[Congressional Record (Bound Edition), Volume 154 (2008), Part 4]
[House]
[Pages 4786-4826]
[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

  The SPEAKER pro tempore. Pursuant to House Resolution 1065 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 5501.

                              {time}  1215


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 5501). To authorize appropriations for fiscal years 2009 through 
2013 to provide assistance to foreign countries to combat HIV/AIDS, 
tuberculosis, and malaria, and for other purposes, with Ms. Norton in 
the chair.
  The Clerk read the title of the bill.

[[Page 4787]]

  The CHAIRMAN. Pursuant to the rule, the bill is considered read the 
first time.
  The gentleman from California (Mr. Berman) and the gentlewoman from 
Florida (Ms. Ros-Lehtinen) each will control 1 hour.
  The Chair recognizes the gentleman from California.
  Mr. BERMAN. Madam Chairman, I yield myself such time as I may 
consume.
  Madam Chairman, on the President's request 5 years ago, Congress 
launched a global campaign to stop the spread of HIV/AIDS and to treat 
and care for those who are already afflicted. The United States 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act was a 
bipartisan bill from its inception. Today, the Foreign Affairs 
Committee again brings a bipartisan global HIV/AIDS bill to the floor, 
and again this important reauthorization bill enjoys strong support 
from the White House.
  The negotiations that brought forth this compromise bill were 
conducted in the same bipartisan spirit that guided the 2003 act into 
law, a spirit made possible by close cooperation between two former 
chairmen of the Foreign Affairs Committee, our late colleagues Tom 
Lantos and Henry Hyde, and I am pleased to note that this important 
reauthorization bill is named for these two foreign policy titans in 
recognition of their contributions to battling HIV/AIDS overseas.
  As a direct result of the extraordinarily successful law we passed 5 
years ago, the United States has provided lifesaving drugs to nearly 
1.5 million men, women and children; supported care for nearly 7 
million people, including 2.7 million orphans and vulnerable children; 
and prevented an estimated 150,000 infant infections around the world.
  The 2003 legislation firmly established the United States as the 
leading provider in the world of HIV/AIDS assistance for prevention, 
treatment and care. It has reminded the global community that Americans 
are a compassionate and generous people, and so has helped to repair 
our Nation's badly-damaged image overseas. In many ways, that 
legislation has had great healing power.
  Most importantly, with this initiative we have ensured that HIV/AIDS 
is no longer the certain death sentence it was just 5 short years ago. 
Hospital corridors that were jammed with AIDS patients waiting to die 
now brim with hope as lifesaving drugs are dispensed.
  The reauthorization bill before the House today reaffirms our 
commitment to the programs and policies established 5 years ago. The 
2003 legislation worked well as an emergency intervention, but it must 
now be modified to reflect the constantly changing nature of the HIV/
AIDS crisis. We also have 5 years of experience under our belts and we 
know what works and what does not.
  The law we passed in 2003 was designed to deal with the emergency 
phase of the global HIV/AIDS crisis. The Lantos-Hyde bill will move our 
programs towards long-term sustainability that will keep the benefits 
of U.S. global HIV/AIDS programs flowing to those in need. With this 
reauthorization act, host governments will also gain the ability to 
plan, direct and manage prevention treatment and care programs that 
have been established with U.S. assistance.
  The 2003 legislation authorized $15 billion over 5 years. In response 
to the desperate need for lifesaving medicine and a greater number of 
trained health care workers in nations hard hit by HIV/AIDS, the bill 
before us authorizes $50 billion over 5 years for these three 
pandemics.
  The 2003 law relied upon the health care workforce already in place 
in the developing world, yet in many of the hardest hit areas of the 
world there are simply not enough doctors and other health care workers 
to meet the challenges of this pandemic. The Lantos-Hyde legislation 
invests new funds in training new professionals and paraprofessionals, 
as well as building existing capacity.
  The 2003 law focused on creating new programs to tackle the HIV/AIDS 
crisis. The reauthorization bill increases the number of individuals 
receiving prevention, treatment and care services. It also builds 
stronger linkages between the global HIV/AIDS initiative and existing 
programs designed to alleviate hunger, improve health care, and bolster 
HIV education in schools, an approach endorsed by the President's 
Global AIDS Coordinator just a few short weeks ago.
  The 2003 law gave inadequate attention to the needs of women and 
girls. The new legislation remedies this situation by strengthening 
prevention and treatment programs aimed at this especially vulnerable 
population.
  The reauthorization legislation also eliminates the one-third 
abstinence-only earmark, but requires a balanced approach to HIV/AIDS 
sexual transmission prevention programs and a report regarding this 
approach in countries where the epidemic has become generalized.
  The bill before you today is a compromise in the best sense of the 
word, and it is in the true spirit of the great leaders of this 
committee who guided the 2003 act into law, Chairmen Lantos and Hyde. 
This bill is the result of more than a year of preparatory work and 
weeks of discussions, concluding with a bipartisan agreement with the 
White House. President Bush has indicated his support and his intention 
to sign it into law as soon as Congress acts.
  For all its strengths, the bill before the House today is not 
perfect. No compromise ever is. No one got everything they wanted in 
this compromise legislation. But with this agreement, we have 
maintained the strong, bipartisan coalition behind the global HIV/AIDS 
initiative which has been critical to winning rapidly increasing 
funding levels for this important initiative.
  Madam Chairman, 20 million innocent men, women and children have 
perished from HIV/AIDS, and 40 million around the globe are HIV 
positive. Each and every day another 6,000 people become infected with 
HIV. We have a moral imperative to act, and to act decisively.
  I will speak more lengthily about the subject, but I do want to 
initially extend my particular appreciation to our ranking member, 
Ileana Ros-Lehtinen, who played a critical role in working with the 
majority to reach this compromise. A number of Members on her side from 
the committee were active. Don Payne, the gentleman from New Jersey, 
the chairman of the Africa Subcommittee, was critically involved, as 
was Congresswoman Barbara Lee from California, who played such a key 
role in the 2003 law, as well as a number of other people, such as 
Congressman Carnahan. I can't mention everyone who was involved, but 
this was truly a collaborative effort that started long before I became 
Chair of the committee, with great work by Chairman Lantos last year 
and with the staff of the committee.
  Madam Chairman, I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield myself such time as I may 
consume.
  Madam Chairman, I thank my good friend, the new chairman of our 
Foreign Affairs Committee, Howard Berman. He has got a tough act to 
follow, because we all loved Tom Lantos. The gentleman from California 
(Mr. Berman) had a hard act to follow, but, boy, did he fill those big 
shoes very well. So, thank you, Mr. Chairman. This has been your first 
trial by fire, and you came out looking so well because you 
accommodated the concerns and the anxieties and the worries that so 
many of our Members had.
  I want to thank on a bipartisan level all of the members of the 
Foreign Affairs Committee, from the most conservative to the most 
liberal. We were able to forge a compromise that reached a broad 
consensus on this vital and complex legislation. We couldn't have done 
it without the leadership of Chairman Berman, but also without his very 
able staff and the staff on our Republican side of the aisle as well.
  The foundation of this bill, as Chairman Berman has pointed out, is 
the 2003 Leadership Act, which was the first comprehensive U.S. 
emergency response to the HIV/AIDS pandemic and which stands as a noble 
legacy of our two former chairmen, Henry Hyde and

[[Page 4788]]

Tom Lantos. They understood, as do all of us, that millions of lives 
around the world depend on our country's willingness to battle this 
pandemic together. It does honor to our country that 5 years ago we 
undertook this true mission of mercy. We are fortunate to have the 
opportunity to reaffirm that commitment by our vote here today.
  Since the passage of the original Leadership Act of 2003, extensive 
emergency treatment and prevention programs have begun to slow the 
advance of HIV/AIDS, tuberculosis and malaria. The success of these 
programs is well documented. I would like to cite some specifics.
  According to the office of the Global AIDS Coordinator, more than 1.4 
million people infected with the HIV virus are now being treated with 
the necessary drugs to fight this disease. PEPFAR has supported HIV 
testing and counseling for 30 million people, cared for million 6.7 
million, and, as the chairman pointed out, including almost 3 million 
orphans and vulnerable children. We are on our way to achieving the 5-
year goal of preventing the infection of 7 million people. PEPFAR has 
supplied medicines for approximately 800,000 expectant mothers, 
preventing an estimated 157,000 infant HIV infections. What a 
successful program.
  The legislation before us keeps faith with the core principles of the 
Hyde-Lantos Act. We have modified the original blueprint by adding or 
adjusting a number of provisions based on 5 years of real-world 
experience regarding what works and what doesn't.
  In addition to medicines and sophisticated methods of treatment, the 
2003 act mandated that a more comprehensive approach be used that took 
into account local values and indigenous cultures, and the act before 
us does that.
  With respect to this balanced approach, the wife of the President of 
Zambia said it best recently when she said, ``There are several ways in 
which we can reach the young people. One of the effective ways is 
abstinence. It brings back dignity and self-responsibility to young 
people, because they know their bodies are not supposed to be abused 
and they learn to say no.''
  The compromise bill before us removes the specific directive in 
current law so that implementation, as the chairman has pointed out, 
can be better refined to reflect the varying circumstances in host 
countries. Nevertheless, the bill before us continues this 
comprehensive approach by requiring that the AIDS Coordinator provides 
a balanced approach for prevention activities for sexual transmission 
of HIV/AIDS and to ensure that abstinence and faithfulness programs are 
implemented and funded in a meaningful and equitable way.
  The agreement that we have is carefully crafted and designed in the 
area of reproductive health and family planning to ensure that HIV 
funding for prevention is not misused to promote programs beyond the 
scope of this bill. We can do that, if you wish, in other bills. But 
the bill ensures also that those working to fight these diseases are 
not required to choose between their conscience and receiving the 
assistance they need to carry out their work.
  Also we worked a lot on the prostitution and the sex trafficking 
pledge. The bipartisan agreement maintains the existing certification 
requirement that any group or organization receiving PEPFAR funds 
explicitly oppose prostitution and sex trafficking. The U.S. Agency for 
International Development has implemented this prohibition by requiring 
that any group that receives funding sign a pledge affirming its 
opposition to these practices.
  Let me be clear: Neither current law nor the pledge itself prevents 
organizations from working with prostitutes or other high risk groups, 
but it does mandate that that assistance to these individuals not be 
mistaken for approval or support of the activities that take their 
terrible toll on their bodies and that can only be described as 
destructive to human dignity.
  We had issues with accountability and national security, and although 
this bill is absolutely motivated by the altruism of the American 
people, I believe that this legislation ensures that our interests are 
protected as well.

                              {time}  1230

  For example, U.S. contributions to the Global Fund will be subject to 
more stringent oversight than is currently provided by calling for the 
Fund to meet even higher benchmarks of transparency and accountability.
  The legislation also includes a prohibition on taxation of our 
assistance by foreign governments to ensure that assistance intended to 
the afflicted not be siphoned off by unaccountable bureaucrats.
  The bill also strengthens our national security. The HIV pandemic is 
first and foremost a health issue, but it also is one of the most 
significant global, economic, and security threats of our generation. 
General Charles Wald, the Former Deputy Commander of the US-European 
Command, has called HIV/AIDS the third greatest threat to our national 
security.
  Together, HIV/AIDS, tuberculosis, and malaria kill millions of people 
during their most productive years, between the ages of 16 and 50. And 
in the hardest hit countries, the AIDS epidemic alone is killing a 
generation of parents, of teachers, of health care workers, bread 
winners, peacekeepers, shattering the economic and the social life of 
villages, communities, and, indeed, nations.
  Losses on this scale have staggered the economies of the hardest hit 
countries. Without further prevention, without further treatment, 
without further care efforts, the AIDS pandemic will continue to spread 
its mix of death, poverty, and despondency that is further 
destabilizing governments and societies and undermining the security of 
entire regions.
  Our former House colleague from Wisconsin, Mark Green, who now serves 
as the United States Ambassador to Tanzania, wrote to me following the 
committee's passage of this bill highlighting this security aspect. He 
said, ``In tearing apart the social fabric and leaving a generation of 
orphans, the scourge of HIV/AIDS could spread and create a long-term 
breeding ground of radicalism.''
  PEPFAR programs in turn help to counter these precursor conditions. 
As General Wald has said, ``In addition to the obvious humanitarian 
efforts of PEPFAR, the program is one of our Nation's development 
activities that can help strengthen the social structure that keep 
communities and nations secure.''
  The threat is not just in faraway lands, but in our own back yard. 
Many countries in the Caribbean have been particularly hard hit. This 
bill places a new emphasis on assistance to this region. It adds 14 
Caribbean countries to the existing list of nations in which the Global 
AIDS Coordinator is given explicit statutory authority over HIV/AIDS 
programs.
  Let me add that, although all of us share the goal of reducing the 
further spread of this pandemic, this is also a personal issue for me 
both professionally and morally. South Florida, which falls within my 
congressional district, ranks first in the State of Florida in the 
number of AIDS cases. Roughly 19 percent of the State total for those 
living with HIV reside in my district. So, I am all too familiar with 
the human cost of this disease, and hope for the day when its ravages 
are safely confined to the past.
  Although not all Members will fully agree with every aspect of this 
complex compromise, it does contain the bipartisan approach that we 
have maintained throughout the years of work on HIV/AIDS in our 
committee. We have an opportunity, indeed, a responsibility, to 
continue the lifesaving work that began 5 years ago. This legislation 
is a means by which that can happen.
  But the dry text of the legislation, nor the posters behind me, 
cannot adequately capture the human drama for which we are trying to 
write the exit strategy.
  The poster behind me shows where PEPFAR has worldwide activities, the 
number of countries where it has positively had an impact. The second 
poster shows the number of adults and children estimated to be living 
with HIV just this last year. And, the third poster shows some of the 
faces of the children whom this legislation has saved.

[[Page 4789]]

  Let me read, to conclude, from a Washington Post op ed authored by 
our chairman, Henry Hyde, 5 years ago. Mr. Hyde wrote,
  ``Not since the bubonic plague swept across the world in the last 
millennium has our world confronted such a horrible curse as we are now 
witnessing with the growing HIV/AIDS pandemic.
  ``This pandemic is more than a humanitarian crisis.
  ``To those who suggest that the United States has no stake in this 
pandemic, let me observe that the specter of failed states across the 
world is certainly our concern.
  ``The AIDS virus is a mortal challenge to our civilization.
  ``It is my hope that each of us will be animated by the compassion, 
and, yes, the vision, that has always defined what it means to be an 
American.''
  Madam Chairman, endless numbers of children have already been 
orphaned and deprived of the protection and the love of their parents. 
We cannot make their world whole again, but there is much that we can 
do to comfort and care for them and to prevent others from suffering 
the same fate.
  I ask my colleagues to join us in supporting this bill in a strong 
bipartisan manner, and thereby allow our country to continue our 
mission, our mission of mercy, for the waiting millions.
  And with that, Madam Chairman, I reserve the balance of my time.
  Mr. BERMAN. Madam Chairman, I thank the gentlelady for her wonderful 
statement, and I yield 3\1/2\ minutes to the gentleman from 
Massachusetts (Mr. McGovern).
  Mr. McGOVERN. I thank the chairman, and I ask for time for the 
purpose of the gentlelady from Missouri and I entering into a colloquy 
with the chairman on the importance of integrating food and nutrition 
programs with the prevention, care, and treatment of HIV/AIDS-affected 
individuals, families, and communities.
  Last year, I traveled to Africa and had the opportunity to see 
firsthand many of our programs related to food security. In Ethiopia 
and Kenya, I visited HIV/AIDS programs to look at how food and 
nutrition was included. At that time, I heard from local communities, 
NGO partners, and our embassy staff how restrictive guidance for global 
HIV/AIDS assistance often hindered their ability to design and carry 
out effective food and nutrition programs targeted at HIV/AIDS affected 
individuals, families, and communities. The lack of resources available 
for food and nutrition programs within the global HIV/AIDS assistance 
and from other sources also posed a significant barrier.
  I very much appreciate and support the work of the committee in 
ensuring that this bill addresses these concerns throughout, and 
especially in the section entitled ``Food Security and Nutrition 
Support.'' The bill recognizes that strengthening the linkages and 
enhancing coordination among HIV/AIDS programs and vital development 
programs, like food and nutrition programs, will significantly increase 
our effectiveness in the fight against HIV/AIDS while we advance other 
essential U.S. development priorities. I remain concerned, however, 
that the bill is less clear on where or how such funding will be 
provided for these purposes. It is not clear on how much funding will 
come from the Global HIV/AIDS program versus other sources of funding. 
I am concerned that, without adequate resources through the Global HIV/
AIDS program, or necessary increases for current food and nutrition 
services through programs like Food for Peace, that USAID will be faced 
with the possibility of having to divert funding from programs that 
address long-term chronic hunger and food insecurity to meet the 
enhanced mandates of H.R. 5501.
  I know the chairman will agree that we want to avoid this scenario of 
robbing Peter to pay Paul so that we do not end up shortchanging other 
communities suffering from hunger, malnutrition, and food insecurity.
  I want to yield to the gentlelady from Missouri in this regard.
  Mrs. EMERSON. I thank the gentleman from Massachusetts.
  Madam Chairman, I am also concerned that the situation will become 
even worse, because the cost of food, commodities, and transportation 
is skyrocketing. Just last month, on February 12, the USAID's Office of 
Food for Peace announced that the cost of wheat and other food the 
United States donates to poor countries jumped 41 percent, 41 percent, 
in the first half of fiscal year 2008. According to USAID, this means 
$120 million in food assistance will not be available for people who 
are malnourished or food insecure.
  I would ask the chairman to work on strengthening the language in the 
bill as it moves through the legislative process and into conference 
negotiations to clarify how the necessary level of funding for food 
security and nutrition will be provided, especially in light of rising 
food and transportation costs, so that funds won't be diverted from 
U.S. programs addressing chronic hunger and emergency operations.
  I yield back to the gentleman from Massachusetts.
  Mr. McGOVERN. And I yield back to the chairman to express his views.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. BERMAN. Madam Chairman, before I respond with my views, I would 
like to yield 1 minute to the gentleman from New Jersey (Mr. Payne) to 
express his views on the subject of this colloquy.
  Mr. PAYNE. Mr. Chairman, as you know, the provision on food and 
nutrition security in the bill currently under consideration is drawn 
directly from a bill I introduced in December, H.R. 4914, the Global 
HIV/AIDS Food Security and Nutrition Support Act of 2007. I introduced 
the bill after chairing a hearing in the Subcommittee on Africa and 
Global Health to determine whether the Global HIV/AIDS program was 
adequately addressing the nutritional needs of its beneficiaries.
  The hearing corroborated what I had already heard in the field on 
numerous visits to Africa over the past 5 years: PEPFAR is falling 
short in this critical area. I share the concerns of the gentleman from 
Massachusetts and the gentlelady from Missouri about the increasing 
cost of food aid. Just last week, the World Food Program had to issue 
an appeal for an additional $500 million to offset the increased costs 
of food and fuel.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. BERMAN. I yield the gentleman an additional 30 seconds.
  Mr. PAYNE. Without the extra $73 million, people who rely on WFP for 
their daily sustenance may have their rations cut. This is a truly 
alarming situation, and it is not my intent for the provision of this 
bill to exacerbate it. The language under consideration very clearly 
states that these activities are to be funded from amounts authorized 
under section 401 of this bill. I used this language deliberately, as I 
strongly believe that the food assistance and nutritional support we 
are providing under the Global AIDS program must be on top of the food 
aid we are already providing.
  Mr. BERMAN. Madam Chairman, I yield myself 1\1/2\ minutes to respond 
to the concerns raised during this colloquy. I thank my colleagues for 
raising these important concerns.
  H.R. 5501 provides clear and specific instructions to the USAID 
Administrator and the Global AIDS Coordinator to address the food and 
nutrition needs of individuals with HIV/AIDS and other affected 
individuals, including orphans and vulnerable children; and to fully 
integrate food and nutrition support in HIV/AIDS prevention, treatment, 
and care programs carried out under this act.
  I would like to emphasize that the committee and I personally share 
our colleagues' concerns about the negative effect rising costs are 
having on our long-term and emergency food aid programs. This is a 
matter that has our most serious attention, because it affects a wide 
array of our food aid and development programs, including the 
effectiveness and success of this program.
  I want to reassure my colleagues that I will be working over the 
coming weeks to strengthen and clarify in the bill that food security 
and nutrition programs, especially those referred to as wrap-around 
services, are not to be

[[Page 4790]]

funded with monies diverted from other standing commitments to address 
food and security elsewhere in the world or in these countries.
  I yield 30 seconds' additional time to the gentleman from 
Massachusetts.
  Mr. McGOVERN. I want to thank the chairman for that assurance. I know 
that many Members of Congress on both sides of the aisle stand ready to 
support him in these efforts.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield 3 minutes to the gentleman 
from California (Mr. Royce) who is the ranking member of the 
Subcommittee on Terrorism, Nonproliferation, and Trade.
  Mr. ROYCE. Many have described the crisis: HIV/AIDS, tuberculosis, 
malaria. These take countless lives every day, especially on the 
continent of Africa. These diseases devastate families, they devastate 
communities, and nations. This bill is titled the ``Leadership Act,'' 
and it is titled that way because it honors two former Foreign Affairs 
Committee chairmen who indeed did show leadership in forging this 
legislation 5 years ago. And, with this act, the United States will 
continue to lead in tackling these killer diseases.
  As others have said, this legislation did not come together easily; 
and the reason it is difficult is because many people have strong views 
on how best to fight these diseases. This bill is a compromise. It 
would have been far easier to hold onto positions, probably, but that 
would have gotten no bill. But, instead, those working on it did the 
hard work to craft a policy that most everyone could support.

                              {time}  1245

  Frankly, had it not been done, it would have been a sharp rebuke to 
the work Chairman Hyde and Mr. Lantos did 5 years ago. Tens of millions 
of people around the world would have lost, and America would have 
lost. That we are in this position now, to continue these two men's 
legacy, is due to the dedication of Chairman Berman and Ranking Member 
Ros-Lehtinen. I particularly appreciate their inclusion of a provision 
I had recommended prohibiting foreign countries, foreign governments, 
from taxing our aid, and I thank them for that provision.
  While endorsing the policy, the bill's authorization level is a great 
concern, as others have expressed. I have conferred with enough people 
working in the field and been in enough African countries to doubt the 
ability to productively absorb this very large funding level, which is 
well over the administration's request.
  And while these are devastating diseases, these countries face many 
other public challenges, some deadly, which may be shortchanged. Our 
country has many public health needs, too. That leads me to believe 
that this would be a better bill if it conformed more closely with the 
level the administration, which has gotten real results, thinks it 
could best spend.
  I believe this bill's authorization level will be addressed in our 
recommittal motion which will be offered for a vote before this House.
  So again, I thank Chairman Berman and Ranking Member Ros-Lehtinen.
  Mr. BERMAN. Madam Chairman, I am pleased to yield 5 minutes to the 
gentleman from New Jersey (Mr. Payne), the chairman of the Foreign 
Affairs Subcommittee on Africa and Global Health, and a key architect 
of this legislation.
  Mr. PAYNE. Madam Chairman, let me begin by commending Chairman Berman 
of the committee for bringing forth this tremendous, important 
legislation, and for the support in this bipartisan effort from Ranking 
Member Ros-Lehtinen, and for her support of this very important 
legislation.
  I rise in strong support of the legislation currently under 
consideration. I am very pleased to be an original cosponsor of H.R. 
5501, the Tom Lantos and Henry Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
2008.
  This bill is appropriately named because it was under the leadership 
of the late Henry Hyde, then chairman of the Foreign Affairs Committee, 
that the PEPFAR legislation was originally authorized. And under the 
leadership of the late Tom Lantos, reauthorization began. Both of these 
tireless giants who have left us should be remembered by this 
legislation. I might also note that under the leadership of the 
original authorization, Congresswoman Barbara Lee and the Congressional 
Black Caucus were very strong advocates to push the leadership of the 
House and the President to consider this very important legislation.
  In the 5 years, there has certainly been a pandemic that the world is 
facing, and there has not been a pandemic similar to this since the 
plague during medieval days in Europe. So I am pleased that we are 
finally dealing with this pandemic in the way that it should be.
  In the 5 years since Congress passed the original legislation 
authorizing the President's Emergency Plan for AIDS Relief, or PEPFAR, 
as it is well known, it has become an historic program. In my opinion, 
this will be remembered as the single most significant achievement of 
President Bush's two terms in office.
  And from my recent conversations with the President, I know that he 
has worked very hard on this reauthorization, and it is with the 
support of the White House and the staff, they helped us craft this 
bipartisan legislation.
  Prior to PEPFAR, the United States did very little in supporting AIDS 
treatment programs abroad. In fact, Members may recall a high-ranking 
USAID official said that treatment was not feasible in Africa, the most 
heavily AIDS-infected region of the world, because Africans cannot tell 
time and therefore would not be able to take the required medication 
properly. As we know, it was foolish to say that at the time; and as we 
have seen the results, it has proven once again to have been a foolish 
statement.
  These officials advocated limiting our activities only to education 
and prevention, a position that would have in effect sentenced millions 
of HIV-infected men, women and children to die if it were only that 
program. And so I am very pleased we expanded it to where it is today.
  Fortunately, the Congress and the President did not agree with that 
position. And because we were willing to find a way to provide 
treatment for over 800,000 people, today they are receiving 
antiretroviral medication to prevent AIDS in the 15 focus countries, 12 
of which are in sub-Saharan Africa.
  We are also pleased that we are increasing the number of countries to 
the 14 Caribbean countries. And as cochair of the bipartisan Caribbean 
Caucus, and under the leadership of Representative Donna Christensen, 
at a meeting she convened in her district, we had health ministers 
admit that the Caribbean also needed substantial help.
  Our progress, while significant, is not enough. Only 28 percent of 
Africans needing antiretrovirals are receiving them. Shockingly, over 
85 percent of African children who need ARVs are going without them. A 
mere 11 percent of HIV-positive women who need drugs to prevent mother-
to-child transmission of HIV during child birth are getting them.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. BERMAN. I yield the gentleman an additional minute.
  Mr. PAYNE. In light of these troubling facts, we have taken steps in 
this legislation to transform PEPFAR from an emergency response to a 
sustainable program by expanding the program beyond a series of medical 
interventions. For example, the committee incorporated the provision 
that I discussed earlier about food security into the legislation in 
order to address the nutritional needs of HIV patients, their families, 
and communities heavily affected by the disease.
  Lack of food and nutrition support has been, up to now, a major 
impediment to the adherence of HIV/AIDS treatment regimens.
  H.R. 5501 also contains provisions to build and strengthen health 
systems in developing countries. The committee has given the Office of 
Global AIDS Coordinator the flexibility to do prevention, care and 
treatment programs tailored to the characteristics of the epidemic in 
the country in which they are

[[Page 4791]]

operating by eliminating cumbersome earmarks that the GAO said were 
ineffective.
  Finally, the bill authorizes significant funds, $50 billion over the 
next 5 years, in order to accomplish the goals of the bill. I urge the 
House to pass this legislation.
  Ms. ROS-LEHTINEN. Madam Chairman, I am proud to yield 7 minutes to 
the gentleman from New Jersey (Mr. Smith), the ranking member of the 
Subcommittee on Africa and Global Health, who has worked so long and so 
hard on this topic.
  Mr. SMITH of New Jersey. Madam Chairman, I rise in strong support of 
the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
2008, an admittedly long, but appropriate title for a bill that is long 
on substance, meaningful intervention, tangible compassion, and relief.
  Aptly named for two of the giants of this institution who helped 
shepherd President George W. Bush's PEPFAR initiative through the 
Congress in 2003, H.R. 5501 will literally mean the difference between 
life and death to millions, especially in sub-Saharan Africa.
  The bill before us today is consensus legislation, a delicate balance 
that if kept intact, and only if kept intact, will be signed into law. 
So I want to thank Chairman Berman and Ranking Member Ros-Lehtinen and 
other Members and staff for helping to forge today's PEPFAR consensus. 
I want to especially thank Sheri Rickert, Mary Noonan, Autumn 
Fredericks, Yleem Poblete, Peter Yeo, Pearl Alice Marsh, Dr. Bob King, 
Kristin Wells, and David Abramowitz for their extraordinary work in 
drafting this legislation.
  Madam Chairman, as Members know, close to 70 percent of the estimated 
33 million people with HIV live in sub-Saharan Africa. Of the 2.5 
million children afflicted with this dreaded disease, 90 percent live 
in Africa as well.
  When combined with opportunistic infections like tuberculosis--the 
number one killer of individuals with HIV--and malaria alone kills one 
million each year, again mostly in Africa--the HIV/AIDS pandemic 
compares among humanity's worst. Former Chairman Hyde frequently 
compared the sickness to the bubonic plague--the black death--an 
epidemic that claimed the lives of over 25 million people in Europe 
during the mid-1300s.
  I know some Members are likely to wince at the cost of the bill--$50 
billion over 5 years for PEPFAR, the Global Fund, Tuberculosis, and 
Malaria--but that sum of money will be used to prevent 12 million new 
HIV infections worldwide, and support treatment for 3 million people, 
including an estimated 450,000 children. That sum of money will provide 
care to 12 million individuals with HIV/AIDS, including 5 million 
orphans and vulnerable children, and will help train and deploy at 
least 140,000 new health care professionals and workers for HIV/AIDS 
prevention, treatment and care.
  On the prevention side, the legislation requires that the Global AIDS 
Coordinator provide balanced funding for sexual transmission prevention 
including abstinence, delay of sexual debut, monogamy, fidelity, and 
partner reduction. If less than 50 percent of the sexual transmission 
prevention moneys are spent on the Abstinence and the Be Faithful parts 
of the ABC model, the coordinator must provide a written justification. 
I note that currently, the coordinator exercises waiver authority in 
this regard without notifying Congress so this language ensures greater 
transparency and accountability.
  Five years, Madam Chairman, after PEPFAR first began, the efficacy 
and importance of promoting abstinence and be faithful initiatives have 
been demonstrated beyond any reasonable doubt, and the evidence is 
compelling.
  According to joint comments by the U.S. Department of State, USAID, 
and HHS on PEPFAR, ``Congressional directives have helped focus U.S. 
Government prevention strategies to be evidence based. Because of the 
data, ABC is now recognized as the most effective strategy to prevent 
HIV in generalized epidemics.

                              {time}  1300

  The original legislation's emphasis on AB activities has been an 
important factor in the fundamental and needed shift in U.S. government 
prevention strategies from a primarily ``C'' approach prior to PEPFAR 
to a balanced ABC strategy. The Emergency Plan developed a more 
holistic and equitable strategy, one that reflects the growing body of 
data that validates ABC behavioral change.
  The U.S. government report goes on to say that recent data from 
Zimbabwe and Kenya mirrors the earlier successes of Uganda's ABC 
approach to preventing HIV. These three countries, with what is known 
as ``generalized epidemics,'' have demonstrated reductions in HIV 
prevalence. And in each country, the data point to significant AB, 
abstinence, be faithful; behavioral change; and modest, but important, 
changes to C.
  So, I want to thank Mr. Pitts for writing the original AB earmark 
into the original law because it has instructed and has had a 
tremendously positive impact.
  I would note to my colleagues that this past September the Foreign 
Affairs Committee heard from a world renowned expert, Dr. Norman 
Hearst, who said that 5 years ago he had been commissioned by U.N. AIDS 
to conduct a technical review of how well condoms had worked for AIDS 
prevention in the developing world. And he said, and I quote in part, 
``my associates and I collected mountains of data, and here is what we 
found: When we looked for evidence of public health impact for condoms 
in generalized epidemics, to our surprise we couldn't find anything. No 
generalized HIV epidemic has ever been rolled back by a prevention 
strategy primarily based on condoms. Instead, a few successes in 
turning around generalized epidemics, such as Uganda, were achieved not 
through condoms, but by getting people to change their sexual 
behavior.''
  He goes on to say that these are not just our conclusions. A recent 
consensus statement in the Lancet was endorsed by 150 AIDS experts, 
including Nobel Laureates, the President of Uganda, and officials of 
the most prominent international AIDS organizations. And it said, ``the 
priority for adults should be, B, limiting one's partners. The priority 
for young people should be A, not starting sexual activity too soon.'' 
And this contrasted with other funders that often officially endorse 
ABC, but in practice continue to put their money in the same old 
strategies that have been unsuccessful in Africa for the past 15 years.
  A Washington Post article by Craig Timberg noted that ``men and women 
in Botswana continued to contract HIV faster than almost anyone else on 
Earth. Researchers increasingly attribute the resilience of HIV in 
Botswana, and in southern Africa generally, to the high incidence of 
multiple sexual relationships.''
  ``Researchers increasingly agree,'' and please, I ask my colleagues 
to take note of this, ``that curbing behavior is key to slowing the 
spread of AIDS in Africa.'' In a July report, southern African AIDS 
experts said that reducing multiple and concurrent partnerships was 
their first priority for stopping the spread.
  The CHAIRMAN. The time of the gentleman has expired.
  Ms. ROS-LEHTINEN. Madam Chair, I yield 3 additional minutes to the 
gentleman.
  Mr. SMITH of New Jersey. Thank you.
  Madam Chairman, the legislation before us also leaves intact the 
anti-prostitution/sex tracking pledge, a policy designed to ensure that 
pimps and brothel owners don't become, via an NGO that supports such 
exploitation, U.S. government partners.
  Last February, the U.S. Government Court of Appeals for the District 
of Columbia upheld the prostitution pledge and said, in pertinent part, 
``In this case, the government's objective is to eradicate HIV/AIDS. 
One of the means of accomplishing this objective is for the U.S. to 
speak out against legalizing prostitution in other countries.''
  The Court of Appeals goes on to say, ``it would make little sense for 
the government to provide billions of dollars

