED>    (A) by striking ``fiscal years 2006 
                through 2008'' and inserting ``fiscal years 2009 
                through 2013''; and</DELETED>
                <DELETED>    (B) by striking ``vulnerable children 
                affected by'' and inserting ``other children affected 
                by, or vulnerable to,''.</DELETED>

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
Sec. 5. Authority to consolidate and combine reports.

               TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of an updated, comprehensive, 5-year, global 
                            strategy.
Sec. 102. Interagency working group.
Sec. 103. Sense of Congress.

TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

Sec. 201. Voluntary contributions to international vaccine funds.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis 
                            and Malaria.
Sec. 203. Research on methods for women to prevent transmission of HIV 
                            and other diseases.
Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
                            strengthening health policies and health 
                            systems of partner countries.
Sec. 205. Facilitating effective operations of the Centers for Disease 
                            Control.
Sec. 206. Facilitating vaccine development.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Malaria Response Coordinator.
Sec. 305. Amendment to Immigration and Nationality Act.
Sec. 306. Clerical amendment.
Sec. 307. Requirements.
Sec. 308. Annual report on prevention of mother-to-child transmission 
                            of HIV.
Sec. 309. Prevention of mother-to-child transmission expert panel.

                     TITLE IV--FUNDING ALLOCATIONS

Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.

SEC. 2. FINDINGS.

    Section 2 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is amended by 
adding at the end the following:
            ``(29) On May 27, 2003, the President signed this Act into 
        law, launching the largest international public health program 
        of its kind ever created.
            ``(30) Between 2003 and 2008, the United States, through 
        the President's Emergency Plan for AIDS Relief (PEPFAR) and in 
        conjunction with other bilateral programs and the multilateral 
        Global Fund has helped to--
                    ``(A) provide antiretroviral therapy for over 
                1,900,000 people;
                    ``(B) ensure that over 150,000 infants, most of 
                whom would have likely been infected with HIV during 
                pregnancy or childbirth, were not infected; and
                    ``(C) provide palliative care and HIV prevention 
                assistance to millions of other people.
            ``(31) While United States leadership in the battles 
        against HIV/AIDS, tuberculosis, and malaria has had an enormous 
        impact, these diseases continue to take a terrible toll on the 
        human race.
            ``(32) According to the 2007 AIDS Epidemic Update of the 
        Joint United Nations Programme on HIV/AIDS (UNAIDS)--
                    ``(A) an estimated 2,100,000 people died of AIDS-
                related causes in 2007; and
                    ``(B) an estimated 2,500,000 people were newly 
                infected with HIV during that year.
            ``(33) According to the World Health Organization, malaria 
        kills more than 1,000,000 people per year, 70 percent of whom 
        are children under 5 years of age.
            ``(34) According to the World Health Organization, \1/3\ of 
        the world's population is infected with the tuberculosis 
        bacterium, and tuberculosis is 1 of the greatest infectious 
        causes of death of adults worldwide, killing 1,600,000 people 
        per year.
            ``(35) Efforts to promote abstinence, fidelity, the correct 
        and consistent use of condoms, the delay of sexual debut, and 
        the reduction of concurrent sexual partners represent important 
        elements of strategies to prevent the transmission of HIV/AIDS.
            ``(36) According to UNAIDS--
                    ``(A) women and girls make up nearly 60 percent of 
                persons in sub-Saharan Africa who are HIV positive;
                    ``(B) women and girls are more biologically, 
                economically, and socially vulnerable to HIV infection; 
                and
                    ``(C) gender issues are critical components in the 
                effort to prevent HIV/AIDS and to care for those 
                affected by the disease.
            ``(37) Children who have lost a parent to HIV/AIDS, who are 
        otherwise directly affected by the disease, or who live in 
        areas of high HIV prevalence may be vulnerable to the disease 
        or its socioeconomic effects.
            ``(38) Lack of health capacity, including insufficient 
        personnel and inadequate infrastructure, in sub-Saharan Africa 
        and other regions of the world is a critical barrier that 
        limits the effectiveness of efforts to combat HIV/AIDS, 
        tuberculosis, and malaria, and to achieve other global health 
        goals.
            ``(39) On March 30, 2007, the Institute of Medicine of the 
        National Academies released a report entitled `PEPFAR 
        Implementation: Progress and Promise', which found that budget 
        allocations setting percentage levels for spending on 
        prevention, care, and treatment and for certain subsets of 
        activities within the prevention category--
                    ``(A) have `adversely affected implementation of 
                the U.S. Global AIDS Initiative';
                    ``(B) have inhibited comprehensive, integrated, 
                evidence based approaches;
                    ``(C) `have been counterproductive';
                    ``(D) `may have been helpful initially in ensuring 
                a balance of attention to activities within the 4 
                categories of prevention, treatment, care, and orphans 
                and vulnerable children';
                    ``(E) `have also limited PEPFAR's ability to tailor 
                its activities in each country to the local epidemic 
                and to coordinate with the level of activities in the 
                countries' national plans'; and
                    ``(F) should be removed by Congress and replaced 
                with more appropriate mechanisms that--
                            ``(i) `ensure accountability for results 
                        from Country Teams to the U.S. Global AIDS 
                        Coordinator and to Congress'; and
                            ``(ii) `ensure that spending is directly 
                        linked to and commensurate with necessary 
                        efforts to achieve both country and overall 
                        performance targets for prevention, treatment, 
                        care, and orphans and vulnerable children'.
            ``(40) The United States Government has endorsed the 
        principles of harmonization in coordinating efforts to combat 
        HIV/AIDS commonly referred to as the `Three Ones', which 
        includes--
                    ``(A) 1 agreed HIV/AIDS action framework that 
                provides the basis for coordination of the work of all 
                partners;
                    ``(B) 1 national HIV/AIDS coordinating authority, 
                with a broadbased multisectoral mandate; and
                    ``(C) 1 agreed HIV/AIDS country-level monitoring 
                and evaluating system.
            ``(41) In the Abuja Declaration on HIV/AIDS, Tuberculosis 
        and Other Related Infectious Diseases, of April 26-27, 2001 
        (referred to in this Act as the `Abuja Declaration'), the Heads 
        of State and Government of the Organization of African Unity 
        (OAU)--
                    ``(A) declared that they would `place the fight 
                against HIV/AIDS at the forefront and as the highest 
                priority issue in our respective national development 
                plans';
                    ``(B) committed `TO TAKE PERSONAL RESPONSIBILITY 
                AND PROVIDE LEADERSHIP for the activities of the 
                National AIDS Commissions/Councils';
                    ``(C) resolved `to lead from the front the battle 
                against HIV/AIDS, Tuberculosis and Other Related 
                Infectious Diseases by personally ensuring that such 
                bodies were properly convened in mobilizing our 
                societies as a whole and providing focus for unified 
                national policymaking and programme implementation, 
                ensuring coordination of all sectors at all levels with 
                a gender perspective and respect for human rights, 
                particularly to ensure equal rights for people living 
                with HIV/AIDS'; and
                    ``(D) pledged `to set a target of allocating at 
                least 15% of our annual budget to the improvement of 
                the health sector'.''.

SEC. 3. DEFINITIONS.

    Section 3 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is amended--
            (1) in paragraph (2), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs of the House of Representatives, the Committee on 
        Appropriations of the Senate, and the Committee on 
        Appropriations'';
            (2) by redesignating paragraph (6) as paragraph (12);
            (3) by redesignating paragraphs (3) through (5), as 
        paragraphs (4) through (6), respectively;
            (4) by inserting after paragraph (2) the following:
            ``(3) Global aids coordinator.--The term `Global AIDS 
        Coordinator' means the Coordinator of United States Government 
        Activities to Combat HIV/AIDS Globally.'';
            (5) by inserting after paragraph (6), as redesignated, the 
        following:
            ``(7) Impact evaluation research.--The term `impact 
        evaluation research' means the application of research methods 
        and statistical analysis to measure the extent to which change 
        in a population-based outcome can be attributed to program 
        intervention instead of other environmental factors.
            ``(8) Operations research.--The term `operations research' 
        means the application of social science research methods and 
        statistical analysis to judge, compare, and improve policies 
        and program outcomes, from the earliest stages of defining and 
        designing programs through their development and 
        implementation, with the objective of the rapid dissemination 
        of conclusions and concrete impact on programming.
            ``(9) Paraprofessional.--The term `paraprofessional' means 
        an individual who is trained and employed as a health agent for 
        the provision of basic assistance in the identification, 
        prevention, or treatment of illness or disability.
            ``(10) Partner government.--The term `partner government' 
        means a government with which the United States is working to 
        provide assistance to combat HIV/AIDS, tuberculosis, or malaria 
        on behalf of people living within the jurisdiction of such 
        government.
            ``(11) Program monitoring.--The term `program monitoring' 
        means the collection, analysis, and use of routine program data 
        to determine--
                    ``(A) how well a program is carried out; and
                    ``(B) how much the program costs.''; and
            (6) by inserting after paragraph (12), as redesignated, the 
        following:
            ``(13) Structural hiv prevention.--The term `structural HIV 
        prevention' means activities or programs designed to--
                    ``(A) address environmental factors that could 
                create conditions conducive to the spread of HIV; and
                    ``(B) determine the best ways to remedy such 
                factors by enhancing life skills and promoting changes 
                in laws, policies, and social norms.''.

SEC. 4. PURPOSE.

    Section 4 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7603) is amended to 
read as follows:

``SEC. 4. PURPOSE.

    ``The purpose of this Act is to strengthen and enhance United 
States leadership and the effectiveness of the United States response 
to the HIV/AIDS, tuberculosis, and malaria pandemics and other related 
and preventable infectious diseases as part of the overall United 
States health and development agenda by--
            ``(1) establishing comprehensive, coordinated, and 
        integrated 5-year, global strategies to combat HIV/AIDS, 
        tuberculosis, and malaria by--
                    ``(A) building on progress and successes to date;
                    ``(B) improving harmonization of United States 
                efforts with national strategies of partner governments 
                and other public and private entities; and
                    ``(C) emphasizing capacity building initiatives in 
                order to promote a transition toward greater 
                sustainability through the support of country-driven 
                efforts;
            ``(2) providing increased resources for bilateral and 
        multilateral efforts to fight HIV/AIDS, tuberculosis, and 
        malaria as integrated components of United States development 
        assistance;
            ``(3) intensifying efforts to--
                    ``(A) prevent HIV infection;
                    ``(B) ensure the continued support for, and 
                expanded access to, treatment and care programs;
                    ``(C) enhance the effectiveness of prevention, 
                treatment, and care programs; and
                    ``(D) address the particular vulnerabilities of 
                girls and women;
            ``(4) encouraging the expansion of private sector efforts 
        and expanding public-private sector partnerships to combat HIV/
        AIDS, tuberculosis, and malaria;
            ``(5) reinforcing efforts to--
                    ``(A) develop safe and effective vaccines, 
                microbicides, and other prevention and treatment 
                technologies; and
                    ``(B) improve diagnostics capabilities for HIV/
                AIDS, tuberculosis, and malaria; and
            ``(6) helping partner countries to--
                    ``(A) strengthen health systems;
                    ``(B) improve human health capacity; and
                    ``(C) address infrastructural weaknesses.''.

SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

    Section 5 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7604) is amended by 
inserting ``, with the exception of the 5-year strategy'' before the 
period at the end.

               TITLE I--POLICY PLANNING AND COORDINATION

SEC. 101. DEVELOPMENT OF AN UPDATED, COMPREHENSIVE, 5-YEAR, GLOBAL 
              STRATEGY.

