[Congressional Record Volume 154, Number 122 (Thursday, July 24, 2008)]
[House]
[Pages H7097-H7122]
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

  Mr. BERMAN. Mr. Speaker, pursuant to House Resolution 1362, I call 
from the Speaker's table the bill (H.R. 5501) to authorize 
appropriations for fiscal years 2009 through 2013 to provide assistance 
to foreign countries to combat HIV/AIDS, tuberculosis, and malaria, and 
for other purposes, with a Senate amendment thereto, and ask for its 
immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. The Clerk will designate the Senate 
amendment.
  The text of the Senate amendment is as follows:

       Senate amendment:
       Strike all after the enacting clause and insert 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.

                         TITLE V--MISCELLANEOUS

Sec. 501. Machine readable visa fees.

         TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

Sec. 601. Emergency plan for Indian safety and health.

     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

[[Page H7098]]

     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.''; and
       (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, 
     statistical analysis, and other appropriate scientific 
     methods 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.''.

     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) expand health workforce; 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--
       ``(i) the increase in the number of individuals with HIV/
     AIDS receiving antiretroviral treatment above the goal 
     established under section 402(a)(3) and increased pursuant to 
     paragraphs (1) through (3) of section 403(d); and
       ``(ii) additional treatment through coordinated 
     multilateral efforts;
       ``(C) support care for 12,000,000 individuals infected with 
     or affected by 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 and support for persons with, or affected by, HIV/
     AIDS;
       ``(H) provide and share best practices for combating HIV/
     AIDS with health professionals;
       ``(I) promote pediatric HIV/AIDS training for physicians, 
     nurses, and other health care workers, through public-private 
     partnerships if possible, including through the designation, 
     if appropriate, of centers of excellence for training in 
     pediatric HIV/AIDS prevention, care, and treatment in partner 
     countries; and
       ``(J) 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 with an emphasis on 
     training and in country deployment of critically needed 
     doctors and nurses 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 with country-level benchmarks for antiretroviral 
     treatment;
       ``(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) support the in-country or intra-regional training, 
     preferably through public-private partnerships, of scientific 
     investigators, managers, and other staff who are capable of 
     promoting the systematic uptake of clinical research findings 
     and other evidence-based interventions into routine practice, 
     with the goal of improving the quality, effectiveness, and 
     local leadership of HIV/AIDS health care;

[[Page H7099]]

       ``(10) expand and accelerate research on and development of 
     HIV/AIDS prevention methods for women, including enhancing 
     inter-agency collaboration, staffing, and organizational 
     infrastructure dedicated to microbicide research;
       ``(11) 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;
       ``(12) 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 partner country and community efforts to 
     identify and address social, economic, or cultural factors, 
     such as migration, urbanization, conflict, gender-based 
     violence, lack of empowerment for women, and transportation 
     patterns, which directly contribute to the transmission of 
     HIV;
       ``(H) supporting comprehensive programs to promote 
     alternative livelihoods, safety, and social reintegration 
     strategies for commercial sex workers and their families;
       ``(I) promoting cooperation with law enforcement to 
     prosecute offenders of trafficking, rape, and sexual assault 
     crimes with the goal of eliminating such crimes; and
       ``(J) working to eliminate rape, gender-based violence, 
     sexual assault, and the sexual exploitation of women and 
     children;
       ``(13) include programs to reduce the transmission of HIV, 
     particularly addressing the heightened vulnerabilities of 
     women and girls to HIV in many countries; and
       ``(14) 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;
       ``(C) promoting universal precautions in formal and 
     informal health care settings;
       ``(D) educating the public to recognize and to avoid risks 
     to contract HIV through blood exposures during formal and 
     informal health care and cosmetic services;
       ``(E) investigating suspected nosocomial infections to 
     identify and stop further nosocomial transmission; and
       ``(F) other mechanisms to reduce the transmission of HIV;
       ``(15) increase support for prevention of mother-to-child 
     transmission;
       ``(16) build capacity within the public health sector of 
     developing countries by improving health systems and public 
     health infrastructure and developing indicators to measure 
     changes in broader public health sector capabilities;
       ``(17) increase the coordination of HIV/AIDS programs with 
     development programs;
       ``(18) 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;
       ``(19) provide a plan for national and regional priorities 
     for resource distribution and a global investment plan by 
     region;
       ``(20) 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, 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;
       ``(21) provide a plan to--
       ``(A) determine the local factors that may put men and boys 
     at elevated risk of contracting or transmitting HIV;
       ``(B) address male norms and behaviors to reduce these 
     risks, including by reducing alcohol abuse;
       ``(C) promote responsible male behavior; and
       ``(D) promote male participation and leadership at the 
     community level in efforts to promote HIV prevention, reduce 
     stigma, promote participation in voluntary counseling and 
     testing, and provide care, treatment, and support for persons 
     with HIV/AIDS;
       ``(22) provide a plan to address the vulnerabilities and 
     needs of orphans and children who are vulnerable to, or 
     affected by, HIV/AIDS;
       ``(23) encourage partner countries to develop health care 
     curricula and promote access to training tailored to 
     individuals receiving services through, or exiting from, 
     existing programs geared to orphans and vulnerable children;
       ``(24) 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;
       ``(25) enhance the coordination of United States bilateral 
     efforts to combat global HIV/AIDS with other major public and 
     private entities;
       ``(26) 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;
       ``(27) 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;
       ``(28) ensure coordination between the Global AIDS 
     Coordinator and the Malaria Coordinator and address issues of 
     comorbidity between HIV/AIDS and malaria; and
       ``(29) 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 with country-level 
     estimates of numbers of persons in need of antiretroviral 
     treatment, country-level benchmarks for United States support 
     for assistance for antiretroviral treatment, and numbers of 
     persons enrolled in antiretroviral treatment programs 
     receiving United States support. If global benchmarks are not 
     achieved within the reporting period, the report shall 
     include a description of steps being taken to ensure that 
     global benchmarks will be achieved and a detailed breakdown 
     and justification of spending priorities in countries in 
     which benchmarks are not being met, including a description 
     of other donor or national support for antiretroviral 
     treatment in the country, if appropriate.
       ``(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 (K), 
     an examination of additional planned means of preventing the 
     transmission of

[[Page H7100]]

     HIV including medical male circumcision, maintenance of a 
     safe blood supply, public education about risks to acquire 
     HIV infection from blood exposures, promotion of universal 
     precautions, investigation of suspected nosocomial infections 
     and other tools.
       ``(M) A description of efforts to assist partner country 
     and community to identify and address social, economic, or 
     cultural factors, such as migration, urbanization, conflict, 
     gender-based violence, lack of empowerment for women, and 
     transportation patterns, which directly contribute to the 
     transmission of HIV.
       ``(N) 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) activities directed toward men and boys;
       ``(ii) activities to enhance educational, microfinance, and 
     livelihood opportunities for women and girls;
       ``(iii) activities to promote and protect the legal 
     empowerment of women, girls, and orphans and vulnerable 
     children;
       ``(iv) programs targeted toward gender-based violence and 
     sexual coercion;
       ``(v) strategies to meet the particular needs of 
     adolescents;
       ``(vi) assistance for victims of rape, sexual abuse, 
     assault, exploitation, and trafficking; and
       ``(vii) programs to prevent alcohol abuse.
       ``(O) A description of strategies to address male norms and 
     behaviors that contribute to the transmission of HIV, to 
     promote responsible male behavior, and to promote male 
     participation and leadership in HIV/AIDS prevention, care, 
     treatment, and voluntary counseling and testing.
       ``(P) 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.
       ``(Q) 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.
       ``(R) 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 the use of codes of conduct for ethical 
     recruiting practices for health care workers; and
       ``(vi) increase the sustainability of health programs.
       ``(S) 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.
       ``(T) A strategy to better coordinate HIV/AIDS assistance 
     with nutrition and food assistance programs.
       ``(U) A description of transnational or regional 
     initiatives to combat regionalized epidemics in highly 
     affected areas such as the Caribbean.
       ``(V) A description of planned resource distribution and 
     global investment by region.
       ``(W) 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.
       ``(X) A description of coordination efforts to address 
     malaria and comorbidity with malaria and HIV/AIDS.''.
       (c) Study.--Section 101(c) of such Act (22 U.S.C. 7611(c)) 
     is amended to read as follows:
       ``(c) Study of Progress Toward Achievement of Policy 
     Objectives.--
       ``(1) Design and budget plan for data evaluation.--The 
     Global AIDS Coordinator shall enter into a contract with the 
     Institute of Medicine of the National Academies that provides 
     that not later than 18 months after the date of the enactment 
     of the Tom Lantos and Henry J. Hyde United States Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008, the Institute, in consultation 
     with the Global AIDS Coordinator and other relevant parties 
     representing the public and private sector, shall provide the 
     Global AIDS Coordinator with a design plan and budget for the 
     evaluation and collection of baseline and subsequent data to 
     address the elements set forth in paragraph (2)(B). The 
     Global AIDS Coordinator shall submit the budget and design 
     plan to the appropriate congressional committees.
       ``(2) Study.--
       ``(A) In general.--Not later than 4 years after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde United 
     States Global Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Reauthorization Act of 2008, the Institute of 
     Medicine of the National Academies shall publish a study that 
     includes--
       ``(i) an assessment of the performance of United States-
     assisted global HIV/AIDS programs; and
       ``(ii) an evaluation of the impact on health of prevention, 
     treatment, and care efforts that are supported by United 
     States funding, including multilateral and bilateral programs 
     involving joint operations.
       ``(B) Content.--The study conducted under this paragraph 
     shall include--
       ``(i) an assessment of progress toward prevention, 
     treatment, and care targets;
       ``(ii) an assessment of the effects on health systems, 
     including on the financing and management of health systems 
     and the quality of service delivery and staffing;
       ``(iii) an assessment of efforts to address gender-specific 
     aspects of HIV/AIDS, including gender related constraints to 
     accessing services and addressing underlying social and 
     economic vulnerabilities of women and men;
       ``(iv) an evaluation of the impact of treatment and care 
     programs on 5-year survival rates, drug adherence, and the 
     emergence of drug resistance;
       ``(v) an evaluation of the impact of prevention programs on 
     HIV incidence in relevant population groups;
       ``(vi) an evaluation of the impact on child health and 
     welfare of interventions authorized under this Act on behalf 
     of orphans and vulnerable children;
       ``(vii) an evaluation of the impact of programs and 
     activities authorized in this Act on child mortality; and
       ``(viii) recommendations for improving the programs 
     referred to in subparagraph (A)(i).
       ``(C) Methodologies.--Assessments and impact evaluations 
     conducted under the study shall utilize sound statistical 
     methods and techniques for the behavioral sciences, including 
     random assignment methodologies as feasible. Qualitative data 
     on process variables should be used for assessments and 
     impact evaluations, wherever possible.
       ``(3) Contract authority.--The Institute of Medicine may 
     enter into contracts or cooperative agreements or award 
     grants to conduct the study under paragraph (2).
       ``(4) Authorization of appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out the study under this subsection.''.
       (d) Report.--Section 101 of such Act, as amended by this 
     section, is further amended by adding at the end the 
     following:
       ``(d) Comptroller General Report.--
       ``(1) Report required.--Not later than 3 years after the 
     date of the enactment of the Tom Lantos and Henry J. Hyde 
     United States Global Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Reauthorization Act of 2008, the 
     Comptroller General of the United States shall submit a 
     report on the global HIV/AIDS programs of the United States 
     to the appropriate congressional committees.
       ``(2) Contents.--The report required under paragraph (1) 
     shall include--
       ``(A) a description and assessment of the monitoring and 
     evaluation practices and policies in place for these 
     programs;
       ``(B) an assessment of coordination within Federal agencies 
     involved in these programs, examining both internal 
     coordination within these programs and integration with the 
     larger global health and development agenda of the United 
     States;
       ``(C) an assessment of procurement policies and practices 
     within these programs;
       ``(D) an assessment of harmonization with national 
     government HIV/AIDS and public health strategies as well as 
     other international efforts;
       ``(E) an assessment of the impact of global HIV/AIDS 
     funding and programs on other United States global health 
     programming; and
       ``(F) recommendations for improving the global HIV/AIDS 
     programs of the United States.
       ``(e) Best Practices Report.--
       ``(1) In general.--Not later than 1 year after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde United 
     States Global Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Reauthorization Act of 2008, and annually thereafter, 
     the Global AIDS Coordinator shall publish a best practices 
     report that highlights the programs receiving financial 
     assistance from the United States that have the potential for 
     replication or adaption, particularly at a low cost, across 
     global AIDS programs, including those that focus on both 
     generalized and localized epidemics.
       ``(2) Dissemination of findings.--
       ``(A) Publication on internet website.--The Global AIDS 
     Coordinator shall disseminate the full findings of the annual 
     best practices report on the Internet website of the Office 
     of the Global AIDS Coordinator.
       ``(B) Dissemination guidance.--The Global AIDS Coordinator 
     shall develop guidance to ensure timely submission and 
     dissemination of significant information regarding best 
     practices with respect to global AIDS programs.
       ``(f) Inspectors General.--
       ``(1) Oversight plan.--
       ``(A) Development.--The Inspectors General of the 
     Department of State and Broadcasting Board of Governors, the 
     Department of Health and Human Services, and the United 
     States Agency for International Development shall jointly 
     develop 5 coordinated annual plans for oversight activity in 
     each of the fiscal years 2009 through 2013, with regard to 
     the programs authorized under this Act and sections 104A, 
     104B, and 104C of the Foreign Assistance Act of 1961 (22 
     U.S.C. 2151b-2, 2151b-3, and 2151b-4).
       ``(B) Contents.--The plans developed under subparagraph (A) 
     shall include a schedule for financial audits, inspections, 
     and performance reviews, as appropriate.
       ``(C) Deadline.--
       ``(i) Initial plan.--The first plan developed under 
     subparagraph (A) shall be completed not later than the later 
     of--

       ``(I) September 1, 2008; or
       ``(II) 60 days after the date of the enactment of the Tom 
     Lantos and Henry J. Hyde United

[[Page H7101]]

     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 $15,000,000 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.''.
       (e) Annual Study; Message.--Section 101 of such Act, as 
     amended by this section, is further amended by adding at the 
     end the following:
       ``(g) Annual Study.--
       ``(1) In general.--Not later than September 30, 2009, and 
     annually thereafter through September 30, 2013, the Global 
     AIDS Coordinator shall complete a study of treatment 
     providers that--
       ``(A) represents a range of countries and service 
     environments;
       ``(B) estimates the per-patient cost of antiretroviral HIV/
     AIDS treatment and the care of people with HIV/AIDS not 
     receiving antiretroviral treatment, including a comparison of 
     the costs for equivalent services provided by programs not 
     receiving assistance under this Act;
       ``(C) estimates per-patient costs across the program and in 
     specific categories of service providers, including--
       ``(i) urban and rural providers;
       ``(ii) country-specific providers; and
       ``(iii) other subcategories, as appropriate.
       ``(2) Publication.--Not later than 90 days after the 
     completion of each study under paragraph (1), the Global AIDS 
     Coordinator shall make the results of such study available on 
     a publicly accessible Web site.
       ``(h) Message.--The Global AIDS Coordinator shall develop a 
     message, to be prominently displayed by each program 
     receiving funds under this Act, that--
       ``(1) demonstrates that the program is a commitment by 
     citizens of the United States to the global fight against 
     HIV/AIDS, tuberculosis, and malaria; and
       ``(2) enhances awareness by program recipients that the 
     program is an effort on behalf of the citizens of the United 
     States.''.

