[Congressional Record Volume 154, Number 51 (Wednesday, April 2, 2008)]
[House]
[Pages H1904-H1942]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
TOM LANTOS AND HENRY J. HYDE UNITED STATES GLOBAL LEADERSHIP AGAINST
HIV/AIDS, TUBERCULOSIS, AND MALARIA REAUTHORIZATION ACT OF 2008
The SPEAKER pro tempore. Pursuant to House Resolution 1065 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the State of the Union for the consideration of the bill, H.R. 5501.
{time} 1215
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union for the consideration of the bill
(H.R. 5501). To authorize appropriations for fiscal years 2009 through
2013 to provide assistance to foreign countries to combat HIV/AIDS,
tuberculosis, and malaria, and for other purposes, with Ms. Norton in
the chair.
The Clerk read the title of the bill.
The CHAIRMAN. Pursuant to the rule, the bill is considered read the
first time.
The gentleman from California (Mr. Berman) and the gentlewoman from
Florida (Ms. Ros-Lehtinen) each will control 1 hour.
The Chair recognizes the gentleman from California.
Mr. BERMAN. Madam Chairman, I yield myself such time as I may
consume.
Madam Chairman, on the President's request 5 years ago, Congress
launched a global campaign to stop the spread of HIV/AIDS and to treat
and care for those who are already afflicted. The United States
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act was a
bipartisan bill from its inception. Today, the Foreign Affairs
Committee again brings a bipartisan global HIV/AIDS bill to the floor,
and again this important reauthorization bill enjoys strong support
from the White House.
The negotiations that brought forth this compromise bill were
conducted in the same bipartisan spirit that guided the 2003 act into
law, a spirit made possible by close cooperation between two former
chairmen of the Foreign Affairs Committee, our late colleagues Tom
Lantos and Henry Hyde, and I am pleased to note that this important
reauthorization bill is named for these two foreign policy titans in
recognition of their contributions to battling HIV/AIDS overseas.
As a direct result of the extraordinarily successful law we passed 5
years ago, the United States has provided lifesaving drugs to nearly
1.5 million men, women and children; supported care for nearly 7
million people, including 2.7 million orphans and vulnerable children;
and prevented an estimated 150,000 infant infections around the world.
The 2003 legislation firmly established the United States as the
leading provider in the world of HIV/AIDS assistance for prevention,
treatment and care. It has reminded the global community that Americans
are a compassionate and generous people, and so has helped to repair
our Nation's badly-damaged image overseas. In many ways, that
legislation has had great healing power.
Most importantly, with this initiative we have ensured that HIV/AIDS
is no longer the certain death sentence it was just 5 short years ago.
Hospital corridors that were jammed with AIDS patients waiting to die
now brim with hope as lifesaving drugs are dispensed.
The reauthorization bill before the House today reaffirms our
commitment to the programs and policies established 5 years ago. The
2003 legislation
[[Page H1905]]
worked well as an emergency intervention, but it must now be modified
to reflect the constantly changing nature of the HIV/AIDS crisis. We
also have 5 years of experience under our belts and we know what works
and what does not.
The law we passed in 2003 was designed to deal with the emergency
phase of the global HIV/AIDS crisis. The Lantos-Hyde bill will move our
programs towards long-term sustainability that will keep the benefits
of U.S. global HIV/AIDS programs flowing to those in need. With this
reauthorization act, host governments will also gain the ability to
plan, direct and manage prevention treatment and care programs that
have been established with U.S. assistance.
The 2003 legislation authorized $15 billion over 5 years. In response
to the desperate need for lifesaving medicine and a greater number of
trained health care workers in nations hard hit by HIV/AIDS, the bill
before us authorizes $50 billion over 5 years for these three
pandemics.
The 2003 law relied upon the health care workforce already in place
in the developing world, yet in many of the hardest hit areas of the
world there are simply not enough doctors and other health care workers
to meet the challenges of this pandemic. The Lantos-Hyde legislation
invests new funds in training new professionals and paraprofessionals,
as well as building existing capacity.
The 2003 law focused on creating new programs to tackle the HIV/AIDS
crisis. The reauthorization bill increases the number of individuals
receiving prevention, treatment and care services. It also builds
stronger linkages between the global HIV/AIDS initiative and existing
programs designed to alleviate hunger, improve health care, and bolster
HIV education in schools, an approach endorsed by the President's
Global AIDS Coordinator just a few short weeks ago.
The 2003 law gave inadequate attention to the needs of women and
girls. The new legislation remedies this situation by strengthening
prevention and treatment programs aimed at this especially vulnerable
population.
The reauthorization legislation also eliminates the one-third
abstinence-only earmark, but requires a balanced approach to HIV/AIDS
sexual transmission prevention programs and a report regarding this
approach in countries where the epidemic has become generalized.
The bill before you today is a compromise in the best sense of the
word, and it is in the true spirit of the great leaders of this
committee who guided the 2003 act into law, Chairmen Lantos and Hyde.
This bill is the result of more than a year of preparatory work and
weeks of discussions, concluding with a bipartisan agreement with the
White House. President Bush has indicated his support and his intention
to sign it into law as soon as Congress acts.
For all its strengths, the bill before the House today is not
perfect. No compromise ever is. No one got everything they wanted in
this compromise legislation. But with this agreement, we have
maintained the strong, bipartisan coalition behind the global HIV/AIDS
initiative which has been critical to winning rapidly increasing
funding levels for this important initiative.
Madam Chairman, 20 million innocent men, women and children have
perished from HIV/AIDS, and 40 million around the globe are HIV
positive. Each and every day another 6,000 people become infected with
HIV. We have a moral imperative to act, and to act decisively.
I will speak more lengthily about the subject, but I do want to
initially extend my particular appreciation to our ranking member,
Ileana Ros-Lehtinen, who played a critical role in working with the
majority to reach this compromise. A number of Members on her side from
the committee were active. Don Payne, the gentleman from New Jersey,
the chairman of the Africa Subcommittee, was critically involved, as
was Congresswoman Barbara Lee from California, who played such a key
role in the 2003 law, as well as a number of other people, such as
Congressman Carnahan. I can't mention everyone who was involved, but
this was truly a collaborative effort that started long before I became
Chair of the committee, with great work by Chairman Lantos last year
and with the staff of the committee.
Madam Chairman, I reserve the balance of my time.
Ms. ROS-LEHTINEN. Madam Chairman, I yield myself such time as I may
consume.
Madam Chairman, I thank my good friend, the new chairman of our
Foreign Affairs Committee, Howard Berman. He has got a tough act to
follow, because we all loved Tom Lantos. The gentleman from California
(Mr. Berman) had a hard act to follow, but, boy, did he fill those big
shoes very well. So, thank you, Mr. Chairman. This has been your first
trial by fire, and you came out looking so well because you
accommodated the concerns and the anxieties and the worries that so
many of our Members had.
I want to thank on a bipartisan level all of the members of the
Foreign Affairs Committee, from the most conservative to the most
liberal. We were able to forge a compromise that reached a broad
consensus on this vital and complex legislation. We couldn't have done
it without the leadership of Chairman Berman, but also without his very
able staff and the staff on our Republican side of the aisle as well.
The foundation of this bill, as Chairman Berman has pointed out, is
the 2003 Leadership Act, which was the first comprehensive U.S.
emergency response to the HIV/AIDS pandemic and which stands as a noble
legacy of our two former chairmen, Henry Hyde and Tom Lantos. They
understood, as do all of us, that millions of lives around the world
depend on our country's willingness to battle this pandemic together.
It does honor to our country that 5 years ago we undertook this true
mission of mercy. We are fortunate to have the opportunity to reaffirm
that commitment by our vote here today.
Since the passage of the original Leadership Act of 2003, extensive
emergency treatment and prevention programs have begun to slow the
advance of HIV/AIDS, tuberculosis and malaria. The success of these
programs is well documented. I would like to cite some specifics.
According to the office of the Global AIDS Coordinator, more than 1.4
million people infected with the HIV virus are now being treated with
the necessary drugs to fight this disease. PEPFAR has supported HIV
testing and counseling for 30 million people, cared for million 6.7
million, and, as the chairman pointed out, including almost 3 million
orphans and vulnerable children. We are on our way to achieving the 5-
year goal of preventing the infection of 7 million people. PEPFAR has
supplied medicines for approximately 800,000 expectant mothers,
preventing an estimated 157,000 infant HIV infections. What a
successful program.
The legislation before us keeps faith with the core principles of the
Hyde-Lantos Act. We have modified the original blueprint by adding or
adjusting a number of provisions based on 5 years of real-world
experience regarding what works and what doesn't.
In addition to medicines and sophisticated methods of treatment, the
2003 act mandated that a more comprehensive approach be used that took
into account local values and indigenous cultures, and the act before
us does that.
With respect to this balanced approach, the wife of the President of
Zambia said it best recently when she said, ``There are several ways in
which we can reach the young people. One of the effective ways is
abstinence. It brings back dignity and self-responsibility to young
people, because they know their bodies are not supposed to be abused
and they learn to say no.''
The compromise bill before us removes the specific directive in
current law so that implementation, as the chairman has pointed out,
can be better refined to reflect the varying circumstances in host
countries. Nevertheless, the bill before us continues this
comprehensive approach by requiring that the AIDS Coordinator provides
a balanced approach for prevention activities for sexual transmission
of HIV/AIDS and to ensure that abstinence and faithfulness programs are
implemented and funded in a meaningful and equitable way.
The agreement that we have is carefully crafted and designed in the
area of reproductive health and family planning to ensure that HIV
funding for prevention is not misused to promote programs beyond the
scope of this bill.
[[Page H1906]]
We can do that, if you wish, in other bills. But the bill ensures also
that those working to fight these diseases are not required to choose
between their conscience and receiving the assistance they need to
carry out their work.
Also we worked a lot on the prostitution and the sex trafficking
pledge. The bipartisan agreement maintains the existing certification
requirement that any group or organization receiving PEPFAR funds
explicitly oppose prostitution and sex trafficking. The U.S. Agency for
International Development has implemented this prohibition by requiring
that any group that receives funding sign a pledge affirming its
opposition to these practices.
Let me be clear: Neither current law nor the pledge itself prevents
organizations from working with prostitutes or other high risk groups,
but it does mandate that that assistance to these individuals not be
mistaken for approval or support of the activities that take their
terrible toll on their bodies and that can only be described as
destructive to human dignity.
We had issues with accountability and national security, and although
this bill is absolutely motivated by the altruism of the American
people, I believe that this legislation ensures that our interests are
protected as well.
{time} 1230
For example, U.S. contributions to the Global Fund will be subject to
more stringent oversight than is currently provided by calling for the
Fund to meet even higher benchmarks of transparency and accountability.
The legislation also includes a prohibition on taxation of our
assistance by foreign governments to ensure that assistance intended to
the afflicted not be siphoned off by unaccountable bureaucrats.
The bill also strengthens our national security. The HIV pandemic is
first and foremost a health issue, but it also is one of the most
significant global, economic, and security threats of our generation.
General Charles Wald, the Former Deputy Commander of the US-European
Command, has called HIV/AIDS the third greatest threat to our national
security.
Together, HIV/AIDS, tuberculosis, and malaria kill millions of people
during their most productive years, between the ages of 16 and 50. And
in the hardest hit countries, the AIDS epidemic alone is killing a
generation of parents, of teachers, of health care workers, bread
winners, peacekeepers, shattering the economic and the social life of
villages, communities, and, indeed, nations.
Losses on this scale have staggered the economies of the hardest hit
countries. Without further prevention, without further treatment,
without further care efforts, the AIDS pandemic will continue to spread
its mix of death, poverty, and despondency that is further
destabilizing governments and societies and undermining the security of
entire regions.
Our former House colleague from Wisconsin, Mark Green, who now serves
as the United States Ambassador to Tanzania, wrote to me following the
committee's passage of this bill highlighting this security aspect. He
said, ``In tearing apart the social fabric and leaving a generation of
orphans, the scourge of HIV/AIDS could spread and create a long-term
breeding ground of radicalism.''
PEPFAR programs in turn help to counter these precursor conditions.
As General Wald has said, ``In addition to the obvious humanitarian
efforts of PEPFAR, the program is one of our Nation's development
activities that can help strengthen the social structure that keep
communities and nations secure.''
The threat is not just in faraway lands, but in our own back yard.
Many countries in the Caribbean have been particularly hard hit. This
bill places a new emphasis on assistance to this region. It adds 14
Caribbean countries to the existing list of nations in which the Global
AIDS Coordinator is given explicit statutory authority over HIV/AIDS
programs.
Let me add that, although all of us share the goal of reducing the
further spread of this pandemic, this is also a personal issue for me
both professionally and morally. South Florida, which falls within my
congressional district, ranks first in the State of Florida in the
number of AIDS cases. Roughly 19 percent of the State total for those
living with HIV reside in my district. So, I am all too familiar with
the human cost of this disease, and hope for the day when its ravages
are safely confined to the past.
Although not all Members will fully agree with every aspect of this
complex compromise, it does contain the bipartisan approach that we
have maintained throughout the years of work on HIV/AIDS in our
committee. We have an opportunity, indeed, a responsibility, to
continue the lifesaving work that began 5 years ago. This legislation
is a means by which that can happen.
But the dry text of the legislation, nor the posters behind me,
cannot adequately capture the human drama for which we are trying to
write the exit strategy.
The poster behind me shows where PEPFAR has worldwide activities, the
number of countries where it has positively had an impact. The second
poster shows the number of adults and children estimated to be living
with HIV just this last year. And, the third poster shows some of the
faces of the children whom this legislation has saved.
Let me read, to conclude, from a Washington Post op ed authored by
our chairman, Henry Hyde, 5 years ago. Mr. Hyde wrote,
``Not since the bubonic plague swept across the world in the last
millennium has our world confronted such a horrible curse as we are now
witnessing with the growing HIV/AIDS pandemic.
``This pandemic is more than a humanitarian crisis.
``To those who suggest that the United States has no stake in this
pandemic, let me observe that the specter of failed states across the
world is certainly our concern.
``The AIDS virus is a mortal challenge to our civilization.
``It is my hope that each of us will be animated by the compassion,
and, yes, the vision, that has always defined what it means to be an
American.''
Madam Chairman, endless numbers of children have already been
orphaned and deprived of the protection and the love of their parents.
We cannot make their world whole again, but there is much that we can
do to comfort and care for them and to prevent others from suffering
the same fate.
I ask my colleagues to join us in supporting this bill in a strong
bipartisan manner, and thereby allow our country to continue our
mission, our mission of mercy, for the waiting millions.
And with that, Madam Chairman, I reserve the balance of my time.
Mr. BERMAN. Madam Chairman, I thank the gentlelady for her wonderful
statement, and I yield 3\1/2\ minutes to the gentleman from
Massachusetts (Mr. McGovern).
Mr. McGOVERN. I thank the chairman, and I ask for time for the
purpose of the gentlelady from Missouri and I entering into a colloquy
with the chairman on the importance of integrating food and nutrition
programs with the prevention, care, and treatment of HIV/AIDS-affected
individuals, families, and communities.
Last year, I traveled to Africa and had the opportunity to see
firsthand many of our programs related to food security. In Ethiopia
and Kenya, I visited HIV/AIDS programs to look at how food and
nutrition was included. At that time, I heard from local communities,
NGO partners, and our embassy staff how restrictive guidance for global
HIV/AIDS assistance often hindered their ability to design and carry
out effective food and nutrition programs targeted at HIV/AIDS affected
individuals, families, and communities. The lack of resources available
for food and nutrition programs within the global HIV/AIDS assistance
and from other sources also posed a significant barrier.
I very much appreciate and support the work of the committee in
ensuring that this bill addresses these concerns throughout, and
especially in the section entitled ``Food Security and Nutrition
Support.'' The bill recognizes that strengthening the linkages and
enhancing coordination among HIV/AIDS programs and vital development
programs, like food and nutrition programs, will significantly increase
our effectiveness in the fight against HIV/AIDS while we advance other
essential U.S. development priorities. I remain concerned, however,
that the bill is less clear on where or how such funding will be
provided for these purposes. It is not clear on how much funding will
[[Page H1907]]
come from the Global HIV/AIDS program versus other sources of funding.
I am concerned that, without adequate resources through the Global HIV/
AIDS program, or necessary increases for current food and nutrition
services through programs like Food for Peace, that USAID will be faced
with the possibility of having to divert funding from programs that
address long-term chronic hunger and food insecurity to meet the
enhanced mandates of H.R. 5501.
I know the chairman will agree that we want to avoid this scenario of
robbing Peter to pay Paul so that we do not end up shortchanging other
communities suffering from hunger, malnutrition, and food insecurity.
I want to yield to the gentlelady from Missouri in this regard.
Mrs. EMERSON. I thank the gentleman from Massachusetts.
Madam Chairman, I am also concerned that the situation will become
even worse, because the cost of food, commodities, and transportation
is skyrocketing. Just last month, on February 12, the USAID's Office of
Food for Peace announced that the cost of wheat and other food the
United States donates to poor countries jumped 41 percent, 41 percent,
in the first half of fiscal year 2008. According to USAID, this means
$120 million in food assistance will not be available for people who
are malnourished or food insecure.
I would ask the chairman to work on strengthening the language in the
bill as it moves through the legislative process and into conference
negotiations to clarify how the necessary level of funding for food
security and nutrition will be provided, especially in light of rising
food and transportation costs, so that funds won't be diverted from
U.S. programs addressing chronic hunger and emergency operations.
I yield back to the gentleman from Massachusetts.
Mr. McGOVERN. And I yield back to the chairman to express his views.
The CHAIRMAN. The gentleman's time has expired.
Mr. BERMAN. Madam Chairman, before I respond with my views, I would
like to yield 1 minute to the gentleman from New Jersey (Mr. Payne) to
express his views on the subject of this colloquy.
Mr. PAYNE. Mr. Chairman, as you know, the provision on food and
nutrition security in the bill currently under consideration is drawn
directly from a bill I introduced in December, H.R. 4914, the Global
HIV/AIDS Food Security and Nutrition Support Act of 2007. I introduced
the bill after chairing a hearing in the Subcommittee on Africa and
Global Health to determine whether the Global HIV/AIDS program was
adequately addressing the nutritional needs of its beneficiaries.
The hearing corroborated what I had already heard in the field on
numerous visits to Africa over the past 5 years: PEPFAR is falling
short in this critical area. I share the concerns of the gentleman from
Massachusetts and the gentlelady from Missouri about the increasing
cost of food aid. Just last week, the World Food Program had to issue
an appeal for an additional $500 million to offset the increased costs
of food and fuel.
The CHAIRMAN. The gentleman's time has expired.
Mr. BERMAN. I yield the gentleman an additional 30 seconds.
Mr. PAYNE. Without the extra $73 million, people who rely on WFP for
their daily sustenance may have their rations cut. This is a truly
alarming situation, and it is not my intent for the provision of this
bill to exacerbate it. The language under consideration very clearly
states that these activities are to be funded from amounts authorized
under section 401 of this bill. I used this language deliberately, as I
strongly believe that the food assistance and nutritional support we
are providing under the Global AIDS program must be on top of the food
aid we are already providing.
Mr. BERMAN. Madam Chairman, I yield myself 1\1/2\ minutes to respond
to the concerns raised during this colloquy. I thank my colleagues for
raising these important concerns.
H.R. 5501 provides clear and specific instructions to the USAID
Administrator and the Global AIDS Coordinator to address the food and
nutrition needs of individuals with HIV/AIDS and other affected
individuals, including orphans and vulnerable children; and to fully
integrate food and nutrition support in HIV/AIDS prevention, treatment,
and care programs carried out under this act.
I would like to emphasize that the committee and I personally share
our colleagues' concerns about the negative effect rising costs are
having on our long-term and emergency food aid programs. This is a
matter that has our most serious attention, because it affects a wide
array of our food aid and development programs, including the
effectiveness and success of this program.
I want to reassure my colleagues that I will be working over the
coming weeks to strengthen and clarify in the bill that food security
and nutrition programs, especially those referred to as wrap-around
services, are not to be funded with monies diverted from other standing
commitments to address food and security elsewhere in the world or in
these countries.
I yield 30 seconds' additional time to the gentleman from
Massachusetts.
Mr. McGOVERN. I want to thank the chairman for that assurance. I know
that many Members of Congress on both sides of the aisle stand ready to
support him in these efforts.
Ms. ROS-LEHTINEN. Madam Chairman, I yield 3 minutes to the gentleman
from California (Mr. Royce) who is the ranking member of the
Subcommittee on Terrorism, Nonproliferation, and Trade.
Mr. ROYCE. Many have described the crisis: HIV/AIDS, tuberculosis,
malaria. These take countless lives every day, especially on the
continent of Africa. These diseases devastate families, they devastate
communities, and nations. This bill is titled the ``Leadership Act,''
and it is titled that way because it honors two former Foreign Affairs
Committee chairmen who indeed did show leadership in forging this
legislation 5 years ago. And, with this act, the United States will
continue to lead in tackling these killer diseases.
As others have said, this legislation did not come together easily;
and the reason it is difficult is because many people have strong views
on how best to fight these diseases. This bill is a compromise. It
would have been far easier to hold onto positions, probably, but that
would have gotten no bill. But, instead, those working on it did the
hard work to craft a policy that most everyone could support.
{time} 1245
Frankly, had it not been done, it would have been a sharp rebuke to
the work Chairman Hyde and Mr. Lantos did 5 years ago. Tens of millions
of people around the world would have lost, and America would have
lost. That we are in this position now, to continue these two men's
legacy, is due to the dedication of Chairman Berman and Ranking Member
Ros-Lehtinen. I particularly appreciate their inclusion of a provision
I had recommended prohibiting foreign countries, foreign governments,
from taxing our aid, and I thank them for that provision.
While endorsing the policy, the bill's authorization level is a great
concern, as others have expressed. I have conferred with enough people
working in the field and been in enough African countries to doubt the
ability to productively absorb this very large funding level, which is
well over the administration's request.
And while these are devastating diseases, these countries face many
other public challenges, some deadly, which may be shortchanged. Our
country has many public health needs, too. That leads me to believe
that this would be a better bill if it conformed more closely with the
level the administration, which has gotten real results, thinks it
could best spend.
I believe this bill's authorization level will be addressed in our
recommittal motion which will be offered for a vote before this House.
So again, I thank Chairman Berman and Ranking Member Ros-Lehtinen.
Mr. BERMAN. Madam Chairman, I am pleased to yield 5 minutes to the
gentleman from New Jersey (Mr. Payne), the chairman of the Foreign
Affairs Subcommittee on Africa and Global Health, and a key architect
of this legislation.
Mr. PAYNE. Madam Chairman, let me begin by commending Chairman Berman
of the committee for bringing forth this tremendous, important
legislation, and for the support in this bipartisan effort from Ranking
Member
[[Page H1908]]
Ros-Lehtinen, and for her support of this very important legislation.
I rise in strong support of the legislation currently under
consideration. I am very pleased to be an original cosponsor of H.R.
5501, the Tom Lantos and Henry Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of
2008.
This bill is appropriately named because it was under the leadership
of the late Henry Hyde, then chairman of the Foreign Affairs Committee,
that the PEPFAR legislation was originally authorized. And under the
leadership of the late Tom Lantos, reauthorization began. Both of these
tireless giants who have left us should be remembered by this
legislation. I might also note that under the leadership of the
original authorization, Congresswoman Barbara Lee and the Congressional
Black Caucus were very strong advocates to push the leadership of the
House and the President to consider this very important legislation.
In the 5 years, there has certainly been a pandemic that the world is
facing, and there has not been a pandemic similar to this since the
plague during medieval days in Europe. So I am pleased that we are
finally dealing with this pandemic in the way that it should be.
In the 5 years since Congress passed the original legislation
authorizing the President's Emergency Plan for AIDS Relief, or PEPFAR,
as it is well known, it has become an historic program. In my opinion,
this will be remembered as the single most significant achievement of
President Bush's two terms in office.
And from my recent conversations with the President, I know that he
has worked very hard on this reauthorization, and it is with the
support of the White House and the staff, they helped us craft this
bipartisan legislation.
Prior to PEPFAR, the United States did very little in supporting AIDS
treatment programs abroad. In fact, Members may recall a high-ranking
USAID official said that treatment was not feasible in Africa, the most
heavily AIDS-infected region of the world, because Africans cannot tell
time and therefore would not be able to take the required medication
properly. As we know, it was foolish to say that at the time; and as we
have seen the results, it has proven once again to have been a foolish
statement.
These officials advocated limiting our activities only to education
and prevention, a position that would have in effect sentenced millions
of HIV-infected men, women and children to die if it were only that
program. And so I am very pleased we expanded it to where it is today.
Fortunately, the Congress and the President did not agree with that
position. And because we were willing to find a way to provide
treatment for over 800,000 people, today they are receiving
antiretroviral medication to prevent AIDS in the 15 focus countries, 12
of which are in sub-Saharan Africa.
We are also pleased that we are increasing the number of countries to
the 14 Caribbean countries. And as cochair of the bipartisan Caribbean
Caucus, and under the leadership of Representative Donna Christensen,
at a meeting she convened in her district, we had health ministers
admit that the Caribbean also needed substantial help.
Our progress, while significant, is not enough. Only 28 percent of
Africans needing antiretrovirals are receiving them. Shockingly, over
85 percent of African children who need ARVs are going without them. A
mere 11 percent of HIV-positive women who need drugs to prevent mother-
to-child transmission of HIV during child birth are getting them.
The CHAIRMAN. The gentleman's time has expired.
Mr. BERMAN. I yield the gentleman an additional minute.
Mr. PAYNE. In light of these troubling facts, we have taken steps in
this legislation to transform PEPFAR from an emergency response to a
sustainable program by expanding the program beyond a series of medical
interventions. For example, the committee incorporated the provision
that I discussed earlier about food security into the legislation in
order to address the nutritional needs of HIV patients, their families,
and communities heavily affected by the disease.
Lack of food and nutrition support has been, up to now, a major
impediment to the adherence of HIV/AIDS treatment regimens.
H.R. 5501 also contains provisions to build and strengthen health
systems in developing countries. The committee has given the Office of
Global AIDS Coordinator the flexibility to do prevention, care and
treatment programs tailored to the characteristics of the epidemic in
the country in which they are operating by eliminating cumbersome
earmarks that the GAO said were ineffective.
Finally, the bill authorizes significant funds, $50 billion over the
next 5 years, in order to accomplish the goals of the bill. I urge the
House to pass this legislation.
Ms. ROS-LEHTINEN. Madam Chairman, I am proud to yield 7 minutes to
the gentleman from New Jersey (Mr. Smith), the ranking member of the
Subcommittee on Africa and Global Health, who has worked so long and so
hard on this topic.
Mr. SMITH of New Jersey. Madam Chairman, I rise in strong support of
the Tom Lantos and Henry J. Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of
2008, an admittedly long, but appropriate title for a bill that is long
on substance, meaningful intervention, tangible compassion, and relief.
Aptly named for two of the giants of this institution who helped
shepherd President George W. Bush's PEPFAR initiative through the
Congress in 2003, H.R. 5501 will literally mean the difference between
life and death to millions, especially in sub-Saharan Africa.
The bill before us today is consensus legislation, a delicate balance
that if kept intact, and only if kept intact, will be signed into law.
So I want to thank Chairman Berman and Ranking Member Ros-Lehtinen and
other Members and staff for helping to forge today's PEPFAR consensus.
I want to especially thank Sheri Rickert, Mary Noonan, Autumn
Fredericks, Yleem Poblete, Peter Yeo, Pearl Alice Marsh, Dr. Bob King,
Kristin Wells, and David Abramowitz for their extraordinary work in
drafting this legislation.
Madam Chairman, as Members know, close to 70 percent of the estimated
33 million people with HIV live in sub-Saharan Africa. Of the 2.5
million children afflicted with this dreaded disease, 90 percent live
in Africa as well.
When combined with opportunistic infections like tuberculosis--the
number one killer of individuals with HIV--and malaria alone kills one
million each year, again mostly in Africa--the HIV/AIDS pandemic
compares among humanity's worst. Former Chairman Hyde frequently
compared the sickness to the bubonic plague--the black death--an
epidemic that claimed the lives of over 25 million people in Europe
during the mid-1300s.
I know some Members are likely to wince at the cost of the bill--$50
billion over 5 years for PEPFAR, the Global Fund, Tuberculosis, and
Malaria--but that sum of money will be used to prevent 12 million new
HIV infections worldwide, and support treatment for 3 million people,
including an estimated 450,000 children. That sum of money will provide
care to 12 million individuals with HIV/AIDS, including 5 million
orphans and vulnerable children, and will help train and deploy at
least 140,000 new health care professionals and workers for HIV/AIDS
prevention, treatment and care.
On the prevention side, the legislation requires that the Global AIDS
Coordinator provide balanced funding for sexual transmission prevention
including abstinence, delay of sexual debut, monogamy, fidelity, and
partner reduction. If less than 50 percent of the sexual transmission
prevention moneys are spent on the Abstinence and the Be Faithful parts
of the ABC model, the coordinator must provide a written justification.
I note that currently, the coordinator exercises waiver authority in
this regard without notifying Congress so this language ensures greater
transparency and accountability.
Five years, Madam Chairman, after PEPFAR first began, the efficacy
and importance of promoting abstinence and be faithful initiatives have
been demonstrated beyond any reasonable doubt, and the evidence is
compelling.
According to joint comments by the U.S. Department of State, USAID,
and
[[Page H1909]]
HHS on PEPFAR, ``Congressional directives have helped focus U.S.
Government prevention strategies to be evidence based. Because of the
data, ABC is now recognized as the most effective strategy to prevent
HIV in generalized epidemics.
{time} 1300
The original legislation's emphasis on AB activities has been an
important factor in the fundamental and needed shift in U.S. government
prevention strategies from a primarily ``C'' approach prior to PEPFAR
to a balanced ABC strategy. The Emergency Plan developed a more
holistic and equitable strategy, one that reflects the growing body of
data that validates ABC behavioral change.
The U.S. government report goes on to say that recent data from
Zimbabwe and Kenya mirrors the earlier successes of Uganda's ABC
approach to preventing HIV. These three countries, with what is known
as ``generalized epidemics,'' have demonstrated reductions in HIV
prevalence. And in each country, the data point to significant AB,
abstinence, be faithful; behavioral change; and modest, but important,
changes to C.
So, I want to thank Mr. Pitts for writing the original AB earmark
into the original law because it has instructed and has had a
tremendously positive impact.
I would note to my colleagues that this past September the Foreign
Affairs Committee heard from a world renowned expert, Dr. Norman
Hearst, who said that 5 years ago he had been commissioned by U.N. AIDS
to conduct a technical review of how well condoms had worked for AIDS
prevention in the developing world. And he said, and I quote in part,
``my associates and I collected mountains of data, and here is what we
found: When we looked for evidence of public health impact for condoms
in generalized epidemics, to our surprise we couldn't find anything. No
generalized HIV epidemic has ever been rolled back by a prevention
strategy primarily based on condoms. Instead, a few successes in
turning around generalized epidemics, such as Uganda, were achieved not
through condoms, but by getting people to change their sexual
behavior.''
He goes on to say that these are not just our conclusions. A recent
consensus statement in the Lancet was endorsed by 150 AIDS experts,
including Nobel Laureates, the President of Uganda, and officials of
the most prominent international AIDS organizations. And it said, ``the
priority for adults should be, B, limiting one's partners. The priority
for young people should be A, not starting sexual activity too soon.''
And this contrasted with other funders that often officially endorse
ABC, but in practice continue to put their money in the same old
strategies that have been unsuccessful in Africa for the past 15 years.
A Washington Post article by Craig Timberg noted that ``men and women
in Botswana continued to contract HIV faster than almost anyone else on
Earth. Researchers increasingly attribute the resilience of HIV in
Botswana, and in southern Africa generally, to the high incidence of
multiple sexual relationships.''
``Researchers increasingly agree,'' and please, I ask my colleagues
to take note of this, ``that curbing behavior is key to slowing the
spread of AIDS in Africa.'' In a July report, southern African AIDS
experts said that reducing multiple and concurrent partnerships was
their first priority for stopping the spread.
The CHAIRMAN. The time of the gentleman has expired.
Ms. ROS-LEHTINEN. Madam Chair, I yield 3 additional minutes to the
gentleman.
Mr. SMITH of New Jersey. Thank you.
Madam Chairman, the legislation before us also leaves intact the
anti-prostitution/sex tracking pledge, a policy designed to ensure that
pimps and brothel owners don't become, via an NGO that supports such
exploitation, U.S. government partners.
Last February, the U.S. Government Court of Appeals for the District
of Columbia upheld the prostitution pledge and said, in pertinent part,
``In this case, the government's objective is to eradicate HIV/AIDS.
One of the means of accomplishing this objective is for the U.S. to
speak out against legalizing prostitution in other countries.''
The Court of Appeals goes on to say, ``it would make little sense for
the government to provide billions of dollars to encourage the
reduction of HIV/AIDS behavioral risks, including prostitution and sex
trafficking, and yet to engage as partners in this effort organizations
that are neutral towards or even actively promote the same practices
sought to be eradicated.''
Finally, we've come a long way, Madam Chairman, since 2003, when
significant opposition materialized against an amendment that I had
offered to ensure that faith-based providers, and others, are not
excluded from participation. Worldwide, but especially in Africa,
faith-based organizations are absolutely critical in the fight against
AIDS. So, we welcome and are deeply grateful for their support and
their work.
The conscience clause in H.R. 5501 restates, improves, and expands
conscience protection in a way that ensures that organizations like the
Catholic Relief Services, with its 250 plus projects in 52 countries,
which has had a remarkable record on HIV/AIDS prevention, treatment and
care, are not discriminated against or in any way precluded from
receiving public funds.
Madam Chairman, this bill is carefully crafted, and again, I want to
thank my colleagues on both sides of the aisle for the enormous amount
of work that has been poured into its creation.
Mr. BERMAN. Madam Chairman, I am very pleased to yield 3 minutes to
the chairman of the Foreign Affairs Subcommittee on the Western
Hemisphere. And remember, this is a bill about HIV/AIDS, malaria, and
tuberculosis. He played a major role in the tuberculosis section of the
bill, the gentleman from New York (Mr. Engel).