    (a) Strategy.--Section 101(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7611(a)) is amended to read as follows:
    ``(a) Strategy.--The President shall establish a comprehensive, 
integrated, 5-year strategy to expand and improve efforts to combat 
global HIV/AIDS. This strategy shall--
            ``(1) further strengthen the capability of the United 
        States to be an effective leader of the international campaign 
        against this disease and strengthen the capacities of nations 
        experiencing HIV/AIDS epidemics to combat this disease;
            ``(2) maintain sufficient flexibility and remain responsive 
        to--
                    ``(A) changes in the epidemic;
                    ``(B) challenges facing partner countries in 
                developing and implementing an effective national 
                response; and
                    ``(C) evidence-based improvements and innovations 
                in the prevention, care, and treatment of HIV/AIDS;
            ``(3) situate United States efforts to combat HIV/AIDS, 
        tuberculosis, and malaria within the broader United States 
        global health and development agenda, establishing a roadmap to 
        link investments in specific disease programs to the broader 
        goals of strengthening health systems and infrastructure and to 
        integrate and coordinate HIV/AIDS, tuberculosis, or malaria 
        programs with other health or development programs, as 
        appropriate;
            ``(4) provide a plan to--
                    ``(A) prevent 12,000,000 new HIV infections 
                worldwide;
                    ``(B) support treatment of at least 3,000,000 
                individuals with HIV/AIDS and support additional 
                treatment through coordinated multilateral efforts;
                    ``(C) support care for 12,000,000 individuals with 
                HIV/AIDS, including 5,000,000 orphans and vulnerable 
                children affected by HIV/AIDS, with an emphasis on 
                promoting a comprehensive, coordinated system of 
                services to be integrated throughout the continuum of 
                care;
                    ``(D) help partner countries in the effort to 
                achieve goals of 80 percent access to counseling, 
                testing, and treatment to prevent the transmission of 
                HIV from mother to child, emphasizing a continuum of 
                care model;
                    ``(E) help partner countries to provide care and 
                treatment services to children with HIV in proportion 
                to their percentage within the HIV-infected population 
                in each country;
                    ``(F) promote preservice training for health 
                professionals designed to strengthen the capacity of 
                institutions to develop and implement policies for 
                training health workers to combat HIV/AIDS, 
                tuberculosis, and malaria;
                    ``(G) equip teachers with skills needed for HIV/
                AIDS prevention, treatment, and care;
                    ``(H) provide and share best practices for 
                combating HIV/AIDS with health professionals; and
                    ``(I) help partner countries to train and support 
                retention of health care professionals and 
                paraprofessionals, with the target of training and 
                retaining at least 140,000 new health care 
                professionals and paraprofessionals and to strengthen 
                capacities in developing countries, especially in sub-
                Saharan Africa, to deliver primary health care with the 
                objective of helping countries achieve staffing levels 
                of at least 2.3 doctors, nurses, and midwives per 1,000 
                population, as called for by the World Health 
                Organization;
            ``(5) include multisectoral approaches and specific 
        strategies to treat individuals infected with HIV/AIDS and to 
        prevent the further transmission of HIV infections, with a 
        particular focus on the needs of families with children 
        (including the prevention of mother-to-child transmission), 
        women, young people, orphans, and vulnerable children;
            ``(6) establish a timetable with annual global treatment 
        targets;
            ``(7) expand the integration of timely and relevant 
        research within the prevention, care, and treatment of HIV/
        AIDS;
            ``(8) include a plan for program monitoring, operations 
        research, and impact evaluation and for the dissemination of a 
        best practices report to highlight findings;
            ``(9) provide for consultation with local leaders and 
        officials to develop prevention strategies and programs that 
        are tailored to the unique needs of each country and community 
        and targeted particularly toward those most at risk of 
        acquiring HIV infection;
            ``(10) make the reduction of HIV/AIDS behavioral risks a 
        priority of all prevention efforts by--
                    ``(A) promoting abstinence from sexual activity and 
                encouraging monogamy and faithfulness;
                    ``(B) encouraging the correct and consistent use of 
                male and female condoms and increasing the availability 
                of, and access to, these commodities;
                    ``(C) promoting the delay of sexual debut and the 
                reduction of multiple concurrent sexual partners;
                    ``(D) promoting education for discordant couples 
                (where an individual is infected with HIV and the other 
                individual is uninfected or whose status is unknown) 
                about safer sex practices;
                    ``(E) promoting voluntary counseling and testing, 
                addiction therapy, and other prevention and treatment 
                tools for illicit injection drug users and other 
                substance abusers;
                    ``(F) educating men and boys about the risks of 
                procuring sex commercially and about the need to end 
                violent behavior toward women and girls;
                    ``(G) supporting comprehensive programs to promote 
                alternative livelihoods, safety, and social 
                reintegration strategies for commercial sex workers and 
                their families;
                    ``(H) promoting cooperation with law enforcement to 
                prosecute offenders of trafficking, rape, and sexual 
                assault crimes with the goal of eliminating such 
                crimes; and
                    ``(I) working to eliminate rape, gender-based 
                violence, sexual assault, and the sexual exploitation 
                of women and children;
            ``(11) include programs to reduce the transmission of HIV 
        through structural prevention efforts, particularly addressing 
        the heightened vulnerabilities of women and girls to HIV in 
        many countries; and
            ``(12) support other important means of preventing or 
        reducing the transmission of HIV, including--
                    ``(A) medical male circumcision;
                    ``(B) the maintenance of a safe blood supply; and
                    ``(C) other mechanisms to reduce the transmission 
                of HIV;
            ``(13) increase support for prevention of mother-to-child 
        transmission;
            ``(14) build capacity within the public health sector of 
        developing countries by improving health systems and public 
        health infrastructure and developing indicators to measure 
        changes in broader public health sector capabilities;
            ``(15) increase the coordination of HIV/AIDS programs with 
        development programs;
            ``(16) provide a framework for expanding or developing 
        existing or new country or regional programs, including--
                    ``(A) drafting compacts or other agreements, as 
                appropriate;
                    ``(B) establishing criteria and objectives for such 
                compacts and agreements; and
                    ``(C) promoting sustainability;
            ``(17) provide a plan for national and regional priorities 
        for resource distribution and a global investment plan by 
        region;
            ``(18) provide a plan to address the immediate and ongoing 
        needs of women and girls, which--
                    ``(A) addresses the vulnerabilities that contribute 
                to their elevated risk of infection;
                    ``(B) includes specific goals and targets to 
                address these factors;
                    ``(C) provides clear guidance to field missions to 
                integrate gender across prevention, care, and treatment 
                programs;
                    ``(D) sets forth gender-specific indicators to 
                monitor progress on outcomes and impacts of gender 
                programs;
                    ``(E) supports efforts in countries in which women 
                or orphans lack inheritance rights and other 
                fundamental protections to promote the passage, 
                implementation, and enforcement of such laws;
                    ``(F) supports life skills training and other 
                structural prevention activities, especially among 
                women and girls, with the goal of reducing 
                vulnerabilities to HIV/AIDS;
                    ``(G) addresses and prevents gender-based violence; 
                and
                    ``(H) addresses the posttraumatic and psychosocial 
                consequences and provides postexposure prophylaxis 
                protecting against HIV infection to victims of gender-
                based violence and rape;
            ``(19) provide a plan to address the vulnerabilities and 
        needs of orphans and children who are vulnerable to, or 
        affected by, HIV/AIDS;
            ``(20) provide a framework to work with international 
        actors and partner countries toward universal access to HIV/
        AIDS prevention, treatment, and care programs, recognizing that 
        prevention is of particular importance in terms of sequencing;
            ``(21) enhance the coordination of United States bilateral 
        efforts to combat global HIV/AIDS with other major public and 
        private entities;
            ``(22) enhance the attention given to the national 
        strategic HIV/AIDS plans of countries receiving United States 
        assistance by--
                    ``(A) reviewing the planning and programmatic 
                decisions associated with that assistance; and
                    ``(B) helping to strengthen such national 
                strategies, if necessary;
            ``(23) support activities described in the Global Plan to 
        Stop TB, including--
                    ``(A) expanding and enhancing the coverage of the 
                Directly Observed Treatment Short-course (DOTS) in 
                order to treat individuals infected with tuberculosis 
                and HIV, including multi-drug resistant or extensively 
                drug resistant tuberculosis; and
                    ``(B) improving coordination and integration of 
                HIV/AIDS and tuberculosis programming;
            ``(24) ensure coordination between the Global AIDS 
        Coordinator and the Malaria Coordinator and address issues of 
        comorbidity between HIV/AIDS and malaria; and
            ``(25) include a longer term estimate of the projected 
        resource needs, progress toward greater sustainability and 
        country ownership of HIV/AIDS programs, and the anticipated 
        role of the United States in the global effort to combat HIV/
        AIDS during the 10-year period beginning on October 1, 2013.''.
    (b) Report.--Section 101(b) of such Act (22 U.S.C. 7611(b)) is 
amended to read as follows:
    ``(b) Report.--
            ``(1) In general.--Not later than October 1, 2009, the 
        President shall submit a report to the appropriate 
        congressional committees that sets forth the strategy described 
        in subsection (a).
            ``(2) Contents.--The report required under paragraph (1) 
        shall include a discussion of the following elements:
                    ``(A) The purpose, scope, methodology, and general 
                and specific objectives of the strategy.
                    ``(B) The problems, risks, and threats to the 
                successful pursuit of the strategy.
                    ``(C) The desired goals, objectives, activities, 
                and outcome-related performance measures of the 
                strategy.
                    ``(D) A description of future costs and resources 
                needed to carry out the strategy.
                    ``(E) A delineation of United States Government 
                roles, responsibility, and coordination mechanisms of 
                the strategy.
                    ``(F) A description of the strategy--
                            ``(i) to promote harmonization of United 
                        States assistance with that of other 
                        international, national, and private actors as 
                        elucidated in the `Three Ones'; and
                            ``(ii) to address existing challenges in 
                        harmonization and alignment.
                    ``(G) A description of the manner in which the 
                strategy will--
                            ``(i) further the development and 
                        implementation of the national multisectoral 
                        strategic HIV/AIDS frameworks of partner 
                        governments; and
                            ``(ii) enhance the centrality, 
                        effectiveness, and sustainability of those 
                        national plans.
                    ``(H) A description of how the strategy will seek 
                to achieve the specific targets described in subsection 
                (a) and other targets, as appropriate.
                    ``(I) A description of, and rationale for, the 
                timetable for annual global treatment targets.
                    ``(J) A description of how operations research is 
                addressed in the strategy and how such research can 
                most effectively be integrated into care, treatment, 
                and prevention activities in order to--
                            ``(i) improve program quality and 
                        efficiency;
                            ``(ii) ascertain cost effectiveness;
                            ``(iii) ensure transparency and 
                        accountability;
                            ``(iv) assess population-based impact;
                            ``(v) disseminate findings and best 
                        practices; and
                            ``(vi) optimize delivery of services.
                    ``(K) An analysis of United States-assisted 
                strategies to prevent the transmission of HIV/AIDS, 
                including methodologies to promote abstinence, 
                monogamy, faithfulness, the correct and consistent use 
                of male and female condoms, reductions in concurrent 
                sexual partners, and delay of sexual debut, and of 
                intended monitoring and evaluation approaches to 
                measure the effectiveness of prevention programs and 
                ensure that they are targeted to appropriate audiences.
                    ``(L) Within the analysis required under 
                subparagraph (J), an examination of additional planned 
                means of preventing the transmission of HIV including 
                medical male circumcision, maintenance of a safe blood 
                supply, and other tools.
                    ``(M) A description of the specific targets, goals, 
                and strategies developed to address the needs and 
                vulnerabilities of women and girls to HIV/AIDS, 
                including--
                            ``(i) structural prevention activities;
                            ``(ii) activities directed toward men and 
                        boys;
                            ``(iii) activities to enhance educational, 
                        microfinance, and livelihood opportunities for 
                        women and girls;
                            ``(iv) activities to promote and protect 
                        the legal empowerment of women, girls, and 
                        orphans and vulnerable children;
                            ``(v) programs targeted toward gender-based 
                        violence and sexual coercion;
                            ``(vi) strategies to meet the particular 
                        needs of adolescents;
                            ``(vii) assistance for victims of rape, 
                        sexual abuse, assault, exploitation, and 
                        trafficking; and
                            ``(viii) programs to prevent alcohol abuse.
                    ``(N) A description of strategies--
                            ``(i) to address the needs of orphans and 
                        vulnerable children, including an analysis of--
                                    ``(I) factors contributing to 
                                children's vulnerability to HIV/AIDS; 
                                and
                                    ``(II) vulnerabilities caused by 
                                the impact of HIV/AIDS on children and 
                                their families; and
                            ``(ii) in areas of higher HIV/AIDS 
                        prevalence, to promote a community-based 
                        approach to vulnerability, maximizing community 
                        input into determining which children 
                        participate.
                    ``(O) A description of capacity-building efforts 
                undertaken by countries themselves, including adherents 
                of the Abuja Declaration and an assessment of the 
                impact of International Monetary Fund macroeconomic and 
                fiscal policies on national and donor investments in 
                health.
                    ``(P) A description of the strategy to--
                            ``(i) strengthen capacity building within 
                        the public health sector;
                            ``(ii) improve health care in those 
                        countries;
                            ``(iii) help countries to develop and 
                        implement national health workforce strategies;
                            ``(iv) strive to achieve goals in training, 
                        retaining, and effectively deploying health 
                        staff;
                            ``(v) promote ethical recruiting practices 
                        for health care workers; and
                            ``(vi) increase the sustainability of 
                        health programs.
                    ``(Q) A description of the criteria for selection, 
                objectives, methodology, and structure of compacts or 
                other framework agreements with countries or regional 
                organizations, including--
                            ``(i) the role of civil society;
                            ``(ii) the degree of transparency;
                            ``(iii) benchmarks for success of such 
                        compacts or agreements; and
                            ``(iv) the relationship between such 
                        compacts or agreements and the national HIV/
                        AIDS and public health strategies and 
                        commitments of partner countries.
                    ``(R) A strategy to better coordinate HIV/AIDS 
                assistance with nutrition and food assistance programs.
                    ``(S) A description of transnational or regional 
                initiatives to combat regionalized epidemics in highly 
                affected areas such as the Caribbean.
                    ``(T) A description of planned resource 
                distribution and global investment by region.
                    ``(U) A description of coordination efforts in 
                order to better implement the Stop TB Strategy and to 
                address the problem of coinfection of HIV/AIDS and 
                tuberculosis and of projected challenges or barriers to 
                successful implementation.
                    ``(V) A description of coordination efforts to 
                address malaria and comorbidity with malaria and HIV/
                AIDS.''.
    (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) is 
amended to read as follows:
    ``(c) Study of Progress Toward Achievement of Policy Objectives.--
            ``(1) Design and budget plan for data evaluation.--The 
        Global AIDS Coordinator shall enter into a contract with the 
        Institute of Medicine of the National Academies that provides 
        that not later than 18 months after the date of the enactment 
        of the Tom Lantos and Henry J. Hyde United States Global 
        Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, the Institute, in consultation 
        with the Global AIDS Coordinator and other relevant parties 
        representing the public and private sector, shall provide the 
        Global AIDS Coordinator with a design plan and budget for the 
        evaluation and collection of baseline and subsequent data to 
        address the elements set forth in paragraph (2)(B). The Global 
        AIDS Coordinator shall submit the budget and design plan to the 
        appropriate congressional committees.
            ``(2) Study.--
                    ``(A) In general.--Not later than 4 years after the 
                date of the enactment of the Tom Lantos and Henry J. 
                Hyde United States Global Leadership Against HIV/AIDS, 
                Tuberculosis, and Malaria Reauthorization Act of 2008, 
                the Institute of Medicine of the National Academies 
                shall publish a study that includes--
                            ``(i) an assessment of the performance of 
                        United States-assisted global HIV/AIDS 
                        programs; and
                            ``(ii) an evaluation of the impact on 
                        health of prevention, treatment, and care 
                        efforts that are supported by United States 
                        funding, including multilateral and bilateral 
                        programs involving joint operations.
                    ``(B) Content.--The study conducted under this 
                paragraph shall include--
                            ``(i) an assessment of progress toward 
                        prevention, treatment, and care targets;
                            ``(ii) an assessment of the effects on 
                        health systems, including on the financing and 
                        management of health systems and the quality of 
                        service delivery and staffing;
                            ``(iii) an assessment of efforts to address 
                        gender-specific aspects of HIV/AIDS, including 
                        gender related constraints to accessing 
                        services and addressing underlying social and 
                        economic vulnerabilities of women and men;
                            ``(iv) an evaluation of the impact of 
                        treatment and care programs on 5-year survival 
                        rates, drug adherence, and the emergence of 
                        drug resistance;
                            ``(v) an evaluation of the impact of 
                        prevention programs on HIV incidence in 
                        relevant population groups;
                            ``(vi) an evaluation of the impact on child 
                        health and welfare of interventions authorized 
                        under this Act on behalf of orphans and 
                        vulnerable children;
                            ``(vii) an evaluation of the impact of 
                        programs and activities authorized in this Act 
                        on child mortality; and
                            ``(viii) recommendations for improving the 
                        programs referred to in subparagraph (A)(i).
                    ``(C) Methodologies.--Assessments and impact 
                evaluations conducted under the study shall utilize 
                sound statistical methods and techniques for the 
                behavioral sciences, including random assignment 
                methodologies as feasible. Qualitative data on process 
                variables should be used for assessments and impact 
                evaluations, wherever possible.
            ``(3) Contract authority.--The Institute of Medicine may 
        enter into contracts or cooperative agreements or award grants 
        to conduct the study under paragraph (2).
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated such sums as may be necessary to 
        carry out the study under this subsection.''.
    (d) Report.--Section 101 of such Act, as amended by this section, 
is further amended by adding at the end the following:
    ``(d) Comptroller General Report.--
            ``(1) Report required.--Not later than 3 years after the 
        date of the enactment of the Tom Lantos and Henry J. Hyde 
        United States Global Leadership Against HIV/AIDS, Tuberculosis, 
        and Malaria Reauthorization Act of 2008, the Comptroller 
        General of the United States shall submit a report on the 
        global HIV/AIDS programs of the United States to the 
        appropriate congressional committees.
            ``(2) Contents.--The report required under paragraph (1) 
        shall include--
                    ``(A) a description and assessment of the 
                monitoring and evaluation practices and policies in 
                place for these programs;
                    ``(B) an assessment of coordination within Federal 
                agencies involved in these programs, examining both 
                internal coordination within these programs and 
                integration with the larger global health and 
                development agenda of the United States;
                    ``(C) an assessment of procurement policies and 
                practices within these programs;
                    ``(D) an assessment of harmonization with national 
                government HIV/AIDS and public health strategies as 
                well as other international efforts;
                    ``(E) an assessment of the impact of global HIV/
                AIDS funding and programs on other United States global 
                health programming; and
                    ``(F) recommendations for improving the global HIV/
                AIDS programs of the United States.
    ``(e) Best Practices Report.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, and annually thereafter, the 
        Global AIDS Coordinator shall publish a best practices report 
        that highlights the programs receiving financial assistance 
        from the United States that have the potential for replication 
        or adaption, particularly at a low cost, across global AIDS 
        programs, including those that focus on both generalized and 
        localized epidemics.
            ``(2) Dissemination of findings.--
                    ``(A) Publication on internet website.--The Global 
                AIDS Coordinator shall disseminate the full findings of 
                the annual best practices report on the Internet 
                website of the Office of the Global AIDS Coordinator.
                    ``(B) Dissemination guidance.--The Global AIDS 
                Coordinator shall develop guidance to ensure timely 
                submission and dissemination of significant information 
                regarding best practices with respect to global AIDS 
                programs.
    ``(f) Inspectors General.--
            ``(1) Oversight plan.--
                    ``(A) Development.--The Inspectors General of the 
                Department of State and Broadcasting Board of 
                Governors, the Department of Health and Human Services, 
                and the United States Agency for International 
                Development shall jointly develop 5 coordinated annual 
                plans for oversight activity in each of the fiscal 
                years 2009 through 2013, with regard to the programs 
                authorized under this Act and sections 104A, 104B, and 
                104C of the Foreign Assistance Act of 1961 (22 U.S.C. 
                2151b-2, 2151b-3, and 2151b-4).
                    ``(B) Contents.--The plans developed under 
                subparagraph (A) shall include a schedule for financial 
                audits, inspections, and performance reviews, as 
                appropriate.
                    ``(C) Deadline.--
                            ``(i) Initial plan.--The first plan 
                        developed under subparagraph (A) shall be 
                        completed not later than the later of--
                                    ``(I) September 1, 2008; or
                                    ``(II) 60 days after the date of 
                                the enactment of the Tom Lantos and 
                                Henry J. Hyde United States Global 
                                Leadership Against HIV/AIDS, 
                                Tuberculosis, and Malaria 
                                Reauthorization Act of 2008.
                            ``(ii) Subsequent plans.--Each of the last 
                        four plans developed under subparagraph (A) 
                        shall be completed not later than 30 days 
                        before each of the fiscal years 2010 through 
                        2013, respectively.
            ``(2) Coordination.--In order to avoid duplication and 
        maximize efficiency, the Inspectors General described in 
        paragraph (1) shall coordinate their activities with--
                    ``(A) the Government Accountability Office; and
                    ``(B) the Inspectors General of the Department of 
                Commerce, the Department of Defense, the Department of 
                Labor, and the Peace Corps, as appropriate, pursuant to 
                the 2004 Memorandum of Agreement Coordinating Audit 
                Coverage of Programs and Activities Implementing the 
                President's Emergency Plan for AIDS Relief, or any 
                successor agreement.
            ``(3) Funding.--The Global AIDS Coordinator and the 
        Coordinator of the United States Government Activities to 
        Combat Malaria Globally shall make available necessary funds 
        not exceeding $10,000,000 during the 5-year period beginning on 
        October 1, 2008 to the Inspectors General described in 
        paragraph (1) for the audits, inspections, and reviews 
        described in that paragraph.''.

