[Congressional Record Volume 154, Number 115 (Monday, July 14, 2008)]
[Senate]
[Pages S6621-S6632]
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 PRESIDING OFFICER. Under the previous order, the motion to 
proceed to S. 2731 is agreed to, and the Senate will proceed to the 
consideration of the measure, which the clerk will report by title.
  The assistant legislative clerk read as follows:

       A bill (S. 2731) 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.

  Thereupon, the Senate proceeded to consider the bill, which had been 
reported from the Committee on Foreign Relations, with an amendment to 
strike all after the enacting clause and insert in lieu thereof the 
following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

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

               TITLE I--POLICY PLANNING AND COORDINATION

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

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

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

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

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

                     TITLE IV--FUNDING ALLOCATIONS

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

     SEC. 2. FINDINGS.

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

     SEC. 3. DEFINITIONS.

       Section 3 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602) is 
     amended--
       (1) in paragraph (2), by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs of the House of Representatives, the 
     Committee on Appropriations of the Senate, and the Committee 
     on Appropriations'';
       (2) by redesignating paragraph (6) as paragraph (12);
       (3) by redesignating paragraphs (3) through (5), as 
     paragraphs (4) through (6), respectively;
       (4) by inserting after paragraph (2) the following:
       ``(3) Global aids coordinator.--The term `Global AIDS 
     Coordinator' means the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally.'';

[[Page S6622]]

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

     SEC. 4. PURPOSE.

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

     ``SEC. 4. PURPOSE.

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

     SEC. 5. AUTHORITY TO CONSOLIDATE AND COMBINE REPORTS.

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

               TITLE I--POLICY PLANNING AND COORDINATION

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

       (a) Strategy.--Section 101(a) of the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003 (22 U.S.C. 7611(a)) is amended to read as follows:
       ``(a) Strategy.--The President shall establish a 
     comprehensive, integrated, 5-year strategy to expand and 
     improve efforts to combat global HIV/AIDS. This strategy 
     shall--
       ``(1) further strengthen the capability of the United 
     States to be an effective leader of the international 
     campaign against this disease and strengthen the capacities 
     of nations experiencing HIV/AIDS epidemics to combat this 
     disease;
       ``(2) maintain sufficient flexibility and remain responsive 
     to--
       ``(A) changes in the epidemic;
       ``(B) challenges facing partner countries in developing and 
     implementing an effective national response; and
       ``(C) evidence-based improvements and innovations in the 
     prevention, care, and treatment of HIV/AIDS;
       ``(3) situate United States efforts to combat HIV/AIDS, 
     tuberculosis, and malaria within the broader United States 
     global health and development agenda, establishing a roadmap 
     to link investments in specific disease programs to the 
     broader goals of strengthening health systems and 
     infrastructure and to integrate and coordinate HIV/AIDS, 
     tuberculosis, or malaria programs with other health or 
     development programs, as appropriate;
       ``(4) provide a plan to--
       ``(A) prevent 12,000,000 new HIV infections worldwide;
       ``(B) support treatment of at least 3,000,000 individuals 
     with HIV/AIDS and support additional treatment through 
     coordinated multilateral efforts;
       ``(C) support care for 12,000,000 individuals with HIV/
     AIDS, including 5,000,000 orphans and vulnerable children 
     affected by HIV/AIDS, with an emphasis on promoting a 
     comprehensive, coordinated system of services to be 
     integrated throughout the continuum of care;
       ``(D) help partner countries in the effort to achieve goals 
     of 80 percent access to counseling, testing, and treatment to 
     prevent the transmission of HIV from mother to child, 
     emphasizing a continuum of care model;
       ``(E) help partner countries to provide care and treatment 
     services to children with HIV in proportion to their 
     percentage within the HIV-infected population in each 
     country;
       ``(F) promote preservice training for health professionals 
     designed to strengthen the capacity of institutions to 
     develop and implement policies for training health workers to 
     combat HIV/AIDS, tuberculosis, and malaria;
       ``(G) equip teachers with skills needed for HIV/AIDS 
     prevention, treatment, and care;
       ``(H) provide and share best practices for combating HIV/
     AIDS with health professionals; and
       ``(I) help partner countries to train and support retention 
     of health care professionals and paraprofessionals, with the 
     target of training and retaining at least 140,000 new health 
     care professionals and paraprofessionals and to strengthen 
     capacities in developing countries, especially in sub-Saharan 
     Africa, to deliver primary health care with the objective of 
     helping countries achieve staffing levels of at least 2.3 
     doctors, nurses, and midwives per 1,000 population, as called 
     for by the World Health Organization;
       ``(5) include multisectoral approaches and specific 
     strategies to treat individuals infected with HIV/AIDS and to 
     prevent the further transmission of HIV infections, with a 
     particular focus on the needs of families with children 
     (including the prevention of mother-to-child transmission), 
     women, young people, orphans, and vulnerable children;
       ``(6) establish a timetable with annual global treatment 
     targets;
       ``(7) expand the integration of timely and relevant 
     research within the prevention, care, and treatment of HIV/
     AIDS;
       ``(8) include a plan for program monitoring, operations 
     research, and impact evaluation and for the dissemination of 
     a best practices report to highlight findings;
       ``(9) provide for consultation with local leaders and 
     officials to develop prevention strategies and programs that 
     are tailored to the unique needs of each country and 
     community and targeted particularly toward those most at risk 
     of acquiring HIV infection;
       ``(10) make the reduction of HIV/AIDS behavioral risks a 
     priority of all prevention efforts by--
       ``(A) promoting abstinence from sexual activity and 
     encouraging monogamy and faithfulness;
       ``(B) encouraging the correct and consistent use of male 
     and female condoms and increasing the availability of, and 
     access to, these commodities;
       ``(C) promoting the delay of sexual debut and the reduction 
     of multiple concurrent sexual partners;
       ``(D) promoting education for discordant couples (where an 
     individual is infected with HIV and the other individual is 
     uninfected or whose status is unknown) about safer sex 
     practices;
       ``(E) promoting voluntary counseling and testing, addiction 
     therapy, and other prevention and treatment tools for illicit 
     injection drug users and other substance abusers;
       ``(F) educating men and boys about the risks of procuring 
     sex commercially and about the need to end violent behavior 
     toward women and girls;
       ``(G) supporting comprehensive programs to promote 
     alternative livelihoods, safety, and social reintegration 
     strategies for commercial sex workers and their families;
       ``(H) promoting cooperation with law enforcement to 
     prosecute offenders of trafficking, rape, and sexual assault 
     crimes with the goal of eliminating such crimes; and
       ``(I) working to eliminate rape, gender-based violence, 
     sexual assault, and the sexual exploitation of women and 
     children;
       ``(11) include programs to reduce the transmission of HIV 
     through structural prevention efforts, particularly 
     addressing the heightened vulnerabilities of women and girls 
     to HIV in many countries; and
       ``(12) support other important means of preventing or 
     reducing the transmission of HIV, including--
       ``(A) medical male circumcision;
       ``(B) the maintenance of a safe blood supply; and
       ``(C) other mechanisms to reduce the transmission of HIV;
       ``(13) increase support for prevention of mother-to-child 
     transmission;
       ``(14) build capacity within the public health sector of 
     developing countries by improving

[[Page S6623]]

