[Congressional Record (Bound Edition), Volume 154 (2008), Part 11]
[Senate]
[Pages 15160-15199]
[From the U.S. 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--
                               Continued

  The ACTING PRESIDENT pro tempore. The Senate will now continue 
consideration of S. 2731, which the clerk will report.
  The assistant legislative clerk read as follows:

       A bill (S. 2731) to authorize appropriation for fiscal 
     years 2009 through 2013 to provide assistance to foreign 
     countries to combat HIV/AIDS, tuberculosis, and malaria, and 
     for other purposes.

  The Senator from New Hampshire is recognized.
  Mr. SUNUNU. Mr. President, I rise to speak in support of the 
legislation before the Senate today. This legislation is really of 
historic scope and importance, dealing with the global crisis of HIV/
AIDS, tuberculosis, and malaria.
  There has been a lot said about this legislation. It is certainly not 
a perfect piece of legislation, and rarely do we see something that 
fits that description, but when we talk about infections and the impact 
of HIV/AIDS, tuberculosis, and malaria around the world, it is hard to 
exaggerate the devastating impact these diseases have had. It is also 
hard to fully appreciate the positive impact the U.S. leadership in 
this area has had as well.

[[Page 15161]]

  Around the world, there are over 30 million people infected with HIV/
AIDS. I think perhaps even more striking is that you have 2.6 million 
deaths attributed to tuberculosis and malaria a year. These are deaths 
that are preventable. That is why the funding in this legislation is so 
important, because we know it will not just deal with the spread of 
HIV/AIDS and new infections around the world, but will also help 
prevent deaths today, tomorrow, the year after, and the year after.
  We have the ability to prevent these illnesses, to treat them as 
never before, and to save lives. That is why this funding is so badly 
needed and will be so beneficial. I think this is the greatest 
humanitarian crisis I have seen, certainly in my lifetime, the spread 
of these diseases around the world and in particular in Sub-Saharan 
Africa.
  Many people have observed that this legislation includes a dramatic 
increase in funding, and it certainly does include a significant 
increase in funding, but it is essential that we allocate these funds 
to PEPFAR, the President's initiative, and to the global fight because 
we have seen the dramatic impact and success of the funds we have 
already allocated and appropriated.
  Today, we can look back over the last 5 years and appreciate that 1.7 
million people around the world now have the ARVs to treat HIV/AIDS 
that didn't have them before, 55 million people around the world have 
been reached with prevention efforts dealing with HIV/AIDS, and 25 
million malaria deaths have been prevented. That is a dramatic success, 
and that is something all of those countries that have participated in 
this fight should be very proud of.
  Under this legislation, the funding and initiative and the effort 
will continue, with $4 billion to deal with tuberculosis, $5 billion to 
deal with malaria, and $2 billion in funding for the Global Fund. These 
are significant sums of money. Many of my colleagues have observed that 
with such a significant allocation, oversight and accountability are 
essential. I could not agree more.
  We need to ensure, through every avenue possible within the U.S. 
Government, the Global Fund, and within other relief organizations, 
that every effort is made to ensure appropriate use of the funds, to 
ensure the use of efficient allocation, and, of course, to ensure 
accountability.
  We are measuring success, measuring performance better today than we 
have ever done before. We need to continue to improve that effort. We 
need to make sure we understand how much it costs to reach an 
individual or a family with ARVs, how much it costs to get treatment 
for malaria into the hands of those who can most benefit, how we can 
reduce those costs, and so on.
  The fact that we have not always been able to account for these funds 
as effectively as we would like is not a reason not to pursue such an 
important initiative. We have better benchmarks than ever before in 
this legislation, better standards for accountability and oversight 
than ever before. The cost of delay isn't measured in days or weeks; 
the cost of a delay of this legislation is measured in lives. That is 
why it is so important that we act on the legislation this week, before 
we break for August, and that we have it signed into law this year.
  Only the United States can provide this kind of leadership in terms 
of public awareness and in financing. It is the U.S. leadership that 
has been the driving force behind the successes I mentioned earlier--
the numbers reached with ARVs, the numbers reached with prevention 
efforts, the number of lives saved, and the number of malaria deaths 
prevented.
  There are many reasons to undertake a piece of legislation of this 
scope and importance. We can begin with the humanitarian aspect. There 
is no greater crisis anywhere in the world than the humanitarian crisis 
created by the spread of HIV/AIDS and the millions who die every year 
from malaria, tuberculosis, and the millions of deaths that are 
preventable. There are the public health aspects that, in the long run, 
benefit not just those countries that benefit from PEPFAR, but in 
countries around the world, in the United States and our allies, where 
improvements in public health, reductions in the number of infections 
and, in the end, programs lead to healthier and longer lives and a 
better quality of life.
  There are the economic impacts and benefits. It is hard to imagine a 
disease that has had a greater economic impact in the last 20 or 30 
years than HIV/AIDS on the continent of Africa. The economic costs are 
borne not just by the individuals in those countries where the 
infection rates are high, but, again, they are borne by neighboring 
countries, by their trading partners, and they are borne by the 
economies of the Western World that are called on to provide the 
humanitarian relief, which could be avoided if we do a better job with 
prevention and treatment. So there is a humanitarian cost, a public 
health cost, and there is an economic cost.
  Finally, there is also a national security benefit to dealing more 
effectively with infections of HIV/AIDS and the cost of these diseases. 
If a public health crisis such as this is allowed to go unchecked and 
the economic effects are devastating, and we see weakness and 
collapsing economies around the world, in particular in Sub-Saharan 
Africa, and the subsequent collapse of civil society brings important 
government institutions to a halt or renders those institutions 
dysfunctional, then the United States and our allies will have to deal 
with the crisis of a failed state.
  We have seen the way in which public health crises around the world 
have contributed to chaos and failure of government institutions and, 
ultimately, to the potential to lead to a more fertile ground for 
oppression, terrorism, and a collapse in the rule of law. All of those 
failures have national security implications not just for the United 
States, but for our allies around the world.
  This is an important piece of legislation for what it does, for those 
around the world who are affected by HIV/AIDS, but also for what it 
does in setting us and our allies on the right path to deal with a 
humanitarian and public health crisis around the world.
  I encourage my colleagues to support the legislation, even though in 
the eyes of some it may not be perfect, because it is certainly 
something that is necessary, needed, valued, and it is an area of 
investment that has already had a dramatic and positive impact in the 
lives of millions around the world.
  I yield the floor.
  Mr. DURBIN. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. SUNUNU. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                     Low-Income Heating Assistance

  Mr. SUNUNU. Mr. President, I wish to take this opportunity to speak 
for a few minutes on a piece of legislation which is not pending but 
which I know is scheduled to be debated in the coming days in the 
Senate, and that measure deals with the Low-Income Home Energy 
Assistance Program or LIHEAP.
  Senator Sanders of Vermont has introduced the Warm in Winter and Cool 
in Summer Act to address a potential crisis as we enter the fall and 
winter heating months. Heating assistance for those in economic need--
not just in New England but across the country--will become a pressing 
issue.
  I think this is important legislation, and I am pleased to be a 
cosponsor of Senator Sanders' initiative to provide emergency funding 
now so that Congress does not have to deal with it in a crisis mode as 
the winter months approach.
  With heating oil over $4 a gallon, this is an issue that Congress 
needs to address early and aggressively. It is imperative that those 
seniors and families who depend on low-income heating assistance in New 
Hampshire and across the country feel confident that the resources will 
be there when they need them.

[[Page 15162]]

  It is also important that Congress address this issue early so States 
can work with those agencies that administer the heating assistance 
program. In New Hampshire, the community action programs have done an 
outstanding job ensuring that appropriate funding is available at 
different eligibility levels and that this assistance gets to where it 
is needed as efficiently and effectively as is possible. As we approach 
this debate, I encourage my colleagues, to give this legislation 
careful consideration and support because it will make a difference in 
the lives of millions of people across the country. This bipartisan 
legislation is also something that we have the ability to pass right 
now.
  In addition, the Senate needs to take up legislation that deals with 
our nation's energy situation, and I firmly believe that means being 
proactive on conservation, alternative and renewable clean energy 
development, and new energy exploration here at home. Congress must 
stop ruling things out. We have to stop saying: We can't do this, we 
can't do that. Both sides of the aisle must find ways to work together 
or we will never reduce our dependence on foreign oil.
  As we debate additional low-income heating assistance funding, we 
need to look at conservation, alternative and renewable energy, and 
more energy production at home--there is no magic bullet; all of these 
avenues must be pursued to address the issue in the medium and long 
term. But for many families, whether heating oil is at $4 a gallon or 
$3 a gallon, the impact of the cost is dramatic. That is why we also 
need to have in place a strong Low-Income Home Energy Assistance 
Program that will make a difference to those families in need.
  I look forward to supporting the legislation of my colleague from 
Vermont and, again, encourage all my colleagues to support the bill.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The majority leader is recognized.


                               Oil Crisis

  Mr. REID. Mr. President, the Republicans have been talking now for 
several weeks about needing to do something about oil. But you see, we 
on this side of the aisle have been talking about doing something about 
it for a long time--a long time. That is why we brought the global 
warming bill to the floor. That is why we pushed very hard to have the 
renewable energy tax credits put in place so the American entrepreneur 
can invest in solar, wind, and geothermal, creating hundreds of 
thousands of jobs. We have been stopped doing anything about global 
warming, we have been stopped doing anything, of course, about 
renewable energy, which would take tremendous pressure off the oil 
markets.
  We have worked on doing other things. We introduced legislation 
dealing specifically with gas prices, and we were turned back from 
doing that. We could not get 60 votes.
  The causes of high gas prices we all know are complicated: We have 
stability problems in Iraq and in Iran, the Middle East; we have 
problems in Nigeria now, which is the fifth largest producer of oil in 
the world; the weak dollar is creating more problems; some say the 
global demand is outpacing supply with India and China coming online to 
buy a lot of this oil; and the failure of the oil companies to use 
their record profits to invest in new refining capacity and research 
alternatives.
  Speculation in oil, is that the problem? Of course not. But it is a 
problem. It is a big problem, and I think there is a lot of agreement 
to that effect. Economists agree that probably up to 30 percent or more 
of the price we pay at the pump is due to speculation.
  I had a conversation this morning with the head of United Airlines. 
This man comes with a pretty good resume. I did not meet him until a 
few months ago when he and a number of people from the airline 
industry--all the bosses--came to see me lamenting the fact that these 
companies were in desperate need of help. They explained to me there 
were airplanes that were filled to capacity every trip they took in 
America, but they were going to cancel those flights. Why? Because the 
airplanes they are using use a lot of gas. The flights they took used a 
lot of kerosene, is basically what they burn. Therefore, they were 
going to terminate the flights and use airplanes that did not use as 
much gas because they lose less money. They lose basically money on 
every flight they take and that we take as consumers.
  I met him then the first time. I have had other conversations with 
him. He is one of the experts we had in a meeting last Thursday to talk 
about speculation. Today I talked with him because we introduced 
legislation to deal with speculation to get the energy debate started.
  The Republicans, in the bill they have introduced, have a provision 
about speculation. So they should join with us in allowing us to get 
this bill to the floor.
  Mr. Tilton said to me today he appreciated our working to get this 
bill done. We have taken parts from Democratic bills and Republican 
bills to be at a place where we are now. Mr. Tilton said this is 
extremely important for the industry, to recognize that we in Congress 
are trying to do something to tamp down speculation.
  President Bush said yesterday there is no immediate fix, that it took 
a while to get to this problem; there is no short-term solution. That 
is true. When President Bush took office, a gallon of gasoline cost 
$1.46. Today the average price is $4.11 or $4.12 a gallon. When 
President Bush took office, a barrel of oil cost $32. Today, with the 
volatility involved, it has been up near $150 and has dropped down to 
$140, but it is very high, certainly more than $32 a barrel.
  The President is correct that his administration's energy policy has 
created a crisis that the American people will suffer long past his 
Presidency. It is true we need long-term solutions, including a serious 
commitment to providing tax cuts, as I already talked about, to 
companies and innovators who are investing in clean alternative fuels 
that could take us off our addiction to oil--and that is what it is. 
President Bush identified that in one of his first State of the Union 
Messages, but he has not done anything about that.
  The American people deserve solutions that will ease the pain at the 
pump and also make the future look better for them. One of those 
solutions is this bill that has been introduced, the Energy Speculation 
Act of 2008. We have done that together. We reach out and ask the 
Republicans to join with us in a bipartisan effort to tamp down 
speculation. Right now Wall Street traders are raising gas prices with 
nothing more than a click of a mouse.
  In the nearly 8 years of this Bush-Cheney administration, the most 
oil-friendly administration in the history of the country--both made 
their fortunes in oil--they have turned a blind eye to this excessive 
speculation. Our legislation will finally hold the energy futures 
market to the same standards of accountability that other futures 
markets are held.
  Sadly, for American consumers, the Federal watchdog that is working 
to do this has been understaffed over the last many years. Part of our 
legislation gives them more staff, to give them more power to do 
things. They were tremendously underfunded as a result of the work of 
Phil Gramm, one of John McCain's chief economic advisers. The 2000 
Commodities Futures Modernization Act, which, in effect, allowed 
traders to buy and sell oil without actually taking physical delivery 
of it.
  We are not saying in our legislation they have to take physical 
delivery of it. But we know where the problem started. The so-called 
mouse-click energy market was born as a result of John McCain's chief 
economic adviser, who, by the way, thinks people who are complaining 
about high gas prices and the housing crisis are a bunch of whiners. 
Those are his words.

[[Page 15163]]

  We talked with one of the most fair, seasoned legislators in 
Congress, Carl Levin, a Senator from Michigan, to get more information 
on large traders of energy quantities in over-the-counter markets. That 
is in our legislation--something he came up with.
  So we feel we are headed in the right direction. We have gotten help 
from the CFTC, the man who runs that, we have gotten help from the 
chairman of the Energy Committee, Senator Bingaman, and we are doing 
our best to address an issue we feel is very important to the American 
people.
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. REID. I would be glad to yield to my colleague from Illinois.
  Mr. DURBIN. I say, through the Chair, that in a recent hearing of my 
Appropriations subcommittee, I asked the Acting Chairman of the 
Commodity Futures Trading Commission, responsible for regulating these 
energy futures markets: What is the size of the market? There is one 
exchange known as NYMEX, which is regulated by his commission, there is 
another known as ISE, based in London, which is coming under 
regulation, but there is a whole world of trading out there involving 
futures trading with swaps, over the counter and the like, and he 
said--this Acting Chairman said--I don't know. I don't know the size of 
the market.
  So when Americans express their concerns about speculation and its 
impact on oil and ask whether our Government is doing its job to make 
sure there is no manipulation of the future price of oil, that there is 
not excessive speculation, the honest answer from Mr. Lukkin and I 
believe it was honest--is he doesn't know.
  This legislation which we are presenting is going to call for more 
disclosure and more oversight and more reporting of these markets so we 
will have information and be able to look closely at these trades. I 
ask the Senator from Nevada, as part of this legislation, is it not a 
fact that we are going to dramatically increase the number of people 
working at this commission--100 new full-time employees--and new 
computer capabilities so they can keep up with the dramatic increase in 
trading which is taking place, and will have people to deal with the 
new information that is collected?
  Mr. REID. I say to my friend, if you had to put a mark on this 
legislation--what does it do more than anything else--I would say 
transparency. It will allow the entity we depend on to allow us to know 
what is going on with trading of futures, to have more manpower in 
order to get more information for the American people.
  I say to my friend from Illinois it is important that we have 
transparency. That is what we are talking about. That is why I 
mentioned Senator Gramm and what he did. He took away transparency so 
that the American people will have some idea of what is going on.
  Mr. DURBIN. If the Senator will yield for one more question--because 
I see some of my other colleagues on the floor, including Senator 
Dorgan, who has done some extraordinarily good work on this issue--I 
ask the Senator from Nevada: A month ago, when I visited the Air 
Transport Association here in Washington and met with the CEOs of all 
the major airlines in America--I say half jokingly that it is a good 
thing you couldn't open the windows on that high floor of that building 
because some might have been tempted to jump out, they were so 
despondent about what is happening to their businesses as airlines--and 
I know the Senator from Nevada has seen flights canceled to his home 
State, I have seen flights canceled in and out of Chicago, American 
today announced the layoff of 200 more pilots, more planes being 
grounded--when this bill has a limitation on the positions, which is 
the amount that can be traded, does this bill not also protect the 
right of companies, such as airlines, that want to legitimately hedge 
so they can be protected from future oil increases, so those legitimate 
commercial interests can trade on the markets and use this speculation 
in a positive way to protect them from the uncertainty of oil prices in 
the future?
  Mr. REID. I say to my friend that the direct answer to the point is 
yes. But talking about 200 pilot layoffs, the last time I flew to Las 
Vegas was right before the July 4 break. I got on the plane and the 
pilot said to me, the captain: Senator, good to have you on our plane. 
He said: You know, there are 950 of us going to be laid off--950 pilots 
were given notice less than a month ago. Now we have 200 more.
  The Senator said in a side remark that these people likely felt like 
jumping out of that window of that high-rise. My comment to that is, 
that is fairly valid. They are desperate. These are companies which are 
the largest companies in America--United Airlines, Delta, Northwest. 
These companies have been around for a long time and have employed 
hundreds of thousands of people.
  The State of Nevada has two population centers. It is a huge State 
areawise, some 700 miles tall and some 400 miles wide at its widest 
part. But the population, 90 percent of the people, live in Reno and 
Las Vegas. If you want to go to Elko or Ely, you have to drive. It used 
to be that from Salt Lake to Elko you had a flight every hour. Now 
there is one a day. There used to be a number of flights from Reno to 
Elko. None.
  Rural America is going to be in deep trouble. We have become an 
airplane society. We go places in airplanes. That is going to come to a 
screeching halt unless something is done quickly, because these 
airlines are cutting the flights as we speak. I repeat, every hour 
there was a flight from Salt Lake to Elko. Now there is one a day.
  Mr. DORGAN. Mr. President, would the Senator from Nevada yield for a 
question?
  Mr. REID. Be happy to.
  Mr. DORGAN. I was noticing a story that just moved on the wire, and 
it says:
       In a big win for the U.S. futures industry, new Senate 
     legislation unveiled on Wednesday would not impose higher 
     margins on oil traders but would still aim to rein in 
     excessive speculation in energy markets.

  I want to make a comment about that, because it goes on to say:

       Futures markets participants had feared that earlier 
     legislation introduced by Senator Byron Dorgan to boost 
     significantly the amount of money, or margin, that 
     speculators would have to put up to trade oil futures would 
     make it into the final anti-speculation bill.