SEC. 102. INTERAGENCY WORKING GROUP.

    Section 1(f)(2) of the State Department Basic Authorities Act of 
1956 (22 U.S.C. 2651a(f)(2)) is amended--
            (1) in subparagraph (A), by inserting ``, partner country 
        finance, health, and other relevant ministries,'' after 
        ``community based organizations)'' each place it appears;
            (2) in subparagraph (B)(ii)--
                    (A) by striking subclauses (IV) and (V);
                    (B) by inserting after subclause (III) the 
                following:
                                    ``(IV) Establishing an interagency 
                                working group on HIV/AIDS headed by the 
                                Global AIDS Coordinator and comprised 
                                of representatives from the United 
                                States Agency for International 
                                Development and the Department of 
                                Health and Human Services, for the 
                                purposes of coordination of activities 
                                relating to HIV/AIDS, including--
                                            ``(aa) meeting regularly to 
                                        review progress in partner 
                                        countries toward HIV/AIDS 
                                        prevention, treatment, and care 
                                        objectives;
                                            ``(bb) participating in the 
                                        process of identifying 
                                        countries to consider for 
                                        increased assistance based on 
                                        the epidemiology of HIV/AIDS in 
                                        those countries, including 
                                        clear evidence of a public 
                                        health threat, as well as 
                                        government commitment to 
                                        address the HIV/AIDS problem, 
                                        relative need, and coordination 
                                        and joint planning with other 
                                        significant actors;
                                            ``(cc) assisting the 
                                        Coordinator in the evaluation, 
                                        execution, and oversight of 
                                        country operational plans;
                                            ``(dd) reviewing policies 
                                        that may be obstacles to 
                                        reaching targets set forth for 
                                        HIV/AIDS prevention, treatment, 
                                        and care; and
                                            ``(ee) consulting with 
                                        representatives from additional 
                                        relevant agencies, including 
                                        the National Institutes of 
                                        Health, the Health Resources 
                                        and Services Administration, 
                                        the Department of Labor, the 
                                        Department of Agriculture, the 
                                        Millennium Challenge 
                                        Corporation, the Peace Corps, 
                                        and the Department of Defense.
                                    ``(V) Coordinating overall United 
                                States HIV/AIDS policy and programs, 
                                including ensuring the coordination of 
                                relevant executive branch agency 
                                activities in the field, with efforts 
                                led by partner countries, and with the 
                                assistance provided by other relevant 
                                bilateral and multilateral aid agencies 
                                and other donor institutions to promote 
                                harmonization with other programs aimed 
                                at preventing and treating HIV/AIDS and 
                                other health challenges, improving 
                                primary health, addressing food 
                                security, promoting education and 
                                development, and strengthening health 
                                care systems.'';
                    (C) by redesignating subclauses (VII) and VIII) as 
                subclauses (IX) and (XII), respectively;
                    (D) by inserting after subclause (VI) the 
                following:
                                    ``(VII) Holding annual 
                                consultations with nongovernmental 
                                organizations in partner countries that 
                                provide services to improve health, and 
                                advocating on behalf of the individuals 
                                with HIV/AIDS and those at particular 
                                risk of contracting HIV/AIDS, including 
                                organizations with members who are 
                                living with HIV/AIDS.
                                    ``(VIII) Ensuring, through 
                                interagency and international 
                                coordination, that HIV/AIDS programs of 
                                the United States are coordinated with, 
                                and complementary to, the delivery of 
                                related global health, food security, 
                                development, and education.'';
                    (E) in subclause (IX), as redesignated by 
                subparagraph (C)--
                            (i) by inserting ``Vietnam,'' after 
                        ``Uganda,'';
                            (ii) by inserting after ``of 2003'' the 
                        following: ``and other countries in which the 
                        United States is implementing HIV/AIDS programs 
                        as part of its foreign assistance program''; 
                        and
                            (iii) by adding at the end the following: 
                        ``In designating additional countries under 
                        this subparagraph, the President shall give 
                        priority to those countries in which there is a 
                        high prevalence or significantly rising 
                        incidence of HIV/AIDS, countries with large 
                        populations and inadequate health 
                        infrastructure, countries in which a 
                        concentrated HIV/AIDS epidemic could become 
                        generalized to the entire population of the 
                        country, and in countries whose governments 
                        demonstrate a commitment to combating HIV/
                        AIDS.'';
                    (F) by inserting after subclause (IX), as 
                redesignated by subparagraph (C), the following:
                                    ``(X) Working with partner 
                                countries in which the HIV/AIDS 
                                epidemic is prevalent among injection 
                                drug users to establish, as a national 
                                priority, national HIV/AIDS prevention 
                                programs, including education and 
                                services demonstrated to be effective 
                                in reducing the transmission of HIV 
                                infection among injection drug users 
                                without increasing illicit drug use.
                                    ``(XI) Working with partner 
                                countries in which the HIV/AIDS 
                                epidemic is prevalent among individuals 
                                involved in commercial sex acts to 
                                establish, as a national priority, 
                                national prevention programs, including 
                                education, voluntary testing, and 
                                counseling, and referral systems that 
                                link HIV/AIDS programs with programs to 
                                eradicate trafficking in persons and 
                                support alternatives to 
                                prostitution.'';
                    (G) in subclause (XII), as redesignated by 
                subparagraph (C), by striking ``funds section'' and 
                inserting ``funds appropriated for HIV/ AIDS assistance 
                pursuant to the authorization of appropriations under 
                section 401 of the United States Leadership Against 
                HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
                U.S.C. 7671)''; and
                    (H) by adding at the end the following:
                                    ``(XIII) Publicizing updated drug 
                                pricing data to inform the purchasing 
                                decisions of pharmaceutical procurement 
                                partners.''.

SEC. 103. SENSE OF CONGRESS.

    Section 102 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7612) is amended by 
adding at the end the following:
    ``(d) Sense of Congress.--It is the sense of Congress that--
            ``(1) full-time country level coordinators, preferably with 
        management experience, should head each HIV/AIDS country team 
        for United States missions overseeing significant HIV/AIDS 
        programs;
            ``(2) foreign service nationals provide critically 
        important services in the design and implementation of United 
        States country-level HIV/AIDS programs and their skills and 
        experience as public health professionals should be recognized 
        within hiring and compensation practices; and
            ``(3) staffing levels for United States country-level HIV/
        AIDS teams should be adequately maintained to fulfill oversight 
        and other obligations of the positions.''.

TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE 
                              PARTNERSHIPS

SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE FUNDS.

