[House Report 110-546]
[From the U.S. Government Publishing Office]



110th Congress                                            Rept. 110-546
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 1

======================================================================

 
 TOM LANTOS AND HENRY J. HYDE UNITED STATES GLOBAL LEADERSHIP AGAINST 
    HIV/AIDS, TUBERCULOSIS, AND MALARIA REAUTHORIZATION ACT OF 2008

                                _______
                                

                 March 10, 2008.--Ordered to be printed

                                _______
                                

   Mr. Berman, from the Committee on Foreign Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 5501]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Foreign Affairs, to whom was referred 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, having considered the same, reports favorably thereon 
without amendment and recommends that the bill do pass.

                           TABLE OF CONTENTS

                                                                   Page
Summary..........................................................     1
Background and Purpose for the Legislation.......................     2
Hearings.........................................................    11
Committee Consideration..........................................    11
Votes of the Committee...........................................    11
Committee Oversight Findings.....................................    11
New Budget Authority and Tax Expenditures........................    11
Congressional Budget Office Cost Estimate........................    12
Performance Goals and Objectives.................................    14
Constitutional Authority Statement...............................    14
New Advisory Committees..........................................    14
Congressional Accountability Act.................................    14
Earmark Identification...........................................    14
Section-by-Section Analysis and Discussion.......................    14
Changes in Existing Law Made by the Bill, as Reported............    20

                                Summary

    H.R. 5501, the ``Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008,'' authorizes $50 billion for the 
United States' bilateral and multilateral programs to combat 
HIV/AIDS, tuberculosis (TB) and malaria for Fiscal Years 2009 
through 2013. It seeks to continue the bipartisan commitment to 
aggressively prevent, treat, and care for those living with 
HIV/AIDS, and prevent and cure those with TB and malaria in the 
least developed countries by launching a second five-year 
strategy to achieve these goals.
    In the first five years of the U.S. response to the global 
HIV/AIDS pandemic, U.S. policy was driven by the urgency of an 
emergency response. Under this Act, the United States will 
develop and implement strategies to transition from the 
emergency phase to long-term sustainability that can be 
maintained by the host countries. The new authorization also 
seeks to further integrate HIV/AIDS programs with TB and 
malaria programs. It strengthens health care delivery systems 
to boost host country capacities to reach and provide HIV/AIDS 
services to populations that are difficult to reach. In 
addition, the Reauthorization Act invests in rebuilding the 
health care workforce through training and the redistribution 
of tasks among health workers. Lastly, H.R. 5501 includes a 
provision that employs the expertise of the Department of the 
Treasury to work with the finance and health ministries of 
focus countries to establish public finance management systems 
for greater accountability.

               Background and Purpose for the Legislation

    In his State of the Union address in 2003, President George 
W. Bush announced the ``President's Emergency Plan for AIDS 
Relief'' (PEPFAR), requesting $15 billion to intervene in the 
worst global health pandemic since the Plague.
    In 2003, according to UNAIDS, 3 million people were newly 
infected with HIV and 2 million died. Worldwide, an estimated 
30.9 million people were living with HIV/AIDS. Sub-Saharan 
Africa, the most severely affected region of the world, 
accounted for over 2.1 million of these new infections and 1.6 
million AIDS deaths. Every day in 2003, an estimated 8,200 
people were newly infected with HIV worldwide.\1\ At the time, 
antiretroviral drug treatment regimens in poor settings were 
viewed by some policy makers as prohibitively expensive and 
complicated. Primary focus was on the cheaper and more easily 
administered drugs for the prevention of mother-to-child 
transmission.
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    \1\UNAIDS, 2007
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    Soon after the President's announcement, Congress passed 
and the President signed the ``U.S Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003,'' Public Law 108-25 
(``the 2003 Act''), authorizing $15 billion in assistance to 
combat these diseases for Fiscal Years 2004--2008.\2\ President 
Bush signed the Act into law in May 2003.
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    \2\The efforts were concentrated primarily in 14 ``focus 
countries''--Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, 
Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, 
and Zambia. Vietnam was later added as a 15th focus country, and PEPFAR 
also supports bilateral programs in dozens of other countries.
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    The 2003 Act established, within the Department of State, a 
Coordinator of United States Government Activities to Combat 
HIV/AIDS Globally, appointed by the President with the advice 
and consent of the Senate. The Office of the Global AIDS 
Coordinator (OGAC) now leads interagency implementation of and 
administers U.S. global HIV/AIDS policy. The Reauthorization 
Act seeks to strengthen the Coordinator's role of coordinating 
the Federal agencies engaged in implementing global HIV/AIDS 
policy.
    The 2003 Act required a five-year emergency plan (2004-
2008) designed to coordinate all U.S.-funded bilateral HIV/AIDS 
programs, including those established by PEPFAR and 
administered through the seven implementing agencies,\3\ to 
address the emergency. With this new funding, combined with 
other HIV/AIDS program funding, the U.S. bilateral programs to 
combat HIV/AIDS, tuberculosis, and malaria were expanded to 114 
countries. The U.S. now supports programs in 136 countries, 
including programs funded by the United States and administered 
through The Global Fund to Fight AIDS, Tuberculosis and Malaria 
(the Global Fund), an international financing mechanism for 
collective global funding of programs to combat these three 
diseases. A major goal of the 2003 Act was to focus the 
delivery of services through local community and faith-based 
organizations in the host countries. On World AIDS Day in 2005, 
the President announced the creation of ``The New Partners 
Initiative'' (NPI) to provide technical assistance enabling 
faith-based and community organizations with little prior 
experience working with the U.S. Government to administer 
sustainable HIV/AIDS programs.
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    \3\Department of State, USAID, Department of Defense, Department of 
Commerce, Department of Labor, Department of Health and Human Services 
and the Peace Corps.
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    The initial ``emergency phase'' was also designed to scale 
up HIV/AIDS treatment, care, and prevention programs (including 
prevention of mother-to-child transmission programs), and 
extend them to hard-to-reach rural areas and vulnerable 
populations, including women, girls, orphans and vulnerable 
children. The three major infectious diseases--HIV/AIDS, TB, 
and malaria--were covered by the 2003 Act because research 
demonstrated that co-infection with HIV/AIDS and one or both of 
the other diseases resulted in more severe symptoms and certain 
and untimely death. For example, according to the World Health 
Organization (WHO), 90% of people living with AIDS die within 
months of contracting TB if they do not receive TB 
treatment.\4\
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    \4\``Frequently Asked Questions About TB and HIV/AIDS,'' World 
Health Organization, 2008.
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    For the past five years, the United States has been the 
leading international provider of global HIV/AIDS support for 
prevention, treatment, and care. Over this period, Congress 
appropriated more funds than were initially authorized. In 
Fiscal Years 2004 through 2008, the U.S. appropriated more than 
$19 billion for programs to combat HIV/AIDS, tuberculosis and 
malaria internationally, including more than $3 billion in 
contributions to The Global Fund.
    The U.S. emergency program intervened in this horrific 
pandemic and performed well in the face of a massive 
humanitarian disaster, broken infrastructure and a major 
shortage of health care workers. As of September 30, 2007: the 
U.S. had supported life-saving antiretroviral treatment for 
1,445,500 men, women, and children; supported care for more 
than 6.6 million, including care for more than 2.7 million 
orphans and vulnerable children; and supported prevention of an 
estimated 157,000 infant infections (cumulative for Fiscal 
Years 2004 through 2007). In virtually every host country, in 
order to treat and care for individuals, major investment in 
infrastructure and workforce training has taken place, though 
there is still much more to be done. Shortages of health care 
workers, clinics, hospitals, laboratories, and storage 
facilities in many areas of host countries have made it 
incredibly difficult to reach vast numbers of individuals who 
needed care and treatment.
    By 2007, the news, while still grim, was beginning to 
improve. The HIV/AIDS prevalence rates were leveling off and 
annual deaths stabilized. According to UNAIDS, in 2007 there 
were 33.2 million people worldwide living with HIV/AIDS, of 
whom 2.5 million were children under the age of 15; 2.5 million 
were newly infected, of whom 420,000 were children under the 
age of 15; and there were 2.1 million deaths, of whom 330,000 
were children under the age of 15. Due to the massive 
intervention by the U.S. Government, the Global Fund, other 
bilateral donors, and the governments and people of the 
countries most affected by the disease, the growth of the 
pandemic has slowed and the estimates are headed in the right 
direction.
    Host countries that have partnered with the U.S. to fight 
HIV/AIDS have expressed their deep appreciation of the program. 
As President Jakaya Kikwete of Tanzania said when talking to 
President Bush in February 2008, ``Today there are thousands of 
children who have managed to avoid joining the already long 
list of orphans, and who continue to enjoy the love, guidance 
and support of their parents who are alive because of the AIDS 
care and treatment they get with the support of PEPFAR 
initiative. Mr. President, thank you. Today, as a result of 
PEPFAR, parents with AIDS are able to take care of their 
children.''\5\
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    \5\Joint Press Availability with President Kikwete and President 
Bush in Tanzania, 2/17/08
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    In September 2007, President Festus Mogae of Botswana said, 
``. . . The modest successes we have recorded in my country . . 
. and indeed in many African countries, could not have been 
achieved without United States support under the President 
Bush's Emergency Fund for AIDS Relief, PEPFAR. . . . The fund 
has, in addition, provided impetus to other donors and major 
contributors to contribute to international efforts to fight 
the scourge of HIV/AIDS around the world. The quantum of 
resources under PEPFAR, a significant amount from a single 
source by any standard, has helped translate international 
consensus into tangible opportunity and hope for millions 
around the world. . . . PEPFAR has galvanized donor countries 
and agencies alike to act in concert in the interest of 
humanity.''\6\
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    \6\``Botswana's Future: Reflections on HIV/AIDS, Democratization, 
and U.S.-Botswana Relations,'' Center for Strategic & International 
Studies, Washington, DC, 9/21/2007.
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    While the program has been able to reach a large number of 
people, the more difficult challenges lie ahead. The number of 
those receiving prevention, treatment, and care services needs 
to increase towards the goal of universal access, and host 
country programs must be strengthened to sustain those on 
treatment for life. Measures must be taken to create 
sustainability of host country HIV/AIDS programs far into the 
future. Research is needed to address further developments of 
the virus and the disease. Lastly, health care delivery systems 
strengthening and maintenance and workforce stability must be 
achieved. Without these improvements, the threat of a rapid 
expansion of HIV/AIDS in countries where the epidemic has 
become generalized and into countries that have relatively low 
prevalence rates remains grave.

                      REAUTHORIZATION ACT OF 2008

    The reauthorization of the Act for FY 2009-2013 is designed 
with four major priorities to move the U.S. global HIV/AIDS 
response from the ``emergency phase'' towards long-term 
``sustainability.'' The first priority is to continue to 
designate and meet ambitious targets for prevention, treatment, 
and care that will move poor countries toward universal access 
(defined as providing treatment and other services to 80% of 
the affected population). The second priority is to strengthen 
and build the capacity of health care delivery systems, 
including refurbishing hospital facilities, free-standing 
clinics, and laboratories; providing supplies; and training and 
extending the workforce to expand the reach of HIV/AIDS 
programs to those yet to be serviced. The third priority is to 
coordinate HIV/AIDS programs closely with programs for 
tuberculosis, malaria, and, where appropriate, other diseases. 
The fourth priority is to provide technical assistance to 
improve the ability of host governments to plan, direct, 
finance, and manage the programs that the U.S. Government and 
other donors have helped to put in place. To that end, the 
reauthorization increases U.S. funding for HIV/AIDS, 
tuberculosis, and malaria to $50 billion over the next five 
fiscal years.
Estimates of Funding
    The $50 billion five-year authorization will provide a 
total of $41 billion for HIV/AIDS programs, $5 billion for 
malaria programs, and $4 billion for tuberculosis programs 
through bilateral programs and Global Fund contributions 
combined. According to projections based on the most recent 
UNAIDS estimates of prevalence, developing country financial 
needs to fight HIV/AIDS (not including tuberculosis and 
malaria) will be $28 billion per annum in 2009 and will rise to 
$45 billion in 2013. The 2009-2013 total projected low and 
middle-income country need is $198 billion for HIV/AIDS 
programs. Donors collectively should take on 70% of the total 
finances required and the host countries should cover 30% of 
these costs. Assuming the appropriate U.S. contribution to 
address the global need is the same as the 33% ``cap'' on 
contributions to the Global Fund, the U.S. share of developing 
world HIV/AIDS financing would be $46 billion for five years.
    Based on the work of the WHO Commission on Macroeconomics 
and Health, developed countries need to provide at least one-
third of country-level needs identified in the WHO Global Plan 
to Stop TB, and 50% of the extensively drug resistant 
tuberculosis (XDR-TB) and multi-drug resistant tuberculosis 
(MDR-TB) costs. Thirty-three percent of this donor share is 
$3.85 billion for the Fiscal Years 2009 to 2013. Additional 
resources are required for research and development of new 
diagnostics, drugs, and vaccines.
    The current best estimate of global need for malaria 
programs by the World Malaria Report is $4.1 billion ($3.2 
billion for implementation; $0.9 billion for research and 
development) per year. The Reauthorization Act authorizes up 
to$5 billion as the U.S. Government's contribution to this 
global effort.
Prevention Policy
    The Reauthorization Act continues support for the 
``Abstinence, Be Faithful, Correct and Consistent Use of 
Condoms'' (ABC) approach that has proven to be effective in 
combating the spread of HIV/AIDS, with modifications. The Act 
emphasizes prevention by increasing the importance of 
abstinence, delay of sexual debut and faithfulness programming. 
It requires that policy makers further prioritize these 
approaches in their programming and reporting as part of the 
integrated ABC prevention approach. The Committee remains 
committed to each part of this approach, recognizing that the 
greatest gains have been found when all three components of ABC 
are used in an integrated approach. The Committee also values 
the benefit of abstinence and be faithful-only programs, 
particularly in countries where the epidemic is generalized. 
The Committee is committed to the enforcement of the 
``conscience clause'' to protect and ensure the participation 
of organizations that have a religious or moral objection to 
certain programs or activities.
    Reflecting the Committee's continued commitment to the ABC 
approach, H.R. 5501 removes the one-third ``abstinence until 
marriage'' funding directive from the 2003 Act. Instead, it 
includes a requirement that the Coordinator provide balanced 
funding for prevention activities for sexual transmission of 
HIV/AIDS and ensure that behavioral change programs, including 
abstinence, delay of sexual debut, monogamy, fidelity and 
partner reduction programs, 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 infection, and in consultation with the government of 
each host country involved in HIV/AIDS prevention activities. 
The objective epidemiological evidence to be used for the 
Coordinator's determination should be primarily the Demographic 
and Health Surveys, the AIDS Information Service (AIS), and 
other United States Government supported surveys, including 
surveys requested by the Congress and other independent, 
scientifically-sound studies. The modification of the previous 
abstinence spending requirement should not be interpreted to 
imply that abstinence and be faithful programs are no longer 
considered by the Committee to be a priority for prevention 
funding.
    In addition, H.R. 5501 provides that the Coordinator shall 
establish an HIV sexual transmission prevention strategy 
governing the expenditure of funds authorized by the Act and 
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 (defined to include 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.
    The country-by-country breakout for FY 2008, which 
indicates current patterns of prevention efforts under the 
Global HIV/AIDS program, was as follows:

                        PEPFAR Focus Countries Sexual Prevention Planned Funding--FY 2008
                                    Field & Central Programs (in USD million)
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                                          Sexual Prevention                              AB as a % of All Sexual
               Country                         Funding                 AB Funding               Prevention
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Botswana                               12.4...................  8.4....................  67.6%
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Cote D'Ivoire                          11.9...................  7.8....................  65.9%
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Ethiopia                               36.3...................  16.9...................  46.5%
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Guyana                                 3.8....................  2.3....................  60.0%
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Haiti                                  8.4....................  5.1....................  60.8%
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Kenya                                  64.0...................  38.0...................  59.4%
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Mozambique                             24.1...................  14.1...................  58.7%
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Namibia                                16.6...................  11.0...................  66.1%
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Nigeria                                27.5...................  18.2...................  66.1%
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Rwanda                                 12.1...................  8.0....................  66.0%
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South Africa                           60.2...................  37.5...................  62.2%
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Tanzania                               29.6...................  18.2...................  61.5%
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Uganda                                 30.3...................  17.2...................  56.9%
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Vietnam                                15.8...................  2.9....................  18.3%
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Zambia                                 32.9...................  20.8...................  63.3%
================================================================================================================
All Focus Countries                    385.8..................  226.4..................  58.7%
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Faith-Based Organizations
    The Reauthorization Act continues the support of 
nongovernmental organizations, including faith-based 
organizations, which have long played a critical role in the 
provision of heath care services in the poorest countries in 
the world. In many communities in developing nations, the only 
medical services available within a reasonable distance from 
people's homes are those provided by clinics and hospitals run 
by churches and other nongovernmental organizations. Faith-
based organizations have played an important role in providing 
prevention, treatment and care services for HIV/AIDS since 
before the passage of the 2003 Act, and have taken the lead in 
integrating nutrition with treatment and care services, 
particularly to orphans and vulnerable children.
    The Committee applauds the important work of these 
organizations and encourages the U.S. Government's continued 
partnership with them. We look forward to continued 
participation of these organizations in all aspects of HIV/AIDS 
programming, including, for example, providing services related 
to abstinence, delay of sexual debut and faithfulness. We 
expect the Global HIV/AIDS program to continue to provide 
services through faith-based organizations.
    To strengthen the relationship with such organizations, the 
2008 Act strengthens the ``conscience clause,'' a provision 
that has ensured that faith-based organizations are not 
required to endorse or utilize any prevention or treatment 
method to which they have a religious or moral objection. The 
2008 Act strengthens this provision by specifically adding 
language indicating that faith-based groups are not required to 
integrate with or refer people to other programs or activities 
to which the organizations have a religious or moral objection 
and are not discriminated against in the solicitation or 
issuance of grants, contracts or cooperative agreements for 
refusing to do so.
Expanding Program Linkages, Coordination and Cooperation
    The Reauthorization Act of 2008 establishes stronger 
linkages between HIV/AIDS programs and programs in nutrition 
and education that are vital to improving the success of 
treatment by enhancing the overall health of the person with 
HIV/AIDS. The 2008 Act also strengthens prevention activities 
for women and girls that were missing in the original Act. The 
Coordinator is charged with developing strategies that will 
make women and girls less vulnerable to situations that 
increase their chances of getting HIV/AIDS, including the 
provision of antiretroviral post-exposure prophylaxis for 
victims of gender-based violence and rape, the development of 
microenterprise and job creation programs, and empowering women 
and youth to avoid cross-generational sex.
    The Reauthorization Act calls for ensuring access to HIV/
AIDS education and testing in family planning and maternal 
health programs supported by the United States Government. The 
2008 Annual Report to Congress on the implementation of the 
Global HIV/AIDS program specifically discussed existing 
``linkages between HIV/AIDS and voluntary family planning 
programs.'' The 2008 Act is consistent with the 
Administration's implementation of the Global HIV/AIDS effort. 
Currently, the Coordinator is providing grants for HIV/AIDS 
prevention services in family planning settings in order to 
reach a wider population. The Committee commends the 
Coordinator for doing so and the new authorization of 
assistance in this area is intended to build on existing 
efforts.
    The Reauthorization Act increases and strengthens the 
linkage between HIV/AIDS and tuberculosis programs. The dual 
epidemics of HIV/AIDS and tuberculosis are particularly deadly 
due to widespread stigma, low levels of awareness, and poorly 
coordinated services. In sub-Saharan Africa, tuberculosis is 
the most common cause of death and illness for individuals with 
HIV. Additionally, XDR-TB is particularly dangerous and almost 
universally fatal for those living with HIV. Responding to the 
need for greater mobilization and coordination efforts for 
tuberculosis and HIV/AIDS co-infection, this Act provides 
stronger linkages for prevention, care, and treatment services 
to reduce tuberculosis-related illness and death among people 
living with HIV/AIDS. It provides for tuberculosis diagnostic 
counseling, testing, and treatment (including for MDR-TB and 
XDR-TB) to those with HIV/AIDS and HIV/AIDS voluntary 
counseling, testing, and treatment to those with any form of 
tuberculosis. The Act supports the linking of individuals with 
both HIV/AIDS and any form of tuberculosis to HIV/AIDS 
treatment and care services.
    Globally, malaria has become one of the many opportunistic 
infections afflicting people living with HIV/AIDS. There is a 
particular burden on pregnant women, children and those 
individuals who suffer high HIV viral loads, and those in end 
stage HIV disease. Pregnant women who experience malaria also 
risk higher rates of cognitive disability in their newborn 
children. Malaria is a disease that kills swiftly. According to 
the World Health Organization, in many cases, the first 48 
hours of malaria parasite infection are the most critical. 
Individuals whose systems have been compromised by HIV/AIDS 
stand little chance of surviving malaria. This Act establishes 
strong linkages between HIV/AIDS and malaria programs to 
prevent the debilitating and deadly effects of malaria on 
individuals served by this program.
    The Act calls for the training of health care workers to 
diagnose, treat, and provide care for individuals with HIV/AIDS 
and tuberculosis. According to the United Nations Development 
Programme, Human Development Report 2003, approximately 3 out 
of 4 countries in sub-Saharan Africa have fewer than 20 
physicians per 100,000 people, the minimum ratio recommended by 
the World Health Organization, and 13 countries have 5 or fewer 
physicians per 100,000 people. Nurses play particularly 
important roles in sub-Saharan African health care systems, but 
approximately one-quarter of sub-Saharan African countries have 
fewer than 50 nurses per 100,000 people or less than 1/2 the 
staffing levels recommended by the World Health Organization. 
Paraprofessionals and community health workers can be trained 
more quickly than nurses or doctors and are critically needed 
in sub-Saharan Africa to meet immediate health care needs. 
While the scope of the problem of dire shortfalls of personnel 
and inadequacies of infrastructure in the sub-Saharan African 
health systems is immense, effective and targeted interventions 
to improve working conditions, management, and productivity 
will yield significant dividends in improved health care.
    To empower host countries to sustain these programs, the 
Reauthorization Act of 2008 invests in strengthening health 
care delivery systems and building health workforce capacities 
through recruitment and training. The Committee has encouraged 
stronger linkages between the Global HIV/AIDS programs and 
initiatives to increase the capacity of the health care 
delivery systems. For example, instead of equipping 
laboratories with equipment that can only be used to test and 
manage HIV/AIDS testing, through this Act laboratories will be 
designed and equipped to handle general medical and public 
health care. Also, the Act authorizes the Department of the 
Treasury to carry out a public finance management program to 
work with host countries to create policy environments that 
will support the modernization of the health sector.
    Since 1999, the International Monetary Fund (IMF) has 
provided concessional loans to national governments with the 
goal of reducing poverty and supporting economic growth in 
developing countries. As a condition of receiving these loans, 
national governments are required to develop Poverty Reduction 
Strategy Papers which frequently prevent national governments 
from increasing health sector spending to address urgent and 
emerging health epidemics such as HIV/AIDS, tuberculosis, or 
malaria. In response, this Act directs the Coordinator to work 
with the Secretary of the Treasury to reform existing IMF 
macroeconomic and fiscal policies that result in limitations on 
health sector spending by national governments receiving 
assistance from the IMF. The Act further directs the Secretary 
of the Treasury to instruct the United States Executive 
Director at the IMF to oppose all IMF programs that do not 
exempt increased health sector spending by national governments 
from any loan conditions set by the IMF.

      THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS, AND MALARIA\7\
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    \7\A United Nations General Assembly Special Session on AIDS in 
June 2001 concluded with a commitment to create a global fund. The 
commitment was endorsed by the G8 that helped finance it at their 
meeting in Genoa in July 2001. Following that commitment, a 
Transitional Working Group was formed to develop a framework for how 
the Global Fund would be structured and operate on an ongoing basis and 
in January 2002, a permanent secretariat was established in Geneva. 
Three months later the Global Fund Board approved the first round of 
grants to 36 countries. The U.S. was a leader in the creation of the 
Global Fund and continues to be its largest contributor.
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    In addition to our bilateral programs, the Global Fund to 
Fight AIDS, Tuberculosis, and Malaria (the Global Fund) is a 
vehicle through which the U.S. Government extends its support 
even more broadly. The Global Fund is a public-private 
partnership dedicated to raising and disbursing large amounts 
of funding to prevent and treat the pandemics of HIV/AIDS, 
malaria and tuberculosis. As a financing organization with no 
regional or country offices, the Global Fund is unable (and not 
intended) to provide hands-on technical support to improve 
grant performance; this becomes the responsibility of 
international and bilateral partners.\8\
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    \8\http://www.pepfar.gov/coop/c18962.htm
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    The U.S. Government, as a founding member of the Global 
Fund and its first and largest contributor, continues to play a 
leadership role in ensuring the success of this essential 
international effort. Though the Fund was not established until 
2002, President Bush made the founding contribution to the 
Global Fund of $200 million in May 2001. As of February 2008, 
donors have pledged more than $18 billion to the Fund, of which 
nearly $10 billion has been paid. The funds have been used to 
support nearly 500 grants totaling $8.3 billion for projects in 
136 countries, of which $5.2 billion has been disbursed. To 
date, the U.S. has appropriated and pledged $3.5 billion for 
contributions to the Global Fund.
    The 2003 Act included a provision that limits the U.S. 
contribution to the Global Fund to 33% of overall 
contributions. This policy was adopted to ensure other public 
and private donors made substantial contributions to the Global 
Fund and has allowed the leaders of the Global Fund to use the 
U.S. funds as matching for others. Many believe that without 
this restriction, other donor countries would not have stepped 
forward to make significant contributions. Increased 
investments by the Organization for Economic Development and 
Cooperation's Development Assistance Committee (OECD/DAC) 
countries have kept pace with the U.S. increases.\9\
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    \9\Kates, J. et al., ``Financing the response to AIDS in the low- 
and middle income countries: International assistance from the G8, 
European Commission and other donor governments''. 2006.
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    In the Reauthorization Act, the authorized U.S. 
contribution to the Global Fund doubles from $1 billion to $2 
billion per year. This level anticipates the growing demand on 
funding from the Global Fund and increased bilateral funding 
from other donor countries. The ``1/3 cap'' on the U.S. 
Government contribution limits the total amount contributed in 
any given year. The Reauthorization Act retains the ``1/3 cap'' 
as a demonstration of the Committee's commitment to 
multilateral funding for the enormous challenges that lie ahead 
for HIV/AIDS, tuberculosis and malaria programs. The ``1/3 
cap'' expresses our intention to call on other donor countries 
to make substantial contributions. In addition, the Committee 
expects increased transparency and accountability for the Fund, 
particularly in light of the authorization for increased 
funding, and has provided a set of benchmarks to help improve 
the Global Fund's operations.

                                Hearings

    The Committee held five hearings directly related to the 
subject matter of the bill. On March 21, 2007, the Subcommittee 
on Africa and Global Health held a hearing entitled ``The 
Global Threat of Drug-Resistant TB: A Call to Action for World 
TB Day.'' On April 24, 2007, the full committee held a hearing 
entitled ``PEPFAR: An Assessment of Progress and Challenges.'' 
On April 25, 2007, the Subcommittee on Africa and Global Health 
held a hearing entitled ``Malaria Awareness Day: Leveraging 
Progress for Future Advances.'' On September 25, 2007, the full 
committee held a hearing entitled ``PEPFAR Reauthorization: 
From Emergency to Sustainability.'' On October 9, 2007, the 
Subcommittee on Africa and Global Health held a hearing 
entitled ``The President's Emergency Plan for AIDS Relief: Is 
It Fulfilling the Nutrition and Food Security Needs of People 
Living with HIV/AIDS?''