[[Page 4792]]

to encourage the reduction of HIV/AIDS behavioral risks, including 
prostitution and sex trafficking, and yet to engage as partners in this 
effort organizations that are neutral towards or even actively promote 
the same practices sought to be eradicated.''
  Finally, we've come a long way, Madam Chairman, since 2003, when 
significant opposition materialized against an amendment that I had 
offered to ensure that faith-based providers, and others, are not 
excluded from participation. Worldwide, but especially in Africa, 
faith-based organizations are absolutely critical in the fight against 
AIDS. So, we welcome and are deeply grateful for their support and 
their work.
  The conscience clause in H.R. 5501 restates, improves, and expands 
conscience protection in a way that ensures that organizations like the 
Catholic Relief Services, with its 250 plus projects in 52 countries, 
which has had a remarkable record on HIV/AIDS prevention, treatment and 
care, are not discriminated against or in any way precluded from 
receiving public funds.
  Madam Chairman, this bill is carefully crafted, and again, I want to 
thank my colleagues on both sides of the aisle for the enormous amount 
of work that has been poured into its creation.
  Mr. BERMAN. Madam Chairman, I am very pleased to yield 3 minutes to 
the chairman of the Foreign Affairs Subcommittee on the Western 
Hemisphere. And remember, this is a bill about HIV/AIDS, malaria, and 
tuberculosis. He played a major role in the tuberculosis section of the 
bill, the gentleman from New York (Mr. Engel).
  Mr. ENGEL. I thank our distinguished chairman for yielding to me.
  Madam Chairman, I'm proud to be an original cosponsor of H.R. 5501, 
the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, 
named after our dearly departed two great House Foreign Affairs 
Committee chairmen that I had the pleasure of serving under, Tom Lantos 
and Henry Hyde.
  The HIV/AIDS pandemic continues to pose a major threat to the health 
of the global community, from the most severely affected regions of 
sub-Saharan Africa and the Caribbean, as the chairman mentioned, I'm 
the chairman of the Subcommittee of the Western Hemisphere, to the 
emerging epidemics of eastern Europe, central Asia, south and southeast 
Asia, and Latin America.
  I also want to take this time to pay tribute to our colleague who is 
in the Chamber, the gentlewoman from California (Ms. Lee), who has 
worked so hard in combating global AIDS, probably harder than anyone 
else in the Congress. I'm delighted that she's here, and her hard work 
has not gone unnoticed.
  While most widely recognized for reviewing our commitment to global 
AIDS relief, H.R. 5501 reauthorizes provisions on HIV/AIDS, malaria and 
tuberculosis, all deadly diseases of poverty. The Lantos-Hyde Act is a 
decisive step forward for global health, particularly for our efforts 
to control tuberculosis.
  I want to take a moment to specifically address the tuberculosis 
provisions included, as the chairman mentioned, as my bill H.R. 1567, 
the Stop TB Now Act which passed the floor earlier this year, was 
largely incorporated into this bill, and I'm delighted about that.
  The World Health Organization reports that 1.5 million people died of 
tuberculosis in 2006, with another 200,000 dying from HIV-associated 
tuberculosis. The multi-drug resistant and extensively drug resistant 
TB, known as MDR and XDR, poses a grave risk to global health. A 
contagious airborne disease, TB knows no barriers or borders and can 
only be successfully controlled in the United States by controlling it 
overseas.
  This Lantos-Hyde Act declares TB control a major objective of U.S. 
foreign assistance programs. In support of WHO targets, the bill 
prioritizes halving TB deaths and disease, cutting them in half, and 
achieving a 70 percent detection rate and an 85 percent cure rate by 
2015.
  The Lantos-Hyde Act prioritizes the Stop TB Partnership's strategy, 
which includes expansion of the successful treatment regimen for 
standard TB, treatment for individuals infected with both TB and HIV, 
treatment for individuals with drug-resistant TB, and enabling research 
and development of new tools.
  Recognizing the deadly synergy between TB, an opportunistic 
infection, and HIV, the Lantos-Hyde Act authorizes assistance to 
strengthen the coordination of HIV/AIDS and TB programs. TB is the 
leading killer of people with HIV/AIDS.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. ENGEL. May I ask for an additional minute?
  Mr. BERMAN. I yield the gentleman an additional minute.
  Mr. ENGEL. And the explosion of drug-resistant TB in sub-Saharan 
Africa threatens to halt and roll back our progress in combating both 
diseases.
  The legislation supports key TB-HIV activities, such as providing 
AIDS patients with TB screening and treatment, and providing TB 
patients with proper counseling, testing and treatment for HIV/AIDS.
  Finally, the legislation authorizes assistance for the development of 
new vaccines for TB. The current TB vaccine is more than 85 years old 
and is unreliable against pulmonary TB, which accounts for most of the 
worldwide disease burden. New TB vaccines have the potential to save 
millions of lives and would lead to substantial cost savings.
  Studies modelling the 10-year economic benefits of a vaccine that is 
75 percent effective have estimated worldwide savings in medical costs 
of $25 billion or more.
  I strongly urge my colleagues to support this bill. This is a very, 
very important bill.
  Ms. ROS-LEHTINEN. Madam Chairman, before yielding to my distinguished 
colleague from Illinois, I would like to recognize the efforts of Yleem 
Poblete, our staff director on the GOP side, Mark Gage, Joan Condon, 
Sarah Kiko of our committee staff, they have all been working so hard, 
and our detailee, a valuable addition to our PEPFAR team, Ben Snyder. 
Thank you to everyone who has worked so hard.
  Madam Chairman, I would like to yield 3 minutes to the gentleman from 
Illinois (Mr. Weller), an esteemed member of the Committee on Ways and 
Means.
  Mr. WELLER of Illinois. Madam Chairman, I rise in strong support for 
the Tom Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act. I want 
to commend the current leadership of the committee, the bipartisan 
leadership, Mr. Berman and Ms. Ros-Lehtinen, for their leadership in 
moving this legislation to the floor in a bipartisan way. And it's most 
appropriate that it be named after Tom Lantos and Henry Hyde, two 
distinguished chairmen of the International and Foreign Relations 
Committees that changed names, but one thing that was in common between 
Tom Lantos and Henry Hyde was they always worked to ensure that foreign 
policy should be a bipartisan product and a team effort. So, it is so 
appropriate that they be recognized by naming this legislation after 
them, which reauthorizes President Bush's emergency plans for AIDS 
relief.
  As noted by a number of my colleagues, almost 33 million citizens of 
this planet today suffer from the consequences of HIV/AIDS. We have a 
moral responsibility, and it's important that the United States exhibit 
and demonstrate moral leadership in addressing this crisis, which not 
only is a health issue, but it's a security issue for this globe.
  I think we all watched the reception of President Bush when he 
traveled recently to Africa and the appreciation that was shown by the 
leadership in Africa for the President's initiative and the bipartisan 
support that we've seen in the effort against AIDS, and to help those 
who are victims of AIDS in Africa.
  We often think of Africa when we talk about global AIDS, but of the 
33

[[Page 4793]]

million, there are also many living in Latin America and the Caribbean 
who suffer from HIV/AIDS as well. In Latin America today there are 
1,600,000 people living with HIV/AIDS, that's up from 1.3 million in 
2001; and 58,000 citizens of Latin America have lost their lives to 
HIV/AIDS. In the Caribbean, 230,000 adults and children are currently 
known to be infected with HIV/AIDS. That's up from 190,000 in 2001. In 
the Caribbean, 11,000 citizens of the Caribbean have lost their lives.
  I note we've made some progress as a result of the President's 
initiative for AIDS relief. In Haiti alone, a large recipient of aid as 
a result of this initiative, almost 4 percent of the population of 
Haiti is infected with HIV/AIDS. Think about that, 190,000 people. And 
since 2004, thanks to this initiative, the number of people receiving 
care and support has grown from 30,000 to 125,000, and an anticipated 
150,000 people will be reached this year because of this initiative. 
Haiti received almost $85 million from this program in the past year to 
address this crisis which affects many in the Caribbean.
  The point is is that PEPFAR, as we know it, has allowed us to reach 
almost every person in Haiti struggling with HIV/AIDS. And, for 
example, the continued support is necessary to make sure we reach every 
person struggling with HIV/AIDS in the world, and that's why this 
extension is so important.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. WELLER of Illinois. May I ask for an additional 2 minutes?
  Ms. ROS-LEHTINEN. I yield an additional 2 minutes to the gentleman 
from Illinois.
  Mr. WELLER of Illinois. I would also like to share a couple other 
examples of the success of this initiative and how this funding is 
helping regular people and making a difference in Latin America.
  Bolivia, a large nation the size of Texas with 9 million people, 
thanks to the PEPFAR initiative we're using data to combat HIV/AIDS. In 
fact, real-time data is helping Bolivian health officials carry out 
more HIV/AIDS prevention education, including HIV counseling and 
testing services. And according to the Joint United Nations Program on 
HIV/AIDS, prevalence rates in Bolivia's general population has remained 
at 1-10th of 1 percent, which is remarkable success compared to some of 
its neighbors.
  In Central America, in the Republic of Honduras, beginning in 
February of 2005 the United States awarded its first set of grants 
through USAID to 10 local nongovernmental organizations working with 43 
Honduran communities most impacted by HIV/AIDS.

                              {time}  1315

  In their first 7 months of implementation, the organization has 
reached over 27,000 at-risk individuals with behavioral change models. 
As part of the HIV prevention efforts, the group began offering HIV 
counseling and testing, and the counseling and testing programs were 
the first in Honduras to be offered by those trained in accordance 
working with the Ministry of Health standards as part of a larger 
national prevention effort. And this collaboration between the 
government of the Honduras, USAID, indigenous organizations and the 
Ministry of Health has set this standard expanding access to testing in 
the Nation of Honduras.
  The bottom line is, this program is making a difference in combating 
what is clearly a terrible crisis throughout the world, currently 
impacting 33 million citizens of this planet.
  We have a moral obligation, and it's important that the United States 
continue to exert the leadership and demonstrate the leadership we have 
over the last few years to address the global AIDS crisis.
  I urge bipartisan support.
  Mr. BERMAN. Madam Chairman, I am very pleased to yield to my friend 
from California, someone who has been heavily invested in getting our 
attention on this issue and passing the legislation, putting, 
fashioning and passing the legislation in 2003 and again this time, our 
gentlelady from California, Barbara Lee, for 5 minutes.
  Ms. LEE. Madam Chairman, I rise in strong support of H.R. 5501.
  And let me begin by thanking Chairman Berman, our ranking member, Ms. 
Ros-Lehtinen, our subcommittee chair, Mr. Payne, also Chairman Waxman, 
Mr. Smith, ranking member of the subcommittee, and all who have helped 
to make this legislation an amazing piece of legislation. And I know 
that Chairman Lantos and Chairman Hyde want to thank us and are here 
with us honoring their legacy because they would want to see this move 
forward as it is today.
  As one the five original co-authors of both the initial legislation 
establishing PEPFAR and of this new bill reauthorizing PEPFAR, I am 
pleased that we are moving forward. And again, I have to thank Chairman 
Berman and Ms. Ros-Lehtinen for making sure that this legislation is 
really in the spirit of the bipartisan cooperation that we have moved 
forward with in the past.
  There's no other piece of legislation that we will consider in 
Congress this year that will have the greatest impact on the lives of 
people around the world. Like many, I have witnessed firsthand many 
times the dramatic and positive impact of our AIDS programs on 
individuals and communities throughout the world, especially in sub-
Saharan Africa. But it wasn't always this way.
  Now, 10 years ago, actually, when I first came to Congress, I think 
it was 10 years in April, the world really had not recognized the 
devastating toll that HIV and AIDS were beginning to take on families 
and communities throughout Africa. Since that time, however, we have 
worked together on a bipartisan basis on a number of very important 
legislative initiatives that have put the United States on the right 
side of history when it comes to this global pandemic.
  First, in 2000, we passed and President Clinton signed into law, H.R. 
3519, the Global AIDS and Tuberculosis Relief Act. Now this important 
bill was a vision inspired by an idea by our former colleague and our 
friend, former Congressman, now Mayor Ron Dellums of Oakland, 
California to establish an AIDS Marshall plan in Africa, for Africa, 
funded through a World Bank AIDS Trust Fund.
  With the help and leadership of our former colleague, Congressman Jim 
Leach of Iowa, we turned this idea into legislation which provided the 
founding contribution and the framework for what we know today as the 
Global Fund to Fight AIDS, Tuberculosis and Malaria.
  In 2001, working with both former Chairmen Hyde and Lantos, Mr. 
Berman, Mr. Payne, Ms. Ros-Lehtinen, Mr. Smith, we drafted H.R. 2069, 
which was called the Global Access to HIV/AIDS Prevention, Awareness, 
Education and Treatment Act. This was the first bill that dared to 
provide large scale antiretroviral therapy to people living in the 
developing world.
  Although we made progress in advancing this legislation through 
Congress in 2001 and 2002, we weren't able to reach a conference 
agreement with the Senate before the 107th Congress. Thankfully, 
however, our discussions would lay the foundation for quick action in 
the next Congress.
  So at the end of 2002, the Congressional Black Caucus, along with 
practically every advocacy group in the United States, sent a letter to 
President Bush urging him to set up and create a presidential 
initiative on AIDS especially for sub-Saharan Africa.
  In January of 2003, the President took up our cause, understanding 
the growing sense of urgency that had been building for years. His 
promise of $15 billion during his State of the Union address provided 
the impetus that we needed to pass H.R. 1298, the United States 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, 
which created PEPFAR.
  In 2005, we took yet another step forward when we recognized that our 
foreign assistance programs did not adequately address the needs of 
children orphaned or made vulnerable by AIDS. So, working again with 
former Chairman Hyde and Chairman Lantos, we passed, and the President 
signed H.R. 1409, the Assistance for Orphans and Vulnerable Children in 
Developing Countries Act.

[[Page 4794]]

  So, Madam Chairman, I lay out some of the history of our work on this 
important issue because it speaks volumes about what is possible when 
we come together in the spirit of bipartisan compromise as we honor the 
great legacy of both Chairman Lantos and Chairman Hyde through this 
legislation. Chairman Lantos, I know, very much wanted to reach a 
bipartisan compromise on this bill, as did Chairman Hyde. I'm saddened 
that both of them are not with us to witness this moment. But I know 
that they are very pleased with what we have put together today.
  The CHAIRMAN. The gentlewoman's time has expired.
  Ms. LEE. May I have an additional minute, please?
  Mr. BERMAN. I yield the gentlelady an additional 2 minutes.
  Ms. LEE. As a former member of the staff here on Capitol Hill for 11 
years, I have to mention some of our staff members' names particularly 
because they did a phenomenal job in this. Dr. Pearl Alice Marsh, of 
course, Kristin Wells, David Abramowitz, Peter Yeo, Bob King, Yleem 
Poblete, Mark Gage, Joan Condon, Heather Flynn, Sheri Rickert, Naomi 
Seiler, Jessica Boyer, and of course Christos Tsentas of my staff. 
These staff members and other members, they deserved, their work 
deserves really to be applauded because this was not just work as a 
professional on the Hill. This is part of their life's work and I have 
to thank them again for their diligence and their competence.
  This is a bipartisan compromise, so there were things that we had to 
give up and things that our colleagues on the other side of the aisle 
had to give up, but that's what compromise is all about.
  Let me just mention a few of the items that were included in this 
bill. Of course it included language taken from my bill, H.R. 1713, the 
PATHWAY Act, to strike the 33 percent abstinence-until-marriage and 
provide a comprehensive prevention strategy to address the needs of 
women and children.
  It also includes language taken from my bill, H.R. 3812, the African 
Health Capacity and Investment Act, to build health capacity by 
recruiting, training and retaining health professionals and strengthen 
health systems.
  Now, of course there's still some issues I think need to be addressed 
which aren't in this bill. I think we should eliminate the prostitution 
pledge, which violates the first amendment and poses an unnecessary 
barrier to organizations that work with sex workers.
  I think we need to recognize the public health benefits of linking 
our HIV and AIDS programs with family planning services by eliminating 
ideological restrictions imposed by the global gag rule.
  I think we need to end the unjust and discriminatory travel and 
immigration ban on people living with HIV and AIDS who wish to enter 
into the United States.
  So these are not impossible goals. In addition, we should fully fund 
the recruitment, training and retention programs for health 
professionals with a focus on training doctors and nurses to build 
health capacity and strengthen health care systems. So I hope that we 
can do this as we move forward.
  Let me again thank the chairman for his leadership in addressing the 
greatest humanitarian, national security and public health crisis of 
our time.
  Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield 5 minutes to 
the gentleman from Indiana, Congressman Pence, the ranking member on 
the Subcommittee on Middle East and South Asia, who spoke so eloquently 
during the committee markup on the need for this bill. 5 minutes.
  Mr. PENCE. I thank the ranking member for yielding.
  I rise in support of the Tom Lantos and Henry Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis and Malaria 
Reauthorization Act of 2008.
  The Bible tells us to whom much is given much is expected. And I 
believe the United States has a moral obligation to lead the world in 
confronting the pandemic of HIV/AIDS.
  The dimensions of this crisis are truly staggering. The HIV/AIDS 
pandemic has infected more than 60 million people worldwide. It has 
killed more than 25 million, a number which grows grievously every day 
by more than 8,500. HIV/AIDS has orphaned some 14 million children. And 
today, 70 percent of the people in the world with HIV/AIDS reside in 
Africa. Within that continent, there are entire countries where more 
than one-third of the adult population is infected.
  More startlingly, if current infection rates continue, new epicenters 
for the disease are likely to arise out of India, China, Eastern Europe 
with numbers that could surpass Africa in a few short years.
  And the threat this pandemic poses to our security is also real. Left 
unaddressed, this plague will continue to undermine the stability of 
nations throughout the two-thirds world, leaving behind collapsing 
economies and tragedy and desperation, a breeding ground for extremist 
violence. This is truly a global crisis. And because the United States 
can render timely assistance, I believe we must.
  Originally titled the President's Emergency Plan for AIDS Relief, 
PEPFAR put the world on notice that America will not ignore despair, 
desperation and disease. I am proud to have supported the original 
passage of PEPFAR in 2003, and I'm proud to support it today.
  You know, every so often, in this place, we have the opportunity to 
do something for humanity and serve the American people, and this is 
such a time.
  I thank Chairman Berman and Ranking Member Ros-Lehtinen for their 
strong leadership. I commend my colleague, Chris Smith in particular 
for his yeoman's work on carefully preserving the delicate balance of 
this legislation.
  And I also would like to publicly acknowledge the work of our 
President, George W. Bush. Mr. President, because of your moral 
leadership and compassion, Africa will never be the same, and history 
will record your work.
  This Global AIDS bill seeks to address the crisis, not by providing 
medicine and health care to those in need, but also by providing 
resources for evidence based programs that have been successful in 
preventing infection. It's imperative, I believe, that we not only send 
our resources, but we also send them in a manner that is consistent 
with our values. We cannot send billions of dollars to Africa without 
sending value-based safeguards and techniques that work to fight the 
spread of HIV/AIDS by changing behavior.
  Currently, within the Global AIDS bill, these pivotal provisions 
exist in the form of a requirement to ``provide balanced funding for 
prevention activities'' and to ensure that abstinence and faithfulness 
programs are ``implemented and funded in a meaningful and equitable 
way.''
  It was essential that we preserve these prevention methods that focus 
on behavioral change, that we work with faith-based and nongovernmental 
organizations at the local level, particularly through the ABC model 
that has produced such undeniable results.
  Also, it was absolutely critical that we administer this foreign aid 
under the historic pro-life guidelines that prevent our foreign aid 
from going in a direction that's antithetical to the values of millions 
of Americans. I'm pleased to say the Lantos/Hyde Global AIDS bill 
preserves all of these vital pro-family provisions.
  As we tend to the suffering though, we always have to figure out how 
we're going to pay for it. The Federal budget, I believe, is packed 
with wasteful and bloated programs which could supply more than enough 
opportunities to cover the costs of the Lantos/Hyde Global AIDS bill.

                              {time}  1330

  This summer, Madam Chairman, when it comes time to fund this program 
during the appropriations process, I believe Congress should make the 
hard choices necessary to ensure that this global health crisis does 
not become a crisis of debt for our children and grandchildren. I 
believe it is possible to be responsible to our fiscal

[[Page 4795]]

constraints while being obedient to our moral calling.
  The greatest of all human rights is the right to live. America is a 
Nation of great wealth, wealth of resources, but more importantly, a 
wealth of compassion. The history of the world is filled with telling 
moments regarding the character of a people. Sometimes we are witness 
to mankind's great inhumanities; other times, we marvel at the beauty 
of mankind's selfless acts of compassion when we rise above politics 
and raise up those in dire need. Let this be such a day.
  I urge my colleagues to support the Lantos/Hyde Global AIDS bill and 
its carefully crafted bipartisan compromise.
  Mr. BERMAN. Madam Chairman, I am pleased to yield 1 liberal minute to 
the majority leader, the gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. Thank you, Mr. Chairman. Congratulations to the chairman 
of the committee. He is an extraordinary individual whom I have known 
for four decades. He will do an excellent job. We lament the loss, 
however, of the two individuals for whom this bill is named.
  I want to congratulate my good friend, Ileana Ros-Lehtinen, as well 
for her leadership, and I want to associate myself generally with the 
remarks of the previous speaker. And I think it is emblematic of the 
partnership that we have, not only with the administration, but on both 
sides of the aisle as it relates to this moral, as well as health, 
issue, and I thank the gentleman for his comments.
  Madam Chairman, 5 years ago, the United States made an unprecedented 
commitment to the people of the world who suffer from HIV and AIDS, 
malaria, tuberculosis, and other diseases. We pledged $15 billion, and 
with that funding, we have provided life-saving drugs to almost a 
million and a half people. We facilitated care for over 2 million 
orphans and vulnerable children and provided mother-to-child 
transmission prevention services during more than 6 million 
pregnancies.
  We have played a very real role in helping to transform HIV from a 
death sentence to a manageable disease.
  And, Madam Chairman, as I said 5 years ago when we first passed this 
legislation, we must recognize that our Nation and each one of us has a 
moral obligation and a national security interest, as has been spoken 
of, in combating the HIV/AIDS pandemic, as well as malaria and 
tuberculosis.
  Today, with this legislation, the Tom Lantos and Henry J. Hyde Global 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization 
Act, we build on and increase our commitment to stop the spread of HIV/
AIDS.
  Through this legislation, we make a $50 billion contribution to the 
fight to eradicate HIV/AIDS, malaria and tuberculosis. In addition to 
expanding our prior efforts, this carefully negotiated legislation will 
strengthen HIV-related healthcare delivery systems and increase health 
workforce capacities; foster stronger relationships between HIV/AIDS 
initiatives and other support programs, including those that promote 
better nutrition and education; allow HIV/AIDS testing and counseling 
to be provided in the United States bilateral family planning programs, 
and it finances prevention and treatment programs targeting women and 
girls.
  This bill, Madam Chairman, also eliminates an ineffective 
requirement: that one-third of PEPFAR prevention funds be spent on 
abstinence. Instead, we have directed the administration to create a 
balanced approach requiring behavioral change programs to receive 50 
percent of the funds devoted to the prevention of sexual transmission 
of HIV, and in addition, we require the administration to report to 
Congress if programs in nations where the epidemic has become 
generalized do not adhere to this balanced approach. This legislation 
represents both commitment and compromise.
  It will not make everyone happy, but it does signal to the 
international community that the United States recognizes and accepts 
our moral obligation to act.
  Last year alone, 2.5 million people contracted HIV, roughly 6,800 
people per day. Last year alone, 2.1 million people died of HIV. Global 
AIDS is a problem too large to fall prey to political sport.
  My very good friend, the late Chairman Lantos, noted 5 years ago that 
this health care crisis ruins families, communities, and indeed, whole 
nations, fueling violence and bloodshed across borders. And thus, it is 
a global challenge that demands a global humanitarian response with the 
United States in the lead.
  Madam Chairman, this is a very good bill. It builds on proven 
outcomes, and it deserves the support of the Members on both sides of 
the aisle.
  And again, I congratulate Chairman Berman and Ranking Member Ros-
Lehtinen on their leadership on this effort.
  Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield such time as 
he may consume to the gentleman from New Jersey (Mr. Smith) for the 
purpose of engaging in a colloquy with our chairman, Mr. Berman of 
California.
  Mr. SMITH of New Jersey. I thank my good friend for yielding.
  Madam Chairman, I would like to engage in a colloquy with my friend 
and colleague, the chairman of the Foreign Affairs Committee, Mr. 
Berman.
  I would note there are two versions of the committee report for H.R. 
5501 designated as part 1 and part 2. I wish to clarify that the 
definitive version that applies for purposes of the legislative history 
of this bill is part 2.
  Is that the understanding of the chairman?
  Mr. BERMAN. I appreciate the gentleman yielding, and the gentleman is 
absolutely correct. Part 2 of the report is the definitive report on 
the legislation being considered by the House today.
  Mr. SMITH of New Jersey. I thank the Chair for that clarification.
  Mr. BERMAN. Madam Chairman, I am pleased to yield 2 minutes to my 
colleague from California (Ms. Woolsey), the chairman of the Education 
and Labor Subcommittee on Workforce Protections and a member of the 
Foreign Affairs Committee.
  Ms. WOOLSEY. Madam Chairman, I rise today in strong support of 5501 
and to congratulate our new chairman of the International Relations 
Committee and to thank our chairman and to thank our Ranking Member 
Ros-Lehtinen, and particularly congratulate the chairman of the Africa 
and Global Health Care Subcommittee for writing a bill that clearly 
reaffirms Congress' commitment to healthy communities, this time with 
the focus overseas.
  As a member of the subcommittee, I'm especially pleased that this 
bill supports maternal health, orphans, and vulnerable children. Today, 
in Africa and throughout the world, children are losing their parents 
to the AIDS epidemic. These same kids will grow up too soon. They will 
be forced to become caregivers to their own siblings, leaving school, 
joining the underage workforce, praying that they are not the next in 
line for the graveyard.
  In a world as prosperous as our own, Madam Chairman, it is absolutely 
unacceptable that this could be happening anywhere. But this bill 
actually continues our promise to rid the planet of this plague. This 
bill offers real hope. We invest in treatment, but most importantly, it 
works towards prevention.
  Like many of my colleagues, I'm disappointed that conservative forces 
pushed to reduce the Reproductive Health Initiative, but the overall 
result will actually be remarkable. And most importantly, it will be 
life saving.
  I encourage all of my colleagues to vote for H.R. 5501 to make this a 
better place to live in worldwide.
  Mr. PAYNE. I recognize the gentleman from Missouri (Mr. Carnahan) for 
2 minutes.
  Mr. CARNAHAN. Madam Chairman, I am proud to rise in support of H.R. 
5501, properly named after our former Chairmen Lantos and Hyde, both of 
whom I had the honor to serve under on the Foreign Affairs Committee.
  I also want to thank President Bush for reaffirming his commitment to 
Africa in his State of the Union but also

[[Page 4796]]

to being open to improvements in how we deliver our support in Africa.
  I want to also add my thanks to Chairman Berman and Ranking Member 
Ros-Lehtinen for their leadership in bringing this to the floor, but 
especially to Chairman Berman for his great instincts to reach out and 
craft an achievable and better bill in this Congress in this way.
  Today, we have an opportunity to improve the way the U.S. funds and 
administers these HIV/AIDS, TB and malaria programs around the world. I 
believe that it is important to make real changes and real progress in 
reauthorizing this vital life-saving program.
  In February, I had the opportunity to travel to Ethiopia and study 
and investigate the effectiveness of many of these programs. The 
positive effect that PEPFAR has had over the last several years is 
quite obvious: countless lives have been saved and numerous infections 
have been prevented.
  I visited health clinics in rural Ethiopia, including PMTCT, family 
planning, and government-supported clinics. This bill makes important 
steps to not just increase funding but to have a more balanced approach 
to integrate prevention programs.
  While I would have liked to have seen even greater integration in 
these programs with family planning and prevention programs, I'm 
pleased with the steps the bill does take and steps that are being 
taken in a bipartisan way that can help this be done sooner.
  Mr. PAYNE. We will now have the gentleman from New York (Mr. Crowley) 
for 2 minutes, a member of the Foreign Affairs Committee.
  Mr. CROWLEY. Madam Chairman, I rise in support of the bipartisan 
agreement that will reauthorize PEPFAR for an additional 5 years. I 
want to thank both the Chair of the committee, Howard Berman, the new 
and very capable chair of the committee, Howard Berman, as well as my 
long-time friend, the ranking member, Ms. Ros-Lehtinen, for their 
crafting of the legislation and in naming it the Tom Lantos/Henry Hyde 
United States Global Leadership Against HIV/AIDS, Tuberculosis and 
Malaria, the Reauthorization Act of 2008. And in so doing, I think it 
enhances the legacy of both of these fine gentlemen.
  Let me say from the start, I support the strong program and will urge 
my colleagues to do the same. The first 5 years of PEPFAR have provided 
unprecedented prevention, care, and treatment of HIV/AIDS for millions 
around the world. By passing this bill we can, and we will, do more.
  Through PEPFAR, the United States has spearheaded the global fight 
against HIV/AIDS by supporting services to prevent mother-to-child HIV 
transmission. These services have helped women during more than 10 
million pregnancies and led to the prevention of more than 150,000 
infant infections. It has supported life-saving treatment for almost 
1.5 million men, women, and children. In the focus countries, over 60 
percent of those receiving treatment are women and girls.
  It is my honor to say that I have supported this program when it was 
first introduced before this body, and I worked to ensure that PEPFAR 
was as effective and as efficient as possible. An example of this 
bipartisan effort was the inclusion of language, which I championed, to 
emphasize education on gender equality and respect for women and girls. 
The reauthorization act strengthens these provisions by calling for the 
empowerment of women and youth and by promoting changes in male 
behavior and attitudes that respect the human rights of women and youth 
and that support and foster gender equity.

                              {time}  1345

  However, let me be equally clear, this bill could do so much more and 
could prevent many more infections if it improved a critical 
partnership with these programs in the fields that have served women 
and their families for over four decades, and that is in the field of 
family planning providers.
  The CHAIRMAN. The gentleman's time has expired.
  Mr. PAYNE. Madam Chairman, I yield an additional minute to the 
gentleman from New York.
  Mr. CROWLEY. Madam Chairman, the House version of the U.S. Global 
AIDS Act contains language suggesting that only family planning 
programs compliant with the global gag rule will be eligible to receive 
PEPFAR funds to provide HIV education, counseling, and testing. I 
believe that this would be a new restriction. No such requirement 
exists in current law or policy. And I believe if we are serious about 
preventing the most new infections, we need to put aside our political 
differences on the merits of the global gag rule and ensure that the 
very best in the field have the support of the U.S. to do what they 
need to do, and that is prevent the spreading of HIV/AIDS.
  Mr. PAYNE. Madam Chairman, I yield 3 minutes to the gentleman from 
the Ways and Means Committee, from the State of Washington (Mr. 
McDermott).
  Mr. McDERMOTT. Madam Chairman, we know what needs to be done. The 
PEPFAR reauthorization bill is it, and we're doing it.
  This bipartisan bill not only reauthorizes PEPFAR but also 
dramatically strengthens the programs. H.R. 5501 elevates the fight 
against HIV/AIDS, TB, and malaria from an emergency to sustainability. 
In so doing, we declare that HIV is no longer the death sentence that 
it was only 5 short years ago. We can hope and strive for a generation 
free of HIV and AIDS.
  I want to thank the chairman and the subcommittee chairman for 
including provisions in the legislation that Representative Granger and 
I introduced, which strengthens the prevention of mother-to-child 
transmission of HIV. We must ensure that women and children have access 
to early screening and lifesaving drug therapies. We can do this by 
providing greater training and education on effective prevention. We 
also must ensure that they integrate these services with other maternal 
health efforts.
  Every day more than 1,000 children around the world are infected with 
HIV. An estimated 90 percent of those infections occur in Africa. But a 
single dose of an antiretroviral drug given once to the mother at the 
onset of labor and once to the newborn during the first 3 days of life 
reduces transmission by 50 percent. Fewer than 10 percent of pregnant 
women with HIV in resource-poor countries have access to these 
prevention services. But I'm proud that this bill includes prevention 
provisions to strengthen our commitment to prevention and save lives in 
the process.
  Perhaps the most important provisions are those that recognize the 
importance of expanding access to screening and treatment of women and 
children. H.R. 5501 also provides my provisions to establish two 5-year 
targets that will bring us closer to a generation free of HIV/AIDS.
  The first goal is to increase the percentage of children receiving 
treatment under PEPFAR from 9 to 15 percent. Treatment allows the 
greatest hope for giving a child infected with HIV the chance to an 
adulthood free of the disease.
  The second goal is for 80 percent of pregnant women in the most 
affected countries to receive HIV counseling and testing and, where 
necessary, antiretroviral treatment to prevent mother-to-child 
transmission.
  The biggest limitation on reaching these goals is the availability of 
trained personnel. This bill sets a goal of 140,000 people to be 
trained by 2015. In South Africa, where my wife is working on the 
ground in this epidemic, they are closing pediatric hospitals because 
there's no pediatrician to run them. Now, the 80 percent goal is a down 
payment on our hope of achieving 100 percent by the time this 
authorization expires.
  We have a chance today to send a message that America cares enough to 
lead the world in fighting these deadly diseases. We should speak loud 
and clearly. The legislation gives more people the chance to be 
survivors instead of statistics.
  I urge my colleagues to support this important bill that strengthens 
our commitment to fighting the global HIV/AIDS/TB and malaria epidemic.
  Mr. PAYNE. Madam Chairman, it is my pleasure to yield to a member of

[[Page 4797]]

the Foreign Affairs Committee, the gentleman from Florida (Mr. Klein) 
for 2 minutes.
  Mr. KLEIN of Florida. Madam Chairman, I rise today in strong support 
of the Tom Lantos and Henry J. Hyde Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act.
  This legislation represents the best in bipartisan compromise, and it 
demonstrates that, despite what divides us from time to time as 
Republicans and Democrats, we can and do come together to tackle issues 
that matter most. And the global HIV/AIDS crisis matters deeply to all 
of us. Some 40 million people around the world are living with this 
disease. We have a moral imperative to act and to act decisively.
  Just 5 years ago, an HIV diagnosis for a poor villager in Africa was 
a death sentence. Thanks to lifesaving drugs provided by the American 
people, this is no longer the case. The global AIDS program works, and 
it works because it is an initiative not of one political party or 
another. It is truly a compassionate statement by the American people, 
and I am very proud to support its reauthorization and urge my 
colleagues to do the same.
  Mr. PAYNE. Madam Chairman, I yield to the vice chairperson of the 
Subcommittee on Africa, a member, of course, of the Foreign Affairs 
Committee, the gentlewoman from California (Ms. Watson) for 2 minutes.
  Ms. WATSON. Madam Chairman, I just returned from South Africa, and I 
did a single codel visiting the various clinics and hospices that are 
receiving PEPFAR funds. And I happily report that the small donations 
they do receive are stretched beyond imagination. They are finally 
realizing that the NGOs have really made great strides.
  About 4 years ago, when we went offering them assistance and so on, 
most of our help was rejected. But I want you to know that one clinic, 
which is a hospice, gets $70,000 a year. And what they do is reach out 
to the NGOs in the area. There are volunteers from America there. They 
run an excellent facility, and you can see gradual progress.
  I was told by our appointed ambassador that he was going to reduce 
the amount of donation by $50 million, and I cautioned him because that 
would be the wrong message to send for the small successes they have 
had and that what we can do is say to the government there that we will 
cap it at a certain amount and then you need to also kick in.
  So I want to report to our committee and to Mr. Payne, the Chair, 
that the funds are working. They're improving our image, and they're 
helping to save lives in South Africa.
  Thank you so much, Mr. Payne.
  Mr. PAYNE. Madam Chairman, I thank Representative Watson for her kind 
remarks.
  Madam Chairman, at this time I would like to yield 3 minutes to the 
gentlewoman from Texas, a member of the Foreign Affairs Committee and 
Africa Subcommittee (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Madam Chairman, there's a terminology that 
we use to describe joyous occasions. Sometimes it describes freedom. 
The Fisk Singers in Tennessee were called the Jubilee Singers, and it 
was because they organized around slavery and after slavery and the 
ability to be free with jubilation, and, therefore, they were called 
the Jubilee Singers.
  I think today is a day of jubilation, and it certainly is a time to 
express the jubilation that we feel with the passage, or the intended 
passage, of this legislation.
  Let me thank the chairman of the subcommittee, Mr. Payne, for 
persistence and determination and wisdom. Let me also acknowledge his 
ranking member, Mr. Smith; and, of course, our chairman, Mr. Berman; 
and the ranking member of the full committee, Ms. Ileana Ros-Lehtinen 
for working with us.
  But I do want to spend some time acknowledging that we have named 
this bill after the late former Chairman Tom Lantos and Henry J. Hyde. 
That is a jubilation. It is something to express great excitement about 
because these two distinct figures, in many instances with common views 
but many instances different views, came together around this 
lifesaving legislation, Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria. And it is particularly important because we 
have added malaria and tuberculosis as an element that is not a partner 
but results thereof and/or stands alone, but all of them kill.
  I am reminded of the first mission to Zimbabwe, to Zambia, and to 
South Africa, where we went on a Presidential mission, three Members of 
Congress, to look closely at the devastation of HIV/AIDS. It was in 
1996/1997. And it was there that I saw a 4 year old taking care of a 
dying grandparent, the last person surviving who had tuberculosis and 
HIV/AIDS. So this legislation is crucial, and it is particularly 
crucial because it recognizes the devastation of all of them.
  It is likewise crucial because we have not won the war. The 
jubilation is that the bill is on the floor, but we have not won this 
war. And I might also say that we have not won the war in education, 
the ability to prevent all of these diseases.
  So let me ask my colleagues to support this legislation.
  Madam Speaker, I rise today in strong support of H.R. 5501, The 
Global HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. 
I believe that the legislation we are considering today makes vital 
improvements to what is already a groundbreaking program. I would like 
to thank Chairman Berman for his ongoing leadership on this issue, and 
for bringing this legislation to the floor today. I would also like to 
thank the Committee's Ranking Member, Congresswoman Ros-Lehtinen, and 
my colleagues across the aisle, for working toward a compromise, to 
develop legislation of which we can all be proud. Today's legislation 
is a crucial step toward transforming PEPFAR from an emergency response 
to a sustainable program.
  I would also like to thank both Chairman Berman and the Chairman of 
the Subcommittee on African and Global Health, Congressman Payne, for 
working with me to include important language in this legislation. My 
language, in Section 301 of this bill, addresses the necessity of 
making children a priority among individuals with HIV for proper food 
and nutritional support. Section 301, with my language included, states 
that it is the sense of Congress that ``for the purposes of determining 
which individuals infected with HIV should be provided with nutrition 
and food support--
  (i) children with moderate or severe malnutrition, according to WHO 
standards, shall be given priority for such nutrition and food support; 
and
  (ii) adults with a body mass index, BMI of 18.5 or less, or at the 
prevailing WHO-approved measurement for BMI, should be considered 
`malnourished' and should be given priority for such nutrition and food 
support;''
  Madam Chairman, as Chair of the Congressional Children's Caucus, I 
believe that this language is crucial, and I thank the Chairman for 
including it in the text of the bill. HIV-infected children have been 
underrepresented among beneficiaries of PEPFAR-supported programs. As 
this legislation cites in the findings section, ``of those infected 
with HIV, 2.5 million are children under 15 who also account for 
460,000 of the newly-infected individuals.'' And even these large 
numbers are deceiving, as children die much quicker from AIDS than do 
adults. UNICEF reports that every minute, a child dies from an AIDS-
related illness, and only 1 child in 20 who needs HIV treatment 
receives it. I am pleased to see this language, which focuses attention 
on the plight of these children, and makes serving their needs a 
priority.
  I am particularly pleased to support an amendment offered by my 
colleague Congressman Carson. Representative Carson's amendment would 
direct the Coordinator of United States Government Activities to Combat 
HIV/AIDS Globally and the Administrator of the United States Agency for 
International Development to expand their plan for strengthening health 
systems of host countries by allowing for postsecondary educational 
institutions, particularly in Africa, to collaborate with United States 
postsecondary educational institutions and specifically historically 
black colleges and universities. I believe that such educational 
exchanges would be extremely beneficial for students both in our own 
Nation and in developing nations. I urge my colleagues to join me in 
supporting this amendment.
  In addition, I am also pleased to support the amendment offered by my 
colleague Congressman Blumenauer. This amendment adds safe drinking 
water to nutrition and income security on the list of programs for