Mr. ENGEL. I thank our distinguished chairman for yielding to me.
Madam Chairman, I'm proud to be an original cosponsor of H.R. 5501,
the Tom Lantos and Henry J. Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008,
named after our dearly departed two great House Foreign Affairs
Committee chairmen that I had the pleasure of serving under, Tom Lantos
and Henry Hyde.
The HIV/AIDS pandemic continues to pose a major threat to the health
of the global community, from the most severely affected regions of
sub-Saharan Africa and the Caribbean, as the chairman mentioned, I'm
the chairman of the Subcommittee of the Western Hemisphere, to the
emerging epidemics of eastern Europe, central Asia, south and southeast
Asia, and Latin America.
I also want to take this time to pay tribute to our colleague who is
in the Chamber, the gentlewoman from California (Ms. Lee), who has
worked so hard in combating global AIDS, probably harder than anyone
else in the Congress. I'm delighted that she's here, and her hard work
has not gone unnoticed.
While most widely recognized for reviewing our commitment to global
AIDS relief, H.R. 5501 reauthorizes provisions on HIV/AIDS, malaria and
tuberculosis, all deadly diseases of poverty. The Lantos-Hyde Act is a
decisive step forward for global health, particularly for our efforts
to control tuberculosis.
I want to take a moment to specifically address the tuberculosis
provisions included, as the chairman mentioned, as my bill H.R. 1567,
the Stop TB Now Act which passed the floor earlier this year, was
largely incorporated into this bill, and I'm delighted about that.
The World Health Organization reports that 1.5 million people died of
tuberculosis in 2006, with another 200,000 dying from HIV-associated
tuberculosis. The multi-drug resistant and extensively drug resistant
TB, known as MDR and XDR, poses a grave risk to global health. A
contagious airborne disease, TB knows no barriers or borders and can
only be successfully controlled in the United States by controlling it
overseas.
This Lantos-Hyde Act declares TB control a major objective of U.S.
foreign assistance programs. In support of WHO targets, the bill
prioritizes halving TB deaths and disease, cutting them in half, and
achieving a 70 percent detection rate and an 85 percent cure rate by
2015.
[[Page H1910]]
The Lantos-Hyde Act prioritizes the Stop TB Partnership's strategy,
which includes expansion of the successful treatment regimen for
standard TB, treatment for individuals infected with both TB and HIV,
treatment for individuals with drug-resistant TB, and enabling research
and development of new tools.
Recognizing the deadly synergy between TB, an opportunistic
infection, and HIV, the Lantos-Hyde Act authorizes assistance to
strengthen the coordination of HIV/AIDS and TB programs. TB is the
leading killer of people with HIV/AIDS.
The CHAIRMAN. The gentleman's time has expired.
Mr. ENGEL. May I ask for an additional minute?
Mr. BERMAN. I yield the gentleman an additional minute.
Mr. ENGEL. And the explosion of drug-resistant TB in sub-Saharan
Africa threatens to halt and roll back our progress in combating both
diseases.
The legislation supports key TB-HIV activities, such as providing
AIDS patients with TB screening and treatment, and providing TB
patients with proper counseling, testing and treatment for HIV/AIDS.
Finally, the legislation authorizes assistance for the development of
new vaccines for TB. The current TB vaccine is more than 85 years old
and is unreliable against pulmonary TB, which accounts for most of the
worldwide disease burden. New TB vaccines have the potential to save
millions of lives and would lead to substantial cost savings.
Studies modelling the 10-year economic benefits of a vaccine that is
75 percent effective have estimated worldwide savings in medical costs
of $25 billion or more.
I strongly urge my colleagues to support this bill. This is a very,
very important bill.
Ms. ROS-LEHTINEN. Madam Chairman, before yielding to my distinguished
colleague from Illinois, I would like to recognize the efforts of Yleem
Poblete, our staff director on the GOP side, Mark Gage, Joan Condon,
Sarah Kiko of our committee staff, they have all been working so hard,
and our detailee, a valuable addition to our PEPFAR team, Ben Snyder.
Thank you to everyone who has worked so hard.
Madam Chairman, I would like to yield 3 minutes to the gentleman from
Illinois (Mr. Weller), an esteemed member of the Committee on Ways and
Means.
Mr. WELLER of Illinois. Madam Chairman, I rise in strong support for
the Tom Lantos and Henry J. Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act. I want
to commend the current leadership of the committee, the bipartisan
leadership, Mr. Berman and Ms. Ros-Lehtinen, for their leadership in
moving this legislation to the floor in a bipartisan way. And it's most
appropriate that it be named after Tom Lantos and Henry Hyde, two
distinguished chairmen of the International and Foreign Relations
Committees that changed names, but one thing that was in common between
Tom Lantos and Henry Hyde was they always worked to ensure that foreign
policy should be a bipartisan product and a team effort. So, it is so
appropriate that they be recognized by naming this legislation after
them, which reauthorizes President Bush's emergency plans for AIDS
relief.
As noted by a number of my colleagues, almost 33 million citizens of
this planet today suffer from the consequences of HIV/AIDS. We have a
moral responsibility, and it's important that the United States exhibit
and demonstrate moral leadership in addressing this crisis, which not
only is a health issue, but it's a security issue for this globe.
I think we all watched the reception of President Bush when he
traveled recently to Africa and the appreciation that was shown by the
leadership in Africa for the President's initiative and the bipartisan
support that we've seen in the effort against AIDS, and to help those
who are victims of AIDS in Africa.
We often think of Africa when we talk about global AIDS, but of the
33 million, there are also many living in Latin America and the
Caribbean who suffer from HIV/AIDS as well. In Latin America today
there are 1,600,000 people living with HIV/AIDS, that's up from 1.3
million in 2001; and 58,000 citizens of Latin America have lost their
lives to HIV/AIDS. In the Caribbean, 230,000 adults and children are
currently known to be infected with HIV/AIDS. That's up from 190,000 in
2001. In the Caribbean, 11,000 citizens of the Caribbean have lost
their lives.
I note we've made some progress as a result of the President's
initiative for AIDS relief. In Haiti alone, a large recipient of aid as
a result of this initiative, almost 4 percent of the population of
Haiti is infected with HIV/AIDS. Think about that, 190,000 people. And
since 2004, thanks to this initiative, the number of people receiving
care and support has grown from 30,000 to 125,000, and an anticipated
150,000 people will be reached this year because of this initiative.
Haiti received almost $85 million from this program in the past year to
address this crisis which affects many in the Caribbean.
The point is is that PEPFAR, as we know it, has allowed us to reach
almost every person in Haiti struggling with HIV/AIDS. And, for
example, the continued support is necessary to make sure we reach every
person struggling with HIV/AIDS in the world, and that's why this
extension is so important.
The CHAIRMAN. The gentleman's time has expired.
Mr. WELLER of Illinois. May I ask for an additional 2 minutes?
Ms. ROS-LEHTINEN. I yield an additional 2 minutes to the gentleman
from Illinois.
Mr. WELLER of Illinois. I would also like to share a couple other
examples of the success of this initiative and how this funding is
helping regular people and making a difference in Latin America.
Bolivia, a large nation the size of Texas with 9 million people,
thanks to the PEPFAR initiative we're using data to combat HIV/AIDS. In
fact, real-time data is helping Bolivian health officials carry out
more HIV/AIDS prevention education, including HIV counseling and
testing services. And according to the Joint United Nations Program on
HIV/AIDS, prevalence rates in Bolivia's general population has remained
at 1-10th of 1 percent, which is remarkable success compared to some of
its neighbors.
In Central America, in the Republic of Honduras, beginning in
February of 2005 the United States awarded its first set of grants
through USAID to 10 local nongovernmental organizations working with 43
Honduran communities most impacted by HIV/AIDS.
{time} 1315
In their first 7 months of implementation, the organization has
reached over 27,000 at-risk individuals with behavioral change models.
As part of the HIV prevention efforts, the group began offering HIV
counseling and testing, and the counseling and testing programs were
the first in Honduras to be offered by those trained in accordance
working with the Ministry of Health standards as part of a larger
national prevention effort. And this collaboration between the
government of the Honduras, USAID, indigenous organizations and the
Ministry of Health has set this standard expanding access to testing in
the Nation of Honduras.
The bottom line is, this program is making a difference in combating
what is clearly a terrible crisis throughout the world, currently
impacting 33 million citizens of this planet.
We have a moral obligation, and it's important that the United States
continue to exert the leadership and demonstrate the leadership we have
over the last few years to address the global AIDS crisis.
I urge bipartisan support.
Mr. BERMAN. Madam Chairman, I am very pleased to yield to my friend
from California, someone who has been heavily invested in getting our
attention on this issue and passing the legislation, putting,
fashioning and passing the legislation in 2003 and again this time, our
gentlelady from California, Barbara Lee, for 5 minutes.
Ms. LEE. Madam Chairman, I rise in strong support of H.R. 5501.
And let me begin by thanking Chairman Berman, our ranking member, Ms.
Ros-Lehtinen, our subcommittee chair, Mr. Payne, also Chairman Waxman,
Mr. Smith, ranking member of the subcommittee, and all who have helped
to make this legislation an amazing piece of legislation. And I know
that Chairman Lantos and Chairman Hyde
[[Page H1911]]
want to thank us and are here with us honoring their legacy because
they would want to see this move forward as it is today.
As one the five original co-authors of both the initial legislation
establishing PEPFAR and of this new bill reauthorizing PEPFAR, I am
pleased that we are moving forward. And again, I have to thank Chairman
Berman and Ms. Ros-Lehtinen for making sure that this legislation is
really in the spirit of the bipartisan cooperation that we have moved
forward with in the past.
There's no other piece of legislation that we will consider in
Congress this year that will have the greatest impact on the lives of
people around the world. Like many, I have witnessed firsthand many
times the dramatic and positive impact of our AIDS programs on
individuals and communities throughout the world, especially in sub-
Saharan Africa. But it wasn't always this way.
Now, 10 years ago, actually, when I first came to Congress, I think
it was 10 years in April, the world really had not recognized the
devastating toll that HIV and AIDS were beginning to take on families
and communities throughout Africa. Since that time, however, we have
worked together on a bipartisan basis on a number of very important
legislative initiatives that have put the United States on the right
side of history when it comes to this global pandemic.
First, in 2000, we passed and President Clinton signed into law, H.R.
3519, the Global AIDS and Tuberculosis Relief Act. Now this important
bill was a vision inspired by an idea by our former colleague and our
friend, former Congressman, now Mayor Ron Dellums of Oakland,
California to establish an AIDS Marshall plan in Africa, for Africa,
funded through a World Bank AIDS Trust Fund.
With the help and leadership of our former colleague, Congressman Jim
Leach of Iowa, we turned this idea into legislation which provided the
founding contribution and the framework for what we know today as the
Global Fund to Fight AIDS, Tuberculosis and Malaria.
In 2001, working with both former Chairmen Hyde and Lantos, Mr.
Berman, Mr. Payne, Ms. Ros-Lehtinen, Mr. Smith, we drafted H.R. 2069,
which was called the Global Access to HIV/AIDS Prevention, Awareness,
Education and Treatment Act. This was the first bill that dared to
provide large scale antiretroviral therapy to people living in the
developing world.
Although we made progress in advancing this legislation through
Congress in 2001 and 2002, we weren't able to reach a conference
agreement with the Senate before the 107th Congress. Thankfully,
however, our discussions would lay the foundation for quick action in
the next Congress.
So at the end of 2002, the Congressional Black Caucus, along with
practically every advocacy group in the United States, sent a letter to
President Bush urging him to set up and create a presidential
initiative on AIDS especially for sub-Saharan Africa.
In January of 2003, the President took up our cause, understanding
the growing sense of urgency that had been building for years. His
promise of $15 billion during his State of the Union address provided
the impetus that we needed to pass H.R. 1298, the United States
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003,
which created PEPFAR.
In 2005, we took yet another step forward when we recognized that our
foreign assistance programs did not adequately address the needs of
children orphaned or made vulnerable by AIDS. So, working again with
former Chairman Hyde and Chairman Lantos, we passed, and the President
signed H.R. 1409, the Assistance for Orphans and Vulnerable Children in
Developing Countries Act.
So, Madam Chairman, I lay out some of the history of our work on this
important issue because it speaks volumes about what is possible when
we come together in the spirit of bipartisan compromise as we honor the
great legacy of both Chairman Lantos and Chairman Hyde through this
legislation. Chairman Lantos, I know, very much wanted to reach a
bipartisan compromise on this bill, as did Chairman Hyde. I'm saddened
that both of them are not with us to witness this moment. But I know
that they are very pleased with what we have put together today.
The CHAIRMAN. The gentlewoman's time has expired.
Ms. LEE. May I have an additional minute, please?
Mr. BERMAN. I yield the gentlelady an additional 2 minutes.
Ms. LEE. As a former member of the staff here on Capitol Hill for 11
years, I have to mention some of our staff members' names particularly
because they did a phenomenal job in this. Dr. Pearl Alice Marsh, of
course, Kristin Wells, David Abramowitz, Peter Yeo, Bob King, Yleem
Poblete, Mark Gage, Joan Condon, Heather Flynn, Sheri Rickert, Naomi
Seiler, Jessica Boyer, and of course Christos Tsentas of my staff.
These staff members and other members, they deserved, their work
deserves really to be applauded because this was not just work as a
professional on the Hill. This is part of their life's work and I have
to thank them again for their diligence and their competence.
This is a bipartisan compromise, so there were things that we had to
give up and things that our colleagues on the other side of the aisle
had to give up, but that's what compromise is all about.
Let me just mention a few of the items that were included in this
bill. Of course it included language taken from my bill, H.R. 1713, the
PATHWAY Act, to strike the 33 percent abstinence-until-marriage and
provide a comprehensive prevention strategy to address the needs of
women and children.
It also includes language taken from my bill, H.R. 3812, the African
Health Capacity and Investment Act, to build health capacity by
recruiting, training and retaining health professionals and strengthen
health systems.
Now, of course there's still some issues I think need to be addressed
which aren't in this bill. I think we should eliminate the prostitution
pledge, which violates the first amendment and poses an unnecessary
barrier to organizations that work with sex workers.
I think we need to recognize the public health benefits of linking
our HIV and AIDS programs with family planning services by eliminating
ideological restrictions imposed by the global gag rule.
I think we need to end the unjust and discriminatory travel and
immigration ban on people living with HIV and AIDS who wish to enter
into the United States.
So these are not impossible goals. In addition, we should fully fund
the recruitment, training and retention programs for health
professionals with a focus on training doctors and nurses to build
health capacity and strengthen health care systems. So I hope that we
can do this as we move forward.
Let me again thank the chairman for his leadership in addressing the
greatest humanitarian, national security and public health crisis of
our time.
Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield 5 minutes to
the gentleman from Indiana, Congressman Pence, the ranking member on
the Subcommittee on Middle East and South Asia, who spoke so eloquently
during the committee markup on the need for this bill. 5 minutes.
(Mr. PENCE asked and was given permission to revise and extend his
remarks.)
Mr. PENCE. I thank the ranking member for yielding.
I rise in support of the Tom Lantos and Henry Hyde United States
Global Leadership Against HIV/AIDS, Tuberculosis and Malaria
Reauthorization Act of 2008.
The Bible tells us to whom much is given much is expected. And I
believe the United States has a moral obligation to lead the world in
confronting the pandemic of HIV/AIDS.
The dimensions of this crisis are truly staggering. The HIV/AIDS
pandemic has infected more than 60 million people worldwide. It has
killed more than 25 million, a number which grows grievously every day
by more than 8,500. HIV/AIDS has orphaned some 14 million children. And
today, 70 percent of the people in the world with HIV/AIDS reside in
Africa. Within that continent, there are entire countries where more
than one-third of the adult population is infected.
More startlingly, if current infection rates continue, new epicenters
for the disease are likely to arise out of India,
[[Page H1912]]
China, Eastern Europe with numbers that could surpass Africa in a few
short years.
And the threat this pandemic poses to our security is also real. Left
unaddressed, this plague will continue to undermine the stability of
nations throughout the two-thirds world, leaving behind collapsing
economies and tragedy and desperation, a breeding ground for extremist
violence. This is truly a global crisis. And because the United States
can render timely assistance, I believe we must.
Originally titled the President's Emergency Plan for AIDS Relief,
PEPFAR put the world on notice that America will not ignore despair,
desperation and disease. I am proud to have supported the original
passage of PEPFAR in 2003, and I'm proud to support it today.
You know, every so often, in this place, we have the opportunity to
do something for humanity and serve the American people, and this is
such a time.
I thank Chairman Berman and Ranking Member Ros-Lehtinen for their
strong leadership. I commend my colleague, Chris Smith in particular
for his yeoman's work on carefully preserving the delicate balance of
this legislation.
And I also would like to publicly acknowledge the work of our
President, George W. Bush. Mr. President, because of your moral
leadership and compassion, Africa will never be the same, and history
will record your work.
This Global AIDS bill seeks to address the crisis, not by providing
medicine and health care to those in need, but also by providing
resources for evidence based programs that have been successful in
preventing infection. It's imperative, I believe, that we not only send
our resources, but we also send them in a manner that is consistent
with our values. We cannot send billions of dollars to Africa without
sending value-based safeguards and techniques that work to fight the
spread of HIV/AIDS by changing behavior.
Currently, within the Global AIDS bill, these pivotal provisions
exist in the form of a requirement to ``provide balanced funding for
prevention activities'' and to ensure that abstinence and faithfulness
programs are ``implemented and funded in a meaningful and equitable
way.''
It was essential that we preserve these prevention methods that focus
on behavioral change, that we work with faith-based and nongovernmental
organizations at the local level, particularly through the ABC model
that has produced such undeniable results.
Also, it was absolutely critical that we administer this foreign aid
under the historic pro-life guidelines that prevent our foreign aid
from going in a direction that's antithetical to the values of millions
of Americans. I'm pleased to say the Lantos/Hyde Global AIDS bill
preserves all of these vital pro-family provisions.
As we tend to the suffering though, we always have to figure out how
we're going to pay for it. The Federal budget, I believe, is packed
with wasteful and bloated programs which could supply more than enough
opportunities to cover the costs of the Lantos/Hyde Global AIDS bill.
{time} 1330
This summer, Madam Chairman, when it comes time to fund this program
during the appropriations process, I believe Congress should make the
hard choices necessary to ensure that this global health crisis does
not become a crisis of debt for our children and grandchildren. I
believe it is possible to be responsible to our fiscal constraints
while being obedient to our moral calling.
The greatest of all human rights is the right to live. America is a
Nation of great wealth, wealth of resources, but more importantly, a
wealth of compassion. The history of the world is filled with telling
moments regarding the character of a people. Sometimes we are witness
to mankind's great inhumanities; other times, we marvel at the beauty
of mankind's selfless acts of compassion when we rise above politics
and raise up those in dire need. Let this be such a day.
I urge my colleagues to support the Lantos/Hyde Global AIDS bill and
its carefully crafted bipartisan compromise.
Mr. BERMAN. Madam Chairman, I am pleased to yield 1 liberal minute to
the majority leader, the gentleman from Maryland (Mr. Hoyer).
Mr. HOYER. Thank you, Mr. Chairman. Congratulations to the chairman
of the committee. He is an extraordinary individual whom I have known
for four decades. He will do an excellent job. We lament the loss,
however, of the two individuals for whom this bill is named.
I want to congratulate my good friend, Ileana Ros-Lehtinen, as well
for her leadership, and I want to associate myself generally with the
remarks of the previous speaker. And I think it is emblematic of the
partnership that we have, not only with the administration, but on both
sides of the aisle as it relates to this moral, as well as health,
issue, and I thank the gentleman for his comments.
Madam Chairman, 5 years ago, the United States made an unprecedented
commitment to the people of the world who suffer from HIV and AIDS,
malaria, tuberculosis, and other diseases. We pledged $15 billion, and
with that funding, we have provided life-saving drugs to almost a
million and a half people. We facilitated care for over 2 million
orphans and vulnerable children and provided mother-to-child
transmission prevention services during more than 6 million
pregnancies.
We have played a very real role in helping to transform HIV from a
death sentence to a manageable disease.
And, Madam Chairman, as I said 5 years ago when we first passed this
legislation, we must recognize that our Nation and each one of us has a
moral obligation and a national security interest, as has been spoken
of, in combating the HIV/AIDS pandemic, as well as malaria and
tuberculosis.
Today, with this legislation, the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization
Act, we build on and increase our commitment to stop the spread of HIV/
AIDS.
Through this legislation, we make a $50 billion contribution to the
fight to eradicate HIV/AIDS, malaria and tuberculosis. In addition to
expanding our prior efforts, this carefully negotiated legislation will
strengthen HIV-related healthcare delivery systems and increase health
workforce capacities; foster stronger relationships between HIV/AIDS
initiatives and other support programs, including those that promote
better nutrition and education; allow HIV/AIDS testing and counseling
to be provided in the United States bilateral family planning programs,
and it finances prevention and treatment programs targeting women and
girls.
This bill, Madam Chairman, also eliminates an ineffective
requirement: that one-third of PEPFAR prevention funds be spent on
abstinence. Instead, we have directed the administration to create a
balanced approach requiring behavioral change programs to receive 50
percent of the funds devoted to the prevention of sexual transmission
of HIV, and in addition, we require the administration to report to
Congress if programs in nations where the epidemic has become
generalized do not adhere to this balanced approach. This legislation
represents both commitment and compromise.
It will not make everyone happy, but it does signal to the
international community that the United States recognizes and accepts
our moral obligation to act.
Last year alone, 2.5 million people contracted HIV, roughly 6,800
people per day. Last year alone, 2.1 million people died of HIV. Global
AIDS is a problem too large to fall prey to political sport.
My very good friend, the late Chairman Lantos, noted 5 years ago that
this health care crisis ruins families, communities, and indeed, whole
nations, fueling violence and bloodshed across borders. And thus, it is
a global challenge that demands a global humanitarian response with the
United States in the lead.
Madam Chairman, this is a very good bill. It builds on proven
outcomes, and it deserves the support of the Members on both sides of
the aisle.
And again, I congratulate Chairman Berman and Ranking Member Ros-
Lehtinen on their leadership on this effort.
Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield such time as
he may consume to the gentleman from New Jersey (Mr. Smith) for the
[[Page H1913]]
purpose of engaging in a colloquy with our chairman, Mr. Berman of
California.
Mr. SMITH of New Jersey. I thank my good friend for yielding.
Madam Chairman, I would like to engage in a colloquy with my friend
and colleague, the chairman of the Foreign Affairs Committee, Mr.
Berman.
I would note there are two versions of the committee report for H.R.
5501 designated as part 1 and part 2. I wish to clarify that the
definitive version that applies for purposes of the legislative history
of this bill is part 2.
Is that the understanding of the chairman?
Mr. BERMAN. I appreciate the gentleman yielding, and the gentleman is
absolutely correct. Part 2 of the report is the definitive report on
the legislation being considered by the House today.
Mr. SMITH of New Jersey. I thank the Chair for that clarification.
Mr. BERMAN. Madam Chairman, I am pleased to yield 2 minutes to my
colleague from California (Ms. Woolsey), the chairman of the Education
and Labor Subcommittee on Workforce Protections and a member of the
Foreign Affairs Committee.
Ms. WOOLSEY. Madam Chairman, I rise today in strong support of 5501
and to congratulate our new chairman of the International Relations
Committee and to thank our chairman and to thank our Ranking Member
Ros-Lehtinen, and particularly congratulate the chairman of the Africa
and Global Health Care Subcommittee for writing a bill that clearly
reaffirms Congress' commitment to healthy communities, this time with
the focus overseas.
As a member of the subcommittee, I'm especially pleased that this
bill supports maternal health, orphans, and vulnerable children. Today,
in Africa and throughout the world, children are losing their parents
to the AIDS epidemic. These same kids will grow up too soon. They will
be forced to become caregivers to their own siblings, leaving school,
joining the underage workforce, praying that they are not the next in
line for the graveyard.
In a world as prosperous as our own, Madam Chairman, it is absolutely
unacceptable that this could be happening anywhere. But this bill
actually continues our promise to rid the planet of this plague. This
bill offers real hope. We invest in treatment, but most importantly, it
works towards prevention.
Like many of my colleagues, I'm disappointed that conservative forces
pushed to reduce the Reproductive Health Initiative, but the overall
result will actually be remarkable. And most importantly, it will be
life saving.
I encourage all of my colleagues to vote for H.R. 5501 to make this a
better place to live in worldwide.
Mr. PAYNE. I recognize the gentleman from Missouri (Mr. Carnahan) for
2 minutes.
Mr. CARNAHAN. Madam Chairman, I am proud to rise in support of H.R.
5501, properly named after our former Chairmen Lantos and Hyde, both of
whom I had the honor to serve under on the Foreign Affairs Committee.
I also want to thank President Bush for reaffirming his commitment to
Africa in his State of the Union but also to being open to improvements
in how we deliver our support in Africa.
I want to also add my thanks to Chairman Berman and Ranking Member
Ros-Lehtinen for their leadership in bringing this to the floor, but
especially to Chairman Berman for his great instincts to reach out and
craft an achievable and better bill in this Congress in this way.
Today, we have an opportunity to improve the way the U.S. funds and
administers these HIV/AIDS, TB and malaria programs around the world. I
believe that it is important to make real changes and real progress in
reauthorizing this vital life-saving program.
In February, I had the opportunity to travel to Ethiopia and study
and investigate the effectiveness of many of these programs. The
positive effect that PEPFAR has had over the last several years is
quite obvious: countless lives have been saved and numerous infections
have been prevented.
I visited health clinics in rural Ethiopia, including PMTCT, family
planning, and government-supported clinics. This bill makes important
steps to not just increase funding but to have a more balanced approach
to integrate prevention programs.
While I would have liked to have seen even greater integration in
these programs with family planning and prevention programs, I'm
pleased with the steps the bill does take and steps that are being
taken in a bipartisan way that can help this be done sooner.
Mr. PAYNE. We will now have the gentleman from New York (Mr. Crowley)
for 2 minutes, a member of the Foreign Affairs Committee.
(Mr. CROWLEY asked and was given permission to revise and extend his
remarks.)
Mr. CROWLEY. Madam Chairman, I rise in support of the bipartisan
agreement that will reauthorize PEPFAR for an additional 5 years. I
want to thank both the Chair of the committee, Howard Berman, the new
and very capable chair of the committee, Howard Berman, as well as my
long-time friend, the ranking member, Ms. Ros-Lehtinen, for their
crafting of the legislation and in naming it the Tom Lantos/Henry Hyde
United States Global Leadership Against HIV/AIDS, Tuberculosis and
Malaria, the Reauthorization Act of 2008. And in so doing, I think it
enhances the legacy of both of these fine gentlemen.
Let me say from the start, I support the strong program and will urge
my colleagues to do the same. The first 5 years of PEPFAR have provided
unprecedented prevention, care, and treatment of HIV/AIDS for millions
around the world. By passing this bill we can, and we will, do more.
Through PEPFAR, the United States has spearheaded the global fight
against HIV/AIDS by supporting services to prevent mother-to-child HIV
transmission. These services have helped women during more than 10
million pregnancies and led to the prevention of more than 150,000
infant infections. It has supported life-saving treatment for almost
1.5 million men, women, and children. In the focus countries, over 60
percent of those receiving treatment are women and girls.
It is my honor to say that I have supported this program when it was
first introduced before this body, and I worked to ensure that PEPFAR
was as effective and as efficient as possible. An example of this
bipartisan effort was the inclusion of language, which I championed, to
emphasize education on gender equality and respect for women and girls.
The reauthorization act strengthens these provisions by calling for the
empowerment of women and youth and by promoting changes in male
behavior and attitudes that respect the human rights of women and youth
and that support and foster gender equity.
{time} 1345
However, let me be equally clear, this bill could do so much more and
could prevent many more infections if it improved a critical
partnership with these programs in the fields that have served women
and their families for over four decades, and that is in the field of
family planning providers.
The CHAIRMAN. The gentleman's time has expired.
Mr. PAYNE. Madam Chairman, I yield an additional minute to the
gentleman from New York.
Mr. CROWLEY. Madam Chairman, the House version of the U.S. Global
AIDS Act contains language suggesting that only family planning
programs compliant with the global gag rule will be eligible to receive
PEPFAR funds to provide HIV education, counseling, and testing. I
believe that this would be a new restriction. No such requirement
exists in current law or policy. And I believe if we are serious about
preventing the most new infections, we need to put aside our political
differences on the merits of the global gag rule and ensure that the
very best in the field have the support of the U.S. to do what they
need to do, and that is prevent the spreading of HIV/AIDS.
Mr. PAYNE. Madam Chairman, I yield 3 minutes to the gentleman from
the Ways and Means Committee, from the State of Washington (Mr.
McDermott).
(Mr. McDERMOTT asked and was given permission to revise and extend
his remarks.)
Mr. McDERMOTT. Madam Chairman, we know what needs to be done. The
PEPFAR reauthorization bill is it, and we're doing it.
This bipartisan bill not only reauthorizes PEPFAR but also
dramatically strengthens the programs. H.R.
[[Page H1914]]
5501 elevates the fight against HIV/AIDS, TB, and malaria from an
emergency to sustainability. In so doing, we declare that HIV is no
longer the death sentence that it was only 5 short years ago. We can
hope and strive for a generation free of HIV and AIDS.
I want to thank the chairman and the subcommittee chairman for
including provisions in the legislation that Representative Granger and
I introduced, which strengthens the prevention of mother-to-child
transmission of HIV. We must ensure that women and children have access
to early screening and lifesaving drug therapies. We can do this by
providing greater training and education on effective prevention. We
also must ensure that they integrate these services with other maternal
health efforts.
Every day more than 1,000 children around the world are infected with
HIV. An estimated 90 percent of those infections occur in Africa. But a
single dose of an antiretroviral drug given once to the mother at the
onset of labor and once to the newborn during the first 3 days of life
reduces transmission by 50 percent. Fewer than 10 percent of pregnant
women with HIV in resource-poor countries have access to these
prevention services. But I'm proud that this bill includes prevention
provisions to strengthen our commitment to prevention and save lives in
the process.
Perhaps the most important provisions are those that recognize the
importance of expanding access to screening and treatment of women and
children. H.R. 5501 also provides my provisions to establish two 5-year
targets that will bring us closer to a generation free of HIV/AIDS.
The first goal is to increase the percentage of children receiving
treatment under PEPFAR from 9 to 15 percent. Treatment allows the
greatest hope for giving a child infected with HIV the chance to an
adulthood free of the disease.
The second goal is for 80 percent of pregnant women in the most
affected countries to receive HIV counseling and testing and, where
necessary, antiretroviral treatment to prevent mother-to-child
transmission.
The biggest limitation on reaching these goals is the availability of
trained personnel. This bill sets a goal of 140,000 people to be
trained by 2015. In South Africa, where my wife is working on the
ground in this epidemic, they are closing pediatric hospitals because
there's no pediatrician to run them. Now, the 80 percent goal is a down
payment on our hope of achieving 100 percent by the time this
authorization expires.
We have a chance today to send a message that America cares enough to
lead the world in fighting these deadly diseases. We should speak loud
and clearly. The legislation gives more people the chance to be
survivors instead of statistics.
I urge my colleagues to support this important bill that strengthens
our commitment to fighting the global HIV/AIDS/TB and malaria epidemic.
Mr. PAYNE. Madam Chairman, it is my pleasure to yield to a member of
the Foreign Affairs Committee, the gentleman from Florida (Mr. Klein)
for 2 minutes.
Mr. KLEIN of Florida. Madam Chairman, I rise today in strong support
of the Tom Lantos and Henry J. Hyde Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act.
This legislation represents the best in bipartisan compromise, and it
demonstrates that, despite what divides us from time to time as
Republicans and Democrats, we can and do come together to tackle issues
that matter most. And the global HIV/AIDS crisis matters deeply to all
of us. Some 40 million people around the world are living with this
disease. We have a moral imperative to act and to act decisively.
Just 5 years ago, an HIV diagnosis for a poor villager in Africa was
a death sentence. Thanks to lifesaving drugs provided by the American
people, this is no longer the case. The global AIDS program works, and
it works because it is an initiative not of one political party or
another. It is truly a compassionate statement by the American people,
and I am very proud to support its reauthorization and urge my
colleagues to do the same.
Mr. PAYNE. Madam Chairman, I yield to the vice chairperson of the
Subcommittee on Africa, a member, of course, of the Foreign Affairs
Committee, the gentlewoman from California (Ms. Watson) for 2 minutes.
Ms. WATSON. Madam Chairman, I just returned from South Africa, and I
did a single codel visiting the various clinics and hospices that are
receiving PEPFAR funds. And I happily report that the small donations
they do receive are stretched beyond imagination. They are finally
realizing that the NGOs have really made great strides.
About 4 years ago, when we went offering them assistance and so on,
most of our help was rejected. But I want you to know that one clinic,
which is a hospice, gets $70,000 a year. And what they do is reach out
to the NGOs in the area. There are volunteers from America there. They
run an excellent facility, and you can see gradual progress.
I was told by our appointed ambassador that he was going to reduce
the amount of donation by $50 million, and I cautioned him because that
would be the wrong message to send for the small successes they have
had and that what we can do is say to the government there that we will
cap it at a certain amount and then you need to also kick in.
So I want to report to our committee and to Mr. Payne, the Chair,
that the funds are working. They're improving our image, and they're
helping to save lives in South Africa.
Thank you so much, Mr. Payne.
Mr. PAYNE. Madam Chairman, I thank Representative Watson for her kind
remarks.
Madam Chairman, at this time I would like to yield 3 minutes to the
gentlewoman from Texas, a member of the Foreign Affairs Committee and
Africa Subcommittee (Ms. Jackson-Lee).
(Ms. JACKSON-LEE of Texas asked and was given permission to revise
and extend her remarks.)
Ms. JACKSON-LEE of Texas. Madam Chairman, there's a terminology that
we use to describe joyous occasions. Sometimes it describes freedom.