     health systems and public health infrastructure and 
     developing indicators to measure changes in broader public 
     health sector capabilities;
       ``(15) increase the coordination of HIV/AIDS programs with 
     development programs;
       ``(16) provide a framework for expanding or developing 
     existing or new country or regional programs, including--
       ``(A) drafting compacts or other agreements, as 
     appropriate;
       ``(B) establishing criteria and objectives for such 
     compacts and agreements; and
       ``(C) promoting sustainability;
       ``(17) provide a plan for national and regional priorities 
     for resource distribution and a global investment plan by 
     region;
       ``(18) provide a plan to address the immediate and ongoing 
     needs of women and girls, which--
       ``(A) addresses the vulnerabilities that contribute to 
     their elevated risk of infection;
       ``(B) includes specific goals and targets to address these 
     factors;
       ``(C) provides clear guidance to field missions to 
     integrate gender across prevention, care, and treatment 
     programs;
       ``(D) sets forth gender-specific indicators to monitor 
     progress on outcomes and impacts of gender programs;
       ``(E) supports efforts in countries in which women or 
     orphans lack inheritance rights and other fundamental 
     protections to promote the passage, implementation, and 
     enforcement of such laws;
       ``(F) supports life skills training and other structural 
     prevention activities, especially among women and girls, with 
     the goal of reducing vulnerabilities to HIV/AIDS;
       ``(G) addresses and prevents gender-based violence; and
       ``(H) addresses the posttraumatic and psychosocial 
     consequences and provides postexposure prophylaxis protecting 
     against HIV infection to victims of gender-based violence and 
     rape;
       ``(19) provide a plan to address the vulnerabilities and 
     needs of orphans and children who are vulnerable to, or 
     affected by, HIV/AIDS;
       ``(20) provide a framework to work with international 
     actors and partner countries toward universal access to HIV/
     AIDS prevention, treatment, and care programs, recognizing 
     that prevention is of particular importance in terms of 
     sequencing;
       ``(21) enhance the coordination of United States bilateral 
     efforts to combat global HIV/AIDS with other major public and 
     private entities;
       ``(22) enhance the attention given to the national 
     strategic HIV/AIDS plans of countries receiving United States 
     assistance by--
       ``(A) reviewing the planning and programmatic decisions 
     associated with that assistance; and
       ``(B) helping to strengthen such national strategies, if 
     necessary;
       ``(23) support activities described in the Global Plan to 
     Stop TB, including--
       ``(A) expanding and enhancing the coverage of the Directly 
     Observed Treatment Short-course (DOTS) in order to treat 
     individuals infected with tuberculosis and HIV, including 
     multi-drug resistant or extensively drug resistant 
     tuberculosis; and
       ``(B) improving coordination and integration of HIV/AIDS 
     and tuberculosis programming;
       ``(24) ensure coordination between the Global AIDS 
     Coordinator and the Malaria Coordinator and address issues of 
     comorbidity between HIV/AIDS and malaria; and
       ``(25) include a longer term estimate of the projected 
     resource needs, progress toward greater sustainability and 
     country ownership of HIV/AIDS programs, and the anticipated 
     role of the United States in the global effort to combat HIV/
     AIDS during the 10-year period beginning on October 1, 
     2013.''.
       (b) Report.--Section 101(b) of such Act (22 U.S.C. 7611(b)) 
     is amended to read as follows:
       ``(b) Report.--
       ``(1) In general.--Not later than October 1, 2009, the 
     President shall submit a report to the appropriate 
     congressional committees that sets forth the strategy 
     described in subsection (a).
       ``(2) Contents.--The report required under paragraph (1) 
     shall include a discussion of the following elements:
       ``(A) The purpose, scope, methodology, and general and 
     specific objectives of the strategy.
       ``(B) The problems, risks, and threats to the successful 
     pursuit of the strategy.
       ``(C) The desired goals, objectives, activities, and 
     outcome-related performance measures of the strategy.
       ``(D) A description of future costs and resources needed to 
     carry out the strategy.
       ``(E) A delineation of United States Government roles, 
     responsibility, and coordination mechanisms of the strategy.
       ``(F) A description of the strategy--
       ``(i) to promote harmonization of United States assistance 
     with that of other international, national, and private 
     actors as elucidated in the `Three Ones'; and
       ``(ii) to address existing challenges in harmonization and 
     alignment.
       ``(G) A description of the manner in which the strategy 
     will--
       ``(i) further the development and implementation of the 
     national multisectoral strategic HIV/AIDS frameworks of 
     partner governments; and
       ``(ii) enhance the centrality, effectiveness, and 
     sustainability of those national plans.
       ``(H) A description of how the strategy will seek to 
     achieve the specific targets described in subsection (a) and 
     other targets, as appropriate.
       ``(I) A description of, and rationale for, the timetable 
     for annual global treatment targets.
       ``(J) A description of how operations research is addressed 
     in the strategy and how such research can most effectively be 
     integrated into care, treatment, and prevention activities in 
     order to--
       ``(i) improve program quality and efficiency;
       ``(ii) ascertain cost effectiveness;
       ``(iii) ensure transparency and accountability;
       ``(iv) assess population-based impact;
       ``(v) disseminate findings and best practices; and
       ``(vi) optimize delivery of services.
       ``(K) An analysis of United States-assisted strategies to 
     prevent the transmission of HIV/AIDS, including methodologies 
     to promote abstinence, monogamy, faithfulness, the correct 
     and consistent use of male and female condoms, reductions in 
     concurrent sexual partners, and delay of sexual debut, and of 
     intended monitoring and evaluation approaches to measure the 
     effectiveness of prevention programs and ensure that they are 
     targeted to appropriate audiences.
       ``(L) Within the analysis required under subparagraph (J), 
     an examination of additional planned means of preventing the 
     transmission of HIV including medical male circumcision, 
     maintenance of a safe blood supply, and other tools.
       ``(M) A description of the specific targets, goals, and 
     strategies developed to address the needs and vulnerabilities 
     of women and girls to HIV/AIDS, including--
       ``(i) structural prevention activities;
       ``(ii) activities directed toward men and boys;
       ``(iii) activities to enhance educational, microfinance, 
     and livelihood opportunities for women and girls;
       ``(iv) activities to promote and protect the legal 
     empowerment of women, girls, and orphans and vulnerable 
     children;
       ``(v) programs targeted toward gender-based violence and 
     sexual coercion;
       ``(vi) strategies to meet the particular needs of 
     adolescents;
       ``(vii) assistance for victims of rape, sexual abuse, 
     assault, exploitation, and trafficking; and
       ``(viii) programs to prevent alcohol abuse.
       ``(N) A description of strategies--
       ``(i) to address the needs of orphans and vulnerable 
     children, including an analysis of--

       ``(I) factors contributing to children's vulnerability to 
     HIV/AIDS; and
       ``(II) vulnerabilities caused by the impact of HIV/AIDS on 
     children and their families; and

       ``(ii) in areas of higher HIV/AIDS prevalence, to promote a 
     community-based approach to vulnerability, maximizing 
     community input into determining which children participate.
       ``(O) A description of capacity-building efforts undertaken 
     by countries themselves, including adherents of the Abuja 
     Declaration and an assessment of the impact of International 
     Monetary Fund macroeconomic and fiscal policies on national 
     and donor investments in health.
       ``(P) A description of the strategy to--
       ``(i) strengthen capacity building within the public health 
     sector;
       ``(ii) improve health care in those countries;
       ``(iii) help countries to develop and implement national 
     health workforce strategies;
       ``(iv) strive to achieve goals in training, retaining, and 
     effectively deploying health staff;
       ``(v) promote ethical recruiting practices for health care 
     workers; and
       ``(vi) increase the sustainability of health programs.
       ``(Q) A description of the criteria for selection, 
     objectives, methodology, and structure of compacts or other 
     framework agreements with countries or regional 
     organizations, including--
       ``(i) the role of civil society;
       ``(ii) the degree of transparency;
       ``(iii) benchmarks for success of such compacts or 
     agreements; and
       ``(iv) the relationship between such compacts or agreements 
     and the national HIV/AIDS and public health strategies and 
     commitments of partner countries.
       ``(R) A strategy to better coordinate HIV/AIDS assistance 
     with nutrition and food assistance programs.
       ``(S) A description of transnational or regional 
     initiatives to combat regionalized epidemics in highly 
     affected areas such as the Caribbean.
       ``(T) A description of planned resource distribution and 
     global investment by region.
       ``(U) A description of coordination efforts in order to 
     better implement the Stop TB Strategy and to address the 
     problem of coinfection of HIV/AIDS and tuberculosis and of 
     projected challenges or barriers to successful 
     implementation.
       ``(V) A description of coordination efforts to address 
     malaria and comorbidity with malaria and HIV/AIDS.''.
       (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) 
     is amended to read as follows:
       ``(c) Study of Progress Toward Achievement of Policy 
     Objectives.--
       ``(1) Design and budget plan for data evaluation.--The 
     Global AIDS Coordinator shall enter into a contract with the 
     Institute of Medicine of the National Academies that provides 
     that not later than 18 months after the date of the enactment 
     of the Tom Lantos and Henry J. Hyde United States Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008, the Institute, in consultation 
     with the Global AIDS Coordinator and other relevant parties 
     representing the public and private sector, shall provide the 
     Global AIDS Coordinator with a design plan and budget for the 
     evaluation and collection of baseline and subsequent data to 
     address the elements set forth in paragraph (2)(B). The 
     Global AIDS Coordinator shall submit the budget and design 
     plan to the appropriate congressional committees.
       ``(2) Study.--
       ``(A) In general.--Not later than 4 years after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde United 
     States Global Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Reauthorization Act of 2008, the Institute of 
     Medicine of the National Academies shall publish a study that 
     includes--

[[Page S6624]]