    Section 302 of the Foreign Assistance Act of 1961 (22 U.S.C. 2222) 
is amended--
            (1) by inserting after subsection (c) the following:
    ``(d) Tuberculosis Vaccine Development Programs.--In addition to 
amounts otherwise available under this section, there are authorized to 
be appropriated to the President such sums as may be necessary for each 
of the fiscal years 2009 through 2013, which shall be used for United 
States contributions to tuberculosis vaccine development programs, 
which may include the Aeras Global TB Vaccine Foundation.'';
            (2) in subsection (k), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013'';
            (3) in subsection (l), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
            (4) in subsection (m), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''.

SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS 
              AND MALARIA.

    (a) Findings; Sense of Congress.--Section 202(a) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7622(a)) is amended to read as follows:
    ``(a) Findings; Sense of Congress.--
            ``(1) Findings.--Congress makes the following findings:
                    ``(A) The establishment of the Global Fund in 
                January 2002 is consistent with the general principles 
                for an international AIDS trust fund first outlined by 
                Congress in the Global AIDS and Tuberculosis Relief Act 
                of 2000 (Public Law 106-264).
                    ``(B) The Global Fund is an innovative financing 
                mechanism which--
                            ``(i) has made progress in many areas in 
                        combating HIV/AIDS, tuberculosis, and malaria; 
                        and
                            ``(ii) represents the multilateral 
                        component of this Act, extending United States 
                        efforts to more than 130 countries around the 
                        world.
                    ``(C) The Global Fund and United States bilateral 
                assistance programs--
                            ``(i) are demonstrating increasingly 
                        effective coordination, with each possessing 
                        certain comparative advantages in the fight 
                        against HIV/AIDS, tuberculosis, and malaria; 
                        and
                            ``(ii) often work most effectively in 
                        concert with each other.
                    ``(D) The United States Government--
                            ``(i) is the largest supporter of the 
                        Global Fund in terms of resources and technical 
                        support;
                            ``(ii) made the founding contribution to 
                        the Global Fund; and
                            ``(iii) is fully committed to the success 
                        of the Global Fund as a multilateral public-
                        private partnership.
            ``(2) Sense of congress.--It is the sense of Congress 
        that--
                    ``(A) transparency and accountability are crucial 
                to the long-term success and viability of the Global 
                Fund;
                    ``(B) the Global Fund has made significant progress 
                toward addressing concerns raised by the Government 
                Accountability Office by--
                            ``(i) improving risk assessment and risk 
                        management capabilities;
                            ``(ii) providing clearer guidance for and 
                        oversight of Local Fund Agents; and
                            ``(iii) strengthening the Office of the 
                        Inspector General for the Global Fund;
                    ``(C) the provision of sufficient resources and 
                authority to the Office of the Inspector General for 
                the Global Fund to ensure that office has the staff and 
                independence necessary to carry out its mandate will be 
                a measure of the commitment of the Global Fund to 
                transparency and accountability;
                    ``(D) regular, publicly published financial, 
                programmatic, and reporting audits of the Fund, its 
                grantees, and Local Fund Agents are also important 
                benchmarks of transparency;
                    ``(E) the Global Fund should establish and maintain 
                a system to track--
                            ``(i) the amount of funds disbursed to each 
                        subrecipient on the grant's fiscal cycle; and
                            ``(ii) the distribution of resources, by 
                        grant and principal recipient, for prevention, 
                        care, treatment, drug and commodity purchases, 
                        and other purposes;
                    ``(F) relevant national authorities in recipient 
                countries should exempt from duties and taxes all 
                products financed by Global Fund grants and procured by 
                any principal recipient or subrecipient for the purpose 
                of carrying out such grants;
                    ``(G) the Global Fund, UNAIDS, and the Global AIDS 
                Coordinator should work together to standardize program 
                indicators wherever possible; and
                    ``(H) for purposes of evaluating total amounts of 
                funds contributed to the Global Fund under subsection 
                (d)(4)(A)(i), the timetable for evaluations of 
                contributions from sources other than the United States 
                should take into account the fiscal calendars of other 
                major contributors.''.
    (b) United States Financial Participation.--Section 202(d) of such 
Act (22 U.S.C. 7622(d)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``$1,000,000,000 for the period of 
                fiscal year 2004 beginning on January 1, 2004'' and 
                inserting ``$2,000,000,000 for fiscal year 2009,''; and
                    (B) by striking ``the fiscal years 2005-2008'' and 
                inserting ``each of the fiscal years 2010 through 
                2013'';
            (2) in paragraph (4)--
                    (A) in subparagraph (A)--
                            (i) in clause (i), by striking ``fiscal 
                        years 2004 through 2008'' and inserting 
                        ``fiscal years 2009 through 2013'';
                            (ii) in clause (ii), by striking ``during 
                        any of the fiscal years 2004 through 2008'' and 
                        inserting ``during any of the 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 ``prior to fiscal 
                                year 2004'' and inserting ``before 
                                fiscal year 2009'';
                    (B) in subparagraph (B)(iv), by striking ``fiscal 
                years 2004 through 2008'' and inserting ``fiscal years 
                2009 through 2013''; and
                    (C) in subparagraph (C)(ii), by striking 
                ``Committee on International Relations'' and inserting 
                ``Committee on Foreign Affairs''; and
            (3) by adding at the end the following:
            ``(5) Withholding funds.--Notwithstanding any other 
        provision of this Act, 20 percent of the amounts appropriated 
        pursuant to this Act for a contribution to support the Global 
        Fund for each of the fiscal years 2010 through 2013 shall be 
        withheld from obligation to the Global Fund until the Secretary 
        of State certifies to the appropriate congressional committees 
        that the Global Fund--
                    ``(A) has established an evaluation framework for 
                the performance of Local Fund Agents (referred to in 
                this paragraph as `LFAs');
                    ``(B) is undertaking a systematic assessment of the 
                performance of LFAs;
                    ``(C) 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 principal recipients and subrecipients;
                    ``(D) is maintaining an independent, well-staffed 
                Office of the Inspector General that--
                            ``(i) reports directly to the Board of the 
                        Global Fund; and
                            ``(ii) is responsible for regular, publicly 
                        published audits of financial, programmatic, 
                        and reporting aspects of the Global Fund, its 
                        grantees, and LFAs;
                    ``(E) has established, and is reporting publicly 
                on, standard indicators for all program areas;
                    ``(F) has established a methodology to track and is 
                reporting on--
                            ``(i) all subrecipients and the amount of 
                        funds disbursed to each subrecipient on the 
                        grant's fiscal cycle; and
                            ``(ii) the distribution of resources, by 
                        grant and principal recipient, for prevention, 
                        care, treatment, drugs and commodities 
                        purchase, and other purposes;
                    ``(G) has established a policy on tariffs imposed 
                by national governments on all goods and services 
                financed by the Global Fund;
                    ``(H) through its Secretariat, has taken meaningful 
                steps to prevent national authorities in recipient 
                countries from imposing taxes or tariffs on goods or 
                services provided by the Fund;
                    ``(I) is maintaining its status as a financing 
                institution focused on programs directly related to 
                HIV/AIDS, malaria, and tuberculosis; and
                    ``(J) is maintaining and making progress on--
                            ``(i) sustaining its multisectoral 
                        approach, through country coordinating 
                        mechanisms; and
                            ``(ii) the implementation of grants, as 
                        reflected in the proportion of resources 
                        allocated to different sectors, including 
                        governments, civil society, and faith- and 
                        community-based organizations.''.

SEC. 203. RESEARCH ON METHODS FOR WOMEN TO PREVENT TRANSMISSION OF HIV 
              AND OTHER DISEASES.

    (a) Sense of Congress.--Congress recognizes the need and urgency to 
expand the range of interventions for preventing the transmission of 
human immunodeficiency virus (HIV), including nonvaccine prevention 
methods that can be controlled by women.
    (b) NIH Office of AIDS Research.--Subpart 1 of part D of title 
XXIII of the Public Health Service Act (42 U.S.C. 300cc-40 et seq.) is 
amended by inserting after section 2351 the following:

``SEC. 2351A. MICROBICIDE RESEARCH.

    ``(a) Federal Strategic Plan.--
            ``(1) In general.--The Director of the Office shall--
                    ``(A) expedite the implementation of the Federal 
                strategic plans for the conduct and support of research 
                on, and development of, a microbicide for use in 
                developing countries to prevent the transmission of the 
                human immunodeficiency virus; and
                    ``(B) annually review and, as appropriate, revise 
                such plan to prioritize funding and activities relative 
                to their scientific urgency and potential market 
                readiness.
            ``(2) Coordination.--In implementing, reviewing, and 
        prioritizing elements of the plan described in paragraph (1), 
        the Director of the Office shall consult with--
                    ``(A) representatives of other Federal agencies 
                involved in microbicide research, including the 
                Coordinator of United States Government Activities to 
                Combat HIV/AIDS Globally, the Director of the Centers 
                for Disease Control and Prevention, and the 
                Administrator of the United States Agency for 
                International Development;
                    ``(B) the microbicide research and development 
                community; and
                    ``(C) health advocates.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of the fiscal years 
2009 through 2013 to carry out this section.''.
    (c) National Institute of Allergy and Infectious Diseases.--Subpart 
6 of part C of title IV of the Public Health Service Act (42 U.S.C. 
285f et seq.) is amended by adding at the end the following:

``SEC. 447C. MICROBICIDE RESEARCH AND DEVELOPMENT.

    ``The Director of the Institute, acting through the head of the 
Division of AIDS, shall carry out research on, and development of, a 
microbicide for use in developing countries to prevent the transmission 
of the human immunodeficiency virus. The Director shall ensure that 
there are a sufficient number of employees and structure dedicated to 
carrying out such activities.''.
    (d) CDC.--Part B of title III of the Public Health Service Act (42 
U.S.C. 243 et seq.) is amended by inserting after section 317S the 
following:

``SEC. 317T. MICROBICIDE RESEARCH.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention shall fully implement the Centers' microbicide agenda to 
support research and development of microbicides for use in developing 
countries to prevent the transmission of the human immunodeficiency 
virus.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2009 through 2013 to carry out this section.''.
    (e) United States Agency for International Development.--
            (1) In general.--The Administrator of the United States 
        Agency for International Development, in coordination with the 
        Coordinator of United States Government Activities to Combat 
        HIV/AIDS Globally, shall develop and implement a program to 
        facilitate availability and accessibility of microbicides that 
        prevent the transmission of HIV if such microbicides are proven 
        safe and effective.
            (2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401 of the United 
        States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there are 
        authorized to be appropriated to the President such sums as may 
        be necessary for each of the fiscal years 2009 through 2013 to 
        carry out this subsection.

SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.

    (a) In General.--Title II of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7621) is 
amended by adding at the end the following:

``SEC. 204. COMBATING HIV/AIDS, TUBERCULOSIS, AND MALARIA BY 
              STRENGTHENING HEALTH POLICIES AND HEALTH SYSTEMS OF 
              PARTNER COUNTRIES.

    ``(a) Statement of Policy.--It shall be the policy of the United 
States Government--
            ``(1) to invest appropriate resources authorized under this 
        Act--
                    ``(A) to carry out activities to strengthen HIV/
                AIDS, tuberculosis, and malaria health policies and 
                health systems; and
                    ``(B) to provide workforce training and capacity-
                building consistent with the goals and objectives of 
                this Act; and
            ``(2) to support the development of a sound policy 
        environment in partner countries to increase the ability of 
        such countries--
                    ``(A) to maximize utilization of health care 
                resources from donor countries;
                    ``(B) to increase national investments in health 
                and education and maximize the effectiveness of such 
                investments;
                    ``(C) to improve national HIV/AIDS, tuberculosis, 
                and malaria strategies;
                    ``(D) to deliver evidence-based services in an 
                effective and efficient manner; and
                    ``(E) to reduce barriers that prevent recipients of 
                services from achieving maximum benefit from such 
                services.
    ``(b) Assistance To Improve Public Finance Management Systems.--
            ``(1) In general.--Consistent with the authority under 
        section 129 of the Foreign Assistance Act of 1961 (22 U.S.C. 
        2152), the Secretary of the Treasury, acting through the head 
        of the Office of Technical Assistance, is authorized to provide 
        assistance for advisors and partner country finance, health, 
        and other relevant ministries to improve the effectiveness of 
        public finance management systems in partner countries to 
        enable such countries to receive funding to carry out programs 
        to combat HIV/AIDS, tuberculosis, and malaria and to manage 
        such programs.
            ``(2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401 for HIV/AIDS 
        assistance, there are authorized to be appropriated to the 
        Secretary of the Treasury such sums as may be necessary for 
        each of the fiscal years 2009 through 2013 to carry out this 
        subsection.''.
    (b) Clerical Amendment.--The table of contents for the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7601 note) is amended by inserting after the item 
relating to section 203, as added by section 203 of this Act, the 
following:

``Sec. 204. Combating HIV/AIDS, tuberculosis, and malaria by 
                            strengthening health policies and health 
                            systems of partner countries.''.

SEC. 205. FACILITATING EFFECTIVE OPERATIONS OF THE CENTERS FOR DISEASE 
              CONTROL.