[[Page 4798]]

which direct linkages are encouraged. People with HIV/AIDS are at 
increased risk for diarrheal diseases, and these illnesses leave HIV-
infected patients with a reduced ability to absorb antiretroviral and 
other medications. The availability of safe drinking water must be part 
of any sustainable strategy of HIV prevention and treatment.
  As this House is aware, it is estimated that HIV/AIDS, tuberculosis, 
TB, and malaria together kill more than 6 million people each year. In 
January 2003, President Bush announced the President's Emergency Plan 
for AIDS Relief, or PEPFAR. As its name implies, PEPFAR was envisioned 
as an emergency response; the bill before us today represents a crucial 
first step in the process of transitioning to a sustainable program to 
address these global epidemics.
  Seventeen years after the first cases were diagnosed, AIDS remains 
the most relentless and indiscriminate killer of our time, with 39.5 
million people worldwide now living with HIV or AIDS. Despite pouring 
billions and billions of private and Federal dollars into drug research 
and development to treat and ``manage'' infections, HIV strains persist 
as a global health threat by virtue of their complex life cycle and 
mutation rates. Of those infected, 24.7 million, or about 63 percent, 
live in Sub-Saharan Africa, a region with just 11 percent of the 
world's population. 61 percent of those infected in this region are 
women. Though Africa, and even more specifically African women, bears 
the brunt of the AIDS pandemic, Americans should be reminded that HIV/
AIDS does not discriminate, with well over a million people in our own 
country currently living with HIV or AIDS.
  Tragically, 6 percent of the 39.5 million people currently infected 
with HIV/AIDS are children under 15 years of age. In 2006, the virus 
killed 380,000 children (13 percent of all HIV/AIDS deaths), and 90 
percent of all children living with HIV reside in sub-Saharan Africa. 
According to UNAIDS statistics from 2005, 1,500 children worldwide 
became newly infected with HIV every single day, due largely to 
inadequate access to drugs that prevent the transmission of HIV from 
mother to child. Only 8 percent of pregnant women in low- and middle-
income countries were offered services to prevent HIV transmission to 
their newborns.
  Madam Chairman, HIV/AIDS continues to represent a serious and large-
scale challenge throughout much of the world. It goes far beyond a 
simple health problem, and it hinders attempts to foster economic 
development and political stability. As we reauthorize PEPFAR, I 
believe it is crucial that we emphasize the long-term sustainability of 
our HIV efforts, and that we integrate AIDS prevention and treatment 
within our larger-scale development initiatives. I believe that the 
legislation before us today makes groundbreaking strides toward moving 
the Global HIV/AIDS program beyond emergency implementation and toward 
sustainability. It dramatically boosts HIV/AIDS programming related to 
women and girls, strengthens health systems in countries hardest-hit by 
the HIV virus, increases U.S. contributions to the Global Fund, and 
authorizes HIV/AIDS programs to include linkages to food, nutrition, 
education, and health care programs.
  Though we have drugs that are effective in managing infections and 
reducing mortality by slowing the progression to AIDS in an individual, 
they do little to reduce disease prevalence and prevent new infections. 
For this reason, there is growing consensus among health experts that 
we must put greater emphasis on comprehensive prevention programs, 
which are perhaps the most critical aspect of any initiative to combat 
global HIV/AIDS. Even as increasing numbers of people have access to 
anti-retroviral drugs, ARVs, an estimated 5.1 million people who needed 
treatment did not receive it in 2006. In sub-Saharan Africa, the 
percentage of individuals needing treatment who actually received it 
rose substantially, from 2 percent in 2003 to 28 percent in 2006. This 
growth is impressive, and represents a significant step forward, but it 
also means that 72 percent of sub-Saharan Africans requiring treatment 
did not receive it.
  Madam Chairman, despite our concerted efforts, we continue to face a 
serious and persistent health threat. I believe that it is imperative 
that we ensure that American taxpayer dollars are used to greatest 
effect, not to bolster ideology. This legislation makes important 
strides forward by removing elements of the original authorization that 
speak more to ideology than actual conditions in the field. Under the 
current law, one-third of all prevention funds under PEPFAR must be 
used on abstinence-only education, which neglects the real needs of 
populations both in America and abroad. These stipulations hurt the 
ability of PEPFAR to adapt its activities in accordance with local HIV 
transmission patterns, and they impair efforts to coordinate with 
national health plans. Though AIDS is clearly a global problem, it does 
not affect every nation equally or in the same manner.
  Madam Chairman, I am extremely pleased that the legislation we are 
considering today removes these restrictive provisions, allowing PEPFAR 
to better address the requirements of each country, making more 
efficient and effective use of taxpayer dollars in serving the millions 
affected by this disease. According to studies by both the Government 
Accountability Office and the National Academy of Science's Institute 
of Medicine, the abstinence-only earmark has forced a reduction in 
mother-to-child transmission programs, reduced prevention efforts with 
high-risk groups, and undermined efforts to implement Abstinence, 
Faithfulness, and Condoms, ABC, prevention programs.
  Under the provisions of today's compromise legislation, the 
administration will be directed to promote a ``balanced'' prevention 
program in target countries. This will include all elements of the ABC 
approach to HIV prevention. The legislation will require that the 
administration report to Congress if behavioral change programs do not 
receive 50 percent of funds devoted to the prevention of sexual 
transmission of HIV in countries in which there is a generalized 
epidemic. I believe this language is extremely important, as it not 
only recognizes that HIV is transmitted in other ways, besides sexual 
activity, but it also acknowledges that the epidemic is not the same in 
every country. By requiring a report, rather than earmarking the 
expenditure of funds, this legislation provides guidance while still 
affording organizations working in the field the flexibility to respond 
to nuanced circumstances.
  I am proud to be part of this Democratic Congress, which will produce 
legislation reauthorizing a Global HIV/AIDS program driven by facts, 
rather than ideology. The removal of the abstinence-only earmark will 
make this reauthorization legislation stronger than the original 2003 
legislation that it will replace, and I strongly urge my colleagues to 
oppose any efforts that might attempt to reinstate it.
  In addition, I believe it is crucial that we dedicate greater 
attention to strengthening local health infrastructure. Health experts 
have expressed concern that the high amount of spending directed toward 
HIV/AIDS initiatives has drawn health workers away from public health 
facilities and other important programs. This merely compounds a 
chronic shortage of qualified health workers, which, according to WHO's 
2006 World Health Report, is the single most important health issue 
facing countries today. This need is felt particularly sharply in 
Southeast Asia and sub-Saharan Africa.
  Many health experts also continue to advocate greater integration 
between PEPFAR and other health programs, including those focused on 
nutrition, maternal and child heath, and other infectious diseases. 
These experts note that HIV is intricately linked to these other areas 
of concern; for example, malnutrition and lack of food may heighten 
exposure to HIV, raise the likelihood of engaging in risky behavior, 
increase susceptibility to infection, and complicate efforts to provide 
anti-retroviral, ARV, medication. Further, an HIV epidemic will likely 
worsen food insecurity, by depleting the agricultural workforce. I 
believe it is necessary, to ensure maximum effectiveness, that we 
integrate PEPFAR with other aspects of our international health 
outreach and development programs. The legislation before us today does 
that.
  Madam Chairman, while I recognize the importance of compromise, and I 
am glad we were able to reach an accord with our colleagues on the 
other side of the aisle, I am disappointed that the compromise text 
does not include a repeal of the language, known as the pledge 
requirement, requiring that all funding recipients to ``have a policy 
explicitly opposing prostitution and sex trafficking.''
  Madam Chairman, the removal of the prostitution pledge was a critical 
facet of the bill we are considering today. The pledge currently 
restricts recipients' privately funded HIV prevention programs. No 
funds may be used to provide assistance to any group or organization 
that does not have a policy explicitly opposing prostitution and sex 
trafficking. Funding recipients must refrain from speech or conduct 
that is inconsistent with the Government's views on prostitution, even 
when they use private funds. Organizations must refrain from some 
effective HIV prevention strategies, for fear that the Government will 
view it as ``pro-prostitution.'' A repeal of the prostitution pledge 
language would leave in place language ensuring that U.S. Government 
funds may not be used to ``promote or advocate the legalization or 
practice of prostitution and sex trafficking.''
  Madam Chairman, the prostitution pledge undermines prevention efforts 
targeting one of the populations most vulnerable to HIV transmission. 
Because high-risk populations such as sex workers are extremely 
marginalized, it

[[Page 4799]]

is crucial that any intervention promotes a level of trust between sex 
workers and service providers. Failure to provide sex workers with 
information and services that will help them protect themselves and 
their partners from HIV transmission and other sexually-transmitted 
diseases also puts the broader community at risk. I am disappointed 
that this legislation does not remove this vague and counterproductive 
requirement.
  This legislation also contains crucial provisions with regards to 
malaria and tuberculosis prevention and treatment. It incorporates H.R. 
1567, the Stop Tuberculosis, TB, Now Act of 2007 sponsored by 
Congressman Engel, important legislation which I am proud to cosponsor. 
Today's legislation emphasizes the linkages between HIV/AIDS and TB, 
and it also creates new strategies for attacking MDR and XDR forms of 
drug-resistant TB. The bill also requires the President to develop a 
comprehensive 5-year strategy to combat malaria globally and strengthen 
United States leadership against this disease, and creates a new 
Coordinator of United States Government Activities to Combat Malaria 
Globally.
  If we are to turn the tide of turmoil and tragedy that HIV/AIDS, 
malaria, and tuberculosis cause to millions around the world, and 
hundreds of thousands right here in our backyard, it is imperative that 
we continue to fund and expand medical research and education and 
outreach programs. However, the only cure we currently have for HIV/
AIDS is prevention. While we must continue efforts to develop advanced 
treatment options, it is crucial that those efforts are accompanied by 
dramatic increases in public health education and prevention measures. 
Investments in education, research and outreach programs continue to be 
a crucial part of tackling and eliminating this devastating disease.
  As Americans, we have a strong history, through science and 
innovation, of detecting, conquering and defeating many illnesses. We 
must and we will continue to fight HIV/AIDS until the battle is won.
  Ms. ROS-LEHTINEN. Madam Chairman, at this time I am pleased to yield 
1 minute to my colleague, my friend from California (Mr. Rohrabacher), 
who is the ranking member of the Subcommittee on International 
Organizations, Human Rights, and Oversight.
  Mr. ROHRABACHER. Madam Chairman, I rise in strong opposition to 
sending $50 billion, $50 billion taken from the American people, to 
Africa to fight AIDS.
  When it comes to this situation with AIDS in Africa, obviously, we 
have some people in crisis who are very deserving people. But where 
does that $50 billion come from? Are we going to be helping people 
overseas at the expense of the well-being of our own people?
  There are only three ways of getting the money: We can take it from 
domestic programs, take it from those programs to help our own elderly 
and the health care for our own people, our own veterans; or we can 
raise taxes, which would knock the legs out from under our economy and 
make our deficit even higher; or we can borrow the money. And if we 
borrow the money, we end up spending hundreds of millions of dollars a 
year on interest. We're going to borrow $50 billion in order to help 
people overseas and then end up paying interest on it for the next 
umpteen years? This is benevolence gone wild.
  Yes, we would like to help everybody in the world. But if we vote for 
this, it's the most irresponsible measure that I have ever seen in my 
term here in Congress for 20 years. We are taking directly from our 
veterans, from our elderly, and others to give $50 billion to Africa.
  The CHAIRMAN. The gentleman's time has expired.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield the gentleman an additional 
30 seconds.
  Mr. ROHRABACHER. Thank you very much.
  Thus what we have to decided to is, are we going to deprive our own 
people, our seniors? I just came from a meeting with doctors from my 
district. We can't afford to provide health care for our seniors, for 
our veterans. We can't afford all the educational things we want to do. 
How can we possibly, then, take $50 billion and send it to Africa, even 
though it's a worthy cause?
  We should not be doing this. It is not in the interests of the 
American people. And I would call on my colleagues to oppose this 
totally wasteful expenditure of money.

                              {time}  1400

  Mr. PAYNE. It is my pleasure to recognize the Speaker of the House 
for 1 minute, the gentlewoman from California, Speaker Pelosi.
  Ms. PELOSI. I thank the gentleman for yielding, and recognize his 
extraordinary leadership on issues that relate to the alleviation of 
poverty and eradication of disease, which really are a national 
security interest for our country. They are about the health and well-
being, the respect we command throughout the world.
  I want to commend Chairman Berman. I think this is probably the first 
piece of legislation to come out of the committee under your leadership 
as chairman, and Congresswoman Ileana Ros-Lehtinen, the ranking member 
of the committee, for their leadership in bringing a bipartisan, strong 
initiative to the floor. This initiative is a continuation of the work 
that President Bush has as a priority in the eradication of AIDS, 
malaria, and tuberculosis.
  For those of us who have been involved in these issues over the 
years, whether on the committees of authorization, and Congresswoman 
Barbara Lee has been on the authorizing committee, and now on the 
appropriating committee; Congresswoman Waters, in many ways in the 
House; and you, Madam Chairman, all of us know that for our country to 
be healthy, for the eradication of these diseases to take place, we 
must have a global approach to it. Disease knows no borders and 
boundaries. So, again, while it is the compassionate thing to do, it is 
in our self-interest to do as well.
  The distinguished chair, Congresswoman Eleanor Holmes Norton, and I, 
and others, just had the opportunity to visit a PEPFAR site in India at 
the Salvation Army, where they were distributing these drugs through a 
regimen, an organized regimen related to hygiene and the rest to people 
with HIV and AIDS. We can tell you from firsthand experience; I visited 
these sites in South Africa, this trip was to India, that wherever we 
go, there is great appreciation for what our country is doing, and 
President Bush's leadership on this subject.
  I am so pleased that the bill is named for Congressman Chairman 
Lantos, our friend who left us earlier this year, and Congressman Hyde 
before that, because they were the original authors of the first 
historic President's emergency plan for AIDS relief legislation in 
2003. That landmark bill authorized $15 billion for 5 years. Working 
together with the Bush administration and Appropriations Committee, we 
succeeded in providing lifesaving antiretroviral treatment to almost 
1.5 million people, supporting care for nearly 6.7 million people, 
including more than 2.7 million orphans and vulnerable children; and 
supporting prevention of more than 150,000 infected infants. We are 
talking about AIDS, malaria, and tuberculosis. Now we must take the 
next step in fighting AIDS in the poorest countries of the world. The 
legislation before us will move us from the emergency phase to the 
sustainability phase in fighting AIDS, tuberculosis, and malaria.
  My colleagues have presented the provisions of the bill to you, so I 
will just submit mine for the Record, Madam Chairman, and just say in 
closing that the leadership against HIV/AIDS is our compact with 
developing nations across the globe. It says that America stands with 
them in this fight, that our commitment will not waver, and shows them 
America's true face of passion.
  Since the AIDS epidemic began, 20 million men, women, and children 
have died from the disease. Twenty million. Forty million around the 
globe are HIV positive. That is what we know. We don't even know of 
those who have not come forth to be tested. Each and every day, another 
6,000 people become infected with HIV. In addition, the number of 
orphans, vulnerable children with sick parents and adolescents at risk 
with HIV continues to grow, with an estimated 19 million needing 
assistance by 2010.
  There is a moral imperative to combat this epidemic. If we have these 
drugs distributed in the manner in which they are under the President's

[[Page 4800]]

program, this PEPFAR, then people will come forward to be tested, then 
we will have better success with our prevention initiatives. So it's 
all related. Care causes people to say there is a reason to be tested, 
and knowing the consequences of the disease contributes to the 
prevention effort.
  Few crises have called out for more sustained constructive American 
leadership. This legislation before us makes that commitment. I urge 
our colleagues to support it. Once again, I salute you, Mr. Payne, for 
your leadership in so many ways that relate to, again, the eradication 
of disease and the alleviation of poverty and the strength of America 
related to that and how we are viewed in the world and how that all 
contributes to a healthier America.
  All of these, if we don't, we will have a fury of despair that 
springs from a lack of hope in the world that contributes to violence 
and, again, takes us back to the security of our country. So for that 
security, and out of compassion, I urge my colleagues to support this 
initiative, which is President's Bush's initiative, named for our 
colleagues, Mr. Lantos and Mr. Hyde, put forth by the chair, Mr. 
Berman, and Congresswoman Ros-Lehtinen in a strong bipartisan way, and 
we salute that, and advocated by Mr. Payne of New Jersey.
  I urge my colleagues to support it.


                     INTRODUCTION/ACKNOWLEDGEMENTS

  I rise today in strong support of the Tom Lantos and Henry Hyde 
United States Global Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Reauthorization Act.
  I congratulate Chairman Howard Berman and Ranking Member Ileana Ros-
Lehtinen for their bipartisan efforts to fight HIV/AIDS and to help 
alleviate poverty and disease in the developing world.


                   PROGRESS IN THE FIGHT AGAINST AIDS

  This legislation is appropriately named to honor the two authors of 
the first historic President's Emergency Plan for AIDS Relief 
legislation in 2003. That landmark bill authorized $15 billion over 5 
years.
  Working together with the Bush administration and the Appropriations 
Committee we succeeded in: providing lifesaving antiretroviral 
treatment to almost 1.5 million people; supporting care for nearly 6.7 
million including more than 2.7 orphans and vulnerable children; and 
supporting prevention of more than 150,000 infant infections.


                               NEXT STEPS

  Now we must take the next step in fighting AIDS in the poorest 
countries of the world.
  The legislation before us today will move us from the emergency phase 
to the sustainability phase in fighting AIDS, TB and Malaria.
  The legislation will: authorize $50 billion for the sustained 
commitment required to stop the global AIDS pandemic; dramatically 
strengthen health care delivery systems; encourage new and innovative 
ways to deliver the ABC prevention message; improve relationships with 
governments and NGOs; eliminate the requirement that one third of the 
funding be used for abstinence programs; improve services for women and 
girls and prevent violence against them; and build stronger linkages to 
health care and hunger initiatives.


                                 CLOSE

  The Leadership Against HIV/AIDS Act is our compact with developing 
nations across the globe. It says that America stands with them in this 
fight, that our commitment will not waver, and shows them America's 
true face of compassion.
  Since the HIV/AIDS epidemic began, 20 million men, women, and 
children have died from the disease. Forty million around the globe are 
HIV-positive. Each and every day, another 6,000 people become infected 
with HIV.
  In addition, the number of orphans, vulnerable children with sick 
parents, and adolescents at risk for HIV continues to grow, with an 
estimated 19 million needing assistance by 2010. There is a moral 
imperative to combat this epidemic.
  Few crises have called out more for sustained, constructive America 
leadership. The legislation before us makes that commitment and I urge 
its adoption.
  Ms. ROS-LEHTINEN. Madam Chairman, I would like to yield myself such 
time as I may consume.
  Madam Chairman, sometimes when we are negotiating legislative text or 
debating the merits of an important bill, such as the one before us 
today, we can lose sight of the extent of the impact that our decisions 
here can have on the lives of so many.
  I would like to quote from some of the African leaders whose people 
and societies have been rescued from certain death by our PEPFAR 
programs. The President of Tanzania has said the following, ``There 
would have been so many orphans to date. Had it not been for PEPFAR, 
the care and treatment, so many parents now who would have been 
infected can now live. And some of them can live as many years as 
possible. So can you imagine if this program is discontinued or 
disrupted? There would be so many people who would lose hope, and 
certainly there would be death. You create more orphans. So my 
passionate appeal is for PEPFAR to continue.''
  Or listen to the words of the President of Botswana when he said, 
``PEPFAR is now a critical partner in the historic and heroic battle to 
save lives. PEPFAR has turned despair into hope. PEPFAR has galvanized 
donor countries and agencies alike to act in concert in the interest of 
humanity. If the fund is not renewed and if it is not replenished, the 
momentum generated by PEPFAR thus far will no doubt be lost, and the 
hope rekindled by the generosity of the American people will be 
extinguished. I say this to you,'' said the President of Botswana, 
``and that's what I said to the congressional committees recently.''
  So, Madam Chairman, these and so many other statements reflect the 
human contribution of this critical United States program. But they 
also demonstrate that PEPFAR programs are helping to win hearts and 
minds throughout the world. They are building and strengthening the 
bonds between the governments and the people of these countries and the 
United States of America. They are building good will toward our Nation 
and toward the American people.
  Madam Chairman, after the deplorable attacks on our Nation on that 
fateful day almost 7 years ago, we in this Chamber committed ourselves 
to using the range of U.S. foreign policy tools, including soft power, 
to counter the conditions that breed hatred, intolerance and 
radicalism; radicalism that targets the United States, our interests 
and our allies, and seeks to undermine our freedom and democracy 
everywhere. The bill before us is a vital tool in that effort.
  Again, as our former colleague, our Ambassador to Tanzania has said, 
``I want you to know that PEPFAR is crucial to my current mission as 
Ambassador to the United Republic of Tanzania. It is a tremendous 
public diplomacy tool that shows America at her best, a compassionate 
partner who is committed to helping Tanzania meet its enormous HIV/AIDS 
challenges.''
  ``I was asked to present remarks to the National Consultive Meeting 
of Islamic Leaders and Scholars here in Dar es Salaam,'' continues the 
Ambassador. ``This was a historic gathering, as it was the first time 
that the most esteemed Muslim leaders of Tanzania had gathered together 
to discuss their role in the fight against HIV/AIDS. They invited me to 
speak alongside the President because of their concern about HIV/AIDS 
and their awareness of America's historic contribution to HIV 
prevention, treatment and care programs.'' Why? Because of PEPFAR. ``So 
as we help to save lives and restore hope,'' the Ambassador ends, ``we 
are leaving a lasting impression on the people of this country.''
  Madam Chairman, I hope that our colleagues will see the great merit 
of this program and that we will continue to build upon it to save many 
more lives.
  With that, I reserve the balance of my time.
  Mr. BERMAN. Madam Chairman, I am pleased to yield 2 minutes to my 
friend and colleague from California, the gentlelady, Maxine Waters.
  Ms. WATERS. Madam Chairman and Members, I am pleased and proud to be 
here today to commend not only Chairman Berman but the late Tom Lantos 
and Henry Hyde for their wisdom and their foresight in putting together 
this most important legislation.
  Ladies and gentlemen, I just returned from South Africa and I am 
pleased to announce that while I was there, I was recognized and given 
the Order of the Companions of Oliver Tombo Award for

[[Page 4801]]

my work to help dismantle apartheid in South Africa, and basically for 
being a friend of South Africa's. I was very proud.
  But as I sat there talking with President Umbeke and others, I was 
reminded that in South Africa there is an estimated 5.5 million people 
living with HIV and AIDS. That is more than any other country in the 
world. Over 18 percent of the adult population of South Africa is 
infected by HIV. Infected persons include thousands of well-educated 
professionals, such as doctors, nurses, civil servants, and teachers.
  In recognizing that we have done a great job in helping to promote 
democracy and get rid of apartheid, the enemy now is HIV and AIDS and 
tuberculosis. They are losing all of their professionals. They don't 
have the personnel to carry out the plan that they have put together to 
continue to move South Africa to where South Africa needs to be.
  I was very proud that they had built 2.3 million new houses over the 
last 10 years. But, again, tuberculosis, HIV and AIDS is destroying 
this population. This legislation will help this country and other 
countries. These are our friends. They love us. And they love us for 
having been involved in the struggle to help save them. These are 
countries that we will be able to count on in the world because we have 
come to their aid.
  Let me also recognize that there were many Americans traveling in 
South Africa. Those Americans who were there are being served by people 
who live in areas where tuberculosis and HIV is rampant.
  So we need this for protection and security of all peoples.
  Mr. BERMAN. Might I inquire of the remaining time.
  The CHAIRMAN. The gentleman from California has 9 minutes remaining. 
The gentlewoman from Florida has 18 minutes remaining.
  Ms. ROS-LEHTINEN. Thank you, Madam Chairman.
  We have no further requests for time. I would like to yield back the 
balance of my time.

                              {time}  1415

  Mr. BERMAN. Madam Chairman, we have no further requests for time. I 
would like to make a few closing comments, and I yield myself such time 
as I may consume.
  It is an accident of fate and hanging around a long time that put me 
in the position of managing this bill today, and it is the first bill 
not on the Suspension Calendar that has come out of the committee since 
I have become Chair. But the fact is the work on this legislation began 
a very long time before I became the Chair.
  They have been mentioned before, but there are so many new 
initiatives and so much thoughtful logic underlying this legislation 
that I thought it would pay to once again mention a group of staff 
people who, working under the leadership of our staff director, Dr. Bob 
King, spent a huge amount of time working for Chairman Lantos, working 
with the minority staff, to craft what became a strong, bipartisan 
piece of legislation:
  Peter Yeo; Pearl Alice Marsh; Kristin Wells; David Abramowitz; Macani 
Toungara; Heather Flynn from Chairman Payne's Africa Subcommittee; 
Christos Tsentas from Congresswoman Barbara Lee's staff; Naomi Seiler 
and Jessica Boyer from the Government Oversight Committee staff, all 
played important roles on our side in working on this legislation. 
Yleem Poblette on the minority staff made major contributions.
  The result is a bipartisan product where in a way we have 
internalized on our side the logic of efforts to change behavior and 
recognized the validity of abstinence programs in the context of a 
comprehensive approach to this problem and accepted the value of faith-
based organizations, and the minority has accepted the logic that this 
is a fundamental, moral and humanitarian concern that we should address 
and be willing to put a lot of value to, because we know it works.
  We know there is a direct relationship between the resources we put 
into this program and the lives saved, the people who can avoid and 
prevent it, and that it has implications beyond just the moral and 
humanitarian dimension, as Speaker Pelosi and Congresswoman Ros-
Lehtinen said, in terms of security and economic welfare and economic 
growth in so many parts of the world, which ultimately all inure to our 
benefit and our national interest.
  So, once again, I am very pleased to be part of this process with my 
partner, the ranking member.
  Mr. SIRES. Madam Chairman, I rise today in support of H.R. 5501, the 
Tom Lantos Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The 
passage of this bipartisan bill will continue Congress' commitment to 
the fight against HIV, TB and malaria around the world. Currently, 95 
percent of people with HIV live in the developing world, and I believe 
we must be leaders in combating the global AIDS crisis. H.R. 5501 
would: dramatically boost HIV/AIDS programs for women and girls, 
strengthen health and education systems in nations hard-hit by the HIV 
virus, and provide funding for orphans and vulnerable children, as well 
as food and nutrition programs.
  The World Health Organization estimates that over 38 million people 
are living with HIV/AIDS.
  I believe H.R. 5501 provides needed funding and support to transition 
the very successful PEPFAR program, and I urge my colleagues to vote in 
favor of this bill. Finally, I can think of no better way to honor our 
late chairman, Tom Lantos, and his predecessor, Henry Hyde, by naming 
this bill after them. Chairman Lantos was an inspiration to so many and 
spent his entire life fighting for those around the world that were 
less fortunate. His memory will live on through his wife, family, and 
the lives of those who are saved with this vital legislation.
  Ms. SCHAKOWSKY. Madam Chairman, I want to commend the chairman and 
ranking member of the committee for their work in bringing such a 
strong reauthorization before us today.
  In an op-ed that appeared in the Washington Post a few weeks ago, 
Michael Gerson wrote that in voting for this bill, members of Congress 
can participate in ``something extraordinary--a true miracle of science 
and conscience, and politics at its noblest.''
  When the emergency plan for aids was first announced, there were 
approximately 50,000 people on AIDS drugs in sub-Saharan Africa. Today 
there are roughly 1.4 million, so I share Mr. Gerson's enthusiasm for 
this bill, and I am proud of the statement we will make as a Congress 
by passing it.
  I am also extremely encouraged by provisions in the Senate bill that 
will play a key role in the development of safe and effective 
microbicides. I hope that in conference, the Committee will look at 
these microbicides provisions, which hold great promise to save the 
lives of millions of women as part of a comprehensive program to stem 
the spread of global AIDS.
  I am so pleased to be able to lend my voice in support of this 
critical and imperative bill. I urge my colleagues to support it.
  Mr. GENE GREEN of Texas. Madam Chairman, I rise today to show my 
support for H.R. 5501, the Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008. This important bill will aim to address 
the devastating effects of AIDS, malaria, and tuberculosis on our 
global community.
  Numbers from the Joint United Nations Program on HIV/AIDS show that 
since AIDS was identified in 1981, about 65 million people have been 
infected with HIV and more than 30 million have died from AIDS. These 
numbers include the figures from 2005 that show more than 2 million of 
those living with HIV/AIDS were children and the daily infection of an 
estimated 1,500 children worldwide was due in large part to inadequate 
access to drugs that prevent the transmission from mother to child.
  Additionally, programs within the Department of Health and Human 
Services account for 71 percent of the total amount spent, with the 
U.S. as the largest single contributor to the Global Fund, an 
independent foundation dedicated to disbursing new resources in 
developing countries aimed at combating AIDS, tuberculosis and malaria.
  This bill will further these efforts that we started 5 years ago by 
raising the United States' contribution to $50 billion over the next 5 
years. I am also encouraged that this bill will encourage the 
development of a TB vaccine.
  The TB germ is constantly changing and drug resistant strains have 
been found in 28 countries on 6 continents, including right here in the 
United States, where it is estimated that

[[Page 4802]]

10 to 15 million people in the U.S. have latent TB. These drug 
resistant forms of TB have severe implications both internationally and 
domestically.
  The World Health Organization recently released its new tuberculosis 
drug resistance surveillance report. The WHO found that the MDR and XDR 
strains of TB are at their highest levels ever. Both of these strains 
are far deadlier than normal TB, and are much more difficult and 
expensive to treat.
  In fact, the Department of Homeland Security recently identified XDR-
TB as an ``emerging threat to the homeland.'' For this reason, we need 
to devote resources to stopping this disease and developing a new 
vaccine is the first step. This is not a partisan issue.
  Some of my colleagues might ask why an AIDS reauthorization bill 
should be the vehicle for doing this; there is a very simple reason. TB 
is the number one infectious killer among people living with HIV/AIDS, 
and accounts for up to half of HIV/AIDS deaths in some parts of Africa. 
If we do not address TB in a systematic way and work to develop a 
vaccine, then much of the progress that we have made on addressing HIV/
AIDS globally will be undone.
  Studies also show that the 10-year economic benefits of a TB vaccine 
that was only 75 percent effective could result in an estimated savings 
of $25 billion dollars. There is no denying that this is a significant 
amount. Our current TB vaccine, BCG, is more than 85 years old and is 
not compatible against pulmonary TB, which accounts for most TB cases.
  This legislation is a good start in our critical battle against TB. 
Finally, I am happy to see that this bill will encourage public-private 
partnerships in combating these diseases. The Baylor Pediatric AIDS 
Initiative has been working in Africa for several years, and the 
government should work with this and similar programs to leverage the 
expertise that they can provide.
  I support these strong health initiatives across the globe and I 
encourage my colleagues to do the same.
  Mrs. TAUSCHER. Madam Chairman, I rise today in support of H.R. 5501, 
the Lantos-Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act of 2008.
  The world has achieved more in the fight against HIV/AIDS in the past 
decade than it has since this deadly epidemic began nearly 30 years 
ago, due in no small part to the efforts of the President's Emergency 
Plan for AIDS Relief (PEPFAR), combined with Congressional enactment of 
the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2003.
  As a nation, we have provided care for more than 6 million HIV-
infected individuals, including nearly 3 million orphans. We have 
prevented 150,000 infant infections by providing mother-to-child HIV 
transmission prevention services for more than 10 million pregnancies. 
And we have provided anti-retroviral drugs for nearly 1.5 million men, 
women, and children.
  Yet in an era where 40 million men, women, and children are infected 
with HIV worldwide, and where infections continue at a rate of nearly 
6,000 per day, U.S. global leadership on HIV/AIDS--as well as the 
associated diseases of TB and malaria--remains as important as ever.
  I quote Stephen Lewis, the former United Nations Special Envoy for 
HIV/AIDS in Africa: ``the international community must now finally keep 
its word and mobilize for global AIDS treatment delivery . . . it is a 
moral imperative that global leaders and institutions keep their 
promises to scale up AIDS services with urgency and increased 
resources.''
  I believe passage of H.R. 5501 displays our commitment to doing just 
that.
  This legislation authorizes $50 billion over the next 5 years, 
including $41 billion for HIV/AIDS, $4 billion for tuberculosis, and $5 
billion for malaria, and is designed to move these programs from the 
``emergency'' phase, towards greater sustainability.
  In particular, I am pleased to see a strengthened focus on the needs 
of women and girls, and prevention and treatment programs targeted 
towards this population--including, for the first time, the provision 
of HIV/AIDS testing and counseling services in family planning 
programs. I would note that concerns have been raised that the bill's 
language would block HIV testing and counseling services from being 
offered by family planning providers that are not compliant with the 
misguided ``global gag rule'' policy, and I hope that Congressional 
intent can be clarified that this is not the case.
  I am also supportive of provisions that remove the requirement 
targeting one-third of prevention funding towards abstinence-only 
programs. Prevention programs must be evidence-based, rather than 
ideologically-based.
  This legislation doubles, to $2 billion per year, the U.S. 
contribution to the multilateral Global Fund to Fight AIDS, 
Tuberculosis, and Malaria. The Global Fund, with its emphasis on 
stimulating a global commitment under an umbrella organization with a 
truly international AIDS budget, is the best chance the world has of 
combating this epidemic. I urge my colleagues and the President to 
ensure that these new authorization levels are fully funded.
  Madam Chairman, I applaud the bipartisan work of the Foreign Affairs 
Committee, including its new Chairman, Howard Berman, and Ranking 
Member Ileana Ros-Lehtinen. I also want to recognize and commemorate 
the leadership of our dear friend, Congressman Tom Lantos, whose 
commitment to the most vulnerable people worldwide continues to be felt 
through our work on HIV/AIDS. I urge my colleagues to support H.R. 
5501.
  Mr. WAXMAN. Madam Chairman, as one of the original cosponsors of this 
bill, I am proud of what it represents, and I strongly urge my 
colleagues to support it. This five-year reauthorization tells the 
world that the United States is truly committed to a sustainable global 
response to HIV, TB, and malaria.
  The bill raises our financial commitment. It authorizes the 
strengthening of local health systems and the training of workers, 
including the doctors and nurses on whom the sustainability of this 
program will rely.
  The bill also eliminates the onerous abstinence-only spending 
requirement. It replaces it with a provision directing country teams to 
tell Congress if they spend less than half of their funds for sexual 
transmission on behavior change programs. This is merely a reporting 
requirement, and should not be understood as a restriction on country 
spending.
  I do want to acknowledge some concerns about the bill. Many would 
have liked to see stronger and more inclusive language encouraging 
linkages to reproductive health services. I would have liked to see 
such language too.
  There is also concern about the current requirement that recipients 
sign an ``anti-prostitution pledge.'' People involved in sex work are 
very vulnerable to HIV infection, along with many other health and 
social risks. But what we hear from the field is that the pledge has 
had the unintended consequence of making groups shy away from effective 
outreach programs for sex workers. They are scared of running afoul of 
this broad oath requirement. I'm disappointed that we weren't able to 
eliminate it.
  While I think we've got more work to do in certain areas, I'd like to 
take this opportunity to comment on several elements of the bill which 
I believe are vitally important.
  First, despite the prostitution pledge, it is unambiguous that the 
intent of Congress is to direct close attention to the needs of sex 
workers and other marginalized groups. The bill specifically directs 
the provision of care, treatment, and prevention services to sex 
workers, injection drug users, and men who have sex with men. And it 
requires the development of strategies for providing evidence-based 
prevention services to each of these populations.
  This bill also makes some important refinements to the treatment 
program. The expansion of antiretroviral services has been a huge 
success. But many people still lack needed treatment. Others require 
more expensive second-line therapy. And while significant progress has 
been made in the utilization of generic drugs, some U.S. dollars are 
still being used to buy brand-name drugs when lower-cost generics are 
available.
  In light of these challenges, this bill instructs the AIDS 
coordinator to develop mechanisms for encouraging and facilitating the 
purchase of safe and effective drugs at the lowest possible price. The 
bill also requires the coordinator to report annually on the amounts 
paid for generic and branded antiretroviral drugs. And it requires that 
information on drug pricing be shared and updated routinely, so our 
partners can make purchases based on the best available information.
  Finally, I'd like to note that this bill puts an important new 
emphasis on research. While we've learned much through this program, we 
haven't seen a coordinated research agenda to address questions about 
what works and what doesn't, especially in the area of prevention. This 
bill mandates a detailed strategic plan for program monitoring, 
operational research and impact evaluation research. It also requires a 
strategy for maximizing the capacity of host countries to conduct their 
own research.
  But we should not let these developments make us complacent. The most 
basic, but often most pressing, health needs of the world's poor aren't 
being met. Children are still dying for lack of clean drinking water. 
Women face staggering rates of morbidity and death related to pregnancy 
and childbirth. And people across the world succumb to disability and