       ``(i) an assessment of the performance of United States-
     assisted global HIV/AIDS programs; and
       ``(ii) an evaluation of the impact on health of prevention, 
     treatment, and care efforts that are supported by United 
     States funding, including multilateral and bilateral programs 
     involving joint operations.
       ``(B) Content.--The study conducted under this paragraph 
     shall include--
       ``(i) an assessment of progress toward prevention, 
     treatment, and care targets;
       ``(ii) an assessment of the effects on health systems, 
     including on the financing and management of health systems 
     and the quality of service delivery and staffing;
       ``(iii) an assessment of efforts to address gender-specific 
     aspects of HIV/AIDS, including gender related constraints to 
     accessing services and addressing underlying social and 
     economic vulnerabilities of women and men;
       ``(iv) an evaluation of the impact of treatment and care 
     programs on 5-year survival rates, drug adherence, and the 
     emergence of drug resistance;
       ``(v) an evaluation of the impact of prevention programs on 
     HIV incidence in relevant population groups;
       ``(vi) an evaluation of the impact on child health and 
     welfare of interventions authorized under this Act on behalf 
     of orphans and vulnerable children;
       ``(vii) an evaluation of the impact of programs and 
     activities authorized in this Act on child mortality; and
       ``(viii) recommendations for improving the programs 
     referred to in subparagraph (A)(i).
       ``(C) Methodologies.--Assessments and impact evaluations 
     conducted under the study shall utilize sound statistical 
     methods and techniques for the behavioral sciences, including 
     random assignment methodologies as feasible. Qualitative data 
     on process variables should be used for assessments and 
     impact evaluations, wherever possible.
       ``(3) Contract authority.--The Institute of Medicine may 
     enter into contracts or cooperative agreements or award 
     grants to conduct the study under paragraph (2).
       ``(4) Authorization of appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out the study under this subsection.''.
       (d) Report.--Section 101 of such Act, as amended by this 
     section, is further amended by adding at the end the 
     following:
       ``(d) Comptroller General Report.--
       ``(1) Report required.--Not later than 3 years after the 
     date of the enactment of the Tom Lantos and Henry J. Hyde 
     United States Global Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Reauthorization Act of 2008, the 
     Comptroller General of the United States shall submit a 
     report on the global HIV/AIDS programs of the United States 
     to the appropriate congressional committees.
       ``(2) Contents.--The report required under paragraph (1) 
     shall include--
       ``(A) a description and assessment of the monitoring and 
     evaluation practices and policies in place for these 
     programs;
       ``(B) an assessment of coordination within Federal agencies 
     involved in these programs, examining both internal 
     coordination within these programs and integration with the 
     larger global health and development agenda of the United 
     States;
       ``(C) an assessment of procurement policies and practices 
     within these programs;
       ``(D) an assessment of harmonization with national 
     government HIV/AIDS and public health strategies as well as 
     other international efforts;
       ``(E) an assessment of the impact of global HIV/AIDS 
     funding and programs on other United States global health 
     programming; and
       ``(F) recommendations for improving the global HIV/AIDS 
     programs of the United States.
       ``(e) Best Practices Report.--
       ``(1) In general.--Not later than 1 year after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde United 
     States Global Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Reauthorization Act of 2008, and annually thereafter, 
     the Global AIDS Coordinator shall publish a best practices 
     report that highlights the programs receiving financial 
     assistance from the United States that have the potential for 
     replication or adaption, particularly at a low cost, across 
     global AIDS programs, including those that focus on both 
     generalized and localized epidemics.
       ``(2) Dissemination of findings.--
       ``(A) Publication on internet website.--The Global AIDS 
     Coordinator shall disseminate the full findings of the annual 
     best practices report on the Internet website of the Office 
     of the Global AIDS Coordinator.
       ``(B) Dissemination guidance.--The Global AIDS Coordinator 
     shall develop guidance to ensure timely submission and 
     dissemination of significant information regarding best 
     practices with respect to global AIDS programs.
       ``(f) Inspectors General.--
       ``(1) Oversight plan.--
       ``(A) Development.--The Inspectors General of the 
     Department of State and Broadcasting Board of Governors, the 
     Department of Health and Human Services, and the United 
     States Agency for International Development shall jointly 
     develop 5 coordinated annual plans for oversight activity in 
     each of the fiscal years 2009 through 2013, with regard to 
     the programs authorized under this Act and sections 104A, 
     104B, and 104C of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b-2, 2151b-3, and 2151b-4).
       ``(B) Contents.--The plans developed under subparagraph (A) 
     shall include a schedule for financial audits, inspections, 
     and performance reviews, as appropriate.
       ``(C) Deadline.--
       ``(i) Initial plan.--The first plan developed under 
     subparagraph (A) shall be completed not later than the later 
     of--

       ``(I) September 1, 2008; or
       ``(II) 60 days after the date of the enactment of the Tom 
     Lantos and Henry J. Hyde United States Global Leadership 
     Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
     Act of 2008.

       ``(ii) Subsequent plans.--Each of the last four plans 
     developed under subparagraph (A) shall be completed not later 
     than 30 days before each of the fiscal years 2010 through 
     2013, respectively.
       ``(2) Coordination.--In order to avoid duplication and 
     maximize efficiency, the Inspectors General described in 
     paragraph (1) shall coordinate their activities with--
       ``(A) the Government Accountability Office; and
       ``(B) the Inspectors General of the Department of Commerce, 
     the Department of Defense, the Department of Labor, and the 
     Peace Corps, as appropriate, pursuant to the 2004 Memorandum 
     of Agreement Coordinating Audit Coverage of Programs and 
     Activities Implementing the President's Emergency Plan for 
     AIDS Relief, or any successor agreement.
       ``(3) Funding.--The Global AIDS Coordinator and the 
     Coordinator of the United States Government Activities to 
     Combat Malaria Globally shall make available necessary funds 
     not exceeding $10,000,000 during the 5-year period beginning 
     on October 1, 2008 to the Inspectors General described in 
     paragraph (1) for the audits, inspections, and reviews 
     described in that paragraph.''.

     SEC. 102. INTERAGENCY WORKING GROUP.

       Section 1(f)(2) of the State Department Basic Authorities 
     Act of 1956 (22 U.S.C. 2651a(f)(2)) is amended--
       (1) in subparagraph (A), by inserting ``, partner country 
     finance, health, and other relevant ministries,'' after 
     ``community based organizations)'' each place it appears;
       (2) in subparagraph (B)(ii)--
       (A) by striking subclauses (IV) and (V);
       (B) by inserting after subclause (III) the following:

       ``(IV) Establishing an interagency working group on HIV/
     AIDS headed by the Global AIDS Coordinator and comprised of 
     representatives from the United States Agency for 
     International Development and the Department of Health and 
     Human Services, for the purposes of coordination of 
     activities relating to HIV/AIDS, including--

       ``(aa) meeting regularly to review progress in partner 
     countries toward HIV/AIDS prevention, treatment, and care 
     objectives;
       ``(bb) participating in the process of identifying 
     countries to consider for increased assistance based on the 
     epidemiology of HIV/AIDS in those countries, including clear 
     evidence of a public health threat, as well as government 
     commitment to address the HIV/AIDS problem, relative need, 
     and coordination and joint planning with other significant 
     actors;
       ``(cc) assisting the Coordinator in the evaluation, 
     execution, and oversight of country operational plans;
       ``(dd) reviewing policies that may be obstacles to reaching 
     targets set forth for HIV/AIDS prevention, treatment, and 
     care; and
       ``(ee) consulting with representatives from additional 
     relevant agencies, including the National Institutes of 
     Health, the Health Resources and Services Administration, the 
     Department of Labor, the Department of Agriculture, the 
     Millennium Challenge Corporation, the Peace Corps, and the 
     Department of Defense.

       ``(V) Coordinating overall United States HIV/AIDS policy 
     and programs, including ensuring the coordination of relevant 
     executive branch agency activities in the field, with efforts 
     led by partner countries, and with the assistance provided by 
     other relevant bilateral and multilateral aid agencies and 
     other donor institutions to promote harmonization with other 
     programs aimed at preventing and treating HIV/AIDS and other 
     health challenges, improving primary health, addressing food 
     security, promoting education and development, and 
     strengthening health care systems.'';

       (C) by redesignating subclauses (VII) and VIII) as 
     subclauses (IX) and (XII), respectively;
       (D) by inserting after subclause (VI) the following:

       ``(VII) Holding annual consultations with nongovernmental 
     organizations in partner countries that provide services to 
     improve health, and advocating on behalf of the individuals 
     with HIV/AIDS and those at particular risk of contracting 
     HIV/AIDS, including organizations with members who are living 
     with HIV/AIDS.
       ``(VIII) Ensuring, through interagency and international 
     coordination, that HIV/AIDS programs of the United States are 
     coordinated with, and complementary to, the delivery of 
     related global health, food security, development, and 
     education.'';

       (E) in subclause (IX), as redesignated by subparagraph 
     (C)--
       (i) by inserting ``Vietnam,'' after ``Uganda,'';
       (ii) by inserting after ``of 2003'' the following: ``and 
     other countries in which the United States is implementing 
     HIV/AIDS programs as part of its foreign assistance 
     program''; and
       (iii) by adding at the end the following: ``In designating 
     additional countries under this subparagraph, the President 
     shall give priority to those countries in which there is a 
     high prevalence or significantly rising incidence of HIV/
     AIDS, countries with large populations and inadequate health 
     infrastructure, countries in which a concentrated HIV/AIDS 
     epidemic could become generalized to the entire population of 
     the country, and in countries whose governments demonstrate a 
     commitment to combating HIV/AIDS.'';
       (F) by inserting after subclause (IX), as redesignated by 
     subparagraph (C), the following:

[[Page S6625]]

       ``(X) Working with partner countries in which the HIV/AIDS 
     epidemic is prevalent among injection drug users to 
     establish, as a national priority, national HIV/AIDS 
     prevention programs, including education and services 
     demonstrated to be effective in reducing the transmission of 
     HIV infection among injection drug users without increasing 
     illicit drug use.
       ``(XI) Working with partner countries in which the HIV/AIDS 
     epidemic is prevalent among individuals involved in 
     commercial sex acts to establish, as a national priority, 
     national prevention programs, including education, voluntary 
     testing, and counseling, and referral systems that link HIV/
     AIDS programs with programs to eradicate trafficking in 
     persons and support alternatives to prostitution.'';

       (G) in subclause (XII), as redesignated by subparagraph 
     (C), by striking ``funds section'' and inserting ``funds 
     appropriated for HIV/ AIDS assistance pursuant to the 
     authorization of appropriations under section 401 of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7671)''; and
       (H) by adding at the end the following:

       ``(XIII) Publicizing updated drug pricing data to inform 
     the purchasing decisions of pharmaceutical procurement 
     partners.''.

     SEC. 103. SENSE OF CONGRESS.

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

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

     SEC. 201. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE 
                   FUNDS.