  So they paint this as some sort of victory, but let me point out what 
they missed. Yes, I am the one who authored a bill that said: Let's put 
in 25 percent margin requirements in order to wring out the speculation 
in this market. What they missed, however, is that last week we met in 
a room over here for 3 hours into the evening, and I indicated then 
that I don't need to have a 25-percent margin requirement if you have 
position limits that are effective. The bill the majority leader has 
introduced, which I am cosponsor of, and pleased to be a part of it, 
does the following: It distinguishes between legitimate hedge trading 
by commercial producers and purchasers of physical energy commodities 
for future delivery and their direct counterparties, and all other 
speculators. Then it establishes real position limits. That is what 
wrings the speculators out of the system.
  Now, there are some who say: Well, speculation is not going on here. 
There is no issue with speculation. A study done by the House 
Subcommittee on Oversight and Investigations found that in the year 
2000 about 37 percent of those who were in the oil futures market were 
speculators. Today, it is 71 percent. This market is broken. It has 
been taken over by speculators. Will Rogers described them as people 
who are buying things they will never get from people who never had it, 
making money on both sides of the trade, and grinning all the way to 
the bank. The problem is they are damaging this economy, hurting 
American families and destroying this country's airlines and farmers 
and truckers.
  I wanted to make the point to the Senator from Nevada that when 
someone writes a story and says this is a big victory for the futures 
market because it doesn't have the 25-percent margin requirement, I was 
fine with dropping that piece if we had strong position limits that 
apply against those who aren't engaged in legitimate hedging

[[Page 15164]]

but, instead, are engaged in pure, raw, unadulterated speculation.
  If I might make one other point. This market was set up in 1936 by 
President Franklin Delano Roosevelt. When he signed the bill, he warned 
about speculation. He warned about speculators taking over a market. 
The fact is, the bill that created this market has a provision that 
deals with excess speculation. Our problem is that under this 
administration, there is no such thing as regulation. So the 
regulators, who are supposed to be wearing the striped shirts and 
blowing the whistles and calling the fouls in these markets, have 
decided they don't want to regulate. These folks have gone hog wild and 
destroyed the market for oil futures and driven these prices up to 
$130, $140 a barrel, far beyond where supply and demand would justify 
it being.
  That is why I wanted to make the point that the bill we introduced 
last night--and I applaud the majority leader--is a bill that does 
exactly what we had intended it to do following our meeting last week. 
Yes, we dropped the new margin requirement, but that is not a failure. 
We dropped that because we put in very strong position limits to wring 
the speculation out of these markets. Isn't that the case, I ask the 
Senator?
  Mr. REID. Yes. And let me say to my friend, going back to the 
President of the United Airlines today--and again let me remind 
everyone of his background: president of Texaco, vice chairman of 
Chevron, and now the chief executive officer of United Airlines. He 
said not only are businesses, including the airline industry--using his 
words--``patting us on the back,'' but in addition to that, all the 
banks that have loaned money to these airline companies, all the other 
entities around our country that are looking at these businesses, such 
as the airline industry, to succeed, this has a wide-ranging impact on 
our success as a country. We have to do something about this.
  Now, people can criticize this legislation all they want. It is not 
perfect legislation, but it is very good legislation.
  Mr. DORGAN. If I might make an additional point, Mr. President, by 
asking the Senator from Nevada a question. The issue of position limits 
is critical. That is why this bill has teeth and bite and could 
actually accomplish something. We will have some other people here in 
this Chamber who will come to the floor believing in their policy, 
which is yesterday forever--drill, drill, drill, drill. Every 20 years, 
we have another debate about who wants to drill where. But the fact is, 
that is not a game-changing approach to address energy in a significant 
way.
  We want to do this in 2 steps: No. 1, wring the speculation out of 
this market and bring down prices, and some say by as much as 40 
percent; and No. 2, we see a very different kind of energy future. Yes, 
we increase production, but we must have conservation, efficiency, 
renewables, and other things.
  So for those who come to the floor and say, well, taking on 
speculation is too easy, well, it is easy when it is right in front of 
you. There are some people refusing to recognize it when it is right in 
front of them.
  I want to show this chart to my colleague from Nevada. This chart 
shows what has happened to the price of oil, and every driver in this 
country knows that is what has happened to the price of gasoline as 
well. This red line is the price, and it goes up like a Roman candle: 
up, up, up, up.
  Here is what our Energy Information Administration said. We spend 
$100 million a year on this agency down at the Department of Energy 
that has all the people who estimate what is going to happen to the 
price of oil. Let me show you their estimates. Back in May of last 
year, here is what the price of oil is going to be--straight across. 
Kind of a bump here and there. In July, here is the price. January of 
this year, here is where we think the price of oil will be.
  So how is it they could miss it by so far? Because at each of these 
junctures they took a look at supply and demand and estimated what the 
price would be. They missed it by a country mile. You would have to be 
blind to miss it by this far, right?
  Why did they miss it? Because this is all about speculation. It has 
nothing to do with supply and demand--not a thing. And if we say 
speculation is fine, let's let it damage our country, let's do nothing 
about it, I think we would be fools. The American people understand you 
have to take these two steps: No. 1, wring the speculation out of this 
system and put downward pressure on prices; and then, No. 2, do a new 
construct with a game-changing plan on energy for the future.
  But I ask the Senator from Nevada: Is it not the case that the agency 
we rely on for estimates has not just been wrong by a foot but wrong by 
a mile in every case because they could not measure what this excess 
speculation was going to do to this country?
  Mr. REID. Would my friend be good enough to put up the previous chart 
that is under that one?
  Common sense enters into Government as it does in everything. Common 
sense dictates, when looking at this information we have before us, 
that we should do something about speculation. Now, this is not 
information that was dreamed up by some high school student. These were 
hearings that brought this out, congressional hearings that looked at 
what took place in 2000 and what took place in 2008. Look at this 
difference. Look at the difference--a more than 100-percent increase or 
close to a 100-percent increase as to what has taken place.
  If somebody could sue us because we didn't do anything, they should 
sue us for negligence that we, looking at this chart, would do nothing 
as it relates to speculation.
  Now, I say to my friend, is speculation the only thing we need to do? 
Of course not. There is a lot more we can do. Do we believe in 
increasing domestic production? Of course we do. We want to work and 
increase domestic production, and there are lots of ways we can do 
that. But it speaks volumes. My friends on the other side of the aisle 
keep talking about: let's go drill someplace else. The 68 million 
acres? We will just hang on to that, and that will be part of our 
balance sheet. We have 68 million acres, and we want other places to 
go.
  I say to my friend, and everyone within the sound of my voice: We 
listened to the oil companies less than 2 years ago. They said they 
wanted to drill in the best place they could find in America, in the 
Gulf of Mexico, the Outer Continental Shelf in the Gulf of Mexico. We 
agreed with them. We said: OK, 8.3 million acres--because this is what 
they wanted. We gave it to them.
  Everyone should know what they have done in 2 years: Nothing. 
Nothing. In the area they said was the most ripe for discovering new 
oil, they have not driven a boat to fish off the side of there. They 
have done nothing.
  Now they are coming to us, these oil companies that have during the 
past year made $250 billion. Have they built new refineries as we gave 
them tax incentives to do? Of course not. It appears, some say, they 
don't want the quantity to go up any more so they keep these prices 
high.
  But separate and apart from that, we know the last 8.3 million acres 
we gave them they have not so much as gone swimming there, as far as we 
know.
  Mr. DORGAN. If the Senator will yield for one additional question, I 
would make the observation that we come to the floor of the Senate 
wanting to do something. I understand there are 100 ideas, some of them 
long term, some would have an impact in 10 years, some in the sweet by-
and-by. But this proposition is about the here and now. What do we do 
about the here and now with respect to speculation?
  There is a radio announcer who was talking once about interviewing an 
old man--age 85 years old. The radio announcer said: I bet you have 
seen a lot of changes in your life.
  And the old guy said: Yes, and I have been against every one them.
  We know some people like that, and they serve in this Chamber. They 
are against anything.
  My question is, wouldn't it make sense for us at least to put this in 
the bank of progress; that is, to shut down the speculation, put 
downward pressure on oil and gas prices? If some experts are right--Mr. 
Gates, for example, a

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top energy analyst for Oppenheimer & Co. for 30 years, says as much as 
40 percent or more of the increase in the price of oil and gas is 
because of excess speculation. He said to us it is like a casino open 
24/7 today, like a highway with no speed limit and no cops.
  Let's assume he is right. Other experts have said the same thing. 
Wouldn't it make sense for all of us at least to agree to take this 
step and then take the other steps? Let's try to find a way to come 
together rather than to have all the folks who come to this Chamber 
say: No, not now, not this. Every single day we hear that.
  My hope will be that we will get bipartisan support because it is the 
right thing to do and it is the right time to do it.
  Mr. REID. I say to my friend, the business community is crying for 
help. They believe this is a big step in the right direction. Our 
offices are now receiving e-mails and phone calls from all the airline 
companies, banks that are concerned about them, and hundreds of other 
business entities that believe this is the right thing to do.
  Are these organizations usually those that support Democrats? I am 
somewhat constrained to say no. They usually are all Republican-
oriented businesses. But they know we are doing the right thing. I 
plead that my Republican friends will join us in helping the American 
business community. If there are other things that need to be done at a 
subsequent time, we will try to work with our colleagues on the other 
side of the aisle. But this is part of their legislation.
  Mr. DORGAN. That is right.
  Mr. REID. When they introduced their bill, they said speculation was 
important, so let's focus on speculation.
  I want to say one other thing, Mr. President. My friend from North 
Dakota has been a real activist on this issue and trade issues and 
others that are important to the American economy. I appreciate his 
willingness to compromise. This legislation is not everything he wants. 
If he were King Dorgan, he would have written something else. But we 
are now in the legislative process, and the Senator from North Dakota 
and I have been in it for a long time. Legislation is the art of 
compromise, and that is what we have.
  I hope my friends will realize our good faith. I am trying to do 
something we believe will have tremendous impact on stabilizing oil 
prices in our country.
  Mr. DORGAN. If I might make just one final very brief comment. There 
are people in this Chamber, in the Republican caucus and the Democratic 
caucus, who have all spoken of speculation. My hope is that we can come 
together, work together, and do something in the next week or two, 
Republicans and Democrats, on this issue. I think we have put together 
a good bill.
  I would say to the Senator from Nevada, one of the things he talked 
about in the middle of last week was making this a bipartisan 
initiative in the Chamber of the Senate. I very much hope that can be 
the case in the coming days.
  The PRESIDING OFFICER. The Senator from Washington is recognized.
  Mrs. MURRAY. Will the majority leader yield?
  Mr. REID. I will be happy to.
  Mrs. MURRAY. As the majority leader knows, I travel home a long 
distance every week to Washington State and get in my car and drive for 
several hours to get to my home. I have been paying these increased gas 
prices like my constituents. It is shocking. Last weekend I paid $4.45 
a gallon to fill up my tank in my car. This is impacting absolutely 
everybody in my State, my region, just as it is the rest of the Nation.
  My constituents say to me: I have been hearing all this talk about 
drilling. Please tell me that will bring my gas prices down.
  I have told my constituents, as we all know--in fact, not just me but 
the Bush administration's Energy Information Office, this is the Bush 
administration: The impact on wellhead prices from opening the Pacific, 
the Atlantic, and the gulf waters to drilling ``is expected to be 
insignificant.'' I have not said that. This administration, the Bush 
administration's Energy Information Administration Office, has said 
that.
  I say to my constituents, the drill, drill, drill or, as the Senator 
from North Dakota called it, ``the forever yesterday policy of drill, 
drill, drill,'' is not going to have a significant impact at all on 
their gas prices.
  I thank the majority leader for coming forward with a package that we 
do believe will have an impact on gas prices and deal with the 
excessive speculation that is in the market today.
  We met last week with a number of experts in this field. We have 
listened to our Republican counterparts as well who agree that 
speculation is an issue that we can all come together on and on which 
we can have an immediate impact in passing a bill.
  I come to the Senate floor today to thank the majority leader and to 
ask him, as he puts this bill together, to deal with excessive 
speculation with the hope that it will, as the experts have told us, 
begin to reduce gas prices, that we as a caucus, and I hope as a 
Senate, will begin to look also at the longer term issues affecting 
energy and investing in alternative energy so we do not continue to be 
so dependent on oil.
  I ask the majority leader his comments on that.
  Mr. REID. I say through the Chair to my friend from Washington, I 
have been to Washington. I have driven a lot of the State of 
Washington. It is absolutely a beautiful State. Part of it reminds me 
of Nevada. People think that Washington is a State where the ocean is 
everyplace, and it is not. Washington is a State where there is desert. 
So I love the State of Washington.
  But the Senator from Washington is in a very good position to 
understand how I am sure her constituents feel about what we are trying 
to do; that is, do something to affect this increase in price, to try 
to tamp down speculation. To have the people of Washington be told this 
doesn't matter, speculation doesn't matter, let's drill some more off 
the coast of Washington and not only drill some more, in effect--no one 
questions the Federal Government owns 200 miles off our coast. That is 
the Outer Continental Shelf, and that is recognized by international 
law.
  To think that the Federal Government would just give up on that and 
say: OK, States, do whatever you want--how do the people of Washington 
feel about that?
  Mrs. MURRAY. I say to the majority leader that the people of my State 
are a very generous people. If there were a real national crisis that 
we could solve from my home State by drilling off our coast, my 
constituents would be willing to sacrifice that. But we know that 
drilling off the Outer Continental Shelf will have a huge economic 
impact in my State with no result of reducing gas prices. So that is a 
sacrifice they should not be asked to give at this time.
  As a matter of fact, what I see happening is that the oil companies 
in this country that hold 68 million acres of land they can drill 
today, that they are not drilling, are just looking at this crisis we 
have today as a land grab, that they can reach out, scare all of us, 
and have this Congress give them more land, including the pristine 
shores off my State of Washington, never intending to use them.
  I was on the Senate floor with Senator Biden yesterday as we 
discussed this issue. He made a very cogent argument. The fact that if 
we all decided this was it, this was it and we absolutely had to drill 
everything, and we gave the oil companies the Outer Continental Shelf 
off the coast of Washington and Oregon and California and his State of 
Delaware, that a minimal amount of oil in 20 or 30 years may be 
drilled, but who among us thinks that OPEC--which actually controls the 
price of gas--if a 3-percent increase in oil came about as an effect of 
that drilling, wouldn't reduce their capacity by 3 percent in order to 
keep their prices high and their profits at maximum level?
  Let's not sell the American people a bill of goods. Let's not promise 
them something that cannot be delivered. No one wants to hear empty 
rhetoric or to give up something that is extremely

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important to them if the facts are not there to back it and only, by 
the way, to give oil companies more excessive profits.
  Let's do something that is real--and that is what the bill the 
majority leader and others have introduced does--to deal with the issue 
of excessive speculation; to do what many experts have told us to bring 
the price of gas down. Then, for the long term, we, as a body, have to 
say: What are we going to invest in in this country for the long-term 
future so we are not so dependent on oil, so that the next generation 
behind us doesn't come back and hear yesterday forever, drill, drill, 
drill, as Senator Dorgan has said time and time again is the solution 
that doesn't work.
  We need to get off our dependence on oil. We need to do that in the 
long run. But in the short term let's deal with the speculation issue 
and let's pass responsible legislation in a bipartisan way, not as a 
silver bullet. No one thinks that is the ultimate answer to bring gas 
prices to what they were a year ago, but it is a step in the right 
direction. It is a responsible step to meet the important crisis that 
we face today, coupled with looking at what we will do long term.
  The Senator from North Dakota has been a leader on this issue. I know 
he is the chair on the Energy appropriations bill, where he is looking 
at the investments we can make in alternative energy so we can get off 
of the same argument of yesterday forever and really begin to be 
responsible leaders at a critical time in our Nation's history.
  It is so easy to come out here and say drill on the Outer Continental 
Shelf. But I will tell you, in a State such as mine, Washington State, 
that has an economy that is dependent upon our waters, whether it is 
our fisheries or our environment or tourism but a place that our Nation 
should say is absolutely one of critical importance--not just my coast 
but the rest of the coastal States--we should not jeopardize it to get 
nothing--to get nothing because, as the Bush administration itself 
said: The impact on wellhead prices from opening the Pacific, the 
Atlantic, and the gulf waters to drilling ``is expected to be 
insignificant.''
  Let's focus on doing something that is responsible, that is not just 
empty rhetoric, that obviously is not a silver bullet to the energy 
crisis in total but is sincerely a step in the right direction.
  I am proud to join my colleague as we move this legislation forward. 
I look forward to working, I hope, with Members on both sides of the 
aisle to move forward on this critical piece of legislation.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. McCaskill). The Senator from North Dakota 
is recognized.
  Mr. DORGAN. Madam President, let me make a couple of points. No. 1, 
this legislation is real. I know people who look at the Congress and 
look at Washington, DC, and its Government and say, they have not done 
one thing to address this issue or that issue. This is one thing, and I 
think a significant thing, that could address the issue of the prices 
of oil and gas that have doubled in a year, with no justification for 
that doubling relating to supply and demand. This is one thing.
  My hope is, in a Chamber that disagrees so often--my hope is that on 
this issue of national importance we could agree on this one thing.
  I was sitting here thinking about when I was growing up. We raised 
some livestock and lived in a very small town. My father also had a gas 
station that he managed. So as a young man, I worked at that gas 
station. I pumped a lot of gas. People have told me my occupation may 
not have changed very much.
  But the fact is, back in those days when gasoline was priced at a 
very low price and plentiful, the supplies of energy were plentiful, 
people did not think much about where is the energy going to come from.
  Near my little hometown, they decided to drill an oil well. I had 
never seen an oil well. I remember as a little boy going out about 1 
mile from town, looking at the oil well. There was not much to do in 
that small town. So you drive out and look at the lights on that 
drilling rig and stare. How exciting it was. And then it turned out to 
be a dry hole.
  Well, 2 weeks ago, I was in western North Dakota where they are 
drilling in what is called the Bakken shale. When my colleagues talk 
about drilling, let me remind them that I asked for an assessment of 
what is called the Bakken shale formation. The U.S. Geological Survey 
completed it 2 months ago. It turns out they estimate there is 3.6 to 
4.3 billion barrels of oil recoverable in the Bakken shale formation in 
eastern Montana and western North Dakota. The 3.6 to 4.3 billion is 
just in the North Dakota portion. The fact is, we have nearly 80 drill 
rigs right now drilling in that area, producing a great amount of 
additional oil. So I support that, my colleagues support that. We do 
support additional production. That additional production is ongoing 
and happening right now. It will be good for this country.
  But the fact is, we are in a situation where we have an urgent need 
to deal with something that is happening in this country that is 
damaging our economy. The price of oil has doubled in the past year, 
and there is no justification in the marketplace for it related to the 
supply or demand--in fact, demand is going down in this country. We 
drove 5 or 6 billion fewer miles in the 6-month period than a 
comparable period before.
  Today, we saw another monthly description of inventory going up. So 
the fact is, there is no justification for prices to have doubled. Now, 
to do nothing about this issue of speculation, which has run up the 
price double in a year, is to ignore the obvious. I mean, some might be 
content to ignore the obvious, not me.
  Let's say someone who is grossly obese is brought to the hospital on 
a stretcher having a heart attack, and a doctor takes a look at this 
grossly obese patient having a heart attack and says: Well, what we 
need to do, we need to work first on the weight problem. Let's 
prescribe a diet.
  No, that is not what they would do. They would deal with the heart 
attack first. That is what we need to do with respect to energy. We 
need do a lot of things, but first and foremost, we have to find a way 
to make this futures market work and wring the speculation out of that 
market and bring down prices.
  Now, we have people who talk about the ``free market.'' Well, I am a 
big fan of markets. I do not know of a better allocator of goods and 
services than the marketplace. I am a big fan. I used to teach 
economics in college ever so briefly. The marketplace is something I 
admire. I want the free market to work. But sometimes the market is 
broken. Sometimes the arteries to the market are clogged and do not 
work. That is certainly the case with oil.
  How do you make the market in oil? Well, you have the OPEC countries. 
They formed a cartel. It would be illegal and prosecutable in this 
country. OPEC forms a cartel. They all close and lock a door and have a 
suggestion about how much they want to produce and what price they are 
going to extract for it. That is the front end.
  Second, you have oil companies, bigger and stronger through mergers. 
All of them now have two names: ExxonMobil, ConocoPhillips, they all 
have two names because they decided to get together and get hitched. So 
they did mergers. They are all more powerful and have more muscle in 
the marketplace.
  You have OPEC, bigger oil companies with more muscle in the 
marketplace, and at the other end you have this futures market that has 
become an orgy of speculation, unbridled speculation. I showed a chart 
a bit ago that showed over 70 percent of the trades in the oil futures 
market are not by people who ever want to see a can of oil or carry a 
5-gallon can of oil or see a 30-gallon drum of oil.
  They are people who want to trade contracts and make money. That 
might be fun for them. They might be the most satisfied people in the 
world traipsing back and forth to put our money in their bank accounts 
in the last year. God bless them.
  But if we have our way on the floor of the Senate, that is going to 
end. Because what is happening when you run