[[Page 4803]]

death from treatable, and often preventable, illnesses.
  As we pass this bill today, let's not forget these other pressing 
health problems. I urge my colleagues to vote yes on H.R. 5501. And I 
hope that the lessons and successes of our global AIDS program inspire 
us to reinvigorate our commitment to a broader global health agenda.
  Mr. VAN HOLLEN. Madam Chairman, I rise in strong support of the 
critical bipartisan Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008.
  We have a moral obligation to address the global pandemics of HIV/
AIDS, tuberculosis and malaria. It was 5 years ago that Congress took 
leadership to address this crisis. Today, because of Congress's 
actions, the United States has become the leading provider in the world 
of HIV/AIDS assistance, treatment, prevention and care.
  AIDS continues to be the leading cause of death in sub-Saharan 
Africa. The United Nations estimates that 33 million people are 
infected with HIV worldwide, with an estimated 22 million HIV-infected 
people in sub-Saharan Africa. Approximately 1.6 million deaths in sub-
Saharan African resulted from AIDS in 2007. This legislation reaffirms 
our commitment to combating this deadly epidemic by reauthorizing the 
2003 law and will give more flexibility to host governments in 
planning, directing, and managing prevention, treatment and care 
programs that have been established with our assistance.
  I am pleased that the bill also includes a provision that authorizes 
funding for U.S. contributions to research and development of a 
tuberculosis vaccine. Tuberculosis is a deadly epidemic that faces our 
planet today. Nearly 2 million people die from it each year and 
approximately 9 million are diagnosed with tuberculosis annually. It is 
the largest killer of people with HIV/AIDS, accounting for one-third of 
AIDS deaths alone. The current tuberculosis vaccine is more than 85 
years old and is unreliable against pulmonary tuberculosis. New 
tuberculosis vaccines have the potential to save millions of lives and 
would lead to substantial cost savings.
  Madam Chairman, let us honor the spirit of the two men--Chairmen 
Lantos and Hyde--who guided the 2003 law through this body in 
bipartisan manner by passing this much needed legislation to combat 
these deadly diseases.
  Mr. MORAN of Virginia. Madam Chairman, I rise today in support of 
this important bill. PEPFAR-funded programs have provided life-saving 
assistance in the fight against HIV/AIDS, and I welcome any expansion 
of this assistance. Additionally, I am pleased that we have removed the 
``hard earmark'' requiring 33% of all prevention funds be spent on 
abstinence-only until marriage programs. Studies by GAO and the 
Institutes of Medicine found that the one-third earmark undermines 
successful HIV prevention efforts by limiting flexibility in developing 
countries. However, I continue to be concerned about any funds being 
directed towards unproven, ineffective programs using the ``abstinence-
only'' approach. I worry that the new ``balanced funding'' requirement 
may cause mission directors and public health officials to be anxious 
about doing what they think Congress wants, instead of what is needed 
in the field. Public health experts on the ground are the ones who can 
best determine the mix of prevention activities, especially since what 
works for one culture may be disastrous for another. Even in our own 
country, young people who take part in abstinence-only education are 
less likely to use condoms. With 15,000 new HIV infections every day, 
the need for additional resources is clearly tremendous, and I'm 
extremely supportive of the goals of this important legislation, and I 
continue to believe that our highest priority should be funding 
science-based, comprehensive efforts to prevent HIV.
  Ms. WATERS. Madam Chairman, I strongly support H.R. 5501, the Tom 
Lantos and Henry Hyde Global Leadership Against HIV/AIDS, Tuberculosis, 
and Malaria Reauthorization Act of 2008. This bill authorizes $50 
billion over the next five years for international health programs, 
including $41 billion for HIV/AIDS treatment and prevention, $4 billion 
for tuberculosis programs, and $5 billion for malaria programs.
  I just returned from South Africa, where I received the ``OR Tambo 
Award,'' from South African President Thabo Mbeki. I received this 
award because of my efforts to end the brutal system of apartheid in 
South Africa and to obtain the release of South African anti-apartheid 
activist Nelson Mandela from prison. Apartheid was dismantled and 
Nelson Mandela was elected President of South Africa in 1994, when 
South Africa held its first democratic elections.
  I was very proud to receive the OR Tambo Award because I have always 
been and continue to be a friend to South Africa. However, in South 
Africa today, the enemy is HIV/AIDS. It is estimated that 5.5 million 
people are living with HIV/AIDS in South Africa. That is more than any 
other country in the world. Over 18 percent of the adult population of 
South Africa is infected by HIV. Infected persons include thousands of 
well-educated professionals, such as doctors, nurses, civil servants 
and teachers.
  Everywhere I went in South Africa, people told me about the terrible 
problem they have trying to fill professional positions. The shortage 
of educated professionals is a result of the fact that so many South 
African professionals have died of AIDS or are too sick to work.
  The involvement of doctors, nurses, teachers, and other professionals 
is critical to stopping the spread of HIV and AIDS. That is why I am 
pleased that this bill includes provisions to strengthen the health 
care infrastructure in countries like South Africa and train at least 
140,000 new health care professionals and workers for HIV/AIDS 
prevention, treatment and care. The bill also includes prevention funds 
to stop the spread of HIV and treatment funds to allow infected 
individuals to live productive lives and continue to serve their 
communities.
  It is impossible to address HIV without also addressing tuberculosis. 
Almost 9 million people develop tuberculosis every year. At least 2.4 
million are killed by the disease. According to the World Health 
Organization, HIV and tuberculosis form a lethal combination, each 
speeding the progress of the other. In the past 15 years, tuberculosis 
rates have doubled in Africa overall and tripled in areas with high HIV 
concentrations. In some areas of Africa, up to 80 percent of 
tuberculosis patients also test positive for HIV. This makes 
tuberculosis clinics an ideal location for HIV prevention, treatment, 
and care.
  I urge all of my colleagues to support this bill and help stop the 
spread of HIV/AIDS, tuberculosis, and malaria in South Africa and 
around the world.
  Mr. HOLT. Madam Chairman, I rise today in strong support of the Tom 
Lantos and Henry J. Hyde United States Global Leadership against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, H.R. 5501.
  This important legislation reauthorizes and expands the President's 
Emergency Plan for AIDS Relief (PEPFAR). I have long supported this 
bold initiative that has made the U.S. a leader in this critical health 
and moral issue of our time. PEPFAR has shown to the world our nation's 
vision and compassion in addressing this healthcare crisis.
  Five years ago, an estimated 31 million people were living with HIV/
AIDS worldwide, anti-retroviral drug treatments were expensive, and 
approximately 8,200 people were infected with HIV/AIDS every day.
  I have heard from a number of my constituents about their support for 
continued U.S. efforts to combat AIDS and the spread of HIV around the 
globe. It is obvious that Americans care. In the absence of a cure for 
AIDS, this worldwide epidemic continues to spread at an alarming rate.
  That is why I am pleased that H.R. 5501 makes an important transition 
from emergency relief to the establishment of long-term and sustainable 
AIDS relief programs. The legislation also works to better integrate 
the tuberculosis and malaria programs with the HIV/AIDS programs. This 
is essential because in sub-Saharan Africa tuberculosis is the leading 
killer of individuals with HIV/AIDS.
  Since the creation of this program, the United States has invested 
more than $19 billion to combat HIV/AIDS, tuberculosis, and malaria. 
The results have been striking. By the end of 2007, the United States 
had helped provide anti-retroviral drug treatments to approximately 1.5 
million people with AIDS, supported care for 6.6 million--including 2.7 
million orphans and vulnerable children--and helped to prevent more 
than 157,000 infant infections.
  H.R. 5501 greatly expands our efforts abroad by authorizing a total 
of $50 billion over five years. This total includes $41 billion for 
HIV/AIDS programs, $5 billion for malaria programs, and $4 billion for 
tuberculosis programs. This dramatic increase in funding will help 
partner countries continue to identify and meet targets for treatment 
and prevention. Additionally, the funding will help build and 
strengthen the existing health systems in host countries.
  While I support the underlying bill, I do have some concern about one 
specific issue. I have long been concerned by the restrictions placed 
on how PEPFAR funds can be spent. I have opposed the requirement that 
one-third of the funds be spent on abstinence-only education because it 
has not proven to be a successful way to prevent the spread of HIV/
AIDS. A report by the Government Accountability Office

[[Page 4804]]

found that this restriction tied the local hands of public health 
workers.
  I believe that PEPFAR funds should be spent on the most effective 
HIV/AIDS treatment and prevention strategies available. That is why I 
am pleased that H.R. 5501 removes the requirement that one-third of the 
funds be spent on abstinence education. As this bill works through the 
legislative process, I hope that any language in the bill that might be 
interpreted to limit funding to programs that are compliant with the 
global gag rule be removed.
  Madam Chairman, our country has done more to end the spread of HIV/
AIDS in the last five years than any nation in the history of the 
world. We must continue. This bill represents a reasonable expansion of 
our efforts and makes the important transition to permanent HIV/AIDS 
relief. I urge my colleagues to support this investment in the health 
of our global community and in the fight against HIV/AIDS.
  Mrs. LOWEY. Madam Chairman, I rise today to urge my colleagues to 
vote in favor of H.R. 5501, the Tom Lantos and Henry J. Hyde U.S. 
Global Leadership against HIV/AIDS, Tuberculosis and Malaria 
Reauthorization Act.
  Over the past five years two major initiatives have been created to 
combat HIV/AIDS and TB: the Global Fund and the President's Emergency 
Plan for AIDS Relief (PEPPAR). These initiatives have provided over $18 
billion and exceeded the President's target of $15 billion by more than 
$3 billion. As we seek to reauthorize this program today, I commend the 
target of $50 billion over the next five years for these critical 
programs. This funding will allow us to prevent 12 million new HIV 
infections, provide treatment for 3 million people living with HIV/
AIDS, treat 450,000 children and provide care for 12 million 
individuals, including 5 million orphans and vulnerable children. This 
funding will reduce tuberculosis deaths and disease burden by half, the 
primary cause of death for those living with HIV/AIDS.
  Five years ago, only 50,000 people living with HIV/AIDS were 
receiving antiretroviral treatment. Today with American leadership, 
almost 2 million people are receiving treatment. Clearly, we are making 
a difference.
  With this next phase, we need to devote more resources to strengthen 
the capacity of nations to meet their own health challenges. If any of 
these interventions are to be sustainable in the long term, it requires 
that developing countries be able to shoulder more of the 
responsibility for the health of their populations. I am pleased that 
this bill invests more in health infrastructure and the training of 
healthcare professionals. In addition, I am pleased that the bill 
recognizes the important role played by the Global Fund to Fight AIDS, 
Tuberculosis, and Malaria in empowering countries to address their own 
health problems.
  The HIV/AIDS pandemic has ravaged the world, especially the African 
continent, and shows no signs of slowing down. While U.S.-funded HIV/
AIDS prevention programs reached 57 million people last year alone, new 
infections are on the rise. It is essential that we renew our focus on 
prevention efforts, including key work on preventing mother-to-child 
transmission. Additionally, we must provide the flexibility to respond 
to the needs of the communities served including through the removal of 
the abstinence earmark in this bill, which I applaud.
  While I believe this bill represents the strong bipartisan commitment 
of Congress to combating these epidemics, I am disappointed that the 
bill took a step backwards in the struggle for poor women to receive 
access to critical family planning services. A provision in the bill 
could be interpreted to limit, for the first time and contrary to 
current practice, the types of family planning programs that would be 
eligible for PEPFAR funding. I understand this was not the intent of 
the Committee and hope that this issue can be addressed during 
conference.
  I commend Congressman Berman and Congresswoman Ros-Lehtinen for 
crafting a bipartisan bill that will save millions of lives. It truly 
honors the legacy of our great colleagues, Congressman Lantos and 
Congressman Hyde.
  I urge my colleagues to vote in favor of this critical legislation.
  Mr. BERMAN. Madam Chairman, I yield back the balance of my time.
  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered read for amendment 
under the 5-minute rule.
  The text of the bill is as follows:

                               H.R. 5501

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

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

Sec. 1. Short title and table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Purpose.

               TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of a comprehensive, five-year, global strategy.
Sec. 102. HIV/AIDS Response Coordinator.

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

Sec. 201. Sense of Congress on public-private partnerships.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis 
              and Malaria.
Sec. 203. Voluntary contributions to international vaccine funds.
Sec. 204. Program to facilitate availability of microbicides to prevent 
              transmission of HIV and other diseases.
Sec. 205.  Plan to combat HIV/AIDS, tuberculosis, and malaria by 
              strengthening health policies and health systems of host 
              countries.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

Sec. 301. Assistance to combat HIV/AIDS.
Sec. 302. Assistance to combat tuberculosis.
Sec. 303. Assistance to combat malaria.
Sec. 304. Health care partnerships to combat HIV/AIDS.

        Subtitle B--Assistance for Women, Children, and Families

Sec. 311. Policy and requirements.
Sec. 312. Annual reports on prevention of mother-to-child transmission 
              of the HIV infection.
Sec. 313. Strategy to prevent HIV infections among women and youth.
Sec. 314. Clerical amendment.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

Sec. 401. Authorization of appropriations.
Sec. 402. Sense of Congress.
Sec. 403. Allocation of funds.
Sec. 404. Prohibition on taxation by foreign governments.

    TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

Sec. 501. Sustainability and strengthening of health care systems.
Sec. 502. Clerical amendment.

     SEC. 2. FINDINGS.

       Section 2 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601) is 
     amended by adding at the end the following:
       ``(29) The HIV/AIDS pandemic continues to pose a major 
     threat to the health of the global community, from the most 
     severely-affected regions of sub-Saharan Africa and the 
     Caribbean, to the emerging epidemics of Eastern Europe, 
     Central Asia, South and Southeast Asia, and Latin America.
       ``(30) According to UNAIDS' 2007 global estimates, there 
     are 33.2 million individuals with HIV/AIDS worldwide, 
     including 2.5 million people newly-infected with HIV. Of 
     those infected with HIV, 2.5 million are children under 15 
     who also account for 460,000 of the newly-infected 
     individuals.
       ``(31) Sub-Saharan Africa continues to be the region most 
     affected by the HIV/AIDS pandemic. More than 68 percent of 
     adults and nearly 90 percent of children with HIV/AIDS live 
     in sub-Saharan Africa, and more than 76 percent of AIDS 
     deaths in 2007 occurred in sub-Saharan Africa.
       ``(32) Although sub-Saharan Africa carries the heaviest 
     disease burden of HIV/AIDS, the HIV/AIDS pandemic continues 
     to affect virtually every world region. While prevalence 
     rates are relatively low in Eastern Europe, Central Asia, 
     South and Southeast Asia, and Latin America, without 
     effective prevention strategies, HIV prevalence rates could 
     rise quickly in these regions.
       ``(33) By world region, according to UNAIDS' 2007 global 
     estimates--
       ``(A) in sub-Saharan Africa, there were 22.5 million adults 
     and children infected with HIV, up from 20.9 million in 2001, 
     with 1.7 million new HIV infections, a 5 percent prevalence 
     rate, and 1.6 million deaths;
       ``(B) in South and Southeast Asia, there were 4 million 
     adults and children infected with HIV, up from 3.5 million in 
     2001, with 340,000 new HIV infections, a 0.3 percent 
     prevalence rate, and 270,000 deaths;
       ``(C) in East Asia, there were 800,000 adults and children 
     infected with HIV, up from 420,000 in 2001, with 92,000 new 
     HIV infections, a 0.1 percent prevalence rate, and 32,000 
     deaths;
       ``(D) in Eastern and Central Europe, there were 1.6 million 
     adults and children infected with HIV, up from 630,000 in 
     2001, with 150,000 new HIV infections, a 0.9 percent 
     prevalence rate, and 55,000 deaths; and

[[Page 4805]]

       ``(E) in the Caribbean, there were 230,000 adults and 
     children infected with HIV, up from 190,000 in 2001, with 
     17,000 new HIV infections, a 1 percent prevalence rate, and 
     11,000 deaths.
       ``(34) Tuberculosis is the number one killer of individuals 
     with HIV/AIDS and is responsible for up to one-half of HIV/
     AIDS deaths in Africa.
       ``(35) The wide extent of drug resistant tuberculosis, 
     including both multi-drug resistant tuberculosis (MDR-TB) and 
     extensively drug resistant tuberculosis (XDR-TB), driven by 
     the HIV/AIDS pandemic in sub-Saharan Africa, has hampered 
     both HIV/AIDS and tuberculosis treatment services. The World 
     Health Organization (WHO) has declared the prevalence of 
     tuberculosis to be at emergency levels in sub-Saharan Africa.
       ``(36) Forty percent of the world's population, mostly 
     poor, live in malarial zones, and malaria, which is highly 
     preventable, kills more than 1 million individuals worldwide 
     each year. Ninety percent of malaria's victims are in sub-
     Saharan Africa and 70 percent of malaria's victims are 
     children under the age of 5. Additionally, hunger and 
     malnutrition kill another 6 million individuals worldwide 
     each year.
       ``(37) Assistance to combat HIV/AIDS must address the 
     nutritional factors associated with the disease in order to 
     be effective and sustainable. The World Food Program 
     estimates that 6.4 million individuals affected by HIV will 
     need nutritional support by 2008.
       ``(38) Women and girls continue to be vulnerable to HIV, in 
     large part, due to gender-based cultural norms that leave 
     many women and girls powerless to negotiate social 
     relationships.
       ``(39) Women make up 50 percent of individuals infected 
     with HIV worldwide. In sub-Saharan Africa, where the HIV/AIDS 
     epidemic is most severe, women make up 57 percent of 
     individuals infected with HIV, and 75 percent of young people 
     infected with HIV in sub-Saharan Africa are young women ages 
     15 to 24.
       ``(40) Women and girls are biologically, socially, and 
     economically more vulnerable to HIV infection. Gender 
     disparities in the rate of HIV infection are the result of a 
     number of factors, including the following:
       ``(A) Cross-generational sex with older men who are more 
     likely to be infected with HIV, and a lack of choice 
     regarding when and whom to marry, leading to early marriages 
     and high rates of child marriages with older men. About one-
     half of all adolescent females in sub-Saharan Africa and two-
     thirds of adolescent females in Asia are married by age 18.
       ``(B) Studies show that married women and married and 
     unmarried girls often are unable or find it difficult to 
     negotiate the frequency and timing of sexual intercourse, 
     ensure their partner's faithfulness, or insist on condom use. 
     Under these circumstances, women often run the risk of being 
     infected by husbands or male partners in societies where men 
     in relationships have more than one partner. Behavior change 
     is particularly important in societies in which this is a 
     common practice.
       ``(C) Because young married women and girls are more likely 
     to have unprotected sex and have more frequent sex than their 
     unmarried peers, and women and girls who are faithful to 
     their spouses can be placed at risk of HIV/AIDS through a 
     husband's infidelity or prior infection, marriage is not 
     always a guarantee against HIV infection, although it is a 
     protective factor overall.
       ``(D) Social and economic inequalities based largely on 
     gender limit access for women and girls to education and 
     employment opportunities and prevent them from asserting 
     their inheritance and property rights. For many women, a lack 
     of independent economic means combines with socio-cultural 
     practices to sustain and exacerbate their fear of 
     abandonment, eviction, or ostracism from their homes and 
     communities and can leave many more women trapped within 
     relationships where they are vulnerable to HIV infection.
       ``(E) A lack of educational opportunities for women and 
     girls is linked to younger sexual debut, earlier childhood 
     marriage, earlier childbearing, decreased child survival, 
     worsening nutrition, and increased risk of HIV infection.
       ``(F) High rates of gender-based violence, rape, and sexual 
     coercion within and outside marriage contribute to high rates 
     of HIV infection. According to the World Health Organization, 
     between one-sixth and three-quarters of women in various 
     countries and settings have experienced some form of physical 
     or sexual violence since the age of 15 within or outside of 
     marriage. Women who are unable to protect themselves from 
     such violence are often unable to protect themselves from 
     being infected with HIV through forced sexual contact.
       ``(G) Fear of domestic violence and the continuing stigma 
     and discrimination associated with HIV/AIDS prevent many 
     women from accessing information about HIV/AIDS, getting 
     tested, disclosing their HIV status, accessing services to 
     prevent mother-to-child transmission of HIV, or receiving 
     treatment and counseling even when they already know they 
     have been infected with HIV.
       ``(H) According to UNAIDS, the vulnerability of individuals 
     involved in commercial sex acts to HIV infection is 
     heightened by stigmatization and marginalization, limited 
     economic options, limited access to health, social, and legal 
     services, limited access to information and prevention means, 
     gender-related differences and inequalities, sexual 
     exploitation and trafficking, harmful or non-protective laws 
     and policies, and exposure to risks associated with 
     commercial sex acts, such as violence, substance abuse, and 
     increased mobility.
       ``(I) Lack of access to basic HIV prevention information 
     and education and lack of coordination with existing primary 
     health care to reduce stigma and maximize coverage.
       ``(J) Lack of access to currently available female-
     controlled HIV prevention methods, such as the female condom, 
     and lack of training on proper use of either male or female 
     condoms.
       ``(K) High rates of other sexually transmitted infections 
     and complications during pregnancies and childbirth.
       ``(L) An absence of functioning legal frameworks to protect 
     women and girls and, where such frameworks exist, the lack of 
     accountable and effective enforcement of such frameworks.
       ``(41) In addition to vulnerabilities to HIV infection, 
     women in sub-Saharan Africa face a 1-in-13 chance of dying in 
     childbirth compared to a 1-in-16 chance in least-developed 
     countries worldwide, a 1-in-60 chance in developing 
     countries, and a 1-in-4,100 chance in developed countries.
       ``(42) Due to these high maternal mortality rates and high 
     HIV prevalence rates in certain countries, special attention 
     is needed in these countries to help HIV-positive women 
     safely deliver healthy babies and save women's lives.
       ``(43) Unprotected sex within or outside of marriage is the 
     single greatest factor in the transmission of HIV worldwide 
     and is responsible for 80 percent of new HIV infections in 
     sub-Saharan Africa.
       ``(44) Multiple randomized controlled trials have 
     established that male circumcision reduces a man's risk of 
     contracting HIV by 60 percent or more. Twelve acceptability 
     studies have found that in regions of sub-Saharan Africa 
     where circumcision is not traditionally practiced, a majority 
     of men want the procedure. Broader availability of male 
     circumcision services could prevent millions of HIV 
     infections not only in men but also in their female partners.
       ``(45)(A) Youth also face particular challenges in 
     receiving services for HIV/AIDS.
       ``(B) Nearly one-half of all orphans who have lost one 
     parent and two-thirds of those who have lost both parents are 
     ages 12 to 17. These orphans are in particular need of 
     services to protect themselves against sexually-transmitted 
     infections, including HIV.
       ``(C) Research indicates that many youth benefit from full 
     disclosure of medically accurate, age-appropriate information 
     about abstinence, partner reduction, and condoms. Providing 
     comprehensive information about HIV, including delay of 
     sexual debut and the ABC model: `Abstain, Be faithful, use 
     Condoms', and linking such information to health care can 
     help improve awareness of safe sex practices and address the 
     fact that only 1 in 3 young men and 1 in 5 young women ages 
     15 to 24 can correctly identify ways to prevent HIV 
     infection.
       ``(D) Surveys indicate that no country has succeeded in 
     fully educating more than one-half of its youth about the 
     prevention and transmission of HIV.
       ``(46) According to the United Nations High Commissioner 
     for Refugees (UNHCR), HIV/AIDS prevalence rates among 
     refugees are generally lower than the HIV/AIDS prevalence 
     rates for their host communities, though perceptions run 
     counter to this fact. However, peacekeeping operations that 
     no longer deploy HIV/AIDS-positive troops still face 
     vulnerabilities to sexual transmission of HIV with HIV-
     positive individuals in refugee camps. Host countries 
     generally do not provide HIV/AIDS prevention, treatment, and 
     care services for refugees.
       ``(47) Continuing progress to reach the millions of 
     impoverished individuals who need voluntary testing, 
     counseling, treatment, and care for HIV/AIDS requires 
     increased efforts to strengthen health care delivery systems 
     and infrastructure, rebuild and expand the health care 
     workforce, and strengthen allied and support services in 
     countries receiving United States global HIV/AIDS assistance.
       ``(48) While HIV/AIDS poses the greatest health threat of 
     modern times, it also poses the greatest development 
     challenge for developing countries with fragile economies and 
     weak public financial management systems that are ill 
     equipped to shoulder the burden of this disease. 
     International donors will have to play a critical role in 
     providing resources for HIV/AIDS programs far into the 
     future.
       ``(49) The emerging partnerships between countries most 
     affected by HIV/AIDS and the United States must include 
     stronger coordination between HIV/AIDS programs and other 
     United States foreign assistance programs, and stronger 
     collaboration with other donors in the areas of economic 
     development and growth strategies.
       ``(50) The future control of HIV/AIDS demands coordination 
     between international organizations such as the Global Fund 
     to Fight AIDS, Tuberculosis and Malaria,

[[Page 4806]]

     UNAIDS, the World Health Organization (WHO), the World Bank 
     and the International Monetary Fund (IMF), the international 
     donor community, national governments, and private sector 
     organizations, including community and faith-based 
     organizations.
       ``(51) The future control of HIV/AIDS further requires 
     effective and transparent public finance management systems 
     in developing countries to advance the ability of such 
     countries to manage public revenues and donor funds aimed at 
     combating HIV/AIDS and other diseases.
       ``(52) The HIV/AIDS pandemic contributes to the shortage of 
     health care personnel through loss of life and illness, 
     unsafe working conditions, increased workloads for diminished 
     staff, and resulting stress and burnout, while the shortage 
     of health care personnel undermines efforts to prevent and 
     provide care and treatment for individuals with HIV/AIDS.
       ``(53) The shortage of health care personnel, including 
     doctors, nurses, pharmacists, counselors, laboratory staff, 
     paraprofessionals, trained lay workers, and researchers is 
     one of the leading obstacles to combating HIV/AIDS in sub-
     Saharan Africa.
       ``(54) Since 2003, important progress has been made in 
     combating HIV/AIDS, yet there is more to be done. The number 
     of new HIV infections is still increasing at an alarming 
     rate. According to the United States National Institute of 
     Allergy and Infectious Diseases, globally, for every 1 
     individual put on antiretroviral therapy, 6 individuals are 
     newly infected with HIV.
       ``(55) The United States Government continues to be the 
     world's leader in the fight against HIV/AIDS and the 
     unsurpassed partner with developing countries in their 
     efforts to control this disease.
       ``(56) By September 2007, the United States, through the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 et seq.), had provided 
     services to prevent mother-to-child-transmission of HIV to 
     women during 10 million pregnancies; provided antiretroviral 
     prophylaxis for women during over 827,300 pregnancies; 
     prevented an estimated 157,240 HIV infections in infants; 
     cared for over 6.6 million individuals, including over 2.7 
     million orphans and vulnerable children; supported lifesaving 
     antiretroviral therapies for approximately 1.4 million men, 
     women, and children in sub-Saharan Africa, Asia, and the 
     Carribean; and provided counseling and testing to over 33.7 
     million men, women, and children in developing countries.
       ``(57) These numbers were achieved because of the 
     commitment of substantial resources and support of the United 
     States Government to our partners on the front lines--the 
     dedicated and committed women and men, communities, and 
     nations who are taking control of the HIV/AIDS epidemics in 
     their own countries.''.

     SEC. 3. DEFINITIONS.

       Section 3(2) of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7602(2)) is amended by striking ``Committee on International 
     Relations'' and inserting ``Committee on Foreign Affairs''.

     SEC. 4. PURPOSE.

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

     ``SEC. 4. PURPOSE.

       ``The purpose of this Act is to strengthen and enhance 
     United States global leadership and the effectiveness of the 
     United States response to the HIV/AIDS, tuberculosis, and 
     malaria pandemics and other related and preventable 
     infectious diseases in developing countries by--
       ``(1) establishing a comprehensive, integrated five-year, 
     global strategy to fight HIV/AIDS, tuberculosis, and malaria 
     that encompasses a plan for continued expansion and 
     coordination of critical programs and improved coordination 
     among relevant executive branch agencies and between the 
     United States and foreign governments and international 
     organizations;
       ``(2) providing increased resources for United States 
     bilateral efforts to combat HIV/AIDS, tuberculosis, and 
     malaria, particularly for prevention, treatment, and care 
     (including nutritional support), technical assistance and 
     training, the strengthening of health care systems, health 
     care workforce development, monitoring and evaluations 
     systems, and operations research;
       ``(3) providing increased resources for multilateral 
     efforts to combat HIV/AIDS, tuberculosis, and malaria;
       ``(4) encouraging the expansion of private sector efforts 
     and expanding public-private sector partnerships to combat 
     HIV/AIDS; and
       ``(5) intensifying efforts to support the development of 
     vaccines, microbicides, and other prevention technologies and 
     improved diagnostics treatment for HIV/AIDS, tuberculosis, 
     and malaria.''.

               TITLE I--POLICY PLANNING AND COORDINATION

     SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL 
                   STRATEGY.

       (a) Strategy.--Subsection (a) of section 101 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7611) is amended--
       (1) in the first sentence of the matter preceding paragraph 
     (1), by striking ``to combat'' and inserting ``to develop 
     efforts further to combat'';
       (2) by amending paragraph (4) to read as follows:
       ``(4) provide that the reduction of HIV/AIDS behavioral 
     risks shall be a priority of all prevention efforts in terms 
     of funding, scientifically-accurate educational services, and 
     activities by--
       ``(A) designing prevention strategies and programs based on 
     sound epidemiological evidence, tailored to the unique needs 
     of each country and community, and reaching those populations 
     found to be most at risk for acquiring HIV infection;
       ``(B) promoting abstinence from sexual activity and 
     substance abuse;
       ``(C) encouraging delay of sexual debut, monogamy, 
     fidelity, and partner reduction;
       ``(D) promoting the effective use of male and female 
     condoms;
       ``(E) promoting the use of measures to reduce the risk of 
     HIV transmission for discordant couples (where one individual 
     has HIV/AIDS and the other individual does not have HIV/AIDS 
     or whose status is unknown);
       ``(F) educating men and boys about the risks of procuring 
     sex commercially and about the need to end violent behavior 
     toward women and girls;
       ``(G) promoting the rapid expansion of safe and voluntary 
     male circumcision services;
       ``(H) promoting life skills training and development for 
     children and youth;
       ``(I) supporting advocacy for child and youth community-
     based protective social services;
       ``(J) eradicating trafficking in persons and creating 
     alternatives to prostitution;
       ``(K) promoting cooperation with law enforcement to 
     prosecute offenders of trafficking, rape, and sexual assault 
     crimes with the goal of eliminating such crimes;
       ``(L) promoting services demonstrated to be effective in 
     reducing the transmission of HIV infection among injection 
     drug users without increasing illicit drug use;
       ``(M) promoting policies and programs to end the sexual 
     exploitation of and violence against women and children; and
       ``(N) promoting prevention and treatment services for men 
     who have sex with men;'';
       (3) by redesignating paragraphs (5) through (10) as 
     paragraphs (6) through (11), respectively;
       (4) by inserting after paragraph (4) (as amended by 
     paragraph (2) of this subsection) the following:
       ``(5) include specific plans for linkage to, and referral 
     systems for nongovernmental organizations that implement 
     multisectoral approaches, including faith-based and 
     community-based organizations, for--
       ``(A) nutrition and food support for individuals with HIV/
     AIDS and affected communities;
       ``(B) child health services and development programs;
       ``(C) HIV/AIDS prevention and treatment services for 
     injection drug users;
       ``(D) access to HIV/AIDS education and testing in family 
     planning and maternal health programs supported by the United 
     States Government; and
       ``(E) medical, social, and legal services for victims of 
     violence;'';
       (5) by redesignating paragraphs (10) and (11) (as 
     redesignated by paragraph (3) of this subsection) as 
     paragraphs (11) and (12), respectively; and
       (6) by inserting after paragraph (9) (as redesignated by 
     paragraph (3) of this subsection) the following:
       ``(10) maximize host country capacities in training and 
     research, particularly operations research;''.
       (b) Report.--Subsection (b) of such section is amended--
       (1) in paragraph (1), by striking ``this Act'' and 
     inserting ``the Tom Lantos and Henry J. Hyde Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008''; and
       (2) in paragraph (3)--
       (A) by amending subparagraph (C) to read as follows:
       ``(C) A description of the manner in which the strategy 
     will address the following:
       ``(i) The fundamental elements of prevention and education, 
     care and treatment, including increasing access to 
     pharmaceuticals, vaccines, and microbicides, as they become 
     available, screening, prophylaxis, and treatment of major 
     opportunistic infections, including tuberculosis, and 
     increasing access to nutrition and food for individuals on 
     antiretroviral therapies.
       ``(ii) The promotion of delay of sexual debut, abstinence, 
     monogamy, fidelity, and partner reduction.
       ``(iii) The promotion of correct and consistent use of male 
     and female condoms and other strategies and skills 
     development to reduce the risk of HIV transmission.
       ``(iv) Increasing voluntary access to safe male 
     circumcision services.
       ``(v) Life-skills training.
       ``(vi) The provision of information and services to 
     encourage young people to delay sexual debut and ensure 
     access to HIV/AIDS prevention information and services.
       ``(vii) Prevention of sexual violence leading to 
     transmission of HIV and assistance for

[[Page 4807]]

     victims of violence who are at risk of HIV transmission.
       ``(viii) HIV/AIDS prevention, care, and treatment services 
     for injection drug users.
       ``(ix) Research, including incentives for HIV vaccine 
     development and new protocols.
       ``(x) Advocacy for community-based child and youth 
     protective services.
       ``(xi) Training of health care workers.
       ``(xii) The development of health care infrastructure and 
     delivery systems.
       ``(xiii) Prevention efforts for substance abusers.
       ``(xiv) Prevention, treatment, care, and outreach efforts 
     for men who have sex with men.'';
       (B) in subparagraph (D), by adding at the end before the 
     period the following: ``, including through faith-based and 
     other nongovernmental organizations'';
       (C) in subparagraph (E), by inserting ``access to HIV/AIDS 
     education and testing in family planning and maternal and 
     child health programs supported by the United States 
     Government and'' after ``the unique needs of women, 
     including'';
       (D) in subparagraph (F), by inserting ``(including by 
     accessing voluntary clinical circumcision services)'' after 
     ``in their sexual behavior'';
       (E) in subparagraph (G), by inserting ``and men's'' after 
     ``women's'';
       (F) by redesignating subparagraphs (M) through (W) as 
     subparagraphs (N) through (X);
       (G) by inserting after subparagraph (L) the following:
       ``(M) A description of efforts to be undertaken to 
     strengthen the public finance management systems of selected 
     host countries to ensure transparent, efficient, and 
     effective management of national and donor financial 
     investments in health.'';
       (H) in subparagraph (O) (as redesignated by subparagraph 
     (F) of this paragraph), by striking ``evaluating programs,'' 
     and inserting ``evaluating programs to ensure medical 
     accuracy, operations research,'';
       (I) in subparagraph (Q) (as redesignated by subparagraph 
     (F) of this paragraph), by inserting ``, strengthen national 
     health care delivery systems, and increase national health 
     workforce capacities,'' after ``HIV/AIDS pandemic'';
       (J) in subparagraph (R) (as redesignated by subparagraph 
     (F) of this paragraph), by inserting at the end before the 
     period the following: ``, including strategies relating to 
     agricultural development, trade and economic growth, and 
     education'';
       (K) in subparagraph (T) (as redesignated by subparagraph 
     (F) of this paragraph), by inserting ``efforts of 
     intergenerational caregivers and'' after ``, including'';
       (L) by redesignating subparagraphs (V) through (X) (as 
     redesignated by subparagraph (F) of this paragraph), as 
     subparagraphs (W) through (Y), respectively;
       (M) by inserting after subparagraph (U) (as redesignated by 
     subparagraph (F) of this paragraph) the following:
       ``(V) A plan to strengthen and implement health care 
     workforce strategies to enable countries to increase the 
     supply and retention of all cadres of trained professional 
     and paraprofessional health care workers by numbers that move 
     toward global health program needs and toward targets 
     established by the World Health Organization, while enabling 
     health systems to expand coverage consistent with national 
     and international targets and goals.''; and
       (N) by striking subparagraph (Y) (as redesignated by 
     subparagraphs (F) and (L) of this paragraph) and inserting 
     the following:
       ``(Y) A description of the specific strategies, developed 
     in coordination with existing health programs, to prevent 
     mother-to-child transmission of HIV, including the extent to 
     which HIV-positive women and men in treatment, care, and 
     support programs and HIV-negative women and men are counseled 
     about methods of preventing HIV transmission and the extent 
     to which HIV prevention methods are provided on-site or by 
     referral in treatment, care, and support programs.
       ``(Z) A description of the specific strategies developed to 
     maximize the capacity of health care providers, including 
     faith-based and other nongovernmental organizations, and 
     family planning providers supported by the United States 
     Government to ensure access to necessary and comprehensive 
     information about reducing sexual transmission of HIV among 
     women, men, and young people, including strategies to ensure 
     HIV/AIDS prevention training for such providers.
       ``(AA) A strategy to work with international and host 
     country partners toward universal access to HIV/AIDS 
     prevention, treatment, and care programs.''.
       (c) Strategic Plan for Program Monitoring, Operations 
     Research, and Impact Evaluation Research.--
       (1) In general.--Not later than 1 year after the date of 
     the enactment of this Act, the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally shall 
     develop a 5-year strategic plan for program monitoring, 
     operations research, and impact evaluation research of United 
     States HIV/AIDS, tuberculosis, and malaria programs.
       (2) Elements of plan.--The strategic plan developed under 
     this subsection shall include--
       (A) the amount of funding provided for program monitoring, 
     operations research, and impact evaluation research under 
     sections 104A, 104B, and 104C of the Foreign Assistance Act 
     of 1961 (22 U.S.C. 2151b-2, 2151b-3, and 2151b-4) and the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 et seq.) available 
     through fiscal year 2009;
       (B) strategies to--
       (i) improve the efficiency, effectiveness, quality, and 
     accessibility of services provided under the provisions of 
     law described in subparagraph (A);
       (ii) establish the cost-effectiveness of program models;
       (iii) ensure the transparency and accountability of 
     services provided under the provisions of law described in 
     subparagraph (A);
       (iv) disseminate and promote the utilization of evaluation 
     findings, lessons, and best practices in services provided 
     under the provisions of law described in subparagraph (A); 
     and
       (v) encourage and evaluate innovative service models and 
     strategies to optimize the delivery of care, treatment, and 
     prevention programs financed by the United States Government;
       (C) priorities for program monitoring, operations research, 
     and impact evaluation research and a time line for completion 
     of activities associated with such priorities; and
       (D) other information that the Coordinator determines to be 
     necessary.
       (3) Consultation.--In developing the strategic plan under 
     this subsection and implementing, disseminating, and 
     promoting the use of program monitoring, operations research, 
     and impact evaluation research, the Coordinator shall consult 
     with representatives of relevant executive branch agencies, 
     other appropriate executive branch agencies, multilateral 
     institutions involved in providing HIV/AIDS assistance, 
     nongovernmental organizations involved in implementing HIV/
     AIDS programs, and the governments of host countries.
       (4) Definitions.--In this subsection--
       (A) the terms ``program monitoring'', ``operations 
     research'', and ``impact evaluation research'', have the 
     meanings given such terms in section 104A(d)(4)(B) of the 
     Foreign Assistance Act of 1961 (as added by section 
     301(a)(4)(C) of this Act); and
       (B) the term ``relevant executive branch agencies'' has the 
     meaning given the term in section 3 of the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003 (22 U.S.C. 7602).