                        Committee Consideration

    On February 27, 2008, the Full Committee held a markup on 
H.R. 5501, the Tom Lantos and Henry J. Hyde United States 
Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Reauthorization Act of 2008, and it was favorably reported to 
the House, by voice vote, a quorum being present.

                         Votes of the Committee

    There were no recorded votes on H.R. 5501.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    In compliance with Clause 3(c) (2) of House Rule XIII, the 
Committee adopts as its own the estimate of new budget 
authority, entitlement authority, or tax expenditures or 
revenues contained in the cost estimate prepared by the 
Director of the Congressional Budget Office, pursuant to 
section 402 of the Congressional Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R.5501, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, Month 5, 2008.
Hon. Howard L. Berman, Acting Chairman,
Committee on Foreign Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5501, the Tom 
Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Michelle S. 
Patterson, who can be reached at 226-2840.
            Sincerely,
                                           Peter R. Orszag.
Enclosure

cc:
        Honorable Ileana Ros-Lehtinen
        Ranking Member
H.R. 5501--Tom Lantos and Henry J. Hyde U.S. Global Leadership Against 
        HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 
        2008.

                                SUMMARY

    H.R. 5501 would reauthorize several assistance programs 
aimed at preventing and treating HIV/AIDS, tuberculosis, and 
malaria in other countries. For those programs, the bill would 
authorize the appropriation of $10 billion a year over the 
2009-2013 period. CBO estimates that implementing H.R. 5501 
would cost $1.5 billion in 2009 and $35 billion over the 2009-
2013 period, assuming appropriation of the authorized amounts. 
Enacting the bill would not affect direct spending or receipts.
    H.R. 5501 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.

                ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 5501 is shown in the 
following table. The costs of this legislation fall within 
budget functions 150 (international affairs) and 550 (health). 
For this estimate, CBO assumes that the bill will be enacted by 
September 30, 2008, that the authorized amounts are 
appropriated for each year, and that outlays will follow 
historical spending patterns for the existing programs.

                                     By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------------------------------------------------
                                                                       2009     2010     2011     2012     2013
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION

HIV/AIDS, Tuberculosis, and Malaria Programs                          10,000   10,000   10,000   10,000   10,000
  Authorization Level
  Estimated Outlays                                                    1,392    6,392    8,262    9,082    9,482

Contributions to Vaccine Funds                                           108      108      108      158      158
  Estimated Authorization Level
  Estimated Outlays                                                      108      108      108      158      158

Total Changes                                                         10,108   10,108   10,108   10,158   10,158
  Estimated Authorization Level
  Estimated Outlays                                                    1,500    6,500    8,370    9,240    9,640
----------------------------------------------------------------------------------------------------------------

                           BASIS OF ESTIMATE

    Section 401 of H.R. 5501 would authorize the appropriation 
of $10 billion each year from 2009 through 2013. Those funds 
would be used to operate and expand the existing assistance 
programs that provide grants and contributions to organizations 
and global funds devoted to treating the effects of HIV/AIDS, 
tuberculosis, and malaria, and to preventing the transmission 
of those diseases. Those programs, which received a total of $3 
billion in appropriations for 2008, are run by the Department 
of State, the United States Agency for International 
Development (USAID), and the Department of Health and Human 
Services.
    Section 203 would authorize the appropriation of such sums 
as may be necessary to make contributions for research and 
development of various vaccines. Based on information from 
USAID on the current amount of contributions to those funds 
(about $100 million in 2008) and the amount needed to fund the 
final stages of development for a tuberculosis vaccine, CBO 
estimates that implementing section 203 would cost $640 million 
over the 2009-2013 period.
    Based on information from the Department of State, CBO 
estimates that the amount authorized to be appropriated is 
sufficient to fund the expanded requirements. Because it will 
take some time to expand existing programs and develop new 
procedures and activities, CBO estimates that implementing this 
bill would cost $1.5 billion in 2009 and about $35 billion over 
the 2009-2013 period. Most of the additional amounts from the 
authorized funding would be spent by 2018.

              INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    H.R. 5501 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments.

                         ESTIMATE PREPARED BY:

Federal Costs: Michelle S. Patterson (226-2840)
Impact on State, Local, and Tribal Governments: Neil Hood (225-
        3220)
Impact on the Private Sector: MarDestinee C. Perez (226-2940)

                         ESTIMATE APPROVED BY:

Peter H. Fontaine
Assistant Director for Budget Analysis

                    Performance Goals and Objectives

    Pursuant to clause (3)(c) of House rule XIII, upon 
enactment of this legislation, assistance should be expanded to 
reach more people around the world with HIV/AIDS prevention, 
treatment and care programs and should provide integrated food 
and nutrition programs. Special attention should be given to 
women, youth and mother-to-child transmission, and more 
expansive programming to reduce the tuberculosis and malaria 
pandemics.

                   Constitutional Authority Statement

    Pursuant to clause 3(d) (1) of rule XIII of the Rules of 
the House of Representatives, the Committee finds the authority 
for this legislation in article I, section 8 of the 
Constitution.

                        New Advisory Committees

    H.R. 5501 does not establish or authorize any new advisory 
committees.

                    Congressional Accountability Act

    H.R. 5501 does not apply to the Legislative Branch.

                         Earmark Identification

    H.R. 5501 does not include any earmarks, and does not 
include limited tax benefits, or limited tariff benefits as 
defined in clause 9(d), 9(e), or 9(f) of rule XXI.

               Section-by-Section Analysis and Discussion

Sec. 1. Short Title and Table of Contents.
    The short title of this Act is the ``Tom Lantos and Henry 
J. Hyde United States Global Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Reauthorization Act of 2008''.
Sec. 2. Findings.
    This section amends the findings in the United States 
Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 
2003 (22 U.S.C. 7601) (``the 2003 Act'') by adding to the end 
of that Act's findings, additional findings with updated data 
on human immunodeficiency virus (HIV) and the acquired 
immunodeficiency syndrome (AIDS), hereinafter collectively 
referred to as HIV/AIDS, tuberculosis and malaria around the 
world and the impact of U.S. assistance in combating these 
diseases since the 2003 Act was passed. The findings also 
identify ongoing and growing challenges in meeting the needs 
for treatment, care, prevention, cure and research of and 
related to these diseases in coming years.
Sec. 3. Definitions.
    This section amends the 2003 Act by updating the title of 
the Committee to the ``Committee on Foreign Affairs.''
Sec. 4. Purpose.
    This section amends the purpose of the 2003 Act by adding 
the creation of five-year plans for tuberculosis and malaria; 
calling for increased resources for bilateral efforts for 
prevention, treatment and care; expanding this assistance to 
cover nutrition assistance, heath system and workforce 
development, monitoring and evaluations and operations 
research; and including efforts to develop research for 
tuberculosis and other prevention technologies.

               TITLE I--POLICY PLANNING AND COORDINATION

Sec. 101. Development of a Comprehensive, Five-Year, Global Strategy.
    This section amends section 101 of the 2003 Act by 
providing additional guidance to the President on the 
development of the second five-year plan to combat HIV/AIDS 
globally. It instructs the President to expand the strategic 
approach to behavioral risks related to transmission of HIV/
AIDS. It instructs the President to provide for linkages and 
referral systems to nutrition and food support for individuals 
with HIV/AIDS, child health services and development programs, 
and other social service programs related to HIV/AIDS. It also 
calls on the President to provide access to HIV/AIDS education 
and testing in family planning and maternal health programs 
supported by the United States Government, and to maximize host 
country capacity for HIV/AIDS training and research in the 
five-year strategy.
Sec. 102. HIV/AIDS Response Coordinator.
    This section amends section 1(f)(2) of the State Department 
Basic Authorities Act of 1956 (22 U.S.C. 2651a(f)(2)) to 
strengthen and expand the duties of the HIV/AIDS Response 
Coordinator, including enhancing the role of the Coordinator in 
consulting and coordinating with foreign governments, 
nongovernmental organizations and other U.S. Government 
agencies.

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

Sec. 201. Sense of Congress on Public-Private Partnerships.
    This section amends section 201 of the 2003 Act by updating 
the purpose of public-private partnerships to address easily 
preventable and treatable infectious diseases.
Sec. 202. Participation in the Global Fund to Fight AIDS, Tuberculosis 
        and Malaria.
    This section amends section 202 of the 2003 Act relating to 
U.S. contributions to the Global Fund. Subsection (a) updates 
findings in that Act. Subsection (b) increases the annual 
authorization for the U.S. contribution to the Global Fund from 
$1 billion to $2 billion for Fiscal Years 2009 and 2010 of the 
amounts authorized to be appropriated under section 401 of the 
2003 Act. It also moves the deadline after which funds 
appropriated for such contribution can be transferred to the 
U.S. bilateral programs from July 1 to December 31 of the year 
after the funds are appropriated (if they are available for 
more than one fiscal year) and provides new benchmarks designed 
to improve the accountability and transparency of the Global 
Fund's activities.
Sec. 203. Voluntary Contributions to International Vaccine Funds.
    This section amends section 302 of the Foreign Assistance 
Act of 1961 to reauthorize the existing programs for the 
vaccine fund authorized under section 302(k) of that Act, the 
International AIDS Vaccine authorized by section 302(l) of such 
Act and the malaria vaccine development program authorized by 
section 302(m) of such Act. Section 203 also adds a new section 
302(n) relating to authorizing a U.S. contribution to research 
and development of a tuberculosis vaccine.
Sec. 204. Program to Facilitate Availability of Microbicides to Prevent 
        Transmission of HIV and Other Diseases.
    Subsection (a) expresses the sense of Congress recognizing 
the need and urgency to expand the range of interventions for 
preventing the transmission of HIV, including non-vaccine 
prevention methods that can be controlled by women.
    Subsection (b) authorizes the Administrator of USAID, in 
coordination with the Coordinator of U.S. Government Activities 
to Combat HIV/AIDS Globally, to 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.
    Subsection (c) authorizes of the amounts authorized by 
section 401 of the 2003 Act, such sums as may be necessary for 
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.
    This section amends Title II of the 2003 Act by adding a 
new section 204 relating to strengthening health policies and 
health systems of host countries. Subsection (a) provides 
findings on the need for strengthening of such health policies 
and systems. Subsection (b) provides for a statement of policy 
directed to this need. Subsection (c) requires the Coordinator 
to develop and implement a plan to combat HIV/AIDS by 
strengthening such policies and systems as part of the United 
States Agency for International Development's ``Health Systems 
2020 Project.'' Subsection (d) authorizes the appropriation of 
funds authorized under section 401 of the Act to the Department 
of the Treasury to provide technical assistance to host 
countries to improve the public finance management systems of 
such countries to enable them to receive HIV/AIDS assistance, 
collect revenue and manage their own programs.