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

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

       (a) Findings; Sense of Congress.--Section 202(a) of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7622(a)) is amended to read as 
     follows:
       ``(a) Findings; Sense of Congress.--
       ``(1) Findings.--Congress makes the following findings:
       ``(A) The establishment of the Global Fund in January 2002 
     is consistent with the general principles for an 
     international AIDS trust fund first outlined by Congress in 
     the Global AIDS and Tuberculosis Relief Act of 2000 (Public 
     Law 106-264).
       ``(B) The Global Fund is an innovative financing mechanism 
     which--
       ``(i) has made progress in many areas in combating HIV/
     AIDS, tuberculosis, and malaria; and
       ``(ii) represents the multilateral component of this Act, 
     extending United States efforts to more than 130 countries 
     around the world.
       ``(C) The Global Fund and United States bilateral 
     assistance programs--
       ``(i) are demonstrating increasingly effective 
     coordination, with each possessing certain comparative 
     advantages in the fight against HIV/AIDS, tuberculosis, and 
     malaria; and
       ``(ii) often work most effectively in concert with each 
     other.
       ``(D) The United States Government--
       ``(i) is the largest supporter of the Global Fund in terms 
     of resources and technical support;
       ``(ii) made the founding contribution to the Global Fund; 
     and
       ``(iii) is fully committed to the success of the Global 
     Fund as a multilateral public-private partnership.
       ``(2) Sense of congress.--It is the sense of Congress 
     that--
       ``(A) transparency and accountability are crucial to the 
     long-term success and viability of the Global Fund;
       ``(B) the Global Fund has made significant progress toward 
     addressing concerns raised by the Government Accountability 
     Office by--
       ``(i) improving risk assessment and risk management 
     capabilities;
       ``(ii) providing clearer guidance for and oversight of 
     Local Fund Agents; and
       ``(iii) strengthening the Office of the Inspector General 
     for the Global Fund;
       ``(C) the provision of sufficient resources and authority 
     to the Office of the Inspector General for the Global Fund to 
     ensure that office has the staff and independence necessary 
     to carry out its mandate will be a measure of the commitment 
     of the Global Fund to transparency and accountability;
       ``(D) regular, publicly published financial, programmatic, 
     and reporting audits of the Fund, its grantees, and Local 
     Fund Agents are also important benchmarks of transparency;
       ``(E) the Global Fund should establish and maintain a 
     system to track--
       ``(i) the amount of funds disbursed to each subrecipient on 
     the grant's fiscal cycle; and
       ``(ii) the distribution of resources, by grant and 
     principal recipient, for prevention, care, treatment, drug 
     and commodity purchases, and other purposes;
       ``(F) relevant national authorities in recipient countries 
     should exempt from duties and taxes all products financed by 
     Global Fund grants and procured by any principal recipient or 
     subrecipient for the purpose of carrying out such grants;
       ``(G) the Global Fund, UNAIDS, and the Global AIDS 
     Coordinator should work together to standardize program 
     indicators wherever possible; and
       ``(H) for purposes of evaluating total amounts of funds 
     contributed to the Global Fund under subsection (d)(4)(A)(i), 
     the timetable for evaluations of contributions from sources 
     other than the United States should take into account the 
     fiscal calendars of other major contributors.''.
       (b) United States Financial Participation.--Section 202(d) 
     of such Act (22 U.S.C. 7622(d)) is amended--
       (1) in paragraph (1)--
       (A) by striking ``$1,000,000,000 for the period of fiscal 
     year 2004 beginning on January 1, 2004'' and inserting 
     ``$2,000,000,000 for fiscal year 2009,''; and
       (B) by striking ``the fiscal years 2005-2008'' and 
     inserting ``each of the fiscal years 2010 through 2013'';
       (2) in paragraph (4)--
       (A) in subparagraph (A)--
       (i) in clause (i), by striking ``fiscal years 2004 through 
     2008'' and inserting ``fiscal years 2009 through 2013'';
       (ii) in clause (ii), by striking ``during any of the fiscal 
     years 2004 through 2008'' and inserting ``during any of the 
     fiscal years 2009 through 2013''; and
       (iii) in clause (vi)--

       (I) by striking ``for the purposes'' and inserting ``For 
     the purposes'';
       (II) by striking ``fiscal years 2004 through 2008'' and 
     inserting ``fiscal years 2009 through 2013''; and
       (III) by striking ``prior to fiscal year 2004'' and 
     inserting ``before fiscal year 2009'';

       (B) in subparagraph (B)(iv), by striking ``fiscal years 
     2004 through 2008'' and inserting ``fiscal years 2009 through 
     2013''; and
       (C) in subparagraph (C)(ii), by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs''; and
       (3) by adding at the end the following:
       ``(5) Withholding funds.--Notwithstanding any other 
     provision of this Act, 20 percent of the amounts appropriated 
     pursuant to this Act for a contribution to support the Global 
     Fund for each of the fiscal years 2010 through 2013 shall be 
     withheld from obligation to the Global Fund until the 
     Secretary of State certifies to the appropriate congressional 
     committees that the Global Fund--
       ``(A) has established an evaluation framework for the 
     performance of Local Fund Agents (referred to in this 
     paragraph as `LFAs');
       ``(B) is undertaking a systematic assessment of the 
     performance of LFAs;
       ``(C) is making available for public review, according to 
     the Fund Board's policies and practices on disclosure of 
     information, a regular collection and analysis of performance 
     data of Fund grants, which shall cover principal recipients 
     and subrecipients;
       ``(D) is maintaining an independent, well-staffed Office of 
     the Inspector General that--
       ``(i) reports directly to the Board of the Global Fund; and
       ``(ii) is responsible for regular, publicly published 
     audits of financial, programmatic, and reporting aspects of 
     the Global Fund, its grantees, and LFAs;
       ``(E) has established, and is reporting publicly on, 
     standard indicators for all program areas;
       ``(F) has established a methodology to track and is 
     reporting on--
       ``(i) all subrecipients and the amount of funds disbursed 
     to each subrecipient on the grant's fiscal cycle; and
       ``(ii) the distribution of resources, by grant and 
     principal recipient, for prevention, care, treatment, drugs 
     and commodities purchase, and other purposes;
       ``(G) has established a policy on tariffs imposed by 
     national governments on all goods and services financed by 
     the Global Fund;
       ``(H) through its Secretariat, has taken meaningful steps 
     to prevent national authorities in recipient countries from 
     imposing taxes or tariffs on goods or services provided by 
     the Fund;
       ``(I) is maintaining its status as a financing institution 
     focused on programs directly related to HIV/AIDS, malaria, 
     and tuberculosis; and
       ``(J) is maintaining and making progress on--
       ``(i) sustaining its multisectoral approach, through 
     country coordinating mechanisms; and
       ``(ii) the implementation of grants, as reflected in the 
     proportion of resources allocated to different sectors, 
     including governments, civil society, and faith- and 
     community-based organizations.''.

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

       (a) Sense of Congress.--Congress recognizes the need and 
     urgency to expand the range of

[[Page S6626]]

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

     ``SEC. 2351A. MICROBICIDE RESEARCH.

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

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

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

     ``SEC. 317T. MICROBICIDE RESEARCH.

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

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

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

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

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

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

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

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

     SEC. 206. FACILITATING VACCINE DEVELOPMENT.

       (a) Technical Assistance for Developing Countries.--The 
     Administrator of the United States Agency for International 
     Development, utilizing public-private partners, as 
     appropriate, and working in coordination with other 
     international development agencies, is authorized to 
     strengthen the capacity of developing countries' governmental 
     institutions to--
       (1) collect evidence for informed decision-making and 
     introduction of new vaccines, including potential HIV/AIDS, 
     tuberculosis, and malaria vaccines, if such vaccines are 
     determined to be safe and effective;
       (2) review protocols for clinical trials and impact studies 
     and improve the implementation of clinical trials; and
       (3) ensure adequate supply chain and delivery systems.
       (b) Advanced Market Commitments.--
       (1) Purpose.--The purpose of this subsection is to improve 
     global health by requiring the United States to participate 
     in negotiations for advance market commitments for the 
     development of future vaccines, including potential vaccines 
     for HIV/AIDS, tuberculosis, and malaria.
       (2) Negotiation requirement.--The Secretary of the Treasury 
     shall enter into negotiations with the appropriate officials 
     of the International Bank of Reconstruction and Development 
     (World Bank) and the GAVI Alliance, the member nations of 
     such entities, and other interested parties to establish 
     advanced market commitments to purchase vaccines to combat 
     HIV/AIDS, tuberculosis, malaria, and other related infectious 
     diseases.
       (3) Requirements.--In negotiating the United States 
     participation in programs for advanced market commitments, 
     the Secretary of the Treasury shall take into account whether 
     programs for advance market commitments include--
       (A) legally binding contracts for product purchase that 
     include a fair market price for up to a maximum number of 
     treatments, creating a strong market incentive;
       (B) clearly defined and transparent rules of program 
     participation for qualified developers and suppliers of the 
     product;

[[Page S6627]]

       (C) clearly defined requirements for eligible vaccines to 
     ensure that they are safe and effective and can be delivered 
     in developing country contexts;
       (D) dispute settlement mechanisms; and
       (E) sufficient flexibility to enable the contracts to be 
     adjusted in accord with new information related to projected 
     market size and other factors while still maintaining the 
     purchase commitment at a fair price.
       (4) Report.--Not later than 1 year after the date of the 
     enactment of this Act--
       (A) the Secretary of the Treasury shall submit a report to 
     the appropriate congressional committees on the status of the 
     United States negotiations to participate in programs for the 
     advanced market commitments under this subsection; and
       (B) the President shall produce a comprehensive report, 
     written by a study group of qualified professionals from 
     relevant Federal agencies and initiatives, nongovernmental 
     organizations, and industry representatives, that sets forth 
     a coordinated strategy to accelerate development of vaccines 
     for infectious diseases, such as HIV/AIDS, malaria, and 
     tuberculosis, which includes--
       (i) initiatives to create economic incentives for the 
     research, development, and manufacturing of vaccines for HIV/
     AIDS, tuberculosis, malaria, and other infectious diseases;
       (ii) an expansion of public-private partnerships and the 
     leveraging of resources from other countries and the private 
     sector; and
       (iii) efforts to maximize United States capabilities to 
     support clinical trials of vaccines in developing countries 
     and to address the challenges of delivering vaccines in 
     developing countries to minimize delays in access once 
     vaccines are available.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

     SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

       (a) Amendments to the Foreign Assistance Act of 1961.--
       (1) Finding.--Section 104A(a) of the Foreign Assistance Act 
     of 1961 (22 U.S.C. 2151b-2(a)) is amended by inserting 
     ``Central Asia, Eastern Europe, Latin America'' after 
     ``Caribbean,''.
       (2) Policy.--Section 104A(b) of such Act is amended to read 
     as follows:
       ``(b) Policy.--
       ``(1) Objectives.--It is a major objective of the foreign 
     assistance program of the United States to provide assistance 
     for the prevention and treatment of HIV/AIDS and the care of 
     those affected by the disease. It is the policy objective of 
     the United States, by 2013, to--
       ``(A) assist partner countries to--
       ``(i) prevent 12,000,000 new HIV infections worldwide;
       ``(ii) support treatment of at least 3,000,000 individuals 
     with HIV/AIDS;
       ``(iii) support additional treatment through coordinated 
     multilateral efforts;
       ``(iv) support care for 12,000,000 individuals with HIV/
     AIDS, including 5,000,000 orphans and vulnerable children 
     affected by HIV/AIDS, with an emphasis on promoting a 
     comprehensive, coordinated system of services to be 
     integrated throughout the continuum of care;
       ``(v) provide at least 80 percent of the target population 
     with access to counseling, testing, and treatment to prevent 
     the transmission of HIV from mother-to-child;
       ``(vi) provide care and treatment services to children with 
     HIV in proportion to their percentage within the HIV-infected 
     population of a given partner country; and
       ``(vii) train and support retention of health care 
     professionals, paraprofessionals, and community health 
     workers in HIV/AIDS prevention, treatment, and care, with the 
     target of providing such training to at least 140,000 new 
     health care professionals and paraprofessionals;
       ``(B) strengthen the capacity to deliver primary health 
     care in developing countries, especially in sub-Saharan 
     Africa; and
       ``(C) help countries achieve staffing levels of at least 
     2.3 doctors, nurses, and midwives per 1,000 population, as 
     called for by the World Health Organization.
       ``(2) Coordinated global strategy.--The United States and 
     other countries with the sufficient capacity should provide 
     assistance to countries in sub-Saharan Africa, the Caribbean, 
     Central Asia, Eastern Europe, and Latin America, and other 
     countries and regions confronting HIV/AIDS epidemics in a 
     coordinated global strategy to help address generalized and 
     concentrated epidemics through HIV/AIDS prevention, 
     treatment, care, monitoring and evaluation, and related 
     activities.
       ``(3) Priorities.--The United States Government's response 
     to the global HIV/AIDS pandemic and the Government's efforts 
     to help countries assume leadership of sustainable campaigns 
     to combat their local epidemics should place high priority 
     on--
       ``(A) the prevention of the transmission of HIV; and
       ``(B) moving toward universal access to HIV/AIDS prevention 
     counseling and services.''.
       (b) Authorization.--Section 104A(c) of such Act is 
     amended--
       (1) in paragraph (1), by striking ``and other countries and 
     areas.'' and inserting ``Central Asia, Eastern Europe, Latin 
     America, and other countries and areas, particularly with 
     respect to refugee populations or those in postconflict 
     settings in such countries and areas with significant or 
     increasing HIV incidence rates.'';
       (2) in paragraph (2), by striking ``and other countries and 
     areas affected by the HIV/AIDS pandemic'' and inserting 
     ``Central Asia, Eastern Europe, Latin America, and other 
     countries and areas affected by the HIV/AIDS pandemic, 
     particularly with respect to refugee populations or those in 
     post-conflict settings in such countries and areas with 
     significant or increasing HIV incidence rates.''; and
       (3) in paragraph (3)--
       (A) by striking ``foreign countries'' and inserting 
     ``partner countries, other international actors,''; and
       (B) by inserting ``within the framework of the principles 
     of the Three Ones'' before the period at the end.
       (c) Activities Supported.--Section 104A(d) of such Act is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A)--
       (i) by inserting ``and multiple concurrent sexual 
     partnering,'' after ``casual sexual partnering''; and
       (ii) by striking ``condoms'' and inserting ``male and 
     female condoms'';
       (B) in subparagraph (B)--
       (i) by striking ``programs that'' and inserting ``programs 
     that are designed with local input and''; and
       (ii) by striking ``those organizations'' and inserting 
     ``those locally based organizations'';
       (C) in subparagraph (D), by inserting ``and promoting the 
     use of provider-initiated or `opt-out' voluntary testing in 
     accordance with World Health Organization guidelines'' before 
     the semicolon at the end;
       (D) by redesignating subparagraphs (F), (G), and (H) as 
     subparagraphs (H), (I), and (J), respectively;
       (E) by inserting after subparagraph (E) the following:
       ``(F) assistance to--
       ``(i) achieve the goal of reaching 80 percent of pregnant 
     women for prevention and treatment of mother-to-child 
     transmission of HIV in countries in which the United States 
     is implementing HIV/AIDS programs by 2013; and
       ``(ii) promote infant feeding options and treatment 
     protocols that meet the most recent criteria established by 
     the World Health Organization;
       ``(G) medical male circumcision programs as part of 
     national strategies to combat the transmission of HIV/
     AIDS;'';
       (F) in subparagraph (I), as redesignated, by striking 
     ``and'' at the end;
       (G) in subparagraph (H), as redesignated--
       (i) by striking the period at the end and inserting ``, 
     including education and services demonstrated to be effective 
     in reducing the transmission of HIV infection without 
     increasing illicit drug use; and''; and
       (H) by adding at the end the following:
       ``(K) assistance for counseling, testing, treatment, care, 
     and support programs, including--
       ``(i) counseling and other services for the prevention of 
     reinfection of individuals with HIV/AIDS;
       ``(ii) counseling to prevent sexual transmission of HIV, 
     including--

       ``(I) life skills development for practicing abstinence and 
     faithfulness;
       ``(II) reducing the number of sexual partners;
       ``(III) delaying sexual debut; and
       ``(IV) ensuring correct and consistent use of condoms;

       ``(iii) assistance to engage underlying vulnerabilities to 
     HIV/AIDS, especially those of women and girls, through 
     structural prevention programs;
       ``(iv) assistance for appropriate HIV/AIDS education 
     programs and training targeted to prevent the transmission of 
     HIV among men who have sex with men;
       ``(v) assistance to provide male and female condoms;
       ``(vi) diagnosis and treatment of other sexually 
     transmitted infections;
       ``(vii) strategies to address the stigma and discrimination 
     that impede HIV/AIDS prevention efforts; and
       ``(viii) assistance to facilitate widespread access to 
     microbicides for HIV prevention, if safe and effective 
     products become available, including financial and technical 
     support for culturally appropriate introductory programs, 
     procurement, distribution, logistics management, program 
     delivery, acceptability studies, provider training, demand 
     generation, and postintroduction monitoring.''; and
       (2) in paragraph (2)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C)--
       (i) by inserting ``pain management,'' after ``opportunistic 
     infections,''; and
       (ii) by striking the period at the end and inserting a 
     semicolon; and
       (C) by adding at the end the following:
       ``(D) as part of care and treatment of HIV/AIDS, assistance 
     (including prophylaxis and treatment) for common HIV/AIDS-
     related opportunistic infections for free or at a rate at 
     which it is easily affordable to the individuals and 
     populations being served;
       ``(E) as part of care and treatment of HIV/AIDS, assistance 
     or referral to available and adequately resourced service 
     providers for nutritional support, including counseling and 
     where necessary the provision of commodities, for persons 
     meeting malnourishment criteria and their families;'';
       (3) in paragraph (4)--
       (A) in subparagraph (C), by striking ``and'' at the end;
       (B) in subparagraph (D), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding at the end the following:
       ``(E) carrying out and expanding program monitoring, impact 
     evaluation research and analysis, and operations research and 
     disseminating data and findings through mechanisms to be 
     developed by the Coordinator of United States Government 
     Activities to Combat HIV/AIDS Globally, in coordination with 
     the Director of the Centers for Disease Control, in order 
     to--
       ``(i) improve accountability, increase transparency, and 
     ensure the delivery of evidence-based services through the 
     collection, evaluation, and analysis of data regarding 
     gender-responsive interventions, disaggregated by age and 
     sex;
       ``(ii) identify and replicate effective models; and

[[Page S6628]]

       ``(iii) develop gender indicators to measure outcomes and 
     the impacts of interventions; and
       ``(F) establishing appropriate systems to--
       ``(i) gather epidemiological and social science data on 
     HIV; and
       ``(ii) evaluate the effectiveness of prevention efforts 
     among men who have sex with men, with due consideration to 
     stigma and risks associated with disclosure.'';
       (4) in paragraph (5)--
       (A) by redesignating subparagraph (C) as subparagraph (D); 
     and
       (B) by inserting after subparagraph (B) the following:
       ``(C) Mechanism to ensure cost-effective drug purchasing.--
     Subject to subparagraph (B), mechanisms to ensure that safe 
     and effective pharmaceuticals, including antiretrovirals and 
     medicines to treat opportunistic infections, are purchased at 
     the lowest possible price at which such pharmaceuticals may 
     be obtained in sufficient quantity on the world market.'';
       (5) in paragraph (6)--
       (A) by amending the paragraph heading to read as follows:
       ``(6) Related and coordinated
     activities.--'';
       (B) in subparagraph (B), by striking ``and'' at the end;
       (C) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (D) by adding at the end the following:
       ``(D) coordinated or referred activities to--
       ``(i) enhance the clinical impact of HIV/AIDS care and 
     treatment; and
       ``(ii) ameliorate the adverse social and economic costs 
     often affecting AIDS-impacted families and communities 
     through the direct provision, as necessary, or through the 
     referral, if possible, of support services, including--