     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 of HIV or risk of significantly increasing 
     incidence of HIV within the general population and inadequate 
     financial means within the country.'';
       (F) by inserting after subclause (IX), as redesignated by 
     subparagraph (C), the following:

       ``(X) Working with partner countries in which the HIV/AIDS 
     epidemic is prevalent among injection drug users to 
     establish, as a national priority, national HIV/AIDS 
     prevention programs.
       ``(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)--
       (A) by striking ``fiscal years 2004 through 2008'' and 
     inserting ``fiscal years 2009 through 2013''; and
       (B) by striking ``Vaccine Fund'' and inserting ``GAVI 
     Fund''.
       (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

[[Page H7102]]

       ``(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;
       ``(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; and
       ``(I) the Global Fund should not support activities 
     involving the `Affordable Medicines Facility-Malaria' or 
     similar entities pending compelling evidence of success from 
     pilot programs as evaluated by the Coordinator of United 
     States Government Activities to Combat Malaria Globally.''.
       (b) Statement of Policy.--Section 202(b) of such Act is 
     amended by adding at the end the following:
       ``(3) Statement of policy.--The United States Government 
     regards the imposition by recipient countries of taxes or 
     tariffs on goods or services provided by the Global Fund, 
     which are supported through public and private donations, 
     including the substantial contribution of the American 
     people, as inappropriate and inconsistent with standards of 
     good governance. The Global AIDS Coordinator or other 
     representatives of the United States Government shall work 
     with the Global Fund to dissuade governments from imposing 
     such duties, tariffs, or taxes.''.
       (c) 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)--

       (I) by striking ``during any of the fiscal years 2004 
     through 2008'' and inserting ``during any of the fiscal years 
     2009 through 2013''; and
       (II) by adding at the end the following: ``The President 
     may waive the application of this clause with respect to 
     assistance for Sudan that is overseen by the Southern Country 
     Coordinating Mechanism, including Southern Sudan, Southern 
     Kordofan, Blue Nile State, and Abyei, if the President 
     determines that the national interest or humanitarian reasons 
     justify such a waiver. The President shall publish each 
     waiver of this clause in the Federal Register and, not later 
     than 15 days before the waiver takes effect, shall consult 
     with the Committee on Foreign Relations of the Senate and the 
     Committee on Foreign Affairs of the House of Representatives 
     regarding the proposed waiver.''; 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) has adopted, and is implementing, a policy to publish 
     on a publicly available Web site--
       ``(i) grant performance reviews;
       ``(ii) all reports of the Inspector General of the Global 
     Fund, in a manner that is consistent with the Policy for 
     Disclosure of Reports of the Inspector General, approved at 
     the 16th Meeting of the Board of the Global Fund;
       ``(iii) decision points of the Board of the Global Fund;
       ``(iv) reports from Board committees to the Board; and
       ``(v) a regular collection and analysis of performance data 
     and funding of grants of the Global Fund, which shall cover 
     all principal recipients and all 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) compiles 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 
     publicly 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;
       ``(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; and
       ``(K) has established procedures providing access by the 
     Office of Inspector General of the Department of State and 
     Broadcasting Board of Governors, as cognizant Inspector 
     General, and the Inspector General of the Health and Human 
     Services and the Inspector General of the United States 
     Agency for International Development, to Global Fund 
     financial data, and other information relevant to United 
     States contributions (as determined by the Inspector General 
     in consultation with the Global AIDS Coordinator).
       ``(6) Summaries of board decisions and united states 
     positions.--Following each meeting of the Board of the Global 
     Fund, the Coordinator of United States Government Activities 
     to Combat HIV/AIDS Globally shall report on the public 
     website of the Coordinator a summary of Board decisions and 
     how the United States Government voted and its positions on 
     such decisions.''.

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

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

     ``SEC. 2351A. MICROBICIDE RESEARCH.

       ``(a) Federal Strategic Plan.--The Director of the Office 
     shall--
       ``(1) expedite the implementation of the Federal strategic 
     plans required by section 403(a) of the Public Health Service 
     Act (42 U.S.C. 283(a)(5)) regarding the conduct and support 
     of research on, and development of, a microbicide to prevent 
     the transmission of the human immunodeficiency virus; and
       ``(2) review and, as appropriate, revise such plan to 
     prioritize funding and activities relative to their 
     scientific urgency and potential market readiness.
       ``(b) Coordination.--In implementing, reviewing, and 
     prioritizing elements of the plan described in subsection 
     (a), the Director of the Office shall consult, as 
     appropriate, with--
       ``(1) representatives of other Federal agencies involved in 
     microbicide research, including the

[[Page H7103]]

     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;
       ``(2) the microbicide research and development community; 
     and
       ``(3) health advocates.''.
       (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, consistent with the peer-review 
     process of the National Institutes of Health, carry out 
     research on, and development of, safe and effective methods 
     for use by women to prevent the transmission of the human 
     immunodeficiency virus, which may include microbicides.''.
       (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 is strongly encouraged to fully 
     implement the Centers' microbicide agenda to support research 
     and development of microbicides for use 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, may facilitate availability and 
     accessibility of microbicides, provided that such 
     pharmaceuticals are approved, tentatively approved, or 
     otherwise authorized for use by--
       (A) the Food and Drug Administration;
       (B) a stringent regulatory agency acceptable to the 
     Secretary of Health and Human Services; or
       (C) a quality assurance mechanism acceptable to the 
     Secretary of Health and Human Services.
       (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.
       ``(c) Plan Required.--The Global AIDS Coordinator, in 
     collaboration with the Administrator of the United States 
     Agency for International Development (USAID), shall develop 
     and implement a plan to combat HIV/AIDS by strengthening 
     health policies and health systems of partner countries as 
     part of USAID's `Health Systems 2020' project. Recognizing 
     that human and institutional capacity form the core of any 
     health care system that can sustain the fight against HIV/
     AIDS, tuberculosis, and malaria, the plan shall include a 
     strategy to encourage postsecondary educational institutions 
     in partner countries, particularly in Africa, in 
     collaboration with United States postsecondary educational 
     institutions, including historically black colleges and 
     universities, to develop such human and institutional 
     capacity and in the process further build their capacity to 
     sustain the fight against these diseases.''.
       (b) Clerical Amendment.--The table of contents for the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by 
     inserting after the item relating to section 203, as added by 
     section 203 of this Act, the following:

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

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

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

     SEC. 206. FACILITATING VACCINE DEVELOPMENT.

       (a) Technical Assistance for Developing Countries.--The 
     Administrator of the United States Agency for International 
     Development, utilizing public-private partners, as 
     appropriate, and working in coordination with other 
     international development agencies, is authorized to 
     strengthen the capacity of developing countries' governmental 
     institutions to--
       (1) collect evidence for informed decision-making and 
     introduction of new vaccines, including potential HIV/AIDS, 
     tuberculosis, and malaria vaccines, if such vaccines are 
     determined to be safe and effective;
       (2) review protocols for clinical trials and impact studies 
     and improve the implementation of clinical trials; and
       (3) ensure adequate supply chain and delivery systems.
       (b) Advanced Market Commitments.--
       (1) Purpose.--The purpose of this subsection is to improve 
     global health by requiring the United States to participate 
     in negotiations for advance market commitments for the 
     development of future vaccines, including potential vaccines 
     for HIV/AIDS, tuberculosis, and malaria.
       (2) Negotiation requirement.--The Secretary of the Treasury 
     shall enter into negotiations with the appropriate officials 
     of the International Bank of Reconstruction and Development 
     (World Bank) and the GAVI Alliance, the member nations of 
     such entities, and other interested parties to establish 
     advanced market commitments to purchase vaccines to combat 
     HIV/AIDS, tuberculosis, malaria, and other related infectious 
     diseases.
       (3) Requirements.--In negotiating the United States 
     participation in programs for advanced market commitments, 
     the Secretary of the Treasury shall take into account whether 
     programs for advance market commitments include--
       (A) legally binding contracts for product purchase that 
     include a fair market price for up to a maximum number of 
     treatments, creating a strong market incentive;
       (B) clearly defined and transparent rules of program 
     participation for qualified developers and suppliers of the 
     product;
       (C) clearly defined requirements for eligible vaccines to 
     ensure that they are safe and effective and can be delivered 
     in developing country contexts;
       (D) dispute settlement mechanisms; and
       (E) sufficient flexibility to enable the contracts to be 
     adjusted in accord with new information related to projected 
     market size and other factors while still maintaining the 
     purchase commitment at a fair price.
       (4) Report.--Not later than 1 year after the date of the 
     enactment of this Act--

[[Page H7104]]

       (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--

       ``(I) the increase in the number of individuals with HIV/
     AIDS receiving antiretroviral treatment above the goal 
     established under section 402(a)(3) and increased pursuant to 
     paragraphs (1) through (3) of section 403(d); and
       ``(II) additional treatment through coordinated 
     multilateral efforts;

       ``(iii) support care for 12,000,000 individuals infected 
     with or affected by 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;
       ``(iv) 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;
       ``(v) 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
       ``(vi) 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 with an 
     emphasis on training and in country deployment of critically 
     needed doctors and nurses;
       ``(B) strengthen the capacity to deliver primary health 
     care in developing countries, especially in sub-Saharan 
     Africa;
       ``(C) support and help countries in their efforts to 
     achieve staffing levels of at least 2.3 doctors, nurses, and 
     midwives per 1,000 population, as called for by the World 
     Health Organization; and
       ``(D) help partner countries to develop independent, 
     sustainable HIV/AIDS programs.
       ``(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;
       ``(B) moving toward universal access to HIV/AIDS prevention 
     counseling and services;
       ``(C) the inclusion of cost sharing assurances that meet 
     the requirements under section 110; and
       ``(D) the inclusion of transition strategies to ensure 
     sustainability of such programs and activities, including 
     health care systems, under other international donor support, 
     or budget support by respective foreign governments.''.
       (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; and
       (G) 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;
       ``(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;

[[Page H7105]]

       ``(ii) identify and replicate effective models; and
       ``(iii) develop gender indicators to measure outcomes and 
     the impacts of interventions; and
       ``(F) establishing appropriate systems to--
       ``(i) gather epidemiological and social science data on 
     HIV; and
       ``(ii) evaluate the effectiveness of prevention efforts 
     among men who have sex with men, with due consideration to 
     stigma and risks associated with disclosure.'';
       (4) in paragraph (5)--
       (A) by redesignating subparagraph (C) as subparagraph (D); 
     and
       (B) by inserting after subparagraph (B) the following:
       ``(C) Mechanism to ensure cost-effective drug purchasing.--
     Subject to subparagraph (B), mechanisms to ensure that safe 
     and effective pharmaceuticals, including antiretrovirals and 
     medicines to treat opportunistic infections, are purchased at 
     the lowest possible price at which such pharmaceuticals may 
     be obtained in sufficient quantity on the world market, 
     provided that such pharmaceuticals are approved, tentatively 
     approved, or otherwise authorized for use by--
       ``(i) the Food and Drug Administration;
       ``(ii) a stringent regulatory agency acceptable to the 
     Secretary of Health and Human Services; or
       ``(iii) a quality assurance mechanism acceptable to the 
     Secretary of Health and Human Services.'';
       (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) safe drinking water and adequate sanitation;
       ``(III) nutritional counseling;
       ``(IV) income-generating activities and livelihood 
     initiatives;
       ``(V) maternal and child health care;
       ``(VI) primary health care;
       ``(VII) the diagnosis and treatment of other infectious or 
     sexually transmitted diseases;
       ``(VIII) substance abuse and treatment services; and
       ``(IX) 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 
     to improve laboratory capacities, infection control, and 
     adherence; and
       ``(G) activities to--
       ``(i) improve the effectiveness of national responses to 
     HIV/AIDS;
       ``(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
       ``(iii) encourage fair and transparent procurement 
     practices among partner countries; and
       ``(iv) promote in-country or intra-regional pediatric 
     training for physicians and other health professionals, 
     preferably through public-private partnerships involving 
     colleges and universities, with the goal of increasing 
     pediatric HIV workforce capacity.''; 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, 
     including--
       ``(A) cost sharing assurances that meet the requirements 
     under section 110; and
       ``(B) transition strategies to ensure sustainability of 
     such programs and activities, including health care systems, 
     under other international donor support, or budget support by 
     respective foreign governments.''.
       (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.
       ``(2) Elements.--Compacts on HIV/AIDS authorized under 
     subsection (d)(8) shall include the following elements:
       ``(A) Compacts whose primary purpose is to provide direct 
     services to combat HIV/AIDS are to be made between--
       ``(i) the United States Government; and
       ``(ii)(I) national or regional entities representing low-
     income countries served by an existing United States Agency 
     for International Development or Department of Health and 
     Human Services presence or regional platform; or
       ``(II) countries or regions--

       ``(aa) experiencing significantly high HIV prevalence or 
     risk of significantly increasing incidence within the general 
     population;
       ``(bb) served by an existing United States Agency for 
     International Development or Department of Health and Human 
     Services presence or regional platform; and

       ``(cc) that have inadequate financial means within such 
     country or region.

       ``(B) Compacts whose primary purpose is to provide limited 
     technical assistance to a country or region connected to 
     services provided within the country or region--
       ``(i) may be made with other countries or regional entities 
     served by an existing United States Agency for International 
     Development or Department of Health and Human Services 
     presence or regional platform;
       ``(ii) shall require significant investments in HIV 
     prevention, care, and treatment services by the host country;
       ``(iii) shall be time-limited in terms of United States 
     contributions; and
       ``(iv) shall be made only upon prior notification to 
     Congress--

       ``(I) justifying the need for such compacts;
       ``(II) describing the expected investment by the country or 
     regional entity; and
       ``(III) describing the scope, nature, expected total United 
     States investment, and time frame of the limited technical 
     assistance under the compact and its intended impact.

       ``(C) Compacts shall include provisions to--
       ``(i) promote local and national efforts to reduce stigma 
     associated with HIV/AIDS; and
       ``(ii) work with and promote the role of civil society in 
     combating HIV/AIDS.
       ``(D) Compacts shall take into account the overall national 
     health and development and national HIV/AIDS and public 
     health strategies of each country.
       ``(E) Compacts shall contain--
       ``(i) consideration of the specific objectives that the 
     country and the United States expect to achieve during the 
     term of a compact;
       ``(ii) consideration of the respective responsibilities of 
     the country and the United States in the achievement of such 
     objectives;
       ``(iii) consideration of regular benchmarks to measure 
     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) consideration of the methods by which the compact is 
     intended to--

       ``(I) address the factors that put women and girls at 
     greater risk of HIV/AIDS; and
       ``(II) strengthen elements such as the economic, 
     educational, and social status of women, girls, orphans, and 
     vulnerable children and the inheritance rights and safety of 
     such individuals;

       ``(vi) consideration of the methods by which the compact 
     will--

       ``(I) strengthen the health care capacity, including 
     factors such as the training, retention, deployment, 
     recruitment, and utilization of health care workers;
       ``(II) improve supply chain management; and
       ``(III) 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) consideration of proposed mechanisms to provide 
     oversight;
       ``(viii) consideration of 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) consideration of a plan to ensure appropriate fiscal 
     accountability for the use of assistance.
       ``(F) For regional compacts, priority shall be given to 
     countries that are included in regional funds and programs in 
     existence as of the date of the enactment of the Tom Lantos 
     and Henry J. Hyde United States Global Leadership

[[Page H7106]]

     Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
     Act of 2008.
       ``(G) Amounts made available for compacts described in 
     subparagraphs (A) and (B) shall be subject to the inclusion 
     of--
       ``(i) cost sharing assurances that meet the requirements 
     under section 110; and
       ``(ii) transition strategies to ensure sustainability of 
     such programs and activities, including health care systems, 
     under other international donor support, and budget support 
     by respective foreign governments.
       ``(3) Local input.--In entering into a compact on HIV/AIDS 
     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.
       ``(4) Congressional and public notification after entering 
     into a compact.--Not later than 10 days after entering into a 
     compact authorized under subsection (d)(8), the Global AIDS 
     Coordinator shall--
       ``(A) submit a report containing a detailed summary of the 
     compact and a copy of the text of the compact to--
       ``(i) the Committee on Foreign Relations of the Senate;
       ``(ii) the Committee on Appropriations of the Senate;
       ``(iii) the Committee on Foreign Affairs of the House of 
     Representatives; and
       ``(iv) the Committee on Appropriations of the House of 
     Representatives; and
       ``(B) publish such information in the Federal Register and 
     on the Internet website of the Office of the Global AIDS 
     Coordinator.''.
       (e) Annual Report.--Section 104A(f) of such Act, as 
     redesignated, is amended--
       (1) in paragraph (1), by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs''; and
       (2) in paragraph (2)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) by striking subparagraph (C) and inserting the 
     following:
       ``(C) a detailed breakdown of funding allocations, by 
     program and by country, for prevention activities; and
       ``(D) a detailed assessment of the impact of programs 
     established pursuant to such sections, including--
       ``(i)(I) the effectiveness of such programs in reducing--

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

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

       ``(I) improving health care delivery systems (including the 
     training of health care workers, including doctors, nurses, 
     midwives, pharmacists, laboratory technicians, and 
     compensated community health workers, and the use of codes of 
     conduct for ethical recruiting practices for health care 
     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) 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;
       ``(iv) 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;

       ``(v) 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';
       ``(vi) 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;

       ``(vii) 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);
       ``(viii) 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;

       ``(ix) 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;

       ``(x) 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; and
       ``(III) medication-assisted drug treatment for individuals 
     with HIV or at risk of HIV;

       ``(xi) 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;

       ``(xii) building capacity to identify, investigate, and 
     stop nosocomial transmission of infectious diseases, 
     including HIV and tuberculosis; 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, for 
     HIV/AIDS prevention, treatment, or care--

[[Page H7107]]