     SEC. 102. HIV/AIDS RESPONSE COORDINATOR.

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

       ``(IV) Establishing an interagency working group on HIV/
     AIDS that is comprised of, but not limited to, 
     representatives from the United States Agency for 
     International Development, the Department of Health and Human 
     Services (including the Centers for Disease Control and 
     Prevention, the National Institutes of Health, and the Health 
     Resources and Services Administration), the Department of 
     Labor, the Department of Agriculture, the Millennium 
     Challenge Corporation, the Department of Defense, and the 
     Office of the Coordinator of United States Government 
     Activities to Combat Malaria Globally, for the purposes of 
     coordination of activities relating to HIV/AIDS. The 
     interagency working group shall--

       ``(aa) meet regularly to review progress in host countries 
     toward HIV/AIDS prevention, treatment, and care objectives;
       ``(bb) participate in the process of identifying countries 
     in need of increased assistance based on the epidemiology of 
     HIV/AIDS in those countries; and
       ``(cc) review policies that may be obstacles to reaching 
     objectives set forth for HIV/AIDS prevention, treatment, and 
     care.

       ``(V) Coordinating overall United States HIV/AIDS policy 
     and programs with efforts led by host countries and with the 
     assistance provided by other relevant bilateral and 
     multilateral aid agencies and other donor institutions to 
     achieve complementarity with other programs aimed at 
     improving child and maternal health, and food security, 
     promoting education, and strengthening health care 
     systems.'';

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

       ``(VII) Holding annual consultations with host country 
     nongovernmental organizations providing services to improve 
     health, and advocating on behalf of the individuals with HIV/
     AIDS and those at particular risk of contracting HIV/AIDS.
       ``(VIII) Ensuring, through interagency and international 
     coordination, that United

[[Page 4808]]

     States HIV/AIDS programs are coordinated with and 
     complementary to the delivery of related global health, food 
     security, and education services, including--

       ``(aa) maternal and child health care;
       ``(bb) services for other neglected and easily preventable 
     and treatable infectious diseases, such as tuberculosis;
       ``(cc) treatment and care services for injection drug 
     users; and
       ``(dd) programs and services to improve legal, social, and 
     economic status of women and girls.'';
       (D) in subclause (IX) (as redesignated by subparagraph (B) 
     of this paragraph)--
       (i) by inserting ``Vietnam, Antigua and Barbuda, the 
     Bahamas, Barbados, Belize, Dominica, Grenada, Jamaica, 
     Montserrat, Saint Kitts and Nevis, Saint Vincent and the 
     Grenadines, Saint Lucia, Suriname, Trinidad and Tobago, the 
     Dominican Republic'' after ``Zambia,'';
       (ii) by adding at the end before the period the following: 
     ``and other countries in which the United States is 
     implementing HIV/AIDS programs''; and
       (iii) by adding at the end the following: ``In designating 
     countries under this subclause, the President shall give 
     priority to those countries in which there is a high 
     prevalence of HIV/AIDS and countries with large populations 
     that have a concentrated HIV/AIDS epidemic.'';
       (E) by redesignating subclause (X) (as redesignated by 
     subparagraph (B) of this paragraph) as subclause (XII);
       (F) by inserting after subclause (IX) (as redesignated by 
     subparagraph (B) and amended by subparagraph (D) of this 
     paragraph) the following:
       ``(X) Working, in partnership with host countries in which 
     the HIV/AIDS epidemic is prevalent among injection drug 
     users, to establish, as a national priority, national HIV/
     AIDS prevention programs, including education, and services 
     demonstrated to be effective in reducing the transmission of 
     HIV infection among injection drug users without increasing 
     drug use.
       ``(XI) Working, in partnership with host countries in which 
     the HIV/AIDS epidemic is prevalent among individuals involved 
     in commercial sex acts, to establish, as a national priority, 
     national prevention programs, including education, voluntary 
     testing, and counseling, and referral systems that link HIV/
     AIDS programs with programs to eradicate trafficking in 
     persons and create alternatives to prostitution.'';
       (G) in subclause (XII) (as redesignated by subparagraphs 
     (B) and (E) of this paragraph), by striking ``funds section'' 
     and inserting ``funds appropriated pursuant to the 
     authorization of appropriations under section 401 of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 for HIV/AIDS assistance''; and
       (H) by adding at the end the following:

       ``(XIII) Publicizing updated drug pricing data to inform 
     pharmaceutical procurement partners' purchasing decisions.
       ``(XIV) Working in partnership with host countries in which 
     the HIV/AIDS epidemic is prevalent among men who have sex 
     with men, to establish, as a national priority, national HIV/
     AIDS prevention programs, including education and services 
     demonstrated to be effective in reducing the transmission of 
     HIV among men who have sex with men.''.

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

     SEC. 201. SENSE OF CONGRESS ON PUBLIC-PRIVATE PARTNERSHIPS.

       Section 201(a) of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7621(a)) is amended--
       (1) in paragraph (2), by striking ``infectious diseases'' 
     and inserting ``easily preventable and treatable infectious 
     diseases''; and
       (2) in paragraph (4), by striking ``infectious diseases'' 
     and inserting ``easily preventable and treatable infectious 
     diseases''.

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

       (a) Findings.--Subsection (a) of section 202 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7622) is amended--
       (1) by redesignating paragraphs (1) through (3) as 
     paragraphs (7) through (9), respectively; and
       (2) by inserting before paragraph (7) (as redesignated by 
     paragraph (1) of this subsection) the following:
       ``(1) The Global Fund to Fight AIDS, Tuberculosis and 
     Malaria is the multilateral component of this Act, extending 
     United States efforts to a total of 136 countries around the 
     world.
       ``(2) Created in 2002, the Global Fund has played a leading 
     role in the fight against HIV/AIDS, tuberculosis, and malaria 
     around the world and has grown into an organization that 
     currently provides nearly a quarter of all international 
     financing to combat HIV/AIDS and two-thirds of all 
     international financing to combat tuberculosis and malaria.
       ``(3) By 2010, it is estimated that the demand for funding 
     by the Global Fund will grow in size to between $6 and $8 
     billion annually, requiring significant contributions from 
     donors around the world, including at least $2 billion 
     annually from the United States.
       ``(4) The Global Fund is an innovative financing mechanism 
     to combat HIV/AIDS, tuberculosis, and malaria, and has made 
     progress in many areas.
       ``(5) The United States Government is the largest supporter 
     of the Global Fund, both in terms of resources and technical 
     support.
       ``(6) The United States made the initial contribution to 
     the Global Fund and is fully committed to its success.''.
       (b) United States Financial Participation.--
       (1) Authorization of appropriations.--Subsection (d)(1) of 
     such section is amended--
       (A) by striking ``$1,000,000,000'' and inserting 
     ``$2,000,000,000'';
       (B) by striking ``for the period of fiscal year 2004 
     beginning on January 1, 2004,'' and inserting ``for each of 
     the fiscal years 2009 and 2010,''; and
       (C) by striking ``the fiscal years 2005-2008'' and 
     inserting ``each of the fiscal years 2011 through 2013''.
       (2) Limitation.--Subsection (d)(4) of such section is 
     amended--
       (A) in subparagraph (A)--
       (i) in clause (i), by striking ``fiscal years 2004 through 
     2008'' and inserting ``fiscal years 2009 through 2013'';
       (ii) in clause (ii), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''; and
       (iii) in clause (vi)--

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

       (B) in subparagraph (B)(iv)--
       (i) by striking ``fiscal years 2004 through 2008'' and 
     inserting ``fiscal years 2009 through 2013''; and
       (ii) by adding at the end before the period the following: 
     ``, unless such amount is made available for more than one 
     fiscal year, in which case such amount is authorized to be 
     made available for such purposes after December 31 of the 
     fiscal year following the fiscal year in which such funds 
     first became available.''; and
       (C) in subparagraph (C)(ii) by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs''.
       (3) Statement of policy.--The following shall be the policy 
     of the United States:
       (A) Support for the Global Fund to Fight AIDS, Tuberculosis 
     and Malaria should be based upon achievement of the following 
     benchmarks related to transparency and accountability:
       (i) As recommended by the Government Accountability Office, 
     the Fund Secretariat has established standardized 
     expectations for the performance of Local Fund Agents (LFAs), 
     is undertaking a systematic assessment of the performance of 
     LFAs, and is making available for public review, according to 
     the Fund Board's policies and practices on disclosure of 
     information, a regular collection and analysis of performance 
     data of Fund grants, which shall cover both Principal 
     Recipients and sub-recipients.
       (ii) A well-staffed, independent Office of the Inspector 
     General reports directly to the Board and is responsible for 
     regular, publicly published audits of both financial and 
     programmatic and reporting aspects of the Fund, its grantees, 
     and LFAs.
       (iii) The Fund Secretariat has established and is reporting 
     publicly on standard indicators for all program areas.
       (iv) The Fund Secretariat has established a database that 
     tracks all subrecipients and the amounts of funds disbursed 
     to each, as well as the distribution of resources, by grant 
     and Principal Recipient, for prevention, care, treatment, the 
     purchases of drugs and commodities, and other purposes.
       (v) The Fund Board has established a penalty to offset 
     tariffs imposed by national governments on all goods and 
     services provided by the Fund.
       (vi) The Fund Board has successfully terminated its 
     Administrative Services Agreement with the World Health 
     Organization and completed the Fund Secretariat's transition 
     to a fully independent status under the Headquarters 
     Agreement the Fund has established with the Government of 
     Switzerland.
       (B) Support for the Global Fund to Fight AIDS, Tuberculosis 
     and Malaria should be based upon achievement of the following 
     benchmarks related to the founding principles of the Fund:
       (i) The Fund must maintain its status as a financing 
     institution.
       (ii) The Fund must remain focused on programs directly 
     related to HIV/AIDS, malaria, and tuberculosis.
       (iii) The Fund must maintain its Comprehensive Funding 
     Policy, which requires confirmed pledges to cover the full 
     amount of new grants before the Board approves them.
       (iv) The Fund must maintain and make progress on sustaining 
     its multisectoral approach, through Country Coordinating 
     Mechanisms (CCMs) and in the implementation of

[[Page 4809]]

     grants, as reflected in percent and resources allocated to 
     different sectors, including governments, civil society, and 
     faith- and community-based organizations.
       (4) Sense of congress.--Congress--
       (A) notes that section 625 of Public Law 110-161 
     establishes a requirement to withhold 20 percent of funds 
     appropriated for the Global Fund if the Global Fund fails to 
     meet certain benchmarks; and
       (B) will continue to review the implementation of the 
     benchmarks to ensure accountability and transparency of the 
     Global Fund.

     SEC. 203. VOLUNTARY CONTRIBUTIONS TO INTERNATIONAL VACCINE 
                   FUNDS.

       (a) Vaccine Fund.--Subsection (k) of section 302 of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2222) is amended by 
     striking ``fiscal years 2004 through 2008'' and inserting 
     ``fiscal years 2009 through 2013''.
       (b) International AIDS Vaccine Initiative.--Subsection (l) 
     of such section is amended by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.
       (c) Malaria Vaccine Development Programs.--Subsection (m) 
     of such section is amended by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.
       (d) Research and Development of a Tuberculosis Vaccine.--
     Such section is further amended by adding at the end the 
     following:
       ``(n) In addition to amounts otherwise available under this 
     section, there are authorized to be appropriated to the 
     President such sums as may be necessary for each of the 
     fiscal years 2009 through 2013 to be available for United 
     States contributions to research and development of a 
     tuberculosis vaccine.''.

     SEC. 204. PROGRAM TO FACILITATE AVAILABILITY OF MICROBICIDES 
                   TO PREVENT TRANSMISSION OF HIV AND OTHER 
                   DISEASES.

       (a) Statement of Policy.--Congress recognizes the need and 
     urgency to expand the range of interventions for preventing 
     the transmission of human immunodeficiency virus (HIV), 
     including nonvaccine prevention methods that can be 
     controlled by women.
       (b) Program Authorized.--The Administrator of the United 
     States Agency for International Development, in coordination 
     with the Coordinator of United States Government Activities 
     to Combat HIV/AIDS Globally, shall develop and implement a 
     program to facilitate wide-scale availability of microbicides 
     that prevent the transmission of HIV after such microbicides 
     are proven safe and effective.
       (c) Authorization of Appropriations.--Of the amounts 
     authorized to be appropriated under section 401 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7671) for HIV/AIDS assistance, there 
     are authorized to be appropriated to the President such sums 
     as may be necessary for each of the fiscal years 2009 through 
     2013 to carry out this section.

     SEC. 205. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                   BY STRENGTHENING HEALTH POLICIES AND HEALTH 
                   SYSTEMS OF HOST COUNTRIES.

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

     ``SEC. 204. PLAN TO COMBAT HIV/AIDS, TUBERCULOSIS, AND 
                   MALARIA BY STRENGTHENING HEALTH POLICIES AND 
                   HEALTH SYSTEMS OF HOST COUNTRIES.

       ``(a) Findings.--Congress makes the following findings:
       ``(1) One of the most significant barriers to achieving 
     universal access to HIV/AIDS treatment and prevention in 
     developing countries is the lack of health infrastructure, 
     particularly in sub-Saharan Africa.
       ``(2) In addition to HIV/AIDS programs, other treatable and 
     preventable infectious diseases could be treated concurrently 
     and easily if health care delivery systems in developing 
     countries were significantly improved.
       ``(3) More public investment in basic primary health care 
     should be a priority in public spending in developing 
     countries.
       ``(b) Statement of Policy.--It shall be the policy of the 
     United States Government--
       ``(1) to invest appropriate resources authorized under this 
     Act and the amendments made by this Act to carry out 
     activities to strengthen HIV/AIDS health policies and health 
     systems and provide workforce training and capacity-building 
     consistent with the goals and objectives of this Act and the 
     amendments made by this Act; and
       ``(2) to support the development of a sound policy 
     environment in host countries to increase the ability of such 
     countries to maximize utilization of health care resources 
     from donor countries, deliver services to the people of such 
     host countries in an effective and efficient manner, and 
     reduce barriers that prevent recipients of services from 
     achieving maximum benefit from such services.
       ``(c) Plan Required.--The Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally, in 
     collaboration with the Administrator of the United States 
     Agency for International Development, shall develop and 
     implement a plan to combat HIV/AIDS by strengthening health 
     policies and health systems of host countries as part of the 
     United States Agency for International Development's `Health 
     Systems 2020' project.
       ``(d) Assistance To Improve Public Finance Management 
     Systems.--
       ``(1) In general.--The Secretary of the Treasury, acting 
     through the head of the Office of Technical Assistance, is 
     authorized to provide assistance for advisors and host 
     country finance, health, and other relevant ministries to 
     improve the effectiveness of public finance management 
     systems in host countries to enable such countries to receive 
     funding to carry out programs to combat HIV/AIDS, 
     tuberculosis, and malaria and to manage such programs.
       ``(2) Authorization of appropriations.--Of the amounts 
     authorized to be appropriated under section 401 for HIV/AIDS 
     assistance, there are authorized to be appropriated to the 
     Secretary of the Treasury such sums as may be necessary for 
     each of the fiscal years 2009 through 2013 to carry out this 
     subsection.''.
       (b) Clerical Amendment.--The table of contents for the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by 
     inserting after the item relating to section 203 the 
     following:

``Sec. 204. Plan to combat HIV/AIDS by strengthening health policies 
              and health systems of host countries.''.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

     SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

       (a) Amendments to the Foreign Assistance Act of 1961.--
       (1) Finding.--Subsection (a) of section 104A of the Foreign 
     Assistance Act of 1961 (22 U.S.C. 2151b-2) is amended by 
     inserting ``, South and Southeast Asia, Central and Eastern 
     Europe'' after ``the Caribbean''.
       (2) Policy.--Subsection (b) of such section is amended--
       (A) in the first sentence--
       (i) by striking ``It is a major'' and inserting the 
     following:
       ``(1) General policy.--It is a major'';
       (ii) by striking ``control'' and inserting ``care''; and
       (iii) by adding at the end before the period the following: 
     ``and to fulfill United States commitments to move toward the 
     goal of universal access to prevention, treatment, and care 
     of HIV/AIDS'';
       (B) by adding at the end the following: ``The United States 
     and other developed countries should provide assistance for 
     the prevention, treatment, and care of HIV/AIDS to countries 
     in sub-Saharan Africa, the Caribbean, South and Southeast 
     Asia and Central and Eastern Europe, addressing both 
     generalized epidemics and epidemics concentrated among 
     populations at high risk of infection.''; and
       (C) by further adding at the end the following:
       ``(2) Specific policy.--It is therefore the policy of the 
     United States, by 2013, to--
       ``(A) prevent 12,000,000 new HIV infections worldwide;
       ``(B) support treatment of at least 3,000,000 individuals 
     with HIV/AIDS with the goal of treating 450,000 children;
       ``(C) provide care for 12,000,000 individuals affected by 
     HIV/AIDS, including 5,000,000 orphans and vulnerable children 
     in communities affected by HIV/AIDS, including orphans with 
     HIV/AIDS; and
       ``(D) train at least 140,000 new health care professionals 
     and workers for HIV/AIDS prevention, treatment and care.''.
       (3) Authorization.--Subsection (c) of such section is 
     amended--
       (A) in paragraph (1)--
       (i) by inserting ``, South and Southeast Asia, Central and 
     Eastern Europe'' after ``the Caribbean''; and
       (ii) by adding at the end before the period the following: 
     ``, and particularly with respect to refugee populations in 
     such countries and areas'';
       (B) in paragraph (2)--
       (i) by inserting ``, South and Southeast Asia, Central and 
     Eastern Europe'' after ``the Caribbean''; and
       (ii) by adding at the end before the period the following: 
     ``, and particularly with respect to refugee populations in 
     such countries and areas'';
       (C) by redesignating paragraph (3) as paragraph (4);
       (D) by inserting after paragraph (2) the following:
       ``(3) Role of public health care delivery systems.--It is 
     the sense of Congress that--
       ``(A) the President should provide an appropriate level of 
     assistance under paragraph (1) to help strengthen public 
     health care delivery systems financed by host countries; and
       ``(B) the President, acting through the Coordinator of 
     United States Government Activities to Combat HIV/AIDS 
     Globally, should support the development of a policy 
     framework in such host countries for the

[[Page 4810]]

     long-term sustainability of HIV/AIDS prevention, treatment, 
     and care programs, and for strengthening health care delivery 
     systems and increasing health workforces through recruitment, 
     training, and policies that allows the devolution of clinical 
     responsibilities to increase the work force able to deliver 
     prevention, treatment, and care services, as necessary, with 
     clearly identified objectives and reporting strategies for 
     such services.'';
       (E) in paragraph (4) (as redesignated by subparagraph (C) 
     of this paragraph), by striking ``foreign countries'' and 
     inserting ``host countries and donor countries''; and
       (F) by adding at the end the following:
       ``(5) Sense of congress.--
       ``(A) In general.--It is the sense of Congress that the 
     Coordinator of United States Government Activities to Combat 
     HIV/AIDS Globally and the heads of relevant executive branch 
     agencies (as such term is defined in section 3 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003) should operate in a manner consistent with the 
     `Three Ones' goals of UNAIDS.
       ``(B) `Three ones' goals of unaids defined.--In this 
     paragraph, the term `` `Three Ones'' goals of UNAIDS' means--
       ``(i) the goal of one agreed HIV/AIDS action framework that 
     provides the basis for coordinating the work of all partners 
     in host countries;
       ``(ii) the goal of one national HIV/AIDS coordinating 
     authority, with a broad-based multisectoral mandate; and
       ``(iii) the goal of one agreed country-level data-
     collection, monitoring, and evaluation system.''.
       (4) Activities supported.--
       (A) Prevention.--Subsection (d)(1) of such section is 
     amended--
       (i) in subparagraph (A)--

       (I) by inserting ``efforts by faith-based and other 
     nongovernmental organizations and'' after ``infection, 
     including'';
       (II) by inserting ``, including access to such programs and 
     efforts in family planning programs supported by the United 
     States Government,'' after ``health programs''; and
       (III) by inserting ``male and female'' before ``condoms'';

       (ii) in subparagraph (B)--

       (I) by inserting ``relevant and'' after ``culturally'';
       (II) by inserting ``and programs'' after ``those 
     organizations''; and
       (III) by inserting ``, level of scientific and fact-based 
     knowledge'' after ``experience'';

       (iii) in subparagraph (D), by inserting ``and nonjudgmental 
     approaches'' after ``protections'';
       (iv) by amending subparagraph (E) to read as follows:
       ``(E) assistance to achieve the target of reaching 80 
     percent of pregnant women for prevention and treatment of 
     mother-to-child transmission of HIV in countries in which the 
     United States is implementing HIV/AIDS programs by 2013, as 
     described in section 312(b)(1) of the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003, and to promote infant feeding options that meet the 
     criteria described in the World Health Organization's Global 
     Strategy for Infant and Young Child Feeding;'';
       (v) in subparagraph (G)--

       (I) by adding at the end before the semicolon the 
     following: ``, including education and services demonstrated 
     to be effective in reducing the transmission of HIV infection 
     without increasing illicit drug use''; and
       (II) by striking ``and'' at the end;

       (vi) in subparagraph (H), by striking the period at the end 
     and inserting ``; and''; and
       (vii) by adding at the end the following:
       ``(I)(i) assistance for counseling, testing, treatment, 
     care, and support programs for prevention of re-infection of 
     individuals with HIV/AIDS;
       ``(ii) counseling to prevent sexual transmission of HIV, 
     including skill development for practicing abstinence, 
     reducing the number of sexual partners, and providing 
     information on correct and consistent use of male and female 
     condoms;
       ``(iii) assistance to provide male and female condoms;
       ``(iv) diagnosis and treatment of other sexually-
     transmitted infections;
       ``(v) strategies to address the stigma and discrimination 
     that impede HIV/AIDS prevention efforts; and
       ``(vi) assistance to facilitate widespread access to 
     microbicides for HIV prevention, as safe and effective 
     products become available, including financial and technical 
     support for culturally appropriate introductory programs, 
     procurement, distribution, logistics management, program 
     delivery, acceptability studies, provider training, demand 
     generation, and post-introduction monitoring; and
       ``(J) assistance for HIV/AIDS education targeted to reach 
     and prevent the spread of HIV among men who have sex with 
     men.''.
       (B) Treatment.--Subsection (d)(2) of such section is 
     amended--
       (i) in subparagraph (B), by striking ``; and'' at the end 
     and inserting a semicolon;
       (ii) in subparagraph (C), by striking the period at the end 
     and inserting a semicolon; and
       (iii) by adding at the end the following:
       ``(D) assistance specifically to address barriers that 
     might limit the start of and adherence to treatment services, 
     especially in rural areas, through such measures as mobile 
     and decentralized distribution of treatment services, and 
     where feasible and necessary, direct linkages with nutrition 
     and income security programs, referrals to services for 
     victims of violence, support groups for individuals with HIV/
     AIDS, and efforts to combat stigma and discrimination against 
     all such individuals;
       ``(E) assistance to support comprehensive HIV/AIDS 
     treatment (including free prophylaxis and treatment for 
     common HIV/AIDS-related opportunistic infections) for at 
     least one-third of individuals with HIV/AIDS in the poorest 
     countries worldwide who are in clinical need of 
     antiretroviral treatment; and
       ``(F) assistance to improve access to psychosocial support 
     systems and other necessary services for youth who are 
     infected with HIV to ensure the start of and adherence to 
     treatment services.''.
       (C) Monitoring.--Subsection (d)(4) of such section is 
     amended--
       (i) by striking ``The monitoring'' and inserting the 
     following:
       ``(A) In general.--The monitoring'';
       (ii) by inserting ``and paragraph (8)'' after ``paragraphs 
     (1) through (3)'';
       (iii) by redesignating subparagraphs (A) through (D) as 
     clauses (i) through (iv), respectively;
       (iv) in clause (iii) (as redesignated by clause (iii) of 
     this subparagraph), by striking ``and'' at the end;
       (v) in clause (iv) (as redesignated by clause (iii) of this 
     subparagraph), by striking the period at the end and 
     inserting ``; and'';
       (vi) by adding at the end the following:
       ``(v) carrying out and expanding program monitoring, impact 
     evaluation research, and operations research (including 
     research and evaluations of gender-responsive interventions, 
     disaggregated by age and sex, in order to identify and 
     replicate effective models, develop gender indicators to 
     measure both outcomes and impacts of interventions, 
     especially interventions designed to reduce gender 
     inequalities, and collect lessons learned for dissemination 
     among different countries) in order to--

       ``(I) improve the coverage, efficiency, effectiveness, 
     quality and accessibility of services provided under this 
     section;
       ``(II) establish the cost-effectiveness of program models;
       ``(III) assess the population-level impact of programs, 
     projects, and activities implemented;
       ``(IV) ensure the transparency and accountability of 
     services provided under this section;
       ``(V) disseminate and promote the utilization of evaluation 
     findings, lessons, and best practices in the implementation 
     of programs, projects, and activities supported under this 
     section; and
       ``(VI) encourage and evaluate innovative service models and 
     strategies to optimize functionality of programs, projects, 
     and activities.''; and

       (vii) by further adding at the end the following:
       ``(B) Definitions.--For purposes of subparagraph (A)(v)--
       ``(i) the term `impact evaluation research' means the 
     application of research methods and statistical analysis to 
     measure the extent to which a change in a population-based 
     outcome can be attributed to a program, project, or activity 
     as opposed to other factors in the environment;
       ``(ii) the term `program monitoring' means the collection, 
     analysis, and use of routine data with respect to a program, 
     project, or activity to determine how well the program, 
     project, or activity is carried out and at what cost; and
       ``(iii) the term `operations research' means the 
     application of social science research methods and 
     statistical analysis to judge, compare, and improve policy 
     outcomes and outcomes of a program, project, or activity, 
     from the earliest stages of defining and designing the 
     program, project, or activity through the development and 
     implementation of the program, project, or activity.''.
       (D) Pharmaceuticals.--Subsection (d)(5) of such section is 
     amended--
       (i) by redesignating subparagraph (C) as subparagraph (D); 
     and
       (ii) by inserting after subparagraph (B) the following:
       ``(C) Mechanisms to ensure cost-effective drug 
     purchasing.--Mechanisms to ensure that pharmaceuticals, 
     including antiretrovirals and medicines to treat 
     opportunistic infections, are purchased at the lowest 
     possible price at which such pharmaceuticals may be obtained 
     in sufficient quantity on the world market.''.
       (E) Referral systems and coordination with other assistance 
     programs.--
       (i) Finding.--The effectiveness of all HIV/AIDS prevention, 
     treatment, and care programs and the survival of individuals 
     with HIV/AIDS would be enhanced by ensuring that such 
     individuals are referred to appropriate support programs, 
     including education, income generation, HIV/AIDS support 
     group and food and nutrition programs, and by providing 
     assistance directly to such programs to the extent such 
     programs would

[[Page 4811]]

     further the purposes of expanding access to and the success 
     of HIV/AIDS prevention, treatment, and care.
       (ii) Amendment.--Subsection (d) of such section is further 
     amended by adding at the end the following:
       ``(8) Referral systems and coordination with other 
     assistance programs.--
       ``(A) Referral systems.--Assistance to ensure that a 
     continuum of care is available to individuals participating 
     in HIV/AIDS prevention, treatment, and care programs through 
     the development of referral systems for such individuals to 
     community-based programs that, where practicable, are co-
     located with such HIV/AIDS programs, and that provide support 
     activities for such individuals, including HIV/AIDS treatment 
     adherence, HIV/AIDS support groups, food and nutrition 
     support, maternal health services, substance abuse prevention 
     and treatment services, income-generation programs, legal 
     services, and other program support.
       ``(B) Coordination with other assistance programs.--
       ``(i)(I) Assistance to integrate HIV/AIDS testing with 
     testing for other easily detectable and treatable infectious 
     diseases, such as malaria, tuberculosis, and respiratory 
     infections, and to provide treatment if possible or referral 
     to appropriate treatment programs.
       ``(II) Assistance to provide, whenever possible, as a 
     component of HIV/AIDS prevention, treatment, and care 
     services, and co-treatment of curable diseases, such as other 
     sexually transmitted diseases.
       ``(III) Assistance and other activities to ensure, through 
     interagency and international coordination, that United 
     States global HIV/AIDS programs are integrated and 
     complementary to delivering related health services.
       ``(ii) Assistance to support schools and related programs 
     for children and youth that increase the effectiveness of 
     programs described in this subsection by providing the 
     infrastructure, teachers, and other support to such programs.
       ``(iii) Assistance and other activities to provide access 
     to HIV/AIDS prevention, treatment, and care programs in 
     family planning and maternal and child health programs 
     supported by the United States Government.
       ``(iv) Assistance to United States and host country 
     nonprofit development organizations that directly support 
     livelihood initiatives in HIV/AIDS-affected countries that 
     provide opportunities for direct lending to 
     microentrepreneurs by United States citizens or opportunities 
     for United States citizens to purchase livestock and plants 
     for families to provide nutrition and generate income for 
     individual households and communities.
       ``(v) Assistance to coordinate and provide linkages between 
     HIV/AIDS prevention, treatment, and care programs with 
     efforts to improve the economic and legal status of women and 
     girls.
       ``(vi) Technical assistance coordinated across implementing 
     agencies, offered on a regular basis, and made available upon 
     request, for faith-based and community-based organizations, 
     especially indigenous organizations and new partners who do 
     not have extensive experience managing United States foreign 
     assistance programs, including for training and logistical 
     support to establish financial mechanisms to track program 
     receipts and expenditures and data management systems to 
     ensure data quality and strengthen reporting.
       ``(vii) In accordance with the World Health Organization's 
     Interim Policy on TB/HIV Activities (2004), assistance to 
     individuals with or symptomatic of tuberculosis, and 
     assistance to implement the following:
       ``(I) Provide opt-out HIV/AIDS counseling and testing and 
     appropriate referral for treatment and care to individuals 
     with or symptomatic of tuberculosis, and work with host 
     countries to ensure that such individuals in host countries 
     are provided such services.
       ``(II) Ensure, in coordination with host countries, that 
     individuals with HIV/AIDS receive tuberculosis screening and 
     other appropriate treatment.
       ``(III) Provide increased funding for HIV/AIDS and 
     tuberculosis activities, by increasing total resources for 
     such activities, including lab strengthening and infection 
     control.
       ``(IV) Improve the management and dissemination of 
     knowledge gained from HIV/AIDS and tuberculosis activities to 
     increase the replication of best practices.''.
       (5) Annual report.--Subsection (e) of such section is 
     amended--
       (A) in paragraph (1), by striking ``Committee on 
     International Relations'' and inserting ``Committee on 
     Foreign Affairs'';
       (B) in paragraph (2)--
       (i) in subparagraph (B), by striking ``and'' at the end;
       (ii) in subparagraph (C)--

       (I) in the matter preceding clause (i), by striking 
     ``including'' and inserting ``including--'';
       (II) by striking clauses (i) and (ii) and inserting the 
     following:

       ``(i)(I) the effectiveness of such programs in reducing the 
     transmission of HIV, particularly in women and girls, in 
     reducing mother-to-child transmission of HIV, including 
     through drug treatment and therapies, either directly or by 
     referral, and in reducing mortality rates from HIV/AIDS, 
     including through drug treatment, and addiction therapies;
       ``(II) a description of strategies, goals, programs, and 
     interventions to address the specific needs and 
     vulnerabilities of young women and young men; the progress 
     toward expanding access among young women and young men to 
     evidence-based, comprehensive HIV/AIDS health care services 
     and HIV prevention and sexuality and abstinence education 
     programs at the individual, community, and national levels; 
     and clear targets for integrating adolescents who are 
     orphans, including adolescents who are infected with HIV, 
     into programs for orphans and vulnerable children; and
       ``(III) the amount of United States funding provided under 
     the authorities of this Act to procure drugs for HIV/AIDS 
     programs in countries described in section 1(f)(2)(B)(IX) of 
     the State Department Basic Authorities Act of 1956 (22 U.S.C. 
     2651a(f)(2)(B)(VIII)), including a detailed description of 
     anti-retroviral drugs procured, including--