                      TITLE III--BILATERAL EFFORTS

Subtitle A--General Assistance and Programs
Sec. 301. Assistance to Combat HIV/AIDS.
    This section amends section 104A of the Foreign Assistance 
Act of 1961 and section 301 of the 2003 Act, both of which 
relate to bilateral U.S. HIV/AIDS assistance.
    Subsection (a) amends section 104A by updating and 
sharpening the focus on certain assistance activities. In 
particular, the amendments to section 104A create new targets 
for U.S. HIV/AIDS assistance by 2013 of preventing 12 million 
infections, treating 3 million persons with HIV/AIDS and caring 
for 12 million individuals (including 5 million HIV/AIDS 
orphans and vulnerable children), and training health workers 
and professionals for HIV/AIDS prevention, treatment and care; 
widening U.S. efforts to regions such as Central and Eastern 
Europe and South and Southeast Asia; and creating a new focus 
on support for host countries.
    Subsection (a) also expands the activities for which U.S. 
HIV/AIDS assistance can be used for prevention, including an 
increased focus on counseling, delay of sexual debut, 
abstinence, fidelity, life skills, prevention of mother-to-
child HIV transmission, and the use of safe and effective 
microbicides when they become available. It also expands 
activities for treatment, including assistance to support 
treatment for one-third of all individuals in clinical need of 
treatment in the poorest countries worldwide, assistance to 
reduce barriers to treatment, and assistance for psycho-social 
treatment for youth to ensure adherence to treatment. It also 
provides for a more integrated approach to HIV/AIDS by 
supporting referral of individuals with HIV/AIDS to relevant 
services and enhanced support of related programs that can 
improve the effectiveness of HIV/AIDS programs, such as 
nutrition, education, and programs that improve the livelihood 
of individuals with HIV/AIDS. Subsection (a) also expands the 
annual report required by section 104A(e) to address a number 
of the new approaches described in this Act.
    Subsection (b) amends section 301 of the 2003 Act to expand 
the authorization to Fiscal Years 2009 through 2013.
    Subsection (c) amends section 301(c) of the 2003 Act to 
create an enhanced focus on food and nutrition assistance as 
critical to an integrated approach to treatment of individuals 
with HIV/AIDS.
    Subsection (d) clarifies that not only are groups receiving 
funds under the Act not required to endorse or utilize any 
activities or programs to which they have a moral or religious 
objection, they are also not required to integrate with or 
refer to programs to which they have a moral or religious 
objection.
    Subsection (e) repeals a sense of Congress that is 
superfluous in light of the amendment made by subsection (c).
    Subsection (f) requires the Coordinator to provide 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.
Sec. 302. Assistance to Combat Tuberculosis.
    Subsection (a) makes amendments to section 104B of the 
Foreign Assistance Act of 1961 relating to assistance to combat 
tuberculosis, drawing from the House-passed version of H.R. 
1567, the Stop Tuberculosis (TB) Now Act of 2007. These 
amendments include additional findings and an amended statement 
of policy; a requirement to provide assistance to combat 
tuberculosis; and a list of activities to be carried out, 
including diagnostic testing and counseling, treatment, and 
integration of HIV/AIDS and tuberculosis training. The 
amendments also include providing for a new U.S. strategy to 
combat tuberculosis and an authorization to provide increased 
resources to the World Health Organization.
    Subsection (b) amends section 302 of the 2003 Act to 
authorize up to a total of $4 billion for Fiscal Years 2009 to 
2013 from the overall amounts authorized by section 401 of the 
2003 Act (as amended by this Act) for assistance to combat 
tuberculosis.
Sec. 303. Assistance to Combat Malaria.
    Subsection (a) amends section 104C of the Foreign 
Assistance Act of 1961 to ensure that treatment is part of the 
U.S. effort to combat malaria.
    Subsection (b) amends section 303 of the 2003 Act to 
authorize up to a total of $5 billion for Fiscal Years 2009 to 
2013 from the overall amounts authorized by section 401 of the 
2003 Act (as amended by this Act) for assistance to combat 
malaria.
    Subsection (c) further amends section 303 of the 2003 Act 
by adding a requirement for a comprehensive strategy to combat 
malaria and to establish within USAID a malaria coordinator. It 
also provides for contributions to the Roll Back Malaria 
Partnership and the World Health Organization; for research by 
relevant U.S. agencies to address prevention, treatment and 
care of malaria; and for an annual report on the prevention, 
treatment, control and elimination of malaria.
Sec. 304. Health Care Partnerships to Combat HIV/AIDS.
    This section supports the development of partnerships 
between institutions based in the United States and foreign 
institutions, including national and local health agencies, 
medical facilities, health education and training institutions, 
and faith- and community-based organizations involved in 
prevention, treatment and care of individuals with HIV/AIDS.
Subtitle B--Assistance for Women, Children, and Families
Sec. 311. Policy and Requirements.
    This section amends section 312 of the 2003 Act to provide 
for additional policy and other requirements. Subsection (a) 
provides for collaboration among all relevant actors that 
combat HIV/AIDS. Subsection (b) revises section 312(b) of the 
2003 Act to provide for requirements regarding the five-year 
strategy required by section 101 of the 2003 Act, including 
establishing targets for reaching 80 percent of pregnant women 
for prevention of mother-to-child transmission (PMTCT) of HIV; 
for requiring that up to 15 percent of those receiving 
treatment and up to 15 percent of those receiving care from 
U.S. HIV/AIDS assistance are children; for integrating care and 
treatment with PMTCT programs; and for expanding programs to 
care for children orphaned by HIV/AIDS.
Sec. 312. Annual Reports on Prevention of Mother-to-Child Transmission 
        of the HIV Infection.
    This section amends section 313 of the 2003 Act by 
extending the duration of the annual PMTCT report required by 
such section and requires that such report include additional 
information on the number of women who receive various types of 
assistance related to PMTCT.
Sec. 313. Strategy to Prevent HIV Infections Among Women and Youth.
    This section provides for a comprehensive, integrated and 
culturally appropriate global HIV/AIDS prevention strategy that 
addresses the vulnerabilities of women and youth. Subsection 
(a) provides a statement of policy regarding this matter. 
Subsection (b) requires the strategy and describes its 
elements. Subsection (c) provides, in formulating and 
implementing the strategy required by subsection (b), 
coordination with relevant actors involved in combating HIV/
AIDS. Subsection (d) provides for guidance to field missions 
based on the strategy described in subsection (b). Subsection 
(e) requires a report on the implementation of the strategy.
Sec. 314. Clerical Amendment.
    This section makes a clerical amendment to the 2003 Act.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

Sec. 401. Authorization of Appropriations.
    This section increases the authorization under section 
401(a) of the 2003 Act to $10 billion for each of the Fiscal 
Years 2009 to 2013.
Sec. 402. Sense of Congress.
    This section amends the sense of Congress language included 
in section 402(b) of the 2003 Act to eliminate specific 
spending directives in the legislation, including the 55% 
directive, expressed as a sense of Congress, for treatment, and 
the directive, again expressed as a sense of Congress, that 
one-third of prevention funds be used for abstinence programs.
Sec. 403. Allocation of Funds.
    This section amends section 403(a) of the 2003 Act to 
maintain focus on balanced prevention programming. In 
particular, the new subsection (a) provides that 20 percent of 
all funds authorized for HIV/AIDS programs by the Act shall be 
used to support HIV prevention programs. In addition, the 
revised section 403(a) includes a requirement that the 
Coordinator provide balanced funding for prevention activities 
for sexual transmission of HIV/AIDS and 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 infection and in consultation with the 
government of each host country involved in HIV/AIDS prevention 
activities. The new subsection also provides that 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 (defined 
to include 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. Finally, this section extends the focus of the 
Act relating to orphans and vulnerable children.
Sec. 404. Prohibition on Taxation by Foreign Governments.
    Subsection (a) provides that none of the funds appropriated 
pursuant to the authorization of the 2003 Act, as amended by 
this Act, 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.
    Subsection (b) provides for a de minimus exception to this 
section.
    Subsection (c) authorizes that any funds withheld pursuant 
to subsection (a) shall be reprogrammed for HIV/AIDS assistance 
to another country.
    Subsection (d) provides that subsection (a) shall not apply 
if the Secretary of State determines that a country does not 
assess such taxes, has a mechanism for reimbursement of such 
taxes, or that U.S. foreign policy interests outweigh the 
purposes of subsection (a).
    Subsection (e) provides for the issuance of regulations 
regarding this section.
    Subsection (f) provides definitions.

    TITLE V--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

Sec. 501. Sustainability and Strengthening of Health Care Systems.
    This section amends the 2003 Act by adding a new title 
relating to sustainability and strengthening of health care 
systems in countries as part of overall efforts to combat HIV/
AIDS. The new title also directs U.S. representatives to 
relevant international financial institutions to support the 
exemption of health expenditures from any proposed national 
budget caps or other limits.
Sec. 502. Clerical Amendment.
    This section makes a clerical amendment to the 2003 Act to 
reflect the new title.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

 UNITED STATES LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA 
                              ACT OF 2003

 AN ACT To provide assistance to foreign countries to combat HIV/AIDS, 
           tuberculosis, and malaria, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) * * *
    (b) Table of Contents.--The table of contents for this Act 
is as follows:

Sec. 1. Short title; table of contents.
     * * * * * * *

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

Sec. 201. Sense of Congress on public-private partnerships.
     * * * * * * *
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.
     * * * * * * *
[Sec. 304. Pilot program for the placement of health care professionals 
          in overseas areas severely affected by HIV/AIDS, tuberculosis, 
          and malaria.]
Sec. 304. Health care partnerships to combat HIV/AIDS.
     * * * * * * *

           [Subtitle B--Assistance for Children and Families]

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

Sec. 311. Findings.
     * * * * * * *
Sec. 316. Strategy to prevent HIV infections among women and youth.
     * * * * * * *

    TITLE VI--SUSTAINABILITY AND STRENGTHENING OF HEALTH CARE SYSTEMS

Sec. 601. Findings.
Sec. 602. National health workforce strategies and other policies.
Sec. 603. Exemption of investments in health from limits sought by 
          international financial institutions.
Sec. 604. Public-sector procurement, drug registration, and supply chain 
          management systems.
Sec. 605. Authorization of appropriations.
          * * * * * * *