The Fisk Singers in Tennessee were called the Jubilee Singers, and it
was because they organized around slavery and after slavery and the
ability to be free with jubilation, and, therefore, they were called
the Jubilee Singers.
I think today is a day of jubilation, and it certainly is a time to
express the jubilation that we feel with the passage, or the intended
passage, of this legislation.
Let me thank the chairman of the subcommittee, Mr. Payne, for
persistence and determination and wisdom. Let me also acknowledge his
ranking member, Mr. Smith; and, of course, our chairman, Mr. Berman;
and the ranking member of the full committee, Ms. Ileana Ros-Lehtinen
for working with us.
But I do want to spend some time acknowledging that we have named
this bill after the late former Chairman Tom Lantos and Henry J. Hyde.
That is a jubilation. It is something to express great excitement about
because these two distinct figures, in many instances with common views
but many instances different views, came together around this
lifesaving legislation, Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria. And it is particularly important because we
have added malaria and tuberculosis as an element that is not a partner
but results thereof and/or stands alone, but all of them kill.
I am reminded of the first mission to Zimbabwe, to Zambia, and to
South Africa, where we went on a Presidential mission, three Members of
Congress, to look closely at the devastation of HIV/AIDS. It was in
1996/1997. And it was there that I saw a 4 year old taking care of a
dying grandparent, the last person surviving who had tuberculosis and
HIV/AIDS. So this legislation is crucial, and it is particularly
crucial because it recognizes the devastation of all of them.
It is likewise crucial because we have not won the war. The
jubilation is that the bill is on the floor, but we have not won this
war. And I might also say that we have not won the war in education,
the ability to prevent all of these diseases.
So let me ask my colleagues to support this legislation.
Madam Speaker, I rise today in strong support of H.R. 5501, The
Global HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008.
I believe that the legislation we are considering today makes vital
improvements to
[[Page H1915]]
what is already a groundbreaking program. I would like to thank
Chairman Berman for his ongoing leadership on this issue, and for
bringing this legislation to the floor today. I would also like to
thank the Committee's Ranking Member, Congresswoman Ros-Lehtinen, and
my colleagues across the aisle, for working toward a compromise, to
develop legislation of which we can all be proud. Today's legislation
is a crucial step toward transforming PEPFAR from an emergency response
to a sustainable program.
I would also like to thank both Chairman Berman and the Chairman of
the Subcommittee on African and Global Health, Congressman Payne, for
working with me to include important language in this legislation. My
language, in Section 301 of this bill, addresses the necessity of
making children a priority among individuals with HIV for proper food
and nutritional support. Section 301, with my language included, states
that it is the sense of Congress that ``for the purposes of determining
which individuals infected with HIV should be provided with nutrition
and food support--
(i) children with moderate or severe malnutrition, according to WHO
standards, shall be given priority for such nutrition and food support;
and
(ii) adults with a body mass index, BMI of 18.5 or less, or at the
prevailing WHO-approved measurement for BMI, should be considered
`malnourished' and should be given priority for such nutrition and food
support;''
Madam Chairman, as Chair of the Congressional Children's Caucus, I
believe that this language is crucial, and I thank the Chairman for
including it in the text of the bill. HIV-infected children have been
underrepresented among beneficiaries of PEPFAR-supported programs. As
this legislation cites in the findings section, ``of those infected
with HIV, 2.5 million are children under 15 who also account for
460,000 of the newly-infected individuals.'' And even these large
numbers are deceiving, as children die much quicker from AIDS than do
adults. UNICEF reports that every minute, a child dies from an AIDS-
related illness, and only 1 child in 20 who needs HIV treatment
receives it. I am pleased to see this language, which focuses attention
on the plight of these children, and makes serving their needs a
priority.
I am particularly pleased to support an amendment offered by my
colleague Congressman Carson. Representative Carson's amendment would
direct the Coordinator of United States Government Activities to Combat
HIV/AIDS Globally and the Administrator of the United States Agency for
International Development to expand their plan for strengthening health
systems of host countries by allowing for postsecondary educational
institutions, particularly in Africa, to collaborate with United States
postsecondary educational institutions and specifically historically
black colleges and universities. I believe that such educational
exchanges would be extremely beneficial for students both in our own
Nation and in developing nations. I urge my colleagues to join me in
supporting this amendment.
In addition, I am also pleased to support the amendment offered by my
colleague Congressman Blumenauer. This amendment adds safe drinking
water to nutrition and income security on the list of programs for
which direct linkages are encouraged. People with HIV/AIDS are at
increased risk for diarrheal diseases, and these illnesses leave HIV-
infected patients with a reduced ability to absorb antiretroviral and
other medications. The availability of safe drinking water must be part
of any sustainable strategy of HIV prevention and treatment.
As this House is aware, it is estimated that HIV/AIDS, tuberculosis,
TB, and malaria together kill more than 6 million people each year. In
January 2003, President Bush announced the President's Emergency Plan
for AIDS Relief, or PEPFAR. As its name implies, PEPFAR was envisioned
as an emergency response; the bill before us today represents a crucial
first step in the process of transitioning to a sustainable program to
address these global epidemics.
Seventeen years after the first cases were diagnosed, AIDS remains
the most relentless and indiscriminate killer of our time, with 39.5
million people worldwide now living with HIV or AIDS. Despite pouring
billions and billions of private and Federal dollars into drug research
and development to treat and ``manage'' infections, HIV strains persist
as a global health threat by virtue of their complex life cycle and
mutation rates. Of those infected, 24.7 million, or about 63 percent,
live in Sub-Saharan Africa, a region with just 11 percent of the
world's population. 61 percent of those infected in this region are
women. Though Africa, and even more specifically African women, bears
the brunt of the AIDS pandemic, Americans should be reminded that HIV/
AIDS does not discriminate, with well over a million people in our own
country currently living with HIV or AIDS.
Tragically, 6 percent of the 39.5 million people currently infected
with HIV/AIDS are children under 15 years of age. In 2006, the virus
killed 380,000 children (13 percent of all HIV/AIDS deaths), and 90
percent of all children living with HIV reside in sub-Saharan Africa.
According to UNAIDS statistics from 2005, 1,500 children worldwide
became newly infected with HIV every single day, due largely to
inadequate access to drugs that prevent the transmission of HIV from
mother to child. Only 8 percent of pregnant women in low- and middle-
income countries were offered services to prevent HIV transmission to
their newborns.
Madam Chairman, HIV/AIDS continues to represent a serious and large-
scale challenge throughout much of the world. It goes far beyond a
simple health problem, and it hinders attempts to foster economic
development and political stability. As we reauthorize PEPFAR, I
believe it is crucial that we emphasize the long-term sustainability of
our HIV efforts, and that we integrate AIDS prevention and treatment
within our larger-scale development initiatives. I believe that the
legislation before us today makes groundbreaking strides toward moving
the Global HIV/AIDS program beyond emergency implementation and toward
sustainability. It dramatically boosts HIV/AIDS programming related to
women and girls, strengthens health systems in countries hardest-hit by
the HIV virus, increases U.S. contributions to the Global Fund, and
authorizes HIV/AIDS programs to include linkages to food, nutrition,
education, and health care programs.
Though we have drugs that are effective in managing infections and
reducing mortality by slowing the progression to AIDS in an individual,
they do little to reduce disease prevalence and prevent new infections.
For this reason, there is growing consensus among health experts that
we must put greater emphasis on comprehensive prevention programs,
which are perhaps the most critical aspect of any initiative to combat
global HIV/AIDS. Even as increasing numbers of people have access to
anti-retroviral drugs, ARVs, an estimated 5.1 million people who needed
treatment did not receive it in 2006. In sub-Saharan Africa, the
percentage of individuals needing treatment who actually received it
rose substantially, from 2 percent in 2003 to 28 percent in 2006. This
growth is impressive, and represents a significant step forward, but it
also means that 72 percent of sub-Saharan Africans requiring treatment
did not receive it.
Madam Chairman, despite our concerted efforts, we continue to face a
serious and persistent health threat. I believe that it is imperative
that we ensure that American taxpayer dollars are used to greatest
effect, not to bolster ideology. This legislation makes important
strides forward by removing elements of the original authorization that
speak more to ideology than actual conditions in the field. Under the
current law, one-third of all prevention funds under PEPFAR must be
used on abstinence-only education, which neglects the real needs of
populations both in America and abroad. These stipulations hurt the
ability of PEPFAR to adapt its activities in accordance with local HIV
transmission patterns, and they impair efforts to coordinate with
national health plans. Though AIDS is clearly a global problem, it does
not affect every nation equally or in the same manner.
Madam Chairman, I am extremely pleased that the legislation we are
considering today removes these restrictive provisions, allowing PEPFAR
to better address the requirements of each country, making more
efficient and effective use of taxpayer dollars in serving the millions
affected by this disease. According to studies by both the Government
Accountability Office and the National Academy of Science's Institute
of Medicine, the abstinence-only earmark has forced a reduction in
mother-to-child transmission programs, reduced prevention efforts with
high-risk groups, and undermined efforts to implement Abstinence,
Faithfulness, and Condoms, ABC, prevention programs.
Under the provisions of today's compromise legislation, the
administration will be directed to promote a ``balanced'' prevention
program in target countries. This will include all elements of the ABC
approach to HIV prevention. The legislation will require that the
administration report to Congress if behavioral change programs do not
receive 50 percent of funds devoted to the prevention of sexual
transmission of HIV in countries in which there is a generalized
epidemic. I believe this language is extremely important, as it not
only recognizes that HIV is transmitted in other ways, besides sexual
activity, but it also acknowledges that the epidemic is not the same in
every country. By requiring a report, rather than earmarking the
expenditure of funds, this legislation provides guidance while still
affording organizations working in the field the flexibility to respond
to nuanced circumstances.
I am proud to be part of this Democratic Congress, which will produce
legislation reauthorizing a Global HIV/AIDS program driven by facts,
rather than ideology. The removal of the abstinence-only earmark will
make this reauthorization legislation stronger than the original
[[Page H1916]]
2003 legislation that it will replace, and I strongly urge my
colleagues to oppose any efforts that might attempt to reinstate it.
In addition, I believe it is crucial that we dedicate greater
attention to strengthening local health infrastructure. Health experts
have expressed concern that the high amount of spending directed toward
HIV/AIDS initiatives has drawn health workers away from public health
facilities and other important programs. This merely compounds a
chronic shortage of qualified health workers, which, according to WHO's
2006 World Health Report, is the single most important health issue
facing countries today. This need is felt particularly sharply in
Southeast Asia and sub-Saharan Africa.
Many health experts also continue to advocate greater integration
between PEPFAR and other health programs, including those focused on
nutrition, maternal and child heath, and other infectious diseases.
These experts note that HIV is intricately linked to these other areas
of concern; for example, malnutrition and lack of food may heighten
exposure to HIV, raise the likelihood of engaging in risky behavior,
increase susceptibility to infection, and complicate efforts to provide
anti-retroviral, ARV, medication. Further, an HIV epidemic will likely
worsen food insecurity, by depleting the agricultural workforce. I
believe it is necessary, to ensure maximum effectiveness, that we
integrate PEPFAR with other aspects of our international health
outreach and development programs. The legislation before us today does
that.
Madam Chairman, while I recognize the importance of compromise, and I
am glad we were able to reach an accord with our colleagues on the
other side of the aisle, I am disappointed that the compromise text
does not include a repeal of the language, known as the pledge
requirement, requiring that all funding recipients to ``have a policy
explicitly opposing prostitution and sex trafficking.''
Madam Chairman, the removal of the prostitution pledge was a critical
facet of the bill we are considering today. The pledge currently
restricts recipients' privately funded HIV prevention programs. No
funds may be used to provide assistance to any group or organization
that does not have a policy explicitly opposing prostitution and sex
trafficking. Funding recipients must refrain from speech or conduct
that is inconsistent with the Government's views on prostitution, even
when they use private funds. Organizations must refrain from some
effective HIV prevention strategies, for fear that the Government will
view it as ``pro-prostitution.'' A repeal of the prostitution pledge
language would leave in place language ensuring that U.S. Government
funds may not be used to ``promote or advocate the legalization or
practice of prostitution and sex trafficking.''
Madam Chairman, the prostitution pledge undermines prevention efforts
targeting one of the populations most vulnerable to HIV transmission.
Because high-risk populations such as sex workers are extremely
marginalized, it is crucial that any intervention promotes a level of
trust between sex workers and service providers. Failure to provide sex
workers with information and services that will help them protect
themselves and their partners from HIV transmission and other sexually-
transmitted diseases also puts the broader community at risk. I am
disappointed that this legislation does not remove this vague and
counterproductive requirement.
This legislation also contains crucial provisions with regards to
malaria and tuberculosis prevention and treatment. It incorporates H.R.
1567, the Stop Tuberculosis, TB, Now Act of 2007 sponsored by
Congressman Engel, important legislation which I am proud to cosponsor.
Today's legislation emphasizes the linkages between HIV/AIDS and TB,
and it also creates new strategies for attacking MDR and XDR forms of
drug-resistant TB. The bill also requires the President to develop a
comprehensive 5-year strategy to combat malaria globally and strengthen
United States leadership against this disease, and creates a new
Coordinator of United States Government Activities to Combat Malaria
Globally.
If we are to turn the tide of turmoil and tragedy that HIV/AIDS,
malaria, and tuberculosis cause to millions around the world, and
hundreds of thousands right here in our backyard, it is imperative that
we continue to fund and expand medical research and education and
outreach programs. However, the only cure we currently have for HIV/
AIDS is prevention. While we must continue efforts to develop advanced
treatment options, it is crucial that those efforts are accompanied by
dramatic increases in public health education and prevention measures.
Investments in education, research and outreach programs continue to be
a crucial part of tackling and eliminating this devastating disease.
As Americans, we have a strong history, through science and
innovation, of detecting, conquering and defeating many illnesses. We
must and we will continue to fight HIV/AIDS until the battle is won.
Ms. ROS-LEHTINEN. Madam Chairman, at this time I am pleased to yield
1 minute to my colleague, my friend from California (Mr. Rohrabacher),
who is the ranking member of the Subcommittee on International
Organizations, Human Rights, and Oversight.
Mr. ROHRABACHER. Madam Chairman, I rise in strong opposition to
sending $50 billion, $50 billion taken from the American people, to
Africa to fight AIDS.
When it comes to this situation with AIDS in Africa, obviously, we
have some people in crisis who are very deserving people. But where
does that $50 billion come from? Are we going to be helping people
overseas at the expense of the well-being of our own people?
There are only three ways of getting the money: We can take it from
domestic programs, take it from those programs to help our own elderly
and the health care for our own people, our own veterans; or we can
raise taxes, which would knock the legs out from under our economy and
make our deficit even higher; or we can borrow the money. And if we
borrow the money, we end up spending hundreds of millions of dollars a
year on interest. We're going to borrow $50 billion in order to help
people overseas and then end up paying interest on it for the next
umpteen years? This is benevolence gone wild.
Yes, we would like to help everybody in the world. But if we vote for
this, it's the most irresponsible measure that I have ever seen in my
term here in Congress for 20 years. We are taking directly from our
veterans, from our elderly, and others to give $50 billion to Africa.
The CHAIRMAN. The gentleman's time has expired.
Ms. ROS-LEHTINEN. Madam Chairman, I yield the gentleman an additional
30 seconds.
Mr. ROHRABACHER. Thank you very much.
Thus what we have to decided to is, are we going to deprive our own
people, our seniors? I just came from a meeting with doctors from my
district. We can't afford to provide health care for our seniors, for
our veterans. We can't afford all the educational things we want to do.
How can we possibly, then, take $50 billion and send it to Africa, even
though it's a worthy cause?
We should not be doing this. It is not in the interests of the
American people. And I would call on my colleagues to oppose this
totally wasteful expenditure of money.
{time} 1400
Mr. PAYNE. It is my pleasure to recognize the Speaker of the House
for 1 minute, the gentlewoman from California, Speaker Pelosi.
Ms. PELOSI. I thank the gentleman for yielding, and recognize his
extraordinary leadership on issues that relate to the alleviation of
poverty and eradication of disease, which really are a national
security interest for our country. They are about the health and well-
being, the respect we command throughout the world.
I want to commend Chairman Berman. I think this is probably the first
piece of legislation to come out of the committee under your leadership
as chairman, and Congresswoman Ileana Ros-Lehtinen, the ranking member
of the committee, for their leadership in bringing a bipartisan, strong
initiative to the floor. This initiative is a continuation of the work
that President Bush has as a priority in the eradication of AIDS,
malaria, and tuberculosis.
For those of us who have been involved in these issues over the
years, whether on the committees of authorization, and Congresswoman
Barbara Lee has been on the authorizing committee, and now on the
appropriating committee; Congresswoman Waters, in many ways in the
House; and you, Madam Chairman, all of us know that for our country to
be healthy, for the eradication of these diseases to take place, we
must have a global approach to it. Disease knows no borders and
boundaries. So, again, while it is the compassionate thing to do, it is
in our self-interest to do as well.
The distinguished chair, Congresswoman Eleanor Holmes Norton, and I,
and others, just had the opportunity to visit a PEPFAR site in India at
the Salvation Army, where they were distributing these drugs through a
regimen, an organized regimen related to hygiene and the rest to people
with HIV and AIDS. We can tell you from firsthand experience; I visited
these
[[Page H1917]]
sites in south Africa, this trip was to India, that wherever we go,
there is great appreciation for what our country is doing, and
President Bush's leadership on this subject.
I am so pleased that the bill is named for Congressman Chairman
Lantos, our friend who left us earlier this year, and Congressman Hyde
before that, because they were the original authors of the first
historic President's emergency plan for AIDS relief legislation in
2003. That landmark bill authorized $15 billion for 5 years. Working
together with the Bush administration and Appropriations Committee, we
succeeded in providing lifesaving antiretroviral treatment to almost
1.5 million people, supporting care for nearly 6.7 million people,
including more than 2.7 million orphans and vulnerable children; and
supporting prevention of more than 150,000 infected infants. We are
talking about AIDS, malaria, and tuberculosis. Now we must take the
next step in fighting AIDS in the poorest countries of the world. The
legislation before us will move us from the emergency phase to the
sustainability phase in fighting AIDS, tuberculosis, and malaria.
My colleagues have presented the provisions of the bill to you, so I
will just submit mine for the Record, Madam Chairman, and just say in
closing that the leadership against HIV/AIDS is our compact with
developing nations across the globe. It says that America stands with
them in this fight, that our commitment will not waver, and shows them
America's true face of passion.
Since the AIDS epidemic began, 20 million men, women, and children
have died from the disease. Twenty million. Forty million around the
globe are HIV positive. That is what we know. We don't even know of
those who have not come forth to be tested. Each and every day, another
6,000 people become infected with HIV. In addition, the number of
orphans, vulnerable children with sick parents and adolescents at risk
with HIV continues to grow, with an estimated 19 million needing
assistance by 2010.
There is a moral imperative to combat this epidemic. If we have these
drugs distributed in the manner in which they are under the President's
program, this PEPFAR, then people will come forward to be tested, then
we will have better success with our prevention initiatives. So it's
all related. Care causes people to say there is a reason to be tested,
and knowing the consequences of the disease contributes to the
prevention effort.
Few crises have called out for more sustained constructive American
leadership. This legislation before us makes that commitment. I urge
our colleagues to support it. Once again, I salute you, Mr. Payne, for
your leadership in so many ways that relate to, again, the eradication
of disease and the alleviation of poverty and the strength of America
related to that and how we are viewed in the world and how that all
contributes to a healthier America.
All of these, if we don't, we will have a fury of despair that
springs from a lack of hope in the world that contributes to violence
and, again, takes us back to the security of our country. So for that
security, and out of compassion, I urge my colleagues to support this
initiative, which is President's Bush's initiative, named for our
colleagues, Mr. Lantos and Mr. Hyde, put forth by the chair, Mr.
Berman, and Congresswoman Ros-Lehtinen in a strong bipartisan way, and
we salute that, and advocated by Mr. Payne of New Jersey.
I urge my colleagues to support it.
INTRODUCTION/ACKNOWLEDGEMENTS
I rise today in strong support of the Tom Lantos and Henry Hyde
United States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act.
I congratulate Chairman Howard Berman and Ranking Member Ileana Ros-
Lehtinen for their bipartisan efforts to fight HIV/AIDS and to help
alleviate poverty and disease in the developing world.
PROGRESS IN THE FIGHT AGAINST AIDS
This legislation is appropriately named to honor the two authors of
the first historic President's Emergency Plan for AIDS Relief
legislation in 2003. That landmark bill authorized $15 billion over 5
years.
Working together with the Bush administration and the Appropriations
Committee we succeeded in: providing lifesaving antiretroviral
treatment to almost 1.5 million people; supporting care for nearly 6.7
million including more than 2.7 orphans and vulnerable children; and
supporting prevention of more than 150,000 infant infections.
NEXT STEPS
Now we must take the next step in fighting AIDS in the poorest
countries of the world.
The legislation before us today will move us from the emergency phase
to the sustainability phase in fighting AIDS, TB and Malaria.
The legislation will: authorize $50 billion for the sustained
commitment required to stop the global AIDS pandemic; dramatically
strengthen health care delivery systems; encourage new and innovative
ways to deliver the ABC prevention message; improve relationships with
governments and NGOs; eliminate the requirement that one third of the
funding be used for abstinence programs; improve services for women and
girls and prevent violence against them; and build stronger linkages to
health care and hunger initiatives.
CLOSE
The Leadership Against HIV/AIDS Act is our compact with developing
nations across the globe. It says that America stands with them in this
fight, that our commitment will not waver, and shows them America's
true face of compassion.
Since the HIV/AIDS epidemic began, 20 million men, women, and
children have died from the disease. Forty million around the globe are
HIV-positive. Each and every day, another 6,000 people become infected
with HIV.
In addition, the number of orphans, vulnerable children with sick
parents, and adolescents at risk for HIV continues to grow, with an
estimated 19 million needing assistance by 2010. There is a moral
imperative to combat this epidemic.
Few crises have called out more for sustained, constructive America
leadership. The legislation before us makes that commitment and I urge
its adoption.
Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield myself such
time as I may consume.
Madam Chairman, sometimes when we are negotiating legislative text or
debating the merits of an important bill, such as the one before us
today, we can lose sight of the extent of the impact that our decisions
here can have on the lives of so many.
I would like to quote from some of the African leaders whose people
and societies have been rescued from certain death by our PEPFAR
programs. The President of Tanzania has said the following, ``There
would have been so many orphans to date. Had it not been for PEPFAR,
the care and treatment, so many parents now who would have been
infected can now live. And some of them can live as many years as
possible. So can you imagine if this program is discontinued or
disrupted? There would be so many people who would lose hope, and
certainly there would be death. You create more orphans. So my
passionate appeal is for PEPFAR to continue.''
Or listen to the words of the President of Botswana when he said,
``PEPFAR is now a critical partner in the historic and heroic battle to
save lives. PEPFAR has turned despair into hope. PEPFAR has galvanized
donor countries and agencies alike to act in concert in the interest of
humanity. If the fund is not renewed and if it is not replenished, the
momentum generated by PEPFAR thus far will no doubt be lost, and the
hope rekindled by the generosity of the American people will be
extinguished. I say this to you,'' said the President of Botswana,
``and that's what I said to the congressional committees recently.''
So, Madam Chairman, these and so many other statements reflect the
human contribution of this critical United States program. But they
also demonstrate that PEPFAR programs are helping to win hearts and
minds throughout the world. They are building and strengthening the
bonds between the governments and the people of these countries and the
United States of America. They are building good will toward our Nation
and toward the American people.
Madam Chairman, after the deplorable attacks on our Nation on that
fateful day almost 7 years ago, we in this Chamber committed ourselves
to using the range of U.S. foreign policy tools, including soft power,
to counter the conditions that breed hatred, intolerance and
radicalism; radicalism that targets the United States, our interests
and our allies, and seeks to undermine our freedom and democracy
everywhere. The bill before us is a vital tool in that effort.
Again, as our former colleague, our Ambassador to Tanzania has said,
``I
[[Page H1918]]
want you to know that PEPFAR is crucial to my current mission as
Ambassador to the United Republic of Tanzania. It is a tremendous
public diplomacy tool that shows America at her best, a compassionate
partner who is committed to helping Tanzania meet its enormous HIV/AIDS
challenges.''
``I was asked to present remarks to the National Consultive Meeting
of Islamic Leaders and Scholars here in Dar es Salaam,'' continues the
Ambassador. ``This was a historic gathering, as it was the first time
that the most esteemed Muslim leaders of Tanzania had gathered together
to discuss their role in the fight against HIV/AIDS. They invited me to
speak alongside the President because of their concern about HIV/AIDS
and their awareness of America's historic contribution to HIV
prevention, treatment and care programs.'' Why? Because of PEPFAR. ``So
as we help to save lives and restore hope,'' the Ambassador ends, ``we
are leaving a lasting impression on the people of this country.''
Madam Chairman, I hope that our colleagues will see the great merit
of this program and that we will continue to build upon it to save many
more lives.
With that, I reserve the balance of my time.
Mr. BERMAN. Madam Chairman, I am pleased to yield 2 minutes to my
friend and colleague from California, the gentlelady, Maxine Waters.
MS. WATERS. Madam Chairman and Members, I am pleased and proud to be
here today to commend not only Chairman Berman but the late Tom Lantos
and Henry Hyde for their wisdom and their foresight in putting together
this most important legislation.
Ladies and gentlemen, I just returned from south Africa and I am
pleased to announce that while I was there, I was recognized and given
the Order of the Companions of Oliver Tombo Award for my work to help
dismantle apartheid in South Africa, and basically for being a friend
of south Africa's. I was very proud.
But as I sat there talking with President Umbeke and others, I was
reminded that in south Africa there is an estimated 5.5 million people
living with HIV and AIDS. That is more than any other country in the
world. Over 18 percent of the adult population of south Africa is
infected by HIV. Infected persons include thousands of well-educated
professionals, such as doctors, nurses, civil servants, and teachers.
In recognizing that we have done a great job in helping to promote
democracy and get rid of apartheid, the enemy now is HIV and AIDS and
tuberculosis. They are losing all of their professionals. They don't
have the personnel to carry out the plan that they have put together to
continue to move south Africa to where south Africa needs to be.
I was very proud that they had built 2.3 million new houses over the
last 10 years. But, again, tuberculosis, HIV and AIDS is destroying
this population. This legislation will help this country and other
countries. These are our friends. They love us. And they love us for
having been involved in the struggle to help save them. These are
countries that we will be able to count on in the world because we have
come to their aid.
Let me also recognize that there were many Americans traveling in
South Africa. Those Americans who were there are being served by people
who live in areas where tuberculosis and HIV is rampant.
So we need this for protection and security of all peoples.
Mr. BERMAN. Might I inquire of the remaining time.
The CHAIRMAN. The gentleman from California has 9 minutes remaining.
The gentlewoman from Florida has 18 minutes remaining.
Ms. ROS-LEHTINEN. Thank you, Madam Chairman.
We have no further requests for time. I would like to yield back the
balance of my time.
{time} 1415
Mr. BERMAN. Madam Chairman, we have no further requests for time. I
would like to make a few closing comments, and I yield myself such time
as I may consume.
It is an accident of fate and hanging around a long time that put me
in the position of managing this bill today, and it is the first bill
not on the Suspension Calendar that has come out of the committee since
I have become Chair. But the fact is the work on this legislation began
a very long time before I became the Chair.
They have been mentioned before, but there are so many new
initiatives and so much thoughtful logic underlying this legislation
that I thought it would pay to once again mention a group of staff
people who, working under the leadership of our staff director, Dr. Bob
King, spent a huge amount of time working for Chairman Lantos, working
with the minority staff, to craft what became a strong, bipartisan
piece of legislation:
Peter Yeo; Pearl Alice Marsh; Kristin Wells; David Abramowitz; Macani
Toungara; Heather Flynn from Chairman Payne's Africa Subcommittee;
Christos Tsentas from Congresswoman Barbara Lee's staff; Naomi Seiler
and Jessica Boyer from the Government Oversight Committee staff, all
played important roles on our side in working on this legislation.
Yleem Poblette on the minority staff made major contributions.
The result is a bipartisan product where in a way we have
internalized on our side the logic of efforts to change behavior and
recognized the validity of abstinence programs in the context of a
comprehensive approach to this problem and accepted the value of faith-
based organizations, and the minority has accepted the logic that this
is a fundamental, moral and humanitarian concern that we should address
and be willing to put a lot of value to, because we know it works.
We know there is a direct relationship between the resources we put
into this program and the lives saved, the people who can avoid and
prevent it, and that it has implications beyond just the moral and
humanitarian dimension, as Speaker Pelosi and Congresswoman Ros-
Lehtinen said, in terms of security and economic welfare and economic
growth in so many parts of the world, which ultimately all inure to our
benefit and our national interest.
So, once again, I am very pleased to be part of this process with my
partner, the ranking member.
Mr. SIRES. Madam Chairman, I rise today in support of H.R. 5501, the
Tom Lantos Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The
passage of this bipartisan bill will continue Congress' commitment to
the fight against HIV, T–B and malaria around the world.
Currently, 95 percent of people with HIV live in the developing world,
and I believe we must be leaders in combating the global AIDS crisis.
H.R. 5501 would: dramatically boost HIV/AIDS programs for women and
girls, strengthen health and education systems in nations hard-hit by
the HIV virus, and provide funding for orphans and vulnerable children,
as well as food and nutrition programs.
The World Health Organization estimates that over 38 million people
are living with HIV/AIDS.
I believe H.R. 5501 provides needed funding and support to transition
the very successful PEPFAR program, and I urge my colleagues to vote in
favor of this bill. Finally, I can think of no better way to honor our
late chairman, Tom Lantos, and his predecessor, Henry Hyde, by naming
this bill after them. Chairman Lantos was an inspiration to so many and
spent his entire life fighting for those around the world that were
less fortunate. His memory will live on through his wife, family, and
the lives of those who are saved with this vital legislation.
Ms. SCHAKOWSKY. Madam Chairman, I want to commend the chairman and
ranking member of the committee for their work in bringing such a
strong reauthorization before us today.
In an op-ed that appeared in the Washington Post a few weeks ago,
Michael Gerson wrote that in voting for this bill, members of Congress
can participate in ``something extraordinary--a true miracle of science
and conscience, and politics at its noblest.''
When the emergency plan for aids was first announced, there were
approximately 50,000 people on AIDS drugs in sub-Saharan Africa. Today
there are roughly 1.4 million, so I share Mr. Gerson's enthusiasm for
this bill, and I am proud of the statement we will make as a Congress
by passing it.
I am also extremely encouraged by provisions in the Senate bill that
will play a key role in the development of safe and effective
microbicides. I hope that in conference, the Committee will look at
these microbicides provisions, which hold great promise to save the
lives of millions of women as part of a comprehensive program to stem
the spread of global AIDS.
[[Page H1919]]
I am so pleased to be able to lend my voice in support of this
critical and imperative bill. I urge my colleagues to support it.
Mr. GENE GREEN of Texas. Madam Chairman, I rise today to show my
support for H.R. 5501, the Tom Lantos and Henry J. Hyde United States
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008. This important bill will aim to address
the devastating effects of AIDS, malaria, and tuberculosis on our
global community.
Numbers from the Joint United Nations Program on HIV/AIDS show that
since AIDS was identified in 1981, about 65 million people have been
infected with HIV and more than 30 million have died from AIDS. These
numbers include the figures from 2005 that show more than 2 million of
those living with HIV/AIDS were children and the daily infection of an
estimated 1,500 children worldwide was due in large part to inadequate
access to drugs that prevent the transmission from mother to child.
Additionally, programs within the Department of Health and Human
Services account for 71 percent of the total amount spent, with the
U.S. as the largest single contributor to the Global Fund, an
independent foundation dedicated to disbursing new resources in
developing countries aimed at combating AIDS, tuberculosis and malaria.
This bill will further these efforts that we started 5 years ago by
raising the United States' contribution to $50 billion over the next 5
years. I am also encouraged that this bill will encourage the
development of a TB vaccine.
The TB germ is constantly changing and drug resistant strains have
been found in 28 countries on 6 continents, including right here in the
United States, where it is estimated that 10 to 15 million people in
the U.S. have latent TB. These drug resistant forms of TB have severe
implications both internationally and domestically.
The World Health Organization recently released its new tuberculosis
drug resistance surveillance report. The WHO found that the MDR and XDR
strains of TB are at their highest levels ever. Both of these strains
are far deadlier than normal TB, and are much more difficult and
expensive to treat.
In fact, the Department of Homeland Security recently identified XDR-
TB as an ``emerging threat to the homeland.'' For this reason, we need
to devote resources to stopping this disease and developing a new
vaccine is the first step. This is not a partisan issue.
Some of my colleagues might ask why an AIDS reauthorization bill
should be the vehicle for doing this; there is a very simple reason. TB
is the number one infectious killer among people living with HIV/AIDS,
and accounts for up to half of HIV/AIDS deaths in some parts of Africa.
If we do not address TB in a systematic way and work to develop a
vaccine, then much of the progress that we have made on addressing HIV/
AIDS globally will be undone.
Studies also show that the 10-year economic benefits of a TB vaccine
that was only 75 percent effective could result in an estimated savings
of $25 billion dollars. There is no denying that this is a significant
amount. Our current TB vaccine, BCG, is more than 85 years old and is
not compatible against pulmonary TB, which accounts for most TB cases.
This legislation is a good start in our critical battle against TB.
Finally, I am happy to see that this bill will encourage public-private
partnerships in combating these diseases. The Baylor Pediatric AIDS
Initiative has been working in Africa for several years, and the
government should work with this and similar programs to leverage the
expertise that they can provide.
I support these strong health initiatives across the globe and I
encourage my colleagues to do the same.
Mrs. TAUSCHER. Madam Chairman, I rise today in support of H.R. 5501,
the Lantos-Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Reauthorization Act of 2008.
The world has achieved more in the fight against HIV/AIDS in the past
decade than it has since this deadly epidemic began nearly 30 years
ago, due in no small part to the efforts of the President's Emergency
Plan for AIDS Relief (PEPFAR), combined with Congressional enactment of
the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2003.