       ``(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 should support the objectives 
     of the Global Plan to Stop TB, including through achievement 
     of the following goals:
       ``(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 successful treatment of at least 85 percent of the cases 
     detected in countries with established United States Agency 
     for International Development tuberculosis programs.
       ``(3) In support of the Global Plan to Stop TB, the 
     President shall establish a comprehensive, 5-year United 
     States strategy to expand and improve United States efforts 
     to combat tuberculosis globally, including a plan to 
     support--
       ``(A) the successful treatment of 4,500,000 new sputum 
     smear tuberculosis patients under DOTS programs by 2013, 
     primarily through direct support for needed services, 
     commodities, health workers, and training, and additional 
     treatment through coordinated multilateral efforts; and
       ``(B) the diagnosis and treatment of 90,000 new multiple 
     drug resistant tuberculosis cases by 2013, and additional 
     treatment through coordinated multilateral efforts.''.
       (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) direct services described in the Stop TB Strategy, 
     including expansion and enhancement of Directly Observed 
     Treatment Short-course (DOTS) coverage, rapid testing, 
     treatment for individuals infected with both tuberculosis and 
     HIV, and treatment for individuals with multi-drug resistant 
     tuberculosis (MDR-TB), strengthening of health systems, use 
     of the International Standards for Tuberculosis Care by all 
     providers, empowering individuals with tuberculosis, and 
     enabling and promoting research to develop new diagnostics, 
     drugs, and vaccines, and program-based operational research 
     relating to tuberculosis; and
       ``(2) funding for the Global Tuberculosis Drug Facility, 
     the Stop Tuberculosis Partnership, and the Global Alliance 
     for TB Drug Development.''.
       (c) Assistance for the World Health Organization and the 
     Stop Tuberculosis Partnership.--Section 104B of such Act is 
     amended--
       (1) by redesignating subsection (f) as subsection (h); 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) Annual Report.--Section 104B of such Act is amended by 
     inserting after subsection (f), as added by subsection (c) of 
     this section, the following:
       ``(g) Annual Report.--The President shall submit an annual 
     report to Congress that describes the impact of United States 
     foreign assistance on efforts to control tuberculosis, 
     including--
       ``(1) the number of tuberculosis cases diagnosed and the 
     number of cases cured in countries receiving United States 
     bilateral foreign assistance for tuberculosis control 
     purposes;
       ``(2) a description of activities supported with United 
     States tuberculosis resources in each country, including a 
     description of how those activities specifically contribute 
     to increasing the number of people diagnosed and treated for 
     tuberculosis;
       ``(3) in each country receiving bilateral United States 
     foreign assistance for tuberculosis control purposes, the 
     percentage provided for direct tuberculosis services in 
     countries receiving United States bilateral foreign 
     assistance for tuberculosis control purposes;
       ``(4) a description of research efforts and clinical trials 
     to develop new tools to combat tuberculosis, including 
     diagnostics, drugs, and vaccines supported by United States 
     bilateral assistance;
       ``(5) the number of persons who have been diagnosed and 
     started treatment for multidrug-resistant tuberculosis in 
     countries receiving United States bilateral foreign 
     assistance for tuberculosis control programs;
       ``(6) a description of the collaboration and coordination 
     of United States anti-tuberculosis efforts with the World 
     Health Organization, the Global Fund, and other major public 
     and private entities within the Stop TB Strategy;
       ``(7) the constraints on implementation of programs posed 
     by health workforce shortages and capacities;
       ``(8) the number of people trained in tuberculosis control; 
     and
       ``(9) a breakdown of expenditures for direct patient 
     tuberculosis services, drugs and other commodities, drug 
     management, training in diagnosis and treatment, health 
     systems strengthening, research, and support costs.''.
       (e) Definitions.--Section 104B(h) of such Act, as 
     redesignated by subsection (c), 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.''.
       (f) 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;

[[Page H7108]]

       ``(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 
     antimalarial 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, the Malaria 
     Coordinator, in accordance with section 104C of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 1151d-4), shall ensure that 
     operations and implementation research conducted under this 
     Act will closely complement the clinical and program research 
     being undertaken by the National Institutes of Health. The 
     Centers for Disease Control and Prevention should advise the 
     Malaria Coordinator on priorities for operations and 
     implementation research and should be a key implementer of 
     this research.
       ``(g) Monitoring.--To ensure that adequate malaria controls 
     are established and implemented, the Centers for Disease 
     Control and Prevention should advise the Malaria Coordinator 
     on monitoring, surveillance, and evaluation activities and be 
     a key implementer of such activities under this Act. Such 
     activities shall complement, rather than duplicate, the work 
     of the World Health Organization.
       ``(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 congressional committees 
     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--

[[Page H7109]]

       ``(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 ``$48,000,000,000 for the 5-year period 
     beginning on October 1, 2008''.
       (b) Sense of Congress.--It is the sense of the Congress 
     that the appropriations authorized under section 401(a) of 
     the United States Leadership Against HIV/AIDS, Tuberculosis, 
     and Malaria Act of 2003, as amended by subsection (a), should 
     be allocated among fiscal years 2009 through 2013 in a manner 
     that allows for the appropriations to be gradually increased 
     in a manner that is consistent with program requirements, 
     absorptive capacity, and priorities set forth in such Act, as 
     amended by this Act.

     SEC. 402. SENSE OF CONGRESS.

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

     SEC. 403. ALLOCATION OF FUNDS.

       Section 403 of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) 
     is amended--
       (1) by amending subsection (a) to read as follows:
       ``(a) Balanced Funding Requirement.--
       ``(1) In general.--The Global AIDS Coordinator shall--
       ``(A) provide balanced funding for prevention activities 
     for sexual transmission of HIV/AIDS; and
       ``(B) ensure that activities promoting 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 an 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 activities promoting 
     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, public education about risks to 
     acquire HIV infection from blood exposures, promoting 
     universal precautions, investigating suspected nosocomial 
     infections, 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.'';
       (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,''; 
     and
       (3) by adding at the end the following:
       ``(c) Funding Allocation.--For each of the fiscal years 
     2009 through 2013, more than half of the amounts appropriated 
     for bilateral global HIV/AIDS assistance pursuant to section 
     401 shall be expended for--
       ``(1) antiretroviral treatment for HIV/AIDS;
       ``(2) clinical monitoring of HIV-seropositive people not in 
     need of antiretroviral treatment;
       ``(3) care for associated opportunistic infections;
       ``(4) nutrition and food support for people living with 
     HIV/AIDS; and
       ``(5) other essential HIV/AIDS-related medical care for 
     people living with HIV/AIDS.
       ``(d) Treatment, Prevention, and Care Goals.--For each of 
     the fiscal years 2009 through 2013--
       ``(1) the treatment goal under section 402(a)(3) shall be 
     increased above 2,000,000 by at least the percentage increase 
     in the amount appropriated for bilateral global HIV/AIDS 
     assistance for such fiscal year compared with fiscal year 
     2008;
       ``(2) any increase in the treatment goal under section 
     402(a)(3) above the percentage increase in the amount 
     appropriated for bilateral global HIV/AIDS assistance for 
     such fiscal year compared with fiscal year 2008 shall be 
     based on long-term requirements, epidemiological evidence, 
     the share of treatment needs being met by partner governments 
     and other sources of treatment funding, and other appropriate 
     factors;
       ``(3) the treatment goal under section 402(a)(3) shall be 
     increased above the number calculated under paragraph (1) by 
     the same percentage that the average United States Government 
     cost per patient of providing treatment in countries 
     receiving bilateral HIV/AIDS assistance has decreased 
     compared with fiscal year 2008; and
       ``(4) the prevention and care goals established in clauses 
     (i) and (iv) of section 104A(b)(1)(A) of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 2151b-2(b)(1)(A)) shall be 
     increased consistent with epidemiological evidence and 
     available resources.''.

                         TITLE V--MISCELLANEOUS

     SEC. 501. MACHINE READABLE VISA FEES.

       (a) Fee Increase.--Notwithstanding any other provision of 
     law--
       (1) not later than October 1, 2010, the Secretary of State 
     shall increase by $1 the fee or surcharge authorized under 
     section 140(a) of the Foreign Relations Authorization Act, 
     Fiscal Years 1994 and 1995 (Public Law 103-236; 8 U.S.C. 1351 
     note) for processing machine readable nonimmigrant visas and 
     machine readable combined border crossing identification 
     cards and nonimmigrant visas; and
       (2) not later than October 1, 2013, the Secretary shall 
     increase the fee or surcharge described in paragraph (1) by 
     an additional $1.
       (b) Deposit of Amounts.--Notwithstanding section 140(a)(2) 
     of the Foreign Relations Authorization Act, Fiscal Years 1994 
     and 1995 (Public Law 103-236; 8 U.S.C. 1351 note), fees 
     collected under the authority of subsection (a) shall be 
     deposited in the Treasury.

         TITLE VI--EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH

     SEC. 601. EMERGENCY PLAN FOR INDIAN SAFETY AND HEALTH.

       (a) Establishment of Fund.--There is established in the 
     Treasury of the United States a

[[Page H7110]]

     fund, to be known as the ``Emergency Fund for Indian Safety 
     and Health'' (referred to in this section as the ``Fund''), 
     consisting of such amounts as are appropriated to the Fund 
     under subsection (b).
       (b) Transfers to Fund.--
       (1) In general.--There is authorized to be appropriated to 
     the Fund, out of funds of the Treasury not otherwise 
     appropriated, $2,000,000,000 for the 5-year period beginning 
     on October 1, 2008.
       (2) Availability of amounts.--Amounts deposited in the Fund 
     under this section shall--
       (A) be made available without further appropriation;
       (B) be in addition to amounts made available under any 
     other provision of law; and
       (C) remain available until expended.
       (c) Expenditures From Fund.--On request by the Attorney 
     General, the Secretary of the Interior, or the Secretary of 
     Health and Human Services, the Secretary of the Treasury 
     shall transfer from the Fund to the Attorney General, the 
     Secretary of the Interior, or the Secretary of Health and 
     Human Services, as appropriate, such amounts as the Attorney 
     General, the Secretary of the Interior, or the Secretary of 
     Health and Human Services determines to be necessary to carry 
     out the emergency plan under subsection (f).
       (d) Transfers of Amounts.--
       (1) In general.--The amounts required to be transferred to 
     the Fund under this section shall be transferred at least 
     monthly from the general fund of the Treasury to the Fund on 
     the basis of estimates made by the Secretary of the Treasury.
       (2) Adjustments.--Proper adjustment shall be made in 
     amounts subsequently transferred to the extent prior 
     estimates were in excess of or less than the amounts required 
     to be transferred.
       (e) Remaining Amounts.--Any amounts remaining in the Fund 
     on September 30 of an applicable fiscal year may be used by 
     the Attorney General, the Secretary of the Interior, or the 
     Secretary of Health and Human Services to carry out the 
     emergency plan under subsection (f) for any subsequent fiscal 
     year.
       (f) Emergency Plan.--Not later than 1 year after the date 
     of enactment of this Act, the Attorney General, the Secretary 
     of the Interior, and the Secretary of Health and Human 
     Services, in consultation with Indian tribes (as defined in 
     section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450b)), shall jointly establish an 
     emergency plan that addresses law enforcement, water, and 
     health care needs of Indian tribes under which, for each of 
     fiscal years 2010 through 2019, of amounts in the Fund--
       (1) the Attorney General shall use--
       (A) 18.5 percent for the construction, rehabilitation, and 
     replacement of Federal Indian detention facilities;
       (B) 1.5 percent to investigate and prosecute crimes in 
     Indian country (as defined in section 1151 of title 18, 
     United States Code);
       (C) 1.5 percent for use by the Office of Justice Programs 
     for Indian and Alaska Native programs; and
       (D) 0.5 percent to provide assistance to--
       (i) parties to cross-deputization or other cooperative 
     agreements between State or local governments and Indian 
     tribes (as defined in section 102 of the Federally Recognized 
     Indian Tribe List Act of 1994 (25 U.S.C. 479a)) carrying out 
     law enforcement activities in Indian country; and
       (ii) the State of Alaska (including political subdivisions 
     of that State) for carrying out the Village Public Safety 
     Officer Program and law enforcement activities on Alaska 
     Native land (as defined in section 3 of Public Law 103-399 
     (25 U.S.C. 3902));
       (2) the Secretary of the Interior shall--
       (A) deposit 15.5 percent in the public safety and justice 
     account of the Bureau of Indian Affairs for use by the Office 
     of Justice Services of the Bureau in providing law 
     enforcement or detention services, directly or through 
     contracts or compacts with Indian tribes under the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450 et seq.); and
       (B) use 50 percent to implement requirements of Indian 
     water settlement agreements that are approved by Congress (or 
     the legislation to implement such an agreement) under which 
     the United States shall plan, design, rehabilitate, or 
     construct, or provide financial assistance for the planning, 
     design, rehabilitation, or construction of, water supply or 
     delivery infrastructure that will serve an Indian tribe (as 
     defined in section 4 of the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450b)); and
       (3) the Secretary of Health and Human Services, acting 
     through the Director of the Indian Health Service, shall use 
     12.5 percent to provide, directly or through contracts or 
     compacts with Indian tribes under the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450 et 
     seq.)--
       (A) contract health services;
       (B) construction, rehabilitation, and replacement of Indian 
     health facilities; and
       (C) domestic and community sanitation facilities serving 
     members of Indian tribes (as defined in section 4 of the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450b)) pursuant to section 7 of the Act of August 5, 
     1954 (42 U.S.C. 2004a).

                      Motion Offered by Mr. Berman

  Mr. BERMAN. Mr. Speaker, I offer the motion at the desk.
  The SPEAKER pro tempore. The Clerk will designate the motion.
  The text of the motion is as follows:

       Motion offered by Mr. Berman:
       Mr. Berman moves that the House concur in the Senate 
     amendment.

  The SPEAKER pro tempore. Pursuant to House Resolution 1362, the 
gentleman from California (Mr. Berman) and the gentlewoman from Florida 
(Ms. Ros-Lehtinen) each will control 30 minutes.
  The Chair recognizes the gentleman from California.
  Mr. BERMAN. Mr. Speaker, I rise in strong support of this bill, and I 
yield myself 7 minutes.
  Mr. Speaker, a few short months ago the House gave its strong 
bipartisan approval to H.R. 5501, the Tom Lantos and Henry J. Hyde 
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008. Last Thursday, the Senate followed suit, 
approving its amendment to the House bill by an overwhelming margin of 
80-16.
  We meet today to take up the Senate amendments and to send this 
bipartisan legislation to the President for his signature. The measure 
before the House today is a compromise, a compromise between Democrats 
and Republicans, between the House and the Senate, and between Congress 
and the executive branch. The fact that compromise was achievable in 
this highly politicized era is a testament to the bipartisan roots of 
this legislation.
  Five years ago, Tom Lantos and Henry Hyde, our dear deceased 
colleagues, working closely with the White House, crafted a global HIV/
AIDS bill that enjoyed broad bipartisan support. This groundbreaking 
legislation had a clear and achievable goal, to respond with compassion 
to those who were dying of AIDS, dramatically increase our Nation's 
efforts to stop the spread of HIV virus, provide care to children 
orphaned by AIDS, and get lifesaving medications immediately to those 
in need.
  As a result, our Nation has provided lifesaving antiretroviral 
medicines to nearly 1\1/2\ million men, women and children, supported 
care for nearly 7 million people, including nearly 3 million orphans 
and vulnerable children, and prevented an estimated 150,000 infant 
infections around the world.
  Most importantly, the United States has given hope to millions 
infected with the HIV virus, which just a few short years ago was 
tantamount to a death sentence.
  This law worked well as an emergency intervention to deal with the 
rapidly expanding HIV/AIDS crisis. But the nature of that disease has 
changed significantly since then. We now have 5 years of experience in 
grappling with this pandemic on a global scale, and the reauthorization 
bill before us reflects what we have learned.
  The law we passed in 2003 was designed to deal with the emergency 
phase of the HIV/AIDS crisis. This legislation moves our programs 
towards long-term sustainability that will keep the benefit of U.S. 
global HIV/AIDS programs flowing to those in need. With this 
reauthorization, host governments will also gain the ability to plan, 
direct and manage prevention, treatment and care programs that were 
originally established with U.S. assistance.
  The reauthorization bill authorizes nearly $50 billion over 5 years 
for these three pandemics. These additional funds allow us to 
significantly boost the health care workforce in those countries hard 
hit by HIV/AIDS with new professional and paraprofessional training 
programs, and to increase the number of HIV positive individuals 
receiving lifesaving medicine.
  The 2003 law focused on creating new programs to tackle the crisis. 
The reauthorization bill increases the number of individuals receiving 
prevention treatment and care services. It builds stronger linkages 
between the global HIV/AIDS initiative and existing programs designed 
to alleviate hunger among those treated. It helps to improve health 
care and bolster HIV education in schools.