       ``(I) nutritional and food support;
       ``(II) nutritional counseling;
       ``(III) income-generating activities and livelihood 
     initiatives;
       ``(IV) maternal and child health care;
       ``(V) primary health care;
       ``(VI) the diagnosis and treatment of other infectious or 
     sexually transmitted diseases;
       ``(VII) substance abuse and treatment services; and
       ``(VIII) legal services;

       ``(E) coordinated or referred activities to link programs 
     addressing HIV/AIDS with programs addressing gender-based 
     violence in areas of significant HIV prevalence to assist 
     countries in the development and enforcement of women's 
     health, children's health, and HIV/AIDS laws and policies 
     that--
       ``(i) prevent and respond to violence against women and 
     girls;
       ``(ii) promote the integration of screening and assessment 
     for gender-based violence into HIV/AIDS programming;
       ``(iii) promote appropriate HIV/AIDS counseling, testing, 
     and treatment into gender-based violence programs; and
       ``(iv) assist governments to develop partnerships with 
     civil society organizations to create networks for 
     psychosocial, legal, economic, or other support services;
       ``(F) coordinated or referred activities to--
       ``(i) address the frequent coinfection of HIV and 
     tuberculosis, in accordance with World Health Organization 
     guidelines;
       ``(ii) promote provider-initiated or `opt-out' HIV/AIDS 
     counseling and testing and appropriate referral for treatment 
     and care to individuals with tuberculosis or its symptoms, 
     particularly in areas with significant HIV prevalence; and
       ``(iii) strengthen programs to ensure that individuals 
     testing positive for HIV receive tuberculosis screening and 
     appropriate screening and to improve laboratory capacities, 
     infection control, and adherence; and
       ``(G) activities to--
       ``(i) improve the effectiveness of national responses to 
     HIV/AIDS; and
       ``(ii) strengthen overall health systems in high-prevalence 
     countries, including support for workforce training, 
     retention, and effective deployment, capacity building, 
     laboratory development, equipment maintenance and repair, and 
     public health and related public financial management systems 
     and operations.''; and
       (6) by adding at the end the following:
       ``(8) Compacts and framework agreements.--The development 
     of compacts or framework agreements, tailored to local 
     circumstances, with national governments or regional 
     partnerships in countries with significant HIV/AIDS burdens 
     to promote host government commitment to deeper integration 
     of HIV/AIDS services into health systems, contribute to 
     health systems overall, and enhance sustainability.''.
       (d) Compacts and Framework Agreements.--Section 104A of 
     such Act is amended--
       (1) by redesignating subsections (e) through (g) as 
     subsections (f) through (h); and
       (2) by inserting after subsection (d) the following:
       ``(e) Compacts and Framework Agreements.--
       ``(1) Findings.--Congress makes the following findings:
       ``(A) The congressionally mandated Institute of Medicine 
     report entitled `PEPFAR Implementation: Progress and Promise' 
     states: `The next strategy [of the U.S. Global AIDS 
     Initiative] should squarely address the needs and challenges 
     involved in supporting sustainable country HIV/AIDS programs, 
     thereby transitioning from a focus on emergency relief.'.
       ``(B) One mechanism to promote the transition from an 
     emergency to a public health and development approach to HIV/
     AIDS is through compacts or framework agreements between the 
     United States Government and each participating nation.
       ``(C) Key components of a transition toward a more 
     sustainable approach toward fighting HIV/AIDS, tuberculosis, 
     and malaria and thus priorities for such compacts include--
       ``(i) building capacity to expand the size of the trained 
     health care workforce in partner countries and improve its 
     retention, safety, deployment, and utilization of skills and 
     to improve public health infrastructure and systems;
       ``(ii) partner governments increasing their national 
     investments in health and education systems, as called for in 
     the Abuja Declaration;
       ``(iii) increasing the focus of United States government 
     efforts to address the factors that put women and girls at 
     greater risk of HIV/AIDS and to strengthen the legal, 
     economic, educational, and social status of women, girls, 
     orphans, and vulnerable children and encouraging partner 
     governments to do the same;
       ``(iv) building on the New Partners Initiative and other 
     efforts currently underway to strengthen the capacities of 
     community- and faith-based organizations and civil society in 
     partner countries to contribute to country efforts to prevent 
     or manage the effects of HIV/AIDS, tuberculosis, and malaria 
     epidemics and to improve health care delivery;
       ``(v) improving the coordination of efforts to combat HIV/
     AIDS, tuberculosis, and malaria with broader national health 
     and development strategies;
       ``(vi) promoting HIV/AIDS-related laws, regulations, and 
     policies that support voluntary diagnostic counseling and 
     rapid testing, pediatric diagnosis, rapid, tariff-free 
     regulatory procedures for drugs and commodities, and full 
     inclusion of people living with HIV/AIDS in a multisectoral 
     national response.
       ``(vii) sharing and implementing findings based on program 
     evaluations and operations research; and
       ``(viii) reducing the disease burden of HIV/AIDS, 
     tuberculosis, and malaria through improved prevention 
     efforts.
       ``(D) Such compacts should also take into account the 
     overall national health and development and national HIV/AIDS 
     and public health strategies of each country and should 
     contain provisions including--
       ``(i) the specific objectives that the country and the 
     United States expect to achieve during the term of a compact;
       ``(ii) the respective responsibilities of the country and 
     the United States in the achievement of such objectives;
       ``(iii) regular benchmarks to measure, where appropriate, 
     progress toward achieving such objectives;
       ``(iv) an identification of the intended beneficiaries, 
     disaggregated by gender and age, and including information on 
     orphans and vulnerable children, to the maximum extent 
     practicable;
       ``(v) the methods by which the compact is intended to 
     address the factors that put women and girls at greater risk 
     of HIV/AIDS and to strengthen the legal, economic, 
     educational, and social status of women, girls, orphans, and 
     vulnerable children;
       ``(vi) the methods by which the compact will strengthen the 
     health care capacity, including the training, retention, 
     deployment, and utilization of health care workers, improve 
     supply chain management, and improve the health systems and 
     infrastructure of the partner country, including the ability 
     of compact participants to maintain and operate equipment 
     transferred or purchased as part of the compact;
       ``(vii) proposed mechanisms to provide oversight;
       ``(viii) the role of civil society in the development of a 
     compact and the achievement of its objectives;
       ``(ix) a description of the current and potential 
     participation of other donors in the achievement of such 
     objectives, as appropriate; and
       ``(x) a plan to ensure appropriate fiscal accountability 
     for the use of assistance.
       ``(2) Local input.--In entering into a compact authorized 
     under subsection (d)(8), the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally shall seek 
     to ensure that the government of a country--
       ``(A) takes into account the local perspectives of the 
     rural and urban poor, including women, in each country; and
       ``(B) consults with private and voluntary organizations, 
     including faith-based organizations, the business community, 
     and other donors in the country.
       ``(3) Congressional and public notification after entering 
     into a compact.--Not later than 10 days after entering into a 
     compact authorized under subsection (d)(8), the Global AIDS 
     Coordinator shall--
       ``(A) submit a report containing a detailed summary of the 
     compact and a copy of the text of the compact to--
       ``(i) the Committee on Foreign Relations of the Senate;
       ``(ii) the Committee on Appropriations of the Senate;
       ``(iii) the Committee on Foreign Affairs of the House of 
     Representatives; and
       ``(iv) the Committee on Appropriations of the House of 
     Representatives; and
       ``(B) publish such information in the Federal Register and 
     on the Internet website of the Office of the Global AIDS 
     Coordinator.''.
       (e) Annual Report.--Section 104A(f) of such Act, as 
     redesignated, is amended--
       (1) in paragraph (1), by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs''; and
       (2) in paragraph (2)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) by striking subparagraph (C) and inserting the 
     following:
       ``(C) a detailed breakdown of funding allocations, by 
     program and by country, for prevention activities; and
       ``(D) a detailed assessment of the impact of programs 
     established pursuant to such sections, including--

[[Page S6629]]

       ``(i)(I) the effectiveness of such programs in reducing--

       ``(aa) the transmission of HIV, particularly in women and 
     girls;
       ``(bb) mother-to-child transmission of HIV, including 
     through drug treatment and therapies, either directly or by 
     referral; and
       ``(cc) mortality rates from HIV/AIDS;

       ``(II) the number of patients receiving treatment for AIDS 
     in each country that receives assistance under this Act;
       ``(III) an assessment of progress towards the achievement 
     of annual goals set forth in the timetable required under the 
     5-year strategy established under section 101 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 and, if annual goals are not being met, the 
     reasons for such failure; and
       ``(IV) retention and attrition data for programs receiving 
     United States assistance, including mortality and loss to 
     follow-up rates, organized overall and by country;
       ``(ii) the progress made toward--

       ``(I) improving health care delivery systems (including the 
     training of health care workers, including doctors, nurses, 
     midwives, pharmacists, laboratory technicians, and 
     compensated community health workers);
       ``(II) advancing safe working conditions for health care 
     workers; and
       ``(III) improving infrastructure to promote progress toward 
     universal access to HIV/AIDS prevention, treatment, and care 
     by 2013;

       ``(iii) with respect to tuberculosis--

       ``(I) the increase in the number of people treated and the 
     number of tuberculosis patients cured through each program, 
     project, or activity receiving United States foreign 
     assistance for tuberculosis control purposes through, or in 
     coordination with, HIV/AIDS programs;
       ``(II) a description of drug resistance rates among persons 
     treated;
       ``(III) the percentage of such United States foreign 
     assistance provided for diagnosis and treatment of 
     individuals with tuberculosis in countries with the highest 
     burden of tuberculosis, as determined by the World Health 
     Organization; and
       ``(IV) a detailed description of efforts to integrate HIV/
     AIDS and tuberculosis prevention, treatment, and care 
     programs; and