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) * * *
          * * * * * * *
            (29) The HIV/AIDS pandemic continues to pose a 
        major threat to the health of the global community, 
        from the most severely-affected regions of sub-Saharan 
        Africa and the Caribbean, to the emerging epidemics of 
        Eastern Europe, Central Asia, South and Southeast Asia, 
        and Latin America.
            (30) According to UNAIDS' 2007 global estimates, 
        there are 33.2 million individuals with HIV/AIDS 
        worldwide, including 2.5 million people newly-infected 
        with HIV. Of those infected with HIV, 2.5 million are 
        children under 15 who also account for 460,000 of the 
        newly-infected individuals.
            (31) Sub-Saharan Africa continues to be the region 
        most affected by the HIV/AIDS pandemic. More than 68 
        percent of adults and nearly 90 percent of children 
        with HIV/AIDS live in sub-Saharan Africa, and more than 
        76 percent of AIDS deaths in 2007 occurred in sub-
        Saharan Africa.
            (32) Although sub-Saharan Africa carries the 
        heaviest disease burden of HIV/AIDS, the HIV/AIDS 
        pandemic continues to affect virtually every world 
        region. While prevalence rates are relatively low in 
        Eastern Europe, Central Asia, South and Southeast Asia, 
        and Latin America, without effective prevention 
        strategies, HIV prevalence rates could rise quickly in 
        these regions.
            (33) By world region, according to UNAIDS' 2007 
        global estimates--
                    (A) in sub-Saharan Africa, there were 22.5 
                million adults and children infected with HIV, 
                up from 20.9 million in 2001, with 1.7 million 
                new HIV infections, a 5 percent prevalence 
                rate, and 1.6 million deaths;
                    (B) in South and Southeast Asia, there were 
                4 million adults and children infected with 
                HIV, up from 3.5 million in 2001, with 340,000 
                new HIV infections, a 0.3 percent prevalence 
                rate, and 270,000 deaths;
                    (C) in East Asia, there were 800,000 adults 
                and children infected with HIV, up from 420,000 
                in 2001, with 92,000 new HIV infections, a 0.1 
                percent prevalence rate, and 32,000 deaths;
                    (D) in Eastern and Central Europe, there 
                were 1.6 million adults and children infected 
                with HIV, up from 630,000 in 2001, with 150,000 
                new HIV infections, a 0.9 percent prevalence 
                rate, and 55,000 deaths; and
                    (E) in the Caribbean, there were 230,000 
                adults and children infected with HIV, up from 
                190,000 in 2001, with 17,000 new HIV 
                infections, a 1 percent prevalence rate, and 
                11,000 deaths.
            (34) Tuberculosis is the number one killer of 
        individuals with HIV/AIDS and is responsible for up to 
        one-half of HIV/AIDS deaths in Africa.
            (35) The wide extent of drug resistant 
        tuberculosis, including both multi-drug resistant 
        tuberculosis (MDR-TB) and extensively drug resistant 
        tuberculosis (XDR-TB), driven by the HIV/AIDS pandemic 
        in sub-Saharan Africa, has hampered both HIV/AIDS and 
        tuberculosis treatment services. The World Health 
        Organization (WHO) has declared the prevalence of 
        tuberculosis to be at emergency levels in sub-Saharan 
        Africa.
            (36) Forty percent of the world's population, 
        mostly poor, live in malarial zones, and malaria, which 
        is highly preventable, kills more than 1 million 
        individuals worldwide each year. Ninety percent of 
        malaria's victims are in sub-Saharan Africa and 70 
        percent of malaria's victims are children under the age 
        of 5. Additionally, hunger and malnutrition kill 
        another 6 million individuals worldwide each year.
            (37) Assistance to combat HIV/AIDS must address the 
        nutritional factors associated with the disease in 
        order to be effective and sustainable. The World Food 
        Program estimates that 6.4 million individuals affected 
        by HIV will need nutritional support by 2008.
            (38) Women and girls continue to be vulnerable to 
        HIV, in large part, due to gender-based cultural norms 
        that leave many women and girls powerless to negotiate 
        social relationships.
            (39) Women make up 50 percent of individuals 
        infected with HIV worldwide. In sub-Saharan Africa, 
        where the HIV/AIDS epidemic is most severe, women make 
        up 57 percent of individuals infected with HIV, and 75 
        percent of young people infected with HIV in sub-
        Saharan Africa are young women ages 15 to 24.
            (40) Women and girls are biologically, socially, 
        and economically more vulnerable to HIV infection. 
        Gender disparities in the rate of HIV infection are the 
        result of a number of factors, including the following:
                    (A) Cross-generational sex with older men 
                who are more likely to be infected with HIV, 
                and a lack of choice regarding when and whom to 
                marry, leading to early marriages and high 
                rates of child marriages with older men. About 
                one-half of all adolescent females in sub-
                Saharan Africa and two-thirds of adolescent 
                females in Asia are married by age 18.
                    (B) Studies show that married women and 
                married and unmarried girls often are unable or 
                find it difficult to negotiate the frequency 
                and timing of sexual intercourse, ensure their 
                partner's faithfulness, or insist on condom 
                use. Under these circumstances, women often run 
                the risk of being infected by husbands or male 
                partners in societies where men in 
                relationships have more than one partner. 
                Behavior change is particularly important in 
                societies in which this is a common practice.
                    (C) Because young married women and girls 
                are more likely to have unprotected sex and 
                have more frequent sex than their unmarried 
                peers, and women and girls who are faithful to 
                their spouses can be placed at risk of HIV/AIDS 
                through a husband's infidelity or prior 
                infection, marriage is not always a guarantee 
                against HIV infection, although it is a 
                protective factor overall.
                    (D) Social and economic inequalities based 
                largely on gender limit access for women and 
                girls to education and employment opportunities 
                and prevent them from asserting their 
                inheritance and property rights. For many 
                women, a lack of independent economic means 
                combines with socio-cultural practices to 
                sustain and exacerbate their fear of 
                abandonment, eviction, or ostracism from their 
                homes and communities and can leave many more 
                women trapped within relationships where they 
                are vulnerable to HIV infection.
                    (E) A lack of educational opportunities for 
                women and girls is linked to younger sexual 
                debut, earlier childhood marriage, earlier 
                childbearing, decreased child survival, 
                worsening nutrition, and increased risk of HIV 
                infection.
                    (F) High rates of gender-based violence, 
                rape, and sexual coercion within and outside 
                marriage contribute to high rates of HIV 
                infection. According to the World Health 
                Organization, between one-sixth and three-
                quarters of women in various countries and 
                settings have experienced some form of physical 
                or sexual violence since the age of 15 within 
                or outside of marriage. Women who are unable to 
                protect themselves from such violence are often 
                unable to protect themselves from being 
                infected with HIV through forced sexual 
                contact.
                    (G) Fear of domestic violence and the 
                continuing stigma and discrimination associated 
                with HIV/AIDS prevent many women from accessing 
                information about HIV/AIDS, getting tested, 
                disclosing their HIV status, accessing services 
                to prevent mother-to-child transmission of HIV, 
                or receiving treatment and counseling even when 
                they already know they have been infected with 
                HIV.
                    (H) According to UNAIDS, the vulnerability 
                of individuals involved in commercial sex acts 
                to HIV infection is heightened by 
                stigmatization and marginalization, limited 
                economic options, limited access to health, 
                social, and legal services, limited access to 
                information and prevention means, gender-
                related differences and inequalities, sexual 
                exploitation and trafficking, harmful or non-
                protective laws and policies, and exposure to 
                risks associated with commercial sex acts, such 
                as violence, substance abuse, and increased 
                mobility.
                    (I) Lack of access to basic HIV prevention 
                information and education and lack of 
                coordination with existing primary health care 
                to reduce stigma and maximize coverage.
                    (J) Lack of access to currently available 
                female-controlled HIV prevention methods, such 
                as the female condom, and lack of training on 
                proper use of either male or female condoms.
                    (K) High rates of other sexually 
                transmitted infections and complications during 
                pregnancies and childbirth.
                    (L) An absence of functioning legal 
                frameworks to protect women and girls and, 
                where such frameworks exist, the lack of 
                accountable and effective enforcement of such 
                frameworks.
            (41) In addition to vulnerabilities to HIV 
        infection, women in sub-Saharan Africa face a 1-in-13 
        chance of dying in childbirth compared to a 1-in-16 
        chance in least-developed countries worldwide, a 1-in-
        60 chance in developing countries, and a 1-in-4,100 
        chance in developed countries.
            (42) Due to these high maternal mortality rates and 
        high HIV prevalence rates in certain countries, special 
        attention is needed in these countries to help HIV-
        positive women safely deliver healthy babies and save 
        women's lives.
            (43) Unprotected sex within or outside of marriage 
        is the single greatest factor in the transmission of 
        HIV worldwide and is responsible for 80 percent of new 
        HIV infections in sub-Saharan Africa.
            (44) Multiple randomized controlled trials have 
        established that male circumcision reduces a man's risk 
        of contracting HIV by 60 percent or more. Twelve 
        acceptability studies have found that in regions of 
        sub-Saharan Africa where circumcision is not 
        traditionally practiced, a majority of men want the 
        procedure. Broader availability of male circumcision 
        services could prevent millions of HIV infections not 
        only in men but also in their female partners.
            (45)(A) Youth also face particular challenges in 
        receiving services for HIV/AIDS.
            (B) Nearly one-half of all orphans who have lost 
        one parent and two-thirds of those who have lost both 
        parents are ages 12 to 17. These orphans are in 
        particular need of services to protect themselves 
        against sexually-transmitted infections, including HIV.
            (C) Research indicates that many youth benefit from 
        full disclosure of medically accurate, age-appropriate 
        information about abstinence, partner reduction, and 
        condoms. Providing comprehensive information about HIV, 
        including delay of sexual debut and the ABC model: 
        ``Abstain, Be faithful, use Condoms'', and linking such 
        information to health care can help improve awareness 
        of safe sex practices and address the fact that only 1 
        in 3 young men and 1 in 5 young women ages 15 to 24 can 
        correctly identify ways to prevent HIV infection.
            (D) Surveys indicate that no country has succeeded 
        in fully educating more than one-half of its youth 
        about the prevention and transmission of HIV.
            (46) According to the United Nations High 
        Commissioner for Refugees (UNHCR), HIV/AIDS prevalence 
        rates among refugees are generally lower than the HIV/
        AIDS prevalence rates for their host communities, 
        though perceptions run counter to this fact. However, 
        peacekeeping operations that no longer deploy HIV/AIDS-
        positive troops still face vulnerabilities to sexual 
        transmission of HIV with HIV-positive individuals in 
        refugee camps. Host countries generally do not provide 
        HIV/AIDS prevention, treatment, and care services for 
        refugees.
            (47) Continuing progress to reach the millions of 
        impoverished individuals who need voluntary testing, 
        counseling, treatment, and care for HIV/AIDS requires 
        increased efforts to strengthen health care delivery 
        systems and infrastructure, rebuild and expand the 
        health care workforce, and strengthen allied and 
        support services in countries receiving United States 
        global HIV/AIDS assistance.
            (48) While HIV/AIDS poses the greatest health 
        threat of modern times, it also poses the greatest 
        development challenge for developing countries with 
        fragile economies and weak public financial management 
        systems that are ill equipped to shoulder the burden of 
        this disease. International donors will have to play a 
        critical role in providing resources for HIV/AIDS 
        programs far into the future.
            (49) The emerging partnerships between countries 
        most affected by HIV/AIDS and the United States must 
        include stronger coordination between HIV/AIDS programs 
        and other United States foreign assistance programs, 
        and stronger collaboration with other donors in the 
        areas of economic development and growth strategies.
            (50) The future control of HIV/AIDS demands 
        coordination between international organizations such 
        as the Global Fund to Fight AIDS, Tuberculosis and 
        Malaria, UNAIDS, the World Health Organization (WHO), 
        the World Bank and the International Monetary Fund 
        (IMF), the international donor community, national 
        governments, and private sector organizations, 
        including community and faith-based organizations.
            (51) The future control of HIV/AIDS further 
        requires effective and transparent public finance 
        management systems in developing countries to advance 
        the ability of such countries to manage public revenues 
        and donor funds aimed at combating HIV/AIDS and other 
        diseases.
            (52) The HIV/AIDS pandemic contributes to the 
        shortage of health care personnel through loss of life 
        and illness, unsafe working conditions, increased 
        workloads for diminished staff, and resulting stress 
        and burnout, while the shortage of health care 
        personnel undermines efforts to prevent and provide 
        care and treatment for individuals with HIV/AIDS.
            (53) The shortage of health care personnel, 
        including doctors, nurses, pharmacists, counselors, 
        laboratory staff, paraprofessionals, trained lay 
        workers, and researchers is one of the leading 
        obstacles to combating HIV/AIDS in sub-Saharan Africa.
            (54) Since 2003, important progress has been made 
        in combating HIV/AIDS, yet there is more to be done. 
        The number of new HIV infections is still increasing at 
        an alarming rate. According to the United States 
        National Institute of Allergy and Infectious Diseases, 
        globally, for every 1 individual put on antiretroviral 
        therapy, 6 individuals are newly infected with HIV.
            (55) The United States Government continues to be 
        the world's leader in the fight against HIV/AIDS and 
        the unsurpassed partner with developing countries in 
        their efforts to control this disease.
            (56) By September 2007, the United States, through 
        the United States Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 
        et seq.), had provided services to prevent mother-to-
        child-transmission of HIV to women during 10 million 
        pregnancies; provided antiretroviral prophylaxis for 
        women during over 827,300 pregnancies; prevented an 
        estimated 157,240 HIV infections in infants; cared for 
        over 6.6 million individuals, including over 2.7 
        million orphans and vulnerable children; supported 
        lifesaving antiretroviral therapies for approximately 
        1.4 million men, women, and children in sub-Saharan 
        Africa, Asia, and the Carribean; and provided 
        counseling and testing to over 33.7 million men, women, 
        and children in developing countries.
            (57) These numbers were achieved because of the 
        commitment of substantial resources and support of the 
        United States Government to our partners on the front 
        lines--the dedicated and committed women and men, 
        communities, and nations who are taking control of the 
        HIV/AIDS epidemics in their own countries.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) * * *
            (2) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means the 
        Committee on Foreign Relations of the Senate and the 
        [Committee on International Relations] Committee on 
        Foreign Affairs of the House of Representatives.

           *       *       *       *       *       *       *


[SEC. 4. PURPOSE.

    [The purpose of this Act is to strengthen United States 
leadership and the effectiveness of the United States response 
to certain global infectious diseases by--
            [(1) establishing a comprehensive, integrated five-
        year, global strategy to fight HIV/AIDS that 
        encompasses a plan for phased expansion 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 multilateral 
        efforts to fight HIV/AIDS;
            [(3) providing increased resources for United 
        States bilateral efforts, particularly for technical 
        assistance and training, 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 and treatment for HIV/AIDS, 
        tuberculosis, and malaria.]

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.--The President shall establish a 
comprehensive, integrated, five-year strategy [to combat] to 
develop efforts further to combat global HIV/AIDS that 
strengthens the capacity of the United States to be an 
effective leader of the international campaign against HIV/
AIDS. Such strategy shall maintain sufficient flexibility and 
remain responsive to the ever-changing nature of the HIV/AIDS 
pandemic and shall--
            (1) * * *

           *       *       *       *       *       *       *

            [(4) provide that the reduction of HIV/AIDS 
        behavioral risks shall be a priority of all prevention 
        efforts in terms of funding, educational messages, and 
        activities by promoting abstinence from sexual activity 
        and substance abuse, encouraging monogamy and 
        faithfulness, promoting the effective use of condoms, 
        and eradicating prostitution, the sex trade, rape, 
        sexual assault and sexual exploitation of women and 
        children;]
            (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;
            (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)] (6) improve coordination and reduce 
        duplication among relevant executive branch agencies, 
        foreign governments, and international organizations;
            [(6)] (7) project general levels of resources 
        needed to achieve the stated objectives;
            [(7)] (8) expand public-private partnerships and 
        the leveraging of resources;
            [(8)] (9) maximize United States capabilities in 
        the areas of technical assistance and training and 
        research, including vaccine research;
            (10) maximize host country capacities in training 
        and research, particularly operations research;
            [(9)] (11) establish priorities for the 
        distribution of resources based on factors such as the 
        size and demographics of the population with HIV/AIDS, 
        tuberculosis, and malaria and the needs of that 
        population and the existing infrastructure or funding 
        levels that may exist to cure, treat, and prevent HIV/
        AIDS, tuberculosis, and malaria; and
            [(10)] (12) include initiatives describing how the 
        President will maximize the leverage of private sector 
        dollars in reduction and treatment of HIV/AIDS, 
        tuberculosis, and malaria.
    (b) Report.--
            (1) In general.--Not later than 270 days after the 
        date of enactment of [this Act] the Tom Lantos and 
        Henry J. Hyde Global Leadership Against HIV/AIDS, 
        Tuberculosis, and Malaria Reauthorization Act of 2008, 
        the President shall submit to the appropriate 
        congressional committees a report setting forth the 
        strategy described in subsection (a).

           *       *       *       *       *       *       *

            (3) Report elements.--The elements referred to in 
        paragraph (2) are the following:
                    (A) * * *

           *       *       *       *       *       *       *

                    [(C) A description of the manner in which 
                the strategy will address the fundamental 
                elements of prevention and education, care, and 
                treatment (including increasing access to 
                pharmaceuticals and to vaccines), the promotion 
                of abstinence, monogamy, avoidance of substance 
                abuse, and use of condoms, research (including 
                incentives for vaccine development and new 
                protocols), training of health care workers, 
                the development of health care infrastructure 
                and delivery systems, and avoidance of 
                substance abuse.]
                    (C) A description of the manner in which 
                the strategy will address the following:
                            (i) The fundamental elements of 
                        prevention and education, care and 
                        treatment, including increasing access 
                        to pharmaceuticals, vaccines, and 
                        microbicides, as they become available, 
                        screening, prophylaxis, and treatment 
                        of major opportunistic infections, 
                        including tuberculosis, and increasing 
                        access to nutrition and food for 
                        individuals on antiretroviral 
                        therapies.
                            (ii) The promotion of delay of 
                        sexual debut, abstinence, monogamy, 
                        fidelity, and partner reduction.
                            (iii) The promotion of correct and 
                        consistent use of male and female 
                        condoms and other strategies and skills 
                        development to reduce the risk of HIV 
                        transmission.
                            (iv) Increasing voluntary access to 
                        safe male circumcision services.
                            (v) Life-skills training.
                            (vi) The provision of information 
                        and services to encourage young people 
                        to delay sexual debut and ensure access 
                        to HIV/AIDS prevention information and 
                        services.
                            (vii) Prevention of sexual violence 
                        leading to transmission of HIV and 
                        assistance for victims of violence who 
                        are at risk of HIV transmission.
                            (viii) HIV/AIDS prevention, care, 
                        and treatment services for injection 
                        drug users.
                            (ix) Research, including incentives 
                        for HIV vaccine development and new 
                        protocols.
                            (x) Advocacy for community-based 
                        child and youth protective services.
                            (xi) Training of health care 
                        workers.
                            (xii) The development of health 
                        care infrastructure and delivery 
                        systems.
                            (xiii) Prevention efforts for 
                        substance abusers.
                            (xiv) Prevention, treatment, care, 
                        and outreach efforts for men who have 
                        sex with men.
                    (D) A description of the manner in which 
                the strategy will promote the development and 
                implementation of national and community-based 
                multisectoral strategies and programs, 
                including those designed to enhance leadership 
                capacity particularly at the community level, 
                including through faith-based and other 
                nongovernmental organizations.
                    (E) A description of the specific 
                strategies developed to meet the unique needs 
                of women, including access to HIV/AIDS 
                education and testing in family planning and 
                maternal and child health programs supported by 
                the United States Government and the 
                empowerment of women in interpersonal 
                situations, young people and children, 
                including those orphaned by HIV/AIDS and those 
                who are victims of the sex trade, rape, sexual 
                abuse, assault, and exploitation.
                    (F) A description of the specific 
                strategies developed to encourage men to be 
                responsible in their sexual behavior (including 
                by accessing voluntary clinical circumcision 
                services), child rearing and to respect women 
                including the reduction of sexual violence and 
                coercion.
                    (G) A description of the specific 
                strategies developed to increase women's and 
                men's access to employment opportunities, 
                income, productive resources, and microfinance 
                programs.