As a nation, we have provided care for more than 6 million HIV-
infected individuals, including nearly 3 million orphans. We have
prevented 150,000 infant infections by providing mother-to-child HIV
transmission prevention services for more than 10 million pregnancies.
And we have provided anti-retroviral drugs for nearly 1.5 million men,
women, and children.
Yet in an era where 40 million men, women, and children are infected
with HIV worldwide, and where infections continue at a rate of nearly
6,000 per day, U.S. global leadership on HIV/AIDS--as well as the
associated diseases of TB and malaria--remains as important as ever.
I quote Stephen Lewis, the former United Nations Special Envoy for
HIV/AIDS in Africa: ``the international community must now finally keep
its word and mobilize for global AIDS treatment delivery . . . it is a
moral imperative that global leaders and institutions keep their
promises to scale up AIDS services with urgency and increased
resources.''
I believe passage of H.R. 5501 displays our commitment to doing just
that.
This legislation authorizes $50 billion over the next 5 years,
including $41 billion for HIV/AIDS, $4 billion for tuberculosis, and $5
billion for malaria, and is designed to move these programs from the
``emergency'' phase, towards greater sustainability.
In particular, I am pleased to see a strengthened focus on the needs
of women and girls, and prevention and treatment programs targeted
towards this population--including, for the first time, the provision
of HIV/AIDS testing and counseling services in family planning
programs. I would note that concerns have been raised that the bill's
language would block HIV testing and counseling services from being
offered by family planning providers that are not compliant with the
misguided ``global gag rule'' policy, and I hope that Congressional
intent can be clarified that this is not the case.
I am also supportive of provisions that remove the requirement
targeting one-third of prevention funding towards abstinence-only
programs. Prevention programs must be evidence-based, rather than
ideologically-based.
This legislation doubles, to $2 billion per year, the U.S.
contribution to the multilateral Global Fund to Fight AIDS,
Tuberculosis, and Malaria. The Global Fund, with its emphasis on
stimulating a global commitment under an umbrella organization with a
truly international AIDS budget, is the best chance the world has of
combating this epidemic. I urge my colleagues and the President to
ensure that these new authorization levels are fully funded.
Madam Chairman, I applaud the bipartisan work of the Foreign Affairs
Committee, including its new Chairman, Howard Berman, and Ranking
Member Ileana Ros-Lehtinen. I also want to recognize and commemorate
the leadership of our dear friend, Congressman Tom Lantos, whose
commitment to the most vulnerable people worldwide continues to be felt
through our work on HIV/AIDS. I urge my colleagues to support H.R.
5501.
Mr. WAXMAN. Madam Chairman, as one of the original cosponsors of this
bill, I am proud of what it represents, and I strongly urge my
colleagues to support it. This five-year reauthorization tells the
world that the United States is truly committed to a sustainable global
response to HIV, TB, and malaria.
The bill raises our financial commitment. It authorizes the
strengthening of local health systems and the training of workers,
including the doctors and nurses on whom the sustainability of this
program will rely.
The bill also eliminates the onerous abstinence-only spending
requirement. It replaces it with a provision directing country teams to
tell Congress if they spend less than half of their funds for sexual
transmission on behavior change programs. This is merely a reporting
requirement, and should not be understood as a restriction on country
spending.
I do want to acknowledge some concerns about the bill. Many would
have liked to see stronger and more inclusive language encouraging
linkages to reproductive health services. I would have liked to see
such language too.
There is also concern about the current requirement that recipients
sign an ``anti-prostitution pledge.'' People involved in sex work are
very vulnerable to HIV infection, along with many other health and
social risks. But what we hear from the field is that the pledge has
had the unintended consequence of making groups shy away from effective
outreach programs for sex workers. They are scared of running afoul of
this broad oath requirement. I'm disappointed that we weren't able to
eliminate it.
While I think we've got more work to do in certain areas, I'd like to
take this opportunity to comment on several elements of the bill which
I believe are vitally important.
First, despite the prostitution pledge, it is unambiguous that the
intent of Congress is to direct close attention to the needs of sex
workers and other marginalized groups. The bill specifically directs
the provision of care, treatment, and prevention services to sex
workers, injection drug users, and men who have sex with men. And it
requires the development of strategies for providing evidence-based
prevention services to each of these populations.
This bill also makes some important refinements to the treatment
program. The expansion of antiretroviral services has been a huge
success. But many people still lack needed treatment. Others require
more expensive second-line therapy. And while significant progress has
been made in the utilization of generic drugs, some U.S. dollars are
still being used to buy brand-name drugs when lower-cost generics are
available.
[[Page H1920]]
In light of these challenges, this bill instructs the AIDS
coordinator to develop mechanisms for encouraging and facilitating the
purchase of safe and effective drugs at the lowest possible price. The
bill also requires the coordinator to report annually on the amounts
paid for generic and branded antiretroviral drugs. And it requires that
information on drug pricing be shared and updated routinely, so our
partners can make purchases based on the best available information.
Finally, I'd like to note that this bill puts an important new
emphasis on research. While we've learned much through this program, we
haven't seen a coordinated research agenda to address questions about
what works and what doesn't, especially in the area of prevention. This
bill mandates a detailed strategic plan for program monitoring,
operational research and impact evaluation research. It also requires a
strategy for maximizing the capacity of host countries to conduct their
own research.
But we should not let these developments make us complacent. The most
basic, but often most pressing, health needs of the world's poor aren't
being met. Children are still dying for lack of clean drinking water.
Women face staggering rates of morbidity and death related to pregnancy
and childbirth. And people across the world succumb to disability and
death from treatable, and often preventable, illnesses.
As we pass this bill today, let's not forget these other pressing
health problems. I urge my colleagues to vote yes on H.R. 5501. And I
hope that the lessons and successes of our global AIDS program inspire
us to reinvigorate our commitment to a broader global health agenda.
Mr. VAN HOLLEN. Madam Chairman, I rise in strong support of the
critical bipartisan Tom Lantos and Henry J. Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization
Act of 2008.
We have a moral obligation to address the global pandemics of HIV/
AIDS, tuberculosis and malaria. It was 5 years ago that Congress took
leadership to address this crisis. Today, because of Congress's
actions, the United States has become the leading provider in the world
of HIV/AIDS assistance, treatment, prevention and care.
AIDS continues to be the leading cause of death in sub-Saharan
Africa. The United Nations estimates that 33 million people are
infected with HIV worldwide, with an estimated 22 million HIV-infected
people in sub-Saharan Africa. Approximately 1.6 million deaths in sub-
Saharan African resulted from AIDS in 2007. This legislation reaffirms
our commitment to combating this deadly epidemic by reauthorizing the
2003 law and will give more flexibility to host governments in
planning, directing, and managing prevention, treatment and care
programs that have been established with our assistance.
I am pleased that the bill also includes a provision that authorizes
funding for U.S. contributions to research and development of a
tuberculosis vaccine. Tuberculosis is a deadly epidemic that faces our
planet today. Nearly 2 million people die from it each year and
approximately 9 million are diagnosed with tuberculosis annually. It is
the largest killer of people with HIV/AIDS, accounting for one-third of
AIDS deaths alone. The current tuberculosis vaccine is more than 85
years old and is unreliable against pulmonary tuberculosis. New
tuberculosis vaccines have the potential to save millions of lives and
would lead to substantial cost savings.
Madam Chairman, let us honor the spirit of the two men--Chairmen
Lantos and Hyde--who guided the 2003 law through this body in
bipartisan manner by passing this much needed legislation to combat
these deadly diseases.
Mr. MORAN of Virginia. Madam Chairman, I rise today in support of
this important bill. PEPFAR-funded programs have provided life-saving
assistance in the fight against HIV/AIDS, and I welcome any expansion
of this assistance. Additionally, I am pleased that we have removed the
``hard earmark'' requiring 33% of all prevention funds be spent on
abstinence-only until marriage programs. Studies by GAO and the
Institutes of Medicine found that the one-third earmark undermines
successful HIV prevention efforts by limiting flexibility in developing
countries. However, I continue to be concerned about any funds being
directed towards unproven, ineffective programs using the ``abstinence-
only'' approach. I worry that the new ``balanced funding'' requirement
may cause mission directors and public health officials to be anxious
about doing what they think Congress wants, instead of what is needed
in the field. Public health experts on the ground are the ones who can
best determine the mix of prevention activities, especially since what
works for one culture may be disastrous for another. Even in our own
country, young people who take part in abstinence-only education are
less likely to use condoms. With 15,000 new HIV infections every day,
the need for additional resources is clearly tremendous, and I'm
extremely supportive of the goals of this important legislation, and I
continue to believe that our highest priority should be funding
science-based, comprehensive efforts to prevent HIV.
Ms. WATERS. Madam Chairman, I strongly support H.R. 5501, the Tom
Lantos and Henry Hyde Global Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Reauthorization Act of 2008. This bill authorizes $50
billion over the next five years for international health programs,
including $41 billion for HIV/AIDS treatment and prevention, $4 billion
for tuberculosis programs, and $5 billion for malaria programs.
I just returned from South Africa, where I received the ``OR Tambo
Award,'' from South African President Thabo Mbeki. I received this
award because of my efforts to end the brutal system of apartheid in
South Africa and to obtain the release of South African anti-apartheid
activist Nelson Mandela from prison. Apartheid was dismantled and
Nelson Mandela was elected President of South Africa in 1994, when
South Africa held its first democratic elections.
I was very proud to receive the OR Tambo Award because I have always
been and continue to be a friend to South Africa. However, in South
Africa today, the enemy is HIV/AIDS. It is estimated that 5.5 million
people are living with HIV/AIDS in South Africa. That is more than any
other country in the world. Over 18 percent of the adult population of
South Africa is infected by HIV. Infected persons include thousands of
well-educated professionals, such as doctors, nurses, civil servants
and teachers.
Everywhere I went in South Africa, people told me about the terrible
problem they have trying to fill professional positions. The shortage
of educated professionals is a result of the fact that so many South
African professionals have died of AIDS or are too sick to work.
The involvement of doctors, nurses, teachers, and other professionals
is critical to stopping the spread of HIV and AIDS. That is why I am
pleased that this bill includes provisions to strengthen the health
care infrastructure in countries like South Africa and train at least
140,000 new health care professionals and workers for HIV/AIDS
prevention, treatment and care. The bill also includes prevention funds
to stop the spread of HIV and treatment funds to allow infected
individuals to live productive lives and continue to serve their
communities.
It is impossible to address HIV without also addressing tuberculosis.
Almost 9 million people develop tuberculosis every year. At least 2.4
million are killed by the disease. According to the World Health
Organization, HIV and tuberculosis form a lethal combination, each
speeding the progress of the other. In the past 15 years, tuberculosis
rates have doubled in Africa overall and tripled in areas with high HIV
concentrations. In some areas of Africa, up to 80 percent of
tuberculosis patients also test positive for HIV. This makes
tuberculosis clinics an ideal location for HIV prevention, treatment,
and care.
I urge all of my colleagues to support this bill and help stop the
spread of HIV/AIDS, tuberculosis, and malaria in South Africa and
around the world.
Mr. HOLT. Madam Chairman, I rise today in strong support of the Tom
Lantos and Henry J. Hyde United States Global Leadership against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, H.R. 5501.
This important legislation reauthorizes and expands the President's
Emergency Plan for AIDS Relief (PEPFAR). I have long supported this
bold initiative that has made the U.S. a leader in this critical health
and moral issue of our time. PEPFAR has shown to the world our nation's
vision and compassion in addressing this healthcare crisis.
Five years ago, an estimated 31 million people were living with HIV/
AIDS worldwide, anti-retroviral drug treatments were expensive, and
approximately 8,200 people were infected with HIV/AIDS every day.
I have heard from a number of my constituents about their support for
continued U.S. efforts to combat AIDS and the spread of HIV around the
globe. It is obvious that Americans care. In the absence of a cure for
AIDS, this worldwide epidemic continues to spread at an alarming rate.
That is why I am pleased that H.R. 5501 makes an important transition
from emergency relief to the establishment of long-term and sustainable
AIDS relief programs. The legislation also works to better integrate
the tuberculosis and malaria programs with the HIV/AIDS programs. This
is essential because in sub-Saharan Africa tuberculosis is the leading
killer of individuals with HIV/AIDS.
Since the creation of this program, the United States has invested
more than $19 billion to combat HIV/AIDS, tuberculosis, and malaria.
The results have been striking. By the end of 2007, the United States
had helped provide anti-retroviral drug treatments to approximately 1.5
million people with AIDS, supported care for 6.6 million--including 2.7
million orphans and vulnerable children--and
[[Page H1921]]
helped to prevent more than 157,000 infant infections.
H.R. 5501 greatly expands our efforts abroad by authorizing a total
of $50 billion over five years. This total includes $41 billion for
HIV/AIDS programs, $5 billion for malaria programs, and $4 billion for
tuberculosis programs. This dramatic increase in funding will help
partner countries continue to identify and meet targets for treatment
and prevention. Additionally, the funding will help build and
strengthen the existing health systems in host countries.
While I support the underlying bill, I do have some concern about one
specific issue. I have long been concerned by the restrictions placed
on how PEPFAR funds can be spent. I have opposed the requirement that
one-third of the funds be spent on abstinence-only education because it
has not proven to be a successful way to prevent the spread of HIV/
AIDS. A report by the Government Accountability Office found that this
restriction tied the local hands of public health workers.
I believe that PEPFAR funds should be spent on the most effective
HIV/AIDS treatment and prevention strategies available. That is why I
am pleased that H.R. 5501 removes the requirement that one-third of the
funds be spent on abstinence education. As this bill works through the
legislative process, I hope that any language in the bill that might be
interpreted to limit funding to programs that are compliant with the
global gag rule be removed.
Madam Chairman, our country has done more to end the spread of HIV/
AIDS in the last five years than any nation in the history of the
world. We must continue. This bill represents a reasonable expansion of
our efforts and makes the important transition to permanent HIV/AIDS
relief. I urge my colleagues to support this investment in the health
of our global community and in the fight against HIV/AIDS.
Mr. BERMAN. Madam Chairman, I yield back the balance of my time.
The CHAIRMAN. All time for general debate has expired.
Pursuant to the rule, the bill shall be considered read for amendment
under the 5-minute rule.
The text of the bill is as follows:
H.R. 5501
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Tom Lantos
and Henry J. Hyde United States Global Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of
2008''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title and table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.
TITLE I--POLICY PLANNING AND COORDINATION
Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis
and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.
Sec. 204. Program to facilitate availability of microbicides to prevent
transmission of HIV and other diseases.
Sec. 205. Plan to combat HIV/AIDS, tuberculosis, and malaria by
strengthening health policies and health systems of host
countries.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Health care partnerships to combat HIV/AIDS.
Subtitle B--Assistance for Women, Children, and Families
Sec. 311. Policy and requirements.
Sec. 312. Annual reports on prevention of mother-to-child transmission
of the HIV infection.
Sec. 313. Strategy to prevent HIV infections among women and youth.
Sec. 314. Clerical amendment.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Prohibition on taxation by foreign governments.
TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
Sec. 501. Sustainability and strengthening of health care systems.
Sec. 502. Clerical amendment.
SEC. 2. FINDINGS.
Section 2 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is
amended by adding at the end the following:
``(29) The HIV/AIDS pandemic continues to pose a major
threat to the health of the global community, from the most
severely-affected regions of sub-Saharan Africa and the
Caribbean, to the emerging epidemics of Eastern Europe,
Central Asia, South and Southeast Asia, and Latin America.
``(30) According to UNAIDS' 2007 global estimates, there
are 33.2 million individuals with HIV/AIDS worldwide,
including 2.5 million people newly-infected with HIV. Of
those infected with HIV, 2.5 million are children under 15
who also account for 460,000 of the newly-infected
individuals.
``(31) Sub-Saharan Africa continues to be the region most
affected by the HIV/AIDS pandemic. More than 68 percent of
adults and nearly 90 percent of children with HIV/AIDS live
in sub-Saharan Africa, and more than 76 percent of AIDS
deaths in 2007 occurred in sub-Saharan Africa.
``(32) Although sub-Saharan Africa carries the heaviest
disease burden of HIV/AIDS, the HIV/AIDS pandemic continues
to affect virtually every world region. While prevalence
rates are relatively low in Eastern Europe, Central Asia,
South and Southeast Asia, and Latin America, without
effective prevention strategies, HIV prevalence rates could
rise quickly in these regions.
``(33) By world region, according to UNAIDS' 2007 global
estimates--
``(A) in sub-Saharan Africa, there were 22.5 million adults
and children infected with HIV, up from 20.9 million in 2001,
with 1.7 million new HIV infections, a 5 percent prevalence
rate, and 1.6 million deaths;
``(B) in South and Southeast Asia, there were 4 million
adults and children infected with HIV, up from 3.5 million in
2001, with 340,000 new HIV infections, a 0.3 percent
prevalence rate, and 270,000 deaths;
``(C) in East Asia, there were 800,000 adults and children
infected with HIV, up from 420,000 in 2001, with 92,000 new
HIV infections, a 0.1 percent prevalence rate, and 32,000
deaths;
``(D) in Eastern and Central Europe, there were 1.6 million
adults and children infected with HIV, up from 630,000 in
2001, with 150,000 new HIV infections, a 0.9 percent
prevalence rate, and 55,000 deaths; and
``(E) in the Caribbean, there were 230,000 adults and
children infected with HIV, up from 190,000 in 2001, with
17,000 new HIV infections, a 1 percent prevalence rate, and
11,000 deaths.
``(34) Tuberculosis is the number one killer of individuals
with HIV/AIDS and is responsible for up to one-half of HIV/
AIDS deaths in Africa.
``(35) The wide extent of drug resistant tuberculosis,
including both multi-drug resistant tuberculosis (MDR-TB) and
extensively drug resistant tuberculosis (XDR-TB), driven by
the HIV/AIDS pandemic in sub-Saharan Africa, has hampered
both HIV/AIDS and tuberculosis treatment services. The World
Health Organization (WHO) has declared the prevalence of
tuberculosis to be at emergency levels in sub-Saharan Africa.
``(36) Forty percent of the world's population, mostly
poor, live in malarial zones, and malaria, which is highly
preventable, kills more than 1 million individuals worldwide
each year. Ninety percent of malaria's victims are in sub-
Saharan Africa and 70 percent of malaria's victims are
children under the age of 5. Additionally, hunger and
malnutrition kill another 6 million individuals worldwide
each year.
``(37) Assistance to combat HIV/AIDS must address the
nutritional factors associated with the disease in order to
be effective and sustainable. The World Food Program
estimates that 6.4 million individuals affected by HIV will
need nutritional support by 2008.
``(38) Women and girls continue to be vulnerable to HIV, in
large part, due to gender-based cultural norms that leave
many women and girls powerless to negotiate social
relationships.
``(39) Women make up 50 percent of individuals infected
with HIV worldwide. In sub-Saharan Africa, where the HIV/AIDS
epidemic is most severe, women make up 57 percent of
individuals infected with HIV, and 75 percent of young people
infected with HIV in sub-Saharan Africa are young women ages
15 to 24.
``(40) Women and girls are biologically, socially, and
economically more vulnerable to HIV infection. Gender
disparities in the rate of HIV infection are the result of a
number of factors, including the following:
``(A) Cross-generational sex with older men who are more
likely to be infected with HIV, and a lack of choice
regarding when and whom to marry, leading to early marriages
and high rates of child marriages with older men. About one-
half of all adolescent females in sub-Saharan Africa and two-
thirds of adolescent females in Asia are married by age 18.
``(B) Studies show that married women and married and
unmarried girls often are unable or find it difficult to
negotiate the frequency and timing of sexual intercourse,
ensure their partner's faithfulness, or insist on condom use.
Under these circumstances, women often run the risk of being
infected by husbands or male partners in societies where men
in relationships have more than one partner. Behavior change
is particularly important in societies in which this is a
common practice.
[[Page H1922]]
``(C) Because young married women and girls are more likely
to have unprotected sex and have more frequent sex than their
unmarried peers, and women and girls who are faithful to
their spouses can be placed at risk of HIV/AIDS through a
husband's infidelity or prior infection, marriage is not
always a guarantee against HIV infection, although it is a
protective factor overall.
``(D) Social and economic inequalities based largely on
gender limit access for women and girls to education and
employment opportunities and prevent them from asserting
their inheritance and property rights. For many women, a lack
of independent economic means combines with socio-cultural
practices to sustain and exacerbate their fear of
abandonment, eviction, or ostracism from their homes and
communities and can leave many more women trapped within
relationships where they are vulnerable to HIV infection.
``(E) A lack of educational opportunities for women and
girls is linked to younger sexual debut, earlier childhood
marriage, earlier childbearing, decreased child survival,
worsening nutrition, and increased risk of HIV infection.
``(F) High rates of gender-based violence, rape, and sexual
coercion within and outside marriage contribute to high rates
of HIV infection. According to the World Health Organization,
between one-sixth and three-quarters of women in various
countries and settings have experienced some form of physical
or sexual violence since the age of 15 within or outside of
marriage. Women who are unable to protect themselves from
such violence are often unable to protect themselves from
being infected with HIV through forced sexual contact.
``(G) Fear of domestic violence and the continuing stigma
and discrimination associated with HIV/AIDS prevent many
women from accessing information about HIV/AIDS, getting
tested, disclosing their HIV status, accessing services to
prevent mother-to-child transmission of HIV, or receiving
treatment and counseling even when they already know they
have been infected with HIV.
``(H) According to UNAIDS, the vulnerability of individuals
involved in commercial sex acts to HIV infection is
heightened by stigmatization and marginalization, limited
economic options, limited access to health, social, and legal
services, limited access to information and prevention means,
gender-related differences and inequalities, sexual
exploitation and trafficking, harmful or non-protective laws
and policies, and exposure to risks associated with
commercial sex acts, such as violence, substance abuse, and
increased mobility.
``(I) Lack of access to basic HIV prevention information
and education and lack of coordination with existing primary
health care to reduce stigma and maximize coverage.
``(J) Lack of access to currently available female-
controlled HIV prevention methods, such as the female condom,
and lack of training on proper use of either male or female
condoms.
``(K) High rates of other sexually transmitted infections
and complications during pregnancies and childbirth.
``(L) An absence of functioning legal frameworks to protect
women and girls and, where such frameworks exist, the lack of
accountable and effective enforcement of such frameworks.
``(41) In addition to vulnerabilities to HIV infection,
women in sub-Saharan Africa face a 1-in-13 chance of dying in
childbirth compared to a 1-in-16 chance in least-developed
countries worldwide, a 1-in-60 chance in developing
countries, and a 1-in-4,100 chance in developed countries.
``(42) Due to these high maternal mortality rates and high
HIV prevalence rates in certain countries, special attention
is needed in these countries to help HIV-positive women
safely deliver healthy babies and save women's lives.
``(43) Unprotected sex within or outside of marriage is the
single greatest factor in the transmission of HIV worldwide
and is responsible for 80 percent of new HIV infections in
sub-Saharan Africa.
``(44) Multiple randomized controlled trials have
established that male circumcision reduces a man's risk of
contracting HIV by 60 percent or more. Twelve acceptability
studies have found that in regions of sub-Saharan Africa
where circumcision is not traditionally practiced, a majority
of men want the procedure. Broader availability of male
circumcision services could prevent millions of HIV
infections not only in men but also in their female partners.
``(45)(A) Youth also face particular challenges in
receiving services for HIV/AIDS.
``(B) Nearly one-half of all orphans who have lost one
parent and two-thirds of those who have lost both parents are
ages 12 to 17. These orphans are in particular need of
services to protect themselves against sexually-transmitted
infections, including HIV.
``(C) Research indicates that many youth benefit from full
disclosure of medically accurate, age-appropriate information
about abstinence, partner reduction, and condoms. Providing
comprehensive information about HIV, including delay of
sexual debut and the ABC model: `Abstain, Be faithful, use
Condoms', and linking such information to health care can
help improve awareness of safe sex practices and address the
fact that only 1 in 3 young men and 1 in 5 young women ages
15 to 24 can correctly identify ways to prevent HIV
infection.
``(D) Surveys indicate that no country has succeeded in
fully educating more than one-half of its youth about the
prevention and transmission of HIV.
``(46) According to the United Nations High Commissioner
for Refugees (UNHCR), HIV/AIDS prevalence rates among
refugees are generally lower than the HIV/AIDS prevalence
rates for their host communities, though perceptions run
counter to this fact. However, peacekeeping operations that
no longer deploy HIV/AIDS-positive troops still face
vulnerabilities to sexual transmission of HIV with HIV-
positive individuals in refugee camps. Host countries
generally do not provide HIV/AIDS prevention, treatment, and
care services for refugees.
``(47) Continuing progress to reach the millions of
impoverished individuals who need voluntary testing,
counseling, treatment, and care for HIV/AIDS requires
increased efforts to strengthen health care delivery systems
and infrastructure, rebuild and expand the health care
workforce, and strengthen allied and support services in
countries receiving United States global HIV/AIDS assistance.
``(48) While HIV/AIDS poses the greatest health threat of
modern times, it also poses the greatest development
challenge for developing countries with fragile economies and
weak public financial management systems that are ill
equipped to shoulder the burden of this disease.
International donors will have to play a critical role in
providing resources for HIV/AIDS programs far into the
future.
``(49) The emerging partnerships between countries most
affected by HIV/AIDS and the United States must include
stronger coordination between HIV/AIDS programs and other
United States foreign assistance programs, and stronger
collaboration with other donors in the areas of economic
development and growth strategies.
``(50) The future control of HIV/AIDS demands coordination
between international organizations such as the Global Fund
to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World
Health Organization (WHO), the World Bank and the
International Monetary Fund (IMF), the international donor
community, national governments, and private sector
organizations, including community and faith-based
organizations.
``(51) The future control of HIV/AIDS further requires
effective and transparent public finance management systems
in developing countries to advance the ability of such
countries to manage public revenues and donor funds aimed at
combating HIV/AIDS and other diseases.
``(52) The HIV/AIDS pandemic contributes to the shortage of
health care personnel through loss of life and illness,
unsafe working conditions, increased workloads for diminished
staff, and resulting stress and burnout, while the shortage
of health care personnel undermines efforts to prevent and
provide care and treatment for individuals with HIV/AIDS.
``(53) The shortage of health care personnel, including
doctors, nurses, pharmacists, counselors, laboratory staff,
paraprofessionals, trained lay workers, and researchers is
one of the leading obstacles to combating HIV/AIDS in sub-
Saharan Africa.
``(54) Since 2003, important progress has been made in
combating HIV/AIDS, yet there is more to be done. The number
of new HIV infections is still increasing at an alarming
rate. According to the United States National Institute of
Allergy and Infectious Diseases, globally, for every 1
individual put on antiretroviral therapy, 6 individuals are
newly infected with HIV.
``(55) The United States Government continues to be the
world's leader in the fight against HIV/AIDS and the
unsurpassed partner with developing countries in their
efforts to control this disease.
``(56) By September 2007, the United States, through the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 et seq.), had provided
services to prevent mother-to-child-transmission of HIV to
women during 10 million pregnancies; provided antiretroviral
prophylaxis for women during over 827,300 pregnancies;
prevented an estimated 157,240 HIV infections in infants;
cared for over 6.6 million individuals, including over 2.7
million orphans and vulnerable children; supported lifesaving
antiretroviral therapies for approximately 1.4 million men,
women, and children in sub-Saharan Africa, Asia, and the
Carribean; and provided counseling and testing to over 33.7
million men, women, and children in developing countries.
``(57) These numbers were achieved because of the
commitment of substantial resources and support of the United
States Government to our partners on the front lines--the
dedicated and committed women and men, communities, and
nations who are taking control of the HIV/AIDS epidemics in
their own countries.''.
SEC. 3. DEFINITIONS.
Section 3(2) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7602(2)) is amended by striking ``Committee on International
Relations'' and inserting ``Committee on Foreign Affairs''.
SEC. 4. PURPOSE.
Section 4 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7603) is
amended to read as follows:
``SEC. 4. PURPOSE.
``The purpose of this Act is to strengthen and enhance
United States global leadership
[[Page H1923]]
and the effectiveness of the United States response to the
HIV/AIDS, tuberculosis, and malaria pandemics and other
related and preventable infectious diseases in developing
countries by--
``(1) establishing a comprehensive, integrated five-year,
global strategy to fight HIV/AIDS, tuberculosis, and malaria
that encompasses a plan for continued expansion and
coordination of critical programs and improved coordination
among relevant executive branch agencies and between the
United States and foreign governments and international
organizations;
``(2) providing increased resources for United States
bilateral efforts to combat HIV/AIDS, tuberculosis, and
malaria, particularly for prevention, treatment, and care
(including nutritional support), technical assistance and
training, the strengthening of health care systems, health
care workforce development, monitoring and evaluations
systems, and operations research;
``(3) providing increased resources for multilateral
efforts to combat HIV/AIDS, tuberculosis, and malaria;
``(4) encouraging the expansion of private sector efforts
and expanding public-private sector partnerships to combat
HIV/AIDS; and
``(5) intensifying efforts to support the development of
vaccines, microbicides, and other prevention technologies and
improved diagnostics treatment for HIV/AIDS, tuberculosis,
and malaria.''.
TITLE I--POLICY PLANNING AND COORDINATION
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL
STRATEGY.
(a) Strategy.--Subsection (a) of section 101 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7611) is amended--
(1) in the first sentence of the matter preceding paragraph
(1), by striking ``to combat'' and inserting ``to develop
efforts further to combat'';
(2) by amending paragraph (4) to read as follows:
``(4) provide that the reduction of HIV/AIDS behavioral
risks shall be a priority of all prevention efforts in terms
of funding, scientifically-accurate educational services, and
activities by--
``(A) designing prevention strategies and programs based on
sound epidemiological evidence, tailored to the unique needs
of each country and community, and reaching those populations
found to be most at risk for acquiring HIV infection;
``(B) promoting abstinence from sexual activity and
substance abuse;
``(C) encouraging delay of sexual debut, monogamy,
fidelity, and partner reduction;
``(D) promoting the effective use of male and female
condoms;
``(E) promoting the use of measures to reduce the risk of
HIV transmission for discordant couples (where one individual
has HIV/AIDS and the other individual does not have HIV/AIDS
or whose status is unknown);
``(F) educating men and boys about the risks of procuring
sex commercially and about the need to end violent behavior
toward women and girls;
``(G) promoting the rapid expansion of safe and voluntary
male circumcision services;
``(H) promoting life skills training and development for
children and youth;
``(I) supporting advocacy for child and youth community-
based protective social services;
``(J) eradicating trafficking in persons and creating
alternatives to prostitution;
``(K) promoting cooperation with law enforcement to
prosecute offenders of trafficking, rape, and sexual assault
crimes with the goal of eliminating such crimes;
``(L) promoting services demonstrated to be effective in
reducing the transmission of HIV infection among injection
drug users without increasing illicit drug use;
``(M) promoting policies and programs to end the sexual
exploitation of and violence against women and children; and
``(N) promoting prevention and treatment services for men
who have sex with men;'';
(3) by redesignating paragraphs (5) through (10) as
paragraphs (6) through (11), respectively;
(4) by inserting after paragraph (4) (as amended by
paragraph (2) of this subsection) the following:
``(5) include specific plans for linkage to, and referral
systems for nongovernmental organizations that implement
multisectoral approaches, including faith-based and
community-based organizations, for--
``(A) nutrition and food support for individuals with HIV/
AIDS and affected communities;
``(B) child health services and development programs;
``(C) HIV/AIDS prevention and treatment services for
injection drug users;
``(D) access to HIV/AIDS education and testing in family
planning and maternal health programs supported by the United
States Government; and
``(E) medical, social, and legal services for victims of
violence;'';
(5) by redesignating paragraphs (10) and (11) (as
redesignated by paragraph (3) of this subsection) as
paragraphs (11) and (12), respectively; and
(6) by inserting after paragraph (9) (as redesignated by
paragraph (3) of this subsection) the following:
``(10) maximize host country capacities in training and
research, particularly operations research;''.
(b) Report.--Subsection (b) of such section is amended--
(1) in paragraph (1), by striking ``this Act'' and
inserting ``the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008''; and
(2) in paragraph (3)--
(A) by amending subparagraph (C) to read as follows:
``(C) A description of the manner in which the strategy
will address the following:
``(i) The fundamental elements of prevention and education,
care and treatment, including increasing access to
pharmaceuticals, vaccines, and microbicides, as they become
available, screening, prophylaxis, and treatment of major
opportunistic infections, including tuberculosis, and
increasing access to nutrition and food for individuals on
antiretroviral therapies.
``(ii) The promotion of delay of sexual debut, abstinence,
monogamy, fidelity, and partner reduction.
``(iii) The promotion of correct and consistent use of male
and female condoms and other strategies and skills
development to reduce the risk of HIV transmission.
``(iv) Increasing voluntary access to safe male
circumcision services.
``(v) Life-skills training.
``(vi) The provision of information and services to
encourage young people to delay sexual debut and ensure
access to HIV/AIDS prevention information and services.
``(vii) Prevention of sexual violence leading to
transmission of HIV and assistance for victims of violence
who are at risk of HIV transmission.
``(viii) HIV/AIDS prevention, care, and treatment services
for injection drug users.
``(ix) Research, including incentives for HIV vaccine
development and new protocols.
``(x) Advocacy for community-based child and youth
protective services.
``(xi) Training of health care workers.
``(xii) The development of health care infrastructure and
delivery systems.
``(xiii) Prevention efforts for substance abusers.