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up the price of oil--and gasoline doubled--and do the kind of damage 
that exists in this country today, airlines declaring bankruptcy, 
cities losing their airlines, family truckers who have been working for 
30 years saying they cannot go on because they cannot afford to fill 
their tanks with diesel fuel, farmers and families trying to figure 
out: How do I scrape up enough money to fill my tank to be able to 
drive to work?
  The fact is, it does not work for us to allow this to continue. This 
market is broken. We have a right, it seems to me, to restore the 
market to its original purpose. Go back and look at the legislation 
that created the oil futures market. The purpose was to have normal 
hedging to hedge risk between producers and consumers of a physical 
product, a perfectly reasonable and necessary thing to do. But what has 
happened is the market is taken over now by other interests. Those 
interests are described by a Wall Street Journal article many months 
ago that piqued my interest in what was going on: investment banks, 
hedge funds, pension funds, running deep into these futures markets 
driving up prices. Investment banks buying oil storage capability to 
buy oil and take it off the market.
  That is not the way a market should work or should be expected to 
work. When a broken market damages this country's economy, we have a 
right and, in fact, we have a responsibility, in my judgment, to 
address it. There will be those who disagree very strongly with that 
which I say. They will be surrounding Capitol Hill with substantial 
effort to say: This legislation that we introduced last evening will be 
destructive and damaging.
  I say to them: I know what is destructive and damaging, it is 
doubling the price of oil and gasoline in the last year. That is 
destructive and damaging to this country, to the families in this 
country, and to a good many businesses in this country that cannot fly 
through that storm.
  So my hope is we will be able to get some bipartisan support for a 
piece of legislation that begins to shut down the excess speculation in 
the market that is damaging this country's economy.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DeMINT. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DeMINT. Madam President, I rise to speak on the bill being 
considered at this time, the foreign aid bill we call PEPFAR. I would 
like to speak about it in relation to the overall condition of America, 
America's economy, so that we can put it in context.
  These are very difficult times for our country, we all know. It seems 
the news keeps getting worse. Obviously, we are at war. As the 
situation improves in Iraq, Afghanistan seems to be deteriorating. We 
have to keep our focus on the terrorist problem around the world.
  Our economy also seems to be failing or at least slowing at this 
time. The energy situation is crushing Americans. Just filling up their 
cars and trucks with gasoline every day becomes more burdensome. People 
are really hurting. It is very difficult to make ends meet paycheck to 
paycheck. The mortgage companies and banks are experiencing extreme 
difficulty, making it harder for people to buy homes and to stay in 
their homes. Now we hear that the government-sponsored enterprises we 
call Fannie Mae and Freddie Mac, which are the largest credit 
organizations in the world, are experiencing difficulty and that we may 
need to step in this year and bail them out to the tune of $40, $50 
billion this year. Families are struggling. Any family that has debt 
and can't make ends meet, can't meet their expenses, would not consider 
going out and buying a new gas-guzzling SUV. We wouldn't do it.
  Why, at a time when our country is in debt and, as far as we can see, 
expenses will be more than revenues, would we create the biggest 
foreign aid bill in history and borrow more money, $50 billion, and 
send it all around the world to some countries that are much better off 
than we are? We are doing this in the name of generosity and 
compassion, helping countries in Africa with the epidemic of AIDS. I 
supported the program in 2003, and it was a huge, expensive program at 
the time of $15 billion. Because it has been focused and somewhat 
accountable, it has been somewhat effective. But now we come back and 
increase that budget over 300 percent, expand it from countries it was 
originally designated for to the point where now money is going to the 
United Nations, to China, India, other countries. Some of these 
countries are much better off than we are as a nation.
  This chart will help my colleagues focus on what we are dealing with 
and what we should consider as we talk about spending more money at a 
time when we are at war and our economy is in difficulty and the credit 
industry is in trouble.
  Historically, we have been at about 20 percent of spending as the 
Federal Government in relation to our total economy, what we call GDP, 
or gross domestic product. Beginning now, projected spending is 
increasing dramatically because of retirees and those going on Social 
Security and Medicare and the fact that younger workers are not coming 
in at nearly the rate people are retiring. Our expenses as a country 
are increasing dramatically and will for the foreseeable future. We 
have no plans to meet this type of spending increase and no place to 
get the revenue. We are already in so much debt that some of the 
countries holding our debt are trying to get rid of it. Yet we continue 
to spend money. This doesn't even reflect all of the expenses we are 
going to have to continue the war on terror and supplemental emergency 
spending, such as floods. None of that is in here. So spending is going 
to increase dramatically. By 2050, which seems a long way off, it is 
going to go from around 20 to over 40. During that period, we continue 
to see astronomical increases in spending, with no plans to curtail it.
  Perhaps even worse, we need to address our debt. That affects the 
value of our dollar, interest rates, and the money we have to spend on 
other priorities. We have never seen anything like this. This is not 
made up. This comes from the Committee on the Budget, as well as the 
Congressional Budget Office and the Office of Management and Budget 
from the administration. This is real.
  In 2007, Government debt was 37 percent of our total economy. If we 
continue spending at the current rate, the U.S. Government's debt will 
be at 109 percent--larger than our total economy--in a little over 20 
years. There is no way we can maintain a successful economy and be the 
leader of the world with this scenario.
  Some of our colleagues have rightly said in private that this is a 
crisis; we could be close to a meltdown as a nation. Yet what we are 
doing here this week I consider obscene and completely unacceptable. It 
is almost unthinkable that we would come in here, at a time when we 
need to be addressing an energy problem or looking at how we are going 
to deal with Social Security and Medicare and stay more competitive as 
a nation and keep jobs here, and talk about expanding the largest 
foreign aid program in history, with no thought of where we are.
  The world has to look on us and wonder: What are they thinking? They 
are running out of energy. Yet their laws keep them from developing 
their own energy supplies. They are in huge debt. Yet they keep giving 
money away to other countries that are eating our lunch economically, 
such as China. What are we thinking?
  The fact is, we are thinking about the next election instead of the 
next generation. We have heard comments such as: There is no need to go 
after any energy in America; it will take 5 or 10 years. That is what 
President Clinton said when he vetoed a bill that would have given us 
oil supplies from Alaska 10 years ago. We would today be getting as 
much oil from Alaska as we

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are having to buy from Venezuela if we didn't have a President who said 
we didn't need to be thinking 10 years in the future. I say we need to 
be thinking 50 years in the future. We don't need to be borrowing more 
and more money and charging it to our children and grandchildren.
  This bill we are talking about this week is all with borrowed money. 
It is not our generosity. None of us are going to give a penny to help 
Africa or other nations.
  We are going to charge it to our children and grandchildren and walk 
out of here and feel good about ourselves. And we should be ashamed of 
ourselves. We should be more accountable to the American people.
  This is a devastating chart to look at, yet we ignore it every day. 
Every spending bill that is put on this floor passes with flying 
colors, and it seems to be an insult to this body to even suggest we 
might cut the budget to some realistic level.
  I have an amendment we will vote on in a few minutes that takes the 
level of spending from $50 billion to $35 billion over 5 years. That is 
still way too much, and we should not be doing it. It is still more 
than the President asked for. He asked for $30 billion. What it is, is 
the amount of money that the Congressional Budget Office said that no 
matter how hard you tried with this PEPFAR Program, you can't spend 
more than $35 billion effectively in 5 years; without wasting money, 
you can't spend more than $35 billion.
  There is no reason this Senate can't say: Wait a minute. We are in 
financial trouble as a country. We still want to help people around the 
world. Let's bring it back to a level that at least is reasonable in 
the sense that it is all we can spend without wasting it.
  My amendment does not change anything about the bill except moves the 
level from $50 billion to $35 billion. This will not take one dime away 
from AIDS treatment in Africa because if we keep it at $50 billion or 
$60 billion or $100 billion, we cannot get any more money to the people 
we are trying to help. So if we are at $35 billion, we are at the level 
that is going to help the people we are intending. In fact, it is still 
more than twice what we started this program with only a few years ago.
  I encourage my colleagues to take a moment to think about America and 
where we are. It is wonderful to be compassionate and generous. But 
this bill is not about compassion and generosity because none of this 
money is coming from us or our salaries, and we are not paying for one 
penny of it by cutting another program or making a sacrifice somewhere 
else.
  We are not being honest about where the money is going because it is 
no longer an AIDS to Africa program, it is an ``anything anywhere in 
the world'' program. We at least need to say we have the discipline to 
bring it back to the level that is the maximum amount our own services 
tell us we can spend. If we cannot do this, if Members of this Senate 
cannot take that one, small step of responsibility, we should not be in 
this body. We certainly should not go out to the American people and 
pretend we have done something good for them around the world because 
we have not. We are doing business as usual here, spending like there 
is no tomorrow, and there might not be if these same folks stay in the 
Senate and the Congress and continue to spend our money here.
  I plead with my colleagues to look at reality, to look at where we 
are as a country, in debt and spending. Please, let's demonstrate to 
the American people that we can trim in one place--this massive foreign 
aid bill, giving money, which we are borrowing, all over the world--
that we can, we have the self-discipline. We can walk out of here and 
say: We at least trimmed it back to the maximum amount they said we 
could spend.
  I hope some of my colleagues are listening. I appeal to them to show 
one grain, one little bit of sanity here as we approach the future, to 
take this bill back down to a level that is at least vaguely 
responsible.
  With that, Madam President, I yield back.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. Madam President, I thank Senator DeMint for causing us 
to confront a very difficult truth; and that is, that we do not have 
unlimited money. We do have to manage it well.
  I, frankly, have been uneasy as to the way this process developed. I 
supported the previous $15 billion AIDS bill for Africa that was the 
largest expenditure to fight a disease in the history of the world. I 
remember thinking the President's plan to double it was a bold, big 
step, and I hoped to be able to support that. I certainly favored an 
increase in what we were spending on this program because I think it 
has made some positive difference. Then I was shocked that out of the 
blue they added another $20 billion to it. So a 5-year program spending 
$15 billion on this disease has all of a sudden been converted into a 
5-year program that will spend $50 billion.
  It is very difficult to spend that kind of money wisely in 
undeveloped countries. In fact, as the Senator noted, the Congressional 
Budget Office--our independent analysis branch of the Congress--has 
concluded we cannot spend that much. They say all we can spend is $35 
billion. He has an amendment to bring this bill down to that amount, 
and I intend to support it. I think that is a very generous increase.
  I will note that the G8 nations that are supposed to be participating 
with us in this--the nations we are supposed to be leading and, in 
fact, are dramatically leading in this effort worldwide based on the 
amount of money we have put forth, and with the leadership President 
Bush has given--those G8 nations recently met and committed to spending 
$60 billion in the next five years on this project. Obviously, most of 
it is, of course, the money we are spending. So I do not know that we 
have the kind of followers that leaders ought to have. We need to stay 
on those other nations around the world and insist they participate in 
a generous way.
  But I have to tell you, it is not easy to spend this money wisely. 
Five years ago, when we were talking about this bill, Sir Elton John 
testified before our committee. He has an AIDS program in Africa, and 
he works hard at it. They raised a few million dollars. They spend a 
few million dollars a year. I cannot remember the number. I asked him 
about that at the committee hearing. I said: Sir, we are talking about 
$15 billion. What do you think about that? Is that something we can 
spend wisely? I am sure you try to use your money wisely. What advice 
do you have?
  This is what this man, who has committed much of his life and effort 
fighting AIDS in Africa, responded:

       I concur with you totally. . . . This is just something 
     that the politicians have to make sure that when the [AIDS] 
     money goes to governments--

  That is governments throughout Africa primarily--

     the money is spent in the right way. . . . We are a very 
     small AIDS organization; we can control where everything 
     goes, and we do. We know where every penny goes. But when you 
     get to these vast sums of money that we are talking about 
     here today--

  He was talking about $15 billion, not $50 billion--

     you are going to run into those kinds of problems, and I do 
     not personally know myself how you solve them, but I do 
     concur with you that that is a major problem.

  Well, that is obvious to us. So we have not had any kind of intensive 
effort to ensure this money will be spent wisely. It went to the 
Foreign Relations Committee, and they popped it out with the full 
funding--$20 billion more than the President originally asked for, and 
he is the world leader on this, and the money is just passed along. I 
say to my colleagues, we ought to be more responsible.
  I shared with a group of Senators the other day--yesterday, in fact--
these figures, following up on Senator DeMint's comments. In this year, 
this is what this Congress has done:
  We have voted for a $150 billion stimulus package--every penny of 
that in emergency appropriations, going straight to the debt.
  We expanded the GI bill by $60 billion. Everybody wanted to help the 
soldiers have more education. How could

[[Page 15169]]

we say no to that? Senator McCain raised a concern that was very 
legitimate. They attacked him as not caring about veterans. Basically, 
thank goodness, most of what he asked for got fixed in that bill 
because it was contrary to what the Defense Department believed was 
good, and Senator McCain helped us improve that bill.
  We passed a $180 billion war supplemental. We spent about $18 billion 
on a Medicare fix. We now are doing a $50 billion AIDS bill. We are 
going to have a $15 billion to $18 billion housing bill.
  Revenue to the U.S. Treasury, because of the economic slowdown, is 
going down. So that is a difficulty we face. Last year, after 3 
consecutive years of reducing the $400 billion deficit--it fell to $177 
billion, and we were feeling pretty good. But now our expenditures are 
surging, and our revenue is going to be down as a result of the 
declining taxes because people are not making as much money, they are 
not making as much overtime, they are not going to get the bonuses they 
got in the past, which they may well have paid 35 percent on to the 
U.S. Treasury.
  The Wall Street Journal said the deficit this year, instead of $177 
billion, would be $500 billion. So I am telling you, we have to be 
responsible here. Every single billion has to be watched with care, and 
I wanted to mention it.
  I thank Senator Biden and Senator Lugar for their support on an 
amendment I have offered on this bill. It follows up on an amendment I 
offered 5 years ago to deal with the concern of how many people are 
being infected with AIDS as a result of medical treatment--either 
through blood transfusions or reusing needles in medical settings. We 
had an estimate 5 years ago that 300,000 people a year were being 
infected as a result of medical transmissions. It is hard to believe 
the testimony to that effect. So we came up with a program that 
required needles that could not be reused, and checking the blood 
supply before transfusions. I was pleased to see that in the USAID's 
report on their Web site a few days ago, they have calculated that the 
efforts to improve the safety of immunizations, made possible through 
the legislation Senator McConnell and others accepted which I 
proposed--and it went in that bill--have saved as many as 300,000 
lives.
  But Dr. Gisselquist, a researcher from Pennsylvania, who raised that 
issue originally, and some others who supported this concern, believe 
there are other things that need to be done, and I have offered some 
additional legislation this time.
  I thank Senator Biden--I know he cares about it--for accepting this 
legislation.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. BIDEN. Madam President, I do support the initiative of the 
Senator from Alabama. I think what he has said about the consequences 
and effects of what he is doing are absolutely correct. At the 
appropriate time, with the permission of the Senator from Indiana, and 
in the context of a unanimous consent agreement here, we would be 
prepared to accept the amendment. But we are not quite there yet.
  While I have the floor, if I could say for the benefit of my 
colleagues and their staffs who are listening as to the status of where 
we are, the Senator from Indiana and I think we are very close to the 
wrapping up of an entire unanimous consent agreement which would allow 
us to have no more than four votes, including final passage--at least 
that is the expectation--and that we would be able to do that sometime 
within the next 2 hours, and we would be out of here relatively early.
  On that point, I thank all the Senators who have had amendments for 
their cooperation in moving this along, I think a great deal more 
rapidly than anybody anticipated, at least more rapidly than I 
anticipated we would be able to do.
  To conclude where I began, I say to the Senator from Alabama, I think 
his initiative is first rate. Everything he says about the consequences 
of what he is talking about is absolutely accurate, as best I know the 
situation.
  In the context of a wrap-up unanimous consent agreement, we will be 
able to handle all of this. So that is the intention, I say to the 
Senator.
  I am told in the meantime if and when the Senator from Alabama yields 
the floor, the Senator from Florida is looking to proceed as in morning 
business for some relatively short period of time.


                           Amendment No. 5086

  Madam President, I ask unanimous consent that the pending amendments 
be set aside, and on behalf of Senator Vitter, I send to the desk an 
amendment to the Vitter amendment, and ask for its immediate 
consideration.
  The PRESIDING OFFICER. Without objection, the clerk will report.
  The legislative clerk read as follows:

       The Senator from Delaware [Mr. Biden], for Mr. Vitter, 
     proposes an amendment numbered 5086.

  Mr. BIDEN. Mr. President, I ask unanimous consent that reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To withhold 20 percent of the Federal funding appropriated 
for the Global Fund until the Secretary certifies that the Global Fund 
 has provided the State Department with access to financial and other 
                                 data)

       On page 60, strike line 2.
       On page 60, line 12, strike the period at the end and 
     insert the following: ``; 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).

  Mr. BIDEN. Madam President, I wish to correct what I said. I said I 
send to the desk an amendment to the Vitter amendment. I send the 
Vitter amendment to the desk, and I ask unanimous consent that we move 
to its immediate consideration.
  The PRESIDING OFFICER. The amendment is now pending.
  If there is no further debate, the question is on agreeing to the 
amendment.
  The amendment (No. 5086) was agreed to.
  Mr. BIDEN. Madam President, for the benefit of my colleagues, I 
believe we are down to three amendments. As my grandfather would say, 
God willing and the creek not rising, we will get a UC that can wrap 
this up pretty quickly.
  I yield the floor.
  Mr. SESSIONS. Madam President, I thank Senator Biden for his 
commitment and Senator Lugar's commitment to this. I know it is quite 
sincere, and I know this reauthorization will, indeed, save lives. I 
will note I have a New York Times article from 2004 about 428 Libyan 
children who were infected with HIV by Bulgarian nurses who were 
reusing needles. So during our discussion before, we learned there were 
quite a number of children infected with HIV whose mothers were not 
infected with HIV, and it indicated they got it from some other source. 
It was believed that medical transmissions were a part of that. So I 
believe we can make a difference.
  One of the things this legislation calls for is that whenever a 
circumstance such as this is discovered, that an investigation be 
undertaken to find out how it occurred so a stop can be put to the 
tragedy of someone going to a physician--a doctor--or a clinic to get a 
shot for an infection or a virus or an antibiotic and they come home 
with a deadly disease. We can do better with that, and I hope we will.
  I will note also how proud I have been of Dr. Michael Saag at the 
Center for AIDS Research at the University of Alabama at Birmingham, a 
part of the infectious disease program. They have operated programs 
throughout the world, including Zambia, under a program headed by Dr. 
Jeff Stringer.
  I also wish to thank Senator Tom Coburn. Sometimes people complain 
that Dr. Tom Coburn holds up bills and doesn't always let them pass by 
unanimous consent--with no debate, no ability to offer amendments. He 
felt this bill needed to be improved. I met with

[[Page 15170]]

a group from Africa who urged us to oppose the legislation as 
originally written for a few reasons, primarily because it removed the 
requirement that a significant percentage of the money from the bill be 
spent on medical treatment. They said, in fact, we should oppose the 
bill, even though they would, in many ways, benefit. We had a 
grandmother come whose daughter died from AIDS and she had her 
granddaughter with her and the granddaughter was infected with HIV. So 
it was an emotional moment.
  I wish to say that as a result of Senator Coburn's objections to the 
bill and the willingness of the sponsors and leaders of the bill to 
listen to Dr. Coburn's complaints and concerns, considerable changes 
were made that I think made this bill better. I do feel better about 
that. I wish to say I am pleased that occurred.
  So, again, I am going to support the amendment of Senator DeMint 
which would reduce the funding to a level above that which President 
Bush originally asked for, to the level the Congressional Budget Office 
has said is all we can spend.
  I am going to remember--I will not forget--what Sir Elton John said: 
That it is a responsibility that he felt to everybody who contributed 
to his program to see that every penny is spent wisely. There is no way 
this huge increase in spending can effectively occur with this 
legislation. There is no way it can be passed down through governmental 
agencies and bureaucracies and be wisely spent. I hope some of the 
amendments and ideas to ensure integrity in the process will become 
part of the law.
  So I thank the Chair for the opportunity to speak on this. I do 
believe it will have a positive impact in the world. I do believe the 
United States should lead, and we are able to lead, but I have to tell 
my colleagues that we are in a position financially where we can't do 
everything we would like. We wanted to help the veterans. We wanted to 
stimulate the economy. We wanted to support housing. We wanted to 
support a worldwide program to fight disease, as this bill does, but 
there comes a point in time when we have to ask ourselves: Where are we 
going to get the money?
  I am telling my colleagues, the deficit this year will be more than 
twice what it was last year. A lot of this spending we approved this 
year is not going to come out of the budget until next year. Unless the 
economy dramatically improves, we will probably see less tax revenue 
next year than this year. Much of this AIDS money would not come out 
until next year to be spent. So I am worried about that. I think we 
ought to be responsible. I don't think we have been sufficiently frugal 
in managing this program and in ensuring that every single penny does 
what we want it to do and that we are building up the funding at a rate 
we are sure can be done safely and effectively and protect the 
taxpayers' money.
  So for that reason, I intend to support the amendment of Senator 
DeMint and some of the other amendments that call for rigorous 
monitoring to ensure that the money is spent wisely.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Madam President, I understand that when we 
finish the work on this Global AIDS relief bill, we are going to take 
up the urgent matter of speculation in the commodities trading markets 
specifically with regard to energy and specifically with regard to oil. 
I wish to speak on that critical subject. Is it my understanding that I 
should speak as in morning business?
  The PRESIDING OFFICER. That is up to the Senator to make that 
determination.
  Mr. NELSON of Florida. Well, I will speak with the existing floor 
legislation then.