    Section 307 of the Public Health Service Act (42 U.S.C. 242l) is 
amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) The Secretary may participate with other countries in 
cooperative endeavors in--
            ``(1) biomedical research, health care technology, and the 
        health services research and statistical analysis authorized 
        under section 306 and title IX; and
            ``(2) biomedical research, health care services, health 
        care research, or other related activities in furtherance of 
        the activities, objectives or goals authorized under the Tom 
        Lantos and Henry J. Hyde United States Global Leadership 
        Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act 
        of 2008.''; and
            (2) in subsection (b)--
                    (A) in paragraph (7), by striking ``and'' after the 
                semicolon at the end;
                    (B) by striking ``The Secretary may not, in the 
                exercise of his authority under this section, provide 
                financial assistance for the construction of any 
                facility in any foreign country.''
                    (C) in paragraph (8), by striking ``for any 
                purpose.'' and inserting ``for the purpose of any law 
                administered by the Office of Personnel Management;''; 
                and
                    (D) by adding at the end the following:
            ``(9) provide such funds by advance or reimbursement to the 
        Secretary of State, as may be necessary, to pay the costs of 
        acquisition, lease, construction, alteration, equipping, 
        furnishing or management of facilities outside of the United 
        States; and
            ``(10) in consultation with the Secretary of State, through 
        grant or cooperative agreement, make funds available to public 
        or nonprofit private institutions or agencies in foreign 
        countries in which the Secretary is participating in activities 
        described under subsection (a) to acquire, lease, construct, 
        alter, or renovate facilities in those countries.''.
            (3) in subsection (c)--
                    (A) by striking ``1990'' and inserting ``1980''; 
                and
                    (B) by inserting or ``or section 903 of the Foreign 
                Service Act of 1980 (22 U.S.C. 4083)'' after ``Code''.

SEC. 206. FACILITATING VACCINE DEVELOPMENT.

    (a) Technical Assistance for Developing Countries.--The 
Administrator of the United States Agency for International 
Development, utilizing public-private partners, as appropriate, and 
working in coordination with other international development agencies, 
is authorized to strengthen the capacity of developing countries' 
governmental institutions to--
            (1) collect evidence for informed decision-making and 
        introduction of new vaccines, including potential HIV/AIDS, 
        tuberculosis, and malaria vaccines, if such vaccines are 
        determined to be safe and effective;
            (2) review protocols for clinical trials and impact studies 
        and improve the implementation of clinical trials; and
            (3) ensure adequate supply chain and delivery systems.
    (b) Advanced Market Commitments.--
            (1) Purpose.--The purpose of this subsection is to improve 
        global health by requiring the United States to participate in 
        negotiations for advance market commitments for the development 
        of future vaccines, including potential vaccines for HIV/AIDS, 
        tuberculosis, and malaria.
            (2) Negotiation requirement.--The Secretary of the Treasury 
        shall enter into negotiations with the appropriate officials of 
        the International Bank of Reconstruction and Development (World 
        Bank) and the GAVI Alliance, the member nations of such 
        entities, and other interested parties to establish advanced 
        market commitments to purchase vaccines to combat HIV/AIDS, 
        tuberculosis, malaria, and other related infectious diseases.
            (3) Requirements.--In negotiating the United States 
        participation in programs for advanced market commitments, the 
        Secretary of the Treasury shall take into account whether 
        programs for advance market commitments include--
                    (A) legally binding contracts for product purchase 
                that include a fair market price for up to a maximum 
                number of treatments, creating a strong market 
                incentive;
                    (B) clearly defined and transparent rules of 
                program participation for qualified developers and 
                suppliers of the product;
                    (C) clearly defined requirements for eligible 
                vaccines to ensure that they are safe and effective and 
                can be delivered in developing country contexts;
                    (D) dispute settlement mechanisms; and
                    (E) sufficient flexibility to enable the contracts 
                to be adjusted in accord with new information related 
                to projected market size and other factors while still 
                maintaining the purchase commitment at a fair price.
            (4) Report.--Not later than 1 year after the date of the 
        enactment of this Act--
                    (A) the Secretary of the Treasury shall submit a 
                report to the appropriate congressional committees on 
                the status of the United States negotiations to 
                participate in programs for the advanced market 
                commitments under this subsection; and
                    (B) the President shall produce a comprehensive 
                report, written by a study group of qualified 
                professionals from relevant Federal agencies and 
                initiatives, nongovernmental organizations, and 
                industry representatives, that sets forth a coordinated 
                strategy to accelerate development of vaccines for 
                infectious diseases, such as HIV/AIDS, malaria, and 
                tuberculosis, which includes--
                            (i) initiatives to create economic 
                        incentives for the research, development, and 
                        manufacturing of vaccines for HIV/AIDS, 
                        tuberculosis, malaria, and other infectious 
                        diseases;
                            (ii) an expansion of public-private 
                        partnerships and the leveraging of resources 
                        from other countries and the private sector; 
                        and
                            (iii) efforts to maximize United States 
                        capabilities to support clinical trials of 
                        vaccines in developing countries and to address 
                        the challenges of delivering vaccines in 
                        developing countries to minimize delays in 
                        access once vaccines are available.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