                              {time}  1600

  The 2003 law began to address the needs of women and girls. But given 
the changing nature of the epidemic, we clearly did not go far enough 
to meet these needs.
  The new legislation remedies this situation by strengthening 
prevention and treatment programs aimed at this extremely vulnerable 
population. The Lantos-Hyde bill eliminates the one-third abstinence-
only earmark, but requires a balanced approach to sexual

[[Page H7111]]

transmission programs and a report regarding this approach in countries 
where the epidemic has become generalized.
  In an effort to ensure that our contributions to the global fund are 
being wisely spent, the bill provides for certain benchmarks to improve 
the transparency and the accountability of the fund. The bill 
incorporates tuberculosis prevention from H.R. 1567 sponsored by 
Congressman Engel. It seeks to further integrate HIV/AIDS programs with 
TB and malaria programs and create linkages and referrals between these 
programs for patients.
  H.R. 5501 heightens U.S. efforts to combat malaria by requiring the 
development of a comprehensive 5-year strategy to combat this disease. 
It creates a new U.S. Government Malaria Coordinator, and it enhances 
support for clinical research for new diagnostics, treatments, and 
interventions to prevent, cure, and control malaria.
  The Senate made several changes in our bill. It overturned the 
existing visa ban on HIV-positive individuals. It targeted $2 billion 
of the $50 billion authorization for Indian health care, water 
resources, and law enforcement issues. It modified the goal for people 
living with AIDS and removed a linkage between the global HIV/AIDS 
program and family planning.
  Despite these changes, the language before the House today is very 
close to what we approved last April. With passage of this 
reauthorization bill, Congress signals to the world that the United 
States would exercise continued leadership in the global battle against 
malaria, tuberculosis, and HIV/AIDS.
  So what we have here is a bipartisan bill providing nearly $50 
billion for the battle against HIV/AIDS, tuberculosis, and malaria, a 
bill that has strong bipartisan support, and one that the President has 
indicated he will sign into law.
  I urge my colleagues to support this legislation, and I want to take 
special note that in the short time that I have been chairing this 
committee, I want to mention two particular people who have both helped 
educate me, two Members, colleagues on the committee who have played a 
major role in helping to guide this legislation and the earlier 
legislation: the chairman of the Africa Subcommittee, Don Payne, and 
Congresswoman Barbara Lee, both of whom have been involved in this 
legislation and the previous legislation from the beginning and were 
pushing for this even long before that passed.
  With that, I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, many of us seek a place in this hallowed institution to 
serve our country and our constituents, to make a difference, to help 
change the world for the better. Mr. Speaker, today we are given an 
opportunity to edge ever closer to the accomplishment of these goals.
  Today we have an opportunity to positively impact the lives of 
countless human beings worldwide by recommitting ourselves to fighting 
and eliminating a great threat to our international security, and that 
is the global AIDS pandemic.
  The bill before us reauthorizes the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003. Before this bill was 
enacted, known as PEPFAR, only 55,000 people living in sub-Saharan 
Africa were receiving life-saving treatment, but according to the 
Office of the Global AIDS Coordinator, through PEPFAR, the United 
States now has supported treatment for 1.68 million people in Africa 
and 1.73 million people worldwide.
  Further, the United States has provided prevention of mother-to-child 
HIV transmission services for women enduring nearly 12.7 million 
pregnancies. We have also prevented an estimated 194,000 infant 
infections. We have supported care for more than 6.6 million people in 
need, including more than 2.7 million orphans and vulnerable children. 
We have supported over 33 million counseling and testing sessions to 
date for men, women, and children.
  These successes are truly remarkable and serve as a testament that 
all can be accomplished when Members from the House and the Senate on 
both sides of the aisle work together to find solutions to one of the 
world's most pressing challenges.
  The 2008 reauthorization seeks to consolidate and advance the 
successes of the past 5 years by providing the funding and the 
framework to transform this from an emergency program to a sustainable 
program. It stands as a noble legacy of the late Henry J. Hyde and Tom 
Lantos who spearheaded this mission of mercy 5 years ago, and I am 
proud that the bill bears their names.
  The stakes for this initiative, Mr. Speaker, are higher than ever. 
Despite the best efforts of responsible nations to confront the global 
AIDS pandemic, there are now over 33 million people around the world 
living with this disease. An estimated 7,000 new infections occur every 
day. In its wake, the HIV/AIDS pandemic is leaving a trail of poverty, 
of despondency, of death, which has destabilized societies and 
undermined the security of entire regions.
  Our former House colleague and current ambassador to Tanzania, the 
Honorable Mark Green, wrote to me highlighting the threat that HIV/AIDS 
poses to the security of our country. And he said, ``In tearing apart 
the social fabric and leaving a generation of orphans, the scourge of 
HIV/AIDS could create a long-term breeding ground for radicalism.''
  So it is therefore incumbent upon us, Mr. Speaker, to advance this 
critical program which not only saves lives and exemplifies the 
generous humanitarian nature of the American people, but it also helps 
to preserve our national security.
  It is important to note that even in the most remote areas of Kenya 
or Haiti, for example, people know about the PEPFAR program. They know 
from where the test kits, the medicines, and other life-saving support 
is coming. They recognize the leadership and the resources that the 
United States has provided in an effort to fight this deadly disease, 
and they are deeply appreciative. This is not just a health program. 
This is a public diplomacy program as well, and it has greatly enhanced 
global understanding of the true nature and the essence of the American 
people at a critical time in our Nation's history. We have led by 
example, and our success has been measured in human lives saved.
  Now, the House has debated and adopted this bill by an overwhelming 
margin in April of this year. This House text was the product of a 
bipartisan compromise that preserved the spirit of the 2003 Act while 
balancing a number of congressional imperatives. Just as in the House, 
our Senate colleagues sought to produce legislation that would 
capitalize and expand upon the success of the energy plan while 
maintaining the bipartisan political consensus that has guided this 
program from its inception.
  After 3 months of negotiations, the amendment before us was approved 
in the Senate by a margin of 80-16, demonstrating the strong bipartisan 
commitment of the Senate of their own carefully constructed compromise.
  The Senate amendment contains numerous modifications to the text 
approved by the House in April. It reduces the authorization of HIV/
AIDS, tuberculosis, and malaria programs from $50 billion to $48 
billion. It allows for a gradual increase of resources over time rather 
than authorizing $10 billion for each of the fiscal years 2008 through 
2013. It requires more than half of all funding appropriated for 
bilateral HIV/AIDS assistance be expended for treatment and care. It 
replaces the hard target for treatment with a sliding scale whereby the 
treatment target will increase over $3 million in direct proportion to 
increased appropriations. And further, it authorizes the use of 
compacts as further vehicles for HIV/AIDS assistance in an effort to 
promote sustainability.
  Mr. Speaker, the Senate amendment preserves and strengthens other 
critical provisions that were at the heart of the House compromise 
overwhelmingly adopted in April. For example, it corrects an unintended 
omission by including care under the conscience clause which allows 
faith-based organizations to disassociate themselves from any program 
or activity to which they have a religious or moral objection. Also, it 
amends the abstinence and fidelity language contained in section 403 by 
striking behavior change programs including abstinence and fidelity, 
and inserting activities promoting

[[Page H7112]]

abstinence and fidelity. This modification provides clarity to the 
compromise reached in the House last spring.
  The Senate amendment also includes two provisions that have raised 
some concern, including the establishment of a $2 billion emergency 
plan for Indian safety and health, and the lifting of certain 
restrictions under the Immigration and Nationality Act.
  The first provision, the Indian Safety and Health title of the Senate 
amendment initially raised concerns about mandatory spending and 
unfunded mandates. However, the Congressional Budget Office has 
verified that the language in question is an authorization and does not 
have implications for direct spending.
  It also bears mentioning that the health programs will be implemented 
through the Indian Health Service which is subject to the rules and 
regulations of the Department of Health and Human Services.
  With respect to the second item, Mr. Speaker, lifting the ban is 
largely symbolic because the authority to waive the restriction already 
exists and is routinely exercised, albeit on a case-by-case basis. 
Furthermore, an alien with HIV would still be inadmissible under 
current HHS recommendations on communicable diseases of public health 
significance, and this would continue to be the case until and unless 
the regulations are changed. The Senate amendment includes offsets for 
the estimated additional costs involved with the processing of these 
new visas.
  Throughout this process, Members on both sides of the aisle have been 
forced to make difficult choices to arrive at a consensus that 
carefully balances U.S. priorities and the range of congressional 
concerns. The challenges have been great and at times have seemed 
insurmountable. But a failure to act now would imperil our ability to 
provide life-saving support to millions of people in need around the 
world and will ultimately undermine what is arguably the most 
successful United States foreign assistance and public diplomacy 
program today.
  We have been given a unique opportunity to help make the world a 
better place for those who have been victimized by the AIDS pandemic 
while simultaneously enhancing our own Nation's security.
  I urge my colleagues to support the Senate amendment to the Tom 
Lantos and Henry Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008 so that this bill 
can be signed by the President without further delay and we can get to 
work on saving even more lives.
  With that, Mr. Speaker, I reserve the balance of my time.
  Mr. BERMAN. Mr. Speaker, I thank the gentlelady very much for her 
great words, and more importantly, for her really complete commitment 
to this project before and now.


                             General Leave

  Mr. BERMAN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material.
  The SPEAKER pro tempore (Mr. Ross). Is there objection to the request 
of the gentleman from California?
  There was no objection.
  Mr. BERMAN. Mr. Speaker, I am now very pleased to yield 5 minutes to 
the gentleman I referenced earlier, the chairman of the Africa 
Subcommittee, Mr. Payne of New Jersey.
  Mr. PAYNE. Thank you very much, Mr. Chairman. And let me begin by 
thanking you for your strong leadership in bringing this legislation 
through the House and advocating it through the Senate and our ranking 
member, Ms. Ileana Ros-Lehtinen, for her support, and as you mentioned 
before, Representative Barbara Lee and Donna Christensen.
  As chairman of the Subcommittee on Africa and Global Health, this 
bill, the Tom Lantos and Henry Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
2008, is very timely.
  This bill is important. In the 5 years since I have been in Congress, 
the original legislation authorized by the President's Emergency Plan 
for Aids Relief, or PEPFAR, as it is known, has become a historical 
program.

                              {time}  1615

  The road toward serious consideration regarding HIV and AIDS was a 
long journey. The Congressional Black Caucus began advocating for a 
sound domestic and international effort during the late 1980s with 
little success. Pressure continued through the executive branch, and in 
the Clinton years, an office was established headed by Ms. Thurman on 
the President's initiative on HIV and AIDS. However, adequate funding 
was still lacking, especially on the international focus.
  And so I must say that PEPFAR is destined, in my view, to be 
remembered as the single most significant achievement of the Bush 
administration's two terms in office because it was there that we 
catapulted the funding of this legislation.
  Over 800,000 people who would otherwise have no access to treatment 
are receiving anti-retroviral medication in PEPFAR's 15 focus 
countries. Twelve of those countries are in sub-Saharan Africa.
  Such progress is remarkable. However, we still have a lot of work 
ahead of us. Despite our best efforts, only 28 percent of Africans 
needing anti-retrovirals are receiving them.
  A mere 11 percent of HIV-positive women on the continent who need 
drugs to prevent mother-to-child transmission is getting it. 
Shockingly, over 85 percent of Africa's children who need ARVs are 
going without it.
  This is why Congress is taking such an extraordinary step of 
authorizing close to $50 billion to transform PEPFAR from an emergency 
response to a sustainable program. It represents the best efforts to 
turn those statistics around.
  The new bill transforms PEPFAR by expanding the program beyond a 
series of medical interventions. For example, the lack of food and 
nutrition support for people on ARVs have been, up to now, a major 
impediment to the adherence to AIDS treatment regimens. The lack of 
adherence limits PEPFAR's effectiveness.
  Fortunately, the new component will help ease the nutrition problem. 
The Senate bill has incorporated elements of the provision which I 
authored that were in the original House bill related to addressing the 
nutrition needs of HIV patients, their families, and communities. When 
I introduced the nutrition component a year ago, no one could have 
accurately predicted the tremendous food security problem which besets 
us today worldwide.
  The Senate bill also contains a provision to build and strengthen 
health systems in developing countries.
  Like the House bill, it eliminates cumbersome earmarks that the 
Government Accountability Office and the Institute of Medicine have 
said limits program efficacy.
  Just as important as the money and programs for HIV and AIDS, the 
bill we are voting on today also authorizes $9 billion to fight two 
other diseases that have wrought havoc in the developing world: malaria 
and tuberculosis.
  Malaria kills a child in Africa every 30 seconds. It contributes to 
the death of an estimated 10,000 pregnant women and up to 200,000 
infants each year on the continent. And what is astonishing is that 
malaria is preventable. With education, providing bed nets and 
spraying, malaria can be eliminated.
  TB is just as deadly. Nearly 20 percent of the people who develop 
full-blown TB die of the disease. They cannot get a simple, low-cost 
cure which is available.
  And those with HIV and AIDS are very vulnerable to TB infections due 
to lowered immunity factors. In fact, TB is the number one killer of 
people with AIDS. With the new cases of MDR and XDR TB, a more radical 
strain that is much more difficult to treat, the new emphasis on TB is 
very important. In South Africa in a village, 52 of 53 people who had 
contracted MDR TB died within a 2-week period.
  Mr. Speaker, given the aforementioned toll that AIDS, TB and malaria 
has taken around the globe, and how much we still need to do to fight 
all three deadly diseases, it is imperative that we redouble our 
efforts.
  The SPEAKER pro tempore. The time of the gentleman from New Jersey 
has expired.
  Mr. BERMAN. I yield the gentleman an additional 30 seconds.
  Mr. PAYNE. As I conclude, we must do so for the obvious reason: U.S.-
funded programs save lives. We have a

[[Page H7113]]

moral obligation to continue them. We should also do so for a less 
obvious reason: to counter a growing perception in the world that the 
United States does not care about anything but counterterrorism.
  Fairly or not, I think that this bill will go far to continue to 
uplift the image of the United States. It's saving lives, and it's 
doing the right thing.
  I urge my colleagues to support the bill.
  Ms. ROS-LEHTINEN. Mr. Speaker, I yield 3 minutes to the gentleman 
from California (Mr. Rohrabacher), the ranking member of the 
Subcommittee on International Organization, Human Rights, and 
Oversight.
  Mr. ROHRABACHER. Mr. Speaker, I rise in strong opposition to H.R. 
5501.
  During this time of economic difficulty, this bill is humanitarianism 
gone wild. It's irrational benevolence that we cannot afford.
  Where are we going to get the $48 billion for combating AIDS and the 
$2 billion for Native American programs? Well, we can get it out of 
programs by gutting programs that are for our own people. We can raise 
taxes, which would likely throw us into a recession that would leave us 
with even less of a tax base for our people at home, or of course, we 
can borrow it and let our grandchildren pay for it in some way. And 
yes, if we borrow it, it will probably come from Communist China, 
making ourselves even more vulnerable to their pressure.
  Mr. Speaker, we have big hearts, but we need to use our brains. We 
cannot afford $50 billion of generosity to foreigners. This will cost 
the American people. It will cost them their health care and the 
education for their children. It will cost the veterans, and it will 
cost our seniors.
  Our economy is facing a catastrophic setback because of the 
irresponsible spending and taxing policies of the Federal Government, 
and now we're going to exacerbate that problem with a $50 billion 
commitment to provide a health care package to Africa.
  Concerning my friends on my side of the aisle, Mr. Speaker, I say to 
those who oppose earmarks in the name of fiscal responsibility, they 
should not be expected to be taken seriously if they support this 
enormously expensive, feel-good spending. This $50 billion burden will 
be shouldered by our veterans, by our elderly, and by our children.
  My friends on the other side of the aisle often remind us America 
does not spend enough on our own people. More funds are needed, we are 
repeatedly told, for our veterans, our elderly, and yes, for our 
children. When we are already at a high level of deficit spending, how 
then can we advocate spending an additional $50 billion overseas?
  And we're not fooling anybody. When we have spending like this, it 
comes right out of the pot of limited resources that are available to 
Americans.
  This expenditure is not going to cure AIDS in the end. I wish I could 
say that I was very confident that it would succeed in that, but I'm 
not confident with that. What I am confident is that it will break our 
back. This could well be the 2-ton tree trunk that broke the camel's 
back, the item that finally destroyed the hope for responsible spending 
policies by Congress.
  I ask my colleagues to vote against this kind of generosity that is 
perhaps good-hearted but totally irrational. I say our number one job 
here is to watch out for the well-being of the American people. This 
bill is not in the well-being of our people. It will undermine the 
well-being of our people.
  Mr. BERMAN. I yield myself 30 seconds.
  Mr. Speaker, without joining issue with the gentleman on his other 
comments, the suggestion that this is not curing AIDS is directly 
contrary to the evidence I saw firsthand in Africa earlier this month. 
There are huge numbers of people there who would now be dead, who are 
alive simply because of the drugs that this money allowed them to get. 
I don't know what the definition of the gentleman's cure is, but they 
are living normal, active lives as a result of the drug therapies.
  I insert a Statement of Legislative Intent regarding nutrition into 
the Record at this time.
  On behalf of Chairman Payne, Mr. McGovern, and Mrs. Emerson, I would 
like to make the following statement regarding the intent of the House 
on H.R. 5501.
  H.R. 5501 and the Senate amendment to H.R. 5501 provide clear and 
specific instructions to the USAID Administrator and the Global AIDS 
Coordinator to address the food and nutrition needs of individuals with 
HIV/AIDS and other affected individuals, including orphans and 
vulnerable children; and to fully integrate food and nutrition support 
in HIV/AIDS prevention, treatment, and care programs carried out under 
this act.
  We are concerned about the negative effect rising costs are having on 
our long-term and emergency food aid programs. This is a matter that 
affects a wide array of our food aid and development programs, 
including the effectiveness and success of our Global HIV/AIDS 
programs.
  On behalf of the Committee on Foreign Affairs and members who have 
been very involved in international nutrition, we wish to state that it 
is the legislative intent of H.R. 5501 and the Senate amendment to H.R. 
5501 that food security and nutrition programs, especially those 
referred to as wrap-around services, are not to be funded with monies 
diverted from other standing commitments to address food insecurity 
elsewhere in the world or in these countries.
  I'm very pleased to yield 5 minutes to my friend, just a major 
architect of this whole program, the gentlelady from California (Ms. 
Lee).
  Ms. LEE. Mr. Speaker, first, let me thank Chairman Berman for your 
leadership and for your commitment to addressing this very devastating 
public health crisis, humanitarian crisis, and national security 
crisis.
  I also want to thank Ranking Member Ros-Lehtinen, Chairman Payne, 
Ranking Member Smith, Chairman Waxman, and Congresswoman Donna 
Christensen for working together to bring this bipartisan bill to the 
floor.
  Our Speaker, Nancy Pelosi, has been such a leader early on in 
addressing the HIV and AIDS crisis, and without her support, we would 
not have such an important bill before us today.
  As an original coauthor of both the initial legislation establishing 
PEPFAR and of this new bill reauthorizing PEPFAR, I am pleased that 
today we will complete action on this important initiative and send it 
to the President for his signature.
  Each of us has witnessed, as Mr. Berman indicated earlier, the 
devastation that AIDS has caused in Africa and in the developing world, 
and we've seen the very dramatic impact of our AIDS programs over the 
last 5 years in actually saving lives. And this bill will save millions 
more in terms of life-saving drugs and treatment and care.
  And, yes, to the gentleman from California (Mr. Rohrabacher), I 
believe that spending $50 billion to address a global health emergency 
makes more sense than spending over 600-700 billion dollars on a war, 
quite frankly, that did not have to be fought.
  Quite simply, by enacting this bill, we will help change the lives of 
millions of people around the world for the better.
  This bill is a model of compromise and stands as a testament to what 
true bipartisanship can accomplish.
  Let me remind this body that it is the latest in a long string of 
initiatives on HIV and AIDS that have been born out of a willingness to 
work together and put the United States on the right side of history 
when it comes to this global pandemic.
  First, in 2000, we passed and President Clinton signed into law the 
Global AIDS and Tuberculosis Relief Act. This important bill provided 
the founding contribution and framework for the Global Trust Fund. It 
was inspired, really, by my colleague, my predecessor, Congressman Ron 
Dellums, now-Mayor Ron Dellums of Oakland, California, and supported by 
former Chairman Jim Leach of Iowa.
  In 2001, working with both former Chairman Hyde and Chairman Lantos, 
we drafted H.R. 2069, the Global Access to HIV/AIDS Prevention, 
Awareness, Education and Treatment Act. This was the first bill that 
dared to provide a large scale antiretroviral therapy to people living 
in the developing world. Unfortunately, it wasn't enacted because we 
couldn't reach a conference agreement with the Senate.
  At the end of 2002, the Congressional Black Caucus, along with 
practically every advocacy group in the United States, sent a letter to 
President Bush urging him to create a presidential initiative to fight 
AIDS in Africa.
  In January of 2003, the President stepped up to the plate and 
promised $15 billion to fight AIDS during his State of the Union 
address.