           *       *       *       *       *       *       *

                    (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.
                    [(M)] (N) The level of resources that will 
                be needed on an annual basis and the manner in 
                which those resources would generally be 
                allocated among the relevant executive branch 
                agencies.
                    [(N)] (O) A description of the mechanisms 
                to be established for monitoring and 
                [evaluating programs,] evaluating programs to 
                ensure medical accuracy, operations research, 
                promoting successful models, and for 
                terminating unsuccessful programs.
                    [(O)] (P) A description of the manner in 
                which private, nongovernmental entities will 
                factor into the United States Government-led 
                effort and a description of the type of 
                partnerships that will be created to maximize 
                the capabilities of these private sector 
                entities and to leverage resources.
                    [(P)] (Q) A description of the ways in 
                which United States leadership will be used to 
                enhance the overall international response to 
                the HIV/AIDS pandemic, strengthen national 
                health care delivery systems, and increase 
                national health workforce capacities, and 
                particularly to heighten the engagement of the 
                member states of the G-8 and to strengthen key 
                financial and coordination mechanisms such as 
                the Global Fund and UNAIDS.
                    [(Q)] (R) A description of the manner in 
                which the United States strategy for combating 
                HIV/AIDS relates to and supports other United 
                States assistance strategies in developing 
                countries, including strategies relating to 
                agricultural development, trade and economic 
                growth, and education.
                    [(R)] (S) A description of the programs to 
                be carried out under the strategy that are 
                specifically targeted at women and girls to 
                educate them about the spread of HIV/AIDS.
                    [(S)] (T) A description of efforts being 
                made to address the unique needs of families 
                with children with respect to HIV/AIDS, 
                including efforts of intergenerational 
                caregivers and efforts to preserve the family 
                unit.
                    [(T)] (U) An analysis of the emigration of 
                critically important medical and public health 
                personnel, including physicians, nurses, and 
                supervisors from sub-Saharan African countries 
                that are acutely impacted by HIV/AIDS, 
                including a description of the causes, effects, 
                and the impact on the stability of health 
                infrastructures, as well as a summary of 
                incentives and programs that the United States 
                could provide, in concert with other private 
                and public sector partners and international 
                organizations, to stabilize health institutions 
                by encouraging critical personnel to remain in 
                their home countries.
                    (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.
                    [(U)] (W) A description of the specific 
                strategies developed to promote sustainability 
                of HIV/AIDS pharmaceuticals (including 
                antiretrovirals) and the effects of drug 
                resistance on HIV/AIDS patients.
                    [(V)] (X) A description of the specific 
                strategies to ensure that the extraordinary 
                benefit of HIV/AIDS pharmaceuticals (especially 
                antiretrovirals) are not diminished through the 
                illegal counterfeiting of pharmaceuticals and 
                black market sales of such pharmaceuticals.
                    [(W) An analysis of the prevalence of Human 
                Papilloma Virus (HPV) in sub-Saharan Africa and 
                the impact that condom usage has upon the 
                spread of HPV in sub-Saharan Africa.]
                    (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.

           *       *       *       *       *       *       *


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

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

    (a) Findings.--Congress makes the following findings:
            (1) * * *
            (2) Public-private sector partnerships multiply 
        local and international capacities to strengthen the 
        delivery of health services in developing countries and 
        to accelerate research for vaccines and other 
        pharmaceutical products that are essential to combat 
        [infectious diseases] easily preventable and treatable 
        infectious diseases decimating the populations of these 
        countries.

           *       *       *       *       *       *       *

            (4) Sustaining existing public-private partnerships 
        and building new ones are critical to the success of 
        the international community's efforts to combat HIV/
        AIDS and other [infectious diseases] easily preventable 
        and treatable infectious diseases around the globe.

           *       *       *       *       *       *       *


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

    (a) Findings.--The Congress finds as follows:
            (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.
            [(1)] (7) The establishment of the Global Fund in 
        January 2002 is consistent with the general principles 
        for an international AIDS trust fund first outlined by 
        the Congress in the Global AIDS and Tuberculosis Relief 
        Act of 2000 (Public Law 106-264).
            [(2)] (8) Section 2, Article 5 of the bylaws of the 
        Global Fund provides for the International Bank for 
        Reconstruction and Development to serve as the initial 
        collection trustee for the Global Fund.
            [(3)] (9) The trustee agreement signed between the 
        Global Fund and the International Bank for 
        Reconstruction and Development narrows the range of 
        duties to include receiving and investing funds from 
        donors, disbursing the funds upon the instruction of 
        the Global Fund, reporting on trust fund resources to 
        donors and the Global Fund, and providing an annual 
        external audit report to the Global Fund.

           *       *       *       *       *       *       *

    (d) United States Financial Participation.--
            (1) Authorization of appropriations.--In addition 
        to any other funds authorized to be appropriated for 
        bilateral or multilateral HIV/AIDS, tuberculosis, or 
        malaria programs, of the amounts authorized to be 
        appropriated under section 401, there are authorized to 
        be appropriated to the President up to [$1,000,000,000 
        for the period of fiscal year 2004 beginning on January 
        1, 2004,] $2,000,000,000 for each of the fiscal years 
        2009 and 2010, and such sums as may be necessary for 
        [the fiscal years 2005-2008] each of the fiscal years 
        2011 through 2013, for contributions to the Global 
        Fund.

           *       *       *       *       *       *       *

            (4) Limitation.--
                    (A)(i) At any time during [fiscal years 
                2004 through 2008] fiscal years 2009 through 
                2013, no United States contribution to the 
                Global Fund may cause the total amount of 
                United States Government contributions to the 
                Global Fund to exceed 33 percent of the total 
                amount of funds contributed to the Global Fund 
                from all sources. Contributions to the Global 
                Fund from the International Bank for 
                Reconstruction and Development and the 
                International Monetary Fund shall not be 
                considered in determining compliance with this 
                paragraph.
                    (ii) If, at any time during any of the 
                [fiscal years 2004 through 2008] fiscal years 
                2009 through 2013, the President determines 
                that the Global Fund has provided assistance to 
                a country, the government of which the 
                Secretary of State has determined, for purposes 
                of section 6(j)(1) of the Export Administration 
                Act of 1979 (50 U.S.C. App. 2405(j)(1)), has 
                repeatedly provided support for acts of 
                international terrorism, then the United States 
                shall withhold from its contribution for the 
                next fiscal year an amount equal to the amount 
                expended by the Fund to the government of each 
                such country.

           *       *       *       *       *       *       *

                    (vi) [for the purposes] For the purposes of 
                clause (i), ``funds contributed to the Global 
                Fund from all sources'' means funds contributed 
                to the Global Fund at any time during [fiscal 
                years 2004 through 2008] fiscal years 2009 
                through 2013 that are not contributed to 
                fulfill a commitment made for a fiscal year 
                prior to [fiscal year 2004] fiscal year 2009.
                    (B)(i) * * *

           *       *       *       *       *       *       *

                    (iv) Notwithstanding clause (i), after July 
                31 of each of the [fiscal years 2004 through 
                2008] fiscal years 2009 through 2013, any 
                amount made available under this subsection 
                that is withheld by reason of 
                subparagraph(A)(i) is authorized to be made 
                available to carry out sections 104A, 104B, and 
                104C of the Foreign Assistance Act of 1961 (as 
                added by title III of this Act), 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..
                    (C)(i) * * *
                    (ii) The President shall notify the 
                [Committee on International Relations] 
                Committee on Foreign Affairs of the House of 
                Representatives and the Committee on Foreign 
                Relations of the Senate not less than 5 days 
                before making a determination under clause (i) 
                with respect to the application of subparagraph 
                (A)(i) and shall include in the notification--
                            (I) * * *

           *       *       *       *       *       *       *


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.

                      TITLE III--BILATERAL EFFORTS

              Subtitle A--General Assistance and Programs

SEC. 301. ASSISTANCE TO COMBAT HIV/AIDS.

    (a) * * *
    (b) Authorization of Appropriations.--
            (1) In general.--In addition to funds available 
        under section 104(c) of the Foreign Assistance Act of 
        1961 (22 U.S.C. 2151b(c)) for such purpose or under any 
        other provision of that Act, there are authorized to be 
        appropriated to the President, from amounts authorized 
        to be appropriated under section 401, such sums as may 
        be necessary for each of the [fiscal years 2004 through 
        2008] fiscal years 2009 through 2013 to carry out 
        section 104A of the Foreign Assistance Act of 1961, as 
        added by subsection (a).

           *       *       *       *       *       *       *

            (3) Allocation of funds.--Of the amount authorized 
        to be appropriated by paragraph (1) for the [fiscal 
        years 2004 through 2008] fiscal years 2009 through 
        2013, such sums as may be necessary are authorized to 
        be appropriated to carry out section 104A(d)(4) of the 
        Foreign Assistance Act of 1961 (as added by subsection 
        (a)), relating to the procurement and distribution of 
        HIV/AIDS pharmaceuticals.
    [(c) Relationship to Assistance Programs to Enhance 
Nutrition.--In recognition of the fact that malnutrition may 
hasten the progression of HIV to AIDS and may exacerbate the 
decline among AIDS patients leading to a shorter life span, the 
Administrator of the United States Agency for International 
Development shall, as appropriate--
            [(1) integrate nutrition programs with HIV/AIDS 
        activities, generally;
            [(2) provide, as a component of an anti-retroviral 
        therapy program, support for food and nutrition to 
        individuals infected with and affected by HIV/AIDS; and
            [(3) provide support for food and nutrition for 
        children affected by HIV/AIDS and to communities and 
        households caring for children affected by HIV/AIDS.
    [(d) Eligibility for Assistance.--An 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) to prevent, treat, or monitor HIV/AIDS shall not 
be required, as a condition of receiving the assistance, to 
endorse or utilize a multisectoral approach to combatting HIV/
AIDS, or to endorse, utilize, or participate in a prevention 
method or treatment program to which the organization has a 
religious or moral objection.]
    (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.
                    (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.--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.

           *       *       *       *       *       *       *

    [(g) Sense of Congress Relating to Food Assistance for 
Individuals Living With HIV/AIDS.--
            [(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 infected or 
                living with HIV/AIDS is a major problem in 
                countries with large populations of such 
                individuals, particularly in African countries.
                    [(C) Although the United States is willing 
                to provide food assistance to these countries 
                in need, a few of the countries object to part 
                or all of the assistance because of fears of 
                benign genetic modifications to the foods.
                    [(D) Healthy and nutritious foods for 
                individuals infected or living with HIV/AIDS 
                are an important complement to HIV/AIDS 
                medicines for such individuals.
                    [(E) 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 therefore the sense 
        of Congress that United States food assistance should 
        be accepted by countries with large populations of 
        individuals infected or living with HIV/AIDS, 
        particularly African countries, in order to help feed 
        such individuals.]

SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS.

    (a) * * *
    (b) Authorization of Appropriations.--
            (1) In general.--In addition to funds available 
        under section 104(c) of the Foreign Assistance Act of 
        1961 (22 U.S.C. 2151b(c)) for such purpose or under any 
        other provision of that Act, there are authorized to be 
        appropriated to the President, from amounts authorized 
        to be appropriated under section 401, [such sums as may 
        be necessary for each of the fiscal years 2004 through 
        2008] $4,000,000,000 for fiscal years 2009 through 2013 
        to carry out section 104B of the Foreign Assistance Act 
        of 1961, as added by subsection (a).

           *       *       *       *       *       *       *

            (3) Transfer of prior year funds.--Unobligated 
        balances of funds made available for fiscal year 2001, 
        2002, or 2003 under section 104(c)(7) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2151b(c)(7) (as in 
        effect immediately before the date of enactment of this 
        Act) shall be transferred to, merged with, and made 
        available for the same purposes as funds made available 
        for [fiscal years 2004 through 2008] fiscal years 2009 
        through 2013 under paragraph (1).

SEC. 303. ASSISTANCE TO COMBAT MALARIA.

    (a) * * *
    (b) Authorization of Appropriations.--
            (1) In general.--In addition to funds available 
        under section 104(c) of the Foreign Assistance Act of 
        1961 (22 U.S.C. 2151b(c)) for such purpose or under any 
        other provision of that Act, there are authorized to be 
        appropriated to the President, from amounts authorized 
        to be appropriated under section 401, [such sums as may 
        be necessary for fiscal years 2004 through 2008] 
        $5,000,000,000 for fiscal years 2009 through 2013 to 
        carry out section 104C of the Foreign Assistance Act of 
        1961, as added by subsection (a), including for the 
        development of anti-malarial pharmaceuticals by the 
        Medicines for Malaria Venture.

           *       *       *       *       *       *       *

            (3) Transfer of prior year funds.--Unobligated 
        balances of funds made available for fiscal year 2001, 
        2002, or 2003 under section 104(c) of the Foreign 
        Assistance Act of 1961 (22 U.S.C. 2151b(c) (as in 
        effect immediately before the date of enactment of this 
        Act) and made available for the control of malaria 
        shall be transferred to, merged with, and made 
        available for the same purposes as funds made available 
        for [fiscal years 2004 through 2008] fiscal years 2009 
        through 2013 under paragraph (1).

           *       *       *       *       *       *       *

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

[SEC. 304. PILOT PROGRAM FOR THE PLACEMENT OF HEALTH CARE PROFESSIONALS 
                    IN OVERSEAS AREAS SEVERELY AFFECTED BY HIV/AIDS, 
                    TUBERCULOSIS, AND MALARIA.