                            Energy Concerns

  Madam President, it is time for us to address this matter of 
speculation. We have heard testimony on Capitol Hill from numerous 
experts in the Agriculture Committee, the Commerce Committee, the 
Homeland Security Committee, and many others over the course of the 
last several weeks. All signs are indicating there is something 
terribly wrong with the markets--the energy markets, the financial 
markets--and they are having an effect upon each other. Something is 
clearly causing high gas prices and our people are hurting and we have 
to get to the bottom of it.
  When somebody comes up with a solution, those who are on the other 
side of that say: No, that is not true. Well, we are going to have to 
force the issue and get to the bottom of it because now the President 
has lifted the moratorium on offshore drilling in the areas that have 
been under a moratorium for decades.
  The President is offering that as if that were the solution, instead 
of taking on the oil speculators. The President implies that by lifting 
the moratorium, if you drill off the coast in the areas that heretofore 
had been off limits to drilling, it is going to affect the price of gas 
but, in fact, the President's own Energy Information Agency has stated 
in a report they published last year that if you drilled all over the 
entire offshore, it would not affect the price of gasoline until the 
year 2030. So the President's own administration is undercutting the 
very argument the President is saying. So if they know it would not 
affect gas prices, why are they saying it? They are saying it because 
they know it is a seductive argument at a time when people are hurting 
under the strain of paying for $4 gas. It sounds simple: Well, let's go 
drill. However, the fact is, if we want to drill, why don't we drill?
  There are 68 million acres under lease by the oil companies. Let me 
repeat that figure: 68 million acres under lease by the oil companies 
that have not been drilled. It is seductive to say: Well, let's drill. 
Well, then, if we are going to drill, let's drill. Let's drill in what 
is available with thousands of permits that have already been issued to 
drill. Why aren't we drilling? If we look at the argument, we will find 
that to lower gas prices by as much as half, you have to go after the 
unregulated speculation that keeps driving up the price of crude oil, 
and up to unrealistic and shockingly high prices, largely because of a 
legal loophole called the Enron loophole that was enacted in December 
of 2000.
  Oil is hovering now at about $138 a barrel, but recent congressional 
testimony has told us from a leading industry executive--I am talking 
about an oil industry executive--that under normal supply and demand, 
the crude oil price ought to be about $55 a barrel, not $138 a barrel. 
If you brought that price back down to what normal supply and demand 
would require, then instead of gas being $4 a gallon, you are talking 
about gas being around $2.28 a gallon. So that is why a number of us 
have gotten into this act and offered various bills on speculation.
  My legislation, S. 3134, would take us back to the status quo before 
the Enron loophole was enacted, and it would say you would have to 
regulate the energy commodity trading markets. That way, I think we 
could bring gas prices back down to a more realistic level.
  So what Senator Reid has done is, he has reached out to all these 
different speculation bills, and he has tried to put them together into 
a leadership bill that reins in the speculation by imposing position 
limits so one particular speculator couldn't absorb most of the oil 
contracts in a particular market, so it would ensure legitimate 
speculation doesn't get out of hand. Senator Reid's approach is a more 
complicated approach that leaves the door open for unregulated trading, 
but if it is done right, the approach that the majority leader has 
taken can get us where we need to be. So I am going to be trying to 
assist our leader as we try to get this kind of legislation passed.
  Now, it is interesting what we have heard coming from the Wall Street 
investment banks that have a lot of involvement in this speculative 
bidding up of the price, and what we have heard from the editorial page 
of the Wall Street Journal, which says that if you attack speculation 
it is misguided, and they say that the spiking price of a

[[Page 15171]]

barrel of oil is just the supply and demand question; that the demand 
exceeds supply.
  Just ask yourself if that makes sense. When the Saudis agreed to 
increase production, there was no drop in the price of oil. They 
increased the supply, but there was no drop in the price, and the price 
of oil keeps spiraling on. And one day it jumped up $11 a barrel.
  When there is no evidence of any dramatically increased demand, there 
is plenty of evidence that speculative money is pouring into the energy 
futures market. If you were making that much money, putting it into 
that marketplace, why wouldn't you pour your money in there?
  Madam President, our airlines are just about to go out of business. 
The day that oil jumped $11 a barrel, just that $11 a barrel jump cost 
the airline industry $4 billion extra. The airlines go out and they bid 
in the speculative market to hedge against increases in the price of 
jet fuel. But they are hurting so bad because of this marketplace going 
haywire. There are legitimate hedgers who try to use the futures 
market. Every CEO of every major airline has written us, all asking us 
to take action against excessive speculation. In the meantime, you know 
the drill--the oil companies keep asking loudly, along with the 
President--they claim they need to drill in new areas off of Florida 
and off of California. They will argue that this is going to increase 
the supply of oil.
  But what they don't tell us is that in the Gulf of Mexico, there is 
already 39 million acres under lease, and 32 million acres of that 39 
has not been drilled. So why wouldn't they drill?
  Well, there is a fact of a balance sheet and assets. The more areas 
of land and offshore land they can have under lease, the more reserves 
the oil company accumulates, and the more that is a valuable asset that 
is added to their books.
  This Senator was involved in crafting a compromise 2 years ago on 
drilling in the Gulf of Mexico. Initially, the proposal was to drill in 
2.5 million acres. That was going to go on a beeline straight toward 
Tampa, FL. This Senator, and others, crafted a compromise of 8.3 
million new acres for lease, keeping it away from the coast of Florida 
and away from the military testing and training area. We have the 
largest testing and training area for the U.S. military in the world, 
which is basically the Gulf of Mexico off of Florida. So we worked out 
that compromise.
  But in this argument to lift the moratorium, their side is not 
telling you that in the 8.3 million new acres they got in the gulf 2 
years ago--that did nothing to bring down the price of gasoline and 
oil. They don't tell you they have not drilled in any of that new 8.3 
million acres. It is available, and it is there.
  So the fact is, they ought to be sinking wells in the areas they have 
under lease--68 million acres--before demanding the control of millions 
of new acres with all the resulting tradeoffs that may occur. What do I 
mean? For example, States such as my State of Florida or California 
have an enormous part of their economy depending on pristine beaches. 
In our State alone, we have a $60 billion-a-year tourism industry. Do 
we want that threatened? Do we want our economy threatened?
  In States such as mine, the State of California, and many other 
States, there are these delicate bays and estuaries where so much 
marine life is spawned. Do we want that threat? No. I admit everything 
is a tradeoff. So why can't we balance the interests here by protecting 
the economic interests, the environmental interests, and the military 
interests against the interests to have additional oil drilling by 
utilizing the 68 million acres to drill on, already leased, including 
the 32 million acres available in the Gulf of Mexico that is under 
lease but hasn't been drilled? It is too much of a commonsense question 
that people like to ignore. This Senator is going to continue to demand 
that we answer that in a commonsense way.
  Let me point out something else. By the lifting of the moratorium, 
which the President has just done on Monday, it would lift the 
moratorium all up and down the eastern seaboard, from Maine all the way 
down to the Keys in the State of Florida. That would open in the 
Atlantic the area off of the Cape Canaveral Air Force Station and the 
Kennedy Space Center. Do you think we ought to be having oil rigs out 
there where we are dropping the solid rocket boosters of every space 
shuttle flight, and where the defense satellites that are being 
launched out of the Cape Canaveral Air Force Station, on whose ride to 
space are expendable booster rockets, with the first stages dropping 
off into the Atlantic--should we threaten that capability of our 
national security? Yet what Senator McConnell is going to offer as a 
Republican alternative is to allow this drilling in all of the areas 
offshore of the United States, with the exception that the Governor of 
an individual State could veto drilling off that State.
  Do we, the United States, whose main function as a government is to 
provide for the national security, want a Governor of an individual 
State to have veto power over whether the military interests of the 
Nation are going to be able to be conducted off the shore of that 
particular State? I think the answer is clearly no. You can't let a 
single individual, with their point of view of a State, say we are 
going to drill out there and kill that military testing and training 
area or in the case of Cape Canaveral, the area where we have to launch 
our rockets into space. Yet this is what we have come to.
  So why do we want, in this system of tradeoffs, a tradeoff against 
the interests of our national security, our environment, and our 
individual State economies? It is simply not worth it if you have an 
alternative. The alternative is to go ahead and drill in the 68 million 
acres you already have under lease. We are not opposed to drilling. We 
want to make sure we approach this, as you make the decisions of 
tradeoff, in a commonsense way. That is what a lot of people do not 
understand. We simply cannot allow the administration to take advantage 
of the situation, to give away the store, before this President leaves 
office in about 5 months.
  Instead, we need to do something that is going to reduce gas prices 
by curbing the profiteering and the excessive speculation on the 
unregulated markets. That is the real solution for the short term. 
Then, for the long term, we must rapidly develop alternative fuels and 
vehicles and have a legitimate alternative to petroleum as a means of 
the source of energy as we propel ourselves forward in this country in 
this century.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware is recognized.
  Mr. BIDEN. Madam President, for the benefit of my colleagues, I am 
going to propound, very shortly, two unanimous consent requests 
relative to the legislation. I wanted to make sure Senator Lugar has 
copies of them.
  The first one relates to the Sessions amendment. Then the second 
relates to wrapping up the entirety of the bill, all remaining 
amendments. With the Senator's permission, I will proceed.
  Madam President, I ask unanimous consent that it be in order for 
Senator Sessions to substitute an amendment on promoting blood safety 
for the amendment he currently has listed under the agreement with 
respect to S. 2731, with no second-degree amendments in order to the 
amendment; that the Sessions amendment be agreed to and the motion to 
reconsider be laid upon the table; that the Sessions amendment on the 
list be deleted, and that no point of order be in order to the bill 
based on section 305.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BIDEN. Madam President, that means the Sessions amendment is now 
agreed to; is that correct?
  The PRESIDING OFFICER. We do not have the amendment.


                           Amendment No. 5087

  Mr. BIDEN. Madam President, I send the amendment to the desk.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Delaware [Mr. Biden], for Mr. Sessions, 
     proposes an amendment numbered 5087.


[[Page 15172]]

  Mr. BIDEN. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 5087) is as follows:

(Purpose: To advise the public about the risks of contracting HIV from 
blood exposures, to investigate unexplained infections, and to promote 
             universal precautions in health care settings)

       On page 20, line 13, strike ``and'' and all that follows 
     through ``(C)'' on line 14, and insert the following:
       ``(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)
       On page 28, line 13, insert ``public education about risks 
     to acquire HIV infection from blood exposures, promotion of 
     universal precautions, investigation of suspected nosocomial 
     infections'' after ``safe blood supply,''.
       On page 102, line 21, strike ``and'' and all that follows 
     through ``(xii)'' on line 22, and insert the following:
       ``(xii) building capacity to identify, investigate, and 
     stop nosocomial transmission of infectious diseases, 
     including HIV and tuberculosis; and
       ``(xiii)''
       On page 132, between lines 12 and 13, insert ``public 
     education about risks to acquire HIV infection from blood 
     exposures, promoting universal precautions, investigating 
     suspected nosocomial infections,''.

  Mr. BIDEN. Madam President, I urge passage of the amendment by voice 
vote.
  The PRESIDING OFFICER. Is there further debate? If not, the question 
is on agreeing to the amendment.
  The amendment (No. 5087) was agreed to.
  Mr. BIDEN. Madam President, I ask unanimous consent that no further 
amendments be in order to S. 2731; that the Senate then proceed to vote 
in relation to the pending amendments in the order listed below; that 
prior to each vote there be 4 minutes equally divided and controlled in 
the usual form; that after the first vote in the sequence, each 
succeeding vote be limited to 10 minutes each; that upon disposition of 
all of the amendments, and prior to voting on final passage of H.R. 
5501, the House companion, there be 40 minutes of debate, with the time 
equally divided and controlled between the chair and ranking member; 
that upon the use or yielding back of that time, the Senate proceed to 
vote on passage of H.R. 5501, as amended, with any other provisions of 
the previous order remaining in effect.
  The amendments in question are the Gregg amendment, No. 5081; the Kyl 
amendment, No. 5082; and the DeMint amendment, No. 5077.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BIDEN. Madam President, I believe we are looking for a unanimous 
consent to begin the first amendment in the series of votes at 5 
o'clock.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BIDEN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BIDEN. Madam President, I ask unanimous consent that the order of 
the votes that was set out in the unanimous consent agreement begin at 
5 o'clock, the first vote beginning at 5 o'clock.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BIDEN. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. GREGG. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 5081

  Mr. GREGG. Madam President, is the regular order now that we are to 
proceed to a vote on a series of amendments?
  The PRESIDING OFFICER. A series of amendments with 2 minutes of 
debate on each side preceding each amendment vote.
  Mr. GREGG. Is the first amendment my amendment relating to the 
inspector general?
  The PRESIDING OFFICER. The first amendment is the amendment, of the 
Senator from New Hampshire, Mr. Gregg.
  Mr. GREGG. Madam President, I will go forward, and I guess the 
Senator from Indiana will close.
  This amendment seems to me to be eminently reasonable in the sense 
that all it does--it is certainly not partisan in any way--is set up an 
independent inspector general for this specific program. Why does this 
program need an independent, specific inspector general? It is because 
under the present law, where we have over $15 billion being spent over 
5 years, we have five different inspectors general looking at these 
programs, and it has been pretty clear that they haven't had time to do 
it very effectively. Only one inspector general has spent any time, in 
fact, and that has been the USAID inspector general. By requiring the 
program to increase threefold, we are dramatically increasing the 
responsibility relative to spending money, but the USAID inspector 
general isn't going to have time to increase their efforts 
significantly in this account. So it is very important that we have an 
independent inspector general.
  This is especially true because almost every country that these 
dollars are going to go into is a country which rates very low on the 
international evaluation of transparency, integrity, and functioning of 
the government in a way that we would deem to be efficient and 
effective. We cannot afford to have U.S. tax dollars wasted, and we 
certainly don't want to have them going to processes which are corrupt. 
The way to avoid that is to set up a specific inspector general for 
this account.
  I wouldn't ask for it if we weren't expanding it so dramatically. But 
when you take a program and triple its size, you better have someone 
looking over the shoulders of the folks spending that money. That is 
why we need an independent inspector general relative to this account.
  I yield the remainder of my time, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second. The yeas and nays are ordered.
  The Senator from Indiana is recognized for 2 minutes.
  Mr. LUGAR. Madam President, while I agree with the oversight goals 
the Senator has suggested, the underlying bill we are debating has a 
very strong inspector general infrastructure, and it operates at much 
less cost than the cost that would be assumed by the Senator's 
amendment.
  PEPFAR has set a high standard for results-based, accountable 
development programs both within our own Government and in the 
international community. PEPFAR has been among the most evaluated of 
new programs in the U.S. Government, with five GAO reports already 
completed and a sixth on the way.
  I believe we now have a strong system of oversight already in the 
bill that recognizes the participation of many agencies in our 
antidisease programs, and this system has extensive experience and 
continuity of oversight over these programs. I believe we should retain 
this system. Therefore, I hope Members will oppose the amendment.
  The PRESIDING OFFICER. The question is on agreeing to the amendment 
of the Senator from New Hampshire. The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Indiana (Mr. Bayh), the 
Senator from Massachusetts (Mr. Kennedy), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Arizona (Mr. McCain) and the Senator from Virginia (Mr. Warner).
  The PRESIDING OFFICER (Mr. Schumer). Are there any other Senators in 
the Chamber desiring to vote?

[[Page 15173]]

  The result was announced--yeas 44, nays 51, as follows:

                      [Rollcall Vote No. 179 Leg.]

                                YEAS--44

     Alexander
     Allard
     Barrasso
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Dole
     Ensign
     Enzi
     Feingold
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Klobuchar
     Kyl
     McCaskill
     McConnell
     Roberts
     Sessions
     Shelby
     Smith
     Snowe
     Specter
     Sununu
     Tester
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--51

     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Boxer
     Brown
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Clinton
     Conrad
     Dodd
     Domenici
     Dorgan
     Durbin
     Feinstein
     Hagel
     Harkin
     Inouye
     Johnson
     Kerry
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Rockefeller
     Salazar
     Sanders
     Schumer
     Stabenow
     Stevens
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--5

     Bayh
     Kennedy
     McCain
     Obama
     Warner
  The amendment (No. 5081) was rejected.
  Mr. BIDEN. Mr. President, I move to reconsider the vote.
  Mr. LEAHY. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 5082

  The PRESIDING OFFICER. There is now 4 minutes of debate equally 
divided in relation to the vote on the Kyl amendment, No. 5082. Who 
yields time?
  The Senator from Arizona is recognized.
  Mr. KYL. I would like my colleagues' attention so I can briefly 
explain the amendment.
  Mr. President, this will take a moment. This is a very simple 
amendment. We have tried to authorize $50 billion over 5 years. All my 
amendment says is that in those 5 years, the last year will have $10 
billion authorized--in other words, one-fifth of the total. And that if 
there is an appropriation exceeding that amount, that there would be a 
point of order against it.
  The reason for it is very simple. Under the current law, we have 
exceeded the authorization by about $4 billion, actually close to $5 
billion. What that does is to affect the baseline for the following 
reauthorization.
  All we are trying to do is to say if this is $50 billion--that is $10 
billion a year. The House actually has it designated as such, the 
Senate does not. All I am saying is, is not even designate each year as 
10, just make sure the last year is 10.
  One reason for doing that is to make sure that is the baseline for 
the subsequent reauthorization. That is all we are trying to do. This 
is a very simple, very easy amendment to support. I would think those 
who are strongly in support of PEPFAR would agree to this amendment 
because it would grant further assurances about the program not having 
mission creep and expanding more than it should in future years, that 
would make some folks feel better about it.
  Mr. President, I reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. LUGAR. Mr. President, I ask Senators to oppose this amendment. 
Because of the anticipated funding curve over the next 5 years, this 
amendment likely would have the effect of cutting funds available in 
the final year by several billion dollars.
  We should retain the flexibility to spend less than $10 billion now, 
while spending more than $10 billion in future years, if needed, when 
our programs are reaching more individuals with treatment and 
prevention services.
  We want the program to expand at a rational pace based on thoughtful 
goals and on the developing capacity to absorb investments. Our 
agencies have demonstrated they know how to achieve this. We should 
retain the flexibility that will give them the best opportunity to 
succeed.
  I ask Senators to oppose the amendment.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. KYL. Mr. President, that is a reasonable argument. My amendment 
does not preclude the reasonable ramping up of the money. But what we 
are hoping to do is to keep the appropriation to $50 billion--actually 
it is now $48 billion. Under current law, at $15 billion authorized, we 
are spending just under $20.
  In other words, the appropriations have exceeded the authorization. 
All I am trying to do is not prevent the internal adjustment to allow 
the full expenditure of the amount authorized but to prevent an 
appropriation above that. That is why the point of order would only 
apply to appropriations that exceed the authorized amount in the final 
year.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. BIDEN. Mr. President, I want the Senator to have the last word, 
so I would ask that he have another 15 seconds to respond to what I am 
going to say.
  Let's get this straight. This is an authorization. This is not an 
appropriation. I understand the Senator's concern. But we may need to, 
in terms of rationally ramping up the expenditures of this money 
without wasting the $48 billion, be spending $11 or $12 billion in the 
fifth year.
  His concern is that becomes the baseline for the next 5 years. We are 
not authorizing for the next 5 years. We are authorizing for this 5 
years. All we are doing is authorizing.
  So I would strongly urge us to vote against this amendment.
  The PRESIDING OFFICER. The Senator from Arizona has 15 seconds to sum 
up.
  Mr. KYL. Mr. President, I appreciate the hard work both the chairman 
and the ranking member have put in. Their arguments have been made. I 
ask my colleagues to improve the bill a little bit by adopting our 
amendment.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Indiana (Mr. Bayh), the 
Senator from Massachusetts (Mr. Kennedy), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Arizona (Mr. McCain) and the Senator from Virginia (Mr. Warner).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 28, nays 67, as follows:

                      [Rollcall Vote No. 180 Leg.]