    (a) Amendments to the Foreign Assistance Act of 1961.--
            (1) Finding.--Section 104A(a) of the Foreign Assistance Act 
        of 1961 (22 U.S.C. 2151b-2(a)) is amended by inserting 
        ``Central Asia, Eastern Europe, Latin America'' after 
        ``Caribbean,''.
            (2) Policy.--Section 104A(b) of such Act is amended to read 
        as follows:
    ``(b) Policy.--
            ``(1) Objectives.--It is a major objective of the foreign 
        assistance program of the United States to provide assistance 
        for the prevention and treatment of HIV/AIDS and the care of 
        those affected by the disease. It is the policy objective of 
        the United States, by 2013, to--
                    ``(A) assist partner countries to--
                            ``(i) prevent 12,000,000 new HIV infections 
                        worldwide;
                            ``(ii) support treatment of at least 
                        3,000,000 individuals with HIV/AIDS;
                            ``(iii) support additional treatment 
                        through coordinated multilateral efforts;
                            ``(iv) support care for 12,000,000 
                        individuals with HIV/AIDS, including 5,000,000 
                        orphans and vulnerable children affected by 
                        HIV/AIDS, with an emphasis on promoting a 
                        comprehensive, coordinated system of services 
                        to be integrated throughout the continuum of 
                        care;
                            ``(v) provide at least 80 percent of the 
                        target population with access to counseling, 
                        testing, and treatment to prevent the 
                        transmission of HIV from mother-to-child;
                            ``(vi) provide care and treatment services 
                        to children with HIV in proportion to their 
                        percentage within the HIV-infected population 
                        of a given partner country; and
                            ``(vii) train and support retention of 
                        health care professionals, paraprofessionals, 
                        and community health workers in HIV/AIDS 
                        prevention, treatment, and care, with the 
                        target of providing such training to at least 
                        140,000 new health care professionals and 
                        paraprofessionals;
                    ``(B) strengthen the capacity to deliver primary 
                health care in developing countries, especially in sub-
                Saharan Africa; and
                    ``(C) help countries achieve staffing levels of at 
                least 2.3 doctors, nurses, and midwives per 1,000 
                population, as called for by the World Health 
                Organization.
            ``(2) Coordinated global strategy.--The United States and 
        other countries with the sufficient capacity should provide 
        assistance to countries in sub-Saharan Africa, the Caribbean, 
        Central Asia, Eastern Europe, and Latin America, and other 
        countries and regions confronting HIV/AIDS epidemics in a 
        coordinated global strategy to help address generalized and 
        concentrated epidemics through HIV/AIDS prevention, treatment, 
        care, monitoring and evaluation, and related activities.
            ``(3) Priorities.--The United States Government's response 
        to the global HIV/AIDS pandemic and the Government's efforts to 
        help countries assume leadership of sustainable campaigns to 
        combat their local epidemics should place high priority on--
                    ``(A) the prevention of the transmission of HIV; 
                and
                    ``(B) moving toward universal access to HIV/AIDS 
                prevention counseling and services.''.
    (b) Authorization.--Section 104A(c) of such Act is amended--
            (1) in paragraph (1), by striking ``and other countries and 
        areas.'' and inserting ``Central Asia, Eastern Europe, Latin 
        America, and other countries and areas, particularly with 
        respect to refugee populations or those in postconflict 
        settings in such countries and areas with significant or 
        increasing HIV incidence rates.'';
            (2) in paragraph (2), by striking ``and other countries and 
        areas affected by the HIV/AIDS pandemic'' and inserting 
        ``Central Asia, Eastern Europe, Latin America, and other 
        countries and areas affected by the HIV/AIDS pandemic, 
        particularly with respect to refugee populations or those in 
        post-conflict settings in such countries and areas with 
        significant or increasing HIV incidence rates.''; and
            (3) in paragraph (3)--
                    (A) by striking ``foreign countries'' and inserting 
                ``partner countries, other international actors,''; and
                    (B) by inserting ``within the framework of the 
                principles of the Three Ones'' before the period at the 
                end.
    (c) Activities Supported.--Section 104A(d) of such Act is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)--
                            (i) by inserting ``and multiple concurrent 
                        sexual partnering,'' after ``casual sexual 
                        partnering''; and
                            (ii) by striking ``condoms'' and inserting 
                        ``male and female condoms'';
                    (B) in subparagraph (B)--
                            (i) by striking ``programs that'' and 
                        inserting ``programs that are designed with 
                        local input and''; and
                            (ii) by striking ``those organizations'' 
                        and inserting ``those locally based 
                        organizations'';
                    (C) in subparagraph (D), by inserting ``and 
                promoting the use of provider-initiated or `opt-out' 
                voluntary testing in accordance with World Health 
                Organization guidelines'' before the semicolon at the 
                end;
                    (D) by redesignating subparagraphs (F), (G), and 
                (H) as subparagraphs (H), (I), and (J), respectively;
                    (E) by inserting after subparagraph (E) the 
                following:
                    ``(F) assistance to--
                            ``(i) achieve the goal of reaching 80 
                        percent of pregnant women for prevention and 
                        treatment of mother-to-child transmission of 
                        HIV in countries in which the United States is 
                        implementing HIV/AIDS programs by 2013; and
                            ``(ii) promote infant feeding options and 
                        treatment protocols that meet the most recent 
                        criteria established by the World Health 
                        Organization;
                    ``(G) medical male circumcision programs as part of 
                national strategies to combat the transmission of HIV/
                AIDS;'';
                    (F) in subparagraph (I), as redesignated, by 
                striking ``and'' at the end;
                    (G) in subparagraph (H), as redesignated--
                            (i) by striking the period at the end and 
                        inserting ``, including education and services 
                        demonstrated to be effective in reducing the 
                        transmission of HIV infection without 
                        increasing illicit drug use; and''; and
                    (H) by adding at the end the following:
                    ``(K) assistance for counseling, testing, 
                treatment, care, and support programs, including--
                            ``(i) counseling and other services for the 
                        prevention of reinfection of individuals with 
                        HIV/AIDS;
                            ``(ii) counseling to prevent sexual 
                        transmission of HIV, including--
                                    ``(I) life skills development for 
                                practicing abstinence and faithfulness;
                                    ``(II) reducing the number of 
                                sexual partners;
                                    ``(III) delaying sexual debut; and
                                    ``(IV) ensuring correct and 
                                consistent use of condoms;
                            ``(iii) assistance to engage underlying 
                        vulnerabilities to HIV/AIDS, especially those 
                        of women and girls, through structural 
                        prevention programs;
                            ``(iv) assistance for appropriate HIV/AIDS 
                        education programs and training targeted to 
                        prevent the transmission of HIV among men who 
                        have sex with men;
                            ``(v) assistance to provide male and female 
                        condoms;
                            ``(vi) diagnosis and treatment of other 
                        sexually transmitted infections;
                            ``(vii) strategies to address the stigma 
                        and discrimination that impede HIV/AIDS 
                        prevention efforts; and
                            ``(viii) assistance to facilitate 
                        widespread access to microbicides for HIV 
                        prevention, if safe and effective products 
                        become available, including financial and 
                        technical support for culturally appropriate 
                        introductory programs, procurement, 
                        distribution, logistics management, program 
                        delivery, acceptability studies, provider 
                        training, demand generation, and 
                        postintroduction monitoring.''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C)--
                            (i) by inserting ``pain management,'' after 
                        ``opportunistic infections,''; and
                            (ii) by striking the period at the end and 
                        inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(D) as part of care and treatment of HIV/AIDS, 
                assistance (including prophylaxis and treatment) for 
                common HIV/AIDS-related opportunistic infections for 
                free or at a rate at which it is easily affordable to 
                the individuals and populations being served;
                    ``(E) as part of care and treatment of HIV/AIDS, 
                assistance or referral to available and adequately 
                resourced service providers for nutritional support, 
                including counseling and where necessary the provision 
                of commodities, for persons meeting malnourishment 
                criteria and their families;'';
            (3) in paragraph (4)--
                    (A) in subparagraph (C), by striking ``and'' at the 
                end;
                    (B) in subparagraph (D), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(E) carrying out and expanding program 
                monitoring, impact evaluation research and analysis, 
                and operations research and disseminating data and 
                findings through mechanisms to be developed by the 
                Coordinator of United States Government Activities to 
                Combat HIV/AIDS Globally, in coordination with the 
                Director of the Centers for Disease Control, in order 
                to--
                            ``(i) improve accountability, increase 
                        transparency, and ensure the delivery of 
                        evidence-based services through the collection, 
                        evaluation, and analysis of data regarding 
                        gender-responsive interventions, disaggregated 
                        by age and sex;
                            ``(ii) identify and replicate effective 
                        models; and
                            ``(iii) develop gender indicators to 
                        measure outcomes and the impacts of 
                        interventions; and
                    ``(F) establishing appropriate systems to--
                            ``(i) gather epidemiological and social 
                        science data on HIV; and
                            ``(ii) evaluate the effectiveness of 
                        prevention efforts among men who have sex with 
                        men, with due consideration to stigma and risks 
                        associated with disclosure.'';
            (4) in paragraph (5)--
                    (A) by redesignating subparagraph (C) as 
                subparagraph (D); and
                    (B) by inserting after subparagraph (B) the 
                following:
                    ``(C) Mechanism to ensure cost-effective drug 
                purchasing.--Subject to subparagraph (B), mechanisms to 
                ensure that safe and effective pharmaceuticals, 
                including antiretrovirals and medicines to treat 
                opportunistic infections, are purchased at the lowest 
                possible price at which such pharmaceuticals may be 
                obtained in sufficient quantity on the world market.'';
            (5) in paragraph (6)--
                    (A) by amending the paragraph heading to read as 
                follows:
            ``(6) Related and coordinated
        activities.--'';
                    (B) in subparagraph (B), by striking ``and'' at the 
                end;
                    (C) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by adding at the end the following:
                    ``(D) coordinated or referred activities to--
                            ``(i) enhance the clinical impact of HIV/
                        AIDS care and treatment; and
                            ``(ii) ameliorate the adverse social and 
                        economic costs often affecting AIDS-impacted 
                        families and communities through the direct 
                        provision, as necessary, or through the 
                        referral, if possible, of support services, 
                        including--
                                    ``(I) nutritional and food support;
                                    ``(II) nutritional counseling;
                                    ``(III) income-generating 
                                activities and livelihood initiatives;
                                    ``(IV) maternal and child health 
                                care;
                                    ``(V) primary health care;
                                    ``(VI) the diagnosis and treatment 
                                of other infectious or sexually 
                                transmitted diseases;
                                    ``(VII) substance abuse and 
                                treatment services; and
                                    ``(VIII) legal services;
                    ``(E) coordinated or referred activities to link 
                programs addressing HIV/AIDS with programs addressing 
                gender-based violence in areas of significant HIV 
                prevalence to assist countries in the development and 
                enforcement of women's health, children's health, and 
                HIV/AIDS laws and policies that--
                            ``(i) prevent and respond to violence 
                        against women and girls;
                            ``(ii) promote the integration of screening 
                        and assessment for gender-based violence into 
                        HIV/AIDS programming;
                            ``(iii) promote appropriate HIV/AIDS 
                        counseling, testing, and treatment into gender-
                        based violence programs; and
                            ``(iv) assist governments to develop 
                        partnerships with civil society organizations 
                        to create networks for psychosocial, legal, 
                        economic, or other support services;
                    ``(F) coordinated or referred activities to--
                            ``(i) address the frequent coinfection of 
                        HIV and tuberculosis, in accordance with World 
                        Health Organization guidelines;
                            ``(ii) promote provider-initiated or `opt-
                        out' HIV/AIDS counseling and testing and 
                        appropriate referral for treatment and care to 
                        individuals with tuberculosis or its symptoms, 
                        particularly in areas with significant HIV 
                        prevalence; and
                            ``(iii) strengthen programs to ensure that 
                        individuals testing positive for HIV receive 
                        tuberculosis screening and appropriate 
                        screening and to improve laboratory capacities, 
                        infection control, and adherence; and
                    ``(G) activities to--
                            ``(i) improve the effectiveness of national 
                        responses to HIV/AIDS; and
                            ``(ii) strengthen overall health systems in 
                        high-prevalence countries, including support 
                        for workforce training, retention, and 
                        effective deployment, capacity building, 
                        laboratory development, equipment maintenance 
                        and repair, and public health and related 
                        public financial management systems and 
                        operations.''; and
            (6) by adding at the end the following:
            ``(8) Compacts and framework agreements.--The development 
        of compacts or framework agreements, tailored to local 
        circumstances, with national governments or regional 
        partnerships in countries with significant HIV/AIDS burdens to 
        promote host government commitment to deeper integration of 
        HIV/AIDS services into health systems, contribute to health 
        systems overall, and enhance sustainability.''.
    (d) Compacts and Framework Agreements.--Section 104A of such Act is 
amended--
            (1) by redesignating subsections (e) through (g) as 
        subsections (f) through (h); and
            (2) by inserting after subsection (d) the following:
    ``(e) Compacts and Framework Agreements.--
            ``(1) Findings.--Congress makes the following findings:
                    ``(A) The congressionally mandated Institute of 
                Medicine report entitled `PEPFAR Implementation: 
                Progress and Promise' states: `The next strategy [of 
                the U.S. Global AIDS Initiative] should squarely 
                address the needs and challenges involved in supporting 
                sustainable country HIV/AIDS programs, thereby 
                transitioning from a focus on emergency relief.'.
                    ``(B) One mechanism to promote the transition from 
                an emergency to a public health and development 
                approach to HIV/AIDS is through compacts or framework 
                agreements between the United States Government and 
                each participating nation.
                    ``(C) Key components of a transition toward a more 
                sustainable approach toward fighting HIV/AIDS, 
                tuberculosis, and malaria and thus priorities for such 
                compacts include--
                            ``(i) building capacity to expand the size 
                        of the trained health care workforce in partner 
                        countries and improve its retention, safety, 
                        deployment, and utilization of skills and to 
                        improve public health infrastructure and 
                        systems;
                            ``(ii) partner governments increasing their 
                        national investments in health and education 
                        systems, as called for in the Abuja 
                        Declaration;
                            ``(iii) increasing the focus of United 
                        States government efforts to address the 
                        factors that put women and girls at greater 
                        risk of HIV/AIDS and to strengthen the legal, 
                        economic, educational, and social status of 
                        women, girls, orphans, and vulnerable children 
                        and encouraging partner governments to do the 
                        same;
                            ``(iv) building on the New Partners 
                        Initiative and other efforts currently underway 
                        to strengthen the capacities of community- and 
                        faith-based organizations and civil society in 
                        partner countries to contribute to country 
                        efforts to prevent or manage the effects of 
                        HIV/AIDS, tuberculosis, and malaria epidemics 
                        and to improve health care delivery;
                            ``(v) improving the coordination of efforts 
                        to combat HIV/AIDS, tuberculosis, and malaria 
                        with broader national health and development 
                        strategies;
                            ``(vi) promoting HIV/AIDS-related laws, 
                        regulations, and policies that support 
                        voluntary diagnostic counseling and rapid 
                        testing, pediatric diagnosis, rapid, tariff-
                        free regulatory procedures for drugs and 
                        commodities, and full inclusion of people 
                        living with HIV/AIDS in a multisectoral 
                        national response.
                            ``(vii) sharing and implementing findings 
                        based on program evaluations and operations 
                        research; and
                            ``(viii) reducing the disease burden of 
                        HIV/AIDS, tuberculosis, and malaria through 
                        improved prevention efforts.
                    ``(D) Such compacts should also take into account 
                the overall national health and development and 
                national HIV/AIDS and public health strategies of each 
                country and should contain provisions including--
                            ``(i) the specific objectives that the 
                        country and the United States expect to achieve 
                        during the term of a compact;
                            ``(ii) the respective responsibilities of 
                        the country and the United States in the 
                        achievement of such objectives;
                            ``(iii) regular benchmarks to measure, 
                        where appropriate, progress toward achieving 
                        such objectives;
                            ``(iv) an identification of the intended 
                        beneficiaries, disaggregated by gender and age, 
                        and including information on orphans and 
                        vulnerable children, to the maximum extent 
                        practicable;
                            ``(v) the methods by which the compact is 
                        intended to address the factors that put women 
                        and girls at greater risk of HIV/AIDS and to 
                        strengthen the legal, economic, educational, 
                        and social status of women, girls, orphans, and 
                        vulnerable children;
                            ``(vi) the methods by which the compact 
                        will strengthen the health care capacity, 
                        including the training, retention, deployment, 
                        and utilization of health care workers, improve 
                        supply chain management, and improve the health 
                        systems and infrastructure of the partner 
                        country, including the ability of compact 
                        participants to maintain and operate equipment 
                        transferred or purchased as part of the 
                        compact;
                            ``(vii) proposed mechanisms to provide 
                        oversight;
                            ``(viii) the role of civil society in the 
                        development of a compact and the achievement of 
                        its objectives;
                            ``(ix) a description of the current and 
                        potential participation of other donors in the 
                        achievement of such objectives, as appropriate; 
                        and
                            ``(x) a plan to ensure appropriate fiscal 
                        accountability for the use of assistance.
            ``(2) Local input.--In entering into a compact authorized 
        under subsection (d)(8), the Coordinator of United States 
        Government Activities to Combat HIV/AIDS Globally shall seek to 
        ensure that the government of a country--
                    ``(A) takes into account the local perspectives of 
                the rural and urban poor, including women, in each 
                country; and
                    ``(B) consults with private and voluntary 
                organizations, including faith-based organizations, the 
                business community, and other donors in the country.
            ``(3) Congressional and public notification after entering 
        into a compact.--Not later than 10 days after entering into a 
        compact authorized under subsection (d)(8), the Global AIDS 
        Coordinator shall--
                    ``(A) submit a report containing a detailed summary 
                of the compact and a copy of the text of the compact 
                to--
                            ``(i) the Committee on Foreign Relations of 
                        the Senate;
                            ``(ii) the Committee on Appropriations of 
                        the Senate;
                            ``(iii) the Committee on Foreign Affairs of 
                        the House of Representatives; and
                            ``(iv) the Committee on Appropriations of 
                        the House of Representatives; and
                    ``(B) publish such information in the Federal 
                Register and on the Internet website of the Office of 
                the Global AIDS Coordinator.''.
    (e) Annual Report.--Section 104A(f) of such Act, as redesignated, 
is amended--
            (1) in paragraph (1), by striking ``Committee on 
        International Relations'' and inserting ``Committee on Foreign 
        Affairs''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) by striking subparagraph (C) and inserting the 
                following:
                    ``(C) a detailed breakdown of funding allocations, 
                by program and by country, for prevention activities; 
                and
                    ``(D) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                including--
                            ``(i)(I) the effectiveness of such programs 
                        in reducing--
                                    ``(aa) the transmission of HIV, 
                                particularly in women and girls;
                                    ``(bb) mother-to-child transmission 
                                of HIV, including through drug 
                                treatment and therapies, either 
                                directly or by referral; and
                                    ``(cc) mortality rates from HIV/
                                AIDS;
                            ``(II) the number of patients receiving 
                        treatment for AIDS in each country that 
                        receives assistance under this Act;
                            ``(III) an assessment of progress towards 
                        the achievement of annual goals set forth in 
                        the timetable required under the 5-year 
                        strategy established under section 101 of the 
                        United States Leadership Against HIV/AIDS, 
                        Tuberculosis, and Malaria Act of 2003 and, if 
                        annual goals are not being met, the reasons for 
                        such failure; and
                            ``(IV) retention and attrition data for 
                        programs receiving United States assistance, 
                        including mortality and loss to follow-up 
                        rates, organized overall and by country;
                            ``(ii) the progress made toward--
                                    ``(I) improving health care 
                                delivery systems (including the 
                                training of health care workers, 
                                including doctors, nurses, midwives, 
                                pharmacists, laboratory technicians, 
                                and compensated community health 
                                workers);
                                    ``(II) advancing safe working 
                                conditions for health care workers; and
                                    ``(III) improving infrastructure to 
                                promote progress toward universal 
                                access to HIV/AIDS prevention, 
                                treatment, and care by 2013;
                            ``(iii) with respect to tuberculosis--
                                    ``(I) the increase in the number of 
                                people treated and the number of 
                                tuberculosis patients cured through 
                                each program, project, or activity 
                                receiving United States foreign 
                                assistance for tuberculosis control 
                                purposes through, or in coordination 
                                with, HIV/AIDS programs;
                                    ``(II) a description of drug 
                                resistance rates among persons treated;
                                    ``(III) 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; and
                                    ``(IV) a detailed description of 
                                efforts to integrate HIV/AIDS and 
                                tuberculosis prevention, treatment, and 
                                care programs; and
                            ``(iv) a description of coordination 
                        efforts with relevant executive branch agencies 
                        to link HIV/AIDS clinical and social services 
                        with non-HIV/AIDS services as part of the 
                        United States health and development agenda;
                            ``(v) a detailed description of integrated 
                        HIV/AIDS and food and nutrition programs and 
                        services, including--
                                    ``(I) the amount spent on food and 
                                nutrition support;
                                    ``(II) the types of activities 
                                supported; and
                                    ``(III) an assessment of the 
                                effectiveness of interventions carried 
                                out to improve the health status of 
                                persons with HIV/AIDS receiving food or 
                                nutritional support;
                            ``(vi) a description of efforts to improve 
                        harmonization, in terms of relevant executive 
                        branch agencies, coordination with other public 
                        and private entities, and coordination with 
                        partner countries' national strategic plans as 
                        called for in the `Three Ones';
                            ``(vii) a description of--
                                    ``(I) the efforts of partner 
                                countries that were signatories to the 
                                Abuja Declaration on HIV/AIDS, 
                                Tuberculosis and Other Related 
                                Infectious Diseases to adhere to the 
                                goals of such Declaration in terms of 
                                investments in public health, including 
                                HIV/AIDS; and
                                    ``(II) a description of the HIV/
                                AIDS investments of partner countries 
                                that were not signatories to such 
                                Declaration;
                            ``(viii) a detailed description of any 
                        compacts or framework agreements reached or 
                        negotiated between the United States and any 
                        partner countries, including a description of 
                        the elements of compacts described in 
                        subsection (e);
                            ``(ix) a description of programs serving 
                        women and girls, including--
                                    ``(I) HIV/AIDS prevention programs 
                                that address the vulnerabilities of 
                                girls and women to HIV/AIDS;
                                    ``(II) information on the number of 
                                individuals served by programs aimed at 
                                reducing the vulnerabilities of women 
                                and girls to HIV/AIDS and data on the 
                                types, objectives, and duration of 
                                programs to address these issues;
                                    ``(III) information on programs to 
                                address the particular needs of 
                                adolescent girls and young women; and
                                    ``(IV) programs to prevent gender-
                                based violence or to assist victims of 
                                gender based violence as part, of or in 
                                coordination with, HIV/AIDS programs;
                            ``(x) a description of strategies, goals, 
                        programs, and interventions to--
                                    ``(I) address the needs and 
                                vulnerabilities of youth populations;
                                    ``(II) expand access among young 
                                men and women to evidence-based HIV/
                                AIDS health care services and HIV 
                                prevention programs, including 
                                abstinence education programs; and
                                    ``(III) expand community-based 
                                services to meet the needs of orphans 
                                and of children and adolescents 
                                affected by or vulnerable to HIV/AIDS 
                                without increasing stigmatization;
                            ``(xi) a description of--
                                    ``(I) the specific strategies 
                                funded to ensure the reduction of HIV 
                                infection among injection drug users;
                                    ``(II) the number of injection drug 
                                users, by country, reached by such 
                                strategies;
                                    ``(III) medication-assisted drug 
                                treatment for individuals with HIV or 
                                at risk of HIV; and
                                    ``(IV) HIV prevention programs 
                                demonstrated to be effective in 
                                reducing HIV transmission without 
                                increasing drug use;
                            ``(xii) a detailed description of program 
                        monitoring, operations research, and impact 
                        evaluation research, including--
                                    ``(I) the amount of funding 
                                provided for each research type;
                                    ``(II) an analysis of cost-
                                effectiveness models; and
                                    ``(III) conclusions regarding the 
                                efficiency, effectiveness, and quality 
                                of services as derived from previous or 
                                ongoing research and monitoring 
                                efforts; and
                            ``(xiii) a description of staffing levels 
                        of United States government HIV/AIDS teams in 
                        countries with significant HIV/AIDS programs, 
                        including whether or not a full-time 
                        coordinator was on staff for the year.''.
    (f) Authorization of Appropriations.--Section 301(b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7631(b)) is amended--
            (1) in paragraph (1), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''; and
            (2) in paragraph (3), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013''.
    (g) Relationship To Assistance Programs To Enhance Nutrition.--
Section 301(c) of such Act is amended to read as follows:
    ``(c) Food and Nutritional Support.--
            ``(1) In general.--As indicated in the report produced by 
        the Institute of Medicine, entitled `PEPFAR Implementation: 
        Progress and Promise', inadequate caloric intake has been 
        clearly identified as a principal reason for failure of 
        clinical response to antiretroviral therapy. In recognition of 
        the impact of malnutrition as a clinical health issue for many 
        persons living with HIV/AIDS that is often associated with 
        health and economic impacts on these individuals and their 
        families, the Global AIDS Coordinator and the Administrator of 
        the United States Agency for International Development shall--
                    ``(A) follow World Health Organization guidelines 
                for HIV/AIDS food and nutrition services;
                    ``(B) integrate nutrition programs with HIV/AIDS 
                activities through effective linkages among the health, 
                agricultural, and livelihood sectors and establish 
                additional services in circumstances in which referrals 
                are inadequate or impossible;
                    ``(C) provide, as a component of care and treatment 
                programs for persons with HIV/AIDS, food and 
                nutritional support to individuals infected with, and 
                affected by, HIV/AIDS who meet established criteria for 
                nutritional support (including clinically malnourished 
                children and adults, and pregnant and lactating women 
                in programs in need of supplemental support), 
                including--
                            ``(i) anthropometric and dietary 
                        assessment;
                            ``(ii) counseling; and
                            ``(iii) therapeutic and supplementary 
                        feeding;
                    ``(D) provide food and nutritional support for 
                children affected by HIV/AIDS and to communities and 
                households caring for children affected by HIV/AIDS; 
                and
                    ``(E) in communities where HIV/AIDS and food 
                insecurity are highly prevalent, support programs to 
                address these often intersecting health problems 
                through community-based assistance programs, with an 
                emphasis on sustainable approaches.
            ``(2) Authorization of appropriations.--Of the amounts 
        authorized to be appropriated under section 401, there are 
        authorized to be appropriated to the President such sums as may 
        be necessary for each of the fiscal years 2009 through 2013 to 
        carry out this subsection.''.
    (h) Eligibility for Assistance.--Section 301(d) of such Act is 
amended to read as follows:
    ``(d) Eligibility for Assistance.--An organization, including a 
faith-based organization, that is otherwise eligible to receive 
assistance under section 104A of the Foreign Assistance Act of 1961, 
under this Act, or under any amendment made by this Act or by the Tom 
Lantos and Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, to 
prevent, treat, or monitor HIV/AIDS--
            ``(1) shall not be required, as a condition of receiving 
        such assistance--
                    ``(A) to endorse or utilize a multisectoral or 
                comprehensive approach to combating HIV/AIDS; or
                    ``(B) to endorse, utilize, make a referral to, 
                become integrated with, or otherwise participate in any 
                program or activity to which the organization has a 
                religious or moral objection; and
            ``(2) shall not be discriminated against in the 
        solicitation or issuance of grants, contracts, or cooperative 
        agreements under such provisions of law for refusing to meet 
        any requirement described in paragraph (1).''.

SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

    (a) Policy.--Section 104B(b) of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b-3(b)) is amended to read as follows:
    ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest burden 
of tuberculosis and other countries with high rates of tuberculosis, 
the United States Government should prioritize the achievement of the 
following goals by not later than December 31, 2015:
            ``(1) Reduce by half the tuberculosis death and disease 
        burden from the 1990 baseline.
            ``(2) Sustain or exceed the detection of at least 70 
        percent of sputum smear-positive cases of tuberculosis and the 
        cure of at least 85 percent of those cases detected.''.
    (b) Priority To Stop TB Strategy.--Section 104B(e) of such Act is 
amended to read as follows:
    ``(e) Priority To Stop TB Strategy.--In furnishing assistance under 
subsection (c), the President shall give priority to--
            ``(1) activities described in the Stop TB Strategy, 
        including expansion and enhancement of Directly Observed 
        Treatment Short-course (DOTS) coverage, rapid testing, 
        treatment for individuals infected with both tuberculosis and 
        HIV, and treatment for individuals with multi-drug resistant 
        tuberculosis (MDR-TB), strengthening of health systems, use of 
        the International Standards for Tuberculosis Care by all 
        providers, empowering individuals with tuberculosis, and 
        enabling and promoting research to develop new diagnostics, 
        drugs, and vaccines, and program-based operational research 
        relating to tuberculosis; and
            ``(2) funding for the Global Tuberculosis Drug Facility, 
        the Stop Tuberculosis Partnership, and the Global Alliance for 
        TB Drug Development.''.
    (c) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--Section 104B of such Act is amended--
            (1) by redesignating subsection (f) as subsection (g); and
            (2) by inserting after subsection (e) the following:
    ``(f) Assistance for the World Health Organization and the Stop 
Tuberculosis Partnership.--In carrying out this section, the President, 
acting through the Administrator of the United States Agency for 
International Development, is authorized to provide increased resources 
to the World Health Organization and the Stop Tuberculosis Partnership 
to improve the capacity of countries with high rates of tuberculosis 
and other affected countries to implement the Stop TB Strategy and 
specific strategies related to addressing multiple drug resistant 
tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-
TB).''.
    (d) Definitions.--Section 104B(g) of such Act, as redesignated, is 
amended--
            (1) in paragraph (1), by striking the period at the end and 
        inserting the following: ``including--
                    ``(A) low-cost and effective diagnosis, treatment, 
                and monitoring of tuberculosis;
                    ``(B) a reliable drug supply;
                    ``(C) a management strategy for public health 
                systems;
                    ``(D) health system strengthening;
                    ``(E) promotion of the use of the International 
                Standards for Tuberculosis Care by all care providers;
                    ``(F) bacteriology under an external quality 
                assessment framework;
                    ``(G) short-course chemotherapy; and
                    ``(H) sound reporting and recording systems.''; and
            (2) by redesignating paragraph (5) as paragraph (6); and
            (3) by inserting after paragraph (4) the following:
            ``(5) Stop tb strategy.--The term `Stop TB Strategy' means 
        the 6-point strategy to reduce tuberculosis developed by the 
        World Health Organization, which is described in the Global 
        Plan to Stop TB 2006-2015: Actions for Life, a comprehensive 
        plan developed by the Stop TB Partnership that sets out the 
        actions necessary to achieve the millennium development goal of 
        cutting tuberculosis deaths and disease burden in half by 
        2015.''.
    (e) Authorization of Appropriations.--Section 302 (b) of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7632(b)) is amended--
            (1) in paragraph (1), by striking ``such sums as may be 
        necessary for each of the fiscal years 2004 through 2008'' and 
        inserting ``a total of $4,000,000,000 for the 5-year period 
        beginning on October 1, 2008.''; and
            (2) in paragraph (3), by striking ``fiscal years 2004 
        through 2008'' and inserting ``fiscal years 2009 through 
        2013.''.

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

    (a) Amendment to the Foreign Assistance Act of 1961.--Section 
104C(b) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151-4(b)) is 
amended by inserting ``treatment,'' after ``control,''.
    (b) Authorization of Appropriations.--Section 303 of the United 
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003, and Malaria Act of 2003 (22 U.S.C. 7633) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), by striking ``such sums as 
                may be necessary for fiscal years 2004 through 2008'' 
                and inserting ``$5,000,000,000 during the 5-year period 
                beginning on October 1, 2008''; and
                    (B) in paragraph (3), by striking ``fiscal years 
                2004 through 2008'' and inserting ``fiscal years 2009 
                through 2013''; and
            (2) by adding at the end the following:
    ``(c) Statement of Policy.--Providing assistance for the 
prevention, control, treatment, and the ultimate eradication of malaria 
is--
            ``(1) a major objective of the foreign assistance program 
        of the United States; and
            ``(2) 1 component of a comprehensive United States global 
        health strategy to reduce disease burdens and strengthen 
        communities around the world.
    ``(d) Development of a Comprehensive 5-Year Strategy.--The 
President shall establish a comprehensive, 5-year strategy to combat 
global malaria that--
            ``(1) strengthens the capacity of the United States to be 
        an effective leader of international efforts to reduce malaria 
        burden;
            ``(2) maintains sufficient flexibility and remains 
        responsive to the ever-changing nature of the global malaria 
        challenge;
            ``(3) includes specific objectives and multisectoral 
        approaches and strategies to reduce the prevalence, mortality, 
        incidence, and spread of malaria;
            ``(4) describes how this strategy would contribute to the 
        United States' overall global health and development goals;
            ``(5) clearly explains how outlined activities will 
        interact with other United States Government global health 
        activities, including the 5-year global AIDS strategy required 
        under this Act;
            ``(6) expands public-private partnerships and leverage of 
        resources;
            ``(7) coordinates among relevant Federal agencies to 
        maximize human and financial resources and to reduce 
        duplication among these agencies, foreign governments, and 
        international organizations;
            ``(8) coordinates with other international entities, 
        including the Global Fund;
            ``(9) maximizes United States capabilities in the areas of 
        technical assistance and training and research, including 
        vaccine research; and
            ``(10) establishes priorities and selection criteria for 
        the distribution of resources based on factors such as--
                    ``(A) the size and demographics of the population 
                with malaria;
                    ``(B) the needs of that population;
                    ``(C) the country's existing infrastructure; and
                    ``(D) the ability to closely coordinate United 
                States Government efforts with national malaria control 
                plans of partner countries.''.

SEC. 304. MALARIA RESPONSE COORDINATOR.

    Section 304 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7634) is amended to 
read as follows:

``SEC. 304. MALARIA RESPONSE COORDINATOR.