       ``(aa) the total amount expended for each generic and name 
     brand drug;
       ``(bb) the price paid per unit of each drug; and
       ``(cc) the vendor from which each drug was purchased; and

       ``(ii) the progress made toward improving health care 
     delivery systems (including the training of adequate numbers 
     of health care professionals) and infrastructure to ensure 
     increased access to care and treatment, including a 
     description of progress toward--

       ``(I)(aa) the training and retention of adequate numbers of 
     health care professionals in order to meet a nationally-
     determined ratio of doctors, nurses, and midwives to 
     patients, based on the target of the 2.3 per-thousand ratio 
     established by the World Health Organization (WHO);
       ``(bb) increases in the number of other health care 
     professions, such as pharmacists and lab technicians, as 
     necessary; and
       ``(cc) the improvement of infrastructure needed to ensure 
     universal access to HIV/AIDS prevention, treatment, and care 
     by 2015;
       ``(II) national health care workforce strategy benchmarks, 
     as required by section 202(d)(5)(B) of the United States 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 
     2003, United States contributions to developing and 
     implementing the benchmarks, and main challenges to 
     implementing the benchmarks;
       ``(III) ensuring, to the extent practicable, that health 
     care workers providing services under this Act have safe 
     working conditions and are receiving health care services, 
     including services relating to HIV/AIDS;
       ``(IV) activities to strengthen health care systems in 
     order to overcome obstacles and barriers to the provision of 
     HIV/AIDS, tuberculosis, and malaria services;
       ``(V) improving integration and coordination of HIV/AIDS 
     programs with related health care services and supporting the 
     capacity of health care programs to refer individuals to 
     community-based services; and
       ``(VI) strengthening procurement and supply chain 
     management systems of host countries;'';

       (III) in clause (iii), by adding at the end before the 
     semicolon the following: ``, including the percentage of such 
     United States foreign assistance provided for diagnosis and 
     treatment of individuals with tuberculosis in countries with 
     the highest burden of tuberculosis, as determined by the 
     World Health Organization (WHO)''; and
       (IV) in clause (iv), by striking the period at the end and 
     inserting a semicolon; and

       (iii) by adding at the end the following:
       ``(D) a description of efforts to integrate HIV/AIDS and 
     tuberculosis prevention, treatment, and care programs, 
     including--
       ``(i) the number and percentage of HIV-infected individuals 
     receiving HIV/AIDS treatment or care services who are also 
     receiving screening and subsequent treatment for 
     tuberculosis;
       ``(ii) the number and percentage of individuals with 
     tuberculosis who are receiving HIV/AIDS counseling and 
     testing, and appropriate referral to HIV/AIDS services;
       ``(iii) the number and location of laboratories with the 
     capacity to perform tuberculosis culture tests and 
     tuberculosis drug susceptibility tests;
       ``(iv) the number and location of laboratories with the 
     capacity to perform appropriate tests for multi-drug 
     resistant tuberculosis (MDR-TB) and extensively drug 
     resistant tuberculosis (XDR-TB); and
       ``(v) the number of HIV-infected individuals suspected of 
     having tuberculosis who are provided tuberculosis culture 
     diagnosis or tuberculosis drug susceptibility testing;
       ``(E) a description of coordination efforts with relevant 
     executive branch agencies (as such term is defined in section 
     3 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003) and at the global 
     level in the effort to link HIV/AIDS services with non-HIV/
     AIDS services;
       ``(F) a description of programs serving women and girls, 
     including--
       ``(i) a description of HIV/AIDS prevention programs that 
     address the vulnerabilities of girls and women to HIV/AIDS; 
     and

[[Page 4812]]

       ``(ii) information on the number of individuals served by 
     programs aimed at reducing the vulnerabilities of women and 
     girls to HIV/AIDS;
       ``(G) a description of the specific strategies funded to 
     ensure the reduction of HIV infection among injection drug 
     users, and the number of injection drug users, by country, 
     reached by such strategies, including medication-assisted 
     drug treatment for individuals with HIV or at risk of HIV, 
     and HIV prevention programs demonstrated to be effective in 
     reducing HIV transmission without increasing drug use; and
       ``(H) a detailed description of monitoring, impact 
     evaluation research, and operations research of programs, 
     projects, and activities carried out pursuant to subsection 
     (d)(4)(A)(v).''; and
       (C) by adding at the end the following:
       ``(3) Public availability.--The Coordinator of United 
     States Government Activities to Combat HIV/AIDS Globally 
     shall make publicly available on the Internet website of the 
     Office of the Coordinator the information contained in 
     paragraph (2)(H) of each report and, in addition, the 
     individual evaluations and other reports that were the basis 
     of such information, including lessons learned and collected 
     in such evaluations and reports.''.
       (b) Authorization of Appropriations.--Subsection (b) of 
     section 301 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7631) is 
     amended--
       (1) in paragraph (1), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''; and
       (2) in paragraph (3), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.
       (c) Food Security and Nutrition Support.--Subsection (c) of 
     such section is amended to read as follows:
       ``(c) Food Security and Nutrition Support.--
       ``(1) Findings.--Congress finds the following:
       ``(A) The United States provides more than 60 percent of 
     all food assistance worldwide.
       ``(B) According to the United Nations World Food Program 
     and other United Nations agencies, food insecurity of 
     individuals with HIV/AIDS is a major problem in countries 
     with large populations of such individuals, particularly in 
     sub-Saharan African countries.
       ``(C) Individuals infected with HIV have higher nutritional 
     requirements than individuals who are not infected with HIV, 
     particularly with respect to the need for protein. Also, 
     there is evidence to suggest that the full benefit of therapy 
     to treat HIV/AIDS may not be achieved in individuals who are 
     malnourished, particularly in pregnant and lactating women.
       ``(2) Sense of congress.--It is the sense of Congress 
     that--
       ``(A) malnutrition, especially for individuals with HIV/
     AIDS, is a clinical health issue with wider nutrition, 
     health, and social implications for such individuals, their 
     families, and their communities that must be addressed by 
     United States HIV/AIDS prevention, treatment, and care 
     programs;
       ``(B) food security and nutrition directly impact an 
     individual's vulnerability to HIV infection, the progression 
     of HIV to AIDS, an individual's ability to begin an 
     antiretroviral medication treatment regimen, the efficacy of 
     an antiretroviral medication treatment regimen once an 
     individual begins such a regimen, and the ability of 
     communities to effectively cope with the HIV/AIDS epidemic 
     and its impacts;
       ``(C) international guidelines established by the World 
     Health Organization (WHO) should serve as the reference 
     standard for HIV/AIDS food and nutrition activities supported 
     by this Act and the amendments made by this Act;
       ``(D) the Coordinator of United States Government 
     Activities to Combat HIV/AIDS Globally and the Administrator 
     of the United States Agency for International Development 
     should make it a priority to work together and with other 
     United States Government agencies, donors, and multilateral 
     institutions to increase the integration of food and 
     nutrition support and livelihood activities into HIV/AIDS 
     prevention, treatment, and care activities funded by the 
     United States and other governments and organizations;
       ``(E) for purposes of determining which individuals 
     infected with HIV should be provided with nutrition and food 
     support--
       ``(i) children with moderate or severe malnutrition, 
     according to WHO standards, shall be given priority for such 
     nutrition and food support; and
       ``(ii) adults with a body mass index (BMI) of 18.5 or less, 
     or at the prevailing WHO-approved measurement for BMI, should 
     be considered `malnourished' and should be given priority for 
     such nutrition and food support;
       ``(F) programs funded by the United States should include 
     therapeutic and supplementary feeding, food, and nutrition 
     support and should include strong links to development 
     programs that provide support for livelihoods; and
       ``(G) the inability of individuals with HIV/AIDS to access 
     food for themselves or their families should not be allowed 
     to impair or erode the therapeutic status of such individuals 
     with respect to HIV/AIDS or related co-morbidities.
       ``(3) Statement of policy.--It is the policy of the United 
     States to--
       ``(A) address the food and nutrition needs of individuals 
     with HIV/AIDS and affected individuals, including orphans and 
     vulnerable children;
       ``(B) fully integrate food and nutrition support into HIV/
     AIDS prevention, treatment, and care programs carried out 
     under this Act and the amendments made by this Act;
       ``(C) ensure, to the extent practicable, that--
       ``(i) HIV/AIDS prevention, treatment, and care providers 
     and health care workers are adequately trained so that such 
     providers and workers can provide accurate and informed 
     information regarding food and nutrition support to 
     individuals enrolled in treatment and care programs and 
     individuals affected by HIV/AIDS; and
       ``(ii) individuals with HIV/AIDS who, with their 
     households, are identified as food insecure are provided with 
     adequate food and nutrition support; and
       ``(D) effectively link food and nutrition support provided 
     under this Act and the amendments made by this Act to 
     individuals with HIV/AIDS, their households, and their 
     communities, to other food security and livelihood programs 
     funded by the United States and other donors and multilateral 
     agencies.
       ``(4) Integration of food security and nutrition activities 
     into hiv/aids prevention, treatment, and care activities.--
       ``(A) Requirements relating to global aids coordinator.--
     Consistent with the statement of policy described in 
     paragraph (3), the Coordinator of United States Government 
     Activities to Combat HIV/AIDS Globally shall--
       ``(i) ensure, to the extent practicable, that--

       ``(I) an assessment, using validated criteria, of the food 
     security and nutritional status of each individual enrolled 
     in antiretroviral medication treatment programs supported 
     with funds authorized under this Act or any amendment made by 
     this Act is carried out; and
       ``(II) appropriate nutritional counseling is provided to 
     each individual described in subclause (I);

       ``(ii) coordinate with the Administrator of the United 
     States Agency for International Development, the Secretary of 
     Agriculture, and the heads of other relevant executive branch 
     agencies to--

       ``(I) ensure, to the extent practicable, that, in 
     communities in which a significant proportion of individuals 
     with HIV/AIDS are in need of food and nutrition support, a 
     status and needs assessment for such support employing 
     validated criteria is conducted and a plan to provide such 
     support is developed and implemented;
       ``(II) improve and enhance coordination between food 
     security and livelihood programs for individuals infected 
     with HIV in host countries and food security and livelihood 
     programs that may already exist in such countries;
       ``(III) establish effective linkages between the health and 
     agricultural development and livelihoods sectors in order to 
     enhance food security; and
       ``(IV) ensure, by providing increased resources if 
     necessary, effective coordination between activities 
     authorized under this Act and the amendments made by this Act 
     and activities carried out under other provisions of the 
     Foreign Assistance Act of 1961 when establishing new HIV/AIDS 
     treatment sites;

       ``(iii) develop effective, validated indicators that 
     measure outcomes of nutrition and food security interventions 
     carried out under this section and use such indicators to 
     monitor and evaluate the effectiveness of such interventions; 
     and
       ``(iv) evaluate the role of and, to the extent appropriate, 
     support and expand partnerships and linkages between United 
     States postsecondary educational institutions with 
     postsecondary educational institutions in host countries in 
     order to provide training and build indigenous human and 
     institutional capacity and expertise to respond to HIV/AIDS, 
     and to improve capacity to address nutrition, food security, 
     and livelihood needs of HIV/AIDS-affected and impoverished 
     communities.
       ``(B) Requirements relating to usaid administrator.--
     Consistent with the statement of policy described in 
     paragraph (3), the Administrator of the United States Agency 
     for International Development, in coordination with the 
     Coordinator of United States Government Activities to Combat 
     HIV/AIDS Globally and the Secretary of Agriculture, shall 
     provide, to the extent practicable, as an essential component 
     of antiretroviral medication treatment programs supported 
     with funds authorized under this Act and the amendments made 
     by this Act, food and nutrition support to each individual 
     with HIV/AIDS who is determined to need such support by the 
     assessing health professional, based on a body mass index 
     (BMI) of 18.5 or less, or at the prevailing WHO-approved 
     measurement for BMI, and the individual's household, for a 
     period of not less than 180 days, either directly or through 
     referral to an assistance program or organization with 
     demonstrable ability to provide such support.

[[Page 4813]]

       ``(C) Report.--Not later than October 31, 2010, and 
     annually thereafter, the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally, in 
     consultation with the Administrator of the United States 
     Agency for International Development, shall submit to the 
     appropriate congressional committees a report on the 
     implementation of this subsection for the prior fiscal year. 
     The report shall include a description of--
       ``(i) the effectiveness of interventions carried out to 
     improve the nutritional status of individuals with HIV/AIDS;
       ``(ii) the amount of funds provided for food and nutrition 
     support for individuals with HIV/AIDS and affected 
     individuals in the prior fiscal year and the projected amount 
     of funds to be provided for such purpose for next fiscal 
     year; and
       ``(iii) a strategy for improving the linkage between 
     assistance provided with funds authorized under this 
     subsection and food security and livelihood programs under 
     other provisions of law as well as activities funded by other 
     donors and multilateral organizations.
       ``(D) Authorization of appropriations.--Of the amounts 
     authorized to be appropriated under section 401 for HIV/AIDS 
     assistance, there are authorized to be appropriated to the 
     President such sums as may be necessary for each of the 
     fiscal years 2009 through 2013 to carry out this 
     subsection.''.
       (d) Eligibility for Assistance.--Subsection (d) of such 
     section is amended to read as follows:
       ``(d) Eligibility for Assistance.--An organization, 
     including a faith-based organization, that is otherwise 
     eligible to receive assistance under section 104A of the 
     Foreign Assistance Act of 1961 (as added by subsection (a)) 
     or under any other provision of this Act (or any amendment 
     made by this Act or the Tom Lantos and Henry J. Hyde Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008) to prevent, treat, or monitor 
     HIV/AIDS--
       ``(1) shall not be required, as a condition of receiving 
     the assistance, to endorse or utilize a multisectoral 
     approach to combating HIV/AIDS, or to endorse, utilize, make 
     a referral to, become integrated with or otherwise 
     participate in any program or activity to which the 
     organization has a religious or moral objection; and
       ``(2) shall not be discriminated against in the 
     solicitation or issuance of grants, contracts, or cooperative 
     agreements under such provisions of law for refusing to do 
     so.''.
       (e) Sense of Congress.--Such section is further amended by 
     striking subsection (g).
       (f) Report.--
       (1) In general.--Not later than 270 days after the date of 
     the enactment of this Act, the Coordinator of United States 
     Government Activities to Combat HIV/AIDS Globally shall 
     submit to the appropriate congressional committees a report 
     identifying a target for the number of additional health 
     professionals and workers needed in host countries to provide 
     HIV/AIDS prevention, treatment, and care and the training 
     needs of such health professionals and workers. The target 
     should reflect available data and should identify the need 
     for United States Government contributions to meet the 
     target.
       (2) Definition.--In this subsection, the term ``appropriate 
     congressional committees'' has the meaning given the term in 
     section 3 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7602).

     SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

       (a) Amendments to the Foreign Assistance Act of 1961.--
       (1) Findings.--Subsection (a) of section 104B of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3) is amended 
     by striking paragraphs (1) and (2) and inserting the 
     following:
       ``(1) Tuberculosis is one of the greatest infectious causes 
     of death of adults worldwide, killing 1.6 million individuals 
     per year--one person every 20 seconds.
       ``(2) Tuberculosis is the leading infectious cause of death 
     among individuals who are infected with HIV due to their 
     weakened immune systems, and it is estimated that one-third 
     of such individuals have tuberculosis. Tuberculosis is also a 
     leading killer of women of reproductive age.
       ``(3) Driven by the HIV/AIDS pandemic, incidence rates of 
     tuberculosis in sub-Saharan Africa have more than doubled on 
     average since 1990. The problem is so pervasive that in 
     August 2005, African health ministers and the World Health 
     Organization (WHO) declared tuberculosis to be an emergency 
     in sub-Saharan Africa.
       ``(4)(A) The wide extent of drug resistance, including both 
     multi-drug resistant tuberculosis (MDR-TB) and extensively 
     drug resistant tuberculosis (XDR-TB), represents both a 
     critical challenge to the global control of tuberculosis and 
     a serious worldwide public health threat.
       ``(B) XDR-TB, which is a form of MDR-TB with additional 
     resistance to multiple second-line anti-tuberculosis drugs, 
     is associated with worst treatment outcomes of any form of 
     tuberculosis.
       ``(C) XDR-TB is converging with the HIV/AIDS epidemic, 
     undermining gains in HIV/AIDS prevention and treatment 
     programs and requires urgent interventions.
       ``(D) Drug resistance surveillance reports have confirmed 
     the serious scale and spread of tuberculosis, with XDR-TB 
     strains confirmed on six continents.
       ``(E) Demonstrating the lethality of XDR-TB, an initial 
     outbreak in Tugela Ferry, South Africa, in 2006 killed 52 of 
     53 patients with hundreds more cases reported since that 
     time.
       ``(F) Of the world's regions, sub-Saharan Africa, faces the 
     greatest gap in capacity to prevent, treat, and care for 
     individuals with XDR-TB.''.
       (2) Policy.--Subsection (b) of such section is amended to 
     read as follows:
       ``(b) Policy.--It is a major objective of the foreign 
     assistance program of the United States to control 
     tuberculosis. In all countries in which the Government of the 
     United States has established development programs, 
     particularly in countries with the highest burden of 
     tuberculosis and other countries with high rates of 
     tuberculosis, the United States Government should prioritize 
     the achievement of the following goals by not later than 
     December 31, 2015:
       ``(1) Reduce by one-half the tuberculosis death and disease 
     burden from the 1990 baseline.
       ``(2) Sustain or exceed the detection of at least 70 
     percent of sputum smear-positive cases of tuberculosis and 
     the cure of at least 85 percent of such cases detected.''.
       (3) Activities supported.--Such section is further 
     amended--
       (A) by redesignating subsections (d) through (f) as 
     subsections (e) through (g); and
       (B) by inserting after subsection (c) the following:
       ``(d) Activities Supported.--Assistance provided under 
     subsection (c) shall, to the maximum extent practicable, be 
     used to carry out the following activities:
       ``(1) Provide diagnostic counseling and testing to 
     individuals with HIV/AIDS for tuberculosis (including a 
     culture diagnosis to rule out multi-drug resistant 
     tuberculosis (MDR-TB) and extensively drug resistant 
     tuberculosis (XDR-TB) and provide HIV/AIDS voluntary 
     counseling and testing to individuals with any form of 
     tuberculosis.
       ``(2) Provide tuberculosis treatment to individuals 
     receiving treatment and care for HIV/AIDS who have active 
     tuberculosis and provide prophylactic treatment to 
     individuals with HIV/AIDS who also have a latent tuberculosis 
     infection.
       ``(3) Link individuals with both HIV/AIDS and tuberculosis 
     to HIV/AIDS treatment and care services, including 
     antiretroviral therapy and cotrimoxazole therapy.
       ``(4) Ensure that health care workers trained to diagnose, 
     treat, and provide care for HIV/AIDS are also trained to 
     diagnose, treat, and provide care for individuals with both 
     HIV/AIDS and tuberculosis.
       ``(5) Ensure that individuals with active pulmonary 
     tuberculosis are provided a culture diagnosis, including drug 
     susceptibility testing to rule out multi-drug resistant 
     tuberculosis (MDR-TB) and extensively drug resistant 
     tuberculosis (XDR-TB) in areas with high prevalence of 
     tuberculosis drug resistance.''.
       (4) Priority to stop tb strategy.--Subsection (f) of such 
     section (as redesignated by paragraph (3) of this subsection) 
     is amended--
       (A) by amending the heading to read as follows: ``Priority 
     To Stop TB Strategy'';
       (B) in the first sentence, by striking ``In furnishing'' 
     and all that follows through ``, including funding'' and 
     inserting the following:
       ``(1) Priority.--In furnishing assistance under subsection 
     (c), the President shall give priority to--
       ``(A) activities described in the Stop TB Strategy, 
     including expansion and enhancement of Directly Observed 
     Treatment Short-course (DOTS) coverage, treatment for 
     individuals infected with both tuberculosis and HIV and 
     treatment for individuals with multi-drug resistant 
     tuberculosis (MDR-TB), strengthening of health systems, use 
     of the International Standards for Tuberculosis Care by all 
     care providers, empowering individuals with tuberculosis, and 
     enabling and promoting research to develop new diagnostics, 
     drugs, and vaccines, and program-based operational research 
     relating to tuberculosis; and
       ``(B) funding''; and
       (C) in the second sentence--
       (i) by striking ``In order to'' and all that follows 
     through ``not less than'' and inserting the following:
       ``(2) Availability of amounts.--In order to meet the 
     requirements of paragraph (1), the President--
       ``(A) shall ensure that not less than'';
       (ii) by striking ``for Directly Observed Treatment Short-
     course (DOTS) coverage and treatment of multi-drug resistant 
     tuberculosis using DOTS-Plus,'' and inserting ``to implement 
     the Stop TB Strategy; and''; and
       (iii) by striking ``including'' and all that follows and 
     inserting the following:
       ``(B) should ensure that not less than $15,000,000 of the 
     amount made available to carry out this section for a fiscal 
     year is used to make a contribution to the Global 
     Tuberculosis Drug Facility.''.
       (5) Assistance for who and the stop tuberculosis 
     partnership.--Such section is further amended--

[[Page 4814]]

       (A) by redesignating subsection (g) (as redesignated by 
     paragraph (3) of this subsection) as subsection (h); and
       (B) by inserting after subsection (f) (as redesignated by 
     paragraph (4) and amended by paragraph (5) of this 
     subsection) the following new subsection:
       ``(g) Assistance for WHO and the Stop Tuberculosis 
     Partnership.--In carrying out this section, the President, 
     acting through the Administrator of the United States Agency 
     for International Development, is authorized to provide 
     increased resources to the World Health Organization (WHO) 
     and the Stop Tuberculosis Partnership to improve the capacity 
     of countries with high rates of tuberculosis and other 
     affected countries to implement the Stop TB Strategy and 
     specific strategies related to addressing extensively drug 
     resistant tuberculosis (XDR-TB).''.
       (6) Definitions.--Subsection (h) of such section (as 
     redesignated by paragraph (5)(A) of this subsection) is 
     amended--
       (A) in paragraph (1), by adding at the end before the 
     period the following: ``, including low cost and effective 
     diagnosis and evaluation of treatment regimes, vaccines, and 
     monitoring of tuberculosis, as well as a reliable drug 
     supply, and a management strategy for public health systems, 
     with health system strengthening, promotion of the use of the 
     International Standards for Tuberculosis Care by all care 
     providers, bacteriology under an external quality assessment 
     framework, short-course chemotherapy, and sound reporting and 
     recording systems''; and
       (B) by adding after paragraph (5) the following new 
     paragraph:
       ``(6) Stop tb strategy.--The term `Stop TB Strategy' means 
     the six-point strategy to reduce tuberculosis developed by 
     the World Health Organization. The strategy is described in 
     the Global Plan to Stop TB 2007-2016: Actions for Life, a 
     comprehensive plan developed by the Stop Tuberculosis 
     Partnership that sets out the actions necessary to achieve 
     the millennium development goal of cutting tuberculosis 
     deaths and disease burden in half by 2016.''.
       (b) Authorization of Appropriations.--Section 302(b) of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended--
       (1) in paragraph (1), by striking ``such sums as may be 
     necessary for each of the fiscal years 2004 through 2008'' 
     and inserting ``$4,000,000,000 for fiscal years 2009 through 
     2013''; and
       (2) in paragraph (3), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.

     SEC. 303. ASSISTANCE TO COMBAT MALARIA.

       (a) Amendment to the Foreign Assistance Act of 1961.--
     Section 104C(b) of the Foreign Assistance Act of 1961 (22 
     U.S.C. 21516-4(b)) is amended by striking ``control, and 
     cure'' and inserting ``treatment, and care''.
       (b) Authorization of Appropriations.--Section 303(b) of the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7633(b)) is amended--
       (1) in paragraph (1), by striking ``such sums as may be 
     necessary for fiscal years 2004 through 2008'' and inserting 
     ``$5,000,000,000 for fiscal years 2009 through 2013''; and
       (2) in paragraph (3), by striking ``fiscal years 2004 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.
       (c) Development of a Comprehensive Five-Year Strategy.--
     Section 303 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7633) is 
     amended by adding at the end the following:
       ``(d) Development of a Comprehensive Five-Year Strategy.--
     The President shall establish a comprehensive, five-year 
     strategy to combat global malaria that strengthens the 
     capacity of the United States to be an effective leader of 
     international efforts to reduce the global malaria disease 
     burden. Such strategy shall maintain sufficient flexibility 
     and remain responsive to the ever-changing nature of the 
     global malaria challenge and shall--
       ``(1) include specific objectives, multisectoral approaches 
     and strategies to treat and provide care to individuals 
     infected with malaria, to prevent the further spread of 
     malaria;
       ``(2) describe how this strategy would contribute to the 
     United States' overall global health and development goals;
       ``(3) clearly explain how proposed activities to combat 
     malaria will be coordinated with other United States global 
     health activities, including the five-year global HIV/AIDS 
     and tuberculosis strategies developed pursuant to section 101 
     of this Act;
       ``(4) expand public-private partnerships and leveraging of 
     resources to combat malaria, including private sector 
     resources;
       ``(5) coordinate among relevant executive branch agencies 
     providing assistance to combat malaria in order to maximize 
     human and financial resources and reduce unnecessary 
     duplication among such agencies and other donors;
       ``(6) maximize United States capabilities in the areas of 
     technical assistance, training, and research, including 
     vaccine research, to combat malaria; and
       ``(7) establish priorities and selection criteria for the 
     distribution of resources to combat malaria based on factors 
     such as the size and demographics of the population with 
     malaria, the needs of that population, the host countries' 
     existing infrastructure, and the host countries' ability to 
     complement United States efforts with strategies outlined in 
     national malaria control plans.
       ``(e) Malaria Response Coordinator.--
       ``(1) In general.--There should be established within the 
     United States Agency for International Development a 
     Coordinator of United States Government Activities to Combat 
     Malaria Globally, who should be appointed by the President.
       ``(2) Authorities.--The Coordinator, acting through such 
     nongovernmental organizations and relevant executive branch 
     agencies as may be necessary and appropriate to effect the 
     purposes of section 104C of the Foreign Assistance Act of 
     1961 (22 U.S.C. 2151b-4), is authorized--
       ``(A) to operate internationally to carry out prevention, 
     treatment, care, support, capacity development of health 
     systems, and other activities for combating malaria;
       ``(B) to transfer and allocate funds to relevant executive 
     branch agencies;
       ``(C) to provide grants to, and enter into contracts with, 
     nongovernmental organizations to carry out the purposes of 
     such section 104C;
       ``(D) to enter into contracts and transfer and allocate 
     funds to international organizations to carry out the 
     purposes of such section 104C; and
       ``(E) to coordinate with a public-private partnership to 
     discover and develop effective new antimalarial drugs, 
     including drugs for multi-drug resistant malaria and malaria 
     in pregnant women.
       ``(3) Duties.--
       ``(A) In general.--The Coordinator shall have primary 
     responsibility for the oversight and coordination of all 
     resources and global United States government activities to 
     combat malaria.
       ``(B) Specific duties.--The Coordinator shall--
       ``(i) facilitate program and policy coordination among 
     relevant executive branch agencies and nongovernmental 
     organizations, including auditing, monitoring and evaluation 
     of such programs;
       ``(ii) ensure that each relevant executive branch agency 
     has sufficient resources to execute programs in areas in 
     which the agency has the greatest expertise, technical 
     capability, and potential for success;
       ``(iii) coordinate with the Office of the Coordinator of 
     United States Government Activities to Combat HIV/AIDS 
     Globally and equivalent managers of other relevant executive 
     branch agencies that are implementing global health programs 
     to develop and implement program plans, country-level 
     interactions, and recipient administrative requirements in 
     countries in which more than one program operates;
       ``(iv) coordinate relevant executive branch agency 
     activities in the field, including coordination of planning, 
     implementation, and evaluation of malaria programs with HIV/
     AIDS programs in countries in which both programs are being 
     carried out;
       ``(v) pursue coordinate program implementation with host 
     governments, other donors, and the private sector; and
       ``(vi) establish due diligence criteria for all recipients 
     of funds appropriated pursuant to the authorizations of 
     appropriations under section 401 for malaria assistance.
       ``(f) Assistance to Who.--In carrying out this section, the 
     President is authorized to make a United States contribution 
     to the Roll Back Malaria Partnership and the World Health 
     Organization (WHO) to improve the capacity of countries with 
     high rates of malaria and other affected countries to 
     implement comprehensive malaria control programs.
       ``(g) Annual Report.--
       ``(1) In general.--Not later than 270 days after the date 
     of the enactment of the Tom Lantos and Henry J. Hyde Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008, and annually thereafter, the 
     President shall transmit to the appropriate congressional 
     committees a report on United States assistance for the 
     prevention, treatment, control, and elimination of malaria.
       ``(2) Matters to be included.--The report required under 
     paragraph (1) shall include a description of--
       ``(A) the countries and activities to which malaria 
     assistance has been allocated;
       ``(B) the number of people reached through malaria 
     assistance programs;
       ``(C) the percentage and number of children and mothers 
     reached through malaria assistance programs;
       ``(D) research efforts to develop new tools to combat 
     malaria, including drugs and vaccines;
       ``(E) collaboration with the World Health Organization 
     (WHO), the Global Fund to Fight AIDS, Tuberculosis and 
     Malaria, other donor governments, and relevant executive 
     branch agencies to combat malaria;
       ``(F) quantified impact of United States assistance on 
     childhood morbidity and mortality;
       ``(G) the number of children who received immunizations 
     through malaria assistance programs; and

[[Page 4815]]

       ``(H) the number of women receiving ante-natal care through 
     malaria assistance programs.''.

     SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.

       (a) In General.--Title III of the United States Leadership 
     Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
     U.S.C. 7631 et seq.) is amended by striking section 304 and 
     inserting the following:

     ``SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/AIDS.

       ``(a) Sense of Congress.--It is the sense of Congress that 
     the use of health care partnerships that link United States 
     and host country health care institutions create 
     opportunities for sharing of knowledge and expertise among 
     individuals with significant experience in health-related 
     fields and build local capacity to combat HIV/AIDS and 
     increase scientific understanding of the progression of HIV/
     AIDS and the HIV/AIDS epidemic.
       ``(b) Authority To Facilitate Health Care Partnerships To 
     Combat HIV/AIDS.--The President, acting through the 
     Coordinator of United States Government Activities to Combat 
     HIV/AIDS Globally, shall facilitate the development of health 
     care partnerships described in subsection (a) by-
       ``(1) supporting short- and long-term institutional 
     partnerships, including partnerships that build capacity in 
     ministries of health, central- and district-level health 
     agencies, medical facilities, health education and training 
     institutions, academic centers, and faith- and community-
     based organizations involved in prevention, treatment, and 
     care of HIV/AIDS;
       ``(2) supporting the development of consultation services 
     using appropriate technologies, including online courses, 
     DVDs, telecommunications services, and other technologies to 
     eliminate the barriers that prevent host country 
     professionals from accessing high quality health care 
     services information, particularly providers located in rural 
     areas;
       ``(3) supporting the placements of highly qualified 
     individuals to strengthen human and organizational capacity 
     through the use of health care professionals to facilitate 
     skills transfer, building local capacity, and to expand 
     rapidly the pool of providers, managers, and other health 
     care staff delivering HIV/AID services in host countries; and
       ``(4) meeting individual country needs and, where possible, 
     insisting on the implementation of a national strategic plan, 
     by providing training and mentoring to strengthen human and 
     organizational capacity among local health care service 
     organizations.
       ``(c) Authorization of Appropriations.--Of the amounts 
     authorized to be appropriated under section 401 for HIV/AIDS 
     assistance, there are authorized to be appropriated to the 
     President such sums as may be necessary for each of the 
     fiscal years 2009 through 2013 to carry out this section.''.
       (b) Clerical Amendment.--The table of contents for the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by 
     striking the item relating to section 304 and inserting the 
     following new item:

``Sec. 304. Health care partnerships to combat HIV/AIDS.''.

        Subtitle B--Assistance for Women, Children, and Families

     SEC. 311. POLICY AND REQUIREMENTS.

       (a) Policy.--Subsection (a) of section 312 of the United 
     States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Act of 2003 (22 U.S.C. 7652) is amended--
       (1) in the first sentence, by striking ``The United States 
     Government's'' and inserting the following:
       ``(1) In general.--The United States''; and
       (2) by adding at the end the following:
       ``(2) Collaboration.--The United States should work in 
     collaboration with governments, donors, the private sector, 
     nongovernmental organizations, and other key stakeholders to 
     carry out the policy described in paragraph (1).''.
       (b) Requirements.--Subsection (b) of such section is 
     amended to read as follows:
       ``(b) Requirements.--The 5-year United States strategy 
     required by section 101 of this Act shall--
       ``(1) establish a target for prevention and treatment of 
     mother-to-child transmission of HIV that by 2013 will reach 
     at least 80 percent of pregnant women in those countries most 
     affected by HIV/AIDS;
       ``(2) establish a target requiring that by 2013 up to 15 
     percent of individuals receiving care and up to 15 percent of 
     individuals receiving treatment under this Act and the 
     amendments made by this Act are children;
       ``(3) integrate care and treatment with prevention of 
     mother-to-child transmission of HIV programs in order to 
     improve outcomes for HIV-affected women and families as soon 
     as is feasible, consistent with the national government 
     policies of countries in which programs under this Act are 
     administered, and including support for strategies to ensure 
     successful follow-up and continuity of care;
       ``(4) expand programs designed to care for children 
     orphaned by HIV/AIDS;
       ``(5) develop a timeline for expanding access to more 
     effective regimes to prevent mother-to-child transmission of 
     HIV, consistent with the national government policies of 
     countries in which programs under this Act are administered 
     and the goal of achieving universal use of such regimens as 
     soon as possible;
       ``(6) ensure that women receiving voluntary contraceptive 
     counseling, services, or commodities in programs supported by 
     the United States Government have access to the full range of 
     HIV/AIDS services; and
       ``(7) ensure that women in prevention of mother-to-child 
     transmission of HIV programs are provided with appropriate 
     maternal and child services, either directly or by 
     referral.''.

     SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD 
                   TRANSMISSION OF THE HIV INFECTION.

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

     SEC. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN AND 
                   YOUTH.

       (a) In General.--Title III of the United States Leadership 
     Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
     U.S.C. 7631 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG WOMEN 
                   AND YOUTH.

       ``(a) Statement of Policy.--In order to meet the United 
     States Government's goal of preventing 12,000,000 new HIV 
     infections worldwide, it shall be the policy of the United 
     States to pursue a global HIV/AIDS prevention strategy that 
     emphasizes the immediate and ongoing needs of women and youth 
     and addresses the factors that lead to gender disparities in 
     the rate of HIV infection.
       ``(b) Strategy.--
       ``(1) In general.--The President shall formulate a 
     comprehensive, integrated, and culturally-appropriate global 
     HIV/AIDS prevention strategy that, to the extent 
     epidemiologically appropriate, addresses the vulnerabilities 
     of women and youth to HIV infection and seeks to reduce the 
     factors that lead to gender disparities in the rate of HIV 
     infection.
       ``(2) Elements.--The strategy required under paragraph (1) 
     shall include specific goals and targets under the 5-year 
     strategy outlined in section 101 and shall include 
     comprehensive HIV/AIDS prevention education at the individual 
     and national level including the ABC (`Abstain, Be faithful, 
     use Condoms') model as a means to reduce HIV infections and 
     shall include the following:
       ``(A) Specific goals under the five-year strategy outlined 
     in section 101.
       ``(B) Empowering women and youth to avoid cross-
     generational sex and to decide when and whom to marry in 
     order to reduce the incidence of early or child marriage.
       ``(C) Dramatically increasing access to currently available 
     female-controlled prevention methods and including 
     investments in training to increase the effective and 
     consistent use of both male and female condoms.
       ``(D) Accelerating the de-stigmatization of HIV/AIDS among 
     women and youth as a major risk factor for the transmission 
     of HIV.
       ``(E) Addressing and preventing post-traumatic and psycho-
     social consequences and providing post-exposure prophylaxis 
     to victims of gender-based violence and rape against women 
     and youth through appropriate medical, social, educational, 
     and legal assistance and through prosecutions and legal 
     penalties to address such violence.
       ``(F) Promoting changes in male attitudes and behavior that 
     respect the human rights of women and youth and that support 
     and foster gender equality.
       ``(G) Supporting the development of microenterprise 
     initiatives, job training programs, and other such efforts to 
     assist women in developing and retaining independent economic 
     means.
       ``(H) Supporting universal basic education and expanded 
     educational opportunities for women and youth.
       ``(I) Protecting the property and inheritance rights of 
     women.
       ``(J) Coordinating inclusion of HIV/AIDS prevention 
     information and education services and programs for 
     individuals with HIV/AIDS with existing health care services 
     targeted to women and youth, such as ensuring access to HIV/
     AIDS education and testing in family planning programs 
     supported by the United States Government and programs to 
     reduce mother-to-child transmission of HIV, and expanding the 
     reach of such HIV/AIDS health services.
       ``(K) Promoting gender equality by supporting the 
     development of nongovernmental organizations, including 
     faith-based and community-based organizations, that support 
     the needs of women and utilizing such organizations that are 
     already empowering women and youth at the community level.
       ``(L) Encouraging the creation and effective enforcement of 
     legal frameworks that guarantee women equal rights and equal 
     protection under the law.
       ``(M) Encouraging the participation and involvement of 
     women in drafting, coordinating, and implementing the 
     national HIV/AIDS strategic plans of their countries.
       ``(N) Responding to other economic and social factors that 
     increase the vulnerability of women and youth to HIV 
     infection.