[[Page H7114]]

  Within 5 months, working with Chairman Hyde and Chairman Lantos, we 
passed H.R. 1298, the United States Leadership Against HIV/AIDS, 
Tuberculosis and Malaria Act of 2003, which created PEPFAR.
  In 2005, we took yet another step forward when we passed H.R. 1409, 
the Assistance for Orphans and Vulnerable Children in Developing 
Countries Act, again with Chairman Hyde and Chairman Lantos and 
Chairman Berman and Chairman Payne. This bill fine-tuned our programs 
to meet the needs of children orphaned and made vulnerable by AIDS.
  So, Mr. Speaker, I lay out some of the history of our work on this 
very important issue because it speaks volumes about what is possible 
when we come together in the spirit of bipartisan compromise.

                              {time}  1630

  It is that bipartisan spirit that is again on display today as we 
honor the legacy of both Chairman Lantos and Chairman Hyde through this 
legislation. I'm saddened that both of them are not with us, like all 
of us are, to witness this moment, but I know that they would have been 
very, very pleased.
  As I have said, this bill is a compromise. And as in all compromises, 
each side did not get everything it wanted, but that's what compromise 
is about.
  I want to mention just a few important items that I worked on which 
have been included in this bill. First, it takes language from H.R. 
1713, the PATHWAY Act, to strike the 33 percent abstinence-until-
marriage and helps address the needs of women and girls in a 
comprehensive fashion--abstinence, be faithful, use condoms. 
Comprehensive.
  It includes language taken from H.R. 3812, the African Health 
Capacity and Investment Act, to build health capacity by recruiting, 
training and retaining health professionals and strengthening health 
care systems.
  The SPEAKER pro tempore. The time of the gentlewoman from California 
has expired.
  Mr. BERMAN. I am pleased to yield the gentlelady an additional 
minute.
  Ms. LEE. Thank you, Mr. Chairman, very much.
  I am also very grateful that the Senate added language that I 
originally authored in H.R. 3337, the HIV Nondiscrimination in Travel 
and Immigration Act, to remove this, quite frankly, unjust and 
discriminatory statutory ban on travel and immigration for people 
living with HIV/AIDS. I'm especially pleased that we are lifting this 
statutory ban just prior to this year's International AIDS Conference 
in Mexico City. As a delegate to the last four conferences, I look 
forward to bringing this good news to Mexico City.
  While I support the underlying compromise, there are many, many items 
that I wish had been included: Eliminating the prostitution pledge 
loyalty oath, recognizing the public health benefits of linking our 
HIV/AIDS programs with family services, recognizing the need to engage 
with communities that are at the forefront of this pandemic, such as 
men who have sex with men, and injection drug users, and clearly 
committing to provide lifesaving AIDS drugs to no less than 3 million 
people. So let me just thank you again, Chairman Berman.
  I want to thank our staff, especially Christos Tsentas of my office. 
And I would like to insert for the the Record all of our staff members' 
names who worked on this bill.

                   List of Staff Who Worked on PEPFAR


                                 HOUSE

       Dr. Pearl Alice Marsh, Kristin Wells, David Abramowitz, 
     Peter Yeo, and Bob King from Chairman Berman's staff of the 
     House Foreign Affairs Committee.
       Yleem Poblete, Mark Gage, Sarah Kiko and Joan Condon from 
     Ranking Member Ros-Lehtinen's staff on the House Foreign 
     Affairs Committee.
       From the Subcommittee on Africa and Global Health, Heather 
     Flynn with Chairman Donald Payne and Sheri Rickert with 
     Ranking Member Chris Smith.
       Naomi Seiler and Jesseca Boyer from Mr. Waxman's staff on 
     Oversight and Government Reform Committee.
       And Christos Tsentas of my staff.


                                 SENATE

       Shannon Smith, Brian McKeon with Chairman Biden's staff on 
     the Senate Foreign Relations Committee.
       Shellie Bressler, Paul Foldi, and Dan Diller from Senator 
     Lugar's staff on the Senate Foreign Relations Committee.
       Alexandra Nunez with Senator Kerry's office.

  Ms. ROS-LEHTINEN. Mr. Speaker, I yield 3 minutes to the gentleman 
from Indiana (Mr. Pence), the ranking member of the Subcommittee on the 
Middle East and South Asia.
  (Mr. PENCE asked and was given permission to revise and extend his 
remarks.)
  Mr. PENCE. Mr. Speaker, I rise today in support of H.R. 5501, the Tom 
Lantos and Henry Hyde Global AIDS bill. As Congresswoman Barbara Lee 
just eloquently stated, it is poignant to those of us who knew these 
two great legislators to see the important expansion of this 
legislation occur after both of them have gone home to be with the 
Lord. But I can think of no better tribute to these men of character 
and vision and compassion than this legislation.
  I commend Chairman Berman and Ranking Member Ros-Lehtinen for their 
strong leadership. I also want to commend my colleague, Chris Smith, 
for his yeoman's work in preserving a delicate balance of this bill. 
Also Mr. Speaker, let me publicly acknowledge the work of our 
President, George W. Bush. Mr. President, because of your moral 
leadership and compassion, Africa will never be the same, and history 
will record your work.
  The Bible tells us, ``To whom much is given much is expected.'' I 
believe the United States has a moral obligation to lead the world in 
confronting the pandemic of HIV/AIDS.
  The dimensions of this crisis are truly staggering. The HIV/AIDS 
pandemic has infected more than 60 million people worldwide, killed 
more than 25 million, a number that grows grievously every day by 
nearly 9,000. HIV/AIDS has orphaned some 14 million children. And 
today, 70 percent of the people in the world with HIV/AIDS reside in 
Africa. More startling, if current infection rates continue, new 
epicenters for the disease are likely to arise out of India, China and 
eastern Europe.
  The threat this pandemic poses to our security is real. If not 
addressed, this plague will continue to undermine the stability of 
nations throughout the third world, leaving behind collapsing 
economies, tragedy, and desperation, which we all know is a breeding 
ground for extremist violence and terrorism. This is truly a global 
crisis. And because the United States of America can render timely 
assistance, I believe we must.
  You know, every so often in this place we have the opportunity to do 
something, not just for the American people, but for humanity, and this 
is such a time. And this global AIDS bill seeks to address this crisis 
not only by providing medicine and health care to those in need, but 
also by providing funding resources for evidence-based programs that 
have been successful in preventing infection.
  It's imperative, I believe, that we not only send our resources, but 
that we send them in a manner that is consistent with our values. We 
cannot send billions of dollars to Africa without sending values-based 
safeguards and techniques that work to fight the spread of HIV/AIDS by 
changing behavior, and this current version of the global AIDS bill 
includes those safeguards.
  It was essential that we preserve these prevention methods that focus 
on behavioral change, and that we continue to work with faith-based, 
nongovernmental organizations that promote programs, including the ABC 
model, which has produced such undeniable results.
  But as a conservative let me say, as we tend to the suffering abroad, 
we also have to figure out how to pay for it. The Federal budget, I 
believe, is filled with opportunities to responsibly fund this program, 
and I look forward to finding the right priorities to do just that.
  Mr. Speaker, I rise today in support of H.R. 5501, the ``Tom Lantos 
and Henry J. Hyde Global AIDS Bill.''
  The Bible tells us, `to whom much is given, much is expected,'' and I 
believe the United States has a moral obligation to lead the world in 
confronting the pandemic of HIV/AIDS.
  The dimensions of this crisis are truly staggering. The HIV/AIDS 
pandemic has infected more than 60 million people worldwide. It has 
killed more than 25 million, a number which grows grievously every day 
by more than

[[Page H7115]]

8,500. HIV/AIDS has orphaned some 14 million children. And today, 70 
percent of the people in the world with HIV/AIDS reside in Africa. 
Within that continent there are entire countries where more than one-
third of the adult population is infected.
  More startling, if current infection rates continue, new epicenters 
for the disease are likely to arise out of India, China and Eastern 
Europe, with numbers that could surpass Africa in a few short years.
  And the threat that this pandemic poses to our security is also real. 
If not addressed, this plague will continue to undermine the stability 
of nations throughout the third world, leaving behind collapsing 
economies and tragedy and desperation--a breeding ground for extremist 
violence and terrorism.
  This is truly a global crisis and because the United States can 
render timely assistance, I believe we must.
  You know, every so often in this place, we have the opportunity to do 
something for humanity and serve the American people--and this is such 
a time.
  I thank Chairman Berman and Ranking Member Ros-Lehtinen for their 
strong leadership. I commend my colleague, Mr. Chris Smith, in 
particular for his yeoman's work on carefully preserving the delicate 
balance of this legislation.
  And I'd also like to publicly acknowledge the work of our President, 
George W. Bush. Mr. President, because of your moral leadership and 
compassion, Africa will never be the same, and history will record your 
work.
  And this Global AIDS bill seeks to address the crisis, not only by 
providing medicine and health care to those in need, but also by 
providing funding resources for evidence-based programs that have been 
successful in preventing infection. It is imperative, I believe, that 
we not only send our resources but also that we send them in a manner 
that is consistent with our values. We cannot send billions of dollars 
to Africa without sending values-based safeguards and techniques that 
work to fight the spread of HIV/AIDS by changing behavior.
  Within the current version the Global AIDS bill that the Senate 
recently passed, these pivotal provisions exist in the form of a 
requirement to provide `balanced funding for prevention activities for 
sexual transmission of HIV/AIDS,' and to ensure that abstinence and 
faithfulness programs `are implemented and funded in a meaningful and 
equitable way.' This is enforced by requiring the Global AIDS 
Coordinator to report to the appropriate Congressional committee if 
funding for abstinence, delay of sexual debut, monogamy, or fidelity 
programs drops below 50 percent of the total sexual prevention program 
funding.
  It was essential that we preserve prevention methods that focus on 
behavioral change, and that we work with faith-based and non-
governmental organizations at the local level, in particular through 
the ABC Model, which has produced undeniable results.
  As we tend to the suffering, through, we always have to figure out 
how we're going to pay for it.
  The federal budget, I believe, is packed with wasteful and bloated 
programs, which could supply more than enough opportunities to cover 
the cost of the Lantos/Hyde Global AIDS bill.
  When it comes time to fund this program in the appropriations 
process, I believe Congress should make the hard choices necessary to 
ensure that this global health crisis does not become a crisis of debt 
for our children and grandchildren.
  I believe it is possible to be both responsible to our fiscal 
constraints while being obedient to our moral calling. The greatest of 
all human rights is the right to live. America is a nation of great 
wealth--wealth of resources, but more importantly, a wealth of 
compassion. The history of the world is filled with telling moments 
regarding the character of a people. Sometimes we are witness to 
mankind's great inhumanities. Other times we marvel at the beauty of 
mankind's selfless acts of compassion, when we rise above politics and 
raise up those in dire need. Let this be such a day.
  I urge my colleagues to join me in support of this legislation.
  Mr. PAYNE. I yield 2 minutes to the gentlelady from California, a 
member of the Africa Subcommittee, Congresswoman Woolsey.
  Ms. WOOLSEY. Mr. Speaker, I'd like to thank Chairman Berman and 
Chairman Payne and Ranking Members Ros-Lehtinen and Smith for their 
excellent leadership on global health issues and on this AIDS bill.
  I support H.R. 5501 because it is so very necessary. The statistics 
are staggering. In 2007, there were nearly 35 million people worldwide 
living with HIV/AIDS. In that year alone, 2.5 million people became 
infected with HIV, 420,000 were children under the age of 15. And most 
tragically, there were 2.1 million deaths, 330,000 children under the 
age of 15.
  But Mr. Speaker, this is not only about statistics. This is about the 
child who must stay home from school to take care of her siblings when 
a parent dies of AIDS. We're talking about the mother, the mother who, 
because she lacked prenatal care, passed the disease onto her unborn 
child.
  Today we can make a difference. We can say that one more diagnosis of 
HIV, one more AIDS death, one more malaria case is absolutely 
unacceptable. I urge my colleagues to support this bill and take a 
strong stand against this horrific pandemic.
  Ms. ROS-LEHTINEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas (Mr. Smith), the ranking member of the Committee on the 
Judiciary.
  Mr. SMITH of Texas. Mr. Speaker, I, in turn, thank the gentlewoman 
and the ranking member of the Foreign Affairs Committee for yielding me 
time.
  Mr. Speaker, I recognize that there are good arguments for and 
against this bill, but I want to focus on a provision that many Members 
may not be aware of.
  Under current law, the Secretary of Health and Human Services is 
required to consider HIV/AIDS a communicable disease of public health 
significance; as a result, aliens with HIV/AIDS are inadmissible. 
Section 305 of the bill rescinds the statutory designation of HIV/AIDS 
as a communicable disease. This change would allow the current or a 
future administration to decide that HIV/AIDS is not a communicable 
disease of public health significance, and immigrants with HIV/AIDS 
would be admitted.
  The Congressional Budget Office estimates that this provision will 
result in the entry of thousands of persons with HIV/AIDS. This change 
of policy inevitably will threaten the health and lives of many 
Americans. The CBO also estimates that allowing entry of thousands of 
persons with HIV/AIDS will cost taxpayers tens of millions of dollars. 
The cost of health care for each person with HIV/AIDS averages more 
than $600,000. Mr. Speaker, this provision removes a safeguard that 
protects the health of Americans and costs many millions of dollars.
  Mr. PAYNE. Mr. Speaker, I yield 2 minutes to the gentleman from the 
State of Washington, the father of the AGOA legislation and a health 
provider for USAID for many years, Mr. McDermott.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, today the people's House will say 
eloquently and unequivocally that America's interest to exert its moral 
leadership in the world is back, that all Americans stand united in 
fighting this global epidemic.
  As we've done in times of the past in great trial, we set aside our 
differences and declare that America stands with commitment, compassion 
and conviction against the HIV/AIDS epidemic.
  The Senate has already passed this legislation. And the President has 
announced that he will sign the legislation, which is one of his top 
priorities. I give him high credit for that decision.
  But beyond the money, beyond the $50 billion, is the fact that we are 
ending the unspoken fear and discrimination in our own country by 
eliminating the travel ban restriction that has stopped scientists and 
others infected with HIV/AIDS from crossing our borders to attend 
medical or educational conferences, or to visit family and friends.
  I was at the United Nations a few months ago, and Members of 
Parliaments all over the world said, how can we end the stigma of AIDS 
if you, in the United States, will not allow someone with AIDS to come 
in? We know how to treat AIDS, we know how to diagnose it, but the 
United States is the example: Today, we are making a statement that we 
want to end the stigma of AIDS. That makes it possible for people to 
come in and be tested, for people to come forward and receive 
medication. As long as people have to keep AIDS in the background or 
hide it, we will not end this epidemic. So this provision alone makes 
it possible.
  Representative Granger and I have some legislation in here that ends 
some of the problems with mother-to-child transmission. These 
provisions will make it possible for us to prevent AIDS spread and have 
a generation without AIDS in the future.