``(xiv) Prevention, treatment, care, and outreach efforts
for men who have sex with men.'';
(B) in subparagraph (D), by adding at the end before the
period the following: ``, including through faith-based and
other nongovernmental organizations'';
(C) in subparagraph (E), by inserting ``access to HIV/AIDS
education and testing in family planning and maternal and
child health programs supported by the United States
Government and'' after ``the unique needs of women,
including'';
(D) in subparagraph (F), by inserting ``(including by
accessing voluntary clinical circumcision services)'' after
``in their sexual behavior'';
(E) in subparagraph (G), by inserting ``and men's'' after
``women's'';
(F) by redesignating subparagraphs (M) through (W) as
subparagraphs (N) through (X);
(G) by inserting after subparagraph (L) the following:
``(M) A description of efforts to be undertaken to
strengthen the public finance management systems of selected
host countries to ensure transparent, efficient, and
effective management of national and donor financial
investments in health.'';
(H) in subparagraph (O) (as redesignated by subparagraph
(F) of this paragraph), by striking ``evaluating programs,''
and inserting ``evaluating programs to ensure medical
accuracy, operations research,'';
(I) in subparagraph (Q) (as redesignated by subparagraph
(F) of this paragraph), by inserting ``, strengthen national
health care delivery systems, and increase national health
workforce capacities,'' after ``HIV/AIDS pandemic'';
(J) in subparagraph (R) (as redesignated by subparagraph
(F) of this paragraph), by inserting at the end before the
period the following: ``, including strategies relating to
agricultural development, trade and economic growth, and
education'';
(K) in subparagraph (T) (as redesignated by subparagraph
(F) of this paragraph), by inserting ``efforts of
intergenerational caregivers and'' after ``, including'';
(L) by redesignating subparagraphs (V) through (X) (as
redesignated by subparagraph (F) of this paragraph), as
subparagraphs (W) through (Y), respectively;
(M) by inserting after subparagraph (U) (as redesignated by
subparagraph (F) of this paragraph) the following:
``(V) A plan to strengthen and implement health care
workforce strategies to enable countries to increase the
supply and retention of all cadres of trained professional
and paraprofessional health care workers by numbers that move
toward global health program needs and toward targets
established by the World Health Organization, while enabling
health systems to expand coverage consistent with national
and international targets and goals.''; and
(N) by striking subparagraph (Y) (as redesignated by
subparagraphs (F) and (L) of this paragraph) and inserting
the following:
``(Y) A description of the specific strategies, developed
in coordination with existing health programs, to prevent
mother-to-child transmission of HIV, including the extent to
which HIV-positive women and men in treatment, care, and
support programs and HIV-negative women and men are counseled
[[Page H1924]]
about methods of preventing HIV transmission and the extent
to which HIV prevention methods are provided on-site or by
referral in treatment, care, and support programs.
``(Z) A description of the specific strategies developed to
maximize the capacity of health care providers, including
faith-based and other nongovernmental organizations, and
family planning providers supported by the United States
Government to ensure access to necessary and comprehensive
information about reducing sexual transmission of HIV among
women, men, and young people, including strategies to ensure
HIV/AIDS prevention training for such providers.
``(AA) A strategy to work with international and host
country partners toward universal access to HIV/AIDS
prevention, treatment, and care programs.''.
(c) Strategic Plan for Program Monitoring, Operations
Research, and Impact Evaluation Research.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally shall
develop a 5-year strategic plan for program monitoring,
operations research, and impact evaluation research of United
States HIV/AIDS, tuberculosis, and malaria programs.
(2) Elements of plan.--The strategic plan developed under
this subsection shall include--
(A) the amount of funding provided for program monitoring,
operations research, and impact evaluation research under
sections 104A, 104B, and 104C of the Foreign Assistance Act
of 1961 (22 U.S.C. 2151b-2, 2151b-3, and 2151b-4) and the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 et seq.) available
through fiscal year 2009;
(B) strategies to--
(i) improve the efficiency, effectiveness, quality, and
accessibility of services provided under the provisions of
law described in subparagraph (A);
(ii) establish the cost-effectiveness of program models;
(iii) ensure the transparency and accountability of
services provided under the provisions of law described in
subparagraph (A);
(iv) disseminate and promote the utilization of evaluation
findings, lessons, and best practices in services provided
under the provisions of law described in subparagraph (A);
and
(v) encourage and evaluate innovative service models and
strategies to optimize the delivery of care, treatment, and
prevention programs financed by the United States Government;
(C) priorities for program monitoring, operations research,
and impact evaluation research and a time line for completion
of activities associated with such priorities; and
(D) other information that the Coordinator determines to be
necessary.
(3) Consultation.--In developing the strategic plan under
this subsection and implementing, disseminating, and
promoting the use of program monitoring, operations research,
and impact evaluation research, the Coordinator shall consult
with representatives of relevant executive branch agencies,
other appropriate executive branch agencies, multilateral
institutions involved in providing HIV/AIDS assistance,
nongovernmental organizations involved in implementing HIV/
AIDS programs, and the governments of host countries.
(4) Definitions.--In this subsection--
(A) the terms ``program monitoring'', ``operations
research'', and ``impact evaluation research'', have the
meanings given such terms in section 104A(d)(4)(B) of the
Foreign Assistance Act of 1961 (as added by section
301(a)(4)(C) of this Act); and
(B) the term ``relevant executive branch agencies'' has the
meaning given the term in section 3 of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003 (22 U.S.C. 7602).
SEC. 102. HIV/AIDS RESPONSE COORDINATOR.
Section 1(f)(2) of the State Department Basic Authorities
Act of 1956 (22 U.S.C. 2651a(f)(2)) is amended--
(1) in subparagraph (A)--
(A) in the matter preceding clause (i), by inserting ``,
host country finance, health, and other relevant ministries''
after ``community-based organizations)''; and
(B) in clause (iii), by inserting ``and host country
finance, health, and other relevant ministries'' after
``community-based organizations)''; and
(2) in subparagraph (B)(ii)--
(A) by striking subclauses (IV) and (V) and inserting the
following:
``(IV) Establishing an interagency working group on HIV/
AIDS that is comprised of, but not limited to,
representatives from the United States Agency for
International Development, the Department of Health and Human
Services (including the Centers for Disease Control and
Prevention, the National Institutes of Health, and the Health
Resources and Services Administration), the Department of
Labor, the Department of Agriculture, the Millennium
Challenge Corporation, the Department of Defense, and the
Office of the Coordinator of United States Government
Activities to Combat Malaria Globally, for the purposes of
coordination of activities relating to HIV/AIDS. The
interagency working group shall--
``(aa) meet regularly to review progress in host countries
toward HIV/AIDS prevention, treatment, and care objectives;
``(bb) participate in the process of identifying countries
in need of increased assistance based on the epidemiology of
HIV/AIDS in those countries; and
``(cc) review policies that may be obstacles to reaching
objectives set forth for HIV/AIDS prevention, treatment, and
care.
``(V) Coordinating overall United States HIV/AIDS policy
and programs with efforts led by host countries and with the
assistance provided by other relevant bilateral and
multilateral aid agencies and other donor institutions to
achieve complementarity with other programs aimed at
improving child and maternal health, and food security,
promoting education, and strengthening health care
systems.'';
(B) by redesignating subclauses (VII) and (VIII) as
subclauses (IX) and (X), respectively;
(C) by inserting after subclause (VI) the following:
``(VII) Holding annual consultations with host country
nongovernmental organizations providing services to improve
health, and advocating on behalf of the individuals with HIV/
AIDS and those at particular risk of contracting HIV/AIDS.
``(VIII) Ensuring, through interagency and international
coordination, that United States HIV/AIDS programs are
coordinated with and complementary to the delivery of related
global health, food security, and education services,
including--
``(aa) maternal and child health care;
``(bb) services for other neglected and easily preventable
and treatable infectious diseases, such as tuberculosis;
``(cc) treatment and care services for injection drug
users; and
``(dd) programs and services to improve legal, social, and
economic status of women and girls.'';
(D) in subclause (IX) (as redesignated by subparagraph (B)
of this paragraph)--
(i) by inserting ``Vietnam, Antigua and Barbuda, the
Bahamas, Barbados, Belize, Dominica, Grenada, Jamaica,
Montserrat, Saint Kitts and Nevis, Saint Vincent and the
Grenadines, Saint Lucia, Suriname, Trinidad and Tobago, the
Dominican Republic'' after ``Zambia,'';
(ii) by adding at the end before the period the following:
``and other countries in which the United States is
implementing HIV/AIDS programs''; and
(iii) by adding at the end the following: ``In designating
countries under this subclause, the President shall give
priority to those countries in which there is a high
prevalence of HIV/AIDS and countries with large populations
that have a concentrated HIV/AIDS epidemic.'';
(E) by redesignating subclause (X) (as redesignated by
subparagraph (B) of this paragraph) as subclause (XII);
(F) by inserting after subclause (IX) (as redesignated by
subparagraph (B) and amended by subparagraph (D) of this
paragraph) the following:
``(X) Working, in partnership with host countries in which
the HIV/AIDS epidemic is prevalent among injection drug
users, to establish, as a national priority, national HIV/
AIDS prevention programs, including education, and services
demonstrated to be effective in reducing the transmission of
HIV infection among injection drug users without increasing
drug use.
``(XI) Working, in partnership with host countries in which
the HIV/AIDS epidemic is prevalent among individuals involved
in commercial sex acts, to establish, as a national priority,
national prevention programs, including education, voluntary
testing, and counseling, and referral systems that link HIV/
AIDS programs with programs to eradicate trafficking in
persons and create alternatives to prostitution.'';
(G) in subclause (XII) (as redesignated by subparagraphs
(B) and (E) of this paragraph), by striking ``funds section''
and inserting ``funds appropriated pursuant to the
authorization of appropriations under section 401 of the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 for HIV/AIDS assistance''; and
(H) by adding at the end the following:
``(XIII) Publicizing updated drug pricing data to inform
pharmaceutical procurement partners' purchasing decisions.
``(XIV) Working in partnership with host countries in which
the HIV/AIDS epidemic is prevalent among men who have sex
with men, to establish, as a national priority, national HIV/
AIDS prevention programs, including education and services
demonstrated to be effective in reducing the transmission of
HIV among men who have sex with men.''.
TITLE II--SUPPORT FOR MULTILATERAL FUNDS, PROGRAMS, AND PUBLIC-PRIVATE
PARTNERSHIPS
SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.
Section 201(a) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7621(a)) is amended--
(1) in paragraph (2), by striking ``infectious diseases''
and inserting ``easily preventable and treatable infectious
diseases''; and
(2) in paragraph (4), by striking ``infectious diseases''
and inserting ``easily preventable and treatable infectious
diseases''.
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS,
TUBERCULOSIS AND MALARIA.
(a) Findings.--Subsection (a) of section 202 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7622) is amended--
[[Page H1925]]
(1) by redesignating paragraphs (1) through (3) as
paragraphs (7) through (9), respectively; and
(2) by inserting before paragraph (7) (as redesignated by
paragraph (1) of this subsection) the following:
``(1) The Global Fund to Fight AIDS, Tuberculosis and
Malaria is the multilateral component of this Act, extending
United States efforts to a total of 136 countries around the
world.
``(2) Created in 2002, the Global Fund has played a leading
role in the fight against HIV/AIDS, tuberculosis, and malaria
around the world and has grown into an organization that
currently provides nearly a quarter of all international
financing to combat HIV/AIDS and two-thirds of all
international financing to combat tuberculosis and malaria.
``(3) By 2010, it is estimated that the demand for funding
by the Global Fund will grow in size to between $6 and $8
billion annually, requiring significant contributions from
donors around the world, including at least $2 billion
annually from the United States.
``(4) The Global Fund is an innovative financing mechanism
to combat HIV/AIDS, tuberculosis, and malaria, and has made
progress in many areas.
``(5) The United States Government is the largest supporter
of the Global Fund, both in terms of resources and technical
support.
``(6) The United States made the initial contribution to
the Global Fund and is fully committed to its success.''.
(b) United States Financial Participation.--
(1) Authorization of appropriations.--Subsection (d)(1) of
such section is amended--
(A) by striking ``$1,000,000,000'' and inserting
``$2,000,000,000'';
(B) by striking ``for the period of fiscal year 2004
beginning on January 1, 2004,'' and inserting ``for each of
the fiscal years 2009 and 2010,''; and
(C) by striking ``the fiscal years 2005-2008'' and
inserting ``each of the fiscal years 2011 through 2013''.
(2) Limitation.--Subsection (d)(4) of such section is
amended--
(A) in subparagraph (A)--
(i) in clause (i), by striking ``fiscal years 2004 through
2008'' and inserting ``fiscal years 2009 through 2013'';
(ii) in clause (ii), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''; and
(iii) in clause (vi)--
(I) by striking ``for the purposes'' and inserting ``For
the purposes'';
(II) by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''; and
(III) by striking ``fiscal year 2004'' and inserting
``fiscal year 2009'';
(B) in subparagraph (B)(iv)--
(i) by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''; and
(ii) by adding at the end before the period the following:
``, unless such amount is made available for more than one
fiscal year, in which case such amount is authorized to be
made available for such purposes after December 31 of the
fiscal year following the fiscal year in which such funds
first became available.''; and
(C) in subparagraph (C)(ii) by striking ``Committee on
International Relations'' and inserting ``Committee on
Foreign Affairs''.
(3) Statement of policy.--The following shall be the policy
of the United States:
(A) Support for the Global Fund to Fight AIDS, Tuberculosis
and Malaria should be based upon achievement of the following
benchmarks related to transparency and accountability:
(i) As recommended by the Government Accountability Office,
the Fund Secretariat has established standardized
expectations for the performance of Local Fund Agents (LFAs),
is undertaking a systematic assessment of the performance of
LFAs, and is making available for public review, according to
the Fund Board's policies and practices on disclosure of
information, a regular collection and analysis of performance
data of Fund grants, which shall cover both Principal
Recipients and sub-recipients.
(ii) A well-staffed, independent Office of the Inspector
General reports directly to the Board and is responsible for
regular, publicly published audits of both financial and
programmatic and reporting aspects of the Fund, its grantees,
and LFAs.
(iii) The Fund Secretariat has established and is reporting
publicly on standard indicators for all program areas.
(iv) The Fund Secretariat has established a database that
tracks all subrecipients and the amounts of funds disbursed
to each, as well as the distribution of resources, by grant
and Principal Recipient, for prevention, care, treatment, the
purchases of drugs and commodities, and other purposes.
(v) The Fund Board has established a penalty to offset
tariffs imposed by national governments on all goods and
services provided by the Fund.
(vi) The Fund Board has successfully terminated its
Administrative Services Agreement with the World Health
Organization and completed the Fund Secretariat's transition
to a fully independent status under the Headquarters
Agreement the Fund has established with the Government of
Switzerland.
(B) Support for the Global Fund to Fight AIDS, Tuberculosis
and Malaria should be based upon achievement of the following
benchmarks related to the founding principles of the Fund:
(i) The Fund must maintain its status as a financing
institution.
(ii) The Fund must remain focused on programs directly
related to HIV/AIDS, malaria, and tuberculosis.
(iii) The Fund must maintain its Comprehensive Funding
Policy, which requires confirmed pledges to cover the full
amount of new grants before the Board approves them.
(iv) The Fund must maintain and make progress on sustaining
its multisectoral approach, through Country Coordinating
Mechanisms (CCMs) and in the implementation of grants, as
reflected in percent and resources allocated to different
sectors, including governments, civil society, and faith- and
community-based organizations.
(4) Sense of congress.--Congress--
(A) notes that section 625 of Public Law 110-161
establishes a requirement to withhold 20 percent of funds
appropriated for the Global Fund if the Global Fund fails to
meet certain benchmarks; and
(B) will continue to review the implementation of the
benchmarks to ensure accountability and transparency of the
Global Fund.
SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE
FUNDS.
(a) Vaccine Fund.--Subsection (k) of section 302 of the
Foreign Assistance Act of 1961 (22 U.S.C. 2222) is amended by
striking ``fiscal years 2004 through 2008'' and inserting
``fiscal years 2009 through 2013''.
(b) International AIDS Vaccine Initiative.--Subsection (l)
of such section is amended by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
(c) Malaria Vaccine Development Programs.--Subsection (m)
of such section is amended by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
(d) Research and Development of a Tuberculosis Vaccine.--
Such section is further amended by adding at the end the
following:
``(n) In addition to amounts otherwise available under this
section, there are authorized to be appropriated to the
President such sums as may be necessary for each of the
fiscal years 2009 through 2013 to be available for United
States contributions to research and development of a
tuberculosis vaccine.''.
SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF MICROBICIDES
TO PREVENT TRANSMISSION OF HIV AND OTHER
DISEASES.
(a) Statement of Policy.--Congress recognizes the need and
urgency to expand the range of interventions for preventing
the transmission of human immunodeficiency virus (HIV),
including nonvaccine prevention methods that can be
controlled by women.
(b) Program Authorized.--The Administrator of the United
States Agency for International Development, in coordination
with the Coordinator of United States Government Activities
to Combat HIV/AIDS Globally, shall develop and implement a
program to facilitate wide-scale availability of microbicides
that prevent the transmission of HIV after such microbicides
are proven safe and effective.
(c) Authorization of Appropriations.--Of the amounts
authorized to be appropriated under section 401 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there
are authorized to be appropriated to the President such sums
as may be necessary for each of the fiscal years 2009 through
2013 to carry out this section.
SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA
BY STRENGTHENING HEALTH POLICIES AND HEALTH
SYSTEMS OF HOST COUNTRIES.
(a) In General.--Title II of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7621 et seq.) is amended by adding at the end the
following:
``SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND
MALARIA BY STRENGTHENING HEALTH POLICIES AND
HEALTH SYSTEMS OF HOST COUNTRIES.
``(a) Findings.--Congress makes the following findings:
``(1) One of the most significant barriers to achieving
universal access to HIV/AIDS treatment and prevention in
developing countries is the lack of health infrastructure,
particularly in sub-Saharan Africa.
``(2) In addition to HIV/AIDS programs, other treatable and
preventable infectious diseases could be treated concurrently
and easily if health care delivery systems in developing
countries were significantly improved.
``(3) More public investment in basic primary health care
should be a priority in public spending in developing
countries.
``(b) Statement of Policy.--It shall be the policy of the
United States Government--
``(1) to invest appropriate resources authorized under this
Act and the amendments made by this Act to carry out
activities to strengthen HIV/AIDS health policies and health
systems and provide workforce training and capacity-building
consistent with the goals and objectives of this Act and the
amendments made by this Act; and
``(2) to support the development of a sound policy
environment in host countries to increase the ability of such
countries to maximize utilization of health care resources
[[Page H1926]]
from donor countries, deliver services to the people of such
host countries in an effective and efficient manner, and
reduce barriers that prevent recipients of services from
achieving maximum benefit from such services.
``(c) Plan Required.--The Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, in
collaboration with the Administrator of the United States
Agency for International Development, shall develop and
implement a plan to combat HIV/AIDS by strengthening health
policies and health systems of host countries as part of the
United States Agency for International Development's `Health
Systems 2020' project.
``(d) Assistance To Improve Public Finance Management
Systems.--
``(1) In general.--The Secretary of the Treasury, acting
through the head of the Office of Technical Assistance, is
authorized to provide assistance for advisors and host
country finance, health, and other relevant ministries to
improve the effectiveness of public finance management
systems in host countries to enable such countries to receive
funding to carry out programs to combat HIV/AIDS,
tuberculosis, and malaria and to manage such programs.
``(2) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401 for HIV/AIDS
assistance, there are authorized to be appropriated to the
Secretary of the Treasury such sums as may be necessary for
each of the fiscal years 2009 through 2013 to carry out this
subsection.''.
(b) Clerical Amendment.--The table of contents for the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by
inserting after the item relating to section 203 the
following:
``Sec. 204. Plan to combat HIV/AIDS by strengthening health policies
and health systems of host countries.''.
TITLE III--BILATERAL EFFORTS
Subtitle A--General Assistance and Programs
SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Amendments to the Foreign Assistance Act of 1961.--
(1) Finding.--Subsection (a) of section 104A of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2) is amended by
inserting ``, South and Southeast Asia, Central and Eastern
Europe'' after ``the Caribbean''.
(2) Policy.--Subsection (b) of such section is amended--
(A) in the first sentence--
(i) by striking ``It is a major'' and inserting the
following:
``(1) General policy.--It is a major'';
(ii) by striking ``control'' and inserting ``care''; and
(iii) by adding at the end before the period the following:
``and to fulfill United States commitments to move toward the
goal of universal access to prevention, treatment, and care
of HIV/AIDS'';
(B) by adding at the end the following: ``The United States
and other developed countries should provide assistance for
the prevention, treatment, and care of HIV/AIDS to countries
in sub-Saharan Africa, the Caribbean, South and Southeast
Asia and Central and Eastern Europe, addressing both
generalized epidemics and epidemics concentrated among
populations at high risk of infection.''; and
(C) by further adding at the end the following:
``(2) Specific policy.--It is therefore the policy of the
United States, by 2013, to--
``(A) prevent 12,000,000 new HIV infections worldwide;
``(B) support treatment of at least 3,000,000 individuals
with HIV/AIDS with the goal of treating 450,000 children;
``(C) provide care for 12,000,000 individuals affected by
HIV/AIDS, including 5,000,000 orphans and vulnerable children
in communities affected by HIV/AIDS, including orphans with
HIV/AIDS; and
``(D) train at least 140,000 new health care professionals
and workers for HIV/AIDS prevention, treatment and care.''.
(3) Authorization.--Subsection (c) of such section is
amended--
(A) in paragraph (1)--
(i) by inserting ``, South and Southeast Asia, Central and
Eastern Europe'' after ``the Caribbean''; and
(ii) by adding at the end before the period the following:
``, and particularly with respect to refugee populations in
such countries and areas'';
(B) in paragraph (2)--
(i) by inserting ``, South and Southeast Asia, Central and
Eastern Europe'' after ``the Caribbean''; and
(ii) by adding at the end before the period the following:
``, and particularly with respect to refugee populations in
such countries and areas'';
(C) by redesignating paragraph (3) as paragraph (4);
(D) by inserting after paragraph (2) the following:
``(3) Role of public health care delivery systems.--It is
the sense of Congress that--
``(A) the President should provide an appropriate level of
assistance under paragraph (1) to help strengthen public
health care delivery systems financed by host countries; and
``(B) the President, acting through the Coordinator of
United States Government Activities to Combat HIV/AIDS
Globally, should support the development of a policy
framework in such host countries for the long-term
sustainability of HIV/AIDS prevention, treatment, and care
programs, and for strengthening health care delivery systems
and increasing health workforces through recruitment,
training, and policies that allows the devolution of clinical
responsibilities to increase the work force able to deliver
prevention, treatment, and care services, as necessary, with
clearly identified objectives and reporting strategies for
such services.'';
(E) in paragraph (4) (as redesignated by subparagraph (C)
of this paragraph), by striking ``foreign countries'' and
inserting ``host countries and donor countries''; and
(F) by adding at the end the following:
``(5) Sense of congress.--
``(A) In general.--It is the sense of Congress that the
Coordinator of United States Government Activities to Combat
HIV/AIDS Globally and the heads of relevant executive branch
agencies (as such term is defined in section 3 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003) should operate in a manner consistent with the
`Three Ones' goals of UNAIDS.
``(B) `Three ones' goals of unaids defined.--In this
paragraph, the term `` `Three Ones'' goals of UNAIDS' means--
``(i) the goal of one agreed HIV/AIDS action framework that
provides the basis for coordinating the work of all partners
in host countries;
``(ii) the goal of one national HIV/AIDS coordinating
authority, with a broad-based multisectoral mandate; and
``(iii) the goal of one agreed country-level data-
collection, monitoring, and evaluation system.''.
(4) Activities supported.--
(A) Prevention.--Subsection (d)(1) of such section is
amended--
(i) in subparagraph (A)--
(I) by inserting ``efforts by faith-based and other
nongovernmental organizations and'' after ``infection,
including'';
(II) by inserting ``, including access to such programs and
efforts in family planning programs supported by the United
States Government,'' after ``health programs''; and
(III) by inserting ``male and female'' before ``condoms'';
(ii) in subparagraph (B)--
(I) by inserting ``relevant and'' after ``culturally'';
(II) by inserting ``and programs'' after ``those
organizations''; and
(III) by inserting ``, level of scientific and fact-based
knowledge'' after ``experience'';
(iii) in subparagraph (D), by inserting ``and nonjudgmental
approaches'' after ``protections'';
(iv) by amending subparagraph (E) to read as follows:
``(E) assistance to achieve the target of reaching 80
percent of pregnant women for prevention and treatment of
mother-to-child transmission of HIV in countries in which the
United States is implementing HIV/AIDS programs by 2013, as
described in section 312(b)(1) of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003, and to promote infant feeding options that meet the
criteria described in the World Health Organization's Global
Strategy for Infant and Young Child Feeding;'';
(v) in subparagraph (G)--
(I) by adding at the end before the semicolon the
following: ``, including education and services demonstrated
to be effective in reducing the transmission of HIV infection
without increasing illicit drug use''; and
(II) by striking ``and'' at the end;
(vi) in subparagraph (H), by striking the period at the end
and inserting ``; and''; and
(vii) by adding at the end the following:
``(I)(i) assistance for counseling, testing, treatment,
care, and support programs for prevention of re-infection of
individuals with HIV/AIDS;
``(ii) counseling to prevent sexual transmission of HIV,
including skill development for practicing abstinence,
reducing the number of sexual partners, and providing
information on correct and consistent use of male and female
condoms;
``(iii) assistance to provide male and female condoms;
``(iv) diagnosis and treatment of other sexually-
transmitted infections;
``(v) strategies to address the stigma and discrimination
that impede HIV/AIDS prevention efforts; and
``(vi) assistance to facilitate widespread access to
microbicides for HIV prevention, as safe and effective
products become available, including financial and technical
support for culturally appropriate introductory programs,
procurement, distribution, logistics management, program
delivery, acceptability studies, provider training, demand
generation, and post-introduction monitoring; and
``(J) assistance for HIV/AIDS education targeted to reach
and prevent the spread of HIV among men who have sex with
men.''.
(B) Treatment.--Subsection (d)(2) of such section is
amended--
(i) in subparagraph (B), by striking ``; and'' at the end
and inserting a semicolon;
(ii) in subparagraph (C), by striking the period at the end
and inserting a semicolon; and
(iii) by adding at the end the following:
``(D) assistance specifically to address barriers that
might limit the start of and adherence to treatment services,
especially in
[[Page H1927]]
rural areas, through such measures as mobile and
decentralized distribution of treatment services, and where
feasible and necessary, direct linkages with nutrition and
income security programs, referrals to services for victims
of violence, support groups for individuals with HIV/AIDS,
and efforts to combat stigma and discrimination against all
such individuals;
``(E) assistance to support comprehensive HIV/AIDS
treatment (including free prophylaxis and treatment for
common HIV/AIDS-related opportunistic infections) for at
least one-third of individuals with HIV/AIDS in the poorest
countries worldwide who are in clinical need of
antiretroviral treatment; and
``(F) assistance to improve access to psychosocial support
systems and other necessary services for youth who are
infected with HIV to ensure the start of and adherence to
treatment services.''.
(C) Monitoring.--Subsection (d)(4) of such section is
amended--
(i) by striking ``The monitoring'' and inserting the
following:
``(A) In general.--The monitoring'';
(ii) by inserting ``and paragraph (8)'' after ``paragraphs
(1) through (3)'';
(iii) by redesignating subparagraphs (A) through (D) as
clauses (i) through (iv), respectively;
(iv) in clause (iii) (as redesignated by clause (iii) of
this subparagraph), by striking ``and'' at the end;
(v) in clause (iv) (as redesignated by clause (iii) of this
subparagraph), by striking the period at the end and
inserting ``; and'';
(vi) by adding at the end the following:
``(v) carrying out and expanding program monitoring, impact
evaluation research, and operations research (including
research and evaluations of gender-responsive interventions,
disaggregated by age and sex, in order to identify and
replicate effective models, develop gender indicators to
measure both outcomes and impacts of interventions,
especially interventions designed to reduce gender
inequalities, and collect lessons learned for dissemination
among different countries) in order to--
``(I) improve the coverage, efficiency, effectiveness,
quality and accessibility of services provided under this
section;
``(II) establish the cost-effectiveness of program models;
``(III) assess the population-level impact of programs,
projects, and activities implemented;
``(IV) ensure the transparency and accountability of
services provided under this section;
``(V) disseminate and promote the utilization of evaluation
findings, lessons, and best practices in the implementation
of programs, projects, and activities supported under this
section; and
``(VI) encourage and evaluate innovative service models and
strategies to optimize functionality of programs, projects,
and activities.''; and
(vii) by further adding at the end the following:
``(B) Definitions.--For purposes of subparagraph (A)(v)--
``(i) the term `impact evaluation research' means the
application of research methods and statistical analysis to
measure the extent to which a change in a population-based
outcome can be attributed to a program, project, or activity
as opposed to other factors in the environment;
``(ii) the term `program monitoring' means the collection,
analysis, and use of routine data with respect to a program,
project, or activity to determine how well the program,
project, or activity is carried out and at what cost; and
``(iii) the term `operations research' means the
application of social science research methods and
statistical analysis to judge, compare, and improve policy
outcomes and outcomes of a program, project, or activity,
from the earliest stages of defining and designing the
program, project, or activity through the development and
implementation of the program, project, or activity.''.
(D) Pharmaceuticals.--Subsection (d)(5) of such section is
amended--
(i) by redesignating subparagraph (C) as subparagraph (D);
and
(ii) by inserting after subparagraph (B) the following:
``(C) Mechanisms to ensure cost-effective drug
purchasing.--Mechanisms to ensure that pharmaceuticals,
including antiretrovirals and medicines to treat
opportunistic infections, are purchased at the lowest
possible price at which such pharmaceuticals may be obtained
in sufficient quantity on the world market.''.
(E) Referral systems and coordination with other assistance
programs.--
(i) Finding.--The effectiveness of all HIV/AIDS prevention,
treatment, and care programs and the survival of individuals
with HIV/AIDS would be enhanced by ensuring that such
individuals are referred to appropriate support programs,
including education, income generation, HIV/AIDS support
group and food and nutrition programs, and by providing
assistance directly to such programs to the extent such
programs would further the purposes of expanding access to
and the success of HIV/AIDS prevention, treatment, and care.
(ii) Amendment.--Subsection (d) of such section is further
amended by adding at the end the following:
``(8) Referral systems and coordination with other
assistance programs.--
``(A) Referral systems.--Assistance to ensure that a
continuum of care is available to individuals participating
in HIV/AIDS prevention, treatment, and care programs through
the development of referral systems for such individuals to
community-based programs that, where practicable, are co-
located with such HIV/AIDS programs, and that provide support
activities for such individuals, including HIV/AIDS treatment
adherence, HIV/AIDS support groups, food and nutrition
support, maternal health services, substance abuse prevention
and treatment services, income-generation programs, legal
services, and other program support.
``(B) Coordination with other assistance programs.--
``(i)(I) Assistance to integrate HIV/AIDS testing with
testing for other easily detectable and treatable infectious
diseases, such as malaria, tuberculosis, and respiratory
infections, and to provide treatment if possible or referral
to appropriate treatment programs.
``(II) Assistance to provide, whenever possible, as a
component of HIV/AIDS prevention, treatment, and care
services, and co-treatment of curable diseases, such as other
sexually transmitted diseases.
``(III) Assistance and other activities to ensure, through
interagency and international coordination, that United
States global HIV/AIDS programs are integrated and
complementary to delivering related health services.
``(ii) Assistance to support schools and related programs
for children and youth that increase the effectiveness of
programs described in this subsection by providing the
infrastructure, teachers, and other support to such programs.
``(iii) Assistance and other activities to provide access
to HIV/AIDS prevention, treatment, and care programs in
family planning and maternal and child health programs
supported by the United States Government.
``(iv) Assistance to United States and host country
nonprofit development organizations that directly support
livelihood initiatives in HIV/AIDS-affected countries that
provide opportunities for direct lending to
microentrepreneurs by United States citizens or opportunities
for United States citizens to purchase livestock and plants
for families to provide nutrition and generate income for
individual households and communities.
``(v) Assistance to coordinate and provide linkages between
HIV/AIDS prevention, treatment, and care programs with
efforts to improve the economic and legal status of women and
girls.
``(vi) Technical assistance coordinated across implementing
agencies, offered on a regular basis, and made available upon
request, for faith-based and community-based organizations,
especially indigenous organizations and new partners who do
not have extensive experience managing United States foreign
assistance programs, including for training and logistical
support to establish financial mechanisms to track program
receipts and expenditures and data management systems to
ensure data quality and strengthen reporting.
``(vii) In accordance with the World Health Organization's
Interim Policy on TB/HIV Activities (2004), assistance to
individuals with or symptomatic of tuberculosis, and
assistance to implement the following:
``(I) Provide opt-out HIV/AIDS counseling and testing and
appropriate referral for treatment and care to individuals
with or symptomatic of tuberculosis, and work with host
countries to ensure that such individuals in host countries
are provided such services.
``(II) Ensure, in coordination with host countries, that
individuals with HIV/AIDS receive tuberculosis screening and
other appropriate treatment.
``(III) Provide increased funding for HIV/AIDS and
tuberculosis activities, by increasing total resources for
such activities, including lab strengthening and infection
control.
``(IV) Improve the management and dissemination of
knowledge gained from HIV/AIDS and tuberculosis activities to
increase the replication of best practices.''.
(5) Annual report.--Subsection (e) of such section is
amended--
(A) in paragraph (1), by striking ``Committee on
International Relations'' and inserting ``Committee on
Foreign Affairs'';
(B) in paragraph (2)--
(i) in subparagraph (B), by striking ``and'' at the end;
(ii) in subparagraph (C)--
(I) in the matter preceding clause (i), by striking
``including'' and inserting ``including--'';
(II) by striking clauses (i) and (ii) and inserting the
following:
``(i)(I) the effectiveness of such programs in reducing the
transmission of HIV, particularly in women and girls, in
reducing mother-to-child transmission of HIV, including
through drug treatment and therapies, either directly or by
referral, and in reducing mortality rates from HIV/AIDS,
including through drug treatment, and addiction therapies;
``(II) a description of strategies, goals, programs, and
interventions to address the specific needs and
vulnerabilities of young women and young men; the progress
toward expanding access among young women and young men to
evidence-based, comprehensive
[[Page H1928]]
HIV/AIDS health care services and HIV prevention and
sexuality and abstinence education programs at the
individual, community, and national levels; and clear targets
for integrating adolescents who are orphans, including
adolescents who are infected with HIV, into programs for
orphans and vulnerable children; and
``(III) the amount of United States funding provided under
the authorities of this Act to procure drugs for HIV/AIDS
programs in countries described in section 1(f)(2)(B)(IX) of
the State Department Basic Authorities Act of 1956 (22 U.S.C.