[[Page 4816]]

       ``(3) Transmission to congress and public availability.--
     Not later than 180 days after the date of the enactment of 
     the Tom Lantos and Henry J. Hyde Global Leadership Against 
     HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
     2008, the President shall transmit to the appropriate 
     congressional committees and make available to the public the 
     strategy required under paragraph (1).
       ``(c) Coordination.--In formulating and implementing the 
     strategy required under subsection (b), the President shall 
     ensure that the United States coordinates its overall HIV/
     AIDS policy and programs with the national governments of the 
     countries for which the United States provides assistance to 
     combat HIV/AIDS and, to the extent practicable, with 
     international organizations, other donor countries, and 
     indigenous organizations, including faith-based and 
     community-based organizations specifically for the purposes 
     of ensuring gender equality and promoting respect of the 
     human rights of women that impact their susceptibility to 
     HIV/AIDS, improving women's health, and expanding education 
     for women and youth, and organizations, including faith-based 
     and other nonprofit organizations, providing services to and 
     advocating on behalf of individuals with HIV/AIDS and 
     individuals affected by HIV/AIDS.
       ``(d) Guidance.--
       ``(1) In general.--The President shall provide clear 
     guidance to field missions of the United States Government in 
     countries for which the United States provides assistance to 
     combat HIV/AIDS, based on the strategy required under 
     subsection (b).
       ``(2) Transmission to congress and public availability.--
     The President shall transmit to the appropriate congressional 
     committees and make available to the public a description of 
     the guidance required under paragraph (1).
       ``(e) Report.--
       ``(1) In general.--Not later than 1 year after the date of 
     the enactment of the Tom Lantos and Henry J. Hyde Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008, and annually thereafter as part 
     of the annual report required under section 104A(e) of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the 
     President shall transmit to the appropriate congressional 
     committees and make available to the public a report on the 
     implementation of this section for the prior fiscal year.
       ``(2) Matters to be included.--The report required under 
     paragraph (1) shall include the following:
       ``(A) A description of the prevention programs designed to 
     address the vulnerabilities of women and youth to HIV/AIDS.
       ``(B) A list of nongovernmental organizations in each 
     country that receive assistance from the United States to 
     carry out HIV prevention activities, including the amount and 
     the source of funding received.''.
       (b) Clerical Amendment.--The table of contents for the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 (22 U.S.C. 7601 note) is amended by 
     inserting after the item relating to section 315 the 
     following:

``Sec. 316. Strategy to prevent HIV infections among women and 
              youth.''.

     SEC. 314. CLERICAL AMENDMENT.

       The table of contents for the United States Leadership 
     Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
     U.S.C. 7601 note) is amended by striking the item relating to 
     subtitle B of title III and inserting the following:

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

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

     SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

       Section 401(a) of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7671(a)) is amended--
       (1) by striking ``$3,000,000,000'' and inserting 
     ``$10,000,000,000''; and
       (2) by striking ``fiscal years 2004 through 2008'' and 
     inserting ``fiscal years 2009 through 2013''.

     SEC. 402. SENSE OF CONGRESS.

       Section 402(b) of the United States Leadership Against HIV/
     AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7672) 
     is amended--
       (1) by striking paragraph (1);
       (2) by redesignating paragraphs (2) through (4) as 
     paragraphs (1) through (3), respectively; and
       (3) in paragraph (2) (as redesignated by paragraph (2) of 
     this section), by striking ``, of which'' and all that 
     follows through ``programs''.

     SEC. 403. ALLOCATION OF FUNDS.

       (a) HIV/AIDS Prevention Activities.--Subsection (a) of 
     section 403 of the United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7673) is 
     amended to read as follows:
       ``(a) HIV/AIDS Prevention Activities.--
       ``(1) In general.--For each of the fiscal years 2009 
     through 2013, not less than 20 percent of the amounts 
     appropriated pursuant to the authorization of appropriations 
     under section 401 for HIV/AIDS assistance for each such 
     fiscal year shall be expended for HIV/AIDS prevention 
     activities consistent with section 104A(d) of the Foreign 
     Assistance Act of 1961.
       ``(2) Balanced funding requirement.--(A) The Coordinator of 
     United States Government Activities to Combat HIV/AIDS 
     Globally shall provide balanced funding for prevention 
     activities for sexual transmission of HIV/AIDS and shall 
     ensure that behavioral change programs, including abstinence, 
     delay of sexual debut, monogamy, fidelity and partner 
     reduction, are implemented and funded in a meaningful and 
     equitable way in the strategy for each host country based on 
     objective epidemiological evidence as to the source of 
     infections and in consultation with the government of each 
     host county involved in HIV/AIDS prevention activities.
       ``(B) In fulfilling the requirement under subparagraph (A), 
     the Coordinator shall establish a HIV sexual transmission 
     prevention strategy governing the expenditure of funds 
     authorized by the Act used to prevent the sexual transmission 
     of HIV in any host country with a generalized epidemic. In 
     each such host country, if this strategy provides less than 
     50 percent of such funds for behavioral change programs, 
     including abstinence, delay of sexual debut, monogamy, 
     fidelity, and partner reduction, the Coordinator shall, 
     within 30 days of the issuance of this strategy, report to 
     the appropriate congressional committees on the justification 
     for this decision.
       ``(C) Programs and activities that implement or purchase 
     new prevention technologies or modalities such as medical 
     male circumcision, pre-exposure prophylaxis, or microbicides 
     and programs and activities that provide counseling and 
     testing for HIV or prevent mother-to-child prevention of HIV 
     shall not be included in determining compliance with this 
     paragraph.
       ``(3) Report.--Not later than 1 year after the date of the 
     enactment of the Tom Lantos and Henry J. Hyde Global 
     Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
     Reauthorization Act of 2008, and annually thereafter as part 
     of the annual report required under section 104A(e) of the 
     Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)), the 
     President shall transmit to the appropriate congressional 
     committees and make available to the public a report on the 
     implementation of paragraph (2) for the prior fiscal year.''.
       (b) Orphans and Vulnerable Children.--Subsection (b) of 
     such section is amended by striking ``fiscal years 2006 
     through 2008'' and inserting ``fiscal years 2009 through 
     2013''.

     SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOVERNMENTS.

       (a) Prohibition on Taxation.--None of the funds 
     appropriated pursuant to the authorization of appropriations 
     under section 401 of the United States Leadership Against 
     HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 
     7671) may be made available to provide assistance for a 
     foreign country under a new bilateral agreement governing the 
     terms and conditions under which such assistance is to be 
     provided unless such agreement includes a provision stating 
     that assistance provided by the United States shall be exempt 
     from taxation, or reimbursed, by the foreign government, and 
     the Secretary of State shall expeditiously seek to negotiate 
     amendments to existing bilateral agreements, as necessary, to 
     conform with this requirement.
       (b) De Minimus Exception.--Foreign taxes of a de minimus 
     nature shall not be subject to the provisions of subsection 
     (a).
       (c) Reprogramming of Funds.--Funds withheld from obligation 
     for each country or entity pursuant to subsection (a) shall 
     be reprogrammed for assistance to countries which do not 
     assess taxes on United States assistance or which have an 
     effective arrangement that is providing substantial 
     reimbursement of such taxes.
       (d) Determinations.--
       (1) In general.--The provisions of this section shall not 
     apply to any country or entity the Secretary of State 
     determines--
       (A) does not assess taxes on United States assistance or 
     which has an effective arrangement that is providing 
     substantial reimbursement of such taxes; or
       (B) the foreign policy interests of the United States 
     outweigh the policy of this section to ensure that United 
     States assistance is not subject to taxation.
       (2) Consultation.--The Secretary of State shall consult 
     with the Committees on Foreign Affairs and Appropriations at 
     least 15 days prior to exercising the authority of this 
     subsection with regard to any country or entity.
       (e) Implementation.--The Secretary of State shall issue 
     rules, regulations, or policy guidance, as appropriate, to 
     implement the prohibition against the taxation of assistance 
     contained in this section.
       (f) Definitions.--As used in this section--
       (1) the terms ``taxes'' and ``taxation'' refer to value 
     added taxes and customs duties imposed on commodities 
     financed with United States assistance for programs for which 
     funds are authorized by this Act; and
       (2) the term ``bilateral agreement'' refers to a framework 
     bilateral agreement between the Government of the United 
     States and the

[[Page 4817]]

     government of the country receiving assistance that describes 
     the privileges and immunities applicable to United States 
     foreign assistance for such country generally, or an 
     individual agreement between the Government of the United 
     States and such government that describes, among other 
     things, the treatment for tax purposes that will be accorded 
     the United States assistance provided under that agreement.

    TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

     SEC. 501. SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE 
                   SYSTEMS.

       The United States Leadership Against HIV/AIDS, 
     Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et 
     seq.) is amended by adding at the end the following:

  ``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

     ``SEC. 601. FINDINGS.

       ``Congress makes the following findings:
       ``(1) The shortage of health personnel, including doctors, 
     nurses, pharmacists, counselors, laboratory staff, and 
     paraprofessionals, is one of the leading obstacles to 
     fighting HIV/AIDS in sub-Saharan Africa.
       ``(2) The HIV/AIDS pandemic aggravates the shortage of 
     health workers through loss of life and illness among medical 
     staff, unsafe working conditions for medical personnel, and 
     increased workloads for diminished staff, while the shortage 
     of health personnel undermines efforts to prevent and provide 
     care and treatment for individuals with HIV/AIDS.
       ``(3) Failure to address the shortage of health care 
     professionals and paraprofessionals, and the factors forcing 
     such individuals to leave sub-Saharan Africa, will undermine 
     the objectives of United States development policy and will 
     subvert opportunities to achieve internationally-recognized 
     goals for the prevention, treatment, and care of HIV/AIDS and 
     other diseases, the reduction of child and maternal 
     mortality, and for economic growth and development in sub-
     Saharan Africa.

     ``SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES AND OTHER 
                   POLICIES.

       ``(a) National Health Workforce Strategies.--
       ``(1) Statement of policy.--It shall be the policy of the 
     United States Government to support countries receiving 
     United States assistance to combat HIV/AIDS, tuberculosis, 
     and malaria, and other health programs in developing, 
     strengthening, and implementing 5-year health workforce 
     strategies.
       ``(2) Technical and financial assistance.--The 
     Administrator of the United States Agency for International 
     Development, in coordination with the Coordinator of United 
     States Government Activities to Combat HIV/AIDS Globally, is 
     authorized to provide technical and financial assistance to 
     countries described in paragraph (1) to enable such 
     countries, in conjunction with other funding sources, to 
     develop, strengthen, and implement health workforce 
     strategies.
       ``(3) Activities supported.--Assistance provided under 
     paragraph (2) shall, to the maximum extent practicable, be 
     used to carry out the following:
       ``(A) Activities to promote an inclusive process that 
     includes nongovernmental organizations and individuals with 
     HIV/AIDS in developing health workforce strategies.
       ``(B) Activities to achieve and sustain a health workforce 
     sufficient in numbers, skill, and capacity to meet United 
     States and host-country international health commitments, 
     including the Millennium Development Goals and universal 
     access to HIV/AIDS prevention, treatment, and care. In 
     particular, such health workforce strategies should include 
     plans for progress toward achieving the minimum ratio of 
     health professionals required to achieve these goals by 2015, 
     estimated by the World Health Organization to require at 
     least 2.3 doctors, nurses, and midwives per 1,000 population, 
     and additional health workers such as pharmacists and lab 
     technicians.
       ``(C) Activities to ensure that health workforce strategies 
     are aimed at creating appropriate distribution of health 
     workers and prioritizing activities required to ensure rural, 
     marginalized, and other underserved populations are able to 
     access skilled and equipped health workers.
       ``(D) Activities to expand the capacity of public and 
     private medical, nursing, pharmaceutical, and other health 
     training institutions.
       ``(b) Positive Broader Health Impact.--It shall be the 
     policy of the United States to ensure to expand the capacity 
     of the health workforce engaged in HIV/AIDS programming in 
     ways that contribute to, and do not detract from, the 
     capacity of countries to meet other health needs, 
     particularly child survival and maternal health.
       ``(c) Safety for Health Workers.--It is the sense of 
     Congress that the United States should ensure that all health 
     workers participating in programs that receive assistance 
     under this Act and the amendments made by this Act have the 
     proper training to create safe and sanitary working 
     conditions in accordance with universal precautions and other 
     forms of infection prevention and control.
       ``(d) Health Care for Health Workers.--The Coordinator of 
     United States Government Activities to Combat HIV/AIDS 
     Globally shall ensure that comprehensive and confidential 
     health services shall be provided to all health workers 
     participating in programs that receive assistance under this 
     Act and the amendments made by this Act, including--
       ``(1) testing and counseling for all such employees;
       ``(2) providing HIV/AIDS treatment to HIV-positive 
     employees; and
       ``(3) taking measures to reduce HIV-related stigma in the 
     workplace.
       ``(e) Training and Compensation Finance.--Where the 
     Coordinator determines such financial support is essential to 
     fulfill the purposes of this Act, the Coordinator shall 
     finance training and provide compensation or other benefits 
     for health workers in order to enhance recruitment and 
     retention of such workers.

     ``SEC. 603. EXEMPTION OF INVESTMENTS IN HEALTH FROM LIMITS 
                   SOUGHT BY INTERNATIONAL FINANCIAL INSTITUTIONS.

       ``(a) Coordination Within the United States Government.--
     The Coordinator of United States Government Activities to 
     Combat HIV/AIDS Globally shall work with the Secretary of the 
     Treasury to reform International Monetary Fund macroeconomic 
     and fiscal policies that result in limitations on national 
     and donor investments in health.
       ``(b) Position of the United States at the Imf.--The 
     Secretary of the Treasury shall instruct the United States 
     Executive Director at the International Monetary Fund to use 
     the voice, vote, and influence of the United States to oppose 
     any loan, project, agreement, memorandum, instrument, plan, 
     or other program of the International Monetary Fund that does 
     not exempt increased government spending on health care from 
     national budget caps or restraints, hiring or wage bill 
     ceilings, or other limits sought by any international 
     financial institution.

     ``SEC. 604. PUBLIC-SECTOR PROCUREMENT, DRUG REGISTRATION, AND 
                   SUPPLY CHAIN MANAGEMENT SYSTEMS.

       ``(a) In General.--The Coordinator of United States 
     Government Activities to Combat AIDS Globally shall work with 
     the Partnership for Supply Chain Management Systems, host 
     countries, and nongovernmental organizations to develop 
     effective, reliable host country-owned and operated public-
     sector procurement and supply chain management systems, 
     including regional distribution, with ongoing technical 
     assistance and sustained support to ensure the function of 
     such systems, as well as the function of existing non-public 
     sector supply chains, including those operated by faith-based 
     and other humanitarian organizations that procure and 
     distribute medical supplies.
       ``(b) Availability of Equipment and Supplies.--The public-
     sector procurement and supply chain management systems 
     developed pursuant to subsection (a) should ensure that 
     adequate laboratory equipment and supplies commonly needed to 
     fight HIV/AIDS, including diagnostic tests for CD4 and viral 
     load counts, x-ray machines, mobile and facility-based rapid 
     HIV test kits and other necessary assays, reagents and basic 
     supplies such as sterile syringes and gloves, are available 
     and distributed in a manner that is accessible to urban and 
     rural populations.
       ``(c) Drug Registration.--The Coordinator shall work with 
     host country partners and development partners to support 
     efficient and effective drug approval and registration 
     systems that allow expeditious access to safe and effective 
     drugs, including antiretroviral drugs.
       ``(d) Report.--The Coordinator shall submit to the 
     appropriate congressional committees an annual report on the 
     implementation of this section, including progress toward 
     specific benchmarks established by the Partnership for Supply 
     Chain Management Systems, and the projection of when host 
     countries can fully sustain their own procurement and supply 
     chain management and distribution systems at a scale 
     necessary for national primary health needs.

     ``SEC. 605. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--Of the amounts authorized to be 
     appropriated under section 401 for HIV/AIDS assistance, there 
     are authorized to be appropriated to the President such sums 
     as may be necessary for each of the fiscal years 2009 through 
     2013 to carry out this title.
       ``(b) Availability.--Amounts appropriated pursuant to the 
     authorization of appropriations under subsection (a) are 
     authorized to remain available until expended.''.

     SEC. 502. CLERICAL AMENDMENT.

       The table of contents for the United States Leadership 
     Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
     U.S.C. 7601 note) is amended by inserting after the items 
     relating to title V the following:

  ``TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

``Sec. 601. Findings.
``Sec. 602. National health workforce strategies and other policies.
``Sec. 603. Exemption of investments in health from limits sought by 
              international financial institutions.

[[Page 4818]]

``Sec. 604. Public-sector procurement, drug registration, and supply 
              chain management systems.
``Sec. 605. Authorization of appropriations.''.

  The CHAIRMAN. No amendment to the bill is in order except those 
printed in House Report 110-562. Each amendment may be offered only in 
the order printed in the report, by a Member designated in the report, 
shall be considered read, shall be debatable for the time specified in 
the report, equally divided and controlled by the proponent and an 
opponent of the amendment, shall not be subject to amendment, and shall 
not be subject to a demand for division of the question.


               Amendment No. 1 Offered by Mr. Blumenauer

  The CHAIRMAN. It is now in order to consider amendment No. 1 printed 
in House Report 110-562.
  Mr. BLUMENAUER. Madam Chairman, I have an amendment made in order 
under the rule.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Mr. Blumenauer:
       Page 59, line 7, insert ``, safe drinking water,'' after 
     ``nutrition''.

  The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from 
Oregon (Mr. Blumenauer) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Oregon.
  Mr. BLUMENAUER. Madam Chairman, I yield myself such time as I may 
consume.
  Madam Chairman, it is a pleasure for me to rise dealing with the 
underlying legislation that contains an important section to address 
barriers that might limit the start of and adherence to treatment 
services. This section also encourages direct linkages between the 
efforts to treat HIV/AIDS, nutrition and income security programs.
  I applaud the chairman and ranking member for the work that they have 
done bringing this together, and the recognition that dealing with HIV/
AIDS must be done in a holistic fashion that treats the entire person 
and their environment, not just the disease.
  I have a very personal connection to this legislation now that was 
not present when I first started working on issues of water for the 
poor now that I have a daughter working in Mozambique in the Peace 
Corps who is dealing with these problems on a day-to-day basis.
  This direct amendment would add safe drinking water to nutrition and 
income security on the list of programs for which direct linkages are 
encouraged. This is an important tribute to our late colleagues, 
Chairman Lantos and Chairman Hyde, who were so instrumental in the 
enactment of our Water for the Poor Act, and their insights that are 
bringing safe drinking is an important component of developmental 
sectors from health to the environment. To include safe drinking water 
in legislation through which we honor their memories is a small 
testament to their lasting legacies.
  Including safe drinking water is critical because we cannot treat 
HIV/AIDS without safe drinking water. USAID has recognized in its 
guidance for missions carrying out these programs that people with HIV/
AIDS are at increased risk for diarrheal diseases and far more likely 
to suffer severe and chronic complications if infected.
  There is terrible irony in providing patients with advanced 
antiretroviral agents, and then asking them to use the water in a glass 
that may infect them with a life-threatening illness to wash down the 
life-saving pills.
  To add irony, one of the complications of diarrheal illnesses is HIV-
infected patients have a reduced ability to absorb antiretroviral and 
other medications from the gut. This poor absorption can contribute to 
the development of HIV strains that are resistant. In addition to the 
negative impact on life expectancy and quality of life, they also add 
significantly to the burdens on caregivers in clinics and at home and 
put them and other family members at risk for infection.
  We are all a part of this in the global community. This legislation 
is important to tie these challenges together, not deal with it 
piecemeal, and to help with advancing the overall objective of this 
legislation.
  Madam Chairman, I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim 
the time in opposition to the amendment for purposes of debate.
  The CHAIRMAN. Without objection, the gentlewoman from Florida is 
recognized for 5 minutes.
  There was no objection.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield myself such time as I may 
consume.
  Madam Chairman, I support Mr. Blumenauer's amendment, which would add 
safe drinking water to nutrition and income security on the list of 
programs for which direct linkages are encouraged. For patients whose 
immune systems have been compromised by AIDS, the availability of safe, 
clean drinking water is vitally important. This is especially true for 
HIV positive women with young infants who use infant formula to avoid 
transmitting the virus to their babies during feeding. If the water 
used in the formula is not clean, their babies are at high risk for 
waterborne diseases. Therefore, this amendment would allow PEPFAR to 
link with existing safe drinking water programs in order to provide 
clean water to these treatment patients.
  Mr. BERMAN. Madam Chairman, will the gentlewoman yield?
  Ms. ROS-LEHTINEN. I yield to the gentleman from California.
  Mr. BERMAN. Madam Chairman, I appreciate the gentlewoman yielding, 
and I rise to join you in supporting the gentleman's amendment. What 
was interesting to me was to learn, and there are many things I learned 
in this bill that I didn't know, but one was that about 1.2 billion 
people globally lack safe water to consume in the least-developed 
countries, and up to 90 percent of AIDS patients, 90 percent, suffer 
and frequently die from the chronic diarrheal diseases that the 
gentleman discussed. These diseases are caused by the use of unsafe 
water.
  This is a compelling amendment. I join the gentlewoman in supporting 
it.
  Ms. ROS-LEHTINEN. Madam Chairman, I would also like to yield such 
time as he may consume to the gentleman from New Jersey (Mr. Payne).
  Mr. PAYNE. Madam Chairman, I rise in support of Mr. Blumenauer's 
amendment to ensure that safe drinking water is a component of our HIV/
AIDS strategy. Congressman Blumenauer, the lead sponsor of the Water 
for the Poor Act of 2005, has been a strong advocate on this issue for 
years, and he was kind enough to testify about the challenge of clean 
water in Africa at a hearing of the Subcommittee on Global Health I 
chaired in May of 2007.
  During the course of that hearing, it became clear that in Africa, 
the region hardest hit by the AIDS pandemic, the problem of safe water 
is particularly acute. The total number of people without access to 
potable water in the region has actually increased by 60 million in the 
past half decade. That is why Mr. Blumenauer and I, along with other 
Members of Congress, successfully secured $300 million for safe 
drinking water and sanitation projects for fiscal year 2008.
  We all know that HIV compromises the immune system. Those infected 
with the disease are far more likely to succumb to the illness caused 
by unsafe drinking water, especially if they are children, and there is 
no way that people can take ARVs if they do not have access to clean 
drinking water.
  I strongly support Mr. Blumenauer's amendment, and thank him for his 
cosponsorship of H. Res. 318, supporting the goals of the United 
Nations International Year of Sanitation. His resolution encourages 
international communities to achieve the target of halving the 
proportion of people without access to safe drinking water and basic 
sanitation. I encourage my colleagues to support the Blumenauer 
amendment.
  Mr. BLUMENAUER. Madam Chairman, I yield myself such time as I may 
consume.
  I would like to express my deep appreciation to Chairman Payne. I 
appreciate the ranking member yielding

[[Page 4819]]

time to him. I was prepared to do so, but she was able to give him more 
time, and that is important.
  Congressman Payne, your laser-like focus on this with the 
subcommittee, your long-term advocacy, your work on the continent, is 
something that I find inspirational. I look forward to working with you 
and partnering on these issues as we move forward.
  To the Chair and ranking member, your willingness to include this is 
important, and our work together to be able to focus on the whole 
person and to be able to deal with waterborne disease, the number one 
preventible cause of death and disease around the world. Half the 
people who are sick today anywhere in the world are sick needlessly 
from water-borne disease. Adding this critical amendment to your 
important legislation is an important step forward. I hope it is just 
one step that we can work on together to bring people around the world 
to support this critical priority.
  As I say, I can think of no more fitting tribute to your previous 
predecessors as Chair of the committee, Congressman Hyde and 
Congressman Lantos, who worked so hard to advance this cause. I urge 
adoption of this amendment.
  Madam Chairman, I yield back the balance of my time.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield back the balance of my 
time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Oregon (Mr. Blumenauer).
  The amendment was agreed to.


               Amendment No. 2 Offered by Mr. Fortenberry

  The CHAIRMAN. It is now in order to consider amendment No. 2 printed 
in House Report 110-562.
  Mr. FORTENBERRY. Madam Chairman, I have an amendment at the desk.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 offered by Mr. Fortenberry:
       Page 43, line 4, insert before the period at the end the 
     following: ``, including both Principal Recipients and sub-
     recipients''.

  The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from 
Nebraska (Mr. Fortenberry) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Nebraska.
  Mr. FORTENBERRY. Madam Chairman, I yield myself such time as I may 
consume.
  Madam Chairman, as a member of the House Foreign Affairs Committee 
and the Subcommittee on Africa and Global Health, I have been involved 
extensively in the issues before us today. I really do appreciate the 
bipartisan cooperation that has guided this process, particularly by 
Chairman Berman and our ranking member, Ms. Ros-Lehtinen. Thank you. 
This bill is appropriately named for two giants of this institution, 
Tom Lantos and Henry Hyde.
  My amendment addresses the issue of transparency and accountability 
in the Global Fund. The Global Fund is a unique, non-governmental 
multilateral organization headquartered in Switzerland and focused on 
combating HIV/AIDS, tuberculosis and malaria throughout the developing 
world.

                              {time}  1430

  The U.S. Government is the single largest provider of resources and 
technical assistance to the Global Fund, and since 2001 Congress has 
appropriated nearly $4 billion to the Fund. The Lantos-Hyde bill before 
us today authorizes additional funds that will total in the billions.
  The bill currently and appropriately calls for systematic assessments 
of performance data of principal recipients and subrecipients of funds, 
as recommended by the Government Accountability Office, the GAO. This 
technical amendment simply clarifies that audits by the Fund's 
Inspector General should also encompass principal recipients and 
subrecipients, the entities that actually receive programmatic funding.
  Madam Chairman, I believe that this amendment strengthens the spirit 
of accountability that is present in the underlying bill. According to 
a June 2005 report by the GAO, the Global Fund possessed a limited 
ability to monitor and evaluate grants. Concerns have also been raised 
that the volume of funding provided through the Global Fund may exceed 
the capacity of the recipients in the field to actually utilize it.
  Since we are considering an additional contribution that may total in 
the billions of U.S. taxpayer dollars to the Global Fund over the life 
of this reauthorization, I believe that it would be beneficial for 
ourselves, as well as for the Fund, as well as for other donors, to 
have additional clarity on how these funds are being used in the field 
for those most in need of our assistance.
  Madam Chairman, I intend to support the overall bill, and I urge my 
colleagues to support this amendment.
  I reserve the balance of my time.
  Mr. BERMAN. Madam Chairman, while I do not oppose the amendment, I 
ask unanimous consent to take the time in opposition.
  The CHAIRMAN. Without objection, the gentleman from California is 
recognized for 5 minutes.
  There was no objection.
  Mr. BERMAN. Madam Chairman, the gentleman's amendment, and I have 
spoken to him about it, encourages the Global Fund Inspector General to 
not only audit its grantees, but also the subgrantees and subrecipients 
who receive Global Fund money.
  Obviously, I share the gentleman's concern that transparency and 
accountability in the use of HIV/AIDS assistance provided through the 
Global Fund is critically important for all the reasons that he stated. 
The Global Fund, in all fairness, I do want to point out, has shown, I 
believe, its commitment to that transparency and accountability. It has 
a new inspector general, and has instituted an enhanced accounting 
system that focuses on improving accountability among subrecipients. 
But the principle of this amendment makes sense. While there are some 
technical issues I will want to talk to him about as we move through 
the legislative process, I look forward to working with him on it and I 
certainly urge the adoption of the amendment.
  I yield 1 minute to the gentlelady from Florida, the ranking member.
  Ms. ROS-LEHTINEN. Madam Chairman, I also support Mr. Fortenberry's 
amendment which would ensure that audits by the Global Fund Inspector 
General include information on subcontractors.
  The U.S. government is the largest contributor to the Global Fund to 
fight HIV/AIDS, tuberculosis, and malaria. Since the fund was created, 
the U.S. has appropriated and pledged $3.5 billion for contributions to 
the Global Fund, representing nearly one-third of the total budget of 
the Global Fund. It is an important component to the world's response 
to these three diseases, and has made progress on issues of 
transparency and accountability in recent years.
  As the bill makes clear, continued support to the Global Fund should 
be based on the Fund's ability to meet certain transparency and 
accountability benchmarks.
  This amendment builds on and clarifies the underlying text in order 
to ensure that the audits conducted by the Global Fund's Office of 
Inspector General cover both primary recipients of grant funding and 
subrecipients who perform smaller pieces of the grants. These audits 
are important. I thank the gentleman for the time, and I support the 
Fortenberry amendment on Inspector General audits at the Global Fund.
  Mr. BERMAN. Madam Chairman, I yield 1 minute to the chairman of the 
Africa Subcommittee, the gentleman from New Jersey (Mr. Payne).
  Mr. PAYNE. Madam Chairman, I rise to speak on the amendment offered 
by Mr. Fortenberry. We appreciate the work that he does on the 
subcommittee and he contributes greatly.
  We feel that the Inspector General has been doing an adequate job; 
however, we do not oppose this amendment. The Office has approved over 
$10

[[Page 4820]]

billion for programs in 136 countries around the world so far, which 
amounts to 21 percent of all donor HIV/AIDS spending, and two-thirds of 
all the donor spending on malaria and tuberculosis. Through the Global 
Fund, 1.4 million people have been treated with life-saving antivirals, 
3.3 million cases of TB have been treated; and, in a new area, 46 
million bed nets have been distributed to protect children against 
malaria. And I am pleased to say that Ray Chambers from New Jersey and 
my congressional district has been appointed ambassador for the U.N. to 
combat malaria.
  So, we do not oppose this amendment, and we look forward to the 
bill's passage.
  Mr. BERMAN. Madam Chairman, I have no further requests for time, and 
I yield back the balance of my time.
  Mr. FORTENBERRY. Madam Chairman, I want to thank the chairman of the 
Foreign Affairs Committee for his support of this. I understand the 
concerns he addressed and understand his comments, as well as the 
chairman's of the subcommittee. I look forward to continuing to work 
with him, but do appreciate his support of the amendment.
  I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Nebraska (Mr. Fortenberry).
  The amendment was agreed to.


         Amendment No. 3 Offered by Ms. Mc Collum of Minnesota

  The CHAIRMAN. It is now in order to consider amendment No. 3 printed 
in House Report 110-562.
  Ms. McCOLLUM of Minnesota. Madam Chairman, I have an amendment made 
in order under the rule.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 3 offered by Ms. McCollum of Minnesota:
       Page 35, line 13, insert ``, Malawi, Swaziland, Lesotho'' 
     after ``Republic''.

  The CHAIRMAN. Pursuant to House Resolution 1065, the gentlewoman from 
Minnesota (Ms. McCollum) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Minnesota.
  Ms. McCOLLUM of Minnesota. Madam Chairman, the amendment offered by 
Mr. Jackson of Illinois and myself would add three Southern African 
countries, Malawi, Swaziland, and Lesotho, to the lists of countries 
that will be a part of the focus countries in the reauthorization of 
this Global HIV/AIDS legislation.
  In 2003, the original PEPFAR legislation designated 14 focus 
countries. These countries were prioritized for intensive investment of 
resources and technical expertise as provided through PEPFAR. The bill 
on the floor today adds focus countries by designating Vietnam and 14 
Caribbean basic countries with PEPFAR focus status. Unfortunately, 
these three countries in Southern Africa, each confronting devastation 
as a result of HIV/AIDS, have not been granted priority status in 
PEPFAR. The crisis of HIV/AIDS confronting Malawi, Swaziland, and 
Lesotho is real and in some cases worse than the existing focus 
countries.
  Malawi is a country of 13 million people, with 900,000 children 
orphaned by AIDS and nearly 1 million of its adults living with HIV, a 
14 percent infection rate. Swaziland, with a population of only 1.1 
million people, has over 200,000 adults living with HIV, one in three 
adults, or a 33 percent adult infection rate. Lesotho has a population 
of 2 million people, and an HIV infection rate among its adults of 23 
percent.
  These three countries are not only confronting HIV and AIDS, but they 
are also among the poorest countries on the planet, which makes their 
challenge so much greater. Malawi, for example, is 164th out of 177 
countries on the United Nations Human Development Index. Also, each 
country is geographically surrounded by countries that were designated 
focus countries in the original PEPFAR legislation, South Africa, 
Mozambique, Zambia, Tanzania, which are presently receiving massive 
investments to confront their epidemics.
  Malawi, Swaziland, and Lesotho are working bilaterally with the 
United States; but by not being granted PEPFAR's focus country status, 
the gap that they face between the needs and available resources means 
that too many people will continue to be infected, too many people will 
continue to die needlessly, and too many orphans will be left to fend 
for themselves.
  This amendment has the support of the governments of Malawi, 
Swaziland and Lesotho.
  I submit for the Record a letter of support from the three 
governments.

                            Embassy of the Republic of Malawi,

                                   Washington, DC, March 28, 2008.
     Hon. Betty McCollum,
     House of Representatives,
     Washington DC.
       Dear Honourable McCollum, we are writing to follow up on 
     our recent meeting during which we discussed, among other 
     things, the re-authorization of the President's Emergency 
     Plan for AIDS Relief (PEPFAR).
       We are deeply concerned that the three countries that have 
     been heavily impacted by the HIV/AIDS virus in Southern 
     Africa, and whose prevalence rates are above 14% have been 
     left out from the new list of focus countries as reflected in 
     H.R. 5501. Our countries have become islands amidst countries 
     that are receiving tremendous resources from PEPFAR within 
     the region.
       The AIDS epidemic in our countries has brought additional 
     pressure to bear on the health sector. We are failing to 
     train adequate number of health workers to provide services 
     to those living with HIV and suffering from AIDS. The few 
     that we have trained have died from the virus while others 
     have left the continent for greener pastures in the western 
     countries. Although the recent increase in the provision of 
     ARV has brought hope to many, it has also put increased 
     strain on the remaining healthcare workers. In addition, 
     there are many more people living with the HIV virus who are 
     not receiving treatment due to lack of resources to purchase 
     drugs and to train personnel to administer treatment.
       The presence of AIDS has also affected many households. 
     Many children have lost one or both parents due to HIV/AIDS. 
     At the same time, we have a large number of children who were 
     born with the virus because the risk of mother-to-child 
     transmission remains very high. Although we have put in place 
     orphan care programs, the need for more resources to provide 
     comprehensive care cannot be overemphasized. The pandemic has 
     also added strain to the food insecurity in many areas 
     because agricultural work has been neglected or abandoned due 
     to household illness. The labor force, in general, has also 
     been affected by HIV/AIDS, setting back economic and social 
     progress.
       Our leadership is highly committed to the fight against 
     HIV/AIDS. Our governments have provided enough domestic 
     resources within their means and are receiving external 
     funding for HIV/AIDS programs. However, there is a wide 
     funding gap between planned programs and resources required 
     for implementation. It is for this reason that we humbly 
     request you to introduce an amendment to H.R. 5501, to 
     include Lesotho, Malawi and Swaziland as focus countries.
       Your assistance on this matter will be greatly appreciated.
           Yours sincerely,
     Hawa Olga Ndilowe,
       Ambassador of Malawi to the U.S.
     Ephraim Mandlenkosi M. Hope,
       Ambassador of the Kingdom of Swaziland to the U.S.
     Mabasia Ntsoaki Mohobane,
       Charge d'Affaires, Embassy of the Kingdom of Lesotho to the 
     U.S.