       ``(iv) a description of coordination efforts with relevant 
     executive branch agencies to link HIV/AIDS clinical and 
     social services with non-HIV/AIDS services as part of the 
     United States health and development agenda;
       ``(v) a detailed description of integrated HIV/AIDS and 
     food and nutrition programs and services, including--

       ``(I) the amount spent on food and nutrition support;
       ``(II) the types of activities supported; and
       ``(III) an assessment of the effectiveness of interventions 
     carried out to improve the health status of persons with HIV/
     AIDS receiving food or nutritional support;

       ``(vi) a description of efforts to improve harmonization, 
     in terms of relevant executive branch agencies, coordination 
     with other public and private entities, and coordination with 
     partner countries' national strategic plans as called for in 
     the `Three Ones';
       ``(vii) a description of--

       ``(I) the efforts of partner countries that were 
     signatories to the Abuja Declaration on HIV/AIDS, 
     Tuberculosis and Other Related Infectious Diseases to adhere 
     to the goals of such Declaration in terms of investments in 
     public health, including HIV/AIDS; and
       ``(II) a description of the HIV/AIDS investments of partner 
     countries that were not signatories to such Declaration;

       ``(viii) a detailed description of any compacts or 
     framework agreements reached or negotiated between the United 
     States and any partner countries, including a description of 
     the elements of compacts described in subsection (e);
       ``(ix) a description of programs serving women and girls, 
     including--

       ``(I) HIV/AIDS prevention programs that address the 
     vulnerabilities of girls and women to HIV/AIDS;
       ``(II) information on the number of individuals served by 
     programs aimed at reducing the vulnerabilities of women and 
     girls to HIV/AIDS and data on the types, objectives, and 
     duration of programs to address these issues;
       ``(III) information on programs to address the particular 
     needs of adolescent girls and young women; and
       ``(IV) programs to prevent gender-based violence or to 
     assist victims of gender based violence as part, of or in 
     coordination with, HIV/AIDS programs;

       ``(x) a description of strategies, goals, programs, and 
     interventions to--

       ``(I) address the needs and vulnerabilities of youth 
     populations;
       ``(II) expand access among young men and women to evidence-
     based HIV/AIDS health care services and HIV prevention 
     programs, including abstinence education programs; and
       ``(III) expand community-based services to meet the needs 
     of orphans and of children and adolescents affected by or 
     vulnerable to HIV/AIDS without increasing stigmatization;

       ``(xi) a description of--

       ``(I) the specific strategies funded to ensure the 
     reduction of HIV infection among injection drug users;
       ``(II) the number of injection drug users, by country, 
     reached by such strategies;
       ``(III) medication-assisted drug treatment for individuals 
     with HIV or at risk of HIV; and
       ``(IV) HIV prevention programs demonstrated to be effective 
     in reducing HIV transmission without increasing drug use;

       ``(xii) a detailed description of program monitoring, 
     operations research, and impact evaluation research, 
     including--

       ``(I) the amount of funding provided for each research 
     type;
       ``(II) an analysis of cost-effectiveness models; and
       ``(III) conclusions regarding the efficiency, 
     effectiveness, and quality of services as derived from 
     previous or ongoing research and monitoring efforts; and

       ``(xiii) a description of staffing levels of United States 
     government HIV/AIDS teams in countries with significant HIV/
     AIDS programs, including whether or not a full-time 
     coordinator was on staff for the year.''.
       (f) Authorization of Appropriations.--Section 301(b) of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7631(b)) is amended--
       (1) in paragraph (1), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''; and
       (2) in paragraph (3), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.
       (g) Relationship To Assistance Programs To Enhance 
     Nutrition.--Section 301(c) of such Act is amended to read as 
     follows:
       ``(c) Food and Nutritional Support.--
       ``(1) In general.--As indicated in the report produced by 
     the Institute of Medicine, entitled `PEPFAR Implementation: 
     Progress and Promise', inadequate caloric intake has been 
     clearly identified as a principal reason for failure of 
     clinical response to antiretroviral therapy. In recognition 
     of the impact of malnutrition as a clinical health issue for 
     many persons living with HIV/AIDS that is often associated 
     with health and economic impacts on these individuals and 
     their families, the Global AIDS Coordinator and the 
     Administrator of the United States Agency for International 
     Development shall--
       ``(A) follow World Health Organization guidelines for HIV/
     AIDS food and nutrition services;
       ``(B) integrate nutrition programs with HIV/AIDS activities 
     through effective linkages among the health, agricultural, 
     and livelihood sectors and establish additional services in 
     circumstances in which referrals are inadequate or 
     impossible;
       ``(C) provide, as a component of care and treatment 
     programs for persons with HIV/AIDS, food and nutritional 
     support to individuals infected with, and affected by, HIV/
     AIDS who meet established criteria for nutritional support 
     (including clinically malnourished children and adults, and 
     pregnant and lactating women in programs in need of 
     supplemental support), including--
       ``(i) anthropometric and dietary assessment;
       ``(ii) counseling; and
       ``(iii) therapeutic and supplementary feeding;
       ``(D) provide food and nutritional support for children 
     affected by HIV/AIDS and to communities and households caring 
     for children affected by HIV/AIDS; and
       ``(E) in communities where HIV/AIDS and food insecurity are 
     highly prevalent, support programs to address these often 
     intersecting health problems through community-based 
     assistance programs, with an emphasis on sustainable 
     approaches.
       ``(2) Authorization of appropriations.--Of the amounts 
     authorized to be appropriated under section 401, there are 
     authorized to be appropriated to the President such sums as 
     may be necessary for each of the fiscal years 2009 through 
     2013 to carry out this subsection.''.
       (h) Eligibility for Assistance.--Section 301(d) of such Act 
     is amended to read as follows:
       ``(d) Eligibility for Assistance.--An organization, 
     including a faith-based organization, that is otherwise 
     eligible to receive assistance under section 104A of the 
     Foreign Assistance Act of 1961, under this Act, or under any 
     amendment made by this Act or by the Tom Lantos and Henry J. 
     Hyde United States Global Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Reauthorization Act of 2008, to 
     prevent, treat, or monitor HIV/AIDS--
       ``(1) shall not be required, as a condition of receiving 
     such assistance--
       ``(A) to endorse or utilize a multisectoral or 
     comprehensive approach to combating HIV/AIDS; or
       ``(B) to endorse, utilize, make a referral to, become 
     integrated with, or otherwise participate in any program or 
     activity to which the organization has a religious or moral 
     objection; and
       ``(2) shall not be discriminated against in the 
     solicitation or issuance of grants, contracts, or cooperative 
     agreements under such provisions of law for refusing to meet 
     any requirement described in paragraph (1).''.

     SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

       (a) Policy.--Section 104B(b) of the Foreign Assistance Act 
     of 1961 (22 U.S.C. 2151b-3(b)) is amended to read as follows:
       ``(b) Policy.--It is a major objective of the foreign 
     assistance program of the United States to control 
     tuberculosis. In all countries in which the Government of the 
     United States has established development programs, 
     particularly in countries with the highest burden of 
     tuberculosis and other countries with high rates of 
     tuberculosis, the United States Government should prioritize 
     the achievement of the following goals by not later than 
     December 31, 2015:
       ``(1) Reduce by half the tuberculosis death and disease 
     burden from the 1990 baseline.
       ``(2) Sustain or exceed the detection of at least 70 
     percent of sputum smear-positive cases of tuberculosis and 
     the cure of at least 85 percent of those cases detected.''.
       (b) Priority To Stop TB Strategy.--Section 104B(e) of such 
     Act is amended to read as follows:
       ``(e) Priority To Stop TB Strategy.--In furnishing 
     assistance under subsection (c), the President shall give 
     priority to--
       ``(1) activities described in the Stop TB Strategy, 
     including expansion and enhancement of

[[Page S6630]]

     Directly Observed Treatment Short-course (DOTS) coverage, 
     rapid testing, treatment for individuals infected with both 
     tuberculosis and HIV, and treatment for individuals with 
     multi-drug resistant tuberculosis (MDR-TB), strengthening of 
     health systems, use of the International Standards for 
     Tuberculosis Care by all providers, empowering individuals 
     with tuberculosis, and enabling and promoting research to 
     develop new diagnostics, drugs, and vaccines, and program-
     based operational research relating to tuberculosis; and
       ``(2) funding for the Global Tuberculosis Drug Facility, 
     the Stop Tuberculosis Partnership, and the Global Alliance 
     for TB Drug Development.''.
       (c) Assistance for the World Health Organization and the 
     Stop Tuberculosis Partnership.--Section 104B of such Act is 
     amended--
       (1) by redesignating subsection (f) as subsection (g); and
       (2) by inserting after subsection (e) the following:
       ``(f) Assistance for the World Health Organization and the 
     Stop Tuberculosis Partnership.--In carrying out this section, 
     the President, acting through the Administrator of the United 
     States Agency for International Development, is authorized to 
     provide increased resources to the World Health Organization 
     and the Stop Tuberculosis Partnership to improve the capacity 
     of countries with high rates of tuberculosis and other 
     affected countries to implement the Stop TB Strategy and 
     specific strategies related to addressing multiple drug 
     resistant tuberculosis (MDR-TB) and extensively drug 
     resistant tuberculosis (XDR-TB).''.
       (d) Definitions.--Section 104B(g) of such Act, as 
     redesignated, is amended--
       (1) in paragraph (1), by striking the period at the end and 
     inserting the following: ``including--
       ``(A) low-cost and effective diagnosis, treatment, and 
     monitoring of tuberculosis;
       ``(B) a reliable drug supply;
       ``(C) a management strategy for public health systems;
       ``(D) health system strengthening;
       ``(E) promotion of the use of the International Standards 
     for Tuberculosis Care by all care providers;
       ``(F) bacteriology under an external quality assessment 
     framework;
       ``(G) short-course chemotherapy; and
       ``(H) sound reporting and recording systems.''; and
       (2) by redesignating paragraph (5) as paragraph (6); and
       (3) by inserting after paragraph (4) the following:
       ``(5) Stop tb strategy.--The term `Stop TB Strategy' means 
     the 6-point strategy to reduce tuberculosis developed by the 
     World Health Organization, which is described in the Global 
     Plan to Stop TB 2006-2015: Actions for Life, a comprehensive 
     plan developed by the Stop TB Partnership that sets out the 
     actions necessary to achieve the millennium development goal 
     of cutting tuberculosis deaths and disease burden in half by 
     2015.''.
       (e) Authorization of Appropriations.--Section 302 (b) of 
     the United States Leadership Against HIV/AIDS, Tuberculosis, 
     and Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended--
       (1) in paragraph (1), by striking ``such sums as may be 
     necessary for each of the fiscal years 2004 through 2008'' 
     and inserting ``a total of $4,000,000,000 for the 5-year 
     period beginning on October 1, 2008.''; and
       (2) in paragraph (3), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013.''.