    [(a) In General.--The President should establish a program 
to demonstrate the feasibility of facilitating the service of 
United States health care professionals in those areas of sub-
Saharan Africa and other parts of the world severely affected 
by HIV/AIDS, tuberculosis, and malaria.
    [(b) Requirements.--Participants in the program shall--
            [(1) provide basic health care services for those 
        infected and affected by HIV/AIDS, tuberculosis, and 
        malaria in the area in which they are serving;
            [(2) provide on-the-job training to medical and 
        other personnel in the area in which they are serving 
        to strengthen the basic health care system of the 
        affected countries;
            [(3) provide health care educational training for 
        residents of the area in which they are serving;
            [(4) serve for a period of up to 3 years; and
            [(5) meet the eligibility requirements in 
        subsection (d).
    [(c) Eligibility Requirements.--To be eligible to 
participate in the program, a candidate shall--
            [(1) be a national of the United States who is a 
        trained health care professional and who meets the 
        educational and licensure requirements necessary to be 
        such a professional such as a physician, nurse, 
        physician assistant, nurse practitioner, pharmacist, 
        other type of health care professional, or other 
        individual determined to be appropriate by the 
        President; or
            [(2) be a retired commissioned officer of the 
        Public Health Service Corps.
    [(d) Recruitment.--The President shall ensure that 
information on the program is widely distributed, including the 
distribution of information to schools for health 
professionals, hospitals, clinics, and nongovernmental 
organizations working in the areas of international health and 
aid.
    [(e) Placement of Participants.--
            [(1) In general.--To the maximum extent 
        practicable, participants in the program shall serve in 
        the poorest areas of the affected countries, where 
        health care needs are likely to be the greatest. The 
        decision on the placement of a participant should be 
        made in consultation with relevant officials of the 
        affected country at both the national and local level 
        as well as with local community leaders and 
        organizations.
            [(2) Coordination.--Placement of participants in 
        the program shall be coordinated with the United States 
        Agency for International Development in countries in 
        which that Agency is conducting HIV/AIDS, tuberculosis, 
        or malaria programs. Overall coordination of placement 
        of participants in the program shall be made by the 
        Coordinator of United States Government Activities to 
        Combat HIV/AIDS Globally (as described in section 1(f) 
        of the State Department Basic Authorities Act of 1956 
        (as added by section 102(a) of this Act)).
    [(f) Incentives.--The President may offer such incentives 
as the President determines to be necessary to encourage 
individuals to participate in the program, such as partial 
payment of principal, interest, and related expenses on 
government and commercial loans for educational expenses 
relating to professional health training and, where possible, 
deferment of repayments on such loans, the provision of 
retirement benefits that would otherwise be jeopardized by 
participation in the program, and other incentives.
    [(g) Report.--Not later than 18 months after the date of 
enactment of this Act, the President shall submit to the 
appropriate congressional committees a report on steps taken to 
establish the program, including--
            [(1) the process of recruitment, including the 
        venues for recruitment, the number of candidates 
        recruited, the incentives offered, if any, and the cost 
        of those incentives;
            [(2) the process, including the criteria used, for 
        the selection of participants;
            [(3) the number of participants placed, the 
        countries in which they were placed, and why those 
        countries were selected; and
            [(4) the potential for expansion of the program.
    [(h) Authorization of Appropriations.--
            [(1) In general.--In addition to amounts otherwise 
        available for such purpose, there are authorized to be 
        appropriated to the President, from amounts authorized 
        to be appropriated under section 401, such sums as may 
        be necessary for each of the fiscal years 2004 through 
        2008 to carry out the program.
            [(2) Availability of funds.--Amounts appropriated 
        pursuant to the authorization of appropriations under 
        paragraph (1) are authorized to remain available until 
        expended.]

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.

           *       *       *       *       *       *       *


Subtitle B--Assistance for Children and Families

           *       *       *       *       *       *       *


SEC. 312. POLICY AND REQUIREMENTS.

    (a) Policy.--[The United States Government's]
            (1) In general.--The United States response to the 
        global HIV/AIDS pandemic should place high priority on 
        the prevention of mother-to-child transmission, the 
        care and treatment of family members and caregivers, 
        and the care of children orphaned by AIDS. To the 
        maximum extent possible, the United States Government 
        should seek to leverage its funds by seeking matching 
        contributions from the private sector, other national 
        governments, and international organizations.
            (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.--The 5-year United States Government 
strategy required by section 101 of this Act shall--
            [(1) provide for meeting or exceeding the goal to 
        reduce the rate of mother-to-child transmission of HIV 
        by 20 percent by 2005 and by 50 percent by 2010;
            [(2) include programs to make available testing and 
        treatment to HIV-positive women and their family 
        members, including drug treatment and therapies to 
        prevent mother-to-child transmission; and
            [(3) expand programs designed to care for children 
        orphaned by AIDS.]
    (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. 313. ANNUAL REPORTS ON PREVENTION OF MOTHER-TO-CHILD TRANSMISSION 
                    OF THE HIV INFECTION.

    (a) In General.--Not later than 1 year after the date of 
the enactment of this Act, and annually thereafter for a period 
of [5 years] 10 years, the President shall submit to 
appropriate congressional committees a report on the activities 
of relevant executive branch agencies during the reporting 
period to assist in the prevention of mother-to-child 
transmission of the HIV infection.

           *       *       *       *       *       *       *


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.
            (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.

               TITLE IV--AUTHORIZATION OF APPROPRIATIONS

SEC. 401. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to 
the President to carry out this Act and the amendments made by 
this Act [$3,000,000,000] $10,000,000,000 for each of the 
[fiscal years 2004 through 2008] fiscal years 2009 through 
2013.

           *       *       *       *       *       *       *


SEC. 402. SENSE OF CONGRESS.

    (a) * * *
    (b) Effective Distribution of HIV/AIDS Funds.--It is the 
sense of Congress that, of the amounts appropriated pursuant to 
the authorization of appropriations under section 401 for HIV/
AIDS assistance, an effective distribution of such amounts 
would be--
            [(1) 55 percent of such amounts for treatment of 
        individuals with HIV/AIDS;]
            [(2)] (1) 15 percent of such amounts for palliative 
        care of individuals with HIV/AIDS;
            [(3)] (2) 20 percent of such amounts for HIV/AIDS 
        prevention consistent with section 104A(d) of the 
        Foreign Assistance Act of 1961 (as added by section 301 
        of this Act)[, of which such amount at least 33 percent 
        should be expended for abstinence-until-marriage 
        programs]; and
            [(4)] (3) 10 percent of such amounts for orphans 
        and vulnerable children.

SEC. 403. ALLOCATION OF FUNDS.

    [(a) Therapeutic Medical Care.--For fiscal years 2006 
through 2008, not less than 55 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 therapeutic medical care of 
individuals infected with HIV, of which such amount at least 75 
percent should be expended for the purchase and distribution of 
antiretroviral pharmaceuticals and at least 25 percent should 
be expended for related care. For fiscal years 2006 through 
2008, not less than 33 percent of the amounts appropriated 
pursuant to the authorization of appropriations under section 
401 for HIV/AIDS prevention consistent with section 104A(d) of 
the Foreign Assistance Act of 1961 (as added by section 301 of 
this Act) for each such fiscal year shall be expended for 
abstinence-until-marriage programs.]
    (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.--For [fiscal years 
2006 through 2008] fiscal years 2009 through 2013, not less 
than 10 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 
assistance for orphans and vulnerable children affected by HIV/
AIDS, of which such amount at least 50 percent shall be 
provided through non-profit, nongovernmental organizations, 
including faith-based organizations, that implement programs on 
the community level.

           *       *       *       *       *       *       *


   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.
                              ----------                              


             STATE DEPARTMENT BASIC AUTHORITIES ACT OF 1956



           *       *       *       *       *       *       *
                  TITLE I--BASIC AUTHORITIES GENERALLY

    Section 1. (a) * * *

           *       *       *       *       *       *       *

    (f) HIV/AIDS Response Coordinator.--
            (1) * * *
            (2) Authorities and duties; definitions.--
                    (A) Authorities.--The Coordinator, acting 
                through such nongovernmental organizations 
                (including faith-based and community-based 
                organizations), host country finance, health, 
                and other relevant ministries and relevant 
                executive branch agencies as may be necessary 
                and appropriate to effect the purposes of this 
                section, is authorized--
                            (i)  * * *

           *       *       *       *       *       *       *

                            (iii) to provide grants to, and 
                        enter into contracts with, 
                        nongovernmental organizations 
                        (including faith-based and community-
                        based organizations) and host country 
                        finance, health, and other relevant 
                        ministries to carry out the purposes of 
                        section.
                    (B) Duties.--
                            (i) * * *
                            (ii) Specific duties.--The duties 
                        of the Coordinator shall specifically 
                        include the following:
                                    (I) * * *

           *       *       *       *       *       *       *

                                    [(IV) Ensuring coordination 
                                of relevant executive branch 
                                agency activities in the field.
                                    [(V) Pursuing coordination 
                                with other countries and 
                                international organizations.]
                                    (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.

           *       *       *       *       *       *       *

                                    (VII) Holding annual 
                                consultations with host country 
                                nongovernmental organizations 
                                providing services to improve 
                                health, and advocating on 
                                behalf of the individuals with 
                                HIV/AIDS and those at 
                                particular risk of contracting 
                                HIV/AIDS.
                                    (VIII) Ensuring, through 
                                interagency and international 
                                coordination, that United 
                                States HIV/AIDS programs are 
                                coordinated with and 
                                complementary to the delivery 
                                of related global health, food 
                                security, and education 
                                services, including--
                                            (aa) maternal and 
                                        child health care;
                                            (bb) services for 
                                        other neglected and 
                                        easily preventable and 
                                        treatable infectious 
                                        diseases, such as 
                                        tuberculosis;
                                            (cc) treatment and 
                                        care services for 
                                        injection drug users; 
                                        and
                                            (dd) programs and 
                                        services to improve 
                                        legal, social, and 
                                        economic status of 
                                        women and girls.
                                    [(VII)] (IX) Directly 
                                approving all activities of the 
                                United States (including 
                                funding) relating to combatting 
                                HIV/AIDS in each of Botswana, 
                                Cote d'Ivoire, Ethiopia, 
                                Guyana, Haiti, Kenya, 
                                Mozambique, Namibia, Nigeria, 
                                Rwanda, South Africa, Tanzania, 
                                Uganda, Zambia, 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 and 
                                other countries designated by 
                                the President, which other 
                                designated countries may 
                                include those countries in 
                                which the United States is 
                                implementing HIV/AIDS programs 
                                as of the date of the enactment 
                                of the United States Leadership 
                                Against HIV/AIDS, Tuberculosis, 
                                and Malaria Act of 2003 and 
                                other countries in which the 
                                United States is implementing 
                                HIV/AIDS programs. 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.
                            (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.
                                    [(VIII)] (XII) Establishing 
                                due diligence criteria for all 
                                recipients of [funds section] 
                                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 all activities subject to 
                                the coordination and 
                                appropriate monitoring, 
                                evaluation, and audits carried 
                                out by the Coordinator 
                                necessary to assess the 
                                measurable outcomes of such 
                                activities.
                                    (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.

           *       *       *       *       *       *       *

                              ----------                              


                     FOREIGN ASSISTANCE ACT OF 1961



           *       *       *       *       *       *       *
                                 PART I

Chapter 1--Policy; Development Assistance Authorizations

           *       *       *       *       *       *       *


SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.