2651a(f)(2)(B)(VIII)), including a detailed description of
anti-retroviral drugs procured, including--
``(aa) the total amount expended for each generic and name
brand drug;
``(bb) the price paid per unit of each drug; and
``(cc) the vendor from which each drug was purchased; and
``(ii) the progress made toward improving health care
delivery systems (including the training of adequate numbers
of health care professionals) and infrastructure to ensure
increased access to care and treatment, including a
description of progress toward--
``(I)(aa) the training and retention of adequate numbers of
health care professionals in order to meet a nationally-
determined ratio of doctors, nurses, and midwives to
patients, based on the target of the 2.3 per-thousand ratio
established by the World Health Organization (WHO);
``(bb) increases in the number of other health care
professions, such as pharmacists and lab technicians, as
necessary; and
``(cc) the improvement of infrastructure needed to ensure
universal access to HIV/AIDS prevention, treatment, and care
by 2015;
``(II) national health care workforce strategy benchmarks,
as required by section 202(d)(5)(B) of the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of
2003, United States contributions to developing and
implementing the benchmarks, and main challenges to
implementing the benchmarks;
``(III) ensuring, to the extent practicable, that health
care workers providing services under this Act have safe
working conditions and are receiving health care services,
including services relating to HIV/AIDS;
``(IV) activities to strengthen health care systems in
order to overcome obstacles and barriers to the provision of
HIV/AIDS, tuberculosis, and malaria services;
``(V) improving integration and coordination of HIV/AIDS
programs with related health care services and supporting the
capacity of health care programs to refer individuals to
community-based services; and
``(VI) strengthening procurement and supply chain
management systems of host countries;'';
(III) in clause (iii), by adding at the end before the
semicolon the following: ``, including the percentage of such
United States foreign assistance provided for diagnosis and
treatment of individuals with tuberculosis in countries with
the highest burden of tuberculosis, as determined by the
World Health Organization (WHO)''; and
(IV) in clause (iv), by striking the period at the end and
inserting a semicolon; and
(iii) by adding at the end the following:
``(D) a description of efforts to integrate HIV/AIDS and
tuberculosis prevention, treatment, and care programs,
including--
``(i) the number and percentage of HIV-infected individuals
receiving HIV/AIDS treatment or care services who are also
receiving screening and subsequent treatment for
tuberculosis;
``(ii) the number and percentage of individuals with
tuberculosis who are receiving HIV/AIDS counseling and
testing, and appropriate referral to HIV/AIDS services;
``(iii) the number and location of laboratories with the
capacity to perform tuberculosis culture tests and
tuberculosis drug susceptibility tests;
``(iv) the number and location of laboratories with the
capacity to perform appropriate tests for multi-drug
resistant tuberculosis (MDR-TB) and extensively drug
resistant tuberculosis (XDR-TB); and
``(v) the number of HIV-infected individuals suspected of
having tuberculosis who are provided tuberculosis culture
diagnosis or tuberculosis drug susceptibility testing;
``(E) a description of coordination efforts with relevant
executive branch agencies (as such term is defined in section
3 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003) and at the global
level in the effort to link HIV/AIDS services with non-HIV/
AIDS services;
``(F) a description of programs serving women and girls,
including--
``(i) a description of HIV/AIDS prevention programs that
address the vulnerabilities of girls and women to HIV/AIDS;
and
``(ii) information on the number of individuals served by
programs aimed at reducing the vulnerabilities of women and
girls to HIV/AIDS;
``(G) a description of the specific strategies funded to
ensure the reduction of HIV infection among injection drug
users, and the number of injection drug users, by country,
reached by such strategies, including medication-assisted
drug treatment for individuals with HIV or at risk of HIV,
and HIV prevention programs demonstrated to be effective in
reducing HIV transmission without increasing drug use; and
``(H) a detailed description of monitoring, impact
evaluation research, and operations research of programs,
projects, and activities carried out pursuant to subsection
(d)(4)(A)(v).''; and
(C) by adding at the end the following:
``(3) Public availability.--The Coordinator of United
States Government Activities to Combat HIV/AIDS Globally
shall make publicly available on the Internet website of the
Office of the Coordinator the information contained in
paragraph (2)(H) of each report and, in addition, the
individual evaluations and other reports that were the basis
of such information, including lessons learned and collected
in such evaluations and reports.''.
(b) Authorization of Appropriations.--Subsection (b) of
section 301 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631) is
amended--
(1) in paragraph (1), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''; and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
(c) Food Security and Nutrition Support.--Subsection (c) of
such section is amended to read as follows:
``(c) Food Security and Nutrition Support.--
``(1) Findings.--Congress finds the following:
``(A) The United States provides more than 60 percent of
all food assistance worldwide.
``(B) According to the United Nations World Food Program
and other United Nations agencies, food insecurity of
individuals with HIV/AIDS is a major problem in countries
with large populations of such individuals, particularly in
sub-Saharan African countries.
``(C) Individuals infected with HIV have higher nutritional
requirements than individuals who are not infected with HIV,
particularly with respect to the need for protein. Also,
there is evidence to suggest that the full benefit of therapy
to treat HIV/AIDS may not be achieved in individuals who are
malnourished, particularly in pregnant and lactating women.
``(2) Sense of congress.--It is the sense of Congress
that--
``(A) malnutrition, especially for individuals with HIV/
AIDS, is a clinical health issue with wider nutrition,
health, and social implications for such individuals, their
families, and their communities that must be addressed by
United States HIV/AIDS prevention, treatment, and care
programs;
``(B) food security and nutrition directly impact an
individual's vulnerability to HIV infection, the progression
of HIV to AIDS, an individual's ability to begin an
antiretroviral medication treatment regimen, the efficacy of
an antiretroviral medication treatment regimen once an
individual begins such a regimen, and the ability of
communities to effectively cope with the HIV/AIDS epidemic
and its impacts;
``(C) international guidelines established by the World
Health Organization (WHO) should serve as the reference
standard for HIV/AIDS food and nutrition activities supported
by this Act and the amendments made by this Act;
``(D) the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally and the Administrator
of the United States Agency for International Development
should make it a priority to work together and with other
United States Government agencies, donors, and multilateral
institutions to increase the integration of food and
nutrition support and livelihood activities into HIV/AIDS
prevention, treatment, and care activities funded by the
United States and other governments and organizations;
``(E) for purposes of determining which individuals
infected with HIV should be provided with nutrition and food
support--
``(i) children with moderate or severe malnutrition,
according to WHO standards, shall be given priority for such
nutrition and food support; and
``(ii) adults with a body mass index (BMI) of 18.5 or less,
or at the prevailing WHO-approved measurement for BMI, should
be considered `malnourished' and should be given priority for
such nutrition and food support;
``(F) programs funded by the United States should include
therapeutic and supplementary feeding, food, and nutrition
support and should include strong links to development
programs that provide support for livelihoods; and
``(G) the inability of individuals with HIV/AIDS to access
food for themselves or their families should not be allowed
to impair or erode the therapeutic status of such individuals
with respect to HIV/AIDS or related co-morbidities.
``(3) Statement of policy.--It is the policy of the United
States to--
``(A) address the food and nutrition needs of individuals
with HIV/AIDS and affected individuals, including orphans and
vulnerable children;
``(B) fully integrate food and nutrition support into HIV/
AIDS prevention, treatment, and care programs carried out
under this Act and the amendments made by this Act;
``(C) ensure, to the extent practicable, that--
``(i) HIV/AIDS prevention, treatment, and care providers
and health care workers are adequately trained so that such
providers and workers can provide accurate and informed
information regarding food and nutrition support to
individuals enrolled in treatment and care programs and
individuals affected by HIV/AIDS; and
[[Page H1929]]
``(ii) individuals with HIV/AIDS who, with their
households, are identified as food insecure are provided with
adequate food and nutrition support; and
``(D) effectively link food and nutrition support provided
under this Act and the amendments made by this Act to
individuals with HIV/AIDS, their households, and their
communities, to other food security and livelihood programs
funded by the United States and other donors and multilateral
agencies.
``(4) Integration of food security and nutrition activities
into hiv/aids prevention, treatment, and care activities.--
``(A) Requirements relating to global aids coordinator.--
Consistent with the statement of policy described in
paragraph (3), the Coordinator of United States Government
Activities to Combat HIV/AIDS Globally shall--
``(i) ensure, to the extent practicable, that--
``(I) an assessment, using validated criteria, of the food
security and nutritional status of each individual enrolled
in antiretroviral medication treatment programs supported
with funds authorized under this Act or any amendment made by
this Act is carried out; and
``(II) appropriate nutritional counseling is provided to
each individual described in subclause (I);
``(ii) coordinate with the Administrator of the United
States Agency for International Development, the Secretary of
Agriculture, and the heads of other relevant executive branch
agencies to--
``(I) ensure, to the extent practicable, that, in
communities in which a significant proportion of individuals
with HIV/AIDS are in need of food and nutrition support, a
status and needs assessment for such support employing
validated criteria is conducted and a plan to provide such
support is developed and implemented;
``(II) improve and enhance coordination between food
security and livelihood programs for individuals infected
with HIV in host countries and food security and livelihood
programs that may already exist in such countries;
``(III) establish effective linkages between the health and
agricultural development and livelihoods sectors in order to
enhance food security; and
``(IV) ensure, by providing increased resources if
necessary, effective coordination between activities
authorized under this Act and the amendments made by this Act
and activities carried out under other provisions of the
Foreign Assistance Act of 1961 when establishing new HIV/AIDS
treatment sites;
``(iii) develop effective, validated indicators that
measure outcomes of nutrition and food security interventions
carried out under this section and use such indicators to
monitor and evaluate the effectiveness of such interventions;
and
``(iv) evaluate the role of and, to the extent appropriate,
support and expand partnerships and linkages between United
States postsecondary educational institutions with
postsecondary educational institutions in host countries in
order to provide training and build indigenous human and
institutional capacity and expertise to respond to HIV/AIDS,
and to improve capacity to address nutrition, food security,
and livelihood needs of HIV/AIDS-affected and impoverished
communities.
``(B) Requirements relating to usaid administrator.--
Consistent with the statement of policy described in
paragraph (3), the Administrator of the United States Agency
for International Development, in coordination with the
Coordinator of United States Government Activities to Combat
HIV/AIDS Globally and the Secretary of Agriculture, shall
provide, to the extent practicable, as an essential component
of antiretroviral medication treatment programs supported
with funds authorized under this Act and the amendments made
by this Act, food and nutrition support to each individual
with HIV/AIDS who is determined to need such support by the
assessing health professional, based on a body mass index
(BMI) of 18.5 or less, or at the prevailing WHO-approved
measurement for BMI, and the individual's household, for a
period of not less than 180 days, either directly or through
referral to an assistance program or organization with
demonstrable ability to provide such support.
``(C) Report.--Not later than October 31, 2010, and
annually thereafter, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally, in
consultation with the Administrator of the United States
Agency for International Development, shall submit to the
appropriate congressional committees a report on the
implementation of this subsection for the prior fiscal year.
The report shall include a description of--
``(i) the effectiveness of interventions carried out to
improve the nutritional status of individuals with HIV/AIDS;
``(ii) the amount of funds provided for food and nutrition
support for individuals with HIV/AIDS and affected
individuals in the prior fiscal year and the projected amount
of funds to be provided for such purpose for next fiscal
year; and
``(iii) a strategy for improving the linkage between
assistance provided with funds authorized under this
subsection and food security and livelihood programs under
other provisions of law as well as activities funded by other
donors and multilateral organizations.
``(D) Authorization of appropriations.--Of the amounts
authorized to be appropriated under section 401 for HIV/AIDS
assistance, there are authorized to be appropriated to the
President such sums as may be necessary for each of the
fiscal years 2009 through 2013 to carry out this
subsection.''.
(d) Eligibility for Assistance.--Subsection (d) of such
section is amended to read as follows:
``(d) Eligibility for Assistance.--An organization,
including a faith-based organization, that is otherwise
eligible to receive assistance under section 104A of the
Foreign Assistance Act of 1961 (as added by subsection (a))
or under any other provision of this Act (or any amendment
made by this Act or the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008) to prevent, treat, or monitor
HIV/AIDS--
``(1) shall not be required, as a condition of receiving
the assistance, to endorse or utilize a multisectoral
approach to combating HIV/AIDS, or to endorse, utilize, make
a referral to, become integrated with or otherwise
participate in any program or activity to which the
organization has a religious or moral objection; and
``(2) shall not be discriminated against in the
solicitation or issuance of grants, contracts, or cooperative
agreements under such provisions of law for refusing to do
so.''.
(e) Sense of Congress.--Such section is further amended by
striking subsection (g).
(f) Report.--
(1) In general.--Not later than 270 days after the date of
the enactment of this Act, the Coordinator of United States
Government Activities to Combat HIV/AIDS Globally shall
submit to the appropriate congressional committees a report
identifying a target for the number of additional health
professionals and workers needed in host countries to provide
HIV/AIDS prevention, treatment, and care and the training
needs of such health professionals and workers. The target
should reflect available data and should identify the need
for United States Government contributions to meet the
target.
(2) Definition.--In this subsection, the term ``appropriate
congressional committees'' has the meaning given the term in
section 3 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602).
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Amendments to the Foreign Assistance Act of 1961.--
(1) Findings.--Subsection (a) of section 104B of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3) is amended
by striking paragraphs (1) and (2) and inserting the
following:
``(1) Tuberculosis is one of the greatest infectious causes
of death of adults worldwide, killing 1.6 million individuals
per year--one person every 20 seconds.
``(2) Tuberculosis is the leading infectious cause of death
among individuals who are infected with HIV due to their
weakened immune systems, and it is estimated that one-third
of such individuals have tuberculosis. Tuberculosis is also a
leading killer of women of reproductive age.
``(3) Driven by the HIV/AIDS pandemic, incidence rates of
tuberculosis in sub-Saharan Africa have more than doubled on
average since 1990. The problem is so pervasive that in
August 2005, African health ministers and the World Health
Organization (WHO) declared tuberculosis to be an emergency
in sub-Saharan Africa.
``(4)(A) The wide extent of drug resistance, including both
multi-drug resistant tuberculosis (MDR-TB) and extensively
drug resistant tuberculosis (XDR-TB), represents both a
critical challenge to the global control of tuberculosis and
a serious worldwide public health threat.
``(B) XDR-TB, which is a form of MDR-TB with additional
resistance to multiple second-line anti-tuberculosis drugs,
is associated with worst treatment outcomes of any form of
tuberculosis.
``(C) XDR-TB is converging with the HIV/AIDS epidemic,
undermining gains in HIV/AIDS prevention and treatment
programs and requires urgent interventions.
``(D) Drug resistance surveillance reports have confirmed
the serious scale and spread of tuberculosis, with XDR-TB
strains confirmed on six continents.
``(E) Demonstrating the lethality of XDR-TB, an initial
outbreak in Tugela Ferry, South Africa, in 2006 killed 52 of
53 patients with hundreds more cases reported since that
time.
``(F) Of the world's regions, sub-Saharan Africa, faces the
greatest gap in capacity to prevent, treat, and care for
individuals with XDR-TB.''.
(2) Policy.--Subsection (b) of such section is amended to
read as follows:
``(b) Policy.--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis. In all countries in which the Government of the
United States has established development programs,
particularly in countries with the highest burden of
tuberculosis and other countries with high rates of
tuberculosis, the United States Government should prioritize
the achievement of the following goals by not later than
December 31, 2015:
``(1) Reduce by one-half the tuberculosis death and disease
burden from the 1990 baseline.
``(2) Sustain or exceed the detection of at least 70
percent of sputum smear-positive
[[Page H1930]]
cases of tuberculosis and the cure of at least 85 percent of
such cases detected.''.
(3) Activities supported.--Such section is further
amended--
(A) by redesignating subsections (d) through (f) as
subsections (e) through (g); and
(B) by inserting after subsection (c) the following:
``(d) Activities Supported.--Assistance provided under
subsection (c) shall, to the maximum extent practicable, be
used to carry out the following activities:
``(1) Provide diagnostic counseling and testing to
individuals with HIV/AIDS for tuberculosis (including a
culture diagnosis to rule out multi-drug resistant
tuberculosis (MDR-TB) and extensively drug resistant
tuberculosis (XDR-TB) and provide HIV/AIDS voluntary
counseling and testing to individuals with any form of
tuberculosis.
``(2) Provide tuberculosis treatment to individuals
receiving treatment and care for HIV/AIDS who have active
tuberculosis and provide prophylactic treatment to
individuals with HIV/AIDS who also have a latent tuberculosis
infection.
``(3) Link individuals with both HIV/AIDS and tuberculosis
to HIV/AIDS treatment and care services, including
antiretroviral therapy and cotrimoxazole therapy.
``(4) Ensure that health care workers trained to diagnose,
treat, and provide care for HIV/AIDS are also trained to
diagnose, treat, and provide care for individuals with both
HIV/AIDS and tuberculosis.
``(5) Ensure that individuals with active pulmonary
tuberculosis are provided a culture diagnosis, including drug
susceptibility testing to rule out multi-drug resistant
tuberculosis (MDR-TB) and extensively drug resistant
tuberculosis (XDR-TB) in areas with high prevalence of
tuberculosis drug resistance.''.
(4) Priority to stop tb strategy.--Subsection (f) of such
section (as redesignated by paragraph (3) of this subsection)
is amended--
(A) by amending the heading to read as follows: ``Priority
To Stop TB Strategy'';
(B) in the first sentence, by striking ``In furnishing''
and all that follows through ``, including funding'' and
inserting the following:
``(1) Priority.--In furnishing assistance under subsection
(c), the President shall give priority to--
``(A) activities described in the Stop TB Strategy,
including expansion and enhancement of Directly Observed
Treatment Short-course (DOTS) coverage, treatment for
individuals infected with both tuberculosis and HIV and
treatment for individuals with multi-drug resistant
tuberculosis (MDR-TB), strengthening of health systems, use
of the International Standards for Tuberculosis Care by all
care providers, empowering individuals with tuberculosis, and
enabling and promoting research to develop new diagnostics,
drugs, and vaccines, and program-based operational research
relating to tuberculosis; and
``(B) funding''; and
(C) in the second sentence--
(i) by striking ``In order to'' and all that follows
through ``not less than'' and inserting the following:
``(2) Availability of amounts.--In order to meet the
requirements of paragraph (1), the President--
``(A) shall ensure that not less than'';
(ii) by striking ``for Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis using DOTS-Plus,'' and inserting ``to implement
the Stop TB Strategy; and''; and
(iii) by striking ``including'' and all that follows and
inserting the following:
``(B) should ensure that not less than $15,000,000 of the
amount made available to carry out this section for a fiscal
year is used to make a contribution to the Global
Tuberculosis Drug Facility.''.
(5) Assistance for who and the stop tuberculosis
partnership.--Such section is further amended--
(A) by redesignating subsection (g) (as redesignated by
paragraph (3) of this subsection) as subsection (h); and
(B) by inserting after subsection (f) (as redesignated by
paragraph (4) and amended by paragraph (5) of this
subsection) the following new subsection:
``(g) Assistance for WHO and the Stop Tuberculosis
Partnership.--In carrying out this section, the President,
acting through the Administrator of the United States Agency
for International Development, is authorized to provide
increased resources to the World Health Organization (WHO)
and the Stop Tuberculosis Partnership to improve the capacity
of countries with high rates of tuberculosis and other
affected countries to implement the Stop TB Strategy and
specific strategies related to addressing extensively drug
resistant tuberculosis (XDR-TB).''.
(6) Definitions.--Subsection (h) of such section (as
redesignated by paragraph (5)(A) of this subsection) is
amended--
(A) in paragraph (1), by adding at the end before the
period the following: ``, including low cost and effective
diagnosis and evaluation of treatment regimes, vaccines, and
monitoring of tuberculosis, as well as a reliable drug
supply, and a management strategy for public health systems,
with health system strengthening, promotion of the use of the
International Standards for Tuberculosis Care by all care
providers, bacteriology under an external quality assessment
framework, short-course chemotherapy, and sound reporting and
recording systems''; and
(B) by adding after paragraph (5) the following new
paragraph:
``(6) Stop tb strategy.--The term `Stop TB Strategy' means
the six-point strategy to reduce tuberculosis developed by
the World Health Organization. The strategy is described in
the Global Plan to Stop TB 2007-2016: Actions for Life, a
comprehensive plan developed by the Stop Tuberculosis
Partnership that sets out the actions necessary to achieve
the millennium development goal of cutting tuberculosis
deaths and disease burden in half by 2016.''.
(b) Authorization of Appropriations.--Section 302(b) of the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended--
(1) in paragraph (1), by striking ``such sums as may be
necessary for each of the fiscal years 2004 through 2008''
and inserting ``$4,000,000,000 for fiscal years 2009 through
2013''; and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
SEC. 303. ASSISTANCE TO COMBAT MALARIA.
(a) Amendment to the Foreign Assistance Act of 1961.--
Section 104C(b) of the Foreign Assistance Act of 1961 (22
U.S.C. 21516-4(b)) is amended by striking ``control, and
cure'' and inserting ``treatment, and care''.
(b) Authorization of Appropriations.--Section 303(b) of the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7633(b)) is amended--
(1) in paragraph (1), by striking ``such sums as may be
necessary for fiscal years 2004 through 2008'' and inserting
``$5,000,000,000 for fiscal years 2009 through 2013''; and
(2) in paragraph (3), by striking ``fiscal years 2004
through 2008'' and inserting ``fiscal years 2009 through
2013''.
(c) Development of a Comprehensive Five-Year Strategy.--
Section 303 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7633) is
amended by adding at the end the following:
``(d) Development of a Comprehensive Five-Year Strategy.--
The President shall establish a comprehensive, five-year
strategy to combat global malaria that strengthens the
capacity of the United States to be an effective leader of
international efforts to reduce the global malaria disease
burden. Such strategy shall maintain sufficient flexibility
and remain responsive to the ever-changing nature of the
global malaria challenge and shall--
``(1) include specific objectives, multisectoral approaches
and strategies to treat and provide care to individuals
infected with malaria, to prevent the further spread of
malaria;
``(2) describe how this strategy would contribute to the
United States' overall global health and development goals;
``(3) clearly explain how proposed activities to combat
malaria will be coordinated with other United States global
health activities, including the five-year global HIV/AIDS
and tuberculosis strategies developed pursuant to section 101
of this Act;
``(4) expand public-private partnerships and leveraging of
resources to combat malaria, including private sector
resources;
``(5) coordinate among relevant executive branch agencies
providing assistance to combat malaria in order to maximize
human and financial resources and reduce unnecessary
duplication among such agencies and other donors;
``(6) maximize United States capabilities in the areas of
technical assistance, training, and research, including
vaccine research, to combat malaria; and
``(7) establish priorities and selection criteria for the
distribution of resources to combat malaria based on factors
such as the size and demographics of the population with
malaria, the needs of that population, the host countries'
existing infrastructure, and the host countries' ability to
complement United States efforts with strategies outlined in
national malaria control plans.
``(e) Malaria Response Coordinator.--
``(1) In general.--There should be established within the
United States Agency for International Development a
Coordinator of United States Government Activities to Combat
Malaria Globally, who should be appointed by the President.
``(2) Authorities.--The Coordinator, acting through such
nongovernmental organizations and relevant executive branch
agencies as may be necessary and appropriate to effect the
purposes of section 104C of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b-4), is authorized--
``(A) to operate internationally to carry out prevention,
treatment, care, support, capacity development of health
systems, and other activities for combating malaria;
``(B) to transfer and allocate funds to relevant executive
branch agencies;
``(C) to provide grants to, and enter into contracts with,
nongovernmental organizations to carry out the purposes of
such section 104C;
``(D) to enter into contracts and transfer and allocate
funds to international organizations to carry out the
purposes of such section 104C; and
``(E) to coordinate with a public-private partnership to
discover and develop effective new antimalarial drugs,
including drugs for
[[Page H1931]]
multi-drug resistant malaria and malaria in pregnant women.
``(3) Duties.--
``(A) In general.--The Coordinator shall have primary
responsibility for the oversight and coordination of all
resources and global United States government activities to
combat malaria.
``(B) Specific duties.--The Coordinator shall--
``(i) facilitate program and policy coordination among
relevant executive branch agencies and nongovernmental
organizations, including auditing, monitoring and evaluation
of such programs;
``(ii) ensure that each relevant executive branch agency
has sufficient resources to execute programs in areas in
which the agency has the greatest expertise, technical
capability, and potential for success;
``(iii) coordinate with the Office of the Coordinator of
United States Government Activities to Combat HIV/AIDS
Globally and equivalent managers of other relevant executive
branch agencies that are implementing global health programs
to develop and implement program plans, country-level
interactions, and recipient administrative requirements in
countries in which more than one program operates;
``(iv) coordinate relevant executive branch agency
activities in the field, including coordination of planning,
implementation, and evaluation of malaria programs with HIV/
AIDS programs in countries in which both programs are being
carried out;
``(v) pursue coordinate program implementation with host
governments, other donors, and the private sector; and
``(vi) establish due diligence criteria for all recipients
of funds appropriated pursuant to the authorizations of
appropriations under section 401 for malaria assistance.
``(f) Assistance to Who.--In carrying out this section, the
President is authorized to make a United States contribution
to the Roll Back Malaria Partnership and the World Health
Organization (WHO) to improve the capacity of countries with
high rates of malaria and other affected countries to
implement comprehensive malaria control programs.
``(g) Annual Report.--
``(1) In general.--Not later than 270 days after the date
of the enactment of the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter, the
President shall transmit to the appropriate congressional
committees a report on United States assistance for the
prevention, treatment, control, and elimination of malaria.
``(2) Matters to be included.--The report required under
paragraph (1) shall include a description of--
``(A) the countries and activities to which malaria
assistance has been allocated;
``(B) the number of people reached through malaria
assistance programs;
``(C) the percentage and number of children and mothers
reached through malaria assistance programs;
``(D) research efforts to develop new tools to combat
malaria, including drugs and vaccines;
``(E) collaboration with the World Health Organization
(WHO), the Global Fund to Fight AIDS, Tuberculosis and
Malaria, other donor governments, and relevant executive
branch agencies to combat malaria;
``(F) quantified impact of United States assistance on
childhood morbidity and mortality;
``(G) the number of children who received immunizations
through malaria assistance programs; and
``(H) the number of women receiving ante-natal care through
malaria assistance programs.''.
SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.
(a) In General.--Title III of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7631 et seq.) is amended by striking section 304 and
inserting the following:
``SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.
``(a) Sense of Congress.--It is the sense of Congress that
the use of health care partnerships that link United States
and host country health care institutions create
opportunities for sharing of knowledge and expertise among
individuals with significant experience in health-related
fields and build local capacity to combat HIV/AIDS and
increase scientific understanding of the progression of HIV/
AIDS and the HIV/AIDS epidemic.
``(b) Authority To Facilitate Health Care Partnerships To
Combat HIV/AIDS.--The President, acting through the
Coordinator of United States Government Activities to Combat
HIV/AIDS Globally, shall facilitate the development of health
care partnerships described in subsection (a) by-
``(1) supporting short- and long-term institutional
partnerships, including partnerships that build capacity in
ministries of health, central- and district-level health
agencies, medical facilities, health education and training
institutions, academic centers, and faith- and community-
based organizations involved in prevention, treatment, and
care of HIV/AIDS;
``(2) supporting the development of consultation services
using appropriate technologies, including online courses,
DVDs, telecommunications services, and other technologies to
eliminate the barriers that prevent host country
professionals from accessing high quality health care
services information, particularly providers located in rural
areas;
``(3) supporting the placements of highly qualified
individuals to strengthen human and organizational capacity
through the use of health care professionals to facilitate
skills transfer, building local capacity, and to expand
rapidly the pool of providers, managers, and other health
care staff delivering HIV/AID services in host countries; and
``(4) meeting individual country needs and, where possible,
insisting on the implementation of a national strategic plan,
by providing training and mentoring to strengthen human and
organizational capacity among local health care service
organizations.
``(c) Authorization of Appropriations.--Of the amounts
authorized to be appropriated under section 401 for HIV/AIDS
assistance, there are authorized to be appropriated to the
President such sums as may be necessary for each of the
fiscal years 2009 through 2013 to carry out this section.''.
(b) Clerical Amendment.--The table of contents for the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by
striking the item relating to section 304 and inserting the
following new item:
``Sec. 304. Health care partnerships to combat HIV/AIDS.''.
Subtitle B--Assistance for Women, Children, and Families
SEC. 311. POLICY AND REQUIREMENTS.
(a) Policy.--Subsection (a) of section 312 of the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (22 U.S.C. 7652) is amended--
(1) in the first sentence, by striking ``The United States
Government's'' and inserting the following:
``(1) In general.--The United States''; and
(2) by adding at the end the following:
``(2) Collaboration.--The United States should work in
collaboration with governments, donors, the private sector,
nongovernmental organizations, and other key stakeholders to
carry out the policy described in paragraph (1).''.
(b) Requirements.--Subsection (b) of such section is
amended to read as follows:
``(b) Requirements.--The 5-year United States strategy
required by section 101 of this Act shall--
``(1) establish a target for prevention and treatment of
mother-to-child transmission of HIV that by 2013 will reach
at least 80 percent of pregnant women in those countries most
affected by HIV/AIDS;
``(2) establish a target requiring that by 2013 up to 15
percent of individuals receiving care and up to 15 percent of
individuals receiving treatment under this Act and the
amendments made by this Act are children;
``(3) integrate care and treatment with prevention of
mother-to-child transmission of HIV programs in order to
improve outcomes for HIV-affected women and families as soon
as is feasible, consistent with the national government
policies of countries in which programs under this Act are
administered, and including support for strategies to ensure
successful follow-up and continuity of care;
``(4) expand programs designed to care for children
orphaned by HIV/AIDS;
``(5) develop a timeline for expanding access to more
effective regimes to prevent mother-to-child transmission of
HIV, consistent with the national government policies of
countries in which programs under this Act are administered
and the goal of achieving universal use of such regimens as
soon as possible;
``(6) ensure that women receiving voluntary contraceptive
counseling, services, or commodities in programs supported by
the United States Government have access to the full range of
HIV/AIDS services; and
``(7) ensure that women in prevention of mother-to-child
transmission of HIV programs are provided with appropriate
maternal and child services, either directly or by
referral.''.
SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION OF THE HIV INFECTION.
Section 313(a) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7653(a)) is amended by striking ``5 years'' and inserting
``10 years''.
SEC. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN AND
YOUTH.
(a) In General.--Title III of the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7631 et seq.) is amended by adding at the end the
following:
``SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN
AND YOUTH.
``(a) Statement of Policy.--In order to meet the United
States Government's goal of preventing 12,000,000 new HIV
infections worldwide, it shall be the policy of the United
States to pursue a global HIV/AIDS prevention strategy that
emphasizes the immediate and ongoing needs of women and youth
and addresses the factors that lead to gender disparities in
the rate of HIV infection.
``(b) Strategy.--
``(1) In general.--The President shall formulate a
comprehensive, integrated, and culturally-appropriate global
HIV/AIDS prevention strategy that, to the extent
epidemiologically appropriate, addresses the vulnerabilities
of women and youth to HIV
[[Page H1932]]
infection and seeks to reduce the factors that lead to gender
disparities in the rate of HIV infection.
``(2) Elements.--The strategy required under paragraph (1)
shall include specific goals and targets under the 5-year
strategy outlined in section 101 and shall include
comprehensive HIV/AIDS prevention education at the individual
and national level including the ABC (`Abstain, Be faithful,
use Condoms') model as a means to reduce HIV infections and
shall include the following:
``(A) Specific goals under the five-year strategy outlined
in section 101.
``(B) Empowering women and youth to avoid cross-
generational sex and to decide when and whom to marry in
order to reduce the incidence of early or child marriage.
``(C) Dramatically increasing access to currently available
female-controlled prevention methods and including
investments in training to increase the effective and
consistent use of both male and female condoms.
``(D) Accelerating the de-stigmatization of HIV/AIDS among
women and youth as a major risk factor for the transmission
of HIV.
``(E) Addressing and preventing post-traumatic and psycho-
social consequences and providing post-exposure prophylaxis
to victims of gender-based violence and rape against women
and youth through appropriate medical, social, educational,
and legal assistance and through prosecutions and legal
penalties to address such violence.
``(F) Promoting changes in male attitudes and behavior that
respect the human rights of women and youth and that support
and foster gender equality.
``(G) Supporting the development of microenterprise
initiatives, job training programs, and other such efforts to
assist women in developing and retaining independent economic
means.
``(H) Supporting universal basic education and expanded
educational opportunities for women and youth.
``(I) Protecting the property and inheritance rights of
women.
``(J) Coordinating inclusion of HIV/AIDS prevention
information and education services and programs for
individuals with HIV/AIDS with existing health care services
targeted to women and youth, such as ensuring access to HIV/
AIDS education and testing in family planning programs
supported by the United States Government and programs to
reduce mother-to-child transmission of HIV, and expanding the
reach of such HIV/AIDS health services.
``(K) Promoting gender equality by supporting the
development of nongovernmental organizations, including
faith-based and community-based organizations, that support
the needs of women and utilizing such organizations that are
already empowering women and youth at the community level.
``(L) Encouraging the creation and effective enforcement of
legal frameworks that guarantee women equal rights and equal
protection under the law.
``(M) Encouraging the participation and involvement of
women in drafting, coordinating, and implementing the
national HIV/AIDS strategic plans of their countries.
``(N) Responding to other economic and social factors that
increase the vulnerability of women and youth to HIV
infection.
``(3) Transmission to congress and public availability.--
Not later than 180 days after the date of the enactment of
the Tom Lantos and Henry J. Hyde Global Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of
2008, the President shall transmit to the appropriate
congressional committees and make available to the public the
strategy required under paragraph (1).