  These countries believe, as I do, that the severity of the epidemic 
in their countries should make their fight against AIDS a priority for 
this Congress and for the American people.
  Finally, I want to thank the chairman and the ranking member for 
their commitment for fighting HIV/AIDS, and for their hard work in 
bringing H.R. 5501 to the floor.
  I also had the honor of serving on the International Relations 
Committee under the leadership of Mr. Hyde and Mr. Lantos when we 
passed the original PEPFAR legislation. They were both extraordinary 
men and wonderful mentors to me. They were compassionate leaders in 
this House, and it is fitting that we pay tribute to their lives and 
their contributions to this country by passing a bill that will save 
lives and improve life all around the world. I urge my colleagues to 
support this amendment to be included in the bill,

[[Page 4821]]

and also to support passage of this important bill.
  I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim 
the time in opposition to the amendment for purposes of debate.
  The CHAIRMAN. Without objection, the gentlewoman from Florida is 
recognized for 5 minutes.
  Ms. ROS-LEHTINEN. Madam Chairman, I actually support the McCollum-
Jackson amendment, which would add Malawi, Swaziland and Lesotho to the 
list of countries in which the Global AIDS Coordinator is given 
explicit statutory authority.
  Malawi, Swaziland, and Lesotho all face major HIV/AIDS epidemics and 
have received significant resources through PEPFAR in the first 5 years 
of implementation. By giving the Global AIDS Coordinator explicit 
authority over the U.S. Government's HIV/AIDS programs in these 
countries, the Congress is signaling that it believes the U.S. 
Government should continue to come alongside these nations' governments 
and their citizens to support them in the fight against HIV/AIDS, and I 
commend Ms. McCollum and Mr. Jackson for offering it.
  I would like to yield the remaining time, Madam Chairman, to our 
chairman, Chairman Berman of California, as well as Mr. Payne of New 
Jersey, with Mr. Payne of New Jersey first.
  Mr. PAYNE. I thank the gentlelady for yielding. I rise in strong 
support of the amendment offered by the gentlelady from Wisconsin.
  Southern Africa has the highest rate of HIV and AIDS in the entire 
world. In Lesotho, we have heard, a country with an HIV/AIDS prevalence 
rate of 38 percent among pregnant women, only 19 percent of those in 
need of treatment for the disease have access for it. Even more 
troubling is the fact that only 5 percent of HIV-positive mothers get 
drugs to prevent the transmission of the virus to their children during 
childbirth. Life expectancy for women is 44 years, and for men a mere 
39.
  In Malawi, the situation is a little better; men are expected to live 
41 years, women 42. The health care worker shortage in the country 
remains a major obstacle.
  Circumstances in Swaziland are equally grim: 26 percent of adults are 
HIV positive. In a country of just over 1 million, there are 70,000 
AIDS orphans. Clearly, HIV and AIDS pose a dire threat in these 
countries and must be urgently addressed. Therefore, I commend the 
gentlewoman, Ms. McCollum, for her amendment to make Swaziland, 
Lesotho, and Malawi focus countries, and I urge my colleagues to 
support this amendment.
  Ms. ROS-LEHTINEN. Madam Chairman, if I could yield now to Chairman 
Berman, the gentleman from California.
  Mr. BERMAN. I thank the gentlelady for yielding.
  I support this amendment. I congratulate Representatives McCollum and 
Jackson for their leadership in adding these hard-hit nations to the 
focus country list.
  All three of these Southern African countries suffer from both high 
HIV/AIDS prevalence rates and high poverty rates, with devastating 
effects. The statistics in all three countries regarding AIDS have been 
put on the record by both the gentlelady from Minnesota and the 
gentleman from New Jersey, so I will just add my words of support for 
the amendment.

                              {time}  1445

  Ms. ROS-LEHTINEN. Madam Chairman, I yield back the balance of my 
time.
  Ms. McCOLLUM of Minnesota. Madam Chairman, I would like to thank the 
chairman, the ranking member, and the distinguished Chair of the 
Subcommittee on Africa and Global Health for their kind words, and urge 
all of my colleagues to support the amendment.
  I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentlewoman from Minnesota (Ms. McCollum).
  The amendment was agreed to.


            Amendment No. 4 Offered by Mr. Carson of Indiana

  The CHAIRMAN. It is now in order to consider amendment No. 4 printed 
in House Report 110-562.
  Mr. CARSON of Indiana. Madam Chairman, I have an amendment made in 
order under the rule.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 4 offered by Mr. Carson of Indiana:
       Page 49, line 10, insert before the period at the end the 
     following: ``Recognizing that human and institutional 
     capacity form the core of any health care system that can 
     sustain the fight against HIV/AIDS, tuberculosis, and 
     malaria, the plan shall include a strategy to encourage 
     postsecondary educational institutions in host countries, 
     particularly in Africa, in collaboration with United States 
     postsecondary educational institutions, historically black 
     colleges and universities, to develop such human and 
     institutional capacity and in the process further build their 
     capacity to sustain the fight against these diseases.''.
       Page 104, line 21, before ``capacity'' insert ``human and 
     institutional''.
       Page 105, line 5, insert ``partnerships,'' after 
     ``telecommunications services,''.

  The CHAIRMAN. Pursuant to House Resolution 1065, the gentleman from 
Indiana (Mr. Carson) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Indiana.
  Mr. CARSON of Indiana. Madam Chairman, I rise today in support of 
H.R. 5501, the Tom Lantos and Henry Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008 and to offer my amendment which I believe will enhance the 
base bill. I want to thank Chairman Berman and Ranking Member Ros-
Lehtinen for their hard work in bringing this legislation to the floor.
  I find it of coincidence the timing of our consideration of this 
legislation for it is juxtaposed between two pivotal historical moments 
in time: The deaths of the renowned African American medical doctor, 
Dr. Charles Drew on April 1, 1950, and the celebrated human rights 
leader, Dr. Martin Luther King, Jr. on April 4, 1968.
  Both Dr. Drew and Dr. King were products of the American educational 
system and particularly of historically black colleges and 
universities. Madam Chairman, I cannot think of any better way to 
explain the importance of this amendment and its use. The effort to 
address HIV/AIDS requires the best of human rights and of medical 
science.
  My amendment is a simple amendment that would make changes to section 
204 of H.R. 5501. The amendment directs the coordinator of the United 
States Government Activities to Combat HIV/AIDS Globally and the 
administrator of the United States Agency for International Development 
to expand their plan for strengthening health systems of host countries 
by allowing for African post secondary educational institutions to 
collaborate with United States post secondary educational institutions 
and specifically historically black colleges and universities to 
develop such human and institutional capacity.
  The goal of my amendment is to allow our Nation's finest post 
secondary educational institutions to be directly involved in the 
training of health care workers that will enhance the effectiveness and 
efficacy of the efforts put forth in H.R. 5501.
  Madam Chairman, I can think of no better way for the citizens of 
Indiana, the great Hoosier State, to contribute in the fight against 
this pandemic than to train the best and brightest, and to commit to 
countries whose health care systems suffer woefully from the lack of 
trained health professionals. After all, who are we to block the 
opportunity to these children to be successful.
  Madam Chairman, before I close, I want to acknowledge and salute the 
two men this piece of legislation is named after, Congressmen Tom 
Lantos and Henry Hyde. I didn't get a chance to work with them in this 
body, but I cannot think of a better way to honor their service in this 
great institution.
  Finally, I want to thank the wonderful staff of the Foreign Relations 
Committee and the Rules Committee for helping me craft this amendment.

[[Page 4822]]

Madam Chairman, I ask for support of my amendment.
  Madam Chairman, I reserve the balance of my time.
  Ms. ROS-LEHTINEN. Madam Chairman, I ask unanimous consent to claim 
the time in opposition to the amendment for purposes of debate.
  The CHAIRMAN. Without objection, the gentlewoman from Florida is 
recognized for 5 minutes.
  There was no objection.
  Ms. ROS-LEHTINEN. Madam Chairman, first of all, I would like to thank 
Mr. Carson for his well-reasoned and important amendment. We all had 
the honor of serving with his grandmother, Julia Carson, for many years 
in this body, and I know that Congresswoman Carson is looking down at 
her grandson and saying she is mighty proud. So thank you so much for 
your amendment, and thank you for carrying on in her great legacy by 
presenting wonderful topics and themes for us to discuss on the floor.
  I fully support the Carson amendment because it focuses on building 
human and institutional capacity in PEPFAR host countries. It directs 
the global AIDS coordinator and the USAID administrator to expand their 
plan by strengthening health systems of host countries by encouraging 
post secondary educational institutions, particularly those in the 
African continent, to collaborate with the post secondary educational 
institutions here in the United States, including historically black 
colleges and universities in training health care workers.
  As other provisions of this bill made clear, an important component 
of the fight against HIV/AIDS, tuberculosis, and malaria, is the 
strengthening of the educational capacity in host countries to train 
health care workers. The Carson amendment does exactly that. I 
congratulate him for it. He is a welcome addition to our Chamber.
  I would like to yield to Ms. Lee of California who has been working 
on this issue for a long time, Madam Chairman.
  Ms. LEE. I want to thank the gentlelady for yielding.
  I rise today to support this amendment and to commend the gentleman 
from Indiana. I understand this is his first amendment, and it shows 
that he has hit the ground running. Today, I am reminded of our former 
colleague, his grandmother, our beloved Congresswoman Julia Carson. I 
know she is smiling today and is very proud of your efforts; thank you.
  Historically black colleges and universities have trained some of our 
finest dedicated doctors, nurses, and health care workers. These 
colleges and universities go way beyond the call of duty. They have a 
deep cultural and historical understanding and connection to the 
continent of Africa. They are attacking HIV/AIDS here on the homefront 
where HIV and AIDS is disproportionately affecting the African-American 
community. So by developing human and institutional capacity in Africa 
and in the Caribbean, we are bringing to bear, in a comprehensive 
manner, mechanisms to maximize our effectiveness in combating HIV and 
AIDS, malaria and tuberculosis.
  So I want to salute and thank the gentleman from Indiana once again 
for his leadership and for helping to strengthen this bill.
  Ms. ROS-LEHTINEN. Madam Chairman, I yield such time as he may consume 
to the gentleman from New Jersey (Mr. Payne).
  Mr. PAYNE. Madam Chairman, I appreciate the gentlelady, the ranking 
member, yielding me this time, and I rise in strong support of the 
Carson amendment relating to the building of human capacity to fight 
HIV/AIDS through collaborations between U.S. colleges and universities 
and those in the developing world.
  I, too, am very pleased to see this piece of legislation by Mr. 
Carson. We all knew Julia Carson. She came to my district to deal with 
health disparities in my district in New Jersey, and traveled to Africa 
with me on a trip dealing with this problem. So this is very 
appropriate, and let me commend you again.
  In May of 2007, Doctors Without Borders released a report that found 
that in southern Africa, a shortage of trained health care workers was 
the main barrier to increasing access to antiretroviral treatment.
  The report found that in Mozambique, people had to wait up to 2 
months to start ARVs because there were not enough doctors and nurses 
to manage it. In one health district in Lesotho, nearly half of the 
nursing posts were vacant. Malawi has only two doctors per 100,000 
people. The minimum standard according to the WHO is 20 doctors per 
100,000 people.
  I am pleased to say that the bill under consideration seeks to 
address those problems. It calls on the United States to train 140,000 
new health care workers and professionals so people can start on life-
saving therapy.
  University partnerships are a logical and effective means through 
which to support this goal. So I once again commend Mr. Carson for his 
amendment, and urge my colleagues to support it.
  Mr. CARSON of Indiana. Madam Chairman, I yield 1\1/2\ minutes to the 
gentleman from South Carolina (Mr. Clyburn).
  Mr. CLYBURN. Madam Chairman, I thank the gentleman for yielding me 
this time.
  I rise in strong support of the amendment offered by Mr. Carson. 
Congressman Carson's amendment rightfully recognizes that the HIV/AIDS 
epidemic is proliferating at an alarming rate around the globe, 
particularly in Africa.
  This amendment establishes a cooperative framework in which AIDS 
researchers in Africa can collaborate with American medical experts, 
including researchers at historically black colleges and universities, 
on the best ways to treat and prevent the spread of this devastating 
infectious disease.
  I commend and thank the gentleman from Indiana for offering this 
worthwhile amendment. I encourage my colleagues to support this 
amendment and the underlying bill.
  Mr. CARSON of Indiana. I want to thank the Members for listening and 
considering this amendment. I think it is a great opportunity for us.
  Madam Chairman, I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Indiana (Mr. Carson).
  The question was taken; and the Chairman announced that the ayes 
appeared to have it.


                             Recorded Vote

  Mr. BERMAN. Madam Chairman, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 415, 
noes 10, not voting 10, as follows:

                             [Roll No. 156]

                               AYES--415

     Abercrombie
     Ackerman
     Aderholt
     Akin
     Alexander
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Bachmann
     Bachus
     Baird
     Baldwin
     Barrett (SC)
     Barrow
     Bartlett (MD)
     Barton (TX)
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop (GA)
     Bishop (NY)
     Blackburn
     Blumenauer
     Blunt
     Boehner
     Bonner
     Bono Mack
     Boozman
     Bordallo
     Boren
     Boucher
     Boustany
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Brady (TX)
     Braley (IA)
     Broun (GA)
     Brown (SC)
     Brown, Corrine
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Butterfield
     Buyer
     Calvert
     Camp (MI)
     Cantor
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Carter
     Castle
     Castor
     Chabot
     Chandler
     Christensen
     Clarke
     Clay
     Cleaver
     Clyburn
     Coble
     Cohen
     Cole (OK)
     Conaway
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crenshaw
     Crowley
     Cuellar
     Culberson
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis (KY)
     Davis, David
     Davis, Lincoln
     Davis, Tom
     Deal (GA)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly
     Doolittle
     Doyle
     Drake
     Dreier
     Duncan
     Edwards
     Ehlers
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Etheridge
     Everett
     Fallin
     Farr
     Fattah
     Feeney
     Ferguson
     Filner
     Flake
     Forbes
     Fortenberry
     Fortuno
     Fossella
     Foster
     Foxx
     Frank (MA)
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gerlach
     Giffords
     Gilchrest
     Gillibrand
     Gingrey
     Gohmert
     Gonzalez
     Goodlatte
     Gordon
     Graves
     Green, Al
     Green, Gene

[[Page 4823]]


     Grijalva
     Gutierrez
     Hall (NY)
     Hall (TX)
     Hare
     Harman
     Hastings (FL)
     Hastings (WA)
     Hayes
     Heller
     Herger
     Herseth Sandlin
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hobson
     Hodes
     Hoekstra
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Hulshof
     Hunter
     Inglis (SC)
     Inslee
     Israel
     Issa
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson (IL)
     Johnson, E. B.
     Johnson, Sam
     Jones (NC)
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Keller
     Kennedy
     Kildee
     Kilpatrick
     Kind
     King (IA)
     King (NY)
     Kingston
     Kirk
     Klein (FL)
     Kline (MN)
     Knollenberg
     Kucinich
     Kuhl (NY)
     LaHood
     Lamborn
     Lampson
     Langevin
     Larsen (WA)
     Larson (CT)
     Latham
     LaTourette
     Latta
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lucas
     Lungren, Daniel E.
     Lynch
     Mack
     Mahoney (FL)
     Maloney (NY)
     Manzullo
     Marchant
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (CA)
     McCarthy (NY)
     McCaul (TX)
     McCollum (MN)
     McCotter
     McCrery
     McDermott
     McGovern
     McHenry
     McHugh
     McIntyre
     McKeon
     McMorris Rodgers
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Mica
     Michaud
     Miller (MI)
     Miller (NC)
     Miller, Gary
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Musgrave
     Myrick
     Nadler
     Napolitano
     Neal (MA)
     Norton
     Nunes
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pearce
     Pence
     Perlmutter
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Pomeroy
     Porter
     Price (GA)
     Price (NC)
     Pryce (OH)
     Putnam
     Radanovich
     Rahall
     Ramstad
     Rangel
     Regula
     Rehberg
     Reichert
     Renzi
     Reyes
     Reynolds
     Richardson
     Rodriguez
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Roskam
     Ross
     Rothman
     Roybal-Allard
     Royce
     Ruppersberger
     Ryan (OH)
     Ryan (WI)
     Salazar
     Sali
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Saxton
     Schakowsky
     Schiff
     Schmidt
     Schwartz
     Scott (GA)
     Scott (VA)
     Sensenbrenner
     Serrano
     Sestak
     Shadegg
     Shays
     Shea-Porter
     Sherman
     Shimkus
     Shuler
     Shuster
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stearns
     Stupak
     Sullivan
     Sutton
     Tancredo
     Tanner
     Taylor
     Terry
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Tiahrt
     Tiberi
     Tierney
     Towns
     Tsongas
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walberg
     Walden (OR)
     Walsh (NY)
     Walz (MN)
     Wamp
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Weldon (FL)
     Weller
     Wexler
     Whitfield (KY)
     Wilson (NM)
     Wilson (OH)
     Wilson (SC)
     Wittman (VA)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth
     Young (AK)
     Young (FL)

                                NOES--10

     Campbell (CA)
     Cannon
     Garrett (NJ)
     Goode
     Hensarling
     Jordan
     Neugebauer
     Poe
     Sessions
     Westmoreland

                             NOT VOTING--10

     Bishop (UT)
     Boswell
     Cubin
     Faleomavaega
     Granger
     Jefferson
     Miller (FL)
     Rush
     Souder
     Tauscher

                              {time}  1521

  Mr. WESTMORELAND changed his vote from ``aye'' to ``no.''
  Mr. ADERHOLT and Mrs. BACHMANN changed their vote from ``no'' to 
``aye.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  The CHAIRMAN. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Ross) having assumed the chair, Ms. Norton, Chairman of the Committee 
of the Whole House on the state of the Union, reported that that 
Committee, having had under consideration the bill (H.R. 5501) to 
authorize appropriations for fiscal years 2009 through 2013 to provide 
assistance to foreign countries to combat HIV/AIDS, tuberculosis, and 
malaria, and for other purposes, pursuant to House Resolution 1065, she 
reported the bill back to the House with sundry amendments adopted by 
the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment reported from the 
Committee of the Whole? If not, the Chair will put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


          Motion to Recommit Offered by Mr. Ryan of Wisconsin

  Mr. RYAN of Wisconsin. Mr. Speaker, I have a motion to recommit at 
the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. RYAN of Wisconsin. I am in its current form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Ryan of Wisconsin moves to recommit the bill H.R. 5501 
     to the Committee on Foreign Affairs with instructions to 
     report the same back to the House forthwith with the 
     following amendments:
       Page 96, line 10, strike ``$4,000,000,000'' and insert 
     ``such sums as may be necessary''.
       Page 97, line 1, strike ``$5,000,000,000'' and insert 
     ``such sums as may be necessary''.
       Page 116, line 8, strike ``$10,000,000,000'' and insert 
     ``6,000,000,000''.
       Page 122, after line 2, insert the following:

     SEC. 405. SENSE OF CONGRESS.

       (a) Findings.--Congress finds the following:
       (1) According to Congressional Budget Office estimates, $50 
     billion to carry out the United States Leadership Against 
     HIV/AIDS, Tuberculosis, and Malaria Act of 2003 would not be 
     spent during the five-year authorization period, but instead 
     would take 10 years or until 2018 to spend.
       (2) Recent funding disbursement trends for the current 
     program suggest that the current funding levels are outpacing 
     the capacity of the countries and nongovernmental 
     organizations to efficiently implement the program. Over the 
     2005-2006 funding period, assistance commitments grew $1.3 
     billion from $4.3 billion to $5.6 billion, while the actual 
     disbursements of funds grew at a much slower rate of $400 
     million from $3.5 billion to $3.9 billion. As such, the 
     current commitment exceeds disbursement by $1.7 billion, or 
     30 percent of the current commitment.
       (3) Reports from recipient countries indicate the 
     absorptive capacity for HIV/AIDS programs has become a 
     constraint on actual expenditure of funds. For instance, a 
     2005 survey of World Bank Multi-Country AIDS Program (MAP) 
     country directors in Africa found that nearly 40 percent of 
     those countries believed that absorptive capacity ``remains 
     limited and is the real issue; new financial resources will 
     exacerbate this problem''.
       (4) Additionally, a 2007 Center for Global Development 
     report on HIV/AIDS programs in Mozambique, Uganda, and Zambia 
     found that overburdened government staff at all levels, along 
     with the limited absorptive capacity of sub-grantees, created 
     major bottlenecks for funding disbursement.
       (5) Advocates of increased HIV/AIDS funding appear to have 
     based their recommendations for such funding at least in part 
     on UNAIDS' estimates of a global price tag for addressing the 
     HIV/AIDS epidemic. Such international estimates are flawed, 
     however, because the primary source for such projections--the 
     UNAIDS' ``Resource Needs Model'', or RNM--overestimates the 
     resources needed, relies on a higher estimate of people 
     living with HIV/AIDS, and includes support for countries that 
     are also Global Fund donors. Specifically:
       (A) The UNAIDS report titled ``Critical Review of Costing 
     Models to Estimate Resource Needs to Address Global HIV and 
     AIDS'' found that ``the [RNM] has a number of limitations'', 
     each of which contributes to an overestimate of the resources 
     needed to mount a successful response.
       (B) Newer projections such as the 2007 ``Epidemic Update'' 
     lowered the estimated number of people living with HIV/AIDS 
     worldwide from 39.5 million to 33.2 million--a 16 percent 
     reduction--yet UNAIDS has not publicly released a revised 
     lower projection of resource needs.
       (C) Projections in the RNM report include significant 
     financing for middle-income countries such as China, Russia, 
     and Brazil that are actually Global Fund donors themselves 
     and should not require international assistance.
       (b) Sense of Congress.--In light of the findings contained 
     in subsection (a), which indicate that even current levels of 
     funding for HIV/AIDS programs cannot be disbursed in an 
     efficient and effective manner, Congress should ensure that 
     the amount of funding authorized by this Act to carry out the 
     United States Leadership Against HIV/AIDS, Tuberculosis, and 
     Malaria Act of 2003 is consistent with the demonstrated 
     absorptive capacity to carry out such programs around the 
     world.


[[Page 4824]]


  The SPEAKER pro tempore (during the reading). Without objection, the 
reading is dispensed with.
  There was no objection.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Wisconsin is recognized for 5 minutes in support of his motion.
  Mr. RYAN of Wisconsin. Mr. Speaker, I want to start off by 
complimenting the chairman of the committee and the ranking member of 
the committee, along with all the other members of the Foreign Affairs 
Committee for working in a bipartisan way to put together this 
compromise.
  We heard a very good fulfilling debate about the merits of PEPFAR. I, 
too, agree that the PEPFAR program is a very worthwhile program. So we 
agree that this is the right thing to do.
  The question is, should we more than double the authorization of this 
program? Now, the President's budget called for doing just that. And I 
think you can make a very good and compelling case that this program is 
so successful that it ought to be doubled. That's not what the 
underlying bill does. This underlying bill more than triples this 
program.
  I have three concerns about this tripling of this program. Number 1, 
the spending levels set out in this authorization bill are higher than 
the recipient countries can even accept. They can't absorb all of this 
money. We know this from the studies in the field. So even if we hit 
these authorization levels, we know that the recipient countries cannot 
even accept all of this money. They can't spend it that fast.
  Point Number 2, the Congressional Budget Office has told us that we 
couldn't even spend this money this fast. So why are we having this 
kind of an authorization level when our own Congressional Budget Office 
is telling us that it would take at least 10 years to spend down a $50 
billion authorization?
  And that brings me to my third point, and that is the budget 
resolution that passed the floor just 2\1/2\ weeks ago. The Democratic 
budget resolution itself assumes the $30 billion level. The Democratic 
budget resolution assumes we're funding this at the President's request 
of $30 billion. In fact, the Democratic budget resolution has a lower 
level of funding for section 150, the Foreign Affairs program, than 
even the President's budget does. We don't know what cut they're 
talking about, but more to the point, why don't we defend the budget 
resolution that passed this very house 2\1/2\ weeks ago?
  Mr. Speaker, we support this program. I support this program. It's a 
good program. It has proven to work. By any metric, by any definition, 
it's impossible to deny the success of PEPFAR.
  The question is, should we be tripling a program when we know full 
well it breaks the budget resolution, it purports to spend money faster 
than we can even spend, and those who are receiving this money can't 
receive it nearly as fast as we're proposing.

                              {time}  1530

  This recommit is not intended to kill this bill. This is a forthwith 
recommit. This recommit is very simple. It says, rather than funding it 
at $50 billion, let's fund it at $30 billion. That's the level called 
for on the Democratic budget resolution. That's the level called for in 
the President's budget. That's the level that independent experts have 
said can be justified. So this says go from 50 to 30 forthwith, that's 
all.
  I want to compliment the gentleman, the chairman of the committee, 
the ranking member of the committee, all of those who worked in a 
bipartisan basis for this very worthwhile program, but this is a time 
when we have fiscal problems in America. We have a deficit. We have a 
looming debt. We need to show discipline in Congress. We should not be 
tripling funding for programs that we know the recipients themselves 
cannot receive at this pace and we know from our own independent budget 
experts that we simply can't spend at this pace.
  Let's bring it back down to earth. Let's double it and keep it within 
reason. That is why we should pass this motion to recommit.
  I yield back the balance of my time.
  Mr. BERMAN. Mr. Speaker, I rise to oppose the motion to recommit.
  The SPEAKER pro tempore. The gentleman from California is recognized 
for 5 minutes.
  Mr. BERMAN. Thank you, Mr. Speaker.
  First, I appreciate the compliments of my friend from Wisconsin. I 
prefer that the compliments be withheld and the motion to slash this 
bill by 40 percent be rejected, although I do appreciate the 
implication of his comments that a recommittal motion that is forthwith 
is not intended to kill the bill and that, therefore, the recommittal 
motions that are not forthwith are intended to kill the bills they are 
made to.
  But getting to the merits of this. The purpose of my comments is 
directly to the other side. I know the easy vote, even for those who 
support this bill, is to vote both to cut some money and to support the 
minority on their motion to recommit.
  But I would like to suggest that in this particular case, given what 
has transpired in terms of putting together this bipartisan bill, both 
on the merits of the motion to recommit and on the message it sends 
about how we can work on a bipartisan basis in the future, this motion 
is wrong and that Members on the other side should oppose it along with 
the Members on our side.
  First, on the facts. The administration supports this bill and 
supports our number on this bill. To the extent they have concerns 
about what the level of appropriations may be in this year, their 
statement of administration position directly says, talk about the 
level of appropriation; don't cut the authorization.
  Secondly, the U.N. HIV/AIDS commission, which I'm not a fan of a lot 
of different agencies that start with ``U.N.,'' but this one is the 
preeminent authority, talks about the incredible remaining need. And in 
the issue of absorptive capacity, this was the same argument made in 
2003 against a $15 billion authorization for which the Republican 
Congress appropriated far more than the authorization because we were 
able to see an absorptive capacity, and we saved well over a million 
lives.
  But here we are dealing with a situation where there are 35 million 
people worldwide that are still living with HIV/AIDS. This is a program 
that works. The combination of changing behavior, prevention, and 
treatment is saving lives. I don't like to throw the words ``moral 
imperative'' around. It's usually used for anything people feel 
passionately about. But talk about pro-life, I can't think of any 
single program that I have been involved with where we are going to be 
more pro-life than in pushing this with programs that work, with the 
capacity that can be absorbed. No one is saying we are going to spend 
$50 billion in the next 5 years. We are going to obligate, based on the 
appropriation moneys, and those moneys will be spent probably over the 
course of 8 to 10 years. That's the way this appropriation process 
works, as everyone knows.
  My final point is the ranking member and I, the White House directly, 
the President and his chief of staff were directly involved, the 
Republican leadership in this body, we put together a bipartisan bill. 
Part of the key negotiation was about the number. In return for that, a 
number of issues of importance to the minority were preserved in this 
bill: the preservation of the concept of behavior change through 
abstinence and faithfulness; the understanding that approved family 
planning programs would be the ones that were funded. A variety of 
different aspects. The belief in the use of faith-based institutions.
  How are we, in the future, going to come together on bipartisan 
programs where the deal is made and then all of a sudden a key part of 
the quid pro quo, the other side says ``no'' to?
  I would suggest, sure there are issues about what is our fiscal 
condition and what can we do, and the appropriations could be weighing 
these very carefully. But this was a fundamental agreement to maintain 
a bipartisan tradition on this legislation named after Henry

[[Page 4825]]

Hyde and Tom Lantos, both of whom worked in that capacity.
  I think this motion to recommit massively undercuts that whole 
bipartisan approach, and I would urge my colleagues to defeat it.
  I would be happy to yield to the gentleman from New Jersey.
  Mr. SMITH of New Jersey. I do rise in opposition to this motion to 
recommit with great respect to my friend from Wisconsin.
  The SPEAKER pro tempore. All time for debate has expired.
  Without objection, the previous question is ordered on the motion to 
recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. RYAN of Wisconsin. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair 
will reduce to 5 minutes the minimum time for any electronic vote on 
the question of passage.
  The vote was taken by electronic device, and there were--yeas 175, 
nays 248, not voting 7, as follows:

                             [Roll No. 157]

                               YEAS--175

     Aderholt
     Akin
     Alexander
     Altmire
     Bachmann
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blunt
     Boehner
     Bonner
     Bono Mack
     Boozman
     Boustany
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Coble
     Cole (OK)
     Conaway
     Crenshaw
     Davis (KY)
     Davis, Tom
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Ehlers
     Everett
     Fallin
     Feeney
     Flake
     Forbes
     Fossella
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gillibrand
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Graves
     Hall (TX)
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Herger
     Hoekstra
     Hulshof
     Hunter
     Inglis (SC)
     Issa
     Johnson (IL)
     Johnson, Sam
     Jones (NC)
     Keller
     King (IA)
     Kingston
     Kline (MN)
     Knollenberg
     Kuhl (NY)
     LaHood
     Lamborn
     Lampson
     Latham
     LaTourette
     Latta
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas
     Lungren, Daniel E.
     Marchant
     McCarthy (CA)
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McHugh
     McKeon
     McMorris Rodgers
     Mica
     Miller (MI)
     Miller, Gary
     Moran (KS)
     Murphy, Tim
     Musgrave
     Myrick
     Neugebauer
     Nunes
     Paul
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Radanovich
     Ramstad
     Regula
     Rehberg
     Reichert
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Schmidt
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Sullivan
     Taylor
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walberg
     Walden (OR)
     Wamp
     Weldon (FL)
     Whitfield (KY)
     Wilson (NM)
     Wilson (SC)
     Wittman (VA)
     Wolf
     Young (AK)
     Young (FL)

                               NAYS--248

     Abercrombie
     Ackerman
     Allen
     Andrews
     Arcuri
     Baca
     Bachus
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blackburn
     Blumenauer
     Boren
     Boswell
     Boucher
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Castor
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis, David
     Davis, Lincoln
     Deal (GA)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Duncan
     Edwards
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Etheridge
     Farr
     Fattah
     Ferguson
     Filner
     Fortenberry
     Foster
     Frank (MA)
     Giffords
     Gilchrest
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth Sandlin
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hobson
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Jones (OH)
     Jordan
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     King (NY)
     Kirk
     Klein (FL)
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lynch
     Mack
     Mahoney (FL)
     Maloney (NY)
     Manzullo
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Perlmutter
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Richardson
     Rodriguez
     Ros-Lehtinen
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shays
     Shea-Porter
     Sherman
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tancredo
     Tanner
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Tsongas
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walsh (NY)
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Weller
     Westmoreland
     Wexler
     Wilson (OH)
     Woolsey
     Wu
     Wynn
     Yarmuth

                             NOT VOTING--7

     Cubin
     Culberson
     Granger
     Jefferson
     Miller (FL)
     Rush
     Tauscher

                              {time}  1555

  Messrs. GILCHREST, DUNCAN, MACK, Mrs. CAPPS, Messrs. MANZULLO, 
MARSHALL, KANJORSKI, Ms. HARMAN, and Mr. PETERSON of Minnesota changed 
their vote from ``yea'' to ``nay.''
  Mr. ALTMIRE changed his vote from ``nay'' to ``yea.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. BERMAN. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 308, 
noes 116, not voting 7, as follows:

                             [Roll No. 158]

                               AYES--308

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Altmire
     Andrews
     Arcuri
     Baca
     Bachus
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Biggert
     Bilirakis
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Bonner
     Bono Mack
     Boozman
     Boren
     Boswell
     Boucher
     Boustany
     Boyd (FL)
     Boyda (KS)
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Butterfield
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson
     Carter
     Castle
     Castor
     Chabot
     Chandler
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Cole (OK)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Cramer
     Crowley
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis (KY)
     Davis, Lincoln
     Davis, Tom
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly
     Doyle
     Dreier
     Edwards
     Ehlers
     Ellison
     Ellsworth
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Etheridge
     Farr
     Fattah
     Ferguson
     Filner
     Fortenberry
     Fossella
     Foster
     Frank (MA)
     Frelinghuysen
     Gerlach
     Giffords
     Gilchrest
     Gillibrand
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hall (NY)
     Hare
     Harman
     Hastings (FL)
     Herseth Sandlin
     Higgins
     Hill
     Hinchey
     Hinojosa
     Hirono
     Hobson
     Hodes
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Hulshof
     Inglis (SC)
     Inslee
     Israel
     Issa
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson (IL)
     Johnson, E. B.
     Jones (OH)
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind
     King (NY)

[[Page 4826]]


     Kirk
     Klein (FL)
     Kline (MN)
     Knollenberg
     Kucinich
     Kuhl (NY)
     LaHood
     Lampson
     Langevin
     Larsen (WA)
     Larson (CT)
     Latham
     Latta
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Lipinski
     Loebsack
     Lofgren, Zoe
     Lowey
     Lungren, Daniel E.
     Lynch
     Mahoney (FL)
     Maloney (NY)
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy (NY)
     McCollum (MN)
     McCotter
     McDermott
     McGovern
     McHugh
     McIntyre
     McNerney
     McNulty
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Nunes
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Pence
     Perlmutter
     Peterson (MN)
     Pickering
     Platts
     Pomeroy
     Porter
     Price (NC)
     Pryce (OH)
     Rahall
     Ramstad
     Rangel
     Regula
     Rehberg
     Reichert
     Reyes
     Reynolds
     Richardson
     Rodriguez
     Rogers (AL)
     Rogers (MI)
     Ros-Lehtinen
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schiff
     Schmidt
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shays
     Shea-Porter
     Sherman
     Shimkus
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Solis
     Souder
     Space
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Taylor
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Tiahrt
     Tierney
     Towns
     Tsongas
     Turner
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Walberg
     Walsh (NY)
     Walz (MN)
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch (VT)
     Weller
     Wexler
     Wilson (NM)
     Wilson (OH)
     Wilson (SC)
     Wolf
     Woolsey
     Wu
     Wynn
     Yarmuth
     Young (AK)
     Young (FL)

                               NOES--116

     Akin
     Alexander
     Bachmann
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Bilbray
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Brady (TX)
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Buchanan
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Coble
     Conaway
     Crenshaw
     Culberson
     Davis, David
     Deal (GA)
     Doolittle
     Drake
     Duncan
     Everett
     Fallin
     Feeney
     Flake
     Forbes
     Foxx
     Franks (AZ)
     Gallegly
     Garrett (NJ)
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Graves
     Hall (TX)
     Hastings (WA)
     Hayes
     Heller
     Hensarling
     Herger
     Hoekstra
     Hunter
     Johnson, Sam
     Jones (NC)
     Jordan
     Keller
     King (IA)
     Kingston
     Lamborn
     LaTourette
     Linder
     LoBiondo
     Lucas
     Mack
     Manzullo
     Marchant
     McCarthy (CA)
     McCaul (TX)
     McCrery
     McHenry
     McKeon
     McMorris Rodgers
     Mica
     Miller (MI)
     Miller, Gary
     Musgrave
     Myrick
     Neugebauer
     Paul
     Pearce
     Peterson (PA)
     Petri
     Pitts
     Poe
     Price (GA)
     Putnam
     Radanovich
     Rogers (KY)
     Rohrabacher
     Roskam
     Royce
     Ryan (WI)
     Sali
     Saxton
     Sensenbrenner
     Sessions
     Shadegg
     Shuster
     Simpson
     Smith (NE)
     Smith (TX)
     Stearns
     Sullivan
     Tancredo
     Terry
     Tiberi
     Upton
     Walden (OR)
     Wamp
     Weldon (FL)
     Westmoreland
     Whitfield (KY)
     Wittman (VA)

                             NOT VOTING--7

     Cubin
     Granger
     Jefferson
     Miller (FL)
     Renzi
     Rush
     Tauscher


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). Less than 2 minutes 
remain.

                              {time}  1603

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________