    ``(a) In General.--There is established within the United States 
Agency for International Development a Coordinator of United States 
Government Activities to Combat Malaria Globally (referred to in this 
section as the `Malaria Coordinator'), who shall be appointed by the 
President.
    ``(b) Authorities.--The Malaria Coordinator, acting through 
nongovernmental organizations (including faith-based and community-
based organizations), partner country finance, health, and other 
relevant ministries, and relevant executive branch agencies as may be 
necessary and appropriate to carry out this section, is authorized to--
            ``(1) operate internationally to carry out prevention, 
        care, treatment, support, capacity development, and other 
        activities to reduce the prevalence, mortality, and incidence 
        of malaria;
            ``(2) provide grants to, and enter into contracts and 
        cooperative agreements with, nongovernmental organizations 
        (including faith-based organizations) to carry out this 
        section; and
            ``(3) transfer and allocate executive branch agency funds 
        that have been appropriated for the purposes described in 
        paragraphs (1) and (2).
    ``(c) Duties.--
            ``(1) In general.--The Malaria Coordinator has primary 
        responsibility for the oversight and coordination of all 
        resources and international activities of the United States 
        Government relating to efforts to combat malaria.
            ``(2) Specific duties.--The Malaria Coordinator shall--
                    ``(A) facilitate program and policy coordination of 
                antimalaria efforts among relevant executive branch 
                agencies and nongovernmental organizations by auditing, 
                monitoring, and evaluating such programs;
                    ``(B) ensure that each relevant executive branch 
                agency undertakes antimalarial programs primarily in 
                those areas in which the agency has the greatest 
                expertise, technical capability, and potential for 
                success;
                    ``(C) coordinate relevant executive branch agency 
                activities in the field of malaria prevention and 
                treatment;
                    ``(D) coordinate planning, implementation, and 
                evaluation with the Global AIDS Coordinator in 
                countries in which both programs have a significant 
                presence;
                    ``(E) coordinate with national governments, 
                international agencies, civil society, and the private 
                sector; and
                    ``(F) establish due diligence criteria for all 
                recipients of funds appropriated by the Federal 
                Government for malaria assistance.
    ``(d) Assistance for the World Health Organization.--In carrying 
out this section, the President may provide financial assistance to the 
Roll Back Malaria Partnership of the World Health Organization to 
improve the capacity of countries with high rates of malaria and other 
affected countries to implement comprehensive malaria control programs.
    ``(e) Coordination of Assistance Efforts.--In carrying out this 
section and in accordance with section 104C of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b-4), the Malaria Coordinator shall 
coordinate the provision of assistance by working with--
            ``(1) relevant executive branch agencies, including--
                    ``(A) the Department of State (including the Office 
                of the Global AIDS Coordinator);
                    ``(B) the Department of Health and Human Services;
                    ``(C) the Department of Defense; and
                    ``(D) the Office of the United States Trade 
                Representative;
            ``(2) relevant multilateral institutions, including--
                    ``(A) the World Health Organization;
                    ``(B) the United Nations Children's Fund;
                    ``(C) the United Nations Development Programme;
                    ``(D) the Global Fund;
                    ``(E) the World Bank; and
                    ``(F) the Roll Back Malaria Partnership;
            ``(3) program delivery and efforts to lift barriers that 
        would impede effective and comprehensive malaria control 
        programs; and
            ``(4) partner or recipient country governments and national 
        entities including universities and civil society organizations 
        (including faith- and community-based organizations).
    ``(f) Research.--To carry out this section and in accordance with 
section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 1151d-4), 
the Secretary of Health and Human Services, through the Centers for 
Disease Control and Prevention and the National Institutes of Health, 
shall conduct appropriate programmatically relevant clinical and 
operational research to identify and evaluate new diagnostics, 
treatment regimens, and interventions to prevent and control malaria.
    ``(g) Monitoring.--To ensure that adequate malaria controls are 
established and implemented, the Centers for Disease Control and 
Prevention shall carry out appropriate surveillance and evaluation 
activities to monitor global malaria trends and assess environmental 
and health impacts of malarial control efforts. Such activities shall 
complement the work of the World Health Organization, rather than 
duplicate such work.
    ``(h) Annual Report.--
            ``(1) Submission.--Not later than 1 year after the date of 
        the enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, and annually thereafter, the 
        President shall submit a report to the appropriate 
        congressional committees that describes United States 
        assistance for the prevention, treatment, control, and 
        elimination of malaria.
            ``(2) Contents.--The report required under paragraph (1) 
        shall describe--
                    ``(A) the countries and activities to which malaria 
                resources have been allocated;
                    ``(B) the number of people reached through malaria 
                assistance programs, including data on children and 
                pregnant women;
                    ``(C) research efforts to develop new tools to 
                combat malaria, including drugs and vaccines;
                    ``(D) the collaboration and coordination of United 
                States antimalarial efforts with the World Health 
                Organization, the Global Fund, the World Bank, other 
                donor governments, major private efforts, and relevant 
                executive agencies;
                    ``(E) the coordination of United States 
                antimalarial efforts with the national malarial 
                strategies of other donor or partner governments and 
                major private initiatives;
                    ``(F) the estimated impact of United States 
                assistance on childhood mortality and morbidity from 
                malaria;
                    ``(G) the coordination of antimalarial efforts with 
                broader health and development programs; and
                    ``(H) the constraints on implementation of programs 
                posed by health workforce shortages or capacities; and
                    ``(I) the number of personnel trained as health 
                workers and the training levels achieved.''.

SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.

    Section 212(a)(1)(A)(i) of the Immigration and Nationality Act (8 
U.S.C. 1182(a)(1)(A)(i)) is amended by striking ``, which shall include 
infection with the etiologic agent for acquired immune deficiency 
syndrome,'' and inserting a semicolon.

SEC. 306. CLERICAL AMENDMENT.

    Title III of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is 
amended by striking the heading for subtitle B and inserting the 
following:

     ``Subtitle B--Assistance for Women, Children, and Families''.

SEC. 307. REQUIREMENTS.

    Section 312(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652(b)) is amended by 
striking paragraphs (1), (2), and (3) and inserting the following:
            ``(1) establish a target for the prevention and treatment 
        of mother-to-child transmission of HIV that, by 2013, will 
        reach at least 80 percent of pregnant women in those countries 
        most affected by HIV/AIDS in which the United States has HIV/
        AIDS programs;
            ``(2) establish a target that, by 2013, the proportion of 
        children receiving care and treatment under this Act is 
        proportionate to their numbers within the population of HIV 
        infected individuals in each country;
            ``(3) integrate care and treatment with prevention of 
        mother-to-child transmission of HIV programs to improve 
        outcomes for HIV-affected women and families as soon as is 
        feasible and support strategies that promote successful follow-
        up and continuity of care of mother and child;
            ``(4) expand programs designed to care for children 
        orphaned by, affected by, or vulnerable to HIV/AIDS;
            ``(5) ensure that women in prevention of mother-to-child 
        transmission of HIV programs are provided with, or referred to, 
        appropriate maternal and child services; and
            ``(6) develop a timeline for expanding access to more 
        effective regimes to prevent mother-to-child transmission of 
        HIV, consistent with the national policies of countries in 
        which programs are administered under this Act and the goal of 
        achieving universal use of such regimes as soon as possible.''.

SEC. 308. ANNUAL REPORT ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION 
              OF HIV.

    Section 313(a) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7653(a)) is amended by 
striking ``5 years'' and inserting ``10 years''.

SEC. 309. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION EXPERT PANEL.

    Section 312 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7652) is amended by 
adding at the end the following:
    ``(c) Prevention of Mother-to-Child Transmission Expert Panel.--
            ``(1) Establishment.--The Global AIDS Coordinator shall 
        establish a panel of experts to be known as the Prevention of 
        Mother-to-Child Transmission Panel (referred to in this 
        subsection as the `Panel') to--
                    ``(A) provide an objective review of activities to 
                prevent mother-to-child transmission of HIV; and
                    ``(B) provide recommendations to the Global AIDS 
                Coordinator and to the appropriate 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 Global AIDS Coordinator, who shall serve as a nonvoting 
        member. The Panel shall consist of not more than 15 members 
        (excluding the Global AIDS Coordinator), to be appointed by the 
        Global AIDS Coordinator not later than 1 year after the date of 
        the enactment of this Act, including--
                    ``(A) 2 members from the Department of Health and 
                Human Services with expertise relating to the 
                prevention of mother-to-child transmission activities;
                    ``(B) 2 members from the United States Agency for 
                International Development with expertise relating to 
                the prevention of mother-to-child transmission 
                activities;
                    ``(C) 2 representatives from among health ministers 
                of national governments of foreign countries in which 
                programs under this Act are administered;
                    ``(D) 3 members representing organizations 
                implementing prevention of mother-to-child transmission 
                activities under this Act;
                    ``(E) 2 health care researchers with expertise 
                relating to global HIV/AIDS activities; and
                    ``(F) representatives from among patient advocate 
                groups, health care professionals, persons living with 
                HIV/AIDS, and non-governmental organizations with 
                expertise relating to the prevention of mother-to-child 
                transmission activities, giving priority to individuals 
                in foreign countries in which programs under this Act 
                are administered.
            ``(3) Duties of panel.--The Panel shall--
                    ``(A) assess the effectiveness of current 
                activities in reaching the target described in 
                subsection (b)(1);
                    ``(B) review scientific evidence related to the 
                provision of mother-to-child transmission prevention 
                services, including programmatic data and data from 
                clinical trials;
                    ``(C) review and assess ways in which the Office of 
                the United States Global AIDS Coordinator collaborates 
                with international and multilateral entities on efforts 
                to prevent mother-to-child transmission of HIV in 
                affected countries;
                    ``(D) identify barriers and challenges to 
                increasing access to mother-to-child transmission 
                prevention services and evaluate potential mechanisms 
                to alleviate those barriers and challenges;
                    ``(E) identify the extent to which stigma has 
                hindered pregnant women from obtaining HIV counseling 
                and testing or returning for results, and provide 
                recommendations to address such stigma and its effects;
                    ``(F) identify opportunities to improve linkages 
                between mother-to-child transmission prevention 
                services and care and treatment programs; and
                    ``(G) recommend specific activities to facilitate 
                reaching the target described in subsection (b)(1).
            ``(4) Report.--
                    ``(A) In general.--Not later than 1 year after the 
                date on which the Panel is first convened, the Panel 
                shall submit a report containing a detailed statement 
                of the recommendations, findings, and conclusions of 
                the Panel to the appropriate congressional committees.
                    ``(B) Availability.--The report submitted under 
                subparagraph (A) shall be made available to the public.
                    ``(C) Consideration by coordinator.--The 
                Coordinator shall--
                            ``(i) consider any recommendations 
                        contained in the report submitted under 
                        subparagraph (A); and
                            ``(ii) include in the annual report 
                        required under section 104A(f) of the Foreign 
                        Assistance Act of 1961 a description of the 
                        activities conducted in response to the 
                        recommendations made by the Panel and an 
                        explanation of any recommendations not 
                        implemented at the time of the report.
            ``(5) Authorization of appropriations.--There are 
        authorized to be appropriated to the Panel such sums as may be 
        necessary for each of the fiscal years 2009 through 2011 to 
        carry out this section.
            ``(6) Termination.--The Panel shall terminate on the date 
        that is 60 days after the date on which the Panel submits the 
        report to the appropriate congressional committees under 
        paragraph (4).''.

                     TITLE IV--FUNDING ALLOCATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--Section 401(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
7671(a)) is amended by striking ``$3,000,000,000 for each of the fiscal 
years 2004 through 2008'' and inserting ``$50,000,000,000 for the 5-
year period beginning on October 1, 2008''.
    (b) Sense of Congress.--It is the sense of the Congress that the 
appropriations authorized under section 401(a) of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, as 
amended by subsection (a), should be allocated among fiscal years 2009 
through 2013 in a manner that allows for the appropriations to be 
gradually increased in a manner that is consistent with program 
requirements, absorptive capacity, and priorities set forth in such 
Act, as amended by this Act.

SEC. 402. SENSE OF CONGRESS.

    Section 402(b) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672(b)) is amended by 
striking ``an effective distribution of such amounts would be'' and all 
that follows through ``10 percent of such amounts'' and inserting ``10 
percent should be used''.

SEC. 403. ALLOCATION OF FUNDS.

    Section 403 of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) Balanced Funding Requirement.--
            ``(1) In general.--The Global AIDS Coordinator shall--
                    ``(A) provide balanced funding for prevention 
                activities for sexual transmission of HIV/AIDS; and
                    ``(B) ensure that 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.
            ``(2) Prevention strategy.--
                    ``(A) Establishment.--In carrying out paragraph 
                (1), the Global AIDS Coordinator shall establish a HIV 
                sexual transmission prevention strategy governing the 
                expenditure of funds authorized under this Act to 
                prevent the sexual transmission of HIV in any host 
                country with a generalized epidemic.
                    ``(B) Report.--In each host country described in 
                subparagraph (A), if the strategy established under 
                subparagraph (A) provides less than 50 percent of the 
                funds described in subparagraph (A) for behavioral 
                change programs, including abstinence, delay of sexual 
                debut, monogamy, fidelity, and partner reduction, the 
                Global AIDS Coordinator shall, not later than 30 days 
                after the issuance of this strategy, report to the 
                appropriate congressional committees on the 
                justification for this decision.
            ``(3) Exclusion.--Programs and activities that implement or 
        purchase new prevention technologies or modalities, such as 
        medical male circumcision, pre-exposure pharmaceutical 
        prophylaxis to prevent transmission of HIV, or microbicides and 
        programs and activities that provide counseling and testing for 
        HIV or prevent mother-to-child prevention of HIV, shall not be 
        included in determining compliance with paragraph (2).
            ``(4) Report.--Not later than 1 year after the date of the 
        enactment of the Tom Lantos and Henry J. Hyde United States 
        Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Reauthorization Act of 2008, and annually thereafter as part of 
        the annual report required under section 104A(e) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the President 
        shall--
                    ``(A) submit a report on the implementation of 
                paragraph (2) for the most recently concluded fiscal 
                year to the appropriate congressional committees; and
                    ``(B) make the report described in subparagraph (A) 
                available to the public.''; and
            (2) in subsection (b)--
                    (A) by striking ``fiscal years 2006 through 2008'' 
                and inserting ``fiscal years 2009 through 2013''; and
                    (B) by striking ``vulnerable children affected by'' 
                and inserting ``other children affected by, or 
                vulnerable to,''.
                                                       Calendar No. 698

110th CONGRESS

  2d Session

                                S. 2731

                          [Report No. 110-325]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                             April 15, 2008

                       Reported with an amendment