``(c) Coordination.--In formulating and implementing the
strategy required under subsection (b), the President shall
ensure that the United States coordinates its overall HIV/
AIDS policy and programs with the national governments of the
countries for which the United States provides assistance to
combat HIV/AIDS and, to the extent practicable, with
international organizations, other donor countries, and
indigenous organizations, including faith-based and
community-based organizations specifically for the purposes
of ensuring gender equality and promoting respect of the
human rights of women that impact their susceptibility to
HIV/AIDS, improving women's health, and expanding education
for women and youth, and organizations, including faith-based
and other nonprofit organizations, providing services to and
advocating on behalf of individuals with HIV/AIDS and
individuals affected by HIV/AIDS.
``(d) Guidance.--
``(1) In general.--The President shall provide clear
guidance to field missions of the United States Government in
countries for which the United States provides assistance to
combat HIV/AIDS, based on the strategy required under
subsection (b).
``(2) Transmission to congress and public availability.--
The President shall transmit to the appropriate congressional
committees and make available to the public a description of
the guidance required under paragraph (1).
``(e) Report.--
``(1) In general.--Not later than 1 year after the date of
the enactment of the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter as part
of the annual report required under section 104A(e) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the
President shall transmit to the appropriate congressional
committees and make available to the public a report on the
implementation of this section for the prior fiscal year.
``(2) Matters to be included.--The report required under
paragraph (1) shall include the following:
``(A) A description of the prevention programs designed to
address the vulnerabilities of women and youth to HIV/AIDS.
``(B) A list of nongovernmental organizations in each
country that receive assistance from the United States to
carry out HIV prevention activities, including the amount and
the source of funding received.''.
(b) Clerical Amendment.--The table of contents for the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by
inserting after the item relating to section 315 the
following:
``Sec. 316. Strategy to prevent HIV infections among women and
youth.''.
SEC. 314. CLERICAL AMENDMENT.
The table of contents for the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7601 note) is amended by striking the item relating to
subtitle B of title III and inserting the following:
``Subtitle B--Assistance for Women, Children, and Families''.
TITLE IV--AUTHORIZATION OF APPROPRIATIONS
SEC. 401. AUTHORIZATION OF APPROPRIATIONS.
Section 401(a) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7671(a)) is amended--
(1) by striking ``$3,000,000,000'' and inserting
``$10,000,000,000''; and
(2) by striking ``fiscal years 2004 through 2008'' and
inserting ``fiscal years 2009 through 2013''.
SEC. 402. SENSE OF CONGRESS.
Section 402(b) of the United States Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672)
is amended--
(1) by striking paragraph (1);
(2) by redesignating paragraphs (2) through (4) as
paragraphs (1) through (3), respectively; and
(3) in paragraph (2) (as redesignated by paragraph (2) of
this section), by striking ``, of which'' and all that
follows through ``programs''.
SEC. 403. ALLOCATION OF FUNDS.
(a) HIV/AIDS Prevention Activities.--Subsection (a) of
section 403 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is
amended to read as follows:
``(a) HIV/AIDS Prevention Activities.--
``(1) In general.--For each of the fiscal years 2009
through 2013, not less than 20 percent of the amounts
appropriated pursuant to the authorization of appropriations
under section 401 for HIV/AIDS assistance for each such
fiscal year shall be expended for HIV/AIDS prevention
activities consistent with section 104A(d) of the Foreign
Assistance Act of 1961.
``(2) Balanced funding requirement.--(A) The Coordinator of
United States Government Activities to Combat HIV/AIDS
Globally shall provide balanced funding for prevention
activities for sexual transmission of HIV/AIDS and shall
ensure that behavioral change programs, including abstinence,
delay of sexual debut, monogamy, fidelity and partner
reduction, are implemented and funded in a meaningful and
equitable way in the strategy for each host country based on
objective epidemiological evidence as to the source of
infections and in consultation with the government of each
host county involved in HIV/AIDS prevention activities.
``(B) In fulfilling the requirement under subparagraph (A),
the Coordinator shall establish a HIV sexual transmission
prevention strategy governing the expenditure of funds
authorized by the Act used to prevent the sexual transmission
of HIV in any host country with a generalized epidemic. In
each such host country, if this strategy provides less than
50 percent of such funds for behavioral change programs,
including abstinence, delay of sexual debut, monogamy,
fidelity, and partner reduction, the Coordinator shall,
within 30 days of the issuance of this strategy, report to
the appropriate congressional committees on the justification
for this decision.
``(C) Programs and activities that implement or purchase
new prevention technologies or modalities such as medical
male circumcision, pre-exposure prophylaxis, or microbicides
and programs and activities that provide counseling and
testing for HIV or prevent mother-to-child prevention of HIV
shall not be included in determining compliance with this
paragraph.
``(3) Report.--Not later than 1 year after the date of the
enactment of the Tom Lantos and Henry J. Hyde Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008, and annually thereafter as part
of the annual report required under section 104A(e) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the
President shall transmit to the appropriate congressional
committees and make available to the public a report on the
implementation of paragraph (2) for the prior fiscal year.''.
(b) Orphans and Vulnerable Children.--Subsection (b) of
such section is amended by
[[Page H1933]]
striking ``fiscal years 2006 through 2008'' and inserting
``fiscal years 2009 through 2013''.
SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOVERNMENTS.
(a) Prohibition on Taxation.--None of the funds
appropriated pursuant to the authorization of appropriations
under section 401 of the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C.
7671) may be made available to provide assistance for a
foreign country under a new bilateral agreement governing the
terms and conditions under which such assistance is to be
provided unless such agreement includes a provision stating
that assistance provided by the United States shall be exempt
from taxation, or reimbursed, by the foreign government, and
the Secretary of State shall expeditiously seek to negotiate
amendments to existing bilateral agreements, as necessary, to
conform with this requirement.
(b) De Minimus Exception.--Foreign taxes of a de minimus
nature shall not be subject to the provisions of subsection
(a).
(c) Reprogramming of Funds.--Funds withheld from obligation
for each country or entity pursuant to subsection (a) shall
be reprogrammed for assistance to countries which do not
assess taxes on United States assistance or which have an
effective arrangement that is providing substantial
reimbursement of such taxes.
(d) Determinations.--
(1) In general.--The provisions of this section shall not
apply to any country or entity the Secretary of State
determines--
(A) does not assess taxes on United States assistance or
which has an effective arrangement that is providing
substantial reimbursement of such taxes; or
(B) the foreign policy interests of the United States
outweigh the policy of this section to ensure that United
States assistance is not subject to taxation.
(2) Consultation.--The Secretary of State shall consult
with the Committees on Foreign Affairs and Appropriations at
least 15 days prior to exercising the authority of this
subsection with regard to any country or entity.
(e) Implementation.--The Secretary of State shall issue
rules, regulations, or policy guidance, as appropriate, to
implement the prohibition against the taxation of assistance
contained in this section.
(f) Definitions.--As used in this section--
(1) the terms ``taxes'' and ``taxation'' refer to value
added taxes and customs duties imposed on commodities
financed with United States assistance for programs for which
funds are authorized by this Act; and
(2) the term ``bilateral agreement'' refers to a framework
bilateral agreement between the Government of the United
States and the government of the country receiving assistance
that describes the privileges and immunities applicable to
United States foreign assistance for such country generally,
or an individual agreement between the Government of the
United States and such government that describes, among other
things, the treatment for tax purposes that will be accorded
the United States assistance provided under that agreement.
TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
SEC. 501. SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE
SYSTEMS.
The United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et
seq.) is amended by adding at the end the following:
``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
``SEC. 601. FINDINGS.
``Congress makes the following findings:
``(1) The shortage of health personnel, including doctors,
nurses, pharmacists, counselors, laboratory staff, and
paraprofessionals, is one of the leading obstacles to
fighting HIV/AIDS in sub-Saharan Africa.
``(2) The HIV/AIDS pandemic aggravates the shortage of
health workers through loss of life and illness among medical
staff, unsafe working conditions for medical personnel, and
increased workloads for diminished staff, while the shortage
of health personnel undermines efforts to prevent and provide
care and treatment for individuals with HIV/AIDS.
``(3) Failure to address the shortage of health care
professionals and paraprofessionals, and the factors forcing
such individuals to leave sub-Saharan Africa, will undermine
the objectives of United States development policy and will
subvert opportunities to achieve internationally-recognized
goals for the prevention, treatment, and care of HIV/AIDS and
other diseases, the reduction of child and maternal
mortality, and for economic growth and development in sub-
Saharan Africa.
``SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES AND OTHER
POLICIES.
``(a) National Health Workforce Strategies.--
``(1) Statement of policy.--It shall be the policy of the
United States Government to support countries receiving
United States assistance to combat HIV/AIDS, tuberculosis,
and malaria, and other health programs in developing,
strengthening, and implementing 5-year health workforce
strategies.
``(2) Technical and financial assistance.--The
Administrator of the United States Agency for International
Development, in coordination with the Coordinator of United
States Government Activities to Combat HIV/AIDS Globally, is
authorized to provide technical and financial assistance to
countries described in paragraph (1) to enable such
countries, in conjunction with other funding sources, to
develop, strengthen, and implement health workforce
strategies.
``(3) Activities supported.--Assistance provided under
paragraph (2) shall, to the maximum extent practicable, be
used to carry out the following:
``(A) Activities to promote an inclusive process that
includes nongovernmental organizations and individuals with
HIV/AIDS in developing health workforce strategies.
``(B) Activities to achieve and sustain a health workforce
sufficient in numbers, skill, and capacity to meet United
States and host-country international health commitments,
including the Millennium Development Goals and universal
access to HIV/AIDS prevention, treatment, and care. In
particular, such health workforce strategies should include
plans for progress toward achieving the minimum ratio of
health professionals required to achieve these goals by 2015,
estimated by the World Health Organization to require at
least 2.3 doctors, nurses, and midwives per 1,000 population,
and additional health workers such as pharmacists and lab
technicians.
``(C) Activities to ensure that health workforce strategies
are aimed at creating appropriate distribution of health
workers and prioritizing activities required to ensure rural,
marginalized, and other underserved populations are able to
access skilled and equipped health workers.
``(D) Activities to expand the capacity of public and
private medical, nursing, pharmaceutical, and other health
training institutions.
``(b) Positive Broader Health Impact.--It shall be the
policy of the United States to ensure to expand the capacity
of the health workforce engaged in HIV/AIDS programming in
ways that contribute to, and do not detract from, the
capacity of countries to meet other health needs,
particularly child survival and maternal health.
``(c) Safety for Health Workers.--It is the sense of
Congress that the United States should ensure that all health
workers participating in programs that receive assistance
under this Act and the amendments made by this Act have the
proper training to create safe and sanitary working
conditions in accordance with universal precautions and other
forms of infection prevention and control.
``(d) Health Care for Health Workers.--The Coordinator of
United States Government Activities to Combat HIV/AIDS
Globally shall ensure that comprehensive and confidential
health services shall be provided to all health workers
participating in programs that receive assistance under this
Act and the amendments made by this Act, including--
``(1) testing and counseling for all such employees;
``(2) providing HIV/AIDS treatment to HIV-positive
employees; and
``(3) taking measures to reduce HIV-related stigma in the
workplace.
``(e) Training and Compensation Finance.--Where the
Coordinator determines such financial support is essential to
fulfill the purposes of this Act, the Coordinator shall
finance training and provide compensation or other benefits
for health workers in order to enhance recruitment and
retention of such workers.
``SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM LIMITS
SOUGHT BY INTERNATIONAL FINANCIAL INSTITUTIONS.
``(a) Coordination Within the United States Government.--
The Coordinator of United States Government Activities to
Combat HIV/AIDS Globally shall work with the Secretary of the
Treasury to reform International Monetary Fund macroeconomic
and fiscal policies that result in limitations on national
and donor investments in health.
``(b) Position of the United States at the Imf.--The
Secretary of the Treasury shall instruct the United States
Executive Director at the International Monetary Fund to use
the voice, vote, and influence of the United States to oppose
any loan, project, agreement, memorandum, instrument, plan,
or other program of the International Monetary Fund that does
not exempt increased government spending on health care from
national budget caps or restraints, hiring or wage bill
ceilings, or other limits sought by any international
financial institution.
``SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REGISTRATION, AND
SUPPLY CHAIN MANAGEMENT SYSTEMS.
``(a) In General.--The Coordinator of United States
Government Activities to Combat AIDS Globally shall work with
the Partnership for Supply Chain Management Systems, host
countries, and nongovernmental organizations to develop
effective, reliable host country-owned and operated public-
sector procurement and supply chain management systems,
including regional distribution, with ongoing technical
assistance and sustained support to ensure the function of
such systems, as well as the function of existing non-public
sector supply chains, including those operated by faith-based
and other humanitarian organizations that procure and
distribute medical supplies.
[[Page H1934]]
``(b) Availability of Equipment and Supplies.--The public-
sector procurement and supply chain management systems
developed pursuant to subsection (a) should ensure that
adequate laboratory equipment and supplies commonly needed to
fight HIV/AIDS, including diagnostic tests for CD4 and viral
load counts, x-ray machines, mobile and facility-based rapid
HIV test kits and other necessary assays, reagents and basic
supplies such as sterile syringes and gloves, are available
and distributed in a manner that is accessible to urban and
rural populations.
``(c) Drug Registration.--The Coordinator shall work with
host country partners and development partners to support
efficient and effective drug approval and registration
systems that allow expeditious access to safe and effective
drugs, including antiretroviral drugs.
``(d) Report.--The Coordinator shall submit to the
appropriate congressional committees an annual report on the
implementation of this section, including progress toward
specific benchmarks established by the Partnership for Supply
Chain Management Systems, and the projection of when host
countries can fully sustain their own procurement and supply
chain management and distribution systems at a scale
necessary for national primary health needs.
``SEC. 605. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--Of the amounts authorized to be
appropriated under section 401 for HIV/AIDS assistance, there
are authorized to be appropriated to the President such sums
as may be necessary for each of the fiscal years 2009 through
2013 to carry out this title.
``(b) Availability.--Amounts appropriated pursuant to the
authorization of appropriations under subsection (a) are
authorized to remain available until expended.''.
SEC. 502. CLERICAL AMENDMENT.
The table of contents for the United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22
U.S.C. 7601 note) is amended by inserting after the items
relating to title V the following:
``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS
``Sec. 601. Findings.
``Sec. 602. National health workforce strategies and other policies.
``Sec. 603. Exemption of investments in health from limits sought by
international financial institutions.
``Sec. 604. Public-sector procurement, drug registration, and supply
chain management systems.
``Sec. 605. Authorization of appropriations.''.
The CHAIRMAN. No amendment to the bill is in order except those
printed in House Report 110-562. Each amendment may be offered only in
the order printed in the report, by a Member designated in the report,
shall be considered read, shall be debatable for the time specified in
the report, equally divided and controlled by the proponent and an
opponent of the amendment, shall not be subject to amendment, and shall
not be subject to a demand for division of the question.
Amendment No. 1 Offered by Mr. Blumenauer
The CHAIRMAN. It is now in order to consider amendment No. 1 printed
in House Report 110-562.
Mr. BLUMENAUER. Madam Chairman, I have an amendment made in order
under the rule.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 1 offered by Mr. Blumenauer:
Page 59, line 7, insert ``, safe drinking water,'' after
``nutrition''.
The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from
Oregon (Mr. Blumenauer) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from Oregon.
Mr. BLUMENAUER. Madam Chairman, I yield myself such time as I may
consume.
Madam Chairman, it is a pleasure for me to rise dealing with the
underlying legislation that contains an important section to address
barriers that might limit the start of and adherence to treatment
services. This section also encourages direct linkages between the
efforts to treat HIV/AIDS, nutrition and income security programs.
I applaud the chairman and ranking member for the work that they have
done bringing this together, and the recognition that dealing with HIV-
AIDS must be done in a holistic fashion that treats the entire person
and their environment, not just the disease.
I have a very personal connection to this legislation now that was
not present when I first started working on issues of water for the
poor now that I have a daughter working in Mozambique in the Peace
Corps who is dealing with these problems on a day-to-day basis.
This direct amendment would add safe drinking water to nutrition and
income security on the list of programs for which direct linkages are
encouraged. This is an important tribute to our late colleagues,
Chairman Lantos and Chairman Hyde, who were so instrumental in the
enactment of our Water for the Poor Act, and their insights that are
bringing safe drinking is an important component of developmental
sectors from health to the environment. To include safe drinking water
in legislation through which we honor their memories is a small
testament to their lasting legacies.
Including safe drinking water is critical because we cannot treat
HIV/AIDS without safe drinking water. USAID has recognized in its
guidance for missions carrying out these programs that people with HIV/
AIDS are at increased risk for diarrheal diseases and far more likely
to suffer severe and chronic complications if infected.
There is terrible irony in providing patients with advanced
antiretroviral agents, and then asking them to use the water in a glass
that may infect them with a life-threatening illness to wash down the
life-saving pills.
To add irony, one of the complications of diarrheal illnesses is HIV-
infected patients have a reduced ability to absorb antiretroviral and
other medications from the gut. This poor absorption can contribute to
the development of HIV strains that are resistant. In addition to the
negative impact on life expectancy and quality of life, they also add
significantly to the burdens on caregivers in clinics and at home and
put them and other family members at risk for infection.
We are all a part of this in the global community. This legislation
is important to tie these challenges together, not deal with it
piecemeal, and to help with advancing the overall objective of this
legislation.
Madam Chairman, I reserve the balance of my time.
Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim
the time in opposition to the amendment for purposes of debate.
The CHAIRMAN. Without objection, the gentlewoman from Florida is
recognized for 5 minutes.
There was no objection.
Ms. ROS-LEHTINEN. Madam Chairman, I yield myself such time as I may
consume.
Madam Chairman, I support Mr. Blumenauer's amendment, which would add
safe drinking water to nutrition and income security on the list of
programs for which direct linkages are encouraged. For patients whose
immune systems have been compromised by AIDS, the availability of safe,
clean drinking water is vitally important. This is especially true for
HIV positive women with young infants who use infant formula to avoid
transmitting the virus to their babies during feeding. If the water
used in the formula is not clean, their babies are at high risk for
waterborne diseases. Therefore, this amendment would allow PEPFAR to
link with existing safe drinking water programs in order to provide
clean water to these treatment patients.
Mr. BERMAN. Madam Chairman, will the gentlewoman yield?
Ms. ROS-LEHTINEN. I yield to the gentleman from California.
Mr. BERMAN. Madam Chairman, I appreciate the gentlewoman yielding,
and I rise to join you in supporting the gentleman's amendment. What
was interesting to me was to learn, and there are many things I learned
in this bill that I didn't know, but one was that about 1.2 billion
people globally lack safe water to consume in the least-developed
countries, and up to 90 percent of AIDS patients, 90 percent, suffer
and frequently die from the chronic diarrheal diseases that the
gentleman discussed. These diseases are caused by the use of unsafe
water.
This is a compelling amendment. I join the gentlewoman in supporting
it.
Ms. ROS-LEHTINEN. Madam Chairman, I would also like to yield such
time as he may consume to the gentleman from New Jersey (Mr. Payne).
Mr. PAYNE. Madam Chairman, I rise in support of Mr. Blumenauer's
amendment to ensure that safe drinking water is a component of our HIV/
AIDS strategy. Congressman
[[Page H1935]]
Blumenauer, the lead sponsor of the Water for the Poor Act of 2005, has
been a strong advocate on this issue for years, and he was kind enough
to testify about the challenge of clean water in Africa at a hearing of
the Subcommittee on Global Health I chaired in May of 2007.
During the course of that hearing, it became clear that in Africa,
the region hardest hit by the AIDS pandemic, the problem of safe water
is particularly acute. The total number of people without access to
potable water in the region has actually increased by 60 million in the
past half decade. That is why Mr. Blumenauer and I, along with other
Members of Congress, successfully secured $300 million for safe
drinking water and sanitation projects for fiscal year 2008.
We all know that HIV compromises the immune system. Those infected
with the disease are far more likely to succumb to the illness caused
by unsafe drinking water, especially if they are children, and there is
no way that people can take ARVs if they do not have access to clean
drinking water.
I strongly support Mr. Blumenauer's amendment, and thank him for his
cosponsorship of H. Res. 318, supporting the goals of the United
Nations International Year of Sanitation. His resolution encourages
international communities to achieve the target of halving the
proportion of people without access to safe drinking water and basic
sanitation. I encourage my colleagues to support the Blumenauer
amendment.
Mr. BLUMENAUER. Madam Chairman, I yield myself such time as I may
consume.
I would like to express my deep appreciation to Chairman Payne. I
appreciate the ranking member yielding time to him. I was prepared to
do so, but she was able to give him more time, and that is important.
Congressman Payne, your laser-like focus on this with the
subcommittee, your long-term advocacy, your work on the continent, is
something that I find inspirational. I look forward to working with you
and partnering on these issues as we move forward.
To the Chair and ranking member, your willingness to include this is
important, and our work together to be able to focus on the whole
person and to be able to deal with waterborne disease, the number one
preventible cause of death and disease around the world. Half the
people who are sick today anywhere in the world are sick needlessly
from water-borne disease. Adding this critical amendment to your
important legislation is an important step forward. I hope it is just
one step that we can work on together to bring people around the world
to support this critical priority.
As I say, I can think of no more fitting tribute to your previous
predecessors as Chair of the committee, Congressman Hyde and
Congressman Lantos, who worked so hard to advance this cause. I urge
adoption of this amendment.
Madam Chairman, I yield back the balance of my time.
Ms. ROS-LEHTINEN. Madam Chairman, I yield back the balance of my
time.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Oregon (Mr. Blumenauer).
The amendment was agreed to.
Amendment No. 2 Offered by Mr. Fortenberry
The CHAIRMAN. It is now in order to consider amendment No. 2 printed
in House Report 110-562.
Mr. FORTENBERRY. Madam Chairman, I have an amendment at the desk.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 2 offered by Mr. Fortenberry:
Page 43, line 4, insert before the period at the end the
following: ``, including both Principal Recipients and sub-
recipients''.
The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from
Nebraska (Mr. Fortenberry) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from Nebraska.
Mr. FORTENBERRY. Madam Chairman, I yield myself such time as I may
consume.
Madam Chairman, as a member of the House Foreign Affairs Committee
and the Subcommittee on Africa and Global Health, I have been involved
extensively in the issues before us today. I really do appreciate the
bipartisan cooperation that has guided this process, particularly by
Chairman Berman and our ranking member, Ms. Ros-Lehtinen. Thank you.
This bill is appropriately named for two giants of this institution,
Tom Lantos and Henry Hyde.
My amendment addresses the issue of transparency and accountability
in the Global Fund. The Global Fund is a unique, non-governmental
multilateral organization headquartered in Switzerland and focused on
combating HIV/AIDS, tuberculosis and malaria throughout the developing
world.
{time} 1430
The U.S. Government is the single largest provider of resources and
technical assistance to the Global Fund, and since 2001 Congress has
appropriated nearly $4 billion to the Fund. The Lantos-Hyde bill before
us today authorizes additional funds that will total in the billions.
The bill currently and appropriately calls for systematic assessments
of performance data of principal recipients and subrecipients of funds,
as recommended by the Government Accountability Office, the GAO. This
technical amendment simply clarifies that audits by the Fund's
Inspector General should also encompass principal recipients and
subrecipients, the entities that actually receive programmatic funding.
Madam Chairman, I believe that this amendment strengthens the spirit
of accountability that is present in the underlying bill. According to
a June 2005 report by the GAO, the Global Fund possessed a limited
ability to monitor and evaluate grants. Concerns have also been raised
that the volume of funding provided through the Global Fund may exceed
the capacity of the recipients in the field to actually utilize it.
Since we are considering an additional contribution that may total in
the billions of U.S. taxpayer dollars to the Global Fund over the life
of this reauthorization, I believe that it would be beneficial for
ourselves, as well as for the Fund, as well as for other donors, to
have additional clarity on how these funds are being used in the field
for those most in need of our assistance.
Madam Chairman, I intend to support the overall bill, and I urge my
colleagues to support this amendment.
I reserve the balance of my time.
Mr. BERMAN. Madam Chairman, while I do not oppose the amendment, I
ask unanimous consent to take the time in opposition.
The CHAIRMAN. Without objection, the gentleman from California is
recognized for 5 minutes.
There was no objection.
Mr. BERMAN. Madam Chairman, the gentleman's amendment, and I have
spoken to him about it, encourages the Global Fund Inspector General to
not only audit its grantees, but also the subgrantees and subrecipients
who receive Global Fund money.
Obviously, I share the gentleman's concern that transparency and
accountability in the use of HIV/AIDS assistance provided through the
Global Fund is critically important for all the reasons that he stated.
The Global Fund, in all fairness, I do want to point out, has shown, I
believe, its commitment to that transparency and accountability. It has
a new inspector general, and has instituted an enhanced accounting
system that focuses on improving accountability among subrecipients.
But the principle of this amendment makes sense. While there are some
technical issues I will want to talk to him about as we move through
the legislative process, I look forward to working with him on it and I
certainly urge the adoption of the amendment.
I yield 1 minute to the gentlelady from Florida, the ranking member.
Ms. ROS-LEHTINEN. Madam Chairman, I also support Mr. Fortenberry's
amendment which would ensure that audits by the Global Fund Inspector
General include information on subcontractors.
The U.S. government is the largest contributor to the Global Fund to
fight HIV/AIDS, tuberculosis, and malaria. Since the fund was created,
the U.S.
[[Page H1936]]
has appropriated and pledged $3.5 billion for contributions to the
Global Fund, representing nearly one-third of the total budget of the
Global Fund. It is an important component to the world's response to
these three diseases, and has made progress on issues of transparency
and accountability in recent years.
As the bill makes clear, continued support to the Global Fund should
be based on the Fund's ability to meet certain transparency and
accountability benchmarks.
This amendment builds on and clarifies the underlying text in order
to ensure that the audits conducted by the Global Fund's Office of
Inspector General cover both primary recipients of grant funding and
subrecipients who perform smaller pieces of the grants. These audits
are important. I thank the gentleman for the time, and I support the
Fortenberry amendment on Inspector General audits at the Global Fund.
Mr. BERMAN. Madam Chairman, I yield 1 minute to the chairman of the
Africa Subcommittee, the gentleman from New Jersey (Mr. Payne).
Mr. PAYNE. Madam Chairman, I rise to speak on the amendment offered
by Mr. Fortenberry. We appreciate the work that he does on the
subcommittee and he contributes greatly.
We feel that the Inspector General has been doing an adequate job;
however, we do not oppose this amendment. The Office has approved over
$10 billion for programs in 136 countries around the world so far,
which amounts to 21 percent of all donor HIV/AIDS spending, and two-
thirds of all the donor spending on malaria and tuberculosis. Through
the Global Fund, 1.4 million people have been treated with life-saving
antivirals, 3.3 million cases of TB have been treated; and, in a new
area, 46 million bed nets have been distributed to protect children
against malaria. And I am pleased to say that Ray Chambers from New
Jersey and my congressional district has been appointed ambassador for
the U.N. to combat malaria.
So, we do not oppose this amendment, and we look forward to the
bill's passage.
Mr. BERMAN. Madam Chairman, I have no further requests for time, and
I yield back the balance of my time.
Mr. FORTENBERRY. Madam Chairman, I want to thank the chairman of the
Foreign Affairs Committee for his support of this. I understand the
concerns he addressed and understand his comments, as well as the
chairman's of the subcommittee. I look forward to continuing to work
with him, but do appreciate his support of the amendment.
I yield back the balance of my time.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Nebraska (Mr. Fortenberry).
The amendment was agreed to.
Amendment No. 3 Offered by Ms. Mc Collum of Minnesota
The CHAIRMAN. It is now in order to consider amendment No. 3 printed
in House Report 110-562.
Ms. McCOLLUM of Minnesota. Madam Chairman, I have an amendment made
in order under the rule.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 3 offered by Ms. McCollum of Minnesota:
Page 35, line 13, insert ``, Malawi, Swaziland, Lesotho''
after ``Republic''.
The CHAIRMAN. Pursuant to House Resolution 1065, the gentlewoman from
Minnesota (Ms. McCollum) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Minnesota.
Ms. McCOLLUM of Minnesota. Madam Chairman, the amendment offered by
Mr. Jackson of Illinois and myself would add three Southern African
countries, Malawi, Swaziland, and Lesotho, to the lists of countries
that will be a part of the focus countries in the reauthorization of
this Global HIV/AIDS legislation.
In 2003, the original PEPFAR legislation designated 14 focus
countries. These countries were prioritized for intensive investment of
resources and technical expertise as provided through PEPFAR. The bill
on the floor today adds focus countries by designating Vietnam and 14
Caribbean basic countries with PEPFAR focus status. Unfortunately,
these three countries in Southern Africa, each confronting devastation
as a result of HIV/AIDS, have not been granted priority status in
PEPFAR. The crisis of HIV/AIDS confronting Malawi, Swaziland, and
Lesotho is real and in some cases worse than the existing focus
countries.
Malawi is a country of 13 million people, with 900,000 children
orphaned by AIDS and nearly 1 million of its adults living with HIV, a
14 percent infection rate. Swaziland, with a population of only 1.1
million people, has over 200,000 adults living with HIV, one in three
adults, or a 33 percent adult infection rate. Lesotho has a population
of 2 million people, and an HIV infection rate among its adults of 23
percent.
These three countries are not only confronting HIV and AIDS, but they
are also among the poorest countries on the planet, which makes their
challenge so much greater. Malawi, for example, is 164th out of 177
countries on the United Nations Human Development Index. Also, each
country is geographically surrounded by countries that were designated
focus countries in the original PEPFAR legislation, South Africa,
Mozambique, Zambia, Tanzania, which are presently receiving massive
investments to confront their epidemics.
Malawi, Swaziland and Lesotho are working bilaterally with the United
States; but by not being granted PEPFAR's focus country status, the gap
that they face between the needs and available resources means that too
many people will continue to be infected, too many people will continue
to die needlessly, and too many orphans will be left to fend for
themselves.
This amendment has the support of the governments of Malawi,
Swaziland and Lesotho.
I submit for the Record a letter of support from the three
governments.
Embassy of the Republic of Malawi,
Washington, DC, March 28, 2008.
Hon. Betty McCollum,
House of Representatives,
Washington DC.
Dear Honourable McCollum, we are writing to follow up on
our recent meeting during which we discussed, among other
things, the re-authorization of the President's Emergency
Plan for AIDS Relief (PEPFAR).
We are deeply concerned that the three countries that have
been heavily impacted by the HIV/AIDS virus in Southern
Africa, and whose prevalence rates are above 14% have been
left out from the new list of focus countries as reflected in
H.R. 5501. Our countries have become islands amidst countries
that are receiving tremendous resources from PEPFAR within
the region.
The AIDS epidemic in our countries has brought additional
pressure to bear on the health sector. We are failing to
train adequate number of health workers to provide services
to those living with HIV and suffering from AIDS. The few
that we have trained have died from the virus while others
have left the continent for greener pastures in the western
countries. Although the recent increase in the provision of
ARV has brought hope to many, it has also put increased
strain on the remaining healthcare workers. In addition,
there are many more people living with the HIV virus who are
not receiving treatment due to lack of resources to purchase
drugs and to train personnel to administer treatment.
The presence of AIDS has also affected many households.
Many children have lost one or both parents due to HIV/AIDS.
At the same time, we have a large number of children who were
born with the virus because the risk of mother-to-child
transmission remains very high. Although we have put in place
orphan care programs, the need for more resources to provide
comprehensive care cannot be overemphasized. The pandemic has
also added strain to the food insecurity in many areas
because agricultural work has been neglected or abandoned due
to household illness. The labor force, in general, has also
been affected by HIV/AIDS, setting back economic and social
progress.
Our leadership is highly committed to the fight against
HIV/AIDS. Our governments have provided enough domestic
resources within their means and are receiving external
funding for HIV/AIDS programs. However, there is a wide
funding gap between planned programs and resources required
for implementation. It is for this reason that we humbly
request you to introduce an amendment to H.R. 5501, to
include Lesotho, Malawi and Swaziland as focus countries.
Your assistance on this matter will be greatly appreciated.
Yours sincerely,
Hawa Olga Ndilowe,
Ambassador of Malawi to the U.S.
Ephraim Mandlenkosi M. Hope,
Ambassador of the Kingdom of Swaziland to the U.S.
[[Page H1937]]
Mabasia Ntsoaki Mohobane,
Charge d'Affaires, Embassy of the Kingdom of Lesotho to the
U.S.
These countries believe, as I do, that the severity of the epidemic
in their countries should make their fight against AIDS a priority for
this Congress and for the American people.
Finally, I want to thank the chairman and the ranking member for
their commitment for fighting HIV/AIDS, and for their hard work in
bringing H.R. 5501 to the floor.
I also had the honor of serving on the International Relations
Committee under the leadership of Mr. Hyde and Mr. Lantos when we
passed the original PEPFAR legislation. They were both extraordinary
men and wonderful mentors to me. They were compassionate leaders in
this House, and it is fitting that we pay tribute to their lives and
their contributions to this country by passing a bill that will save
lives and improve life all around the world. I urge my colleagues to
support this amendment to be included in the bill, and also to support
passage of this important bill.
I reserve the balance of my time.
Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim
the time in opposition to the amendment for purposes of debate.
The CHAIRMAN. Without objection, the gentlewoman from Florida is
recognized for 5 minutes.
Ms. ROS-LEHTINEN. Madam Chairman, I actually support the McCollum-
Jackson amendment, which would add Malawi, Swaziland and Lesotho to the
list of countries in which the Global AIDS Coordinator is given
explicit statutory authority.
Malawi, Swaziland, and Lesotho all face major HIV/AIDS epidemics and
have received significant resources through PEPFAR in the first 5 years
of implementation. By giving the Global AIDS Coordinator explicit
authority over the U.S. Government's HIV/AIDS programs in these
countries, the Congress is signaling that it believes the U.S.
Government should continue to come alongside these nations' governments
and their citizens to support them in the fight against HIV/AIDS, and I
commend Ms. McCollum and Mr. Jackson for offering it.