                                YEAS--28

     Alexander
     Allard
     Barrasso
     Bond
     Bunning
     Burr
     Chambliss
     Coburn
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Kyl
     McConnell
     Sessions
     Thune
     Vitter
     Wicker

                                NAYS--67

     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Boxer
     Brown
     Brownback
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Clinton
     Cochran
     Coleman
     Collins
     Conrad
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Feingold
     Feinstein
     Hagel
     Harkin
     Inouye
     Johnson
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCaskill
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Schumer
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Tester
     Voinovich
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--5

     Bayh
     Kennedy
     McCain
     Obama
     Warner
  The amendment (No. 5082) was rejected.
  Mr. BIDEN. Mr. President, I move to reconsider the vote.

[[Page 15174]]


  Mr. LUGAR. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                           Amendment No. 5077

  The PRESIDING OFFICER. There are now 4 minutes of debate equally 
divided prior to a vote in relation to the DeMint amendment No. 5077. 
Who yields time?
  The Senator from South Carolina.
  Mr. DeMINT. Mr. President, since the President introduced his bill to 
reauthorize the PEPFAR program several months ago, a lot has changed. 
Our economy has continued to slow. We have passed a housing bill that 
allows up to $300 billion of risky loans to be added to the Federal 
debt. We have now been told by Secretary Paulson that it is likely we 
will have to come up with $40 to $50 billion in the next year to prop 
up the Government-sponsored enterprises of Fannie Mae and Freddie Mac. 
I appeal to my colleagues to consider reducing the amount of 
authorization for this PEPFAR bill to $35 billion. The Congressional 
Budget Office tells us we cannot spend more than $35 billion over a 5-
year period without wasting, that the mechanisms are not there. For us, 
in the face of what we are dealing with, to go beyond what the 
Congressional Budget Office tells us we can spend and authorize $50 
billion at this time is irresponsible. I encourage my colleagues to 
vote for this amendment to reduce the authorization amount to $35 
billion.
  I retain the remainder of my time.
  The PRESIDING OFFICER. The Senator from Indiana.
  Mr. LUGAR. Mr. President, the President and Members of the House of 
Representatives have carefully examined the PEPFAR situation and 
strongly recommended the $50 billion authorization. In the event we 
were to pass this amendment, it would be a severe blow to United States 
leadership and prestige on this issue, because it would profoundly 
affect the calculations of individuals, groups, and governments that we 
are trying to engage in this fight against HIV/AIDS. These commitments, 
many of them, are contingent upon our action today. I believe the $50 
billion figure will maximize the humanitarian and foreign policy 
benefits of the PEPFAR program. We have an opportunity to save lives on 
a massive scale and preserve the fabric of numerous fragile societies. 
I ask my colleagues to continue to work together for this result. I 
oppose the amendment.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. DeMINT. How much time do I have remaining?
  The PRESIDING OFFICER. There is 32 seconds.
  Mr. DeMINT. Mr. President, with due respect to my colleague, 
apparently there is nothing magic about $50 billion, because today we 
arbitrarily cut $2 billion and sent it somewhere else. Again, the 
Congressional Budget Office says that nothing will be sacrificed. No 
aid will be taken away from Africans with AIDS and others we are trying 
to help, because within the 5-year period we cannot spend $50 billion 
effectively and efficiently. Let's show some restraint in this body and 
at least move it to the maximum figure we can do effectively.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. BIDEN. Mr. President, currently we are spending $6.3 billion a 
year. This amendment is based in part on the Congressional Budget 
Office report that assumes PEPFAR, tuberculosis, and malaria spending 
for fiscal 2009 will only be $1.5 billion. That false assumption stems 
from the fact that the Congressional Budget Office is evaluating this 
authorization act as if it were starting from zero. That is how they 
get the $35 billion. It is not starting from zero. It is starting from 
$6.3 billion. Slashing funding will require slashing targets set in 
this bill, including prevention of 12 million HIV infections; care for 
12 million people, including 5 million orphans and vulnerable children; 
treatment of millions of people with AIDS, according to a formula that 
climbs as appropriations rise over time; and a major expansion of 
efforts to combat tuberculosis and malaria together which claim 6.3 
million lives a year.
  The PRESIDING OFFICER. The question is on agreeing to amendment No. 
5077.
  Mr. BIDEN. I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Indiana (Mr. Bayh), the 
Senator from Massachusetts (Mr. Kennedy), and the Senator from Illinois 
(Mr. Obama) are necessarily absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Arizona (Mr. McCain) and the Senator from Virginia (Mr. Warner).
  The PRESIDING OFFICER (Ms. Cantwell). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 31, nays 64, as follows:

                      [Rollcall Vote No. 181 Leg.]

                                YEAS--31

     Alexander
     Allard
     Barrasso
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hutchison
     Inhofe
     Isakson
     Kyl
     McCaskill
     McConnell
     Nelson (NE)
     Roberts
     Sessions
     Thune
     Vitter
     Wicker

                                NAYS--64

     Akaka
     Baucus
     Bennett
     Biden
     Bingaman
     Boxer
     Brown
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Clinton
     Cochran
     Coleman
     Collins
     Conrad
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Feingold
     Feinstein
     Hagel
     Harkin
     Hatch
     Inouye
     Johnson
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Salazar
     Sanders
     Schumer
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Tester
     Voinovich
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--5

     Bayh
     Kennedy
     McCain
     Obama
     Warner
  The amendment (No. 5077) was rejected.
  Mr. BIDEN. I move to reconsider the vote.
  Mr. LUGAR. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                             Change of Vote

  Mr. DOMENICI. Madam President, on rollcall vote 181, I voted ``yea.'' 
It was my intention to vote ``nay.'' Therefore, I ask unanimous consent 
that I be permitted to change my vote since it will not affect the 
outcome.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The foregoing tally has been changed to reflect the above order.)
  Mrs. CLINTON. Madam President, I rise today in strong support of S. 
2731, the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
2008. This legislation would provide a substantial increase in our 
resources to address these devastating diseases on a global scale. It 
will enable us to increase the number of health professionals, expand 
treatment, and prevent new infections, thus improving the lives and 
futures of millions in countries around the world.
  I am particularly pleased to see the advances that this bill makes in 
providing information about effective interventions, such as those that 
can prevent the perinatal transmission of HIV and save the lives of 
newborns. It also will allow us to implement new strategies to protect 
women and girls from HIV infection. This bill is an important step in 
our fight against global AIDS, and I would urge all of my colleagues in 
the Senate to vote for it.
  I would like to draw attention to several provisions in this 
legislation which I believe will help to improve our efforts to combat 
AIDS around the world. One of these is an increased emphasis on 
identifying and replicating best practices in service delivery, a 
science known as operations research.

[[Page 15175]]

  Let me give you an example of how operations research can help to 
improve our response to global AIDS. In the developing world, about 1 
out of every 3 children born to mothers with HIV end up with the 
virus--a tragic statistic and one we know how to prevent. We have 
learned from our experience in the United States, where less than 100 
cases of perinatal transmission were recorded in 2005, that providing 
access to critically needed, life-extending drugs can significantly 
reduce cases of mother-to-child transmission of HIV. With data from 
operations research, we will be able to understand how we can, in low 
resource settings, improve testing, education, and treatment options in 
order to reduce mother-to-child transmission to levels that are 
comparable to those we see in the United States. And prevention of 
mother-to-child transmission of HIV is just one of the areas where the 
data from operations research can transform our ability to maximize the 
U.S. investment in global AIDS funding.
  Earlier this year, I introduced the PEPFAR Accountability and 
Transparency Act to expand our investment in operations research. I am 
pleased to note that several of the provisions from that legislation 
have been incorporated into this bill, which will require the 
government to incorporate plans to improve program monitoring, 
evaluation and operations research into its overall strategic plan for 
AIDS. Doing so will allow us to determine the effectiveness of the 
interventions we are funding, so that we can replicate those that are 
working well, and examine ways to improve those that could be better. 
The bill would also increase the dissemination of research findings, so 
that information about cost-effective interventions will be available 
with people working to combat diseases in their own communities, shared 
through a ``best practices'' report compiled and published annually by 
our government.
  I am also pleased to see that this legislation increases our efforts 
to address the vulnerability of women and girls to HIV infection. 
According to the United Nations, more than 15 million women were living 
with HIV at the end of 2007, accounting for slightly less than half of 
all those living with HIV. But in the places that are hardest hit by 
epidemic, AIDS has a disproportionate impact upon women. In sub-Saharan 
Africa, for example, 61 percent of those living with HIV are women. And 
we are not doing enough to help women protect themselves against 
infection, particularly young women. Studies completed in 17 countries 
in 2003 show that more than 75 percent of the young women surveyed 
could not identify ways to protect themselves against HIV infection.
  Last year, I joined Representative Barbara Lee in introducing the 
Protection Against Transmission of HIV for Women and Youth (PATHWAY) 
Act, which would require the President to develop and implement an HIV 
prevention strategy that addresses the particular vulnerabilities of 
women and girls--the links between gender-based violence, lack of 
educational and economic opportunity, human trafficking and sexual 
exploitation, and increased risk for HIV infection. I am pleased to see 
that this legislation contains a strong emphasis on addressing the 
needs of women and girls. It will require the inclusion of programs to 
address the needs of women and girls, in the President's 5-year 
strategy to combat global AIDS, and will provide clear guidance to help 
integrate gender across prevention, care and treatment programs. With 
this increased commitment, we will be able to help prevent additional 
HIV infections among women, and increase access to care and treatment. 
Doing so will help not only women living with HIV, but the families for 
whom so many of these women are the primary caregivers.
  In addition to requiring a strategy to address the needs of women and 
girls, the PATHWAY Act also repealed requirements that one-third of 
prevention funding under PEPFAR be spent on abstinence until marriage 
programs. I believe that we need to repeal this hard spending 
requirement in order to give countries the flexibility to tailor 
prevention programs to their local needs. Both the Government 
Accountability Office and the Institute of Medicine have produced 
reports demonstrating that such spending requirements impact the 
ability of in-country programs to carry out effective interventions. 
The bill we are voting on today removes the abstinence earmark and 
replaces it with a requirement to submit reports on spending if in-
country funding for abstinence and monogamy promotion drop below 
certain levels. I am hopeful that this compromise will allow countries 
to tailor their prevention messages to the epidemic that exists, and 
improve the efficacy of our efforts to halt the spread of HIV, and I 
will monitor implementation of this provision to ensure that it does 
not also constrain the ability of grantees to help prevent as many new 
infections as possible.
  This bipartisan legislation is an opportunity for us to renew our 
commitment as a nation to fighting the global scourges of AIDS, 
tuberculosis, and malaria. It improves our ability to care for those in 
need, to help countries torn apart by these epidemics, to combat the 
dangerous stigma that often still exists around these diseases, and to 
prevent new infections. Today's vote represents a critical step in our 
efforts to halt and reverse the burden of these diseases, and I am 
proud to join my colleagues in supporting this bill.
  Mr. DODD. Madam President, I rise in strong support of the Global 
HIV/AIDS, tuberculosis, and malaria reauthorization bill and urge its 
immediate passage. As a member of the Senate Foreign Relations 
Committee and chairman of its Subcommittee on Western Hemisphere, Peace 
Corps, and Narcotics Affairs, I can say that of all the global 
challenges we face, few are more daunting in scope or immediate in need 
than the scourge of HIV/AIDS. In so many parts of the world, the global 
HIV/AIDS pandemic threatens to undermine all of our other efforts to 
bring stability and prosperity to the world.
  As a result of the original law Congress passed in 2003, the United 
States has provided lifesaving drugs to nearly 1.5 million men, women 
and children; supported care for nearly 7 million people, including 2.7 
million orphans and vulnerable children; and prevented an estimated 
150,000 infant infections around the world. Through this law alone, we 
as a nation have shown the world that Americans are a compassionate, 
caring and generous people. It is a spirit I know to be true throughout 
our remarkable country. Our sustained commitment to the treatment, 
prevention, and care of HIV/AIDS globally through this law has helped 
us make great strides toward helping repair our Nation's image overseas 
so badly damaged by the war in Iraq. So, I tell my colleagues, the eyes 
of the world are upon us. We must reauthorize this program and we 
cannot wait another day to do it.
  I want to thank and commend the chairman and ranking member of the 
Senate Foreign Relations Committee, Senator Biden and Senator Lugar, 
for crafting this bipartisan legislation that will continue the success 
of the 2003 law and make many important improvements to the program. I 
would like to take a minute to highlight a few of what I believe are 
the most critical improvements. Following that, I want to go into a bit 
more detail about provisions in this bill that I am proud to have 
authored, along with my colleague Senator Gordon Smith, relating to the 
prevention of mother-to-child transmission of HIV and the treatment of 
children living with this disease.
  To begin with, the bill increases the authorization of appropriations 
to $50 billion, allowing for incremental increases in funding over the 
course of the next 5 years. HIV/AIDS killed more than 2 million people 
last year, including 330,000 children under the age of 15, and an 
estimated 2.5 million people including 420,000 children were newly 
infected. These numbers are staggering. Absent an increase in our 
funding commitment, we may well lose all the hard-fought gains we've 
made against this disease.
  The bill also eliminates the restrictive ``one-third earmark'' 
limiting prevention funding to abstinence-until-marriage programs. The 
Institute of

[[Page 15176]]

Medicine and the Government Accountability Office, GAO, both concluded 
that the one-third abstinence earmark unduly limited flexibility for 
the people implementing HIV/AIDS programs on the ground. In fact, the 
GAO found that in order to meet the one-third spending requirement, 
country teams reported having to divert funds from prevention of 
mother-to-child transmission services.
  The bill sets several key targets for HIV/AIDS prevention, treatment 
and care as well as targets to expand the healthcare workforce in order 
to help achieve staffing levels recommended by the World Health 
Organization. The bill moves from a reliance on a healthcare workforce 
that was already in place in the developing world under the original 
law to investing new funds to train new healthcare workers and 
paraprofessionals, especially nurses and doctors, under the 
reauthorization bill. The various targets in the bill will help move 
the program toward sustainability over the long term. That can only be 
achieved by a bold, sustained effort to train and retain new healthcare 
workers, including adding new workers to the most rural of areas.
  The legislation repeals the provision in current law barring the 
admission into the U.S. of individuals who are HIV positive or have 
AIDS. This policy is an international embarrassment and its repeal 
should be maintained in the final bill. Because of this law, the 
President has to seek a waiver from his own State Department to invite 
guests to White House events related to this program. The U.S. cannot 
even host an international conference on HIV/AIDS. The time to repeal 
this statutory ban that discriminates solely on the basis of an HIV/
AIDS diagnosis is long past due.
  I would like to take a moment now to highlight a couple of key 
provisions included in this bill that were drawn from legislation I 
introduced earlier this year with my colleague, Senator Gordon Smith. 
Our bill, the Global Pediatric HIV/AIDS Prevention and Treatment Act, 
and the bill before us today set a target for the prevention and 
treatment of mother-to-child transmission of HIV that, within 5 years, 
will reach 80 percent of pregnant women in those countries most 
affected by HIV/AIDS in which the U.S. has such programs.
  The bill also calls for integrating care and treatment with 
prevention of mother-to-child transmission programs, increasing access 
of women in these programs to maternal and child health services, and a 
timeline for expanding access to prevention of mother-to-child regimes. 
The ultimate goal of these policy improvements is to improve the health 
outcomes of HIV-affected women and their families and to improve 
followup and continuity of care.
  I also want to thank the chairman and ranking member of the Foreign 
Relations Committee for including an amendment I offered in committee 
that will convene a prevention of mother-to-child expert panel which 
will report to the Office of the Global AIDS Coordinator and the public 
within a year on a plan for the scale-up of mother-to-child 
transmission prevention services. This provision was not included in 
the House-passed bill but I urge my colleagues to maintain it in the 
bill that is sent to the President.
  We can prevent the transmission of HIV mother-to-child. We know how 
to do it. In the industrialized world, the standard of care involving a 
complex drug regimen has reduced mother-to-child transmission rates to 
as low as 2 percent. By the end of 2007, 34 percent of HIV-infected 
pregnant women around the world received the medicines they need to 
prevent transmission of HIV to their babies, a substantial increase 
from 14 percent in 2005. While this is considerable progress, still 
almost two-thirds of HIV-positive pregnant women did not receive the 
medicines necessary to prevent the transmission of HIV to their baby. 
That is why the target in the bill is so crucial.
  I am in the unique position of serving on both the Foreign Relations 
Committee and the Health, Education, Labor and Pensions Committee where 
I have spent many years working to improve the health and welfare of 
children and families. We have made great strides through the Ryan 
White CARE Act program in this country toward ensuring that children 
and their families receive adequate, family-centered care and treatment 
for HIV/AIDS. In the United States, we have reached a point where a 
child living with HIV/AIDS no longer faces certain death. Thanks to 
antiretroviral, ARV, therapy, many children born infected with HIV/AIDS 
now have the opportunity to grow up healthy. However, long-term 
survival remains a dream that eludes most of the 2.5 million HIV-
infected children around the world.
  Globally, HIV/AIDS infection rates in children continue to outpace 
the rate at which they are treated. Every day approximately 1,100 
children across the globe are infected with HIV, the vast majority 
through mother-to-child transmission during pregnancy, labor or 
delivery or soon after through breastfeeding. Approximately 90 percent 
of these infections occur in Africa.
  With no medical intervention, HIV-positive mothers have a 25 to 30 
percent chance of passing the virus to their babies during pregnancy 
and childbirth. Without proper care and treatment, half of these newly-
infected children will die before their second birthday and 75 percent 
will die before their fifth. Sadly, although children represent close 
to 16 percent of HIV infections, they are only 10 percent of those 
receiving treatment.
  That is why the bill before us today also includes a 5-year target 
that the number of children receiving care and treatment for HIV/AIDS 
is proportionate to their infection rate in each country funded under 
this program. One cannot lag behind the other and, with passage of this 
bill, they won't.
  I thank the chairman and ranking member again for working with me to 
include these vital provisions for children and families. I believe 
they will have an enormous impact on the long-term health and survival 
of the millions of men, women and children affected by HIV/AIDS.
  I would be remiss if I did not take a moment to highlight an area 
where I believe the bill regrettably does not incorporate the lessons 
learned over the past 5 years about addressing HIV/AIDS, and that is 
the lack of language in the bill facilitating linkages between HIV/AIDS 
activities and family planning activities.
  I recognize that Members have strong feelings on this issue. But 
family planning providers serve millions of women in developing 
countries that are now at the center of the global HIV/AIDS pandemic. 
Moreover, it is critical that this program continue to support 
voluntary family planning counseling and referral as a core component 
of prevention of mother-to-child transmission and other HIV-service 
programs. I look forward to working to ensure that this program links 
HIV/AIDS activities and family planning activities.
  With that, I urge my colleagues to act quickly to pass this bill to 
reauthorize a program that has helped save the lives of millions of 
men, women and children. The President has asked Congress to pass the 
bill. The leading organizations advocating for reauthorization of this 
program have called on Congress to pass the bill. The House has already 
passed the bill. It is time for the Senate to do the same. I implore my 
colleagues to put aside their differences and support passage of this 
bill.
  Mr. COLEMAN. Madam President, I strongly support the reauthorization 
of the President's emergency plan for AIDS relief. The fight against 
pandemic AIDS is an important international priority, and I am very 
pleased that we can work toward a bipartisan consensus on this 
legislation. We have the benefit of 5 years of lessons learned to 
integrate into this bill, and the resources that we are putting into 
action through this measure will deliver lifesaving medicines, basic 
health care infrastructure and hope to millions of people around the 
global who face the threat of HIV/AIDS, malaria and tuberculosis.
  I have had a particular interest in the area of health care 
infrastructure in Africa, and have worked closely with