     SEC. 303. ASSISTANCE TO COMBAT MALARIA.

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

     SEC. 304. MALARIA RESPONSE COORDINATOR.

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

     ``SEC. 304. MALARIA RESPONSE COORDINATOR.

       ``(a) In General.--There is established within the United 
     States Agency for International Development a Coordinator of 
     United States Government Activities to Combat Malaria 
     Globally (referred to in this section as the `Malaria 
     Coordinator'), who shall be appointed by the President.
       ``(b) Authorities.--The Malaria Coordinator, acting through 
     nongovernmental organizations (including faith-based and 
     community-based organizations), partner country finance, 
     health, and other relevant ministries, and relevant executive 
     branch agencies as may be necessary and appropriate to carry 
     out this section, is authorized to--
       ``(1) operate internationally to carry out prevention, 
     care, treatment, support, capacity development, and other 
     activities to reduce the prevalence, mortality, and incidence 
     of malaria;
       ``(2) provide grants to, and enter into contracts and 
     cooperative agreements with, nongovernmental organizations 
     (including faith-based organizations) to carry out this 
     section; and
       ``(3) transfer and allocate executive branch agency funds 
     that have been appropriated for the purposes described in 
     paragraphs (1) and (2).
       ``(c) Duties.--
       ``(1) In general.--The Malaria Coordinator has primary 
     responsibility for the oversight and coordination of all 
     resources and international activities of the United States 
     Government relating to efforts to combat malaria.
       ``(2) Specific duties.--The Malaria Coordinator shall--
       ``(A) facilitate program and policy coordination of 
     antimalaria efforts among relevant executive branch agencies 
     and nongovernmental organizations by auditing, monitoring, 
     and evaluating such programs;
       ``(B) ensure that each relevant executive branch agency 
     undertakes antimalarial programs primarily in those areas in 
     which the agency has the greatest expertise, technical 
     capability, and potential for success;
       ``(C) coordinate relevant executive branch agency 
     activities in the field of malaria prevention and treatment;
       ``(D) coordinate planning, implementation, and evaluation 
     with the Global AIDS Coordinator in countries in which both 
     programs have a significant presence;
       ``(E) coordinate with national governments, international 
     agencies, civil society, and the private sector; and
       ``(F) establish due diligence criteria for all recipients 
     of funds appropriated by the Federal Government for malaria 
     assistance.
       ``(d) Assistance for the World Health Organization.--In 
     carrying out this section, the President may provide 
     financial assistance to the Roll Back Malaria Partnership of 
     the World Health Organization to improve the capacity of 
     countries with high rates of malaria and other affected 
     countries to implement comprehensive malaria control 
     programs.
       ``(e) Coordination of Assistance Efforts.--In carrying out 
     this section and in accordance with section 104C of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4), the 
     Malaria Coordinator shall coordinate the provision of 
     assistance by working with--
       ``(1) relevant executive branch agencies, including--
       ``(A) the Department of State (including the Office of the 
     Global AIDS Coordinator);
       ``(B) the Department of Health and Human Services;
       ``(C) the Department of Defense; and
       ``(D) the Office of the United States Trade Representative;
       ``(2) relevant multilateral institutions, including--
       ``(A) the World Health Organization;
       ``(B) the United Nations Children's Fund;
       ``(C) the United Nations Development Programme;
       ``(D) the Global Fund;
       ``(E) the World Bank; and
       ``(F) the Roll Back Malaria Partnership;
       ``(3) program delivery and efforts to lift barriers that 
     would impede effective and comprehensive malaria control 
     programs; and
       ``(4) partner or recipient country governments and national 
     entities including universities and civil society 
     organizations (including faith- and community-based 
     organizations).
       ``(f) Research.--To carry out this section and in 
     accordance with section 104C of the Foreign Assistance Act of 
     1961 (22 U.S.C. 1151d-4), the

[[Page S6631]]

     Secretary of Health and Human Services, through the Centers 
     for Disease Control and Prevention and the National 
     Institutes of Health, shall conduct appropriate 
     programmatically relevant clinical and operational research 
     to identify and evaluate new diagnostics, treatment regimens, 
     and interventions to prevent and control malaria.
       ``(g) Monitoring.--To ensure that adequate malaria controls 
     are established and implemented, the Centers for Disease 
     Control and Prevention shall carry out appropriate 
     surveillance and evaluation activities to monitor global 
     malaria trends and assess environmental and health impacts of 
     malarial control efforts. Such activities shall complement 
     the work of the World Health Organization, rather than 
     duplicate such work.
       ``(h) Annual Report.--
       ``(1) Submission.--Not later than 1 year after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde United 
     States Global Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Reauthorization Act of 2008, and annually thereafter, 
     the President shall submit a report to the appropriate 
     congressional committees that describes United States 
     assistance for the prevention, treatment, control, and 
     elimination of malaria.
       ``(2) Contents.--The report required under paragraph (1) 
     shall describe--
       ``(A) the countries and activities to which malaria 
     resources have been allocated;
       ``(B) the number of people reached through malaria 
     assistance programs, including data on children and pregnant 
     women;
       ``(C) research efforts to develop new tools to combat 
     malaria, including drugs and vaccines;
       ``(D) the collaboration and coordination of United States 
     antimalarial efforts with the World Health Organization, the 
     Global Fund, the World Bank, other donor governments, major 
     private efforts, and relevant executive agencies;
       ``(E) the coordination of United States antimalarial 
     efforts with the national malarial strategies of other donor 
     or partner governments and major private initiatives;
       ``(F) the estimated impact of United States assistance on 
     childhood mortality and morbidity from malaria;
       ``(G) the coordination of antimalarial efforts with broader 
     health and development programs; and
       ``(H) the constraints on implementation of programs posed 
     by health workforce shortages or capacities; and
       ``(I) the number of personnel trained as health workers and 
     the training levels achieved.''.

     SEC. 305. AMENDMENT TO IMMIGRATION AND NATIONALITY ACT.

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

     SEC. 306. CLERICAL AMENDMENT.

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

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

     SEC. 307. REQUIREMENTS.

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

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

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

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

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

                     TITLE IV--FUNDING ALLOCATIONS

     SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

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

     SEC. 402. SENSE OF CONGRESS.

       Section 402(b) of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7672(b)) is amended by striking ``an effective distribution 
     of such

[[Page S6632]]

     amounts would be'' and all that follows through ``10 percent 
     of such amounts'' and inserting ``10 percent should be 
     used''.

     SEC. 403. ALLOCATION OF FUNDS.

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


                   Unanimous-Consent request--S. 3186

  Mr. REID. Mr. President, I now ask unanimous consent that upon 
disposition of S. 2731/H.R. 5501, the global AIDS legislation, the 
Senate then proceed to Calendar No. 835, S. 3186, which is a bill to 
provide for the Low-Income Home Energy Assistance Program.
  The PRESIDING OFFICER. Is there objection?
  Mr. LUGAR. Mr. President, reserving the right to object.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. LUGAR. Mr. President, I have asked the leader for clarification 
of the situation. My understanding is that, as things stood, we would 
be automatically moving on to discussion of PEPFAR. I appreciate the 
anxiety of the leader with regard to the situation, but, at the same 
time, from our standpoint on this side of the aisle, I have been 
advised we would need to object to that simply because the agreement 
our Members feel they have realized would be that we would move to 
PEPFAR today and have the debates on PEPFAR, as opposed to additional 
material.
  Mr. REID. Mr. President, I would say to my friend that is absolutely 
what we are going to do. The only way we would not do that is if you 
object to it. I have explained in more detail than probably everyone 
wants to hear, but we have a situation now, procedurally in the Senate, 
where there is a spot open. It has nothing to do with PEPFAR. It is 
separate and apart from PEPFAR. There is an empty spot there that 
anyone can walk in here--any Senator can walk in here--and move to 
anything we have on the calendar. By doing that, of course, they could 
also accompany that with a cloture motion, and that is what we would be 
on. That would take away from what the President wants and, I would 
say, 90 Senators want. So I am not trying to take advantage of anyone. 
No one loses anything, nothing, other than the ability to sucker punch 
the entire Senate.
  So I would say to my friend, the distinguished Senator from Indiana, 
if we are on this matter here, I would be happy to--and no harm can be 
done. If people do not want us to move to that, I could not do it. I 
could not do it anyway. I would have to have 60 Senators to agree to 
that. This is simply an effort to allow us to complete PEPFAR--without 
using the term too many times; this is the third time I have used it--
without the entire Senate being sucker punched.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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