[[Page H7116]]

  This legislation will provide the resources policies necessary to 
take the fight against HIV/AIDS to the next level. An increase in 
funding to $48 billion over 5 years will provide the resources to 
sustain the fight on so many fronts in so many countries especially 
hard hit by the pandemic.
  Our provisions included in this legislation will provide training and 
education, integrate services into maternal health care and ensure that 
women and children have access to early screening and life-saving drug 
therapies.
  We know that providing a short regimen of anti-retroviral drugs to 
the mother and newborn reduces transmission by 50 percent. And now we 
will have the means to do it.
  H.R. 5501 also includes my provision to establish two 5-year targets 
to protect the next generation. The first goal is that 16 percent of 
those receiving treatment under PEPFAR be children, which is 
significantly higher than the children receiving treatment under 
current PEPFAR programs.
  The second goal is that 80 percent of pregnant women in the most 
affected countries receive HIV counseling and testing and where 
necessary, antiretroviral treatment to prevent mother to child 
transmission.
  We know how to stop transmission and, over time, we can achieve the 
goal of a generation born free of HIV/AIDS.
  This legislation addresses the fatal connection between HIV and TB, 
which itself has claimed 1.7 million lives directly or through HIV-
associated TB. I'm proud that the Bill and Melinda Gates Foundation in 
Seattle is a leader in the fight against TB as it is in reversing other 
global medical crises.
  My community rightly swells with pride over the local leadership and 
resources being devoted to fighting on behalf of all humanity.
  We have come a long way in a short period of time. H.R. 5501 will 
build on the systems and success we have had so far by integrating 
additional services and providing the vital funding needed to train 
health care professionals and community workers.
  Trained medical personnel, on the ground in country, are the front 
line in this fight and this legislation gives us the ability to send in 
reinforcements to help fight a war against this disease. There is so 
much to say about what this day means. Above all, it means we are going 
to save lives.
  We are going to provide global leadership and real hope. The day will 
come when medical science will discover a vaccine that will end this 
scourge once and for all. Until then, let us stand together as one 
Nation and one world, united in one common goal--in the fight against 
HIV/AIDS.
  I cast my vote for passage on behalf of every person in Seattle, in 
Africa, China, India and elsewhere who lives with or is threatened by 
the HIV/AIDS pandemic. I urge my colleagues to support this 
legislation.
  Ms. ROS-LEHTINEN. Mr. Speaker, I'm proud to yield 5 minutes to the 
gentleman from New Jersey (Mr. Smith), the ranking member of the 
Subcommittee on Africa and Global Health.
  Mr. SMITH of New Jersey. I want to thank my good friend for yielding, 
and thank her for her great work on this legislation, as well as 
Chairman Berman and my good friend, Don Payne, and so many others who 
have made this day possible in this launching of a new initiative, 
building on the old.
  Mr. Speaker, H.R. 5501, as amended, will literally mean the 
difference between life or death to millions, especially in Sub-Saharan 
Africa. As Members know, close to 70 percent of the estimated 33 
million people with HIV live in Sub-Saharan Africa. Of the 2.5 million 
children afflicted with this dreaded disease, 90 percent of them live 
in Africa as well.
  When combined with opportunistic infections like tuberculosis--the 
number one killer of individuals with HIV--and malaria, which kills at 
least one million people a year--again, mostly in Africa--the HIV/AIDS 
pandemic compares among humanity's worst.
  Our distinguished late chairman, Henry Hyde, prime sponsor of the 
original PEPFAR program, frequently compared the sickness to the 
bubonic plague--the black death--an epidemic that claimed the lives of 
over 25 million during the mid-1300s.
  So with that much at stake, I want to remind my colleagues how 
important it is that we get this right. And I think, after a lot of 
hard work, we have managed to come to a consensus, first in the House, 
and now also in the Senate, and I hope it will be a sustainable 
consensus.
  I want to note that Congress has unequivocally rejected the attempts 
of abortion-promoting organizations who wanted to hijack the Global 
AIDS program and link their abortion agenda to the compassionate effort 
to prevent this illness or to relieve the deleterious effects of HIV/
AIDS.
  Look at the progression of this bill. The congressional intent is 
clear with respect to diverting HIV funding to reproductive health/
family planning programming: It was rejected. In the first House 
drafts, there were numerous provisions mandating not only 
``integration'' and ``linkages'' between HIV programming and 
reproductive health and family planning services, but even explicit 
authorization to fund those services. This priority is wrong. We are 
trying to prevent HIV/AIDS, not children.
  I know some Members are likely to wince at the cost of the bill, $48 
billion over 5 years. But that sum of money will likely provide 
treatment for millions suffering from the disease, prevent some 12 
million new HIV infections worldwide, support care for 12 million 
individuals with HIV/AIDS, including five million orphans and 
vulnerable children, and will help train and deploy at least 140,000 
new health care professionals and workers for HIV/AIDS prevention, 
treatment and care.
  On the prevention side, the legislation requires that the Global AIDS 
Coordinator provide balanced funding for sexual transmission prevention 
activities that promote abstinence, delay of sexual debut, monogamy, 
fidelity, and partner reduction. If less than 50 percent of sexual 
transmission prevention monies are spent on the abstinence and be 
faithful part of the ABC model, the coordinator must provide a written 
justification.
  Five years after PEPFAR first began, the efficacy and importance of 
promoting abstinence and be faithful initiatives has been demonstrated 
beyond any reasonable doubt.
  The legislation before us also retains the antiprostitution/sex 
trafficking pledge, an amendment I sponsored in 2003 designed to ensure 
that pimps and brothel owners don't become, via an NGO that supports 
such exploitation, U.S. Government partners.

                              {time}  1645

  Current law ensures that the U.S. Government is not in the position 
of ``promoting or advocating the legalization of prostitution or sex 
trafficking.'' Prostitution and sex trafficking exploit and degrade 
women and children and exacerbate the HIV/AIDS pandemic.
  Finally, we have come a long way since 2003 when significant 
opposition materialized against an amendment that I offered to include 
faith-based providers with conscience clause protection. The conscience 
clause in H.R. 5501, as amended, restates, improves, and expands 
conscience protection in a way that ensures that organizations like 
Catholic Relief Services, which has a remarkable record of HIV/AIDS 
prevention, treatment, and care, are not discriminated against or in 
any way precluded from receiving public funds.
  This legislation is clearly a great legacy and a great honor to our 
former Members Tom Lantos and Henry Hyde and certainly to President 
Bush, who led so ably and so nobly on this initiative.
  Mr. Speaker, I rise today to submit several items of clarification 
for the Record concerning a provision in HR 5501, the Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008. One of the major 
differences in this bill today from when we voted on it in April, is an 
amendment that adds Title VI--an Emergency Plan for Indian Safety and 
Health. Because it is a new addition and because there has been some 
confusion about how this Title should be read and how it would be 
implemented, I wanted to make the intent of Congress clear with these 
submissions to the Record.
  First, I have been told by the Congressional Budget Office that this 
amendment is an authorization of appropriations and consequently has a 
score of 0 since there is ``no direct spending or revenues 
implications.'' Since there has been some confusion on this point, I 
want to restate that Title VI of HR 5501 is exclusively an 
authorization of appropriations and a further act of Congress would be 
necessary before any money could be provided to this Emergency Fund.
  Second, I also want to clarify that according to the author of this 
amendment, Senator John Thune of South Dakota, the Emergency Fund, 
including all health-related contracts or compacts, programs, or other 
services authorized in this amendment will be conducted exclusively as 
programs of the Indian Health Service, subject to all regulations and 
restrictions that ordinarily apply to the Indian Health

[[Page H7117]]

Service. This is what the amendment language means and I want that to 
be clear, so I'm including the letter I received from Senator Thune 
which clarified this point.
  Last, I would also like this letter from the Department of Health and 
Human Services to be included in the Record. This letter makes it clear 
that the Administration and the relevant Department also understand 
that this amendment does not appropriate funds and that all health-
related programs that will later receive appropriations will be 
administered through the Indian Health Service. They go on to explain 
that this Emergency Fund is, by legislative requirement, subject to the 
provisions of the Hyde Amendment, which are currently set forth in 
section 507 of the FY08 L/HHS/ED appropriations act as referenced by 25 
U.S.C. Section 1676.

                                                  U.S. Senate,

                                    Washington, DC, July 23, 2008.
     Hon. Chris Smith,
     Rayburn House Office Building,
     Washington, DC.
       Dear Congressman Smith: Thank you for your interest in my 
     Amendment # 5076 to S. 2731, the Tom Lantos and Henry J. Hyde 
     United States Global Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Reauthorization Act of 2008. As you 
     may know, my amendment, which was accepted by voice vote, 
     authorizes $2 billion in appropriations over the next five 
     years to tribal public safety, health, and water projects.
       My amendment requires that the Attorney General, the 
     Secretary of Interior, and the Secretary of Health and Human 
     Services establish an emergency plan to address the law 
     enforcement, health, and safe drinking water needs of Native 
     Americans across the nation. Specifically, the amendment 
     provides an authorization totaling $750 million, to be used 
     by the Attorney General and Secretary of Interior, to address 
     tribal law enforcement, court, and detention facility needs.
       Additionally, the Amendment established $250 million in 
     authorization to be used by the Secretary of Health and Human 
     Services, acting through the Director of the Indian Health 
     Service (IHS), to provide IHS contract care, health facility 
     construction and rehabilitation, and sanitation facilities. 
     Finally, $1 billion in authorization is to be used to 
     implement Indian drinking water projects that have been 
     approved by Congress.
       Again, thank you for your interest in my amendment. Once 
     enacted, I am hopeful that this modest authorization will 
     begin to meet the critical public safety, health, and water 
     needs that many of our nation's reservations face subject to 
     future appropriations by Congress.
           Sincerely.
                                                       John Thune,
                                             United States Senate.
                                  ____
                                  
                                              Department of Health


                                           and Human Services,

                                    Washington, DC, July 22, 2008.
     Hon. Chris Smith,
     Rayburn House Office Building,
     Washington, DC.
       Dear Mr. Smith: We understand that concerns have been 
     raised regarding whether the Hyde Amendment will attach to 
     funds used for Indian Health purposes under Section 601 of 
     H.R. 5501, the Senate bill that seeks to reauthorize the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003. The Department's position is that the 
     Hyde Amendment will attach to funds appropriated for Indian 
     Health purposes.
       Section 601 of H.R. 5501 would establish in the Treasury an 
     Emergency Fund for Indian Safety and Health (the ``Fund''). 
     Under Section 601(t)(3), the Secretary of Health and Human 
     Services shall use 12.5 percent of the Fund to provide health 
     services and improve health and sanitation facilities for 
     members of Indian tribes. The Secretary must act ``through 
     the Director of the Indian Health Service,'' thus, such 
     activities will be conducted as programs of the Indian Health 
     Service. Although Section 601 authorizes the establishment of 
     the Fund, it does not actually appropriate money to the Fund. 
     Subsequent legislation is necessary to appropriate money to 
     the Indian Health Service for Indian Health purposes as 
     authorized by the Fund.
       The Hyde Amendment, which is currently set forth in section 
     507 of the FY08 L/HHS/Ed appropriations act, will attach to 
     money appropriated to the Fund for Indian Health purposes 
     under section 601(f)(3). If the L/HHS/Ed appropriations act 
     contains the Hyde Amendment, and Congress appropriates money 
     to the Fund in another act, then the money used for the 
     Indian Health Service will be subject to the Hyde Amendment 
     because 25 U.S.C. Sec. 1676 will apply. 25 U.S.C. Sec. 1676 
     states that ``[a]ny limitation on the use of funds contained 
     in an Act providing appropriations for the Department of 
     Health and Human Services for a period with respect to the 
     performance of abortions shall apply for that period with 
     respect to the performance of abortions using funds contained 
     in an Act providing appropriations for the Indian Health 
     Service.'' Because an act that appropriates money to the Fund 
     would ``provid[e] appropriations for the Indian Health 
     Service,'' the Hyde Amendment contained in the L/HHS/Ed 
     appropriations act would be applicable to money used for 
     Indian health purposes under section 601(f)(3).
           Sincerely,
                                               Charles E. Johnson,
                 Assistant Secretary for Resources and Technology.

  Mr. PAYNE. Mr. Speaker, I would like to recognize the gentleman from 
New York (Mr. Engel), chairman of the Western Hemisphere Committee, for 
2 minutes.
  Mr. ENGEL. I thank the gentleman for yielding to me.
  Mr. Speaker, I rise in strong support for H.R. 5501.
  While most widely recognized for renewing our commitment to global 
AIDS relief, the Tom Lantos and Henry J. Hyde Global Leadership against 
HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 
reauthorizes provisions on all three of these deadly diseases of 
poverty.
  The World Health Organization reports that 1.7 million people died of 
tuberculosis in 2006, with 200,000 dying from HIV-associated TB. The 
emergence of multidrug-resistant and extensively drug-resistant TB, 
known as MDR and XDR, pose a grave risk to global health. These strains 
are far deadlier than normal TB and are much more difficult and 
expensive to treat. A contagious, airborne disease, TB knows no 
barriers or borders and can only be successfully controlled in the 
United States by also controlling it overseas.
  The Lantos-Hyde Act declares TB control a major objective of U.S. 
foreign assistance programs. The legislation requires a 5-year plan to 
support the treatment of 4.5 million tuberculosis patients and 90,000 
new MDR-TB cases.
  This bill incorporates substantial portions of my bill, H.R. 1567, 
the Stop Tuberculosis Now Act. The Lantos-Hyde Act prioritizes the Stop 
TB Partnership's strategy, including expansion of the successful 
treatment regimen for both standard TB and drug-resistant TB. It 
further promotes research and development of new tools.
  Recognizing the deadly synergy between tuberculosis, an opportunistic 
infection, and HIV/AIDS, the Lantos-Hyde Act authorizes assistance to 
strengthen the coordination of HIV/AIDS and TB programs. TB is the 
leading killer of people with HIV/AIDS, and the explosion of drug-
resistant TB in sub-Saharan Africa threatens to halt and roll back our 
progress in combating both diseases.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PAYNE. Mr. Speaker, I yield the gentleman 20 seconds.
  Mr. ENGEL. I'll talk fast.
  Finally, Mr. Speaker, the legislation authorizes assistance for the 
development of new vaccines for TB. The current TB vaccine is more than 
85 years old and is unreliable against pulmonary TB, which accounts for 
most of the worldwide disease burden. New TB vaccines have the 
potential to save millions of lives and would lead to substantial cost 
savings.
  I urge my colleagues to vote ``aye'' on H.R. 5501 today. We can 
control and win the fight against AIDS and TB.
  Ms. ROS-LEHTINEN. Mr. Speaker, I would like to yield 3 minutes to the 
gentleman from Iowa (Mr. Latham), a member of the Committee on 
Appropriations.
  Mr. LATHAM. I thank the gentlewoman for yielding the time.
  Mr. Speaker, this bill is very important. Helping people in need 
overseas has always been a national priority, and I stand in favor of 
H.R. 5501. However, I must say that helping American taxpayers hurt by 
natural disasters should be our highest priority. This Congress is 
letting them down.
  According to the House and Senate leadership, there simply isn't 
enough time for Congress to pass emergency aid to help Midwestern 
States affected by the devastating floods last month.
  Not enough time?
  When Hurricane Katrina hit the gulf on Monday, August 29, 2005, 
Congress began working. On Friday of that same week, the House and 
Senate introduced, passed, and had a supplemental appropriation bill 
signed into law that same day. Five days later another supplemental 
bill was introduced and was signed into law the very next day. And in 
2004 after Hurricanes Charlie and Frances landed, the Congress passed a 
supplemental appropriations bill and had it signed into law in 1 week.
  Yet here I stand almost 2 months after the most damaging natural 
disaster in Iowa's history began and the Democrat leadership in the 
House and the Senate are telling the people up and down the Mississippi 
River that

[[Page H7118]]

they can wait until there is frost on the beans until we decide on 
additional aid.
  Earlier this week the Governor of Iowa told the leadership of this 
House that Iowa alone needs an additional $1.2 billion more than FEMA 
can provide. Iowa has suffered a loss of $10 billion. Now we are told 
we will be waiting until September for a bill.
  Where's the outrage? Well, I will tell you. It's in Iowa. It's with 
the 25,000 homeless Iowans. It's with the small business owners, the 
employers, the people who sacrificed their homes to help their 
neighbors.
  This House has had time since the first waters started flowing 
through Midwestern homes to vote on numerous bills under the suspension 
calendar. We have had time to designate the ``National Day of the 
Cowboy'' and the ``National Carriage Driving Month.'' And 348 Members 
of Congress walked over here to vote to honor the life of a musician 
who had a number one hit entitled ``What's the Use of Getting Sober, 
When You're Gonna Get Drunk Again?''
  Well, it appears that Congress needs to sober up and help the people 
of the Midwest. The House should not leave for the August recess until 
we finish our work and help the victims of the Midwest.
  Mr. PAYNE. Mr. Speaker, I yield 2 minutes to the gentlewoman from the 
State of Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Let me thank the gentleman from New Jersey 
for his leadership and the ranking member, the chairperson of the full 
committee, Mr. Berman, and pay tribute to our good friends the late Tom 
Lantos and Henry J. Hyde, who have captured, in essence, what our war 
against HIV/AIDS is all about. It has to be comprehensive and 
expansive. It has to recognize the overlapping impact of tuberculosis 
and malaria.
  Mr. Speaker, I think one of the most telling scenes that I was able 
to experience, sadly so, was walking into a little hut in Zambia and 
seeing an emaciated body or person, if you will, being taken care of by 
a 4 year old. That individual had HIV/AIDS and tuberculosis.
  So this legislation is crucial in the overall comprehensive war 
against the devastating diseases when there is no water, no nutrition, 
and poverty. This targets 12 million new HIV infections. It is treating 
millions of people. It's supporting care for 12 million. It has a focus 
on women and girls. It provides a focus on the anti-retroviral 
treatment that is so important that goes after opportunistic 
infections. It provides a certain amount of money, $9 billion, for 
malaria and tuberculosis over 5 years. It goes to the very essence of a 
4 year old being the only remaining healthy person in his family having 
to care for sick relatives suffering from HIV/AIDS and tuberculosis and 
many suffering from malaria.
  This is an important step forward. And, yes, we have many 
responsibilities in this Congress. I join my friend from Iowa. We will 
be working hard to provide the support systems that those individuals 
need. But at the same time, this is a tribute to great leaders like our 
former and late chairpersons of this committee, Chairman Hyde and 
Chairman Lantos, who recognized that to those who are given much, much 
is expected.
  This bill responds to the devastation and need around the world. I 
ask my colleagues to support this legislation.
  Thank you, Mr. Speaker, for allowing me to speak on not only an 
important issue in this country but around the world. I can only note 
that it gives me great pause that my colleague, Congressman Tom Lantos, 
did not live to see the fruit of his hard work on this bill. However, I 
know his family and his colleague Congressman Henry Hyde have kept this 
legislation alive and moving through this Congress.
  Mr. Speaker, thank you for allowing for H.R. 5501, the Tom Lantos and 
Henry J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008 on PEPFAR to come 
to the floor today.