    (a) Finding.--Congress recognizes that the alarming spread 
of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, 
South and Southeast Asia, Central and Eastern Europe, and other 
developing countries is a major global health, national 
security, development, and humanitarian crisis.
    (b) Policy.--[It is a major]
            (1) General policy.--It is a major objective of the 
        foreign assistance program of the United States to 
        provide assistance for the prevention, treatment, and 
        [control] care of HIV/AIDS. The United States and other 
        developed countries should provide assistance to 
        countries in sub-Saharan Africa, the Caribbean, and 
        other countries and areas to control this crisis 
        through HIV/AIDS prevention, treatment, monitoring, and 
        related activities, particularly activities focused on 
        women and youth, including strategies to protect women 
        and prevent mother-to-child transmission of the HIV 
        infection and to fulfill United States commitments to 
        move toward the goal of universal access to prevention, 
        treatment, and care of HIV/AIDS. 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.
            (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.
    (c) Authorization.--
            (1) In general.--Consistent with section 104(c), 
        the President is authorized to furnish assistance, on 
        such terms and conditions as the President may 
        determine, for HIV/AIDS, including to prevent, treat, 
        and monitor HIV/AIDS, and carry out related activities, 
        in countries in sub-Saharan Africa, the Caribbean, 
        South and Southeast Asia, Central and Eastern Europe, 
        and other countries and areas, and particularly with 
        respect to refugee populations in such countries and 
        areas.
            (2) Role of ngos.--It is the sense of Congress that 
        the President should provide an appropriate level of 
        assistance under paragraph (1) through nongovernmental 
        organizations (including faith-based and community-
        based organizations) in countries in sub-Saharan 
        Africa, the Caribbean, South and Southeast Asia, 
        Central and Eastern Europe, and other countries and 
        areas affected by the HIV/AIDS pandemic, and 
        particularly with respect to refugee populations in 
        such countries and areas.
            (3) Role of public health care delivery systems.--
        It is the sense of Congress that--
                    (A) the President should provide an 
                appropriate level of assistance under paragraph 
                (1) to help strengthen public health care 
                delivery systems financed by host countries; 
                and
                    (B) the President, acting through the 
                Coordinator of United States Government 
                Activities to Combat HIV/AIDS Globally, should 
                support the development of a policy framework 
                in such host countries for the long-term 
                sustainability of HIV/AIDS prevention, 
                treatment, and care programs, and for 
                strengthening health care delivery systems and 
                increasing health workforces through 
                recruitment, training, and policies that allows 
                the devolution of clinical responsibilities to 
                increase the work force able to deliver 
                prevention, treatment, and care services, as 
                necessary, with clearly identified objectives 
                and reporting strategies for such services.
            [(3)] (4) Coordination of assistance efforts.--The 
        President shall coordinate the provision of assistance 
        under paragraph (1) with the provision of related 
        assistance by the Joint United Nations Programme on 
        HIV/AIDS (UNAIDS), the United Nations Children's Fund 
        (UNICEF), the World Health Organization (WHO), the 
        United Nations Development Programme (UNDP), the Global 
        Fund to Fight AIDS, Tuberculosis and Malaria and other 
        appropriate international organizations (such as the 
        International Bank for Reconstruction and Development), 
        relevant regional multilateral development 
        institutions, national, state, and local governments of 
        [foreign countries] host countries and donor countries, 
        appropriate governmental and nongovernmental 
        organizations, and relevant executive branch agencies.
            (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.
    (d) Activities Supported.--Assistance provided under 
subsection (c) shall, to the maximum extent practicable, be 
used to carry out the following activities:
            (1) Prevention.--Prevention of HIV/AIDS through 
        activities including--
                    (A) programs and efforts that are designed 
                or intended to impart knowledge with the 
                exclusive purpose of helping individuals avoid 
                behaviors that place them at risk of HIV 
                infection, including efforts by faith-based and 
                other nongovernmental organizations and 
                integration of such programs into health 
                programs, including access to such programs and 
                efforts in family planning programs supported 
                by the United States Government, and the 
                inclusion in counseling programs of information 
                on methods of avoiding infection of HIV, 
                including delaying sexual debut, abstinence, 
                fidelity and monogamy, reduction of casual 
                sexual partnering, reducing sexual violence and 
                coercion, including child marriage, widow 
                inheritance, and polygamy, and where 
                appropriate, use of male and female condoms;
                    (B) assistance to establish and implement 
                culturally relevant and appropriate HIV/AIDS 
                education and prevention programs that focus on 
                helping individuals avoid infection of HIV/
                AIDS, implemented through nongovernmental 
                organizations, including faith-based and 
                community-based organizations, particularly 
                those organizations and programs that utilize 
                both professionals and volunteers with 
                appropriate skills, experience, level of 
                scientific and fact-based knowledge, and 
                community presence;

           *       *       *       *       *       *       *

                    (D) assistance for the purpose of providing 
                voluntary testing and counseling (including the 
                incorporation of confidentiality protections 
                and nonjudgmental approaches with respect to 
                such testing and counseling);
                    [(E) assistance for the purpose of 
                preventing mother-to-child transmission of the 
                HIV infection, including medications to prevent 
                such transmission and access to infant formula 
                and other alternatives for infant feeding;]
                    (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;

           *       *       *       *       *       *       *

                    (G) assistance to help avoid substance 
                abuse and intravenous drug use that can lead to 
                HIV infection, including education and services 
                demonstrated to be effective in reducing the 
                transmission of HIV infection without 
                increasing illicit drug use; [and]
                    (H) assistance for the purpose of 
                increasing women's access to employment 
                opportunities, income, productive resources, 
                and microfinance programs, where 
                appropriate[.]; and
                    (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.
            (2) Treatment.--The treatment and care of 
        individuals with HIV/AIDS, including--
                    (A) * * *
                    (B) assistance to strengthen and expand 
                hospice and palliative care programs to assist 
                patients debilitated by HIV/AIDS, their 
                families, and the primary caregivers of such 
                patients, including programs that utilize 
                faith-based and community-based organizations[; 
                and];
                    (C) assistance for the purpose of the care 
                and treatment of individuals with HIV/AIDS 
                through the provision of pharmaceuticals, 
                including antiretrovirals and other 
                pharmaceuticals and therapies for the treatment 
                of opportunistic infections, nutritional 
                support, and other treatment modalities[.];
                    (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.

           *       *       *       *       *       *       *

            (4) Monitoring.--[The monitoring]
                    (A) In general.--The monitoring of 
                programs, projects, and activities carried out 
                pursuant to paragraphs (1) through (3) and 
                paragraph (8), including--
                    [(A)] (i) monitoring to ensure that 
                adequate controls are established and 
                implemented to provide HIV/AIDS pharmaceuticals 
                and other appropriate medicines to poor 
                individuals with HIV/AIDS;
                    [(B)] (ii) appropriate evaluation and 
                surveillance activities;
                    [(C)] (iii) monitoring to ensure that 
                appropriate measures are being taken to 
                maintain the sustainability of HIV/AIDS 
                pharmaceuticals (especially antiretrovirals) 
                and ensure that drug resistance is not 
                compromising the benefits of such 
                pharmaceuticals; [and]
                    [(D)] (iv) monitoring to ensure appropriate 
                law enforcement officials are working to ensure 
                that HIV/AIDS pharmaceuticals are not 
                diminished through illegal counterfeiting or 
                black market sales of such pharmaceuticals[.]; 
                and
                            (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.
                    (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.
            (5) Pharmaceuticals.--
                    (A) * * *

           *       *       *       *       *       *       *

                    (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.
                    [(C)] (D) Distribution.--The distribution 
                of such HIV/AIDS pharmaceuticals, antiviral 
                therapies, and other appropriate medicines 
                (including medicines to treat opportunistic 
                infections) to qualified national, regional, or 
                local organizations for the treatment of 
                individuals with HIV/AIDS in accordance with 
                appropriate HIV/AIDS testing and monitoring 
                requirements and treatment protocols and for 
                the prevention of mother-to-child transmission 
                of the HIV infection.

           *       *       *       *       *       *       *

            (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.
    (e) Annual Report.--
            (1) In general.--Not later than January 31 of each 
        year, the President shall submit to the Committee on 
        Foreign Relations of the Senate and the [Committee on 
        International Relations] Committee on Foreign Affairs 
        of the House of Representatives a report on the 
        implementation of this section for the prior fiscal 
        year.
            (2) Report elements.--Each report shall include--
                    (A) * * *
                    (B) a description of the programs 
                established pursuant to such sections; [and]
                    (C) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                [including] including----
                            [(i)(I) the effectiveness of such 
                        programs in reducing the spread of the 
                        HIV infection, particularly in women 
                        and girls, in reducing mother-to-child 
                        transmission of the HIV infection, and 
                        in reducing mortality rates from HIV/
                        AIDS; and
                            [(II) the number of patients 
                        currently receiving treatment for AIDS 
                        in each country that receives 
                        assistance under this Act.
                            [(ii) the progress made toward 
                        improving health care delivery systems 
                        (including the training of adequate 
                        numbers of staff) and infrastructure to 
                        ensure increased access to care and 
                        treatment;]
                            (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) with respect to tuberculosis, 
                        the increase in the number of people 
                        treated and the increase in number of 
                        tuberculosis patients cured through 
                        each program, project, or activity 
                        receiving United States foreign 
                        assistance for tuberculosis control 
                        purposes, 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) with respect to malaria, the 
                        increase in the number of people 
                        treated and the increase in number of 
                        malaria patients cured through each 
                        program, project, or activity receiving 
                        United States foreign assistance for 
                        malaria control purposes[.];
                    (D) a description of efforts to integrate 
                HIV/AIDS and tuberculosis prevention, 
                treatment, and care programs, including--
                            (i) the number and percentage of 
                        HIV-infected individuals receiving HIV/
                        AIDS treatment or care services who are 
                        also receiving screening and subsequent 
                        treatment for tuberculosis;
                            (ii) the number and percentage of 
                        individuals with tuberculosis who are 
                        receiving HIV/AIDS counseling and 
                        testing, and appropriate referral to 
                        HIV/AIDS services;
                            (iii) the number and location of 
                        laboratories with the capacity to 
                        perform tuberculosis culture tests and 
                        tuberculosis drug susceptibility tests;
                            (iv) the number and location of 
                        laboratories with the capacity to 
                        perform appropriate tests for multi-
                        drug resistant tuberculosis (MDR-TB) 
                        and extensively drug resistant 
                        tuberculosis (XDR-TB); and
                            (v) the number of HIV-infected 
                        individuals suspected of having 
                        tuberculosis who are provided 
                        tuberculosis culture diagnosis or 
                        tuberculosis drug susceptibility 
                        testing;
                    (E) a description of coordination efforts 
                with relevant executive branch agencies (as 
                such term is defined in section 3 of the United 
                States Leadership Against HIV/AIDS, 
                Tuberculosis, and Malaria Act of 2003) and at 
                the global level in the effort to link HIV/AIDS 
                services with non-HIV/AIDS services;
                    (F) a description of programs serving women 
                and girls, including--
                            (i) a description of HIV/AIDS 
                        prevention programs that address the 
                        vulnerabilities of girls and women to 
                        HIV/AIDS; and
                            (ii) information on the number of 
                        individuals served by programs aimed at 
                        reducing the vulnerabilities of women 
                        and girls to HIV/AIDS;
                    (G) a description of the specific 
                strategies funded to ensure the reduction of 
                HIV infection among injection drug users, and 
                the number of injection drug users, by country, 
                reached by such strategies, including 
                medication-assisted drug treatment for 
                individuals with HIV or at risk of HIV, and HIV 
                prevention programs demonstrated to be 
                effective in reducing HIV transmission without 
                increasing drug use; and
                    (H) a detailed description of monitoring, 
                impact evaluation research, and operations 
                research of programs, projects, and activities 
                carried out pursuant to subsection 
                (d)(4)(A)(v).
            (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.

           *       *       *       *       *       *       *


SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

    (a) Findings.--Congress makes the following findings:
            [(1) Congress recognizes the growing international 
        problem of tuberculosis and the impact its continued 
        existence has on those countries that had previously 
        largely controlled the disease.
            [(2) Congress further recognizes that the means 
        exist to control and treat tuberculosis through 
        expanded use of the DOTS (Directly Observed Treatment 
        Short-course) treatment strategy, including DOTS-Plus 
        to address multi-drug resistant tuberculosis, and 
        adequate investment in newly created mechanisms to 
        increase access to treatment, including the Global 
        Tuberculosis Drug Facility established in 2001 pursuant 
        to the Amsterdam Declaration to Stop TB and the Global 
        Alliance for TB Drug Development.]
            (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.
    [(b) Policy.--It is a major objective of the foreign 
assistance program of the United States to control 
tuberculosis, including the detection of at least 70 percent of 
the cases of infectious tuberculosis, and the cure of at least 
85 percent of the cases detected, not later than December 31, 
2005, in those countries classified by the World Health 
Organization as among the highest tuberculosis burden, and not 
later than December 31, 2010, in all countries in which the 
United States Agency for International Development has 
established development programs.]
    (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.

           *       *       *       *       *       *       *

    (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.
    [(d)] (e) Coordination.--In carrying out this section, the 
President shall coordinate with the World Health Organization, 
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and 
other organizations with respect to the development and 
implementation of a comprehensive tuberculosis control program.
    [(e) Priority to DOTS Coverage.--In furnishing assistance 
under subsection (c), the President shall give priority to 
activities that increase Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant 
tuberculosis where needed using DOTS-Plus, including funding]
    (f) Priority To Stop TB Strategy.--
            (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 for the Global Tuberculosis 
                Drug Facility, the Stop Tuberculosis 
                Partnership, and the Global Alliance for TB 
                Drug Development. [In order to meet the 
                requirement of the preceding sentence, the 
                President should ensure that not less than]
            (2) Availability of amounts.--In order to meet the 
        requirements of paragraph (1), the President--
                    (A) shall ensure that not less than 75 
                percent of the amount made available to carry 
                out this section for a fiscal year should be 
                expended for antituberculosis drugs, supplies, 
                direct patient services, and training in 
                diagnosis and treatment [for Directly Observed 
                Treatment Short-course (DOTS) coverage and 
                treatment of multi-drug resistant tuberculosis 
                using DOTS-Plus,] to implement the Stop TB 
                Strategy; and [including substantially 
                increased funding for the Global Tuberculosis 
                Drug Facility.]
                    (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.
    (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).
    [(f)] (h) Definitions.--In this section:
            (1) DOTS.--The term ``DOTS'' or ``Directly Observed 
        Treatment Short-course'' means the World Health 
        Organization-recommended strategy for treating 
        tuberculosis, 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.

           *       *       *       *       *       *       *

            (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.

           *       *       *       *       *       *       *


SEC. 104C. ASSISTANCE TO COMBAT MALARIA.

    (a) * * *
    (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to provide assistance 
for the prevention, [control, and cure] treatment, and care of 
malaria.

           *       *       *       *       *       *       *


TITLE XII--FAMINE PREVENTION AND FREEDOM FROM HUNGER

           *       *       *       *       *       *       *


Chapter 3--International Organizations and Programs

           *       *       *       *       *       *       *


    Sec. 302. Authorization.--(a) * * *

           *       *       *       *       *       *       *

    (k) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the 
President such sums as may be necessary for each of the [fiscal 
years 2004 through 2008] fiscal years 2009 through 2013 to be 
available only for United States contributions to the Vaccine 
Fund.
    (l) In addition to amounts otherwise available under this 
section, there is authorized to be appropriated to the 
President such sums as may be necessary for each of the [fiscal 
years 2004 through 2008] fiscal years 2009 through 2013 to be 
available only for United States contributions to the 
International AIDS Vaccine Initiative.
    (m) 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 2004 through 2008] fiscal years 2009 through 2013 to be 
available for United States contributions to malaria vaccine 
development programs, including the Malaria Vaccine Initiative 
of the Program for Appropriate Technologies in Health (PATH).
    (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.

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