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my colleagues Senators Durbin and Feingold on legislation relating to 
this. I am very pleased that some of our language and ideas have been 
integrated into the current PEPFAR bill. The fact of the matter is that 
we face great challenges in the area of health infrastructure in 
Africa, including serious shortages of health care workers, clinics, 
and hospitals in many areas of the host countries that limit our 
ability to reach the millions of people who need care and treatment. It 
is my view that at least some of the answers may be found in the 
private sector, and it is my hope that U.S. agencies will reach out to 
the private sector to help us meet the overwhelming needs of the 
affected countries.
  I would like to share with my colleagues the success of one unique 
nonprofit from my home State that has harnessed the powerful force of 
franchising to establish a sustainable network of health clinics and 
pharmacies in two PEPFAR countries. This program, run by the 
HealthStore Foundation, was established more than a decade ago to 
``prevent needless death and illness by sustainably improving access to 
essential medicines.'' Since that time, the HealthStore Foundation has 
established a network of more than 65 franchises in Kenya, serving 
roughly 525,000 patients and customers in 2007. Currently, the program 
is expanding to Rwanda, and the first franchise should be open within a 
few weeks. By 2012, the HealthStore Foundation plans to expand its 
network to over 14 countries serving millions of patients per year.
  Each HealthStore franchise is locally owned and operated by a 
licensed nurse or by a community health worker. Some hire employees, 
creating still more jobs, mostly for women. HealthStore operates as a 
typical franchisor, and franchises are licensed under the Child and 
Family Wellness Shops, CFW shops, brand name. The model incorporates 
key elements of any successful franchise network: strong branding, 
proven operating systems and training; strict quality controls enforced 
through regular inspections; and well-chosen locations. It is worth 
noting that franchising the distribution of health care and 
pharmaceuticals has also helped to curtail incentives for corruption, 
as franchisees risk losing their business if they fail to comply with 
franchise system standards.
  I describe the HealthStore Foundation program as a ``microfranchise'' 
model, because this model shares many of the unique characteristics of 
the microlending efforts led by the Grameen Bank. In Kenya, clinics are 
easily accessible, located within an hour's walk of the communities 
they serve. Each clinic offers a range of government-approved, tested 
medicines and products along with basic health care services from 
licensed nurses. Up front costs for each franchise unit are modest, and 
the stores generate a steady income for their owners. To ensure that 
capital is available, the HealthStore Foundation provides financing for 
up to 88 percent of the required initial capital, although many owners 
raise funds through family and friends. Most importantly, these clinics 
operate to turn a profit, and it is the long-term maintenance of this 
profit that sustains the system.
  Franchising delivers certain competitive advantages, including 
economies of scale, centralized distribution of high-quality drugs, 
central management of regulatory and legal issues, and a critical mass 
of locations that can share best practices and leverage resources. 
Apart from the benefits accrued through these competitive advantages, 
franchise owners also receive extensive training, marketing and 
promotions support, technical advice, and an established, trusted brand 
name.
  The genius of the HealthStore Foundation's strategy for building a 
sustainable infrastructure of health care delivery in Kenya and Rwanda 
is the adoption of the franchise business model. Franchising is such a 
tried and true business strategy in this country that most Americans 
take it for granted, but franchising is taking place all around us. In 
fact, a recent report by the International Franchise Association 
Educational Foundation shows that roughly 909,000 franchise businesses 
in the United States account for 21 million jobs and more $2.3 trillion 
in annual economic activity, and franchising has been growing at a 
faster pace than the overall economy. In the United States, franchising 
is a business strategy that works because an entrepreneur with a great 
idea or great product can quickly and efficiently develop a network of 
businesses to deliver a consistent, high quality product in every 
State, city and town across the Nation.
  The goal of this legislation is to halt the spread of pandemic 
diseases in a large part of the world. Certainly, the HealthStore 
Foundation has proven that microfranchise businesses can be capable 
partners in this effort, but the ownership opportunities provided by 
franchising also offer us other benefits. We know that ownership is a 
powerful incentive. Ownership gives people a stake in the future. In 
Kenya, owning a HealthStore clinic has become an attractive career 
choice for health care workers, helping to slow the pace of emigration 
of these trained professionals. The microfranchise model also supports 
the development of a strong small business infrastructure in villages 
and towns throughout the PEPFAR regions, and the lessons learned 
through franchised health care clinics can be repeated in other kinds 
of businesses.
  For these reasons, the Senate should work with U.S. agencies to 
consider microfranchise business creation among the strategies for 
putting these resources to work in the PEPFAR region. In order to 
continue to raise awareness around this important approach that has 
been tried by the HealthStore Foundation, I plan to follow up this 
statement with a colloquy with one of my Senate colleagues.
  Mr. ENZI. Madam President, I rise today to reiterate my continued 
support for the passage of the Tom Lantos and Henry J. Hyde U.S. Global 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization 
Act of 2008. The compromise that many of my colleagues were able to 
support is what I call the third way. Many on both sides of the aisle 
would prefer to have it changed one way or another to assuage some of 
their concerns with the policies set out in the bill, and I can 
understand those concerns. However, now is the time to put away our 
partisan politics and pass a bill that will reach to save over 3 
million more lives, care for more than 12 million more people affected 
by HIV/AIDS and continue to stop the spread of the disease by spreading 
the messages about prevention. That is the bottom line--it saves lives 
and it really is a shining example of the generosity and goodness of 
America and her people. Senators Coburn, Burr and I worked with 
Senators Biden and Lugar and many other members of the Senate to reach 
an agreement that we all think is fair, just and conscientious.
  As I mentioned the other day, I have been to Africa more than once, 
so I have seen first hand the tremendous benefit that this program has 
achieved and I am confident that this bill will allow it to achieve 
even more. Now I know that some of us are concerned about, and have 
legitimate disagreements, over the high authorization level attached to 
this bill. I have always supported having a fair debate on this issue 
on the Senate floor and I hope to find a fiscally responsible way to 
address this crisis by having every member vote on a number that is 
reasonable and get the job done. There is an urgent need to meet this 
world health crisis, and America has never turned her back when there 
is such a profound and pressing crisis affecting those who are far less 
fortunate. I again want to reiterate my support for this discussion and 
for the continuation of the floor process to have this bill passed as 
quickly as possible.
  I believe that the American people support these humanitarian 
efforts, and as their elected Representatives, we have the solemn 
responsibility to see to it that their hard-earned dollars are being 
spent wisely and effectively. I happen to believe that it is critical 
that the bulk of these funds are spent for the specific benefit of 
people who are infected--for their direct medical care and treatment. I 
personally am

[[Page 15178]]

satisfied that we have secured a bill that will do just that. In fact, 
in order to assure that this does happen, we have built in safeguards 
to ensure transparency and accountability throughout this bill so that 
we may better monitor the outcomes of this program and easily find the 
areas that are in need of improvement.
  We have come a long way in assuring that over half of these funds 
will be focused on treating people directly, so that the funds will 
follow the individuals affected by HIV/AIDS. The more we are focusing 
our efforts on treatment, the less likely these funds will be spent on 
so called extraneous provisions that so many of my colleagues are 
concerned about.
  I hope that we can all agree to act on this bill in a timely manner 
without partisan politics. This is a good bill; it will save lives. As 
I said the other day, I urge all my colleagues to vote for passage and 
send a message to the world's nations that America will always be there 
for those who cannot help themselves--our commitment is to ridding the 
world of these dread diseases, and we are resolute in our determination 
to reach that goal.
  Ms. MIKULSKI. Madam President, I rise today to applaud the passage of 
the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act. I am 
proud to have voted in support of this legislation that reauthorizes 
the President's Emergency Plan for AIDS Relief, PEPFAR, and provides 
much-needed foreign aid to countries to combat these devastating 
diseases.
  Currently, more than 33 million people worldwide live with HIV/AIDS. 
My own dear State of Maryland is one of the hardest hit States in the 
U.S. Maryland has the ninth highest AIDS rate in the Nation and the 
Baltimore metropolitan area has the second highest rate of AIDS cases 
compared to other cities in the country. Today, by providing $50 
billion over the next 5 years to 120 countries we are recommitting 
ourselves to fighting the deadly diseases of HIV/AIDS, tuberculosis, 
and malaria. These global health problems affect not just patients, but 
their families and communities.
  This act provides funding for education, prevention, research, care, 
and treatment for HIV/AIDS, tuberculosis, and malaria. It expands 
programs to increase access to care for children and expands the 
international health workforce to train and retain health care workers 
who can provide much-needed care. As the champion of the Nurse 
Reinvestment Act, I understand how critical it is for any country to 
have a large enough health care workforce available to treat such 
destructive diseases.
  I would like to honor and thank the men and women who work hard daily 
to make a difference in the fight against these deadly diseases. There 
are many great organizations throughout the state of Maryland that have 
been on the front lines for decades fighting HIV/AIDS, tuberculosis and 
malaria in the U.S. and worldwide. The National Institutes of Health is 
home to some of the most significant advances made to treat HIV/AIDS 
and the Johns Hopkins Bloomberg School of Public Health has been an 
international leader in creating innovative programs to fight disease 
epidemics. The University of Maryland is home to the Institute of Human 
Virology, where some of the world's most renowned scientists are 
undertaking groundbreaking research, such as developing an AIDS 
vaccine. I am also proud of organizations like Catholic Relief 
Services, which is headquartered in Baltimore, that work tirelessly all 
over the world to provide assistance and compassion to those who suffer 
the physical, economic, social and emotional toll of these diseases. We 
have made giant leaps forward because of their efforts.
  I have always fought in the Senate to fund important programs that 
assist individuals living with HIV/AIDS, as well as fund the research 
that will one day lead to a cure. I will continue the battle and stand 
sentry to fight and prevent HIV/AIDS, tuberculosis, and malaria in 
Maryland and around the world.
  Mr. LEAHY. Madam President, I support this bill, which extends the 
authorization of United States HIV/AIDS programs administered by the 
Office of the Global AIDS Coordinator, and includes several important 
changes to the former authorization act. I commend Senators Biden and 
Lugar, and their capable staff, for the outstanding work they have 
done, over many months, to get this bill through committee and to the 
Senate floor.
  This administration will not be remembered for its foreign policy 
achievements. In fact our country's reputation and leadership have been 
badly damaged in the past 7 years, due to colossal blunders by this 
White House that will take years to overcome. But I do credit President 
Bush for his consistent support for significant increases in funding to 
combat HIV/AIDS around the world.
  The Congress, of course, has surpassed the President's requests by 
increasing funding for the PEPFAR program by $2 billion over the past 5 
years. We will continue to support this program whoever is the next 
President.
  In addition to authorizing $50 billion over 5 years for HIV/AIDS 
programs, the bill would call for increased U.S. contributions to the 
global fund to fight AIDS, TB and malaria. The global fund is a 
mechanism for multilateral cooperation which has strong support in 
Congress, although the President has consistently cut funding for it. 
Like PEPFAR, the global fund is providing antiretroviral drugs to 
increasing numbers of people infected with HIV, and it is expanding its 
prevention programs in many countries that are not PEPFAR focus 
countries.
  This bill does authorize considerably more--$20 billion more--than 
what the President initially proposed. Some Senators in the other party 
have objected to that increase. Madam President, $50 billion is a lot 
of money. But those same Senators have never uttered a word of 
objection to spending hundreds of billions of dollars in emergency, off 
budget funding for a war that could have been avoided, has cost 
thousands of lives, that has made us less secure.
  There is little doubt these additional funds will be needed, although 
the capacity to use such large increases will take time to build. 
Ultimately, it will be a matter for the Appropriations Committee. At 
this point we are a long way from having the budget allocation to fund 
these amounts, so we should not be under any illusions. It is one thing 
to authorize funding, but quite another to appropriate the money. Were 
we to try to meet this level today, we would have nothing left to meet 
other pressing demands and threats around the world. We cannot put all 
our eggs in one basket without causing serious damage to other critical 
foreign policy programs.
  There is also the question of how much we can do bilaterally and how 
much should be done through the global fund. We need to know what the 
right balance is--something the President has repeatedly ignored in his 
budget requests.
  This bill tackles many other issues, including how best to allocate 
HIV/AIDS funds. When the Republicans were in the majority at the time 
of the first PEPFAR authorization, the Congress took a prescriptive 
approach, even legislating percentages of the funds that must be used 
for treatment or prevention, or which types of organizations could 
receive funding. We are still struggling with that misguided legacy.
  My own view is that the less Congress injects itself into matters of 
global health the better, because the result is too often that politics 
and ideology take precedence over what is in the best interest of 
public health in a particular country. Every country has different 
conditions, different capacity, and different social traditions, and 
trying to legislate in Washington the approach that should be used in 
Mali or Bangladesh or Brazil is fraught with problems.
  To me, the bottom line is simple. We are a country whose economy 
dwarfs all others. AIDS is a global pandemic--with over 33 million 
people infected--that knows no geographical boundaries. It threatens us 
all, but in some

[[Page 15179]]

countries the needs are far greater. In Africa, people suffering from 
AIDS succumb from malnutrition and water borne illnesses. Others, in 
Haiti or Asia, suffer in pitiful conditions with no one to care for 
them. From Cambodia to Cameroon, grandmothers are caring for five, six, 
seven children on an income of a dollar or two a day.
  The PEPFAR program represents the best face of America. It is one way 
for the United States to mitigate some of the damage to our image, by 
saving lives in countries where AIDS no longer has to mean a death 
sentence.
  We need to do a better job of making sure that our PEPFAR and global 
fund dollars are used as effectively as possible, which has not always 
been the case. The oil producing countries, which are making huge 
profits and yet contribute little to the global fund, need to do a lot 
more. And the Congress needs to give the public health professionals at 
PEPFAR, the U.S. Agency for International Development, and the Global 
Fund the flexibility to make decisions based on the health needs of 
each country.
  Again, I commend Senators Biden and Lugar, and their staffs, for 
completing this bill.
  Mr. DURBIN. Madam President, I rise to speak in support of section 
305 of the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act. 
Section 305 would make an important change in our laws that is long 
overdue.
  Under current law, foreign students, tourists, refugees and 
immigrants with HIV are prohibited from entering the United States. 
Section 305 would eliminate this HIV travel ban. I was pleased to join 
Senator Kerry and Senator Smith as an original cosponsor of the HIV 
Nondiscrimination in Travel and Immigration Act, the original version 
of this provision.
  Our immigration laws treat people with HIV differently than people 
with any other medical condition. HIV is the only disease specifically 
listed in U.S. law as a bar to entering the United States. For all 
other medical conditions, the Secretary of Health and Human Services 
determines whether the public health risk justifies a bar to admission.
  Only 11 other countries have such harsh travel restrictions for 
people with HIV. Listen to the other countries with HIV travel bans: 
Armenia, Colombia, Iraq, Oman, Qatar, Russia, Saudi Arabia, Solomon 
Islands, South Korea, Sudan, and Yemen. Even China recently took steps 
to overturn its HIV travel ban. Does the United States really want to 
be in the company of Sudan when it comes to the treatment of people 
with HIV?
  This HIV travel ban undermines our global leadership in the fight 
against AIDS and is incompatible with the goals of PEPFAR.
  How can we tell other countries to end discrimination against people 
with HIV when we ourselves treat people with HIV who want to travel to 
our country differently than those with any other medical condition?
  The travel ban for persons with HIV was enacted in 1993, at a time 
when there was fear and misunderstanding about this disease. The travel 
ban is a relic of an earlier time. Hasn't our knowledge about HIV and 
tolerance for people with HIV expanded enough in the 15 years to 
eliminate the travel ban?
  The travel ban does not further any public health goals. Eliminating 
the ban will simply return the authority to the Secretary of Health and 
Human Services to decide whether or not persons with HIV should be 
admitted into our country, as they do for all other diseases.
  Our laws already require that anyone who wants to immigrate here 
demonstrate that they are unlikely to become an economic burden to the 
U.S. Government, which ensures that lifting the HIV travel ban would 
not have a significant financial cost.
  Over 200 organizations, including the American Medical Association, 
the American Public Health Association and the World Health 
Organization, oppose the HIV travel ban. A broad range of faith-based 
groups, including the U.S. Conference of Catholic Bishops, support 
lifting the HIV travel ban.
  The HIV travel ban allows for a discretionary, case-by-case waiver 
process, but it is available only to a restricted group of visa 
applicants, and it is cumbersome and time-consuming. Let's take just 
one example: when Chicago hosted the Gay Games in 2006, the organizers 
had to work with various government agencies for several months before 
securing a waiver for persons with HIV to attend the event.
  We will take an important step towards ending discrimination against 
people with HIV by lifting this travel ban and treating persons with 
HIV the same way we treat those with other medical conditions. That is 
consistent with the goals of PEPFAR and the U.S. leadership role in 
fighting discrimination against people with HIV around the world.
  I urge my colleagues to support this legislation.
  Mr. SMITH. Madam President, let me first commend the work of Senators 
Lugar and Biden for their leadership in chaperoning this bill through 
the committee and on to the Senate floor. And, I am a proud cosponsor 
of this legislation. I also want to thank them for including the Kerry/
Smith language on lifting the HIV/AIDS travel ban. This legislation is 
an important commitment to meeting the global challenges of this 
epidemic.
  Right now, PEPFAR is on schedule to achieve its goals of supporting 
treatment for 2 million AIDS patients with life-saving antiretroviral 
therapies; preventing the transmission of 7 million new cases of the 
disease; and supporting care for 10 million people infected and 
affected with HIV/AIDS, including orphans and most vulnerable the 
world's children.
  Despite what we have witnessed on the Senate floor over the past few 
weeks, PEPFAR, since its inception, has enjoyed wide bipartisan 
support. More importantly, it has served as a powerful demonstration of 
our Nation's leadership on global health issues and our Nation's 
collective compassion to the most vulnerable throughout the world.
  In the past, I have had the fortune of working with Senator Boxer on 
The Stop Tuberculosis (TB) Act Now Act. Based on the recommendations of 
the World Health Organization and the Stop TB Partnership, this 
legislation would increase the resources available to combat TB in 
countries with high drug resistant TB infection rates. For people 
infected with AIDS, TB is often deadly. We have worked to have key 
provisions of this legislation included in the bill.
  Senator Dodd and I have worked closely with the Senate Foreign 
Relations Committee chair and ranking member to include provisions from 
our pediatric HIV/AIDS bill. This legislation, the Global Pediatric 
HIV/AIDS Prevention and Treatment Act, would increase the number of 
children receiving treatment under PEPFAR. Specifically, it would 
expand services to prevent thousands of new mother-to-child 
transmission cases.
  Lastly, this legislation should serve as a mirror of reflection on 
our own Nation's policies related to individuals living with HIV/AIDS. 
I have sought in my years in the Senate to help in this fight, pushing 
for more funding, authoring the Early Treatment for HIV Act and helping 
Oregon's largest HIV/AIDS service provider, Cascade AIDS, where I am 
able. I honor the good work that Cascade AIDS has done in Oregon from 
education and testing to hospice care at Our House and food services 
through Esther's Pantry. Cascade AIDS truly proves the good in 
Oregonians in answering the many needs of those living with HIV/AIDS.
  Yet while we have come a long way from the stigma, fear-mongering, 
and rampant discrimination of the 1980s against those living with HIV/
AIDS, our Nation continues to discriminate. As many of you may not 
know, the United States is 1 of only 12 Nations with an HIV immigration 
and visitor travel ban. Although we are the leader in public and 
private HIV research, we also legally ban people from entering the 
country who are HIV positive. It does not matter whether the individual 
seeks to enter the U.S. to attend a global health conference, conduct 
business, vacation, or visit family or

[[Page 15180]]

friends--they are all categorically banned from entering the U.S. 
because they are HIV-positive. HIV/AIDS is the only medical condition 
that serves as permanent grounds for inadmissibility to the U.S. Even 
TB and leprosy are left to the discretion of the Health and Human 
Services Secretary in determining admissibility. While individuals with 
HIV can seek a waiver from inadmissibility, it is cumbersome, 
restrictive, and ineffective.
  As a result, the U.S. has made it clear to individuals with HIV/AIDS 
worldwide that they are unwelcome in our country--period. The other 
Nations that have put the ``unwelcome mat'' out to individuals with 
HIV/AIDS include Russia, Saudi Arabia, South Korea, and Sudan. Aside 
from the U.S., only 11 other Nations have a ban. Even China, fearing 
embarrassment with hosting the upcoming Olympics, recently acted to 
remove its ban on HIV-positive visitors. It is time we join China and 
most of the rest of the world.
  Senator Kerry and I have introduced legislation, which was been 
included in this bill, to simply return the authority to the Department 
of Health and Human Services--as with other diseases--to decide whether 
or not HIV should be grounds for inadmissibility to the U.S. This ban 
is a byproduct of the ignorance surrounding HIV in the 1980s and 1990s. 
By lifting this ban, we can finally set free the specters of phobia 
from our past and fully embrace our global leadership on HIV/AIDS. I 
urge my colleagues to join with me and Senator Kerry in removing this 
stigma from our immigration policy.
  The PRESIDING OFFICER. Under the previous order, the question is on 
the engrossment and third reading of the bill.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  The PRESIDING OFFICER. Under the previous order, the Committee on 
Foreign Relations is discharged from further consideration of H.R. 
5501, and the Senate will proceed to its consideration, which the clerk 
will report by title.
  The legislative clerk read as follows:

       A 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.