                         jackson-lee amendment

  I would also like to thank both Chairman Berman and the Chairman of 
the Subcommittee on African and Global Health, Congressman Payne, for 
working with me to include important language in this legislation. My 
language, in Section 301 of this bill, addresses the necessity of 
making children a priority among individuals with HIV for proper food 
and nutritional support. Section 301, with my language included, states 
that it is the sense of Congress that ``for the purposes of determining 
which individuals infected with HIV should be provided with nutrition 
and food support--(i) children with moderate or severe malnutrition, 
according to WHO standards, shall be given priority for such nutrition 
and food support; and (ii) adults with a body mass index, BMI, of 18.5 
or less, or at the prevailing WHO-approved measurement for BMI, should 
be considered `malnourished' and should be given priority for such 
nutrition and food support;''
  Mr. Speaker, as Chair of the Congressional Children's Caucus, I 
believe that this language is crucial, and I thank the Chairman for 
including it in the text of the bill. HIV-infected children have been 
underrepresented among beneficiaries of PEPFAR-supported programs. As 
this legislation cites in the findings section, ``of those infected 
with HIV, 2.5 million are children under 15 who also account for 
460,000 of the newly-infected individuals.'' And even these large 
numbers are deceiving, as children die much quicker from AIDS than do 
adults. I am pleased to see this language, which focuses attention on 
the plight of these children, and makes serving their needs a priority.


                                 pepfar

  In January 2003, President Bush announced the President's Emergency 
Plan for AIDS Relief, or PEPFAR. As its name implies, PEPFAR was 
envisioned as an emergency response; we are here today to discuss how 
to transition to a sustainable program to address these global 
epidemics.
  HIV/AIDS continues to represent a serious and large-scale challenge 
throughout much of the world. It goes far beyond a simple health 
problem, and it hinders attempts to foster economic development and 
political stability. As we begin the process of reauthorizing PEPFAR, I 
believe it is crucial that we emphasize the long-term sustainability of 
our HIV efforts, and that we integrate AIDS prevention and treatment 
within our larger-scale development initiatives.

  Though we have drugs that are effective in managing infections and 
reducing mortality by slowing the progression to AIDS in an individual, 
they do little to reduce disease prevalence and prevent new infections. 
For this reason, there is growing consensus among health experts that 
we must put greater emphasis on prevention programs, which are perhaps 
the most critical aspect of any initiative to combat global HIV/AIDS. 
Even as increasing numbers of people have access to anti-retroviral 
drugs, ARVs, an estimated 5.1 million people who needed treatment did 
not receive it in 2006.


                              tuberculosis

  The World Health Organization, WHO, estimates that throughout the 
world someone contracts TB every second and that one third of all 
people in the world are currently infected with TB. Tuberculosis 
spreads easily from one person to another: when the infected person 
coughs, the bacilli or TB germs are spread into the air and another 
person need only to inhale a small number of the bacilli to be 
infected. The World Health Organization, WHO, estimates that each 
person left untreated with active TB will infect, on average, between 
10 and 15 people every year. Although the TB bacilli can lie dormant in 
the body for years and its effects may not be immediately felt, if one 
has a weakened immune system, such as through HIV/AIDS, the chances of 
becoming sick will increase.
  In 2005, nearly 9 million people contracted tuberculosis, of which 84 
percent occurred in high burden countries, with all but two of the high 
burden countries in Africa and Asia. This demonstrates the necessity 
for special attention to these high burden countries, particularly in 
Africa. Among the 15 countries with the highest estimated TB incidence 
rates, 12 were in Africa, due in part to relatively high rates of HIV 
co-infection. About 80 percent of all cases in the world were found in 
22 countries, all but 4 were found in Africa or Asia.
  Some 2.97 million people in Southeast Asia were newly infected with 
TB and about 2.57 million in sub-Saharan Africa. In 2004, sub-Saharan 
Africa was the only region in the world where TB prevalence was 
growing; elsewhere the number of cases was stable or falling. Despite 
our concerted efforts, we continue to face a serious and persistent 
health threat. I believe that it is imperative that we ensure that 
American taxpayer dollars are used to greatest effect, not to bolster 
ideology.
  Current restrictions on PEPFAR mandating that \1/3\ of all prevention 
funds must be used on abstinence-only education neglect the real needs 
of populations both in America and abroad. These stipulations hurt the 
ability of PEPFAR to adapt its activities in accordance with local HIV 
transmission patterns, and they impair efforts to coordinate with 
national health plans. Though AIDS is clearly a global problem, it does 
not affect every nation equally or in the same manner. Removing these 
stipulations would allow PEPFAR to better address

[[Page H7119]]

the requirements of each country, making more efficient and effective 
use of taxpayer dollars in serving the millions affected by this 
disease.

  In addition, I believe it is crucial that we dedicate greater 
attention to strengthening local health infrastructure. Health experts 
have expressed concern that the high amount of spending directed toward 
HIV/AIDS initiatives has drawn health workers away from public health 
facilities and other important programs. This merely compounds a 
chronic shortage of qualified health workers, which, according to WHO's 
2006 World Health Report, is the single most important health issue 
facing countries today. This need is felt particularly sharply in 
Southeast Asia and sub-Saharan Africa.
  Many health experts also continue to advocate greater integration 
between PEPFAR and other health programs, including those focused on 
nutrition, maternal and child heath, and other infectious diseases. 
These experts note that HIV is intricately linked to these other areas 
of concern; for example, malnutrition and lack of food may heighten 
exposure to HIV, raise the likelihood of engaging in risky behavior, 
increase susceptibility to infection, and complicate efforts to provide 
anti-retroviral, ARV, medication. Further, an HIV epidemic will likely 
worsen food insecurity, by depleting the agricultural workforce. I 
believe it is necessary, to ensure maximum effectiveness, that we 
integrate PEPFAR with other aspects of our international health 
outreach and development programs.
  Mr. Speaker, if we are to turn the tide of turmoil and tragedy that 
HIV/AIDS causes to millions around the world, and hundreds of thousands 
right here in our backyard, it is imperative that we continue to fund 
and expand medical research and education and outreach programs.


                                hiv/aids

  I want to share briefly the importance of continued action in 
awareness for this virulent disease and the nexus between TB and HIV/
AIDS, another issue which I am passionate about and would like to see 
eradicated as I am sure many of my colleagues would. According to the 
World Health Organization, there were 33.2 million people living with 
HIV/AIDS worldwide in 2007.
  People living with HIV/AIDS are at a greater risk of becoming 
infected with TB because of their weakened immunity. In 2004, out of 
the more than 740,000 people who contracted TB and were co-infected 
with HIV/AIDS, 600,000 of those co-infected were found in sub-Saharan 
Africa.
  Similar to TB, HIV/AIDS has risen to epidemic levels particularly for 
our African countrymen. According to UNAIDS, in 2005, there were 3.2 
million newly infected Africans and 2.4 million Africans who died of 
HIV/AIDS related complications. The current life expectancy for a 
person living with AIDS in Africa is 47 years old.
  Such high rates of infection can be prevented. The transmission of 
HIV can be reduced through proper education and resources. 
Additionally, proper resources can help the treatment of HIV. We must 
make these resources more accessible to those who need it most.


                                malaria

  Malaria is another disease that must be addressed. According to the 
World Health Organization, more than 500 million people become severely 
ill with malaria and more than one million people die of malaria every 
year, mostly infants, young children and pregnant women. Perhaps most 
shocking is WHO's estimate that a child dies of malaria every 30 
seconds. More than 90 percent of malaria cases occur in sub-Saharan 
Africa.
  Mr. Speaker, malaria is both preventable and curable. Early and 
effective treatment can shorten its duration and prevent the 
development of complications and the great majority of deaths.


                         concluding statements

  Key factors that contribute to continuing high rates of HIV/AIDS, 
Tuberculosis, and Malaria include: weak health care systems, poor 
access to health facilities, insufficient staffing and other human 
resource constraints, ill equipped and substandard laboratory services, 
and little collaboration between TB and HIV programs.
  Mr. Speaker, what is so striking about these factors is that they are 
all preventable. We must address and work to rectify these human 
factors that have led to such unnecessarily high fatality rates 
throughout the world, particularly in African nations. I urge my fellow 
colleagues to join me in support of PEPFAR and H.R. 5501.
  Ms. ROS-LEHTINEN. Mr. Speaker, I would like to yield 1 minute to the 
gentleman from Illinois (Mr. Kirk), a member of the Committee on 
Appropriations.
  Mr. KIRK. I thank the gentlewoman for yielding.
  Mr. Speaker, 23 years as a staff member, I heard from WHO that AIDS 
was not an epidemic based in New York, San Francisco, or Haiti, as we 
thought back in 1985, but instead was an epidemic that raged in Zaire 
for years.
  I got my then boss, John Porter, and Democratic Congressman Bob 
Mrazek to begin the foreign AIDS program. We were told by the leaders 
of the Appropriations Committee that we could not do this, but we did. 
We started with just a $25 million funding level, and as recently as 
1999, I had a tough time even getting members to show up for a hearing 
on this subject. I feel a bit like a country music singer who worked in 
every honky-tonk for years before hitting the big time. But this bill 
is the big time. It's the largest investment in health of another 
country from just one country, the United States of America. The 
original legislation put too many congressional restrictions on this 
program. This frees up those restrictions.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Ms. ROS-LEHTINEN. I yield the gentleman 30 seconds, Mr. Speaker.
  Mr. KIRK. Mr. Speaker, this legislation takes us in the right 
direction by freeing up restrictions because we knew even back in 1985 
that to save the most lives this program should be run by doctors and 
not politicians.
  Now, 23 years ago John Porter, Bob Mrazek, and I had no idea how 
large and successful this program would be. My only wish is the head of 
the Harvard Public School of Health, our first director of this early 
program, Dr. Jonathan Mann, could be with us. Dr. Mann was killed in a 
tragic airline accident, but I wish he could see us now.
  Mr. BERMAN. Mr. Speaker, I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Mr. Speaker, I am pleased to yield 2 minutes to my 
good friend from Connecticut (Mr. Shays).
  Mr. SHAYS. I thank the gentlewoman for yielding.
  Mr. Speaker, I rise in support of H.R. 5501, the Tom Lantos and Henry 
Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act. I am pleased the committee named this 
bill after two great leaders of the Foreign Affairs Committee, Chairmen 
Lantos and Hyde, who guided the original 2003 act into law.
  An estimated 38.6 million people are infected with HIV/AIDS 
throughout the world today. The majority of them are women and girls. 
In sub-Saharan Africa, women and girls make up 60 percent of those 
infected with HIV/AIDS.
  It is impossible to overstate the importance of ensuring we are doing 
all we can to address the spread of this dreaded disease around the 
world. It is heart breaking to think of children going to school with 
no teachers, coming home to no parents.
  H.R. 5501 would authorize $48 billion over 5 years to treat AIDS and 
other global diseases and another $2 billion for Native American health 
care, law enforcement, and drinking water programs.
  America faces a new generation of threats in the 21st century, 
including global health pandemics, terrorism, and climate change. 
Today's legislation and other critical foreign assistance programs are 
absolutely vitally important to our national interests and security. 
Legislation like this helps make our country more secure and, just as 
importantly, more humane.
  Mr. BERMAN. Mr. Speaker, I continue to reserve the balance of my 
time.
  Ms. ROS-LEHTINEN. Mr. Speaker, I would like to yield myself the 
balance of my time.
  I believe that PEPFAR is the most successful example of American 
foreign assistance since the Marshall Plan. Just as the Marshall Plan 
protected American lives by helping to stabilize a continent ravaged by 
war, PEPFAR is protecting American lives today by helping to stabilize 
a continent ravaged by disease.

                              {time}  1700

  More than just express American compassion, PEPFAR also protects 
American security. Let us give our strong support to H.R. 5501.
  In closing, I would like to thank the following staff members of our 
Foreign Affairs Committee who have dedicated many long hours to 
ensuring that this bill is signed into law and we can continue U.S. 
efforts to save lives. For the

[[Page H7120]]