I would like to yield the remaining time, Madam Chairman, to our
chairman, Chairman Berman of California, as well as Mr. Payne of New
Jersey, with Mr. Payne of New Jersey first.
Mr. PAYNE. I thank the gentlelady for yielding. I rise in strong
support of the amendment offered by the gentlelady from Wisconsin.
Southern Africa has the highest rate of HIV and AIDS in the entire
world. In Lesotho, we have heard, a country with an HIV/AIDS prevalence
rate of 38 percent among pregnant women, only 19 percent of those in
need of treatment for the disease have access for it. Even more
troubling is the fact that only 5 percent of HIV-positive mothers get
drugs to prevent the transmission of the virus to their children during
childbirth. Life expectancy for women is 44 years, and for men a mere
39.
In Malawi, the situation is a little better; men are expected to live
41 years, women 42. The health care worker shortage in the country
remains a major obstacle.
Circumstances in Swaziland are equally grim: 26 percent of adults are
HIV positive. In a country of just over 1 million, there are 70,000
AIDS orphans. Clearly, HIV and AIDS pose a dire threat in these
countries and must be urgently addressed. Therefore, I commend the
gentlewoman, Ms. McCollum, for her amendment to make Swaziland,
Lesotho, and Malawi focus countries, and I urge my colleagues to
support this amendment.
Ms. ROS-LEHTINEN. Madam Chairman, if I could yield now to Chairman
Berman, the gentleman from California.
Mr. BERMAN. I thank the gentlelady for yielding.
I support this amendment. I congratulate Representatives McCollum and
Jackson for their leadership in adding these hard-hit nations to the
focus country list.
All three of these Southern African countries suffer from both high
HIV/AIDS prevalence rates and high poverty rates, with devastating
effects. The statistics in all three countries regarding AIDS have been
put on the record by both the gentlelady from Minnesota and the
gentleman from New Jersey, so I will just add my words of support for
the amendment.
{time} 1445
Ms. ROS-LEHTINEN. Madam Chairman, I yield back the balance of my
time.
Ms. McCOLLUM of Minnesota. Madam Chairman, I would like to thank the
chairman, the ranking member, and the distinguished Chair of the
Subcommittee on Africa and Global Health for their kind words, and urge
all of my colleagues to support the amendment.
I yield back the balance of my time.
The CHAIRMAN. The question is on the amendment offered by the
gentlewoman from Minnesota (Ms. McCollum).
The amendment was agreed to.
Amendment No. 4 Offered by Mr. Carson of Indiana
The CHAIRMAN. It is now in order to consider amendment No. 4 printed
in House Report 110-562.
Mr. CARSON of Indiana. Madam Chairman, I have an amendment made in
order under the rule.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 4 offered by Mr. Carson of Indiana:
Page 49, line 10, insert before the period at the end the
following: ``Recognizing that human and institutional
capacity form the core of any health care system that can
sustain the fight against HIV/AIDS, tuberculosis, and
malaria, the plan shall include a strategy to encourage
postsecondary educational institutions in host countries,
particularly in Africa, in collaboration with United States
postsecondary educational institutions, historically black
colleges and universities, to develop such human and
institutional capacity and in the process further build their
capacity to sustain the fight against these diseases.''.
Page 104, line 21, before ``capacity'' insert ``human and
institutional''.
Page 105, line 5, insert ``partnerships,'' after
``telecommunications services,''.
The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from
Indiana (Mr. Carson) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Indiana.
Mr. CARSON of Indiana. Madam Chairman, I rise today in support of
H.R. 5501, the Tom Lantos and Henry Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization
Act of 2008 and to offer my amendment which I believe will enhance the
base bill. I want to thank Chairman Berman and Ranking Member Ros-
Lehtinen for their hard work in bringing this legislation to the floor.
I find it of coincidence the timing of our consideration of this
legislation for it is juxtaposed between two pivotal historical moments
in time: The deaths of the renowned African American medical doctor,
Dr. Charles Drew on April 1, 1950, and the celebrated human rights
leader, Dr. Martin Luther King, Jr. on April 4, 1968.
Both Dr. Drew and Dr. King were products of the American educational
system and particularly of historically black colleges and
universities. Madam Chairman, I cannot think of any better way to
explain the importance of this amendment and its use. The effort to
address HIV/AIDS requires the best of human rights and of medical
science.
My amendment is a simple amendment that would make changes to section
204 of H.R. 5501. The amendment directs the coordinator of the United
States Government Activities to Combat HIV/AIDS Globally and the
administrator of the United States Agency for International Development
to expand their plan for strengthening health systems of host countries
by allowing for African post secondary educational institutions to
collaborate with United States post secondary educational institutions
and specifically historically black colleges and universities to
develop such human and institutional capacity.
The goal of my amendment is to allow our Nation's finest post
secondary educational institutions to be directly involved in the
training of health care workers that will enhance the effectiveness and
efficacy of the efforts put forth in H.R. 5501.
Madam Chairman, I can think of no better way for the citizens of
Indiana, the great Hoosier State, to contribute
[[Page H1938]]
in the fight against this pandemic than to train the best and
brightest, and to commit to countries whose health care systems suffer
woefully from the lack of trained health professionals. After all, who
are we to block the opportunity to these children to be successful.
Madam Chairman, before I close, I want to acknowledge and salute the
two men this piece of legislation is named after, Congressmen Tom
Lantos and Henry Hyde. I didn't get a chance to work with them in this
body, but I cannot think of a better way to honor their service in this
great institution.
Finally, I want to thank the wonderful staff of the Foreign Relations
Committee and the Rules Committee for helping me craft this amendment.
Madam Chairman, I ask for support of my amendment.
Madam Chairman, I reserve the balance of my time.
Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim
the time in opposition to the amendment for purposes of debate.
The CHAIRMAN. Without objection, the gentlewoman from Florida is
recognized for 5 minutes.
There was no objection.
Ms. ROS-LEHTINEN. Madam Chairman, first of all, I would like to thank
Mr. Carson for his well-reasoned and important amendment. We all had
the honor of serving with his grandmother, Julia Carson, for many years
in this body, and I know that Congresswoman Carson is looking down at
her grandson and saying she is mighty proud. So thank you so much for
your amendment, and thank you for carrying on in her great legacy by
presenting wonderful topics and themes for us to discuss on the floor.
I fully support the Carson amendment because it focuses on building
human and institutional capacity in PEPFAR host countries. It directs
the global AIDS coordinator and the USAID administrator to expand their
plan by strengthening health systems of host countries by encouraging
post secondary educational institutions, particularly those in the
African continent, to collaborate with the post secondary educational
institutions here in the United States, including historically black
colleges and universities in training health care workers.
As other provisions of this bill made clear, an important component
of the fight against HIV/AIDS, tuberculosis, and malaria, is the
strengthening of the educational capacity in host countries to train
health care workers. The Carson amendment does exactly that. I
congratulate him for it. He is a welcome addition to our Chamber.
I would like to yield to Ms. Lee of California who has been working
on this issue for a long time, Madam Chairman.
Ms. LEE. I want to thank the gentlelady for yielding.
I rise today to support this amendment and to commend the gentleman
from Indiana. I understand this is his first amendment, and it shows
that he has hit the ground running. Today, I am reminded of our former
colleague, his grandmother, our beloved Congresswoman Julia Carson. I
know she is smiling today and is very proud of your efforts; thank you.
Historically black colleges and universities have trained some of our
finest dedicated doctors, nurses and health care workers. These
colleges and universities go way beyond the call of duty. They have a
deep cultural and historical understanding and connection to the
continent of Africa. They are attacking HIV/AIDS here on the homefront
where HIV and AIDS is disproportionately affecting the African-American
community. So by developing human and institutional capacity in Africa
and in the Caribbean, we are bringing to bear, in a comprehensive
manner, mechanisms to maximize our effectiveness in combating HIV and
AIDS, malaria and tuberculosis.
So I want to salute and thank the gentleman from Indiana once again
for his leadership and for helping to strengthen this bill.
Ms. ROS-LEHTINEN. Madam Chairman, I yield such time as he may consume
to the gentleman from New Jersey (Mr. Payne).
Mr. PAYNE. Madam Chairman, I appreciate the gentlelady, the ranking
member, yielding me this time, and I rise in strong support of the
Carson amendment relating to the building of human capacity to fight
HIV/AIDS through collaborations between U.S. colleges and universities
and those in the developing world.
I, too, am very pleased to see this piece of legislation by Mr.
Carson. We all knew Julia Carson. She came to my district to deal with
health disparities in my district in New Jersey, and traveled to Africa
with me on a trip dealing with this problem. So this is very
appropriate, and let me commend you again.
In May of 2007, Doctors Without Borders released a report that found
that in southern Africa, a shortage of trained health care workers was
the main barrier to increasing access to antiretroviral treatment.
The report found that in Mozambique, people had to wait up to 2
months to start ARVs because there were not enough doctors and nurses
to manage it. In one health district in Lesotho, nearly half of the
nursing posts were vacant. Malawi has only two doctors per 100,000
people. The minimum standard according to the WHO is 20 doctors per
100,000 people.
I am pleased to say that the bill under consideration seeks to
address those problems. It calls on the United States to train 140,000
new health care workers and professionals so people can start on life-
saving therapy.
University partnerships are a logical and effective means through
which to support this goal. So I once again commend Mr. Carson for his
amendment, and urge my colleagues to support it.
Mr. CARSON of Indiana. Madam Chairman, I yield 1\1/2\ minutes to the
gentleman from South Carolina (Mr. Clyburn).
Mr. CLYBURN. Madam Chairman, I thank the gentleman for yielding me
this time.
I rise in strong support of the amendment offered by Mr. Carson.
Congressman Carson's amendment rightfully recognizes that the HIV/AIDS
epidemic is proliferating at an alarming rate around the globe,
particularly in Africa.
This amendment establishes a cooperative framework in which AIDS
researchers in Africa can collaborate with American medical experts,
including researchers at historically black colleges and universities,
on the best ways to treat and prevent the spread of this devastating
infectious disease.
I commend and thank the gentleman from Indiana for offering this
worthwhile amendment. I encourage my colleagues to support this
amendment and the underlying bill.
Mr. CARSON of Indiana. I want to thank the Members for listening and
considering this amendment. I think it is a great opportunity for us.
Madam Chairman, I yield back the balance of my time.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Indiana (Mr. Carson).
The question was taken; and the Chairman announced that the ayes
appeared to have it.
Recorded Vote
Mr. BERMAN. Madam Chairman, I demand a recorded vote.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 415,
noes 10, not voting 10, as follows:
[Roll No. 156]
AYES--415
Abercrombie
Ackerman
Aderholt
Akin
Alexander
Allen
Altmire
Andrews
Arcuri
Baca
Bachmann
Bachus
Baird
Baldwin
Barrett (SC)
Barrow
Bartlett (MD)
Barton (TX)
Bean
Becerra
Berkley
Berman
Berry
Biggert
Bilbray
Bilirakis
Bishop (GA)
Bishop (NY)
Blackburn
Blumenauer
Blunt
Boehner
Bonner
Bono Mack
Boozman
Bordallo
Boren
Boucher
Boustany
Boyd (FL)
Boyda (KS)
Brady (PA)
Brady (TX)
Braley (IA)
Broun (GA)
Brown (SC)
Brown, Corrine
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Butterfield
Buyer
Calvert
Camp (MI)
Cantor
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Carson
Carter
Castle
Castor
Chabot
Chandler
Christensen
Clarke
Clay
Cleaver
Clyburn
Coble
Cohen
Cole (OK)
Conaway
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crenshaw
Crowley
Cuellar
Culberson
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis (KY)
Davis, David
Davis, Lincoln
Davis, Tom
Deal (GA)
DeFazio
DeGette
Delahunt
DeLauro
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Dingell
Doggett
Donnelly
Doolittle
Doyle
Drake
[[Page H1939]]
Dreier
Duncan
Edwards
Ehlers
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Etheridge
Everett
Fallin
Farr
Fattah
Feeney
Ferguson
Filner
Flake
Forbes
Fortenberry
Fortuno
Fossella
Foster
Foxx
Frank (MA)
Franks (AZ)
Frelinghuysen
Gallegly
Gerlach
Giffords
Gilchrest
Gillibrand
Gingrey
Gohmert
Gonzalez
Goodlatte
Gordon
Graves
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hall (TX)
Hare
Harman
Hastings (FL)
Hastings (WA)
Hayes
Heller
Herger
Herseth Sandlin
Higgins
Hill
Hinchey
Hinojosa
Hirono
Hobson
Hodes
Hoekstra
Holden
Holt
Honda
Hooley
Hoyer
Hulshof
Hunter
Inglis (SC)
Inslee
Israel
Issa
Jackson (IL)
Jackson-Lee (TX)
Johnson (GA)
Johnson (IL)
Johnson, E. B.
Johnson, Sam
Jones (NC)
Jones (OH)
Kagen
Kanjorski
Kaptur
Keller
Kennedy
Kildee
Kilpatrick
Kind
King (IA)
King (NY)
Kingston
Kirk
Klein (FL)
Kline (MN)
Knollenberg
Kucinich
Kuhl (NY)
LaHood
Lamborn
Lampson
Langevin
Larsen (WA)
Larson (CT)
Latham
LaTourette
Latta
Lee
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lucas
Lungren, Daniel E.
Lynch
Mack
Mahoney (FL)
Maloney (NY)
Manzullo
Marchant
Markey
Marshall
Matheson
Matsui
McCarthy (CA)
McCarthy (NY)
McCaul (TX)
McCollum (MN)
McCotter
McCrery
McDermott
McGovern
McHenry
McHugh
McIntyre
McKeon
McMorris Rodgers
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Mica
Michaud
Miller (MI)
Miller (NC)
Miller, Gary
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (KS)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Musgrave
Myrick
Nadler
Napolitano
Neal (MA)
Norton
Nunes
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Paul
Payne
Pearce
Pence
Perlmutter
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pomeroy
Porter
Price (GA)
Price (NC)
Pryce (OH)
Putnam
Radanovich
Rahall
Ramstad
Rangel
Regula
Rehberg
Reichert
Renzi
Reyes
Reynolds
Richardson
Rodriguez
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Roskam
Ross
Rothman
Roybal-Allard
Royce
Ruppersberger
Ryan (OH)
Ryan (WI)
Salazar
Sali
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Saxton
Schakowsky
Schiff
Schmidt
Schwartz
Scott (GA)
Scott (VA)
Sensenbrenner
Serrano
Sestak
Shadegg
Shays
Shea-Porter
Sherman
Shimkus
Shuler
Shuster
Simpson
Sires
Skelton
Slaughter
Smith (NE)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stearns
Stupak
Sullivan
Sutton
Tancredo
Tanner
Taylor
Terry
Thompson (CA)
Thompson (MS)
Thornberry
Tiahrt
Tiberi
Tierney
Towns
Tsongas
Turner
Udall (CO)
Udall (NM)
Upton
Van Hollen
Velazquez
Visclosky
Walberg
Walden (OR)
Walsh (NY)
Walz (MN)
Wamp
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Weldon (FL)
Weller
Wexler
Whitfield (KY)
Wilson (NM)
Wilson (OH)
Wilson (SC)
Wittman (VA)
Wolf
Woolsey
Wu
Wynn
Yarmuth
Young (AK)
Young (FL)
NOES--10
Campbell (CA)
Cannon
Garrett (NJ)
Goode
Hensarling
Jordan
Neugebauer
Poe
Sessions
Westmoreland
NOT VOTING--10
Bishop (UT)
Boswell
Cubin
Faleomavaega
Granger
Jefferson
Miller (FL)
Rush
Souder
Tauscher
{time} 1521
Mr. WESTMORELAND changed his vote from ``aye'' to ``no.''
Mr. ADERHOLT and Mrs. BACHMANN changed their vote from ``no'' to
``aye.''
So the amendment was agreed to.
The result of the vote was announced as above recorded.
The CHAIRMAN. Under the rule, the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Ross) having assumed the chair, Ms. Norton, Chairman of the Committee
of the Whole House on the state of the Union, reported that that
Committee, having had under consideration the bill (H.R. 5501) to
authorize appropriations for fiscal years 2009 through 2013 to provide
assistance to foreign countries to combat HIV/AIDS, tuberculosis, and
malaria, and for other purposes, pursuant to House Resolution 1065, she
reported the bill back to the House with sundry amendments adopted by
the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendment reported from the
Committee of the Whole? If not, the Chair will put them en gros.
The amendments were agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit Offered by Mr. Ryan of Wisconsin
Mr. RYAN of Wisconsin. Mr. Speaker, I have a motion to recommit at
the desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. RYAN of Wisconsin. I am in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Ryan of Wisconsin moves to recommit the bill H.R. 5501
to the Committee on Foreign Affairs with instructions to
report the same back to the House forthwith with the
following amendments:
Page 96, line 10, strike ``$4,000,000,000'' and insert
``such sums as may be necessary''.
Page 97, line 1, strike ``$5,000,000,000'' and insert
``such sums as may be necessary''.
Page 116, line 8, strike ``$10,000,000,000'' and insert
``6,000,000,000''.
Page 122, after line 2, insert the following:
SEC. 405. SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) According to Congressional Budget Office estimates, $50
billion to carry out the United States Leadership Against
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 would not be
spent during the five-year authorization period, but instead
would take 10 years or until 2018 to spend.
(2) Recent funding disbursement trends for the current
program suggest that the current funding levels are outpacing
the capacity of the countries and nongovernmental
organizations to efficiently implement the program. Over the
2005-2006 funding period, assistance commitments grew $1.3
billion from $4.3 billion to $5.6 billion, while the actual
disbursements of funds grew at a much slower rate of $400
million from $3.5 billion to $3.9 billion. As such, the
current commitment exceeds disbursement by $1.7 billion, or
30 percent of the current commitment.
(3) Reports from recipient countries indicate the
absorptive capacity for HIV/AIDS programs has become a
constraint on actual expenditure of funds. For instance, a
2005 survey of World Bank Multi-Country AIDS Program (MAP)
country directors in Africa found that nearly 40 percent of
those countries believed that absorptive capacity ``remains
limited and is the real issue; new financial resources will
exacerbate this problem''.
(4) Additionally, a 2007 Center for Global Development
report on HIV/AIDS programs in Mozambique, Uganda, and Zambia
found that overburdened government staff at all levels, along
with the limited absorptive capacity of sub-grantees, created
major bottlenecks for funding disbursement.
(5) Advocates of increased HIV/AIDS funding appear to have
based their recommendations for such funding at least in part
on UNAIDS' estimates of a global price tag for addressing the
HIV/AIDS epidemic. Such international estimates are flawed,
however, because the primary source for such projections--the
UNAIDS' ``Resource Needs Model'', or RNM--overestimates the
resources needed, relies on a higher estimate of people
living with HIV/AIDS, and includes support for countries that
are also Global Fund donors. Specifically:
(A) The UNAIDS report titled ``Critical Review of Costing
Models to Estimate Resource Needs to Address Global HIV and
AIDS'' found that ``the [RNM] has a number of limitations'',
each of which contributes to an overestimate of the resources
needed to mount a successful response.
(B) Newer projections such as the 2007 ``Epidemic Update''
lowered the estimated number of people living with HIV/AIDS
worldwide from 39.5 million to 33.2 million--a 16 percent
reduction--yet UNAIDS has not publicly released a revised
lower projection of resource needs.
(C) Projections in the RNM report include significant
financing for middle-income countries such as China, Russia,
and Brazil that are actually Global Fund donors themselves
and should not require international assistance.
(b) Sense of Congress.--In light of the findings contained
in subsection (a), which indicate that even current levels of
funding for HIV/AIDS programs cannot be disbursed in an
efficient and effective manner, Congress should ensure that
the amount of funding authorized by this Act to carry out the
United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003 is consistent with the demonstrated
absorptive capacity to carry out such programs around the
world.
[[Page H1940]]
The SPEAKER pro tempore (during the reading). Without objection, the
reading is dispensed with.
There was no objection.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Wisconsin is recognized for 5 minutes in support of his motion.
Mr. RYAN of Wisconsin. Mr. Speaker, I want to start off by
complimenting the chairman of the committee and the ranking member of
the committee, along with all the other members of the Foreign Affairs
Committee for working in a bipartisan way to put together this
compromise.
We heard a very good fulfilling debate about the merits of PEPFAR. I,
too, agree that the PEPFAR program is a very worthwhile program. So we
agree that this is the right thing to do.
The question is, should we more than double the authorization of this
program? Now, the President's budget called for doing just that. And I
think you can make a very good and compelling case that this program is
so successful that it ought to be doubled. That's not what the
underlying bill does. This underlying bill more than triples this
program.
I have three concerns about this tripling of this program. Number 1,
the spending levels set out in this authorization bill are higher than
the recipient countries can even accept. They can't absorb all of this
money. We know this from the studies in the field. So even if we hit
these authorization levels, we know that the recipient countries cannot
even accept all of this money. They can't spend it that fast.
Point Number 2, the Congressional Budget Office has told us that we
couldn't even spend this money this fast. So why are we having this
kind of an authorization level when our own Congressional Budget Office
is telling us that it would take at least 10 years to spend down a $50
billion authorization?
And that brings me to my third point, and that is the budget
resolution that passed the floor just 2\1/2\ weeks ago. The Democratic
budget resolution itself assumes the $30 billion level. The Democratic
budget resolution assumes we're funding this at the President's request
of $30 billion. In fact, the Democratic budget resolution has a lower
level of funding for section 150, the Foreign Affairs program, than
even the President's budget does. We don't know what cut they're
talking about, but more to the point, why don't we defend the budget
resolution that passed this very house 2\1/2\ weeks ago?
Mr. Speaker, we support this program. I support this program. It's a
good program. It has proven to work. By any metric, by any definition,
it's impossible to deny the success of PEPFAR.
The question is, should we be tripling a program when we know full
well it breaks the budget resolution, it purports to spend money faster
than we can even spend, and those who are receiving this money can't
receive it nearly as fast as we're proposing.
{time} 1530
This recommit is not intended to kill this bill. This is a forthwith
recommit. This recommit is very simple. It says, rather than funding it
at $50 billion, let's fund it at $30 billion. That's the level called
for on the Democratic budget resolution. That's the level called for in
the President's budget. That's the level that independent experts have
said can be justified. So this says go from 50 to 30 forthwith, that's
all.
I want to compliment the gentleman, the chairman of the committee,
the ranking member of the committee, all of those who worked in a
bipartisan basis for this very worthwhile program, but this is a time
when we have fiscal problems in America. We have a deficit. We have a
looming debt. We need to show discipline in Congress. We should not be
tripling funding for programs that we know the recipients themselves
cannot receive at this pace and we know from our own independent budget
experts that we simply can't spend at this pace.
Let's bring it back down to earth. Let's double it and keep it within
reason. That is why we should pass this motion to recommit.
I yield back the balance of my time.
Mr. BERMAN. Mr. Speaker, I rise to oppose the motion to recommit.
The SPEAKER pro tempore. The gentleman from California is recognized
for 5 minutes.
Mr. BERMAN. Thank you, Mr. Speaker.
First, I appreciate the compliments of my friend from Wisconsin. I
prefer that the compliments be withheld and the motion to slash this
bill by 40 percent be rejected, although I do appreciate the
implication of his comments that a recommittal motion that is forthwith
is not intended to kill the bill and that, therefore, the recommittal
motions that are not forthwith are intended to kill the bills they are
made to.
But getting to the merits of this. The purpose of my comments is
directly to the other side. I know the easy vote, even for those who
support this bill, is to vote both to cut some money and to support the
minority on their motion to recommit.
But I would like to suggest that in this particular case, given what
has transpired in terms of putting together this bipartisan bill, both
on the merits of the motion to recommit and on the message it sends
about how we can work on a bipartisan basis in the future, this motion
is wrong and that Members on the other side should oppose it along with
the Members on our side.
First, on the facts. The administration supports this bill and
supports our number on this bill. To the extent they have concerns
about what the level of appropriations may be in this year, their
statement of administration position directly says, talk about the
level of appropriation; don't cut the authorization.
Secondly, the U.N. HIV/AIDS commission, which I'm not a fan of a lot
of different agencies that start with ``U.N.,'' but this one is the
preeminent authority, talks about the incredible remaining need. And in
the issue of absorptive capacity, this was the same argument made in
2003 against a $15 billion authorization for which the Republican
Congress appropriated far more than the authorization because we were
able to see an absorptive capacity, and we saved well over a million
lives.
But here we are dealing with a situation where there are 35 million
people worldwide that are still living with HIV/AIDS. This is a program
that works. The combination of changing behavior, prevention, and
treatment is saving lives. I don't like to throw the words ``moral
imperative'' around. It's usually used for anything people feel
passionately about. But talk about pro-life, I can't think of any
single program that I have been involved with where we are going to be
more pro-life than in pushing this with programs that work, with the
capacity that can be absorbed. No one is saying we are going to spend
$50 billion in the next 5 years. We are going to obligate, based on the
appropriation moneys, and those moneys will be spent probably over the
course of 8 to 10 years. That's the way this appropriation process
works, as everyone knows.
My final point is the ranking member and I, the White House directly,
the President and his chief of staff were directly involved, the
Republican leadership in this body, we put together a bipartisan bill.
Part of the key negotiation was about the number. In return for that, a
number of issues of importance to the minority were preserved in this
bill: the preservation of the concept of behavior change through
abstinence and faithfulness; the understanding that approved family
planning programs would be the ones that were funded. A variety of
different aspects. The belief in the use of faith-based institutions.
How are we, in the future, going to come together on bipartisan
programs where the deal is made and then all of a sudden a key part of
the quid pro quo, the other side says ``no'' to?
I would suggest, sure there are issues about what is our fiscal
condition and what can we do, and the appropriations could be weighing
these very carefully. But this was a fundamental agreement to maintain
a bipartisan tradition on this legislation named after Henry Hyde and
Tom Lantos, both of whom worked in that capacity.
I think this motion to recommit massively undercuts that whole
bipartisan approach, and I would urge my colleagues to defeat it.
I would be happy to yield to the gentleman from New Jersey.
[[Page H1941]]
Mr. SMITH of New Jersey. I do rise in opposition to this motion to
recommit with great respect to my friend from Wisconsin.
The SPEAKER pro tempore. All time for debate has expired.
Without objection, the previous question is ordered on the motion to
recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. RYAN of Wisconsin. Mr. Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair
will reduce to 5 minutes the minimum time for any electronic vote on
the question of passage.
The vote was taken by electronic device, and there were--yeas 175,
nays 248, not voting 7, as follows:
[Roll No. 157]
YEAS--175
Aderholt
Akin
Alexander
Altmire
Bachmann
Barrett (SC)
Bartlett (MD)
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blunt
Boehner
Bonner
Bono Mack
Boozman
Boustany
Brady (TX)
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Buyer
Calvert
Camp (MI)
Campbell (CA)
Cannon
Cantor
Capito
Carter
Castle
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Davis (KY)
Davis, Tom
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Dreier
Ehlers
Everett
Fallin
Feeney
Flake
Forbes
Fossella
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gillibrand
Gingrey
Gohmert
Goode
Goodlatte
Graves
Hall (TX)
Hastings (WA)
Hayes
Heller
Hensarling
Herger
Hoekstra
Hulshof
Hunter
Inglis (SC)
Issa
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
King (IA)
Kingston
Kline (MN)
Knollenberg
Kuhl (NY)
LaHood
Lamborn
Lampson
Latham
LaTourette
Latta
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas
Lungren, Daniel E.
Marchant
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McHenry
McHugh
McKeon
McMorris Rodgers
Mica
Miller (MI)
Miller, Gary
Moran (KS)
Murphy, Tim
Musgrave
Myrick
Neugebauer
Nunes
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Poe
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Ramstad
Regula
Rehberg
Reichert
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Roskam
Royce
Ryan (WI)
Sali
Saxton
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuster
Simpson
Smith (NE)
Smith (TX)
Souder
Stearns
Sullivan
Taylor
Terry
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walberg
Walden (OR)
Wamp
Weldon (FL)
Whitfield (KY)
Wilson (NM)
Wilson (SC)
Wittman (VA)
Wolf
Young (AK)
Young (FL)
NAYS--248
Abercrombie
Ackerman
Allen
Andrews
Arcuri
Baca
Bachus
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blackburn
Blumenauer
Boren
Boswell
Boucher
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson
Castor
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis, David
Davis, Lincoln
Deal (GA)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Donnelly
Doyle
Duncan
Edwards
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Etheridge
Farr
Fattah
Ferguson
Filner
Fortenberry
Foster
Frank (MA)
Giffords
Gilchrest
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Herseth Sandlin
Higgins
Hill
Hinchey
Hinojosa
Hirono
Hobson
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Johnson (GA)
Johnson, E. B.
Jones (OH)
Jordan
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind
King (NY)
Kirk
Klein (FL)
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mack
Mahoney (FL)
Maloney (NY)
Manzullo
Markey
Marshall
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McIntyre
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Perlmutter
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Richardson
Rodriguez
Ros-Lehtinen
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Shea-Porter
Sherman
Shuler
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sutton
Tancredo
Tanner
Thompson (CA)
Thompson (MS)
Tierney
Towns
Tsongas
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Walsh (NY)
Walz (MN)
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Weller
Westmoreland
Wexler
Wilson (OH)
Woolsey
Wu
Wynn
Yarmuth
NOT VOTING--7
Cubin
Culberson
Granger
Jefferson
Miller (FL)
Rush
Tauscher
{time} 1555
Messrs. GILCHREST, DUNCAN, MACK, Mrs. CAPPS, Messrs. MANZULLO,
MARSHALL, KANJORSKI, Ms. HARMAN, and Mr. PETERSON of Minnesota changed
their vote from ``yea'' to ``nay.''
Mr. ALTMIRE changed his vote from ``nay'' to ``yea.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Mr. BERMAN. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 308,
noes 116, not voting 7, as follows:
[Roll No. 158]
AYES--308
Abercrombie
Ackerman
Aderholt
Allen
Altmire
Andrews
Arcuri
Baca
Bachus
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Biggert
Bilirakis
Bishop (GA)
Bishop (NY)
Blumenauer
Bonner
Bono Mack
Boozman
Boren
Boswell
Boucher
Boustany
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Carson
Carter
Castle
Castor
Chabot
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Cole (OK)
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis (KY)
Davis, Lincoln
Davis, Tom
DeFazio
DeGette
Delahunt
DeLauro
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Dingell
Doggett
Donnelly
Doyle
Dreier
Edwards
Ehlers
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Etheridge
Farr
Fattah
Ferguson
Filner
Fortenberry
Fossella
Foster
Frank (MA)
Frelinghuysen
Gerlach
Giffords
Gilchrest
Gillibrand
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Herseth Sandlin
Higgins
Hill
Hinchey
Hinojosa
Hirono
Hobson
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Hulshof
Inglis (SC)
Inslee
Israel
Issa
Jackson (IL)
Jackson-Lee (TX)
Johnson (GA)
Johnson (IL)
Johnson, E. B.
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind
King (NY)
Kirk
Klein (FL)
Kline (MN)
Knollenberg
Kucinich
Kuhl (NY)
LaHood
Lampson
Langevin
Larsen (WA)
Larson (CT)
Latham
Latta
Lee
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lungren, Daniel E.
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Marshall
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McCotter
McDermott
McGovern
McHugh
McIntyre
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (KS)
Moran (VA)
Murphy (CT)
[[Page H1942]]
Murphy, Patrick
Murphy, Tim
Murtha
Nadler
Napolitano
Neal (MA)
Nunes
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Pelosi
Pence
Perlmutter
Peterson (MN)
Pickering
Platts
Pomeroy
Porter
Price (NC)
Pryce (OH)
Rahall
Ramstad
Rangel
Regula
Rehberg
Reichert
Reyes
Reynolds
Richardson
Rodriguez
Rogers (AL)
Rogers (MI)
Ros-Lehtinen
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schmidt
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Shea-Porter
Sherman
Shimkus
Shuler
Sires
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Solis
Souder
Space
Spratt
Stark
Stupak
Sutton
Tanner
Taylor
Thompson (CA)
Thompson (MS)
Thornberry
Tiahrt
Tierney
Towns
Tsongas
Turner
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Walberg
Walsh (NY)
Walz (MN)
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Weller
Wexler
Wilson (NM)
Wilson (OH)
Wilson (SC)
Wolf
Woolsey
Wu
Wynn
Yarmuth
Young (AK)
Young (FL)
NOES--116
Akin
Alexander
Bachmann
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bilbray
Bishop (UT)
Blackburn
Blunt
Boehner
Brady (TX)
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Buyer
Calvert
Camp (MI)
Campbell (CA)
Cannon
Cantor
Coble
Conaway
Crenshaw
Culberson
Davis, David
Deal (GA)
Doolittle
Drake
Duncan
Everett
Fallin
Feeney
Flake
Forbes
Foxx
Franks (AZ)
Gallegly
Garrett (NJ)
Gingrey
Gohmert
Goode
Goodlatte
Graves
Hall (TX)
Hastings (WA)
Hayes
Heller
Hensarling
Herger
Hoekstra
Hunter
Johnson, Sam
Jones (NC)
Jordan
Keller
King (IA)
Kingston
Lamborn
LaTourette
Linder
LoBiondo
Lucas
Mack
Manzullo
Marchant
McCarthy (CA)
McCaul (TX)
McCrery
McHenry
McKeon
McMorris Rodgers
Mica
Miller (MI)
Miller, Gary
Musgrave
Myrick
Neugebauer
Paul
Pearce
Peterson (PA)
Petri
Pitts
Poe
Price (GA)
Putnam
Radanovich
Rogers (KY)
Rohrabacher
Roskam
Royce
Ryan (WI)
Sali
Saxton
Sensenbrenner
Sessions
Shadegg
Shuster
Simpson
Smith (NE)
Smith (TX)
Stearns
Sullivan
Tancredo
Terry
Tiberi
Upton
Walden (OR)
Wamp
Weldon (FL)
Westmoreland
Whitfield (KY)
Wittman (VA)
NOT VOTING--7
Cubin
Granger
Jefferson
Miller (FL)
Renzi
Rush
Tauscher
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Less than 2 minutes
remain.
{time} 1603
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________