  The PRESIDING OFFICER. All after the enacting clause is stricken and 
the text of S. 2731, as amended, is inserted in lieu thereof.
  The question is on the third reading of the bill.
  The bill, as amended, was ordered to a third reading and was read the 
third time.
  The PRESIDING OFFICER. There is now 40 minutes equally divided for 
debate.
  Who yields time?
  The Senator from Delaware.
  Mr. BIDEN. Madam President, I yield myself 1 minute.
  For the benefit of our colleagues, there is 40 minutes of debate 
equally divided, but it is not the intention of the majority to use 
that 40 minutes. For planning purposes, I do not think we will use more 
than 8 minutes.
  I yield 5 minutes to my friend from Ohio, Senator Brown.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Madam President, I thank the senior Senator from Delaware.
  I rise in support of this very important legislation that the Senate, 
I hope, passes this evening. HIV, as we know, debilitates and kills. It 
orphans children. It fractures communities. It drains resources from 
fragile economies. In addition to what it does to human beings, it 
destabilizes fragile governments in the poorest countries in the world.
  It is a human tragedy, the dimensions of which have humbled the world 
community.
  I thank the Senator from Delaware for his terrific work and 
leadership on this legislation, and the senior Senator from Indiana, 
Mr. Lugar, who has been a leader in combating global poverty, and 
especially fighting for public health, combating malaria, AIDS, and 
tuberculosis.
  I met a young man recently who now lives in my hometown of Mansfield, 
OH. He grew up in the Lake Victoria region of Kenya. He is now married 
to a Mansfielder, after he came to this country. He himself had 
malaria, which caused his weight to drop to 110 pounds at one point.
  Now that he is healthy again, he is finishing his degree at Oberlin 
College, not far from where I live. His life's goal is to train more 
health workers to work in Africa to combat TB, HIV, and malaria.
  I was, earlier this evening, talking with Senator McCaskill about how 
we can, with relatively small amounts of money, cure tuberculosis. With 
literally $20, $30, $40 a patient, over a period of 6 months we can 
give them medicine so they, in fact, can be made whole. It is the 
combination of TB and HIV together--people get TB, their resistance 
goes down, and that is what kills the most people with HIV in Africa 
and increasingly in India and other places around the world. The 
combination of TB and HIV is ravaging Africa.
  In 2006, 65 percent of new HIV cases and 72 percent of all HIV-
related deaths occurred in Africa. TB killed half a million Africans 
last year.
  As important, what happens with TB does not stay necessarily in 
Africa. We saw what happened just a year or so ago when a young man 
from Atlanta, a professional, who had TB--he was not probably sure he 
had TB--flew around the world and could have very likely infected 
people in an airplane with TB. People who are immigrants who come here, 
people who are traveling abroad and come here from other countries, and 
Americans traveling around the world, all can be infected with TB.
  With PEPFAR, we are making a huge investment in services, in 
prevention of these diseases. Now our investment will grow. We 
obviously need to do more. What we are doing with PEPFAR with a scaled-
up investment will mean significant numbers of children won't be dying 
from HIV and won't be dying from TB.
  Investing more in family planning is one of the best ways of 
preventing mother-to-child transmission of HIV. To address this issue, 
this week I am introducing the Senate companion to Representative 
McCollum's bill, a Congressman from St. Paul, MN, legislation entitled 
``Focus on Healthy Families Worldwide Act,'' a bill which will 
significantly scale up U.S. involvement in global family planning.
  When I think of PEPFAR, I am reminded that we constantly need to 
think about how our actions affect people directly in ways we don't 
fully understand, and in terms of our lives of plenty, we need to be 
committed to help. This is major landmark legislation. What Senator 
Biden and Senator Lugar are doing is so very important to our place in 
the world, to a more peaceful world, to a more healthy, developing 
world, but also to a more healthy United States because it really will 
matter in this country. It will help to preserve our public health 
infrastructure, and it deeply matters to people all over the world, 
especially in our country.
  I yield back the remainder of my time.
  Mr. LUGAR. Madam President, on the minority side, I wish to recognize 
the Senator from Oklahoma, Mr. Coburn. I thank the distinguished 
Senator from Ohio for his very generous comments.
  I yield 10 minutes to the distinguished Senator from Oklahoma.
  Mr. COBURN. First of all, let me thank Senator Biden and Senator 
Lugar for their hard work, and the staffs especially, as well as the 
White House, in working with us to accomplish what I think--and I 
believe others think--were significant policy changes that will make a 
real difference for people in other countries. There is no question 
about it.
  I never approached, in any of my negotiations with the White House or 
either of the staffs, the cost of this bill, and I am concerned about 
that. We all should be concerned. The $50 billion, we are going to 
authorize it, and this is one that is going to get spent. This money is 
going to be appropriated. Everybody knows that. The question,

[[Page 15181]]

then, becomes, where is it going to come from?
  Although I think this is our most successful foreign policy 
initiative in my lifetime--I was born after the Marshall Plan started 
or thereabouts--I think this is the most effective thing we have done 
to build American prestige, esteem, and respect and thankfulness that 
we have done in my lifetime. When we look at the 2 million people who 
are now vibrant and vigorous and not wasting, who don't have a 
secondary disease such as Senator Brown talked about, what it does is 
it gives them hope, but it ought to give us hope. So I am extremely 
appreciative of the very cooperative attitude.
  It has been said in recent days that you can't work with me. You 
can't negotiate with Tom Coburn. Well, I will tell my colleagues we 
negotiated a pretty good fix to a pretty good bill that is going to 
make a lot of difference in a lot of people's lives. Talking about the 
Genetic Nondiscrimination Act, people said it couldn't work, but we 
passed that bill, didn't we? We fixed it. We made it to where it met 
all sides and all comers, and we did something great.
  I wish to spend a very short amount of time talking about priorities. 
I think this bill is a priority for our country--making a real 
difference.
  How are we going to afford to appropriate this $50 billion? The only 
way we are going to afford to really do it and do it effectively and 
not charge the $50 billion to Joe Biden's grandchildren or Tom Coburn's 
grandchildren or Dick Lugar's grandchildren is if we go about making 
harder choices about the waste, fraud, and abuse that is in our present 
system. If you add up what the IGs say, what the GAO says, what the CBO 
says, and what the CRS says, we have $300 billion every year that is 
wasted. It is either wasted or defrauded.
  So my challenge as we finish this bill, which is going to pass--and 
it is the right thing to do; you heard me say it; it is the right thing 
to do--is we only have half our work done, because if we walk away 
after the commitment of saying we are going to make a difference in 
Africans' lives and we don't make a difference in our grandchildren's 
lives by getting rid of the waste that can pay for this so that there 
is no additional debt, we will have failed. So that is my plea to the 
Members of this body.
  Jim DeMint made a good plea. He showed you what is getting ready to 
happen to us. He is right. We have precarious financial markets today. 
We have a credit crisis. We have a housing crisis. We have a debt 
crisis. We have a trade deficit crisis. Those things are fixable, but 
we have to fix them with the same kind of zeal, the same kind of 
community that we did on this bill.
  So my challenge to the chairman and the ranking member is, as we 
appropriate this money--and we know it is going to happen--let's start 
making the same hard choices we made as we negotiated this bill about 
the waste and abuse and fraud--$80 billion worth of waste and fraud in 
Medicare alone. Let's do it. Let's don't just give it lip service; 
let's leave a legacy for the next generation so they can not only be 
proud about what we have done as great humanitarians by helping people 
with a deadly infectious disease, but let's leave the same legacy to 
our grandchildren by being responsible. That means we are going to have 
to take some heat because anything we get rid of that is not efficient 
and not effective, somebody likes, somebody benefits from.
  So my plea to the Members of this body as we pass this is let's do 
the second half of the job. Let's get rid of the waste, fraud, and 
abuse. There is $70 billion worth of waste and fraud in the Pentagon. 
There is $30 billion worth of contracting fraud. There is $24 billion 
worth of IT waste every year out of $64 billion we spend on IT. So we 
can do it. My challenge to us--and my thanks to the chairman and the 
ranking member--is let's finish the job when we get down to 
appropriating. Let's really do our homework. Let's give America not 
only lower gas prices, let's give them lower costs for their kids and 
grandkids in the future.
  With that, I yield back the remainder of my time.
  Mr. BIDEN. Madam President, I yield myself 30 seconds.
  I wish to make clear in the Record that I have never had any trouble 
working with Tom Coburn. He is correct. We did work on this. He is one 
smart fellow. He knew a great deal about the substance of this 
legislation but also the financing of it. I wish to thank him and his 
staff for his cooperation and thank him for his compliment to our 
staffs on the committee. I share his view about them, but also it has 
always been a pleasure to work with him.
  I yield 5 minutes of our time to the Senator from Massachusetts, Mr. 
Kerry.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KERRY. I thank you very much, Madam President.
  Let me begin by thanking the chairman of our Foreign Relations 
Committee, Senator Biden, and the ranking member, Senator Lugar, for 
their leadership and their efforts to help bring the Senate to where it 
is today. I appreciate what they have done to help elevate this program 
and bring it down to a new stage.
  The truth is that for two shamefully sluggish decades, the Senate and 
the Congress and the country really ignored this issue and were 
somewhat timid, even scared of it for a lot of different reasons. We 
lost a lot of time in leading the fight against HIV/AIDS on a global 
basis.
  In 1999, I guess it was, Senator Frist and I were privileged to work 
together and bring an effort to the floor of the Senate, working as 
cochairs, ultimately, of CSIS's task force that was put together. We 
wrote a piece of legislation that ultimately drew broad support from 
the Foreign Relations Committee. I am pleased to say that one of the 
important points people began to understand about this issue--not 
partisan and not ideological--was when the then-chair, I think, Senator 
Jesse Helms, came onboard and became a cosponsor of our effort. That 
effort ultimately transformed itself, with President Bush's support, 
into PEPFAR, when he picked up the cry for some $15 billion.
  I will tell everybody that initially many of us had suspicions that 
it was going to be a public relations effort, not a real one. In fact, 
I think President Bush has probably transformed this effort into the 
single most important piece of his legacy. As Senator Coburn just said, 
this is perhaps now one of the most important programs the United 
States is doing on a global basis, and it has made a profound 
difference.
  My wife and I had the privilege of being in South Africa and Botswana 
last November. I will never forget visiting the Umgeni School in 
KwaNgcolosi near Durban, where there was an incredible display of 
community effort that had been brought together because the United 
States was putting this money into the organizational effort of 
community caretaking. I saw children, orphaned children who, long 
before the years that they should have been, had become the caretakers 
for a whole family of brothers and sisters. I saw what they refer to as 
AIDS grannies who assumed responsibilities because of the deaths within 
the family for the caretaking of people who were HIV positive. It was 
impressive, and the gratitude of people toward the United States, the 
connection they had with us as a result of this, is one of the most 
significant foreign policy initiatives in which we have engaged.
  So I am very grateful to Senator Biden and Senator Lugar and the 
committee itself for its work and to the Senate now for embracing this 
measure which will take us to the next tier.
  Two and a half million people will be infected in this next year; 2.1 
million people are going to die of AIDS. The challenge of human 
infrastructure to be able to deliver the antiretroviral drugs, to be 
able to reach people, to even begin to tackle some of the 
infrastructure issues and deal with the mythology that works against 
us, to deal with denial in governments such as South Africa itself. 
Some of the AIDS workers I met with--we had to kick out the press and 
kick out public people in order to get them to talk openly and honestly 
about the difficulties

[[Page 15182]]

they were having because the Government itself was engaged in some 
denial, and they feared retribution. It is our effort, our taxpayer 
money, our initiative, our caring that is making a difference in those 
lives and breaking down those barriers of denial. I think all of us in 
the Senate ought to be profoundly proud of this initiative and this 
effort.
  I am also pleased that in this legislation there are two items that I 
thought were important. One is creating advanced market mechanisms 
where we can say to people where there is no market for the creation of 
a vaccine that that market will be there. Norway, Canada, the Gates 
Foundation, and others are involved--Germany and others are involved 
now in providing that kind of market assurance. In that legislation, 
there is an additional effort to engage us similarly in helping to 
provide those market assurances so that drug manufacturers will invest 
in the creation of vaccines, knowing that indeed there will be a market 
down the road.
  Finally, we are going to allow people who are HIV positive to be 
able, on a case-by-case basis appropriately approved, to come to the 
United States as experts or otherwise on a humane basis to be able to 
travel to the country. We are one of only 12 nations that don't allow 
it. President George Herbert Walker Bush thought we should do this, 
President Clinton thought we should do this, President Bush thinks we 
should do this, and obviously a majority of the Senate thinks we should 
do this. I think that is adopting a humane and sensible policy. The 
International AIDS Committee has held two conferences, one in Canada 
and one in Mexico, simply because they wanted Americans to take part, 
but nobody could travel into this country, so the conference couldn't 
be held here. I think it is a wise policy, and I appreciate the fact 
that the leadership of Senator Biden and Senator Lugar on this 
legislation was able to fight to hold on to that.
  This is a good bipartisan moment for the Senate. Most importantly, it 
is a good moment for the American people because it reflects our values 
and I think will help us to be better understood and better appreciated 
in many parts of the world where today we have to climb back from our 
former reputation.
  The PRESIDING OFFICER. The Senator from Indiana is recognized.
  Mr. LUGAR. Madam President, the distinguished Senator from Arizona 
has sought time, and I wish to give him that time, but I simply wish to 
thank Senator Kerry for his leadership throughout the past decade, 
starting with the task force which he mentioned and his work all the 
time and his work all the time with Senator Biden, with me on the 
Foreign Relations Committee. Likewise, I thank Senator Coburn for his 
gracious remarks and his leadership and his ability to work with all of 
us in a bipartisan way to fashion this bill. I believe that is the 
spirit that has characterized success in this endeavor. I am grateful 
for that.
  I wish to express a special appreciation to Shellie Bressler, Paul 
Foldi, Dan Diller, and Ken Myers of the Senate Foreign Relations Staff 
on the Republican side, who have been so instrumental in working on 
this bill. Of course, I thank profoundly my colleague, Senator Joe 
Biden, our chairman, and his remarkable staff. It has been a joy, once 
again, to work with them on something that is so important.
  I recognize the presence of the Senator from Arizona. I believe we 
still have 5 minutes on this side; is that right?
  The PRESIDING OFFICER. The Senator has 12\1/2\ minutes remaining.
  Mr. LUGAR. I yield that to Senator Kyl.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. KYL. Madam President, I thank both Senator Lugar for his 
courtesies, as well as Senator Biden. I appreciate the fact that we 
have had an opportunity to make some changes in this bill which, while 
modest, do improve it. Senator Coburn talked about some of the more 
important ones. I supported PEPFAR. When the President announced in his 
State of the Union speech that he would request Congress to double the 
authorization for PEPFAR, I swallowed kind of hard but said, if it has 
done a good job, which we will find out, maybe that is all right.
  What we have found is that at the present level of authorization--$15 
billion--it has been a successful program. That is the good news. 
Unfortunately, when the bill was written, many of the policy provisions 
that made it a success were changed. That has required some amendments 
to be adopted to get closer to the original purpose.
  Unfortunately, some policy issues remain. I wish to note that my 
objections to the bill relate to two primary points. First is a couple 
of policy issues, and second is the amount of money being authorized. I 
will just mention three issues. Notwithstanding the positive changes of 
which Senator Coburn spoke, we still have a significant mission creep. 
You cannot go from $15 billion--the amount authorized today--to $50 
billion without having substantial mission creep. You cannot spend it 
all on the original purpose of the program. Indeed, we add things such 
as nutrition, legal aid, and others that are quite far afield from the 
original mission, which was primarily the treatment of AIDS patients.
  Secondly, we still have the problem that it deals with far more 
countries, including wealthy ones, than the poor countries we should be 
focusing on here. Unfortunately, we were not able to constrain it to a 
list of more needy countries that would receive this aid.
  The third policy problem, spoken about before, is the doubling of 
funding for the U.N. Global AIDS Fund, which has had significant 
problems. I think they have been well identified. It disregards U.S. 
policy on matters such as abortion, needle exchange, and others. While 
many of the policy problems have been resolved, there are still policy 
problems with this legislation. If the amount of money was much less 
than it is, this would be less significant. At $50 billion, these 
policy changes can be magnified. Due to the cooperation of the 
colleagues I have already mentioned, $2 billion of the authorization 
has been diverted to some needs in the United States. I am grateful for 
my colleagues' cooperation on that.
  There is a lot we could do with money--$10 billion, $15 billion--in 
the United States that we have not been able to do because of a lack of 
funding. If we are going to commit to authorize $50 billion to deal 
with some difficult issues, it seems to me we could have diverted more 
than $2 billion of that to deal with some of our needs in the United 
States.
  But that brings me to the second points of my concern with the bill 
and that is the pure sticker shock of $50 billion. We are more than 
tripling the current authorization of $15 billion. As we heard earlier 
this afternoon, I don't think there is any intention of appropriating 
less than that amount of money. If anything, we should be appropriating 
more than that. Because one of my amendments was not adopted, there is 
no limitation on how much money could be appropriated. So we have gone 
from $15 billion to $50 billion. That is a lot of money in anybody's 
budget--especially at a time in the United States when we are facing 
several crises.
  I was down at the White House this afternoon with the Secretary of 
the Treasury. We have a crisis dealing with a couple of the mortgage 
holders, we have a Fannie and Freddie problem, as well as other 
potential liabilities that will fall on the shoulders of American 
taxpayers. We need to take these issues on because they are critical to 
our economy and indeed have ramifications throughout the world. But 
they all involve the U.S. taxpayers potentially picking up the tab. We 
don't have any choice. We need to do it. Gas prices are high.
  We are going to take up energy on the floor next, I hope. That is a 
huge problem. People are hurting because they are paying high gas 
prices and high food prices also. This is not the time for us to be 
tripling a worthy program to $50 billion when we are facing

[[Page 15183]]

some huge crises here at home. It seems to me we need to make sure we 
are in better financial condition to face those crises rather than 
authorizing another $50 billion in foreign aid.
  Now, we will hear the argument that this is to do. Nobody denies 
that. The argument is not is this a good thing. Of course, it is. There 
is an argument about whether moving from $15 billion to $50 billion 
more than triples the good that is done. I have heard nobody make that 
argument. In fact, the only way you can spend that much money is to 
increase the mission beyond what it is today. The CBO--a nonpartisan 
office--makes the point that at a $50 billion authorization, no more 
than $34 billion could be effectively spent.
  The point is there is only so much you can do on these programs--
especially without good policy to ensure that the money is spent 
wisely. There could be, and I submit will be, a tremendous amount of 
waste if we authorize this program at $50 billion.
  So for all these reasons, but primarily and, frankly, because of the 
huge unmet needs we have at home and the uncertain future we have here 
and the things that we are going to have to do to shore up our 
financial system and make sure our economy can continue to operate 
strongly, I cannot support a bill that authorizes $50 billion in this 
foreign aid. Our country needs to be strong, and we need to deal with 
the crises here at home. We are a wealthy nation; we can afford to be a 
generous nation. We all want to be generous. We have supported the 
program in its current form.
  The only question here is whether we can efficaciously go from $15 
billion to $50 billion. I find the answer to that question, at this 
point, to be no. To be strong, we have to be strong here at home, and 
then we can help people abroad. Reluctantly--because I realize the 
President supports this program strongly--I must oppose the program. I 
express the appreciation of those who helped adopt one of the 
amendments I proposed. I think it will make a modest difference.
  On behalf of taxpayers, we should not be committing to spend $50 
billion at this time.
  Mr. LUGAR. Madam President, we are prepared to yield back the 
remainder of the time on our side.
  Mr. BIDEN. Madam President, I yield myself a couple of minutes. After 
final passage, I will go through the thank-yous that are robustly 
warranted to the staff and individuals and Senators who are still here 
serving, and some who are not serving here, who have laid the 
groundwork for us to get to this point.
  In a small village in Otse, Botswana, there is a rural health clinic 
run by a retired nurse in her seventies. Their patient log is a simple, 
handwritten ledger. It lists in chronological order the patients who 
have come in to her for treatment. The ledger has several columns, 
including one where, if the patient died, there is a mark made in red 
ink.
  On a visit to this clinic last summer by minority and majority staff, 
this nurse, I am told by our staff, held up this ledger that showed an 
array of red marks in the early part of this decade. Then, a few years 
ago, something drastic happened. The nurse explained, with great 
excitement, to our staffs:

       Look, no red marks. The red marks have stopped.