majority, Dr. Bob King, Peter Yeo, Dr. Pearl Alice Marsh, David 
Abramowitz and Kristin Wells. On our side, the Republican side, Joan 
Condon, Mark Gage, Doug Anderson, Sarah Kiko, Sam Stratman, Sheri 
Rickert, and our fabulous GOP staff director, Dr. Yleem Poblete. Thank 
you so much.
  Mr. Speaker, I hope that our colleagues will see the meritorious 
nature of this proposal, because the HIV/AIDS pandemic is a significant 
threat to global health. It's also a leading threat to global 
stability. We can help fill this void. We can help stabilize the 
continent. We can help save lives by passing this bill today and 
sending it to the President's desk. As soon as tomorrow, we can have it 
on the President's desk and have a bill signed by next week.
  We are in a position where we can make a difference, because this 
virus is killing millions of people in the prime of life. These are 
parents. These are teachers. These are government officials, public 
health workers and military officers, people who hold the fabric of 
life together for their community. We have an opportunity to rise to 
the challenge, pass this bill and save their lives and save a 
generation of lives around the world.
  With that, Mr. Speaker, I yield back the balance of my time.
  Mr. BERMAN. Mr. Speaker, I yield myself the remaining time.
  The bill has been described, and its consequences have been 
discussed. But I can't help but come back to the comments from my 
friend from California (Mr. Rohrabacher) with respect to the effects of 
this bill. The notion that there are now pregnant women who, because of 
new discoveries in medicine, can take drugs which allow their baby to 
be born without being HIV positive, I call that saving lives and curing 
the problem. This is happening all over the countries where these 
programs are working. The notion that the United States is helping to 
take care of the orphans and other vulnerable children who are left 
without parents as a result of this epidemic I call saving lives and 
curing a problem.
  And as the ranking member said in her opening comments, the effect on 
these people and their recognition of the role the United States is 
playing is having a--it's a secondary question, but it's an important 
one--it's having a massive impact on how they perceive this country at 
a time when, for many other reasons, this country has not been 
perceived well in this world.
  This has been a remarkable program that has gone on. And I want to 
add my compliments to the staff, all the staff on the minority who 
worked on it, as well as Peter Yeo and Pearl-Alice Marsh and David 
Abramowitz, Kristin Wells, Heather Flynn with Chairman Don Payne, 
Christos Tsentas with Congresswoman Lee, as well as Mark Synnes with 
legislative counsel, Naomi Seiler and Jessica Boyer from the Oversight 
Committee staff, and on the Senate Foreign Relations majority staff, 
Brian McKeon and Shannon Smith. These are people who not only helped 
put this bill together, not only invested huge amounts of their time in 
working with the outside coalition forces, who have been working on the 
ground on these issues in Africa and other places, and also dealt with 
the administration, these are people who, when I got thrown into this 
issue, helped educate me. And I'm very grateful for all they have done 
to make this happen.
  Mrs. CAPPS. Mr. Speaker, I rise in strong support of H.R. 5501.
  Every day, 6,000 people become infected with HIV, over 1,000 of whom 
are babies.
  We have made terrific advancements in treating and preventing HIV/
AIDS, but they mean nothing unless we ensure that the most vulnerable 
populations have access to them.
  Since its inception, the President's Emergency Plan for AIDS Relief, 
PEPFAR, has saved countless lives and increasing our investment through 
this reauthorization will save millions more.
  I am especially proud to see that this reauthorization places 
stronger emphasis on prevention.
  Without increased efforts to prevent the transmission of HIV/AIDS, we 
will never adequately address the long-term needs of the global HIV/
AIDS population and global health overall.
  This bill takes important steps to increase prevention efforts by 
overturning the ineffective one-third abstinence-only requirement that 
currently applies to global HIV/AIDS prevention funding; providing an 
increased focus on women and girls who are at-risk; and setting a 
target for PEPFAR to provide 80 percent of pregnant women with the 
tools they need to prevent maternal-to-child transmission of HIV.
  Finally I am thrilled to see an increased investment in helping 
countries to expand their healthcare workforce as they face drastic 
shortages in skilled healthcare workers.
  During my recent visit to Africa with the House Democracy Assistance 
Commission, I had the opportunity to visit with doctors, nurses and 
ministries of health in several countries.
  They are desperate for more professionals who can treat individuals 
affected with HIV/AIDS, especially in countries like Malawi where 15 
percent of the population suffers from HIV/AIDS.
  Our investments and improvements of PEPFAR fulfill a moral 
responsibility that we are accountable to.
  Our steadfast commitment to PEPFAR is also one of our proudest 
foreign policy accomplishments over the past few years as we provide 
the necessary humanitarian assistance required for countries to sustain 
themselves in the long-term.
  Finally, I would like to also applaud the provision removing the ban 
on visas for HIV-infected individuals wishing to come to the United 
States. This mean spirited statute should have been repealed long ago 
and I am glad to see that it is finally being ended. Only a few 
countries have such a policy and America should not be one of them.
  I urge my colleagues to enthusiastically support this legislation and 
I look forward to the success we are sure to see in addressing the 
global HIV/AIDS epidemic.
  Mr. WAXMAN. Mr. Speaker, as one of the original cosponsors of the 
House version of this bill, I am happy to see that it is about to 
become law. This reauthorization affirms to our partners around the 
world that we are with them for the long haul in the fight against HIV, 
TB, and malaria.
  The bill retains many of the important provisions of the House 
version. It authorizes strengthening of local health systems and health 
care workforces. It supports fiscal responsibility by directing the 
purchase of safe drugs at the lowest available prices. And it 
encourages operational research and the translation of lessons learned 
into effective programming.
  The bill incorporates Congresswoman Barbara Lee's legislation to 
eliminate the HIV travel ban. This is an important policy step. And it 
is an important message that we reject this relic of a time when fear 
and stigma drove much of the nation's' response to AIDS.
  But unfortunately, fear and stigma around HIV are still very real, 
particularly when we talk about prevention. This bill notes the 
importance of supporting healthy behavior change, and encourages the 
expansion of male circumcision as an effective prevention method. But I 
think there are parts of this bill where Congress could have spoken 
more directly to the need for honest, evidence-based prevention 
programming.
  Injection drug users around the world are among the most vulnerable 
to HIV prevention. This bill makes only brief mention of the need for 
prevention strategy and other programs for this population. Our 
implementers should understand how crucial this focus is to fighting 
the epidemic, not only in countries with HIV driven mainly by drug use, 
but also in countries with emerging, concentrated drug-related 
epidemics.
  The same applies to men who have sex with men. Due to stigma and 
denial, the HIV prevention, treatment, and care needs of sexual 
minorities are often unmet. This bill makes only passing reference to 
men who have sex with men, but the program should be implemented in a 
way that truly recognizes the needs of this population.
  People involved in sex work are also very vulnerable to HIV 
infection, along with many other health and social risks. I'm 
disappointed that we haven't eliminated the current requirement that 
recipients sign an ``anti-prostitution pledge.'' The requirement has 
reportedly had the unintended consequence of scaring grantees away from 
doing effective outreach programs for sex workers. But U.S. officials, 
and all of our partners, should know that Congress wants this law 
implemented in a way that best respects the public health needs of this 
severely marginalized group.
  Finally, I have concerns about integration of activities. I am 
particularly disappointed that the bill does not explicitly encourage 
the close integration of HIV programs with family planning and other 
reproductive health services. What's more, language added to the bill's 
``conscience clause'' could hinder effective integration, when we 
should be doing everything we can to encourage referrals to important 
health services.
  All of these concerns do not outweigh my deep respect for what the 
global AIDS program has accomplished, and my strong support of its 
reauthorization. They do underscore

[[Page H7121]]

the need for ongoing oversight of how the program is designed and 
implemented, particularly in efforts to reduce HIV transmission.
  The first 5 years of PEPFAR showed that a remarkable scale-up of 
effective treatment was possible in the developing world. It's time to 
use all of the public health knowledge and resources we have to do the 
same for prevention.
  Mr. SIRES. Mr. Speaker, I rise today in support of H.R. 5501, the Tom 
Lantos and Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
  The passage of this bipartisan bill will continue Congress' 
commitment to the fight against HIV, TB and malaria around the world. 
This bill will dramatically boost HIV/AIDS and health care programs for 
women and girls, as well as strengthen health and education systems in 
nations hard-hit by the HIV virus.
  H.R. 5501 also provides funding for orphans and vulnerable children, 
as well as food and nutrition programs.
  The World Health Organization estimates that over 38 million people 
are living with HIV/AIDS and 95 percent of those people live in the 
developing world.
  We must be leaders in combating the global AIDS crisis and this bill 
allows maximum flexibility for our staff on the ground. H.R. 5501 
provides needed funding and support to transition the very successful 
PEPFAR program from the emergency phase to the sustainability phase. I 
urge all my colleagues to support this bill.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of the Senate 
amendments to the Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008.
  Five years ago, Congress showed leadership and passed legislation on 
a bipartisan basis to address the global pandemics of HIV/AIDS, 
tuberculosis and malaria. While enormous progress has been made since 
2003, the number of people who are affected by these diseases is still 
staggering. The United Nations estimates that thirty-three million 
people are living with HIV/AIDS worldwide, with AIDS causing 
approximately 1.6 million deaths in sub-Saharan Africa in 2007.
  We have a moral obligation to lead the fight against these global 
diseases. This legislation will authorize $48 billion over five years 
for our global HIV/AIDS, tuberculosis and malaria efforts. It will 
allow the United States to provide continued assistance for these 
pandemics in developing countries and will strengthen the health 
systems in host countries by giving them more flexibility to plan, 
direct, and manage prevention, treatment and care programs. I am also 
pleased that this legislation includes a provision that authorizes 
funding for the research and development of new tuberculosis vaccines, 
which have the potential to save millions of lives.
  Mr. Speaker, we still have much work to do. I urge my colleagues to 
continue and reaffirm America's commitment to combating HIV/AIDS, 
tuberculosis, and malaria by supporting this much-needed bipartisan and 
bicameral legislation.
  Mr. HOYER. Mr. Speaker, five years ago, the United States made an 
unprecedented commitment to the people of the world who suffer from 
HIV/AIDS, malaria, and tuberculosis. We pledged $15 billion--and with 
that funding, we have: Provided life-saving drugs to almost 1.5 million 
people; funded care for over 2 million orphans and vulnerable children; 
and provided mother-to-child transmission prevention services during 
more than 6 million pregnancies.
  For millions, HIV/AIDS has been transformed from a death sentence to 
a manageable condition--and Congress has played a very real role in 
making that happen. On this issue, our moral obligation and our self-
interest speak with one voice. Not only do we have the opportunity to 
save millions of lives--failing to do so will help proliferate disease 
and instability, spreading bloodshed across borders.
  Today, with the Tom Lantos and Henry J. Hyde Global LeadershipAgainst 
HIV/AIDS, Tuberculosis and Malaria Reauthorization Act, we raise our 
commitment to eradicating those diseases to a total of $48 billion. In 
addition to expanding our prior efforts, this carefully negotiated 
legislation will:
  Strengthen HIV -related health care delivery systems and increase 
health workforce capacities;
  Foster stronger relationships between HIV/AIDS initiatives and other 
support programs, including those that promote better nutrition and 
education;
  Allow HIV/AIDS testing and counseling to be provided as part of the 
U.S. bilateral family planning program; and
  Enhance prevention and treatment programs targeting women and girls.
  This bill also eliminates a requirement that \1/3\ of prevention 
funds be spent on abstinence--a requirement that has proven 
ineffective. Instead, we have directed the Administration to create a 
``balanced'' approach, requiring behavioral change programs to receive 
50 percent of the funds devoted to the prevention of sexual 
transmission of HIV. In the face of the AIDS pandemic, this bill will 
show the world, unambiguously, that America accepts its obligation to 
act.
  Last year alone, 2.5 million people contracted HIV--roughly 6,800 
every single day. And last year alone, 2.1 million AIDS victims were 
added to the rolls of the dead. We are confronting a scourge far too 
pressing, far too powerful, to be made the object of political 
inaction. We have rarely faced a greater global challenge. We have 
rarely needed a greater global solution.
  I want to thank Congresswoman Barbara Lee for her hard work to shape 
that solution. But most of all, I want to honor Tom Lantos. This bill, 
in many ways, was the culmination of his career, his lifetime of 
service. I wish he could be here to see it. But how perfect that Tom's 
work, which began in the fight against tyranny in his homeland, 
expanded to encompass the whole world, and the world's struggle against 
the tyrannies of disease and poverty.
  Chastened by the vast challenge of AIDS--but inspired by Tom's 
example, and Henry Hyde's, as well--let us come together across the 
aisle and join the struggle with all the force America can muster. Let 
us pass this bill.
  Mr. PAUL. Mr. Speaker, I in rise opposition to this irresponsible 
legislation, which will ship $48 billion overseas as foreign aid at a 
time when Americans are feeling the pressure of rapidly increasing 
inflation and a weakened dollar. It is particularly objectionable to 
ship money to fund healthcare overseas when so many Americans either 
struggle with high healthcare costs or avoid seeking medical assistance 
altogether due to lack of insurance or funds.
  As we know, the Federal Government does not have $48 billion to send 
overseas so it will have to print the money. It is a cruel irony that 
this will add to inflation at home which will increase even further the 
costs of healthcare in the United States.
  Mr. Speaker, I am saddened by the prevalence of disease in 
impoverished countries overseas. I certainly encourage every American 
concerned about HIV/AIDS, tuberculosis, and malaria overseas to 
voluntarily provide assistance to help alleviate the problem. But I do 
not believe it is appropriate--nor is it constitutional--to forcibly 
take money from American citizens to send abroad. I urge my colleagues 
to reject this and all foreign aid legislation.
  Ms. ZOE LOFGREN of California. Mr. Speaker, this bill underscores the 
United States' position as the world leader in the fight against HIV/
AIDS, Tuberculosis, and Malaria.
  In addition to all that the bill does to fight the three diseases on 
a global level, the bill finally does away with an outdated and 
unnecessary provision in immigration law that prevents persons with HIV 
from visiting or immigrating to the United States.
  This provision, in place for over 20 years, has kept parents from 
children and sisters from brothers. It has slowed research and 
discourse by preventing many researchers and other experts in the field 
from entering the country. And it has significantly undermined our 
leadership in the fight against HIV.
  The U.S. is one of only 12 countries in the world to have such harsh 
HIV-based restrictions on entry. The others include Sudan, Libya, 
Russia and Saudi Arabia. Even China has recently overturned its ban.
  This discriminatory policy has no basis in public health, and it 
should have been stricken long ago.
  Our immigration laws have long prevented the admission of persons who 
have communicable diseases that HHS believes are of ``public health 
significance.'' In 1993, HHS sought to remove HIV from this list. But 
Congress, in a time of fear and ignorance about the disease, kept it 
in.
  HIV is now the only medical condition permanently listed in the INA 
as a basis for inadmissibility. For any other disease, HHS retains the 
discretion to determine, with the wealth of medical and public health 
expertise at its disposal, whether that illness should be a bar to 
admission.
  HHS does not believe that HIV should present such a bar. Neither do 
the American Medical Association, the Centers for Disease Control, the 
World Health Organization, and other public health organizations. These 
experts agree that there is no medical or public health rationale for 
this policy.
  The policy also keeps world-renowned experts, doctors, and 
researchers from participating in U.S. hosted efforts to combat the 
epidemic. Indeed, since 1993, the International Conference on AIDS has 
not been held on U.S. soil.
  It is time we end this discriminatory policy.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise today in strong support 
for H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008.

[[Page H7122]]

  This important piece of legislation outlines the United States' 
efforts to combat the devastating effects of AIDS, Malaria, and 
Tuberculosis on our global community.
  I am extremely encouraged that this bill declares Tuberculosis 
control a major objective of U.S. foreign assistance programs--
particularly, that this bill will encourage the development of a TB 
vaccine.
  TB is the leading killer of people with HIV/AIDS, and the explosion 
of drug-resistant TB in sub-Saharan Africa threatens to halt and roll 
back our progress in combating both diseases.
  In fact, the World Health Organization (WHO) reports that 1.7 milion 
people died of tuberculosis in 2006, with 200,000 dying from HIV-
associated TB.
  The TB germ is constantly changing and drug resistant strains have 
been found in 28 countries on 6 continents.
  Our current TB Vaccine, BCG, is more than 85 years old and is not 
compatible against pulmonary TB, which accounts for most TB cases.
  Even right here in the United States, it is estimated that 10 to 15 
million people in the U.S. have latent TB.
  Therefore, developing a vaccine has important implications both 
internationally and domestically.
  Studies also show that the ten year economic benefits of a TB vaccine 
that was only 75 percent effective could result in an estimated savings 
of $25 billion; no one can deny that this is a significant amount.
  This legislation is a good start in our critical battle against TB 
and we as a legislative body need to continue to work on TB efforts 
both internationally and right here at home.
  I strongly urge my colleagues to support this bill.
  Mr. BLUMENAUER, Mr. Speaker, I'm pleased that Congress has come 
together in a bipartisan and bicameral way to address the devastating 
impact ofHIV/AIDS, tuberculosis, and malaria. The Tom Lantos and Henry 
J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act reaffirms our commitment to fighting 
the causes and the spread of these terrible and largely preventable 
diseases.
  Treating HIV/AIDS is more than taking prescription drugs. I applaud 
my colleagues in the House and Senate, particularly Chairman Berman and 
Ranking Member Ros-Lehtinen, for recognizing that fighting HIV/AIDS 
means treating the person and not just the disease. The latest 
breakthrough medicines are worthless without access to food, water, and 
security.
  This legislation makes the connection and contains an important 
section to address barriers that limit the start of and adherence to 
treatment services. There is specific recognition of the direct 
linkages between efforts to treat HIV/AIDS and nutrition, income 
security, and drinking water and sanitation programs.
  We cannot treat HIV/AIDS without clean water. There is terrible irony 
in providing patients with advanced antiretroviral agents, and asking 
them to wash the life-saving pills down with a glass of water that may 
infect them with a life-threatening, water-bourne illness. I am 
particularly proud that my simple amendment to add safe drinking water 
to the list of related activities vital to treatment is included here. 
This small addition shapes our approach to treatment in a realistic and 
profoundly positive way.
  Much more must be done to deal with the global HIV/AIDS pandemic and 
the problem of lack of access to safe drinking water and sanitization, 
the world's leading preventable cause of death. The recognition of 
these important linkages is a critical step forward in our 
understanding and treatment of these diseases.
  This bill is an important part of the tribute to our late colleagues, 
Chairman Lantos and Chairman Hyde.
  Mr. HONDA. Mr. Speaker, today the House of Representatives will vote 
on H.R. 5501 the Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008.
  As the Chairman of the Congressional Ethiopia and Ethiopian American 
Caucus, I strongly support this critical reauthorization of the 
President's Emergency Plan for AIDS Relief (PEPFAR). Although PEPFAR 
supports a global effort, no one can argue against the fact that the 
African continent has borne the brunt of the HIV/AIDS, TB, and Malaria 
epidemics. The litany of grim statistics documenting the ravages of 
HIV/AIDS, TB, and Malaria on dozens of African countries and millions 
of people is familiar to all of us committed to a morally righteous 
global war on poverty and disease. I have traveled to Ethiopia and 
witnessed first-hand the courage of a people nurturing a fledgling 
democracy in the face of terrible obstacles.
  For me, what those statistics come down to is the human cost of 
disease, countless orphans, hollow-eyed children raising children in 
villages, cities, and countries devastated economically and spiritually 
by death and fear. I have seen the resiliency and courage of people 
who, with access to medicine and food, have raised themselves out of 
abject poverty. As the wealthiest country in the world we have an 
obligation to invest in the global community, and I support the passage 
of this bill.
  Mr. BERMAN: I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1362, the previous question is ordered.
  Pursuant to section 2 of House Resolution 1362, further proceedings 
on the motion will be postponed.

                          ____________________