  There is one reason for that dramatic turn of events in this small 
village in Africa, and that is PEPFAR, which I think would more 
appropriately be named the ``President of the United States fund.'' But 
it is nonetheless called PEPFAR, which is confusing to people.
  The bottom line is what the President of the United States of 
America, all the Senators, and others who have not been mentioned today 
are about to do, began to change the life of that village.
  In 2003, President Bush and this Congress launched the largest public 
health program in the history of the world. It is saving lives--
millions of them. The funerals that were a daily occurrence have been 
reduced in number, and millions of people around the world have been 
given hope.
  We have to sustain and build on this progress, and that is what we 
are doing today. That is what we are about to vote on. This bill we are 
about to vote on will set the course for the next 5 years and, 
hopefully, beyond. I am confident that, with the hard work of our House 
counterparts, this bill we are going to pass today will, in fact, be 
moved very quickly and be sent to the President's desk for signature.
  We set forth very ambitious targets for care, treatment, and 
prevention. We must do all three. We cannot treat our way out of this 
disease, but we have succeeded at treatment in a way that nobody ever 
envisaged when John Kerry, Russ Feingold, and others started talking 
about this a long time ago. Five years ago, when we stood on the floor, 
I don't think anybody thought that the treatment side of this ledger 
would be as successful as it has been. I expect and hope that we are 
going to continue to see this kind of progress.
  There are a lot of people to thank. I will do that after we pass the 
bill. For the moment, I wish to thank the President of the United 
States, President George Bush. His decision to launch this initiative 
was bold, and it was unexpected. I believe historians will regard it as 
his single finest hour. That is not a backhanded compliment. It would 
be a fine hour under the tenure of any President of the United States 
of America.
  I wish to thank--quite frankly, I don't do it often enough around 
here--the American people for their generosity. Let me say it again--
the generosity of the American people. Senator Kyl makes the point that 
we have serious needs here at home. Yes, the American people are 
overwhelmingly supporting what we are doing today, knowing the cost and 
knowing there will be tradeoffs. I also appreciate the hard work of 
thousands of men and women in our Government and of the governments of 
our foreign partners, and their partners in the private sector, who are 
working on the ground around the world and have made this possible.
  I yield back the remainder of the time and I ask for the yeas and 
nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is, Shall the bill pass?
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) and the Senator from Illinois (Mr. Obama) are necessarily 
absent.
  Mr. KYL. The following Senators are necessarily absent: the Senator 
from Arizona (Mr. McCain) and the Senator from Virginia (Mr. Warner).
  Further, if present and voting, the Senator from Virginia (Mr. 
Warner) would have voted ``yea.''
  The PRESIDING OFFICER (Mr. Casey). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 80, nays 16, as follows:

                      [Rollcall Vote No. 182 Leg.]

                                YEAS--80

     Akaka
     Alexander
     Baucus
     Bayh
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Brown
     Brownback
     Burr
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Clinton
     Coburn
     Cochran
     Coleman
     Collins
     Conrad
     Corker
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Enzi
     Feingold
     Feinstein
     Grassley
     Hagel
     Harkin
     Hatch
     Inouye
     Isakson
     Johnson
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCaskill
     McConnell
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Roberts
     Rockefeller
     Salazar
     Sanders
     Schumer
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Tester
     Thune
     Voinovich
     Webb
     Whitehouse
     Wyden

                                NAYS--16

     Allard
     Barrasso
     Bunning
     Cornyn
     Craig
     Crapo
     DeMint
     Ensign
     Graham
     Gregg
     Hutchison
     Inhofe
     Kyl
     Sessions
     Vitter
     Wicker

[[Page 15184]]



                             NOT VOTING--4

     Kennedy
     McCain
     Obama
     Warner
  The bill (H.R. 5501), as amended was passed, as follows:

                               H.R. 5501

       Resolved, That the bill from the House of Representatives 
     (H.R. 5501) entitled ``An Act 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.'', do pass with the 
     following 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 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

[[Page 15185]]

     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;
       ``(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,

[[Page 15186]]

     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 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;

[[Page 15187]]

       ``(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 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

[[Page 15188]]

       ``(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
       ``(ii) represents the multilateral component of this Act, 
     extending United States efforts to more than 130 countries 
     around the world.

[[Page 15189]]

       ``(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.

[[Page 15190]]

       ``(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 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

[[Page 15191]]

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

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

     SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

       (a) Amendments to the Foreign Assistance Act of 1961.--
       (1) Finding.--Section 104A(a) of the Foreign Assistance Act 
     of 1961 (22 U.S.C. 2151b-2(a)) is amended by inserting 
     ``Central Asia, Eastern Europe, Latin America'' after 
     ``Caribbean,''.
       (2) Policy.--Section 104A(b) of such Act is amended to read 
     as follows:
       ``(b) Policy.--
       ``(1) Objectives.--It is a major objective of the foreign 
     assistance program of the United States to provide assistance 
     for the prevention and treatment of HIV/AIDS and the care of 
     those affected by the disease. It is the policy objective of 
     the United States, by 2013, to--
       ``(A) assist partner countries to--
       ``(i) prevent 12,000,000 new HIV infections worldwide;
       ``(ii) support--

       ``(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;

[[Page 15192]]

       ``(E) as part of care and treatment of HIV/AIDS, assistance 
     or referral to available and adequately resourced service 
     providers for nutritional support, including counseling and 
     where necessary the provision of commodities, for persons 
     meeting malnourishment criteria and their families;'';
       (3) in paragraph (4)--
       (A) in subparagraph (C), by striking ``and'' at the end;
       (B) in subparagraph (D), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding at the end the following:
       ``(E) carrying out and expanding program monitoring, impact 
     evaluation research and analysis, and operations research and 
     disseminating data and findings through mechanisms to be 
     developed by the Coordinator of United States Government 
     Activities to Combat HIV/AIDS Globally, in coordination with 
     the Director of the Centers for Disease Control, in order 
     to--
       ``(i) improve accountability, increase transparency, and 
     ensure the delivery of evidence-based services through the 
     collection, evaluation, and analysis of data regarding 
     gender-responsive interventions, disaggregated by age and 
     sex;
       ``(ii) identify and replicate effective models; and
       ``(iii) develop gender indicators to measure outcomes and 
     the impacts of interventions; and
       ``(F) establishing appropriate systems to--
       ``(i) gather epidemiological and social science data on 
     HIV; and
       ``(ii) evaluate the effectiveness of prevention efforts 
     among men who have sex with men, with due consideration to 
     stigma and risks associated with disclosure.'';
       (4) in paragraph (5)--
       (A) by redesignating subparagraph (C) as subparagraph (D); 
     and
       (B) by inserting after subparagraph (B) the following:
       ``(C) Mechanism to ensure cost-effective drug purchasing.--
     Subject to subparagraph (B), mechanisms to ensure that safe 
     and effective pharmaceuticals, including antiretrovirals and 
     medicines to treat opportunistic infections, are purchased at 
     the lowest possible price at which such pharmaceuticals may 
     be obtained in sufficient quantity on the world market, 
     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

[[Page 15193]]

     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 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

[[Page 15194]]

     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--
       ``(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

[[Page 15195]]

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

     SEC. 304. MALARIA RESPONSE COORDINATOR.

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

     ``SEC. 304. MALARIA RESPONSE COORDINATOR.

       ``(a) In General.--There is established within the United 
     States Agency for International Development a Coordinator of 
     United States Government Activities to Combat Malaria 
     Globally (referred to in this section as the `Malaria 
     Coordinator'), who shall be appointed by the President.
       ``(b) Authorities.--The Malaria Coordinator, acting through 
     nongovernmental organizations (including faith-based and 
     community-based organizations), partner country finance, 
     health, and other relevant ministries, and relevant executive 
     branch agencies as may be necessary and appropriate to carry 
     out this section, is authorized to--
       ``(1) operate internationally to carry out prevention, 
     care, treatment, support, capacity development, and other 
     activities to reduce the prevalence, mortality, and incidence 
     of malaria;
       ``(2) provide grants to, and enter into contracts and 
     cooperative agreements with, nongovernmental organizations 
     (including faith-based organizations) to carry out this 
     section; and
       ``(3) transfer and allocate executive branch agency funds 
     that have been appropriated for the purposes described in 
     paragraphs (1) and (2).
       ``(c) Duties.--
       ``(1) In general.--The Malaria Coordinator has primary 
     responsibility for the oversight and coordination of all 
     resources and international activities of the United States 
     Government relating to efforts to combat malaria.
       ``(2) Specific duties.--The Malaria Coordinator shall--
       ``(A) facilitate program and policy coordination of 
     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

[[Page 15196]]

     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--
       ``(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

[[Page 15197]]

       ``(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 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).

  Mr. BIDEN. Mr. President, I move to reconsider the vote by which the 
bill was passed and to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. BIDEN. Mr. President, I have refrained from thanking the people 
who need to be thanked on the incredible work that was done to get us 
to the point of such overwhelming passage on this legislation. I tell 
my colleagues that there are no more votes, so I want to make clear we 
are not holding anybody up here, but I want to take about 5 minutes to 
talk about the work done by our staffs and some of our predecessors in 
this body to produce the result we have today.
  And I might add, way ahead of time Senator Lugar's staff and my staff 
have been coordinating this every step of the way with the House. So 
hopefully--God willing and the creek not rising--we are going to be 
able to produce something for the President's desk within a matter of 
days so that we are not going to have to go to conference.
  There are a lot of people to thank, but let me start saying that this 
was a long time in coming.
  The first bit of thanks, and I want to reiterate it again, goes to 
President Bush. I have been extremely critical of President Bush's 
foreign policy. I have been extremely critical of what I believe the 
damage his foreign policy has done to our image and/or standing in the 
world. But I must say the President of the United States has led us to 
this

[[Page 15198]]

incredible moment, where this is the single largest effort on the part 
of any country in the history of the world to go out and literally save 
and extend the lives of tens of millions of people. This is a gigantic 
accomplishment. So first the credit should go to President Bush. 
Because, in fact, without his making it clear and at the very end of 
this process, making it clear--I am told to some of his Republican 
colleagues--how important this was, not merely to him but to the United 
States, this would have never happened. That is an unusual position for 
me to be in, but credit should go where it is due, and credit is due to 
President Bush and his administration and the many people who have 
worked both in the White House and in the various Departments in order 
to get to this moment.
  I also want to thank an extraordinary combination of people. It is 
presumptuous of me to say this, but the chemistry between the minority 
and majority staffs on the Foreign Relations Committee is 
extraordinary. I have had the great privilege of working with my 
colleague Senator Lugar for a long time. We have been working together 
for over 30 years. To the best of my knowledge, there has never been a 
harsh word, a raised voice, a single solitary slight that ever has gone 
across the aisle between the Senator and me. There is no one in this 
body whose judgment on foreign policy I respect as much as this 
Senator. There is no one in the Congress, and quite frankly there is no 
one else in the country, whose judgment on matters relating to our 
national security and foreign policy I respect more, and I thank him. I 
thank him for his friendship and I also thank him in this specific case 
for his leadership and that of his staff.
  I wish to express my personal appreciation to Shannon Smith. Shannon 
Smith was new to my staff. She came up on the Hill at a time where she 
was able to be the catalyst, along with a few other people I will name, 
to produce the result we have today. I can say to Shannon I am 
absolutely confident--absolutely confident--that if you do nothing else 
in your professional life than what you put together with Senator 
Lugar's staff today, you will have had a significant life, because very 
few people ever get put in a position where they arrive at a moment in 
history where they literally can change the path of people's lives in 
other parts of the world.
  I know that sounds like hyperbole, but it is literally true. Few 
people get that opportunity. So you should relish it. You deserve it.
  I also thank Brian McKeon of my staff, who has been with me since he 
was a kid out of Notre Dame. I guess it is now 20-some years, with a 
brief interlude where he went off to law school and clerked for the 
Federal Court and then came back as our legal counsel. I don't know 
anybody who knows his way around this body better than Brian does, and 
I don't know anybody who doesn't respect him. He is an incredible asset 
to have on this committee. And I should also credit Sherman Patrick, 
Steve Feldstein and Julie Baker on the staff of the Committee.
  I would be remiss if I didn't say that it is hard on the Foreign 
Relations Committee--it is kind of like when Senator Lugar and I first 
got here. There was a unified staff. I mean literally when I came here, 
Senator Fulbright was the chairman and there was a unified staff. The 
chairman hired everybody, but he didn't hire anybody without the 
consultation and agreement of the minority. We have essentially arrived 
at the same place without having to go through that process.
  There is Shellie Bressler, who has traveled the world with Shannon, 
went to those places. I am not being solicitous, Shellie, when I say 
you should understand that you made history. You helped make history.
  People wonder whether we underpay the staff here. I say to the 
American people all the time, and the people of Delaware, and I mean it 
sincerely, the single best buy they get in everything they purchase is 
the incredible talent of the staff who work in this Congress and in the 
Federal Government. These people could go out and be making three and 
four times what they are now, but they are incredibly bright and 
dedicated, and Shellie, I am telling you, you will be able to tell your 
children and grandchildren and your great-grandchildren that you made 
something consequential happen.
  I can say the same about Paul Foldi, who works for Senator Lugar. But 
I want to remind Senator Lugar, he used to work for me. He is a 
Delaware guy. Paul was actually foolish enough to help me when I tried 
the folly of attempting to get the nomination for President. I don't 
want to ruin his reputation. He has gone right since then. He is now 
working for a solid Republican. But Paul has been incredible. And Dan 
Diller has been as well.
  I have managed many bills in my career, and have had some few 
successes, so I apologize, because I usually don't take this much time 
to talk about the staff, but this has been a staff-driven success and 
they deserve the attention and the recognition.
  I also thank, in the Office of Legislative Counsel, Matt McGhie and 
Kevin Davis, whom I have not spoken to, but the staff has spoken to 
constantly and who worked tirelessly to prepare many drafts of this 
bill and numerous amendments that have been developed over the past 
several months.
  In the other body, I also thank Peter Yeo and David Abramowitz and 
Pearl Alice-Marsh on the staff of Chairman Berman, as well as Chairman 
Berman. We are indebted to the House committee for striking the initial 
compromise that got us to this point, and we built on the House bill. 
We have consulted them regularly--I would guess many times a day, when 
I say regularly, in the last few weeks--in the hope that they will be 
able to approve the Senate-passed bill, which is my expectation.
  Finally, in the administration, several people have devoted many 
hours, and maybe a lot more than that, moving this bill forward. In the 
Office of the Global AIDS Coordinator, great credit goes to Ambassador 
Mark Dybul, a very talented public servant, who testified before our 
committee, and who has spent a lot of time with our staffs and helped 
design and implement the PEPFAR program and made several contributions 
to the compromises developed over the past few months to get us to the 
80-plus vote. I am embarrassed to say I don't remember the actual 
count, but I think it was over 80 people who voted for this.
  I thank, and his staff particularly, Myron Meche, and Tom Walsh, who 
contributed a great deal to this moment. Also, at the White House, Deb 
Fiddelke and David Boyer of the Office of Legislative Affairs have been 
critical in this process.
  Most of all, I want to thank in absentia the two people after whom 
this bill is named. Tom Lantos was a friend of all of us, but he was a 
particular friend of mine. Tom Lantos was a very successful 
businessman, an economics professor teaching at San Francisco State 
University, advising a number of banks, as well as two major unions on 
their financial investments. I met him when I was a young Senator, and 
I asked him on a lark whether he would come and be my foreign policy 
and economic adviser, and he came and worked for me. He came and worked 
for me--although, knowing Tom, he never worked for anybody.
  But Tom Lantos, with his great Hungarian charm--everyone says Ireland 
has a Blarney Stone. I am absolutely confident the Blarney Stone is 
only a chip of the stone that is somewhere buried in Lake Balaton, in 
Hungary.
  Tom became a close friend. Annette and his entire family are close 
personal friends still. Tom's daughter came to work with me as well, an 
18-year-old graduate of Yale Law School, who graduated from Yale with 
honors at age 18.
  He was an incredible man who, after a terrible tragedy in Guyana, 
where the San Francisco Congressman was shot dead, went home, ran for 
that seat with my encouragement, and ultimately became the chairman of 
the House Foreign Affairs Committee.
  And Henry Hyde, with whom I had many disagreements philosophically 
but was always a gentleman, became a great friend of both Senator Lugar 
and myself. This is the Lantos-Hyde legislation. It is named after 
them.

[[Page 15199]]

  I know some of my colleagues will sort of wonder whether I am going 
overboard, but I also want to thank, in absentia--and I will thank him 
through Dot Helms--Jesse Helms. Jesse Helms had a conversion on the way 
to Damascus on AIDS. Jesse Helms started as a very hard edged guy, 
mirroring the attitudes of some of the most fundamentalist folks out 
there talking about AIDS, that it was a scourge because of a lot of 
things that I will not go into. This is a man who not only became 
convinced of the necessity of this legislation, he became a disciple of 
pushing this legislation.
  Here in the Senate, and I will end with this, I don't know how we can 
talk about the success here without recognizing on the Republican side 
Senator Brownback, a very conservative Member of the Senate who worked 
very hard.
  I do not think this would have happened without Dick Durbin being on 
the floor of the Senate almost every day for the past 5 or 6 years, 
pounding away, talking--I do not mean literally, but it seemed like 
almost every day for the last 5 years--about the moral responsibility 
we had as a nation to deal with this problem because we could--because 
we could--because we had the capacity.
  Senator Lugar has already mentioned--again, I apologize going on for 
so long, but these people deserve credit--John Kerry. This has been a 
passion of John Kerry's for the last 10 years. John Kerry, when this 
was not at all popular, was not at all sort of the flavor of the day, 
John Kerry was banging away at the need for us to attend to this 
problem. I think he is owed a debt of gratitude for his persistence and 
consistency.
  Also, the former majority leader, Dr. Frist, a doctor who came from 
Tennessee, and he got deeply involved in this process and his 
credibility as a great transplant surgeon sort of transcended the 
politics of this issue. He deserves great credit.
  One of the guys who maybe was--every once in a while there is sort of 
a spark that ignites the kindling and gets it all going. I always kid 
him, but Richard Holbrooke--and I say affectionately, who drives me 
crazy sometimes--but Richard Holbrooke and Senator Feingold were on a 
trip to Africa. Senator Feingold, who has been passionate about this 
issue, was chairman of the African Affairs Subcommittee--or he may have 
been ranking member at that time. In fairness, I cannot remember which 
it was. Senator Holbrooke going through a torturous confirmation 
process with the help of Senator Lugar and myself--was finally 
confirmed and did a great job there.
  He picked up the phone in classic Holbrooke fashion and called 
Senator Feingold and said: We are going to Africa. They went to, I 
think--I would stand corrected by Senator Feingold, but I believe it 
was 12 countries in 14 days. They didn't go for this purpose, but in 
the process they visited clinics and the rest and they saw the depth, 
breadth, and consequence of this problem. Richard Holbrooke, according 
to Russ Feingold, called Kofi Annan on the plane and said: Kofi, we 
need a Security Council meeting on AIDS.
  And Kofi Annan said: I am told we don't have health care Security 
Council meetings.
  They had it, and that was also a major moment. So I thank Senator 
Feingold as well.
  I could go on. There are others I am sure I left out, but in my years 
in the Senate, they were some of the people who delivered us this 
moment.
  Last, and I will not say any more because I am going to yield to 
Senator Wyden to ask a unanimous consent--but, again, nothing works in 
this place unless it is bipartisan. No one has the credibility that is 
more recognized to produce those kinds of bipartisan results than my 
colleague, Senator Lugar, who deserves incredible credit for this bill.
  I am told by staff Senator Wyden wishes to ask unanimous consent 
about an issue.
  The PRESIDING OFFICER. The Senator from Indiana is recognized.
  Mr. LUGAR. If the Senator will yield, I just thank the Senator for 
his wonderful comments about so many very dear friends, both of ours 
and of the Senate.
  I thanked a few people earlier on, but I really thank the Senator for 
his comprehensive views. I think it was well worth both the time, as 
well as the thoughtfulness of his remarks. They will be remembered by 
our staffs and by our friends.
  I will not make further comments because I know other Senators are 
wanting to transact business, and we appreciate their patience.
  Mr. BIDEN. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon is recognized.

                          ____________________